Is the numerical rating scale an adequate predictor for assessing MRI underlying pathologies among painful adolescent idiopathic scoliosis patients?

Olivella, Gerardo; Guzmán, Humberto; Marrero-Ortiz, Pablo; Torres, Yashira; Rosado, Edwin; Pérez-López, José C; Monasterio, Diego; Rivera, Claribel; Ramírez, Norman

doi:10.1097/bpb.0000000000000817

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…Scoliosis rarely causes pain 14,15 and it has been suggested that certain clinical characteristics of pain, including constant pain, night pain, and pain location, may be useful in identifying underlying clinical pathology. 16 However, there is significant debate regarding the utility of clinical factors, 17 with multiple MRI studies demonstrating the poor predictive ability of clinical complaints, 10 no association between severity of pain and incidence of pathologic findings, 18 and an increased rate of inconsequential findings in MRI's ordered for back pain. 11 In this study, 28 patients underwent MRI for "back pain" as the indication.…”

Section: Discussionmentioning

confidence: 99%

Entire-spine Magnetic Resonance Imaging Findings and Costs in Children With Presumed Adolescent Idiopathic Scoliosis

Johnson

Gohel

Mitchell

et al. 2021

Journal of Pediatric Orthopaedics

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Background: Patients with adolescent idiopathic scoliosis (AIS) are commonly monitored for curve progression with spinal radiographs; however, the utility of magnetic resonance imaging (MRI) screening is unclear. The purpose of this study was to assess the findings of screening MRI for patients with a nonsurgical curve size ordered during routine clinical care and compare them with MRI ordered for patients with large curves as part of preoperative screening. Methods: All consecutive patients with presumed AIS who underwent entire-spine MRI with a presumed diagnosis of idiopathic scoliosis at a single institution between 2017 and 2019 were retrospectively reviewed. Patients were stratified based on MRI indication into the following groups: preoperative evaluation, pain, neurological symptoms, abnormal radiographic curve appearance, rapidly progressive curve, and other. Neural axis abnormalities recorded included concern for tethered spinal cord, syringomyelia, and Chiari malformation. The MRI findings of preoperative patients with large curves were compared with all other patients. The number needed to diagnose (NND) a neurological finding was calculated in patients whose MRIs were ordered during routine clinical care. The amount charged for each patient undergoing entire-spine MRI was determined by review of our institution's Financial Decision Support system. Results: There were 344 patients included in this study with 214 (62%) MRIs performed for preoperative evaluation. Although MRI abnormalities were found in 49% of patients, only 7.0% (24/ 344) demonstrated neural axis abnormalities with no difference between preoperative and other indications (P = 0.37). For patients with nonsurgical curves undergoing MRI due to a complaint of back pain (n = 28), there were no neural axis abnormalities, and a lower rate of disk herniation/degenerative changes detected compared with preoperative MRI (3.6% vs. 18%, P = 0.06). Among the 15 patients undergoing MRI for a neurological concern, 1 had a neural axis abnormality that required surgical detethering. The NND for MRI to detect a neural axis abnormality that potentially required neurosurgical intervention in nonpreoperative patients with a neurological concern was 34.4. The average cost for MRI

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Section: Discussionmentioning

confidence: 99%

Entire-spine Magnetic Resonance Imaging Findings and Costs in Children With Presumed Adolescent Idiopathic Scoliosis

Johnson

Gohel

Mitchell

et al. 2021

Journal of Pediatric Orthopaedics

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“…A whole spine magnetic resonance image (MRI) was performed on all patients with back pain without an identifiable cause and no prior spine treatment (surgical or conservative); after undergoing a non-diagnostic history, physical examination, and spinal X-ray, as utilized in previous studies. 3 , 5 , 9 , 10 Institutional review board (IRB) approval was obtained.…”

Section: Methodsmentioning

confidence: 99%

“…Individually, patients were asked: “On a scale from zero to ten, where zero means no pain and ten means the most or worst pain, how much pain are you experiencing?” Afterward, the sample data collected from pain intensity responses (NRS) were stratified into the following three groups: mild NRS score (one to three), moderate NRS score (four to six), and severe NRS score (seven to ten) pain intensity. 9 The cutoffs of each group were chosen given the previous models of score categorization described in previous studies. 10 Additional patient factors such as sex, age, frequency, night pain, neurological exam, and presence of an underlying pathology were compared between groups.…”

Section: Methodsmentioning

confidence: 99%

Assessing need for advance imaging among children with back pain using pain intensity as clinical marker

