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PubMed2004

The relation between electromyography and growth velocity of the spine in the evaluation of curve progression in idiopathic scoliosis.

STUDY DESIGN: A prospective study in which patients with idiopathic scoliosis were examined longitudinally by radiographic and electromyographic measurements according to a protocol. OBJECTIVES: To measure the growth velocity of the spine and the electromyographic ratio of the paraspinal muscles to determine their relation to progression of the scoliotic curve. SUMMARY OF BACKGROUND DATA: Several factors have been reported to be involved in the progression of idiopathic scoliosis. Possible factors may be growth disturbances and muscular abnormality. METHODS: Thirty patients with idiopathic scoliosis were examined over periods of 4 to 5 months. The periods were scored for progression, defined as an increase in Cobb angle of >10 degrees. Spinal growth velocity was measured as the length difference of the scoliotic spine between two consecutive radiographs. The electromyographic activity on both sides of the spine expressed as an electromyographic ratio was measured during relaxed upright standing using bipolar surface electrodes. Predictability of progression was evaluated with regression analysis and receiver operating characteristic analysis. RESULTS.: There was an independent association between both spinal growth velocity and electromyographic ratio and progression of the scoliotic curve. An equal sensitivity and specificity of spinal growth velocity for progression of 79.1% was observed at a growth velocity cutoff point of 11 mm/year. Similarly, a cutoff point of 1.25 for the electromyographic ratio could be determined with a predictive value for progression of 68.9%. In the presented nomogram, a spinal growth velocity >15 mm/year combined with an electromyographic ratio >2 gave an 89% probability of progression of the scoliotic deformity. Growth velocities 38 mm/year never resulted in progression. CONCLUSIONS: The combined measurement of spinal growth velocity and electromyographic ratio has significant predictive potential and may be valuable in the evaluation and treatment of idiopathic scoliosis.

Adolescent↗
PubMed2002

Scoliosis in a patient with Alexander disease.

Alexander disease is a rare, degenerative disorder of the central nervous system. It is characterized clinically by spasticity, seizures, dementia, loss of developmental milestones, and macrocephaly. Here we describe a 13-year-old boy with Alexander disease and severe scoliosis. The patient initially presented at 9 months of age, with profound mental retardation and a history of seizures. When he was 7 years old, a pediatrician had diagnosed Alexander disease (hypotonia, macrocephaly, and progressive low-density white matter predominantly in the frontal region on computed tomography examination). From the age of 10, thoracolumbar scoliosis had gradually become severe. Because treatment using a corrective brace would have produced major problems because of the patient's mental retardation, the scoliosis was successfully treated surgically, by careful posterior spinal fusion with instrumentation, and an autologous iliac crest bone graft. A 64 degrees curve was corrected to 18 degrees (72% correction). Scoliosis with Alexander disease is considered to be very rare because patients with the disease seldom survive long enough to develop spinal deformities.

Central Nervous System Diseases↗
PubMedDate not supplied

The contribution of hospital volume, payer status, and other factors on the surgical outcomes of scoliosis patients: a review of 3,606 cases in the State of California.

While volume/outcomes relationships have been shown for several areas of orthopaedics, previous studies have not examined this relationship in the area of scoliosis surgery. The Office of Statewide Planning and Development (OSHPD) California inpatient discharge database was used for a retrospective review of all patients 25 years of age or younger with a diagnosis of scoliosis and a spinal fusion procedure from 1995 to 1999 (n = 3,606). Univariate and multivariate analyses were conducted to determine the effect of various factors on in-hospital mortality, surgical complications, reoperations, and length of stay (LOS). Univariate analyses revealed significant effects of age, sex, illness severity, neuromuscular disease, surgical approach, Medicaid status, and annual hospital volume on outcomes (P < 0.05). After controlling for these factors using multivariate regression, patients insured by Medicaid were found to have a significantly greater odds for complications (P = 0.017) and a significantly increased LOS (P < 0.001) compared with patients with all other sources of payment. Additionally, multivariate regression revealed an inverse relationship between annual hospital volume and likelihood of reoperation, as patients treated at hospitals with annual volumes of 5.1 to 25.0, 25.1 to 50.0, and greater than 50.0 spinal fusions all had approximately half the odds of reoperation (P = 0.042, P = 0.004, and P = 0.028 respectively) as patients treated at hospitals with an annual volume of 5.0 or fewer spinal fusions per year. The current data suggest that being insured with Medicaid in the state of California is associated with poorer outcomes after scoliosis surgery. Additionally, this study documents a volume/outcomes relationship in scoliosis surgery.

