Return to School After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis: A Prospective Cohort Study

Posterior spinal fusion (PSF) is the standard surgical treatment for progressive adolescent idiopathic scoliosis (AIS). While return to sport after PSF has been described, return to school (RTS) remains poorly defined despite its educational and psychosocial importance. This study aimed to quantify RTS timelines, compare anticipated versus observed absences, and evaluate demographic, surgical, psychosocial, and socioeconomic predictors.

Consecutively enrolled English-speaking AIS and juvenile idiopathic scoliosis (JIS) patients undergoing PSF at a single institution between 2022 and 2025 were prospectively studied. Preoperative surveys captured demographics, school type, anticipated RTS, and awareness of accommodations available through a patient's school setting. Postoperative surveys documented actual RTS, attendance, and barriers. RTS was defined as the first day the patient resumed full-day, in-person school attendance. Partial day attendance, hybrid instruction, and virtual learning were not separately analyzed. The Pain Catastrophizing Scale assessed psychological status, and the Area Deprivation Index (ADI) measured socioeconomic context. Group comparisons used chi-square/Fisher's exact tests and t-tests/Mann-Whitney U; regression identified predictors.

A total of 118 patients (84% female; mean age 14.5 ± 1.9 years) were included. Families anticipated 31.4 days of absence, while 71 postoperative respondents reported a mean absence of 46.8 ± 18.6 days (P = .022). Homeschool and private school students demonstrated numerically shorter RTS intervals than public school students (26.3, 32.8, and 43.1 days, respectively); however, these differences did not reach statistical significance (P = .160). Fusion length, sex, ADI, and race were not independent predictors of RTS.

AIS/JIS patients undergoing PSF returned to school at a mean of 6.7 weeks, approximately 2 weeks later than anticipated. Exploratory analyses suggested possible differences by school type and psychosocial factors, which should be investigated further in future, larger studies.

(1)There may be an educational gap, as families tend to underestimate the time required for their child to return to school (RTS).(2)Surgical and demographic factors, including length of fusion, sex, Area Deprivation Index, and race, were not associated with time to RTS.

II, Prospective cohort study.