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PubMedDate not supplied

Scoliosis in patients treated with growth hormone.

Two hundred fifty children being treated with growth hormone were screened for scoliosis by using the Adams and Bunnell techniques. If indicated, an anteroposterior radiograph was done and measured by the Cobb and Risser methods. Scoliosis was defined as a frontal curve of > or = 10 degrees; progression, as a sustained increase of > or = 5 degrees, and a progressive curve as one > or = 25 degrees and meeting our criteria for orthotic management. In 10 of the 250 patients, scoliosis developed. Six curves were double major thoracic and lumbar; three thoraco-lumbar; and one single thoracic. Six of the 10 patients had progressive curves and required an orthosis. Their average annualized rate of progression was 26 degrees. Progression was associated with double major curves and an earlier Risser stage. Despite bracing, progression continued to fusion in three patients. We conclude that growth hormone may increase the risk of progression of scoliosis. Furthermore, the progression is frequently rapid and requires special vigilance by the treating physician.

Adolescent↗

PubMed1976

Pathogenesis of scoliosis.

Scoliosis often occurs in otherwise normal individuals or it may be associated with many widely differing diseases. The curve patterns are fairly uniform and the vertebrae always rotate in the frontal and horizontal planes producing convex side rotation with little displacement of the spinuous processes. Many small curves do not increase. Progressive scoliosis increases linearly and the rate of increase accelerates at puberty. No endocrine abnormalities have been observed in these patients. Usually the deformity is not caused by abnormal vertebral growth nor by abnormal collagen in verterbral ligaments. The glycosaminoglycans of nucleus pulposus are decreased in patients with idiopathic scoliosis. We speculate that loss of proteoglycans will affect the viscoelastic properties of the intervertebral discs which may result in permanent deformation. The etiology of scoliosis appears to be multifactorial with a genetic tendency to the deformity which is triggered in different individuals by different factors, some medical, some mechanical and some genetic.

Adolescent↗

PubMed1999

Neuroimaging of scoliosis in childhood.

A curvature abnormality may be the initial or major presenting feature in a child with disease of the spinal column or spinal neuraxis. A simplified classification of common spinal curvature abnormalities of childhood include idiopathic, congenital/dysraphic, skeletal dysplasia, neurofibromatosis, and painful. The great majority of childhood scoliosis falls into the idiopathic category. Atypical clinical or radiographic features in a presumed idiopathic scoliosis may indicate an otherwise occult tumor or hydrosyringomyelia, or may be a consequence of increasing curvature with disk protrusion, nerve impingement, or cord attenuation. Neuroimaging beyond plain films is commonly necessary for atypical idiopathic scoliosis and for the other categories of scoliosis listed.

Adolescent↗

PubMed1998

Biomechanical evaluation of a central rod system in the treatment of scoliosis.

OBJECTIVE: To evaluate the efficiency of a central rod system in the treatment of scoliosis. DESIGN: Biomechanical testing and finite element analysis were performed to compare the stiffness and stress distribution of the central rod system with the Cotrel-Dubousset instrumentation. BACKGROUND: During the fixation and derotation processes in the treatment of scoliosis, the Cotrel-Dubousset instrumentation concentrates unilateral stress on the vertebral elements. It may be possible to cause severe injury to the bony tissues especially in the ostaeoporotic patients. A central rod system was developed to reduce the damage to the bony tissue of the vertebrae in the treatment of scoliosis. METHODS: Mechanical non-destructive cyclical tests comparing the compression, flexion, extension and torsional stiffness were carried out on the models of the central rod system and Cotrel-Dubousset instrumentation using a 858 Bionix test system. The stress distribution on the central rod, the Cotrel-Dubousset rod and a vertebral model consisting in four vertebrae each implanted with two screws was evaluated using a general purpose finite element software ANSYS R 5.0a. The SOLID73 element was employed for three-dimensional modelling. RESULTS: Although the central rod system was found to have lower values in the compression, flexion and extension stiffness, its torsional stiffness is comparable to the Cotrel-Dubousset instrumentation. Moreover, the stability of the new design is satisfactory. Finite element analysis indicates that the maximum equivalent stress on the vertebral model with the central rod system is relatively constant. CONCLUSIONS: The central rod system consists of a central rod which applies fixation and derotation through a connector between the screws on both sides of the vertebral column. This new design can not only prevent the effect of unilateral stress concentration, but is also simpler and easier to implant. However, it is necessary to strengthen the material of the rod or the connection between the rod and the screws. RELEVANCE: This study employed the methods of biomechanical testing and finite element analysis to evaluate a newly designed central rod system in the treatment of scoliosis. The same methods can be applied to the evaluation of orthopaedic instrumentations in the pre-clinical stage. The efficiency of the central rod system is comparable to the Cotrel-Dubousset instrumentation, and its implantation is simpler and easier.

