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PubMed2001

Changing curve pattern in infantile idiopathic scoliosis: family report with a follow-up of 15 years.

STUDY DESIGN: The authors monitored a father and his six children, all of whom had idiopathic scoliosis for more than 13 years. OBJECTIVE: To analyze the similarities and differences in curve pattern between the family members. SUMMARY OF BACKGROUND DATA: The etiology and pathogenesis of idiopathic scoliosis are not well understood. Genetic factors play an important role, as is shown by the high concordance in monozygotic twins. METHODS: Radiographs from all family members were analyzed. Location and direction of the curve, Cobb angle, location of the apex, and rib-vertebra angle difference were compared. RESULTS: A father and his six children had idiopathic scoliosis. The curves differed within the family and changed during follow-up. The father had a left convex thoracic scoliosis of 42 degrees. Only three of the children had a curve of similar severity, and only four children had a left convex thoracic scoliosis. In three children the curve pattern changed during follow-up. CONCLUSIONS: This report of idiopathic scoliosis in a father and six children supports the present theories on a genetic origin of the disorder but also stresses the importance of dynamic processes in the development of scoliosis.

Adolescent↗
PubMed2002

Quality of life in women with idiopathic scoliosis.

STUDY DESIGN: The health-related quality of life of 226 female patients with idiopathic scoliosis was compared with that in age-matched general population norms. OBJECTIVES: To describe and characterize health-related quality of life in women with idiopathic scoliosis, taking into account age, Cobb angle, and brace use. SUMMARY OF BACKGROUND DATA: Scoliosis may lead to multiple physical and psychosocial impairments depending on its severity. Previous studies have assessed generic health measures, functional status, body image, and self-image. Health-related quality of life data from patients with idiopathic scoliosis are still lacking. METHODS: Women with idiopathic scoliosis completed an age-appropriate health-related quality of life questionnaire (either the 36-Item Short-Form Health Status Survey, SF-36, or the Berner Questionnaire for Well-Being). The results from this sample were compared with general population norms. In univariate and multivariate analyses it was determined whether age, Cobb angle, and brace use had an impact on health-related quality of life. RESULTS: Compared with the age-matched general population norm, juvenile patients with idiopathic scoliosis were unhappier with their lives (P = 0.001). They reported more physical complaints (P < 0.001) and had lower self-esteem (P = 0.01) and higher depression scores (P = 0.021). Adult patients reported more psychologic (P < 0.001) and physical impairment than in the population norm (P < 0.001). These results were largely independent of age and Cobb angle. CONCLUSION: The results show that health-related quality of life can be impaired in patients with idiopathic scoliosis. Therefore, the psychosocial situation should be taken into account in the treatment of these patients.

Adolescent↗
PubMed2002

Evaluation of ventilatory efficiency during exercise in patients with idiopathic scoliosis undergoing spinal fusion.

STUDY DESIGN: A prospective evaluation of ventilatory function following spinal fusion in adolescent idiopathic scoliosis. OBJECTIVES: To prospectively evaluate pulmonary function, maximal oxygen uptake, and ventilatory efficiency during exercise in patients with adolescent idiopathic scoliosis before surgery and a minimum of 2 years postoperation. SUMMARY OF BACKGROUND DATA: For reasons that are unclear, patients with untreated adolescent idiopathic scoliosis tend to avoid aerobic exercise. Their reluctance may be the result of low ventilatory efficiency, as they often approach their ventilatory ceiling at maximum oxygen uptake despite forced vital capacities that are near normal. This inefficiency of ventilation with exercise may explain the reluctance of patients with scoliosis to pursue aerobic fitness. No study has evaluated the effect spinal fusion has on the ventilatory function of patients with scoliosis during exercise. METHODS: Forty-two patients with adolescent idiopathic scoliosis (36 female and 6 male) at an average age of 14 +/- 3 years (range 10-18 years) underwent spinal fusion. Twenty patients underwent a posterior spinal fusion alone, 20 an anterior spinal fusion alone, and 2 an anterior spinal fusion and posterior spinal fusion. The average Cobb measurement was 55 degrees (range 40-85 degrees). Pulmonary function values (forced vital capacity, total lung capacity, maximum voluntary ventilation), maximum oxygen uptake (VO2max), and ventilatory efficiency were obtained before surgery and a minimum of 2 years postoperation. RESULTS: For all patients, forced vital capacity percent predicted decreased from 88.1% to 81.4% (P < 0.0001). Total lung capacity also declined from 90.5% to 88.5% but was not statistically significant (P = 0.189). Percent predicted maximum oxygen uptake (VO2max) declined from 93.6% to 85.1% (P = 0.00029). Ventilatory efficiency, as measured by VEmax/maximum voluntary ventilation, improved from 0.76 to 0.68 (P = 0.005), whereas measured by VEmax/FEV1 x 40 was unchanged from 0.69 to 0.70 (P = 0.172) postoperation. The choice of operative approach [anterior (n = 20) versus posterior (n = 20)] or whether rib graft was harvested (n = 33) versus iliac crest graft (n = 7) did not change these results. CONCLUSION: Improvement in ventilatory efficiency during exercise does not occur in the majority of patients with adolescent idiopathic scoliosis following spinal fusion and thus cannot be relied on to foster increases in aerobic activity.

