Reference 1st author/year | Design | Tools used for Pain | Results | Comments |
---|---|---|---|---|
Conservative Treatment | ||||
S Negrini/Cochrane Database Syst Rev 2015 [39] | Review including 7 studies (5 initially planned as RCTs and 2 as prospective controlled trails) with a total of 662 adolescents, comparing braces with other treatment. | PedsQL (only 1 item in one of the 4 dimensions focus specifically on pain). | Back pain did not change in the long term (very low quality evidence) | The authors highlight that it was not possible to perform a meta-analysis due to important clinical differences among studies. |
T Maruyama/Physiother Theory Pract 2011 [40] | Systematic review including 20 studies: 2 controlled clinical trials and 18 case-control studies. No RCTs found. | Child Health Questionnaire (1 study) and VAS (1 study) | Compared with observation bracing does not influence back pain or HRQoL. Conflicting evidence reported for studies comparing bracing with other forms of treatment | |
ME Alves de Araujo/J Bodyw Mov Ther 2012 [49] | RCT comparing Pilates-based therapy (N = 20) to weekly meetings with no therapeutic intervention (N = 11). Age ranged from 18 to 25 years | Borg CR 10 | Pain decreased from 5.3(1.5) to 1.8 (1.9) (P = 0.0001) in the experimental group and from 4.4(2.3) to 3.8(2.7) in the control group (NS) | All patients were female students with minor non-structural dorso-lumbar scoliosis (Cobb angles 7.6(3.5) (Experimental) and 7.1(2.8) (Control) respectively. |
M Monticone/Eur Spine J 2014 [51] | RCT comparing self-correction, task-oriented spinal exercises and education (N = 55) with traditional spinal exercises (N = 55). Evaluations pre-, post-treatment, and at 1-year follow-up. Mean age at baseline 12.5 and 12.4 years respectively (NS) | SRS-22 | Pain scores at the 3 evaluations were: 3.8 (0.4), 4.6 (0.3), and 4.7 (0.2) in the experimental program and 3.9 (0.5), 4.3 (0.3), and 4.2 (0.4) in the control group. P < 0.001 for time, group, and interaction effects. | |
DK Noh/J Back Musculoskelet Rehabil 2014 [52] | Comparison of a corrective spinal technique (CST) approach with a conventional exercise (CE) program. Two groups of 16 AIS patients each. Mean age 13.8 years Versus 14.9 (N.S.) | SRS-22 | Pain scores improved from baseline to follow-up in both groups. Results were from 4.5 to 4.9 in CST group and from 3.8 to 4.6 in CE group. | The 2 groups were already small at baseline and the attrition rate was substantial with N = 8 (CST) and 4 (CE) at follow-up. |
KA Zapata/Pediatr Phys Ther 2015 [53] | Randomized trial comparing 8 weeks of weekly supervised spinal stabilization exercises (N = 17) with 1-time treatment (N = 17). Patients with AIS aged 10–17 years | Numeric Pain Rating Scale (NPRS) Oswestry Patient-specific functional scale (PSFS) | NPRS scores improved from 5.4(1.5) to 1.5(1.8) in the supervised group and from 5.4(1.3) to 3.4(1.7) in controls (P ≤ 0.05 & > MCID) The reduction in OSW was similar in both groups and the improvement in PSFS was higher in the supervised group but the difference between the 2 groups < MCID in adults. | All the patients included in the trial had low back pain at baseline. |
M Tavernaro/Scoliosis 2012 [54] | Cross-sectional study followed by retrospective case-control study to verify the impact of a complete rehabilitation team in adolescent patients with bracing (N = 28 AIS and 10 hyperkyphosis). Mean age 15.8 years | SRS-22 | Pain scores were 3.93 ± 0.55 among those treated by the team and 3.54 ± 0.83 in those who were not (N.S.) | Other variables were significantly improved by the team management. |