Adolescent↗
PubMedDate not supplied

Bone density accumulation is not affected by brace treatment of idiopathic scoliosis in adolescent girls.

Bracing for adolescent scoliosis has been postulated to cause permanent loss of bone mass and to predispose to adult osteoporosis. To determine whether brace use affects the rate of bone accretion with growth, the authors conducted a prospective study of 52 girls with adolescent idiopathic scoliosis. Dual-energy x-ray absorptiometry (DEXA) showed a significant increase in spinal bone mineral density (BMD) over a 1-year period of brace wear. BMD correlated with measures of growth and pubertal status, but not average daily brace wear or severity of scoliosis. The annual rate of bone density accumulation was similar to reported normal values. The annual rate of change of volumetric bone density increased only slightly during the study period, suggesting that most of the change in BMD with time reflects growth in the dimensions of the spine. Brace treatment does not appear to inhibit bone density accumulation in girls with adolescent idiopathic scoliosis.

Absorptiometry, Photon↗
PubMedDate not supplied

The association between brace compliance and outcome for patients with idiopathic scoliosis.

This was a prospective study on the association of brace compliance and curve progression in idiopathic scoliosis. Compliance was measured electronically by embedding a temperature sensor and logger in the Wilmington scoliosis brace. To date there have been no studies that relate objective measures of compliance in a scoliosis brace to treatment outcomes. Thirty-four subjects with idiopathic scoliosis were monitored over the duration of their brace wear. Compliance data were downloaded and analyzed. The compliance rate for the patients whose curve progressed (>5 degrees) was 62%; the compliance rate for the patients who did not progress was 85% (P = 0.004). In the group that had high compliance (>90%), one of the nine subjects' curves progressed (11%). In the group with low compliance (<90%), 14 of the 25 subjects' curves progressed (56%, P = 0.0075). Results indicate that the more patients comply with brace treatment, the better their chances of a favorable outcome.

Adolescent↗
PubMed2003

Results of surgical treatment of adult idiopathic scoliosis with low back pain and spinal stenosis: a study of long-term clinical radiographic outcomes.

STUDY DESIGN: A case series of adults with surgical treatment for adult idiopathic thoracolumbar and/or lumbar scoliosis, low back pain, and spinal stenosis was studied. OBJECTIVE: To assess pain relief, curve correction, and complications after combined procedures consisting of decompression, spine fusion, and stabilization. SUMMARY OF BACKGROUND DATA: Only one publication has focused specifically at this group, and this was before the advent of modern segmental instrumentation. This is the first report of long-term follow-up evaluation in such a patient population. METHODS: This study included 16 patients who underwent elective anterior and posterior surgical reconstruction for adult idiopathic thoracolumbar and/or lumbar scoliosis, spinal stenosis, and low back pain with a minimum follow-up period of 2 years. Radiographic findings, clinical results, and long-term outcome data were obtained using the Modified Scoliosis Research Society outcome instrument and the Oswestry Disability Back Pain Questionnaire. RESULTS: Restoration of coronal and sagittal balance, or improvement thereof, was achieved in all the patients with balance problems. There was significant improvement in all outcome domains. Overall, 94% of the patients were satisfied with the surgery. Ten major complications occurred in 10 patients, 8 of whom required additional surgery. There were two minor complications. CONCLUSIONS: Combined symptoms of back pain and spinal stenosis require complex reconstructive surgery in adults with idiopathic thoracolumbar and/or lumbar scoliosis. Significant pain relief, functional restoration, and satisfaction can be achieved and maintained over the long term in the properly selected patient.

Aged↗
PubMed2003

Determination of distal fusion level with segmental pedicle screw fixation in single thoracic idiopathic scoliosis.

