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PubMed1987

School screening for scoliosis in India. The evaluation of a scoliometer.

All school children in Patiala City (25,376) were examined to find out the incidence of scoliosis. There were 12,934 boys and 12,442 girls. Their ages ranged from 5 to 18 years. Adam's forward-bending test and a newly designed "Scoliometer" was used to detect and measure the rib hump in all cases. There was an overall incidence of scoliosis of 0.13%. This was higher in boys (0.15%) than in girls (0.10%). The majority of the curves were mild (81.25%). Paralytic scoliosis was the major group (43.7%) and most the result of poliomyelitis. The incidence was higher in the low socioeconomic group (0.4%), compared to the middle (0.12%) and high (0.01%) income groups.

Adolescent↗
PubMed1996

Predominantly posterior instrumentation and fusion in neuromuscular and neurogenic scoliosis in children and adolescents.

We studied the results in 46 patients with neuromuscular and neurogenic scoliosis (average age 13.5 years, range 6-19 years) who had had posterior fusion with a modified Luque technique between May 1985 and June 1992. The main criteria to recommend surgery were curve progression, loss of balance when sitting, control of the head and difficulties in wearing an external orthotic support. The mean preoperative curve was 63 degrees, the postoperative value was 24 degrees, representing a correction of about 62%. The average number of stabilized segments was 13. In 39 out of 46 patients, lumbosacral fixation was included in the construct. Failure of implants, pseudarthroses and major losses of correction in purely neuromuscular scolioses could be avoided by using rigid segmental fixation and a dorsolateral fusion with a mixture of autologous and allogenous bone. The scoliosis most difficult to influence was found to be Friedreich's ataxia. In Duchenne muscular dystrophy the best method of treatment was surgery performed as early as possible, i.e. at the time of loss of walking capacity in the case of a scoliosis exceeding 20 degrees and with two consecutive X-rays proving curve progression. Analysis of our series does not confirm the morbidity and complication rates of previous studies.

Adolescent↗
PubMed1996

Development of an instrument for clinical evaluation after surgery for neuromuscular scoliosis.

Surgical treatment for neuromuscular scoliosis is effective for most patients. Although those afflicted constitute a heterogeneous group, the aim of surgical treatment is approximately the same for all patients: a spine balanced in the coronal and sagittal planes over a level pelvis. Surgery results in a more stable and straighter spine, which should in turn improve performance in different activities. Previous evaluations of surgery for neuromuscular scoliosis reported in the literature have focused primarily on Cobb angles; there are very few studies dealing with the ability to perform various activities. A new tool for evaluation was developed in several steps, starting with a telephone interview with patients who had undergone surgery and a literature search. The evaluation instrument was then developed, followed by a pilot study and validation of new parts of the instrument. The instrument focuses on performance components and on activity performance. Eight items are evaluated before and after surgery. These data are complemented by a questionnaire administered to the patient or relatives at follow-up. The new parts of the instrument were developed specifically for patients with neuromuscular scoliosis, and the data obtained have been shown to have a high correlation with established measures of activities of daily living of daily living). They should therefore provide us with useful information concerning functional gains as a result of surgery as well as the effect of surgery on activity performance.

Adolescent↗
PubMed1976

[Scoliosis, metabolism and growth of the vertebral column (author's transl)].

Modern investigators incline to the opinion, that more biochemical than biomechanical disorders take part in cause of the "idiopathic'' scolioses. It seems, however, that there is not only one cause but more in some subgroups. Idiopathic scolioses, which have symptomes of arachnodactyly, seem to be a big one of these subgroups. These cases allow to state a hypothesis, in which kind a disordered metabolism leads to a deviation of the spine. This hypothesis is basing on the fact, that the enchondral growth in the length and the periostal growth in the width of "long bones'' are not regulated in the same endocrinological kind and that the enchondral growth of the vertebral-bodies-column happens in cranio-caudal direction, the enchondral growth of the vertebral-archies-column, however, in anterior-posterior direction. If the balance between enchondral and periostal growth is disturbed, you can see typical chances on the long bones, which resemble either an "arachnodactyly" or a "chondrodysplasy". The same disturbance will cause a "kyphosis" respectively a "lordosis" (or scoliosis) on the vertebral spine; either the bodies-column or the archies-column will become longer (higher). The results of metabolism research are suitable to these facts. If the balance between enchondral and periostal growth,--basing on a dysbolism,--is disturbed in such a kind, that the vertebral-bodies-column is growing faster than the vertebral-archies-column, the vertebral spine is forced to change into a lordosis respectively into a scoliosis. If you want to cure an idiopathic scoliosis, you first have to remove or to paralyse the dysbolism. The aim of all research has to be to find an effective chemotherapeutical treatment of mindst a part of all idiopathic scolioses.

