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PubMed1980

[Cerebral dysfunction in patients with idiopathic scoliosis].

To determine a possible involvement of CNS in the etiology of the socalled idiopathic scoliosis, some 115 clinically neurologically and psychically inconspicuous patients suffering from idiopathic scoliosis and some 35 patients with congential scoliosis have been submitted to EEG control. The idiopathic scoliosis group showed a significant percentage of divergence from normal EEG results found in the average normal population. The type and the genesis of the cerebral dysfunction as well as a possible correlation with the etiology of the idiopathic scoliosis are discussed below.

Adolescent↗
PubMed1986

Scoliosis and fractures in young ballet dancers. Relation to delayed menarche and secondary amenorrhea.

In a survey of 75 dancers (mean age, 24.3 years) in four professional ballet companies, we found that the prevalence of scoliosis was 24 percent and that it rose with increases in age at menarche. Fifteen of 18 dancers (83 percent) with scoliosis had had a delayed menarche (14 years or older), as compared with 31 of 57 dancers (54 percent) without scoliosis (P less than 0.04). The dancers with scoliosis had a slightly higher prevalence of secondary amenorrhea (44 percent vs. 31 percent), the mean (+/- SD) duration of their amenorrhea was longer (11.4 +/- 18.3 vs. 4.1 +/- 7.4 months; P less than 0.05), and they scored higher on a questionnaire that assessed anorectic behavior. The incidence of fractures was 61 percent (46 of 75 dancers), and it rose with increasing age at menarche. Sixty-nine percent of the fractures that were described were stress fractures (mostly in the metatarsals), and their occurrence had an even stronger correlation with increased age at menarche. The incidence of secondary amenorrhea was twice as high among the dancers with stress fractures (P less than 0.01), and its duration was longer (P less than 0.05). In 7 of 10 dancers in whom endocrine studies were performed, the amenorrheic intervals were marked by prolonged hypoestrogenism. These data suggest that a delay in menarche and prolonged intervals of amenorrhea that reflect prolonged hypoestrogenism may predispose ballet dancers to scoliosis and stress fractures.

Adolescent↗
PubMed2001

The association between idiopathic scoliosis and the number of acquired melanocytic nevi.

BACKGROUND: Several syndromes in which melanocytic nevi and scoliosis were present in the same patient have been described. No control study has been made to date to determine whether there is a relationship between these disorders. OBJECTIVE: We attempted to demonstrate the association between acquired melanocytic nevi (AMN) and idiopathic scoliosis (IS). METHODS: We studied 93 patients with IS, aged 10 to 18 years, from our hospital. Controls were randomly selected from 2 schools; Adam's forward bending test was used to exclude persons with clinical scoliosis, and the control group finally comprised 101 pupils. An observational, cross-sectional study was done. All AMN 2 mm or larger observed on the body were counted by one dermatologist. Other variables reported as risk factors in the number of nevi were also considered. Reliability of AMN counts was previously demonstrated. RESULTS: The median number of AMN was 18 (range, 10-42) in the IS group and 8 (range, 3-13) in controls (P <.001). The persons with scoliosis had more non-AMN dermatologic lesions than the controls (P <.05). Light phenotype correlated with many AMN. On multivariate analysis only scoliosis and age accounted independently for the number of AMN. CONCLUSION: IS is associated with many AMN. Multiple AMN may become a diagnostic marker for IS, and these two malformations might constitute a syndromic association.

Adolescent↗
PubMedDate not supplied

The use of exercises in the treatment of scoliosis: an evidence-based critical review of the literature.

