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PubMed2006

Right convex thoracic female adolescent scoliosis in the light of the thoracospinal concept.

The most common form of idiopathic scoliosis affects perimenarcheal girls who show either a primary or secondary right convex thoracic curve. The patient displays signs of sympathetic dysfunction, morphological and histochemical abnormalities of muscle fibres and platelets and a persisting osteoporosis. Mechanisms that have been proposed for the causation and the development of these features are supported by the evidence in results of studies into the thoracospinal concept of the etiopathogenesis of this form of scoliosis. The interrelation of these late integrated signs and symptoms suggests that this particular form of IS is a disparate clinical nosological entity rather than a mere orthopedic deformity of the spine. Known characteristics of the infantile and this form of adolescent scoliosis further suggest that the juvenile form is an intermediate rather than a separate group and that the use of the term "idiopathic" is, therefore, obsolete. Deciphering the etiopathogenesis of the pathological complex of the right convex female adolescent scoliosis demands research from new standpoints which demands fresh approaches.

Adolescent↗
PubMed2006

[Distribution and expression of collagen type II, transforming growth factor beta1 and basic fibroblast growth factor in articular process cartilages of scoliosis].

OBJECTIVE: To look into the character of the expression of collagen type II and transforming growth factor beta1 (TGF-beta1), basic fibroblast growth factor (bFGF) in the apical articular process cartilages of adolescent idiopathic scoliosis (AIS) and congenital scoliosis (CS) patients. METHODS: The articular processes of 22 AIS and 18 CS were collected. The techniques of HE staining, immunohistochemistry and in situ hybridization were adopted in this research. By comparing the apical processes with the end processes, the convex processes with the concave processes, the AIS processes with CS processes, the pathological changes of the articular process cartilages of these patients and the distribution of collagen type II and TGF-beta1, bFGF in them were studied. The images of immunohistochemistry and in situ hybridization were input into the image analysis system and were analyzed semi-quantitatively. The SAS software (8.01) was adopted, and P < 0.05 was defined as the significant level. RESULTS: The expression of collagen type II and TGF-beta1, bFGF in AIS was similar to CS: the concave sides of apexes were higher than the convex sides. The comparisons had statistical significance. There was no statistical significance between upper and lower end vertebrae in convex and concave sides, between convex and concave sides in upper and lower end vertebrae. The apical vertebrae were significantly higher than the ipsilateral sides of upper or lower end vertebrae for collagen type II. There was no statistical difference of the expression at the concave, convex, upper, lower end vertebrae between AIS and CS. CONCLUSIONS: The cartilages of the apical processes show some signs of regression and hypoplasia in scoliosis. The concave side is more severe than the convex side. Increase of collagen type II and TGF-beta1, bFGF in the concave sides of apical processes in scoliosis may be the results of reconstruction of extracellular matrix and the compensation reactions which are caused by abnormal biomechanical forces such as compressive stresses. Compressive stress on the concave sides has more influences on the expression of collagen type II than tensile stress on the convex sides.

Adolescent↗
PubMed1991

[Scoliosis and congenital heart diseases in children. Apropos of 44 cases].

In order to evaluate the difficulties of treatment of associated scoliosis and congenital heart disease (C.H.D.), 44 patients who have been treated between 1970 and 1988 were reviewed. The scoliosis was idiopathic in 30 cases, congenital in 11, neurologic in 3. There were 27 females and 17 males. Twenty one patients had a cyanotic C.H.D. (twelve tetralogies of Fallot). No relation was found between the side of the cardiac approach and the side of the thoracic curves. Three cases of right aortic arch with two left thoracic scolioses were noted. Associated anomalies were encountered in 60 p. 100 of cases. The analysis of old chest X-rays, revealed that the scoliosis was already present an average of 5 years before the first orthopaedic consultation. Eight patients had an orthopaedic treatment; in ten cases surgery was decided but not performed. Twenty six patients were operated. (22 posterior and six anterior procedures). The average angulation was 55 degrees pre-operatively, 30 degrees post-operatively and 40 degrees at a 40 months follow-up. In five cases a pseudarthrosis led to re-intervention. One patient died during a posterior procedure, an other post-operatively. Two patients had a severe complication (one heart arrest; one gaz-embolism) but recovered. The surgical prognosis can be evaluated on an original scale including different cardiac parameters, and the importance of the planned surgical procedure. Under a limited mark, no serious complications occurred. In conclusion, a closed collaboration between pediatricians and the orthopaedic team, should lead to more precocious screening of scoliosis in cardiologic children and before the orthopaedic procedure, to a more precise risk factors evaluation.

Child↗
PubMed1991

Mechanism of production of experimental scoliosis in rabbits.

