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PubMed2006

Imaging in scoliosis from the orthopaedic surgeon's point of view.

For treating patients with scoliosis orthopaedic surgeons need diagnostic imaging procedures in order to provide answers about a possible underlying disease, choice of treatment, and prognosis. Once treatment is instituted, imaging is also critical for monitoring changes of the deformity so as to optimize therapy. The combined effort of orthopaedic surgeons and radiologists helps detect treatable causes of scoliosis at an early stage, define the need and timing for surgery, and ensure that every precaution is taken to minimize the risks of surgery. Neurosurgical causes, with particular reference to spinal cord tumours and syringomyelia, need to be addressed before scoliosis surgery can be contemplated.

Adolescent↗
PubMed2005

A prospective comparison of thoracoscopic vs open anterior instrumentation and spinal fusion for idiopathic thoracic scoliosis in children.

BACKGROUND/PURPOSE: The management of scoliosis in children has been evolving. Anterior release, diskectomy, and anterior instrumentation and spinal fusion (AISF) may be of benefit compared with a combined anterior and posterior or a posterior-only approach. Because thoracoscopic AISF (TAISF) has the potential benefit of muscle sparing, superior cosmesis, and less pain, the authors decided to prospectively compare this newer technique with open AISF (OAISF) to evaluate whether the 2 approaches were equivalent. METHODS: All children with idiopathic thoracic scoliosis undergoing AISF at a single center were prospectively examined. One hundred fifty-five children who had a minimum of 1-year follow-up were included in the study. Descriptive statistics are reported as means and SDs. Groups were compared using the independent-samples t test with Levene's test for equality of variances; a 2-tailed P value of .05 or less was considered significant. RESULTS: Open AISF was performed in 114 patients and TAISF was performed in 41; there were 126 girls and 29 boys. Mean age at surgery was similar (14 +/- 3 vs 14.3 +/- 1.5 years; P = .5), as was weight (54.2 +/- 19 vs 54.6 +/- 23 kg; P = .9). There were no differences in preoperative thoracic curves (48.5 degrees +/- 14 degrees vs 49.8 degrees +/- 7 degrees; P = .6) or in the number of vertebral levels instrumented (7.7 +/- 1.3 vs 7.6 +/- 0.7; P = .7). Operative time was shorter with OAISF (383 +/- 65 vs 508 +/- 98 minutes; P < .01), and there was less estimated blood loss (924 +/- 724 vs 1218 +/- 747 mL; P = .03). The OAISF group took longer to extubate (1.4 +/- 1.2 vs 1 +/- 0.3 days; P = .03) and had slightly greater chest tube drainage (1710 +/- 730 vs 1639 +/- 515 mL; P = .5). At the 1-year follow-up, the thoracic curves were similar (17.5 degrees +/- 8 degrees vs 15.2 degrees +/- 7.5 degrees; P = .1) and percentage correction of thoracic curves was also similar (64% vs 69%). CONCLUSIONS: Thoracoscopic AISF is safe and effective in correcting idiopathic childhood scoliosis. Correction of deformity with TAISF is equivalent to OAISF, although it takes longer and has more blood loss. However, it spares cutting muscle, uses smaller skin incisions, and appears to have superior cosmesis.

Adolescent↗
PubMed2004

The influence of right anterolateral thoracotomy in prepubescent female patients on late breast development and on the incidence of scoliosis.

BACKGROUND: It is assumed that a right anterolateral thoracotomy for correction of simple congenital cardiac defects (ie, atrial septal defect) achieves more favorable cosmetic results than a standard median sternotomy. METHODS: Ninety-five patients, 72 with right anterolateral thoracotomy and 23 with median sternotomy, who had corrective transatrial operations when they were younger than 12 years of age were contacted by questionnaire. The mean follow-up time was 23.1 years. Of these, 61 patients (46 thoracotomy and 15 sternotomy) were investigated clinically. Volume differences of the breasts were measured by 3-dimensional surface scanning. By using photographs of the upper chest, breast symmetry was described by an index. The degree of scoliosis was measured by clinical examination. RESULTS: According to the questionnaire analysis, 76% (thoracotomy group) versus 39% (sternotomy group) thought that the cosmetic result was excellent (P =.008). Breast volume measurement showed a volume difference greater than 20% (left side larger than right) in 55% (thoracotomy) versus 0% (sternotomy). With our index, asymmetry in the lower part of the right breast occurred in 61% (thoracotomy) versus 0% (sternotomy; P <.001). A total of 6.6% of the patients had scoliosis, without any differences between groups. CONCLUSIONS: Because our long-term follow-up in prepubescent female patients after right anterolateral thoracotomy revealed significantly impaired unilateral breast development, we propose to abandon right anterolateral thoracotomy in this subgroup of patients, although the subjective satisfaction with the cosmetic result was high. To avoid potential damage of future breast tissue, other surgical approaches, such as right posterior thoracotomy, should be considered. According to the orthopedic investigation, the surgical approach does not cause a higher rate of scoliosis.

