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Prevalence and Predictors of Pain in Surgical Treatment of Adolescent Idiopathic Scoliosis

Landman, Zachary BA*; Oswald, Timothy MD; Sanders, James MD; Diab, Mohammad MD*; Members of the Spinal Deformity Study Group

doi: 10.1097/BRS.0b013e3181de8c2b
Deformity

Study Design. Multicenter, prospective, consecutive clinical series.

Objective. To report on back pain and its association with patients' perceptions of appearance in a prospective cohort study of children before and after posterior spinal fusion for idiopathic scoliosis.

Summary of Background Data. Back pain in idiopathic scoliosis has been noted to be reduced after surgery. However, uncertainty over its prevalence before and after operation persists. There is a paucity of data on correlations between patients' perceptions of their appearance and preoperative and postoperative pain.

Methods. We reviewed 1433 patients entered consecutively into the Prospective Pediatric Scoliosis Study, a database of children (8–22 years) undergoing operation for idiopathic scoliosis who have been followed for 1 and 2 years (n = 295) with the Scoliosis Research Society-22 and Spinal Appearance Questionnaire instruments.

Results. Preoperative pain was reported by 77.9% of patients and 44% of surgeons. More preoperative pain correlated with older age (ρ = −.140, P = 0.000), greater body mass index (ρ = −0.168, P = 0.000), larger proximal thoracic curve ρ = −0.086, P = 0.019), and a higher score on the Spinal Appearance Questionnaire Appearance (greater perception of spinal deformity, ρ = −0.223, P = 0.000) and Appearance Desire scales (stronger desire to change the appearance of their spine, ρ = −0.153, P = 0.000).

Pain was reduced at 1 and 2 years after operation (P = 0.0002). Patients who perceived themselves as less deformed (ρ = −0.284, P < 0.01) or had less desire to change their spinal appearance (ρ = −0.183, P < 0.01) experienced a greater reduction in pain 2 years after operation.

Preoperative analgesic use for back pain was high (28.8%) and remained high at 2 years after operation (29.5%) (P > 0.05).

Conclusion. Back pain affects three-quarters of adolescents with idiopathic scoliosis and is reduced after posterior fusion. Patients who are overweight, older, and have larger proximal thoracic curve magnitudes report more preoperative pain. Patients who view themselves as more deformed tend to have more absolute pain, and less reduction in pain after operation.

In a consecutive clinical series of adolescents undergoing posterior spinal fusion with instrumentation for adolescent idiopathic scoliosis, back pain was found to affect three-quarters of adolescents and was reduced after operation. Patients who were overweight, older, and had larger proximal thoracic curve magnitudes reported more pain. Patients who viewed themselves as more deformed reported more absolute pain, and less reduction in pain after operation.

*Department of Orthopædic Surgery, University of California, San Francisco

Department of Orthopædic Surgery, Pediatric Orthopedic Associates of Atlanta, GA

Department of Orthopædic Surgery, University of Rochester Medical Center, Rochester, NY

Address correspondence and reprint requests to Zachary Landman, BA, Department of Orthopædic Surgery, University of California, San Francisco, 500 Parnassus Ave, MU-316W, San Francisco, CA 94143; E-mail: Zachary.Landman@ucsf.edu

Acknowledgment date: December 15, 2009. Revision date: February 12, 2010. Acceptance date: March 12, 2010.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.