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PubMed2003

The feasibility, safety, and utility of vertebral wedge osteotomies for the fusionless treatment of paralytic scoliosis.

STUDY DESIGN: Before-after intervention study of a fusionless surgical technique to correct scoliosis secondary to spinal cord injury or myelodysplasia in children and adolescents. OBJECTIVES: To determine the feasibility, safety, and utility of a fusionless treatment option for paralytic scoliosis. Once determined, these data could then be applied to develop the application of this operation for patients with other types of scoliosis, such as idiopathic. SUMMARY OF BACKGROUND DATA: The optimal operative treatment for paralytic scoliosis remains to be determined. An ideal procedure would correct the deformity and stop the progression of scoliosis while maintaining mobility of the spine. This latter fact is important, especially for patients who rely heavily on use of trunk mobility for function. METHODS: Fourteen patients with scoliosis secondary to spinal cord injury or myelodysplasia underwent a fusionless vertebral body wedge osteotomy procedure. Feasibility was analyzed by the ability to correct the scoliosis with the osteotomies and preserve mobility. Safety was reported by estimated blood loss, neurologic stability, and complications. Utility was reported by radiographic evidence of arrested curve progression and maintenance of spinal mobility. RESULTS: All 14 patients successfully underwent surgery to insert the wedge-rod system, with an average initial correction of 86% (range 66%-108%). The average estimated blood loss was 1050 cc (range 300-2000 cc). There were no major complications, and no changes in spasticity, bowel or bladder patterns, or motor/sensory levels. There was no case of nonunion at the osteotomy sites. At mean follow-up of 15 months (6-29 months), 10 patients had an improvement in their Cobb magnitude, 1 patient was within 5 degrees of their initial curve, 1 patient had a worse Cobb magnitude, and in 2 patients, the curve direction reversed but still measured less than the preoperative Cobb measurement. Spinal mobility was retained in all patients, as demonstrated on side-bending radiographs. CONCLUSIONS: The vertebral wedge osteotomy procedure appears to be a potential option for the treatment of paralytic scoliosis. The procedure was feasible and safely performed in these 14 patients, with spinal mobility maintained. There were no nonunions. The efficacy of the procedure is still not known, as is for which patients the procedure is indicated and timing of the operation. Long-term follow-up (to skeletal maturity) is needed. Only six of the patients are currently skeletally mature, and more numbers are needed to determine efficacy in this group.

Adolescent↗
PubMed2004

Melatonin signaling dysfunction in adolescent idiopathic scoliosis.

STUDY DESIGN: In vitro assays were performed with bone-forming cells isolated from 41 patients with adolescent idiopathic scoliosis and 17 control patients exhibiting another type of scoliosis or none. OBJECTIVE: To determine whether a dysfunction of the melatonin-signaling pathway in tissues targeted by this hormone is involved in adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Pinealectomy in chicken has led to the formation of a scoliotic deformity, thereby suggesting that a melatonin deficiency may be at the source of adolescent idiopathic scoliosis. However, the relevance of melatonin in the etiopathogenesis of that condition is controversial because most studies have reported no significant change in circulating levels of melatonin in patients with adolescent idiopathic scoliosis. METHODS: Primary osteoblast cultures prepared from bone specimens obtained intraoperatively during spine surgeries were used to test the ability of melatonin and Gpp(NH)p, a GTP analogue, to block cAMP accumulation induced by forskolin. In parallel, melatonin receptor and Gi protein functions were evaluated by immunohistochemistry and by coimmunoprecipitation experiments. RESULTS: The cAMP assays demonstrated that melatonin signaling was impaired in osteoblasts isolated from adolescent idiopathic scoliosis patients to different degrees allowing their classification in 3 distinct groups based on their responsiveness to melatonin or Gpp(NH)p. CONCLUSION: Melatonin signaling is clearly impaired in osteoblasts of all patients with adolescent idiopathic scoliosis tested. Classification of patients with adolescent idiopathic scoliosis in 3 groups based on functional in vitro assays suggests the presence of distinct mutations interfering with the melatonin signal transduction. Posttranslational modifications affecting Gi protein function, such as serine residues phosphorylation, should be considered as one possible mechanism in the etiopathogenesis of AIS.

Adenylyl Cyclases↗
PubMed2005

Scoliosis after median sternotomy in children with congenital heart disease.

