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PubMed1997

The prevalence of back pain in children who have idiopathic scoliosis.

A retrospective study of 2442 patients who had idiopathic scoliosis was performed to determine the prevalence of back pain and its association with an underlying pathological condition. Five hundred and sixty (23 per cent) of the 2442 patients had back pain at the time of presentation, and an additional 210 (9 per cent) had back pain during the period of observation. There was a significant association between back pain and an age of more than fifteen years, skeletal maturity (a Risser sign of 2 or more), postmenarchal status, and a history of injury. There was no association with gender, family history of scoliosis, limb-length discrepancy, magnitude or type of curve, or spinal alignment. At the latest follow-up evaluation, 324 (58 per cent) of the 560 patients who had had back pain at presentation had no additional symptoms. Forty-eight (9 per cent) of the 560 patients who had back pain had an underlying pathological condition: twenty-nine patients had spondylolysis or spondylolisthesis, nine had Scheurmann kyphosis, five had a syrinx, two had a herniated disc, one had hydromyelia, one had a tethered cord, and one had an intraspinal tumor. A painful left thoracic curve or an abnormal neurological finding was most predictive of an underlying pathological condition, although only eight of the thirty-three patients who had such findings were found to have such a condition. When a patient with scoliosis has back pain, a careful history should be recorded, a thorough physical examination should be performed, and good-quality plain radiographs should be made. If this initial evaluation reveals normal findings, a diagnosis of idiopathic scoliosis can be made, the scoliosis can be treated appropriately, and non-operative treatment can be initiated for the back pain. It is not necessary to perform extensive diagnostic studies to evaluate every patient who has scoliosis and back pain.

Adolescent↗
PubMed2001

Clinical value of routine preoperative magnetic resonance imaging in adolescent idiopathic scoliosis. A prospective study of three hundred and twenty-seven patients.

BACKGROUND: The prevalence of intraspinal pathology associated with scoliosis has been reported to be as high as 26% in some series, and, on the basis of this finding, preoperative magnetic resonance imaging is used in the screening of patients with adolescent idiopathic scoliosis. However, this practice continues to be highly controversial. In order to better resolve this issue, we performed what we believe to be the largest prospective study to evaluate the need for preoperative magnetic resonance imaging in patients with adolescent idiopathic scoliosis requiring arthrodesis of the spine. METHODS: A total of 327 consecutive patients with adolescent idiopathic scoliosis were evaluated between December 1991 and March 1999. All patients in the study presented with an adolescent idiopathic scoliosis curve pattern and had a complete physical and neurologic examination. Magnetic resonance imaging of the brain and the spinal cord were performed as part of their preoperative work-up. RESULTS: Seven patients had an abnormality noted on magnetic resonance imaging. These abnormalities included a spinal cord syrinx in two patients (0.6%) and an Arnold-Chiari type-I malformation in four (1.2%). One patient had an abnormal fatty infiltration of the tenth thoracic vertebral body. No patient required neurosurgical intervention or additional work-up. All patients who underwent spinal arthrodesis with segmental instrumentation tolerated the surgery without any immediate or delayed neurologic sequelae. CONCLUSIONS: The fact that magnetic resonance imaging did not detect any important pathology in the large number of patients in this study strongly suggests that magnetic resonance imaging is not indicated prior to arthrodesis of the spine in patients with an adolescent idiopathic scoliosis curve pattern and a normal physical and neurologic examination.

Adolescent↗
PubMed2004

The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis.

