Outcomes after surgical correction of severe scoliosis in patients with osteogenesis imperfecta: a prospective, 2-year minimum follow-up study with radiographic and patient-reported outcomes

PURPOSE: To evaluate both radiographic and patient-reported outcomes after surgical correction of severe scoliosis in osteogenesis imperfecta (OI) patients with minimum 2-year follow-up. The main research question was whether modern multimodal surgical approaches translate into meaningful improvements in both deformity correction and quality of life measures. METHODS: This retrospective analysis of prospectively collected data included 35 OI patients (mean age 12.2 ± 3.7 years) who underwent posterior spinal fusion for scoliosis at a single institution between 2013 and 2022. OI type 3 was most common (69%). Radiographic parameters and patient-reported outcomes (SRS-22, CP CHILD, PROMIS) were assessed preoperatively and at latest follow-up (mean 5.5 ± 3.1 years). Surgical technique included navigation-guided pedicle screw placement, cement augmentation at foundation levels, and perioperative bisphosphonate therapy. RESULTS: Major curve improved from 72.3 ± 15° to 32.2 ± 17° (56% correction, p < 0.001) and minor curve from 53.8 ± 14° to 24.1 ± 12° (55% correction, p < 0.001). Other radiographic parameters including apical vertebral translation, lowest instrumented vertebra tilt, pelvic obliquity, and thoracolumbar kyphosis showed significant improvement while maintaining thoracic kyphosis and lumbar lordosis. SRS-22 total score improved from 3.6 to 4.1 (p = 0.002), with function, pain, and self-image domains achieving minimal clinically important differences. CP CHILD total score improved, with significant improvement in the positioning/transferring/mobility domain. PROMIS showed significant improvements in fatigue and pain interference. Two complications (5.7%) occurred without infections or neurological deficits. CONCLUSION: Modern surgical correction of severe scoliosis in OI patients achieved significant improvements in both radiographic parameters and patient-reported outcomes, demonstrating the effectiveness of current multimodal surgical strategies in this challenging population.