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PubMed1983

[3-dimensional approach to spinal deformities. Application to the study of the prognosis of pediatric scoliosis].

The authors have utilized a computer for a spatial analysis of deformities of the spine using antero-posterior and lateral radiographs. The posterior limits of the sacral plateau and the centre of each vertebral plateau was demarcated on the antero-posterior radiograph. The posterior margin of each vertebra was demarcated on the lateral radiograph. With this information, the computer can make a picture as if the spine were seen from above and vertebral rotation can be assessed. The vertebrae are of different colours according to their level. Thirty cases have been studied and six types of infantile scoliosis defined - scoliosis with a localised hyper-rotation like a hairpin, scoliosis with rotary dislocation at the junction of two rotational levels, infantile scoliosis with a moderate curve, progressive scoliosis, benign scoliosis and spontaneously regressive scoliosis of the newborn. This study was shown that prognostic features were in accordance with classical assessments.

Child↗
PubMed1983

[Scoliosis].

Recent advances in the knowledge of the spontaneous course, pathogenesis and therapy of scoliosis are reported. In adolescent scoliosis, which is the most common form, the necessity for improving systematic detection is emphasized. Diagnostic procedures and currently accepted pathogenetic hypotheses are recalled. Therapeutic indications, which are closely dependent on the severity and the prognosis of each case, are outlined. Physical therapy is often unduly prescribed in patients with non-progressive curves, leading to useless expense. Concerning congenital scoliosis, it is pointed out that progressive scoliosis does not develop in all vertebral malformations. Conversely, progressive scoliosis secondary to vertebral malformations is often severe and may require a surgical procedure in early life. In neurologic scoliosis, preventive steps should be taken as soon as the underlying neurologic disease is diagnosed; therapy should be initiated when the angle is still small. In infants, scoliosis follows a spontaneously regressive course in 92% of cases.

Adolescent↗
PubMed1994

Adult idiopathic lumbar scoliosis. A formula for prediction of progression and review of the literature.

STUDY DESIGN: A retrospective study was conducted of patients with untreated adult-type idiopathic lumbar scoliosis. OBJECTIVES: To construct a mathematical formula that provides accurate progression of an idiopathic adult lumbar scoliosis using initial roentgenographic parameters. SUMMARY OF BACKGROUND DATA: Osteoporosis, lateral spondylolisthesis of L2-L4, and degeneration of disc and joint may contribute to a poor prognosis for lumbar adult-type scoliosis. METHODS: Seven roentgenographic parameters taken from the standing roentgenograms of 91 patients with a scoliosis of more than 10 degrees Cobb angle and who were included in a follow-up for more than 2 years, were put into a multiple regression analysis to observe the relative weight of each in the progression of the scoliosis. RESULTS AND CONCLUSIONS: Only lateral spondylolisthesis of the apical vertebra, Harrington factor, and disc index were related to progression of the scoliosis. Using the mathematical formula, the real progression of lumbar scoliosis can be predicted within an average of 0.85 degrees +/- 3.76 degrees.

Aged↗
PubMed1995

[Idiopathic scoliosis by spinal fusion and brace treatment: evaluation by gait analysis].

UNLABELLED: We have investigated the differences in gait between 68 idiopathic scoliosis patients and 186 normal subjects, and differences in gait before and after treatment of the scoliosis by two different methods. The idiopathic scoliosis patients were divided into two groups according to which treatment they had received; one group of 17 cases had been treated by spinal fusion and the other group of 51 cases had been treated by bracing. Gait analysis was performed using a 1.2 m wide and 10.8 m long force plate walkway. Three components of each step (the lateral, horizontal and vertical components) were measured. Gait velocity, step length, step width and cadence were evaluated as temporal and distance factors, and symmetry, reappearance, smoothness, sway, rhythm and impact were evaluated as gait factors. RESULTS: Before treatment, there was no difference in any temporal or distance factor between the scoliosis patients and the normal subjects. However, the index of symmetry, and of sway, in the vertical component prior to treatment in the scoliosis patients was significantly inferior to that in the normal subjects. A positive correlation was found between the index of sway in the vertical component and the pretreatment Cobb angle. This correlation was found in the right-convex single curve group and in the double curve group, but not in the left-convex single curve group. After spinal fusion, the step width became wider and the index of sway significantly improved, but index of symmetry was unchanged. No gait factor became worse postoperatively. In contrast, in the bracing group, the step width became wider, but the index of symmetry, and of sway in the vertical component, did not improve with the brace. The gait of scoliosis patients could be objectively and quantitatively analyzed by the force plate. The gait analysis was useful for evaluating the effects of spinal fusion, and of brace treatment, in idiopathic scoliosis patients.