Journal Article↗

PubMed2005

Adolescent idiopathic scoliosis screening for school, community, and clinical health promotion practice utilizing the PRECEDE-PROCEED model.

BACKGROUND: Screening for adolescent idiopathic scoliosis (AIS) is a commonly performed procedure for school children during the high risk years. The PRECEDE-PROCEDE (PP) model is a health promotion planning model that has not been utilized for the clinical diagnosis of AIS. The purpose of this research is to study AIS in the school age population using the PP model and its relevance for community, school, and clinical health promotion. METHODS: MEDLINE was utilized to locate AIS data. Studies were screened for relevance and applicability under the auspices of the PP model. Where data was unavailable, expert opinion was utilized based on consensus. RESULTS: The social assessment of quality of life is limited with few studies approaching the long-term effects of AIS. Epidemiologically, AIS is the most common form of scoliosis and leading orthopedic problem in children. Behavioral/environmental studies focus on discovering etiologic relationships yet this data is confounded because AIS is not a behavioral. Illness and parenting health behaviors can be appreciated. The educational diagnosis is confounded because AIS is an orthopedic disorder and not behavioral. The administration/policy diagnosis is hindered in that scoliosis screening programs are not considered cost-effective. Policies are determined in some schools because 26 states mandate school scoliosis screening. There exists potential error with the Adam's test. The most widely used measure in the PP model, the Health Belief Model, has not been utilized in any AIS research. CONCLUSION: The PP model is a useful tool for a comprehensive study of a particular health concern. This research showed where gaps in AIS research exist suggesting that there may be problems to the implementation of school screening. Until research disparities are filled, implementation of AIS screening by school, community, and clinical health promotion will be compromised. Lack of data and perceived importance by school/community health planners may influence clinical health promotion practices.

Journal Article↗

PubMed2006

Adolescent idiopathic scoliosis: natural history and long term treatment effects.

Adolescent idiopathic scoliosis is a lifetime, probably systemic condition of unknown cause, resulting in a spinal curve or curves of ten degrees or more in about 2.5% of most populations. However, in only about 0.25% does the curve progress to the point that treatment is warranted.Untreated, adolescent idiopathic scoliosis does not increase mortality rate, even though on rare occasions it can progress to the >100 degrees range and cause premature death. The rate of shortness of breath is not increased, although patients with 50 degrees curves at maturity or 80 degrees curves during adulthood are at increased risk of developing shortness of breath. Compared to non-scoliotic controls, most patients with untreated adolescent idiopathic scoliosis function at or near normal levels. They do have increased pain prevalence and may or may not have increased pain severity. Self-image is often decreased. Mental health is usually not affected. Social function, including marriage and childbearing may be affected, but only at the threshold of relatively larger curves.Non-operative treatment consists of bracing for curves of 25 degrees to 35 degrees or 40 degrees in patients with one to two years or more of growth remaining. Curve progression of >/= 6 degrees is 20 to 40% more likely with observation than with bracing. Operative treatment consists of instrumentation and arthrodesis to realign and stabilize the most affected portion of the spine. Lasting curve improvement of approximately 40% is usually achieved.In the most completely studied series to date, at 20 to 28 years follow-up both braced and operated patients had similar, significant, and clinically meaningful reduced function and increased pain compared to non-scoliotic controls. However, their function and pain scores were much closer to normal than patient groups with other, more serious conditions.Risks associated with treatment include temporary decrease in self-image in braced patients. Operated patients face the usual risks of major surgery, a 6 to 29% chance of requiring re-operation, and the remote possibility of developing a pain management problem.Knowledge of adolescent idiopathic scoliosis natural history and long-term treatment effects is and will always remain somewhat incomplete. However, enough is know to provide patients and parents the information needed to make informed decisions about management options.

