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PubMed2002

Hemi-epiphysiodesis for unclassified congenital scoliosis: immediate results and mid-term follow-up.

Complex spinal anomalies involved in congenital scoliosis consist of a jumble of vertebral defects. Progressive scoliotic curves are frequently encountered in these patients. We evaluated the results of hemi-epiphysiodesis for this patient population. A series of ten patients with unclassified scoliosis, involving multiple hemivertebrae and/or bars, was reviewed retrospectively. Hemi-epiphysiodesis was the primary treatment in all patients. Mortality, complications and wound healing problems did not occur. The average Cobb angle for all patients changed from 54 degrees (range: 40 degrees -74 degrees), preoperatively, to 58 degrees (range: 30 degrees -104 degrees), postoperatively. Applying the criterion of a minimum change of 20 degrees, to take into account measurement variability, an epiphysiodesis effect was achieved in two procedures, progression was arrested in six procedures and failure occurred in two procedures. The mean rate of Cobb angle change per annum decreased from 2.9 degrees (range: -35 degrees to 14 degrees), preoperatively, to 2.4 degrees (range: -4 degrees to 13 degrees), following surgery. Repeat surgery was necessitated by coexisting progressive kyphosis and pseudoarthrosis in one patient, and involved extension of primary epiphysiodesis in two patients. A mean intervention-free period of 58 months was established. These results suggest that hemi-epiphysiodesis stabilized the unclassified congenital scoliosis. Being under 5 years of age, having a thoracolumbar curve location, and the absence of coexisting kyphosis were found to be associated with a more favorable outcome.

Child, Preschool↗
PubMed2002

No relationship exists between the correction of the thoracic and the lumbar curves after selective thoracic fusion for adolescent idiopathic scoliosis King type II.

In this study we focus on idiopathic scoliosis with a primary thoracic curve and a secondary lumbar curve. We were interested in how the lumbar curve corrects following selective thoracic fusion and whether one can explain or predict the behaviour of the lumbar curve. In the literature it is said that, if the lower level of fusion is properly selected, the lumbar curve spontaneously corrects to balance the thoracic curve after selective thoracic fusion. Most authors have assumed a mechanism whereby improvement of the lumbar curve occurs through counterbalancing the surgical correction of the thoracic curve. The correction of the lumbar curve is said to echo the correction obtained for the thoracic curve. Because of these hypotheses, we postulate there should be a correlation between the correction of the lumbar and the thoracic curves of a scoliosis. To validate this hypothesis, we performed a retrospective study on 27 patients with King type II adolescent idiopathic scoliosis treated by selective thoracic fusion. The mean preoperative Cobb angles were 54 degrees for the thoracic curve and 34 degrees for the lumbar curve. Postoperatively they were 31 degrees and 22 degrees respectively. Using Pearson correlation analysis, we found no significant correlation between the relative corrections of the individual thoracic and lumbar curves. Moreover, there was a decrease in the correlation between the thoracic and lumbar curve after operation (preoperative R=0.787, postoperative R=0.364). These results show that the correction of the lumbar curve is not a reflection of the thoracic correction. The exact mechanism by which the lumbar spine corrects remains to be elucidated.

Adolescent↗
PubMed2003

Rib deformity in scoliosis.

