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Adolescent idiopathic scoliosis patients report increased pain at five years compared with two years after surgical treatment.
- Source :
-
Spine [Spine (Phila Pa 1976)] 2008 May 01; Vol. 33 (10), pp. 1107-12. - Publication Year :
- 2008
-
Abstract
- Study Design: A multicenter study of changes in Scoliosis Research Society (SRS) outcome measures after surgical treatment of adolescent idiopathic scoliosis (AIS).<br />Objective: To evaluate changes in patient determined outcome measures between 2 and 5 years after AIS surgery.<br />Summary of Background Data: Current surgical procedures have been shown to improve subjective measures in patients with AIS. At 2-year follow-up, AIS patients reported significant improvement in all 4 preoperative domains of the SRS questionnaire. In addition, the major Cobb angle was shown to be negatively correlated with preoperative scores in the pain, general self-image, and general function domains. Five-year SRS scores have not been evaluated previously.<br />Methods: A multicenter, prospectively generated database was used to obtain perioperative, radiographic, and SRS-24 outcomes data. The inclusion criteria were: a diagnosis of AIS, surgical treatment (anterior, posterior, or combined), a comprehensive set of radiographic measures, and completed preoperative, 2-year, and 5-year SRS questionnaires. Repeated measures analysis of variance was used to compare changes in patient responses for each of the 7 outcome domains. Univariate analysis of variance was used to compare the change in pain score at 5 years to the level of the lowest instrumented vertebrae and surgical approach. A correlation analysis was used to determine the association between changes in any of the radiographic variables and changes in SRS scores. The data were checked for normality and equal variances, and the level of significance was set at P < 0.01.<br />Results: Forty-nine patients (42 women, 7 men; 14.2 +/- 2.1 year old; 5.4 +/- 0.6 years follow-up) met the inclusion criteria for this study. Thirty-seven of 49 (76%) of these patients underwent an open or thoracoscopic anterior procedure. SRS-24 scores improved significantly in 3 of the 4 preoperative domains at the 2-year visit. At 5 years postop, a statistically significant decrease in the pain score (4.2 +/- 0.6 to 3.9 +/- 0.9, P = 0.003) and a trend toward worsening scores in 4 other domains was observed; however, Patient Satisfaction scores remained unchanged. Lowest instrumented vertebrae and surgical approach could not be correlated to changes in the pain score. In addition, no correlation was found between changes in any of the 21 radiographic measures evaluated and changes in SRS scores.<br />Conclusion: There was a statistically significant increase in reported pain from 2 to 5 years after surgical treatment; however, the etiology of worsening pain scores could not be elucidated. Given continued patient satisfaction, the clinical relevance of this small reduction remains unknown. Nevertheless, this observation deserves further evaluation and must be considered in relation to the natural history of this disease.
- Subjects :
- Adolescent
Adult
Back Pain diagnostic imaging
Back Pain physiopathology
Back Pain surgery
Child
Female
Follow-Up Studies
Humans
Male
Pain Measurement
Pain, Postoperative diagnostic imaging
Pain, Postoperative physiopathology
Patient Satisfaction
Radiography
Recovery of Function
Retrospective Studies
Scoliosis complications
Scoliosis diagnostic imaging
Scoliosis physiopathology
Self Concept
Surveys and Questionnaires
Time Factors
Treatment Outcome
United States
Back Pain etiology
Orthopedic Procedures adverse effects
Pain, Postoperative etiology
Scoliosis surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1528-1159
- Volume :
- 33
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Spine
- Publication Type :
- Academic Journal
- Accession number :
- 18449045
- Full Text :
- https://doi.org/10.1097/BRS.0b013e31816f2849