BACKGROUND: Thoracic insufficiency syndrome is the inability of the thorax to support normal respiration or lung growth and is seen in patients who have severe congenital scoliosis with fused ribs. Traditional spinal surgery does not directly address this syndrome. METHODS: Twenty-seven patients with congenital scoliosis associated with fused ribs of the concave hemithorax had an opening wedge thoracostomy with primary longitudinal lengthening with use of a chest-wall distractor known as a vertical, expandable prosthetic titanium rib. Repeat lengthenings of the prosthesis were performed at intervals of four to six months. Radiographs were analyzed with respect to correction of the spinal deformity, as indicated by a change in the Cobb angle, and lateral deviation of the spine, as indicated by the interpedicular line ratio. Spinal growth was assessed by measuring the change in the length of the spine. Correction of the thoracic deformity and thoracic growth were assessed on the basis of the increase in the height of the concave hemithorax compared with the height of the convex hemithorax (the space available for the lung), the increase in the thoracic spinal height, and the increase in the thoracic depth and width. The thoracic deformity in the transverse plane was measured with computed tomography, and the scans were analyzed for spinal rotation, thoracic rotation, and the posterior hemithoracic symmetry ratio. Clinically, the patients were assessed on the basis of the relative heights of the shoulders and of head and thorax compensation. Pulmonary status was evaluated on the basis of the respiratory rate, capillary blood gas levels, and pulmonary function studies. RESULTS: The mean age at the time of the surgery was 3.2 years (range, 0.6 to 12.5 years), and the mean duration of follow-up was 5.7 years. All patients had progressive congenital scoliosis, with a mean increase of 15 degrees /yr before the operation. The scoliosis decreased from a mean of 74 degrees preoperatively to a mean of 49 degrees at the time of the last follow-up. Both the mean interpedicular line ratio and the space available for the lung ratio improved significantly. The height of the thoracic spine increased by a mean of 0.71 cm/yr. At the time of the last follow-up, the mean percentage of the predicted normal vital capacity was 58% for patients younger than two years of age at the time of the surgery, 44% for those older than two years of age (p < 0.001), and 36% for those older than two years of age who had had prior spine surgery. In a group of patients who had sequential testing, all increases in the volume of vital capacity were significant (p < 0.0001), but the changes in the percentages of the predicted normal vital capacity were not. There was a total of fifty-two complications in twenty-two patients, with the most common being asymptomatic proximal migration of the device through the ribs in seven patients. CONCLUSIONS: Opening wedge thoracostomy with use of a chest-wall distractor directly treats segmental hypoplasia of the hemithorax resulting from fused ribs associated with congenital scoliosis. The operation addresses thoracic insufficiency syndrome by lengthening and expanding the constricted hemithorax and allowing growth of the thoracic spine and the rib cage. The procedure corrects most components of chest-wall deformity and indirectly corrects congenital scoliosis, without the need for spine fusion. The technique requires special training and should be performed by a multispecialty team.

Abnormalities, Multiple↗
PubMed2004

Operative correction of adolescent idiopathic scoliosis in male patients. A radiographic and functional outcome comparison with female patients.

BACKGROUND: The outcomes following surgical treatment of adolescent idiopathic scoliosis have traditionally been assessed on the basis of radiographic parameters and, more recently, functional outcome measures. However, we know of no published studies in which radiographic and functional outcomes following surgery were compared between male and female patients. METHODS: Fifty-two male patients who had had surgery for adolescent idiopathic scoliosis were compared retrospectively with two groups of female patients: a random sample of 130 female patients who had had surgical treatment for adolescent idiopathic scoliosis during the same time period and a subgroup of fifty-two of these female patients who had been matched to the male patients with regard to curve type and magnitude. Radiographic parameters were compared between the male and female patients, and the Scoliosis Research Society outcome questionnaire was used to compare functional results between the male patients and the matched female group. RESULTS: Compared with the random sample of female patients, the male patients were older at the time of presentation (average [and standard deviation], 13.9 +/- 1.9 compared with 12.8 +/- 1.4 years) and at the time of surgery (average, 15.9 +/- 2.0 compared with 14.2 +/- 1.4 years) (p < 0.05). The male and female patients presented with primary coronal curves of similar magnitudes (average, 48 degrees +/- 19 degrees compared with 47 degrees +/- 13 degrees ), but the male patients had larger curves at the time of surgery (average, 62 degrees +/- 11 degrees compared with 56 degrees +/- 10 degrees ) with greater coronal plane imbalance. Compared with the subset of female patients matched for curve type and magnitude, the male patients had, on average, a longer surgical time (263 +/- 61 compared with 202 +/- 40 minutes), greater intraoperative blood loss (1148 +/- 660 compared with 944 +/- 408 mL), and less curve correction in the coronal plane (from 62 degrees +/- 11 degrees to 31 degrees +/- 11 degrees compared with from 59 degrees +/- 10 degrees to 23 degrees +/- 9 degrees ) (p < 0.05). The loss of coronal plane correction, the final coronal balance, all measured sagittal plane parameters, and the prevalence of complications were the same in these two groups. With regard to functional outcome, the scores were similar with the exception that the male patients had lower scores in the category of "function from back condition" when compared with the matched female patients (3.8 +/- 0.2 compared with 4.3 +/- 0.3 points) (p < 0.05). CONCLUSIONS: Adolescent idiopathic scoliosis is identified at a later age in male patients than in female patients with similar curve types. The curve magnitudes in the male patients are greater at the time of surgery. When surgeons are planning operative correction of adolescent idiopathic scoliosis in male patients, they should expect longer operative time, greater blood loss, and less coronal plane correction of the primary curve. However, balance in the coronal and sagittal planes should be achieved and complication rates and functional outcomes can be expected to be similar to those in female patients.

