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PubMed2006

Adolescent idiopathic scoliosis: metric analysis of the deformity.

In order to explore the concept that scoliosis is fundamentally a loss of left-right symmetry. surface topography was used to measure asymmetry in three dimensions at three levels on the back surface. Statistical analysis of prospectively collected topographic, radiographic and clinical data, in girls with adolescent idiopathic scoliosis, was carried out and comparisons were made with theoretically perfect symmetry (test value of zero). All scoliosis showed statistically significant differences in coronal dimensions, index points on the convex side of the scoliosis being further from the mid-line than those on the concave side. Primary thoracic scoliosis differed from thoracolumbar and lumbar in that they showed directional asymmetry at all levels and in all directions, the side of the scoliosis convexity being broader, taller and thicker. This asymmetry is not due to posture, spinal balance or trunk rotation, as left and right sides are being compared independently of their orientation in space. The asymmetry is of size in three dimensions and size is determined by growth. Growth is a three dimensional process, but does not necessarily occur equally in all three. Differential growth is both directional and regional, particularly during the pubertal growth spurt, when proportions change substantially, and is controlled by many genes, as well as by hormones and signalling molecules. The implication is that scoliotic deformity is the result of asymmetric growth, not confined to the vertebrae, but affecting the entire trunk. This is a developmental, rather than pathological, phenomenon. It makes questions of aetiology redundant and natural history logical.

Adolescent↗
PubMed2006

Abnormal spread of junctional acetylcholine receptor of paraspinal muscles in scoliosis associated with syringomyelia.

To test the denervation of paraspinal muscles and further investigate the pathogenesis of scoliosis associated with syringomyelia via detecting the spread of acetylcholine receptor (AChR) beyond the confines of the functional neuromuscular junction. Patients were divided into three groups: Group A consisted of 25 patients with scoliosis associated with syringomyelia, Group B included 16 adolescents with idiopathic scoliosis, and Group C comprised 10 cases without scoliosis. Bilateral biopsy of paraspinal muscles was performed during scheduled spinal surgery. Histological evaluation used a double-stain immunofluorescence technique for AchR and acetylcholinesterase. Histological analysis showed that 14 of 25 patients in Group A scored positive for the presence of AchR outside of the neuromuscular junction. There was no significant difference of the positive rate between patients with different degrees of cerebellar tonsillar descent, between patients with distended and non-distended syrinx, with syringx length 10 vertebral bodies, and with Cobb angle 45 degrees (p>0.05). The denervation of paraspinal muscles is present in some patients with scoliosis associated with syringomyelia, suggesting that scoliosis may be caused by a strength imbalance of paraspinal muscles in these patients.

Adolescent↗
PubMed2006

Hoffmann reflex in idiopathic scoliosis.

This study was carried out in order to determine the dependence of selected Hoffmann reflex parameters on type, progression and morphology of idiopathic scoliosis (IS). Data collected from 129 girls with IS (59 progressive and 70 non-progressive cases) aged 7-16 years and 24 healthy subjects were analysed. H-reflex index (IH) and H/M amplitude index (IH/M) were calculated. Progressive left lumbar scoliosis expressed a significant decrease of IH values and a distinct tendency to IH/M depletion compared to non-progressives and controls. Progressive right thoracic scoliosis expressed marked tendency to IH decrease compared to nonprogressive scoliosis. No significant differences in H-reflex parameters were observed between the convex and concave side of the curvature or between types of scoliosis. H-reflex analysis in idiopathic scoliosis supports the hypothesis of a primary neurological disorder in progressive IS.

Adolescent↗
PubMed2006

Prevalence of subtle cardiac electrical abnormalities in children with idiopathic scoliosis.