Adolescent↗
PubMed1996

Correction of scoliosis by rib resection in pinealectomized chickens.

Experimental scoliosis with the potential for marked progression was treated by rib resection without spinal fusion to investigate the corrective effect of rib resection on progressive scoliosis. Forty chickens were divided into two groups (groups A and B) and pinealectomy was performed at 3 days of age. In group B, three ribs were resected on the concave side if scoliosis of > 20 degrees developed before the age of 4 weeks. Spinal radiographs were taken until the age of 20 weeks at 4-week intervals to evaluate the scoliosis. Chickens in group A developed severe scoliosis (24-85 degrees) that progressed until 20 weeks of age, and chickens in group B showed mild scoliosis (6-56 degrees). Some degree of reprogression was found after early bone union at the sites of rib resection. Rib resection may be able to control progressive scoliosis when performed on the concave side of the curve.

Animals↗
PubMed1996

Posttraumatic scoliosis.

A case of posttraumatic scoliosis due a misdiagnosed lumbosacral unilateral dislocation was observed 6 weeks after a traffic injury in a 15-year-old boy. Cobb angle was 30 degrees on T10-L4 with 20 degrees rotation on L1 and L2. Initial radiographs were normal. The scoliosis was corrected after surgical correction of the dislocation; at 5-year follow-up, the patient worked normally; there was no scoliosis. The suggested physiopathology of this structural scoliosis is similar to spondylolisthetic scoliosis of childhood in which asymmetrical forward displacement of the vertebral body results in rotational shift of the vertebra, with lumbar scoliosis. Correction of the scoliosis depends on correction of the lumbosacral dislocation.

Adolescent↗
PubMed1997

Correction of experimental scoliosis by rib resection in the transverse plane.

Experimental scoliosis with the potential for marked progression was treated by rib resection on the concave side of the curve, and the alterations of the rib cage and vertebrae in the transverse plane were investigated. Twenty-four chickens were divided into four equal groups (groups R, P, PR, and C) and pinealectomy was performed at 3 days of age in groups P and PR. In group R, three unilateral ribs were resected at the age of 4 weeks. In group PR, three ribs on the concave side of scoliosis were resected at 4 weeks of age if scoliosis of > 20 degrees developed before the age of 4 weeks. Group C served as a control. Spinal radiographs and computed tomography scans at the apical vertebrae were taken at 20 weeks of age, and spinal deformities were evaluated. Scoliosis developed markedly in groups R and P, whereas it was mild in group PR. The apical vertebrae rotated to the convex side of the curve in all groups, in the same way as it would in human idiopathic scoliosis. In group PR, the Cobb angle and the rotation angle of the apical vertebra were symmetrically suppressed. This study indicated that rib resection might control the progression of scoliosis not only in the frontal plane but also in the axial plane when it was done on the concave side of the scoliosis. Although this experiment succeeded in chickens, application in humans is uncertain.

Animals↗
PubMed1997

[Review of 87 cases of scoliosis surgically treated].

BACKGROUND: The authors compared the results and complications in surgical treatment of idiopathic scoliosis with Harrington's rod instrumentation with subtrasversal wires in dorsal treat. METHODS: A research on 87 cases operated on for idiopathic scoliosis from 1987 to 1995 is carried out. The 87 cases include 65 females and 25 males, 16 years old in average (range, 11 to 30). The curvature in Cobb's degrees and rotation of vertebrae with Raimondi's method on radiographs take just before, 15 days later and an year later on operation was measured. The patients have been divided into two groups: the first of 77 patients operated with Harrington's rod instrumentation; the second of 10 patients operated with Harrington's rod instrumentation and subtrasversal wires. RESULTS: In a general analysis without taking in to consideration the type and the seriousness of curvature it was obtained a better correction and derotation of vertebrae in patients of second group. The same group with wires had obtained a better correction and derotation of vertebrae in dorsal scoliosis from 40 degrees to 60 degrees and in the double scoliosis, while the first group obtained better results in dorsal scoliosis from 60 degrees to 80 degrees and in derotation of vertebrae on dorsal treat of double scoliosis. One case of pseudarthrosis in every group was observed. Any neurological complication were observed. CONCLUSIONS: The conclusions is drawn that the application of subtrasversal wire improves the Harrington's technique for the correction and derotation of dorsal and double scoliosis without neurological complications sometimes present with subliminar wires.

Adolescent↗
PubMedDate not supplied

Scoliosis and trunk asymmetry in upper limb transverse dysmelia.

