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PubMed1986

A biomechanical analog of curve progression and orthotic stabilization in idiopathic scoliosis.

A biomechanical analog of curve progression and orthotic stabilization in idiopathic scoliosis has been developed using the classical theory of curved beam-columns. The interaction of the spinal musculature and other supporting structures is incorporated in the model using an equivalent flexural rigidity. The stability of a given scoliotic curve relative to a normal spine is described in terms of the so-called critical load ratio (Pc/Pe). This dimensionless quantity appears in the exact solution of the governing differential equation and boundary conditions. It is defined as the ratio of the load bearing capacity of a scoliotic spine (Pc) to that of a normal spine where the load bearing capacity of a normal spine is defined as Euler's buckling load (Pe). The computation of Pc/Pe is based upon a maximum allowable moment criterion. This model is used to study the effect of the degree of initial curvature and curve pattern in the frontal plane on the stability of untreated idiopathic scoliosis. Although restricted to two-dimensions, the model appears to demonstrate the synergistic effects of end support, transverse loading, and curve correction on improvement in relative stability of an orthotically supported scoliotic curve. The results of this study are in qualitative agreement with clinical findings that are based on long-term studies of natural history of idiopathic scoliosis and of patients undergoing orthotic management for scoliosis.

Biomechanical Phenomena↗
PubMed1990

Three-dimensional osseo-ligamentous model of the thorax representing initiation of scoliosis by asymmetric growth.

A biomechanical model of the human thorax was constructed to investigate how asymmetric growth of the thorax might initiate spinal lateral curvature and axial rotation as seen in scoliosis deformities. Geometric data specifying nodal points of the model were taken from stereo-radiographs of an adolescent subject. An initially symmetrical geometry was created by 'mirroring' measurements of a hemi-thorax and spine. Published data provided cross-sectional measurements of the ribs, material properties of tissues and global flexibilities of the intervertebral motion segments. The ribs, sternum, intervertebral motion segments and intercostal ligaments were represented by elastic elements. Model deformations were calculated by the direct stiffness finite element method, with growth represented by an initial strain term in the constitutive law. Non-linear behavior was accommodated by running the model recursively, with updated node locations at each step. Both stress relaxation and stress modulation of growth in the component tissues were simulated. Thoracic growth of 20% with asymmetric growth of the ribs was simulated to give rib length asymmetries of 11%. similar to that observed in a previous study of patients with idiopathic scoliosis. This resulted in the model having a small thoracic scoliosis curvature convex toward the side of the longer ribs. Variations of the model which permitted free motion at the costo-vertebral joints or produced changes in the curvature of the posterior parts of the ribs resulted in axial rotation of the vertebrae similar to that observed clinically. The model supports the idea that growth asymmetry could initiate a small scoliosis during adolescence.

Adolescent↗
PubMed1994

Behavioral treatment of scoliosis and kyphosis.

A behavioral treatment of scoliosis and kyphosis was tested with 27 adolescent patients (19 scoliosis, eight kyphosis patients) to determine in which cases the conspicuous and restraining brace treatment could be replaced. In 22 compliant patients, posture biofeedback (PB) was highly effective compared to five non-compliant patients. Biologically more mature scoliosis patients (menarche at the beginning of treatment) seemed to profit more from PB. With kyphosis patients the PB treatment resulted in rapid straightening of the spine and removal of structural deformities of Scheuermann's disease. PB may serve as an unobtrusive yet effective treatment alternative for both juvenile scoliosis and kyphosis.

Adolescent↗
PubMed1980

A study of a myopathy presenting as idiopathic scoliosis. Multicore disease or mitochondrial myopathy?

Seven cases from a family with a myopathy categorized as "multicore disease" are presented. The clinical picture is unusual because of the predominant progressive involvement of the axial skeletal muscle, with scoliosis and disproportionate respiratory failure as the major clinical features. The propositus and his cousin have both suffered from scoliosis without limb weakness. There is a possibility that this myopathy may be responsible for some cases regarded as idiopathic scoliosis, especially idiopathic infantile scoliosis. The clinical picture is highly variable, and there are sub-clinical cases. The inheritance pattern is consistent with either autosomal dominant, sex-linked recessive or extra-chromosomally inherited disease. Electron microscopy revealed mitochondrial abnormalities, which may have resulted in the Z-disc pathology.

