BMC Musculoskelet Disord

Adolescent idiopathic scoliosis: evaluating perioperative back pain through a simultaneous morphological and biomechanical approach

Maxime St-Georges, Alisson R. Teles, Oded Rabau, Neil Saran, Jean A. Ouellet, Catherine E. Ferland

McGill Scoliosis and Spine Research Group, Montreal


Perioperative pain, Adolescent idiopathic scoliosis, 3D reconstruction, Spinal morphology, Postural balance


Background Adolescent idiopathic scoliosis (AIS) has been associated with diminished postural stability and a greater prevalence of back pain. Currently, the literature is lacking information on the effect of spinal fusion on both postural stability and its association with back pain. Our objectives were to evaluate the postsurgical effect of spinal morphological changes on static standing balance and assess the influence of these alterations on reported pain throughout the perioperative period. Methods Twenty consecutive AIS patients schedule to undergo spinal fusion surgery were recruited and followed prospectively at the Shriners Hospitals for Children-Canada. Data was collected at the preoperative, 6 weeks and 6 months postoperative visits. Spinal morphology data was collected through 3D reconstructed simultaneous standing biplanar radiographs using the SterEOS software. Postural balance was assessed through Moticon© sensor insoles and analyzed through their software. The data was simultaneously collected as part of the Global Biomechanical and morphological Assessment. Pain was evaluated through self-reported questionnaires. Results Morphological curve parameters were significantly reduced after surgery. Balance parameters did not change significantly throughout the perioperative period with the exception of the Center of Pressure of the left foot medial/lateral transient shift (P = 0.017) at 6 weeks. Of note, preoperative balance parameters were associated with the degree of right thoracic Cobb angles (P = 0.029 R = 0.528). Pain scores significantly improved 6 weeks and 6 months after the surgery. Pain intensity diminished in the thoracic and lumbar spine but worsen in the neck region at the 6 weeks and 6 months postoperative time points (P = 0.044). Greater residual Cobb angle difference between Mid thoracic and Thoracolumbar/Lumbar curves was associated with greater pain severity at 6 weeks postop (P < 0.005). In addition, greater residual thoracic deformity was associated with significant pain severity 6 months after surgery (P < 0.05). Conclusions Improved spinal morphology of postsurgical AIS patients has no significant impact on their static standing balance. Suggesting that other factors apart from the spinal morphology may contribute to AIS patients’ balance during stance. Although balance did not influence pain severity, spinal morphology and its correction appear to have influenced the intensity and location of back pain.

Moticon's Summary

The aim of this study was to assess postural stability in patients with adolescent idiopathic scoliosis (AIS) following a spinal fusion surgery as well as the influence of the surgical alterations on the reported pain. For the assessment 20 patients who were scheduled for spinal fusion surgery were recruited. Postural stability in these patients was tested during regular stance using Moticon sensor insoles. The evaluation of postural stability was subsequently based on center of pressure parameters derived from the sensor insoles. Additionally spinal morphology was examined via 3D radiographs. Results revealed a significant reduction of morphological curve parameters. Postural stability largely exhibited no significant post-surgical changes besides left foot center or pressure medial/lateral transient shift. The authors conclude that while spinal morphology in general seems to influence postural stability, the lack of changes in that regard following surgery can likely be attributed to other factors. Other than that, while postural stability didn't influence reported pain, alterations in spinal morphology were associated with reported pain after surgery.

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