Adolescent↗
PubMed2002

Sports activity of patients with idiopathic scoliosis at long-term follow-up.

OBJECTIVE: The aim of the study was to assess long-term the sports activities of operatively and nonoperatively treated patients with idiopathic scoliosis and compare these activities with those of controls. STUDY DESIGN: Cross-sectional case-control study, performed at The Orthopaedic University Hospital Heidelberg. PATIENTS AND METHODS: The study enrolled 59 patients (53 female, 6 male; mean age 43 years) with idiopathic scoliosis and a minimum follow-up of 5 years (mean 22 years) since treatment (28 nonoperative, 31 operative). Mean Cobb angle at the time of the study was 54 degrees. An age-adjusted control group (n = 33) with no history of spinal disorder was evaluated at the same time. All participants in the study (n = 92) completed a questionnaire assessing spinal function (Spine Score) and sporting activity (Sport Score). In addition, the scoliosis patients underwent radiographic evaluation of their spine. The groups were compared by analysis of variance. In order to assess the relationship between two variables, Spearman's correlation coefficient was calculated. RESULTS: Both groups of scoliosis patients attained a lower Sport Score than the controls (p < 0.015 and p < 0.006, respectively). There was no difference between the two scoliosis groups. Reduced spinal function correlated with reduced sports activity (p < 0.001). In both scoliosis groups, the subscales "back pain" and "physical activity" correlated with sporting activity (p < 0.03 and p < 0.02, respectively). In the surgically treated patients, Cobb angle correlated with reduced sports activity (p < 0.03). The extent of the spinal arthrodesis (number of segments) in surgically treated patients had no effect on their sports activity. CONCLUSIONS: Over the long term, patients with idiopathic scoliosis suffer impairment of their sports activities compared with age-matched controls. The main reasons for this are functional impairment and the frequency of back pain. Sports activity is not more restricted after extended spinal fusion than it is after nonoperative treatment.

Activities of Daily Living↗
PubMed2003

Functional and radiographic outcomes after surgery for adult scoliosis using third-generation instrumentation techniques.

STUDY DESIGN: Retrospective radiograph and chart review of 28 patients with adult idiopathic scoliosis undergoing primary corrective surgery. Clinical and radiographic parameters were assessed before surgery, after surgery, and at a 2-year follow-up assessment. A self-perceived outcome questionnaire was administered to the study patients at a minimum 2-year follow-up assessment. OBJECTIVE: To assess patient outcomes after surgery for adult scoliosis using traditional radiographic parameters along with a self-perceived outcomes questionnaire. SUMMARY OF BACKGROUND DATA: The clinical and radiographic results and the outcomes for the surgical treatment of adult idiopathic scoliosis have not been established in the literature with respect to the use of modern third-generation instrumentation techniques. Most studies reviewing the surgical treatment of adult idiopathic scoliosis look primarily at Harrington instrumentation techniques. METHODS: Records and radiographs were reviewed retrospectively for all the patients (n = 54) undergoing primary corrective surgery for adult idiopathic scoliosis between December 30, 1994 and December 30, 1997. Of the 54 patients reviewed, 28 (52%) met the following inclusion criteria: age exceeding 20 years, primary surgery, fusion above the sacrum, availability of medical records along with preoperative, postoperative, and 2-year follow-up radiographs. Additionally, a self-perceived outcomes questionnaire was administered to these patients at a minimum 2-year follow-up assessment. RESULTS: All the patients were women (28/28). The indications for surgery were pain and progression in 54% (15/28) and pain in 29% (8/28) of the patients. The average preoperative major curve measurement was 65 degrees (range, 38-98 degrees ). The average postoperative major curve measurement was 24 degrees (range, 5-59 degrees ), for a correction of 64%. The average follow-up curve measurement was 27 degrees (range, 3-60 degrees ), for a correction of 61%. Whereas 71% of the cases were anteroposterior, 29% were posterior only. There was one intraoperative complication among the 28 patients and four postoperative complications in 3 of the 28 patients. The self-perceived outcome questionnaires were available for 83% (23/28) of the patients. Definite or probable relief of symptoms was reported in 74%(17/23). Improved ability to sleep was reported in 61% (14/23), and ability to return to their usual job was reported in 57% (13/23). Satisfaction with the results of surgery was reported in 87% (20/23). CONCLUSIONS: Surgery for adult idiopathic scoliosis using third-generation instrumentation techniques provides significant clinical improvement, scoliosis correction, maintenance of sagittal alignment, and patient satisfaction, with an acceptable complication rate.

