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PubMed1991

Current treatment approaches in the nonoperative and operative management of adolescent idiopathic scoliosis.

Idiopathic scoliosis is the most common type of lateral curvature of the spine, accounting for about 65% of adolescent patients with structural scoliosis. The treatment goal is to prevent moderate curves from becoming severe, because severe curves, in adults, may not only lead to serious medical and physical complications, but also cause significant cosmetic deformities. Fortunately, early detection, through school screening programs, has led to successful nonoperative management of idiopathic scoliosis. In those instances in which nonoperative management is not an option, surgical correction is available. Surgery prevents curve progression and offers the patient a significant correction of the cosmetic deformity. This article will review both treatment approaches in the management of adolescent idiopathic scoliosis.

Adolescent↗
PubMedDate not supplied

A study of skeletal age and height in girls with idiopathic scoliosis.

The height and skeletal age of girls with idiopathic scoliosis were studied. The skeletal age was evaluated by two independent methods and was compared with the chronological age and the corrected height of the patients. With both methods the same tendency was noticed. Early in the adolescence (ages 11 and 12 years) the skeletal development was more advanced in girls with idiopathic scoliosis than expected. Later (ages 16 and 17 years) the reverse condition was found. The standing height, corrected for the deformity, was significantly greater in idiopathic scoliosis patients than in controls of either the same chronological or skeletal age. These observations indicate that girls with adolescent idiopathic scoliosis have a growth pattern differing from normal, and that growth factors are connected to the disease.

Adolescent↗
PubMed2001

Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis.

Spinal stenosis in combination with scoliosis frequently is seen in elderly patients. Patients typically present with a combination of symptoms attributable to neurogenic claudication and radicular pain, and symptoms of lower back pain. For patients in whom conservative treatment is not sufficient, surgical treatment can be done with careful consideration of the overall patient and his or her medical status. Surgical treatment is twofold; one purpose is to decompress the neural elements, the other purpose is to stabilize and realign the spine to as great a degree as possible. Appropriate balance of the spine at the end of the procedure is more important than the absolute amount of correction obtained. Stabilization and correction of the spine is done with pedicle screw-rod instrumentation and fusion, and the procedure must be done in an efficient and timely manner to involve the least amount of morbidity. There are two types of deformity typically seen, one is a degenerative lumbar scoliosis with no or minimal rotational deformity (Type I), and the other is a degenerative scoliosis often superimposed on a preexisting scoliosis with greater rotational deformity and greater loss of lordosis (Type II). Instrumentation and correction techniques differ for these two types of deformities, with shorter instrumentation procedures usually possible for the Type I deformity and longer instrumentation with sagittal plane reconstitution necessary for Type II deformity.

Aged↗
PubMed1998

Psychological evaluations of patients operated for idiopathic scoliosis by the Harrington method.

A study group of 204 patients operated for idiopathic scoliosis by the Harrington method at The Orthopedic Hospital of the Invalid Foundation (Orton) between 1970 and 1975 was studied to evaluate the integration of these patients into society regarding work outside the home, and to evaluate the patients' adaptation to their illness and factors relating to this adaptation. A brief intelligence test was also given. The mean age at the time of the first operation was 14 years, and at the time of follow-up it was 33 years. Eighty-four percent of the patients were female. The patients completed a questionnaire, which was also sent to an age and gender matched control group. The results show that these patients with idiopathic scoliosis appear to be predominantly content with their lives. These scoliosis patients tend to form families later in life than the controls, and have fewer and less satisfying sexual relationships than the controls. These scoliosis patients feel that their illness has mostly influenced their participation in work outside the home and their partaking in physical activities, but these influences were slight and also influenced by education. The studied patients had some fears about the heredity of their illness, but only those dissatisfied with their lives let it influence their childbearing.

Adaptation, Psychological↗
PubMedDate not supplied

Impact of orthoses on the rate of scoliosis progression in children with cerebral palsy.

This study was undertaken to determine the impact of spinal bracing on curve pattern and the rate of progression of neuromuscular scoliosis in children with cerebral palsy. Twenty-one patients were treated with a Wilmington custom-molded orthosis with 23 h a day brace wear for a mean bracing period of 67 months (range, 22-173). Twenty-two patients had a similar follow-up to spinal fusion but had no bracewear. Patients who were braced had a scoliosis that reached a magnitude of 50 degrees at a mean 12.5 years, compared with a mean age of 14 years for those who were not braced (p > 0.05). Spinal orthotics had no impact on scoliosis curve, shape, or rate of progression in spastic quadriplegic patients who were followed-up on fusion. Apical vertebral rotation > 2 (Nash and Moe criteria) is an indicator of impending rapid progression of the scoliosis curve.

Adolescent↗
PubMedDate not supplied

Efficacy of aprotinin in reducing blood loss in spinal fusion for idiopathic scoliosis.

Aprotinin is a proteinase inhibitor with antifibrinolytic properties that has found widespread application during cardiac surgical procedures due to its ability to decrease blood loss and transfusion requirements. Recently it has been used by orthopedic surgeons in hip replacement and other major surgeries except for scoliosis surgery, which is known to be associated with major blood loss. To evaluate the effect of aprotinin in reducing blood loss during spinal fusion surgery for idiopathic scoliosis, a double-blind randomized prospective clinical study was performed. Forty-three patients with idiopathic scoliosis underwent spinal fusion and instrumentation and were divided randomly into two groups. Fifteen patients received aprotinin, whereas 28 patients received placebo. The aprotinin group had less blood loss than the placebo group. The transfusion requirement was less in the aprotinin group than the placebo group. Although the difference was not significant statistically, the benefit of aprotinin in reducing blood loss in spinal surgery for idiopathic scoliosis was consistent.

Adolescent↗
PubMedDate not supplied

Superior mesenteric artery syndrome in scoliosis surgery: weight percentile for height as an indicator of risk.

A retrospective analysis of charts identified cases of superior mesenteric artery (SMA) syndrome occurring after scoliosis surgery over a 23-year period. Despite numerous reports on this potentially fatal complication of scoliosis surgery, no method exists to stratify patients for risk of developing disease after spine surgery. A study of charts was performed to identify all cases of SMA syndrome occurring after scoliosis surgery from 1972 to 1995. An upper gastrointestinal study with findings specific for the syndrome was requisite for inclusion. Patients' weight and height at the time of diagnosis of SMA syndrome were recorded. Based on standard national data tables, a percentile for weight, percentile for height, and a weight percentile for height were derived for each patient. The syndrome occurred after posterior spinal fusion in six patients (three boys, three girls). The average weight percentile for height, available in five of the six patients, was 3%, significantly different from both age-matched controls in the general population and from age-matched controls undergoing posterior spinal fusion for adolescent idiopathic scoliosis. This study, the largest reported from a single institution, suggests that a weight percentile for height of 5% is the degree of asthenia that allows compromise of the duodenum. The percentile identifies patients at risk for SMA syndrome for the purposes of increasing postoperative vigilance for gastrointestinal complaints, decreasing the threshold for diagnostic workup, and guiding perioperative dietary supplementation.

Adolescent↗
PubMedDate not supplied

High level cross of the esophagus with the descending aorta in scoliosis: CT study.

OBJECTIVE: The esophagus occasionally crosses the descending aorta at an unusually high level (3-5 cm inferior to the carina) in right-sided scoliosis. The purpose of this study was to analyze the mechanism of this finding. MATERIALS AND METHODS: We prospectively evaluated thoracic CT scans in 30 patients with right-sided scoliosis. We assessed the alterations in the positions of the esophagus and the descending aorta by the thoracic deformity. RESULTS: The descending aorta followed the scoliotic curve of the spine in 26 (87%) patients. The esophagus followed the scoliotic curve of the spine in 14 (47%) patients and did not in 16 (53%). The anteroposterior diameter of the thorax in the former group was significantly smaller than that in the latter (p < 0.01). High level cross of both structures was identified in 14 (47%) patients, and all of them belonged to the group in which the esophagus did not follow the scoliotic curve of the spine. CONCLUSION: The unusual high level cross of the esophagus with the descending aorta occasionally seen in scoliosis is due to a difference in the positional alterations of the two structures resulting from the scoliosis.