EM Bunge/Eur Spine J 2007 [63] | Cross-sectional evaluation of HRQoL of AIS patients after completing treatment. Patients had been braced (N = 36), treated by brace and surgery (31), or only by surgery (30). Mean age 16.3 years. | SRS-22 | Mean scores for Pain domain in the 3 groups were: Brace: 4.5 (0.57) Brace & surg: 4.1 (0.90) Only surgery: 4.1 (0.71) | Pain was not significantly correlated with the time span between completing treatment and filling out the questionnaire. |
Surgical Management | ||||
PR Rushton/Spine 2013 [68] | Review of the literature and statistical analysis evaluating the effect of surgery on HRQoL of adolescents with AIS and 2 years follow-up. | SRS-24 | 81 % of the included cohorts reported a statistically significant improvement of pain. The reduction was above MCID only in 1/12 cohorts | |
MC Hawes/Disabil Rehabil 2008 [56] | Systematic review of studies on surgery for AIS with ≥ 10 patients and followed for ≥2 years after surgery. 82 articles (5780 patients) included. | Trials’ results presented as “pain-free”: Yes, No, or Not tested/reported. Yes meant that most or all patients reported minimal or no pain and none reported severe, chronic, or increased pain post-op | The authors conclude that there is no evidence to support that the result in terms of reduced magnitude of the spinal curve is correlated with reduced pain. | 65 % of articles did not include pain in their outcome. Of those who did, definitions were quite different |
Z Landman/Spine 2011 [57] | Multicenter, prospective, consecutive clinical series. N = 1433 patients. Changes in pain assessed in 295 patients with complete data and 2 years follow-up | SRS-22 (Z-test for proportions used to analyze preop and postop differences) | Mild to severe pain within the last month in 73.2 % preop, 53.6 % at 1 year and 53.2 % at 2 years. Pain at rest in 70.5 % preop, 56.9 % at 1 year and 60 % at 2 years. Compared with preoperative data, at 2 years 40 % of patients reported a decrease in pain, 38.6 % no change, and 20.3 % an increase in pain. | A significant disagreement between preoperative pain reported by physicians (44 %) and patients (77.9 %) was found. Patients who were more satisfied with their appearance reported less pain. |
DW Roberts/Spine 2011 [23] | Longitudinal multicenter cohort study to compare functional outcomes between genders before and after surgery. N = 744. Mean age was 15.2 years for males and 14 years for females. | SRS-30 | Postop pain improved significantly in both genders from 4.1 to 4.3 in girls and from 4.3 to 4.5 in boys. The difference between genders is NS. | The pain reduction at 2 years does not seem clinically meaningful. |
T Akazawa/Spine 2012 [58] | Case-control study to compare healthy subjects (N = 80) with idiopathic (N = 80) and non-idiopathic (N = 56) scoliosis patients and ≥ 21 years after surgery. | SRS-22 Roland-Morris (RDQ) | Pain dimension scores were 4.3(0.6) in AIS patients and 4.2(0.5) in controls (NS) RDQ scores were 2.4(4.1) and 1.4(3.1) respectively. | At long-term postoperative follow-up AIS patients had similar pain scores as healthy controls |
TP Bastrom/Spine 2013 [60] | Review of a prospective multicenter database registry. N = 584 AIS patients treated surgically with ≥ 2 years follow-up. Age at surgery 14.7 ± 2 years | SRS-22 Self-reported pain Vs pain free (1st 6 months post-op or 6–24 months post-op). The focus is on the patients with unexplained pain >6 months postoperative | The 2-year pain scores were 4.1 ± 0.7 in patients with postoperative pain and 4.5 ± 0.6 in the postop pain free group (P < 0.001). These 2 groups were also significantly different in terms of preoperative pain (3.8 ± 0.8 Vs 4.1 ± 0.7). | |
CB Sieberg/J Pain 2013 [61] | Prospective multicenter registry examining postoperative outcomes of AIS patients. N = 169 at baseline, 1 and 2 years postop and N = 69 for 5 years follow-up. | SRS-30 | Moderate to severe pain in the past month was reported preop by 35 % of patients. The figures were 11 % at 1 year, 15 % at 2 years, and 15 % at 5-years post-surgery. Pain often to very often at rest was reported by 43 % at baseline, 5 % at 1- and 2-years follow-up and 8 % at final follow-up. | Examining the evolution of pain from preoperatively to 5 years follow-up the authors describe 5 trajectories distinguishable on preop age, mental health, and self-image. |