Adolescent↗
PubMed1997

Melanosis naeviformis of Becker and scoliosis: a coincidence?

Melanosis naeviformis of Becker (MNB) can be associated with hypoplasia of soft tissue or extremities, spina bifida and scoliosis of the vertebral column. We have investigated 50 patients (42 men, 8 women) with MNB radiologically. Scoliosis was diagnosed in 13 patients (26%). The curves of scoliosis varied from 11 degrees to 17 degrees. Physical examination revealed no gross asymmetries of the trunk, extremities or breasts. No correlation was seen between the age of patients and the scoliotic curve. In one family the father and oldest son had MNB with scoliosis and the other son and daughter had MNB without scoliosis. Since only mild scoliosis is found in patients with MNB, X-ray examination of the vertebral column has no therapeutic consequences.

Adolescent↗
PubMed1982

Moiré topography in school screening for structural scoliosis.

Schoolgirls, aged 10-17 years, were screened for structural scoliosis at school using both conventional clinical screening with a forward bending test and moiré topography. Those suspected of having scoliosis were examined in an orthopaedic clinic for the presence of clinically significant scoliosis, defined as lateral deviation of 10 degrees or more measured according to Cobb. The screening revealed 41 cases of scoliosis, corresponding to a prevalence of 4.1 per cent. In 39 girls the scoliosis had not been recognized previously. In this study moiré topography revealed twice as many cases of scoliosis as did conventional clinical screening. The diagnostic sensitivity of moiré topography proved to be high (0.997). The method is, however, loaded by many false positive results. No correlation between the degree of lateral deviation, judged by X-ray examination, and the difference in contour lines, judged by moiré topography, was found.

Adolescent↗
PubMed1986

The case for scoliosis screening in Australian adolescents.

A survey of 3660 Year 10 students, with an average age of 15 years, was carried out in a random sample of Adelaide secondary schools to determine the prevalence of structural scoliosis and the need for implementing a programme of scoliosis screening. By means of the Forward Bending Test and a specially devised scoring system 144 (3.9%) children were found to have signs that were suggestive of scoliosis; all but 12 were assessed subsequently by standardized clinical and radiological examinations. One hundred and three children were found to have structural scoliosis of 5 degrees or more; this represented a prevalence of 3.1%. The prevalence in girls (4.3%) was significantly higher than in boys (1.9%), and girls tended to have more severe curves and require treatment more frequently. Only one third (34) of the cases of structural scoliosis had been detected before this survey; most (28) of these had been detected through an earlier, subsequently discontinued, school screening programme. This study concludes that screening for scoliosis by means of a scored Forward Bending Test should be carried out in South Australian schools for all students in Year 8 and for girls in Year 10. The policy of screening boys in Year 8 should be the subject of further research. An educational programme for health professionals, parents, students and physical education teachers should support the programme.

Adolescent↗
PubMed1999

[Respiratory problems in severe scoliosis].

