Adolescent idiopathic scoliosis: evaluating perioperative back pain through a simultaneous morphological and biomechanical approach

Abstract

Background Adolescent idiopathic scoliosis (AIS) has been associated with diminished postural stability and a greater prevalence of back pain. Currently, the literature is lacking information on the effect of spinal fusion on both postural stability and its association with back pain. Our objectives were to evaluate the postsurgical effect of spinal morphological changes on static standing balance and assess the influence of these alterations on reported pain throughout the perioperative period. Methods Twenty consecutive AIS patients schedule to undergo spinal fusion surgery were recruited and followed prospectively at the Shriners Hospitals for Children-Canada. Data was collected at the preoperative, 6 weeks and 6 months postoperative visits. Spinal morphology data was collected through 3D reconstructed simultaneous standing biplanar radiographs using the SterEOS software. Postural balance was assessed through Moticon© sensor insoles and analyzed through their software. The data was simultaneously collected as part of the Global Biomechanical and morphological Assessment. Pain was evaluated through self-reported questionnaires. Results Morphological curve parameters were significantly reduced after surgery. Balance parameters did not change significantly throughout the perioperative period with the exception of the Center of Pressure of the left foot medial/lateral transient shift ( P = 0.017) at 6 weeks. Of note, preoperative balance parameters were associated with the degree of right thoracic Cobb angles ( P = 0.029 R = 0.528). Pain scores significantly improved 6 weeks and 6 months after the surgery. Pain intensity diminished in the thoracic and lumbar spine but worsen in the neck region at the 6 weeks and 6 months postoperative time points ( P = 0.044). Greater residual Cobb angle difference between Mid thoracic and Thoracolumbar/Lumbar curves was associated with greater pain severity at 6 weeks postop ( P < 0.005). In addition, greater residual thoracic deformity was associated with significant pain severity 6 months after surgery ( P < 0.05). Conclusions Improved spinal morphology of postsurgical AIS patients has no significant impact on their static standing balance. Suggesting that other factors apart from the spinal morphology may contribute to AIS patients’ balance during stance. Although balance did not influence pain severity, spinal morphology and its correction appear to have influenced the intensity and location of back pain.

Is sagittal spinopelvic alignment a cause of low back pain in pediatric spine pathologies? A review

“…Also, other studies have not found statistically significant correlations between sagittal alignment and back pain. [35][36][37] However, a greater spinal deformity with increased radiological parameters of coronal Cobb angle, torsion index, and right thoracic translation did correlate with the likelihood of developing back pain. 36,37 To summarize, even though AIS patients are mostly clinically balanced in the sagittal plane, sagittal spinopel vic alignment is altered, with global flattening and anterior overgrowth of the spine.…”

“…[35][36][37] However, a greater spinal deformity with increased radiological parameters of coronal Cobb angle, torsion index, and right thoracic translation did correlate with the likelihood of developing back pain. 36,37 To summarize, even though AIS patients are mostly clinically balanced in the sagittal plane, sagittal spinopel vic alignment is altered, with global flattening and anterior overgrowth of the spine. The occurrence of back pain in AIS seems to correlate more with the deformity in the cor onal plane than the sagittal alignment.…”

Back pain in adolescent idiopathic scoliosis: A comprehensive review

“…Other residual deformities and their relationship to pain have been explored by various studies. In a study by St. Georges et al, 69 participants completed the SRS-30 questionnaire and a modified version of the Adolescent Pediatric Pain Tool (APPT) to characterize pain. Pain score showed statistically significant improvements at 6 weeks and 6 months.…”

Orthopedic mechanism analysis of growing rod distraction for early‐onset scoliosis based on 3D morphological parameters

“…Initially, spinal morphology measurement based on computed tomographies (CTs) was a guide for the selection of path and safe margin in screw placement 9–11 . Some researchers attempted to probe how the morphological parameters affected disease manifestations such as back pain and IVD lesion 12,13 . For surgeons, understanding the spinal deformity progression will be helpful for the following surgical formulation.…”