UNLABELLED: We aimed to assess the prevalence of ECG abnormalities in children with idiopathic scoliosis (IS). 77 Girls and 13 boys, aged 7 to 18 years (15 +/- 3), including 12 with thoracic scoliosis (mean Cobbe angle 33 degrees), 4 with lumbar scoliosis (29 degrees), 12 with thoracolumbar (27 degrees), and 62 with double-major scoliosis (31 degrees) entered the study. They were grouped as follows: 20 children <14 years of age (A), 35 from 14 to 16 (B), and 35 >16 years of age (C). Routine ECG was recorded and analysed automatically (GE, CASE v.4.1). Several ECG indices were further analysed. Abnormal values were considered if they exceeded upper normal limit (>95 percentile). RESULTS: Abnormalities were found in 66 patients (73%) independent of age. QRS duration gt;90 ms was observed in 40 patients (44%), right axis deviation in 28 (31%), left axis deviation in 2 (2%). The Rsr'(V1-2 ) pattern was noticed in 25 patients (28%). Ventricular gradient gt;60 degrees was found in 11 patients (12%). In patients with normal ECG there was a normal leftward axis rotation with age (-10 degrees +/-18 degrees in gr.A, -5 degrees +/-17 degrees in gr.B and +2 degrees +/-22 degrees in gr.C, difference from median), whereas reversed trend (rightward deviation with age) characterized patients with ECG abnormalities (-7 degrees +/-30 degrees in gr.A, +9 degrees +/-19 degrees in gr.B and +19 degrees +/-2 degrees in gr.C, p<0.001). CONCLUSION: In children with idiopathic scoliosis, subtle ECG abnormalities are frequent. Abnormal trend of rightward QRS axis deviation with age suggests cardiac involvement in natural history of scoliosis and requires more depth cardiac evaluation.

Adolescent↗
PubMed2006

Brachial plexus palsy associated with halo traction before posterior correction in severe scoliosis.

OBJECTIVE: To retrospectively analyse clinical features and related factors of brachial plexus palsy associated with halo traction before posterior correction in severe scoliosis. METHOD: 300 Cases of severe scoliosis performed with halo traction before posterior correction were considered with 7 cases suffering from brachial plexus palsy (2 males and 5 females). The average age was 14 years (range, 9-19 years). The average Cobb angle was 110 degrees (range, 90 degrees - 135 degrees); Diagnoses were idiopathic scoliosis (1), congenital scoliosis (3), and neuromuscular scoliosis (3). Halo-gravity traction was used in 3 cases preoperatively; and Halo-femoral traction used in 4 cases postoperatively (anterior release 2 cases, anterior epiphyseal arrest 1 case, combined anterior and posterior release 1 case). RESULTS: Traction was used for an average of 3.5 weeks before spinal fusion (range, 2-6 weeks) for these 7 patients. The average traction weight was 8 kg; the average traction weight was 19 % ( range 13-26%) of the average body weight (40.2 kg). The mean stature was 175 cm; all the 7 patients had a long and thin body configuration. Duration between brachial plexus paralysis and detection was 1 to 3 hours. All the 7 patients suffered different degree from numbness of ulnaris of the hand and antebrachium. Median nerve palsy was found in 3 cases, ulnar nerve paralysis was found in 4 cases. Complete nerve functional restoration had been achieved by the end of three months after rehabilitation training, drug treatment were adopted. CONCLUSION: Brachial plexus palsy associated with halo traction in severe scoliosis is related to the weight of traction, body type and patient-pathology status. If the symptoms are promptly detected with rehabilitation training and appropriate drug treatment adopted, complete nerve functional restoration can be achieved.

Acute Disease↗
PubMed2006

Gamma subunits expression of junctional acetylcholine receptor of paraspinal muscles in scoliosis associated with syringomyelia.

