Does Improvement of Spine Alignment Lead to Relief of Neck Pain Associated with Scoliosis at Adults?

Abstract

Introduction Patients with scoliosis complain of neck pain very often. MRI demonstrates an availability of disc degenerative disease without the compression of the neural structures. The purpose of research determines correlation between the improvement of spine alignment and the relief of neck pain. Material and Methods This retrospective study evaluated 38 patients underwent the correction of the deformity and multilevel fusion surgery and from 2005 to 2012 for the treatment of AIS. There were 58% females. Mean age of 38 years (range 20–55). Mean follow-up of 3 years (2–5 years). Long cassette standing anteroposterior and lateral radiographs were performed on the preoperative, postoperative and follow-up visits. In all cases we studied preoperative, postoperative, and follow up sagittal plane alignment according to Schwab sagittal modifiers and coronal plane to all the patients. Degenerative disc disease of grade I-II was confirmed by MRI (Pfirrmann classification). All our patients before surgery treatment besides main complains inform about neck pain. The patients were divided into two groups depending on changes of spine alignment after surgery. Was evaluated sagittal (Sagittal vertical axis), coronal balance (central sacral vertical line). Visual Analog Scale (VAS) was used for evaluating of the neck pain, all 38 patients rated neck pain more than moderate (VAS > 5). Full correction of sagittal balance (postoperative SVA: N) was achieved at the first group for all 21 patients and 12 of them didn't achieved satisfactory results of coronal balance (CSVL > 2 cm). There were 17 patients at the second group. The correction of sagittal balance for everyone at the 2nd group wasn't complete (SVA: P, VP) and 11 patients got good correction of the coronal balance (CSVL < 2 cm). Results One year after surgery 78% ( n = 7, p > 0,05) from sagittal and coronal balanced patients of the second group ( n = 9, p > 0.05) evaluated reduce of the neck pain (VAS < 5). 9 of the 12 patients with coronal imbalance reported worsening of neck pain (VAS > 8). All patients from the second group also demonstrated remaining of neck pain. But all patients with full correction of coronal balance ( n = 11) got reduction of pain intensity, neck pain was evaluated less then moderate (VAS < 5). In both groups patients with coronal imbalance demonstrated worse results about current of neck pain, despite the good result of sagittal balance (p > 0.05). And patients with sagittal imbalance, but balanced in a coronal plane got relief of pain. Follow-up studying (2–5 years) demonstrated progression of degenerative disk disease, confirmed using MRI (detection grade IV degenerative changes of discs) followed by surgical treatment of the cervical spine to some patients in both groups. In a first group 14% ( n = 3, p > 0.05). In a second group 12% ( n = 2, p > 0.05). There are slightly higher in the first group, but we did not get significant difference between groups (p > 0.05). Conclusion Correction of coronal balance is very important for the surgery treatment of the adult patients with scoliosis associated with degenerative disk disease of cervical spine. A greater number of such cases are required for obtain of the reliable results.