Rib deformity in scoliosis is of interest because it may help in the diagnosis, and also, in some pronounced cases, it may need correction by costoplasty. There are, however, debates about its use in diagnosis, because some authors think that rib deformity is not closely related to either the magnitude or the extent of rotation of the curve. In order to define the relation between rib deformity and scoliosis, 11 patients were recruited who were to undergo scoliosis surgery and thoracoplasty, and anteroposterior (AP) T1-S1 standing radiographs, computerized tomography (CT) scans, and three-dimensional (3D) reconstructions were obtained. From the radiographs, the most rotated vertebra, the Cobb angle, the apex and the type of the curve were determined. From the CT scans and 3D reconstructions, the exact level of the rib deformity measured was matched with the corresponding vertebral level. In this way, the most rotated vertebra and the most prominent part of the rib cage deformity were identified. The most rotated vertebra was found to be at the same level in both radiographs and CT scans in only five patients. In the rest of the patients, CT scans showed it either one level higher or lower than it appeared on the radiograph. The most prominent part of the rib cage deformity was at the same level as the most rotated vertebra in two patients, and in the rest of the patients it was one, two or three vertebral levels lower. There was no association between the Cobb angle, vertebral rotation and rib deformity. A CT scan is necessary preoperatively in patients who will undergo a costoplasty, to determine the exact levels of the prominence. However, a scanogram or a 3D reconstruction is required for exactly matching the most prominent part of the rib cage deformity to the corresponding vertebral level.

Adolescent↗
PubMed2004

Implant removal for late-developing infection after instrumented posterior spinal fusion for scoliosis: reinstrumentation reduces loss of correction. A retrospective analysis of 45 cases.

A retrospective follow-up study of patients who, having undergone instrumented posterior spinal fusion for scoliosis, experienced late infection and then underwent either implant removal alone or implant removal and instrumented refusion. We conducted this study to determine whether it is possible to avoid loss of correction by a single-stage implant removal and reinstrumentation procedure. There have been a few reports of late-appearing infections after spinal instrumentation. Implant bulk, metallurgic reactions, and contamination with low-virulence microorganisms have been suggested as possible etiologic factors. The clinical symptoms include pain, swelling, redness, and spontaneous drainage of fluid. Complete instrumentation removal and systemic antibiotics is usually curative. We retrospectively reviewed 45 patients who underwent instrumented posterior spinal fusion for scoliosis and experienced development of late infections and, after a mean of 3 years after the initial procedure, either underwent implant removal alone [ n=35, instrumentation removal (HR) group] or additionally underwent reinstrumentation and fusion [ n=10, reinstrumentation and fusion (RI&F) group]. Three patients were reinstrumented 1.5 years after instrumentation removal, and seven underwent a one-stage rod removal and reinstrumentation/refusion procedure. Allergic predisposition, protracted postoperative fever, and pseudarthrosis appear to increase the risk of late-developing infection after posterior spinal fusion. All wounds in both groups healed uneventfully. Preoperative radiographic Cobb measurements showed no statistically significant between-group differences. At follow-up, however, outcome was clearly better in the RI&F group: Loss of correction was significantly smaller in reinstrumented patients. Thus, the thoracic Cobb angle was 28+/-16 degrees (range 0-55 degrees ) in the RI&F group versus 42+/-15 degrees (21-80 degrees ) in the HR group, and the lumbar Cobb angle was 22+/-11 degrees (10-36 degrees ) in the RI&F group versus 29+/-12 degrees (13-54 degrees ) in the HR group. The results of our study demonstrate that wound healing is usually uneventful after instrumentation removal for late infection, also when patients undergo instrumented refusion in a one-stage procedure. Reinstrumentation appears to achieve permanent correction of scoliosis.

Adolescent↗
PubMed2004

A preliminary study on electromyographic analysis of the paraspinal musculature in idiopathic scoliosis.

The paraspinal muscles have been implicated as a major causative factor in the progression of idiopathic scoliosis. Therefore, the objectives of this preliminary study were to measure the electromyographic activity (EMG) of the paraspinal muscles to determine its relationship to progression of the scoliotic curve. Idiopathic scoliotic patients were selected and identified afterwards on curve progression. The EMG activity on both sides of the spine was measured in a set of standardized postures using bipolar surface electrodes at the apex and two end vertebrae of the scoliotic curve. An EMG ratio involving measurements of the EMG activity on the convex and concave sides of the scoliotic curve was used to evaluate the paraspinal muscles. Enhanced EMG ratios at the apex of the scoliotic curve were found in both groups during sitting and standing. The most interesting finding was that children with progression of the curve also showed enhanced EMG ratios at the lower end vertebra of the curve. The EMG ratios between the groups were significantly different from each other at the apex and end vertebrae for several test conditions. Overlap in the EMG-ratio ranges made differentiation difficult for prediction of the progression of the individual scoliosis patient. However, the EMG ratio at the lower end vertebra of the scoliotic curve is significantly higher than 1 in all test conditions in the group of children with subsequent progression of the curve, whereas it is always normal in the non-progressive group. Therefore, EMG of the paraspinal muscles might be of value for prediction of progression in idiopathic scoliosis.

