Differential diagnosis of back pain in adult operated scoliosis patients

Back pain in adult operated scoliosis patients is a usually a major postoperative problem which has to be differentially diagnosed from a number of pathologies. The infection, immediate or delayed infection after elective spinal instrumentation and fusion is the principal postoperative problem for the patient and the surgeon. Surgical treatment is mandated in the majority of these cases, with the use of antibiotic treatment as well. Pseudarthrosis of the fusion is another major problem which needs surgical treatment as well. Some of the hardware problems that may occur are loosening, failure, inappropriate placement, prominence of hardware posteriorly or allergic reaction to it. Adjacent disc disease that is disc failure above or below fusion is a follow up problem appearing after some time postoperatively. Progression of curve after fusion can also happen and is connected to post op deterioration. Spinal balance problems, (trunk imbalance after fusion) create a serious disability to the patient. Flat back syndrome (mainly back pain after Harrington rod instrumentation for idiopathic scoliosis) also creates severe low back pain and disability. Thoracic (rib-cage) problems, rib pain after thoracoplasty and donor graft site pain (complications of iliac crest bone grafting in spine surgery) can appear postoperatively as well.