Akademik Veri Yönetim Sistemi
EUROPEAN SPINE JOURNAL, 2026 (SCI-Expanded, Scopus)
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 R-2 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 degrees vs. 17.2 +/- 7.0 degrees, p = 0.030) and greater T2-T12 kyphosis (38.7 +/- 10.8 degrees vs. 30.0 +/- 8.8 degrees, 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 degrees increase in T2-T12 kyphosis tripled the odds of achieving MCID, whereas a 5 degrees increase in T2-T5 kyphosis reduced the odds by 70%. The final model was highly predictive (Nagelkerke R-2 = 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.