Adolescent↗
PubMed2002

Thoracoscopic techniques for the treatment of scoliosis: early results in procedure development.

OBJECTIVE: The goal of this study was to determine the effectiveness of an endoscopic option for anterior approaches to the thoracolumbar spine for scoliosis treatment. Fifty patients with 24 to 45 months of follow-up data were retrospectively studied. Techniques for endoscopic treatment of spinal disorders have been under development since 1993. The benefits of thoracoscopic surgery for the treatment of spinal deformities have been documented as improved observation of the spine, enhanced access to the extremes of the curve, decreased operative times and blood losses, shorter hospital stays and recuperative periods, and decreased overall costs. After more than 150 endoscopic procedures for the treatment of these spinal deformities had been performed, the next step was to develop a thoracoscopic technique for instrumentation, correction, and fusion for the treatment of primary thoracic scoliosis. Our goal has been to develop a safe, reproducible, and effective endoscopic technique for the treatment of scoliosis that can provide equal or better outcomes, compared with formal open surgical techniques. METHODS: Between October 1996 and October 1998, 50 patients with a diagnosis of primary thoracic scoliosis were selected to undergo thoracoscopic instrumentation, correction, and fusion. Postoperatively, patients were assessed with respect to restoration of spinal alignment, axial derotation, pain management, and incidence of complications. RESULTS: Endoscopic instrumentation was successfully performed for all patients. Curve correction averaged 50.2%, improving to 68.6% in the last 10 cases. Patients with hypokyphosis averaged 20.7 degrees of correction. The preoperative axial rotation (as measured with a scoliometer) averaged 16 degrees, which was corrected to 5 degrees. Postoperative pain was less, and patients could discontinue the use of all pain medications by 1 to 3 weeks, compared with patients who underwent formal open procedures, who required pain medication for 6 to 12 weeks. The hospital stays averaged 2.9 days. Our initial complication rate was high, which could be attributed to the development of a new technique. Keys to successful fusions include total discectomy, complete endplate removal, and the use of autogenous bone graft. CONCLUSION: Although these techniques are still in early development, the initial results for our thoracoscopic techniques are promising. With experience, surgical times are decreasing and fusion and curve correction rates are improving. With further evolution, patients should realize shortened hospitalizations, decreased rehabilitation times, and decreased levels of postoperative pain. This is a technically demanding procedure that requires demonstrated skills in endoscopic discectomy and fusion.

Adolescent↗
PubMedDate not supplied

Studies on spinal and peripheral muscles from patients with scoliosis.

This report describes part of a wider study on muscles from patients with adolescent idiopathic scoliosis. The aim of the study was to clarify if there exists a side-related pathology in the spinal musculature and if extraspinal muscles are abnormal in scoliosis patients. In scoliotic patients, both spinal and peripheral muscles showed frequent abnormalities when examined morphologically and histometrically by light and electron microscopy. Idiopathic scoliosis patients differed from the others. Morphologic pathology seemed worse on the concave side. A mild Type I fiber atrophy occurred in spinal muscles on the concave side and in the deltoids. A generalized tendency towards small myofibers was also noted. The findings suggest that there is a generalized specific neuromuscular disorder causing idiopathic scoliosis.

Adolescent↗
PubMedDate not supplied

Results of spinal fusion for radiation scoliosis.