STUDY DESIGN: A retrospective review of spinal deformity in patients with congenital heart disease surgically treated through a median sternotomy before the age of 8 years. Assessment was done on chest roentgenograms at skeletal maturity. OBJECTIVES: To determine if patients surgically treated through a median sternotomy present a higher prevalence of spinal deformity. SUMMARY OF BACKGROUND DATA: Congenital heart disease is associated with a higher prevalence of scoliosis. The etiology of scoliosis in this group of patients is unknown. Thoracotomy causes scoliosis, but median sternotomy has not been identified as a causal agent in these patients. METHODS: Chest roentgenograms were done after skeletal maturity in 128 patients to assess for the presence of a spinal deformity in the sagittal or coronal plane as a result of a median sternotomy for treatment of congenital heart disease before the age of 8 years in patients without any prior radiographic evidence of spinal or costal deformity before surgery. RESULTS: Forty-four (34.3%) of these patients had scoliosis greater than 10 degrees , 16 of them (12.5%) had curves greater than 20 degrees , and 33 (25.8%) had thoracic kyphosis lesser than 20 degrees . Patients operated before the age of 18 months had a significantly increased risk of developing scoliosis than those operated at a later age (odds ratio = 3.5; confidence interval = 1.3-9.6; P = 0.016). The presence of scoliosis was not related to the type of congenital heart disease. CONCLUSIONS: There is a high prevalence of scoliosis in patients with congenital heart disease surgically treated through a median sternotomy. The prevalence of scoliosis increases in patients operated at an earlier age.

Adolescent↗
PubMed2005

Significant ventilatory functional restriction in adolescents with mild or moderate scoliosis during maximal exercise tolerance test.

STUDY DESIGN: A prospective evaluation of cardiopulmonary tolerance to maximal exercise in adolescent idiopathic scoliosis. OBJECTIVES: To evaluate ventilatory functional restrictions during a maximal exercise tolerance test in idiopathic scoliosis patients with mild and moderate curves and to compare them with the results obtained in healthy adolescents matched in age undergoing similar test. SUMMARY OF BACKGROUND DATA: Adolescents with idiopathic scoliosis with mild curves do not exhibit significant restrictions in ventilatory parameters measured by conventional static spirometry. Few reports have dealt with cardiorespiratory response to maximal exercise in adolescent idiopathic scoliosis with mild to moderate curves. Although results seem to show a reduced exercise tolerance in these patients, the frequency and signification of the restricted work capacity is uncertain because of important design limitations in previous studies. METHODS: Thirty-seven girls diagnosed with adolescent idiopathic scoliosis with a mean age of 13 years (range, 11-16) and an average scoliotic curve of 32.8 degrees Cobb (range, 20-45 degrees) were studied by basal spirometry and dynamic ventilatory parameters during a maximal exercise tolerance test. Similar studies were performed in a control group of 10 healthy girls matched in age. Exercise test consisted of a ramp protocol on treadmill starting at a speed of 0.75 m/second (2.7 km/hour) with increments of 0.2 m/second (0.72 km/hour) per minute. All subjects completed the test to exhaustion to determine maximal oxygen uptake (VO2 max) and ventilatory efficiency parameters. RESULTS: There were no differences between scoliotic and healthy girls in basal ventilatory parameters (FVC, FEV1). However, adolescents with idiopathic scoliosis showed worse tolerance to exercise test with lower maximal speed average (9.4 km/hour versus 11.5 km/hour, P < 0.005), lower ventilatory efficiency at maximal exercise (VE: 68.9 L/minute versus 82.3 L/minute, P < 0.01), early anaerobic threshold, and a lower aerobic power expressed by 23% decreased body weight normalized VO2 max (38.6 mL/kg/minute versus 49.0 mL/kg/minute, P < 0.001). VEmax values were correlated to the severity of the scoliotic curve. Patients with more severe curves had greater limitation of ventilatory capacity (r = -0.374, P < 0.05). Maximal breath frequency was higher in scoliotic girls (54 versus 47, P < 0.05) suggesting a compensatory mechanism adopted in response to the lower ventilatory capacity during demanding exercise. When ventilatory efficiency was considered by the VE/VO2 ratio, scoliotic girls disclosed higher values than control (average 35.2 versus 29.6, P < 0.001) indicating an inefficiency in their ventilation. Patients wearing a brace at the time of ventilatory functional assessment did not exhibit any difference in the parameters investigated both at basal spirometry and during exercise tolerance test. CONCLUSION: Although patients with mild or moderate scoliosis do not exhibit cardiopulmonary restrictions in basal static conditions, they do show a significant lower tolerance to maximal exercise. Respiratory inefficiency together with lower ventilation capacity and lower VO2 max may be responsible for reduced exercise tolerance in adolescents with idiopathic scoliosis. Exercise deconditioning in scoliotic patients cannot be attributed to brace treatment.

