Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “SCOLIOSIS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 343 records · Page 19Linked to original sources
PubMed1988

School screening for scoliosis by the Chiba University Medical School screening program. Results of 1.24 million students over an 8-year period.

The screening program for scoliosis started by Chiba University in 1979 consists of using moiré topography, low-dose roentgenography and a final ordinary x-ray examination. The number of children screened through this Chiba University Medical School (CUMS) screening program to 1986 amounted to 1,246,798. The incidence of scoliosis of more than 15 degrees increased linearly according to age from the fifth grade primary school children (0.07% in boys, 0.44% in girls) to the second grade junior high school students (0.25% in boys, 1.77% in girls). The female predominance of scoliosis cases with curvatures of more than 20 degrees detected during the total period was 10:1 and this female predominance was the same for primary school children and junior high school students. According to a study of the incidence of scoliosis by districts, (areas were divided according to population density and urbanization) there were no significant differences in the fifth grade primary school children between the sparsely and densely populated areas. In the cases of children beyond the fifth grade primary school level, however, the incidence in the densely populated areas were significantly higher than those in the sparsely populated districts. The incidence of scoliosis of more than 20 degrees decreased significantly every year among junior high school students, because they were screened periodically in school and the scoliotic students who had already been detected were left out of the next screening. This study establishes that screening for scoliosis by the CUMS screening program is cost-effective with a low risk of radiation hazards.

Adolescent↗
PubMed1989

Concordance of back surface asymmetry and spine shape in idiopathic scoliosis.

In order to determine why topographic methods have shown a poor correlation with radiographically measured scoliosis in clinical studies, the accuracy of detection of the presence, side, apex, and magnitude of a scoliosis curve was determined topographically (by moiré fringe photography and by projected raster photography) in 104 patients attending a scoliosis clinic. The presence or absence of thoracic curves was correctly shown by the topograms in 77% of cases, and in the lower region (lumbar and thoracolumbar curves) in 79% of cases. For correctly identified curves, the greatest back surface rotation was, on average, 1.0 vertebral levels below the skeletal curve apex in the thoracic region and 0.5 levels below the apex in the lower region. The moiré fringe with the greatest asymmetry occurred on average at 1.5 and 1.8 vertebral levels above the spinal apex in upper and lower regions, respectively. The magnitude of the Cobb angle was determined to within +/- 5 degrees in 24% of cases by moiré measurements, and in 27% by the raster technique. The side of the scoliosis was incorrectly diagnosed by topography in ten patients with minimal or 'nonstandard' vertebral rotation. It was concluded that the presence, level, and side of a scoliosis curvature is well demonstrated by back surface topography in patients with 'standard' rotation, but the magnitude of the scoliosis cannot be determined from topograms sufficiently accurately for most clinical purposes.

Adolescent↗
PubMed1990

Scoliosis in trisomy 18.

Patients with trisomy 18 typically present with multiple congenital anomalies and most die within the first year. However, long-term survivors are not uncommon. Seventeen patients with trisomy 18 were evaluated to study the development of scoliosis associated with this disorder. There were 13 females and 4 males with ages ranging from birth to 22 years. Twelve patients died by age 2. None developed scoliosis or had vertebral anomalies. The five patients who survived beyond age 2 developed scoliosis. Curve progression was demonstrated in the patients who returned for follow-up. Bracing was not well tolerated in two patients with curves of 48 degrees and 58 degrees. Both had poor motor control and sitting ability. One patient with a 30 degree curve was successfully managed by bracing. Another patient with a severe scoliosis was successfully fused with anterior and posterior instrumentation. Patients with trisomy 18 should be carefully evaluated for scoliosis. Scoliosis in the older child, surviving beyond age 2, may be progressive and difficult to manage.

Abnormalities, Multiple↗
PubMed1992

Prevalence of scoliosis in children with myelomeningocele in western Sweden.