There were 150 children with neuroblastoma and 183 children with Wilms' tumor who received radiation therapy, orthovoltage up to 1967, and cobalt therapy thereafter. In all except two cases, radiation therapy crossed the midline. Of all of the children treated, 13 required spinal fusion. There were six with Wilms' tumor; three had kyphosis; and three had scoliosis. Nine fusions were done with three pseudoarthroses, one broken rod, and two hook pullouts. There were seven with neuroblastoma, of whom five had kyphosis and two had scoliosis. Nineteen spinal fusions were done on these seven patients for neuroblastoma; two developed paraplegia; seven had pseudoarthroses; two had broken rods; and one had infection. Complications were attributed to laminectomies (five of seven) and high orthovoltage dosage (3680 rad), causing bone death and destroyed bone growth, with resultant infantile-size spines. The authors continue to follow up postradiation patients and observe rapid deterioration of kyphosis and scoliosis during the adolescent growth spurt. The authors now recommend early and extensive combined two-stage, long anterior and posterior fusions for kyphosis of 35 degrees and over, and a posterior fusion with Harrington rod instrumentation with extensive bone grafting is done for early (35 degrees) pure scoliosis. Postoperative immobilization is much longer than for regular spine fusions--at least one year.

Child↗
PubMedDate not supplied

Progression in scoliosis. A 360 degrees change in 75 years.

With the proliferation of school screening programs for spinal deformity, attention has been directed to methods of scoliosis evaluation and follow-up that avoid serial x-ray exposure. An historical review of the scoliosis literature prior to the extensive use of x-ray in scoliosis care has demonstrated much that is now being "rediscovered." By 1900, screening for spinal deformity in the schools had been instituted, pertinent findings of the physical examination in patients with scoliosis had been well described, and early natural history information had been obtained regarding the behavior of small curves and curves associated with thoracic lordosis. Recordings of surface contours and rib humps, using inclinometers, lead rulers, and other measuring devices, were used to assess the progression of curves. Low contour braces were widely available. Although our orthopaedic forefathers had many erroneous ideas, a perusal of the early orthopaedic writings from around the turn of the century has shown how little is "new" (other than changes in material and spinal instrumentation techniques) from what was recognized 75 years ago.

Europe↗
PubMedDate not supplied

The effect of lumbar flexion and Boston Thoracic Brace on the curves in idiopathic scoliosis.

The correction of scoliosis induced by pure lumbar flexion was compared with the correction with the so-called Boston Thoracic Brace. Ten patients with idiopathic scoliosis were studied. There were 11 primary curves (31 +/- 6 degrees) (mainly thoracic) and four secondary curves (22 +/- 1 degree). Pure lumbar flexion reduced the primary curves by 6 +/- 2 degrees and the secondary curves by 8 +/- 3 degrees. The brace reduced the curves by 16 +/- 6 degrees and 14 +/- 5 degrees, respectively. Lumbar flexion per se produces a correction of the scoliosis of the same degree as the Milwaukee brace. Our results emphasize the importance of reduction of the lumbar lordosis in the conservative treatment of scoliosis.

Adolescent↗
PubMed1988

Experimental scoliosis in the rat. I. Methodology, anatomic features and neurologic characterization.

The purpose of this study was to develop a simple and reproducible model of scoliosis in the rat without producing direct trauma to the spine, in order to both provide a system for the study of human scoliosis and to ultimately study the conditions under which distraction-induced trauma might occur. Right lateral curvatures were produced in three groups of rats (N = 36, 59, 25) at 18-21 days of age by suturing the inferior angle of the scapula to the ipsilateral bony pelvis. In the first group of animals, it was found that a minimum period of 6 weeks of tethering was required in order to produce permanent structural curvatures after release of the tethering sutures. In the second group of rats, a number of morphologic and histologic changes characteristic of human scoliosis were noted, including apical wedging, deviation of the apical spinous process, pelvic asymmetry, rib hump deformity, vertebral rotation, displacement of the nucleus pulposus, disorganized columnization of disc cartilage cells, and an increased number of Type I muscle fibers in paravertebral muscle on the convex side of the curve. Finally, in the third group of rats, a mild spasticity was seen in the ipsilateral hindlimb in approximately one-third of the animals with curvatures greater than 40 degrees. This spasticity was not associated with a change of latency or amplitude of the somatosensory-evoked potential (SSEP). Each curvature group displayed SSEP characteristics that were not statistically different from unoperated control animals. These results indicate the validity of this model system for the study of scoliosis, and, in particular, its usefulness for the study of operative-induced trauma.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Coronal and sagittal plane spinal deformities correlating with back pain and pulmonary function in adult idiopathic scoliosis.