Adult↗
PubMed2003

Studies in the modified Scoliosis Research Society Outcomes Instrument in adults: validation, reliability, and discriminatory capacity.

STUDY DESIGN: Observational study of patients with scoliosis and matched controls. OBJECTIVES: To determine the validity and reliability of the modified Scoliosis Research Society Outcomes Instrument (SRS-22) for use in the assessment of deformity in adults. To demonstrate the discriminate validity of the SRS-22 in differentiating between affected and unaffected adults. SUMMARY OF BACKGROUND DATA: Spinal deformity has an important impact on the general health status of adults. The magnitude of this impact has been difficult to measure and reported variably in the literature. The development of disease-specific outcomes tools permits improved sensitivity and specificity in measuring the patient's self-assessment of health status. An instrument for measuring disease-specific health status in adults with scoliosis has not been validated. MATERIALS AND METHODS: Observational study comparing the health status of adults affected by scoliosis and unaffected controls, matched for age, gender, and socioeconomic status. Pearson correlation analysis was used to determine the relationship of each domain within the SRS-22 and SF-36 with radiographic parameters including sagittal balance, coronal balance, and major curve correction. Discriminate validity of the modified SRS instrument was determined by a comparison of means between affected and unaffected cohorts. The validation of the SRS-22 was determined by criterion validity, using correlation analysis with comparable domains of the SF-36. The reliability of the SRS-22 was demonstrated using test-retest parity and Cronbach's alpha test for internal consistency. RESULTS: One hundred eighty adults were included in the study, 146 with scoliosis and 34 without. Adults with scoliosis scored significantly lower than unaffected controls on every domain of the SRS-22 and the SF-36. The floor and ceiling effect of the SRS-22 were less than observed in the SF-36 instrument. Pearson correlation analysis demonstrated no significant correlation between any radiographic process measure and any specific domain within the SRS-22 or the SF-36 (r < 0.25). Comparison of similar domains in the SRS-22 and the SF-36 demonstrates high correlation between the instruments. Test-retest analysis similarly demonstrates a high degree of reproducibility in each domain (r = 0.83-0.94). Cronbach's alpha test of internal consistency within each domain demonstrates intercorrelation values greater than 0.75 within each domain of the SRS-22. CONCLUSIONS: Adult scoliosis has a significant and measurable impact on affected patients compared with controls. There is a poor correlation between radiographic parameters of outcome and patient self-assessment of health status. The SRS-22 is a reliable instrument in adults as demonstrated by a high degree of internal consistency and reproducibility. The SRS-22 is a valid instrument for use in adult deformity as demonstrated by the criterion validity assessment with the SF-36. The study supports the use of the SRS-22 in the adult spinal deformity population.

Adolescent↗
PubMed2003

Carl Nicoladoni and his contributions to scoliosis.