Journal Article↗

PubMed2003

Patients with mild scoliosis have good prognosis.

Patients with late-onset idiopathic scoliosis have only a modest increase in health problems compared with patients without scoliosis. Clinicians should keep this in mind when providing health education and offer reassurance and watchful waiting to patients with small curves at skeletal maturity. More broadly, whether to screen for scoliosis depends on the performance of the screening test as well as evidence of whether treatment alters the natural history of scoliosis. The US Preventive Services Task Force has concluded that there is insufficient evidence to recommend routine screening.

Comment↗

PubMed2026

The Impact of Baseline Negative Emotions on Postoperative Quality of Life in Adolescent Idiopathic Scoliosis Patients: A 2-Year Follow-Up Study.

OBJECTIVE: Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that develops during puberty without a clear etiology. Beyond physical manifestations, AIS severely impacts adolescents' psychological and social well-being, leading to anxiety, depression, and low self-esteem. While advancements in surgical techniques have enhanced objective outcomes, existing studies on AIS have primarily focused on objective indices, with limited attention to the long-term impact of preoperative negative emotions on patient-reported subjective quality of life. METHODS: This was a retrospective cohort study. A total of 112 eligible AIS patients who underwent posterior spinal correction surgery between April and August 2023 were enrolled. Inclusion criteria included confirmed AIS, completion of 2-year follow-up, and informed consent; exclusion criteria included missing imaging/questionnaire data, comorbid psychiatric/neurological diseases, or prior spinal surgery. Patients were grouped using the Hospital Anxiety and Depression Scale (HADS) administered on admission. Quality of life was assessed preoperatively and 2 years postoperatively using the Scoliosis Research Society-22 (SRS-22, evaluating self-image, mental health, pain, function, treatment satisfaction) and Short Form 36 Health Survey (SF-36, assessing 8 physical and mental health dimensions). Statistical analysis was performed via SPSS, using independent t-tests, paired t-tests, Mann-Whitney U test, and chi-square test. p < 0.05 was considered significant. RESULTS: There were no significant differences in baseline characteristics (age, gender, BMI, surgical parameters, scoliosis type, preoperative/postoperative Cobb angles) between the two groups (all p > 0.05). Preoperatively, SRS-22 and SF-36 scores showed no inter-group differences (all p > 0.05). Postoperatively, the Negative Emotion Group had significantly lower scores in SRS-22 mental health (3.9 ± 0.3 vs. 4.5 ± 0.2) and treatment satisfaction (4.0 ± 0.3 vs. 4.6 ± 0.7), as well as SF-36 general health (68.6 ± 6.4 vs. 79.7 ± 13.3), role-emotional (61.3 ± 9.3 vs. 70.8 ± 9.7), and mental health (61.8 ± 14.3 vs. 68.9 ± 10.7) (all p < 0.05); no inter-group differences were observed in physical function-related dimensions. Both groups showed significant improvements in physical function-related dimensions postoperatively. The Non-Negative Emotion Group also exhibited significant improvements in SRS-22 self-image/pain and SF-36 bodily pain (all p < 0.05), while the Negative Emotion Group showed no significant improvements in these dimensions. CONCLUSIONS: Preoperative anxiety and depression do not affect the recovery of physical function in AIS patients after spinal correction surgery but significantly impede improvements in subjective quality of life dimensions, including mental health and treatment satisfaction. These findings highlight the need to integrate psychological assessment and targeted interventions into the perioperative management of AIS. Such a patient-centered approach will help optimize both physical and psychological outcomes, ultimately achieving comprehensive rehabilitation for AIS adolescents.

Humans↗

PubMed2003

Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study.

