Back Pain and Quality of Life After Surgical Treatment for Adolescent Idiopathic Scoliosis at 5-Year Follow-up: Comparison with Healthy Controls and Patients with Untreated Idiopathic Scoliosis.
Adolescent
Analysis of Variance
Back Pain
/ etiology
Child
Cohort Studies
Female
Humans
Internal Fixators
Male
Multivariate Analysis
Pain Measurement
Pain, Postoperative
/ physiopathology
Prognosis
Quality of Life
Reference Values
Retrospective Studies
Scoliosis
/ complications
Severity of Illness Index
Spinal Fusion
/ adverse effects
Treatment Outcome
Young Adult
Journal
The Journal of bone and joint surgery. American volume
ISSN: 1535-1386
Titre abrégé: J Bone Joint Surg Am
Pays: United States
ID NLM: 0014030
Informations de publication
Date de publication:
21 08 2019
21 08 2019
Historique:
entrez:
23
8
2019
pubmed:
23
8
2019
medline:
22
1
2020
Statut:
ppublish
Résumé
Posterior spinal fusion with pedicle screws is the gold-standard treatment for adolescent idiopathic scoliosis (AIS); however, it is unclear whether this procedure results in improved long-term back pain and health-related quality of life compared with patients not surgically treated for AIS. The aim of the present study was to evaluate back pain and quality of life in surgically managed patients with a minimum follow-up of 5 years compared with patients with untreated AIS and a healthy control group. Fifty-five consecutive adolescent patients who underwent posterior pedicle screw instrumentation for AIS by a single orthopaedic surgeon were prospectively enrolled. At a minimum of 5 years postoperatively, 49 patients completed Scoliosis Research Society (SRS)-24 questionnaires, and data on reoperation were collected. Pain and quality-of-life parameters were compared with those of 49 age and sex-matched patients with untreated AIS and 49 healthy controls. The major curve averaged 53° preoperatively and 12° at 2 years postoperatively. One reoperation (pedicle screw removal) was needed because of a new neurological deficit (transient). The SRS-24 pain, function, and total scores improved significantly from preoperatively to 5 years postoperatively (all p ≤ 0.016), with pain scores improving from 4.0 to 4.3 (p = 0.003). There was no association between pain scores and the preoperative major curve, instrumentation below L1, or postoperative rib hump. The surgical treatment group had significantly better pain, activity, and self-image domain scores at 5 years postoperatively compared with the untreated AIS group (all p ≤ 0.014), and similar pain, self-image, and activity domain scores compared with the healthy control group; however, function scores were significantly lower among patients in the surgical treatment group (p < 0.001). Patients who underwent posterior spinal fusion with pedicle screws experienced improved back pain and health-related quality of life compared with patients with untreated AIS. Patients in the surgical treatment group had similar health-related quality of life to that of the healthy control group, except for function, which was significantly lower. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Sections du résumé
BACKGROUND
Posterior spinal fusion with pedicle screws is the gold-standard treatment for adolescent idiopathic scoliosis (AIS); however, it is unclear whether this procedure results in improved long-term back pain and health-related quality of life compared with patients not surgically treated for AIS. The aim of the present study was to evaluate back pain and quality of life in surgically managed patients with a minimum follow-up of 5 years compared with patients with untreated AIS and a healthy control group.
METHODS
Fifty-five consecutive adolescent patients who underwent posterior pedicle screw instrumentation for AIS by a single orthopaedic surgeon were prospectively enrolled. At a minimum of 5 years postoperatively, 49 patients completed Scoliosis Research Society (SRS)-24 questionnaires, and data on reoperation were collected. Pain and quality-of-life parameters were compared with those of 49 age and sex-matched patients with untreated AIS and 49 healthy controls.
RESULTS
The major curve averaged 53° preoperatively and 12° at 2 years postoperatively. One reoperation (pedicle screw removal) was needed because of a new neurological deficit (transient). The SRS-24 pain, function, and total scores improved significantly from preoperatively to 5 years postoperatively (all p ≤ 0.016), with pain scores improving from 4.0 to 4.3 (p = 0.003). There was no association between pain scores and the preoperative major curve, instrumentation below L1, or postoperative rib hump. The surgical treatment group had significantly better pain, activity, and self-image domain scores at 5 years postoperatively compared with the untreated AIS group (all p ≤ 0.014), and similar pain, self-image, and activity domain scores compared with the healthy control group; however, function scores were significantly lower among patients in the surgical treatment group (p < 0.001).
