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PubMedDate not supplied

Scoliosis in the institutionalized cerebral palsy population.

A prospective review of 272 institutionalized cerebral palsy residents was undertaken in order to determine the incidence and characteristics of neuromuscular scoliosis in this population. The types of cerebral palsy in the group consisted of 75% spastic, 8% dyskinetic, 4% ataxic, 8% mixed, and 5% undefined. There was a 64% incidence of roentgenographic scoliosis greater than 10 degrees. Two distinct curve patterns were determined with equal frequency, single and multiple. The significance of the curve patterns could not be determined. Scoliosis was most common in the spastic group with the highest incidence in the spastic quadriplegics. The incidence directly paralleled the severity of the neurologic deficit but also appeared to be aggravated by the effects of gravity when the individuals were artificially placed in the sitting position. There was a definite inverse relationship between the level of ambulation and scoliosis: the higher the level of ambulation the lower the incidence of scoliosis. Hip stability per se could not be correlated with the incidence of scoliosis. The most important factors in predicting scoliosis in this population are the presence of spasticity and the severity of the neurologic deficit.

Adolescent↗
PubMedDate not supplied

Scoliosis in the elderly: a follow-up study.

A follow-up x-ray study of 554 subjects aged between 50 and 84 years has been carried out to determine the appearance, presence, and progression of scoliosis in the elderly and its relationship to osteoporosis and back pain. The subjects were chosen from a population group of 3600 subjects examined 7 to 13 years previously in the same investigators. Some degree of scoliosis was found in 70% of the subjects, and curves of 10 degrees or more in approximately 30%. Ten percent of the subjects had developed scoliosis de novo during the follow-up period. There was no direct relationship between the presence or progression of scoliosis and osteoporosis. There was no direct relationship between scoliosis and back pain or between scoliosis and degenerative changes in the spine. Since scoliosis in the elderly seldom becomes a clinical problem of significance, there would appear to be no valid reason for a more extensive study of the condition at this time.

Age Factors↗
PubMed1994

Progression of scoliosis in children with myelomeningocele.

In a retrospective follow-up of 64 patients with myelomeningocele and scoliosis of more than 10 degrees, the development of the scoliosis curve was watched. The mean follow-up was 4.3 years. Most progression of scoliosis can be expected before 15 years of age. Fifty-four percent of the patients with scoliosis of 40 degrees or more progressed more than 5 degrees per year. Progression was dependent on the scoliosis angle. A multivariate model for the prediction of the scoliosis progress in a 1-year perspective was applied. The model included the current scoliosis angle, the age of the patient, the skeletal level of the dysraphism, and the patient's ambulation capacity.

Adolescent↗
PubMed1994

Preoperative spinal canal investigation in adolescent idiopathic scoliosis curves > or = 70 degrees.

STUDY DESIGN: This is a prospective evaluation of a consecutive series of patients with adolescent idiopathic scoliosis (AIS) with curves > or = 70 degrees. OBJECTIVE: The authors investigated the possibility that large curve size may constitute an atypical presentation of idiopathic scoliosis suggestive of underlying neurologic pathology, which would warrant preoperative investigation. SUMMARY OF BACKGROUND DATA: The potential for intraspinal pathology to cause scoliosis is well accepted. The incidence of spinal canal abnormalities in congenital or atypical scoliosis may be as high as 30-60%. Identification of clinical neurologic deficits, congenital abnormalities, or atypical features of scoliosis are often helpful in identifying the subpopulation of scoliosis patients at risk for spinal canal pathology. METHODS: Thirty-three consecutive patients with large (> or = 70 degrees) adolescent idiopathic scoliosis (AIS) and without evidence of neurologic or congenital abnormalities, were evaluated with either computed tomography/myelogram (n = 3) or magnetic resonance imaging (n = 30) to assess the entire spinal canal. RESULTS: None of the studies revealed any pathology of the neuraxis, and all 33 patients were treated with surgery without any neurologic sequelae. CONCLUSIONS: Preoperative investigation of the central neuraxis is not mandatory in large (> or = 70 degrees) but otherwise typical AIS curves. These large curves do not appear to suggest associated spinal canal anomalies.

