THE PREVALENCE OF BACK PAIN IN CHILDREN WHO HAVE IDIOPATHIC SCOLIOSIS

A retrospective study of 2342 patients who had idiopathic scoliosis wa s performed to determine the prevalence of back pain and its associati on with an underlying pathological condition. Five hundred and sixty ( 23 per cent) of the 2442 patients had back pain at the time of present ation, and an additional 210 (9 per cent) had back pain during the per iod of observation. There was a significant association between back p ain and an age of more than fifteen years, skeletal maturity (a Risser sign of 2 or more), post-menarchal status, and a history of injury. T here 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 patie nts 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 spondyloly sis or spondylolisthesis, nine had Scheurmann kyphosis, five had a syr inx, 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 underly ing pathological condition, although only eight of the thirty-three pa tients who had such findings were found to have such a condition. When a patient with scoliosis has back pain, a careful history should be r ecorded, 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 ma de, the scoliosis can be treated appropriately, and non-operative trea tment can be initiated for the back pain. It is not necessary to perfo rm extensive diagnostic studies to evaluate every patient who has scol iosis and back pain.