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At least 865 records · Page 48Linked to original sources
PubMed1999

[Somatosensory evoked potentials during surgery of scoliosis: significance of epidural recording].

PURPOSE OF THE STUDY: To evaluate the usefulness of the epidural recording in scoliosis surgery in children or young adults. MATERIAL AND METHOD: We used somatosensory-evoked potentials in 60 children or young adults in surgical treatment of scoliosis. Somatosensory-evoked potentials were elicited and recorded using a standard method recording of cortical P40 and subcortical P27, simultaneously with the monitoring of spinal cord function using epidural electrode to record the ascending somatosensory volley (by tibial nerve stimulation) at a high thoracic level. RESULTS: The use of subcortical and epidural recording sites for the somatosensory-evoked potentials indicated that a reliable response could be obtained in 96 p. 100 of the patients. Cortical somatosensory-evoked demonstrated a 48 p. 100 false positive rate. DISCUSSION: Epidural recording in scoliosis surgery is safe and reliable. Combined subcortical and epidural recordings are especially useful in patients with neuromuscular scoliosis or with cerebral palsy that may not have reliable cortical potentials.

Adolescent↗
PubMed1999

Anterior surgery with short fusion using the Zielke procedure for thoracic scoliosis: focus on the correction of compensatory curves.

Anterior instrumentation is recommended to correct idiopathic thoracolumbar or lumbar scoliosis through short fusion within the major curve. Only a few reports exist of anterior surgical correction for thoracic scoliosis. This study assessed the results of Zielke instrumentation for thoracic curve and analyzed the three-dimensional correction of deformity, especially correction of the uninstrumented compensatory curve. Seventeen patients, who had undergone selective thoracic correction and fusion using the Zielke procedure to treat thoracic scoliosis, had been followed for at least 3 years. Three-dimensional correction was evaluated radiographically. Furthermore, three-dimensional back deformities were evaluated using a topographic body scanner. Twelve patients with a single thoracic curve and five with a double curve were all female, with a mean age of 14.6 years. The preoperative main thoracic curve was 54.8 degrees +/- 10.5 degrees (range, 40-78 degrees), and it was 23.8 degrees +/- 10.5 degrees (range, 7-40 degrees) at the final follow-up examination (p < 0.0001). The average correction rate of the main curves was 56.6%. By correcting the thoracic curve, the upper and lower compensatory curves were corrected spontaneously without surgical instrumentation, with average correction rates of 45.1% and 50.2%, respectively. The average correction loss of the main curve was 2.3 degrees. The hump angle measured using a topographic body scanner decreased from 12.8 degrees +/- 4.5 degrees to 8.4 degrees +/- 4.3 degrees after surgery (p = 0.0001). Of the three patients in whom the rod broke up, only one showed a correction loss of 10 degrees; however, bony fusion was obtained. Anterior short fusion for thoracic scoliosis appears to offer significant correction, stabilization, and spontaneous correction of the compensatory lumbar curve without limiting lumbar motion.

Adolescent↗
PubMedDate not supplied

Peak height velocity as a maturity indicator for males with idiopathic scoliosis.

We retrospectively studied 43 adolescent boys treated with orthoses for idiopathic scoliosis to assess the usefulness of the timing of peak height velocity for predicting growth remaining and the likelihood of curve progression when compared with Risser sign, closure of the triradiate cartilage, and chronologic age. We compared the peak height velocity data in boys to our previous work for girls with adolescent idiopathic scoliosis. We found the median height velocity plots showed a similar high peak and sharp decline as is found in girls. All 13 patients with a curve magnitude > 30 degrees at the time of peak height velocity had progression of their scoliosis to > 45 degrees despite bracing. Four of 29 patients (14%) with curves < or = 30 degrees at peak height velocity progressed to 45 degrees. These values generate a sensitivity of 76%, specificity of 100% and accuracy of 91% in predicting progression to 45 degrees. Similar values have been found in female patients. The use of peak height velocity to predict the length of time for remaining growth was superior to Risser sign and chronologic age for boys with idiopathic scoliosis. Closure of the triradiate cartilage approximated the timing of peak height velocity in boys.

Adolescent↗
PubMed1999

Fusion of spine in children scoliosis with frozen & radiation--sterilized bone allograft.