Adolescent↗
PubMed2004

Visualisation of the brace effect on the spinal profile in idiopathic scoliosis.

We studied the brace effect on the spinal profile in idiopathic scoliosis, using a MR procedure visualising the complete scoliotic spine in any vertical plane, while rotating it 180 degrees on the longitudinal axis of the patient. Thirty-eight female patients (mean age, 14.5 years) were included in the study. Inclusion criteria were an idiopathic scoliosis, a Cobb angle greater than 20 degrees , age of 10-17 years and bracing with a Cheneau brace. The brace effect was studied in 38 thoracic curves. The MR examinations were carried out in direct sequences, with and without brace. A reconstruction algorithm allows visualising the whole spine in vertical projections, with rotational steps of 2 degrees , from -90 degrees to 90 degrees , referred to as MR animation. In various vertical MR projections, the changes of the curves were evaluated by measuring the Cobb angle. Additionally, a translation angle of the apical vertebra was determined, representing the lateral deviation of the apical vertebra from a defined midline. Testing the reproducibility of the Cobb angles, the standard deviation of the intra-individual differences was 1.7 degrees and of the inter-individual differences, 2.1 degrees . For the translation angles, the standard deviation of the intra-individual differences was 0.8 degrees and of the inter-individual differences, 0.9 degrees . With brace the mean Cobb angle of the thoracic curves was significantly reduced in the various vertical MR projections. The mean translation angle was also reduced. MR analysis showed that the brace effect is a translation process, straightening the profile of the scoliotic spine in all vertical planes. MR animation allows visualising the brace effect on the spine in scoliosis based on a 3D data set, without additional radiation exposure. It showed the straightening effect of the brace leading to a flattening of the sagittal spinal profile.

Adolescent↗
PubMed2004

Early changes in pulmonary function following thoracotomy for scoliosis correction: the effect of size of incision.

It is generally believed that minimal access surgery may produce less change in pulmonary function than conventional open thoracotomy for scoliosis correction. Though there is considerable literature regarding changes in pulmonary function tests (PFT) after thoracotomy, there is scant data available regarding the effect of the magnitude of thoracic wall disruption on pulmonary function, particularly in the early postoperative weeks. This study aims to evaluate the effect of the size of incision on pulmonary function after anterior release and fusion in patients with moderate thoracic curves due to adolescent idiopathic scoliosis. The study group was made up of 19 patients with thoracic curves due to adolescent idiopathic scoliosis. The subjects had had thoracotomy for anterior release, followed by posterior instrumentation and fusion at a second sitting. The ten patients who had had conventional, large thoracotomy were placed in group A and the nine minimal access cases in group B. PFTs consisting of volume (FVC) and flow (FEV1) were obtained before the anterior release, 2 weeks later (before the posterior instrumented fusion), and 3 months after the posterior fusion. The degree of deformity in the sagittal and the coronal plane preoperatively and postoperatively were measured and documented. The mean preoperative pulmonary function was significantly less than the predicted values for both patient groups. There was a decline in the postoperative pulmonary function (both percentage predicted value and absolute value) in both groups at 2 weeks and at 3 months. The deterioration of pulmonary function was less in the small-thoracotomy group, but this difference between the groups was statistically significant only for the 2-week values. Our study shows that there is significant pulmonary function restriction even in patients with moderate thoracic curves. There was a lesser decline in pulmonary function in the minimal-access group, as compared with the standard thoracotomy group, but this difference was only in the early postoperative period and became insignificant by 3 months.

Adolescent↗
PubMed2005

The suprapedicle claw construct in anterior scoliosis surgery.

Proximal screw pullout is a well-recognized problem in anterior scoliosis surgery, with a rate of pseudarthrosis or screw pullout ranging from 15 to 30%. To prevent screw pullout at the top of the construct, the authors have devised the concept of a claw for the top instrumented vertebra. The claw consists of a classic anterior vertebral body screw inserted parallel to the inferior end-plate and in the posterior portion of the vertebral body 8 mm in front of the spine canal. After rib desarticulation, a laminar hook of a small size is inserted over the superior aspect of the pedicle of the same vertebra. The rod is then inserted into the two side openings of the screw and the hook. Compression across the hook and the screw is then performed, making a claw construct. This concept can also be extended in the case of early revision for a proximal screw pullout, where it is possible to revise the instrumentation with an offset connector linking the rod to the superior portion of the pedicle where the suprapedicule hook has been inserted. We report two cases where a suprapedicle claw was successfully used in anterior scoliosis correction of a right thoracic curve. Such a concept may represent the solution to proximal screw pullout in anterior scoliosis correction.

Adolescent↗
PubMed2005

Prevalence and clinical significance of superficial abdominal reflex abnormalities in idiopathic scoliosis.

To determine prevalence and significance of abnormal superficial abdominal reflexes (SARs) in idiopathic scoliosis. Study of 73 patients with presumed idiopathic scoliosis referred for magnetic resonance imaging (MRI), either as a routine pre-operative assessment (n=42) or because of abnormal symptoms or neurological signs (n=31). All patients were examined prior to magnetic resonance imaging (MRI), and the presence of abnormal SARs was noted. All patients then underwent MRI of the whole spine from the foramen magnum to the sacrum. The presence of Chiari 1 malformation and syrinx was recorded. The study group consisted of 11 males and 62 females with a mean age at time of MRI of 18 years (range 5-51 years) and a mean Cobb angle of 48 degrees (range 10-104 degrees). Abnormality of the SARs was recorded in eight cases (prevalence 11%). An abnormal MRI study was recorded in nine cases (12.3%), all patients having a syrinx and four having in addition, a Chiari 1 malformation. Of the patients with abnormal SARs, only 2 (25%) had an abnormal MRI study; 1 had unilateral absence of the reflexes whereas the other had complete absence of SARs. Of patients referred for MRI as a routine pre-operative assessment, 5 (11.6%) had an abnormal MRI study. In patients with idiopathic scoliosis, abnormality of the SARs was recorded in 11% of cases. Unilateral absence was present in one case only and was associated with the presence of syrinx. Other patterns of abnormality were not a useful indicator of underlying cord abnormality.

Adolescent↗
PubMed2005

Minimum 20-year follow-up results of Harrington rod fusion for idiopathic scoliosis.

We evaluated the outcome of spinal fusion with a single Harrington distraction rod in patients with idiopathic scoliosis. At follow-up visits a minimum of 20 years post-surgery, we studied 24 patients who had been operated on by the same surgeon. The Scoliosis Research Society (SRS) Instrument and an additional questionnaire of our own, along with an invitation for a follow-up visit, were originally mailed to 28 consecutive patients of the surgeon. The SRS Instrument has seven domains dealing with back pain, general self-image, self-image after surgery, general function, function in terms of level of activity, function after surgery, and degree of satisfaction with the surgery. The length of time between surgery and the follow-up visit averaged 22.9 years (20.2-27.3). The mean age at surgery and follow-up were 15.8 (13-22) and 38.8 (35-48) years, respectively. Twenty-four patients sent back the completed questionnaires and 16 of them participated in the clinic and radiographic follow-up. To assess the meaning of the questionnaires' results, a control group of the same sex, age and geographic provenance was selected from our outpatients without scoliosis. The average follow-up score on the SRS Instrument for the patients was 100.8 (78-110). When we compared the study and control groups, no significant differences in the single SRS domain scores were observed. The mean Cobb angle and rib cage deformity before surgery were 70.46 degrees (40-120) and 36.4 mm (20-60 mm), respectively, whereas on follow-up they were 41.23 degrees (16-75) and 22.3 mm (5-50 mm), respectively. These long-term results lead us to consider Harrington fusion a procedure that produces a long-lasting high degree of self-reported post-operative satisfaction.