Adolescent↗
PubMedDate not supplied

Scoliosis associated with central core disease.

A 12-year-old Japanese girl who had progressive severe scoliosis but with minimal muscle weakness in the extremities was found to have central core disease. In her muscle biopsies obtained from the biceps brachii and paraspinous muscles, there was type 1 fiber atrophy and predominance, as is commonly seen in congenital myopathies, but the core structure was identified only in the former. To determine whether scoliosis is a prominent feature of this disease, we reviewed 10 patients with central core disease in our laboratory and found 6 ambulant patients who had mild-to-moderate scoliosis. Since kyphoscoliosis becomes prominent as muscle weakness progresses to loss of ambulation in most muscle diseases, this disproportionate spinal involvement in central core disease appears to be a striking feature. All patients with 'idiopathic' scoliosis deserve a careful neurological evaluation, even if they have minimal muscle symptoms in the extremities.

Adult↗
PubMed2006

Accelerated intervertebral disc degeneration in scoliosis versus physiological ageing develops against a background of enhanced anabolic gene expression.

Molecular consequences of long-term deformation and altered mechanical loading of intervertebral disc (IVD) tissue in scoliosis have yet to be elucidated. We hypothesized that histological disc degeneration is faster in scoliosis than in normal ageing and that this is reflected by an altered gene expression profile. A semiquantitative histodegeneration score (HDS) revealed significantly enhanced degeneration in scoliosis (HDS 5.3) versus age-matched control IVDs (HDS 2.25; p = 0.001). Gene expression analysis by cDNA array and RT-PCR demonstrated higher mRNA levels for extracellular-matrix molecules like aggrecan, biglycan, decorin, lumican, chondromodulin, and COL2A1 in scoliotic discs versus normal discs of identical degeneration score. No differences were evident for catabolic molecules like MMP3, MMP13, MMP17, and TIMP1. In sum, morphologic disc degeneration was accelerated by about 2 decades in scoliosis versus physiological ageing and developed against a background of stronger anabolic matrix metabolism at younger age or in response to the altered mechanical environment of the tissue.

Adolescent↗
PubMed2004

Modelling of annulus fibrosus imbalance as an aetiological factor in adolescent idiopathic scoliosis.

OBJECTIVE: To assess and model the influence of collagen fibre imbalance within the annulus fibrosus on the initiation and progression of adolescent idiopathic scoliosis deformity. BACKGROUND: A number of aetiological factors have been proposed for idiopathic scoliosis, including a contribution from the intervertebral disc. The specific influence of the annulus fibrosus has yet to be effectively modelled. METHODS: A mathematical model was used to determine the contribution of collagen fibre orientation and directional imbalance within the annulus fibrosus to vertebral rotation and overall deformity of thoracic spine. Rotations, due to collagen fibre imbalance, and translations, due to rapid growth, were applied to a simplified model of the thoracic spine, using a three-dimensional transformation matrix approach. RESULTS: The ratio of clockwise to anti-clockwise fibres in the intervertebral disc (from unity to 0.80) influenced the induced rotation. The three-dimensional model illustrates the initiation and progression of the scoliotic deformity during adolescent growth, being most obvious at larger growth rates. CONCLUSIONS: Imbalance in the ratio of clockwise and anti-clockwise collagen fibres within the annulus fibrosus has been demonstrated to have the potential to contribute to the progression of scoliosis. For a given fibre ratio, the rate of growth does not influence the induced rotation, but directly influences the severity of the resulting deformity. RELEVANCE: The model defines the potential contribution of collagen fibre imbalance to adolescent idiopathic scoliosis, supporting the clinical observation that greatest progression of deformity occurs during phases of rapid adolescent growth. However, the underlying mechanism is within the annulus fibrosus, assisting in the search for the responsible genes.

