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PubMed2005

Identification of candidate regions for familial idiopathic scoliosis.

STUDY DESIGN: A genomic screen and statistical linkage analysis of 202 families with at least two individuals with idiopathic scoliosis was performed. OBJECTIVES: To identify candidate regions or the autosomal loci that may be involved in the expression of familial idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: A large sample of families with individuals having idiopathic scoliosis (202 families; 1,198 individuals) was ascertained; diagnoses were based on physical examination and radiographic criteria. METHODS: Model-independent linkage analysis of qualitative and quantitative traits (degree of lateral curvature) related to scoliosis was used to screen genotyping data from 391 markers in the 202 families. Subsets of families were determined before genotyping based on the most likely mode of inheritance for each family (autosomal dominant vs. X-linked dominant). Fine mapping results corroborated linkage in the primary candidate regions. RESULTS: Candidate regions on chromosomes 6, 9, 16, and 17 were considered to have the strongest evidence for linkage across all subsets considered. CONCLUSION: Linkage analyses have identified several candidate regions, a significant step in defining the genetic etiology of this disorder.

Family↗
PubMed2005

Operative treatment of scoliosis with the Kaneda anterior spine system.

STUDY DESIGN: Prospective, single-cohort study. OBJECTIVE: To evaluate thoracic and thoracolumbar scoliosis using the Kaneda anterior spine dual-rod system (KASS). SUMMARY OF BACKGROUND DATA: In selected cases, anterior correction of scoliosis has several advantages over the traditional posterior instrumentation. Other than 2 primary reports by Kaneda, there are no clinical outcome reports with the KASS in the literature. METHODS: A total of 24 patients with thoracic (n = 10)/thoracolumbar (n = 14) scoliosis were corrected using the KASS. Sagittal and coronal plane radiologic parameters were evaluated before surgery, 1-year after surgery, and at final follow-up (approximately 40 months). RESULTS: Average coronal correction of the primary curve was from 61 degrees to 24 degrees (61%). Apical vertebral rotation decreased by 69%. Apical vertebral translation decreased 10-2 cm. The secondary thoracic and lumbar curves showed a spontaneous correction between 27% and 46%, respectively. Thoracic kyphosis increased 25 degrees -38 degrees (52%), lumbar lordosis showed a minimal decrease from 48 degrees to 43 degrees . Fusion was achieved in all cases. No neurovascular or implant-related problems were observed at final follow-up. CONCLUSIONS: Anterior instrumented fusion for thoracic/thoracolumbar scoliosis using the KASS is a good treatment option for idiopathic thoracic/thoracolumbar curves.

Adolescent↗
PubMed2005

Expression of transforming growth factor and basic fibroblast growth factor and core protein of proteoglycan in human vertebral cartilaginous endplate of adolescent idiopathic scoliosis.

STUDY DESIGN: To compare the expression of cytokines and core protein of proteoglycan in the scoliotic concave and convex cartilaginous endplate using immunohistochemical staining. OBJECTIVES: To define the possible role of transforming growth factor beta 1 (TGFbeta1), basic fibroblast growth factor (bFGF), and core protein of proteoglycan in the development of adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Changes in the endplate composition have been implicated as possible etiologic factors in the pathogenesis of adolescent idiopathic scoliosis. Cytokines have exclusive effects on cartilage. Thus comparing the expression of the cytokines and matrix on the convex and concave sides of scoliotic endplate tissues may help to understand the role of endplate tissues in the induction and/or progression of idiopathic scoliosis. METHODS: The convex and concave half of cartilage endplate was collected at the apex and end vertebrae from 12 patients. The expression of TGFbeta1, bFGF, and core protein on both sides was examined with the immunohistochemistry method, and results were analyzed with the image analysis system. RESULTS: TGFbeta1, bFGF, and core protein of proteoglycan were all expressed in the cytoplasm of chondrocytes in the cartilaginous endplate. The area density and quantity density of TGFbeta1 and bFGF on the concave side are expressed in an even significantly higher level than that on the convex side (P > or = 0.05). The expression of the core protein of proteoglycan on the convex side is higher than that on the concave side, the difference is not significant (P > 0.05). CONCLUSION: There was a significantly higher expression of TGFbeta1 and bFGF, although a lower expression of the core protein on the concave side, which suggests a possible etiological factor or a secondary change in the development of adolescent idiopathic scoliosis.