UNLABELLED: To investigate the denervation of paravertebral muscles in scoliosis associated with syringomyelia via detecting the subunit expression of junctional acetylcholine receptors. METHODS: All the cases were divided into three groups: Group A consisted of 20 patients with scoliosis associated with syringomyelia, Group B included 10 adolescents with idiopathic scoliosis, and Group C was 10 cases without scoliosis. Bilateral biopsy of the paraspinal muscles was performed during scheduled spinal surgery. The mRNA expression of junctional acetylcholine receptor (AchR) subunits were detected by RT-PCR method. RESULTS: 13 Patient (65%) in Group A had a positive expression of the mRNA for the gamma subunit. The positive rate of gamma subunit expression was 40% on the convex side of the curve, and 25% on the convex side. The gamma subunit expression was absent from all samples in Group B. In Group C, only one patient had the gamma subunit expression on the left side. CONCLUSION: The gamma subunit expression of the junctional acetylcholine receptor is changed in scoliosis associated with syringomyelia, suggesting the presence of denervation in paravertebral muscles. The denervation of paravertebral muscles may play an role in the pathogenesis of scoliosis.

Adolescent↗
PubMedDate not supplied

[Scoliosis: ten years' experience of screening].

Scoliosis is a permanent lateral deflection of backbone, associated to a vertebra's rotation and twisting on their vertical axle, and it is one of more common diseases of pediatric age. It exist a great difference between the structural conformations, that are true pathologies, and the functional ones or paramorphisms, without bony alterations. Since about 80% of real scoliosis is idiopathic. The pediatrician's task is of precociously identify the appearance of a scoliotic bend and differentiate the structural and evolutive shapes from simple scoliotic posture. Therefore for ten years, in the preventive medicine programme of school age, we affected a scoliosis research in the secondary school using as clinical method the "bending test" that appraises three essential parameters: size's triangle, gibbus and limbs' asymmetry. Before examination an anamnestic form is compiled and the sexual maturity's degree is appraised. The subjects with suspect of scoliosis are asked to a subsequential control performed in our department's ambulatory service by a doctor of Scoliosis's Center of Pozzolatico (Florence), in order to decide whether to take radiographs and to define, if necessary, treatment. We verified 4453 pupils and of these the 8.9% has been asked to the specialist's control. Of these 106, namely the 2.8% of total pattern, have been X-rayed and 46, namely the 0.9% of total pattern, have been orthopaedically treated because affected by evolutive scoliosis. If we consider the last quinquennium's statistics, we remark that treatment's incidence is lower to 0.4% conforming to literature's data. We never observed false negatives whereas false positive have been only 0.8% of total pattern.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1989

[Long-term follow-up of lung function and standing height following scoliosis surgery in children and adolescents].

Previous investigations have reported conflicting results on the development of lung function and body height after operative correction of scoliosis at young age. Partly the number of patients or the duration of observation were relatively small. 120 patients were followed for at least 10 years (10-14, average 12 years) after surgical correction of scoliosis at the age of 18.2 +/- 6.8 years. Standing height and vital capacity were measured 1, 2, 5 and 10 years after operation. Height was expressed as percentile for age and vital capacity as % expected for actual height. The primary diagnoses were idiopathic scoliosis (n = 84, average Cobb angle 90 degrees), congenital scoliosis (n = 20, 83 degrees), poliomyelitis (n = 10, 128 degrees), neurofibromatosis (n = 6, 101 degrees). We found an initial decrease in lung function after 1 year, which was probably due to post-operative immobilization and increased by the gain in body height achieved by the operation. During the rest of the observation period a significant (p less than 0.05) increase of vital capacity (% of expected for actual height) was observed. The gain was maximal for idiopathic scoliosis (+6%). In congenital scoliosis body height %ile and relative vital capacity appeared fixed at the preoperative level. Interestingly patients with an initial vital capacity below 50% expected (n = 29) or preoperative Cobb angle above 90 degrees showed the best results. They also lacked the initial deterioration of lung function in the first postoperative year and had a significant gain of vital capacity (+14%) over 10 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Scoliosis screening of 3,000 college-aged women. The Utah Study--phase 2.