In kyphoscoliosis restrictive ventilatory defect occurs. In idiopathic scoliosis vital capacity failure is significantly correlated with Cobb angle, vertebral rotation, and thoracic lordosis. Maximum voluntary ventilation is the most affected measurement. Forced expiratory volume in 1 second is reduced. Residual volume remains longtime normal. Hypoxemia due to decrease of diffusing capacity occurs, with initially reflex hyperventilation hypocapnia, and secondary hypercapnia. Pulmonary hypertension and cor pulmonale is related to hypoventilation and hypoxia. The lung situated on the concave side of the scoliosis curve shows a more functional derangement. Ventilatory pattern consists of low tidal volume and high respiratory rate with increase of ventilatory work. Scoliosis that appears in the earlier stage of the life has the worst respiratory prognosis (before 5 years of age) with impairement of lung and thoracic growth. To stimulate pulmonary and thoracic growth, intermittent ventilatory assistance by pressure preset ventilator should be performed as soon as possible and pursued up to 8 years of age, at least, more if necessity. In over 60 degrees angle idiopathic scoliosis, respiratory failure appears after 40 to 50 years of age. Non invasive ventilatory assistance with preset pressure ventilator by oral way in moderate cases and nocturnal nasal ventilation by volume ventilator or inspiratory assistance ventilator, in the most severe cases are efficient. In very severe and acute respiratory insufficiency (scoliosis over 90 degrees) ventilation by intubation then tractheostomy may be required. Earlier orthopedic management and surgical procedure to correct and stabilize spinal deformities is the best to prevent respiratory insufficiency. For scoliosis below 60 degrees, post operative pulmonary complications are very low, with no requirement of post operative ventilatory support. In very severe respiratory insufficiency treatment of respiratory failure precedes, and follows, orthotic treatment and surgical procedures; it shouldle pursued afterwards.

Adolescent↗
PubMedDate not supplied

Increased prevalence of scoliosis in Turner syndrome.

Turner syndrome (TS) is associated with multiple skeletal abnormalities. However, the prevalence of scoliosis in children with TS has not been reported in the orthopaedic literature. The purpose of this study was to determine the prevalence and characteristics of scoliosis in these patients. The authors performed a retrospective study of 43 patients with TS and found 5 children with a curve >10 degrees. The prevalence of scoliosis in this TS population, 11.6%, was significantly greater than the reported prevalence of idiopathic scoliosis in normal girls, 2.4%. The mean age of onset was 9 years 11 months. All curves were >34 degrees, with curves consisting of a right thoracic or S-shaped (larger lumbar segment) pattern. At the time of scoliosis presentation, two patients were not receiving growth hormone therapy. The results of this study suggest that children with TS need to be examined and closely monitored for progression of scoliosis by orthopaedists. Although curve progression can occur during growth acceleration, a direct causal association with growth hormone has not been established.

Adolescent↗
PubMed1992

The etiology and pathogenesis of idiopathic scoliosis.

Idiopathic scoliosis is a complex three-dimensional deformity and in the thoracic region the essential lesion lies in the sagittal plane in the form of an area of inappropriate lordosis. The thoracic kyphosis is normally protected from buckling by being behind the axis of spinal column rotation but when the thoracic lordosis develops it brings the apical region anterior to this axis and thus under compression with resultant buckling failure of the spinal column. The condition of idiopathic thoracic scoliosis is the opposite to idiopathic hyperkyphosis (Scheuermann's disease), the latter being rotationally stable and not moving out of the sagittal plane. The two frequently co-exist in the same spine with thoracic hyperkyphosis above an area of lumbar lordo-scoliosis. There is a spectrum of normal lateral profile and flat backs at the one end are in danger of buckling (lordo-scoliosis) while round backs at the other end of the spectrum are in danger of being defined as Scheuermann's disease. There is no requirement for a specific pathological process. Engineers describe only two ways in which a flexible column can fall into mechanically-angular collapse (kyphosis) and column buckling (lordo-scoliosis). A number of factors favour column buckling (Euler's law) and thus the bigger a deformity the more likely it will be to continue progressing and the taller and more slender the column the more likely it will be to fail and this we see in our patients with idiopathic scoliosis. Not only is lordosis the essential lesion but it is also the primary abnormality which can be demonstrated in children before lateral curvature and rotation develop.

Adolescent↗
PubMedDate not supplied

Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis.