102 children have been treated at the Institute of Traumatology, Orthopaedics & Neurosurgery a result of scoliosis. In all of these multi-step treatment has been applied. Initially a telescopic rod was implanted into the spine. Allografts were introduced around the rod hook, after 6 or 8 months, when angle of scoliosis increased, the rod was exchanged for a longer one. The final step was performed when conditions permitted and the scoliosis was markedly corrected and the fusion of the spine with the solid allograft was accomplished. The result of treatment was evaluated 1 to 7 years after surgery. Bone allografts were rebuilt within 6 month. Correction of scoliosis of 50% to 70% was achieved in all cases.

Adolescent↗
PubMedDate not supplied

An inquiry into chiropractors' intention to treat adolescent idiopathic scoliosis: a telephone survey.

BACKGROUND: The primary aim of this study was to (1) determine the clinical management approach of practicing chiropractors with regard to patients with adolescent idiopathic scoliosis and (2) measure the response rate of a telephone survey. METHODS: A survey instrument was developed and pretested, and a case-specific clinical vignette was generated for a hypothetical typical 12-year-old girl with adolescent idiopathic scoliosis. The instrument addressed 3 domains: the specific management of idiopathic scoliosis, elements guiding the general selection of treatment recommendations, and demographics of respondents. The sample frame consisted of 62,000 US chiropractors, of whom 165 were randomly selected for the survey sample. Interviews were conducted by telephone through use of the tested survey instrument. RESULTS: The response rate was 69% (114/165). Of the 51 nonrespondents, 15 did not have a listed business telephone number and 24 were not in active practice. The response rate of those who met the inclusion criteria (practicing chiropractor with a listed telephone number) was 90% (114/126). The gender, chiropractic college, and years in practice of respondents in this survey were similar to those of respondents in 3 other national surveys. In general, the respondents would provide 6 months of "intensive" chiropractic therapy, then follow the patient for 4 years (near skeletal maturity). Eighty-two percent of respondents named diversified technique as their primary adjustive treatment, 87% would use exercise, and 30% would use electric muscle stimulation as an adjunct to manual therapy. CONCLUSION: Most surveyed chiropractors would use similar methods (frequency and length of treatment, manipulation technique, and exercise) in the treatment of patients with adolescent idiopathic scoliosis. A high response rate to a national survey can be achieved through use of telephone contact.

Adolescent↗
PubMed1975

[Progression of untreated idiopathic scoliosis up to the end of growth].

110 patients with idiopathic scoliosis are reported on, who had no treatment for 2 years or more before growth stopped. Another 36 patients untreated for 1 year could be observed. The changes in the scoliotic angle were followed up radiologically and entered into a diagram. The average progression of these scolioses during one year were calculated. Progression was always most pronounced between the 10th and 15th year and coincided with the prepubertal increase in growth. This has to be expected 2 years later in boys than in girls. The degree of progression definitely depended on the site of the primary curve. Thoracic and S scoliosis showed most pronounced progression, followed by thoracolumbar and lumbar scoliosis. Progression was worse the earlier scoliosis was diagnosed.

Adolescent↗
PubMed2001

The natural history of scoliosis: curve progression of untreated curves of different aetiology, with early (mean 2 year) follow up in surgically treated curves.

We studied the curve progression of untreated curves presenting to the Scoliosis Service of Hospital Kuala Lumpur. One hundred and fifty-two (152) patients were included in this study. The median rate of curve progression of idiopathic scoliosis curves was 7.03 degrees per year, for neuromuscular scoliosis curves was 17.39 degrees per year; and congenital scoliosis curves were 3.67 degrees per year. These rates are similar to the reported rates in the literature. Data for sixty-one (61) surgically treated patients were reviewed to determine the early curve correction of the curves of different aetiology. The mean age of surgery was 14.15 years old, the mean preoperative curve size was 71.61 degrees; and the mean postoperative curve size was 43.78 degrees. The mean duration of follow up after surgery was 2.44 years. The revision and removal of instrumentation rate was 8.3%.

Adolescent↗
PubMedDate not supplied

Posterior ISOLA segmental spinal system in the treatment of scoliosis.

The aim of the current study was to evaluate the effectiveness and safety profile of the posterior ISOLA Segmental Spinal System in the treatment of scoliosis. Forty-one patients (31 girls, 10 boys) were reviewed retrospectively. The average age was 14.2 years and the mean follow-up was 24 months. There were 32 cases of idiopathic scoliosis, 5 cases of neuromuscular scoliosis, and 4 miscellaneous types. An average of 12.3 levels were fused posteriorly. The average preoperative Cobb's angle, apical vertebral rotation, apical vertebral translation, lumbar lordosis, and thoracic kyphosis were 65.9 degrees, 2.2, 47.8 mm, 40 degrees, and 28 degrees, respectively. The corresponding postoperative data were 34.4 degrees (47.8% correction), 1.8, 23.1 mm, 40.2 degrees, and 26.7 degrees. There were five minor complications and one deep wound infection. The ISOLA Segmental Spinal System was an effective and safe posterior system that could be used in different types and patterns of scoliosis with low complication rates.