Adolescent↗
PubMed1994

Scoliosis in Rett syndrome. Clinical and biological aspects.

STUDY DESIGN: The natural history of progression of scoliosis was studied. The authors included a wide range of ages and correlated progression and progression rate to both age of the patient and the neurobiologic staging of the disease. OBJECTIVES: The authors studied information compiled by Hagberg and coworkers regarding Rett syndrome. The total number of patients was 78, with age ranging from 1 to 34 years. Standing or sitting anteroposterior roentgenograms were collected and measured. METHOD: The material was studied initially separately regarding orthopedic and radiologic analysis on one hand and neurobiologic staging on the other. Radiographic films were measured both retrospectively and prospectively, and scoliosis angle and progression and progression rate was calculated. Staging of patients with Rett syndrome was done according to Hagberg. RESULTS: When correlating curve magnitude and progression, the authors found that patients progressing > 15 degrees/year were classified as IV-A or IV-B stages. In the 0-5 year group, of the patients already having a curve of 15 degrees or more, all but one rapidly progressed to stage IV. The ten worst cases were characterized by early hypotonia, weakness, and gross motor disturbance. CONCLUSIONS: The scoliosis in Rett syndrome is of a neurogenic type, and it develops earlier than idiopathic scoliosis. The development of scoliosis is dependent more on stage of disease than on age. Curve progression is usually more rapid than in idiopathic scoliosis and in most other types of neurogenic scoliosis in childhood and occurs in a broader age span. Early hypotonia, weakness, and muscular insufficiency, and an early clinical referral to disease stages IV-A or IV-B are ominous factors. Clinical follow-up should begin early and be repeated regularly and frequently.

Adolescent↗
PubMed1995

Increased femoral neck-shaft angles in adolescent idiopathic scoliosis.

STUDY DESIGN: Ninety-four females from Southern China, 61 with adolescent idiopathic scoliosis and 33 normal subjects, were evaluated for femoral neck shaft angles and associated asymmetry between the hips. For statistical analysis, the groups were divided into adolescent and adult, and the scoliosis group was further divided into sub-groups according to the type of spinal curvature. OBJECTIVES: To evaluate femoral neck-shaft angle and asymmetry between the hips, and their relation to adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Recently published studies have suggested there is an association between asymmetry of the hip and lower limb and the curvature in AIS. In this study, femoral neck-shaft angle in patients with adolescent idiopathic scoliosis and in normal subjects was evaluated. METHODS: Femoral neck-shaft angles of both hips and lateral spinal curvature (using Cobb's method) were measured from standard standing anteroposterior radiographs of the pelvis, including upper femora and spine. Methods of measuring femoral neck-shaft angles were evaluated in an intra- and inter-observer study and were found to be accurate. RESULTS: Patients with scoliosis had highly significantly greater femoral neck-shaft angles of both hips compared with normal subjects. In normal subjects, the femoral neck-shaft angle difference between the hips (asymmetry) was not statistically significant. This asymmetry in the scoliosis group also was not statistically significant when the results were analyzed upon grouping them all together, irrespective of curve pattern. CONCLUSION: Our new findings show that patients with scoliosis have abnormally increased femoral neck-shaft angles, and the asymmetry is characteristic and significantly different from that of normal subjects. Moreover, increased femoral neck-shaft angle is related to type and side of spinal curvature.

Adolescent↗
PubMed1996

A new method using top views of the spine to predict the progression of curves in idiopathic scoliosis during growth.