Adult↗
PubMed2005

A method to investigate intervertebral disc morphology from MRI in early idiopathic scoliosis: a preliminary evaluation in a group of 14 patients.

The aim of the study was to implement a methodology to quantify in vivo and from magnetic resonance imaging (MRI) the 3D geometrical properties of intervertebral discs (IVDs) in early idiopathic scoliosis with small curves. MRI data were posttreated using a custom-made image processing software to semiautomatically determine the location of disc centres, the location of the nucleus pulposus (NP) and the ratio between the NP volume and the disc volume. MRI was performed in a clinical protocol involving 14 patients having an early idiopathic scoliosis. First, the 3D reconstruction errors were quantified using a reproducibility test (intraoperator and interoperator) in one IVD (L5-S1). The maximal errors in location were 0.79 mm in the frontal plane, 1.84 mm in the sagittal plane and 0.76 mm in the vertical plane. The maximal error in relative volume was 42%. Second, the nucleus migration and relative volume were quantified in discs T5-T6 to L5-S1. No significant relative volume variation was detected. Concerning the disc migration, no significant differences were found in the sagittal and axial planes. In the frontal plane, significant differences were observed at the apex of the scoliotic curvature when the Cobb angle was > or =20 degrees . This innovative study in early scoliosis showed reproducible preliminary results, and its application to improve diagnosis and follow-up will be established in an enlarged patient database.

Adolescent↗
PubMed1985

Cardiorespiratory status in relation to mild deformity in adolescent idiopathic scoliosis.

We assessed the cardiorespiratory function in young persons with adolescent idiopathic scoliosis as they entered adult life; the condition had been detected and managed through a Montreal area school screening program in the years 1975 to 1979, and all patients had been discharged with stable condition. Thirty-two youths (average age 17.7 years) with Cobb angle from 3 to 32 degrees and 93 girls (average age 17.3 years) with Cobb angle from 3 to 46 degrees did not differ from their unaffected school friends in smoking habit, respiratory symptoms, lung volumes, expiratory flow rates, diffusing capacity, maximal respiratory pressures, or submaximal exercise results. When expressed as percent predicted, pulmonary functions were within the normal range in all but one patient. Normal results were also recorded in a subsample of 20 girls undergoing a more detailed progressive maximal exercise test. This information is pertinent for counseling the adolescent with scoliosis but needs to be supplemented by prospective measurements to determine the natural history of mild scoliosis in later adult life.

Adolescent↗
PubMed2002

Anterior endoscopic correction of scoliosis.

Our technique of anterior endoscopic scoliosis correction demonstrates the ability to perform an anterior approach through a minimally invasive technique with minimal disruption of the local biology. The initial results appear to equal curve correction and fusion rates to those of a formal open anterior approach. Additional benefits are: 1) shortened operative time, 2) lower blood loss, 3) shortened rehabilitation time, 4) less pain, and 5) shortened hospital stays. Endoscopic technique shows great promise in the management of scoliosis curves; however, this is a technically demanding procedure that requires cross-training in endoscopic discectomy and scoliosis management as well as familiarity with the anterior approach anatomy.

Endoscopy↗
PubMed2003

Degenerative scoliosis. Options for surgical management.

Adult degenerative scoliosis patients present a challenge in trying to achieve the greatest benefit with the least amount of intervention. Tailoring the treatment to the severity of the symptoms and the deformity appears to be vital. Full understanding of the deformity in the coronal and sagittal planes as well as the neural impingement can guide one to the appropriate intervention. The first operation is critical in providing the best prognosis for the long term. Decompression alone is performed in patients with small magnitudes of scoliosis and minimal lateral listhesis. Decompression and posterior fusion with instrumentation is performed on patients with moderate deformity and lateral listhesis, but a balanced sagittal plane. The more technically challenging and larger operation, a combined anterior and posterior fusion with instrumentation, is reserved for those patients with not only moderate to severe curves, but also coronal and sagittal imbalance. Performing a smaller operation on these patients may not only be short-lived but may also start a series of higher-risk revisions. There is a distinct lack of studies identifying and documenting the risks, morbidity, and reoperation rates in this patient population as compared with other deformity groups. Treatment of degenerative scoliosis patients presents a challenge that is only growing larger in numbers with the aging population.

Adult↗
PubMed1999

Adolescent idiopathic scoliosis.

