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PubMed2006

Rasterstereographic analysis of axial back surface rotation in standing versus forward bending posture in idiopathic scoliosis.

The forward bending test according to Adams and rib hump quantification by scoliometer are common clinical examination techniques in idiopathic scoliosis, although precise data about the change of axial surface rotation in forward bending posture are not available. In a pilot study the influence of leg length inequalities on the back shape of five normal subjects was clarified. Then 91 patients with idiopathic scoliosis with Cobb-angles between 20 degrees and 82 degrees were examined by rasterstereography, a 3D back surface analysis system. The axial back surface rotation in standing posture was compared with that in forward bending posture and additionally with a scoliometer measurement in forward bending posture. The changes of back shape in forward bending posture were correlated with the Cobb-angle, the level of the apex of the scoliotic primary curve and the age of the patient. Averaged over all patients, the back surface rotation amplitude increased from 23.1 degrees in standing to 26.3 degrees in forward bending posture. The standard deviation of this difference was high (6.1 degrees ). The correlation of back surface rotation amplitude in standing with that in forward bending posture was poor (R (2)=0.41) as was the correlation of back surface rotation in standing posture with the scoliometer in forward bending posture measured rotation (R (2)=0.35). No significant correlation could be found between the change of back shape in forward bending and the degree of deformity (R (2)=0.07), likewise no correlation with the height of the apex of the scoliosis (R (2)=0.005) and the age of the patient (R (2)=0.001). Before forward bending test leg length inequalities have to be compensated accurately. Compared to the standing posture, forward bending changes back surface rotation. However, this change varies greatly between patients, and is independent of the type and degree of scoliosis. Furthermore remarkable differences were found between scoliometer measurement of the rib hump and rasterstereographic measurement of the vertebral rotation. Therefore the forward bending test and the identification of idiopathic scoliosis rotation by scoliometer can be markedly different compared to rasterstereographic surface measurement in the standing posture.

Back↗
PubMed2006

Is there a role for selective anterior instrumentation in neuromuscular scoliosis?

Our objective was to report on the clinical and radiological outcome from a cohort of patients with neuromuscular scoliosis who underwent selective anterior single rod instrumentation for correction of thoraco-lumbar and lumbar scoliosis. Traditionally combined anterior release with long posterior instrumentation has been advocated for the treatment of neuromuscular scoliosis. Neuromuscular curves tend to be long and may have significant pelvic obliquity. However, certain neuromuscular curves with minimal pelvic obliquity may lend themselves to selective anterior correction thereby saving motion segments and allow continued ambulation for those patients. Nine patients with neuromuscular scoliosis underwent selective anterior instrumentation between 1994 and 2000. The mean follow up was 2 years and 9 months (range 24-55 months). The clinical outcome (including parent and caregiver satisfaction), radiological outcome (Cobb angle, apical vertebral translation, pelvic obliquity, truncal shift, thoracic kyphosis, lumbar lordosis, sagittal vertical axis) and complications are reported. Subjective outcome was excellent in six patients and good in three. All nine patients retained their ability to walk. There were no neurological or vascular complications. Supplementary posterior surgery was required in two patients. The mean pre-operative Cobb angle of 52 degrees (range 44-60) improved to 20 degrees (range 10-28) at 3 months, achieving Cobb angle correction of 61% and was 19 degrees (range 7-28) at final follow-up. The mean pre-operative compensatory curve of 31 degrees (range 20-42) spontaneously corrected to 18 degrees (range 14-24) at 3 months and was maintained at 18 degrees (range 10-26) at final follow up. The mean pre-operative pelvic obliquity of 7 degrees (range 0-14) corrected to 4 degrees (range 0-8) at 3 months and was 3 degrees (range 0-8) at final follow up. Selective anterior instrumentation and fusion in carefully selected patients with neuromuscular scoliosis (short flexible curves, minimal pelvic obliquity, pre-operative walkers, slow or non-progressive pathology) appears to have satisfactory clinical and radiological outcome at least in the short-term.

