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PubMed2005

Growth and progression of adolescent idiopathic scoliosis in girls.

The progression velocity of scoliosis was studied for 535 consecutive girls with untreated adolescent idiopathic scoliosis. At the first visit the mean age of the patients was 13.9 years (range 9-19 years), the mean magnitude of the major curves was 23.4 degrees (range 5-60 degrees), and that of the minor curves 16.4 degrees (range 0-49 degrees). The median follow-up time was 1.1 years (mean 1.4, range 0.5-6.3 years). The right thoracic curves were most progressive. In the major left thoracic and left lumbar curve types, initial minor curves progressed faster than major curves. The scoliosis progressed faster in patients with minor thoracic kyphosis. In these patients major right thoracic curves were more common. The progression of scoliosis was clearly dependent on the growth velocity, also, the greater the curve at the first visit, the greater was the progression. The progression was most notable with a growth velocity of >or=2 cm/year, at ages between 9 and 13 years, bone ages between 9 and 14 years, Risser signs 0-1, and between 0.5-2 years before menarche.

Adolescent↗

PubMed1982

An evaluation of brainstem function as a prognostication of early idiopathic scoliosis.

In an attempt to elucidate whether assessment of the brainstem function helps to predict the outcome of early idiopathic scoliosis, a series of neurophysiological studies in children with idiopathic scoliosis was made cooperatively in Japan and the United States. The eye movement in 86 cases with idiopathic scoliosis in the rapidly growing ages was tested and compared with 66 normal control children. About one-half of the patients with idiopathic scoliosis demonstrated dysfunction in the brainstem test. The natural histories of the curves were available in 48 of the 86 cases in a follow-up study ranging from 6 months to 2 1/2 years. Statistically, there was a positive correlation between the brainstem dysfunction and the curve progression. It was concluded that the functional assessment of the brain center of the postural regulation system can be used in predicting the outcome of idiopathic early curves detected in the school screening program.

Adolescent↗

PubMed1983

The technique of scoliosis revision surgery utilizing L-rod instrumentation.

Operative treatment of failed scoliosis surgery requires an instrumentation that is readily adaptable to the multiple causes and sequelae of failed spinal surgery. A "modified L-rod" technique is described for segmental spinal instrumentation to treat failed scoliosis surgery. Nine patients underwent 10 scoliosis revision operations, with an average follow-up of 37.1 months. Three neuromuscular, five idiopathic, and one congenital scoliosis were revised. The average blood loss for the L-rod instrumentation was 2,960 ml, and the average operative time was 6.2 h. Four patients had attempted correction of their deformities, with 21.2% improvement. Five cases had triangular base-transverse bar pelvic fixation. None of the 10 revisions had pseudarthrosis at follow-up. No postoperative immobilization was used. Complications included one fracture of a fusion mass below the L-rods, penetration of the skin by a prominent wire with subsequent infection, minimal loss of correction in one case, and one broken wire without loss of correction.

Adolescent↗

PubMed1984

Development of trunk asymmetries and structural scoliosis in prepuberal school children in Malmö: follow-up study of children 10-14 years of age.

Trunk asymmetries were diagnosed at the age of 10 in school children (2,200 cases) in Malmö. A combined clinical-moiré screening program was used. Twenty-five percent of the girls and 19% of the boys had a positive forward bending test. A positive moiré asymmetry was seen in 13% of the girls and in 11% of the boys. More extreme moiré asymmetries were seen in 0.8% of the girls and 0.6% of the boys. All of these cases were roentgenographed and the mean Cobb angle was 14 degrees. Moiré asymmetries of one moiré fringe or more were defined as a risk group and were followed up annually until the age of 14 years by means of moiré photography. During the following 3 years, the moiré asymmetry increased markedly in 14 girls and four boys. Five of these 32 roentgenographed cases had progressive scoliosis needing brace treatment. All cases referred to as symmetric trunks at the age of 10 were also reexamined annually. In no case did the scoliosis exceed 15 degrees. This implies that adolescents with scoliosis severe enough to need treatment always had a visible trunk asymmetry at the age of 10. Consequently, progressive idiopathic scoliosis requiring some type of treatment during adolescence can be found in this risk group at the age of 10 years.

