Prevalence and clinical relevance of underlying pathological conditions in painful adolescent idiopathic scoliosis: a MRI-based study

Ramírez, Norman; Olivella, Gerardo; Cúneo, Alejandro; Carrazana, Luis; Ramirez, Nicole; Iriarte, Ivan

doi:10.1007/s43390-020-00065-w

Cited by 9 publications

(15 citation statements)

References 31 publications

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“…In their study, patients with the left thoracic curve, short segment curve, hyperkyphosis, rapid curve progression, focal neurologic findings, male sex, pes cavus and functionally disruptive pain were recommended to undergo MRI screening for further evaluation [20]. In 2020, Ramirez et al published a case series study where they demonstrated that one out of three painful AIS patients would have an underlying pathology [3]. Furthermore, they demonstrated that constant pain and night pain were not adequate clinical markers to help identify an underlying pathology [3].…”

Section: Discussionmentioning

confidence: 99%

“…In 2020, Ramirez et al published a case series study where they demonstrated that one out of three painful AIS patients would have an underlying pathology [3]. Furthermore, they demonstrated that constant pain and night pain were not adequate clinical markers to help identify an underlying pathology [3]. Their results indicated disagreement with the results of previous studies related to general pediatric back pain, were these clinical markers were recommended [4,5,21].…”

Section: Discussionmentioning

confidence: 99%

“…In the midst of a possible underlying pathology, clinicians were enforced to perform extensive workup in all patients complaining of painful scoliosis. This workup resulted in unwarranted radiation exposure, patient or family anxiety and increased cost [3]. On the basis of this uncertainty, there has been a notable interest among physicians to find adequate clinical markers that could identify patients that may have serious underlying pathology by using the minimum number of diagnostics studies.…”

Section: Introductionmentioning

confidence: 99%

“…Nineteen years later, another study questioned constant pain and night pain as adequate clinical markers to predict the presence of underlying pathology in pediatric patients with back pain [6]. Moreover, a recent study performed with painful AIS patients discarded the use of these clinical markers to predict an underlying pathology by MRI [3]. Their results emphasized that further studies are needed to identify adequate clinical markers that may help predict the presence of serious underlying pathology, minimizing patients’ extensive workup [3].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, a recent study performed with painful AIS patients discarded the use of these clinical markers to predict an underlying pathology by MRI [3]. Their results emphasized that further studies are needed to identify adequate clinical markers that may help predict the presence of serious underlying pathology, minimizing patients’ extensive workup [3].…”

Section: Introductionmentioning

confidence: 99%

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Is the numerical rating scale an adequate predictor for assessing MRI underlying pathologies among painful adolescent idiopathic scoliosis patients?

Olivella

Guzmán

Marrero-Ortiz

et al. 2020

Journal of Pediatric Orthopaedics B

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The use of constant pain and night pain as clinical markers for predicting the presence of underlying pathology in painful adolescent idiopathic scoliosis (AIS) patients has been questioned. Pain intensity has been recognized as an important domain in pain assessment. The numerical rating scale (NRS) is one of the most commonly validated tools to assess pain intensity in children above 8 years of age. The aim of this study was to assess the NRS as a predictor of underlying pathologies found by MRI in painful AIS patients. A cross-sectional study comprising of all AIS patients with back pain lasting >4 weeks from April 2015 to April 2019 was performed. An MRI was performed on each AIS patient presenting with back pain after a nondiagnostic history, physical examination and spinal X-ray. The pain was graded using the NRS, ranging from 0 to 10. Patients were divided into three groups: NRS (1-3), NRS (4-6) and NRS (7-10). Variables, including gender, age, scoliosis magnitude and presence of underlying pathology, were compared between the groups. A total of 186 AIS patients were evaluated in the study, were 66/186 (35.5%) of them had underlying pathologies. The mean age of subjects was 14.7 years, 85% being female. An underlying pathology was identified in 4/11 (36.4%) with NRS (1-3), 28/82 (34.2%) with NRS (4-6) and 34/93 (36.6%) with NRS (7-10) (P = 0.94). The use of an NRS was not found to be an adequate predictor for identifying an underlying pathology via MRI in painful AIS patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Is the numerical rating scale an adequate predictor for assessing MRI underlying pathologies among painful adolescent idiopathic scoliosis patients?

