Implementation of Virtual Reality for Postoperative Recovery in an Adolescent Idiopathic Scoliosis Population: a Prospective Pilot Study

Introduction: Postoperative recovery following adolescent idiopathic scoliosis (AIS) surgery includes multimodal pain management and physical therapy. Though virtual reality (VR) has been explored as a non-pharmacologic strategy for reducing pain and anxiety during bedside procedures, its impact on postoperative pain and opioid use following AIS correction has not been well characterized. Methods: Adolescent patients undergoing spinal fusion for AIS between March 2024 and June 2025 were eligible for recruitment. Patients completed a 20-minute immersive underwater VR scenario prior to each postoperative inpatient physical therapy (PT) session. Pain scores (measured on a 10-point Likert scale) before and after PT, opioid usage, number of completed PT sessions, and length of hospitalization were recorded for study subjects and were compared to controls. Results: Ten patients in the VR cohort were compared to 10 controls. There were no differences in sex (p=0.58), race (p=0.07), ethnicity (p>0.99), or average age at surgery (15.1 vs 15.8 years, p=0.30). Patients in the VR cohort had a greater average reduction in pain scores associated with postoperative PT compared to controls (-0.72 vs +0.61, p=0.02). Patients in the VR and control groups did not differ significantly with regard to total opioid usage in morphine equivalents (55.7 vs 49.9 mg, p=0.71), completed PT sessions (3.2 vs 3.2 sessions, p>0.99), or length of hospitalization (2.6 vs 2.4 days, p=0.53). Side effects of the VR intervention included fatigue (n=3), nausea (n=3), headache (n=2), eye strain (n=1), and dizziness (n=1). Conclusion: Our pilot study demonstrated that an immersive VR session prior to each postoperative PT session significantly reduced the change in PT-associated pain scores among patients undergoing spinal fusion for AIS. Future investigations utilizing a randomized-controlled design will continue to elucidate the impact of VR on postoperative recovery for patients undergoing AIS correction.