Adolescent↗

PubMed1984

A study of postural equilibrium in idiopathic scoliosis.

The relationship between upright static and dynamic equilibrium function and idiopathic scoliosis was investigated using a seven-part postural equilibrium test battery. Twenty-three normal subjects and 31 subjects with differing degrees of idiopathic scoliosis participated in the study. No significant difference was found among any of the subtest scores of the normal and scoliotic groups. Subtest scores were not significantly correlated with curve measurements. Curve measurements and subjects' ages proved to have some effect on subtest scores, but other unknown factors accounted for a greater percentage of score variance. The existence of a clinically measurable deficit in upright static and dynamic equilibrium in idiopathic scoliosis could not be proven. Further investigation is suggested to identify the factors that affect equilibrium scores. If these factors could be identified, the test battery might serve as a tool for the examination of female patients with idiopathic scoliosis.

Adolescent↗

PubMedDate not supplied

Syringomyelia and developmental scoliosis.

We attempted to characterize the signs and symptoms of patients presenting with scoliosis as a manifestation of occult syringomyelia, and to determine the effect of syrinx decompression on the deformity and neurologic deficits. This study represented 21 patients treated from 1981 through 1991 at the authors' institution. All patients with occult syringomyelia and no other central nervous system lesions underwent decompression of the syrinx, with improvement in neurologic signs and symptoms. Three of the four with scoliosis that were not treated by arthrodesis showed improvement of their deformity at an average follow-up of 35 months. Three of five patients with myelodysplasia, occult syringomyelia, and scoliosis not previously treated with spinal arthrodesis showed stabilization or improvement of their deformity at an average follow-up of 21 months. We conclude that syringomyelia is associated with a high incidence of developmental scoliosis, and that decompression of the syrinx leads to improvement in, or stabilization of, the majority of scoliotic curves, or postpones the need for fusion.

Adolescent↗

PubMed2004

Prednisolone therapy in Duchenne muscular dystrophy prolongs ambulation and prevents scoliosis.

Steroids may have a beneficial effect on the course of Duchenne muscular dystrophy (DMD). However, results vary in different studies. This study consisted of 66 DMD boys who were in the therapy group and 22 DMD boys in the control group. The mean ages were 6.8 +/- 2.1 years (range 2.5-12.5) and 7.0 +/- 1.3 years (range 5.0-9.0), respectively. We assessed muscle strength, 10-m walking, ankle contracture, and loss of independent walking ability age and onset of scoliosis. Treatment regimen was oral prednisolone 0.75 mg/kg on alternate days, plus vitamin D 600-1200 units/day and a calcium-enriched diet. After a follow-up period of 2.75 +/- 1.1 years (range 1.5-5) and when compared with controls, there was a statistically significant change in muscle strength between the two groups after 12 months (P < 0.05). Although 10-m walking time decreased in therapy group (P < 0.05), there was not significance between the groups in the end. Boys in the control group developed significantly less ankle contractures (P < 0.05). None of the therapy group had scoliosis during the follow-up period (mean age 10.8 +/- 1.2 years), whereas seven boys of the control group had scoliosis at a mean age of 11.7 +/- 2 years. Loss of walking ability age was statistically different between groups (P < 0.05). Our results indicate that, alternate-day prednisolone regimen may prolong ambulation and scoliosis can be delayed or prevented.

Adolescent↗

PubMed1992

The myelodysplastic hip and scoliosis.

