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We appreciate the effort of Aprile and colleagues on the evaluation of long-term effects of surgery or conservative treatment on health-related quality of life in patients with scoliosis. We agree that this is an important topic that needs further evaluation.
Probably due to the time period between completing treatment and follow-up, the authors had trouble reaching more than half, namely 65% of the patients who met the inclusion criteria; another 13 (13%) patients refused to participate. Unfortunately, only 21 patients of the initial population participated, which may have led to biased results.
Aprile did not find statistically significant differences in HRQoL between the CONS patients and the SURG patients, but that could very well be attributable to the small numbers in their treatment groups. For instance, on the Visual Analogue Scale for pain, the difference is not statistically significant, but the CONS group scored 1.7 points higher on a 10 point scale. The CONS group scored 6.9 points which can be interpreted as a satisfactory mark, while the SURG group scored 5.2 points which can be interpreted as an unsatisfactory mark. The scales “SF Social Functioning” and “SF Role Emotional” show a similar trend. On these scales, the conservative group tend to score better, but again, numbers are too small for conclusive evidence.
Danielsson et al.  also studied long-term HRQoL in scoliosis patients using the SF36. SF36 scores tend to be higher (i.e., better) in the study by Danielsson than in the study by Aprile.
Further research on this topic is still needed. Preferably, a large cohort of patients with idiopathic scoliosis should prospectively be followed from the start of treatment (brace, watchful waiting, surgery) till long-term follow-up of 20–50 years.
This author’s reply refers to the article http://dx.doi.org/10.1007/s00586-007-0461-4.