The purpose of this phase of the Utah study was to determine the prevalence of scoliosis in college-aged women over a three-year period. The subjects were 3,210 female college students (mean age = 19.7 +/- 2.1 years) from 34 states and 5 foreign countries. The majority (98.2%) of the students were Caucasian. Nearly 12% of the study sample (n = 380) demonstrated a visually assessed lateral deviation of the spine. This finding demonstrates a higher prevalence of scoliosis among an age group that has reached an age of growth cessation than the literature on scoliosis screening indicates. The college-aged students in this study demonstrated a higher prevalence of scoliosis than the national norm for a younger (10-15 years of age) group. This result suggests that scoliosis may develop later in life than has previously been reported and that physical therapists must become more proficient in conducting scoliosis screening programs.

Adolescent↗
PubMed1986

[A histopathological study on the intervertebral discs of idiopathic and paralytic scoliosis--abnormalities in transition from the notochordal nucleus to the fibrocartilaginous nucleus].

To elucidate morphologic events, 105 intervertebral discs in 22 patients with idiopathic scoliosis and 14 in four patients with paralytic scoliosis were histopathologically compared with 13 control intervertebral discs in 13 cases, including three fetuses. In control intervertebral discs, the notochordal area became smaller with age, and was almost completely occupied by fibrocartilagenous matrix at 16 years of age or more. In intervertebral discs of patients aged 19-33 with idiopathic scoliosis, many notochordal cells were seen and many areas without fibrocartilagenous matrix were found. In contrast, in intervertebral discs of patients aged 21-35 with paralytic scoliosis, there was no notochordal cells or defect of the fibrocartilagenous matrix. The results suggest an impairment of transition from the notochordal nucleus to the fibrocartilagenous nucleus in intervertebral discs in patients with idiopathic scoliosis, and that such abnormalities are related to the onset of idiopathic scoliosis.

Adolescent↗
PubMed1987

Severe spondylolisthesis and scoliosis in association with Marfan's syndrome. Case report and review of the literature.

Scoliosis in Marfan's syndrome may be painful, but severe spondylolisthesis with a cauda equina tension syndrome as the cause of pain has only recently been recognized. Scoliosis may be associated with spondylolisthesis. The scoliosis may be sciatic or structural. These may be true structural curves or secondary to the asymmetric slip of the spondylolithesis. Grade 4 spondylolithesis was treated with an in situ ala-transverse fusion combined with posterior decompression. The tension signs were rapidly dissipated. A plaster spica was applied for six months. Solid fusion was achieved without progression of spondylolisthesis or further rotation. Subsequently, the structural scoliosis was treated with a two-stage anterior release and posterior Harrington fusion. The progression of spondylolisthesis in Marfan syndrome may be related to the poor quality of the surrounding musculoligamentous structures. Sciatic scoliosis resolves after fusion of the spondylolithesis. The results of in situ fusion are satisfactory. Reduction of the spondylolithesis with combined anterior and posterior fusion offers the most satisfactory basis for subsequent treatment of a structural scoliosis but carries a significant risk of neurologic damage and recurrence of slip.

Child↗
PubMed1987

Muscle fiber types in thoracic erector spinae muscles. Fiber types in idiopathic and other forms of scoliosis.

Histochemical studies of the thoracic part of the erector spinae muscles in scoliosis have shown a consistently higher proportion of Type 1 fibers on the convex side. The fiber distribution of the multifidus and semispinalis muscles was studied in adolescent idiopathic scoliosis (AIS). Compared with sex- and age-matched controls, a "normal" percentage of Type 1 fibers was found on the convex right side and significantly smaller percentage of Type 1 fibers on the concave side. Boys with AIS showed the same pattern as girls. In two patients with double major curves, the same pattern could be seen on the convexity of both curves. Patients with congenital scoliosis or scoliosis with early onset showed a different pattern with a "normal" percentage of Type 1 fibers on the concave side but a significantly greater percentage of Type 1 fibers on the convex side. In AIS, the deviation in the fiber distribution may constitute a primary factor in the pathogenesis of scoliosis. In congenital scoliosis the differences in fiber distribution between the convex and concave sides are considered secondary in the pathogenesis of the spinal curvature.