Carl Nicoladoni (1847-1902) studied medicine in Vienna and became Privatdozent in surgery in 1876. He accepted a chair as a Professor of Surgery at the university clinics of Innsbruck (1881) and Graz (1895). Nicoladoni has made significant contributions in the progress of surgery and performed a variety of operations in several surgical disciplines. However, his principal contributions are in the field of orthopedic surgery, in particular his excellent and detailed studies on scoliosis, based on thorough anatomic and kinetic investigation. His commitment to the research of scoliosis resulted in three books and three bigger treatises, all of which were printed in German. His earliest book was printed in 1882 and was on the torsion of the scoliotic spine, Die Torsion der Skoliotischen Wirbelsäule. Three bigger treatises on scoliosis entitled Die Architektur der Sskoliotischen Wirbelsäule (The Architecture of the Scoliotic Spine, 1889), Die Architektur der Kindlichen Skoliose (The Architecture of Juvenile Scoliosis, 1894), and Die Skoliose des Lendensegmentes (The Scoliosis of Lumbar Segments, 1894) were published in an anthology called Denkschriften der Kaiserlichen Akademie der Wissenschaften, a series of publications from the imperial academy of science. Two versions of his epical work, Anatomie und Mechanismus der Skoliose (Anatomy and Mechanism of Scoliosis) were printed. A larger edition printed in 1904 was part of the Bibliotheca Medica, a monumental series of various clinical books published around the beginning of the past century. The second version, a shortened one, with the same title was included in an anthology called Deutsche Chirurgie (German Surgery) and published in 1909. The purpose of this historical article is to discuss Nicoladoni's achievements in the field of scoliosis based on a detailed analysis of his books.

Austria↗
PubMed2003

Short segment bone-on-bone instrumentation for single curve idiopathic scoliosis.

STUDY DESIGN: Retrospective case series review. OBJECTIVES: To evaluate the outcomes of a new short segment anterior scoliosis technique with complete removal of the discs, bone-on-bone apposition of the vertebral bodies, and dual rod instrumentation. To evaluate a new preop planning technique for scoliosis instrumentation. SUMMARY OF BACKGROUND DATA: Scoliosis surgery traditionally was performed via a posterior approach, but anterior scoliosis instrumentation has proven to be superior regarding the amount of curve correction and the number of segments saved from instrumentation. METHODS: Thirty-one patients with single curve idiopathic scoliosis less than 75 degrees were operated using the bone-on-bone surgical technique with dual rod instrumentation (Kaneda Anterior Scoliosis System, Depuy AcroMed, Raynham, MA from 1996 until 2001). Average follow-up was 40 months (range 15-77 months). RESULTS: Surgical correction of the major curve averaged 73.9% over the instrumented levels and 51.4% over the entire curve. The average number of discs fused was 4.6 for thoracic curves and 3.3 for thoracolumbar and lumbar curves. There were no implant-related complications or nonunions. The compensatory curves spontaneously improved by an average of 38.6%. Uneventful healing of all fusions occurred-most within 8 to 12 weeks. One compensatory thoracic curve progressed and posterior instrumentation was done 28 months after correction of the major thoracolumbar curve. CONCLUSIONS: Surgical correction was achieved in over half the levels that would have been operated by standard posterior segmental fixation. Bony healing due to the bone-on-bone apposition was achieved uneventfully after apical correction of the spinal curvature in all patients. Use of dual rod instrumentation (Kaneda Anterior Scoliosis System) is fundamental in maintaining the correction of the curvature achieved in the operating room. The preoperative planning technique worked well.

Adolescent↗
PubMed2004

A prognostic model for the presence of neurogenic lesions in atypical idiopathic scoliosis.

