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PubMed2002

Prevalence of neural axis abnormalities in patients with infantile idiopathic scoliosis.

BACKGROUND: Although reports in the literature have demonstrated an approximately 20% prevalence of neural axis abnormalities in patients with juvenile idiopathic scoliosis who have a curve of >20 degrees, the prevalence of neural axis abnormalities in patients with infantile idiopathic scoliosis is not well documented. In two previous studies involving a total of only ten patients with infantile idiopathic scoliosis, five patients were noted to have a neural axis abnormality on magnetic resonance images. METHODS: The records of forty-six consecutive patients who were seen between 1992 and 2000 at three spinal deformity clinics were retrospectively reviewed. The inclusion criteria included presumed idiopathic scoliosis at the time of presentation, an age of three years or less, a curve magnitude of > or = 20 degrees, normal neurological findings, no associated syndromes, and no congenital abnormalities. All patients were evaluated with a total spine magnetic resonance imaging protocol for examination of neural axis abnormalities from the skull to the coccyx. RESULTS: Ten (21.7%) of the forty-six patients were found to have a neural axis abnormality on magnetic resonance imaging. This group included five patients with an Arnold-Chiari malformation and an associated cervicothoracic syrinx, three with syringomyelia, one with a low-lying conus, and one with a brainstem tumor. Eight of these ten patients needed neurosurgical intervention for treatment of the abnormality. CONCLUSIONS: The 21.7% prevalence of neural axis abnormalities in this group of patients with infantile idiopathic scoliosis was found to be almost identical to that reported in the literature on patients with juvenile idiopathic scoliosis. Because of the high prevalence of abnormalities and the fact that eight of the ten patients with abnormal findings on magnetic resonance images required neurosurgical intervention, a total spine magnetic resonance imaging evaluation at the time of presentation is recommended for all patients with infantile idiopathic scoliosis who have a curve measuring > or = 20 degrees.

Child, Preschool↗
PubMed1997

Postural imbalance and vibratory sensitivity in patients with idiopathic scoliosis: implications for treatment.

Sporadic research reports of decreased proprioception and balance problems have been reported in subjects with idiopathic scoliosis, yet these sensory motor deficits have not been addressed in conservative clinical management programs. The purpose of this study was to compare both balance reactions and vibratory sensitivity (as an estimate of proprioception) in patients with idiopathic scoliosis (N = 24) and age-matched controls (N = 24). Balance was measured by the ability to pass a series of simple static and complex sensory-challenged balance tasks. Vibratory thresholds were measured with the Bio-Thesiometer at the cervical spine, wrist, and foot. Compared with age-matched controls, regardless of curve severity or spinal fusion, the subjects with idiopathic scoliosis had similar simple static balance responses when the somatosensory system was stable (with or without vision or head turning), but they were significantly more likely to fail the complex, sensory-challenged balance tasks when the somatosensory system was challenged by an unstable position of the feet, particularly when the eyes were closed. The vibratory thresholds were similar in subjects with scoliosis and their age-matched controls, but individuals with moderate to severe scoliosis (> 25 degrees) had significantly higher vibratory thresholds than those with mild curves. These findings suggest there may be problems with postural righting in patients with idiopathic scoliosis, particularly when the balance task challenges the vestibular pathways. Although vibration sensitivity did not distinguish normal healthy individuals from individuals with idiopathic scoliosis, those with more severe scoliotic curves appear to have a high threshold to vibration. These balance and vibratory differences could either be interpreted as etiologic risk factors or as consequences of spinal asymmetry. In either case, given that curves can continue to progress even into the adult years, improving the ability to right the body with gravity could help maintain the balance of the spine despite structural asymmetry.

Adolescent↗
PubMed1984

Electromyography of the paravertebral muscles in idiopathic scoliosis. Measurements of amplitude and spectral changes under load.

The myoelectric activity of the paraspinal muscles was recorded in girls with idiopathic scoliosis and in healthy controls. The muscles of the back were loaded isometrically and the signals recorded at the T8 and L3 levels were analysed as regards amplitude and frequency. A comparatively higher signal amplitude was found on the convex side of the scoliosis curve. This was found to be due to a lower amplitude on the concave side when the scoliosis group was compared to the controls. The amplitude difference was correlated to the degree of scoliosis. A shift in the myoelectric spectrum toward lower frequencies occurred during the loading period. There were no differences in this respect between the sides of the scoliosis, nor were there differences between the scoliosis patients and the controls. Secondary adaptation to the higher load demand by the muscles on the convex side in scoliosis is the most probable explanation for our observations.

