I am writing to express my concerns regarding the article by Taniwaki et al. [1] titled “Do different pathologies of adult spinal deformity (idiopathic lumbar scoliosis against de novo lumbar scoliosis) affect preoperative and postoperative selfimage?” recently published in your journal. I appreciate the authors’ effort in exploring how different types of adult spinal curvature affect patients’ self-image before and after surgery [1].

The authors have done a good job in terms of applying appropriate tools to assess patient’s self-image. This focus on self-image is important because it has an influence on the quality of life of the patients. This knowledge allows us to better understand how idiopathic lumbar scoliosis, begins in adolescence and de novo lumbar scoliosis, which starts in adulthood, affects patients’ self-image. However, there are a few areas which could be worked upon to further enhance the value of this research. First, regarding the number of patients, the abstract mentions enrollment of 60 patients who underwent corrective surgery but the materials and methods section describe 85 patients, and the study eligibility flowchart considers only 60 patients by applying inclusion and exclusion criteria. This issue must be resolved to avoid confusion that may affect the reliability and validity of the presented study. Second, the study lacks detail about eligibility criteria, there is less information on the selection of patients in the study, it can lead to biased results [2]. Third, there is the lack of accurately defined subheadings in the materials and methods section where the study design should be described according to the journal instructions, also trial date and registration is not mentioned. The clear subheadings make it easy for the readers to note the framework and methods used for the study, which makes the study to be well in line with journal standards.

Moreover, the authors have limited the study to only female patients, which gives no reason for the selective criterion. Including both may provide a wider view of how such conditions impact the body image in males and females so comparisons may be made. Also, if the authors decide to focus only on females, they should be able to justify this decision. Furthermore, the study does not fully account for confounding variables such as pain levels, functional status, and psychological conditions, which could influence patient self-image. Last, the follow-up period is short. To really understand how surgery affects patients’ self-image, it is important to assess long term effects of surgery [3].

In conclusion, the study by Taniwaki et al. [1] is a useful source on the influence of various types of spinal deformities on self-image. However, the strategies to address these aspects of improvement will help to enhance the study and make it more relevant for different groups of patients. I hope these suggestions are helpful for future research in this important field. I am grateful for the opportunity to give my opinion on this important piece of research.