Adolescent↗
PubMed2005

Anterior dual rod instrumentation in idiopathic thoracic scoliosis: a computed tomography analysis of screw placement relative to the aorta and the spinal canal.

STUDY DESIGN: Axial computed tomography scans (CT) in 20 consecutive patients with idiopathic right thoracic scoliosis and anterior correction and fusion with a dual rod dual screw system. OBJECTIVES: CT evaluation of screw position in anterior dual rod instrumentation relative to the aorta and the spinal canal. SUMMARY OF BACKGROUND DATA: In anterior scoliosis surgery, bicortical screw purchase is used to increase pullout strength. However, impingement of the aorta due to excessive contralateral screw penetration has been reported, especially after endoscopic instrumentation. Data on the accuracy of dual screw instrumentation in thoracic scoliosis are missing. METHODS: All 20 patients underwent an identical anterior surgical technique with double thoracotomy approach and dual rod instrumentation of the primary curve. Postoperative sequential CT scans were analyzed with respect to following parameters: vertebral body width and depth, diameter of the aorta, distance from the aorta to the closest point of the vertebral body cortex, distance between the tip of the screws and the aorta, distance between the screw and the spinal canal, and the amount of contralateral screw penetration. A total amount of 226 screws were evaluated. RESULTS: All screws were placed correctly without any critical proximity to the aorta or spinal canal. A total of 198 of 226 screws (88%) had a bicortical purchase. Thirteen screw tips (5.8%) were within 1 to 3 mm proximity to the aorta. All other screws were more than 3 mm distant from the aorta. The closest proximity of the screw tips to the thoracic aorta was found at the upper end vertebrae (T5, T6, or T7). There were no screws perforating the spinal canal. CONCLUSION: Anterior instrumentation and correction of thoracic scoliosis with a dual rod dual screw system enable a correct and safe screw placement using a standard open approach. Excessive bicortical screw perforation should be avoided in order not to endanger the thoracic aorta.

Adolescent↗
PubMed2006

Automatic measurement of vertebral rotation in idiopathic scoliosis.

STUDY DESIGN: Development of an automatic measurement algorithm and comparison with manual measurement methods. OBJECTIVES: To develop a new computer-based method for automatic measurement of vertebral rotation in idiopathic scoliosis from computed tomography images and to compare the automatic method with two manual measurement techniques. SUMMARY OF BACKGROUND DATA: Techniques have been developed for vertebral rotation measurement in idiopathic scoliosis using plain radiographs, computed tomography, or magnetic resonance images. All of these techniques require manual selection of landmark points and are therefore subject to interobserver and intraobserver error. METHODS: We developed a new method for automatic measurement of vertebral rotation in idiopathic scoliosis using a symmetry ratio algorithm. The automatic method provided values comparable with Aaro and Ho's manual measurement methods for a set of 19 transverse computed tomography slices through apical vertebrae, and with Aaro's method for a set of 204 reformatted computed tomography images through vertebral endplates. RESULTS: Confidence intervals (95%) for intraobserver and interobserver variability using manual methods were in the range 5.5 degrees to 7.2 degrees . The mean (+/-SD) difference between automatic and manual rotation measurements for the 19 apical images was -0.5 degrees +/- 3.3 degrees for Aaro's method and 0.7 degrees +/- 3.4 degrees for Ho's method. The mean (+/-SD) difference between automatic and manual rotation measurements for the 204 endplate images was 0.25 degrees +/- 3.8 degrees . CONCLUSIONS: The symmetry ratio algorithm allows automatic measurement of vertebral rotation in idiopathic scoliosis without intraobserver or interobserver error due to landmark point selection.

Algorithms↗
PubMed2006

Association of estrogen receptor gene polymorphisms with susceptibility to adolescent idiopathic scoliosis.