Adolescent↗
PubMed2005

Scoliosis in association with infantile hypophosphatasia: a case study in two siblings.

STUDY DESIGN: A case study of scoliosis in two siblings with infantile hypophosphatasia and review of literature are presented. OBJECTIVES: To report the rare occurrence of scoliosis in two siblings with infantile hypophosphatasia and detail problems in the surgical management of scoliosis in this rare disease. SUMMARY OF BACKGROUND DATA: To the authors' knowledge there is only one reported case of scoliosis in infantile hypophosphatasia. However, there is no report describing the nature of the curve, its progression, or the surgical management of scoliosis in infantile hypophosphatasia. METHODS: The first sibling was diagnosed shortly after birth to have scoliosis that progressed rapidly despite brace treatment. At 4 years, he underwent anterior convex arthrodesis and posterior T6-L1 Luque trolley stabilization. Because of further curve progression, he had to undergo corrective anterior and posterior osteotomies, stabilization, and fusion at 11 years of age. The second sibling was diagnosed to have scoliosis at the age of 3 years and underwent anterior thoracoscopic release and posterior Luque trolley stabilization. RESULTS: The first sibling with a mild form of infantile hypophosphatasia had to undergo multiple procedures to attain fusion and arrest of curve progression. The second sibling with a severe variety of infantile hypophosphatasia surprisingly attained a spontaneous fusion of the curve following the initial correction and stabilization with no further progression at 9-year follow-up. CONCLUSIONS: Curve progression and fusion rates following scoliosis correction are not related to the disease severity or biochemical findings. These rapidly progressive curves are amenable to surgical correction despite the unfavorable metabolic nature of the disease. Hypercalcemia and seizures responding to pyridoxine are complications in the postoperative period of which the surgeon should be aware.

Child, Preschool↗
PubMed2005

Long-term outcome in neuromuscular scoliosis fused only to lumbar 5.

STUDY DESIGN: Outcomes are retrospectively compared for patients with neuromuscular scoliosis after instrumented surgery and fusion to the pelvis versus lumbar 5 fusion alone. OBJECTIVES: To compare outcomes for patients with neuromuscular scoliosis for correction of scoliosis, lumbar 5 tilt, and pelvic obliquity after instrumented surgery and pelvic fusion, and by fusion only to lumbar 5. SUMMARY OF BACKGROUND DATA: Correction of scoliosis and pelvic obliquity in neuromuscular disease using spinal instrumentation is an accepted surgical procedure. Controversy remains concerning the caudal extent of fusion and instrumentation to lumbar 5 or to the sacrum. METHODS: Patients with progressive neuromuscular scoliosis underwent spinal fusion with segmental instrumentation using a U-rod terminating in pedicle screw fixation at L5. Similar patients underwent spinal fusion with a unit rod and sacral fusion. RESULTS: From 1998 to 2002, 55 patients with neuromuscular scoliosis underwent instrumentation and L5 fusion with the U-rod or to the sacrum with the unit rod. Initial and long-term corrections of scoliosis and pelvic obliquity were similar in both groups. CONCLUSIONS: Instrumentation and fusion to L5 is a less technically difficult procedure, requires less surgical time, has decreased blood loss, and less risk of infection compared to instrumented pelvic fusion. Postoperative and long-term follow-up indicates that L5 fusion can correct scoliosis and pelvic obliquity, comparable to results of sacrum fusion.

Adolescent↗
PubMed2005

The effect of scoliosis surgery on lung function in the immediate postoperative period.

