This group had less pain pre-op. They could not identify the cause of the pain. I would like to see if it is largely the lumbar and double major cases.

The Prevalence of Postoperative Pain in Adolescent Idiopathic Scoliosis and the Association with Preoperative Pain

Bastrom, Tracey P; Marks, Michelle C; Yaszay, Burt; Newton, Peter O; Harms Study Group

Spine., POST ACCEPTANCE, 23 July 2013


Study Design: Review of a prospective database registry of adolescent idiopathic scoliosis (AIS) surgical patients

Objective: The purpose of this study was to examine the prevalence of post-operative pain and its impact on patient reported post-operative outcomes using the SRS 22 outcomes questionnaire.

Summary of Background Data: While reportedly rare, post-operative pain can be a devastating situation for the adolescent idiopathic scoliosis (AIS) patient. Most recent studies examining outcomes in AIS surgical treatment utilize the SRS pain domain score to assess pain in this population.

Methods: A prospectively enrolled multi-center database was queried. Patients with minimum 2 year follow-up and 2 year SRS scores were included. Post-operative pain after the acute phase of recovery when reported by the patient to the treating surgeon/clinical team in follow-up, is recorded as a complication in the database. Patients included in this series were grouped as either reporting pain or not to the surgeon/clinical team post-operatively. Pre and post-op SRS scores were then compared between these 2 groups utilizing ANOVA (p<0.05).

Results: Five hundred and eighty-four patients meeting the inclusion criteria were identified. Sixty-one (11%) reported pain at sometime between 2 weeks and 2 years post-operatively. Thirteen were within the six month post-operative period. Of the remaining 48 reporting pain between 6 and 24 months post-op, 41 (7% of the total cohort) had no obvious cause for their pain. Over half of these patients (26/41) were referred for further treatment (physical therapy, referral to pain specialist, further imaging). These 41 patients had significantly decreased 2 year SRS scores in the domains of pain, self-image, mental health and total score (p<0.05). The patients with post-operative pain were found to have significantly lower pre-operative Pain domain scores (p<0.001), indicative of greater pain pre-operatively, yet there were no other domains effected pre-operatively. For this group the pre to post-operative SRS Pain scores did not show significant change (p>0.05).

Conclusion: Unexplained pain after the 6 month post-operative period occurred in 7% of the cohort. The results indicate that patients reporting pain to their surgeons/clinical team post-operatively have lower pain scores on a subjective outcome instrument thus further validating the SRS-22 outcome tool. This reported pain appears to be associated with decreases in other SRS-22 domains. Interestingly these patients also have lower pre-operative pain scores compared to those without postop pain. Study into causes of pain in AIS and whether pre-operative education and expectations targeted at this population would positively impact outcomes is warranted, especially since on average patients after AIS surgery have less pain.

(C) 2013 by Lippincott Williams & Wilkins