Background: Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is a standard procedure with recognized long-term complications that may emerge years after surgery. Informed consent requires disclosure of material risks, but it is unclear whether these long-term sequelae are consistently communicated. This study systematically reviewed publicly available consent materials to assess disclosure of evidence-based long-term complications of PSF for AIS. Methods: Official websites of spine, orthopedic, and neurosurgical societies, along with major hospitals across North America, South America, Europe, and Australia, were searched for publicly available informed consent forms and patient information leaflets related to PSF for AIS. Documents were assessed for explicit mention of predefined long-term complications: chronic pain/health-related quality of life, pseudoarthrosis, adjacent segment degeneration, future surgery, pulmonary function impact, late infection, local tissue reaction to metal debris, and pregnancy-related issues. Disclosure frequencies were calculated. Results: Thirty-one documents from ten countries were included. Immediate perioperative risks were almost universally reported, whereas long-term complications were inconsistently disclosed. Reporting frequencies were: pseudoarthrosis, 80.6% (n = 25); future surgery, 67.7% (n = 21); adjacent segment degeneration, 51.6% (n = 16); chronic pain, 48.4% (n = 15); local tissue reaction to metal debris, 38.7% (n = 12); late infection, 25.8% (n = 8); pregnancy-related issues, 22.6% (n = 7); and pulmonary impact, 9.7% (n = 3). Conclusions: Publicly available consent materials for AIS surgery incompletely disclose long-term complications compared with the published evidence. However, written information sheets and consent forms represent only one component of the consent process. Consistently with the patient-centered standard articulated in Montgomery v Lanarkshire Health Board, informed consent should include discussion of material risks, benefits, reasonable alternative treatments including standard care, and the option of no treatment, with disclosure tailored to what matters to the patient and family. Updating written materials to better reflect lifelong risks may strengthen one important component of informed consent and shared decision-making for patients and families.
Barrios et al. (Thu,) studied this question.