The loss of flexibility in a spinal curvature defines it as a structural spinal deformity; a curvature sufficiently mobile to resolve with a change in posture is a non-structural or 'functional' scoliosis which is within the normal limits of movement for a human spine. It, therefore, seems logical that exercise-based therapies designed to improve and/or maintain flexibility and range of motion of the spine and thorax would be useful in the treatment of scoliosis. Recognition of the importance of maintaining flexibility of the thoracic spinal column to avoid scoliosis-associated pulmonary dysfunction made the use of exercise-based therapies a topic of clinical interest in ancient Greece. In recent years, successful prevention of polio epidemics has resulted in a stable change in patient populations such that most individuals diagnosed with scoliosis do not suffer from irreversible central nervous system compromise. As a result, realistic opportunities to examine the role of exercise in treatment of scoliosis are available for the first time in history. A growing body of evidence from independent sources is consistent with the hypothesis that exercise-based approaches can be used effectively to reverse the signs and symptoms of spinal deformity and to prevent progression in children and adults.

Adult↗
PubMedDate not supplied

Rehabilitation of adolescent patients with scoliosis--what do we know? A review of the literature.

Different opinions exist about the efficacy of conservative scoliosis treatment. Because this divergence of opinion corresponds to a great variety of standards applied, it is also not surprising that the results of conservative treatment differ a lot. Scoliosis normally does not have such dramatic effects that immediate surgery would be indicated. Moreover, it is clear that functional and physiological impairments of scoliosis patients--including pain, torso deformity, psychological disturbance and pulmonary dysfunction--require therapeutic intervention. The triad of out-patient physiotherapy, intensive in-patient rehabilitation and bracing has proven effective in conservative scoliosis treatment in central Europe. Indication, content and results of the individual treatment procedures are described and discussed. The positive outcomes of this practice validate a policy of offering conservative treatment as an alternative to scoliosis patients, including those for whom surgery is discussed.

Adolescent↗
PubMed1987

Diet as an external factor in the expression of scoliosis in a line of susceptible chickens.

An inbred line of chickens that develops severe scoliosis, an isogenic line and a line of birds derived from crossing the isogenic and inbred lines were used to study factors that influence the expression of scoliosis. Using the line of birds derived from the cross, the incidence of the lesion, defined as a spinal curve greater than 20 degrees, was influenced by deficiencies of copper, manganese or vitamin B-6. In the cross, scoliosis was expressed in 40-50% of birds. Vitamin B-6, manganese or copper deficiency, however, caused an increase in expression to 60-75% of birds. In contrast, protein deficiency, mild vitamin A deprivation, pantothenic deficiency, food restriction or calcium deficiency did not influence expression. Also, the addition of zinc (400 micrograms/g) or cadmium (5 micrograms/g) to a commercial nonpurified diet did not influence expression. That vitamin B-6, manganese and copper are dietary factors important to the expression of scoliosis may be related to their roles in the formation of connective tissue components, such as matrix glycoproteins, collagen or proteoglycans. For example, alterations and abnormalities in connective tissue may partly underlie progression of scoliosis and its potential for expression.

Animals↗
PubMed1995

Experimental scoliosis induced by rib resection in chickens.

Factors which affected the severity of scoliosis induced by rib resection were examined. Seventy chickens were divided into a rib transection group and a rib resection group with seven subgroups, according to the number of ribs treated and the age at surgery, and examined radiographically until 20 weeks postoperatively. Rib transection group chickens showed fusion at the transected site and no marked scoliosis. In the rib resection group, the more ribs resected and the younger the age at operation, the more severely the scoliosis developed. Bone regeneration at the resection site made the progression of scoliosis milder. These findings indicate that the age at rib resection, the number of ribs that are operated on, and nonunion of the resected sites play important roles in the progression of scoliosis induced by rib resection.

Age Factors↗
PubMed1978

Scoliosis in arthrogryposis multiplex congenita.

Fourteen of 50 patients studied with arthrogryposis also had scoliosis, an incidence of 28%. Eight patients developed a severe curve associated with functional disability and poor health. Three patients were unable to walk independently, and 2 died in childhood. Seven patients had congenital scoliosis; 4 had long "C" neuromuscular curves, and 3 had scoliosis associated with pelvic obliquity caused by unilateral hip dislocation or contracture. The natural history of congenital and neuromuscular curves was progression to an extreme and rigid scoliosis. The authors urge others to look for scoliosis in their patients with arthrogryposis and to anticipate its progression.

