SRS-22 Pain Score Research Articles

Factors associated with increased back pain in primary thoracic adolescent idiopathic scoliosis 10years after surgery.

To identify the prevalence and predictors of nonspecific back pain in primary thoracic adolescent idiopathic scoliosis (AIS) patients at 10years after surgery. This was a case-control multi-center study. A query of patients who underwent surgical correction of major thoracic AIS between 1997 and 2007 with 10-year follow-up was reviewed. SRS-22 pain scores at 10years were classified as below normal (≤ 2 standard deviations below average for controls of similar age/sex from published literature) or within/above the control range. One hundred and seventy-one patients with an average of 10.5 ± 0.8-years follow-up were included. Average age at surgery was 14 ± 2years. The rate of pain was 23% for males and 11% for females (p = 0.08). Differences in age, 10-year SRS mental health score, and radiographic measures were noted. Of 12 patients who underwent revision surgery, 42% reported below normal pain scores versus 11% in cases without revision (p = 0.012). Classification and regression tree (CART) analysis identified 10-year thoracic curve magnitude and 10-year mental health scores as significant predictors. Thoracic Cobb of ≤ 26° at 10years was associated with a 7% rate of below normal pain scores compared to 27.5% when the curve was > 26° (OR = 4.8, p < 0.05). Of those with a curve ≤ 26°, no patients had abnormal pain if the SRS mental health score was > 4.2 and 15% had more pain than normal if mental health score was ≤ 4.2 (OR 23, p < 0.05). Increased primary thoracic curve magnitude (> 26°) at 10years was the primary predictor of increased pain. For patients with less coronal deformity (< 26°), a poor mental health score was associated with an increased rate of pain. Male gender and revision surgery may also play a role in increased pain, however, the overall frequency of these variables were low. Level 3.

Mental Health and Self Image Perception of Non-disabled Adult Idiopathic Scoliosis Patients Having Mild to Moderate Curves Compared to Normal Population

Introduction There is little information about the effects of scoliotic curves on self image (SI) and mental health (MH) based on validated questionnaires. Aim was to analyze the effect of scoliosis on MH and SI in a non-disabled adult idiopathic scoliosis (AdIS) population having curves under surgical indication threshold (Main Thoracic (MT) Cobb (≤ 55°), and Thoracolumbar/Lumbar (TL) curve (≤ 45°). Material and Methods A retrospective analysis of a multicenter, prospective, consecutive patient series. Inclusion criteria were: non operated AdIS, ≥ 18 years of age, MT Cobb 20–55°, TL Cobb 20–45°, ODI &lt;20, SRS 22 Pain score &gt; 4. ODI and SRS22 pain score were used to distinguish patients that have pain and disability from the ones that do not. SRS- 22 and SF-36 normative data for different age groups were used for comparison. AP and lateral Cobb measurements, sagittal plane parameters and demographic data were analyzed in terms of correlations with SI and MH parameters. Results 76 patients (64F, 12M) met the inclusion criteria. Mean age was 25.9 (18–44), mean MT Cobb was 38.5° (21–55) and TL Cobb was 34.6° (25–44). SRS-22 MH, SI and other domains were similar with SRS normative data (p &gt; 0.05). SF-36 MCS and PCS domains for age groups 18–24, 25–34 and 35–44 were not significantly different than normative data (p &gt; 0.05). None of the demographic and radiographic parameters were correlated with changes in SRS-22 function, SI, MH and SF 36 MCS, PCS parameters. Conclusion AdIS does not affect mental health and self-image in non-disabled patients with curve magnitudes below the surgical threshold. [Figure: see text]

Which Factors Influence the Surgery vs. Non-surgery Decision for Adult Idiopathic Scoliosis Patients with Gray Zone (40-55°) Main Thoracic Curves?

Introduction To analyze the factors that may influence surgical vs non-surgical treatment for AdIS patients within gray zone (40–55°) main thoracic (MT) curves. Material and Methods A retrospective analysis of a multicenter, prospective, consecutive patient series. Inclusion criteria were: AdIS, ≥18 years of age, major curve to be MT, Cobb between 40 and 55°. Ninety-one patients (69 Non-surgical and 22 Surgical) were included. Non-surgery group had 57F and 12M; mean age: 28.3 (18–47), mean Cobb: 46.8° (40- 55). Surgery group had 19 F and 3M; mean age: 31.1 (18–71), mean Cobb: 49.2°(42–55). All patients completed SF-36, SRS-22 and ODI when they were first seen in the clinic. AP and lateral Cobb measurements and sagittal plane parameters were measured. Independent samples t-test was used to compare groups. Variable importance analysis was done using classification and regression tree algorithm to predict factors that influence surgical decision. Results ODI, SF-36 PCS and SRS-22 subtotal, function, pain, self-image scores were significantly different between the groups ( p &lt; 0.05). Age, MT curve Cobb, Lumbar curve Cobb, trunk shift, SVA, coronal balance, SF-36 MCS and SRS22 mental health were not statistically different (p &gt; 0.05). Most important variable that created a tendency toward surgery was SRS-22 functional status followed by ODI, SRS-22 pain score, SF-36 PCS and SRS-22 self image score ( Fig. 1 ). Conclusion AdIS patients having a curve magnitude in the gray zone (40–55°) with decreased SRS-22 function, pain, self-image and SF-36 PCS and increased ODI scores had a predilection toward surgery. Most important variable was SRS-22 function score. [Figure: see text]

The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis—an assessor and statistician blinded randomized controlled trial: “SOSORT 2015 Award Winner”