BACKGROUND CONTEXT: In degenerative lumbar spinal stenosis with scoliosis (DLS), many authors stated that nerve root compression is almost always seen on the concave side of the scoliosis, and L4 and L5 nerve roots are the most often involved. However, there are few reports on the relationship between nerve root compression and the pattern of scoliosis. PURPOSE: To investigate the factors that may contribute to radiculopathy in DLS and their association with the pattern of the scoliosis. STUDY DESIGN: Retrospective analysis. METHODS: Twenty-two consecutive patients with DLS with radiculopathy were examined. The symptomatic nerve roots were determined by pain distribution, neurological findings and nerve root infiltration using lidocaine. The compressive factors were diagnosed by magnetic resonance imaging or myelography, discography, computed tomography after myelography or discography and radiculography. The pattern of scoliosis was determined in plain radiographs. We evaluated the correlation between the affected nerve root and the compressive factors or the pattern of the scoliosis. RESULTS: The L3 root was affected in 23% of patients; L4 root in 68%, L5 root in 55% and S1 root in 18%. L3 and L4 roots were more compressed by foraminal or extraforaminal stenosis on the concave side of the curve, whereas L5 and S1 roots were commonly affected by lateral recess stenosis on the convex side. The Cobb angle and the lateral slip of the cases in which L3 or L4 root was affected were significantly larger than in cases in which L5 or S1 root was compressed. CONCLUSIONS: In the treatment of radiculopathy caused by DLS, it is important to bear in mind that L3 or L4 roots were more strongly compressed by foraminal or extraforaminal stenosis at the concave side of the curve, whereas L5 or S1 nerve roots were affected more by lateral recess stenosis at the convex side of the curve.

Aged↗
PubMed2003

Peak expiratory flow in children and adolescents with idiopathic scoliosis.

Spirometric and plethysmographic examinations were performed in two groups of children with idiopathic scoliosis and healthy children. Group I, 23--children with scoliosis 1 degree by Cobb, spinal curvature 17.2 degree, 12 girls and 11 boys at the age 8-15 years (the mean age was 11.4 +/- 2.4 yr). In Group II were 35 children, 28 girls and 7 boys at the age 12-19 years (the mean age was 14.67 +/- 1.47 yr) with mean angle of curvature 63.35 degree, which is grade II and III scoliosis according to Cobb. The Control Group were 20 children, 13 girls and 7 boys at the age of 8-16 years (the mean age was 13.77 +/- 1.72 yr). The measurements were done using Body--plethysmography with pneumotachograph Jaeger. All subjects had respiratory function examination performed, which included: total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume in 1 sec. (FEV1), residual volume (RV) and intrathoracic gas volume (ITGV). At the same time peak expiratory flow--PEF were determined. In children with scoliosis at initial stage, Group I, were found slightly decreased total lung capacity--TLC and statistically significantly decreased intrathoracic gas volume--ITGV as well as residual volume--RV in comparison to the control group. Forced vital capacity--FVC and forced expiratory volume in 1 sec.--FEV1 were normal. But statistically significantly decreased PEF values were found in comparison to the control group (p < 0.05). It means that restrictive and obstructive disturbances of lungs progressing in grade II and III scoliosis were shown manifested by reduced values of TLC, FVC, ITGV and RV. A statistically significant decrease of peak expiratory flow together with the growth of spinal curvature angle was shown in grade II and III scoliosis in comparison with both the control group and the studied Group I (p < 0.001, p < 0.05).

Adolescent↗
PubMed2002

The 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 aetiology of AIS and can lead to the development of novel treatement methods.

Animals↗
PubMed2002

The Double Rib Contour Sign (DRCS) in lateral spinal radiographs: aetiologic implications for scoliosis.