STUDY DESIGN: A retrospective study was conducted. OBJECTIVE: To determine the exact distal fusion level in the treatment of single thoracic idiopathic scoliosis (King Types 3 and 4) with segmental pedicle screw fixation. SUMMARY OF BACKGROUND DATA: Pedicle screw fixation effectively shortens the distal fusion extent by improved three-dimensional deformity correction. However, the selection of distal fusion extent remains controversial in single thoracic idiopathic scoliosis. METHODS: This study analyzed 42 patients with single thoracic adolescent idiopathic scoliosis (32 King 3 patients and 10 King 4 patients) who underwent segmental pedicle screw fixation and had a minimum follow-up period of 2 years (range, 2-6 years). The patients were grouped according to the distal fusion level with reference to the standing neutral rotated vertebra (NV) for comparison of deformity correction and spinal balance using standing radiographs. Failure to restore an adequate trunk balance and progression or extension of the primary curve (adding on) was considered unsatisfactory. RESULTS: Preoperative 50 degrees +/- 11 degrees of thoracic deformity was corrected to 13 degrees +/- 5 degrees, for a curve correction of 74%. Preoperative 23 degrees +/- 7 degrees of lumbar deformity was corrected to 2 degrees +/- 8 degrees, for a curve correction of 93%. Curve correction was not significantly affected by King type or distal fusion level (P > 0.05). Postoperative unsatisfactory results were obtained in 14 patients. When the preoperative NV was the same or one level distal to end vertebra (EV), fusion down to NV was satisfactory (14/14). When the preoperative NV was more than two levels distal to EV, fusion down to one level shorter than NV (NV-1) also was satisfactory (9/9). However, when fusion down to NV-2 or shorter was performed, the chances of adding on were higher (14/19; P < 0.01). Preoperative 17 degrees +/- 8 degrees of thoracic kyphosis was improved to 24 degrees +/- 7 degrees. CONCLUSIONS: In single thoracic idiopathic scoliosis, NV is an important factor for the determination of fusion level. When preoperative NV and EV show no more than two-level gap differences, the curve should be fused down to NV. When the gap is more than two levels, fusion down to NV-1 is satisfactory, saving one or two motion segments, as compared with fusion extending to the stable vertebra.

Adolescent↗
PubMed2003

Familial idiopathic scoliosis: evidence of an X-linked susceptibility locus.

STUDY DESIGN: A genomic screen and statistical linkage analysis of a large sample of families with individuals having idiopathic scoliosis was performed. OBJECTIVES: To identify an X-linked susceptibility locus involved in the expression of familial idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: A large sample of families with individuals having idiopathic scoliosis (202 families; 1198 individuals) were diagnosed through physical examination and radiographic criteria, and genomic screening and genetic linkage analyses were performed. METHODS: Model-independent linkage analysis was used to screen genotyping data from 15 X-linked markers in 202 families (1198 individuals). Families were stratified based on the ratio of the likelihood of an X-linked dominant (XLD) inheritance model relative to that of an autosomal dominant (AD) model. Both model-independent and model-dependent linkage analyses were used to identify potential candidate regions. RESULTS: When the entire set of families were analyzed with model-independent methods, no result was significant at the 0.05 level for any of the markers. However, when the families were stratified based on the ratio of the likelihood of the X-linked dominant to autosomal dominant mode of inheritance, results from model-dependent linkage analysis of 15% of the families most likely to have X-linked dominant inheritance showed six adjacent markers with positive lod score values and a maximum lod score of 1.69 (theta = 0.2) at marker GATA172D05. A lod score of 2.23 at this same marker was found in a single family with six affected individuals. CONCLUSION: The results suggest that a region on the X chromosome may be linked to the expression of familial idiopathic scoliosis in a subset of these families.

Alleles↗
PubMed2003

Ventilator weaning after staged anteroposterior spine fusion in a ventilator-dependent patient with congenital scoliosis: a case report.