Adolescent↗
PubMed2006

Pedicle growth asymmetry as a cause of adolescent idiopathic scoliosis: a biomechanical study.

Over the last century the neurocentral junction (NCJ) has been identified as a potential cause of adolescent idiopathic scoliosis (AIS). Disparate growth at this site has been thought to lead to pedicle asymmetry, which then causes vertebral rotation and ultimately, the development of scoliotic curves. The objectives of this study are (1) to incorporate pedicle growth and growth modulation into an existing finite element model of the thoracic and lumbar spine already integrating vertebral body growth and growth modulation; (2) to use the model to investigate whether pedicle asymmetry, either alone or combined with other deformations, could be involved in scoliosis pathomechanisms. The model was personalized to the geometry of a nonpathological subject and used as the reference spinal configuration. Asymmetry of pedicle geometry (i.e. initial length) and asymmetry of the pedicle growth rate alone or in combination with other AIS potential pathogenesis (anterior, lateral, or rotational displacement of apical vertebra) were simulated over a period of 24 months. The Cobb angle and local scoliotic descriptors (wedging angle, axial rotation) were assessed at each monthly growth cycle. Simulations with asymmetrical pedicle geometry did not produce significant scoliosis, vertebral rotation, or wedging. Simulations with asymmetry of pedicle growth rate did not cause scoliosis independently and did not amplify the scoliotic deformity caused by other deformations tested in the previous model. The results of this model do not support the hypothesis that asymmetrical NCJ growth is a cause of AIS. This concurs with recent animal experiments in which NCJ growth was unilaterally restricted and no scoliosis, vertebral wedging, or rotation was noted.

Adolescent↗
PubMed1999

Does bracing affect self-image? A prospective study on 54 patients with adolescent idiopathic scoliosis.

To evaluate the effect of brace treatment on self-image in patients with adolescent idiopathic scoliosis, 54 consecutive patients admitted for brace treatment were interviewed before bracing. A prevalidated questionnaire including the following five aspects of self-image was used: (1) body-image, (2) self-perception of skills and talents, (3) emotional well-being, (4) relations with family, and (5) relations with others. As a control group, the answers of 3465 normal school children were used. Forty-six patients participated in a follow-up interview 1.7 (range 0.8-3.0) years later. In addition, during the first interview, the scoliosis patients answered selected questions about their social circumstances and attitudes towards their forthcoming brace treatment. Grossly, the patient group lived in stable family conditions with a high percentage (40%) of fathers and/or mothers with an academic education or with a high employee status. The patients' relations with families were generally good. Nearly all believed that the brace would affect their posture, but only a few thought that wearing the brace would influence their growth. Two-thirds believed that it would be difficult to wear the brace, and often reflected on the use of it. There were no statistically significant differences between the scoliosis patients and the age-matched controls at the pre-bracing nor at the follow-up interviews. Neither were there any statistically significant differences between the answers of the scoliosis patients in the pre-bracing and follow-up interviews. This was valid for the total score as well as for each subscale item score. It is concluded that wearing the brace does not affect the self-image of adolescents with idiopathic scoliosis negatively.

Adolescent↗
PubMed1986

Cardiorespiratory consequences of unfused idiopathic scoliosis.

A retrospective survey was carried out on approximately 800 scoliotic subjects attending a chest clinic over 25 years. One hundred thirty-one patients with unfused idiopathic scoliosis were identified and further consideration was restricted to 54 who were assessed at 30 years of age or older. Sex, age of onset of curvature, severity at the time of presentation, degree of dyspnoea, presence of independent cardiac or pulmonary disease and smoking habit were recorded. Measurements of lung function were compared with predicted figures calculated according to span, age and sex. Disabling dyspnoea or cardiorespiratory failure were associated with either scoliosis of early onset (curve first noticed before 5 years) or with independent cardiac or pulmonary disease. Only one of 28 patients with unfused idiopathic scoliosis of adolescent onset developed disabling dyspnoea in later life attributable solely to spinal deformity. A similar conclusion was drawn from a separate survey of mortality in 86 patients, 19 of whom suffered from idiopathic scoliosis. Cardiorespiratory failure attributable to the scoliosis was the cause of death of 11 patients, in 10 of whom the curve had first been noticed at less than 5 years of age whereas the onset was during early adolescence (11 years) in only one.

