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PubMed2002

Is the labyrinthine dysfunction a causative factor in idiopathic scoliosis?

The cause of idiopathic scoliosis remains unknown, although research has possibly eliminated some hypothetical causes. Recent reports associating scoliosis convexity with equilibrium control central processing and motor lateralization have suggested that idiopathic scoliosis is connected causally with the motor cortex. In order to analyze these factors a study of labyrinthine function was carried out. This study included seventeen female patients 12 to 14 years old (mean age= 13.36y) with right thoracic idiopathic scoliosis and twelve normal control females 12 to 14 years old (mean age =13.1y). An electro-nystagmographic study of labyrinthine function (potential nystagmus) was performed in all the patients of the study with caloric tests. The nystagmus was recorded with the electronystagmographic technique (ENG) using Hartmann device. We evaluate these parameters: Slow phase velocity (SPV), Total amplitude (Tamp), Frequency of nystagmus (Freq). No children of the study presented spontaneous nystagmus. No correlation was found between the convexity of the curvature and the direction of nystagmus in posture tests. There were no significant differences between left- and right- beating nystagmus. The results are discussed with special reference to aetiology in idiopathic scoliosis.

Adolescent↗
PubMed2004

[Biomechanics of scoliosis].

Scoliosis is defined as a three-dimensional deformity of the spine. The most pronounced component of scoliosis is in the frontal plane, comprising the lateral bending of the spine. Rotation of vertebra takes place in the transverse plane. In most cases of idiopathic scoliosis a decrease of thoracic kyphosis in the sagittal plane occurs. A more rare event is the appearance of a junctional kyphosis between the primary and secondary curve. The instrumentation introduced by Harrington dealt mainly with balancing the bending forces in the frontal plane (distraction of the concavity of the curve), along with fusion of the instrumented area. The multisegmental CD instrumentation allowed for the diminution of the lateral curve in the frontal plane, while at the same time "forcing" an increase of thoracic kyphosis in single curves, and restoration of physiological sagittal curves (thoracic kyphosis lumbar lordosis) in double curve scoliosis. The CD method achieved this good by a 90 degrees rotation of the rod towards the concavity of the curve, "changing" the lateral curve into kyphotic curve. In the AO USS (Universal Spine System) correction is achieved by pulling the hooks towards the rod. The procedure ends with the linking of two rods with transverse connectors forming this way a stable framework. The degree of correction achieved with this method is based on the biomechanic inter relation between the spine and the instrumentation system (application of distraction forces, compensatory forces and translocation of the instrumented segment). Post-op decompensation of the spine is usually the result of incorrect hook fixation, inadequate application of forces (distraction and compression) and use of a standard hook pattern for thoracic curves (type III) in other types of scoliosis.

Biomechanical Phenomena↗
PubMed2005

[Chest wall distraction in thoracogenic scoliosis].

INTRODUCTION: Combined congenital scoliosis and rib fusion associated with other chest deformities during infancy can lead to a progressive hypoplastic thorax that could be unable to support normal lung growth and respiratory function. Campbell introduced an expansion thoracoplasty technique in which fused ribs are separated and a vertical expandable prosthetic titanium rib is used as a chest wall distraction device to enlarge the affected hemithorax. This technique benefits the underlying lung by improving the thoracic volume and the respiratory function. PATIENTS AND METHODS: Four patients (3 boys and 1 girl) with severe unilateral thoracic deformity with combined scoliosis and rib fusion plus a restrictive respiratory insufficiency are presented herein; 1 of them needed continuous CPAP preoperatively. All had progressive scoliosis and failure to thrive. Preoperative evaluation included three-dimensional CT reconstruction. A thoracic expansion placing an intercostal vertical expandable prosthetic titanium device as a chest wall distractor was performed. Afterwards, distraction control was made every four months. RESULTS: Our 4 patients had a satisfactory outcome. Scoliosis was corrected and there were improvements of volume and function of the thorax. CONCLUSIONS: The placement of an intercostal distractor device improves the thoracic insufficiency syndrome, lengthening and expanding the thoracic cage at the same time. These effects benefit respiratory function and correct scoliosis, allowing an adecuate lung function.