CONTEXT: Previous long-term studies of idiopathic scoliosis have included patients with other etiologies, leading to the erroneous conclusion that all types of idiopathic scoliosis inevitably end in disability. Late-onset idiopathic scoliosis (LIS) is a distinct entity with a unique natural history. OBJECTIVE: To present the outcomes related to health and function in untreated patients with LIS. DESIGN, SETTING, AND PATIENTS: Prospective natural history study performed at a midwestern university with outpatient evaluation of patients who presented between 1932 and 1948. At 50-year follow-up, which began in 1992, 117 untreated patients were compared with 62 age- and sex-matched volunteers. The patients' mean age was 66 years (range, 54-80 years). MAIN OUTCOME MEASURES: Mortality, back pain, pulmonary symptoms, general function, depression, and body image. RESULTS: The estimated probability of survival was approximately 0.55 (95% confidence interval [CI], 0.47-0.63) compared with 0.57 expected for the general population. There was no significant difference in the demographic characteristics of the 2 groups. Twenty-two (22%) of 98 patients complained of shortness of breath during everyday activities compared with 8 (15%) of 53 controls. An increased risk of shortness of breath was also associated with the combination of a Cobb angle greater than 80 degrees and a thoracic apex (adjusted odds ratio, 9.75; 95% CI, 1.15-82.98). Sixty-six (61%) of 109 patients reported chronic back pain compared with 22 (35%) of 62 controls (P =.003). However, of those with pain, 48 (68%) of 71 patients and 12 (71%) of 17 controls reported only little or moderate back pain. CONCLUSIONS: Untreated adults with LIS are productive and functional at a high level at 50-year follow-up. Untreated LIS causes little physical impairment other than back pain and cosmetic concerns.

Activities of Daily Living↗

PubMed2001

Relief of central airways obstruction following spinal release in a patient with idiopathic scoliosis.

SUMMARY. Patients with idiopathic scoliosis are reported to have a restrictive pattern on pulmonary function tests. A case is presented of a teenage girl with juvenile idiopathic scoliosis who had evidence of airways obstruction in addition to restriction on pulmonary function tests (PFT). Examination of flow-volume loops suggested central airways obstruction. At the time of induction of anesthesia for the initial spinal release surgery, a double-lumen endotracheal tube could not be passed, despite fiberoptic visualization, because of extreme deviation of the left main-stem bronchus. Postoperatively, PFT demonstrated improved flows at high lung volumes and normalization of the shape of the flow volume loop. We suggest that preoperative PFT may be used to predict which patients have central airways obstruction. This may lessen unanticipated problems with intubation at the time of surgery and may identify patients who may expect immediate improvement in lung function after scoliosis repair.

Adolescent↗

PubMed2003

Clinical and genetic heterogeneity in frontometaphyseal dysplasia: severe progressive scoliosis in two families.

Frontometaphyseal dysplasia is a rare genetic syndrome affecting the skeletal system and connective tissue. It is believed to be inherited as an X-linked trait. Features of frontometaphyseal dysplasia overlap with other skeletal dysplasias. Prominent supraorbital ridges, radiologic evidence of cranial hyperostosis, and flared metaphyses are characteristic. Scoliosis, a rare associated finding, is usually mild, and familial progressive scoliosis has not been reported so far. The skeletal dysplasia and the associated clinical findings show significant intra- and interfamilial variability. The syndrome has been suggested to be an allelic variant of the Melnick-Needles osteodysplasty, an X-linked (dominant) entity. We present two families with frontometaphyseal dysplasia, in which both males and females showed the facial and skeletal features of the syndrome in association with progressive scoliosis. Some of the affected members also had hearing loss and urogenital anomalies, supporting the existence of the recently suggested entity "fronto-otopalatodigital-osteodysplasty syndome".

Abnormalities, Multiple↗

PubMed1983

Joint flexibilities in structurally normal girls and girls with idiopathic scoliosis.

Seven clinical measurements of joint flexibilities were made in 51 girls with untreated mild idiopathic scoliosis and 65 girls with structurally normal spines. Subject ages ranged from 10 to 16 years. Abilities to have the index finger passively extended, the wrist bent, and the elbow and the knee hyperextended, along with abilities to bend the trunk voluntarily forward and to the right and left sides, were measured. The girls with scoliosis in the mean either had the same flexibilities or were less flexible than the normal girls. The study provided no evidence that untreated mild idiopathic scoliosis occurs or progresses because of increased joint flexibilities.

Adolescent↗

PubMed1987

Platelet pathology in minimal curve idiopathic scoliosis: an attempt to predict curve progression.