STUDY DESIGN: Ventilator weaning after staged revision anteroposterior spine fusion in a ventilator-dependent child with congenital scoliosis is reported. OBJECTIVE: To describe the improvement of pulmonary performance after deformity correction in a patient with severe deformity and severe restrictive lung disease. SUMMARY OF BACKGROUND DATA: The effect of scoliotic deformity correction on postoperative pulmonary function is debatable. Recent prospective studies suggest that corrective surgery, especially that involving violation of the chest cage, adversely affect pulmonary function in patients with adolescent idiopathic scoliosis. For patients with severe deformity and severely compromised preoperative pulmonary function, the effect of deformity correction has not been well studied. METHODS: A 15-year-old ventilator-dependent girl with progressive congenital thoracic scoliosis of 130 degrees and a forced vital capacity of 18% underwent staged revision anteroposterior spine fusion. Anterior release, multiple vertebral osteotomies, apical vertebrectomy, and multiple internal thoracoplasties were performed. Five weeks later, when she was medically stable, she underwent posterior reconstruction with multiple vertebral osteotomies, apical vertebrectomy, and translation and cantilever corrective techniques using Isola instrumentation. RESULTS: The patient's pulmonary function was stable 6 months after surgery, and her forced vital capacity was 19%. Currently, 1 year after surgery, she has been weaned to night-only ventilation. Her walking ability has improved. Her spine is well balanced with a thoracic scoliosis of 40 degrees, and she is neurologically intact. CONCLUSIONS: Surgical correction of a severe thoracic spinal deformity in the setting of severe restrictive lung disease can be performed successfully with stabilization of pulmonary volumes and improvement in pulmonary performance.

Abnormalities, Multiple↗
PubMed2003

Three-dimensional quantitative segmental analysis of scoliosis corrected by the in situ contouring technique.

STUDY DESIGN: A three-dimensional analysis of right thoracic scoliosis before and after surgical correction was performed. OBJECTIVE: To compare the orientations of the vertebrae in apical and junctional zones before and after surgery. SUMMARY AND BACKGROUND DATA: Three-dimensional segmental analysis considering the lateral, sagittal, and axial (vertebral and intervertebral) rotations that can define apical and junctional zones has been described previously. Modern surgical techniques have been designed to correct scoliosis three-dimensionally. Therefore, the effect of the surgery must be evaluated in three dimensions. METHODS: The three-dimensional reconstruction of the spine and pelvis of 10 patients with right thoracic scoliosis was obtained by a stereoradiographic method before and after surgery. The orientations of all vertebrae were computed, and the apical and junctional zones were defined. The correction of these characteristic vertebrae obtained by the in situ contouring technique was evaluated. RESULTS: The mean three-dimensional pattern for the 10 patients was 20 degrees of vertebral axial rotation with 6 degrees of intervertebral extension in the thoracic apex and 30 degrees of vertebral lateral rotation with 10 degrees of intervertebral axial rotation in the junctional zones of the thoracic curve. The correction obtained by in situ contouring was 52% to 79% for all these three-dimensional vertebral orientations. CONCLUSIONS: Three-dimensional reconstruction of the spine allows quantitative segmental analysis of the deformity. This could be used as a reliable tool to evaluate both the severity of the scoliosis and the effects of the surgical correction.

Adolescent↗
PubMed2003

Back pain and function 23 years after fusion for adolescent idiopathic scoliosis: a case-control study-part II.

STUDY DESIGN: A consecutive series of patients with adolescent idiopathic scoliosis, treated between 1968 and 1977 before age 21 years with distraction and fusion using Harrington rods (surgically treated: n = 156; 145 females and 11 males) were followed-up at least 20 years after completion of the treatment. OBJECTIVES: To determine the long-term outcome in terms of back pain and function in patients surgically treated for adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Few reports on long-term outcome of back pain and function have previously been presented for this group of patients. Results presented are not conclusive regarding effects on back pain and its correlation to a fusion extending into the lower lumbar spine. MATERIALS AND METHODS: One hundred forty-two (91%) of the patients were reexamined as part of an unbiased personal follow-up. This included a clinical examination and evaluation of curve size (Cobb method) and degenerative findings in full standing frontal and lateral radiographs. Validated questionnaires in terms of general and disease-specific quality of life aspects as well as present back and pain symptoms were used. One hundred thirty-nine had complete follow-up. An age- and sex-matched control group of 100 individuals was randomly selected and subjected to the same examinations. RESULTS: The deterioration of the curves was 3.5 degrees for all curves and eight (5.1%) of the patients treated with fusion had undergone some additional curve-related surgical procedure. The patients had significantly more degenerative disc changes than the controls. Lumbar pain, although mild (2.4 on visual analogue scale), was significantly more frequent among the patients than the controls (65 vs. 47%, P = 0.0079). Only 25% of the patients admitted daily pain, and analgesics were sparsely used. No major differences of back function and general health-related quality of life were noted between the patients or the controls. Except for having been on sick-leave ever because of the back (45% vs. 19%, P = 0.0040) no differences could be seen in sociodemographic variables between the groups. Furthermore, no differences could be found between patients fused to L3 or higher (n = 102) versus L4 or lower (n = 37). No correlation could be found between pain and its localization and various variables on the scoliotic curve, body mass index, or smoking. Persisting discomfort and/or sensory loss were noted significantly more often among the patients who had the autologous bone harvesting performed through a separate incision over the iliac crest (24.3%) than among those in whom this was performed through an elongated midline incision (4.6%, P = 0.0015). CONCLUSIONS: Minimal pain and no dysfunction occurred (mean) 23 years after fusion for adolescent idiopathic scoliosis compared with normal straight controls. Significantly more pain in the scar region occurred when bone graft from an incision over the posterior iliac crest was used for harvesting bone to the fusion compared with an incision performed as an elongation of the midline incision used for the scoliosis surgery.