Adolescent↗
PubMed2006

Anterior dual rod instrumentation in idiopathic thoracic scoliosis.

For anterior correction and instrumentation of thoracic curves single rod techniques are widely used. Disadvantages of this technique include screw pullouts, rod fractures and limited control of kyphosis. This is a prospective study of 23 consecutive patients with idiopathic thoracic scoliosis treated with a new anterior dual rod system. Aim of the study was to evaluate the safety and efficacy of this new technique in the surgical treatment of idiopathic thoracic scoliosis. To the best knowledge of the authors, this is the largest series on dual rod dual screw instrumentation over the entire fusion length in thoracic scoliosis. Twenty-three patients with an average age of 15 years were surgically treated with a new anterior dual rod system through a standard open double thoracotomy approach. Average clinical and radiological follow-up was 28 months (24-46 months). Fusion was carried out mostly from end-to-end vertebra. The primary curve was corrected from 66.6 degrees to 28.3 degrees (57.5% correction) with an average loss of correction of 2.0 degrees at Cobb levels and of 1.3 degrees at fusion levels. Spontaneous correction of the secondary lumbar curve averaged 43.2% (preoperative Cobb angle 41.2 degrees ). The apical vertebral rotation was corrected by 41.1% with a consecutive correction of the rib hump of clinically 66.7%. The thoracic kyphosis measured 29.2 degrees preoperatively and 33.6 degrees at follow-up. In seven patients with a preoperative hyperkyphosis of on average 47.3 degrees thoracic kyphosis was corrected to 41.0 degrees . This new instrumentation enables an entire dual rod instrumentation over the whole thoracic fusion length. It offers primary stability without the need of postoperative bracing. Dual screw dual rod instrumentation offers the advantages of a high screw pullout resistance, an increased overall stability and satisfactory sagittal plane control.

Adolescent↗
PubMed2005

Recombinant coagulation factor VIIa--a novel haemostatic agent in scoliosis surgery?

Spinal fusion surgery in children and adolescents with idiopathic scoliosis is often associated with severe haemorrhage. Recombinant coagulation factor VIIa (rFVIIa) has previously been shown to be an effective haemostatic treatment for severe bleeding associated with a variety of coagulopathic and non-coagulopathic indications. The aim of this retrospective study was to assess the safety and haemostatic efficacy of rFVIIa in a series of 26 consecutive adolescent patients with scoliosis (22 females; mean age 16.6 years) undergoing correctional surgery. A second series of 26 consecutive patients (20 females; mean age 16.2 years) who received standard therapy during surgery, represented historical controls. Blood loss, transfusion requirements, duration of surgery, and peri-operative measurements of coagulation parameters were compared between the two groups. Intra-operative and combined intra-operative and post-operative blood losses were significantly smaller in the rFVIIa-treatment group than in the historical controls (P=0.003 and 0.032, respectively); rFVIIa-treated patients also demonstrated significantly reduced blood loss per vertebral segment fused (P=0.032) and per hour of surgery (P<0.001). Intra-operative requirements for packed red blood cells were also significantly lower in the treatment group (P=0.042). Patients in the treatment group demonstrated rapid and maintained reduction of prothrombin time and international normalised ratio; values among rFVIIa-treated patients remained significantly lower than those in the control group at all time points evaluated (P<0.001). There were no deaths and no adverse events. These results suggest that rFVIIa is a safe and effective haemostatic agent for use during spinal fusion surgery in adolescent patients with idiopathic scoliosis; however, further research and randomised, placebo-controlled trials are needed to confirm these findings.

Adolescent↗
PubMed2006

Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis.

A prospective clinical and radiographic evaluation of 33 consecutive patients with severe and rigid idiopathic scoliosis (average Cobb angle 93 degrees, flexibility on bending films 23%) were treated with combined anterior and posterior instrumentation with a minimum follow-up of 2 years. All patients underwent anterior release and VDS-Zielke Instrumentation of the primary curve. In highly rigid scoliosis, this was preceded by a posterior release. Finally, posterior correction and fusion with a multiple hook and pedicle screw construct was performed. Thirty patients were operated in one stage, three patients in two stages. Preoperative curves ranged from 80 to 122 degrees Cobb angle. Frontal plane correction of the primary curve averaged 67% with an average loss of correction of 2 degrees . The apical vertebral rotation of the primary curve was corrected by 49%. In all but three patients, sagittal alignment was restored. There were no neurological complications, deep wound infections or pseudarthrosis. Combined anterior and posterior instrumentation is safe and enables an effective three-dimensional curve correction in severe and rigid idiopathic scoliosis.

Adolescent↗
PubMed2006

Health-related quality of life in patients with adolescent idiopathic scoliosis after treatment: short-term effects after brace or surgical treatment.

For treatment of teenagers with progressive adolescent idiopathic scoliosis in an early stage, two options are generally considered: treatment with a brace or observation followed by surgery if necessary. Many doctors and patients prefer conservative treatment (i.e. brace treatment) to surgical treatment, because surgery of the spine is generally considered a drastic intervention. Because potential differences in health-related quality of life (HRQoL) after treatment between braced and surgically treated patients are not well explored, this study aimed to determine whether short-term differences exist in HRQoL between adolescents treated with a brace or treated surgically. A cross-sectional analysis of HRQoL was made of 109 patients with adolescent idiopathic scoliosis who, after completing treatment, filled out the Dutch SRS-22 Patient Questionnaire. All patients had been treated either with a brace or surgery, or with a brace followed by surgery. Patients treated surgically had significantly higher mean scores in the satisfaction with management domain than those treated with a brace. No other consistent differences in HRQoL were found between patients treated with a brace and patients treated surgically. Gender, curve type and curve size had no relevant effect on HRQoL. We conclude that short-term differences in HRQoL after treatment in adolescent patients with idiopathic scoliosis are negligible and cannot support preference of one treatment above the other.

Adolescent↗
PubMed2006

Radiation-free quantitative assessment of scoliosis: a multi center prospective study.

Accurate quantitative measurements of the spine are essential for deformity diagnosis and assessment of curve progression. There is much concern related to the multiple exposures to ionizing radiation associated with the Cobb method of radiographic measurement, currently the standard procedure for diagnosis and follow-up of the progression of scoliosis. In addition, the Cobb method relies on 2-D analysis of a 3-D deformity. The aim of this prospective study was to investigate the clinical value of Ortelius800 that provides a radiation-free method for scoliosis assessment in three planes (coronal, sagittal, apical), with simultaneous automatic calculation of the Cobb angle in both coronal and sagittal views. Analysis of the clinical value of the device for assessing spinal deformities was performed on patients with adolescent idiopathic scoliosis, deformity angles ranging from 10 degrees to 48 degrees. Correlation between Cobb angles measured manually on standard erect posteroanterior radiographs and those calculated by Ortelius800 showed an absolute difference between the measurements to be significantly less than +/- 5 degrees for coronal measurements and significantly less than +/- 6 degrees for sagittal measurements indicating good correlation between the two methods. The measurements from four independent sites and six independent examiners were not significantly different. We found the novel clinical tool to be reliable for following mild and moderate idiopathic curves in both coronal and sagittal planes, without exposing the patient to ionizing radiation. Considering the need for further validation of this new method, any change in treatment protocol should still be based on radiographic control.