STUDY DESIGN: A case-control study is presented. OBJECTIVE: To investigate the association of estrogen receptor gene polymorphisms with adolescent idiopathic scoliosis (AIS) risk. SUMMARY OF BACKGROUND DATA: Previous studies have shown that genetic factors are important in the pathogenesis of idiopathic scoliosis. Only 1 publication suggested that XbaI site polymorphism was associated with curve severity of idiopathic scoliosis. However, to our knowledge, the relationship of estrogen receptor gene polymorphisms and the individual susceptibility to idiopathic scoliosis has not been studied. METHODS: This study included 202 patients with AIS and 174 healthy controls. Height, menarche status, curve pattern, Cobb angle, and Risser sign in female patients were recorded. There were 2 polymorphic loci, PvuII and XbaI locus, of estrogen receptor analyzed by restriction fragment length polymorphisms. RESULTS: The frequency of XX genotype was significantly higher in patients than that in controls (P = 0.005). The X allele appeared to be overrepresented in patients compared with controls (P = 0.001). Furthermore, the frequencies of XX genotype in female patients whose height was > or = 160 cm and Cobb angle > or = 40 degrees were higher than those whose height was <160 cm and Cobb angle <40 degrees (P = 0.001 and P < 0.001, respectively). CONCLUSIONS: The XbaI site polymorphism of estrogen receptor gene may be associated with a risk of AIS.

Adolescent↗
PubMed2006

Surgical treatment of scoliosis with pelvic obliquity in cerebral palsy: the influence of intraoperative traction.

STUDY DESIGN: Continuous retrospective series. OBJECTIVES: To compare two techniques sequentially used for surgical correction of neuromuscular scoliosis with pelvic obliquity in children with cerebral palsy. SUMMARY OF BACKGROUND DATA: In nonwalking patients with cerebral palsy, scoliosis is frequently associated with pelvic obliquity. We compared intraoperative traction with no traction with instrumentation to the pelvis to correct pelvic obliquity. METHODS: The initial 59 patients had surgery in the knee-chest position with pelvic obliquity correction by posterior vertebral instrumentation distraction, rotation, and compression. The sequential 51 patients were placed prone and had asymmetric traction applied between a halo and the high pelvic side lower extremity with pelvic correction maneuvers done before posterior surgery and instrumentation. RESULTS: Anesthetic duration was longer in Group 1 because of complexity of the intraoperative correction maneuvers, which also produced less correction of scoliosis and pelvic obliquity compared with the asymmetric traction technique. At 8.6 years of follow-up, frontal and sagittal plane correction improved in all surviving patients. CONCLUSION: We think that intraoperative reduction by asymmetric traction is a reliable and safe technique to correct neuromuscular scoliosis and pelvic obliquity in nonwalking spastic quadriplegic patients.

Cerebral Palsy↗
PubMed2006

Vertebral height growth predominates over intervertebral disc height growth in adolescents with scoliosis.

STUDY DESIGN: A cross-sectional study of spinal stereoradiographs of adolescents with scoliosis to measure growth. OBJECTIVE: To determine the relative contributions of the vertebral bodies and intervertebral discs to the increase in spinal length between T5 and L5, over the age range of 7.5-20 years. SUMMARY OF BACKGROUND DATA: The progression of spinal deformity (scoliosis) is associated with skeletal growth, but the relative roles of asymmetrical growth and remodeling of the vertebrae and discs during adolescent growth are unclear. METHODS: An existing database of 406 spinal stereoradiographic studies of 188 adolescents with idiopathic scoliosis, aged between 7.5 and 20 years, was used to measure the heights of vertebral bodies and intervertebral discs, and the summation of both (spinal length). RESULTS: Spinal length was observed to increase from about 250 to 350 mm over this range of ages. Spinal growth was associated with an increase in vertebral height after age 10 years, with minimal if any increase in disc height. The contribution of vertebral and discal height was estimated to be about 17 and 8 mm per year, respectively, at age 7.5 years, but discal height growth was estimated to be effectively zero after age 12 years. CONCLUSION: Spinal growth of patients with scoliosis aged between 10 and 20 years occurs almost exclusively by height increases in the vertebrae, not the discs.

