Improvement of back pain with operative and nonoperative treatment in adults with scoliosis.
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.
Smith
Justin S
JS
Departments of Neurosurgery and Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia 22908, USA.
Shaffrey
Christopher I
CI
Berven
Sigurd
S
Glassman
Steven
S
Hamill
Christopher
C
Horton
William
W
Ondra
Stephen
S
Schwab
Frank
F
Shainline
Michael
M
Fu
Kai-Ming
KM
Bridwell
Keith
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000150:complications* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications* / Q000628:therapy*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult