Long-term follow-up of adolescent idiopathic scoliosis patients who had Harrington instrumentation and fusion to the lower lumbar vertebrae: is low back pain a problem?
METHODS
Retrospective functional and radiographic analysis.


OBJECTIVE
To analyze the back pain and disability in patients who had instrumentation and fusion to L2, L3, L4, or L5, at least 10 years previously, and to compare them with a control group of the same age, sex, weight, and height.


BACKGROUND
Considerable confusion exists as to the incidence and severity of low back problems in patients with adolescent idiopathic scoliosis fused to the lower lumbar spine.


METHODS
A total of 171 patients met the inclusion criteria of adolescent idiopathic scoliosis, Harrington instrumentation, and fusion to L2, L3, L4, or L5, a minimum follow-up of 10 years following surgery, and a detailed questionnaire at follow-up. These were compared to a control group of 209 persons of equal sex, age, weight, and height. Eighty-eight patients were personally evaluated, including radiographs at follow-up. The mean follow-up was 19 years.


RESULTS
Back pain, no matter how trivial or infrequent, was noted in 75% of the patients and 65% of the controls, statistically different at P=0.039. Pain intensity was equal to controls in fusions to L2 or L3, but increased in those fused to L4. Comparing all fused patients to the controls, there was no difference in narcotic use, use of back supports, visits to physicians, or hospitalizations for back problems. There was no difference in the short form-36 in the patients according to whether fused to L2, L3, or L4.


CONCLUSIONS
When compared to a control group of equal sex, age, weight, and height, adolescent idiopathic scoliosis patients had a slightly higher incidence of back pain. When compared to the control group using short form-36 evaluation, the patients had statistically equal scores in all 8 domains. Most patients were able to perform most activities of daily living.
Bartie
Bruce J
BJ
Twin Cities Spine Center, Minneapolis, MN 55404, USA.
Lonstein
John E
JE
Winter
Robert B
RB
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D015994:Incidence; D016268:Internal Fixators / Q000009:adverse effects / Q000706:statistics & numerical data; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D010149:Postoperative Pain / Q000000981:diagnostic imaging / Q000453:epidemiology*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D011795:Surveys and Questionnaires; D013995:Time; D016896:Treatment Outcome; D055815:Young Adult