In a cross-sectional study of the prevalence of scoliosis in patients with myelomeningocele, 131 patients 5-20 years of age were investigated with clinical examination and radiograms. Sixty-nine percent of the myelomeningocele patients had scoliosis, this prevalence being present already at a young age (6 years). The occurrence of scoliosis increased drastically at high levels of dysraphism, being 20% in patients with sacral myelomeningocele but 94% in patients with thoracic MMC level. Between ages 5 and 10, the mean scoliosis increased successively from 15 to 33 degrees. After this age there was no significant further increase. The ambulatory status of the patients was strongly correlated to the scoliosis incidence. Forty-nine percent of the patients had a uni- or bilateral hip dislocation. There was no correlation between the side of the scoliosis convexity and the side of hip dislocation.

Adolescent↗
PubMed1993

Trunk asymmetry, posture, growth, and risk of scoliosis. A three-year follow-up of Finnish prepubertal school children.

Several anthropometric measurements were studied for their prediction of scoliosis in 896 children (430 girls and 466 boys) who were free from scoliosis at entry. The children were examined annually from the average age of 10.8 to 13.8 years to follow up their trunk asymmetry, posture, and growth. Scoliosis developed in 24 boys and 41 girls (Cobb angle > or = 10 degrees in a posteroanterior standing radiograph) during the 3 years. In both girls and boys, trunk asymmetry measured by the forward bending test was found to be the most powerful determinant of the incidence of scoliosis. In the whole cohort the adjusted odds ratio was 1.61 and its 95% confidence interval was 1.42-1.82 per one millimeter increase in trunk hump. Using spinal pantography the degree of thoracic kyphosis in girls (odds ratio = 1.05, 95% confidence interval = 1.01-1.09, per one degree) and the degree of lumbar lordosis in boys (odds ratio = 1.07, 95% confidence interval = 1.01-1.13, per one degree) were significant predictors of future scoliosis. In the children both sexes who eventually had scoliosis, body height, sitting height, and growth of sitting height were greater than in other children, but these factors carried no statistical significance in the logistic analyses. There were differences between the prescoliotic girls and other girls in both mean age (11.8 vs 12.1 years, P = 0.02) and value (5.5 cm vs 6.1 cm/yr, P = 0.08) of peak sitting height velocity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

An experimental study in chickens for the pathogenesis of idiopathic scoliosis.

Experimentally induced scoliosis was investigated in pinealectomized chickens using pathologic and neurophysiologic means. A total of 90 chickens were tested; 30 served as a normal control, 30 received an autografted pineal body in the intramuscular tissue of the trunk, and 30 underwent pinealectomy without autograft. Scoliosis developed in all pinealectomized chickens within 2 weeks, showing gradual progression during the next 5 or 6 weeks. At 3 months, the three-dimensional spinal deformity consisted of lateral curvature and vertebral body rotation, resulting in a prominent lordoscoliosis at the thoracic level. In contrast, scoliosis developed in only 10% of the autografted chickens. Histologic examination revealed no pathologic change in the brain in either the pinealectomized scoliosis group or in the autografted nonscoliosis group. Cortical potentials in the scoliosis group were delayed, thus suggesting conduction disturbance rostral to the brain stem. Although the relationship between the cause and effect is uncertain, these findings implicate neurotransmitters or neurohormonal systems in the pineal body as a major contributing factor in this type of experimental scoliosis.

Animals↗
PubMed1994

Brace treatment of scoliosis in children with myelomeningocele.

In twenty-one children with myelomeningocele and progressive scoliosis, treatment of scoliosis was attempted with a Boston type underarm brace. Thirteen children finished full brace treatment (average treatment time 2.5 years) and the patients were included in a follow-up more than 2 years after the end of treatment with no further progression of the scoliosis. Two patients are still undergoing brace treatment. Six children were operated due to continued progression of the scoliosis. Among 14 patients with scoliosis 45 degrees or less at the start of brace treatment, only 1 patient progressed and underwent operation. The brace had a temporary effect on severe scoliosis, decreasing the rate of progression. Complications were few. The brace caused decubitus ulcer in one patient, and two patients developed increased pressure of the urinary tract.