Adolescent↗
PubMed2006

Sudden death in a patient with idiopathic scoliosis.

We report an autopsy case of sudden death in a 36-year-old craftsman with idiopathic scoliosis. The doctor identified his scoliosis at the age of thirteen, and he was under medical care for three years until he stopped consulting the doctor. He collapsed while walking at the station and was sent to an emergency room in cardiopulmonary arrest state, where he was declared dead in spite of more than an hour of CPR. Numbers of petechiae were seen on the bilateral palpebral conjunctivae and the lips were cyanotic. There were no particular injuries except for small abrasions observed on the face. The back showed right rib hump owing to midthoracic scoliosis (with 73 degrees of Cobb's angle) and right hemithorax was deformed showing an appearance of pectus excavatum in the front. The volume of the right thoracic cavity was significantly decreased. In the right lung, there was extensive stromal fibrosis, leaving almost no normal alveolar structures, and medial hypertrophy of pulmonary arteriolar walls. Hypertrophy of the right heart ventricle due to these pulmonary changes and the congestion of other organs suggested that the cause of death in this case was cor pulmonale due to pulmonary hypertension. This was a rare case of fatal outcome of advanced idiopathic scoliosis without medical care in spite of early detection through mass screening.

Adult↗
PubMed2006

Scoliosis and the respiratory system.

Scoliosis is caused by the lateral displacement and rotation of the vertebral bodies. It is most common during periods of rapid somatic growth. Scoliosis impedes on the movement of the ribs, places the respiratory muscles at a mechanical disadvantage and displaces the various organs of the thoracic cavity. Scoliosis decreases the chest wall compliance directly and the lung compliance indirectly (due to progressive atelectasis and air-trapping), causing a significant increase in the work of breathing that, because of the associated respiratory muscle weakness may lead to chronic respiratory failure. Progressive pulmonary hypertension also constitutes a leading cause for morbidity and mortality. Scoliosis is not reversible, but it can be controlled. Routine screening should start early and continue until the child reaches skeletal maturation. Pulmonary function testing can provide an easy and reliable means for the evaluation and follow-up of the condition.

Child↗
PubMed2006

Biomechanics of cantilever "plow" during anterior thoracic scoliosis correction.

BACKGROUND CONTEXT: Anterior instrumentation is often used for correction of thoracic scoliosis. Loss of spinal correction may occur after failure at the bone-implant interface, and forces on the bone-implant interface during scoliosis correction remain unclear. PURPOSE: Evaluate two different mechanisms of loading associated with anterior scoliosis correction. STUDY SETTING: In vitro biomechanics lab. METHODS: Polyurethane foam and human cadaveric thoracic vertebral bodies were instrumented with transvertebral body screws. Bone-implant interface failure loads were measured during constrained, fixed-angle screw translation, as well as unconstrained translation allowing coronal plane screw rotation. Vertebral body staples were randomly assigned to both conditions. RESULTS: Data were consistent across foam and cadaveric specimens. Failures occurred at significantly lower loads during unconstrained translation (with rotation) compared with constrained translation. Staple usage significantly increased the load to failure in both testing modes. In cadaveric bone, the constrained plowing load to failure was 562N+110N versus 188N+20N in the unconstrained testing. With a staple, these values increased to 694N+53N and 530N+100N, respectively. CONCLUSIONS: The 280% increase in cadaveric failure loads when a staple was added in the unconstrained testing method exceeds previous reports. The unconstrained method of plow simulated anterior scoliosis instrumentation when a rod was cantilevered and compressed into position. Supplemental vertebral body staples may be clinically indicated, particularly at the ends of the construct where residual deforming forces remain the greatest.

Bone Nails↗
PubMed2003

Regression of juvenile idiopathic scoliosis.