Age Factors↗
PubMed1994

Three-dimensional simulations of the scoliosis derotation maneuver with Cotrel-Dubousset instrumentation.

The derotation maneuver using Cotrel-Dubousset instrumentation (CDI) is intended to correct the counterdirectional transverse plane rotations of the spine and of the vertebrae in thoracic scoliosis. This was simulated in a finite element model of an idealized thoracic scoliosis with an initial 65 degrees scoliosis angle and 0 degree kyphosis angle. After 90 degrees of rod rotation the apical vertebra derotated 50 degrees towards the sagittal plane but the apical vertebra axial rotation worsened by 8 degrees. The scoliosis angle corrected to 29 degrees and a 54 degrees kyphosis was created. If the initial rod curvature was reduced by 9 degrees, the model predicted only small changes in spinal curvature resulting from the forces required to connect the vertebrae to the hooks. Decreased kyphosis and scoliosis curvatures but increased vertebra axial rotation were produced by the derotation maneuver. The increase in apical vertebra axial rotation was reversed by modifying the representation of the motion segments by repositioning their effective axes 30 mm posteriorly.

Biomechanical Phenomena↗
PubMed2006

Occlusal patterns in patients with idiopathic scoliosis.

INTRODUCTION: Idiopathic scoliosis is an orthopedic condition characterized by faulty posture. It might also be associated with some mild forms of facial asymmetry or dental deviations. The aim of the study was to clinically examine the occlusions of patients with idiopathic scoliosis. METHODS: Ninety-six consecutive orthopedic patients with idiopathic scoliosis were examined. The orthopedic data of this group were recorded from their hospital files. The occlusal features of a random group of 705 Ashkenazi children served as the control. Frequency distributions were compared with the chi-square test. RESULTS: The distribution of the Angle classes of malocclusion was significantly different in the 2 groups (P = .0001) because of many Class II subdivision patients in the orthopedic group. Other evidence of asymmetrical malocclusion was found in upper (P =.002) and lower midline deviations (P =.0001), and a higher frequency of anterior (P = .024) and posterior (P =.020) crossbites. In the experimental group, no association was found between site, side, or severity of scoliosis and the appearance or site of the malocclusion features examined. CONCLUSIONS: Patients with idiopathic scoliosis have asymmetric features of malocclusion compared with a random population.

Adolescent↗
PubMedDate not supplied

Scoliosis in Steinert syndrome: a case report.

BACKGROUND CONTEXT: Steinert syndrome is described as an autosomal dominant condition characterized by progressive muscular wasting, myotonia, musculoskeletal manifestations and rare spinal defects. Little is reported about spinal deformity associated with this syndrome. PURPOSE: We present a patient with Steinert syndrome complicated by scoliosis. In the literature on muscular dystrophy, other than Duchenne, little mention is given to the problem of scoliosis in general and its treatment in particular. STUDY DESIGN: A case report of a patient with Steinert syndrome associated with thoracic scoliosis and hypokyphosis is presented. METHODS: A 17-year-old boy presented with King type II right thoracic scoliosis (T5-T11, Cobb angle of 40 degrees) and hypokyphosis--10 degrees. He was treated with posterior stabilization and instrumentation at level T3-L2 with a postoperative correction of the scoliotic curve to 20 degrees. Histopathologic examination of the muscles confirmed the diagnosis of Steinert myotonic dystrophy. RESULTS: At 30-month follow-up, the patient was clinically pain free and well balanced. Plain radiographs showed solid spine fusion with no loss of deformity correction. CONCLUSIONS: Scoliosis in Steinert syndrome shares the characteristic of an arthrogrypotic neuromuscular curve and demands the extensive soft tissue release for optimal surgical correction. Intraoperative observations included profound tissue bleeding, abnormally tough soft tissues and a difficult recovery from anaesthesia.

Abnormalities, Multiple↗
PubMedDate not supplied

External fixation for dynamic correction of severe scoliosis.

BACKGROUND CONTEXT: The ideal treatment for scoliosis may be the correction of the factors that cause the disease. An external fixation device was used in 12 patients to achieve a correction by dynamic distraction, compression and derotation of the curve. Follow-up was done over a 7-year period. PURPOSE: To describe the treatment of inflexible and severe scoliosis by special correction with external fixation. STUDY DESIGN/SETTING: This was a prospective, longitudinal and descriptive study, with a follow-up period of 7 years. PATIENT SAMPLE: Twelve patients (9 female, 3 male) from the National Orthopaedic Institute Spine Service in external consultation. OUTCOME MEASURES: Radiographic measurements with the scoliosis angulation of Cobb's method were used before surgery, after surgery and in the final follow-up period. METHODS: The surgical procedure consisted of two stages, anterior and posterior approach, dissectomies, vertebrectomy at the apex, spinal column shortening and the placement of an external stabilization device. Progressive correction of the curve was done by a daily increase in distraction (3 mm/day). When the correction was finished, a different internal fixation device was used to maintain the correction. The time between initial treatment and final correction was 50 days. Ten thoracic curves, one thoracolumbar curve and one lumbar curve were treated, with an average of 93 degrees. All patients had kyphosis with an average of 89 degrees. Vertebral rotation was not found in two patients. RESULTS: Average correction of scoliosis was 52.9% and of kyphosis, 29%. Vertebral rotation in eight cases was corrected. There were no neurological irreversible lesions in any patient. There was one infection. Using an evaluation result scale, there were 2 excellent, 6 good and 4 fair outcomes. The average loss of correction was 5 degrees. CONCLUSION: The results suggest that the use of an external stabilization device with controlled compression on the convexity and distraction on the concavity of the curve can achieve a correction of up to 50% in scoliosis, 30% in kyphosis and 1 degree in the rotation of the spine.

Adolescent↗
PubMedDate not supplied

Influence of structural pelvic disorders during standing and walking in adolescents with idiopathic scoliosis.

BACKGROUND CONTEXT: In adolescents with idiopathic scoliosis (AIS), several studies have shown that the pelvis is structurally changed by the spinal disorder. In fact, a significant correlation has been observed between the three-dimensional changes in the lumbar curve and the reduction in pelvic displacement in the three spatial planes during gait. However, the impact of this pelvic disorder on the walking mechanism has not been established. PURPOSE: To quantitatively evaluate the influence of scoliosis on the three-dimensional (3D) pelvic position during bipedal standing, on the 3D pelvic displacement during gait, and on the walking mechanics in adolescents with idiopathic lumbar and thoraco-lumbar scoliosis. STUDY DESIGN/SETTING: Paired sample matched for age and gender. PATIENT SAMPLE: Twenty-four subjects, 12 healthy adolescents matched for age and gender with 12 adolescents with lumbar or thoraco-lumbar idiopathic scoliosis. OUTCOME MEASURES: A test battery including clinical examination, radiological assessment, static 3D pelvic examination in bipedal position, and instrumented gait analysis. The statistical analysis was performed by a paired t test to evaluate the differences on nominally recorded data between control subjects and patients and a signed rank test for ordinal data. METHODS: The spine and pelvis were assessed by X-ray, clinical examination, and 3D analysis with the Elite system V5, in the standing position. The gait was assessed by instrumented analysis, including synchronous kinematic, dynamic, and electromyographic (EMG) recordings. RESULTS: Our results showed that radiological measurements of the pelvis were significantly different between patients and control subjects. However, 3D pelvic kinematics were not significantly different between AIS patients and normal subjects during standing and walking. We observed an increase in the muscular external work, a reduction in the efficiency of the locomotor mechanism, and a prolonged duration of activation of the lumbar muscles, ie, erector spinae and quadratum lumborum, in AIS patients. CONCLUSIONS: The scoliosis affected the structural bones of the pelvis with no effect on the 3D pelvis position during standing. During walking, normal 3D pelvic displacements could be explained by the prolonged duration of activation of the erector spinae and quadratum lumborum muscles bilaterally allowing the equilibrium of the pelvis to be maintained. This excessive muscular activity caused a failure of the locomotor mechanism as shown by an increase in the muscular external work.