Adolescent↗
PubMed1984

Etiology of idiopathic scoliosis.

The following investigations concerning scoliosis are in progress at Tokushima University: (1) a study of the incidence of equilibrial dysfunction; (2) a study of the nature of dysequilibrium, with special reference to the origin (functional or organic); (3) a field survey of scoliosis associated with equilibrial dysfunction in school children; (4) a study of experimental and clinical metabolic disturbances in scoliosis; (5) a study of postural reflex in experimental animals; (6) a study of scoliosis in animals with experimentally produced brain stem lesions; and (7) a study of scoliosis in animals with experimentally produced lesions in the posterior part of the hypothalamus. The hypothetic assumption is that dysfunction of the postural reflex regulation induced by functional or organic disorders at the brain stem center may play an important part in the development of idiopathic scoliosis during the period of rapid growth in children.

Adolescent↗
PubMed1981

[Central regulation of breathing in idiopathic scoliosis (author's transl)].

Idiopathic scoliosis is in nearly 80% associated with an EEG deviating from a normal pattern. Therefore a possible cerebral dysfunction as one of the etiologic factors in the development of idiopathic scoliosis is discussed. In consequence, we studied the central respiratory regulation in 26 patients with idiopathic scoliosis by means of CO2 response with the CO2 rebreathing technique, also vital capacity (VC), maximal voluntary ventilation (MVV), respiratory minute volume at 50, 60 and 70 mm Hg arterial pCO2 and EEG. The CO2-index (1/min/mm Hg CO2) was significantly lower in patients with idiopathic scoliosis (0.92 +/- 0.43) than in normals (1.5 +/- 0.3). The decrease of CO2-index is mainly associated with the smaller VC of the patients (76 +/- 26% of predicted). There is no sign of an additional influence of cerebral dysfunction. Patients with idiopathic scoliosis are able to utilize 70% of the individual breathing reserve like normals when stimulated with CO2. The EEG and the VC show a negative correlation. This may possibly be due to a compensation of the preexisting cerebral dysfunction. VC however decreases during the natural course of disease. No significant correlation could be found between CO2-index and the angle of scoliosis, indicating the absence of a causal relation between the degree of deformation itself and the function of the center of respiratory regulation.

Adolescent↗
PubMed1982

Incidence of mitral valve prolapse in adolescent scoliosis and thoracic hypokyphosis.

Seventy-four patients with adolescent scoliosis underwent cardiac examination and M-mode echocardiography to detect the presence of mitral valve prolapse (MVP). Twenty-one (28%) had echocardiographic evidence of MVP, whereas 18 had auscultatory findings of a nonejection click or late systolic murmur. A subset of 41 patients had a family history of scoliosis and 37% had MVP. The incidence of MVP increased to 41% when a first degree relative, such as a sibling, parent, or offspring, had scoliosis. Thirty-six patients with scoliosis had additional thoracic hypokyphosis (straight back) and 13 (36%) had MVP. The incidence of MVP was 48% when the scoliosis and hypokyphosis were hereditary and increased to 53% when a familial history of skeletal abnormality was present. This study indicates a high incidence of MVP in patients with scoliosis and hypokyphosis, especially when the cardiac and skeletal systems may be affected by a generalized soft-tissue defect.

Adolescent↗
PubMed1980

Identifying scoliosis in the adolescent with thermography: a preliminary study.