Adolescent↗
PubMed2006

Balance control in adolescents with idiopathic scoliosis and disturbed somatosensory function.

STUDY DESIGN: A cross-sectional study of the balance control in adolescents with idiopathic scoliosis. OBJECTIVE.: To investigate the relationship among somatosensory function, balance control, and adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: Balance control requires the contribution of somatosensory, visual, and vestibular inputs. Previous studies have shown that abnormal somatosensory evoked potentials (SSEPs) were associated with AIS. METHODS: A total of 105 girls with AIS and 57 normal girls aged 11-14 years entered the study, and were evaluated with bilateral tibial nerve evoked cerebral SSEPs and standing balance control under reduced or conflicting sensory conditions (i.e., the sensory organization test). One-way analysis of variance was conducted to evaluate the effects of scoliosis and somatosensory function tested by SSEPs on the performance of sensory organization test. RESULTS: There were 15 patients with AIS who had abnormal SSEPs. Postural sway was measured on all subjects under normal, reduced, or conflicting somatosensory, visual, and vestibular conditions. One-way analysis of variance indicated no significant effect of spinal deformity or SSEPs on the balance control when there was an increased reliance on the somatosensory, visual, and vestibular systems during stance (P > 0.05). However, in the patients with abnormal SSEPs, a significant effect was found when subjects had to rely on somatosensory input for their balance control (P = 0.023). The effect of scoliosis by itself was not found to be significant (P = 1.0). CONCLUSIONS: The finding of significantly larger difference in bilateral SSEP latencies in patients with AIS indicated the association of abnormal SSEPs with AIS. The finding of a significant effect of SSEPs on the balance control further indicated the presence of abnormal somatosensory function in a subgroup of patients with AIS.

Adolescent↗
PubMed2006

The position of the aorta relative to the spine before and after anterior instrumentation in right thoracic scoliosis.

STUDY DESIGN: Preoperative magnetic resonance images (MRI) and postoperative axial computed tomography (CT) scans in 25 consecutive patients with idiopathic right thoracic adolescent scoliosis (AIS) and anterior correction and fusion with a dual rod system were analyzed in a prospective study. OBJECTIVES: Evaluation of the spatial relations between the vertebral body and the aorta and the relative migration of the aorta due to the anterior correction and instrumentation in right thoracic scoliosis patients. SUMMARY OF BACKGROUND DATA: In anterior scoliosis surgery, bicortical screw purchase is performed to increase pullout strength. However, impingement of the aorta due to excessive contralateral screw penetration has been reported, especially after endoscopic instrumentation. For a safe screw placement, knowledge of both the preoperative topographic relation of aorta and vertebral body and its changes due to surgical correction is crucial. Recent studies reported on a more lateral and posterior position of the aorta in AIS patients. However, there are hardly any data on the changes of the aortic position after anterior curve correction available in the current literature. METHODS: All 25 patients underwent an identical anterior surgical technique with standard open approach and dual rod instrumentation of the primary curve. Preoperative MRI and postoperative sequential CT scans of 180 vertebrae were analyzed with respect to following parameters: vertebral body width and depth, diameter of the aorta, closest distance between aorta and the vertebral body, the aorta-vertebral angle, and the position of the aorta in relation to the spinal canal. RESULTS: Before surgery, the aorta is positioned posterolaterally with an aorta-vertebral angle of between 78 degrees and 92 degrees (between T5 and T10). Between T11 and L2, the aorta is positioned more anteromedially with an aorta-vertebral angle from 62 degrees (T11) to 16 degrees (L2). After surgery, the aorta has migrated from a posterolateral to a more anteromedial position. This migration is maximal at the apex vertebra with an average change of the aorta-vertebral angle of 31.4 degrees . Whereas the distance between the aorta and the vertebral body increases at the upper and lower fusion levels, the aorta moves significantly closer to the vertebral body at the curve apex due to surgical correction. In patients with thoracic hypokyphosis, the aorta is positioned significantly more posterior than in patients with hyperkyphosis. CONCLUSIONS: This MRI and CT based study of 25 patients with thoracic AIS treated by standard open dual rod and dual screw instrumentation demonstrates a migration of the aorta by 31 degrees from a more posterolateral position before surgery to a more anteromedial position after surgery at the curve apex. Scoliosis surgeons should be aware of these changes; any excessive contralateral screw penetration must be avoided at any level.