Because of the relatively recent understanding of the untreated natural history of idiopathic scoliosis, many patients do not require treatment and are simply observed. Immature patients whose curves are between 25 degrees and 40 degrees are at high risk for further progression and should be treated with a brace. Seventy percent to 80% of the time, the patient can expect that the brace will prevent further progression. Curves in growing children greater than 40 degrees require a spinal fusion. Modern scoliosis surgery provides excellent correction of deformity and allows immediate ambulation without a cast or brace. This article reviews the diagnosis, cause, and treatment recommendations for adolescent idiopathic scoliosis.

Adolescent↗
PubMed1986

Screening for congenital dislocation of the hip, scoliosis, and other abnormalities affecting the musculoskeletal system.

The three main conditions affecting the musculoskeletal system currently being screened for are spina bifida cystica, congenital dislocation of the hip, and scoliosis. The techniques of screening are different for each: amniotic fluid analysis for spina bifida cystica, a manual physical examination for congenital dislocation of the hip, and a visual examination for scoliosis. Properly time amniotic fluid analysis for alpha-fetoprotein is both a sensitive and specific test for neural tube defects. However, because of the low incidence of spina bifida cystica, this examination is justified only in high-risk pregnancies. Maternal serum screening has not achieved widespread acceptance because of its lack of sensitivity and the low and apparently falling incidence of the deformity. The neonatal manual examination for congenital dislocation of the hip is now well established and widely practiced. Almost all agree that the incidence of persistent congenital dislocation of the hip has been lowered as a result. However, the examination lacks both sensitivity and specificity because of intrinsic difficulties with the examination and the occurrence of late onset subluxation and dislocation. It is becoming apparent that congenital dislocation of the hip is a dynamic problem in the peri- and early neonatal period. Repeated careful evaluation of the hips during infancy is necessary to make the diagnosis as early as possible. To further enhance early detection, it may be necessary to consider obtaining an anteroposterior pelvis radiograph at age 4 to 6 months in babies at high risk. The visual evaluation for scoliosis is a very sensitive test but lacks specificity. Efforts are now being made to quantify visual screening techniques and thus decrease the numbers of false-positive examinations.

Adolescent↗
PubMed2004

[Postural control in idiopathic scoliosis: comparison between healthy and scoliotic subjects].

PURPOSE OF THE STUDY: To assess the effects of idiopathic scoliosis on undisturbed postural control in young female teenagers. MATERIAL AND METHODS: The centre of pressure (CP) displacements, measured through a force platform, were decomposed into two elementary components in order to differentiate the net postural performance, as revealed by the horizontal motions of the centre of gravity (CGh) and the level of muscular activity expressed by the vertical difference CP-CGv. The CG horizontal displacements were estimated from those of the CP with a low pass filter taking into account the subjects' anthropometry. Fifteen healthy teenagers and fifteen teenagers with idiopathic scoliosis were asked to stand still upright for three successive trials of 64s, rest periods of similar duration being allowed between each trial. RESULTS: The results indicate differences in the postural control between the two populations: scoliotic CG motions are more important than those of healthy subjects. In the medio-lateral direction, the CGh motions can be primarily explained by the concomitant increase observed at the CP-CGv level. To be more precise, one should have in mind that the CP-CGv amplitudes determine the horizontal acceleration communicated to CGh. On the other hand, despite significative increases of the CP-CGv in the antero-posterior direction, the CGh motions appear to be unaffected by these initial conditions. This feature suggests that appropriate control mechanisms can intervene in this antero-posterior direction for the scoliotic group whereas a similar organization cannot be observed in the medio-lateral direction. DISCUSSION: The differences observed in the postural performance for the healthy and scoliotic groups can be explained in various ways. The capacity of the scoliotic group to counteract huge CP-CGv motions may be linked to the location of the postural muscles involved in this control: the triceps surae for the antero-posterior direction, and the abductor-adductor hip muscles for the medio-lateral one. Only the action of the latter group can be indeed perturbed by the specific constraints occurring at the hip level and resulting from the scoliosis. On the other hand, the general increase of the CP-CGv motions, by expressing an overwhelming muscular activity in the whole set of postural muscles, does suggest that the drive of the descending motor commands is largely modulated and is likely the consequence of a central disfunctionning.

Adolescent↗
PubMed2002

Rib cage surgery for the treatment of scoliosis: a biomechanical study of correction mechanisms.