STUDY DESIGN: Prospective, single-cohort study. OBJECTIVES: To determine the immediate change in pulmonary function test (PFT) in children following scoliosis surgery. SUMMARY OF BACKGROUND DATA: The number of pediatric scoliosis surgeries is increasing each year because of recent advances in spinal instrumentation, surgical techniques, and improved perioperative monitoring. Pulmonary function decreases immediately following scoliosis surgery, but the extent of this decrease is not well documented in pediatric patients. To use preoperative PFTs to assess the risk of postoperative complications, knowledge of the postoperative decline in PFT is necessary. METHODS: We measured preoperative and daily postoperative PFT in 24 children who had scoliosis surgery (age 12.7 +/- 2.7 [SD] years) from January 2002 to June 2003. There were 10 male and 14 female patients. Two (8%) patients had congenital scoliosis, 11 (46%) had idiopathic scoliosis, 9 (38%) had scoliosis due to a neuromuscular disease, and 2 (8%) had kyphoscoliosis. Fifteen (62%) patients had posterior spinal fusion (PSF), 5 (21%) had anterior spinal fusion (ASF), and 4 (17%) had both ASF and PSF performed. PFT parameters (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], FEV1/FVC, and forced expiratory rate between 25% and 75% of FVC [FEF25%-75%]) were measured before surgery and daily after surgery by bedside spirometry until hospital discharge. RESULTS: PFT declined up to 60% after surgery. The PFT nadir is at 3 days. PFT values remained significantly decreased at 1 week, with values at about half of preoperative baseline. No patient required postoperative mechanical ventilation > or =3 days. There was no statistical significance between the degree of decline in PFT with etiology of either the scoliosis or the type of surgery performed. CONCLUSIONS: Our study found that patients are still at risk for postoperative complications as long as 1 week postoperatively and that PFTs do not return to near baseline until 1 to 2 months after surgery. The postoperative decrease in PFT should be considered during preoperative prediction of postoperative risk.

Adolescent↗
PubMed2005

Surgical treatment for scoliosis in Marfan syndrome.

STUDY DESIGN: Review of results of patients with Marfan syndrome treated with instrumented posterior fusion alone for scoliosis. OBJECTIVE: To analyze the results of surgical treatment for scoliosis in Marfan syndrome. SUMMARY OF BACKGROUND DATA: Few studies have been reported in the literature on surgical treatment for scoliosis in Marfan syndrome, analyzing long-term results of posterior instrumented fusion. METHODS: Twenty-three patients with Marfan syndrome with a mean age of 17 years (range, 11-31 years) were treated surgically from 1982 to 1995 for scoliosis, using a posterior instrumented fusion alone (Harrington rod with sublaminar wires in the first 16 cases, and a more recent hybrid instrumentation in the remaining 7 cases). All of the patients received a long posterior instrumented fusion, including 12.3 levels on average (range, 9-17), extending the fusion area to vertebrae that were neutral and stable in both coronal and sagittal planes before surgery. Patients were analyzed as two different groups (Group 1 and Group 2) according to the different posterior instrumentations employed: Group 1 included 16 patients treated by the Harrington distraction rod technique with sublaminar wires, while Group 2 included 7 patients treated using more recent hybrid instrumentations. Presentation features, complications, and results were analyzed. RESULTS: At a minimum follow-up of 7 years (maximum, 18 years), all 23 patients were reviewed. The mean age was 26.8 years (range, 20-38 years). The average preoperative scoliosis value of 69.91 degrees was initially corrected to 38.17 degrees, averaged 40.89 degrees 1 year after surgery, and was finally equal to 44.09 degrees at the last follow-up. Differences in terms of scoliosis correction achieved with different instrumentations (Groups 1 and 2) did not reach statistical significance. In Group 2 patients, the percentage of postoperative correction was slightly lower (44.23%) than that of Group 1 (46.55%) but remained more stable at the last follow-up (40.97% vs. 36.38% of Group 1). There were 11 complications in 10 of the 23 patients (43.4%); two complications occurred in 1 patient. Intraoperatively, dural tears occurred in 2 cases (8.6%). Pseudarthrosis with instrumentation failure in 2 cases (8.6%) required revision surgery. Five (21.7%) distal hook dislodgements with moderate loss of scoliosis correction, 1 (4.3%) mild loss of correction without instrumentation failure, and 1 asymptomatic cervicothoracic junctional kyphosis. did not require surgery. All complications occurred among the 16 Group 1 patients, treated using the Harrington rod instrumentation with sublaminar wires. CONCLUSIONS: These results seemed to demonstrate that a satisfactory stabilization of scoliosis can be achieved by posterior instrumentation alone in patients with Marfan syndrome. Instrumented posterior fusion should be extended to include vertebrae that are neutral and stable in both coronal and sagittal planes before surgery, in order to ensure stabilization of the deformity and reduce the risks of decompensation of the spine.