For a young scoliotic boy the customary "wait and watch" management program for rapidly progressive juvenile idiopathic scoliosis was considered unsatisfactory in view of the poor prognosis. The management program devised was based on the congenital postural induction concept of scoliosis with progression accruing from mechanically induced bioengineering fatigue, cumulative molecular scissions, laxity of ligaments, and secondary bone deformation. A coexisting pelvic tilt with restricted movement of the hip and shoulder joints was overlooked initially. Possibly induced simultaneously with the scoliosis, it is considered a contributory factor in scoliosis progression and requires early diagnosis and correction. The rapid improvement in this child's spinal status achieved by physiological traction and specifically designed exercises was such that as a preventive measure the technique warrants further clinical assessment on young scoliotics.

Child, Preschool↗
PubMed1998

Asymmetric otolith vestibulo-ocular responses in children with idiopathic scoliosis.

OBJECTIVE: A suggested cause of idiopathic scoliosis (IS) in children is a disequilibrium in the vestibulospinal control of trunk muscles. We sought a correlation between otolith vestibular dysfunction and IS. METHODS: A recently developed test for evaluation of otolith vestibular function (off-vertical axis rotation, OVAR) was applied to 30 children with IS, 12 control subjects, and 3 with congenital scoliosis as a result of spinal deformities. RESULTS: Of the patients with IS, 67% had significantly greater values of directional preponderance on the OVAR test (a measure of otolith system imbalance) compared with control subjects. Patients with congenital scoliosis showed normal responses on the OVAR test. No correlation was found between the direction of the preponderance and the side of the spine imbalance, or between the directional preponderance and the curve magnitude. The rate of progression of the scoliosis was not significantly correlated with the amplitude of the directional preponderance. CONCLUSION: These results support the hypothesis that central otolith vestibular system disorders lead to a vestibulospinal system imbalance, and may be a factor in the cause of IS.

Case-Control Studies↗
PubMed1984

School screening and pelvic tilt scoliosis.

5303 schoolchildren aged 10-14 years were screened for scoliosis in an epidemiological survey. 375 (7.1%) had curves of 5-9 degrees inclusive and of these 138 had scoliosis secondary to a tilt of the pelvis. Radiographic measurements showed that the pelvic tilt was due to pelvic asymmetry, leg length inequality, or both, but bore no relation to the height of the iliac crests. Pelvic asymmetry occurred more commonly in combination with leg length inequality than as an isolated finding. In order to detect idiopathic scoliosis in the thoracolumbar or lumbar region, pelvic tilt scoliosis must be identified and excluded, but this can only be done radiographically.

Adolescent↗
PubMed1999

The potential role of brain asymmetry in the development of adolescent idiopathic scoliosis: a hypothesis.

BACKGROUND: The size asymmetry of cerebral hemispheres may predispose to head tilt and asymmetric blocking of the zygapophysial joints, potentially leading to the development of compensatory curvatures in the lower segments of the spine. OBJECTIVE: To analyze the effects of spinal manipulation, maintained by an exercise program, on the progression of idiopathic adolescent scoliosis in 2 children aged 6 and 10. CLINICAL FEATURE: The scoliosis found was 16 and 60 degrees. INTERVENTION AND OUTCOME: For diagnosis and monitoring of therapy, we recorded qualitative parameters of shoulder asymmetry, axillary line asymmetry, and scapular angle position. Manual treatment consisted of the examinations of all sliding motion in zygapophysial joints and both sacroiliac joints and removing the limitations of the sliding motions according to the method of Karel Lewit. The treatment procedure consisted of 3 or 4 manipulations within 17 months and an exercise program. The manipulation effects were maintained by the exercise program. The exercises were done in 2 or 3 sessions weekly for a year. In both patients we observed that scoliosis decompensation was successfully stopped and the effects of the correction persisted for 10 years. CONCLUSION: Brain and head asymmetry may be only a transient state, predisposing to asymmetric blocking at the atlanto-occipital level. Removal of blocking may prevent curve progression in children who had adolescent idiopathic scoliosis. The manipulative therapy may also have a promising effect on retarding curve progression when used in skeletally immature patient.

Brain↗
PubMed2002

Indices of torso asymmetry related to spinal deformity in scoliosis.

