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.
Inclusion criteria for the current study included the following: 1) patients enrolled in the Adult Deformity Outcomes section database between January 2002 and February 2006, 2) primary diagnosis of adult untreated idiopathic or degenerative (de novo) scoliosis (Cobb angle >10 degrees), 3) presence of back pain (NRS score for back pain > 0) at baseline, 4) documentation of NRS score for back pain at 2 years, and 5) age older than 21 years. Patients with a history of spine surgery consisting of minor decompressions and/or short segment fusions were not excluded from this study. All patients included, both operative and nonoperative, had 2 years of follow-up.
RESULTS: Of 317 patients with back pain, 147 (46%) were managed surgically. Compared with patients managed nonoperatively, operative patients had higher baseline mean NRS (numeric rating scale) scores for back pain (6.3 versus 4.8; P < 0.001), higher mean ODI (Oswestry Disability Index) 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.
Smith, Justin S. M.D., Ph.D.; Shaffrey, Christopher I. M.D.; Berven, Sigurd M.D.; Glassman, Steven M.D.; Hamill, Christopher M.D.; Horton, William M.D.; Ondra, Stephen M.D.; Schwab, Frank M.D.; Shainline, Michael M.S.; Fu, Kai-Ming M.D., Ph.D.; Bridwell, Keith M.D.; The Spinal Deformity Study Group
Congress of Neurological Surgeons.
July, 2009.
Inclusion criteria for the current study included the following: 1) patients enrolled in the Adult Deformity Outcomes section database between January 2002 and February 2006, 2) primary diagnosis of adult untreated idiopathic or degenerative (de novo) scoliosis (Cobb angle >10 degrees), 3) presence of back pain (NRS score for back pain > 0) at baseline, 4) documentation of NRS score for back pain at 2 years, and 5) age older than 21 years. Patients with a history of spine surgery consisting of minor decompressions and/or short segment fusions were not excluded from this study. All patients included, both operative and nonoperative, had 2 years of follow-up.
RESULTS: Of 317 patients with back pain, 147 (46%) were managed surgically. Compared with patients managed nonoperatively, operative patients had higher baseline mean NRS (numeric rating scale) scores for back pain (6.3 versus 4.8; P < 0.001), higher mean ODI (Oswestry Disability Index) 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.
Smith, Justin S. M.D., Ph.D.; Shaffrey, Christopher I. M.D.; Berven, Sigurd M.D.; Glassman, Steven M.D.; Hamill, Christopher M.D.; Horton, William M.D.; Ondra, Stephen M.D.; Schwab, Frank M.D.; Shainline, Michael M.S.; Fu, Kai-Ming M.D., Ph.D.; Bridwell, Keith M.D.; The Spinal Deformity Study Group
Congress of Neurological Surgeons.
July, 2009.
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