Adolescent↗
PubMed1995

Does bracing affect bone density in adolescent scoliosis?

STUDY DESIGN: This is a case-control, cross-sectional analysis of bone density. OBJECTIVES: To determine if bracing during growth affects bone density in adolescent idiopathic scoliosis and whether the effect is local or systemic. SUMMARY OF BACKGROUND DATA: Data concerning the effect of bracing on bone mass in adolescents with idiopathic scoliosis are nonexistent. We were concerned that bone mass loss resulting from long-term brace use may be permanent and may predispose to problems with osteoporosis. METHODS: Healthy adolescent females (n = 85) with scoliosis measuring 20-45 degrees and treated either by brace or observation were studied. Dietary calcium, activity level, body mass index, and pubertal status were evaluated. Scoliosis was measured by Cobb angle. Bone mineral density at the hip and spine were measured by dual energy x-ray absorptiometry to differentiate local versus systemic effects of bracing. Lateral scans of the L3 vertebral body were used to minimize the influence of the pedicles, the effect of the scoliosis, and the interference of the ilium. RESULTS: Mean age, height, and weight were similar between braced and observed groups. After adjusting for curve, Cobb angle, body mass index, activity, and diet, two-way analysis of covariance showed L3 and femoral bone mineral density was the same for braced and observed patients, and pubertal status affected spinal bone mineral density but had no effect on femoral bone mineral density. Pubertal status and body mass index accounted for 53% of the variation in spine bone mineral density and was not affected by brace use. Cobb angle, curve pattern, activity, and diet were not associated with bone mineral density. CONCLUSION: Brace treatment does not adversely affect bone mass at the spine and hip in children with idiopathic scoliosis.

Absorptiometry, Photon↗
PubMed1998

Surgical correction of scoliosis in patients with generalized seizures. Risk of vertebral body fracture.

STUDY DESIGN: A retrospective evaluation of the outcome of surgical management of progressive scoliosis in institutionalized patients with frequent, uncontrolled, generalized tonic clonic seizures. OBJECTIVES: To determine the safety and stability of internal fixation devices in patients with progressive scoliosis and intractable seizures. SUMMARY OF BACKGROUND DATA: Progressive scoliosis is a common problem in severely disabled patients. It has been the belief among some spine physicians that the coexistence of intractable seizures with progressive scoliosis is a contraindication for surgery, because most of the thoracic and lumbar spine is fixed and "unyielding" after internal fixations, increasing the risk of vertebral fractures. There have been reports of fracture of fixation devices, particularly Harrington rods, under conditions of massive trauma or mechanical stress, such as seizures. METHODS: The authors reviewed the outcome of six profoundly retarded institutionalized patients with a history of intractable seizures who underwent internal fixation of the spine between 1984 and 1987 because of progressive scoliosis. Seizure types and frequency of convulsion were obtained from the institutional charts. Follow-up radiographs of the spine obtained at 1, 3, and 6 months after the surgery and once a year thereafter were reviewed by the radiologist and orthopedic surgeon with special attention paid to fractures, stability of the fusion, and integrity of the instrumentation. RESULTS: Six patients underwent spinal fusion with internal spinal fixation, four patients with Harrington rods and two with Luque rods. All patients had refractory tonic clonic seizures ranging from 11 to 80 generalized tonic clonic convulsions per year for the 10-year follow-up period after surgery. There were no fractures, subluxation, or pseudoarthrosis of the fused vertebrae or the vertebral bodies adjacent to the fusion. There were no fractures of the instrumentation. CONCLUSIONS: The authors' findings suggest that when appropriate fusion is attained, the use of internal fixation devices is not contraindicated in the management of progressive scoliosis in patients with intractable seizures.

Adolescent↗
PubMed1998

Results and morbidity in a consecutive series of patients undergoing spinal fusion for neuromuscular scoliosis.

STUDY DESIGN: A retrospective clinical and radiographic review. OBJECTIVES: To provide current data on the results and complications of patients who have undergone spinal fusion for neuromuscular scoliosis at a center with physicians experienced in these types of cases. SUMMARY OF BACKGROUND DATA: The reported complication rate in the management of neuromuscular scoliosis ranges from 44% to 62% in the recent literature. This literature is that of 1991 or earlier reflecting operative techniques of the mid-1980s, and it has been used to argue against the efficacy of neuromuscular spinal fusions. METHODS: A retrospective chart and radiographic review of 50 consecutive spinal fusions for neuromuscular scoliosis was performed at Connecticut Children's Medical Center between January 1990 and January 1994. The three most common diagnoses were spastic quadriplegic cerebral palsy (20 patients), myelomeningocele (13 patients), and muscle disease (8 patients). There were 38 posterior spinal fusions including two kyphectomies and 12 anteroposterior spinal fusions. The Luque-Galveston technique was used in 39 of 50 patients. The average age at surgery was 13 years and 6 months, with an average follow-up of 40 months (minimum, 24 months). RESULTS: Before surgery, the mean major scoliosis measured 72 degrees, with mean best bend or traction view of 35 degrees. At most recent follow-up, the mean scoliosis magnitude was 25 degrees (mean correction, 65%). There were 17 minor complications in 14 patients and three major complications (deep wound infections) in three myelomeningocele patients. Rod breakage was noted in two patients, one of whom had an asymptomatic pseudarthrosis. There were no neurologic complications or deaths, and none of the complications affected the final results. CONCLUSIONS: The data in the current study support the authors' belief that with current surgical techniques and perioperative management in an experienced center, the results for patients undergoing spinal fusion for neuromuscular scoliosis have been improved, and major complications have been minimized.

Adolescent↗
PubMed1999

Idiopathic scoliosis. The clinical value of radiologists' interpretation of pre- and postoperative radiographs with interobserver and interdisciplinary variability.

STUDY DESIGN: A retrospective analysis of radiographic reports of 161 consecutive patients with idiopathic scoliosis at the authors' institution. OBJECTIVES: To compare various radiographic findings that directly affect surgical decision-making and the evaluation of postsurgical outcomes to determine the usefulness of information gathered from radiologists' multiple duplicate reading of films. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, there are no previous studies on the readings of scoliosis films by radiologists and surgeons. METHODS: The patient pool was drawn from the private practices of two board-certified orthopaedic surgeons. Each set of radiographs was read by one of seven board-certified radiologists and by one of the two surgeons. The two reports of each radiograph were compared. The factors included in the reports were scoliosis deformity, scoliosis type, curve progression, curve magnitude, levels of the curve, kyphosis, lordosis, the presence of instrumentation, and the presence of a fusion. RESULTS: The radiologists and orthopedic surgeons mentioned the presence of scoliosis in 95% and 99.4% of their reports, respectively. The type of scoliosis was mentioned in 5% of reports by radiologists and in 99.4% by orthopedists. Progression of the curve was documented in 16.7% of the radiologists' reports and in 98.4% of orthopedists' reports. The magnitude of the curve was stated in 12.6% of the radiologists' reports, compared with 98.1% of the orthopaedists' reports. The levels of the curve were documented in 10.6% and 95.6% of reports by the radiologists and orthopedists, respectively. Radiologists mentioned kyphosis and lordosis in 28% and 26.5% of reports, respectively. These same two entities were mentioned in 98.2% and 79.4% of reports by the orthopedists. Finally, the radiologists noted the presence of instrumentation and of a fusion in 77.8% and 68.3% of reports, respectively. Orthopedists mentioned these same two entities in 84.4% and 100% of reports, respectively. In the radiologists' reports on the presence of instrumentation, 20% were mislabeled or improperly identified. Seven percent of the fusions documented by the radiologists were incorrect because they were recorded before biologic fusion could have taken place. In all these categories, the radiologists provided information in excess of the orthopedic reports a total of 1.9% of the time. Of this 1.9% additional information, 36.8% was incorrectly read or mislabeled. The other 63.2% of the additional information (1.9% of the total) did not elucidate anything of real clinical significance that was missed by the orthopedic surgeons (e.g., a tumor in the lung). CONCLUSIONS: These findings show that the attending orthopedic spine surgeons gained little useful information from the radiologists' multiple duplicate reading of films.