Olivella

Guzmán

Marrero-Ortiz

et al. 2020

Journal of Pediatric Orthopaedics B

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Back pain in adolescent idiopathic scoliosis: frequency and risk factors

Sarkovich,

Leonardi,

Darlow

et al. 2024

Spine Deform

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Purpose Although back pain is commonly reported in patients with adolescent idiopathic scoliosis (AIS), factors that influence the presence and severity of back pain in AIS, including curve-specific variables, have not been well studied. This study aims to describe the prevalence and severity of back pain in AIS patients and determine the extent to which patient characteristics, including curve-specific factors, are associated with a higher risk of back pain in AIS. Methods The study was a retrospective medical records review of adolescents (aged 10–17 years) diagnosed with AIS between 01/01/2018 and 12/31/2021 at an academic tertiary children’s hospital. Patients with previous spine surgery were excluded. Variables collected included demographics (age, sex, race, insurance), Lenke classification, major coronal curve, back pain-related information, Risser stage, vitamin D levels, post-diagnosis brace utilization, physical therapy or chiropractic treatment, and surgery. Results A total of 891 AIS patients were included in the analysis. The sample was predominantly female (73.3%) and insured by Medicaid (57.8) with a mean age of 12.8 years. The mean major coronal curve was 26.3 degrees. Most patients had Lenke type 1 (47%) and type 5 (41%) curves. Nearly half of patients reported back pain (48.5%) with average pain severity in the low-to-moderate range (4.7) on FACES pain scale (0–10). Among those who reported back pain, 63.2% specified a location with the majority reporting pain in the lumbar region (56%) and, less commonly, in the thoracic (39%) and scapular (8%) regions. Lumbar pain was associated with significantly higher pain intensity (p = 0.033). Additionally, the location of pain reported was associated with location of major coronal curve (p < 0.0001). No association was observed between pain presence and vitamin D deficiency (p = 0.571, n = 175), major coronal curve magnitude (p = 0.999), Lenke curve type (p = 0.577), and sex (p = 0.069). Older patients, those insured by Medicaid, and those with higher Risser scores were more likely to report pain scores (p = 0.001 for all). Conclusion Nearly half (48%) of newly diagnosed AIS patients experience back pain which is higher than the prevalence of 33% seen in the general adolescent population. Pain was more prevalent among patients over the age of 13, with heavier body weight, and those insured by Medicaid. Pain was most commonly reported in the lumbar region, especially among patients with lumbar curves. This information can be helpful in counseling AIS patients, though further investigations are needed, especially to determine the underlying causes of back pain in AIS and to elucidate the discrepancy in pain between patients with Medicaid and commercial insurance. Level of evidence. Prognostic Study Level II.

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Entire-spine Magnetic Resonance Imaging Findings and Costs in Children With Presumed Adolescent Idiopathic Scoliosis

Johnson

Gohel

Mitchell

et al. 2021

Journal of Pediatric Orthopaedics

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Background: Patients with adolescent idiopathic scoliosis (AIS) are commonly monitored for curve progression with spinal radiographs; however, the utility of magnetic resonance imaging (MRI) screening is unclear. The purpose of this study was to assess the findings of screening MRI for patients with a nonsurgical curve size ordered during routine clinical care and compare them with MRI ordered for patients with large curves as part of preoperative screening. Methods: All consecutive patients with presumed AIS who underwent entire-spine MRI with a presumed diagnosis of idiopathic scoliosis at a single institution between 2017 and 2019 were retrospectively reviewed. Patients were stratified based on MRI indication into the following groups: preoperative evaluation, pain, neurological symptoms, abnormal radiographic curve appearance, rapidly progressive curve, and other. Neural axis abnormalities recorded included concern for tethered spinal cord, syringomyelia, and Chiari malformation. The MRI findings of preoperative patients with large curves were compared with all other patients. The number needed to diagnose (NND) a neurological finding was calculated in patients whose MRIs were ordered during routine clinical care. The amount charged for each patient undergoing entire-spine MRI was determined by review of our institution's Financial Decision Support system. Results: There were 344 patients included in this study with 214 (62%) MRIs performed for preoperative evaluation. Although MRI abnormalities were found in 49% of patients, only 7.0% (24/ 344) demonstrated neural axis abnormalities with no difference between preoperative and other indications (P = 0.37). For patients with nonsurgical curves undergoing MRI due to a complaint of back pain (n = 28), there were no neural axis abnormalities, and a lower rate of disk herniation/degenerative changes detected compared with preoperative MRI (3.6% vs. 18%, P = 0.06). Among the 15 patients undergoing MRI for a neurological concern, 1 had a neural axis abnormality that required surgical detethering. The NND for MRI to detect a neural axis abnormality that potentially required neurosurgical intervention in nonpreoperative patients with a neurological concern was 34.4. The average cost for MRI

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Prevalence and clinical relevance of underlying pathological conditions in painful adolescent idiopathic scoliosis: a MRI-based study

Cited by 9 publications

References 31 publications

Is the numerical rating scale an adequate predictor for assessing MRI underlying pathologies among painful adolescent idiopathic scoliosis patients?

Is the numerical rating scale an adequate predictor for assessing MRI underlying pathologies among painful adolescent idiopathic scoliosis patients?

Back pain in adolescent idiopathic scoliosis: frequency and risk factors

Entire-spine Magnetic Resonance Imaging Findings and Costs in Children With Presumed Adolescent Idiopathic Scoliosis

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