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Purpose <p>To identify postoperative radiographic parameters independently associated with clinically meaningful pain improvement one year after surgery in a selected cohort of adolescents with idiopathic scoliosis (AIS) reporting substantial preoperative pain.</p> Methods <p>This was a retrospective analysis of a prospectively collected multicenter database including 378 AIS patients treated with posterior spinal fusion. Patients with substantial preoperative pain (SRS-22 pain ≤ 4.0) and ≥ 1-year follow-up were included. A 0.6-point MCID in SRS-22 pain defined meaningful improvement. Groups were compared and significant postoperative radiographic variables plus preoperative pain entered a multivariate logistic regression model. Nagelkerke R² and ROC-AUC assessed performance.</p> Results <p>Eighty-eight patients met the inclusion criteria (mean age 14.7 ± 1.8 years; 77 females). Sixty-four patients (72.7%) achieved MCID. Groups were similar in baseline demographics and preoperative radiographs. However, those who achieved MCID had significantly lower postoperative T2–T5 kyphosis (12.7 ± 7.6° vs. 17.2 ± 7.0°, <i>p</i> = 0.030) and greater T2–T12 kyphosis (38.7 ± 10.8° vs. 30.0 ± 8.8°, <i>p</i> = 0.001). Multivariate analysis identified three independent predictors: lower preoperative SRS pain scores, greater postoperative T2–T12 kyphosis, and lower postoperative T2–T5 kyphosis. A 10° increase in T2–T12 kyphosis tripled the odds of achieving MCID, whereas a 5° increase in T2–T5 kyphosis reduced the odds by 70%. The final model was highly predictive (Nagelkerke R² = 0.694; AUC = 0.943).</p> Conclusions <p>In AIS patients with significant preoperative pain, greater pain levels, greater restoration of global thoracic kyphosis (T2-T12), and less kyphosis in proximal unfused segments (T2-T5) were independently associated with meaningful postoperative pain improvement. Avoiding thoracic hypokyphosis and its associated compensatory changes may be essential to optimize surgical outcomes in this subgroup.</p>

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Postoperative thoracic kyphosis is associated with clinically significant pain improvement at 1-year follow-up in adolescent idiopathic scoliosis: a multicenter study

  • 期刊论文

  • 发表日期：

    2026年1月22日

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  • Alejandro Gomez-Rice,
  • Susana Núñez-Pereira,
  • Sleiman Haddad,
  • Riccardo Raganato,
  • Yann Philippe Charles,
  • Franciso Pérez-Grueso,
  • Frank Kleinstück,
  • Ibrahim Obeid,
  • Ahmet Alanay,
  • Ferran Pellise,
  • Javier Pizones,
  • ESSG European Spine Study Group

摘要

Purpose

To identify postoperative radiographic parameters independently associated with clinically meaningful pain improvement one year after surgery in a selected cohort of adolescents with idiopathic scoliosis (AIS) reporting substantial preoperative pain.

Methods

This was a retrospective analysis of a prospectively collected multicenter database including 378 AIS patients treated with posterior spinal fusion. Patients with substantial preoperative pain (SRS-22 pain ≤ 4.0) and ≥ 1-year follow-up were included. A 0.6-point MCID in SRS-22 pain defined meaningful improvement. Groups were compared and significant postoperative radiographic variables plus preoperative pain entered a multivariate logistic regression model. Nagelkerke R² and ROC-AUC assessed performance.

Results

Eighty-eight patients met the inclusion criteria (mean age 14.7 ± 1.8 years; 77 females). Sixty-four patients (72.7%) achieved MCID. Groups were similar in baseline demographics and preoperative radiographs. However, those who achieved MCID had significantly lower postoperative T2–T5 kyphosis (12.7 ± 7.6° vs. 17.2 ± 7.0°, p = 0.030) and greater T2–T12 kyphosis (38.7 ± 10.8° vs. 30.0 ± 8.8°, p = 0.001). Multivariate analysis identified three independent predictors: lower preoperative SRS pain scores, greater postoperative T2–T12 kyphosis, and lower postoperative T2–T5 kyphosis. A 10° increase in T2–T12 kyphosis tripled the odds of achieving MCID, whereas a 5° increase in T2–T5 kyphosis reduced the odds by 70%. The final model was highly predictive (Nagelkerke R² = 0.694; AUC = 0.943).

Conclusions

In AIS patients with significant preoperative pain, greater pain levels, greater restoration of global thoracic kyphosis (T2-T12), and less kyphosis in proximal unfused segments (T2-T5) were independently associated with meaningful postoperative pain improvement. Avoiding thoracic hypokyphosis and its associated compensatory changes may be essential to optimize surgical outcomes in this subgroup.