Child↗
PubMed2005

[The expression of collagen IX in the apical disc of idiopathic scoliosis].

OBJECTIVE: To study the distribution of collagen IX gene in the disc and to determine its role in the pathogeny of idiopathic scoliosis (IS). METHODS: The data included apical disc and intermediate disc from 14 cases of adolescent IS, 26 discs from 13 cases of scoliosis of confirmed pathogeny (CPS), which included 10 cases of congenital scoliosis and neurofibromatosis scoliosis. Six discs were obtained from 3 cases of normal young man served as controls. The distribution of collagen IX was studied in the apical disc of IS by immunohistochemistry and in situ hybridization (ISH) with RNA probe. The figure of collagen IX hybridization in the endplate cartilage was input to the figure analysis system. The mRNA content of collagen IX was compared between each group by SPSS software. RESULTS: Collagen IX was mainly distributed in the inner fibrous annulus, nucleus and endplate cartilage. Collagen IX was secreted by the little round chondrocyte-like cells, which was not expressed in the hypertrophic cells. There was significant difference of collagen IX mRNA content between the concave side of apical disc in the IS and the normal disc(P < 0.05), and also between intermediate vertebrae of CS group and normal. CONCLUSIONS: There is no obvious abnormal distribution of collagen IX in the disc of idiopathic scoliosis. Collagen IX may be related to the pathogensis of IS. More investigation such as quantity analysis and protein function determination is needed to confirm its role in the pathogenicity of IS.

Adolescent↗
PubMed2005

Adolescent idiopathic scoliosis: etiology, anatomy, natural history, and bracing.

Adolescent idiopathic scoliosis is a three-dimensional deformity of the spine. Despite active efforts by different research teams, the etiology of scoliosis remains unclear. Treatment of scoliosis requires a solid understanding of the natural history of the disorder as well as sound clinical judgment. The evaluation, monitoring, and institution of conservative treatment such as bracing can present a challenge to the orthopaedic surgeon. Clinical monitoring is the only intervention necessary in most patients. A detailed review of the patient's history as well as a careful physical examination can help establish the diagnosis and the risk for progression. Skeletal maturity, gender; growth velocity, curve location, and magnitude are factors that can help assess the likelihood of progression. Bracing is the only nonsurgical measure proven to have any effect on halting the progression of scoliosis. Other forms of conservative treatment have not been shown to significantly modify the natural history of idiopathic scoliosis. Bracing results are directly related to compliance with brace treatment; therefore, optimal results cannot be achieved without the patient's cooperation and family support.

Adolescent↗
PubMed2006

Prevalence of scoliosis in school-children from Mostar, Bosnia and Herzegovina.

In the school-year 2002/2003 a prospective epidemiological study was performed with the aim of evaluating the prevalence and distribution of scoliosis in the population of schoolchildren from Mostar, Bosnia and Herzegovina. The general check-up of primary-school children covered a total of 2,517 children aged 7-14. The children in which at least one positive symptom of scoliosis was found were directed to undergo orthopedic examination and--if indicated--radiography. Incorrect posture was noted in 33.4% of children, and 11.8% of children were sent to orthopedic specialist examination. The prevalence of structural scoliosis amounted to 3.1%, with the spine curvature threshold being 10 degrees. In eight children (0.32%; 1 boy and 7 girls) a curvature of 20 degrees or more was diagnosed. The most common type of curvature was the thoracal (39%) and the thoraco-lumbar (39%) while 14 children had a double curvature (17.8%). A scoliosis was detected due to here performed check-up in 83.5% of children with scoliosis. No case of serious spine deformity (45 degree or more) was recorded, due to regular general check-ups taking place biannually in this population.

Adolescent↗
PubMed2006

[Costoplasty in scoliosis surgery].

The rib hump is a protrusion of the apicals ribs of the convex side of the toracic scoliosis and it is due to the torsional deformity that appears in scoliosis. It originates a great cosmetic deformity that although improves with the correction of the scoliosis, it appears again by the costal elasticity. For this reason, in cases of important deformity it is necessary to associate a costoplasty for its definitive improvement. 10 cases of Idiopatic Scoliosis with 75.5 degrees of average and rib hump of 22.1 degrees were analysed. A resection of apicals ribs without stabilization in the same surgical act were done; the correction of the curve was 34.6 degrees (55%) and of the hump 8.1 degrees (64%); there were no important complications and the postoperative evolution was normal. The average follow up was 21,9 months, only in 1 case a slight deterioration of the hump was detected, although in all the cases the ribs recovered. In conclusion, costoplasty breaks the vertebro-bicosto-esternal ring. For that reason it is effective for the improvement of the costal hump without adding morbidity to the correction of the scoliosis.

Adolescent↗
PubMed2005

Apical derotation in the treatment of idiopathic scoliosis.

STUDY DESIGN: A prospective study of the pedicular screw plate system in the treatment of idiopathic scoliosis. OBJECTIVES: To study the efficacy of apical derotation of pedicular screw plate system in idiopathic scoliosis correction and evaluate the feasibility of the technique. SUMMARY OF BACKGROUND DATA: In the surgical treatment of idiopathic scoliosis, the standard technique of fixation currently utilized the linkage of the pedicle screws via rods. Alternatively the technique of apical correction of the deformity by sagittally contoured plates found to be a convenient and effective mean of deformity correction and rigid fixation. MATERIAL AND METHOD: Twenty-five patients who were diagnosed as idiopathic scoliosis and underwent posterior spinal fusion and fixation with pedicle screws and plates were prospectively analysed. The parameters were compared between preoperative and postoperative by paired t-test. These parameters included Cobb angles, body height, shoulder height difference, coronal trunk balance, hump difference and vertebral rotation. RESULTS: There was statistically significant difference between the pre-op and post-op parameters studied. CONCLUSION: The instrument can effectively correct the scoliosis of moderately severed deformity in 3 dimensions especially regarding the vertebral derotation and restoration of thoracic kyphosis.

Adolescent↗
PubMed1991

A longitudinal study of growth velocity and development of secondary gender characteristics versus onset of idiopathic scoliosis.

This study focused on evaluating the impact of the adolescent growth spurt on the onset of idiopathic scoliosis. A total of 698 students (362 girls and 336 boys aged nine to 12 years) were followed for three years to study their growth in the pubertal period and changes in spinal status. Every six months measurements were taken of body height and the development of secondary gender characteristics was recorded. The onset of the adolescent growth spurt could thus be detected in each child. When children with and without scoliosis were compared, it became evident that scoliotic children grew faster. Girls whose scoliosis developed from a previously normal body posture showed a peak height velocity (PHV) of 8.1 cm per year, whereas girls with a normal body posture throughout the pubertal stage had a PHV of 7.1 cm per year. The most rapid growth spurt was observed in Stages 2 and 3 of breast and pubic hair development. Simultaneously, the most frequent spinal status changes occurred in Stages 2 and 3 of sexual maturity; they were twice as frequent as in Stage 1 and four times as frequent as in Stages 4 and 5. Students in whom scoliosis developed in puberty during the adolescent growth spurt grew faster than their peers who did not develop scoliosis, which need not imply that they will eventually be taller after growth is completed.

Adolescent↗
PubMed1989

[The surgical treatment of scoliosis with the use of the Rodnianskiĭ-Gupalov endocorrector at a pediatric orthopedic sanatorium].

102 patients with scoliosis at stages II, III and IV aged from 7 to 18 years have been operated making use of Rodnianski'i-Gupalov endocorrector. Half of the patients had scoliosis at stage IV. The best results have been observed in the patients aged from 7 to 12 years at stage 11 and beginning of stage III of scoliosis (to 35 degrees). On the basis of the authors' surgical modifications used in 60 patients with scoliosis it is reported that in the children with scoliosis at stages III and IV it is advisable to use a one-plate endocorrector simultaneously combining mobilizing and stabilizing operations, which allows to spread and effectively use Rodnianski'i-Gupalov endocorrector in the patients aged below 18 years. The complications connected with disorders in the endocorrector construction as well as those due to general surgery have been pointed out. In most patients the complications have had no effect on the results of the treatment.

Adolescent↗
PubMed1989

Scoliosis: biomechanics and rationale for manipulative treatment.

