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Children in the scoliosis surgery ward rarely have the possibility of meeting a psychologist to get support in this difficult situation. As we know, not all children can manage their pain on their own and discharge anger born out of the situation in a constructive way. The purpose of the study is to estimate the strength of individual beliefs conditioning the management of pain (internally), the influence of staff on the management of pain (the influence of others) as well as accidental factors. Also, the objective is to estimate the level of internal and external expression of anger and to estimate the mood of a child before and after the surgery. 52 children between the age of 12.5-17 years old (35 girls and 17 boys) were examined with the Pain Control Beliefs questionnaire by Suzanne Skevington and the Expression of Anger Scale by Oginska. Children who believed their pain was an accidental occurrence reported their mood as being at its lowest, before and after the procedure. Their estimation of the pain experience was the highest. The group taking part in the examination (except for one person) showed a much higher internal expression of anger than that of external which could suggest that they cannot discharge their anger arising out of this difficult situation. It is recommended to expand this research on a bigger group of children and to include psychological support as a standard procedure before and after the surgery for spinal deformity in order to decrease the level of fear and to work with constructive anger discharge.

Back pain is frequently reported as a symptom of adolescent idiopathic scoliosis (AIS). Prediction of pain in adulthood would be useful to identify subjects requiring follow-up. The aim is to determine adolescent predictors of adult back pain. This study is a retrospective review of 27 females with AIS who attended our pediatric scoliosis clinic and later completed the SRS-22 questionnaire as young adults (range 18-25 years). Subjects with surgery at baseline (age 14-16 years) were excluded. The relationships between largest curve size, decompensation and trunk twist at baseline and pain as measured by the SRS-22 pain domain as young adults were studied. At baseline, subjects had a largest curve of 47+/-15 degrees , decompensation of 18+/-14 mm and trunk twist of 14+/-6 degrees . At follow-up, 5.3+/-1.9 years later, the total SRS-22 score was 3.9+/-0.3 and the pain domain score was 3.9+/-0.7. Pearson correlations between the SRS-22 pain domain and largest curve, decompensation and trunk twist were 0.17, -0.11 and -0.25, respectively (p>0.05). Individual questions within the pain domain had similar correlations. Even though the sample represented a wide range of scoliosis severity at baseline and a wide range of pain scores (2.4 to 5) at follow-up, baseline scoliosis deformity parameters of largest curve size, decompensation and trunk twist did not predict scoliosis-related pain in young adulthood.

Unlabelled: A new questionnaire (The Bad Sobernheim Stress Questionnaire BSSQ) has been developed to assess the psychological stress scoliosis patients develop as a consequence of their deformity. The aim of this study was to determine this stress level in a sample of adolescents with scoliosis., Materials and Methods: 206 Patients were recruited to the study and completed a questionnaire (8 items). The average age was 15.7 years with an average Cobb angle of 35.8 degrees. All subjects returned a fully completed questionnaire. Plausibility of the results was assessed by examining for consistent responses to two plausibility questions., Results: The average stress value was 19.97 / 24, which can be regarded as "low stress". The average stress value in the group meeting the plausibility threshold (n = 155) was 21 / 24 while the average stress value in the group not meeting the threshold (n = 51) was 15.9 / 24, regarded as "medium stress". This correlated negatively with the Cobb angle (r = -.54; p < 0,001). The Cobb angle / test value correlation was highest in thoracic curves (n = 87; r = -.49; p < 0,001) and lowest in double major curves (n = 46; r = -.27; p = 0,03)., Conclusions: Adolescents with scoliosis have on average only "low stress" associated with their deformity. Not fulfilling a plausibility threshold seems to be a predictor for more stress associated with the scoliotic deformity.