LY Carreon/Spine 2011 [62] | Longitudinal cohort of AIS patients treated surgically and evaluated preoperatively and 2 years postop. N = 745. Mean age 14.2 years | SRS-22 and SRS satisfaction | Mean pain domain scores improved from 4.16 ± 0.71 preop to 4.31 ± 0.72 (P < 0.0001) Pain and satisfaction domains were significantly correlated (Spearman 0.260) | The pain reduction does not seem clinically relevant |
EM Bunge/Eur Spine J 2007 a [63] | Cross-sectional evaluation of HRQoL of AIS patients after completing treatment. Patients had been braced (N = 36), treated by brace and surgery (31), or only by surgery (30). Mean age 16.3 years. | SRS-22 | Mean scores for Pain domain in the 3 groups were: Brace: 4.5 (0.57) Brace & surg: 4.1 (0.90) Only surgery: 4.1 (0.71) | A subset of patients’ satisfaction scores was compared with that of their surgeons. No significant differences were reported |
MO Andersen/Spine 2006 [64] | Longitudinal study of consecutive AIS patients (N = 181) treated by brace (BT = 82) or surgery (ST = 99). Follow-up 9.7 years | VAS (6 items) SF-36 | Among the 6 VAS scores only “Do you feel leg pain right now” was significantly different with 0.5 (0.2–0.9) in the BT group and 0.2 (0.0–0.3) in the ST group (P = 0.034). The results for the mean Bodily pain dimension of the SF-36 were 74.6 (BT) and 71.4 (ST) which are significantly lower than the mean of 79.8 of a 408 Danish control cohort. | The difference in pain does not seem clinically meaningful |
B Poitras/Spine 1994 [65] | Retrospective cohort study of patients referred to a single center for AIS compared with a sample (N = 1755) of the general population. Among the 723 patients treated surgically, 555 completed the questionnaire. Follow-up 10–30 years. | Pain assessed by Postal questionnaire (taken from McGill Pain Questionnaire, Oswestry and Roland Morris) Controls evaluated by telephone survey. | Back pain in the past year was reported by almost ¾ of the responders. For controls the same figure was 56 %. | The authors found no correlations with several surgical technical variables evaluated (curve correction, number of vertebrae fused, distal level of fusion). |
Untreated | ||||
PR Rushton/Spine 2013 [55] | Review of the literature and statistical analysis to compare untreated adolescents with AIS with normal controls. | SRS-22r | Of the included cohorts 81 % reported statistically significant worse pain among untreated scoliotic patients but the difference was clinically important only in 5 % of cohorts. | |
VM Pham/Ann Readapt Med Phys 2008 [69] | Comparison of 3 groups of patients with AIS 32 without brace, 41 treated full-time with a corset and 35 wearing the brace during the night only. The 3 groups were significantly different in age, Risser, Cobb angle, etc. | VAS Quality of Life Profile for Spine Deformities | No significant differences in the intensity of pain (VAS) were found | |
OF Ugwonali/Spine J 2004 [70] | Cross-sectional questionnaire-based study. Patients with AIS were braced (N = 78) or observed (N = 136) Mean age was respectively 13.6 Versus 13.8 years (N.S.) | Child Health Questionnaire (CHQ Parental form-28) and PODCI | No differences in pain domains were found between the 2 groups despite the fact that Cobb angles were significantly bigger in the braced group. Regression analysis showed a significant association of the CHQ bodily pain dimension and age but not with gender, cobb angle or treatment. | No information gathered from the adolescents themselves is included in the study. The authors conclude that bracing does not decrease QoL |