Quality of Life, Psychosocial Burden, and Structural-functional Status in Adults With Spinal Deformity.

QoL is measured using the SRS-22r questionnaire during screening visit, at 6-weeks, 4 months, 1 year and 2 year.For Scoliosis Research Society 22 Revised (SRS-22r) questionaire a patient reported measure of health related quality of life in individuals with scoliosis. PROM assessing five domains: Function/Activity, Pain, Self image/Appearance, Mental Health, Satisfaction with Management. The mean score is located between 5 (Best) and 1 (Worst).

QoL is measured using EQ-5D-5L questionnaire questionnaire during screening visit, at 6-weeks, 4 months, 1 year and 2 year The EuroQol 5 Dimension 5 Level(EQ-5D-5L) include 5-digit health profile: Mobility, Self Care, Usual Activities, Pain/Discomfort, Anxiety/Depression converting it to an index value using the country-specific value set (range -0.59 to 1.0). EQ-5D-5L score expresses health status as a utility value ranging from <0 (worse than death) to 1 (full health). Higher values indicate better overall health.

QoL is measured using VAS questionnaire during screening visit, at 6-weeks, 4 months, 1 year and 2 year The Visual Anlog Score (VAS) - ranges from 0 to 100, where 0 means "worst imaginable health" and 100 means "best imaginable health." A higher VAS score reflects better self perceived health.

QoL in non-revision ASD patients, adjusted for structural deformity severity, demographic characteristics, treatment pathway, and frailty-related health status. Structural covariates include Sagittal Vertical Axis(SVA), Pelvic tilt(PT), Pelvic incidence-lumbar lordosis mismatch (PI-LL) mismatch, and coronal Cobb angle. Frailty-related health status will be measured using the mFI-5. The modified 5-item frailty index (mFI-5) which assesses five clinical deficits: diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functional dependence. Each deficit is scored as 0 (absent) or 1 (present). The unit of measure is the total frailty score ranging from 0 to 5, where higher scores indicate greater frailty.

Measures include HADS during screening visit, at 6-weeks, 4 months, 1 year and 2 year. Hospital Anxiety and Depression Scale (HADS) a validated 14 item self report questionnaire assessing symptoms of anxiety and depression. Each item is scored on a 0-3 Likert scale, and the unit of measure is the subscale total score for Anxiety (HADS A, range 0-21) and Depression (HADS D, range 0-21). Higher scores indicate more severe symptoms.

Measures include FABQ-DV during screening visit, at 6-weeks, 4 months, 1 year and 2 year. Fear Avoidance Beliefs Questionnaire - Dutch Version( FABQ-DV) validated self report instrument assessing fear avoidance beliefs related to physical activity and work. The questionnaire contains items scored on a Likert scale from 0 to 6, where higher scores indicate stronger fear avoidance beliefs. The unit of measure is the total score per subscale (Physical Activity and Work), each expressed as the sum of item scores, with higher totals reflecting greater fear avoidance.

Measures include FES-I during screening visit, at 6-weeks, 4 months, 1 year and 2 year. Falls Efficacy Scale - International (FES-I) a validated self report questionnaire assessing fear of falling during everyday activities. The instrument contains 16 items, each scored on a 4 point Likert scale (1-4). The unit of measure is the total score ranging from 16 to 64, where higher scores indicate greater fear of falling.

Measures include IPA during screening visit, at 6-weeks, 4 months, 1 year and 2 year. Impact on Participation and Autonomy Questionnaire (IPA) a validated self report instrument assessing perceived participation restrictions and autonomy in daily life. The questionnaire contains multiple domains (e.g., Autonomy Indoors, Autonomy Outdoors, Social Life, Family Role, Work/Education), with items scored on a Likert scale from 0 to 4. The unit of measure is the domain score, expressed as the mean or sum of item scores, where higher scores indicate greater perceived limitations in participation and autonomy.

Measures include FASD. Function Assessment scale for Spinal Deformity (FASD) contains 14 items across three subscales: spinal balance/mobility, stability limits/sensory integration, and ADL/gait. Each is graded on an ordinal 3- or 4-point scale. The maximum total score is 56; higher numbers represent better functional performance.

Measures include ODI. Oswestry Disability Index (ODI) summerise the points from all 10 completed sections like pain intensity, lifting, and walking (each scored from 0 (least disability) to 5 (severe disability). Score is reported as a percentage from 0% to 100% that measures functional impairment from low back pain, divided into five standard ranges: minimal disability (0-20%), moderate disability (21-40%), severe disability (41-60%), crippled (61-80%), and bed-bound or exaggerating symptoms (81-100%)

Cross-sectional differences between conservative, primary surgery, and revision surgery groups in QoL, psychosocial burden, functional impairment, structural deformity severity, spine-specific symptom burden, and frailty-related health status. Longitudinal within-patient changes across repeated routine-care follow-up timepoints in SRS-22r, EQ-5D-5L, HADS, FABQ-DV, FES-I, IPA, FASD, ODI, COMI, SVA, PT, PI-LL mismatch, coronal Cobb angle, and mFI-5. The use of these scales is already described in the primary outcomes.