View Full Version : Improvement of back pain with operative and nonoperative treatment in adults with sco

07-04-2009, 05:01 PM
Neurosurgery. 2009 Jul;65(1):86-94.Click here to read
Smith JS, Shaffrey CI, Berven S, Glassman S, Hamill C, Horton W, Ondra S, Schwab F, Shainline M, Fu KM, Bridwell K; The Spinal Deformity Study Group.

Departments of Neurosurgery and Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia (Smith) (Shaffrey) Spinal Disorders Service, University of California, San Francisco, San Francisco, California (Berven) Spine Institute for Special Surgery, Louisville, Kentucky (Glassman) State University of New York at Buffalo, Buffalo, New York (Hamill) Emory Orthopaedics and Spine Center, Atlanta, Georgia (Horton) Department of Neurosurgery, Northwestern University, Chicago, Illinois (Ondra) Spine Center for Orthopaedic and Neurosurgical Care, New York, New York (Schwab) PhDx Systems, Albuquerque, New Mexico (Shainline) Department of Neurosurgery, University of Virginia, Charlottesville, Virginia (Fu) Spinal Deformity Service, Washington University, St. Louis, Missouri (Bridwell).

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.

07-05-2009, 05:32 AM
An interesting study as far as studies go. Begging the question ... what were the non-operative treatments, specifically?

07-05-2009, 12:23 PM
I have the questionnaires, but I left them at UCSF on Thursday. I'll bring them home next week. I think there are slots for things like chiropractic, acupuncture, physical therapy, etc., and I think there's an open-ended spot to report anything not mentioned.

07-05-2009, 07:50 PM
Thanks Linda - look forward to seeing that.

loves to skate
07-06-2009, 02:55 PM
Thank you for posting this study Linda. I know I would be in a wheelchair by now if I didn't have my surgery and roller skating would be a distant memory, among other things.