Aim: To determine whether either spine or trunk deformity measurements correlate with patients quality of life questionnaire responses., Materials and Methods: Forty five pre operative patients (5M, 40F), average age 15 years, 9 months (range, 10-20) met the inclusion criteria of age (< or = 20 years), Posterior Trunk Symmetry Index (POTSI) and Suzuki Hump Sum (SHS) determination from surface topography, and Scoliosis Research Society-22 (SRS-22)patient questionnaire completion. Average measurement and measurement ranges were largest Cobb 62 degrees (range, 40-137 degrees), POTSI 49 (range, 17-149), SHS 16 (5-32), and SRS-22 subtotal score 3.86 (range, 4.7-2.35). The individual SRS-22 domain scores were function 4.13 (4.80-2.20), pain 4.01 (5-1.60), self image 3.34 (4.4-1.80) and mental health 4.01 (5-1.80). (Scale 5 Best-1 Worst). Correlations between deformity and questionnaire measurements were determined, p<0.01 considered significant., Results: Spine deformity (Cobb) correlated with the SRS-22 subtotal scores (cc-04207, p<0.005) and with the function and self image SRS-22 domain scores: cc0.5182, p<0.001) and cc-0.3981, p<0.01 respectively. Neither trunk deformity score correlated with the SRS-22 Score: POTSI versus SRS-22 (cc 0.0449, ns) and SHS versus SRS-22 (cc-0.0311, ns), Conclusion: Spine deformity correlates well with quality of life questionnaire responses whereas trunk deformity magnitude does not. This is somewhat surprising as it is the trunk deformity that the patient can they themselves see. These findings illustrate the pitfalls of assuming what is important to the patient based on clinical measurements.

Scoliosis may lead to multiple impairments depending on its seriousness. Here we have to make the distinction between direct impairments in the physical field and indirect impairments in the psychosocial field. The findings of different studies indicate that the psychosocial situation in juvenile and adult scoliotic patients is characterized by increased strain. The present study is meant to answer the question in which fields of quality of life female scoliotic patients are impaired and if these impairments are dependent of age or seriousness of illness (Cobb angle). Between May 1998 and February 1999, 226 female patients with idiopathic scoliosis were surveyed in a special clinic for spinal deformities with the help of different quality of life measuring instruments (SF-36, BFW, STAIK) and were compared with norm values. Women with idiopathic scoliosis were questioned with the help of an age adapted set of questionnaires containing questions referring to the health related quality of life (SF-36, BFW, STAIK). The results were compared to the norm values and examined in uni- and multivariat procedures (MANOVA) in order to find out if age and seriousness of illness (Cobb angle) have any impact on the quality of life. In comparison to the norm random sample, the juvenile female scoliosis patients showed a less positive point of view towards life (p = .001) and were easier subject to depressive moods (p = .021). The increased strain of adult patients was shown both in the psychic field (p < .001) and in the physical field (p < .001) (SF-36). These results are largely independent of the seriousness of illness (Cobb angle) and of the patients' age. The results indicate that idiopathic scoliosis in children, adolescents and adults can be regarded as a risk factor for the impairment of health related quality of life and thus stress the importance of psychosocial offers during a patient-orientated scoliosis treatment in order to improve the management of scoliosis.

The goal of this pilot study was to explore the relationship between pelvic obliquity and patient pain, sitting tolerance, pressure sores, and function. Five neuromuscular patients who underwent spinal surgery 6-26 weeks prior to assessment took part in this on-going study (4F; 1M); age at surgery (14.6 +/- 2.6 years). Pelvic obliquity was measured from pre- and post-operative anterior-posterior radiographs. A force-sensing pad with a grid of sensors was placed on a flat surface and the weight distribution pattern was recorded. The pressures were divided into left and right sides and peak levels were noted on each side. The parents or caregivers completed a questionnaire on their child's pain, sitting tolerance, pressure sores, and functional abilities. Pelvic obliquity was reduced after surgery by approximately 50% depending on the method used to assess pelvic obliquity. The major curve was reduced from 64 degrees(10 degrees) to 39 degrees (10 degrees). Post operatively, the average pressure (left/right side) ranged from 1.2 to 2.0 (average 1.6). The peak pressure ratio ranged from 1.1 to 1.9 (average 1.4). The ratio of left/right pressure correlated with improvement in pelvic obliquity (r2=0.9). Pain was moderate/severe in the 2 patients with the least correction as measured with the Cobb angle from surgery; both improved following surgery. Two patients suffered pressure sores pre-operatively and one post-operatively. Only 3/5 felt sitting endurance had increased. All parents felt their child sat straighter after surgery. The outcome measures of pain, pressure sores, sitting tolerance, and function were not well related to the amount of pelvic obliquity. More candidates and a longer follow-up may shed light on the many relationships.

Spinal deformity presenting early in childhood has a poor prognosis, in that progression is probable and severe respiratory compromise is a real possibility. Treatment is difficult, since these patients frequently do not respond to bracing, and surgery is sometimes performed in childhood in an attempt to control relentless progression. This carries the risk of continued deformation during subsequent growth, and the surgical procedures have been adapted in an attempt to minimise this. 25 children undergoing spinal fusion for progressive and severe deformity have sequential topographic scans which show that, despite measures to control the rib hump, progression after surgery is the rule.