The incidence of scoliosis and trunk asymmetry were studied in 60 patients with upper limb dysmelia of the transverse type. The evaluations were based on radiographic measurements of the spine and scoliometer readings of the angle of trunk rotation (ATR), which were correlated with the side and level of the limb deficiency and also with leg length-inequality (LLI). Nineteen patients (31%) had a scoliosis between 10 and 19 degrees, whereas the curves were between 5 and 10 degrees in another 30 patients and the remainder had no measurable curve. The scoliosis seemed at least partly to be of postural origin as LLI significantly correlated with the direction of the curves, but there was no correlation between the Cobb angles and the magnitude of LLI. The scoliometer readings did not correlate with the scoliosis or LLI. Our findings indicate that most patients with upper limb transverse amputations do not develop a significant scoliosis. A scoliometer screen has a low positive predictive rate for scoliosis and the diagnosis of scoliosis requires a radiograph of the spine.

Adolescent↗
PubMed2006

Scoliosis treatment using spinal manipulation and the Pettibon Weighting System: a summary of 3 atypical presentations.

BACKGROUND: Given the relative lack of treatment options for mild to moderate scoliosis, when the Cobb angle measurements fall below the 25-30 degrees range, conservative manual therapies for scoliosis treatment have been increasingly investigated in recent years. In this case series, we present 3 specific cases of scoliosis. CASE PRESENTATION: Patient presentation, examination, intervention and outcomes are detailed for each case. The types of scoliosis presented here are left thoracic, idiopathic scoliosis after Harrington rod instrumentation, and a left thoracic scoliosis secondary to Scheuermann's Kyphosis. Each case carries its own clinical significance, in relation to clinical presentation. The first patient presented for chiropractic treatment with a 35 degrees thoracic dextroscoliosis 18 years following Harrington Rod instrumentation and fusion. The second patient presented with a 22 degrees thoracic levoscoliosis and concomitant Scheuermann's Disease. Finally, the third case summarizes the treatment of a patient with a primary 37 degrees idiopathic thoracic levoscoliosis. Each patient was treated with a novel active rehabilitation program for varying lengths of time, including spinal manipulation and a patented external head and body weighting system. Following a course of treatment, consisting of clinic and home care treatments, post-treatment radiographs and examinations were conducted. Improvement in symptoms and daily function was obtained in all 3 cases. Concerning Cobb angle measurements, there was an apparent reduction in Cobb angle of 13 degrees , 8 degrees , and 16 degrees over a maximum of 12 weeks of treatment. CONCLUSION: Although mild to moderate reductions in Cobb angle measurements were achieved in these cases, these improvements may not be related to the symptomatic and functional improvements. The lack of a control also includes the possibility of a placebo effect. However, this study adds to the growing body of literature investigating methods by which mild to moderate cases of scoliosis can be treated conservatively. Further investigation is necessary to determine whether curve reduction and/or manipulation and/or placebo was responsible for the symptomatic and functional improvements noted in these cases.

Journal Article↗
PubMed2006

The experience of brace treatment in children/adolescents with scoliosis.

BACKGROUND: Idiopathic scoliosis is a chronic illness with several different braces used for its treatment. Brace treatment during childhood/adolescence can produce stress. There are studies supporting that it can decrease body-image perception while other studies support that it has no such effect.The purpose of this study was to explore the experience of brace treatment in children/adolescents with scoliosis. The aim was to investigate which feelings are created by the bracing experience in children/adolescents with scoliosis and what are the children/adolescents' with scoliosis opinions of the support provided to them by health-care professionals and by their families. METHODS: We conducted interviews with the help of a semi-structured interview guide in order to address the topic of the experience of brace treatment. A convenient sample of twelve children and adolescents with scoliosis was selected from patients attending follow-up appointments at the Outpatient Scoliosis Clinics of two Greek hospitals. The data was analysed using the method of content analysis. RESULTS: Patients in the sample were 10-16 years old and they were mainly females (71%). Almost all of the participants reported having to deal with stress, denial, fear, anger, and shame. They were satisfied with the information they received regarding their condition and therapy. However, the information was not accompanied by support from the health care professionals. They reported that they were receiving support mainly from their families, friends, and classmates. CONCLUSION: The present study is contributing to the development of a better understanding of significant issues related to the experience of bracing therapy. It is clear that scoliosis children/adolescents have to be provided with support during the long period of bracing. It is apparent that those children/adolescents have unmet needs for care and health professionals and policy makers should try to find a way to address those needs.