OBJECTIVE: To develop indices that quantify 360 degrees torso surface asymmetry sufficiently well to estimate the Cobb angle of scoliotic spinal deformity within the clinically important 5-10 degrees range. DESIGN: Prospective study in 48 consecutive adolescent scoliosis patients (Cobb angles 10-71 degrees ). BACKGROUND: Scoliotic surface asymmetry has been quantified on the back surface by indices such as back surface rotation (BSR) and curvature of the spinous process line and torso centroid line, though with limited success in spinal deformity estimation. Quantification of 360 degrees torso shape may enhance surface-spine correlation and permit reduced use of harmful X-rays in scoliosis. METHODS: For each patient a 3D torso surface model was generated concurrently with postero-anterior X-rays. We computed indices describing principal axis orientation, back surface rotation, and asymmetry of the torso centroid line, left and right half-areas and the spinous process line. We calculated correlations of each index to the Cobb angle and used stepwise regression to estimate the Cobb angle. RESULTS: Several torso asymmetry indices correlated well to the Cobb angle (r up to 0.8). The Cobb angle was best estimated by age, rib hump and left-right variation in torso width in unbraced patients and by centroid lateral deviation in braced patients. A regression model estimated the Cobb angle from torso indices within 5 degrees in 65% of patients and 10 degrees in 88% (r=0.91, standard error=6.1 degrees ). CONCLUSION: Consideration of 360 degrees torso surface data yielded indices that correlated well to the Cobb angle and estimated the Cobb angle within 10 degrees in 88% of cases. RELEVANCE: The torso asymmetry indices developed here show a strong surface-spine relation in scoliosis, encouraging development of a model to detect scoliosis magnitude and progression from the surface shape with minimal X-ray radiation.

Adolescent↗
PubMed1990

Scoliosis in the Rett syndrome.

Of 32 patients with classical Rett syndrome, radiographs of the spine could be obtained in 30; two had moved. Five (17%), ranging in age from 3.2-11.5 years, had a curve of 10 degrees or less. Twenty-five (83%) had scoliosis. The age at first diagnosis of scoliosis ranged from 4.3 to 18 years of age. The curves ranged from 10 degrees to 86 degrees at a mean age of 14.9 years. Eight of the 21 curves, 38 percent, showed progression, which was first noticed from just before 5 to after 18 years of age. Bracing was done in five of the younger girls with progressive curves at ages 8.3-10.4 years. Three required surgery, performed at ages 10.9, 16.2 and 17.3 years respectively. Physicians following these patients need to refer them for orthopedic care at the first suspicious sign of scoliosis. Orthopedic surgeons taking care of children with the Rett syndrome (RS) should be aware of the clinical unpredictability of the scoliosis in this condition.

Child↗
PubMed1990

Scoliosis in the Rett syndrome: natural history and treatment.

The Rett syndrome (RS) is associated with a neurological form of scoliosis. From 1985 we have instituted a postal survey of families with Rett girls. The prevalence of scoliosis in the survey population is 64%. The age at onset of scoliosis has a normal distribution about a peak age of 8 years, with 72% of cases occurring before age 8. The scoliosis in RS is typically a long thoracolumbar curvature that progresses rapidly in girls over the age of 10 years. Operative treatment is successful in reducing the curvature, preventing curve progression and improving spinal balance for sitting and walking. The 5 girls who walked pre-operatively are still able to do so.

Adolescent↗
PubMed2003

Scoliosis: evidence-based diagnostic evaluation.

This article summarizes the evidence behind the imaging evaluation of scoliosis, which is primarily performed with plain radiographs and MR imaging. Issues related to the radiographic evaluation of spinal curvature include interobserver variability of scoliosis measurements and the radiologist's detection of unexpected findings. The effects of radiation exposure during scoliosis evaluation and strategies to minimize radiation dose are summarized. The use of MR imaging in idiopathic scoliosis is discussed, with special attention to imaging groups at higher risk for underlying pathology of the neural axis.

Evidence-Based Medicine↗