Early diagnosis of adolescent idiopathic scoliosis is essential to prevent severe deformity. The accuracy of thermographic examination of the spine in the detection of minor degrees of curvature has been assessed in 125 asymptomatic young persons mean age 13.4 +/- 0.8 years who were also examined clinically and by spinal X-ray. Assessment of thermograms selected at random from the group of 154 young subjects showed that thermography has a sensitivity of 98.2% and a specificity of 91.0% in the identification of scoliosis when compared with radiography. Thermographic examination of the spine is simple, noninvasive and provides a permanent recording which is easily interpreted. It may provide an ideal method for use in large-scale prospective surveys. The criteria used to detect the thermographic abnormality associated with idiopathic scoliosis was derived from the spinal thermograms of 29 patients, mean age 10.25 +/- 4.65 years with known scoliosis, mean angle of curve 27 degrees +/- 12 degrees. In contrast to the thermal symmetry of the normal spine, all the thermograms of these patients show asymmetry, characteristically an increase in thermal emission on the concave aspect of the curve. Eight of the 16 patients with scoliosis with minor curves and a characteristic thermogram were not detected clinically. There were 25 asymmetrical thermograms in the asymptomatic group. Three of these patients had a simple postural defect, 5 had dorsal kyphosis and 16 had idiopathic scoliosis. Postural defects and kyphosis were readily recognized on clinical examination and did not produce the characteristic scoliotic thermogram.

Adolescent↗
PubMed1980

Association of glycosaminoglycan depletion and degradative enzyme activity in scoliosis.

Although several theories have been advanced about etiology of idiopathic scoliosis, the pathogenesis still remains unknown. One study detected a decrease in the glycosaminoglycan content of the nucleus pulposus in idiopathic scoliosis, and it was theorized that this represented increased degradation. The present study was designed to investigate degradative enzyme activity in scoliotic intervertebral disks. Twenty-three disks from 5 patients with idiopathic scoliosis and 18 disks from 3 patients with scoliosis resulting from myelomeningocele were obtained at surgery (Dwyer procedure). Five disks were obtained during 2 postmortem examinations. Analyses of hydroxyproline, hexosamine and acid phosphatase were performed separately on the annulus and nucleus of each disk. Hexosamine was decreased in idiopathic scoliotic nuclei versus controls (p less than 0.001) by approximately 25%. Hydroxyproline was proportionately increased (p less than 0.05). Similar changes of a greater magnitude were seen when comparing myelomeningoceles to controls. In both types of scoliosis, acid phosphatase was elevated in nuclear and annular tissue. Acid phosphatase activity and hexosamine varied inversely in the nucleus. Finding similar biochemical patterns in idiopathic and neurovascular scoliosis raises the possibility that these changes may be secondary.

Acid Phosphatase↗
PubMed1995

[Value of the study of somatosensory evoked potentials during surgical correction of scoliosis associated with syringomyelia. Apropos of 4 cases].

PURPOSE OF THE STUDY: The presence of a syringomyelia cavity increases the rate of neurological complications on the course of surgical treatment of scoliosis. We have evaluated the results of monitoring of somatosensory evoked potentials (SEP) in these situations. MATERIAL AND METHODS: Four patients presenting a scoliosis associated with syringomyelia have been operated through a posterior-approach with CD instrumentation. SEP monitoring was performed pre and intraoperatively. We studied the latency and the amplitude of P40. RESULTS: Preoperative SEP showed in all cases posterior spinal cord involvement (even without clinical manifestations). During monitoring, we noted in one case no variation. In one case a flattening of the response with normalisation within 5 minutes. In two cases a persistent flattening with normalisation within 10 and 15 minutes following modification of the instrumentation. In all cases, postoperative neurological status was identical to preoperative one. DISCUSSION: Preoperative SEP can make the diagnosis of posterior spinal cord involvement even when clinical status is normal. The extent of the preoperative SEP abnormalities may preclude the risk of intraoperative neurological complications. Intraoperative SEP can be performed with the same anesthetic protocol and the same technique used when operating idiopathic scoliosis. The results seem reliable. When alteration occur as for idiopathic scoliosis alteration of the amplitude appears earlier than alteration of the P40 latency. Restoration of normal responses appears later than in idiopathic scoliosis. CONCLUSION: SEP monitoring should diminish the risk for neurological complications in the course of surgical treatment of scoliosis associated with syringomyelia.

Adolescent↗