To investigate the relationship between unilateral hip dislocation or subluxation and scoliosis, the records were examined of 31 patients aged 10 to 26 years with myelomeningocele and an initial neurosegmental level of L3 or L4. 11 patients had deteriorated neurologically over time; the remainder had stable neurological examinations, with an average follow-up of 14.3 years. Scoliosis occurred in three of the nine patients with unilateral hip instability, compared with five of the 11 remaining patients. Only two patients had the expected pattern of unilateral hip instability on the high side of an oblique pelvis, with scoliosis convex to the opposite (low) side. Several unexpected patterns were observed. The functional neurosegmental level is not stable in many patients with myelodysplasia. In neurologically stable patients, unilateral hip instability and scoliosis are comorbid factors and no causal relationship was identified.

Adolescent↗

PubMed1992

The influence of scoliosis brace treatment on function in children with myelomeningocele.

The influence of Boston brace treatment on the functional and motor ability of children with scoliosis secondary to myelomeningocele was studied in a consecutive series of 20 children of 5-19 years of age. Motor activity, ADL function and ambulation ability were assessed before brace treatment and then annually during the treatment period, which lasted an average of 2.7 years (range 0.6-8.7 years). Thirteen children were followed-up one year after braces were removed. The effect of brace treatment on the scoliosis was favourable as is reported elsewhere. The children's motor activity and ADL function remained unchanged during brace treatment, but brace wearing was accompanied by a decreased ambulatory skill. This may partly be explained by a slight increase of flexion contractures of the hips during treatment. Patients with useful ambulation ability kept this ability up even during brace treatment. Considering the favourable effect of brace treatment on the scoliosis curve and the few complications encountered, we recommend brace treatment for scoliosis in patients with myelomeningocele.

Activities of Daily Living↗

PubMed1977

Kepone-induced scoliosis and its histological consequences in fish.

Scoliosis in fish is caused by several diverse agents that possibly act on the central nervous system, neuromuscular junctions, or ionic metabolism. The organochlorine pesticide Kepone induces scoliosis in the sheepshead minnow. Some effects associated with Kepone-induced scoliosis in these fish are disruption of myotomal patterns, inter- and intramuscular hemorrhage, fractured centra of vertebrae, and death. The histological syndrome of Kepone poisoning in fish and the clinical syndrome in humans suggest that the nervous system is a primary target for Kepone and that scoliosis is a secondary effect of Kepone poisoning in fish.

Animals↗

PubMed2006

Horizontal gaze palsy with progressive scoliosis can result from compound heterozygous mutations in ROBO3.

BACKGROUND: Horizontal gaze palsy with progressive scoliosis (HGPPS) is an autosomal recessive disorder characterised by congenital absence of horizontal gaze, progressive scoliosis, and failure of the corticospinal and somatosensory axon tracts to decussate in the medulla. We previously reported that HGPPS patients from consanguineous pedigrees harbour homozygous mutations in the axon guidance molecule ROBO3. METHODS: We now report two sporadic HGPPS children of non-consanguineous parents who harbour compound heterozygous mutations in ROBO3. The mother of one of the children also had scoliosis DNA was extracted from a blood sample from each participant using a standard protocol, and the coding exons of ROBO3 were amplified and sequenced as previously described. RESULTS: Each patient harboured two unique heterozygous mutations in ROBO3, having inherited one mutation from each parent. CONCLUSIONS: HGPPS can result from compound heterozygous mutations. More comprehensive examinations of parents and siblings of HGPPS patients are required to determine if the incidence of scoliosis in individuals harbouring heterozygous ROBO3 mutations is greater than in the general population.

Child↗

PubMed1980

Scoliosis secondary to fractures of the transverse processes of lumbar vertebrae.

Fractures of the transverse processes of the lumbar vertebrae may be difficult to identify radiographically because they are often obscured by gas and feces. With unilateral fractures, there is often scoliosis convex to the side of the fractures. We propose that this may be due to the ineffective action of the ipsilateral quadratus lumborum muscle which inserts into the transverse processes. The unopposed action of the contralateral quadratus lumborum results in scoliosis convex to the side of the fracture(s). Awareness of this cause of scoliosis can help in differentiating it from scoliosis caused by other painful abdominal processes, and may aid in recognition of the fracture(s).