Adolescent↗
PubMed2006

Relative versus absolute modulation of growth in the fusionless treatment of experimental scoliosis.

STUDY DESIGN: Absolute and relative growth modulation of apical spinal segments were measured during creation and correction of an experimental scoliosis in a goat model. OBJECTIVE: To differentiate relative and absolute changes in growth on the concavity and convexity of an experimental scoliosis treated with anterior vertebral stapling. SUMMARY OF BACKGROUND DATA: The creation and correction of vertebral wedge deformities have been previously described in a rat tail model using external fixation as well as in a goat model using anterior vertebral body stapling. METHODS: Progressive, structural, scoliotic curves convex to the right in the thoracic spine were created in 14 Spanish Cross-X female goats using a posterior asymmetric tether. After 7-13 weeks, all tethers were removed, and goats were randomized into stapled (n = 8) and untreated (n = 6) groups. Stapled goats underwent anterior vertebral stapling with 4 shape memory alloy staples (Medtronic Sofamor Danek, Memphis, TN) along the convexity of the maximal curvature. All goats were observed for an additional 7-13 weeks. There were 12 additional goats matched for age, sex, and weight used as growth controls throughout the study. Serial radiographs were used to document progression or correction of the maximal scoliotic deformity, and changes in relative and absolute growth at the apical spinal segment T9-10 (2 adjacent vertebrae and the intervening disc). RESULTS: All tethered goats had progressive, structural, scoliotic curves of significant magnitude during the tethering period (average 61.4 degrees, range 49 degrees to 73 degrees) (P = 0.001). There was 1 goat from each group eliminated from the study because its apical spinal segment did not match the T9-10 level used to establish normal growth in controls. During the treatment period, stapled goats had a correction of -6.9 degrees (P = 0.03), whereas untreated goats had little change (-1.4 degrees). Apical spinal segment wedging progressed in all tethered goats, from 11.1 degrees to 22.4 degrees, during the tethering period (P = 0.001). During the treatment period, wedging corrected -2.2 degrees (range 22.5 degrees to 20.3 degrees) in the stapled goats but progressed +3.5 degrees (range 22.3 degrees to 25.8 degrees) in the untreated goats (P < 0.05). Apical spinal segment growth in all tethered goats was decreased on the concavity by 78% and increased on the convexity by 33% when compared to growth controls (P < 0.001). During the treatment period, growth on the concavity of the apical spinal segment of the stapled goats was decreased by 10% but increased in the untreated goats by 37% when compared to growth controls. On the convexity, apical spinal segment growth at T9-10 was decreased in the stapled goats by 18% and increased in the untreated goats by 29% when compared to growth controls (P < 0.04). CONCLUSIONS: Data in this study show the ability to modulate relative and absolute growth, according to the Hueter-Volkmann law, at the apical spinal segment of a progressive experimental scoliosis. However, anterior vertebral stapling, although able to control progressive wedging and scoliosis at the apical spinal segment, was not able to reverse fully the Hueter-Volkmann effect.

Animals↗
PubMed2006

A clinical impact classification of scoliosis in the adult.

STUDY DESIGN: Multicenter, prospective, consecutive clinical series. OBJECTIVES: To establish and validate classification of scoliosis in the adult. SUMMARY OF BACKGROUND DATA: Studies of adult scoliosis reveal the impact of radiographic parameters on self-assessed function: lumbar lordosis and frontal plane obliquity of lumbar vertebrae, not Cobb angle, correlate with pain scores. Deformity apex and intervertebral subluxations correlate with disability. METHODS: A total of 947 adults with spinal deformity had radiographic analysis: frontal Cobb angle, deformity apex, lumbar lordosis, and intervertebral subluxation. Health assessment included Oswestry Disability Index and Scoliosis Research Society instrument. Deformity apex, lordosis (T12-S1), and intervertebral subluxation were used to classify patients. Outcomes measures and surgical rates were evaluated. RESULTS: Mean maximal coronal Cobb was 46 degrees and lumbar lordosis 46 degrees . Mean maximal intervertebral subluxation (frontal plane) was 4.2 mm (sagittal plane, 1.2 mm). In thoracolumbar/lumbar deformities, the loss of lordosis/higher subluxation was associated with lower Scoliosis Research Society pain/function and higher Oswestry Disability Index scores. Across the study group, lower apex combined with lower lordosis led to higher disability. Higher surgical rates with decreasing lumbar lordosis and higher intervertebral subluxation were detected. CONCLUSIONS: A clinical impact classification has been established based on radiographic markers of disability. The classification has shown correlation with self-reported disability as well as rates of operative treatment.