Arthrogryposis↗
PubMedDate not supplied

Elevated hair copper level in idiopathic scoliosis: preliminary observations.

Hair samples were collected from 74 patients with idiopathic adolescent scoliosis and from 25 control children and were analyzed for content of the following minerals: copper, sodium, iron, zinc, potassium, magnesium, cadmium, calcium, and manganese. The hair copper level of the scoliotic children was significantly higher than that of the controls. The scoliosis mean was 6.5 micrograms/dl and the control mean was 3.6 micrograms/dl, P less than 0.025. There was no correlation between the amount of hair copper and the severity of the scoliosis. The authors suggest that copper may be a factor in the development of scoliosis since it is part of the lysyl oxidase enzymes that are required for cross-linking of collagen and elastin. Another connection is that postpubertal girls have higher copper levels than boys and also have a greater severity of scoliosis.

Adolescent↗
PubMedDate not supplied

Spinal fusions to the sacrum in adults with scoliosis.

Forty-five skeletally mature patients averaging 44.3 years of age had spinal fusions which extended to the sacrum for pain and/or progression of their scoliosis. The primary diagnosis was idiopathic scoliosis in 35 patients, congenital scoliosis in two patients, and paralytic scoliosis in eight patients. A single curve pattern was present in 41 patients and the remainder had double primary curves. Thirty-eight patients had single stage procedures and 35 of these were done posteriorly. There was an evolution in the type of posterior instrumentation used over the 12 years. Thirty-five patients (78%) had at least one significant postsurgical complication. Thirteen of 22 patients with loss of lordosis required corrective osteotomies. Other complications included pseudoarthrosis in ten patients and neurologic complications in five patients, four of which had complete recovery. Twenty-five patients required a total of 51 subsequent surgical procedures. Despite a 51% initially poor result and a high complication rate, the final results were good or fair in 93% of the patients. This change was primarily the result of successful subsequent surgical procedures for correction of loss of lordosis and pseudoarthrosis. The adult scoliosis patient should be fused to the sacrum only if the lumbosacral disc is clearly a source of pain or the degree of pelvic obliquity makes it necessary in the paralytic curve. Every effort must be made to carefully preserve the patient's lumbar lordosis. Better results were obtained by using segmental spinal fixation in the form of sublaminar wiring of double Luque rods.

Adult↗
PubMed1985

Progressive scoliosis following chest wall resection in children.

The effect of partial chest wall resection on subsequent production of spinal deformity was studied in six pediatric patients. The following observations are made: Scoliosis secondary to chest wall resection in the pediatric age group is progressive. The degree of curvature is related to the number of ribs resected. Anterior resection of ribs does not produce significant scoliosis, whereas resection of the posterior aspect of the ribs promptly produces scoliosis. Scoliosis associated with marked pleural thickening secondary to recurrent tumor, irradiation scarring, and underlying pulmonary metastases is always convex toward the normal side. Scoliosis associated with empyema and chest wall osteomyelitis is likewise convex toward the normal side and may respond to removal of this thether in the growing child.

Bone Neoplasms↗
PubMed1985

Thoracic idiopathic scoliosis curve evolution and prognosis.

This study is a retrospective review of 221 patients with untreated idiopathic thoracic and thoracolumbar scoliosis that were observed from the first months of life until maturity. There are three stages in the evolution of these curves: a single main period of progression, a secondary period of progression, and a stable period. The chronology of these different periods varies. In "infantile scoliosis," the main period of accelerated increase of the curve occurs prior to 6 years of age. In "juvenile-puberal scoliosis," it occurs from 6 years of age to the first stages of puberty, and in "puberal scoliosis," the main increase occurs during puberty or adolescence. The prognosis of the scoliosis can be established at any age based on different parameters, such as the specific angle of rotation from birth to 6 years of age, the torsion angle from 6 years of age to P2, and the Cobb angle after puberty.