Adolescent↗
PubMed2003

Use of video-assisted thoracoscopic surgery to reduce perioperative morbidity in scoliosis surgery.

STUDY DESIGN: A case series of idiopathic scoliosis patients treated with thoracoscopic anterior instrumentation was compared to a similar group of patients treated by open anterior instrumentation. OBJECTIVES: To evaluate the morbidity associated with thoracoscopic instrumentation compared to the open approach for thoracic scoliosis. METHODS: A consecutive group of thoracoscopically treated patients with Lenke 1 adolescent idiopathic scoliosis was compared to similar patients gathered from the DePuy-AcroMed Harms Study Group database. Perioperative outcome measures as well as early postoperative functional outcomes (pulmonary function, shoulder strength) were compared. RESULTS: There were 38 thoracoscopic instrumentation cases with greater than 6 months' follow-up that were compared to 68 anterior open instrumentation cases. The radiographic outcomes were similar (60% +/- 11% vs. 59% +/- 17% thoracic curve correction for the thoracoscopic and open groups, respectively). The reduction in forced vital capacity was significantly (P = 0.01) greater in the open group (0.6 +/- 0.3 L) compared to the endoscopic group (0.4 +/- 0.3 L). There was a trend towards greater return of shoulder girdle strength and range of motion 6 weeks after surgery in the thoracoscopic patients. CONCLUSION: The thoracoscopic approach for instrumentation of scoliosis has advantages of reduced chest wall morbidity compared with the open thoracotomy method but allows comparable curve correction.

Adolescent↗
PubMed2004

Local autograft bone in the surgical management of adolescent idiopathic scoliosis.

STUDY DESIGN: A retrospective study. OBJECTIVES: The study was performed to determine the efficacy of local autograft bone in idiopathic scoliosis surgery on patients who had had spinal fusion with a Cotrel Dubousset device between 1990 and 1995. SUMMARY OF BACKGROUND DATA: Studies seemed to promote the used of autograft bone (iliac crest, ribs), allograft bone, or bone graft substitutes in adolescent idiopathic surgery. To the authors' knowledge, there have been no previous articles concerning in situ local auto graft bone in idiopathic scoliosis surgery in the literature. MATERIALS AND METHODS: Twenty five patients with idiopathic scoliosis, aged 11 to 18 years, were treated by posterior correction and arthrodesis using Cotrel-Dubousset instrumentation. Posterior spinal fusion was performed using only local bone grafts. The patients were reviewed with a mean postoperative observation time of 6 years (5-9). The results were assessed clinically and radiographically. RESULTS: Preoperative single curves averaged 56 degrees in the frontal plane with an average postoperative curve of 16 degrees. Preoperative double curves in the frontal plane averaged 55 degrees in thoracic curves and 49 degrees in lumbar curves with an average postoperative curve of 18 degrees in thoracic and 13 degrees in lumbar. At the final follow-up, there was no losing in the correction. There was no pseudarthrosis clinically or radiographically. CONCLUSIONS: In adolescent idiopathic scoliosis surgery, local autograft bone allows to avoid the necessity of any over graft.

Adolescent↗
PubMed2004

Comparison of SRS questionnaire results submitted by both parents and patients in the operative treatment of idiopathic scoliosis.

