Tracey P Bastrom1, Masayuki Ohashi2, Carrie E Bartley1, Michelle C Marks3, Burt Yaszay1,4, Baron S Lonner5, Paul D Sponseller6, Peter O Newton7,8,9. 1. Orthopedics and Scoliosis Division, Rady Children's Hospital, San Diego, CA, USA. 2. Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan. 3. Setting Scoliosis Straight Foundation, San Diego, CA, USA. 4. Department of Orthopedic Surgery, University of California, San Diego, CA, USA. 5. Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA. 6. Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA. 7. Orthopedics and Scoliosis Division, Rady Children's Hospital, San Diego, CA, USA. pnewton.rady@gmail.com. 8. Department of Orthopedic Surgery, University of California, San Diego, CA, USA. pnewton.rady@gmail.com. 9. , 3020 Children's Way, MC 5062, San Diego, CA, 92123, USA. pnewton.rady@gmail.com.
Abstract
PURPOSE: To identify the prevalence and predictors of nonspecific back pain in primary thoracic adolescent idiopathic scoliosis (AIS) patients at 10 years after surgery. METHODS: This was a case-control multi-center study. A query of patients who underwent surgical correction of major thoracic AIS between 1997 and 2007 with 10-year follow-up was reviewed. SRS-22 pain scores at 10 years were classified as below normal (≤ 2 standard deviations below average for controls of similar age/sex from published literature) or within/above the control range. RESULTS: One hundred and seventy-one patients with an average of 10.5 ± 0.8-years follow-up were included. Average age at surgery was 14 ± 2 years. The rate of pain was 23% for males and 11% for females (p = 0.08). Differences in age, 10-year SRS mental health score, and radiographic measures were noted. Of 12 patients who underwent revision surgery, 42% reported below normal pain scores versus 11% in cases without revision (p = 0.012). Classification and regression tree (CART) analysis identified 10-year thoracic curve magnitude and 10-year mental health scores as significant predictors. Thoracic Cobb of ≤ 26° at 10 years was associated with a 7% rate of below normal pain scores compared to 27.5% when the curve was > 26° (OR = 4.8, p < 0.05). Of those with a curve ≤ 26°, no patients had abnormal pain if the SRS mental health score was > 4.2 and 15% had more pain than normal if mental health score was ≤ 4.2 (OR 23, p < 0.05). CONCLUSION: Increased primary thoracic curve magnitude (> 26°) at 10 years was the primary predictor of increased pain. For patients with less coronal deformity (< 26°), a poor mental health score was associated with an increased rate of pain. Male gender and revision surgery may also play a role in increased pain, however, the overall frequency of these variables were low. LEVEL OF EVIDENCE: Level 3.
PURPOSE: To identify the prevalence and predictors of nonspecific back pain in primary thoracic adolescent idiopathic scoliosis (AIS) patients at 10 years after surgery. METHODS: This was a case-control multi-center study. A query of patients who underwent surgical correction of major thoracic AIS between 1997 and 2007 with 10-year follow-up was reviewed. SRS-22 pain scores at 10 years were classified as below normal (≤ 2 standard deviations below average for controls of similar age/sex from published literature) or within/above the control range. RESULTS: One hundred and seventy-one patients with an average of 10.5 ± 0.8-years follow-up were included. Average age at surgery was 14 ± 2 years. The rate of pain was 23% for males and 11% for females (p = 0.08). Differences in age, 10-year SRS mental health score, and radiographic measures were noted. Of 12 patients who underwent revision surgery, 42% reported below normal pain scores versus 11% in cases without revision (p = 0.012). Classification and regression tree (CART) analysis identified 10-year thoracic curve magnitude and 10-year mental health scores as significant predictors. Thoracic Cobb of ≤ 26° at 10 years was associated with a 7% rate of below normal pain scores compared to 27.5% when the curve was > 26° (OR = 4.8, p < 0.05). Of those with a curve ≤ 26°, no patients had abnormal pain if the SRS mental health score was > 4.2 and 15% had more pain than normal if mental health score was ≤ 4.2 (OR 23, p < 0.05). CONCLUSION: Increased primary thoracic curve magnitude (> 26°) at 10 years was the primary predictor of increased pain. For patients with less coronal deformity (< 26°), a poor mental health score was associated with an increased rate of pain. Male gender and revision surgery may also play a role in increased pain, however, the overall frequency of these variables were low. LEVEL OF EVIDENCE: Level 3.