Adolescent↗
PubMed2006

Unusual presentation of osteoblastoma in a patient with idiopathic scoliosis after posterior spinal fusion.

BACKGROUND CONTEXT: Few studies have described the diagnosis of osteoblastoma of the spine as a cause of scoliosis. These reports have described the tumor in conjunction with initial presentation of painful scoliosis. This case report presents a case of osteoblastoma 9 years removed from diagnosis and fusion of idiopathic scoliosis in the thoracic spine. PURPOSE: To report the late presentation of an osteoblastoma of the thoracic spine 9 years after posterior spinal fusion for scoliosis. STUDY DESIGN: Case report. METHODS: A 25-year-old man presented with thoracolumbar back pain and progressive neurological deficit 9 years after posterior spinal fusion for idiopathic scoliosis. Magnetic resonance imaging of the thoracic spine indicated the presence of a mass in the spinal canal causing cord compression. The patient underwent decompression with resection of the mass which was found to be an aggressive osteoblastoma. RESULTS: The patient enjoyed a full neurological recovery and has subsequently developed a recurrence at 13 months. CONCLUSIONS: We present osteoblastoma as a possible cause of low back pain and neurological deficit postfusion that should be considered in a differential diagnosis.

Abscess↗
PubMed1995

Kinesiologic analysis of dynamic side-shift in patients with idiopathic scoliosis.

OBJECTIVES: The purpose of this study was to analyze the ability of the patients with idiopathic scoliosis to transfer the body weight in the frontal plane. DESIGN: Randomized and controlled study. SETTING: A referral center and institutional practice and outpatient care. SUBJECTS: Fifty patients with idiopathic scoliosis (three men and forty-seven women; average age 15.3 years) and 15 normal women (average age 17.3 years) participated in this study. Thirty patients were treated with underarm braces. MAIN OUTCOME MEASURES: Computer-assisted force plates were used to evaluate the laterally shifted weight and the time period during side-shift on sitting. RESULTS: During both slow and fast side-shifts, shifted weight in the patients with idiopathic scoliosis was significantly less than in the normal controls (p < 0.05). The shifted weight was less on the concave side than on the convex one. The time for the shift to the concave side was longer in the patients than in the normal controls (p < 0.05). The brace was effective in correcting the imbalance of shifted weight in the patients with idiopathic scoliosis. CONCLUSIONS: The current study demonstrated the different patterns of weight side-shift between normal subjects and patients with idiopathic scoliosis. The patients transferred less weight laterally than the normal subjects during slow and fast random movements. The patients also showed slower side-shift patterns than the normal subjects during the fast random movement.

Adolescent↗
PubMed2003

Management of scoliosis with special seating for the non-ambulant spastic cerebral palsy population--a biomechanical study.