STUDY DESIGN: A prospective, cross-sectional analysis of patients with operative idiopathic scoliosis comparing Scoliosis Research Society's Outcomes Instrument (SRS-24) scores from both parents and patients obtained separately on the same day along with pertinent radiographic data. OBJECTIVE: To determine the correlation of parents' and patients' perspectives of the patients' preoperative and postoperative experience using the SRS-24 questionnaire emphasizing parent-patient disparities. SUMMARY OF BACKGROUND DATA: No report to our knowledge has addressed the association between parent assessments of their child's presurgical and postsurgical outcome as verified by SRS-24 questionnaire data. MATERIALS AND METHODS: A total of 101 patients with operative idiopathic scoliosis were analyzed based on paired parent-patient SRS-24 data and radiographs performed on the same day. Patients were analyzed by age at date of examination (9-23 years, mean 17 +/- 5 years), gender (16 male, 85 female), major curve magnitude (41-126 degrees ), procedure type [preoperative (22 pairs), anterior spinal fusion (49 pairs), anterior spinal fusion/posterior spinal fusion (19 pairs), posterior spinal fusion (46 pairs)], and time from surgery (preoperative, postoperative 1-93 months, mean 24 months). All questionnaire scores were classified based on domains of pain, self-image, function, overall satisfaction, and total score. RESULTS: In overall time periods, parents consistently scored higher than their children in the self-image (P = 0.0001), satisfaction (P = 0.0001), and total score (P = 0.04), but not pain or function. Before surgery, parents overestimated patients' scores in self-image (P = 0.002) by 7.5% but not other domains. Satisfaction differences (P = 0.04) improved with increasing age of the patient, but not other domains. There were no significant differences with gender or preoperative/postoperative major curve magnitudes. CONCLUSION: Based on SRS-24 data, parents typically scored higher than their children in the operative treatment of idiopathic scoliosis in total score, self-image, and overall satisfaction. Some parent-patient scores correlated better with increasing age of the patient, and later in the postoperative period.

Adolescent↗
PubMed2004

A prospective comparison of the coronal deformity correction in thoracic scoliosis using four different instrumentations and the fulcrum-bending radiograph.

STUDY DESIGN: A prospective study on comparing coronal deformity correction in thoracic scoliosis using four different instrumentations. OBJECTIVES: To compare the ability of four different instrumentation systems in correcting thoracic scoliosis based on the curve flexibility as reviewed by the fulcrum-bending radiograph. SUMMARY OF BACKGROUND DATA: The fulcrum-bending radiograph has been shown to be able to accurately reflect the flexibility of thoracic curves, and the fulcrum bending correction index (FBCI) predicts the amount of correction achieved by current surgical techniques. By recruiting curves of known flexibility, the efficacy of the different instrumentations in correcting coronal deformity can be truly compared. METHODS: A consecutive series of 127 patients with idiopathic scoliosis were treated by one of four implants: CD-Horizon (CD-H), Moss Miami (MM), TSRH, and ISOLA. All surgeries were performed by the same group of surgeons using the respective recommended techniques. FBCI was used to compare the correction achieved by these implants. RESULTS: The mean FBCI/correction rate was 101.0%/57.9% in the TSRH group, 103.5%/58.5% in ISOLA, 109.1%/67.6% in CD-H, and 100.2%/62.7% in the MM group. The correction rate was significantly (P < 0.05) higher in the CD-H group than those in the TSRH and ISOLA groups, while the differences in the FBCI between the four implants were not statistically significant. CONCLUSIONS: When curve flexibility is taken into account, despite differences in material and design of four commonly used instrumentations, their ability to correct thoracic scoliosis is the same. Future studies describing surgical correction results should be based on the FBCI.

Adolescent↗
PubMed2004

Surgical correction of scoliosis by in situ contouring: a detorsion analysis.