Adolescent↗
PubMed2002

Adolescent idiopathic scoliosis: radiologic decision-making.

Adolescent onset of severe idiopathic scoliosis has traditionally been evaluated using standing posteroanterior radiographs of the full spine to assess lateral curvature with the Cobb method. The most tilted vertebral bodies above and below the apex of the spinal curve are used to create intersecting lines that give the curve degree. This definition is controversial, and patients do not exhibit clinically significant respiratory symptoms with idiopathic scoliosis until their curves are 60 to 100 degrees. There is no difference in the prevalence of back pain or mortality between patients with untreated adolescent idiopathic scoliosis and the general population. Therefore, many patients referred to physicians for evaluation of scoliosis do not need radiographic evaluation, back examinations, or treatment. Consensus recommendations for population screening, evaluation, and treatment of this disorder by medical organizations vary widely. Recent studies cast doubt on the clinical value of school-based screening programs.

Adolescent↗
PubMed1975

[Progress of untreated scoliosis following poliomyelitis up to the end of the growth-period (author's transl)].

Further to an earlier paper on progression of untreated idiopathic scoliosis 37 patients with scoliosis following poliomyelitis are reported on. 16 of them could be observed for 2 years or more having had no treatment. Their progression is clearly more extensive than that of idiopathic scoliosis. But like them it is at a peak during the prepubertal spurt of growth. It also is more obvious the earlier it is recognized. The prognosis of post-poliomyelitic scoliosis is particularly bad when it starts shortly after onset of the paralysis.

Adolescent↗
PubMed2002

Impact of early surgical correction of curves in paralytic scoliosis.

OBJECTIVE: The purpose of this investigation was to investigate the advantages of early surgery in patients suffering from neuromuscular scoliosis. METHODS: Between January 1992 and January 1998, 20 patients with paralytic scoliosis, with an average age of 15 years, were treated surgically in the Department of Orthopedic Surgery, University Hospital, Feiburg, Germany. The parameter investigations included correction of the scoliosis independent of preoperative curves, operation time independent of Cobb angles, complications and blood loss. Surgery included a dorsal semi rigid instrumentation with pedicle screws in the lumbo-sacral region and sublaminar wiring in the thoracic area. RESULTS: The preoperative scoliotic curve measured 73.1 degrees, the postoperative curve 24.5 degrees, the mean correction was 66.4%. The thoracic kyphosis could be corrected from 13.9-25.7 degrees. The operation time was longer and the correction was less if high Cobb angles were found preoperatively. Two wound infections were observed. Rod breakage following a pseudarthrosis occurred in one patient, a refusion was necessary. CONCLUSION: Cobb angles alone should not be the standard to indicate surgery in neuromuscular scoliosis. If a decreased functional ability, pelvic obliquity or trunk decompensation with reduced vital capacity are found, surgery is more dangerous while the obtained correction is less. Therefore, we recommend early surgery.

Adolescent↗
PubMed2002

[Scoliosis and congenital diaphragmatic agenesis].

PURPOSE OF THE STUDY: Diaphragmatic agenesis is the most extreme anatomic form of congenital diaphragmatic defects. Clinically this pathology is not different from posterolateral diaphragmatic hernia described by Bochdalek. We describe our observations of scoliosis in 16 neonates with diaphragmatic agenesis. MATERIAL AND METHODS: Between 1987 and 1996, 69 neonates underwent surgery for a congenital diaphragmatic hernia (CDH) at our institution. Sixteen of these patients had the most extreme form of CDH. Ten of these 16 patients survived. Spinal and/or chest wall deformities were observed in nine patients, including isolated scoliosis in two patients, scoliosis associated with a chest wall deformity in three, and isolated chest wall deformity (pectus excavatum or pectus carnium) in four. These deformities developed between 13 months and three and a half years of age (mean: two years). RESULTS: For two patients the deformity was mild (Cobb angle<15 degrees ) and required only observation. A Milwaukee brace was used in three patients that had severe kyphoscoliosis. Isolated chest wall deformities were treated with observation. No patient required operative treatment for these skeletal deformities. DISCUSSION: The preliminary results of this study indicate that chest wall deformities and scoliosis frequently occur during surgery for diaphragmatic agenesis. Nonoperative treatment is usually sufficient, however, follow-up of these patients until adulthood is recommended.

