Ramirez N, Johnston C E, Browne R H
Texas Scottish Rite Hospital for Children, Dallas 75219-3993, USA.
J Bone Joint Surg Am. 1997 Mar;79(3):364-8. doi: 10.2106/00004623-199703000-00007.
A retrospective study of 2442 patients who had idiopathic scoliosis was performed to determine the prevalence of back pain and its association with an underlying pathological condition. Five hundred and sixty (23 per cent) of the 2442 patients had back pain at the time of presentation, and an additional 210 (9 per cent) had back pain during the period of observation. There was a significant association between back pain and an age of more than fifteen years, skeletal maturity (a Risser sign of 2 or more), postmenarchal status, and a history of injury. There was no association with gender, family history of scoliosis, limb-length discrepancy, magnitude or type of curve, or spinal alignment. At the latest follow-up evaluation, 324 (58 per cent) of the 560 patients who had had back pain at presentation had no additional symptoms. Forty-eight (9 per cent) of the 560 patients who had back pain had an underlying pathological condition: twenty-nine patients had spondylolysis or spondylolisthesis, nine had Scheurmann kyphosis, five had a syrinx, two had a herniated disc, one had hydromyelia, one had a tethered cord, and one had an intraspinal tumor. A painful left thoracic curve or an abnormal neurological finding was most predictive of an underlying pathological condition, although only eight of the thirty-three patients who had such findings were found to have such a condition. When a patient with scoliosis has back pain, a careful history should be recorded, a thorough physical examination should be performed, and good-quality plain radiographs should be made. If this initial evaluation reveals normal findings, a diagnosis of idiopathic scoliosis can be made, the scoliosis can be treated appropriately, and non-operative treatment can be initiated for the back pain. It is not necessary to perform extensive diagnostic studies to evaluate every patient who has scoliosis and back pain.
对2442例特发性脊柱侧凸患者进行了一项回顾性研究，以确定背痛的患病率及其与潜在病理状况的关联。2442例患者中，有560例（23%）在就诊时有背痛，另有210例（9%）在观察期间出现背痛。背痛与年龄超过15岁、骨骼成熟（Risser征为2级或更高）、月经初潮后状态以及受伤史之间存在显著关联。与性别、脊柱侧凸家族史、肢体长度差异、侧弯程度或类型以及脊柱排列无关。在最近的随访评估中，就诊时有背痛的560例患者中有324例（58%）没有其他症状。560例背痛患者中有48例（9%）存在潜在病理状况：29例患者有椎弓根峡部裂或椎体滑脱，9例有休门氏后凸，5例有脊髓空洞症，2例有椎间盘突出，1例有积水性脊髓炎，1例有脊髓栓系，1例有椎管内肿瘤。疼痛的左侧胸弯或异常的神经学表现最能预测潜在的病理状况，尽管在有这些表现的33例患者中只有8例被发现有这种情况。当脊柱侧凸患者出现背痛时，应详细记录病史，进行全面的体格检查，并拍摄高质量的平片。如果初步评估结果正常，则可诊断为特发性脊柱侧凸，对脊柱侧凸进行适当治疗，并对背痛开始非手术治疗。没有必要对每一位有脊柱侧凸和背痛的患者进行广泛的诊断性检查。