Adolescent↗
PubMed2006

Creation of an experimental idiopathic-type scoliosis in an immature goat model using a flexible posterior asymmetric tether.

STUDY DESIGN: Longitudinal follow-up of animals after a surgically initiated scoliosis. OBJECTIVE: To create a progressive, structural, idiopathic-type, lordoscoliotic curve convex to the right in the thoracic spine of the immature goat using a flexible posterior asymmetric tether with minimal disruption of the spinal elements along the curve. SUMMARY OF BACKGROUND DATA: Our previous work created an experimental scoliosis model using a rigid posterior asymmetric tether to study the safety and efficacy of fusionless scoliosis treatments. Posterior asymmetric tethers, whether rigid or flexible, represent the most reliable method of creating an experimental deformity that approximates idiopathic scoliosis. Although our initial rigid model was unique in creating progressive structural scolioses without violation of the essential spinal elements along the curve, there were a number of shortcomings associated with the model. These included substantially stiff curves and unpredictability of curve progression. METHODS: Scoliosis was created in 24 Spanish Cross X female goats (age, 6-8 weeks; weight, 8-12 kg) using a braided synthetic ligament as a left posterior asymmetric tether from T5 to L1. Convex rib resection and concave rib tethering from ribs 8 to 13 were performed without disruption of the spinal elements before tensioning of the posterior tether. All goats were followed over an 8-week period with serial radiographs to document progression of the deformity. At the end of 8 weeks, the 20 goats with progressive curves were randomized into treatment groups for a separate study. However, 6 of these 20 remained untreated in the subsequent study and, therefore, were followed for an additional 12 to 16 weeks. RESULTS: There were two deaths in the early postoperative period due to pulmonary complications. Of the remaining 22 goats, 20 (91%) developed progressive, structural, idiopathic-type, lordoscoliotic curves convex to the right in the thoracic spine. Initial scoliosis after tethering measured 55.4 degrees on average (range, 37 degrees-75 degrees) and progressed to 74.4 degrees on average (range, 42 degrees-93 degrees) over 8 weeks. The average progression of 19.0 degrees (range, 5 degrees-33 degrees) was statistically significant (P < 0.001). The average initial lordosis after tethering measured -18.9 degrees (range, -13 degrees to -27 degrees) and progressed to -40.7 degrees on average (range, -28 degrees to -56 degrees) over 8 weeks. The average progression in lordosis of -21.8 degrees (range, -5 degrees to -43 degrees) was significant (P < 0.001). CONCLUSIONS: This study demonstrated the effectiveness of a flexible posterior asymmetric tether in creating idiopathic-type deformities in a shorter tethering period than previously described. With substantial remaining spinal growth after the 8-week tethering period and preservation of the essential spinal elements in an undisturbed state, this model is suitable for the study of scoliosis progression and various fusionless scoliosis treatment methods.

Animals↗
PubMed1983

Scoliosis in the community.

Screening for scoliosis at schools has become more and more popular despite the lack of knowledge concerning the clinical course of idiopathic scoliosis. An epidemiological study of 5303 schoolchildren showed three types of scoliosis in the community: (1) pelvic tilt scoliosis (an inconsequential deformity caused by an inequality in the length of the legs but accounting for almost 40% of curves detected); (2) spinal scoliosis (a minor asymmetry of the spine in the coronal plane that tends to remain static or to resolve and which may be normal in growing children, accounting for the remaining 60%); and (3) progressive scoliosis (10% of the spinal scolioses measuring 10 degrees or more that progress by 5 degrees or more a year). Progressive scoliosis resembles idiopathic scoliosis because in girls with right thoracic curves the potential for progression is appreciable. Until the natural history is better established growing awareness in the community of spinal deformity should help earlier detection, and screening should be directed towards providing subjects for further epidemiological work.

Adolescent↗
PubMed1999

A genomic approach to scoliosis pathogenesis.