Abnormalities, Multiple↗
PubMed2003

[Surgical treatment of degenerative scoliosis].

OBJECTIVES: To investigate the techniques of posterior lumbar interbody fusion and pedicle screws in the treatment of degenerative scoliosis and evaluate their clinical significance. METHODS: Twenty five patients with degenerative scoliosis were treated operatively during 1997 - 2002. Among the 25 patients, 13 patients were treated with Brantigan I/F carbon cages in 28 intervertebral spaces, 7 patients were treated with Prospace cages in 15 spaces, 1 patient was treated with CONTACT cages in 2 spaces. The correcting effects, complications and follow-up results were analyzed retrospectively. RESULTS: The average correction rate of scoliosis was 59% and the rate of pain relief was 88%. There was a case of pseudoarthritis and a case of embolism. During follow-up, correction rate and height of disc spaces were not lost nor shift of interbody cages. CONCLUSION: Posterior pedicle screws combined with interbody fusion is a safe and effective treatment for degenerative scoliosis.

Adult↗
PubMed2001

Three-dimensional correction of scoliosis using TSRH instrumentation.

OBJECTIVE: To evaluate the results of TSRH instrumentation in the correction of coronal, sagittal and rotational deformity of scoliosis. METHODS: From January 1998 to December 1999, thirty-two consecutive patients (6 males, 26 females)with scoliosis underwent anterior or posterior spinal instrumentation and fusion using TSRH instrumentation. Of these cases, 21 were idiopathic scoliosis and 11 were congenital scoliosis. The average age at surgery was 16.4 years (range, 11 approximately 45 years). The mean Cobb angle at surgery was 71.2 degrees range, 44 degrees approximately 125 degrees) in the coronal plane, and 49. degrees range, 16 degrees aprroximately 67degrees in the sagittal plane. Rotational deformity (Nash-Moe) ranged from I to III degree. Preoperative apical translation averaged 4.8 cm (range, 3 approximately 9 cm). RESULTS: The average follow-up duration was 13.3 months (range, 10 approximately 24 months). At the final follow-up, the mean Cobb angle in the coronal plane was 26.6 (range, 10 degrees approximately 73 degrees), with a 63.8% of improvement. Sagittal alignment was well maintained with a mean Cobb angle of 28 degrees (range, 10 degrees approximatelky 45 degrees). The average correction of rotation of the apical vertebra was I degree. The average apical translation was 1.6 cm (range, 0.5 approximately 5.0 cm) representing a correction rate of 66, 7%. Complication was noted in two cases with an incidence of 3.1%, one case had superficial infection and the other one had lower hook dislocation. There was no neurologic deficit and pseudoarthrodesis in this series. CONCLUSION: TSRH instrumentation is an effective and convenient three-dimensional correction system with a lower rate of complication, which can not only correct the coronal and rotational deformity, but maintain the sagittal alignment as well.

Adolescent↗
PubMed2003

Anterior spinal fusion with TSRH instrumentation for scoliosis.

OBJECTIVE: To introduce a new spinal internal fixation system, Texas Scottish Rite Hospital (TSRH), and to investigate its early clinical outcomes. METHODS: The preliminary clinical outcomes of 15 patients with thoracolumbar or lumbar scoliosis treated by anterior spinal fusion with TSRH instrumentation were studied retrospectively. Fourteen patients were diagnosed as idiopathic scoliosis and 1 as neuromuscular scoliosis. RESULTS: Preoperatively, the Cobb's angle on the coronal plane was 55.8 degrees (range 35 degrees to approximately 78 degrees), and 14 degrees postoperatively, with an average correction of 74.8%. The average unfused thoracical curve was 35.9 degrees preoperatively (range 26 degrees to approximately 51 degrees) and 21.8 degrees (10 degrees to approximately 42 degrees) postoperatively, with 40% correction. The sagittal curve of lumbar was kept physiologically, preoperative 27.9 degrees and postoperative 25.7 degrees respectively. The trunk shift was 13.4 mm (5 to approximately 28 mm) preoperatively and 3.5 mm (0 to approximately 7 mm) postoperatively. The averaged apic vertebra derivation was 47.8 mm (21 to approximately 69 mm) before operation and 10.8 mm (3 to approximately 20 mm) after operation. The distance of C7 to center sacrum vertical line (CSVL) was 19.5 mm (16 to approximately 42) preoperatively and 11.3 mm (0 to approximately 32 mm) postoperatively. The apical vertebra rotation was 3 degree in 15 patients preoperatively, and were improved to normal in 10 patients, 1 degree in 4 patients, and 2 degree in 1 patients postoperatively. None had neurological injury and infection. Only 1 patient complained a cool feeling in the low extremity of concave side, and the symptom vanished at 3-month followed up. CONCLUSION: If used appropriately, TSRH anterior spinal system is a good teatment for low thoracic or thoracic lumbar scoliosis.