STUDY DESIGN: A prospective longitudinal study of 51 patients with idiopathic scoliosis using spinal stereoradiographs was performed. The top view, which was obtained from stereoscopic anteroposterior and lateral radiographs, was analyzed for predicting the progression of spinal deformity. OBJECTIVES: To show that the top view facilitates prediction of curve progression in idiopathic scoliosis at the initial examination. SUMMARY OF BACKGROUND DATA: Four progression factors were set up using the top view and were analyzed statistically for predicting progression. No previous study has assessed this concept. METHODS: Fifty-one patients with idiopathic thoracic scoliosis or combined thoracic and lumbar scoliosis were studied longitudinally. There were 24 untreated patients and 27 patients treated with braces. Four potential progression factors were evaluated using the top view: 1) the ratio of the frontal size and the sagittal size in the top view, 2) the magnitude and direction of the vector describing the plane of maximum curvature in the thoracic spine, 3) the magnitude and direction of the vector describing the plane of maximum curvature in the lumbar spine, and 4) the balance of these vectors between the thoracic and lumbar curve. All cases were classified into five groups according to these four factors. RESULTS: The probability of the progression was evaluated statistically, and the prevalence of curve progression was found in each group. The probability of progression of a scoliosis curve increased according to the increase of these four factors. No significant difference was found between Cobb angle at the initial examination and that at skeletal maturity in untreated patients with a small risk of progression. The patients with a large risk of progression and who were treated with braces showed progression of curvature despite brace treatment. CONCLUSION: The present study has evaluated factors relating to progression in scoliosis using the top view. These results may help predict the risk of progression in idiopathic scoliosis.

Adolescent↗
PubMed1996

Reducing the lifetime risk of cancer from spinal radiographs among people with adolescent idiopathic scoliosis.

STUDY DESIGN: Data from a retrospective cohort study of people with adolescent idiopathic scoliosis were combined with information on full-spinal radiographs to estimate contemporary x-ray doses and lifetime risks for development of cancer. OBJECTIVES: To project the lifetime risk for development of cancer from diagnostic radiographs for people with adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Although a twofold excess risk for breast cancer has been reported for women treated for scoliosis between 1925 and 1965, information on the cancer risks associated with scoliosis management today is sparse. Specifically, there is a lack of up-to-date information on the number of spinal radiographs taken, the organ-specific x-ray doses from current radiographic techniques, and the projected cancer risks. METHODS: The cohort consisted of subjects with adolescent idiopathic scoliosis who were referred to the scoliosis clinic of a large pediatric hospital between 1965 and 1979 in Montreal, Quebec, Canada. Based on radiographic equipment and practices implemented in 1982, organ-specific x-ray doses to the thyroid gland, female breast, respiratory organs, digestive organs, and bone marrow were calculated using Monte Carlo methods. These doses were incorporated into a life table procedure to calculate theoretic lifetime cancer risks. For all organs except the thyroid gland, dose-response models from the United States National Academy of Sciences Fifth Committee on the Biological Effects of ionizing Radiation were used. For thyroid cancer, a risk model was derived from a study of thyroid cancer incidence after x-ray treatment for tinea capitis. RESULTS: The average number of spinal radiographs was 12 for women (80% anteroposterior or posteroanterior) and 10 for men (78% anteroposterior or posteroanterior). Cumulative x-ray doses were in general higher in adolescents who were referred as younger teenagers than at later ages, and doses increased with the size of the spinal curve. Depending on the age at referral and curve size, the total excess lifetime cancer risks were calculated to range from 42 to 238 cases per 100,000 women and 14 to 79 cases per 100,000 men. For subjects who underwent surgery (those exposed to the highest doses), the lifetime number of cancer cases over and above background was almost as great as the number of thyroid cancers that would occur in the absence of radiation exposure. If the anteroposterior view was replaced by the posteroanterior view, a three- to sevenfold reduction in cumulative doses to the thyroid gland and the female breast would be achieved, yielding three- to fourfold reductions in the lifetime risk of breast cancer and a halving of the lifetime risk of thyroid cancer. CONCLUSIONS: The cancer risks from full-spinal radiographs for scoliosis are not negligible and can be reduced from one half to three quarters if the anteroposterior view is replaced with the posteroanterior view.

Adolescent↗
PubMed1996

Long-term alterations of respiratory function in adolescents wearing a brace for idiopathic scoliosis.