STUDY DESIGN: Consecutive series of patients with idiopathic scoliosis with atypical features. OBJECTIVES: The purpose of this study is to define a specific yet sensitive set of signs and symptoms to indicate the use of MRI in patients with atypical idiopathic scoliosis. Specifically, this study empirically defines a new diagnostic test for the presence of neurogenic lesions based on clinical and radiologic data and then reports the properties of this test in relation to MRI as the gold standard. SUMMARY OF BACKGROUND DATA: The reported prevalence of brain stem and spinal cord abnormalities in patients with idiopathic scoliosis associated with atypical features varies from 0% to 60%. This wide range most likely results from the fact that the samples studied are either not well defined or are heterogeneous across studies. Because of these issues, the likelihood of neurogenic lesions in atypical idiopathic scoliosis is not known; consequently, the decision to order an MRI is controversial.METHODS A total of 1,206 patients coded as having idiopathic scoliosis were identified from our institutional database. Of these, 72 patients had one or more atypical features: early-onset scoliosis, atypical curve, severe curve despite immaturity (>45 degrees ), rapidly progressive curve (>1 degrees per month), back pain, headache, or neurologic abnormalities on clinical examination. All 72 patients underwent brain and spinal cord MRI. Logistic regression was used to determine significant predictors of positive MRI and to define the prognostic model. RESULTS: Eleven patients (15%) had abnormal findings on MRI. Eight had an Arnold-Chiari type I malformation associated with a syrinx; 1 had an Arnold-Chiari type I malformation; 1 a syrinx; and 1 a cervical syrinx with a conus lipoma. MRI was positive in 5 of 9 patients (55%) with severe curves despite immaturity. Twenty patients had one or more abnormal neurologic signs. Of these, 8 (40%) had a positive MRI, while only 3 of the 52 patients (6%) with a normal neurologic examination (but other atypical features) had a positive MRI. The most predictive model included the variables neurologic abnormalities (yes or no) and severe curve despite immaturity (yes or no). Using this model, patients with atypical characteristics other than severe curvatures or abnormal neurologic abnormalities(s) had a 3% probability (95% confidence interval [CI], 1-12%) of having a positive MRI; patients with abnormal neurologic change(s), but a nonsevere curve, had a 29% probability of a positive MRI (95% CI, 12-53%) and patients with severe curves and no neurologic change(s) had a 32% probability of positive MRI (95% CI, 8-71%). Patients with both a severe curve and abnormal neurologic change(s) had an 86% probability of positive MRI (95% CI, 46-98%). Agreement between this test and the MRI was 75%, with a sensitivity of 82% (95% CI, 48-97%) and a specificity of 74% (95% CI, 61-83%). CONCLUSIONS: The model derived in this study indicates that the probability of neurogenic lesions is extremely low in most patients with idiopathic scoliosis with atypical features. However, patients with severe curves despite skeletal immaturity and an abnormal neurologic examination have a significant probability of neurogenic lesions. Therefore, clinical efficiency will be enhanced by narrowing the indications for MRI to those patients with these risk factors.

Age of Onset↗
PubMed2004

An analysis of chest wall and diaphragm motions in patients with idiopathic scoliosis using dynamic breathing MRI.

STUDY DESIGN: The motions of chest wall and diaphragm were measured in patients with scoliosis and healthy individuals using dynamic breathing magnetic resonance imaging. OBJECTIVES: To investigate the motions of the chest wall and the diaphragm during deep breathing in patients with idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Despite the central role of the respiratory motions in maintaining ventilation, it is difficult to measure and describe the motions because of the limited methods available. The kinematics of respiration in scoliosis have not yet been clarified. METHODS: Dynamic fast spoiled gradient-recalled echo sequences were used for 18 patients with idiopathic scoliosis and 9 healthy individuals. The chest wall and diaphragm motions were evaluated using a cineloop view and a fusion display of maximal inspiratory and expiratory images. The data were analyzed quantitatively by measuring displacements. RESULTS: Respiratory chest wall movements were significantly restricted in patients with scoliosis, although the diaphragm motion was normal. An analysis of the fusion magnetic resonance displays superimposed with the maximal inspiratory and expiratory images facilitated the understanding of the abnormal respiratory motion in patients with scoliosis. There was some correlation between the values of respiratory motions and pulmonary function tests. CONCLUSIONS: The present technique is useful for assessing respiratory mechanisms dynamically and noninvasively. One of the distinguishing features of respiratory dysfunction in patients with scoliosis is their limited chest wall motion.

Adolescent↗
PubMed2005

A new operative classification of idiopathic scoliosis: a peking union medical college method.

STUDY DESIGN: A retrospective radiographic study on the type of surgically treated idiopathic scoliosis, with a prospective study on the reliability of the type-related fusion guide. OBJECTIVES: To identify and classify surgically treated idiopathic scoliosis, and define its related fusion levels by a new classification system. SUMMARY OF BACKGROUND DATA: Some classification methods for idiopathic scoliosis have been suggested. However, poor intraobserver reproducibility and interobserver reliability were experienced in these studies, and were not appropriate for guiding surgical planning. METHODS: A total of 427 surgically treated idiopathic scoliosis cases were reviewed. Preoperative and postoperative standing anteroposterior, lateral, and preoperative supine side-bending radiograph were analyzed using the Scoliosis Research Society definition of scoliosis and curve apex. The resulting classification was tested for intraobserver reliability and interobserver reliability, and by 6 surgeons. Apical frequencies were determined for each type, and prospective surgical testing of the new type and its related fusion guide was performed. RESULTS: Three major types and 13 subtypes were identified, of which the Peking Union Medical College type I accounted for 56.62%, type II 42.16%, and type III 1.22%. The interobserver reliability testing was 85% (kappa coefficient 0.832), while intraobserver reproducibility was 91% (kappa coefficient 0.898). Each type had its corresponding fusion levels. A prospective study of 152 cases was performed according to the classification. All of these cases were followed over 18 months, and no postoperative decompensation was noted. CONCLUSION: The Peking Union Medical College classification of idiopathic scoliosis is one system to combine each type with its corresponding fusion level, and it had much higher interobserver reliability and intraobserver reproducibility than the King system. Further prospectivestudies would help to clarify and expand this system.