The hypothesis for the mechanism of production of scoliosis, advanced on the basis of morphometric and morphologic studies in human thoracic skeleton, finds further support in the results of an experimental study in rabbits described herein. The removal of transverse processes alone resulted in the production of scoliosis and lordosis. When both transverse processes and facet joints were removed, scoliosis developed rapidly and was considerable. When paraspinal muscles were incised on one side only, however, this resulted in the development of lordosis alone. The convexity of the curve was always toward the operated side, and the apex was almost always at the lowest operated segment. Lordosis was limited to within the operated area. The results of the experiment indicate that scoliosis resulted because of the asymmetry in load transmission through the ribs to the vertebral column in rabbits.

Animals↗
PubMed1990

Effects of rib elongation on the spine. II. Correction of scoliosis in the rabbit.

Three intercostal nerves on the right side of growing rabbits were resected partially. From 1 to 3 months later, moderate left-convex thoracic scoliosis with rotation of vertebrae had developed, and the sagittal curvatures of the spine had diminished. In one group of these animals, a mechanically produced increase of 1 cm in the length of one rib on the side of the convexity resulted in an immediate correction of the scoliotic deformity, an improvement that was still evident 3 weeks after the operation. In two other groups of rabbits, a further resection of three intercostal nerves, this time on the left convex side, 1 and 2 months after the first operation, resulted in regression of scoliosis or halted its progression. These results further support a new concept in which the precipitating factor in the development of scoliosis is ascribed to asymmetric longitudinal growth of the ribs. They also suggest that regulation of the rib length could be a promising approach to the effective correction of progressive scoliosis at an early stage in man.

Animals↗
PubMedDate not supplied

[Idiopathic scoliosis and pneumonia complicated with cor pulmonale. Report of one case].

A 10-year-old boy with idiopathic scoliosis presented with exertional dyspnea, lower leg edema since two weeks prior to admission. Physical examination revealed neck venous engorgement, moist rales, mild hepatomegaly, ascites and lower leg edema in addition to the scoliosis. Chest x-ray films showed cardiomegaly, pulmonary congestion and pneumonic infiltration of both lower lobes with bilateral pleural effusion. Electrocardiograms showed right axis deviation and right atrial hypertrophy. Two-dimensional echocardiography revealed dilatation of the right heart chambers and pulmonary artery. He was treated initially with mechanical ventilation, antibiotics, bronchodilators, diuretics, vasodilators, and digoxin with improvement. Unfortunately the patient became comatose after an episode of cardiopulmonary arrest. He did not recover from this tragedy and was discharged against medical advice in comatose state. Scoliosis may be complicated with pneumonia and cor pulmonale in children. Early surgical correction of the scoliosis may prevent the development of cor pulmonale. Combined medical and surgical managements should be carried out aiming at scoliotic heart disease.

Child↗
PubMed1990

Measurement of scoliosis and kyphosis radiographs. Intraobserver and interobserver variation.

Interobserver variations for measurements of the Cobb angle on radiographs of patients who had kyphosis were comparable with those on the radiographs of patients who had scoliosis. Four staff orthopaedists and one physical therapist measured eight radiographs that showed scoliosis and twenty that showed kyphosis. The measurements were made on two occasions and in random order. For scoliosis, the average difference between readings was 3.8 degrees, and 95 per cent of the differences were 8 degrees or less (range, 0 to 10 degrees). These findings were in keeping with those of other published reports. For kyphosis, the average difference between readings was 3.3 degrees, and 95 per cent of the differences were 7 degrees or less (range, 0 to 30 degrees). One investigator rated the kyphosis radiographs with respect to clarity. There was a trend to less variation with clearer radiographs, but this was not significant. The end-vertebrae were pre-selected for some radiographs and were freely chosen by the interpreter for others. Reliability was not significantly improved when the end-vertebrae of the curve had been pre-selected. Using the statistical method called tolerance limits, we determined that if one were to be 95 per cent confident that a measured difference represented a true change, the difference would have to be 10 degrees for scoliosis radiographs and 11 degrees for kyphosis radiographs. The probability that a measured difference is due to measurement error alone (that is, a false-positive reading) was calculated.

Analysis of Variance↗
PubMedDate not supplied

Brainstem evoked potentials for scoliosis surgery: a reliable method allowing use of halogenated anesthetic agents.

A predictable and accurate method of monitoring cord function during scoliosis surgery using somatosensory brainstem evoked potentials (SBEP) is described. This method allows the use of halogenated anesthetic agents, which are ideal for neuromuscular patients, but easily disrupt traditional cortical monitoring. Fifty-eight children with idiopathic, neuromuscular, and syndrome related scoliosis were monitored with 51 true negative, one false negative, four true positive and two false positive results. The SBEP method is sensitive and effective for all types of scoliosis surgery, especially neuromuscular scoliosis.

Adolescent↗
PubMedDate not supplied

[Pubertal dynamics of growth and spinal scoliosis].

By means of longitudinal observation of growth of 698 pupils in the period of predicted puberty, the dynamics of changes in spine status was observed in relation to accelerated growth. At the beginning of observation, when the majority of pupils were in the period prior to puberty, the prevalence of scolioses with side curve being higher than 10 degrees, according to Cobb, was 1.57%. In those three years that were observed, the majority of pupils developed secondary sexual characteristics followed by adolescent impetus of growth. At the same time of the development of puberty, the spine status started to change in the way that the incidence of scoliosis was tripled with the same children and amounted to 4.87%. At the same time even the number of children having asymmetrical bodies of scoliotic posture increased from 20.9% to 28.8%. Children having regular posture of their bodies before the puberty, almost in three quarters of cases retained the same status. When the status of spine was changed the regular posture also changed to scoliotic one, and vice versa. Such a scoliotic posture was interpreted as a physiological variation of normal appearance of body and not as an important factor of risk in the development of scoliosis. Only 8.9% of children having scoliotic posture in puberty, developed scoliosis. Those children that developed scoliosis in puberty although they had normal postures started to grow at one moment faster and more intensively than their healthy colleagues.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1990

[Idiopathic scoliosis in adults].

Author's opinion is that the disease will very slightly progrediate after adolescent age. Greater progression can be observed only in scoliosis cases higher than 50 degrees. The grown up patient get used to this physical state and it doesn't mean cosmetical handicap. Side effects of adult scoliosis can be pain and less frequently cardio-respiratoric problems. This latter can result in patient's being unable to continue working. Side effects are related to the degree of curving but mainly they come about in cases with more than 50-60 degrees of scoliosis. Consequently much effort should be made by the traditional way or by surgical treatment to stop children patients developing serious curve. Moderate scoliosis can be no handicap for grown ups.

Adolescent↗
PubMedDate not supplied

[Idiopathic scoliosis in a student population].

The etiology of idiopathic thoracic scoliosis is a relevant problem in the fields of scholastic medicine and orthopaedics. This disease affects a population of pre-adolescent between ten and fifteen years of age. This study is based on our observations within a population of junior high school students in a suburban town of central Italy. Our data are based on clinical examinations, and the analysis of biophysical and environmental factors evidentiate the genetic and hereditary factors that are of prime importance in the pathogenesis of thoracic idiopathic scoliosis. It's our goal, to inform the scholastic doctor, the orthopaedist, the pediatrician and the internist on the main clinical and evolutionary aspects of thoracic idiopathic scoliosis and other related vertebral pathology. We therefore believe, that a good diagnosis should be based on a thorough genetic and clinical examination; not to mention an examination of vertebral bone morphology in order to exclude other forms of thoracic scoliosis.

Adolescent↗
PubMed1989

Equilibrial dysfunction in scoliosis--cause or effect?

To determine whether equilibrial dysfunction is the cause or effect of idiopathic scoliosis, patients with idiopathic scoliosis, congenital scoliosis, and comparable controls were tested, using clinical postural tests and electronystagmographic recording of spontaneous and positional nystagmus, smooth visual pursuit, and rotation-induced nystagmus. The scoliosis patients were stratified as progressive or nonprogressive. Dysfunctional responses occurred in the idiopathic progressive and congenital progressive groups, and in two idiopathic non-progressive patients whose curves subsequently deteriorated. These results suggest that equilibrial dysfunction is characteristic of patients with progressive curves, regardless of etiology, implying that it is secondary to the curve rather than a primary event. Seven patients with progressive curves undergoing surgical correction and stabilization were tested preoperatively and 6 months postoperatively. No change in the responses occurred, suggesting the dysfunction persists at least 6 months following arrest of progression.

Adolescent↗
PubMed1989

Scoliosis evaluation and management.

Specific guidelines for the management of scoliosis must be individualized based on a number of factors. It is important to be sure that a patient who appears to have ordinary idiopathic scoliosis does not have some underlying disease process or congenital anomaly, which if undiscovered, may complicate that patient's management. The management of scoliosis has changed in the past few years due to significant advances in blood banking, anesthesia, and spinal instrumentation. Scoliosis fusions are performed regularly throughout the country with a great degree of safety. By combining early detection and modern management techniques, significant untreated curvature of the spine can be eliminated, and functional and cosmetic deformity can be avoided.

Combined Modality Therapy↗
PubMed1987

Scoliosis and pregnancy.

