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Review
. 2023 Nov 28;17(6):527-534.
doi: 10.1177/18632521231215861. eCollection 2023 Dec.

Is scoliosis a source of pain?

Brice Ilharreborde  1 , Anne-Laure Simon  1 , Milud Shadi  2 , Tomasz Kotwicki  2
Affiliations
Review

Is scoliosis a source of pain?

Brice Ilharreborde et al. J Child Orthop. .

Abstract

Purpose: Pain in scoliosis is definitely a hot topic with growing popularity. The literature remains very controversial, with a pain prevalence ranging from 23% to 90%, but this can be explained by the great heterogeneity of the numerous series. The aim of this review was to report results from the literature regarding pain in relation to scoliosis regardless of the etiology.

Methods: A bibliographic search in Medline and Google database from 2003 to March 2023 was performed. Relevant literature was analyzed, summarized, and discussed based on authors' experience. A 1-year prospective series of adolescent idiopathic scoliosis patients was also included to compare with the existing literature.

Results: A total of 126 adolescent idiopathic scoliosis patients were included, with a mean preoperative Cobb angle of 64.5° (range, 45°-112°). Reported pain prevalence was 34.1%. Pain and no-pain groups were very different in their self-reported experience, with a very low mean visual analogue scale score of 0.5 (± 0.6) in the no pain group, while visual analogue scale averaged 5.6 (± 1.2) in the pain group (p < 0.001). No significant difference was found between groups regarding the most relevant demographic and radiological parameters.

Conclusion: Evidence-based literature on "scoliosis as a source of pain" remains ambiguous. There seems to be a consensus on the lack of direct relationship between deformity magnitude and back pain intensity. A comprehensive evaluation of the patient is therefore necessary before any treatment, including medical history, clinical examination, and relevant imaging for any child with scoliosis and back pain.

Level of evidence: Level VI.

Keywords: Idiopathic scoliosis; non-idiopathic scoliosis; pain; pain assessment tool.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Professor B.I. is a consultant for Implanet and Medtronics and perceives royalties from ZimmerBiomet.

Figures

Figure 1.
Figure 1.
Different curve patterns associated with painful adolescent idiopathic scoliosis (AIS).
Figure 2.
Figure 2.
A 11-year-old boy with a 6-month history of stiff and painful lumbar spine presenting a right-sided thoracolumbar curvature with no rotation or compensatory curve (a–c), initially managed as “scoliosis.” Left sublaminar L2 osteoid osteoma of 1.5 cm diameter was identified on scintigraphy and CT scans, and was uneventfully resected; the left lamina reconstruction using local bone graft stabilized by a left L2 pedicular screw connected to sublaminar hook placed on the same L2 vertebra was performed with the aim of avoiding fusion of any articulation. Surgery followed by a 3-month cast immobilization resulted in resolved pain and scoliosis, restoring a full range of motion at a 5-month follow-up (d and e).
Figure 3.
Figure 3.
Painful rib head protrusion in a NF1 patient.
See this image and copyright information in PMC

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