Journal Article↗
PubMed2001

Development of scoliosis following pinealectomy in young chickens is not the result of an artifact of the surgical procedure.

Pinealectomy in young chickens consistently results in scoliosis, which has many characteristics similar to those seen in adolescent idiopathic scoliosis. The mechanism underlying this phenomenon remains a mystery and it is not yet entirely clear whether some unidentified aspect of the extensive surgery is the major factor rather than the removal of the pineal gland. Four different types of pinealectomy surgery were performed on young chickens as well as deliberate damage to the cerebral cortex which simulated the extreme of any accidental damage that might occur during surgery. Scoliosis was assessed from weekly radiographs. No differences in incidence of scoliosis, degree of severity, or pattern of curve development were observed for any of the experimental groups when compared with controls. In all groups approximately 55% of the chickens developed scoliosis that progressed rapidly. Different pinealectomy procedures and deliberate damage to the cerebral cortex produce scoliosis in young chickens with the same incidence and characteristics. This suggests strongly that the mechanism behind the phenomenon is due to the removal of the pineal gland and not some artifact of the extensive surgery. The pinealectomy model in young chickens is proving to be a good model for studying AIS in humans. An understanding of the mechanism underlying this phenomenon has the potential to provide further insights into the etiology of AIS and can lead to the development of novel treatment methods.

Animals↗
PubMed2005

Preoperative predictors of prolonged postoperative mechanical ventilation in children following scoliosis repair.

Scoliosis is associated with progressive restrictive lung disease and an increased risk of pulmonary complications following surgical correction. Identification of higher risks for prolonged postoperative mechanical ventilation (MV) improves postoperative care. Our objective was to determine if preoperative pulmonary function tests (PFT) predict prolonged postoperative MV (defined as MV >or=3 days). We correlated preoperative PFT (forced expired volume in 1 sec, FEV1; vital capacity, VC; inspiratory capacity, IC; maximal inspiratory pressure, MIP; total lung capacity, TLC; and residual volume, RV) and postoperative MV days in 125 patients who had scoliosis surgery (aged 13.7 +/- 3.0 (SD) years) from January 1990-July 2001. We had 71 male and 54 female patients. Scoliosis types were 13 congenital, 27 idiopathic, 57 neuromuscular, 23 syndrome/tumor, and 5 kyphoscoliosis. Forty patients (32%) had postoperative MV >or=3 days. Independent factors likely requiring postoperative MV >or=3 days were neuromuscular scoliosis (P < 0.001) and FEV1 <40% predicted. Independent factors most likely were: neuromuscular scoliosis with preoperative FEV1 <40% predicted (P < 0.01). Independent factors most unlikely were: idiopathic scoliosis (P < 0.002). VC <60% predicted, IC <30 ml/kg, TLC <60% predicted, and MIP <60 cm H2O correlated with postoperative MV >or=3 days (P < 0.05). We found no association between RV and postoperative MV. FEV1 <40% predicted, VC <60% predicted, IC <30 ml/kg, TLC <60% predicted, MIP <60 cm H2O, and neuromuscular disease each correlated with prolonged postoperative MV. Neuromuscular disease or a preoperative FEV(1) <40% predicted were more likely, and older children with neuromuscular disease and FEV1 <40% predicted were most likely to require prolonged postoperative MV (P < 0.01). Clearly FEV1, and possibly VC, IC, TLC, and MIP, may increase accuracy in predicting the need for prolonged postoperative MV.

Adolescent↗
PubMed1980

Scoliosis in neuromuscular disorders.

Hundred-seventy patients with the 4 commonest degenerative neuro-muscular disorders (limbgirdle and Duchenne muscular dystrphy, Kugelberg-Welander's spinal muscular atrophy and peroneal muscular atrophy) were screened for scoliosis, which was found in 56%. Of 76 patients in the early stages of their respective disorders (stages 1-6 of Gardner-Medwin and Walton), scoliosis was found in 72%. The incidence of scoliosis was not related to the duration or degree of clinical weakness. Morphologically, scoliosis in these disorders was not found to differ from idiopathic scoliosis. Neither side nor site of the scoliosis were related to the distribution of muscle weakness as determined by manual testing.

Humans↗
PubMed1996

Vertebral deformities and scoliosis.