OBJECTIVE: To investigate the effects of special seating on lateral spinal curvature in the non-ambulant spastic cerebral palsy population with scoliosis. DESIGN: Prospective study with matched pairs (same subject pre- and post-intervention). BACKGROUND: It is thought that special seating can improve the sitting posture of individuals with spastic cerebral palsy. However, there is little known about how the seating can affect a scoliosis. METHOD: The shape of the spine was measured with subjects sitting in an assessment chair with a clear backrest. The measurement recorded was the "spinous process angle", an approximation to the Cobb angle. The forces exerted on the subject by the chair were measured by electrical resistance strain gauged transducers attached to the lateral support pads and seat base. Measurements were taken with three alternative arrangements of lateral support pads: upper body unsupported in configuration 1; two lateral pads at the same height in configuration 2; body supported by a 3-point force system in configuration 3. RESULTS: Configuration 3 gave a mean correction of +35% in the spinous process angle compared to configuration 1 (P=0.000) and the forces applied through the two lateral thoracic pads were, on average, of similar magnitude (mean values of 51 and 47 N). In comparison, for configuration 2 the mean correction was only +18.7% (P=0.004) and on average the pad on the concave side of the scoliosis applied a much larger force to the chest wall than the pad on the convex side (mean values of 36 and 17 N respectively). CONCLUSIONS: Significant static correction of the scoliotic spine can be achieved with an arrangement of lateral pads on a seating system that applies a 3-point force system to the sides of the body. RELEVANCE: The results suggest that the position of the lateral pads on a special seating system is important and, by the careful configuration of these supports, significant correction of a scoliosis can be obtained for a person with spastic cerebral palsy. Also the methodology and equipment from this study are potentially useful for the assessment and fitting of special seating for individuals with scoliosis.

Biomechanical Phenomena↗
PubMed2002

Perception of vertical and horizontal orientation in children with scoliosis.

To determine whether the perception of body posture is altered in idiopathic scoliosis, a simple neurophysiologic experiment through laser line projection was conducted to test this hypothesis in three groups of individuals: 89 children with idiopathic scoliosis (IS), 50 children with congenital scoliosis (CS) and 45 controls without scoliosis. The subjects were instructed to adjust a laser line projection to the direction of gravity in vertical and in horizontal projections in a dark environment. The performance, expressed as the deviation from the earth vertical (measured in degrees), was calculated by a computer. The three groups fulfilled the vertical and horizontal adjustments within the same accuracy. No relation with age, sex or severity of scoliotic deformity was found. Yet, the angle between vertical and horizontal laser lines was significantly related with the severity of scoliosis, both in IS and CS. In contrast to our hypothesis, it was concluded that perception of postural control in IS is not altered. Therefore, this study indicates that IS is not likely to be caused by a dysfunction of postural control.

Adolescent↗
PubMedDate not supplied

Endoscopic instrumentation, correction, and fusion of idiopathic scoliosis.

BACKGROUND CONTEXT: Endoscopic techniques have been used since 1993 to treat thoracic disk disease. Thorascopic techniques evolved into means of treating not only disk disease but also correcting thoracic spinal deformity with instrumentation and fusion. PURPOSE: To evaluate the efficacy of endoscopic instrumentation, correction, and fusion of thoracic idiopathic scoliosis. STUDY DESIGN: A retrospective review of 50 patients who have undergone endoscopic instrumentation, correction, and fusion for scoliosis. PATIENT SAMPLE: Fifty consecutive patients undergoing treatment for primary thoracic idiopathic scoliosis. OUTCOME MEASURES: Evaluation of operative time, curve correction, and fusion rates were evaluated. METHODS: Fifty patients with the diagnosis of primary thoracic scoliosis underwent thoracoscopic techniques of instrumentation, correction, and fusion. On follow-up, the patients were evaluated for spinal alignment restoration, axial derotation, postoperative pain, rehabilitative time, and complications. RESULTS: The initial curve correction averaged 50%, improving to over 68% in the last 10 cases. Hypokyphosis correction averaged 21 degrees. Additionally, there has been a decrease in rehabilitation time, less time off work or school, and decreased blood loss and postoperative pain. There were 14 complications and no deaths recorded. The factors involved in a successful fusion include total diskectomy, complete cartilaginous end plate removal, and autogenous bone graft. CONCLUSIONS: The initial results of the thoracoscopic-assisted techniques for primary thoracic scoliosis are promising. As with most evolving techniques, surgical times are decreasing and rates of correction are improving.

Adolescent↗
PubMed1976

Skin collagen in idiopathic adolescent scoliosis and Marfan's syndrome.

