IMPROVEMENT OF BACK PAIN WITH OPERATIVE AND NONOPERATIVE TREATMENT IN ADULTS WITH SCOLIOSIS

Author:

,Smith Justin S.1,Shaffrey Christopher I.1,Berven Sigurd2,Glassman Steven3,Hamill Christopher4,Horton William5,Ondra Stephen6,Schwab Frank7,Shainline Michael8,Fu Kai-Ming9,Bridwell Keith10

Affiliation:

1. Departments of Neurosurgery and Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia

2. Spinal Disorders Service, University of California, San Francisco, San Francisco, California

3. Spine Institute for Special Surgery, Louisville, Kentucky

4. State University of New York at Buffalo, Buffalo, New York

5. Emory Orthopaedics and Spine Center, Atlanta, Georgia

6. Department of Neurosurgery, Northwestern University, Chicago, Illinois

7. Spine Center for Orthopaedic and Neurosurgical Care, New York, New York

8. PhDx Systems, Albuquerque, New Mexico

9. Department of Neurosurgery, University of Virginia, Charlottesville, Virginia

10. Spinal Deformity Service, Washington University, St. Louis, Missouri

Abstract

ABSTRACT OBJECTIVE The purpose of this study was to assess whether back pain is improved with surgical treatment compared with nonoperative management in adults with scoliosis. METHODS This is a retrospective review of a prospective, multicentered database of adults with spinal deformity. At the time of enrollment and follow-up, patients completed standardized questionnaires, including the Oswestry Disability Index (ODI) and Scoliosis Research Society 22 questionnaire (SRS-22), and assessment of back pain using a numeric rating scale (NRS) score, with 0 and 10 corresponding to no and maximal pain, respectively. The initial plan for surgical or nonoperative treatment was made at the time of enrollment. RESULTS Of 317 patients with back pain, 147 (46%) were managed surgically. Compared with patients managed nonoperatively, operative patients had higher baseline mean NRS scores for back pain (6.3 versus 4.8; P <0.001), higher mean ODI scores (35 versus 26; P <0.001), and lower mean SRS-22 scores (3.1 versus 3.4; P <0.001). At the time of the 2-year follow-up evaluation, nonoperatively managed patients did not have significant change in the NRS score for back pain (P = 0.9), ODI (P = 0.7), or SRS-22 (P = 0.9). In contrast, at the 2-year follow-up evaluation, surgically treated patients had significant improvement in the mean NRS score for back pain (6.3 to 2.6; P <0.001), ODI score (35 to 20; P <0.001), and SRS-22 score (3.1 to 3.8; P <0.001). Compared with nonoperatively treated patients, at the time of the 2-year follow-up evaluation, operatively treated patients had a lower NRS score for back pain (P <0.001) and ODI (P = 0.001), and higher SRS-22 (P <0.001). CONCLUSIONS Despite having started with significantly greater back pain and disability and worse health status, surgically treated patients had significantly less back pain and disability and improved health status compared with nonoperatively treated patients at the time of the 2-year follow-up evaluation. Compared with nonoperative treatment, surgery can offer significant improvement of back pain for adults with scoliosis.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Clinical Neurology,Surgery

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