Achondroplasia↗
PubMed1985

Scoliosis screening in West Germany and its pitfalls with Scheuermann's disease.

The problems of scoliosis screening in the Federal Republic of Germany are outlined. The main pitfall with regard to the high numbers of very mild scolioses seems to be the disregard of mild forms in connection with Scheuermann's disease, in spite of their good prognosis. This group should be clearly separated, by means of a lateral X-ray, from beginning idiopathic adolescent scoliosis, with its doubtful prognosis. Moreover, it is necessary to exclude all curves below 10 degrees shown on the a.p. standing X-ray, not forgetting the fact that a seemingly mild scoliosis might be due in part to misleading projections and positions. The use of an electronic balance scale may be helpful in this respect.

Adolescent↗
PubMed1979

Moiré topography--a method for school screening of scoliosis.

The moiré method is tested in school screening of scoliosis. Moiré topography registers a three-dimensional description of the shape of the back. In the straight spine, the moiré shadow pattern is equal on both halves of the back. In structural scoliosis, the moiré pattern differs more with the increasing deformity of the spine. This asymmetry is mainly caused by the rotational component of the scoliosis. These shadow patterns consist of contourlines, which can be compared with those on a relief map. By photographing the moiré shadow lines, the status of the back is documented. In 212 cases, the moiré findings are compared with radiograph observations. A statistically significant correlation is found between the moiré asymmetry (rotational component) and the radiograph findings (lateral deviation according to Cobb). The moiré method seems to fulfil the criteria for a screening method--diagnosis of even minor curves, small risk for false negative findings, simple to handle and can document the back in many children in a short time.

Child↗
PubMed1989

Paraspinal muscle pathology in experimental scoliosis.

Paraspinal muscle biopsies from ten rabbits with experimentally induced scoliosis and from four healthy controls were analyzed histologically and histochemically. Scoliosis was induced by two different methods: six animals underwent unilateral damage of the dorsal column of the spinal cord (mean curve: 22 degrees) and four costotransversectomy (mean curve: 47 degrees). In eight scoliotic animals myopathic changes were detected on the muscles of the concave side. Only those animals which underwent costotransversectomy showed a neuropathic pattern with cronic denervation changes on the convex side. As regards the fiber type distribution, the control group showed a higher percentage of type-I fibers, which were similar on both sides of the spinal cord. No fiber proportion asymmetry could be detected in the muscles on the concave side in normal or scoliotic rabbits. There was a tendency to depart from normal values, in two different ways, on the convex side of scoliotic animals. Thus, in contrast to the medullary damage group, the muscles of the costotransversectomized rabbits showed an increased proportion of type-I fibers. Taken together, our findings support the hypothesis that myopathic changes as observed in human idiopathic scoliosis are a consequence of the postural deformity. Fiber type distribution does not appear to be related to the curvature in the same way.

Animals↗
PubMed1997

Syringomyelia and Arnold Chiari in scoliosis initially classified as idiopathic: experience with 25 patients.

The authors analysed the clinical and radiological findings and the surgical management of 25 patients admitted for scoliosis classified as idiopathic at first presentation, but in fact associated with spinal cord and/or brain stem anomalies. Twenty patients had syringomyelia, 19 had Chiari malformation. Scoliosis was the only presenting symptom when all these patients were referred to the orthopaedic surgeon. On examination, five patients had normal neurological findings, while the others showed very mild neurological deficits. The diagnosis of syringomyelia and Chiari malformation was established by MRI, which is the best form of neuroradiological examination for discovering spinal abnormalities. Neurosurgical treatment is strongly recommended as the first step in the management of "pseudo" idiopathic scoliosis.

Adult↗
PubMed1985

Electromyography for the investigation and early diagnosis of scoliosis.