Humans↗
PubMed2000

Effects of thoracolumbosacral orthosis on spinal deformities, trunk asymmetry, and frontal lower rib cage in adolescent idiopathic scoliosis.

STUDY DESIGN: Prospective study. OBJECTIVES: To document immediate and late changes in shape and balance of the thoracic and lumbar spine and lower rib cage on the frontal plane induced by treatment with a thoracolumbosacral orthosis (TLSO). SUMMARY OF BACKGROUND DATA: The effect of TLSO on lateral plane of spinal deformity, frontal lower rib cage, trunk balance, and natural history are poorly understood. METHODS: Twenty-four female adolescents with major thoracic and/or lumbar scoliosis, averaging 30 degrees and 26 degrees, respectively, were treated with a full-time TLSO program. Scoliosis, kyphosis, convex, and concave rib-vertebral angles T7 to T12, frontal trunk balance, frontal vertebral inclination, rotation and translation from T7 to L4-vertebrae were measured before bracing, 1 month after bracing, and biannually thereafter in brace and without brace for a 4-year period and reevaluated at the age of 20 years, at an average of 3.5 years after termination of bracing to measure any permanent changes. RESULTS: Thoracolumbosacral orthosis treatment corrected both thoracic and lumbar scoliosis and reduced lateral trunk shift at the expense of significant, although temporary reduced physiological thoracic kyphosis, increased lateral displacement of T7 to T10, increased frontal inclination of L2 to L4, and elevation of the apical concave rib in favor of reduction of lateral displacement of T11 to L4; decreased frontal inclination of T7, T9, and T11; and derotated L1 and L2 and thoracic apical vertebra without affecting drooping of the 7th to 12th ribs. In this series, there was marked inconsistency in the obtained changes in several of the roentgenographic parameters in the different evaluations, which is probably because of the empiric application of the TLSO during different periods of treatment. 3.5 years after termination of TLSO-wearing, all roentgenographic parameters remained to the prebrace values. CONCLUSIONS: Thoracolumbosacral orthosis program maintained the measured roentgenographic parameters at the prebrace levels in progressive adolescent idiopathic scoliosis, but it had no effect on the droop of the seven lower ribs. The TLSO treatment stopped progression of scoliosis and reduced the number of patients requiring surgery. Thus, it changed the natural history of scoliosis.

Adolescent↗
PubMed2001

Effects of electrical stimulation of the sciatic nerve on background electromyography and static stretch reflex activity of the trunk muscles in rats: possible implications of neuronal mechanisms in the development of sciatic scoliosis.

