Preoperative pain experience and distribution in relation to mental health in Lenke type 1 and 2 adolescent idiopathic scoliosis: a prospective cross-sectional study

Spine Deform. 2026 Mar 18. doi: 10.1007/s43390-026-01328-8. Online ahead of print.

ABSTRACT

BACKGROUND: Pain is common in adolescents with idiopathic scoliosis (AIS), yet its distribution is heterogeneous and mechanisms remain incompletely understood. Beyond structural factors, emerging evidence suggests a psychosocial component with links to mental health. This study examined the relationship between preoperative pain and its distribution with mental health in Lenke type 1-2 AIS patients undergoing posterior spinal fusion.

METHODS: In this prospective single-center cohort study (July 2023-July 2025), Lenke type 1-2 AIS patients completed the revised SRS-22 (SRS-22r) questionnaire and a standardized 10-region pain diagram prior to corrective surgery. Concurrently, coronal and sagittal parameters were measured on EOS imaging. Group comparisons of SRS-22r domain scores between patients with and without pain were performed using the Mann-Whitney U test. An a priori power analysis (80% power, medium effect size 0.3, α = 0.05) indicated that a minimum of 10 patients per parameter was required to detect the intended effect. Univariable linear regressions were conducted to examine the associations between SRS-22r mental health scores, pain regions, and radiographic variables; models were run both unadjusted and adjusted for age, sex, and primary Cobb angle (α < .05).

RESULTS: Sixty patients (47 female; mean age 16.1 ± 2.3 years) were included and divided into a pain group (N = 42) and a no-pain group (N = 18). Patients without preoperative pain demonstrated significantly higher SRS-22r scores across all domains, with the most pronounced difference in mental health (p < 0.001). Within the pain group, neck region pain (R1) was reported by 21.4% of patients and was independently associated with lower mental health scores (β = -0.54, p = .029). No other pain regions or radiographic parameters were significantly associated with mental health outcomes.

CONCLUSION: In this study cohort, preoperative axial neck pain was associated with poorer mental health scores, whereas patients without pain consistently reported higher SRS-22r outcomes across all domains. No associations were found with radiographic parameters, underscoring the role of psychosocial factors in AIS and the need for further multicenter studies.

PMID:41845141 | DOI:10.1007/s43390-026-01328-8