|Back pain and function 23 years after fusion for adolescent idiopathic scoliosis: a case-control study-part II.|
|PMID: 14501939 Owner: NLM Status: MEDLINE|
|STUDY DESIGN: A consecutive series of patients with adolescent idiopathic scoliosis, treated between 1968 and 1977 before age 21 years with distraction and fusion using Harrington rods (surgically treated: n = 156; 145 females and 11 males) were followed-up at least 20 years after completion of the treatment. OBJECTIVES: To determine the long-term outcome in terms of back pain and function in patients surgically treated for adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Few reports on long-term outcome of back pain and function have previously been presented for this group of patients. Results presented are not conclusive regarding effects on back pain and its correlation to a fusion extending into the lower lumbar spine. MATERIALS AND METHODS: One hundred forty-two (91%) of the patients were reexamined as part of an unbiased personal follow-up. This included a clinical examination and 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 were used. One hundred thirty-nine had complete follow-up. An age- and sex-matched control group of 100 individuals was randomly selected and subjected to the same examinations. RESULTS: The deterioration of the curves was 3.5 degrees for all curves and eight (5.1%) of the patients treated with fusion had undergone some additional curve-related surgical procedure. The patients had significantly more degenerative disc changes than the controls. Lumbar pain, although mild (2.4 on visual analogue scale), 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. No major differences of back function and general health-related quality of life were noted between the patients or the controls. Except for having been on sick-leave ever because of the back (45% vs. 19%, P = 0.0040) no differences could be seen in sociodemographic variables between the groups. Furthermore, no differences could be found between patients fused to L3 or higher (n = 102) versus L4 or lower (n = 37). No correlation could be found between pain and its localization and various variables on the scoliotic curve, body mass index, or smoking. Persisting discomfort and/or sensory loss were noted significantly more often among the patients who had the autologous bone harvesting performed through a separate incision over the iliac crest (24.3%) than among those in whom this was performed through an elongated midline incision (4.6%, P = 0.0015). CONCLUSIONS: Minimal pain and no dysfunction occurred (mean) 23 years after fusion for adolescent idiopathic scoliosis compared with normal straight controls. Significantly more pain in the scar region occurred when bone graft from an incision over the posterior iliac crest was used for harvesting bone to the fusion compared with an incision performed as an elongation of the midline incision used for the scoliosis surgery.|
|Aina J Danielsson; Alf L Nachemson|
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|Type: Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't|
|Title: Spine Volume: 28 ISSN: 1528-1159 ISO Abbreviation: Spine Publication Date: 2003 Sep|
|Created Date: 2003-09-22 Completed Date: 2006-01-17 Revised Date: 2009-07-09|
Medline Journal Info:
|Nlm Unique ID: 7610646 Medline TA: Spine (Phila Pa 1976) Country: United States|
|Languages: eng Pagination: E373-83 Citation Subset: IM|
|Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg University, Sweden. firstname.lastname@example.org|
|APA/MLA Format Download EndNote Download BibTex|
Back Pain / epidemiology*, etiology
Bone Transplantation / methods
Cicatrix / epidemiology
Intervertebral Disk / pathology
Lumbar Vertebrae / surgery
Postoperative Complications / epidemiology*, etiology
Pseudarthrosis / epidemiology, etiology
Recovery of Function
Scoliosis / complications, surgery*
Spinal Fusion* / instrumentation
Sweden / epidemiology
Thoracic Vertebrae / surgery
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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