UNLABELLED: All lateral spinal radiographs in idiopathic scoliosis show a DRC sign of the thoracic cage, a radiographic expression of the rib hump. The outline of the convex overlies the contour of the concave ribs. The aim of this study is to assess this DRC sign in children with and without Late Onset Idiopathic Scoliosis (LOIS) with 10 degrees -20 degrees Cobb angle, and to examine whether in scoliosis the deformity of the thorax or that of the spine develops first. METHODS AND MATERIAL: The radiographs of 133 children referred to hospital in a school screening study were examined. There were 47 boys and 86 girls, 13.28 and 13.39 years old respectively. The Cobb angle was measured and the radiological lateral spinal profile (LSP) was appraised from an angle made by a line drawn down the posterior surface of each vertebral body (T1-L5) and by the vertical. The children, boys and girls, were divided in 5 groups, namely: 1) with straight spines, 2) with spinal curvature having a Cobb angle <10 degrees, 3) with thoracic, 4) thoracolumbar and 4) lumbar curves 10 degrees -20 degrees. For quantification of the DRC sign, the "rib index" was defined as d1/d2 ratio, where dl expresses the distance from the most extended point of the most projecting rib contour (RC) to the posterior margin of the corresponding to point vertebra and d2 expresses the distance from the posterior margin of the same vertebra to the most protruding point of the least projecting RC. In a symmetric and non-deformed thorax, these two RC lines are superimposed and the "rib index" is 1. RESULTS: The statistical descriptive of d1 and d2 in boys and girls are presented together because they are not statistically different. There are no sex differences of the "rib index" which is 1.45, 1.51, 1.56, 1.59, 1.47 for the 5 respectively aforementioned groups. According to statistical analysis, there is no correlation of the Cobb angle with the "rib index" of thoracic, thoracolumbar and lumbar scoliosis groups. The DRC sign is present in all referrals and scoliotics. The data show a correlation of the "rib index" with each of T2, T3, T4, T5, T6 and T7 LSP in girls with lumbar curvatures. DISCUSSION: The DRCS primarily appears because of the rib deformation and secondarily because of the vertebral rotation, as it could be present in straight spines with no vertebral rotation. In all our school-screening referrals, (having ATI > or = 7 degrees), the thorax deformity, in terms of the DRC sign, has already been developed. 70% of these children were scoliotic. The others had a curvature of less than 9 degrees of Cobb angle (10%) or they were children with straight spines (20%) who were followed because of their existing rib hump. The non-scoliotics were 1,5-2 years younger than the ones who had already developed scoliosis, and they had both approximately a "rib index" of 1,5. The DRC sign is present in all referrals. In contrary, there is no scoliotic spine without it, as the DRC sign is always present in scoliotic lateral spinal radiographs with no exception. This observation supports our hypothesis that in idiopathic scoliosis, the deformity of the thorax develops first and then the deformity of the spine follows.

Adolescent↗
PubMed2002

The effects of exposure to intense, 24 h light on the development of scoliosis in young chickens.

The aetiology of adolescent 5 coliosis remains unknown and hindering research is the absence of an appropriate animal model. It is now well-established that pinealectomy in young chickens results in the development of scoliosis that has many of the characteristics seen in patients with adolescent idiopathic scoliosis but the mechanism underlying this phenomenon remains elusive. The principle product of the pineal gland is melatonin and so many studies have focused on studying the effects of reduced levels of this hormone. The results have been mixed and the role of melatonin remains unclear. As melatonin production is inhibited by light, it was hypothesised that providing the chickens with an environment consisting of intense, continuous light would reduce serum melatonin levels and avoid any of the potential artifacts involved with the pinealectomy surgery. Consequently, pinealectomised and normal chickens were exposed to very intense light for complete 24 h in each day. At the end of 22 days in this environment serum melatonin levels had been reduced to very low levels in all chickens. Most importantly, 15% of the normal chickens had developed scoliosis and the number of pinealectomised chickens that developed scoliosis increased from 50% to 80%. The results showed that a method for reducing serum melatonin without pinealectomy has been established and which can be used in further experiments. Furthermore, the results also showed that reduced levels of serum melatonin has significant effects on the development of scoliosis. The indication is that there is a threshold level of serum melatonin below which scoliosis may develop probably in conjunction with some other factor which has yet to be identified.

Adolescent↗
PubMed2002

The incidence of idiopathic scoliosis in Greece--analyais of domestic school screening programs.