Adolescent↗

PubMed1997

Clenbuterol, a beta2-adrenoceptor agonist, reduces scoliosis due to partial transection of rat spinal cord.

Injury to the spinal cord often results in abnormal lateral curvature of the spine, or scoliosis, that is associated with neuromuscular weakness. The lateral curvature of the spine is thought to be a consequence of insufficient or asymmetrical loading of the vertebrae. To study neuromuscular scoliosis, an animal model of spinal cord injury was used in which the spinal cord was partially (3/4) transected, with the left lateral columns left intact. Partial transection of the spinal cord in the rat caused scoliosis that was maximal four to five vertebrae distal to the lesion site. As in previous experiments involving unilateral spinal cord lesions, the scoliotic curves were convex on the weakened side. Subtotal transection at T5 or T11 resulted in lateral displacement of vertebrae T9-T12 or L2-L5, respectively, of up to 11 mm. Interestingly, this vertebral displacement is greatly reduced by clenbuterol, a beta2-adrenoceptor agonist that has been found to retard loss of muscle contractility and bone mineralization due to denervation. Together these results suggest that stimulation of beta2-receptors opposes vertebral unloading due to neuromuscular weakness and thereby acts as a countermeasure to scoliosis.

Adrenergic beta-Agonists↗

PubMed2006

[Early postoperative complications of thoracoscopy versus thoracotomy in pediatric idiopathic scoliosis].

INTRODUCTION: Thoracoscopic surgery has been used for anterior release, discectomy, and fusion in severe scoliosis or kyphosis. The indications of thoracoscopy for the treatment of pediatric spinal deformity are similar to those of thoracotomy-based spinal surgery. OBJECTIVE: We designed a comparative study to observe the immediate complications in the postoperative period after thoracoscopy or thoracotomy for scoliosis in the pediatric population. MATERIAL AND METHODS: The postsurgical complications of 63 interventions for idiopathic scoliosis over a 10-year period were analyzed. Conventional thoracotomy was used in 37 interventions (59 %) and thoracoscopy was used in 26 (41 %). RESULTS: In patients treated with the thoracolumbar endoscopic procedure, oral nutrition was resumed earlier, the mean length of hospital stay was lower, and debit drainage or requirement of surgical drainage were lower. CONCLUSIONS: Fewer immediate postsurgical complications were observed in scoliosis surgery when thoracoscopy was used.

Adolescent↗

PubMedDate not supplied

Tethered cord as a cause of scoliosis in children with a myelomeningocele.

Scoliosis interferes significantly with the functional ability of most children with a myelomeningocele. While it is recognized that tethered cord at the repair site causes neurological deterioration, it has been controversial whether tethered cord causes scoliosis. The spinal cord was untethered in 30 children with progressive loss of function and scoliosis. Of 6 children with curves greater than 50 degrees only 1 improved. Of the other 24 children their curves were stable or improved at 1 year follow-up. At late follow-up, 2-7 years, 63% were stable or improved while 38% began to progress. Tethered cord causes scoliosis and stability or improvement can be anticipated following untethering. Close long-term follow-up is essential to identify those individuals with retethering of their cord.

Adolescent↗

PubMed1992

Cardiorespiratory function in surgically treated thoracic scoliosis with respect to degree and apex of scoliotic curve.

