Objectives: To describe the prevalence of pain following fusion for adolescent idiopathic scoliosis and to identify factors associated with pain and disability.
Methods: From 126 consecutive patients surgically treated for scoliosis between 1997 and 2007, 104 (82.5%) completed SRS-22 and ODI questionnaires at a last follow-up (mean, 4.8 years; range 1–11.2 years). Prevalence of pain and disability were determined from SRS questions 1 and 9 respectively, with “any” pain or decrease in activity considered clinically significant. SRS Pain Domain Scores (PDS) were also evaluated.
Results: Most participants reported “no pain” (38.5%) or “mild pain” (30.8%) and 72.1% of participants reported a current work/school activity level of 100% normal. An association between instrument type and the presence of any pain in the previous 6 months was noted (P = .022). Instrument type was the only factor that was significantly associated with the PDS (P = .0052).
Conclusions: The high percentage of patients reporting no pain or mild pain may suggest overall success of the procedures. Although an association between instrument type and pain was seen, unmeasured factors that contributed to the decision of what instrument to use may confound the relationship. From these data a causal inference cannot be made.
Final class of evidence-prognosis
Study design
Prospective Cohort
Retrospective Cohort
•
Case control
Case series
Methods
Patients at similar point in course of treatment
•
F/U ≥ 85%
Similarity of treatment protocols for patient groups
Patients followed up long enough for outcomes to occur
•
Control for extraneous risk factors
•*
Overall class of evidence
III
The definiton of the different classes of evidence is available on page 55.
*Potentially confounding factors were systematically explored and considered for stratified analysis as appropriate.
References
1 D’Andrea LP, Betz RR, Lenke LG , et al. Do radiographic parameters correlate with clinical outcomes in adolescent idiopathic scoliosis?. Spine (Phila Pa 1976) 2000; 25 (14) 1795-1802
2 Wilson PL, Newton PO, Wenger DR , et al. A multicenter study analyzing the relationship of a standardized radiographic scoring system of adolescent idiopathic scoliosis and the Scoliosis Research Society outcomes instrument. Spine (Phila Pa 1976) 2002; 27 (17) 2036-2040
3 Asher M, Min Lai S, Burton D , et al. The reliability and concurrent validity of the scoliosis research society-22 patient questionnaire for idiopathic scoliosis. Spine (Phila Pa 1976) 2003; 28: 63-69
4 Bago J, Climent JM, Ey A , et al. The Spanish version of the SRS-22 patient questionnaire for idiopathic scoliosis: transcultural adaptation and reliability analysis. Spine (Phila Pa 1976) 2004; 29 (15) 1676-1680
6 Danielsson AJ, Nachemson AL. Back pain and function 23 years after fusion for adolescent idiopathic scoliosis: a case-control study-part II. Spine (Phila Pa 1976) 2003; 28: E373-383
7 Remes V, Helenius I, Schlenzka D , et al. Cotrel-Dubousset (CD) or Universal Spine System (USS) instrumentation in adolescent idiopathic scoliosis (AIS): comparison of midterm clinical, functional, and radiologic outcomes. Spine (Phila Pa 1976) 2004; 29 (18) 2024-2030
8 Helenius I, Remes V, Lamberg T , et al. Long-term health-related quality of life after surgery for adolescent idiopathic scoliosis and spondylolisthesis. J Bone Joint Surg Am 2008; 90 (6) 1231-1239
9 Niemeyer T, Bovingloh AS, Grieb S , et al. Low back pain after spinal fusion and Harrington instrumentation for idiopathic scoliosis. Int Orthop 2005; 29 (1) 47-50
10 Dickson JH, Erwin WD, Rossi D. Harrington instrumentation and arthrodesis for idiopathic scoliosis: a twenty-one-year follow-up. J Bone Joint Surg Am 1990; 72 (5) 678-683
11 Bartie BJ, Lonstein JE, Winter RB. Long-term follow-up of adolescent idiopathic scoliosis patients who had Harrington instrumentation and fusion to the lower lumbar vertebrae: is low back pain a problem?. Spine (Phila Pa 1976) 2009; 34 (24) E873-878
12 Pérez-Grueso FS, Fernandez-Baillo N, Arauz de Robles S , et al. The low lumbar spine below Cotrel-Dubousset instrumentation: long-term findings. Spine (Phila Pa 1976) 2000; 25 (18) 2333-2341
13 Takayama K, Nakamura H, Matsuda H. Low back pain in patients treated surgically for scoliosis: longer than sixteen-year follow-up. Spine (Phila Pa 1976) 2009; 34: 2198-2204
14 Helenius I, Remes V, Yrjonen T , et al. Harrington and Cotrel-Dubousset instrumentation in adolescent idiopathic scoliosis: long-term functional and radiographic outcomes. J Bone Joint Surg Am 2003; 85-A (12) 2303-2309
15 Tsutsui S, Pawelek J, Bastrom T , et al. Dissecting the effects of spinal fusion and deformity magnitude on quality of life in patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2009; 34 (18) E653-658
17 Helenius I, Remes V, Yrjönen T , et al. Comparison of long-term functional and radiologic outcomes after Harrington instrumentation and spondylodesis in adolescent idiopathic scoliosis: a review of 78 patients. Spine (Phila Pa 1976) 2002; 27 (2) 176-180
18 Fabry G, Melkebeek JVan, Bockx E. Back pain after Harrington rod instrumentation for idiopathic scoliosis. Spine (Phila Pa 1976) 1989; 14 (6) 620-624
19 Hayes MA, Tompkins SF, Herndon WA , et al. Clinical and radiological evaluation of lumbosacral motion below fusion levels in idiopathic scoliosis. Spine (Phila Pa 1976) 1988; 13 (10) 1161-1167