INTRODUCTION: The aim of the study is the documentation of the national incidence of idiopathic scoliosis (IS) based on the School Screening programs performed at the various geographical departments of the country, and the estimation of the probable number of children who will need to be conservatively or surgically treated. MATERIAL-METHODS: During the years 1975 - 1999, 17 School Screening programs were performed in Greece and their results were analyzed and published in the book "School Screening in Greece". These studies had in common the children age distribution, the clinical examination, the radiological definition of IS when the Cobb - angle was > or = 5 degrees or > or = 10 degrees after SRS. The standing forward bending test was used. An Orthopaedic surgeon always participated in the scientific screening team. 215899 children aged 5.5 - 15 years were screened. When there was suspicion of scoliosis, the child was further assessed radiolographically (standing postero - anterior spinal radiographs), for Cobb angle appraisal. RESULTS: In 130689 screened children, scoliosis was considered when the consequent radiological assessment revealed Cobb angle of > or = 10 degrees, (a), and in 85210 children when it revealed Cobb angle of > or = 5 degrees respectively, (b). In (a) studies the scoliosis incidence was 2.9% (range 1.1 - 5.7%), and (b) 4.9% (range 2.7 - 9.5%) respectively. The right thoracic curves dominated in both (a) and (b) studies and thoraco - lumbar, lumbar and double curves followed. Among 7965 scoliotics out of the total sample of 215899 children, 4.5% were conservatively treated with the use of a brace, and only 0.19% was treated surgically. CONCLUSIONS: From data of 1998 national census, the population of children aged 8 to 14 years old was approximately 751000. With the above -mentioned datum and with a national mean scoliosis incidence of 2.9%, (Cobb angle > or = 10 degrees), 21781 children will be found with scoliosis. 980 will need conservative treatment using a brace while 41 children will need surgical treatment.

Adolescent↗
PubMed2004

[Primary study on collagen X gene expression in the apical disc of idiopathic scoliosis].

OBJECTIVE: To study the distribution of collagen X in the intervertebral disc and determine its role in the pathogeny of idiopathic scoliosis (IS). METHODS: The data included apical disc and intermediate disc from 14 cases of AIS, 26 discs from 13 cases of scoliosis of confirmed pathogeny which included 10 cases of congenital scoliosis and neurofibromatosis scoliosis (CS group). Six discs were obtained from 3 cases of sudden death of normal young man served as controls. The distribution of collagen X in the apical disc of IS was examined by immunohistochemistry and in situ hybridization (ISH) with RNA probe. The figure of collagen X hybridization in the endplate cartilage was input to the figure analysis system. The mRNA content of collagen X was compared between every 2 groups by SPSS software. RESULTS: Collagen X was mainly distributed around the hypertrophic chondrocyte in the endplate cartilage. Its mRNA was expressed in the hypertrophic chondrocyte. Positive signal was found in the nuclei of several scoliosis patients, which was not related to the pathogeny. The collagen X mRNA contents of the apical disc and intermediated disc of the IS group and of the CS group were significantly higher than those of the normal group (P < 0.05). There was no difference between the IS and CS groups. CONCLUSIONS: Collagen X is mainly distributed around the hypertrophic chondrocyte in the endplate cartilage. Its can also be secreted by the chondrocyte-like cells in the nucleus under special condition. Higher expression of collagn X gene in scoliosis patients may be the effects of long term abnormal stress which causes calcification of endplate cartilage. Collagen X expressed in the nucleus may be the result of secretion of chondrocyte-like cells in the disc under abnormal mechanical condition.

Adolescent↗
PubMed2005

[Characteristics of nerve root compression caused by degenerative lumbar stenosis with scoliosis].

OBJECTIVE: To investigate the factors that may contribute to radiculopathy in degenerative lumbar stenosis with scoliosis (DLSS) and their association with the pattern of the scoliosis. METHODS: Twenty-seven patients with DLSS were examined in our hospital. The symptomatic nerve roots were determined by pain distribution, and neurological findings. The compressive factors were diagnosed by magnetic resonance imaging and myelography or radiculography. The pattern of scoliosis was determined by plain radiographs. Correlation between the affected nerve root and the compressive factors or the pattern of the scoliosis were then analyzed. RESULTS: Among the 27 patients, L3 root was affected in 6 patients, L4 root in 13 patients, L5 root in 15 patients, and S1 root in 9 patients. L3 and L4 roots were more compressed by foraminal or extraforaminal stenosis on the concave side of the curve, whereas L5 and S1 roots were commonly affected by lateral recess stenosis on the convex side. CONCLUSION: In DLSS, nerve root compression is not only seen on the concave side of the scoliosis, but also equally involved on the convex side. Most radiculopathy in DLSS distributes close to central sacral vertical line, which may be due to the abnormal weight-bearing for the pattern of scoliosis.

Aged↗