Correlations of Changes in Back and Leg Pain with Changes in Oswestry Disability Index, SRS-22, and SF-12 in Surgically Treated Patients with Adult Scoliosis

Abstract

INTRODUCTION: The Oswestry Disability Index (ODI), SRS-22, and SF-12 demonstrate improvement of adult scoliosis patients after surgical treatment. None of these measures specifically addresses leg pain, the presence of which is an independent predictor of a patient's choice for operative care. The purpose of this study was to assess whether improvement in leg pain after surgery is correlated with improvements in standardized outcome measures, independent of improvement in back pain. METHODS: This study is a retrospective review of a prospective multicenter database of adults with spinal deformity. At the time of enrollment and follow-up, patients complete the ODI, SRS-22, and SF-12, as well as assessment of leg and back pain (visual analog score [VAS]). Multiple linear regression analyses were used to assess for correlation between changes in back and leg pain and changes in ODI, SRS-22, and SF-12 at 2 years after surgery. RESULTS: 101 surgically-treated adult scoliosis patients with both baseline back and leg pain (VAS > 0) were included. Two years after surgery, all mean measures of outcome assessed significantly improved, including ODI (41–24, P < 0.001), SRS-22 (2.8–3.7, P < 0.0001), SF-12 PCS (physical component score, 30–40, P < 0.0001), SF-12 MCS (mental component score, 50–53, P = 0.04), VAS for back pain (6.9–2.8, P < 0.0001), and VAS for leg pain (5.4–2.1, P < 0.0001). Improvements in both back and leg pain were significantly and independently correlated with improvement in ODI (leg pain: B = 1.43, P = 0.001; back pain: B = 1.80, P < 0.001; R = 0.59) and SRS-22 (leg pain: B = −0.058, P = 0.004; back pain: B = −0.071, P = 0.002; R = 0.28). Only change in back pain VAS correlated with change in SF-12 PCS (B = −2.12, P < 0.001; R = 0.49), and only change in leg pain VAS correlated with change in SF-12 MCS (B = −1.44, P = 0.001; R = 0.37). CONCLUSION: Improvement in leg pain after surgery is correlated with improvement in standardized measures of health status and disability, independent of improvement in back pain. These findings emphasize the importance of recognizing and addressing leg pain in adults with scoliosis when contemplating surgical treatment.