STUDY DESIGN: The effects of electrical stimulation of the sciatic nerve on background electromyographic and static stretch reflex activity of the trunk muscles were studied. OBJECTIVES: To verify the hypotheses that sciatic scoliosis is induced reflexively by radiculopathic pain, and that scoliosis might be maintained by prolonged asymmetric alteration of the trunk muscle tonus caused by central sensitization of the spinal neurons that constitute the postural reflex pathways. SUMMARY OF BACKGROUND DATA: Sciatic scoliosis usually occurs with convexity to the side of the herniated disc. The neuronal mechanism of sciatic scoliosis has not been well clarified. Recently, prolonged alteration of motor function in the hindlimbs of animals caused by central sensitization has been reported. METHODS: In spinalized rats (transection of the spinal cord), the sciatic nerve was stimulated electrically as a conditioning stimulus. Muscle stretch elicited by bending of the lumbar spine was applied as a test stimulus. Background and stretch reflex activities of the bilateral oblique abdominal, psoas, and quadratus lumborum muscles were recorded. Rats in which MK-801, an N-methyl-d-aspartate antagonist, was preadministered also were used. RESULTS: The conditioning stimulus enhanced background electromyographic activity in bilateral oblique abdominal, contralateral psoas, and quadratus lumborum muscles. Furthermore, the conditioning stimulus induced prolonged facilitation and depression of stretch reflex activity of the contralateral psoas and quadratus lumborum, and ipsilateral psoas and quadratus lumborum muscles, respectively. Preadministration of MK-801 reduced these excitatory and inhibitory effects. CONCLUSION: It was found that the pattern of electromyographic activity of the trunk muscles evoked by sciatic nerve stimulation coincided with the typical direction of sciatic scoliosis in patients with lumbar disc herniation. It was supposed that the prolonged asymmetric alteration of the trunk muscle tonus was caused by central sensitization, and that central sensitization of spinal neurons may underlie the neuronal mechanism of sciatic scoliosis.

Animals↗
PubMed2001

Influence of different types of progressive idiopathic scoliosis on static and dynamic postural control.

STUDY DESIGN: Balance control assessment of static and dynamic conditions was performed to study the effects of progressive idiopathic scoliosis on postural control in 102 adolescents. OBJECTIVE: To determine how the type and location of idiopathic scoliosis may affect global balance control. SUMMARY OF BACKGROUND DATA: Idiopathic scoliosis may impair postural control components, but the repercussions for global balance are relatively mild. METHODS: The following four different types of idiopathic scoliosis were compared: thoracic (n = 36), thoracolumbar (n = 22), lumbar (n = 23), and double major (n = 21) curves. Center of foot pressure displacements and electromyographic responses were recorded using static and dynamic posturographic tests (single and fast upward tilt, slow sinusoidal oscillations). RESULTS: The major criteria of postural control were better in the double major group for all the tests. In the static test, the patients with high major curves performed better than those with low major curves. In the fast dynamic test, similar latency values were observed in all the groups. In the slow dynamic test, better results were observed for the patients with low major curves. CONCLUSIONS: These data demonstrate that idiopathic scoliosis indeed alters balance control, with different hierarchies, from the best to the worst as follows: double major, thoracic, thoracolumbar, and lumbar curves in the static test and double major, lumbar, thoracolumbar, and thoracic curves in the slow dynamic test. The location of the major curve appeared to be important, with an effect on lateral disequilibrium and vestibular symmetry. The absence of anomaly in the fast dynamic test suggests that the type of scoliosis does not impair proprioception.

Adolescent↗
PubMed2001

Patient outcomes after Harrington instrumentation for idiopathic scoliosis: a 15- to 28-year evaluation.

STUDY DESIGN: A retrospective study was performed, using the Short Form-36 Health Survey and the Roland and Morris Disability Questionnaire, to investigate patient outcomes after fusion for adolescent idiopathic scoliosis using Harrington rod instrumentation. OBJECTIVE: To evaluate health-related quality of life and low back pain in a long-term follow-up study of surgery for adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: The commonly accepted surgical treatment for idiopathic evolutive scoliosis is vertebral fusion. It has been suggested that this procedure may cause low back pain and a poor quality of life over the long term. Outcome measures after surgery for adolescent idiopathic scoliosis have focused mainly on objective parameters such as radiographic measures. However, this information has proved to be correlated only weakly with outcomes that are more relevant to patients, such as functional status and symptoms. Until recently, only a few long-term outcome studies have used standardized and validated patient-oriented tools to evaluate surgically treated patients with scoliosis. METHODS: In this study, 70 patients treated with a standard Harrington technique were recontacted and evaluated by means of self-administered questionnaires (Short Form-36 Health Survey and Roland and Morris Disability, clinical examination, and radiographic analysis. Preoperative and follow-up radiographic findings were registered. Relations between radiographic and patient-oriented data were evaluated. RESULTS: A comparison between the current sample and the Italian age-matched normative data for the Short Form-36 Health Survey showed them to have a similar pattern. Findings showed the patient-oriented outcome to be correlated inversely with the extension of vertebral fusion and the preoperative Cobb angle. CONCLUSION: Long-term follow-up evaluation of Harrington rod fusion for adolescent idiopathic scoliosis showed no important impairment of health-related quality of life, as measured by patient-oriented evaluation.