Adult↗
PubMed2006

Dynamic magnetic resonance imaging in assessing lung volumes, chest wall, and diaphragm motions in adolescent idiopathic scoliosis versus normal controls.

STUDY DESIGN: Dynamic breath-hold (BH)- magnetic resonance (MR) imaging was used to evaluate lung function in adolescent idiopathic scoliosis (AIS). OBJECTIVES: Changes in lung volume, chest wall, and diaphragmatic motions were evaluated in AIS patients and compared with normal controls. SUMMARY OF BACKGROUND DATA: Little is known about whether pulmonary function impairment in AIS is related to restriction of lung volume, poor chest wall expansibility, or impaired diaphragmatic motion. This is a study on the underlying pathophysiology of the abnormal pulmonary function in AIS using the ultrafast BH-MR imaging technique. METHODS: Forty-two patients with moderate to severe right thoracic scoliosis (Cobb angle, 40 degrees -98 degrees), 22 patients with mild right thoracic scoliosis (Cobb angle 10 degrees -30 degrees), and 12 healthy subjects (age ranged, 11-18 years; all girls) were recruited for the following assessments: 1) inspiratory, expiratory, and change in lung volume; 2) change in anteroposterior (AP) and transverse (TS) diameter of the chest wall at two levels: carina and apical vertebra level; and 3) change in diaphragmatic heights. RESULTS: Inspiratory, expiratory lung volume and diaphragmatic heights were significantly reduced in the severe scoliosis group (P < 0.05), but the change in lung volume was not affected. There was no significant difference in the change of AP or TS diameter of the chest wall as well as diaphragmatic motions among groups. CONCLUSION: Impairment in lung function in AIS patients is predominantly due to restriction of lung volume.

Adolescent↗
PubMed2006

Degenerative lumbar scoliosis: radiographic correlation of lateral rotatory olisthesis with neural canal dimensions.

STUDY DESIGN: A radiographic review of 78 consecutive patients with degenerative rotatory lumbar scoliosis. OBJECTIVE: To assess the correlation between rotary olisthesis and neural canal dimensions using radiographic indexes and to establish a gradation system of lateral rotatory olisthesis. SUMMARY OF BACKGROUND DATA: Degenerative scoliosis is a three-dimensional deformity often associated with spinal stenosis, although the association is not well defined. METHODS: A total of 78 consecutive patients (average age, 69 years) with de novo degenerative scoliosis (79% lumbar, 21% thoracolumbar; average curve, 25 degrees) were studied with plain radiographs and MRI at presentation. Radiographic measurements included lateral translation, anteroposterior olisthesis, Cobb angle, and intervertebral rotation (Nash-Moe grade difference). Computerized measurements of MRI included dural sac cross-sectional area and anteroposterior diameter, minimum subarticular height, and foramen cross-sectional area bilaterally (convexity and concavity). Measurements were conducted twice on each lumbar level (total, 312) and the average was recorded. RESULTS: Lateral translation 5 mm or less (Grade I) was associated with Nash-Moe change 0 (23%) or I (77%), lateral translation 6-10 mm (Grade II) was coupled with Nash-Moe change 0 (20%) or I (80%) and lateral deviation more than 11 mm (Grade III) was associated with I (76%) or II (24%) Nash-Moe change. Maximum intervertebral rotation tended to be at either L2-L3 (48%) or L3-L4 (39%). Increased lateral translation was associated with increased intervertebral rotation (r = 0.37, P < 0.001). Increased anteroposterior olisthesis was associated with decreased anteroposterior diameter (r = -0.18, P < 0.001) and cross-sectional area (r = -0.11, P < 0.05) of the dural sac. Larger segmental Cobb angles were associated with greater foraminal cross-sectional area in the convexity (r = 0.12, P < 0.05). In the concavity, there was no significant correlation (P > 0.05) between indexes of rotary olisthesis and foraminal area or subarticular height. Cross-sectional foraminal area and subarticular height were significantly larger in the convexity than in the concavity of the scoliotic levels. CONCLUSIONS: In degenerative scoliotic curves, lateral translation is associated with rotation. Increased rotary olisthesis does not lead to decreased dural sac area. Anteroposterior olisthesis is inversely correlated to the dural sac anteroposterior diameter and cross-sectional area. With increased segmental Cobb angle, foraminal cross-sectional area enlarges in the convexity and does not decrease in the concavity. Presence of intervertebral rotation alone does not appear to be associated with reduced neural canal dimensions. Ligamentum flavum hypertrophy, posterior disc bulging, and bony overgrowth are more likely to contribute to stenosis irrespective of scoliosis.