Adolescent↗
PubMed2003

[Posterior pedicle screw system and interbody fusion in the treatment of degenerative scoliosis].

OBJECTIVE: To investigate clinical results of posterior pedicle screw system and interbody fusion in the treatment of degenerative scoliosis. METHODS: From September 1997 to June 2002, 32 cases with degenerative scoliosis were analyzed for operative effect, postoperative complication and follow-up results. RESULTS: The average correcting ratio of scoliosis was 47.9%, and pain relief ratio 90.6%. There was one case of pseudoarthritis and one case of brain vessel embolism. After an average 15-month (6-57 months) follow-up, there was no loss of correction and height of disc spaces and there was no shift of interbody cages. CONCLUSION: Posterior pedicle screw combined with interbody fusion is one of safe and effective treatments of degenerative scoliosis.

Humans↗
PubMed1992

The Alici spinal system in the surgical treatment of scoliosis.

The Alici spinal system is an instrumentation used for correction and fixation of various deformities of the spine. Idiopathic scoliosis is the most important indication. Scoliosis is a complex deformity in the frontal, sagittal and axial planes, and this system provides perfect correction in all three planes. Furthermore, it permits stable fixation and can be used for both anterior and posterior spinal fusions. The indications for the anterior Alici spinal system are: mature thoracolumbar or lumbar curves of more than 40 degrees, progressive immature thoracolumbar or lumbar curves of more than 35 degrees, painful mature lumbar curves, paralytic or congenital lumbar or thoracolumbar curves, and mature lumbar curves of more than 40 degrees in thoracolumbar double curves. The indications for the posterior Alici spinal system are: immature thoracic curves of more than 40 degrees, progressive thoracic or thoracolumbar curves of more than 35 degrees, and paralytic and congenital curves. During the last two years, 92 scoliosis patients underwent spinal fusion with Alici spinal instrumentation. Scoliosis was idiopathic in 58, congenital in 20, paralytic in 12, and 2 cases were caused by neurofibromatosis. Twenty-four of the patients underwent 2-stage anterior and posterior fusions. In the remaining 68 patients only posterior fusion was performed. The mean follow-up was 14 months (range, 6-24 months). Preoperatively, the mean curves of the idiopathic, congenital, and paralytic groups were 54.7 degrees, 57.8 degrees, and 83 degrees, respectively. In the idiopathic group the mean correction was 93% with anterior instrumentation, and 74.4% with posterior instrumentation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Pathogenesis of idiopathic scoliosis. The Nottingham concept.

There is no generally accepted scientific theory for the etiology of idiopathic scoliosis. Hence, current treatment is pragmatic and not based on knowledge of causation of the deformity. In Nottingham, we have evaluated data from studies of the hips, pelvis, spine, rib cage and trunk muscles in scoliotic (pre- and post operative) and control patients, cadavers and a mechanical model to formulate a new theory of etiology for idiopathic scoliosis (figs. 18 & 19 of ref. 15). Evidence is summarized for the view that idiopathic scoliosis results, in part, from a developmental abnormality in the central nervous system creating rib-vertebra angle asymmetry which leads to a cyclical failure of mechanisms of rotation control in the trunk; these involve rotation-inducing (pelvic) and rotation-defending (discal, ligamentous and costal) mechanisms acting mainly in gait. The mechanical breakdown of rotation occurs in association with a lateral spinal curvature and a lordotic segment to create the initial deformity of idiopathic scoliosis. Then, growth, both abnormal (secondary to vertebral hyper-pressures) and normal (linear spinal growth) with gravity adds to the initiating and continuing neuromuscular mechanisms to augment curve progression. This theory views the spine in the wider perspective of function in the trunk, evolution and development, all in relation to bipedalism. The goal of etiological research is ultimately to base a treatment on some knowledge of causation of the deformity.

Central Nervous System↗