A clinically normal 5 year old child with a family history of scoliosis was studied. Electromyography of the thoracic and lumbar erector spinae muscles and roentgenography of the spine were both done on two separate occasions, six months apart. On the first electromyographic investigation, moderate predominance of activity was found over the left thoracic erector spinae muscles. At that time, spinal roentgenography showed normal results, whereas six months later left thoracolumbar scoliosis was evident. It was concluded that electromyographic investigation is useful for the early diagnosis of scoliosis in school-age children.

Child, Preschool↗
PubMed2004

Biomechanical modelling of growth modulation following rib shortening or lengthening in adolescent idiopathic scoliosis.

A biomechanical model was developed to evaluate the long-term correction resulting from rib shortening or lengthening in adolescent idiopathic scoliosis (AIS). A finite element model of the trunk, personalised to the geometry of a scoliotic patient, was used to simulate rib surgery. Stress relaxation of ligaments following surgery was integrated into the model, as well as longitudinal growth of vertebral bodies and ribs and its modulation due to mechanical stresses. Simulations were performed in an iterative fashion over 24 months. A concave side rib shortening, inducing load patterns on the vertebral end-plates that could act against the scoliosis progression, was tested. A fractional factorial experimental design of 16 runs documented the effects of six modelling parameters. Wedging of the apical vertebra in the frontal plane decreased from 5.2 degrees initially to a mean value of 3.8 degrees after 24 months. The wedging decrease in the thoracic apical region was reflected by changes in the spine curvature, with a Cobb angle decrease from 46 degrees to 44 degrees immediately after the surgery and to a mean of 41 degrees after 24 months. However, both rib hump and vertebral axial rotation increased, on average, by 4 degrees at the curve apex. The most significant parameters were the growth sensitivity to stress in ribs and vertebrae and the rate of stress relaxation of intercostal ligaments. The results confirmed the potential of long-term correction of spinal curvature resulting from the rib shortening on the concavity. This modelling approach could be used for further design of less invasive surgery, taking into account residual growth, for scoliosis correction.

Adolescent↗
PubMed2000

[Minimally invasive ventral release and endoscopic ventral instrumentation in scoliosis].

We report on three years of experience with a new method of a simultaneous endoscopically assisted anterior release in the prone position, combined with transpedicular posterior scoliosis correction and fixation. In 60 cases this simultaneous approach yielded substantial advantages. True derotation of the apex--even in the thoracic spine--is achieved. Because of resection of apical discs, the hypokyphosis can be corrected easily. Apical derotation, restoration of the kypotic profile and more effective correction of lateral translation add up to true three-dimensional correction of scoliosis. The disadvantages of insufficient anterior anchorage of fixation implants are avoided, since correction and fixation are achieved posteriorly. An additional advantage of this combined approach and the use of pedicular screws is the fact that in idiopathic scoliosis fusion that is no longer than from end- to end-vertebrae is sufficient. Thus, in most King II curves the thoracolumbar junction does not need to be fused.

Adolescent↗
PubMed2005

The relationship between bone mineral density and biomechanics in patients with osteoporosis and scoliosis.

Nearly one-third of all women and one-sixth of all men over age 65 have osteoporosis, and this condition is often accompanied by lumbar scoliosis. Previous work has shown that, in a group of postmenopausal women with scoliosis and osteoporosis, both the bone mineral content (BMC) and bone mineral density (BMD) were greater on the concave side than the convex side. The goal of this study was to examine the structure-function relationships in the spines of patients with low bone mass and scoliosis using a patient-specific biomechanical model. We compared the percent change in BMC and the percent change in BMD with axial force, F(a), shear force, F(s), moment, M, local curvature, theta(rel), and the patient's age, A. We found that the percent change in BMC depended on the applied moment and the local curvature. The same dependence was observed for the percent change in BMD, but in this case, the shear force was also significantly inversely correlated. A population with femoral neck BMD with a T-score greater than -2.0 was similarly evaluated and yielded similar results. The percent change in BMD was related to M, theta(rel), A and negatively to the shear force. These results indicate that the osteoporotic spine is still able to respond to changes in the mechanical environment and provides a useful comparison between patients with osteoporosis and those with normal bone mass. In addition, this model may be a useful tool for the in vivo assessment of bone density changes in response to mechanical stimuli and drug treatments.

Absorptiometry, Photon↗
PubMedDate not supplied

Incidence and risk factors for mitral valve prolapse in severe adolescent idiopathic scoliosis.

Mitral valve prolapse (MVP) is known to be associated with thoracic skeletal anomalies. To determine the incidence and risk factors for mitral valve prolapse in the adolescent population with severe idiopathic scoliosis (IS), a prospective follow-up study on 139 adolescent patients with IS from the Pediatric Orthopedic Service was undertaken. Data collected included age, sex, medical and family history, physical exam, electrocardiogram and echocardiogram, spinal x-rays, and pulmonary function tests. MVP was detected by echocardiogram in 13.6% (19/139) of patients with IS as compared with 3.2% in 154 age- and weight-matched controls (p < 0.006). All patients with MVP were asymptomatic and a systolic click or murmur was detected on the single preoperative exam only in 37% (7/19) of them. Patients with MVP and IS weighed less (45.1 +/- 2.0 vs 51.8 +/- 0.1 kg, p < 0.002) as compared with those IS patients without MVP. The electrocardiogram was abnormal in 21% (4/19) of patients with MVP as compared with only 1.6% (2/120) of patients with IS but no MVP. The two groups did not differ with respect to age at diagnosis, severity of scoliosis, positive family history of scoliosis, or the presence of restrictive lung disease. Though IS was more prevalent in females (79%), the presence of MVP was not related to gender. MVP was persistent in 10 of the 19 patients reevaluated by echocardiogram 2-4 years after spinal surgery. We conclude that MVP is four times more common in patients with severe IS than in the normal adolescent population, and is associated with a lower body weight in IS patients with MVP than in IS patients without MVP. The persistent nature of MVP, even after corrective spinal surgery, may be related to factors other than geometric changes of the heart caused by abnormal thoracic curvature.

Adolescent↗
PubMed1999

MRI evaluation of multifidus muscles in adolescent idiopathic scoliosis.

BACKGROUND: The role of the multifidus muscles in the initiation and progression of curve in adolescent idiopathic scoliosis is not fully understood and controversy exists as to the side of the abnormality. OBJECTIVE: To evaluate on MRI the multifidus muscles at the apex of the major curve in adolescent idiopathic scoliosis to ascertain if the multifidus muscles on the convex or concave side are abnormal and the relationship to curve severity. MATERIALS AND METHODS: Forty-six patients with adolescent idiopathic scoliosis, separated into two groups, were studied using a 1.5-T MR scanner with the synergy spine coil, employing a modified STIR (short tau inversion recovery) axial sequence obtained at the apex of the major scoliotic curve. RESULTS: No hyperintense signal change was demonstrated in the convex side multifidus muscles in any patient. In group I, 16 of 18 patients with severe or rapidly progressive curve showed increase in signal intensity in the multifidus muscle on the concave side of the apex of the curve. In group II, of the 15 patients with mild curve (Cobb angle 10-30 degrees), 4 had increased signal intensity in the multifidus muscle on the concave side; of the 13 with more severe curve (Cobb angle greater than 30 degrees), 10 had increase in multifidus signal intensity on the concave side. CONCLUSIONS: The concave-side multifidus muscle at the apex of a scoliotic curve was morphologically abnormal. A significant association between abnormal signal change and curve severity was also established.

Adolescent↗
PubMed1998

Scoliosis circa 2000: radiologic imaging perspective. I. Diagnosis and pretreatment evaluation.

Plain film imaging remains important for the diagnosis and surveillance of scoliosis, as well as for the detection of complications after surgery. Advances in CT and MR imaging have greatly improved the ability to detect or confirming non-idiopathic causes of scoliosis, including abnormalities within the spinal canal. Three-dimensional thinking has become more important in evaluating and understanding scoliosis.

Adolescent↗
PubMed2001

Myelopathy due to scoliosis with vertebral hypertrophy in Klippel-Trenaunay-Weber syndrome.

We describe a 37-year-old man complaining of right back pain and gait disturbance. He had a big soft tumor on his right back, hemihypertrophy of the right lower extremity, and right thoracic scoliosis. We diagnosed Klippel-Trenaunay-Weber syndrome based on the pathological findings of the soft tumor. Computed tomography (CT) scan revealed severe spinal stenosis due to a hypertrophic vertebral body and facet joint at T7. Treatment by decompression of hypertrophic bone led to complete neurological recovery. To our knowledge, no case has been reported of Klippel-Trenaunay-Weber syndrome with myelopathy which originated from thoracic scoliosis with a hypertrophic facet joint and vertebral body. We suggest that the cause of myelopathy in Klippel-Trenaunay-Weber syndrome originated not only from arteriovenous fistula, medullary angioma, and extradural hemangioma but also vertebral hypertrophy with scoliosis.