Adolescent↗
PubMed2005

Posterior vertebral column resection for severe rigid scoliosis.

STUDY DESIGN: Retrospective study. OBJECTIVE: To report on the technique and results of posterior vertebral column resection (PVCR) for severe rigid scoliosis. SUMMARY OF BACKGROUND DATA: The treatment of severe rigid scoliosis is a demanding surgical challenge. Conventional procedures such as combined anteroposterior instrumentation enable limited correction. In rigid scoliosis, vertebral column resection is a better option for accomplishing translation of spinal column. PVCR is performed through a single posterior approach. METHODS: A total of 16 patients with scoliosis (average age 29 years) subjected to PVCR were retrospectively reviewed after a minimum follow-up of 2 years (range 2-6.8). The indication for PVCR was scoliosis more than 80 degrees , with flexibility less than 25%. The radiographic parameters were evaluated, and clinical records were reviewed. RESULTS: The number of vertebrae removed averaged 1.3, and 21 total (15 thoracic and 6 lumbar). Average fusion extent was 10.6 vertebrae. The mean preoperative scoliosis of 109.0 degrees was corrected to 45.6 degrees (59% correction) at the most recent follow-up, and the minor curve of 59.3 degrees was corrected to 29.2 degrees (51% correction). The mean preoperative coronal imbalance of 4.0 cm was improved to 1.0 cm at the most recent follow-up, and sagittal imbalance of 4.2 cm was improved to 1.6 cm. Complications were encountered in 4 patients, including 1 complete paralysis, 1 hematoma, 1 hemopneumothorax, and 1 proximal junctional kyphosis. CONCLUSIONS: PVCR is an effective alternative for severe rigid scoliosis. It is a highly technical procedure and should only be performed by an experienced surgical team.

Adult↗
PubMed2005

The effect of pinealectomy on scoliosis development in young nonhuman primates.

STUDY DESIGN: Prospective study on pinealectomy in primates. OBJECTIVE: To evaluate whether pinealectomy in a bipedal nonhuman primate model will result in the development of scoliosis. SUMMARY OF BACKGROUND DATA: Pinealectomy in newborn chickens consistently resulted in scoliosis development. Published data suggest that the surgical removal of the pineal, loss of melatonin secretion, and a bipedal posture are important elements in the development of scoliosis in lower animal models. METHOD: There were 18 rhesus monkeys between 8 and 11 months old that underwent pineal excision. All monkeys were kept in a regulated 12-hour light-dark cycle. Monthly radiographs assessed scoliosis development. Completeness of pineal excision was assessed by measurement of a major metabolite of melatonin in the urine, 6-sulfatoxymelatonin, using an enzyme-linked immunosorbent assay assessed. RESULTS: Mean follow-up was 28 months (range 10-41). Seven monkeys died prematurely, and 11 survived to date; the data from those that died could still be used, although follow-up was shortened. At the latest follow-up or death, scoliosis did not develop in any of the monkeys. Urinary 6-sulfatoxymelatonin measurements revealed 3 patterns. Group 1 consisted of 10 monkeys, which showed definite evidence of complete pineal excision. Group 2 consisted of an uncertain group of 2 monkeys in which the nighttime melatonin level is slightly high. Group 3 consisted of 6 monkeys that had incomplete pineal excision or ectopic melatonin production. CONCLUSIONS: To our knowledge, this is the first report of pinealectomy in nonhuman primates. Of the 18 monkeys, 10 had a loss of melatonin secretion, for a mean of 29 months after surgery. Because none of the monkeys had scoliosis develop, this study strongly suggests that the possible etiologic factors producing idiopathic scoliosis in lower animals are different from primates, and findings in lower animals cannot necessarily be extrapolated to human beings.

Animals↗
PubMed2006

Bipedal ambulation induces experimental scoliosis in C57BL/6J mice with reduced plasma and pineal melatonin levels.