STUDY DESIGN: This is a prospective study. OBJECTIVE: The authors investigated the effects of continuous bracing for idiopathic scoliosis on lung function variables at three consecutive time points over a 2-year period. SUMMARY OF BACKGROUND DATA: Only short-term results regarding lung function impairment caused by bracing exist. METHODS: Thirty adolescents (aged 13.6 +/- 1.8 years) with primary idiopathic thoracic scoliosis of 28.7 degrees +/- 4.1 degrees and primary lumbar scoliosis of 26.5 degrees +/- 10.4 degrees were treated with a Boston brace. All patients underwent pulmonary function studies at the beginning of brace treatment and 12 and 24 months after treatment initiation. The examinations were always performed while the patients were sitting, in and out of the brace. Patients removed the brace for 1 hour before the measurements for non-brace-wearing were performed. Vital capacity, forced expiratory volume in 1.0 second, and minute ventilation were determined with a low inertia, low resistance bell spirometer. Lung volume, including total lung capacity and functional residual capacity, was recorded. RESULTS: The primary thoracic scoliosis was corrected to 14.5 degrees +/- 4.0 degrees and the primary lumbar scoliosis to 13.0 degrees +/- 6.0 degrees. The values of the following parameters taken while the brace was worn were significantly lower than those taken without the brace at all time points (one-way analysis of variance); vital capacity (P < 0.02), forced vital capacity (P < 0.03), functional residual capacity (P < 0.02), and residual volume (P < 0.05). Furthermore, the predicted negative residual volume and negative functional residual capacity values differed significantly in all time points from negative residual volume and negative functional residual capacity values of patients while wearing the Boston brace (P < 0.01 and P < 0.02, respectively). CONCLUSIONS: The results suggest that brace wearing for mild idiopathic scoliosis does not harm adolescent lung function over a 2-year period and is recommended for treatment of idiopathic scoliosis in early adolescence when the generally accepted criteria for bracing are fulfilled.

Adolescent↗
PubMed1997

The natural history of idiopathic scoliosis. Incidence of treatment in 15 cohorts of children born between 1963 and 1977.

STUDY DESIGN: This study analyzed the incidence of treatment of scoliosis using a cross-sectional and a longitudinal technique. OBJECTIVES: To follow the incidence of treated scoliosis in Malmö, Sweden, in children born between 1970 and 1977 and compare observations with those of a study from 1988, in which the incidence of this disorder was followed in children born between 1963 to 1969. SUMMARY OF BACKGROUND DATA: During the late 1970s and early 1980s, the incidence of treated scoliosis decreased yearly in Malmö. This trend was supported by other reports. However, introduction of worldwide screening for scoliosis was a confounding factor. When cohorts of children born between 1963 and 1969 were analyzed, no change was found. In a study in Malmö in 1988, this was shown to be an effect of using a longitudinal instead of a cross-sectional technique of analyzing the data. METHODS: In a cross-sectional study, the authors registered all new treatments for idiopathic scoliosis, brace treatments, or direct surgery, for each year between 1984 and 1993. In a longitudinal study, all new treatments in each cohort of children born between 1970 and 1977 were followed. The results were compared with figures from the 1988 study. RESULTS: After the introduction of school screening in 1976, a peak in the incidence of treated scoliosis was seen in 1977. After a continuous decrease in the incidence until 1983, a steady state developed. In cohorts born between 1963 and 1977, the incidence is neither increasing nor decreasing. CONCLUSIONS: In cohorts of children followed in a longitudinal study over a 15-year period (born between 1963 and 1977), there is no support for a change in the natural history of idiopathic scoliosis.

Child↗
PubMed1997

Scoliosis induced by asymmetric lordosis and rotation: an experimental study.

