title: Adolescent idiopathic scoliosis patients report increased pain at five years compared with two years after surgical treatment.
abstract: METHODS
  A multicenter study of changes in Scoliosis Research Society (SRS) outcome measures after surgical treatment of adolescent idiopathic scoliosis (AIS).
  
  
  OBJECTIVE
  To evaluate changes in patient determined outcome measures between 2 and 5 years after AIS surgery.
  
  
  BACKGROUND
  Current surgical procedures have been shown to improve subjective measures in patients with AIS. At 2-year follow-up, AIS patients reported significant improvement in all 4 preoperative domains of the SRS questionnaire. In addition, the major Cobb angle was shown to be negatively correlated with preoperative scores in the pain, general self-image, and general function domains. Five-year SRS scores have not been evaluated previously.
  
  
  METHODS
  A multicenter, prospectively generated database was used to obtain perioperative, radiographic, and SRS-24 outcomes data. The inclusion criteria were: a diagnosis of AIS, surgical treatment (anterior, posterior, or combined), a comprehensive set of radiographic measures, and completed preoperative, 2-year, and 5-year SRS questionnaires. Repeated measures analysis of variance was used to compare changes in patient responses for each of the 7 outcome domains. Univariate analysis of variance was used to compare the change in pain score at 5 years to the level of the lowest instrumented vertebrae and surgical approach. A correlation analysis was used to determine the association between changes in any of the radiographic variables and changes in SRS scores. The data were checked for normality and equal variances, and the level of significance was set at P < 0.01.
  
  
  RESULTS
  Forty-nine patients (42 women, 7 men; 14.2 +/- 2.1 year old; 5.4 +/- 0.6 years follow-up) met the inclusion criteria for this study. Thirty-seven of 49 (76%) of these patients underwent an open or thoracoscopic anterior procedure. SRS-24 scores improved significantly in 3 of the 4 preoperative domains at the 2-year visit. At 5 years postop, a statistically significant decrease in the pain score (4.2 +/- 0.6 to 3.9 +/- 0.9, P = 0.003) and a trend toward worsening scores in 4 other domains was observed; however, Patient Satisfaction scores remained unchanged. Lowest instrumented vertebrae and surgical approach could not be correlated to changes in the pain score. In addition, no correlation was found between changes in any of the 21 radiographic measures evaluated and changes in SRS scores.
  
  
  CONCLUSIONS
  There was a statistically significant increase in reported pain from 2 to 5 years after surgical treatment; however, the etiology of worsening pain scores could not be elucidated. Given continued patient satisfaction, the clinical relevance of this small reduction remains unknown. Nevertheless, this observation deserves further evaluation and must be considered in relation to the natural history of this disease.
authors.affiliation: Department of Orthopedic Surgery, University of California San Diego, San Diego, CA, USA.
authors.forename: Vidyadhar V
authors.initials: VV
authors.lastname: Upasani
authors.forename: Christine
authors.initials: C
authors.lastname: Caltoum
authors.forename: Maty
authors.initials: M
authors.lastname: Petcharaporn
authors.forename: Tracey P
authors.initials: TP
authors.lastname: Bastrom
authors.forename: Jeff B
authors.initials: JB
authors.lastname: Pawelek
authors.forename: Randal R
authors.initials: RR
authors.lastname: Betz
authors.forename: David H
authors.initials: DH
authors.lastname: Clements
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Lowe
authors.forename: Peter O
authors.initials: PO
authors.lastname: Newton
mesh_terms: D000293:Adolescent; D000328:Adult; D001416:Back Pain / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D017060:Patient Satisfaction; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012649:Self Concept; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States