CONCLUSIONS
Patients who underwent posterior spinal fusion with pedicle screws experienced improved back pain and health-related quality of life compared with patients with untreated AIS. Patients in the surgical treatment group had similar health-related quality of life to that of the healthy control group, except for function, which was significantly lower.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 31436653
doi: 10.2106/JBJS.18.01370
pii: 00004623-201908210-00004
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1460-1466Commentaires et corrections
Type : CommentIn
Type : ErratumIn
Références
Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA. 2003 Feb 5;289(5):559-67.
Hresko MT. Clinical practice. Idiopathic scoliosis in adolescents. N Engl J Med. 2013 Feb 28;368(9):834-41.
Danielsson AJ, Wiklund I, Pehrsson K, Nachemson AL. Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery. Eur Spine J. 2001 Aug;10(4):278-88.
Helenius I, Remes V, Yrjönen T, Ylikoski M, Schlenzka D, Helenius M, Poussa M. Harrington and Cotrel-Dubousset instrumentation in adolescent idiopathic scoliosis. Long-term functional and radiographic outcomes. J Bone Joint Surg Am. 2003 Dec;85(12):2303-9.
Diarbakerli E, Grauers A, Danielsson A, Gerdhem P. Health-related quality of life in adulthood in untreated and treated individuals with adolescent or juvenile idiopathic scoliosis. J Bone Joint Surg Am. 2018 May 16;100(10):811-7.
Suk SI, Lee CK, Kim WJ, Chung YJ, Park YB. Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine (Phila Pa 1976). 1995 Jun 15;20(12):1399-405.
Kim YJ, Lenke LG, Cho SK, Bridwell KH, Sides B, Blanke K. Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2004 Sep 15;29(18):2040-8.
Lee SM, Suk SI, Chung ER. Direct vertebral rotation: a new technique of three-dimensional deformity correction with segmental pedicle screw fixation in adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2004 Feb 1;29(3):343-9.
Ledonio CG, Polly DW Jr, Vitale MG, Wang Q, Richards BS. Pediatric pedicle screws: comparative effectiveness and safety: a systematic literature review from the Scoliosis Research Society and the Pediatric Orthopaedic Society of North America Task Force. J Bone Joint Surg Am. 2011 Jul 6;93(13):1227-34.
Mattila M, Jalanko T, Helenius I. En bloc vertebral column derotation provides spinal derotation but no additional effect on thoracic rib hump correction as compared with no derotation in adolescents undergoing surgery for idiopathic scoliosis with total pedicle screw instrumentation. Spine (Phila Pa 1976). 2013 Aug 15;38(18):1576-83.
Ward WT, Friel NA, Kenkre TS, Brooks MM, Londino JA, Roach JW. SRS-22r scores in nonoperated adolescent idiopathic scoliosis patients with curves greater than forty degrees. Spine (Phila Pa 1976). 2017 Aug 15;42(16):1233-40.
Palmer H. Pain charts; a description of a technique whereby functional pain may be diagnosed from organic pain. N Z Med J. 1949 Apr;48(264):187-213.
Cobb JR. Outline for the study of scoliosis. Instr Course Lect. 1948;5:261-75.
Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am. 2001 Aug;83(8):1169-81.
Haher TR, Gorup JM, Shin TM, Homel P, Merola AA, Grogan DP, Pugh L, Lowe TG, Murray M. Results of the Scoliosis Research Society instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis. A multicenter study of 244 patients. Spine (Phila Pa 1976). 1999 Jul 15;24(14):1435-40.
Djurasovic M, Glassman SD, Sucato DJ, Lenke LG, Crawford CH 3rd, Carreon LY. Improvement in Scoliosis Research Society-22R pain scores after surgery for adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2018 Jan 15;43(2):127-32.
von Baeyer CL. Numerical rating scale for self-report of pain intensity in children and adolescents: recent progress and further questions. Eur J Pain. 2009 Nov;13(10):1005-7. Epub 2009 Sep 17.
Diarbakerli E, Grauers A, Gerdhem P. Population-based normative data for the Scoliosis Research Society 22r questionnaire in adolescents and adults, including a comparison with EQ-5D. Eur Spine J. 2017 Jun;26(6):1631-7. Epub 2016 Nov 10.
Asher M, Min Lai S, Burton D, Manna B. The reliability and concurrent validity of the Scoliosis Research Society-22 patient questionnaire for idiopathic scoliosis. Spine (Phila Pa 1976). 2003 Jan 1;28(1):63-9.
Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997 Mar;79(3):364-8.
Sieberg CB, Simons LE, Edelstein MR, DeAngelis MR, Pielech M, Sethna N, Hresko MT. Pain prevalence and trajectories following pediatric spinal fusion surgery. J Pain. 2013 Dec;14(12):1694-702.