Adolescent↗
PubMed2007

Pedicle morphology of the thoracic spine in preadolescent idiopathic scoliosis: magnetic resonance supported analysis.

Although several studies have been reported on the adult vertebral pedicle morphology, little is known about immature thoracic pedicles in patients with idiopathic scoliosis. A total of 310 pedicles (155 vertebrae) from T1 to T12 in 10-14 years age group were analyzed with the use of magnetic resonance imaging and digital measurement program in 13 patients with right-sided thoracic idiopathic scoliosis. Each pedicle was measured in the axial and sagittal planes including transverse and sagittal pedicle width and angles, chord length, interpedicular distance and epidural space width on convex and concave sides of the curve. The smallest transverse pedicle widths were in the periapical region and the largest were in the caudal region. No statistically significant difference in transverse pedicle widths was detected between the convex and concave sides. The transverse pedicle angle measured 15.56 degrees at T1 and decreased to 6.32 degrees at T12. Chord length increased gradually from the cephalad part of the thoracic spine to the caudad part as the shortest length was seen at T1 convex level with a mean of 30.45 mm and the largest length was seen at T12 concave level with a mean of 41.73 mm. The width of epidural space on the concave side was significantly smaller than that on the convex side in most levels of the curve. Based on the anatomic measurements, it may be reasonable to consider thoracic pedicle screws in preadolescent idiopathic scoliosis.

Adolescent↗
PubMed2001

Preoperative and early postoperative three-dimensional changes of the rib cage after posterior instrumentation in adolescent idiopathic scoliosis.

Rib cage deformity is an important component of scoliosis, but few authors have reported the three-dimensional (3-D) effect of surgical procedures with posterior instrumentation systems on the shape of the rib cage. The objective of this prospective clinical study was to measure the short-term 3-D changes in the shape of the rib cage at the apex of the curve after corrective surgery of adolescent idiopathic scoliosis by a posterior approach using a multi rod, hook and screw system. The 3-D shape of the spine and rib cage was modelled pre- and postoperatively using a 3-D reconstruction technique based on multi-planar radiography in a group of 29 adolescents with idiopathic scoliosis. Geometrical indices describing the scoliotic deformity of the rib cage were computed from these models and were compared pre- and postoperatively using Student's t-tests. The frontal spinal curve correction averaged 53% in the frontal plane, while no significant change was noted in the sagittal plane. Significant changes were noted in the shape of the rib cage: rib hump at the apex and at the adjacent lower level were improved (36% and 38%), and small but significant differences were detected in rib frontal orientation in the concavity of the curves at the apex and adjacent lower rib levels. Multi rod, hook and screw instrumentation systems, such as Cotrel-Dubousset instrumentation, are effective in producing significant improvements in the 3-D shape of the rib cage, but these changes are less important than those observed at the spine level.

Adolescent↗
PubMed1998

Painful scoliosis secondary to osteoblastoma of the vertebral body.

A 19-year-old boy with a painful thoracolumbar scoliosis was found to have an osteoblastoma of the body of T12. Excision of the tumour was carried out through a left thoracotomy approach and strut bone grafting was performed. Complete excision of the tumour was facilitated by intraoperative radiographs of the removed vertebra. Following surgery the patient's pain resolved completely and the deformity was partially corrected. Osteoblastoma of the vertebral body in the thoracolumbar region has not previously been reported. Diagnosis may be difficult unless the significance of the association between pain and the scoliosis is appreciated. The tumour is often not readily apparent on plain radiographs. Therefore, further radiological investigation in the form of a bone and CT scan is necessary to establish the diagnosis. Early excision of the tumour is essential to prevent a permanent structural scoliosis from developing.

Adult↗