Adult↗
PubMed2002

Weight distribution in the sitting position in patients with paralytic scoliosis: pre- and postoperative evaluation.

Patients with paralytic scoliosis spend most of their time in the sitting position. The spinal deformity, pelvic obliquity and uneven weight distribution on the seating surface necessitates frequent seating adaptations in the wheelchair. In this prospective study, 45 wheelchair-bound patients were evaluated preoperatively and 43 postoperatively. The pre- and postoperative evaluation was done by an independent observer. Surgical correction was performed between 1993 and 1996. Assessments included sitting balance on a box; number of seating supports in the wheelchair; weight distribution on the seating surface, measured with a computerized EMED system; Cobb angle; hip dislocation; mediolateral translation of T1 and of the apex vertebra with reference to a perpendicular line drawn upwards from the spinal process of S1; and pelvic obliquity from a line drawn between the most proximal points in the iliac crests. X-rays for the measurement of Cobb angle and pelvic obliquity were performed in sitting position. Reference values for normal weight distribution on the seating surface were obtained for 27 normal subjects and revealed a mean value of 59% of weight supported on one side. A stepwise regression analysis on the preoperative results showed that pelvic obliquity and thoracolumbar/lumbar spinal imbalance explained weight distribution on the seating surface (R(2)=0.45). There were significant improvements in all variables except in sitting balance and imbalance of T1, 1 year postoperatively. When dividing the material into two subgroups, the results showed no significant difference in any of the assessed parameters of the scoliosis, pelvic obliquity, or sitting position between individuals with even (50-59% on one side) and those with uneven (60-100% on one side) weight distribution postoperatively. The results of the assessment showed a significant improvement after surgical correction, but the majority still had pelvic obliquity and uneven weight distribution in a sitting position. The weight distribution on the seating surface preoperatively was explained by thoracolumbar/lumbar spinal imbalance and pelvic obliquity, with R(2)= 0.45. There were no significant differences in any variables in comparisons between individuals with even weight distribution and those with uneven weight distribution. For the group with even weight distribution, however, the mean pelvic obliquity was 6 degrees and in the group with uneven weight distribution the mean pelvic obliquity was 12 degrees. Attention to seating surface and adjustment of seating position is needed for patients with paralytic scoliosis.

Adolescent↗
PubMed2003

Survivorship analysis of Cotrel-Dubousset instrumentation in idiopathic scoliosis.

This study presents a survivorship analysis of Cotrel-Dubousset instrumentation in the surgical treatment of idiopathic scoliosis. Between 1987 and 1995, a total of 133 patients with idiopathic scoliosis received posterior spine fusion and instrumentation with the CD system at our center. The patients' mean age at surgery was 16.5 years (range 11-43 years). The magnitude of the thoracic scoliosis averaged 62.7 degrees (range 40 degrees -125 degrees ) and that of the lumbar curve was 58.8 degrees (range 40 degrees -100 degrees ). On average, 12.2 segments were fused (range 8-17) and, excluding the rods, 14.1 implants were set for each patient (range 10-21). Survivorship analysis was carried out using the Kaplan-Meier method. Implant removal was considered the terminal event, or "death". The effect of several variables on survival rate was determined with the Cox regression method. The patients remained in the study for 56.7 months (range 2-120 months). One-hundred and ten patients were withdrawn ("censored"): 90 "alive" (did not require repeat surgery and attended follow-up control in 1997) and 20 "lost" (did not attend control in 1997). Twenty-three patients attained the terminal event of implant removal for a variety of reasons: acute infection (three cases), late infection (ten cases), implant failure requiring revision (six cases) and local pain (four cases). The survival rate was 95.5% at 3 months, 94.7% at 6 months, 93.9% at 1 year, 91.5% at 2 years, 82.2% at 5 years and 76.5% at 10 years. The magnitude of the curves, total number of implants and number of fused segments did not correlate with survival probability. A positive correlation was found between survival rate and correction loss between surgery and last control. A survival rate of 76.5% at 10 years is unexpectedly low. Current data suggest that the incapacity to maintain correction after initial surgery plays a major roll in the long-term evolution of Cotrel-Dubousset instrumentation.

Adolescent↗