STUDY DESIGN: A detorsion analysis of the scoliosis surgical correction by means of in situ contouring technique (ISC). OBJECTIVE: To describe the technique of ISC. To measure the vertebral and intervertebral axial rotation in thoracic and lumbar curves and their correction obtained by ISC. SUMMARY AND BACKGROUND DATA: The vertebral and intervertebral axial rotation allows to evaluate the severity of the curves. However, the intervertebral axial rotation is barely studied and the vertebral axial rotation is a controversial point of the surgical correction. METHODS: Twenty patients with thoracic and lumbar scoliosis were operated on with ISC. Vertebral axial rotation at the apex and the sum of intervertebral axial rotations all along the curve were computed before and after surgery from the three-dimensional stereoradiographic reconstruction of the spine and the pelvis. All the measurements were made in the standing position. RESULTS: Correction of the axial rotation was obtained at the apex of both thoracic and lumbar curves of idiopathic and degenerative scoliosis. The mean values of correction (in terms of axial rotation) were 8 degrees to 19 degrees (62%-67%). The percentage of correction of the sum of intervertebral axial rotations all along the curve, proposed as a "detorsion index" (preoperative - postoperative/preoperative), was found at 57% to 92%. No significant differences were found for the correction (in terms of axial rotation and detorsion) between idiopathic and degenerative curves. CONCLUSIONS: The axial rotation was measured in clinics on standing patients with scoliosis from three-dimensional stereoradiographic reconstruction and demonstrated a reliable detorsion obtained by ISC.

Adolescent↗
PubMed2004

Compliance monitoring of brace treatment for patients with idiopathic scoliosis.

STUDY DESIGN: Prospective, blinded study to evaluate compliance with treatment. OBJECTIVE: To evaluate objectively idiopathic scoliosis patients' compliance with Wilmington brace treatment. SUMMARY OF BACKGROUND DATA: Patients' compliance with brace treatment for idiopathic scoliosis traditionally has been determined from patient or parent interviews or both; however, the hours reported by patients are subjective and consequently are not accurate. METHODS: Study participants were 61 consecutive patients with idiopathic scoliosis: 54 girls and 7 boys. Inclusion criteria were curvature of more than 20 degrees and less than 45 degrees of Cobb angle before brace treatment. Actual hours worn per day were measured using a compliance monitor, and compliance was determined by the percentage of actual hours worn in accordance with the prescribed regimen. Accuracy of compliance from hours reported by patients was compared with actual hours measured by the monitor. Correlations between compliance and prescribed regimen and age were analyzed. RESULTS: The overall compliance measured by the monitor was 75 +/- 27% (mean +/- S.D.), and the frequency distribution was similar to a Gaussian distribution. The compliance determined from hours reported by patients was 85 +/- 24%, which was higher than that from actual hours measured by the monitor (P = 0.01). There was a negative correlation between age and compliance (rho = -0.30, P = 0.025); 10-, 12-, and 14-year-old patients had 84, 77, and 60% average compliance, respectively. Compliance among patients with different prescribed regimens (8, 12, 16, or 23 hours of wear) showed no statistical difference (P = 0.361). CONCLUSIONS: Patients with idiopathic scoliosis complied with 75% of prescribed regimen on average and overreported their hours of brace wear to their physician. Age affected compliance. There was no statistical difference in compliance among patients with different prescribed regimens. The present study confirms the need for a compliance monitor to accurately evaluate use and outcome of brace treatment.

Adolescent↗
PubMed2004

Spatial relations between the vertebral body and the thoracic aorta in adolescent idiopathic scoliosis.

STUDY DESIGN: An analysis of computed tomography images of patients with adolescent idiopathic scoliosis. OBJECTIVES: To evaluate the spatial relations between the vertebral body and the thoracic aorta and to verify the safety of anterior instrumentation surgery. SUMMARY OF BACKGROUND DATA: Recent studies have suggested that the aorta is positioned more laterally and posteriorly in patients with idiopathic scoliosis than in normal patients; however, no study used rib heads as references in the analysis. METHODS: Computed tomography images of the whole thoracic spine of 10 patients with adolescent idiopathic scoliosis were analyzed. A line that passed the anterior edge of the bilateral rib heads was regarded as the virtual passage of the screw used for anterior instrumentation surgery. Whether this line crossed the aorta was investigated. A distance between the vertebral body and the aorta was measured along this line. RESULTS: The aorta was located more posteriorly between T6 and T9. At these levels, the virtual passage of the screw crossed the aorta in 33 of 40 vertebrae (83%). At seven vertebrae in 5 patients, this passage crossed the aorta and the distance was less than 2 mm. Of these, four were T6, two T7, and one T8. CONCLUSION: In some patients with adolescent idiopathic scoliosis, the aorta can be located in the direction of the screw passage and close to the vertebral body. Accordingly, when planning anterior instrumentation surgery for right thoracic curve, surgeons should pay attention to these spatial relations.

Adolescent↗