Genetic predisposition contributes to scoliosis in humans. Two syndromes of primary scoliosis occur--congenital scoliosis, which presents at birth, often associated with other abnormalities, and idiopathic scoliosis which becomes apparent between infancy and adolescence. Little is known regarding the genetic transmission of scoliosis risk. Data gleaned from mouse mutations provide a valuable supplement to human family studies. More than 50 mouse mutations include scoliosis, kyphosis, or tail kinks as a phenotype; the locations of the human homologues for 28 of these can be predicted on the basis of synteny conservation. Some mouse mutations are either more penetrant or more fully expressed in one sex. The mouse data provide a basis both for optimism and for caution in understanding human scoliosis. Mouse models provide insight into mechanisms underlying spinal curvature and help direct searches for genes important in human disease. Four types of defects account for most mouse scoliosis: defects of cell-cell communication, intracellular signal transduction, matrix protein synthesis, and matrix protein metabolism. Mouse data suggest that at least two types of heterogeneity complicate genetic analysis: locus heterogeneity, in which lesions of distinct genes lead to a similar phenotype, and allelic heterogeneity, in which the phenotypes arising from alleles of a single gene differ. By focusing initial studies on multiplex families with apparent simple Mendelian inheritance the effect of heterogeneity is minimized.

Animals↗
PubMed2003

Primary cervical dystonia and scoliosis: a multicenter case-control study.

OBJECTIVE: To study the distribution of prior scoliosis among patients with primary adult-onset cervical dystonia (CD) and matched control subjects. METHODS: Case and control subjects were selected among consecutive outpatients attending four Italian centers. Control outpatients were matched for age (+/-5 years), sex, and referral center. Information on prior scoliosis, other spine diseases, and family history of dystonia was obtained by a standardized questionnaire and supported by medical records. Conditional logistic regression models were used to adjust simultaneously for age, disease duration, and education level and to determine the independent association of exposure variables with the outcome. RESULTS: Prior scoliosis developing in middle or late childhood or at around the puberty occurred more frequently among 72 case patients than among 144 neurologic control subjects. No subject reported conditions considered to be responsible for secondary scoliosis. The association of scoliosis and CD was not confounded by age, duration of disease, education level, other spine diseases, or family history of dystonia (adjusted odds ratio [OR] 6.8; 95% CI 1.5 to 29.5; p = 0.011). The OR of family history of dystonia (18.7; 95% CI 2.4 to 147.5; p = 0.005) fell to 11.7 (95% CI 1.3 to 103; p = 0.03) after controlling for scoliosis. CONCLUSIONS: Prior scoliosis may increase the risk of developing CD. The observed decrease in the magnitude of the association between family history of dystonia and CD after controlling for scoliosis suggests a link between the two conditions.

Adolescent↗
PubMed2001

The effect of spinal fusion on the long-term outcome of idiopathic scoliosis. A case-control study.

We have investigated the effect of multisegmental spinal fusion on the long-term functional and radiological outcome in patients with scoliosis. We compared these patients both with those whose spine had not been fused, and with a control group. We studied 68 patients with idiopathic scoliosis (34 operative and 34 non-operative) who had been followed up for a minimum of five years after treatment. They were matched for age (mean 44 years) and Cobb angle (mean 54 degrees) at follow-up. An age- and gender-matched control group of 34 subjects was also recruited. All participants completed a questionnaire to assess spinal function and to grade the severity of back pain using a numerical rating scale. Radiographs of the spine were taken in the patients with scoliosis and lumbar degenerative changes were recorded. The spinal function scores for the patients with scoliosis who had had a fusion were similar to those who had not. Both scoliosis groups, however, had lower scores than the control group (p < 0.001). The frequency and severity of back pain were lower for patients with scoliosis and fusion than for those without, but higher for both scoliosis groups compared with the control group. Radiographs showed similar degenerative changes in both scoliosis groups.

Adult↗
PubMed2005

Comparison of the volume of scoliosis surgery between spine and pediatric orthopaedic fellowship-trained surgeons in New York and California.

