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[Pulmonary function and movement of the thoracic cage in mild idiopathic thoracic scoliosis].

It has not yet been studied whether there is a threshold in the degree of scoliotic deformity, above which the pulmonary function is impaired. Neither has it been confirmed whether the pulmonary dysfunction has some relation to the development of scoliosis and its deterioration, if the impairment of pulmonary function does exists in patients with subclinically mild scoliosis. To elucidate these problems, the author investigated the respiratory function and the movement of the thoracic cage as well, in scoliotic patients with mild involvement on their thoracic spine. The results were as follows. In cases with mild deformity of less than fourty degrees, residual volume and functional residual capacity were increased and static lung compliance was decreased, but vital capacity remained within normal limits. Increased residual volume was observed even in the very mild case with a curvature of as much as ten degrees. No correlation was found between the degree of pulmonary dysfunction and the prognosis of scoliosis. The author believed that prognosis of scoliosis could not be predicted by testing the pulmonary functions alone. The movement of the thoracic cage was greater in the concave side of scoliosis than in the convex side on both tidal breathing and vital capacity measurement maneuver. Both the degree of deformity represented by Cobb's angle and that of rib hump correlated significantly with the restriction of the movement of the thoracic cage on the convex side of scoliotic deformity.

Adolescent↗

Solubility of spinal ligament collagen in idiopathic and secondary scoliosis.

Supraspinous and interspinous ligaments from patients with infantile and adolescent idiopathic scoliosis and from patients with secondary scoliosis were investigated for collagen content and cross-linking. No differences were demonstrated in the collagen content of ligaments from the idiopathic and secondary scoliosis groups. Collagen solubility studies were used to test for cross-linking defects. Similar amounts of neutral salt-soluble and acetic acid-soluble collagen were extracted from the ligaments of all diagnostic groups. Investigation of the normally insoluble collagen pool extracted from the ligaments of different diagnostic groups after "lyotropic relaxation" revealed no differences in the amount of collagen extracted or in its stability to alkaline denaturation. Control experiments using rat skin collagen showed that the lyotropic procedure solubilized undegraded alpha- and beta-polypeptide chains from the tissue. Reports from other laboratories have suggested the presence of a collagen defect in the skin of patients with adolescent idiopathic scoliosis. The results of the present investigation show that it is unlikely that a generalized defect of collagen cross-linking, or a specific defect of ligament collagen cross-linking, occurs in either infantile or adolescent idiopathic scoliosis.

Adolescent↗

Osteotomy of the fusion mass in scoliosis.

The value of an osteotomy of the fusion mass in attaining realignment of the spine when a lateral shift of the trunk over the pelvis has developed in the frontal plane was studied in fifty-five patients. All had had a previously fused but progressive spinal deformity. The indications for osteotomy were progression of the curve, imbalance of the trunk, pain, deteriorating cardiopulmonary function, or pseudarthrosis, or a combination of these conditions. Twenty-one patients had idiopathic scoliosis; fourteen, congenital scoliosis; ten, paralytic scoliosis; four, myelodysplastic scoliosis; and six had scoliosis secondary to miscellaneous conditions. A total of 154 osteotomies of the fusion mass, or 2.8 osteotomies per patient, were performed. Nine patients underwent an anterior spinal osteotomy or wedge resection as well. Most had a two-stage procedure which consisted of a posterior osteotomy, halo-femoral traction, and a posterior re-fusion with Harrington instrumentation two weeks later. At an average follow-up of thirty-two months, it was found that osteotomy of the fusion mass enabled the surgeon to realign the trunk over the pelvis and to correct pelvis obliquity, but correction of the angular deformity was only secondary. Although the rate of complications was high (51 per cent, including one postoperative death), osteotomy of the fusion mass and re-fusion may be indicated in a patient with a previously fused but progressively unbalanced, painful deformity of the spine.

Adolescent↗

Role of melatonin deficiency in the development of scoliosis in pinealectomised chickens.

We studied the possible role of melatonin deficiency in experimentally-induced scoliosis. A total of 90 chickens underwent pinealectomy on the third day after hatching: 30 were treated with serotonin, 30 with melatonin and 30 received no therapy (control group). Scoliosis developed in all the control group, in 22 of the serotonin group, and in only 6 of the melatonin group. The six melatonin-treated chickens with scoliosis had less severe spinal deformities than those in the serotonin-treated group. There were lower blood melatonin concentrations in chickens with scoliosis than in those without. Our findings suggest that melatonin deficiency contributes to the aetiology of this experimental scoliosis, probably by interfering with the normally symmetrical growth of the proprioceptive system involving the paraspinal muscles and the spine.

Animals↗

Sagittal spinal flexibility in patients with idiopathic scoliosis.

To determine whether or not reduced sagittal spinal flexibility is associated with idiopathic scoliosis we measured the sagittal spinal flexibility in 40 normal children and in 93 children with idiopathic scoliosis. Sagittal spinal flexibility, or the range of spinal flexion (RSF), was calculated from lateral radiograms of each spine by measuring the difference in the segmental kyphotic angle between the neutral standing position and the maximally flexed position. The spines of all 40 normal children bent smoothly, but 87 of the 93 scoliosis patients had localized areas of severely decreased RSF. This striking difference in sagittal spinal flexibility between normal children and patients with idiopathic scoliosis suggested that a loss in spinal flexibility in the sagittal plane was associated with idiopathic scoliosis, and may contribute to the pathogenesis and progression of spinal curvature.

Adolescent↗

[Experimental scoliosis in the rat spine induced by binding the spinous processes].

The effects of limitation of spinal mobility in forward flexion on the development of scoliosis was studied in experimental animals. The spinous processes of three lumbar vertebrae of young female rats were sutured together to make persistent limitation in the forward flexion of the spine. The lumbar vertebrae of rats, which normally are kyphotic in their profile, frequently became flattened or lordotic after the operation. Scoliosis with a primary curve at the sutured site was produced, although the curve magnitude was mild in 38% of 73 operated rats, and appeared more frequently in those which had more limitation in the spinal mobility at the sutured vertebrae than in those with less limitation. In histological examinations, the coronal sections of vertebral specimens of scoliotic animals demonstrated wedge-shaped intervertebral discs, deviation in the vertebral nucleus pulposus toward the convex side of scoliosis, and a degeneration in the annulus fibrosus. Thickening of the cartilaginous endplates on the convex side and a rupture in them on the concave side were observed in some of the animals. These findings indicated that the experimentally produced scoliosis was structural. This experimental study suggested that a limitation in the spinal mobility in forward flexion has a causative effect on the development and progress of idiopathic scoliosis.

Animals↗

[Ultrastructural studies of articular cartilaginous degeneration in the facet joints in spinal scoliosis].

The purpose of this study was to determine the relationship between spinal scoliosis and degeneration in the articular cartilage of the intervertebral facet joint. Histological and ultrastructural studies were performed on the articular cartilage of the apical facet joints in the area affected by spinal scoliosis. Histological examinations showed that cartilaginous degeneration in the concave side was more severe than that in the convex side. Over 70 degrees, the histological findings showed increased surface irregularities and hypocellularity in the concave facet joints. A significant correlations were found between the apical degenerative score of the articular cartilage and the pre-operative rotation index and the post-operative correction ratio of the scoliosis. Using transmission electron microscopy (TEM), the development of the organellae of the concave articular cartilage was demonstrated to be commonly disturbed, but the microstructure of the convex cartilage was intact with less than 70 degrees of spinal scoliosis, while similar findings to the concave side were demonstrated over 70 degrees. These results suggest that a biomechanical imbalance disturbed organellae of the cartilage cells in the articular cartilage of the concave apical facet joints initially and this then gradually extended to the convex side over 70 degrees with progressing scoliosis.

Adolescent↗

Neurofibromatous scoliosis. Natural history and results of treatment in thirty-seven cases.

Of 400 patients with the diagnosis of neurofibromatosis on their hospital records, 141 actually had the disease. The presence of at least two of the following features was considered diagnostic: positive family history; positive biopsy; a minimum of six cafe-au-lait spots, each with a diameter of at least 1.5 centimeters; and multiple subcutaneous neurofibromas. Scoliosis was present in thirty-seven patients (26 per cent), most commonly associated with cafe-au-lait spots (thirty-five patients). In many of the patients with scoliosis there were associated medical and surgical problems. Although no standard pattern of spinal deformity could be identified, a sharp single right thoracic curve involving more than five vertebrae was the most common. For the whole group the initial measurement of the scoliosis averaged 42 degrees. Double curves were more sever, buth kyphosis was uncommon and no cases of paraplegia were recorded. In patients with progressive scoliosis, the best results were obtained with early Harrington instrumentation and posterior spine fusion. Progression of the scoliosis was observed both before treatment and postoperatively. The amount of progression was not necessarily related to the severity of other manifestations of neurofibromatosis, and was not significantly dependent on the length of the curve.

Adolescent↗

[Treatment of idiopathic scoliosis in children].

This is an update on the surgical and orthopedic management of scoliosis in children. After a review of the biomechanical factors underlying the scoliotic deformity in the three dimensions, methods and indications of conservative treatment combining physiotherapy and full-time or part-time bracing are discussed. Development of new segmental spinal instrumentation devices has modified the surgical treatment of scoliosis by allowing three-dimensional correction of deformities and obviating the need for postoperative immobilization in a cast or corset. Results of conservative treatment are analyzed in an original series of 56 children with progressive scoliosis treated when the angulation was still under 30 degrees. Mean follow-up since the end of treatment is 14 years. Results show that proper conservative treatment arrests progression and modifies the natural history of scoliosis. Outcome after surgical treatment is analyzed in an original and recent series composed of the 50 first children who had posterior surgery with the new Cotrel-Dubousset instrumentation. Results of anterior surgery (V.D.S. instrumentation), which is still indicated in some cases, are analyzed in an older series of 18 cases. When the deformities are too severe to allow conservative treatment, short segment fusion effectively corrects the scoliosis and reliably provides good cosmetic and functional results.

Adolescent↗

[Evaluation of operative corrigent degree of scoliosis by improved Cobb's angle degree of preoperative suspensive roentgenogram].

To achieve best operative result in correction of scoliosis, and avoid complications of the nerve system due to excess correction, we compared the statistical results of modified Cobb's degree of preoperative suspensive roentgenogram and operative corrigent degrees of 331 patients with scoliosis, including 219 with idiopathic scoliosis. The modified Cobb's degrees of the whole group was 20.15 +/- 9.41 in suspension, the operative corrigent degree was 35.34 +/- 13.05, and the operation-suspension difference was 14.62 +/- 11.02. Referring to idiopathic scoliosis, it was 21.79 +/- 8.39, 37.44 +/- 11.82, 15.58 +/- 9.91 respectively. And the statistacal study was performed according to scoliosis type, involved segments, curvature degree, and ages. The parameters were very helpful in the evaluation of currigent effect before operation.

Adolescent↗

[A study of blood loss during surgery for scoliosis. Posterior approach in 319 adolescents].

A retrospective study including 319 patients was realized from 1984 to 1993 in order to evaluate during scoliosis surgery the incidence on bleeding of the type of scoliosis and the anesthetic procedure. Blood losses were below one litre thus reducing the homologous blood transfusions. The patient was in prone position on a modified Wilson frame which facilitates venous return from the dorsal region. A moderate controlled hypotension was realized by combination of halothane, intravenous nitroglycerin (NG) and beta-blocking drugs (when required). Somatosensory evoked potentials were continuously monitored during surgery. A compression of the dorsal region was realized postoperatively in order to reduce blood loss. The blood losses were compared using Student's t-test. The mean perioperative bleeding was 9.8 ml.kg-1 for idiopathic scoliosis (no transfusion required), 14.1 ml.kg-1 for secondary scoliosis (p < 0.05 vs idiopathic) and 29.3 ml.kg-1 for neuromyopathic scoliosis (p < 0.05 vs idiopathic), indicating a major influence of muscle atonia on bleeding. The moderate controlled hypotension by iterative injection of NG and beta-adrenergic blocking drugs provided a safe and reversible hypotension.

Adolescent↗

Scoliosis in China. A general review.

In modern China the investigation and treatment of scoliosis began in the late 1970s. The incidence of scoliosis in the Chinese population of the Sichuan province was 0.064%, and the incidence of >10 degrees for Beijing students was 1.04%. The surgical treatment of scoliosis for 2122 patients reported in the Chinese literature was reviewed by the authors. In this study, the female to male ratio was 1.3:1, the incidence of idiopathic scoliosis was 67.7%, and the incidence of congenital scoliosis was 18.1%. The overall result showed that the correction rate after surgery in the coronal plane was approximately 50% using the Harrington, Luque, Dwyer, or Cotrel-Dubousset instrumentation techniques. However, it would be increased by >60% if a partial vertebrectomy was carefully done and the soft tissue in the concave side was released completely. The postoperative complications were approximately 20% with 0.24% of major spinal cord injury. Biologic and anatomic research of the spine has been done so that the quality of surgical implants can be improved in the future.

Adolescent↗

[Contractures and growth disturbances in the hip and pelvis as the cause of "idiopathic scoliosis". Biomechanical considerations].

Author's own observations on etiology of "idiopathic scoliosis" in children and adolescents are presented. Abduction or flexion-abduction contracture of the hip, mainly right one, is the chief cause of "idiopathic scoliosis". Scoliosis is the final deformity in the chain of malformations commencing in newborns and infants, known as "contracture syndrome". This condition is described by many authors, Mau and Green-Griffin were the first ones. Adduction contracture of the left hip leads to secondary dysplasia of this joint. Coexisting abduction contracture of the right hip is usually neglected. Insufficient adduction in the right hip in extension causes functional elongation of the right extremity and oblique positioning of the pelvis, thus initiating left hand side lumbar, thoraco-lumbar or lumbo-sacral scoliosis. As the next step thoracic scoliosis develops. Early and late clinical and radiographic symptoms are presented, prophylactics and treatment is discussed.

Adolescent↗

[Idiopathic scoliosis and the stooping position test].

Idiopathic scoliosis, or scoliosis with no recognizable cause, is the most common form of scoliosis. According to Burrows and Young (1991), the stooped position test (where the child is asked to bend forward) has been used by nurses to test school age children since 1947 and is still the most widely used test for early identification of this condition. To provide an accurate reading of this test, nurses need extensive knowledge of the characteristics of this deformity. They must also be able to note with precision the objective, subjective and evolving signs of idiopathic scoliosis. Statistical information relating to the intrinsic and predictive validity of the test are also important for early detection and referral to a physician. This article describes the symptoms of idiopathic scoliosis, the testing methodology and its validity. The authors also suggest using a scoliometer as a supplementary tool because it measures the degree of spinal deformity and specifies the degree of rotation of the spinal cord.

Child↗

[Family prevalence of idiopathic scoliosis].

OBJECTIVE: Review of the literature shows that, for the moment, the cause of idiopathic scoliosis remains unknown. It has been attributed to a wide variety of conditions, including genetics. The aim of this paper was to determine the frequency of antecedents and family prevalence of idiopathic scoliosis in first and second degree relatives. PATIENTS AND METHODS: During 1994-1995, the families, including first and second degree relatives, of 100 schoolchildren with idiopathic scoliosis were surveyed for scoliosis. The screening was done initially by clinical examination, the test of Adams and subsequently the diagnosis was confirmed by roentgenography. RESULTS: Our study showed the following results. Twenty-five percent of patients investigated had one or more affected individuals in their family. Prevalence of idiopathic scoliosis in first degree relatives was 5.16% and in second degree relatives 4.31%. It was more frequent in females than in males (p < 0.05). This prevalence is larger than that in the general population (1-2%). CONCLUSIONS: Our conclusion is that the mechanism of inheritance is most likely multifactorial. In view of the predominance of females, an X-linked inheritance is suggested.

Female↗

[Result on the screening of scoliosis among school students in Beijing area].

An investigation of the morbidity of scoliosis has been carried out in Beijing area including both urban and rural area. The survey involved 21759 elementary school students aged 8 to 14. The result showed that the morbidity of scoliosis was 1.06 per cent. Most patients had idiopathic scoliosis while congenital scoliosis possessed only 5.19% of the whole patients. Prevalence in female students was slightly higher than in males. In terms of morbidity of scoliosis, there was no significant difference seen in the areas of study. The use of Adam-forward-bending test for original examination in the investigation seemed to be simple and effective. The spine measure ruler is qiute simple in production and easy to handle. Using the ruler, one will get less exposure to X-ray. The film which shows the whloe spinal AP and lateral view would lay a final and ture basis for diagnosis.

Adolescent↗

[Study of pre and postsurgical ventilatory function in idiopathic thoracic scoliosis using the Harrington method].

OBJECTIVE: To study the evolution and ventilatory function measured by spirometry after surgery with the Harrington method for idiopathic thoracic scoliosis. PATIENTS AND METHODS: A prospective study with evaluation of changes in scoliosis angle following the Cobb method, as well as ventilatory parameters after surgery, measured after a mean time of 19.2 +/- 11.8 (range: 9-60) months post-surgery. Twenty patients were studied, 6 men and 14 women, with no previous respiratory conditions, with ages ranging from 12 and 35 years, and a mean of 16.3 +/- 4.6 years, and all of them with the diagnosis of idiopathic thoracic scoliosis and with pre-surgery angle of 59.9 degrees +/- 13.5 degrees. RESULTS: No statistically significant changes were observed in any of the ventilatory parameters considering both the absolute value and percentage of the theoretical value, although there was indeed a significant improvement in the scoliosis angle. CONCLUSIONS: In our study no ventilatory function improvement was observed after scoliosis surgery, although we cannot say that the results were the same if the previous thoracic deformity were more remarkable and caused greater changes in ventilatory parameters.

Adolescent↗

Magnetic Resonance Imaging in Children with Scoliosis.

For many years, orthopaedic surgeons and radiologists have used plain-film radiography for diagnosis, treatment decision-making, and postsurgical evaluation of scoliosis. Recently, the direct visualization of the spinal canal and spinal cord became possible with the development of magnetic resonance imaging (MRI), which over a short period of time has become an indicated procedure in children with juvenile-onset idiopathic scoliosis and congenital scoliosis. Children with idiopathic scoliosis associated with neurologic findings on physical examination, with pain or rapid progression of the spine curvature are also being evaluated with MRI, especially if surgery for stabilization of the spine is planned. The use of MRI as a screening modality for all children with scoliosis is still controversial and further studies are needed to evaluate if the examination adds or changes the treatment of these patients.

Journal Article↗