1. Skin collagen from fifteen patients with idiopathic adolescent scoliosis, three with congenital scoliosis, and fourteen patients with various degrees of Marfan's syndrome has been examined. 2. The stability of a polymeric collagen fraction, extracted from the skin of these patients, to depolymerization, has been compared with that from thirty-one matched control subjects. 3. The mean polymeric collagen stability was significantly reduced (P less than 0-01) in the group of fifteen patients with idiopathic adolescent scoliosis. The individual reductions in stability were greater in the younger patients and no reduction was found in two patients aged 19 years who had a mature skeleton. 4. The mean stability of polymeric skin collagen from the group of patients with Marfan's syndrome was not significantly abnormal, although there were individual low values. 5. Polymeric collagen of low stability was present in individual patients from each clinical group. Instability of collagen (from whatever cause) at a time of rapid growth may contribute to the high incidence of scoliosis in adolescent girls. In boys, adolescent scoliosis is less common and the maximum growth rate occurs at a time when collagen stability is less reduced.

Adolescent↗
PubMedDate not supplied

[Scoliosis in patients with osteogenesis imperfecta: a federal nation-wide cross-sectional study].

OBJECTIVE: Quite different prevalence of scoliosis in patients with Osteogenesis imperfecta is reported, not at least owing to the difficult recruitment of patients. The present study aims to investigate Osteogenesis imperfecta-patients with scoliosis by means of a cross-section study. PATIENTS AND METHODS: A total of 102 patients (46 males, 56 females) with an average age of 24.6 years (3-71 yrs.) were investigated in 1995 supported by the "Gesellschaft für Osteogenesis imperfecta Betroffene e.V.". Physical examination included pain and range of motion. Localisation and expanse of the curvature as well as attendant deformities of the spine were assessed by radiograph. RESULTS: Scoliosis was observed in 76 patients (74.5%). Most of them showed thoracal or thoracolumbar localisation with 36 cases of right and 40 cases of left convexity. The curvature was mainly mild (56 pat. < 40 degrees), while 8 patients showed moderate (< 60 degrees), 7 patients severe (< 80 degrees) and 5 patients very severe deformity (> 80 degrees). Average expansion amounted to 6.7 vertebrae (3-12) with an average rotation of 2 (1-4). Attendant deformities were distributed as follows: codfish (59 pat.) or wedge-shaped vertebrae (42 pat.), platyspondylia (16 pat.), thoracal cyphosis (5 pat.), flat back (1 pat.) or lordosis (2 pat.) and lumbar lordosis (10 pat.) or vertical position (14 pat.). 69 scoliosis patients complained about pain with an average VAS-value of 4.3. They also showed moderate to severe impairment of the range of motion. CONCLUSIONS: Our cross-section study with 102 Osteogenesis imperfecta-patients showed scoliotic deformity in 74.5% of cases. 69 patients suffered from remarkable pain and impaired range of motion, which was not only attributable to scoliosis alone, but also to concomitant spinal deformities.

Adolescent↗
PubMedDate not supplied

[Development of paralytic scoliosis in myelomeningocele].

Among other things the probability of developing a scoliosis in myelomeningocele depends on the patients age, the neurological level of lesion and the localisation of the vertebral arch defect. This study tries to analyse the influence of these factors in 465 patients with MMC and paralytic scoliosis. The results show, that the patients age and the neurological level of lesion are the most important factors for the development of paralytic scoliosis. The statistical evaluation based on the data found permits the determination of regression lines, which allow an estimation of further progression of paralytic scoliosis with respect to the neurological level of lesion and the patients age. At levels of paralysis between Th 3 and Th 12 an average progression of 3.5 degrees per year can be expected. Between L 1 and L 3 the progression rate can be estimated to be 2.5 degrees per year. At levels of paralysis distal to L 3 one can expect to find no significant development of scoliosis. In cases, which exceed the prediction interval, additional intraspinal anomalies, i.e. syringomyelia, must be considered and further examinations including MRI are required.

Adolescent↗