This paper discusses methods to biomechanically evaluate scoliosis. From a chiropractic point of view, an understanding of the biomechanics of scoliosis is of paramount importance. By understanding the pathogenesis, the chiropractic physician can apply a rational approach to outline a treatment regimen. Spinal curvatures in the median plane change during growth, and in normal children the thoracic kyphosis reduces in size between the ages of 8 to 14. However, the change occurs at different times for boys and girls. Since scoliosis is a lordotic problem, associating lateral curvatures with gender, age, and attitude of the thoracics during growth spurt may answer questions of a female disposition and a male tendency to Scheuermann's disease. Further, this paper evaluates the lateral curvatures of the spine concerning normal curve mechanics and idiopathic scoliosis. Mechanical stability is considered, applying engineering principals to understand buckling and critical loading. By examining the factors of spine slenderness, flexibility and strengths of the trunk muscles, and applying this understanding to curve mechanics-biomechanics of scoliosis, the chiropractor has a rationale for the treatment of mild lateral curves.

Adolescent↗
PubMed1989

[A study of trunk muscle in idiopathic scoliosis].

Isometric and isokinetic parameters related to trunk muscle function in patients with idiopathic scoliosis were measured by Cybex dynamometer with a trunk stabilization system. Activities of the paraspinal muscles were also determined by electromyographic observations. In scoliotic patients some parameters, especially endurance in lateral bending to the concave side of the trunk, were predominant. In electromyographic analysis, neurogenic changes were observed in 25.9% of patients with idiopathic scoliosis. In nonprogressive scoliosis, the mean amplitude of EMG did not differ between the convex and the concave. In progressive scoliosis, however, the mean amplitude of EMG was higher on the convex side than on the concave side. Thus, the compensatory reaction on the curvature of the spine caused higher amplitude of action potential of the back muscles on the convex side than in the concave side. These data suggest that the trunk muscle imbalance is one of the most important factors in the onset and progression of idiopathic scoliosis.

Adolescent↗
PubMed1986

An algorithm for the management of scoliosis.

Scoliosis is a lateral and rotary deformity of the spine that is often found in children. Treatment of this deformity is based on the principle of early recognition and prevention, although surgical correction may be warranted in the case of progressive curves. There is no scientific evidence that spinal manipulative therapy (SMT) has any effect on curve progression in patients with idiopathic scoliosis; however, there is clinical evidence that SMT is a useful treatment for those patients who have an associated mechanical backache. This paper reviews the classification, natural history, pathogenesis, and clinical and radiological assessment of scoliosis. An algorithm for the management of scoliosis by chiropractors is presented, and illustrative cases from a scoliosis clinic in a university hospital are used to reinforce important clinical principles.

Adolescent↗
PubMed1988

[Bone maturation in scoliosis patients, comparison of the degrees of ossification of the iliac crest and carpal bone age].

The usefulness of the degrees of apophyseal ossification of the iliac crest and bone age as an index of bone maturation was compared in patients with scoliosis. Comparisons of Risser sign, bone age, and chronological age in 85 patients with idiopathic scoliosis showed a close correlation between Risser sign and bone age (R = 0.75, p less than 0.001). Scoliosis progressed after the appearance of type IV Risser sign in more patients than after the appearance of type V sign or a bone age of 16 years. There was no difference between the progress rate of scoliosis after the appearance of type V Risser sign and that after the bone age of 16 years. Risser V is defined by different signs according to the investigators. Some use the time of complete apophyseal fusion of the iliac crest, but others use the beginning of fusion. Therefore, bone age is thought to be a more useful index of bone maturation for a prospect of progress in scoliosis.

Adolescent↗
PubMed1986

[The result of the author's screening system of scoliosis in elementary and junior-high schools].

Since 1978 school screening of scoliosis has been performed every year by the system established by the author consisting of 4 step examinations in Niigata City. The initial examination is carried out with forward bending test associated with swing maneuver by school nurses or school doctors in all school boys and girls from the 4th grade of elementary school to the 3rd grade of junior-high school. The incidence of scoliosis with deformity of more than 20 degrees has been nearly constant ranging from 0.06% to 0.09% in elementary school, and 0.35% to 0.40% in junior-high school. The author compared the number and treatment of the patients of Niigata City seen in our scoliosis clinic in the period of 7 years before and after starting this program. After this program started, the number of the patients with scoliosis of more than 20 degrees has increased by 4 times. The number of surgery in adolescent idiopathic scoliosis, on the contrary, has markedly decreased.