Aged↗
PubMed2006

Electromagnetic topographical technique of curve evaluation for adolescent idiopathic scoliosis.

STUDY DESIGN: Diagnostic testing. OBJECTIVE: The goal of this study is to measure the accuracy and reliability of the Orthoscan (Orthoscan Technologies, Inc.) and to determine whether it can be substituted for radiographs in the surveillance of adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: AIS is usually followed using scoliosis radiographs, which offer the most reliable way to quantify the curve, but carry the risk of exposure to ionizing radiation. The Orthoscan is a nonradiographic topographic method for measuring spinal curves. MATERIALS AND METHODS: There were 5 phases of this study that measured: the accuracy and reliability of the machine when used with a plastic model; the variability with a real patient; the intraobserver variability; the correlation between the measurements of the machine and that of the radiograph; and the correlation between the change in radiograph measurement over time and the change in Orthoscan measurement over time. RESULTS: In measurement of a static plastic model, the machine measured curves with a standard deviation of +/-1 degrees in trunk rotation and +/-2 degrees in curve measurement. Error increased with a real patient. Thirty-six comparisons in the thoracic spine, and 19 comparisons in the lumbar spine, were made between measurements using the Orthoscan and radiographs. Mean curves in the 2 groups were not significantly different and had poor-to-moderate correlation. Longitudinal evaluation included 47 curves in 28 patients. The Orthoscan predicted the radiograph change within an acceptable range 55.3% of the time. CONCLUSIONS: The Orthoscan does not accurately predict the scoliosis curve magnitude or the overall change in curve over time. While analysis in groups of patients using this technique reveals group means that begin to look acceptable, if the variability is too great, then this technology is not yet ready to replace the radiograph in the evaluation of a scoliosis curve.

Adolescent↗
PubMed2006

Repeat surgical interventions following "definitive" instrumentation and fusion for idiopathic scoliosis.