Scoliosis, especially idiopathic scoliosis, is a complex three-dimensional deformity of the spine in which the vertebral deformities are known, cuneal deformation being the most commonly known deformity but not the only one. We report here data concerning these specific vertebral deformities in chickens. A pinealectomy was performed in a controlled series of animal experiments. This technique induces progressive scoliosis in more than 80% of chickens, with the advantage of being non-aggressive to the spine. Vertebrae included in major thoracolumbar curves were observed in 17 chickens (11 male, 6 female) and classified into three types of vertebral deformities. Vertebral deformity type 1 is characterized by three-dimensional corporeal torsion, which defines the horizontal disorientation of the curve. Vertebral deformities type 2 and 3 define lateral imbalance in the election plane of the curve. Radiological and anatomical data collected throughout the progression of the scoliosis indicate that there is a correlation between structural vertebral deformities and growth/maturation patterns. We compare our results with those reported in literature concerning human idiopathic scoliosis and experimental animal scoliosis.

Animals↗
PubMed1992

Scoliosis associated with syringomyelia presenting in children.

The clinical presentations and radiological features of scoliosis accompanying syringomyelia were analyzed in 14 cases of syringomyelia associated with a in 14 cases of syringomyelia associated with a Chiari malformation in children. Scoliosis was the initial symptom in 11 out of 16 patients (64%) with syringomyelia and present in 14 (88%) at the initial examination. The scoliosis associated with syringomyelia was characterized by a higher incidence of a single curve (6 cases, 43%) and convexity to the left (7 cases, 50%) than seen in idiopathic scoliosis. The syrinx was shifted to the convex side of scoliosis on the axial section at the middle or lower thoracic level in patients with a single curve, and at the cervical or upper thoracic level in patients with a double curve. The authors think that the scoliosis develops in children as a result of damage done to the anterior horn, which innervates the muscles of the trunk, by an asymmetrically expanded syrinx.

Arnold-Chiari Malformation↗
PubMed1996

Idiopathic scoliosis: biomechanics and biology.

For whatever reason, right-left asymmetry has attracted an illogical proportion of research effort. Non-structural scoliosis, for example secondary to a leg length inequality, is indeed a problem of right-left asymmetry, but structural scoliosis is a complex three-dimensional deformity involving all planes. Biomechanical, biological and clinical evidence indicates clearly that the problem is one of front-back asymmetry and not right-left. The importance of biological factors lies in their ability to bring the spinal column to and beyond its buckling threshold. Thus a taller and more slender spine is more liable to bend and, being stiffer in the sagittal plane, favours movement into other planes. This epitomises the spine of the scoliosis patient who is growing faster with a spinal template similar to other family members allowing idiopathic scoliosis to express itself genetically. It is the opposite condition to idiopathic hyperkyphosis (Scheuermann's disease), but this deformity is rotationally stable, thus remaining in the sagittal plane. The presence of an adjacent area of lordo-scoliosis below the region of hyperkyphosis testifies to the common nature of the pathogenesis of idiopathic scoliosis and Scheuermann's disease. It is the area of compensatory hyperlordosis below the Scheuermann's area that has obligatorily buckled and represents a human model supporting the lordosis theory, as does surgically tethering the back of the young growing human spine, which crankshafts accelerated progression. Similarly the only successful animal model of the formation of idopathic follows creation of a lordotic spinal segment in an otherwise kyphotic spine. For centuries, engineers have recognised that the mechanical behaviour of a column under load is influenced by geometry, as well as by material properties; it is clear that the spinal column also obeys these well-described laws.

Animals↗
PubMed1996

The benefits of school screening for scoliosis in the central part of The Netherlands.

The Netherlands has well-organized school health services, and children are assessed on a regular basis for scoliosis among other disturbances and pathologies. The purpose of this study was to assess the benefits of an annual screening programme for scoliosis in the Netherlands. Three cohorts of 10,000 children sampled at 10, 12 and 14 years of age, respectively, were followed for 3 years. Children with a positive bending sign were referred to a second screening stage, in which external asymmetry was quantified. Children diagnosed via the programme (group 1) were compared with those children who had been referred for treatment independently of the screening (group 2). The total number of children in these groups combined was then compared with the number that would have been expected on the basis of accepted prevalence figures for idiopathic scoliosis given in current literature. Over 30,000 children were screened. Although the programme established a total of 57 cases of definite scoliosis (0.18%), the 34 cases (0.11%) already known, mainly detected by previous school health checks, were more severe regarding the risk of progression and treatment. The annual screening programme did not detect a single case that needed surgery. These figures provide the basis on which to decide for or against adopting an annual screening programme for scoliosis; the decision is a socio-political one. Based on this study, we expect all scoliotic patients needing treatment should be detected in time if periodic health checks will be maintained biennially. On medical grounds, it is our view, that screening for scoliosis should not be performed in the Netherlands annually.

Adolescent↗