Adolescent↗
PubMed1998

The relationship of cumulative motor asymmetries to scoliosis in Rett syndrome.

OBJECTIVES: Interrelationships between Rett syndrome scoliosis and symmetric and asymmetric motor pull, ambulation, and advancement of age were investigated in order to provide a treatment rationale for slowing the progression of scoliosis. METHOD: Questionnaires (N = 262) completed by International Rett Syndrome Association families were analyzed with logistic regression, odds ratio, Kruskal-Wallis one-way, and Fisher's exact test analyses. RESULTS: Rett syndrome scoliosis was found to be significantly related to orthopedic risk factors of asymmetric movements and positions (odds ratio = 4.5, p < .001). The odds ratio for asymmetric upper-body positioning (4.4), nonambulation (3.1), and age advancement (14.1) indicated that each was a significant predictor of scoliosis by logistic regression analysis. Univariate Kruskal-Wallis one-way analysis identified a significant relationship between scoliosis and asymmetric higher shoulder positioning (p < .001) and bodyside movements (p = .03). Hemisyndrome aspects of Rett syndrome were identified as the increased prevalence of symptoms in either right or left bodyside. CONCLUSION: A significant relationship was found between the prevalence of Rett syndrome scoliosis and orthopedic risk factors. These findings suggest a treatment approach for Rett syndrome scoliosis that focuses on balancing bilateral muscular pull.

Child↗
PubMed1999

Bone mineral density at the femur and lumbar spine in a population of young women treated for scoliosis in adolescence.

OBJECTIVES: To evaluate associations between scoliosis and bone mineral density. Many of the factors involved in the etiopathogenesis of idiopathic scoliosis also affect peak bone mass acquisition, which occurs primarily during puberty, a period of progression for scoliosis. METHOD: We compared 33 patients treated for scoliosis with 33 controls and looked for correlations between bone mineral density and a number of retrospectively collected parameters (e.g., duration of bracing, outcome in adulthood). RESULTS: Bone mineral density values were lower in the patients than in the controls. Among the patients, those with osteopenia wore a brace significantly longer and had more severe scoliosis in adulthood than those without osteopenia. CONCLUSIONS: These findings suggest a need for osteopenia screening and prevention in children with scoliosis, for monitoring physical activity and calcium intake during bracing, for preferring braces that allow greater mobility, and for closely monitoring the scoliosis during adulthood if osteopenia is present.

Adolescent↗
PubMed1975

The management of infants with scoliosis.

This is a study of children who first attended as infants with either progressive infantile idiopathic scoliosis or congenital scoliosis. All had a pattern of scoliosis in which early and damaging deterioration is inevitable. The infants were treated from before the age of three, initially by plaster casts and then a Milwaukee brace, followed at about the age of ten by correction and fusion. The cases were then observed to the end of growth or near that point. In the main study there were twelve cases, six of progressive infantile idiopathic scoliosis and six of congenital scoliosis, which were followed through this long period. Only one of the twelve had a curve worse at the end of growth compared with the initial radiograph as an infant; this one curve had increased only 16 degrees in almost as many years. Although small, the series does show that it is nearly always possible to control even the most serious scoliosis in an infant, if it is tackled early and unremittingly. There are supportive studies of children who have partially completed this regime, and interim results in a newer group of children with spina bifida and scoliosis.

Braces↗
PubMed2001

An audit of the Scoliosis Service at Hospital Kuala Lumpur.

This is a study of patients referred to the Scoliosis Service of Hospital Kuala Lumpur. Three hundred and thirty five (335) consecutive patients who were seen between 1985 and 2000 were reviewed to determine the presentation of scoliosis, the treatment received and the compliance to follow up. Data were determined by measuring the frontal spinal radiographs. Two hundred and ninety eight (298) patients met inclusion criteria. Idiopathic scoliosis accounted for 203 patients (68.1%), 31 (10.4%) were neuromuscular scoliosis; and 44 (14.8%) had congenital scoliosis. Twenty-five point five percent of patients had surgery, 10.4% were treated with brace, while the remaining 69.1% of patients were observed, or had no treatment at all. Congenital scoliosis patients had better compliance compared to idiopathic or neuromuscular scoliosis patients.

