Return to Sport After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis: A Systematic Review and Clinical Recommendations

Background: Return to sport (RTS) after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is a critical patient-centered outcome, yet evidence-based guidelines remain limited. This systematic review synthesizes existing literature on RTS after PSF treatment in AIS to inform clinical practice. Purpose: To evaluate the timing, rates of RTS, and factors influencing RTS outcomes after PSF for AIS and provide recommendations for clinical practice. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the PubMed, Embase, Cochrane Library, and Google Scholar databases from inception to February 24, 2025. Studies evaluating RTS after PSF for AIS were included. Data extracted included patient characteristics, curve characteristics, surgical details, RTS outcomes, and patient-reported outcome measures. Results: Of 1569 identified articles, 11 studies (722 patients) were included. The mean age of patients was 15.2 ± 2.8 years, and the mean maximum Cobb angle was 58.3°± 14.8°. Patients generally resumed sports between 8 and 12 months postoperatively. RTS delays were frequently associated with older patient age, greater curve severity, longer spinal fusions, more distal fusion levels, and psychosocial factors including fear of injury, anxiety, physical deconditioning, and reduced spinal flexibility. Additionally, some patients transitioned from competitive or contact sports to noncompetitive or noncontact sports postoperatively due to these factors or conservative surgeon recommendations. Conclusion: Most patients with AIS successfully returned to sport within 1 year after PSF, although timing and performance levels varied significantly based on individual patient characteristics. Age, spinal curve severity, surgical extent, and psychological readiness considerably influenced RTS outcomes. Clear and individualized clinical guidelines addressing these factors are necessary to optimize RTS outcomes for patients with AIS undergoing PSF. Based on this systematic review, specific phased recommendations have been proposed to guide clinical practice and rehabilitation protocols for athletes with AIS.