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Lower SRS Mental Health Scores are Associated With Greater Preoperative Pain in Patients With Adolescent Idiopathic Scoliosis

Hwang, Steven W. MD; Pahys, Joshua M. MD; Bastrom, Tracey P. MA; Lonner, Baron S. MD; Newton, Peter O. MD; Samdani, Amer F. MD; Harms Study Group§

doi: 10.1097/BRS.0000000000003162

Study Design. Retrospective review of a prospectively collected multicenter database.

Objective. The aim of this study was to investigate factors associated with low preoperative SRS pain scores.

Summary of Background Data. The prevalence of preoperative pain in patients with adolescent idiopathic scoliosis (AIS) has become increasingly evident and is a primary concern for patients and families. Greater preoperative pain is associated with more postoperative pain; however, less is understood about what contributes to preoperative pain.

Methods. A prospectively collected, multicenter database was queried for patients with AIS. Patients were divided into 2 cohorts based on preoperative SRS pain scores: ≤ 3 (Pain cohort), 4 to 5 (No Pain cohort). Univariate analysis was performed identifying which factors were associated with a low preoperative SRS score and used for a CART analysis.

Results. Of 2585 patients total, 2141 (83%) patients had SRS pain scores of 4 to 5 (No Pain) and 444 (17%) had SRS pain scores ≤3 (Pain). Female sex, older age, greater % body mass index, larger lumbar curves, greater T5–12 kyphosis, and lower mental health scores were associated with greater preoperative pain. In multivariate CART analysis, lower mental health SRS scores (P = 0.04) and older age (P = 0.003) remained significant, with mental health scores having the greatest contribution. In subdividing the mental health component questions, anxiety-related questions appeared to have the greatest effect followed by mood/depression (SRS Question 13: OR 2.04; Q16: OR 1.35; Q7: OR 1.31; Q3: OR 1.20).

Conclusion. Anxiety and mood are potentially modifiable risk factors that have the greatest impact on pre- and postoperative pain. These results can be used to identify higher-risk patients and develop preoperative therapeutic protocols to improve postoperative outcomes.

Level of Evidence: 3

We retrospectively queried a prospectively collected cohort of 2585 patients having undergone a spinal fusion for AIS to identify factors associated with more pre-op pain. Patients with lower mental health scores and greater age were associated with increasing pre-op pain; specifically, anxiety and mood were primary contributors.

Shriners Hospitals for Children-Philadelphia, Philadelphia, PA 19140

Rady Children's Hospital, San Diego, CA 92123

Mount Sinai Beth Israel Medical Center, New York, NY 10017

§Setting Scoliosis Straight Foundation, San Diego, CA 98108.

Address correspondence and reprint requests to Steven W. Hwang, MD, Shriners Hospitals for Children-Philadelphia, 3551N Broad St, Philadelphia, PA 19140; E-mail:

Received 14 March, 2019

Revised 23 May, 2019

Accepted 10 June, 2019

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

The Setting Scoliosis Straight Foundation receives grants from DePuy Synthes Spine, EOS Imaging, K2 M, Medtronic, NuVasive, and Zimmer Biomet in support of Harms Study Group research.

Relevant financial activities outside the submitted work: board membership, consultancy, stocks, royalties, patents.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.