Voepel-Lewis T, Caird MS, Tait AR, Malviya S, Farley FA, Li Y, Abbott MD, van Veen T, Hassett AL, Clauw DJ. A high preoperative pain and symptom profile predicts worse pain outcomes for children after spine fusion surgery. Anesth Analg. 2017 May;124(5):1594-602.
Upasani VV, Caltoum C, Petcharaporn M, Bastrom TP, Pawelek JB, Betz RR, Clements DH, Lenke LG, Lowe TG, Newton PO. Adolescent idiopathic scoliosis patients report increased pain at five years compared with two years after surgical treatment. Spine (Phila Pa 1976). 2008 May 1;33(10):1107-12.
Théroux J, Le May S, Hebert JJ, Labelle H. back pain prevalence is associated with curve-type and severity in adolescents with idiopathic scoliosis: a cross-sectional study. Spine (Phil.a Pa 1976). 2017 Aug 1;42(15):E914-9.
Sato T, Hirano T, Ito T, Morita O, Kikuchi R, Endo N, Tanabe N. Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City, Japan. Eur Spine J. 2011 Feb;20(2):274-9. Epub 2010 Dec 17.
Balagué F, Pellisé F. Adolescent idiopathic scoliosis and back pain. Scoliosis Spinal Disord. 2016 Sep 9;11(1):27.
Howard A, Donaldson S, Hedden D, Stephens D, Alman B, Wright J. Improvement in quality of life following surgery for adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2007 Nov 15;32(24):2715-8.
Merola AA, Haher TR, Brkaric M, Panagopoulos G, Mathur S, Kohani O, Lowe TG, Lenke LG, Wenger DR, Newton PO, Clements DH 3rd, Betz RR. A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society (SRS) outcome instrument. Spine (Phila Pa 1976). 2002 Sep 15;27(18):2046-51.
Bastrom TP, Marks MC, Yaszay B, Newton PO; Harms Study Group. Prevalence of postoperative pain in adolescent idiopathic scoliosis and the association with preoperative pain. Spine (Phila Pa 1976). 2013 Oct 1;38(21):1848-52.
Chidambaran V, Ding L, Moore DL, Spruance K, Cudilo EM, Pilipenko V, Hossain M, Sturm P, Kashikar-Zuck S, Martin LJ, Sadhasivam S. Predicting the pain continuum after adolescent idiopathic scoliosis surgery: a prospective cohort study. Eur J Pain. 2017 Aug;21(7):1252-65. Epub 2017 Mar 27.
Connelly M, Fulmer RD, Prohaska J, Anson L, Dryer L, Thomas V, Ariagno JE, Price N, Schwend R. Predictors of postoperative pain trajectories in adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2014 Feb 1;39(3):E174-81.
Landman Z, Oswald T, Sanders J, Diab M; Spinal Deformity Study Group. Prevalence and predictors of pain in surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2011 May 1;36(10):825-9.
Rodrigues LMR, Gotfryd AO, Machado AN, Defino M, Asano LYJ. Adolescent idiopathic scoliosis: surgical treatment and quality of life. Acta Ortop Bras. 2017 May-Jun;25(3):85-9.
Mariconda M, Andolfi C, Cerbasi S, Servodidio V. Effect of surgical correction of adolescent idiopathic scoliosis on the quality of life: a prospective study with a minimum 5-year follow-up. Eur Spine J. 2016 Oct;25(10):3331-40. Epub 2016 Mar 16.
Rushton PR, Grevitt MP. What is the effect of surgery on the quality of life of the adolescent with adolescent idiopathic scoliosis? A review and statistical analysis of the literature. Spine (Phila Pa 1976). 2013 Apr 20;38(9):786-94.
Carreon LY, Sanders JO, Diab M, Sucato DJ, Sturm PF, Glassman SD; Spinal Deformity Study Group. The minimum clinically important difference in Scoliosis Research Society-22 Appearance, Activity, And Pain domains after surgical correction of adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2010 Nov 1;35(23):2079-83.
Altaf F, Heran MK, Wilson LF. Back pain in children and adolescents. Bone Joint J. 2014 Jun;96-B(6):717-23.
Balagué F, Dudler J, Nordin M. Low-back pain in children. Lancet. 2003 Apr 26;361(9367):1403-4.
Calvo-Muñoz I, Gómez-Conesa A, Sánchez-Meca J. Prevalence of low back pain in children and adolescents: a meta-analysis. BMC Pediatr. 2013 Jan 26;13:14.
Turner PG, Green JH, Galasko CS. Back pain in childhood. Spine (Phila Pa 1976). 1989 Aug;14(8):812-4.