STUDY DESIGN: A retrospective chart review was performed on all idiopathic scoliosis patients treated with instrumented spinal fusion over a 15-year period. OBJECTIVES: To provide an experience from a single institution over a prolonged time period. The goal was to determine the frequency of repeat surgical interventions following the "definitive" spinal fusion surgery and identify the factors responsible for these reoperations. SUMMARY OF BACKGROUND DATA: Instrumented spinal fusion remains the standard of care in the surgical management of idiopathic scoliosis. This surgery is considered a "definitive" procedure where, barring a complication, no additional surgical procedures are planned. Although many studies have reported the frequency of specific complications following spinal fusion, little information currently exists regarding the cumulative average of these repeat surgical interventions that occur following these "definitive" procedures. METHODS: Surgical logs were reviewed on all patients who had an instrumented spinal fusion for idiopathic scoliosis from January 1988 through December 2002. All subsequent surgical interventions on these patients were then identified from the logs through December 2004. Pertinent information was gleaned from surgical logs and patient charts to provide details for these reoperations. RESULTS: A total of 1,046 patients underwent an instrumented spinal fusion for idiopathic scoliosis: 809 had a posterior-only fusion, 228 had an anterior-only fusion, and 9 had a combined anterior/posterior spinal fusion. A total of 172 repeat surgical interventions were performed in 135 patients (12.9%). Of these 135 patients, 29 patients (21.5%) had two or more separate procedures performed. The most common reasons for reoperation were infection, symptomatic implant, and pseudarthrosis. Patients who had posterior fusions had a significantly higher rate of reoperation than patients who had anterior fusions (14.0% vs. 9.3%). Reoperations due to infections and symptomatic implants occurred with significantly higher frequency in the posterior spine fusion group compared with those with anterior spinal fusion. No differences in rates of reoperation for pseudarthrosis were noted between posterior and anterior fusion groups. CONCLUSIONS: Repeat surgical interventions are relatively common following these supposedly definitive surgical procedures. The most common reasons for return to surgery are infection, symptomatic implant, and pseudarthrosis.

Adolescent↗
PubMed2007

The selection of operative versus nonoperative treatment in patients with adult scoliosis.

STUDY DESIGN: Retrospective case-control matched series. OBJECTIVE: The purpose of this study is to define factors that influence the patient and surgeon in the selection of surgical versus nonsurgical treatment for adult scoliosis. SUMMARY OF BACKGROUND DATA: There is no literature that specifically examines why adult scoliosis patients and/or their surgeons choose surgical versus nonsurgical treatment. METHODS: This study analyzes a prospective multicentered database for adult spinal deformity. A logistic regression technique was used to perform case-control matching. A total of 161 matched pairs were compared for radiographic characteristics, questionnaire responses, and standardized outcome measures. RESULTS: Nonsurgical patients had greater preoperative medical risk factors. Surgical patients had larger thoracic (51 degrees vs. 44 degrees, P = 0.006) and thoracolumbar/lumbar curves (55 degrees vs. 43 degrees, P = 0.000). Surgical patients had more frequent leg pain (47% vs. 35%, P = 0.04). They reported a higher mean level of daily back pain (P = 0.008) and more frequent moderate-to-severe back pain over the past 6 months (P = 0.03). There were also significant differences in perception of appearance and social function between the cohorts. CONCLUSIONS: This study emphasizes the complexity of surgical decision making for adult scoliosis patients. It also underscores the importance of patient-based health status measures in evaluating the adult scoliosis patient.

Adolescent↗
PubMed2005

The vertical expandable prosthetic titanium rib implant for the treatment of thoracic insufficiency syndrome associated with congenital and neuromuscular scoliosis in young children.

Expansion thoracoplasty and vertical expandable prosthetic titanium rib (VEPTR; Synthes Spine Co., West Chester, Pennsylvania, USA) implantation is a new method for the treatment of thoracic insufficiency syndrome and congenital spinal deformity in children. The longitudinal rib implant expands the thorax and indirectly corrects spinal deformity, thus allowing spinal, thoracic and probably lung growth. VEPTR has been used since 1989 in San Antonio, USA, and was introduced to Europe in 2002. This paper describes the preliminary experience with the European patients. Fifteen children with progressive scoliosis had a VEPTR implantation at a mean age of 6 years (11 months to 12 years). Nine children had thoracic insufficiency syndrome due to unilateral unsegmented bars (n = 4), absent ribs (n = 1), hemivertebrae (n = 2) or bilateral fused ribs (n = 2). Six children had severe thoracolumbar scoliosis and pelvic obliquity due to neuromuscular scoliosis. After VEPTR implantation, families and patients reported improvement of the thoracic insufficiency syndrome and better sitting abilities in the neuromuscular patients, as well as radical cosmetic improvement. There were three complications (skin breakage, lumbar hook displacement, rib fracture) after performing fifteen primary VEPTR implantations and 13 expansion surgeries in eight patients. Our experience suggests that expansion thoracoplasty and VEPTR implantation is a safe and efficient method for the treatment of thoracic insufficiency syndrome in young children with severe scoliosis.

Child↗