Adolescent↗
PubMed1989

Spinal muscular atrophy: natural history and orthopaedic treatment of scoliosis.

To study the natural history of scoliosis in spinal muscular atrophy (SMA), 63 spinal radiographs of affected patients who attended the Muscle Clinic of Rizzoli Orthopaedic Institute between 1974 and 1988 were reviewed. All but one of the intermediate SMA patients, and all of the mild SMA patients who stopped walking had a scoliosis that ranged from 10 degrees to 165 degrees. Out of the 19 mild SMA patients still able to walk, 12 had a scoliosis ranging from 10 degrees to 45 degrees. Mean age at the onset of scoliosis was 4 years 4 months in intermediate SMA, and 9 years 10 months in mild SMA. Data on characteristics of the scoliotic curve are reported. The effectiveness of orthopaedic treatment in the prevention of scoliosis is discussed.

Adolescent↗
PubMed1992

Platelet function in adolescent idiopathic scoliosis.

Recent studies have reported abnormal platelet morphology and function in patients with adolescent idiopathic scoliosis. These abnormalities include increased platelet size and dense body numbers, abnormal aggregation, thromboxane A2 synthesis, serotonin release to adenosine diphosphate and epinephrine stimulus, and decreased myosin-adenosine-triphosphatase-specific activity. It was postulated that a membrane-specific defect in calcium transport may be partially responsible for the abnormalities found. In response to a suggestion in the literature that platelet screening could be clinically useful in scoliosis evaluation as well as in basic research of its pathophysiology, a study was performed to evaluate platelet morphology, biochemistry, and function in patients with adolescent idiopathic scoliosis. Platelets from nine volunteers with adolescent idiopathic scoliosis were compared with cells from a control group of nine patients. No significant differences in measured platelet parameters were noted between adolescent idiopathic scoliosis patients and control groups. Platelets from both groups demonstrated normal aggregation and release patterns with all agents except for a mild decreased aggregation and secretion response to epinephrine. No significant differences were noted in serotonin or adenine nucleotide levels. No significant ultrastructural differences were noted. Earlier findings of an abnormal aggregation and secretion response to adenosine diphosphate, increased numbers of dense bodies, or increased intracellular calcium could not be confirmed. On the contrary, we found normal, if not slightly decreased, numbers of dense bodies per platelet and calcium levels that were not different from controls.

Adolescent↗
PubMed1992

Quantitation of three-dimensional deformity of idiopathic scoliosis.

Three-dimensional deformities in vertebrae of patients with idiopathic scoliosis were analyzed quantitatively using three-dimensional computed tomography. To evaluate the deformities, the vertebral lordosis and scoliosis were defined clearly. An average lordosis of 7.9 degrees and an average scoliosis of 6.8 degrees were calculated in 40 vertebrae near the top of the thoracic curve in 10 subjects with adolescent idiopathic scoliosis. Lordosis is characteristic of idiopathic scoliosis. Three-dimensional deformities in scoliotic patients cannot be represented precisely using the Cobb angle. A new technique for quantifying the three-dimensional deformities must be established.

Adolescent↗
PubMed1992

Results of spinal instrumentation of adolescent idiopathic scoliosis by King type.