Adult↗
PubMed2001

Childbearing, curve progression, and sexual function in women 22 years after treatment for adolescent idiopathic scoliosis: a case-control study.

STUDY DESIGN: A consecutive series of female patients with adolescent idiopathic scoliosis treated between 1968 and 1977, either with distraction and fusion using Harrington rods (n = 145) or with a brace (n = 122), were followed for at least 20 years after completion of the treatment. OBJECTIVES: To determine the long-term outcomes of childbearing and sexual life in women treated for adolescent idiopathic scoliosis, as compared with matched control subjects who did not have scoliosis. SUMMARY OF BACKGROUND DATA: The effect of pregnancy on curve progression is not established, and results are contradictory. Few reports exist on the social life (marriage, childbearing, and sexual function) of formerly treated individuals with scoliosis. METHODS: In this study, 136 surgically treated women (94%) and 111 brace-treated women (91%) completed the Scoliosis Research Society (SRS)/MODEM's questionnaire concerning childbearing and sexual life as a part of an unbiased personal follow-up examination. Of these, 129 surgically treated and 105 brace-treated women also underwent a radiographic examination. The Cobb method was used to measure curve size in present and earlier examinations. An age-matched control group of 90 women was randomly selected and subjected to the same examinations. RESULTS: The mean age for all the groups was 40 years. Of the surgically treated and brace-treated women, 85% were or had been married, as compared with 82% of the control women. In the total cohort, 628 pregnancies had occurred. No significant mean difference existed between the groups in the number of children born (1.8 for the surgically treated, 1.9 for the brace-treated, and 2 for the control women) (P = 0.25). The patients in the brace-treated group had a significantly higher mean age at first pregnancy (28 years) than the control subjects (25.9 years) (P = 0.011), whereas the age for the surgically treated women (26.6 years) did not differ significantly from that for the brace-treated women. There were no significant differences between the groups in rates for low back pain (35% for the surgically treated, 43% for the brace-treated, and 28% for the control group) or for cesarean section (19% for the surgically treated, 14% for the brace-treated, and 18% for the control group) during the first pregnancy. The rate of vacuum extractions was higher in the surgically treated group (16%) than in the control group (5%) (P = 0.036) or the brace-treated group(8%). Limitation of sexual function from the back was admitted by 33% of the surgically treated, 28% of the brace-treated, and 15% of the control women: surgically treated vs control subjects (P = 0.0042), brace-treated vs control subjects (P = 0.026), and brace-treated vs surgically treated subjects (P = 0.57, a nonsignificant difference). These limitations were largely because of difficulties participating physically in activities or self-consciousness about appearance. Pain was a minor reason for limitation. There was no correlation between progression of the major or lumbar curve and number of pregnancies, or between curve progression and age at first pregnancy. CONCLUSIONS: Patients treated for adolescent idiopathic scoliosis appeared to function well with regard to marital status and number of children. The scoliotic curve did not seem to increase as a result of childbearing. Minor problems occurred during pregnancy and delivery. Some patients, however, experienced a slight negative effect in their sexual life.

Adolescent↗
PubMed2001

Is sacral instrumentation mandatory to address pelvic obliquity in neuromuscular thoracolumbar scoliosis due to myelomeningocele?