The effects of pregnancy on patients who have idiopathic scoliosis were investigated in terms of increased risk of progression of the curve. The charts, radiographs, and other pertinent data on 355 affected women who had reached skeletal maturity (Risser Grade 4) before 1975 were reviewed and analyzed. One hundred and seventy-five patients had had at least one pregnancy each (Group A) and 180 patients had never been pregnant (Group B). The groups were comparable with regard to the treatments that they had received. After skeletal maturity was reached, the curve progressed more than 5 degrees in 25 per cent and more than 10 degrees in 10 per cent of the patients in each group. The age of the patient at the time of the first pregnancy did not influence the risk of progression, and the stability of the curve before pregnancy did not decrease the risk of its progression during pregnancy. In patients who had had a spinal fusion, progression in the unfused portion of the spine was negligible in both Group A and Group B. The presence of a pseudarthrosis did not result in progression of the curve during pregnancy. The effects of scoliosis on pregnancy and delivery were evaluated in the 175 women in Group A. No specific problems that were directly related to the scoliosis were noted except for four patients, in whom delivery posed difficulties. The incidence of cesarean section was one-half of the national average, and no sections were directly related to the mother's scoliosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Prevention of the complications of scoliosis by early detection.

The focus of medicine has increasingly turned toward prevention rather than treatment of disease. In the absence of the ability to prevent the occurrence of scoliosis, the focus of attention should be on early identification in order to prevent complications brought on by the disease. Scoliosis detection through screening of school children is a technique that has been popularized over the last three decades. The screening technique can be performed by trained personnel. Though the initial result of these screenings was over-diagnosis, the program has been shown to be cost-effective when the screeners are well-trained and appropriate referrals are made to minimize the lack of specificity. The use of the scoliometer to make a quantitative determination of the degree of truncal rotation has reduced the number of inappropriate referrals. The complications of scoliosis itself include pulmonary compromise, pain, and deformity; these are best prevented by early detection and early treatment. When scoliosis is treated late and larger curves are present, more involved and complication-ridden procedures are required. School children screening programs promote a better understanding and heightened awareness of this disease and acceptance of the treatment methods by the public.

Adolescent↗
PubMed1988

Spinous process segmental instrumentation for scoliosis.

Spinous process segmental instrumentation (SPSI) for spinal fusion was devised in 1983 by Drummond et al. in an attempt to achieve the stability of segmental fixation without the known neurologic risks of passing sublaminar wires. We used SPSI in 75 scoliosis patients. Sixty-one had idiopathic scoliosis, 12 had neurogenic scoliosis, and 2 had congenital scoliosis. There were no deep infections, pseudarthroses, or neurologic complications. Two patients experienced upper hook dislodgement with 10 degrees loss of correction. We concluded that SPSI can achieve the correction of Harrington rod instrumentation and the stability of Luque rod segmental instrumentation, without the neurologic risk of sublaminar wiring.

Adolescent↗
PubMedDate not supplied

MR imaging of syringohydromyelia and Chiari malformations in myelomeningocele patients with scoliosis.

The brain and spinal cord were examined with MR imaging in 30 myelomeningocele patients 3-32 years old to study the prevalence of syringohydromyelia and Chiari malformations and to correlate these conditions with developmental scoliosis and spontaneously arrested hydrocephalus. Twelve patients had neurologic deficits above the level of the myelomeningocele and 10 had spontaneously arrested hydrocephalus. MR visualized syringohydromyelia in four patients with widened or focally bulging spinal cords and in eight patients with atrophic spinal cords. All patients had Chiari malformations, 28 of type II and two of type I. Syringohydromyelia was not correlated with type of scoliosis, result of ventriculoperitoneal shunting procedures, radiologic level of the myelomeningocele, or extent of the Chiari malformation. The two patients with the most rapid progression of thoracic scoliosis had the most extensive syringohydromyelia and radiologically low lumbar levels. Neurologic deterioration due to syringohydromyelia and Chiari malformations is probably more common in myelomeningocele than has been recognized previously and may cause developmental scoliosis, loss of ambulation, impaired extremity function, and progressive cranial nerve paralysis.

Adolescent↗
PubMed1988

Adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis is the single most common form of spinal deformity seen in orthopedic practice. Our knowledge about the epidemiology, etiology, natural history, and treatment has recently increased dramatically. The incidence of small curves is rather high (2% of the population), whereas severe curves are much less common (<0.1%), but we cannot always predict which curve will progress. Abnormalities of the neuromuscular system and of calcium metabolism, and certain growth, genetic, and mechanical factors may all play roles in the pathogenesis of the disorder. The physiologic secondary effects of severe scoliosis relate to restrictive lung disease, but most patients do not have a deformity great enough to affect their cardiorespiratory function. The psychological and social effects of scoliosis are significant for patients but difficult to quantitate. For most patients with moderate scoliosis-that is, more than 25 to 30 degrees-treatment with an underarm brace or electrical stimulation is adequate to "control" progression of the curve. Surgical fusion allows actual correction of the curve but is indicated in only a small percentage of patients-usually those with more than 50 degrees of deformity.

Adolescent↗