Graduate Medical Education, HCA Florida Bayonet Point Hospital, 14000 Fivay Rd, Hudson, FL, 34667, USA.
Department of Orthopaedics, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Spine Deform. 2024 Sep;12(5):1319-1327. doi: 10.1007/s43390-024-00904-0. Epub 2024 Jun 23.
Although back pain is commonly reported in patients with adolescent idiopathic scoliosis (AIS), factors that influence the presence and severity of back pain in AIS, including curve-specific variables, have not been well studied. This study aims to describe the prevalence and severity of back pain in AIS patients and determine the extent to which patient characteristics, including curve-specific factors, are associated with a higher risk of back pain in AIS.
The study was a retrospective medical records review of adolescents (aged 10-17 years) diagnosed with AIS between 01/01/2018 and 12/31/2021 at an academic tertiary children's hospital. Patients with previous spine surgery were excluded. Variables collected included demographics (age, sex, race, insurance), Lenke classification, major coronal curve, back pain-related information, Risser stage, vitamin D levels, post-diagnosis brace utilization, physical therapy or chiropractic treatment, and surgery.
A total of 891 AIS patients were included in the analysis. The sample was predominantly female (73.3%) and insured by Medicaid (57.8) with a mean age of 12.8 years. The mean major coronal curve was 26.3 degrees. Most patients had Lenke type 1 (47%) and type 5 (41%) curves. Nearly half of patients reported back pain (48.5%) with average pain severity in the low-to-moderate range (4.7) on FACES pain scale (0-10). Among those who reported back pain, 63.2% specified a location with the majority reporting pain in the lumbar region (56%) and, less commonly, in the thoracic (39%) and scapular (8%) regions. Lumbar pain was associated with significantly higher pain intensity (p = 0.033). Additionally, the location of pain reported was associated with location of major coronal curve (p < 0.0001). No association was observed between pain presence and vitamin D deficiency (p = 0.571, n = 175), major coronal curve magnitude (p = 0.999), Lenke curve type (p = 0.577), and sex (p = 0.069). Older patients, those insured by Medicaid, and those with higher Risser scores were more likely to report pain scores (p = 0.001 for all).
Nearly half (48%) of newly diagnosed AIS patients experience back pain which is higher than the prevalence of 33% seen in the general adolescent population. Pain was more prevalent among patients over the age of 13, with heavier body weight, and those insured by Medicaid. Pain was most commonly reported in the lumbar region, especially among patients with lumbar curves. This information can be helpful in counseling AIS patients, though further investigations are needed, especially to determine the underlying causes of back pain in AIS and to elucidate the discrepancy in pain between patients with Medicaid and commercial insurance.
Prognostic Study Level II.
尽管青少年特发性脊柱侧凸（AIS）患者常报告背痛，但影响 AIS 患者背痛存在和严重程度的因素，包括与曲线相关的变量，尚未得到很好的研究。本研究旨在描述 AIS 患者背痛的发生率和严重程度，并确定患者特征（包括与曲线相关的因素）与 AIS 患者背痛风险增加之间的关联程度。
本研究是对 2018 年 1 月 1 日至 2021 年 12 月 31 日在一家学术性三级儿童医院诊断为 AIS 的青少年（年龄 10-17 岁）进行的回顾性病历审查。排除既往脊柱手术的患者。收集的变量包括人口统计学资料（年龄、性别、种族、保险）、Lenke 分类、主要冠状曲线、与背痛相关的信息、Risser 分期、维生素 D 水平、诊断后支具使用、物理治疗或整脊治疗和手术。
共纳入 891 例 AIS 患者进行分析。该样本主要为女性（73.3%），由 Medicaid 保险（57.8%）承保，平均年龄为 12.8 岁。主要冠状曲线的平均度数为 26.3 度。大多数患者为 Lenke 1 型（47%）和 5 型（41%）曲线。近一半的患者报告有背痛（48.5%），疼痛严重程度在低中度（4.7），根据 FACES 疼痛量表（0-10）。在报告背痛的患者中，63.2% 指定了疼痛部位，大多数报告腰痛（56%），较少报告胸背痛（39%）和肩胛痛（8%）。腰痛与疼痛强度显著增加相关（p=0.033）。此外，报告的疼痛部位与主要冠状曲线的部位相关（p<0.0001）。疼痛的存在与维生素 D 缺乏之间未观察到相关性（p=0.571，n=175）、主要冠状曲线幅度（p=0.999）、Lenke 曲线类型（p=0.577）和性别（p=0.069）。年龄较大的患者、由 Medicaid 承保的患者和 Risser 评分较高的患者更有可能报告疼痛评分（p=0.001）。
新诊断的 AIS 患者中有近一半（48%）经历背痛，高于一般青少年人群中 33%的患病率。疼痛在 13 岁以上的患者中更为常见，体重较重的患者和 Medicaid 承保的患者更常见。疼痛最常见于腰椎区，尤其是在腰椎曲线患者中。这些信息有助于为 AIS 患者提供咨询，但仍需进一步调查，特别是为了确定 AIS 背痛的根本原因，并阐明 Medicaid 和商业保险患者之间的疼痛差异。
预后研究 II 级。