One hundred one referred adult patients (ages 20-63; mean, 36 years) with painful idiopathic scoliosis were evaluated. None had prior surgical treatment. Severity of pain was graded and localized over radiographic deformities in the coronal and sagittal planes. Radiographic changes in primary as well as full and fractional compensatory curves were studied. Degrees of scoliosis, percent correction on side bending, vertebral body rotation at curve apex, spinal balance, and lateral olisthesis in the coronal plane, degenerative disc disease, and other degenerative changes in all curves were measured and graded in both the coronal and sagittal planes. Lordosis and kyphosis were measured on all standing sagittal radiographs. Forty-one patients had pulmonary function studies. Multiple variable statistical analysis (Spearman correlation coefficients) of the data found fractional lumbosacral curves most painful and disabling. Scoliosis greater than 40 degrees and kyphosis greater than 50 degrees correlated with increasing pain and decreasing forced vital capacity. Reduction in forced vital capacity also correlated with curve rigidity. Rotation correlated closely with degrees of scoliosis (r = 0.70; P less than 0.0001) and had the highest correlation with pain (r = 0.59; P less than 0.0001) of all radiographic findings and deformities studied.

Adult↗
PubMed1990

Handedness and scoliosis convexity: a reappraisal.

The handedness of 254 girls with idiopathic scoliosis, minimum age eight years at diagnosis, attending Our Lady's Hospital was related to their scoliosis convexity. Curve patterns were assigned to right or left on the basis of the convexity of the low thoracic component only, regardless of primary curve. The curve pattern matched handedness in 82%. Of 228 right-handed children, 197 had a right convex curve pattern; of 26 left-handed children, 12 had a left convex pattern. The correlation between scoliosis configuration and handedness was statistically significant. This is in contrast to the findings of previous studies, which have considered convexity only, without reference to the configuration of the whole spine. The implication of this finding is that scoliosis is associated with cortical functions.

Child↗
PubMed1990

Zinc status in patients with idiopathic scoliosis.

The zinc content in m. sacrospinalis, hair, leukocytes of peripheral blood, and in serum was examined in 50 patients with idiopathic scoliosis treated by Harrington instrumentation. A control group included 20 patients treated for spinal column injury. A significant decrease of zinc content in back muscles was observed in patients with scoliosis. The value of zinc in hair, leukocytes, and serum did not differ compared with the control group. Similarly, the potassium and magnesium content in muscle was the same in both groups. These results do not suggest that there is a primary zinc deficiency in patients with idiopathic scoliosis. The authors consider the decreased zinc content in back muscle of patients with idiopathic scoliosis to be a secondary disturbance associated with primary deformation of the spinal column.

Adolescent↗
PubMed1990

The behavior of the unfused lumbar curve following selective thoracic fusion for idiopathic scoliosis.

The behavior of the unfused lumbar curve was evaluated radiographically in 58 cases of adolescent idiopathic thoracic scoliosis that had a selective thoracic fusion only. The lumbar scoliosis echoed the correction obtained in the thoracic scoliosis both immediately postoperatively and at an average 2 1/2-year follow-up. In the sagittal plane, although correction was obtained in the thoracic hypokyphosis, there were no changes seen in the lumbar lordosis at final follow-up. Segmental instrumentation was more effective in correcting thoracic scoliosis and hypokyphosis, but did not alter the behavior of the lumbar curve. The caudal extent of the fusion relative to the stable vertebra did not measurably alter the operative results in either curve or plane.

Adolescent↗