Background: Recently published data suggest that showing patients operated on for adolescent idiopathic scoliosis or kyphosis their preoperative and postoperative photographs may enhance their satisfaction and self-image as measured by Scoliosis Research Society Health-Related Quality of Life Questionnaire (SRS-22) scores. No data exist for adult spinal deformity (ASD) surgery. The aim of this study is to determine the effect on patient postoperative satisfaction and self-image of showing adult deformity patients their preoperative and postoperative whole body photographs.Methods: This was a nonconcurrent prospective study. Patients operated on for ASD with a minimum 2-year postoperative follow-up who had preoperative full-body photographs taken by a professional photographer were included. Two follow-up visits were arranged 7 days apart. In the first visit, patients completed the SRS-22 questionnaire, and full-body standing photographs were taken. In the second visit, patients were asked to complete again questions 4, 6, 10, 14, 19 (self-image), 21, and 22 (satisfaction) of the SRS-22 after seeing their preoperative and postoperative full-body photographs.Results: Thirty patients (28 female) were included. Themedian age at surgery was 50 years (26-76). The median follow-up was 51 months (24-120). SRS-22 results at first visit were: activity 2.79 6 0.75; self-image 2.71 6 0.82; pain 2.53 6 1.10; mental health 3.08 6 0.77; satisfaction 3.46 6 1.20; global 2.74 6 0.72. SRS22 results at second visit were: self-image 2.9 6 0.75; satisfaction 4.02 6 0.97. After seeing the preoperative and final follow-up photographs, patients experienced an improvement in SRS-22 self-image (P ¼ .000) and satisfaction domains (P ¼ .011).Conclusions: In patients operated on for ASD, showing preoperative and postoperative photographs improves patient satisfaction with surgery and self-image.Level of Evidence: 3. Clinical Relevance: Our results could be a starting point for introducing full-body clinical photographs as a routine clinical tool in adult deformity patients undergoing surgery.

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Study Design: This is nonconcurrent prospective study approved by the Institutional Research Ethics Committee Objective: The purpose of this study is to determine if the cranial sagittal vertical axis (Cr-SVA) measured in full spine standing radiographs is a better predictor of clinical results than the C7 sagittal vertical axis (C7-SVA) in adult patients operated on spinal deformity with a minimum 2-year follow-up after surgery. Summary of Background Data: The Cr-SVA has recently been described as a better predictor of health-related quality of life outcomes than the C7-SVA for patients with adult spinal deformity (ASD) before undergoing surgery. This has not been confirmed in patients after ASD surgery. Methods: Inclusion criteria were age at surgery more than 25 years and a minimum 2-year follow-up after a ≥5 level fusion for ASD. Full-length standing lateral radiographs (including nasion-inion line, spine, and femoral heads) and Scoliosis Research Society 22 Questionnaire and SF36 questionnaires were available for every patient at the final follow-up. The distance from the Cr-SVA to the posterior corner of S1 (Cr-SVA-S) and to the centers of the hip (Cr-SVA-H) was measured and also the C7-SVA, lumbar lordosis, pelvic incidence, pelvic tilt, and PI-LL. Results: Sixty-five patients (58 female individuals) operated on ASD in a single institution were included. Age at surgery was 61 years (26–67). The mean follow-up was 53 months (24–120). Spearman rank-order test showed several significant correlations. After multivariable analysis, only Cr-SVA-S and age persisted as predictors for Scoliosis Research Society (SRS) image scores, Cr-SVA-H for SRS satisfaction, Cr-SVA-H and age for SRS total scores, Cr-SVA-H and age for SF36 Physical Function, Cr-SVA-S for SF36 Role Physical, Cr-SVA-H for SF36 Bodily Pain, and Cr-SVA-H for SF36 Role Emotional. Conclusions: The Cr-SVA measured in full spine standing radiographs seems to be a better predictor of health-related quality of life outcomes than the C7-SVA for adults operated on spinal deformity >2 years after surgery.

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