Adolescent↗
PubMedDate not supplied

Ethnic variance in the epidemiology of scoliosis in New Zealand.

A manual and computerized search of orthopaedic outpatient records over a 10-year period (1990-2000) identified 386 new patients younger than age 20 years with a diagnosis of scoliosis. Patients were grouped according to race and their numbers were compared with predicted values calculated from New Zealand census data. Of the various etiological categories, idiopathic scoliosis and scoliosis secondary to syringomyelia showed significant ethnic variance. For idiopathic scoliosis, higher numbers than predicted were observed in Europeans and lower numbers than predicted were observed in Polynesians. Conversely, for scoliosis secondary to syringomyelia, relatively higher numbers were observed in Polynesians and relatively lower numbers in Europeans and other ethnic groups. The demonstration in this study of a low incidence of idiopathic scoliosis and conversely a high incidence of syringomyelia in Polynesians has led the authors to reconsider the indications for magnetic resonance imaging when patients of this ethnic group are referred with scoliosis that initially appears to be idiopathic.

Adolescent↗
PubMed1992

The natural history of mild idiopathic scoliosis.

The aim of the research was to monitor the natural history of mild idiopathic scoliosis in school children, primarily those with a scoliotic curve lesser than 20 degrees according to Cobb who had been treated by regular observation and sports activities. A total of 97 children, 73 girls and 24 boys, aged between 9 and 14 years were enrolled. All the children were monitored for three years and in this period they were subjected to regular examinations and to at least three X-ray examinations. There were 51 thoracal, 39 thoracolumbar and 7 lumbar cases of scoliosis. After the three year observation period thoracic scoliosis improved in 56.9% of patients, 17.7% showed no change while 25.5% of the cases deteriorated. Nonprogressive thoracolumbar scoliosis was found in 76.9% of the cases, 12.9% showed no change from baseline while in 10.3% curve progression was noticed. Nonprogressive lumbar scoliosis was observed in 4 cases, in 2 cases the condition was unaltered while in 1 case curve progression was noticed. In the whole group there were 18.6% cases of progressive scoliosis. The results of this research have confirmed that regular observation and sports activities are the best methods of treating idiopathic scoliosis with a curve lesser than 20 degrees according to Cobb.

Adolescent↗
PubMed2002

Idiopathic scoliosis and quality of life.

Scoliosis may lead to multiple impairments depending on its seriousness. Here we have to make the distinction between direct impairments in the physical field and indirect impairments in the psychosocial field. The findings of different studies indicate that the psychosocial situation in juvenile and adult scoliotic patients is characterized by increased strain. The present study is meant to answer the question in which fields of quality of life female scoliotic patients are impaired and if these impairments are dependent of age or seriousness of illness (Cobb angle). Between May 1998 and February 1999, 226 female patients with idiopathic scoliosis were surveyed in a special clinic for spinal deformities with the help of different quality of life measuring instruments (SF-36, BFW, STAIK) and were compared with norm values. Women with idiopathic scoliosis were questioned with the help of an age adapted set of questionnaires containing questions referring to the health related quality of life (SF-36, BFW, STAIK). The results were compared to the norm values and examined in uni- and multivariat procedures (MANOVA) in order to find out if age and seriousness of illness (Cobb angle) have any impact on the quality of life. In comparison to the norm random sample, the juvenile female scoliosis patients showed a less positive point of view towards life (p = .001) and were easier subject to depressive moods (p = .021). The increased strain of adult patients was shown both in the psychic field (p < .001) and in the physical field (p < .001) (SF-36). These results are largely independent of the seriousness of illness (Cobb angle) and of the patients' age. The results indicate that idiopathic scoliosis in children, adolescents and adults can be regarded as a risk factor for the impairment of health related quality of life and thus stress the importance of psychosocial offers during a patient-orientated scoliosis treatment in order to improve the management of scoliosis.

Adaptation, Psychological↗
PubMed2002

Local energy as a measure of back symmetry in scoliosis.

