Back Pain and Function 23 Years After Fusion for Adolescent Idiopathic Scoliosis- A Follow-up with a Control Group of Straight Individuals

Introduction: A consecutive series of patients with adolescent idiopathic scoliosis (AIS), treated between 1968 and 1977 before 21 years of age, with distraction and fusion using Harrington rods (ST, n=156; 145 females and 11 males) were followed at least twenty years after completion of the treatment.

Purpose: To determine the long term outcome in terms of back pain and function in patients surgically treated for AIS.

Methods: One hundred and thirty-nine patients were reexamined as part of an unbiased personal follow-up, including a clinical examination, evaluation of curve size (Cobb method) and degenerative findings in full standing frontal and lateral radiographs, validated questionnaires in terms of general and disease-specific quality of life aspects as well as present back and pain symptoms. An age- and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations.

Results: Curve size (major curve) was mean 36 degrees (SD 10, 14-66) with a mean increase of 4 degrees from end of treatment to present follow-up. Nine of the patients (6%) had undergone any additional curve-related surgical procedure due to complications. Significantly more patients complained of back pain during the last year (78%) in comparison to the control group (58%, p=0.0004). Lumbar pain was significantly more frequent among the patients than the controls (65 vs 47%, p=0.0079). Only 25% of the patients admitted daily pain and analgesics were sparsely used. A slight but significant difference of the Oswestry Disability Questionnaire as well as scores reflecting general back funtion was found between the patients and controls. No differences could be seen in sociodemographic variables between the groups, except for having been on sick-leave ever due to the back (45% vs 19%, p=0.0040). No difference was found between patients fused to L3/higher versus L4/lower OR between patients fused to L4/higher versus L5/lower. No correlation could be found between pain and its localization and curve size, increase at least 10° since end of treatment, curve type, degenerative changes on any of the two lowest lumbar disc levels, Body Mass index or smoking.

Discussion and Conclusion: Patients surgically treated for adolescent idiopathic scoliosis were found to have approximately the same back function as the general population. No differences in terms of back pain and function could be found between those with a fusion ending proximal to the two lowest discs versus those where these were included.