STUDY DESIGN: An experimental study of the influence of intrinsic muscle imbalance on the spinal column of a growing rabbit. OBJECTIVES: To create an in vivo experimental model of scoliosis for comparison with human scoliosis. SUMMARY OF BACKGROUND DATA: There is evidence that asymmetric lordosis may produce scoliosis and that there is muscle imbalance in scoliotic patients. METHODS: Surgical tethering of the spinous apophysis and transverse apophysis of rabbits was performed at three upper levels on the same side of the spine to simulate dominance of one side of the paravertebral musculature over the other. RESULTS: All animals exhibited scoliosis that was convex toward the side opposite that receiving surgery. Radiography showed the curve to increase with time. Postmortem examination of vertebrae revealed structural alterations similar to those produced in human scoliosis. CONCLUSIONS: Intrinsic muscle imbalance in the spinal column of the experimental growing animal may produce scoliosis with characteristics similar to those of human idiopathic scoliosis.

Animals↗
PubMed1997

Relation between adolescent idiopathic scoliosis and morphologic somatotypes.

STUDY DESIGN: A prospective and controlled comparative study. OBJECTIVES: To verify the difference in morphologic appearance between a group of adolescents with progressive adolescent idiopathic scoliosis and a control group of normal adolescents. SUMMARY OF BACKGROUND DATA: In a previous retrospective study, the possibility of a relation between progressive adolescent idiopathic scoliosis and specific morphotypes was demonstrated. METHODS: Fifty-two adolescent girls with progressive adolescent idiopathic scoliosis were compared with an age-matched control group of 62 unaffected girls using a classification technique based on morphologic somatotypes. Morphotypes were evaluated with standardized pre-established criteria based on Sheldon's technique. RESULTS: Patients with progressive adolescent idiopathic scoliosis showed significantly less mesomorphism (mean value of 0.88 +/- 0.51) than control girls (mean value of 1.72 +/- 0.52). CONCLUSION: Adolescent girls with progressive adolescent idiopathic scoliosis have a morphologic somatotype that is different from the normal adolescent population. Subjects with progressive adolescent idiopathic scoliosis are significantly less mesomorphic than control girls. This observation may be of value as a predictive factor for early identification of subjects with adolescent idiopathic scoliosis at greater risk of progression.

Adolescent↗
PubMed1998

Osteoid osteoma and osteoblastoma of the spine. Factors associated with the presence of scoliosis.

STUDY DESIGN: A retrospective study of 44 museum cases of spinal osteoid osteoma or osteoblastoma and a meta-analysis using 421 additional cases from a review of the literature. OBJECTIVES: To identify the factors that are associated with the development of scoliosis in these patients. SUMMARY OF BACKGROUND DATA: Painful scoliosis is a well recognized presentation of spinal osteoid osteoma and osteoblastoma and is considered to be secondary to pain-provoked muscle spasm on the side of the lesion. Previous studies have been based on small numbers of patients that did not permit statistical validation of the reported observations. METHODS: Eight factors were assessed including: age, gender, duration of symptoms, site of lesion in the spine, vertebral level of lesion, site of lesion in the individual vertebra, type of lesion, and Cobb angle at presentation. Reports were reviewed only if the presence or absence of scoliosis could be determined. Statistical analyses initially were performed on the museum cases and then on a combination of museum cases and cases from the literature. RESULTS: Overall, 63% of subjects had scoliosis. The lesions were typically present on the concave aspect of the curve. Three cases of scoliosis from the literature involved lesions that were reported to be on the convexity. Scoliosis is significantly more common in cases of osteoid osteoma than in cases of osteoblastoma (P < 0.0001); lesions are more common in the thoracic and lumbar regions than in the cervical region (P < 0.0001), in lower cervical region than in the upper cervical region (P value = 0.0027), and they are more commonly located to one side of the midline (P < 0.0001). Age, gender, and duration of symptoms were of no significance. CONCLUSIONS: The findings support the concept that scoliosis is secondary to asymmetric muscle spasm in patients with spinal osteoid osteoma or osteoblastoma.

Adolescent↗
PubMed1998

Changes in collagen cross-linking in degenerative disc disease and scoliosis.

