To investigate whether patients with painful adolescent idiopathic scoliosis
relief with surgical treatment.
Summary of Background Data. Adolescent idiopathic scoliosis
(AIS) was previously thought to be a painless condition, but recent studies have shown that a significant proportion of patients have pain
. Little information is available regarding pain
relief with surgical treatment for AIS.
Patients enrolled in a prospective database of surgically treated AIS were divided into two groups based on their preoperative Scoliosis Research Society (SRS)-22R pain
domain score. Patients with a preoperative pain
domain score of 4 or more (N = 1005) were classified as nonpainful. If the preoperative pain
domain score was less than 4 (N = 505), they were classified as painful. Demographics, SRS total and domain scores, and changes with treatment were compared for the two groups.
The two groups had similar demographics and preoperative coronal curve magnitude. Patients with painful scoliosis experienced significant improvement in SRS-22R pain
scores, from 3.29 preoperatively to 4.03 postoperatively (P
< 0.000). Eighty-one percent of these patients reached the minimum clinically important difference threshold (0.20) for improvement in pain
score. Painful scoliosis patients also had greater 2-year improvement in total and all domain scores than the nonpainful scoliosis patients (P
< 0.000). Absolute values of SRS-22R total and domain scores were all greater at 2 years in the nonpainful group than the painful group.
Patients with AIS with substantial back pain
can be cautiously counseled to expect significant improvement in pain
level with surgical correction of their deformity, even if curve progression is the primary indication for surgery
. Although these patients achieve greater improvements in health-related quality of life
compared with patients with mild or no pain
, 2-year SRS-22R scores were still better in patients with mild or no pain
Level of Evidence: 2