Prevalence and Predictors of Pain in Surgical Treatment of Adolescent Idiopathic Scoliosis

Study Design. Multicenter, prospective, consecutive clinical series. Objective. To report on back pain and its association with patients' perceptions of appearance in a prospective cohort study of children before and after posterior spinal fusion for idiopathic scoliosis. Summary of Background Data. Back pain in idiopathic scoliosis has been noted to be reduced after surgery. However, uncertainty over its prevalence before and after operation persists. There is a paucity of data on correlations between patients' perceptions of their appearance and preoperative and postoperative pain. Methods. We reviewed 1433 patients entered consecutively into the Prospective Pediatric Scoliosis Study, a database of children (8-22 years) undergoing operation for idiopathic scoliosis who have been followed for 1 and 2 years (n = 295) with the Scoliosis Research Society-22 and Spinal Appearance Questionnaire instruments. Results. Preoperative pain was reported by 77.9% of patients and 44% of surgeons. More preoperative pain correlated with older age (rho = -.140, P = 0.000), greater body mass index (rho = -0.168, P = 0.000), larger proximal thoracic curve rho = -0.086, P = 0.019), and a higher score on the Spinal Appearance Questionnaire Appearance (greater perception of spinal deformity, rho = -0.223, P = 0.000) and Appearance Desire scales (stronger desire to change the appearance of their spine, rho = -0.153, P = 0.000). Pain was reduced at 1 and 2 years after operation (P = 0.0002). Patients who perceived themselves as less deformed (rho = -0.284, P < 0.01) or had less desire to change their spinal appearance (rho = -0.183, P < 0.01) experienced a greater reduction in pain 2 years after operation. Preoperative analgesic use for back pain was high (28.8%) and remained high at 2 years after operation (29.5%) (P > 0.05). Conclusion. Back pain affects three-quarters of adolescents with idiopathic scoliosis and is reduced after posterior fusion. Patients who are overweight, older, and have larger proximal thoracic curve magnitudes report more preoperative pain. Patients who view themselves as more deformed tend to have more absolute pain, and less reduction in pain after operation.