STUDY DESIGN: Biochemical study of the changes in the collagen cross-link profile of human intervertebral discs collected at surgery from patients with either low back pain associated with disc degeneration or scoliosis. OBJECTIVE: To determine whether changes occur in the collagen cross-link profile in the disc of patients with either low back pain associated with disc degeneration or scoliosis, which may well influence matrix integrity. Such changes in the cross-link profile of a tissue indicates increased matrix turnover and tissue remodeling and may have implications for the progression of these disorders. SUMMARY OF BACKGROUND DATA: The diseases of the intervertebral disc, degenerative disc disease and scoliosis, are both characterized by changes in the extracellular matrix components that will affect the mechanical function of the tissue. The stability of the collagenous components and hence the mechanical integrity of connective tissues such as the disc is dependent on the degree and type of cross-links between the collagen molecules. This article reports results on the distribution of the different cross-links in the disc and the changes that occur with age, degenerative disc disease, and scoliosis. METHODS: Thirty-three discs were obtained from patients with degenerative disc disease and 29 discs from patients with scoliosis. Samples were acid hydrolyzed and the collagen cross-links analyzed by either fractionation on an amino acid analyzer configured for cross-link analysis using ninhydrin postcolumn detection or fractionation by high-pressure liquid chromatography with fluorescence detection. RESULTS: The reducible cross-links and the mature cross-link all increased from the outer anulus fibrosus through into the nucleus pulposus. The highest levels of the mature cross-link were found in the cartilage end-plate. The nonenzymic derived cross-link, pentosidine, in contrast, showed little difference across the disc, but did show the expected age-related increase. In degenerative disc disease, no change in the levels of the reducible or mature cross-links was found, but a decrease was observed in the levels of the age-related cross-link pentosidine in the more severe disease samples. In scoliosis, significantly higher levels of the reducible cross-links were found on the convex than on the concave side of the scoliotic disc. CONCLUSIONS: These changes in the cross-link profile of the intervertebral disc in degenerative disc disease and scoliosis are indicative of increased matrix turnover and tissue remodeling and likely to have implications for the progression of these disorders.

Adolescent↗
PubMed2000

Safety of sublaminar wires with Isola instrumentation for the treatment of idiopathic scoliosis.

STUDY DESIGN: To investigate the incidence of acute neurologic complications of use of sublaminar wires with third-generation spine instrumentation for the treatment of idiopathic scoliosis. OBJECTIVES: To assess the safety of sublaminar wires in the surgical treatment of idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: The use of sublaminar wires in spine deformity for neuromuscular scoliosis and the Luque system has been reported. Use of sublaminar wires is an integral part of the technique in the surgical treatment of spine deformity with Isola instrumentation (AcroMed, Cleveland, OH). To date, the safety of this technique has not been documented. METHODS: The average age of the patients was 37 years (range, 11-74 years). Preoperative diagnosis was adolescent idiopathic scoliosis in 75 patients and adult idiopathic scoliosis in 66. One hundred nine were primary surgeries, and 32 were revision. Detailed evaluation of the curve type, curve magnitude, number of vertebrae instrumented, level of vertebrae wired, postoperative neurologic deficit, and the findings of intraoperative spinal cord monitoring was performed. Wires were always passed just before corrective maneuvers were performed. RESULTS: A total of 1366 wires were placed, 65% (n = 888) in the thoracic region, 22% (n = 300) in the thoracolumbar, and 13% (n = 178) in the lumbar. No permanent change in intraoperative spinal cord monitoring was detected. Stagnara wake-up test was performed in all patients. No patient with adolescent idiopathic scoliosis had neurologic complication. Two adults underwent revision surgery and had transient dysesthesia in the leg, which completely resolved with observation. CONCLUSION: Despite the increasing complexity of spinal instrumentation systems, sublaminar wire placement is a safe and useful adjunct in the surgical treatment of neurologically intact patients with idiopathic scoliosis.

Adolescent↗
PubMed2000

Scoliosis in rhythmic gymnasts.