In addition to the induction of scoliosis in chickens by pinealectomy (PINX), we previously demonstrated that removal of the pineal gland also produces scoliosis in bipedal rats, which can be inhibited by melatonin treatment. Using C57BL/6J mice with genetically low circulating melatonin levels, the main objective of the present study was to investigate whether bipedal ambulation in C57BL/6J mice has the same effects on spinal deformity as those seen in pinealectomized bipedal rats. The present study consisted of two phases. The aim of the first experiment was to determine whether the C57BL/6J mouse strain actually exhibits depressed plasma concentrations and/or pineal contents of melatonin during both the light and the dark phase of the light:dark cycle. The aims of the second experiment were to evaluate; (i) whether bipedal ambulation alone in the C57BL/6J mouse induces scoliosis, and (ii) whether PINX with bipedal ambulation in another mouse strain, i.e. C3H/HeJ, which normally exhibits diurnal fluctuations in melatonin synthesis and secretion, has effects similar to those of bipedal ambulation alone in C57BL/6J mice. C3H/HeJ mice, serving as controls, showed significant increases in both plasma concentrations and pineal contents of melatonin during the dark phase when compared with the light phase. In contrast, there were no differences in either circulating levels or pineal contents of melatonin between the light and dark phases in C57BL/6J mice. Moreover, plasma melatonin levels were below the detection limit of the assay in both phases and pineal melatonin was < 10% of that in C3H/HeJ mice. Bipedal ambulation for 40 wk in C57BL/6J mice induced scoliosis at a rate of 64.3%, and two of nine scoliotic mice showed two sites of spinal deformity. This type of ambulation in C3H/HeJ mice resulted in scoliosis at a lower rate (25%), and affected animals had only a single scoliotic site. However, PINX combined with bipedal ambulation in C3H/HeJ mice produced scoliosis at a rate (70%) similar to that seen in C57BL/6J mice, and some double deformations were induced. These results confirm our previous observations in rats, and also support our hypothesis that melatonin as well as the bipedal ambulation appear to play a critical pathogenic role in scoliosis in experimental mammals.

Animals↗
PubMed2006

Scoliosis after solid organ transplantation in children and adolescents.

The occurrence of scoliosis in children after solid organ transplantation is not known. A total of 196 children, which is 93% of patients surviving kidney, liver and heart transplantation in our country, participated in a cross-sectional survey. All children were screened for rib hump, and those with clinically significant hump (over 6 degrees ) underwent radiographs of the spine. The occurrence of scoliosis was compared to data obtained from a previously published comparison group. Forty-three (21.9%) of the patients had scoliosis greater than 10 degrees , and 21 (10.7%) of them had curves greater than 20 degrees . The RR (95% CI) for scoliosis needing treatment (over 20 degrees ) was 17.0 (6.75-42.7) in the patients as compared with control population. The occurrence of scoliosis was 17.9% of the kidney, 13.6% of the liver and 51.7% of the heart transplant patients (p < 0.001). In a logistic regression model, heart transplantation (OR (95% CI) 7.27 (2.62-20.2)) and growth hormone treatment (3.98 (1.77-8.94)) were most significant risk factors for scoliosis. The risk of scoliosis is increased in patients with solid organ transplantation. Pediatricians treating these patients should be aware of this increased risk to diagnose early curves and to refer these patients to an orthopedic surgeon.

Adolescent↗
PubMed1989

Scoliosis in spinal muscular atrophy: review of 63 cases.

We reviewed the incidence and severity of scoliosis in 37 patients with the intermediate type and 26 with the mild type of spinal muscular atrophy. In the intermediate type, scoliosis has an early onset and rapid progression before puberty, and a spinal fusion will be needed in virtually all cases. This rapid progression occurred despite routine use of a spinal brace. Hip dislocation was frequently present but, in most cases, was secondary to the pelvic tilt and did not contribute to the scoliosis. In the mild type, the scoliosis was more variable. In the 30% of patients who had scoliosis, progression was rapid during puberty but only in those who had lost ambulation. Of the four children with the intermediate type and the seven with the mild type who walked in light-weight orthoses, progression of scoliosis was slow, except in those who had lost ambulation. The ultimate effect of walking in orthoses is difficult to assess because of small numbers, but it seems to slow or at least delay progressive scoliosis.