BackgroundIn North America, care recommendations for adolescents with small idiopathic scoliosis (AIS) curves include observation or bracing. Schroth scoliosis-specific exercises have demonstrated promising results on various outcomes in uncontrolled studies. This randomized controlled trial (RCT) aimed to determine the effect of Schroth exercises combined with the standard of care on quality-of-life (QOL) outcomes and back muscle endurance (BME) compared to standard of care alone in patients with AIS.Material and MethodsFifty patients with AIS, aged 10–18 years, with curves 10–45 °, recruited from a scoliosis clinic were randomized to receive standard of care or supervised Schroth exercises plus standard of care for 6 months. Schroth exercises were taught over five sessions in the first two weeks. A daily home program was adjusted during weekly supervised sessions. The assessor and the statistician were blinded. Outcomes included the Biering-Sorensen (BME) test, Scoliosis Research Society (SRS-22r) and Spinal Appearance Questionnaires (SAQ) scores. Intention-to-treat (ITT) and per protocol (PP) linear mixed effects models were analyzed. Because ITT and PP analyses produced similar results, only ITT is reported.ResultsAfter 3 months, BME in the Schroth group improved by 32.3 s, and in the control by 4.8 s. This 27.5 s difference in change between groups was statically significant (95 % CI 1.1 to 53.8 s, p = 0.04). From 3 to 6 months, the self-image improved in the Schroth group by 0.13 and deteriorated in the control by 0.17 (0.3, 95 % CI 0.01 to 0.59, p = 0.049). A difference between groups for the change in the SRS-22r pain score transformed to its power of four was observed from 3 to 6 months (85.3, 95 % CI 8.1 to 162.5, p = 0.03), where (SRS-22 pain score)4 increased by 65.3 in the Schroth and decreased by 20.0 in the control group. Covariates: age, self-efficacy, brace-wear, Schroth classification, and height had significant main effects on some outcomes. Baseline ceiling effects were high: SRS-22r (pain = 18.4 %, function = 28.6 %), and SAQ (prominence = 26.5 %, waist = 29.2 %, chest = 46.9 %, trunk shift = 12.2 % and shoulders = 18.4 %).ConclusionsSupervised Schroth exercises provided added benefit to the standard of care by improving SRS-22r pain, self-image scores and BME. Given the high prevalence of ceiling effects on SRS-22r and SAQ questionnaires’ domains, we hypothesize that in the AIS population receiving conservative treatments, different QOL questionnaires with adequate responsiveness are needed.Trial registrationSchroth Exercise Trial for Scoliosis NCT01610908.Electronic supplementary materialThe online version of this article (doi:10.1186/s13013-015-0048-5) contains supplementary material, which is available to authorized users.

Association between preoperative cervical sagittal deformity and inferior outcomes at 2-year follow-up in patients with adult thoracolumbar deformity: analysis of 182 patients.

A high prevalence of cervical deformity (CD) has been identified among adult patients with thoracolumbar spinal deformity undergoing surgical treatment. The clinical impact of this is uncertain. This study aimed to quantify the differences in patient-reported outcomes among patients with adult spinal deformity (ASD) based on presence of CD prior to treatment. A retrospective review was conducted of a multicenter prospective database of patients with ASD who underwent surgical treatment with 2-year follow-up. Patients were grouped by the presence of preoperative CD: 1) cervical positive sagittal malalignment (CPSM) C2-7 sagittal vertical axis ≥ 4 cm; 2) cervical kyphosis (CK) C2-7 angle > 0; 3) CPSM and CK (BOTH); and 4) no baseline CD (NONE). Health-related quality of life (HRQOL) scores included the Physical Component Summary and Mental Component Summary (PCS and MCS) scores of the 36-Item Short Form Health Survey (SF-36), Oswestry Disability Index (ODI), Scoliosis Research Society-22 questionnaire (SRS-22), and minimum clinically important difference (MCID) of these scores at 2 years. Standard radiographic measurements were conducted for cervical, thoracic, and thoracolumbar parameters. One hundred eighty-two patients were included in this study: CPSM, 45; CK, 37; BOTH, 16; and NONE, 84. Patients with preoperative CD and those without had similar baseline thoracolumbar radiographic measurements and similar correction rates at 2 years. Patients with and without preoperative CD had similar baseline HRQOL and on average both groups experienced some HRQOL improvement. However, those with preoperative CPSM had significantly worse postoperative ODI, PCS, SRS-22 Activity, SRS-22 Appearance, SRS-22 Pain, SRS-22 Satisfaction, and SRS-22 Total score, and were less likely to meet MCID for ODI, PCS, SRS-22 Activity, and SRS-22 Pain scores with the following ORs and 95% CIs: ODI 0.19 (0.07-0.58), PCS 0.17 (0.06-0.47), SRS-22 Activity 0.23 (0.09-0.62), SRS-22 Pain 0.20 (0.08-0.53), and SRS-22 Appearance 0.34 (0.12-0.94). Preoperative CK did not have an effect on outcomes. Interestingly, despite correction of the thoracolumbar deformity, 53.3% and 51.4% of patients had persistent CPSM and persistent CK, respectively. Patients with thoracolumbar deformity without preoperative CD are likely to have greater improvements in HRQOL after surgery than patients with concomitant preoperative CD. Cervical positive sagittal alignment in adult patients with thoracolumbar deformity is strongly associated with inferior outcomes and failure to reach MCID at 2-year follow-up despite having similar baseline HRQOL to patients without CD. This was the first study to assess the impact of concomitant preoperative cervical malalignment in adult patients with thoracolumbar deformity. These results can help surgeons educate patients at risk for inferior outcomes and direct future research to identify an etiology and improve patient outcomes. Investigation into the etiology of the baseline cervical malalignment may be warranted in patients who present with thoracolumbar deformity.