The purpose of this study is to determine the usefulness of the King classification in predicting decompensation in adolescent idiopathic scoliosis. Fifty-one patients were reviewed with a mean follow-up of 25 months. Five patients had Type 1 adolescent idiopathic scoliosis: four were treated with Zielke/Cotrel-Dubousset instrumentation or Zielke instrumentation alone. Correction was greater than 51% in these cases and there was no decompensation. Twenty-three patients had Type II scoliosis. Nineteen of whom were treated with Cotrel-Dubousset instrumentation; 3 with Zielke and Cotrel-Dubousset instrumentation, and 1 with Zielke. The best correction occurred with anterior/posterior instrumentation. Decompensation occurred in 9 patients, all of whom were treated with Cotrel-Dubousset instrumentation alone. Fourteen patients had Type III scoliosis. All were treated with Cotrel-Dubousset instrumentation with correction of 65%. Decompensation occurred in 4 patients, all of whom were fused to or beyond the stable vertebra. Four patients had Type IV scoliosis; all were fused short of the stable vertebra with Cotrel-Dubousset instrumentation, resulting in correction of 52% and no decompensation. Five patients had Type V instrumentation; four were treated with Cotrel-Dubousset instrumentation and 1 with Zielke. There was no relationship between level of fusion and decompensation. Based on this study, the authors contend that the King classification is a valuable tool in the selection of type of instrumentation and fusion level.

Adolescent↗
PubMed1995

Scoliosis and fibrous dysplasia of the spine.

STUDY DESIGN: This report is an account of three patients with scoliosis and polyostotic fibrous dysplasia involving the spine. The perioperative course of two patients who underwent posterior spinal arthrodesis is described. OBJECTIVES: The objective of the study was to show that extensive fibrous dysplasia of the spine and scoliosis can be treated by standard methods of posterior spinal arthrodesis with good results. SUMMARY OF BACKGROUND DATA: Scoliosis developed in three patients, and two patients underwent spinal arthrodesis. No report that discusses the results of this type of operation in this patient population exists in the literature. METHODS: Three patients with polyostotic fibrous dysplasia involving the spine and scoliosis were located at our institution. Two of the patients underwent posterior spinal arthodesis in situ; their perioperative courses are described. The course of the nonoperatively treated patient is noted briefly. RESULTS: A stable posterior spinal arthrodesis was achieved in both patients with no major complications. At the time of the last follow-up visit, both patients had radiographic evidence of a solid fusion mass with no signs of pseudarthrosis or graft resorption. Both patients currently are doing well. CONCLUSIONS: Scoliosis and its treatment has been unreported in patients with this condition, and this report demonstrates that satisfactory results can be obtained with attention to detail.

Adult↗
PubMed1996

A comparison of radiographic and electrogoniometric angles in adolescent idiopathic scoliosis.

STUDY DESIGN: This was a cross-sectional study of a consecutive group of adolescent patients presenting to a scoliosis clinic for routine assessment or monitoring of their scoliosis, excluding postsurgical patients. SUMMARY OF BACKGROUND DATA: In vitro studies suggested electrogoniometry could be useful in the evaluation of scoliosis. No prior in vitro study had been performed. OBJECTIVES: To determine the reliability and validity of an electrogoniometric instrument, the Metrecom Skeletal Analysis System, in assessing adolescent idiopathic scoliosis. METHODS: Thirty-one patients were examined, radiographed, and scanned with the Metrecom Skeletal Analysis System twice by two different examiners. The magnitudes of the curves derived from the Metrecom Skeletal Analysis System scans were compared with each other and with the Cobb angles measured from standing radiographs. RESULTS: The intraclass correlation coefficient (a measure of agreement, ranging from 0 to 1, where 1 represents complete agreement) for the intraexaminer reliability of the Metrecom Skeletal Analysis System ranged from 0.71 to 0.83. The interexaminer reliability intraclass correlation coefficient of the Metrecom Skeletal Analysis System was 0.58, with a mean difference between examiners of 5.5 degrees (SD = 5 degrees), and limits of agreement (mean difference +/-2 SD) ranging from -4.5 degrees to 15.6 degrees. The Metrecom Skeletal Analysis System and the radiographically derived Cobb angle correlation was 0.64, but the mean difference between the methods was 3.7 degrees (SD = 11.1), with limits of agreement from 18.4 degrees to 25.9 degrees. CONCLUSION: The Metrecom Skeletal Analysis System does not provide sufficient clinical precision to substitute for the Cobb angle measured from spinal radiographic measurements in the management of adolescents with scoliosis.

Adolescent↗