The Cobb angle has been the most commonly used method in measuring the severity of scoliosis and its progression. However, in recent years a number of researchers have chosen to monitor scoliosis by examining the severity of the surface deformity resulting from the scoliosis. Each of these approaches has been limited by errors introduced in manual location of landmarks. Scoliosis results in an asymmetry of the back. It would be very desirable to have a computer-based method of measuring this asymmetry. This paper investigates the use of wavelets and the concept of local energy to measure asymmetry associated with scoliosis. The local energy model uses wavelet theory to obtain information about shading and boundaries of objects in an image. Edges and sharp discontinuities are areas of high local energy in an image. Features such as scapular prominence, shoulder edges, waist creases and other anomalies that contribute to the scoliotic back asymmetry have high local energy. A preliminary study was completed to determine if this approach was applicable to measurement of back asymmetry. Two-dimensional local energy images were created from photographs of the backs of patients with scoliosis. The local energy was integrated across each image and a left-to right line of symmetry was calculated. This line of symmetry was then correlated with the scoliotic score developed by our group. This technique shows promise of providing an automatic method of measuring scoliosis progression.

Back↗
PubMed2002

Exercise efficiency of girls with idiopathic scoliosis based on the ventilatory anaerobic threshold.

UNLABELLED: The aim of the study was to estimate the exercise efficiency in the group of girls with idiopathic scoliosis based on the ventilatory anaerobic threshold (VAT). MATERIAL AND METHOD: The investigation comprised 58 girls with idiopathic scoliosis, aged 10-16 years; 32 girls (55.20/0) with double major scolioSiS and 26 girls (44.8%) with single scoliosis. The girls were conservatively treated using Dobosiewicz method. The control group consisted of 31 healthy girls aged 10-16 years. The exercise test was performed using cycle ergometer. During the exercise the gas exchange parameters were recorded (minute expiratory ventilation, minute oxygen consumption, carbon dioxide production). On the basis of recorded parameters VAT has been computed, using V-slope method. RESULTS: The following VAT values were obtained in the group with scoliosis: 20.7+3.05 ml O2/min/kg b.m.; in control group: 21.9+3.50 ml O2/minlkg b.m. The differences between girls with idiopathic scoliosis and control group were not statistically significant. CONCLUSIONS: I. The exercise efficiency of girls with idiopathic scoliosis conservatively treated using Dobosiewicz method is normal. 2. Such high level of the exercise efficiency of the studied group probably was due to intensive 3-D respiratory exercises of these girls.

Adolescent↗
PubMed2005

What does the geometry of an arc reveal about methods of assessing spinal radiographs in scoliosis?

BACKGROUND: The shapes of an arc and scoliosis are the same. Therefore, the geometry of an arc can reveal the relationship between the angles within and around a scoliotic spine. OBJECTIVE: To look for angles which are functions of the geometry of an arc and can also be used for assessment of curve progression in scoliosis. DESIGN: Review of the geometry of an arc and that of scoliosis. METHOD: English literature on scoliosis (from 1930 to date), searched manually, via Internet and from colleagues, was reviewed. RESULTS: Methods of curve measurement in use presently are functions of the geometry of scoliosis. Three additional methods are proposed for assessment of curve progression in scoliosis. These methods are geometrically related with the previously known ones. CONCLUSION: All methods of assessment of curve progression in scoliosis are fundamentally the same and interchangeable. There is no reason for preference of one method over another method of curve measurement.

Humans↗
PubMed2005

Prevalence of scoliosis in secondary school children in Osogbo, Osun State, Nigeria.

In order to determine the prevalence and distribution of various parameters associated with scoliosis in school children in Osogbo, Osun State, Nigeria, a two-year prospective study was carried out. The study was carried out in selected secondary schools in Osogbo township, Osun state, Nigeria. A team consisting of one consultant orthopeadic surgeon, one consultant epidemiologist, community health consultant, two laboratory scientists and one clerk performed the school screening. Simple random sampling was used to select the study population. Informed consent was obtained from the school principals, the students, and the parents of the students. A total of 410 children 190(46.3%) males and 220(53.7%) females aged 9-14 years old were screened. Thirty (7.31%) children had signs of scoliosis but only five (1.21%) had radiological evidence of scoliosis. Prevalence of scoliosis in the study group was 1.2%. A sensitive test for detection of scoliosis was forward bending test. Thoracic curve was most common. Cost of screening was affordable. School screening is simple, and cost effective. This study found that scoliosis is not common in school children in Osogbo, Osun state, Nigeria and therefore does not pose as a major public health problem. However, all the children who had radiological evidence of scoliosis were not aware of this prior to the screening exercise. Early detection has implication for choice of management--an advantage of the screening programme.