STUDY DESIGN: An anamnestic, clinical, radiographic study of 100 girls actively engaged in rhythmic gymnastics was performed in an attempt to explain the higher incidence and the specific features of scoliosis in rhythmic gymnastic trainees. OBJECTIVES: To analyze the anthropometry, the regimen of motion and dieting, the specificity of training in rhythmic gymnastics, and the growth and maturing of the trainees, and to outline the characteristics of the scoliotic curves observed. An etiologic hypothesis for this specific subgroup of scoliosis is proposed. SUMMARY OF BACKGROUND DATA: The etiology of scoliosis remains unknown in most cases despite extensive research. In the current classifications, no separate type of sports-associated scoliosis is suggested. METHODS: The examinations included anamnesis, weight and height measurements, growth and maturing data, eating regimen, general and back status, duration, intensity, and specific elements of rhythmic gymnastic training. Radiographs were taken in all the patients with suspected scoliosis. The results obtained were compared with the parameters of normal girls not involved in sports. RESULTS: A 10-fold higher incidence of scoliosis was found in rhythmic gymnastic trainees (12%) than in their normal coevals (1.1%). Delay in menarche and generalized joint laxity are common in rhythmic gymnastic trainees. The authors observed a significant physical loading with the persistently repeated asymmetric stress on the growing spine associated with the nature of rhythmic gymnastics. Some specific features of scoliosis related to rhythmic gymnastics were found also. CONCLUSIONS: This study identified a separate scoliotic entity associated with rhythmic gymnastics. The results strongly suggest the important etiologic role of a "dangerous triad": generalized joint laxity, delayed maturity, and asymmetric spinal loading.

Adolescent↗
PubMed2001

Osteopenia in adolescent idiopathic scoliosis: a histomorphometric study.

STUDY DESIGN: Bone biopsies from iliac crest and spinous process of adolescent idiopathic scoliosis patients were obtained intraoperatively for histology and histomorphometric analysis. OBJECTIVES: To study the histologic features of cancellous bone and to correlate the histomorphometric variables with preoperative bone mineral density in patients with adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Low bone mineral density has been reported in adolescent idiopathic scoliosis. However, there is limited information about the histopathologic changes. METHODS: Undecalcified and decalcified bone specimens from iliac crest and spinous process of adolescent idiopathic scoliosis patients obtained intraoperatively were stained with Goldner and hematoxylin & eosin stain, respectively. Results were correlated with bone mineral density of the lumbar spine (L2-L4) and proximal femur measured before surgery. RESULTS: Bone histology showed significant less osteocyte count in the trabecular bone characterized with smooth and continuous borders in patients with adolescent idiopathic scoliosis. Histomorphometry confirmed the lower static parameters. The results correlated well with the decreased bone mineral density. CONCLUSION: Bone biopsy study suggested disturbance of bone turnover in patients with adolescent idiopathic scoliosis. The abnormal metabolism might contribute to the low bone mineral density and play an important role in the etiology and pathogenesis of adolescent idiopathic scoliosis.

Adolescent↗
PubMed2001

Progressive scoliosis in cri-du-chat syndrome over a 20-year follow-up period: a case report.

STUDY DESIGN: A long-term follow-up study of a patient who had scoliosis associated with cri-du-chat syndrome was performed. OBJECTIVE: To describe for the first time the characteristics and natural course of progressive scoliosis in a patient with cri-du-chat syndrome. SUMMARY OF BACKGROUND DATA: Scoliosis is a common condition in patients with cri-du-chat syndrome. However, there are no reports on the clinical characteristics and course of this spinal deformity. METHODS: The current condition and radiographs of a 33-year-old man with cri-du-chat syndrome were assessed. The records and serial radiographs of his spine were reviewed retrospectively over a 29-year period, between ages 4 and 33 years. RESULTS: The scoliosis had started before the initial radiographic examination and progressed rapidly during the growth period. After this stage, slow but continuous progression was observed over the next 10 years. The final curvature was quite substantial, measuring 119 degrees. CONCLUSIONS: To determine the most appropriate treatment for the scoliosis associated with cri-du-chat syndrome, the characteristics and natural course of the scoliosis should be clarified. Although this first report on this type of scoliosis is informative, more cases and further studies are needed.

Cri-du-Chat Syndrome↗