Scoliosis clinical and radiographic outcomes can be obtained by surgical treatment. Measuring a procedure’s success increasingly focuses on the appearance of the patient. Akif Albayrak writes that the use of pre- and postoperative patient photographs allows patients a better perspective of surgical impact, thus enhancing their satisfaction with the treatment.
In the past, the main parameters of scoliosis patient evaluation were angle correction and body balance, but current considerations include the importance of the effect of surgery on quality of life and on the self-esteem of the patient in question.
In scoliosis surgeries, aesthetic concerns are often more prominent than vital functions. In these operations, the main concerns that are dealt with—eg. back hump, shoulder imbalance and breast asymmetry—are all crucial elements of a healthy posture and therefore essential for a proper self-image.
The Scoliosis Research Society-22 (SRS-22) survey is currently the most frequently used survey for evaluating outcomes of scoliosis treatment. Several studies have shown major improvement after surgery in all outcome domains of the SRS-22 including pain, function/activity, self-image/appearance, mental health and satisfaction.
The clinical evaluation of scoliosis is typically performed from the posterior view. However, this is not a good view for patient self-evaluation as the patient cannot see themselves from that position. In addition to the impossibility of self-evaluation from the posterior view, self-evaluation of surgical outcomes is limited by a patient’s memory—they often forget their preoperative appearance after a long period of follow-up.
My colleagues and I, having undertaken a study examining solutions to these problems, believe that the best indicator of cosmetic improvement is to gauge the patient’s opinion by showing them pre- and postoperative photographs of themselves.
As noted, over time there is a possibility that patients may forget their condition prior to surgery, which might lead to a decline in patient satisfaction. In my opinion, pre- and postoperative photographing and documentation will become very useful devices in such cases. By reminding patients of preoperative conditions and the improvements achieved, a degree of permanency in patient satisfaction will be obtained, which is important from both patients’ and surgeons’ point of view.
In our study we showed 60 patients such photographs, to help them recall their preoperative appearance. When we showed the patients and their relatives the pre- and postoperative photographs, they were able to better judge the residual deformity and improvement provided by surgery. As such, they could decide whether the residual postoperative deformity was within acceptable limits.
In our work we also showed the patients a view that they otherwise could not see, photographing them in Adam’s forward bend and standing positions. With this method, a significant difference was observed between photograph and non-photograph groups in questions 10 (about self-image), 18 (about function and activity), and 21 (about satisfaction) of the survey (p≤0.05).
Our aim was to show the patients how their backs appeared to other people before surgery and compare the pre- and postoperative appearance.
The patients who were reminded of their preoperative back appearance were more satisfied with their appearance after the surgery, and this was confirmed with the increase in some SRS-22 scores.
In our study on Lenke Type I scoliosis patients, we formed homogeneous patient groups to emphasise our point by avoiding deviations, which means cases of extreme corrections are too rare to draw a significant conclusion out of them. However, in another study of ours currently in progress, we are comparing patients with extreme correction levels to those with normal correction levels in the sagittal plane. In the coming months we expect to have data regarding the relationship between severity of correction and satisfaction.
Though we did not focus on differences between age groups, I believe that differences in self-image will be less between the adolescent period and the adult period because aesthetic concerns present themselves in every age. However, a difference in self-confidence will be expected to arise in favour of older patients.
I believe that the use of pre- and postoperative photographing will provide many benefits for both patients and surgeons. In a surgery where aesthetic concerns come first, photographic documentation will give patients an objective, evidential view, which will enable them to evaluate the changes brought by surgery with great clarity. The satisfaction and conviction of patients and their immediate families about the success of surgery will greatly benefit from this method and it will also serve as hard evidence in case of an adverse claim or a lawsuit of malpractice.
Akif Albayrak is a spine surgeon at Baltalimani Metin Sabanci Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey