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PubMed2004

Reliability of the Scoliosis Research Society-22 Patient Questionnaire (Italian version) in mild adolescent vertebral deformities.

AIM: The reliability evaluation of the Italian version of the Scoliosis Research Society-22 Patient Questionnaire (SRS-22-I), administered to adolescents with mild vertebral deformities, is evaluated. METHODS STUDY DESIGN: forward-backward translation, pretest, final version according to a focus-group evaluation, and 1 week test/retest. POPULATION: pretest: 35 subjects (22 females), age range 8.5-19 years, 28 idiopathic scoliosis (17 degrees +/-7 degrees ), 7 hyperkyphosis (54 degrees +/-4 degrees ); test/retest: 20 subjects (11 females), age range 12-17.5 years, 15 idiopathic scoliosis (16 degrees +/-8 degrees ), 5 hyperkyphosis (55 degrees +/-5 degrees ). STATISTICAL ANALYSIS: Spearman rank test, percent of agreement. Statistical significance: 0.05. Software: Statgraphics 3.0. We calculated the results of the questionnaire and performed the statistical analysis using non parametric test because of the charcteristics of the data: this differ from previously published RESULTS RESULTS: Response rate was 100%. Total score: median 4 (range 3-5); results for different domains (median, range): function/activity 4 (3-5), pain 5 (3-5), self image/ appearance 3 (2-5), mental health 4 (3-5), satisfaction with management 4 (2-5). Time required to answer the questionnaire ranged from 5 to 20'; for 12 to 17.5 years old subjects from 5 to 10'. pretest showed difficulties with questions on pain; the questionnaire was changed accordingly. Spearman's rho ranged from 0.42 to 1, not significantly different from null value for questions 12 and 21. Percent of agreement (evaluated only for question 11a) was 100%. The ceiling and floor effects have been found high. CONCLUSIONS: The SRS-22-I was found to be reliable for young patients with mild vertebral deformities of different type. Lack of reliability for questions 12 and 21 should be better understood. Until now the psychometric properties of SRS-22 questionnaire have been evaluated only in USA populations, and in idiopathic scoliosis. Moreover, only one study has been proposed including patients with mild idiopathic scoliosis. This, together with the non-parametric statistical analysis used, could explain the high ceiling and floor effects we found in our data.

Journal Article↗
PubMed1997

Congenital scoliosis (hemivertebra) associated with de novo balanced reciprocal translocation, 46,XX,t(13;17)(q34;p11.2).

We report on an 8-year-old girl with congenital scoliosis (segmented hemivertebra between the second and third lumbar vertebrae) and psychomotor developmental delay. She has a de novo reciprocal translocation, t(13;17)(q34;p11.2). Congenital scoliosis is one type of structural spine deformation and hemivertebra is the most common anomaly causing congenital scoliosis. The cause and the mode of inheritance of hemivertebrae are unknown. Our patient has a de novo balanced chromosome aberration and retains two copies of the LLGL gene, which is usually lacking in patients with Smith-Magenis syndrome (SMS). Since some SMS patients who showed a deletion at 17p11.2 had congenital scoliosis, it is likely that one (17p11.2) of the breakpoints in our patient is a candidate region for a hemivertebra locus.

Child↗
PubMed1982

A new form of metaphyseal chondrodysplasia in two sibs: surgical treatment of tracheobronchial malacia and scoliosis.

We describe a 19-year-old male with a previously unrecognized form of disproportionate short stature, tracheobronchial malacia, and progressive scoliosis and his 28-year-old sister with the same but milder condition. The clinical characteristics were short limbs and digits and thoracolumbar scoliosis. Bone films showed progression from marked metaphyseal dysplasia of tubular bones in childhood to short and broad bones with mild dysplasia of the joints in adulthood. The vertebrae and the intervertebral plates were only mildly affected in spite of marked scoliosis. Trachea and bronchi were reinforced with surrounding acrylate mesh before surgical treatment of the scoliosis. Affected sibs of both sexes and healthy parents suggest an autosomal recessive mode of inheritance.

Abnormalities, Multiple↗
PubMed1986

Balance reactions and eye-hand coordination in idiopathic scoliosis.

We undertook this study to determine if subclinical postural control mechanisms were abnormal in idiopathic scoliosis. Ninety-one female patients and fifty-seven age-matched female controls were examined. We used a force plate ataxiometer to quantitate postural sway in the standing position and recorded the displacement and acceleration of the center of pressure during static stance and under perturbation with eyes opened and closed. A joystick-controlled video system was used to measure reaction time and eye-hand motor coordination. The scoliosis group demonstrated significantly less sway during two of the eight standing balance conditions and on the remaining balance tests there was a similar trend, albeit nonsignificant. The reaction time for the scoliosis group was also significantly slower, but the accuracy was not significantly worse. We noted no statistical differences between progressive and nonprogressive or between braced and unbraced patients. The subgroup of patients whose curves progressed despite bracing had a tendency to demonstrate greater stability on all standing tests. They also exhibited faster reaction times and less error in eye-hand coordination than other patient groups. No correlation existed between severity of curve and test performance. We found no indication of deficient balance in idiopathic scoliosis, and the tests could not predict curve progression.

Adolescent↗
PubMed1989

Rib cage asymmetry in idiopathic scoliosis.

Seventy-one patients attending a scoliosis clinic and 10 control subjects were studied by a stereoradiographic three-dimensional reconstruction of the spine and rib cage. The symmetry of each rib pair (at each anatomic level) was described by measurements of rib arc length, chord length, enclosed area, maximum curvature, and frontal and lateral angulations. Patients were divided into four groups: 19 with a single right thoracic curve, 15 with a single left lumbar or thoracolumbar curve, 22 with double curves, and 15 with a curve with less than 10 degrees Cobb angle. In the control group and the group with minimal scoliosis, there was no statistically significant rib asymmetry. Among the patients with scoliosis, 11 of 19 patients with right single thoracic curves had rib arc lengths greater on the right side at the curve apex, and nine of 15 patients with left lumbar scoliosis had longer ribs on the left side in the corresponding region of the thoracic spine. Eleven of 22 patients with double curves had symmetrical rib lengths (within +/- 3%), the other 11 had ribs longer on the left. These proportions should not have occurred by chance (p less than 0.001). The mean rib length difference in patients with single thoracic curves was 1.39% (right longer than left), in single lumbar curves it was 3.57% (left longer than right), and in double curves 3.18% (left longer than right). These differences between the groups of patients and control subjects were statistically significant (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2004

Preoperative polysomnograms and infant pulmonary function tests do not predict prolonged postoperative mechanical ventilation in children following scoliosis repair.

Our objective was the identification of children with scoliosis at higher risk of prolonged postoperative mechanical ventilation (MV) permits improved pre- and perioperative respiratory care to reduce postoperative complications. Pulmonary function testing (PFT) predicts prolonged postoperative MV in children who can reliably perform PFT, but some children cannot perform PFT. The objective of this study was to determine if polysomnography (PSG) or infant pulmonary function testing (IPFT) could predict prolonged postoperative MV (defined as MV >3 days) in children undergoing scoliosis surgery who could not reliably perform PFT. We studied 110 patients (age range, 10.8 +/- 4.9 [SD] years) who had preoperative PSG, and 18 patients (age range, 4.0 +/- 2.9 [SD] years) who had preoperative IPFT prior to undergoing any type of scoliosis repair by the Children's Hospital of Los Angeles Division of Orthopedic Surgery from January 1990- July 2001. The following information was reviewed and correlated: preoperative PSG parameters (baseline and nadir S(aO(2) ), baseline and peak P(ETCO(2) ), and apnea hypopnea index [AHI]), preoperative IPFT parameters (respiratory system compliance [C(rs)], respiratory system resistance [R(rs)], tidal volume [V(T)], and FRC), and length of postoperative MV. Twenty-seven patients (25%) who had PSG and 5 patients (28%) who had IPFT required postoperative MV >3 days. There was no association between baseline and nadir S(aO(2) ) <or= 92%, baseline and peak P(ETCO(2) ), or AHI, and length of postoperative MV. There was no association between IPFT (C(rs), R(rs), V(T), and FRC) and length of postoperative MV. We conclude that neither PSG nor IPFT can predict the need for prolonged postoperative MV following scoliosis surgery in children who could not reliably perform PFT.

Adolescent↗
PubMed1994

Clinical use of the simple 3D-calculation in scoliosis.

In this paper we show the clinical application of a simple method for calculating three-dimensional shape in scoliosis by the use of two tables based on normal standard X-rays in the anteroposterior and lateral projections. The three-dimensional alignment should be considered in both conservative and operative correction. In 57 patients with 87 scoliotic curves we measured the well-known Cobb angle (alpha) and determined the vertebral rotation according to the method of Nash and Moe. We compared this information with the results of the calculated three-dimensional angles of scoliosis (angle beta between the curvature plane and the sagittal plane, angle sigma as the true angle of scoliosis in this curvature plane). In 76 curves (87%) our method was practicable. The true angle sigma is always higher than the projected angle alpha, especially in the clinically relevant range of 20 degrees-40 degrees. Poor correlation is shown between the projected angle alpha and the true angle sigma (r = 0.41 for thoracic curves and r = 0.57 for lumbar curves) and almost no correlation between vertebral rotation and the true angle sigma (r = 0.10 for thoracic curves and r = 0.44 for lumbar curves) and the curvature plane (beta) (r = 0). The three-dimensional shape of scoliosis cannot be estimated by the well-established projected angles and indices and we recommend the use of our simple method for the radiological investigation of scoliotic patients.

Humans↗
PubMed1994

Variation in Cobb angle measurements in scoliosis.

In order to determine the reliability of the Cobb angle measurement as it is used in the clinical management of scoliosis, a methodological survey was carried out. In the measurement of a Cobb angle two phases can be distinguished: (a) the production of a spinal radiograph and (b) the measurement of the angle itself. In respect of the first phase, the variation in production of the radiographs was calculated on Cobb angle measurements made by one investigator on serial radiographs of patients who underwent spinal fusion for scoliosis and therefore had a fixed spinal curvature. For the second phase, the accuracy of Cobb angle measurement was investigated by comparing measurements on the same radiographs of 46 scoliosis patients obtained by three investigators, namely two orthopaedic surgeons and an orthopaedic fellow who was assigned to a school screening project. Results were expressed as a Spearman correlation coefficient and a standard deviation of the differences. The Spearman correlation coefficient was 0.98 for the repeated radiographs (production variation) and also 0.98 for the repeated measurements on one radiograph (interobserver measurement variation). The standard deviation of the differences in Cobb angle for the repeated radiographs amounted to 3.2 degrees and for the repeated measurements on one radiograph it was 2.0 degrees. Although there is a good reproducibility of the Cobb angle measurement between different investigators, the variation in production of a spinal radiograph is an important source of error. This should be taken into account when making decisions in scoliosis management.

Humans↗
PubMed1981

The changing concept of infantile scoliosis.

A description of infantile scoliosis is presented. It is thought to be provoked by persistent nursing of the infant during the first months of life in an oblique supine position. In addition deformities of the head, thorax, pelvis and contractures of the neck, hip and feet are often observed: the so-called "Seven-point syndrome". Following introduction of the prone-lying position as a prophylactic measure the incidence of infantile scoliosis has decreased considerably in Germany. The oblique positional scoliosis ("resolving") is probably a separate entity. It is not clear, however, whether it may occasionally become progressive or whether the progressive forms represent the lower end of the spectrum idiopathic adolescent, juvenile and infantile scoliosis.

Humans↗
PubMed1981

Study of biochemical and hormonal data in idiopathic scoliosis in girls.

Basic cause and factors determining the progression of idiopathic scoliosis are assumed to be multifarious. A deviating growth pattern has also been suspected. The influence of certain bone and growth-stimulating hormones and related biochemical values has been studied in girls with idiopathic scoliosis compared to controls. The mineral content (S-Ca, S-P and S-Alp) did not differ between idiopathic scoliosis and controls. a2-macroglobulin was slightly increased in the scoliotic group in all ages. Morning fast GH and Somatomedin A level in serum were also increased in the scoliotic group. Even a significant increase of 17-oxosteroids are metabolites of androgens in girls. 17-oxosteroids in urine mainly metabolites of cortisol, neither calcitonin or parathyroid hormone, in contrary, did not differ between scoliosis and controls.

17-Ketosteroids↗
PubMed1982

The experimental study of scoliosis in bipedal rat in lathyrism.

Using Wister albino rats, bipedal rats were prepared; to which semicarbazide at a concentration of 0.075%, 0.05% and 0.025% were given as drinking water and the rats were divided into three groups A, B and C according to such concentrations. Osteolathyrism was caused in this way and the relations between doses as well as the dosing period and the progress of scoliosis were examined roentgenologically and histologically and the following conclusions were obtained. 1. The frequency of occurrence of scoliosis was 82% in the bipedal rats and 13% in the quadrupedal rats (level of significance alpha = 0.001% or less). 2. Primordial top vertebrae were located concentratively in the lower 1/3 of thoracic vertebra. 3. In the primordial curve, those cases showing a right side curve accounted for 76%. 4. After termination of administration of semicarbazide, spontaneous improvement took place only in those cases showing scoliosis of less than 40 degrees. 5. In the author's experimental scoliosis, the static and dynamic condition of posture nearly coincided with those of men in clinical studies. 6. Histological changes were especially marked in the cartilage layer on the vertebral epiphyseal line, being quite diversified.

Animals↗
PubMed1989

Leg-length inequality has poor correlation with lumbar scoliosis. A radiological study of 100 patients with chronic low-back pain.

Leg-length inequality and its hypothetical consequences, pelvic tilt and lumbar scoliosis, were measured in 100 young or middle-aged adults suffering from chronic low-back pain. Leg-length inequality had a good correlation with the pelvic tilt assessed from the iliac crests, a moderate correlation with the sacral tilt, but a poor correlation with the lumbar scoliosis. The sacral tilt correlated well with the lumbar scoliosis when the tilt was more than 3 degrees but poorly when it was smaller. Thus, there is a gradually decreasing correlation between the posture parameters when moving from the hips up to the lumbar spine. We conclude that before a radiologically observed leg-length inequality be considered as the cause of low-back pain, an erect-posture radiograph of the whole pelvis and lumbar spine is essential, in order to assess an existing pelvic tilt and scoliosis.

Adult↗
PubMed1997

Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathic adolescent scoliosis.

This paper presents a new neurophysiological method of evaluating the risk of progression in idiopathic scoliosis in the early stages of the disease, by investigating the unloading reflex in paraspinal muscles. The study included 394 patients with scoliosis and 70 healthy children. Latency of the unloading reflex and repeatability of the rebound and silent period were analysed for each reflex evoked. Prolonged latency and minimal number of cycles are the most important factors in the evaluation of progressive idiopathic scoliosis. The method can be used to detect progressive idiopathic scoliosis in the early stages of the disease. The high sensitivity of the method means it can be used as a basis on which to take an early decision to perform surgery.

Adolescent↗
PubMed1997

Immunological suppression after surgery in scoliosis patients.

This is a prospective study to analyze the postoperative immunological changes in scoliosis surgery. Twenty-eight patients who underwent Harrington instrumentation were analyzed. Seven patients who underwent arthroscopic surgery were analyzed as a control group. The objective of this study is to determine whether surgery and surgical stress (minor versus major surgery) changed the immune capability of patients as indicated by the ratio of lymphocyte cell types and interferon induction. Pre- and postoperative blood from scoliosis and knee arthroscopy patients was analyzed at various times using antisera and two-color flow cytometry with monoclonal antibodies. Both scoliosis and knee arthroscopy patients had a postoperative decrease in the population of B-lymphocytes (Leu 12+) and a transient increase in the natural killer cells (Leu 4-/Leu 19+) and the cytotoxic T-lymphocytes (Leu 2a++/Leu 15-). These changes were significantly greater in the scoliosis patients, who also experienced a prolonged decrease in the inducer T-lymphocytes (Leu 8+/Leu 3a+) for 3 weeks following surgery. Production of interferon-alpha and interferon-gamma by lymphocytes was suppressed postoperatively and returned to preoperative levels within 3 weeks. Immunological depressive changes occurred postoperatively and lasted at least 1 week. These effects are more pronounced with longer surgeries, suggesting greater postoperative vigilance for infections in these cases.

Adolescent↗
PubMedDate not supplied

Case series: Ultrasonography may assist epidural insertion in scoliosis patients.

PURPOSE: Epidural cannulation is a difficult technique in the patient undergoing scoliosis repair, due to axial rotation of the vertebral bodies, as well as angulation of the spinal processes. This case series was performed to investigate whether ultrasonography could facilitate epidural insertion in patients with scoliosis, by assessing the degree of vertebral body rotation. CLINICAL FEATURES: Eleven patients scheduled for corrective scoliosis surgery were studied. The spine was examined ultrasonically using a portable ultrasound system with a 38-mm linear probe in two-dimensional B mode. The angulation of the probe head (measured using an inclinometer held in alignment with its long axis) at which the echo signals from the laminae became level on the screen was taken to correspond to the degree of vertebral rotation. The least rotated (most neutral) vertebral interspace was located, and a supervised anesthesiology trainee then performed epidural catheter insertion, using a loss-of-resistance technique. Bupivacaine 0.125% with fentanyl 4 mug.mL(-1) was infused after surgery, and successful epidural placement was indicated by the presence of effective analgesia and loss of sensation to cold stimuli. In ten patients, the neutral space could be identified, while in one, the least rotated space was measured at 15 degrees from the horizontal. Epidural catheterization was successful in eight of 11 patients at the identified level. In two other patients, the space above was employed. The information was described as helpful in seven patients. CONCLUSION: We conclude that ultrasonography may have a potential role to facilitate insertion of epidural catheters in patients with scoliosis.