Platelets from adolescents with minimal curve scoliosis (mcs) (7-18 degrees) and healthy control subjects were examined for morphometry under the electron microscope and tested for calcium content and surface negative charge. These parameters have previously been found to be abnormal in severe idiopathic scoliosis (is) patients. Significantly more patients than control subjects showed deviations from normal in all tests. Two tests in particular, the average number of dense bodies per cell and an increased surface negative charge, were the most frequent abnormalities. In an attempt to assess the possibility of using platelet tests for prediction of curve progression, statistical comparisons were made and discriminant scores were generated for each patient. The results were compared with the clinical findings after a 2- to 3.5-year follow-up. The predictions proved to be incorrect although each of the five patients who had curve progression had some platelet abnormality. It is concluded that although platelet pathology does occur in early idiopathic scoliosis, it cannot be used as a prognostic indicator of curve progression.

Adolescent↗

PubMed1993

Rib cage deformities in scoliosis: spine morphology, rib cage stiffness, and tomography imaging.

A computer-implemented biomechanical model of a thoracolumbar spine and deformable rib cage was used to investigate the influence of spine morphology and rib cage stiffness properties on the rib cage deformities that arise from scoliosis and to study the relationship of actual rib distortions with those seen on computed tomography (CT) scans. For the purposes of this study, it was assumed that rib cage deformities result from forces imposed on the ribs by the deforming spine. When a structurally normal rib cage was allowed to follow freely the imposition of scoliotic curves on the spine, different configurations of scoliosis led to substantial differences in the resulting rib cage deformities. Rib cage lateral offset correlated well with the Cobb angle of the scoliosis but not with the apical vertebral axial rotation, whereas rib cage axial rotation correlated well with apical vertebral axial rotation but not with the Cobb angle. These model-obtained findings mirror clinical findings that correction of the Cobb angle leads to correction of the lateral offset of the rib cage but does not correlate well with correction of the rib cage axial rotation. The stiffnesses of the ligamentous tissue connecting the sternum to the pelvis, of the costovertebral joints, and of the ribs themselves also influenced the rib deformities substantially. The influence of the sternopelvic ligamentous ties has not been recognized previously. The total rib cage volume remained essentially constant regardless of the severity of the resulting deformity, but the distribution of this volume between convex and concave sides varied somewhat.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗

PubMed1995

Intrathoracic dural ectasia mimicking neurofibroma and scoliosis. A case report.

Angular thoracic scoliosis combined with dural ectasia and foraminal enlargement is reported in a patient with neurofibromatosis. The dural cyst was resected through a high thoracic approach and the scoliosis dealt with by posterior spinal fixation with Modulock instrumentation. Follow up after 12 months showed no neurological deficit and no progress of the scoliosis.

Adult↗

PubMed1980

The production of experimental scoliosis by selective arterial ablation.

Through a lateral thoracotomy, microcoagulation of the proximal segment of the intercostal artery and of its principal posterior collateral was carried out at four consecutive levels in rabbits. Subsequently, structural scoliosis developed in 67.5% of animals. Histological examination of the spinal cord in all animals showed that characteristic changes were found in the animals with scoliosis. It is suggested that these changes were ischaemic in origin and caused abnormal neuromuscular responses in the paravertebral muscles, resulting in scoliosis.

Animals↗

PubMed1984

Scoliosis associated with congenital brain-stem abnormalities. A report of eight cases.

Eight children of five families, seven boys and one girl, suffering from scoliosis associated with absence of lateral eye movement and horizontal nystagmus have been studied. The absence of lateral vision was noticed soon after birth, while the scoliosis appeared after the beginning of walking. A review of the relevant bibliography is presented, with a summary of the 18 cases of this interesting syndrome so far described. The pathogenesis of idiopathic scoliosis is considered in the light of the information obtained from the study of these patients.

Adolescent↗

PubMed1982

Normovolaemic haemodilution in spinal fusion for scoliosis.

Since January 1979 spinal fusions for scoliosis have been carried out at the Galeazzi Orthopaedic Institute in Milan using normovolaemic haemodilution. The object is to eliminate the risks of blood transfusion and to reduce thromboembolic complications. The method is indicated in patients who are not anaemic and when the blood loss during operation can be controlled. This paper analyses the results in 95 consecutive spinal fusion operations for scoliosis. The authors conclude that the method can be safely used for this type of operation, particularly in young patients with moderate scoliosis (a curve of 50 degrees to 60 degrees). The aim of the operation in these cases is to improve the appearance of the back and prevent further deformity.

Adolescent↗