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Chehrassan M, Nikouei F, Shakeri M, Kiaei S M S, Falakeh S, Ghavidel E, et al . Is Surgery Justified for Adolescent Idiopathic Scoliosis Between 35° and 45°?. JROS 2026; 13 (2) :57-64
URL: http://jros.iums.ac.ir/article-1-2319-en.html

Background: Surgical intervention in adolescent idiopathic scoliosis (AIS) is typically reserved for patients with curves exceeding 45°, leaving those with moderate curves often managed conservatively. 
Objectives: This study aimed to evaluate the clinical and radiologic outcomes of posterior spinal fusion (PSF) in AIS patients with preoperative moderate scoliotic curves, with a particular focus on patient-reported outcomes.
Methods: This retrospective cohort study was conducted at a single tertiary hospital. AIS patients aged 10-20 years with preoperative Cobb angles between 35° and 45° who underwent PSF were included. Radiologic parameters and quality of life were assessed preoperatively and at least one year postoperatively using anterior-posterior and lateral total spine X-rays in standing position and the scoliosis research society-22r (SRS-22r) questionnaire. Statistical analysis was performed using SPSS software, version 19.
Results: Forty patients were included (36 females, 4 males) with a mean age of 15.58±2.76 years. The mean thoracic and thoracolumbar Cobb angles decreased significantly postoperatively (P<0.001). While changes in other radiologic parameters were limited, patients demonstrated significant improvement in overall SRS22r scores (from 3.59±0.65 to 3.98±0.54, P<0.001), particularly in the self-image (P=0.008), function (P=0.001), and satisfaction with management (P<0.001) domains. No significant differences were observed based on prior bracing, fusion type, gender, or Lenke classification.
Conclusion: AIS patients with moderate curves may benefit from surgical correction in terms of improved self-image and satisfaction, even when radiographic changes are limited. These findings highlight the importance of incorporating patient-reported outcomes in surgical decision-making for this underrepresented group.