Adolescent↗
PubMed1998

Intraobserver and interobserver reliability of the classification of thoracic adolescent idiopathic scoliosis.

The system described by King et al. is the standard method for the classification of thoracic adolescent idiopathic scoliosis. Although it is widely used and referenced, its reliability and reproducibility among scoliosis surgeons are unknown. We used a scoliosis case-presentation format to examine the interobserver and intraobserver reliability of the classification of thoracic adolescent idiopathic scoliosis with the system of King et al. Eight active, current members of the Scoliosis Research Society reviewed twenty-seven full-length radiographs that had been made before operative correction of the scoliotic deformity. On the basis of these images, which included posteroanterior and lateral radiographs made with the patient standing as well as right and left forced-side-bending radiographs made with the patient supine, the reviewers assigned a type to each curve according to the classification system of King et al. Kappa coefficients were used to test statistical reliability. The mean interobserver reliability of the classification was only 64 per cent (range, 54 to 77 per cent) when the responses of seven of the reviewers were compared with those of one of the originators of the classification. The mean kappa coefficient was 0.49 (range, 0.27 to 0.73), which indicates poor reliability. When each reviewer's responses were compared with those of the other reviewers, the reliability was similarly poor (interobserver reliability, 55 per cent [range, 33 to 81 per cent] and mean kappa coefficient, 0.40 [range, 0.21 to 0.63]). Intraobserver reliability was evaluated in a trial in which five reviewers in a group setting were shown the same radiographs in a different order at two different viewings. Comparison of the results at the two viewings revealed a mean intraobserver reliability of 69 per cent (range, 56 to 85 per cent) and a mean kappa coefficient of 0.62 (range, 0.34 to 0.95), which indicates fair reliability. The current method of classification of adolescent idiopathic scoliosis does not appear to have sufficient intraobserver or interobserver reliability among scoliosis surgeons to portray curve types accurately. Thus, it may not help to guide treatment with use of modern spinal fixation methods.

Adolescent↗
PubMed2000

Relationship of peak height velocity to other maturity indicators in idiopathic scoliosis in girls.

BACKGROUND: Our aim was to compare height velocity data, obtained from clinical height measurements, for girls who had idiopathic scoliosis with the data for adolescents who did not have scoliosis. We also compared the growth data with chronological age, menarchal age, and Risser sign in terms of their accuracy in the prediction of growth and progression of the scoliosis. METHODS: One hundred and twenty of 371 patients in a database of girls managed with a brace for the treatment of idiopathic scoliosis had sufficient height data for us to quantify their growth peak. Height velocity data was generated from standing-height measurements obtained, in a scoliosis clinic, with a minimum six-month interval between measurements, and the timing of peak height velocity was calculated. The age at menarche was recorded from the patients' records. The Risser sign and Cobb angle were determined by a single observer. Progression of the scoliosis was defined as an increase in the Cobb angle of at least 10 degrees, compared with the curve magnitude at the time of the initial evaluation, after a minimum of six months. Progression to a magnitude requiring surgery was defined as progression of at least 10 degrees to a magnitude of 45 degrees or more. RESULTS: The height velocity plot grouped by peak height velocity showed a high peak and a sharp decline with values similar to those in normal populations. Extrapolating from percentile charts, 90 percent of our patients ceased growing by 3.6 years after peak height velocity. The growth peak was blunted (averaged over too long a period such that the data for the period of most rapid growth was averaged in with that for a period of slower growth) when chronological age, menarchal age, and Risser sign were used to predict growth; this indicated that these maturity scales grouped the patients poorly in terms of growth. The primary curve was progressive in eighty-eight of the 120 patients. Sixty of these patients had a curve of more than 30 degrees at peak height velocity, and in fifty (83 percent) of the sixty the curve progressed to 45 degrees or more. The remaining twenty-eight patients had a curve of 30 degrees or less at peak height velocity, with only one curve (4 percent) progressing to 45 degrees or more. Peak height velocity also grouped patients for maximal progression of the curve more accurately than did the other maturity scales, as most of the curves progressed maximally at peak height velocity. There was a wider spread of timing of maximal progression when chronological age, menarchal age, and Risser sign were used to predict progression. CONCLUSIONS: Height velocities generated from clinical height measurements for patients with idiopathic scoliosis document the growth peak and predict cessation of growth reliably. Knowing the timing of the growth peak provides valuable information on the likelihood of progression to a magnitude requiring spinal arthrodesis.

Adolescent↗