BACKGROUND: Controversy exists regarding the optimal fellowship training experience for surgeons who perform scoliosis surgery in pediatric patients. While many studies have demonstrated that higher surgical volumes are associated with superior outcomes, the volume of scoliosis procedures performed by pediatric orthopaedic-trained surgeons as opposed to spine surgery-trained surgeons has not been reported. METHODS: Validated, statewide hospital discharge databases from the states of New York and California were utilized to examine the volume of spinal fusion procedures performed for the treatment of scoliosis in patients who were eighteen years of age or less. Fellowship training of surgeons in New York who had performed more than fifty procedures from 1992 to 2001 (that is, more than five procedures per year) was determined, and the operative volumes of surgeons who had received pediatric orthopaedic as opposed to spine fellowship training were compared. Hospitals in California with either type of fellowship program were identified, and the operative volumes of hospitals and fellows with pediatric orthopaedic or spine fellowship training from 1995 to 1999 were compared. RESULTS: Among the 228 surgeons in New York who had performed one or more spinal fusion procedures in patients eighteen years of age or less from 1992 to 2001, only 13% (thirty) had performed more than five procedures per year. However, these thirty surgeons accounted for 75% (3858) of all 5136 procedures in this age-group. Surgeons who had completed a pediatric orthopaedic fellowship had performed a mean of 14.5 procedures per physician per year, whereas those who had completed a spine fellowship had performed a mean of 10.5 procedures per physician per year. Surgeons who had not completed either type of fellowship had performed a mean of 14.4 procedures per physician per year. In California, the mean annual volume of scoliosis procedures from 1995 to 1999 was 59.0 procedures per year at hospitals with pediatric orthopaedic fellowship programs and 15.7 procedures per year at those with spine surgery programs. The mean number of procedures per fellow at hospitals with pediatric orthopaedic fellowship programs was 31.6 procedures per fellow per year, and the mean number at hospitals with spine surgery programs was 12.7 procedures per fellow per year. Over time, there was a significant increase in the number of procedures per year at hospitals with both types of fellowship programs, but the percentage increase was greater for hospitals with pediatric orthopaedic fellowship programs than for hospitals with spine surgery fellowship programs (45.2% compared with 13.5%). CONCLUSIONS: These data indicate that, on the average, a large number of surgeons in New York performed five scoliosis procedures per year or fewer. Among higher-volume surgeons in New York, those with pediatric orthopaedic fellowship training performed more scoliosis procedures on children and adolescents than those with orthopaedic spine training did. In California, the volume of scoliosis procedures at hospitals with pediatric orthopaedic fellowship programs was nearly four times greater than that at hospitals with spine fellowship programs and the volume of procedures per fellow was more than two times greater, and this disparity is widening over time. These data are an important element in establishing what type of fellowship best prepares surgeons for scoliosis surgery.

Adolescent↗
PubMed2005

The efficacy and integrity of shape memory alloy staples and bone anchors with ligament tethers in the fusionless treatment of experimental scoliosis.

BACKGROUND: Scoliosis is a complex three-dimensional deformity with limited treatment options. Current treatments present potential problems that may be addressed with use of fusionless techniques for the correction of scoliosis. However, there are few data comparing the efficacy of different fusionless implant strategies in controlling scoliosis or on the integrity of rigid compared with flexible devices in an in vivo setting over time. The objective of this study was to compare the efficacy and integrity of rigid and flexible anterior thoracic tethers used to treat experimental scoliosis. METHODS: Experimental scoliosis was created in twenty-four Spanish Cross-X female goats and was subsequently treated with either anterior shape memory alloy staples or anterior ligament tethers attached to bone anchors. Serial radiographs were analyzed to determine the efficacy of the implants in controlling scoliosis progression as well as the integrity of the implants at study completion. After the goats were killed, the implants were analyzed with use of three quantitative indices of implant integrity and implant pullout testing. RESULTS: Over the treatment period, scoliosis progressed from 77.3 degrees to 94.3 degrees in the goats treated with staples and was corrected from 73.4 degrees to 69.9 degrees in the goats treated with bone anchors, with loosening of eighteen of forty-two staples (two of the eighteen dislodged) and evidence of drift in two of forty-nine anchors. Histologic sections revealed a consistent halo of fibrous tissue around the staple tines but well-fixed bone anchors at all sites. Pullout testing demonstrated that bone anchors had greater strength than staples initially and at the study completion, with an increase in bone anchor fixation over the course of the study. CONCLUSIONS: In this scoliosis model, the flexible ligament tethers attached to bone anchors demonstrated greater efficacy and integrity than the more rigid shape memory alloy staples.

Alloys↗
PubMed1982

A prospective prevalence study of scoliosis in Southern Sweden.

