Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis

Théroux, Jean; May, Sylvie Le; Hébert, Jeffrey J.; Labelle, Hubert

doi:10.1097/brs.0000000000001986

Cited by 49 publications

(34 citation statements)

References 42 publications

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“…When considering our independent time point results, they indicate moderate to strong correlations between the thoracic deformity and the pain felt in the thoracic area before surgery. Recent literature [ 19 , 33 ], found similar results, associating severity and the location of the curve in the thoracic area to the pain reported in said area. In all cases, the association was made at the preoperative time point but does not seem to persist throughout the postoperative period.…”

Section: Discussionsupporting

confidence: 55%

“…In fact, back pain prevalence is higher in AIS patients compared to adolescents without scoliosis [ 16 – 20 ]. Despite recognizing that pain is a multifactorial disorder, most research focuses on its association between radiographic parameters [ 17 , 19 , 21 , 22 ]. However, the literature lacks information on the influence of spinal morphology and postural balance on back pain in this population.…”

Section: Introductionmentioning

confidence: 99%

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

St-Georges

Teles

Rabau

et al. 2020

BMC Musculoskelet Disord

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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.

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Section: Discussionsupporting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

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

St-Georges

Teles

Rabau

et al. 2020

BMC Musculoskelet Disord

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“…AIS is found in approximately 0.5–4% of the population, including mild cases, but severe cases are rare [1]. Since the curvature in AIS sometimes progresses [2], and progression of the curvature may lead to respiratory dysfunction [3] and back pain [4], bracing of curvatures > 25° is usually undertaken [5]. Surgery is considered to be required for ≥40–50° of curvature [5] Bracing can have tolerability problems, and multilevel fusion surgery, although the reported complication rates may be acceptable [6], can be associated with cosmetic problems due to scarring and with serious complications such as neural impairment, vascular injury, and deep wound infection [6].…”

Section: Introductionmentioning

confidence: 99%

Differential proteome analysis in adolescent idiopathic scoliosis patients with thoracolumbar/lumbar curvatures

Makino

Seki

Kitajima

et al. 2019

BMC Musculoskelet Disord

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Background Although the pathogenesis of adolescent idiopathic scoliosis (AIS) remains unclear, there are little evidences of the pathogenesis in patients with thoracolumbar/lumbar AIS. The purpose of this study was to identify proteins or proteomes that may be causally related to the pathogenesis of AIS with structured thoracolumbar/lumbar curvature using two-dimensional fluorescence difference gel electrophoresis (2D-DIGE). Methods A total of 20 control volunteers and 61 AIS in patients with thoracolumbar/lumbar curvature were included. First, the plasma samples of each five AIS with pure thoracolumbar/lumbar curvature and control samples were subjected to 2D-DIGE analysis. Protein spots that were expressed differently by the AIS and control groups were selected and identified by nanoscale liquid chromatography–tandem mass spectrometry (nanoLC-MS/MS) analysis. To characterize the differently-expressed proteins in AIS patients, we performed functional pathway analysis using the Protein ANalysis THrough Evolutionary Relationships (PANTHER) system. Additionally, the proteins were compared between control and AIS using western blotting. Lastly, prospectively collected 15 control and 41 AIS with thoracolumbar/lumbar curvature samples were compared to the differentially expressed proteins. Results A total of 3862 ± 137 spots were detected, of which 11 spots met the criteria when compared with controls. Nine proteins were identified by nanoLC-MS/MS. Functional analysis showed the association of the proteins in AIS patients with blood coagulation using the PANTHER system. Of the proteins, vitamin D binding protein (DBP) significantly correlated with Cobb angle in thoracolumbar/lumbar curvatures. DBP expression of the prospectively collected AIS samples were significantly higher than those of controls ( P < 0.05). Conclusions This study suggests that DBP and several coagulation-related proteins may play a role in the pathogenesis of AIS. DBP appears to be a marker of severity of AIS with thoracolumbar/lumbar curvature.

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“…Well-done studies have identified that key spine alignment alterations as determined and quantified on spine radiographs correlate to back pain, disability, and progression of deformity in scoliosis and generalized chronic low back pain patients. [145][146][147][148] Furthermore, in specific types of scoliosis such as adult onset, alterations of the spine alignment have been found to be one of the triggers for the initiation of the scoliotic deformity itself. 149 Several well done RCTs have identified that patients who receive specific rehabilitation interventions designed precisely from their altered alignment on spine radiographs fare better in terms of long-term improved back pain, disability, spine function, and other important variables.…”

Section: Cascading Effects Of Image Wisely Campaignsmentioning

confidence: 99%

Are Restrictive Medical Radiation Imaging Campaigns Misguided? It Seems So: A Case Example of the American Chiropractic Association’s Adoption of “Choosing Wisely”

Oakley

Harrison

2020

Dose-Response

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Since the 1980s, increased utilization of medical radiology, primarily computed tomography, has doubled medically sourced radiation exposures. Ensuing fear-mongering media headlines of iatrogenic cancers from these essential medical diagnostic tools has led the public and medical professionals alike to display escalating radiophobia. Problematically, several campaigns including Image Gently, Image Wisely, and facets of Choosing Wisely propagate fears of all medical radiation, which is necessary for the delivery of effective and efficient health care. Since there are no sound data supporting the alleged risks from low-dose radiation and since there is abundant evidence of health benefits from low-doses, these imaging campaigns seem misguided. Further, thresholds for cancer are 100 to 1000-fold greater than X-rays, which are within the realm of natural background radiation where no harm has ever been validated. Here, we focus on radiographic imaging for use in spinal rehabilitation by manual therapists, chiropractors, and physiotherapists as spinal X-rays represent the lowest levels of radiation imaging and are critical in the diagnosis and management of spine-related disorders. Using a case example of a chiropractic association adopting “Choosing Wisely,” we argue that these campaigns only fuel the pervasive radiophobia and continue to constrain medical professionals, attempting to deliver quality care to patients.

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Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis

Abstract: 3.

Cited by 49 publications

References 42 publications

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

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

Differential proteome analysis in adolescent idiopathic scoliosis patients with thoracolumbar/lumbar curvatures

Are Restrictive Medical Radiation Imaging Campaigns Misguided? It Seems So: A Case Example of the American Chiropractic Association’s Adoption of “Choosing Wisely”

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