Analysis of low back pain in adults with scoliosis

STUDY DESIGN: Prospective study of self-assessed symptom severity.

OBJECTIVES: To carry out a comparative semiological analysis of pain in scoliotic and nonscoliotic adults with low back pain, and to study the factors that correlate with the severity of pain in scoliotic patients.

SUMMARY OF BACKGROUND DATA: Low back pain is a frequent complaint in subjects with adult lumbar scoliosis. Few studies have taken an interest in the semiological specificities of lumbar pain in such patients.

METHODS: Fifty adults with lumbar scoliosis and suffering from chronic low back pain and 50 nonscoliotic adults with chronic low back pain, matched for age and gender underwent a standard examination. The characteristics of the pain described in the 2 groups were compared. Relationships between the features of the scoliosis and the intensity of the pain were sought.

RESULTS: There was no difference between the 2 groups with regard to pain severity (duration and intensity). The pain evolved more steadily in scoliotic patients. Inguinal pain (P < 0.001) and cruralgia (P < 0.05) were particularly associated with scoliosis. In scoliotics, the severity of the low back pain correlated well with the radiologic aspects: Cobb angle (P < 0.05), vertebral rotation (P < 0.05) and rotatory olisthesis (P < 0.05). Cruralgia was significantly associated with the presence of rotatory dislocation (P < 0.01).

CONCLUSION: The pain felt by scoliotic adults has several semiological features, in particular the frequency of inguinal pain and cruralgia. Lumbar scoliosis with a great curvature and/or rotatory olisthesis increases the intensity of low back pain in adults. These findings suggest that the magnitude of the curvature and the existence of rotatory olisthesis must be targeted for prevention and treatment of the chronic low back pain in subjects with a lumbar scoliosis.