Scoliosis Treatment: Evaluating Patient Suitability

Degenerative scoliosis can cause back pain, leg pain, difficulty walking, and impaired daily functioning. When spinal fusion is required, choosing the appropriate fusion extent remains challenging. Short-segment fusion involves fewer spinal levels, whereas long-segment fusion offers greater potential for deformity correction but requires more extensive surgery. It remains uncertain which patients are more likely to benefit from each strategy. This multicenter prospective observational cohort study will investigate whether preoperative spinal alignment modifies the comparative clinical benefit of short-segment and long-segment fusion. Patients will receive surgery selected through routine clinical decision-making, without treatment assignment by the study. Clinical information, standing spinal radiographs, and patient-reported outcomes will be collected before surgery and during postoperative follow-up. The primary outcome will be clinically meaningful improvement in the Scoliosis Research Society-22r subtotal score at 24 months after surgery. The study aims to identify patient subgroups with greater benefit from either fusion strategy and to develop clinically interpretable criteria that may support individualized selection of fusion extent.