Back pain in adolescents with idiopathic scoliosis

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1 Back pain in adolescents with idiopathic scoliosis Toru Hirano, MD Kei Watanabe, MD Tomohiro Izumi, MD Atsuki Sano, MD Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata City, Japan 1

2 Background and Aim Information regarding back pain (BP) in adolescents with idiopathic scoliosis (IS) are scanty and inconsistent. Pratt et al (Spine, 2002) BP was dominant in surgically-treated IS patients preoperatively compared to the prevalence reported previously. Ramirez et al (JBJS, 1997) Incidence of BP was similar to the prevalence reported previously. Both studies did not have proper control group Aim of this study is to clarify the detail of BP in IS by comparing with proper control group with proper statistical method 2

3 IS group (n=147) female age: 10~15 y.o Cobb angle : 20 Materials Main curve Cobb: 20 ~96 (average; 35 ) Level of main curve: Upper thoracic (UT): 9 cases Main thoracic (MT): 95 cases Thoracolumbar/lumbar (TL/L): 43 cases Control group (n=16,194) female 4 th grade in elementary school ~ 3 rd grade in junior high school (compatible age to IS) without history of IS 3

4 Evaluation of BP (base on Questionnaires) for All subject Do you have low or high back pain now? Have you ever had low or high back pain? Point prevalence and life time prevalence for subjects with life time prevalence of BP Duration of BP Recurrence of BP Region of BP Back was divided into 9 parts (3x3) Severity of BP Each item was compared between Control group and IS group < Region of BP > 4

of BP may vary in each grade and grade distribution in two groups was different, comparisons

5 Statistical analysis (%) Lifetime prevalence of low BP in our previous report (%) Grade distribution of tow groups in this study (Sato T, et al, Eur Spine J, 2008) Because prevalence of BP may vary in each grade and grade distribution in two groups was different, comparisons between two groups should be adjusted for Age. Mantel-Haenszel test was used for statistical analysis. 5

6 High BP Result 1; Prevalence of BP IS (point and lifetime) Control point 17/ /16,194 lifetime 40/147 2,386/16,194 Low BP point 12/ /16,194 lifetime 51/147 4,567/16,194 Odds ratio (95% CI) Both point and lifetime prevalence of high BP are significantly higher in IS 6

7 Result 2; Location of pain IS Control 1 1/ /16, / /16, / /16, / /16, / /16, / /16, / /16, / /16, / /16,194 Pain was significantly more frequent around rt. Scapula in IS Odds ratio (95% CI)

8 Result 3; Duration, Severity and Recurrence Location of pain IS Control Odds ratio (95% CI) Duration high 4/64 267/ ( ) low 5/64 229/ ( ) Severity high 3/64 91/ ( ) low 3/64 180/ ( ) Recurrence high 34/ / ( ) low 36/ / ( ) Although duration of pain ( 1M) did not differ, IS patients with high BP had more severe (absent from school) pain and more frequent recurrence 8

9 Discussion: BP in younger population with IS Pratt et al (Spine, 2002) Among 39 patients (11.7 y.o y.o) underwent surgery, 33 patients (85%) had back pain preoperatively. BP was dominant in surgically-treated IS patients preoperatively compared to the prevalence reported previously. Ramirez et al (JBJS, 1997) In 2442 patients (6 y.o-20 y.o) with IS, 23% had BP at first visit and the prevalence was not different from other studies reported previously. Both studies did not have proper control group and the results were inconsistent 9

10 BP in AIS patients with various age groups Mayo et al. (Spine 19; 1994) 1,476 AIS subjects and 1,755 control group (both group had various age groups) were compared using questionnaire study. Lifetime prevalence : 73% in AIS (v.s. 56.2%; Odds ratio 2.14) Point prevalence : 44% in AIS (v.s. 24%; Odds ratio 2.61) AIS subjects experienced more frequent and severe BP, and had longer duration and more recurrences of BP than the control group. Our results are almost similar to our study except for duration, although our IS group was younger. 10

11 Location of BP in IS There have been few studies as for the region of BP in IS. In this study In IS group, BP existed significantly in (2), (3), and (6). Pain around the right scapula was characteristic in IS group. There may be a relationship between location of back pain and the right rib hump that is characteristic in AIS. Impingement or friction between scapula and Rib may be responsible? 11

12 Conclusions In adolescents with IS High back pain especially around the rt. scapula is more frequent. Such pain is more severe and has more tendency to recur compared to the control group. Low back pain is not different from the control group. None of the authors has any potential conflict of interest. 12

Does bracing affect the quality of life of the patients with idiopathic scoliosis?

Does bracing affect the quality of life of the patients with idiopathic scoliosis? Toru Maruyama 1), Katsushi Takeshita 2), Tomoaki Kitagawa 2), Yusuke Nakao 2) 1) Department of orthopaedic surgery, Saitama