We studied the relationship of deterioration of cardiorespiratory function with respect to degree and localisation of apex of spinal curvature. The study comprised 33 patients (27 females and 6 males) aged 15 (11-21) years, surgically treated for an average scoliotic angle of 72 degrees (55-129 degrees, after Cobb) which was postoperatively reduced to 32.6 degrees (13-74 degrees). The static and dynamic cardiorespiratory function parameters were tested (pre-operatively and 24 months after surgery) by spirometry and plethysmography, arterial blood gas analysis, and the exercise tolerance test. In terms of the site and apex of the thoracic curve as determined by spine X-ray, patients were divided into two groups: upper thoracic scoliosis with the apex between T5 and T8 and lower thoracic scoliosis with the apex between T9 and T11. Only upper thoracic scoliosis with Cobb angle of more than 70 degrees correlated (r = -1) with restrictive ventilation disorder (vital capacity 68%) and latent hypoxaemia (uptake O2 ml/kg/min 63%) demonstrated during the exercise tolerance test (p > 0.05). The results of the test have demonstrated that surgically obtained 54% correction of the scoliotic curve improves pulmonary function (p < 0.05). However, the improvement does not match the degree of achieved scoliotic curve correction, what means that even in surgically treated high-angled thoracic scoliosis exists an increased risk of morbidity and mortality.

Adolescent↗

PubMed1991

Pectus excavatum and scoliosis. Thoracic anomalies associated with pulmonary disease caused by Mycobacterium avium complex.

We studied the frequency of pectus excavatum or otherwise abnormally narrowed anterior-posterior thoracic dimension and of thoracic scoliosis among consecutive series of 67 patients with pulmonary disease due to Mycobacterium avium complex and 55 patients with pulmonary Mycobacterium tuberculosis. Among those with M. avium, pectus excavatum and abnormal narrowing was present in 27% and scoliosis was seen in 52%; overall, 47 of the 67 (70%) had one or both of these anomalies. By comparison, of those with M. tuberculosis only 5% had pectus excavatum or abnormal narrowing, only 13% had scoliosis; and none had both. The prevalence of pectus excavatum and abnormal narrowing among female M. avium complex patients was significantly greater than among female tuberculosis patients (p = 0.05) or in the general population (p less than 0.001). Among male M. avium complex patients, pectus excavatum and abnormal narrowing was significantly more common than in the general population (p less than 0.001) but not significantly different than among male tuberculosis patients (p = 0.264). For all M. avium complex versus all M. tuberculosis patients the prevalence of pectus excavatum abnormal narrowing was significantly greater (p = 0.013). Scoliosis was significantly more common among all M. avium complex patients than among M. tuberculosis patients or the general population. We believe that these anomalies, which are associated with a variety of heritable connective disorders, are phenotypic markers of patients who are at increased risk for pulmonary disease due to environmental mycobacteria, such as M. avium complex.

Adult↗

PubMed1982

Diffusing capacity in idiopathic scoliosis and its interpretation regarding alveolar development.

We measured lung volumes, diffusing capacity by the single breath method (DL), membrane permeability (DM), and capillary blood volume (Vc) in 22 subjects with idiopathic scoliosis (mean angle of curvature, 66 degrees). Compared with an age-matched group, vital capacity, total lung capacity, and functional residual capacity were respectively, 21% (p less than 0.0001), 18% (p less than 0.01), and 15% (p less than 0.05) lower. The DL was 17% lower (p less than 0.01), but specific DL (DL divided by alveolar volume = DLVA) was the same. For both groups, DLVA was inversely correlated with VA. The same qualitative relationship existed between DM, Vc, their specific values, and VA except for a larger spread of Vc in the scoliotic group. The data show that DL and its components, DM and Vc, are normal in idiopathic scoliosis when reduced lung volumes are allowed for. These findings are consistent with partial failure of alveolar enlargement as a result of the thoracic deformity rather than any atrophy of the alveoli or pulmonary vasculature. Thus scoliosis results in a delay of lung development, such that in a group of symptomatic patients with moderate degrees of deformity (mean angle of curvature, 66 degrees), lung volumes and DL are about 80% of that of an age-matched control group; the alveolar characteristics of a 12-yr-old with scoliosis are therefore similar to those of a 9-yr-old normal child.

Adolescent↗