Adolescent↗
PubMed1979

Muscle pathology in idiopathic scoliosis.

Muscles from patients with scoliosis were studied to determine the possible relationship between neuromuscular disease and idiopathic scoliosis. Biopsies taken from the paraspinal musculature, the gluteus maximus and other sites were examined and compared with control specimens taken from patients undergoing spinal surgery for other disorders. Morphological and morphometric examinations by light and electron microscopy revealed a wide range of pathological changes and an alteration in the normal distribution of fiber types in most muscles. Changes were mainly nonspecific, but one unusual feature in idiopathic scoliosis but not in the other types of scoliosis consisted of type I fiber atrophy in paraspinal and deltoid muscles of the concave side paraspinal muscle, the site of the maximum morphological changes. The localized muscle changes, which are disease and not deformity related, suggest that idiopathic scoliosis is a separate disease entity and that the central nervous system may be involved in its genesis.

Adolescent↗
PubMed1977

[Scoliosis and spondylolisthesis (author's transl)].

The coincidence of a scoliosis with a lumbosacral spondylolysis or spondylolisthesis has remained largely ignored in the German language literature. After a survey of the foreign literature the pathogenesis of various combination forms is discussed. Primarily with the aid of oblique X-rays of lumbar scoliosis a scheme of classification involving 7 categories is worked out. The two main categories comprise unstable spondylolisthetic scolioses with increasing abnormal posture and scoliotic spondylolistheses. In these cases a lumbar scoliosis probably induces an asymmetric spondylolysis. The scheme provides the basis for discussion of conservative and surgical treatment. Taking of a standing X-ray is indispensable as a preliminary measure with every lumbar scoliosis. Oblique X-rays of the lumbosacral section appear to be equally necessary at least once. Unilateral laminar sclerosis can be a valuable sign of contralateral one-sided spondylolyses, as can scoliotic E-forms of the spinal column as well. Spondylolisthetic "scolioses" should be fused in the lumbosacral section at an early stage to prevent secondary structural curvatures. Scoliotic spondylolyses-spondylolistheses at this level should on the other hand, only be fused in serious cases accompanied by pain and progression, supplementing dorsolumbar fusion of scoliosis. In any case, the lowest lumbar vertebra must only be fused in an almost straight position. The correction should also be carried out in the case of difficult spondylolisthetic scolioses prior to the lumbosacral dorsolateral fusion using the v. Lackum transsection cast if certain, above all neurologic, findings permit.

Adolescent↗
PubMed1981

Surgical treatment of adult scoliosis. A review of two hundred and twenty-two cases.

We evaluated the cases of 222 patients older than twenty years in whom scoliosis was the primary diagnosis. No patient had had prior surgical treatment. The diagnoses were idiopathic scoliosis in 160 patients, paralytic scoliosis in forty-four, and congenital scoliosis in eleven, and there were miscellaneous diagnoses in seven patients. The average age of the patients when first seen was 30.7 years. The indications for operation were pain, progression of the curve, magnitude of the curve, and cardiopulmonary symptoms. Preoperative traction, including halo-femoral traction, did not result in increased correction when compared with the initial supine side-bending roentgenogram. A one-stage fusion was performed in 174 patients and multiple-stage procedures, in forty-eight patients. At an average follow-up of 3.6 years the average loss of correction was 6.2 degrees, 68 per cent of the patients were free of pain, and a solid fusion had been obtained in all but six patients. Complications developed in 53 per cent of the patients, the most common problems being pseudarthrosis, urinary tract infection, wound infection, instrumentation problems, a pulmonary disorder, and loss of lumbar lordosis. Paraplegia occurred in one patient. The over-all mortality rate was 1.4 per cent. Complications increased with age, and the highest mortality rate was in patients with congenital scoliosis who had cor pulmonale.

Adult↗