Beyond the curve: sexual and psychological health after adolescent idiopathic scoliosis treatment

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Abstract
Background While the primary goal of treating Adolescent Idiopathic Scoliosis (AIS) is curve correction, long-term psychological and sexual outcomes are rarely examined. This systematic review evaluates whether bracing or surgical treatment affects sexual health, body image, and psychological well-being compared to healthy controls. Methods A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, and CENTRAL were searched up to November 2024 for studies assessing sexual and psychological outcomes in AIS patients treated with bracing or surgery. Inclusion criteria encompassed observational and interventional studies with validated outcome tools. Risk of bias was assessed using the ROBINS-I tool. Results Nine studies involving 3231 participants were included. Among 1085 AIS patients (average age at treatment 15.6 years; female-to-male ratio 18:1), 498 underwent bracing and 587 underwent surgery. Meta-analyses demonstrated that AIS patients had significantly lower sexual function (FSFI: SMD = 0.54, 95% CI: 0.29–0.80), higher sexual distress (FSDS: SMD = 0.76, 95% CI: 0.21–1.32), and reduced sexual satisfaction (GSSI: SMD = 0.39, 95% CI: 0.10–0.74) compared to controls, with low heterogeneity across outcomes (I2 = 0%). Narrative synthesis further revealed higher rates of body image dissatisfaction and reduced self-esteem among AIS patients. Surgically treated individuals showed marginally better sexual satisfaction than braced patients, though differences in psychological and intimacy outcomes were inconsistent. Physical limitations and pain-related sexual dysfunction were noted across both treatment groups. Conclusion AIS treatment may influence long-term sexual and psychological health, particularly among brace-treated patients. While surgical intervention may offer modest benefits, evidence remains limited. These outcomes should be incorporated into AIS follow-up and future research, emphasizing patient-centred care.

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