Adolescent↗
PubMed2000

[Criteria for treatment of idiopathic scoliosis between 40 degrees and 50 degrees. Surgical vs. conservative therapy].

The treatment of idiopathic scoliosis over 40 degrees (Cobb) during the growth period is under discussion concerning the indication for conservative or surgical treatment. Curve progression depends on the degree of the frontal and sagittal deformity, vertebral rotation, rigidity of the curve, the skeletal age, the age and sex of the patient, the familial frequency of scoliosis and the location of the curve. In scoliosis over 40 degrees progression is fast and the possibilities for successful conservative brace treatment are reduced during the growth period. Progression occurs more frequently in thoracic and double major scolioses, especially in young patients (Risser sign 0 and 1). Predictive factors of a successful brace treatment are the correction of scoliosis and rotation; deterioration of both during the brace treatment leads to poor results. Evaluating the flexibility of the sagittal profile is important, as is primary correction of 30-50% in the brace during the 3 months. Operative correction of small primary curves reduces the fusion length, operation time, and blood loss and is followed by a reduction in loading on the adjacent vertebral segments in comparison to the long fusions necessary in more structural and double major scolioses. So far it is not possible to make an equivalent judgment of the frequency of the "crankshaft" phenomenon and the treatment necessary in young patients (Rissersign 0 and 1) treated by dorsal instrumentation alone, but temporary brace treatment may be considered in those cases.

Adolescent↗
PubMed2000

[Ventrodorsal correction and instrumentation in idiopathic scoliosis].

A number of different procedures are used for the surgical treatment of King II scoliosis. One reason for the controversial discussion in this context is that the term King II scoliosis is usually inadequate, because there are partly marked clinical and radiological differences in this type of curvature. From January 1996 to December 1997, a total of 26 patients with rigid King II scoliosis were submitted to a ventrodorsal procedure. Twenty-three patients were included in the study. The indication for this procedure was established in cases with a secondary lumbar curvature of at least 50 degrees as well as unsatisfactory straightening of the primary and secondary curvature in the bendings and inadequate horizontal positioning of the caudal end vertebra of not less than 10 degrees. Ventral Derotation-Spondylodesis (VDS) and Dorsal correction-Spondylodesis (DKS) led to a thoracic and lumbar straightening from 68.4 degrees to 13.2 degrees and from 61.4 degrees to 17.8 degrees, respectively. The tilt of the vertebra instrumented farthest caudally was corrected from 21.2 degrees to 4.9 degrees. The thoracic hypokyphosis was improved from 16.6 degrees to 25.1 degrees. In 11 patients, the dorsal instrumentation was extended to the caudal end vertebra, in another 11 patients, instrumentation was achieved up to a vertebra cranial from the end vertebra. The correction loss and complication rate was extremely low. Based on the surgical goals discussed further down, combined application of VDS and DKS is efficient and suitable in conjunction with the indication described. The complication rate is quite low. The different types of King II scoliosis have to be differentiated preoperatively.

Adolescent↗
PubMed2001

Treatment planning in severe scoliosis: the role of MRI.

The use of magnetic resonance imaging (MRI) in the preoperative investigation of children with idiopathic scoliosis is controversial. Syringomyelia and other intraspinal lesions may be risk factors for neurological injury during surgical correction. Our purpose was to investigate whether pathology of the neuraxis is associated with scoliosis and to detect lesions which may threaten neurological sequelae during distraction and instrumented correction. We obtained T1- and T2-weighted images of 40 children (28 girls, 12 boys), mean age 12.7 years with severe idiopathic scoliosis (Cobb angle 50-70 degrees) obtained in coronal, sagittal and axial planes from the posterior cranial fossa to the sacrum, and these were assessed by two neuroradiologists and an orthopaedic surgeon prior to further treatment planning. Abnormalities of the neuraxis were found in 24 patients (60%); five (12%) had two or more lesions. No abnormalities of the neuraxis were found in 16 patients (40%). There were 15 patients (38%) with intraspinal abnormalities who deteriorated clinically and nine (22%) who showed no clinical changes. We transferred 16 patients (40%) from the orthopaedic to the neurosurgical department for further assessment. Our results suggest that one should investigate the neuraxis with MRI before contemplating orthopaedic surgical correction of severe idiopathic scoliosis, because the findings may lead to a change of procedure.

Adolescent↗