Abstract
BackgroundAdolescent idiopathic scoliosis (AIS) has been associated with diminished postural stability and a greater prevalence of back pain. Currently, the literature is lacking information on the effect of spinal fusion on both postural stability and its association with back pain. Our objectives were to evaluate the postsurgical effect of spinal morphological changes on static standing balance and assess the influence of these alterations on reported pain throughout the perioperative period.MethodsTwenty consecutive AIS patients schedule to undergo spinal fusion surgery were recruited and followed prospectively at the Shriners Hospitals for Children-Canada. Data was collected at the preoperative, 6 weeks and 6 months postoperative visits. Spinal morphology data was collected through 3D reconstructed simultaneous standing biplanar radiographs using the SterEOS software. Postural balance was assessed through Moticon© sensor insoles and analyzed through their software. The data was simultaneously collected as part of the Global Biomechanical and morphological Assessment. Pain was evaluated through self-reported questionnaires.ResultsMorphological curve parameters were significantly reduced after surgery. Balance parameters did not change significantly throughout the perioperative period with the exception of the Center of Pressure of the left foot medial/lateral transient shift (P = 0.017) at 6 weeks. Of note, preoperative balance parameters were associated with the degree of right thoracic Cobb angles (P = 0.029 R = 0.528). Pain scores significantly improved 6 weeks and 6 months after the surgery. Pain intensity diminished in the thoracic and lumbar spine but worsen in the neck region at the 6 weeks and 6 months postoperative time points (P = 0.044). Greater residual Cobb angle difference between Mid thoracic and Thoracolumbar/Lumbar curves was associated with greater pain severity at 6 weeks postop (P < 0.005). In addition, greater residual thoracic deformity was associated with significant pain severity 6 months after surgery (P < 0.05).ConclusionsImproved spinal morphology of postsurgical AIS patients has no significant impact on their static standing balance. Suggesting that other factors apart from the spinal morphology may contribute to AIS patients’ balance during stance. Although balance did not influence pain severity, spinal morphology and its correction appear to have influenced the intensity and location of back pain.
Highlights
Adolescent idiopathic scoliosis (AIS) has been associated with diminished postural stability and a greater prevalence of back pain
Patients were excluded of the study if their primary diagnosis was not AIS, could not take a standing radiograph, could not speak or understand French or English, had a cognitive disability preventing them from answering questionnaires, had previously undergone spinal or lower limb surgery or were diagnosed with neuromuscular impairment
The questionnaires given to the patients were: the Scoliosis Research Society Questionnaire30 (SRS-30), and a modified version of the Adolescent Pediatric Pain Tool (APPT) containing a back diagram for pain location and intensity
Summary
Adolescent idiopathic scoliosis (AIS) has been associated with diminished postural stability and a greater prevalence of back pain. Studies exploring the association between the vestibular system and balance in patients with adolescent idiopathic scoliosis (AIS) found that when comparing them to a cohort of healthy controls, AIS patients depended significantly more on their vestibular and somatosensory systems to keep their balance [4, 7, 8]. It is sensible to assume that spinal deformity correction would lead to changes in postural balance in AIS. Corroborative evidence of this assumption has been previously reported. Since the reported literature is scarce and investigators have used different methodological approaches [10,11,12,13,14,15], it is difficult to draw a definitive conclusion on the subject
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have