Prévalence, mesures et méthodes alternatives de traitement de la douleur dorsale chez les adolescents ayant une scoliose idiopathique

Adolescent idiopathic scoliosis is a three-dimensional spinal deformity. This pathology is the most common spinal deviation encountered in adolescents and has been thoroughly researched over the past few decades regarding its aetiological factors, its risk of progression and management. It is now commonly accepted that the aetiology of adolescent idiopathic scoliosis is multifactorial and includes, among other things, genetic, hormonal, mechanic, and neuromuscular factors. Though predicting which deviation will progress remain challenging, certain factors such as the age of the patient at presentation, its gender, bone maturity (Risser sign), menarchal status, and the severity of the spinal deformity are now widely accepted as factors that may provide some guidance to estimate this probability. Adolescent idiopathic scoliosis has often been considered as a non-painful pathology, and this is perhaps why researchers have failed to assess back pain in this population more systematically. Only a few studies have been published over the last two decades on this subject. Among those studies, inclusion criteria are widely heterogeneous, as is the working definition of back pain, how the prevalence period was estimated, and which outcome measure was relied upon to assess back pain in this population. Because of this, the determination of back pain prevalence in scoliosis patients remains challenging. Considering the relationship between adolescent and adult spinal pain, and the high societal cost associated with this condition, it would be appropriate to obtain a clearer picture of this condition in this population. v The primary objectives of this thesis were to (objectif 1) update the current knowledge of back pain prevalence in adolescent idiopathic scoliosis patients, to (objectif 2) ascertain if a relationship was present between the severity and localisation of the scoliosis and the back pain, too (objectif 3) reassess the psychometric properties of the SRS-22fv questionnaire, and to (objectif 4) explore an alternative back pain management for those patients. The first retrospective study included in this thesis assessed back pain prevalence in 300 adolescent idiopathic scoliosis patients. It also looked at how pain was reported and if pain management was recommended for patients reporting back pain. This study confirmed that back pain was a prevalent condition in this population and that in the vast majority of those reporting back pain, there was no kind of management recommended. The second prospective study assessed back pain prevalence in more than 500 adolescent idiopathic scoliosis patients. Point prevalence of back pain was close to 68 %. For the thoracic and lumbar regions, the pain was positively associated with the severity of the scoliosis and bracing, prescribed to stabilise or prevent the curve progression, had a protective effect. Data collected in the previous study were employed to validate the most commonly utilised outcome measure in adolescent idiopathic scoliosis, the SRS-22. The SRS-22 is a measurement instrument used to ascertain the quality of life and pain in scoliotic patients. The third article includes a report on analyses done regarding the validation of the SRS- 22fv. Complete data were available for 352 adolescents. The study demonstrated that a briefer version (18 items) had a better internal consistency and explained a greater proportion of the variance thus 63,3 % instead of 47,4 % for the SRS-22fv. vi The last study included in this thesis looked at an alternative treatment for the management scoliotic patients with or without back pain. This modality of spinal manipulation is a treatment that healthy adolescents commonly utilised. However, it was found that the rate of utilisation remains unclear within adolescent idiopathic scoliosis patients. A literature review revealed the need to have better-designed studies to assess the efficacy of spinal manipulation in this population adequately. The acquired knowledge throughout this thesis leads us to a better comprehension and understanding of back pain in adolescent idiopathic scoliosis patients. Back pain appears to be more prevalent than initially estimated and a relationship seems to be present between the level of pain intensity and the scoliosis localisation and severity in patients suffering from this pathology.

Keyphrases: SRS-22, Adolescent idiopathic scoliosis, Back pain, Spinal manipulation