Adolescent↗
PubMed2006

Prevalence of scoliosis in women with visual deficiency.

UNLABELLED: Whether visual impairment influences the prevalence of scoliosis in humans or not remains controversial. The purpose of this study was to assess the prevalence of scoliosis in blind women in a Mediterranean region. MATERIAL AND METHOD: A total of 26 blind women aged 40 years (median, range 20 - 67) were screened for scoliosis. The existence of a possible trunk hump was measured by the forward bending test using the Pruijis Scoliometer. Reading of an Angle of Trunk Inclination (ATI) greater or equal to 7 degrees was used as a cut-off criterion for radiological examination. Standing postero-anterior and lateral spinal radiographs were obtained. Menarche and circadian rhythm was recorded. RESULTS: 11 out of 26 women had a scoliosis with an average Cobb angle of 19 degrees (range 12 - 28). The average ATI was 8 degrees. Thoracolumbar was the most common type of curve identified (9 out of 11, 6 were to the right and 3 to the left). The median age of menarche was 13 years (range, 11 - 15). None of the blind women reported any difficulty sleeping and had a circadian rhythm related to a 24-hour day. DISCUSSION: The prevalence of scoliosis was 42.3%, while the prevalence in the general population in the same regime is 2.9%. Blind women had a later age of menarche (13 versus 12.58 yrs) compared with normal girls. The postural etiology of scoliosis in blind people has been reported. The possible role of light in association to melatonin production, age at menarche and high prevalence of scoliosis in blind women is presented and discussed.

Adult↗
PubMed1988

Current theories on the etiology of idiopathic scoliosis.

Review of the literature shows that the cause of idiopathic scoliosis remains unknown, although research has possibly eliminated some hypothetical causes. Abnormalities of disc, bone, muscle, and collagen do not appear to be etiological factors but, rather, reflect the effects of scoliosis on normal tissues. Although most patients with idiopathic scoliosis are thought of as tall and slender, it has not yet been proven that growth in this condition differs from normal. It is possible that idiopathic scoliosis is caused by multiple factors rather than a single factor. Perhaps there are different factors for curve initiation and curve progression. It appears that a brain stem or equilibrium abnormality does exist in patients with idiopathic scoliosis, although more research is needed to confirm and define the problem. There also may be a genetic basis for idiopathic scoliosis, as it does seem to occur within patients' families more frequently than in the general population. Whether these two factors form the basis for a multifactorial etiology of idiopathic scoliosis remains to be proven.

Endocrine Glands↗
PubMed1988

Scoliosis in myelomeningocele.

Prevalence, type, and magnitude of scoliosis were studied in 163 patients with myelomeningocele. A scoliosis was diagnosed in 143 of them, congenital in 15 percent of the cases and developmental in the remaining patients. The severity of scoliosis increased with age and was more severe the higher the level of the neurologic deficit. The direction of the curves was correlated with pelvic obliquity, but not with hip dislocation. Although some patients with low level anomalies may develop severe scoliosis, patients with levels above L3 run a considerably higher risk in this respect. The radiographic baseline examination of the spine carried out in the newborn seems to permit a reasonable prognosis in regard to future scoliosis. Gross syringohydromyelia caused or contributed to scoliosis in 5 percent of the cases. However, less extensive syringohydromyelia and Chiari malformations due to abnormal neuromuscular control also promote the development of scoliosis in these patients.

Adolescent↗
PubMed1986

"Idiopathic" scoliosis associated with congenital upper-limb deficiency.

Sixty patients with congenital upper-limb deficiency were evaluated for scoliosis in 1972. Twenty-one patients had scoliosis of 5 degrees or more and 15 had scoliosis of 10 degrees or more. Fifteen of these patients had long-term follow-up periods. Thirteen patients had idiopathic scoliosis. Idiopathic scoliosis associated with congenital upper-limb deficiency could be divided into three groups, and the progression of scoliosis was predictable within each group. All but one of these patients had a relatively benign course and did not require treatment. Double curves with rotation progressed throughout the growth period. Double curves with Grade 0 rotation tended not to be progressive. Single curves did not have rotation deformity and resolved spontaneously or remained stable. Magnitude of limb deficiency did not correlate with the curve magnitude, progression, or pattern. Muscle imbalance did not appear implicated as a cause for the scoliosis in these patients. Young age at discovery of the curve did not correlate with progression of the curve.

Adolescent↗