In Malmö, Sweden, 17,181 school children born in the years 1961-1965 were screened for scoliosis once a year between the ages of 7 and 16 years, during 1971-1980. Children with clinical signs of scoliosis including a positive forward bending test were admitted to the Department of Orthopedic Surgery for reinvestigation and AP roentgenograms. There were 474 children with a scoliosis measuring 5 degrees of more (prevalence 2.8 per cent). Among the girls this prevalence was 4.3 per cent (n = 367) and among the boys 1.2 per cent (n = 107). This combined screening test revealed in girls a higher percentage of scoliosis measuring 10-14 degrees than 5-9 degrees, 1.3 and 1.1, respectively. In boys, however, the number of curves measuring 5-9 degrees was almost equal to the number exceeding 9 degrees. Thus, the rotational component of the scoliosis seems to be less pronounced in girls and curves less than 10 degrees can easily be missed in them. Therefore, 10 degrees is recommended as the lower limit when using this screening technique. With 10 degrees as the lower limit, the scoliosis prevalence was 3.2 per cent in girls and 0.5 per cent in boys. Ninety-six of the girls (1.1 per cent) had a scoliosis exceeding 19 degrees. 46 showed a progression of the scoliosis, which indicated brace treatment in 42 cases and surgical treatment in 4 cases. Among the boys 12 had curves measuring more than 19 degrees (0.14 per cent). Four boys with curves exceeding 24 degrees were treated with a brace. Thus, the risk of progression was higher in girls as compared with boys; 0.5 per cent of the girls and 0.05 per cent of the boys were treated. Another 0.2 per cent of the girls should also have been treated but, for various reasons, treatment was not carried out.

Adolescent↗
PubMed1998

Curve patterns and etiologies of scoliosis: analysis in a university hospital clinic in Taiwan.

BACKGROUND: The curvature characteristics and etiologies of scoliosis have been well documented in many countries and among different races but have seldom been reported for Asians. We aimed to determine the etiology frequency and curvature characteristics of scoliotics in Taiwan. MATERIALS AND METHODS: From July 1994 through December 1997, 648 new patients with scoliosis were examined. A whole spine standing radiographic study was taken for each patient. The data were collected prospectively for analysis. RESULTS: Idiopathic scoliosis was the leading type in our series (86%), followed by congenital (6%) and neuromuscular scoliosis (5%). Single thoracic curve was the most common curve pattern (37%), followed by single lumbar (30%), double major (13%), single thoracolumbar (13%), and double thoracic curve (6.6%). The most frequent types of curve were right thoracic (28%) and left lumbar curve (22%), and these were defined as typical curves. The average curve magnitude was smaller in patients with atypical curves (left thoracic or right lumbar) and large curves were not commonly seen. The average curve magnitude increased in patients from the ages of 8 to 12 years and it exceeded Cobb's angle of 20 degrees at the age of 11. CONCLUSION: Idiopathic scoliosis is the most frequent etiology of scoliosis in Taiwan. In our series, idiopathic scoliosis was female predominant (4.3:1), but there were no gender ratio differences in non-idiopathic patients (p < 0.001). Left thoracic curve occurred more often in juvenile idiopathic scoliotics (p = 0.006). Atypical curves were more resistant to curve progression and seldom induced large curves. School scoliosis screening beginning at age 11 is adequate and effective in Taiwan.

Adolescent↗
PubMed2000

[Epidemiological study on idiopathic scoliosis in high school students. Prevalence and relation to physique, physical strength and motor ability].

OBJECTIVE: We applied the tuberculosis examination radiographs to scoliosis screening in high schools. Prevalence, physique, physical strength and motor ability of the students with scoliosis were investigated. METHODS: In this study, 3,299 the first year high school students (1,597 males and 1,702 females) in Wakayama Prefecture, who had taken chest X-ray photographs between 1993 and 1995, were examined and 106 cases (22 males and 84 females) were identified with scoliosis of more than 10 degrees Cobb angle. Each of the cases was assigned age- and sex-matched controls without scoliosis. These pairs were investigated as to the following items: body height, body weight, sitting height, chest girth, leg length, body mass index, vertical jump, side-to-side jump, back strength, grasping power, trunk extension, standing trunk flexibility, 50 m dash, long jump, handball throwing, and chinning. RESULTS: The body weight, chest girth, and body mass index was significantly lower in girls with scoliosis. As to physical strength and motor ability, only standing trunk flexibility was significantly lower in girls with scoliosis. CONCLUSION: Tuberculosis examination radiographs were useful for scoliosis screening in high schools. We found that girls with scoliosis were thinner. We think it is necessary for school teachers to pay more attention to their students' life style.

Adolescent↗