STUDY DESIGN: Prospective study. OBJECTIVE: To evaluate the functional outcome of two-stage anterior and posterior instrumented fusion without fixation to the sacrum on 11 patients with neuromuscular scoliosis from thoracolumbar myelomeningocele. SUMMARY OF BACKGROUND DATA: To our knowledge, there are no published results of combined anterior and posterior correction and fusion without inclusion of the sacrum in neuromuscular scoliosis from thoracolumbar myelomeningocele. In this article we present our experience and critically evaluate the functional outcome on 11 patients with neuromuscular scoliosis. PATIENTS AND METHODS: From July 1, 1992 through June 30, 1995, 11 consecutive patients with severe thoracolumbar scoliosis were admitted at our hospital. The mean age at operation was 12 years 9 months (range 9 years 9 months to 14 years 6 months). All patients underwent a two-stage anterior and posterior spinal reconstruction. The patients were evaluated before surgery and after surgery. RESULTS: All patients were observed for a mean of 4 years 11 months (range 42-88 months) from the time of second stage procedure. Before treatment the mean scoliosis was 81 degrees (range 55-110 degrees ); this was reduced to a mean of 31 degrees (range 8-70 degrees ), and at the final follow-up the correction had deteriorated slightly to a mean of 35 degrees (range 12-80 degrees ). No patient had increased neurologic deficit or showed other major complication. CONCLUSIONS: Pelvic obliquity in thoracolumbar neuromuscular scoliosis from lumbosacral myelomeningocele spontaneously corrected when the scoliotic deformity is adequately addressed with instrumented fusion without inclusion of the sacrum. The correction obtained remained stable at follow-up. In the absence of a control group we believe that sparing lumbar segments from primary fusion offers these patients a better freedom of mobility.

Adolescent↗
PubMed2001

Multisurgeon assessment of surgical decision-making in adolescent idiopathic scoliosis: curve classification, operative approach, and fusion levels.

STUDY DESIGN: A multisurgeon assessment of curve classification, selection of operative approach, and fusion levels via a case study presentation. OBJECTIVES: To evaluate the ability of a group of scoliosis surgeons, not involved in the development of a new classification system, to accurately choose the corresponding curve classification of adolescent idiopathic scoliosis (AIS) cases and to evaluate the variability in the selection of operative approaches and both proximal and distal fusion levels in accordance with the new classification system in operative adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Recent evaluations using the King method for classifying AIS has shown poor intraobserver and interobserver reliability. A new, comprehensive classification system of AIS has been developed, but the result of a scoliosis surgeon's ability to apply the objective classification is unknown. In the surgical treatment of AIS, there are three choices for the operative approach (anterior, posterior, or both) and multiple choices for the selection of fusion levels. METHODS: During an AIS roundtable discussion at a spinal surgery meeting, 28 scoliosis surgeons were presented seven cases of operative AIS via good quality slides. Standard preoperative radiographs and clinical photographs were presented, and the reviewers were asked to classify the cases by a new classification system, choose their preferred surgical approach, and classify both proximal and distal fusion levels. RESULTS: For the seven cases presented, 84% of the curve types, 86% of lumbar modifiers, and 90% of sagittal thoracic modifiers were classified by the reviewers as described in the new classification. The case study found widely variable operative approaches and fusion levels chosen by the reviewers. There was an average of five different proximal (range, 4-8) and four different distal (range, 3-5) fusion levels chosen by the reviewers for each case. CONCLUSIONS: This case study assessment found a relatively high rate (84-90%) of agreement in curve classification of the individual components of a new classification system of AIS. This suggests the ability of a group of scoliosis surgeons to identify the specific criteria necessary for this new classification system of AIS. In addition, the high variability in selection of both operative approach and fusion levels confirms the current lack of standardized treatment paradigms. This further reinforces the need for a method to critically and objectively evaluate these variable treatments to determine the "best" radiographic and clinical results.

Adolescent↗