Olivella

Deliz-Jimenez

Lindsay

et al. 2022

Journal of Children's Orthopaedics

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Introduction: Pediatric back pain evaluation nowadays relies on patient history, physical examination, and plain radiographs to identify underlying pathologies. Constant pain, night pain, radicular pain, and abnormal neurological examination were previously recommended as clinical markers to assess the need for magnetic resonance imaging evaluation. Recent studies have challenged the use of these clinical markers, recommending further studies. This study aimed to assess pain intensity as a predictor of underlying magnetic resonance imaging pathology in children with back pain. Methods: An observational cross-sectional study of pediatric patients between 8 and 17 years with back pain for more than 4 weeks from 2009 to 2021 was conducted. A whole spine magnetic resonance imaging was performed on patients with back pain without an identifiable cause and no prior spine treatment. The numerical rating scale questionnaire was administered to each patient, and answers were divided into three groups: mild (1–3), moderate (4–6), and severe (7–10) numerical rating scale score. Student’s t-test and chi-square analysis were used to correlate differences between continuous and categorical values, respectively. Results: Of 590 patients (70% female and a mean age of 15.25 years), there were 35.1% of patients had a magnetic resonance imaging underlying pathology. No association was found between severe numerical rating scale score and the presence of underlying MRI pathology (p = 0.666). Patients with low or moderate numerical rating scale scores had similar associations to an underlying magnetic resonance imaging pathology as patients with a severe numerical rating scale score (p = 0.256; p = 0.357, respectively). Conclusions: Back pain intensity was not found to be an effective clinical marker for predicting underlying magnetic resonance imaging pathology in pediatric patients with back pain.

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Back pain in adolescent idiopathic scoliosis: frequency and risk factors

Sarkovich,

Leonardi,

Darlow

et al. 2024

Spine Deform

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Purpose Although back pain is commonly reported in patients with adolescent idiopathic scoliosis (AIS), factors that influence the presence and severity of back pain in AIS, including curve-specific variables, have not been well studied. This study aims to describe the prevalence and severity of back pain in AIS patients and determine the extent to which patient characteristics, including curve-specific factors, are associated with a higher risk of back pain in AIS. Methods The study was a retrospective medical records review of adolescents (aged 10–17 years) diagnosed with AIS between 01/01/2018 and 12/31/2021 at an academic tertiary children’s hospital. Patients with previous spine surgery were excluded. Variables collected included demographics (age, sex, race, insurance), Lenke classification, major coronal curve, back pain-related information, Risser stage, vitamin D levels, post-diagnosis brace utilization, physical therapy or chiropractic treatment, and surgery. Results A total of 891 AIS patients were included in the analysis. The sample was predominantly female (73.3%) and insured by Medicaid (57.8) with a mean age of 12.8 years. The mean major coronal curve was 26.3 degrees. Most patients had Lenke type 1 (47%) and type 5 (41%) curves. Nearly half of patients reported back pain (48.5%) with average pain severity in the low-to-moderate range (4.7) on FACES pain scale (0–10). Among those who reported back pain, 63.2% specified a location with the majority reporting pain in the lumbar region (56%) and, less commonly, in the thoracic (39%) and scapular (8%) regions. Lumbar pain was associated with significantly higher pain intensity (p = 0.033). Additionally, the location of pain reported was associated with location of major coronal curve (p < 0.0001). No association was observed between pain presence and vitamin D deficiency (p = 0.571, n = 175), major coronal curve magnitude (p = 0.999), Lenke curve type (p = 0.577), and sex (p = 0.069). Older patients, those insured by Medicaid, and those with higher Risser scores were more likely to report pain scores (p = 0.001 for all). Conclusion Nearly half (48%) of newly diagnosed AIS patients experience back pain which is higher than the prevalence of 33% seen in the general adolescent population. Pain was more prevalent among patients over the age of 13, with heavier body weight, and those insured by Medicaid. Pain was most commonly reported in the lumbar region, especially among patients with lumbar curves. This information can be helpful in counseling AIS patients, though further investigations are needed, especially to determine the underlying causes of back pain in AIS and to elucidate the discrepancy in pain between patients with Medicaid and commercial insurance. Level of evidence. Prognostic Study Level II.

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Is the numerical rating scale an adequate predictor for assessing MRI underlying pathologies among painful adolescent idiopathic scoliosis patients?

Cited by 3 publications

References 23 publications

Entire-spine Magnetic Resonance Imaging Findings and Costs in Children With Presumed Adolescent Idiopathic Scoliosis

Entire-spine Magnetic Resonance Imaging Findings and Costs in Children With Presumed Adolescent Idiopathic Scoliosis

Assessing need for advance imaging among children with back pain using pain intensity as clinical marker

Back pain in adolescent idiopathic scoliosis: frequency and risk factors

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