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 (PT). 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-min immersive underwater VR scenario prior to each postoperative inpatient 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. .