Rib shortening or lengthening are surgical options that are used to address the cosmetic rib cage deformity in scoliosis, but can also alter the equilibrium of forces acting on the spine, thus possibly counteracting in a mechanical way the scoliotic process and correcting the spinal deformities. Although rib surgeries have been successful in animal models, they have not gained wide clinical acceptance for mechanical correction of scoliosis due to the lack of understanding of the complex mechanisms of action involved during and after the operation. The objective of this study was to assess the biomechanical action of different surgical approaches on the rib cage for the treatment of scoliosis using a patient-specific finite element model of the spine and rib cage. Several unilateral and bilateral rib shortening/lengthening procedures were tested at different locations on the ribs (convex/concave side of the thoracic curvature; at the costo-transverse/costo-chondral joint; 20 and 40 mm adjustments). A biomechanical analysis was performed to assess the resulting geometry and load patterns in ribs, costo-vertebral articulations and vertebrae. Only slight immediate geometric variations were obtained. However, concave side rib shortening and convex side rib lengthening induced important loads on vertebral endplates that may lead to possible scoliotic spine correction depending on the remaining growth potential. Convex side rib shortening and concave side rib lengthening produced mostly cosmetic rib cage correction, but generated inappropriate loads on the vertebral endplates that could aggravate vertebral wedging. This study supports the concept of using concave side rib shortening or convex side rib lengthening as useful means to induce correction of the spinal scoliotic deformity during growth, though the effects of growth modulation from induced loads must be addressed in more detail to prove the usefulness of rib shortening/lengthening techniques.

Biomechanical Phenomena↗
PubMed2003

Stress hormones during the wake-up test in scoliosis surgery.

STUDY OBJECTIVE: To compare hemodynamic and endocrine stress responses of two anesthetic regimes during intraoperative wake-up tests in scoliosis surgery. DESIGN: Randomized, controlled clinical study. SETTING: University hospital. PATIENTS: 40 ASA physical status I and II teenage patients scheduled for scoliosis surgery. INTERVENTION: Patients were randomly divided into two groups: the propofol group (Group P) and the sevoflurane group (Group S). In Group P, anesthesia was induced with propofol and remifentanil and was maintained with infusions. Sevoflurane and remifentanil were used in Group S. After surgical instrumentation, patients were awakened, and the wake-up times were recorded. To determine the stress responses, blood samples were taken before induction, 10 minutes after surgical incision, before the wake-up test, during the wake-up test, and 10 minutes after the wake-up test. Cortisol, epinephrine, and norepinephrine concentrations, and hemodynamics all were recorded at the same time. MEASUREMENTS AND MAIN RESULTS: The times from discontinuation of anesthetics to eye opening and movement were similar in both groups. Epinephrine and norepinephrine concentrations during the wake-up test were significantly higher than pretest results in both groups (p < 0.001). There were no statistically significant differences between groups in heart rate or blood pressure. CONCLUSIONS: Propofol-remifentanil anesthesia is equivalent to sevoflurane-remifentanil anesthesia for a wake-up test. Both the propofol- and sevoflurane-based anesthetic regimens abolish hemodynamic and endocrine stress responses to incision for scoliosis surgery in teenagers. Intraoperative wake-up testing is associated with substantial catecholamine stress despite virtually unchanged mean arterial pressure and heart rate.

Adolescent↗
PubMedDate not supplied

Use of ketorolac tromethamine in children undergoing scoliosis surgery. an analysis of complications.

BACKGROUND CONTEXT: Ketorolac Tromethamine (ketorolac) is a nonsteroidal anti-inflammatory drug (NSAID) with proven efficacy in decreasing postoperative pain in various surgical settings, including the treatment of spine deformities. However, some studies have raised questions regarding the potential side effects of this agent, such as increased bleeding and inhibition of bony fusion. PURPOSE: This study was conducted to determine whether there is any association between the use of ketorolac and postoperative complications in a group of children who underwent scoliosis surgery. STUDY DESIGN/SETTING: This is a retrospective review of a group of children who underwent spinal fusion between 1989 to 1999 at our institution. PATIENT SAMPLE: Data on a total of 208 children were analyzed in this study. Sixty received ketorolac and 148 did not. OUTCOME MEASURES: Postoperative transfusion and reoperation rates were the two main outcome measures of interest. METHODS: A retrospective review of 208 children who underwent scoliosis surgery was conducted, with a focus on ketorolac use. Univariate analysis and logistic regression were used to quantify the determinants of postoperative complications. RESULTS: Our analyses detected no significant differences in a broad range of socioclinical variables between the two patient groups, including age at surgery, gender, type of scoliosis, surgical approach, use of erythropoietin, levels of curvature and degree of curvature. Analysis of complication rates focusing on postoperative transfusion and revision surgery showed that there were no significant differences between the two groups. CONCLUSIONS: In this retrospective study of 208 children undergoing spine surgery, postoperative use of ketorolac did not significantly increase complications, including transfusion and reoperation.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMedDate not supplied

Anterior thoracic scoliosis constructs: effect of rod diameter and intervertebral cages on multi-segmental construct stability.

BACKGROUND CONTEXT: Many studies have reported on the use of anterior instrumentation for thoracolumbar scoliosis and more recently thoracic scoliosis. However, the optimal construct design remains an issue of debate. PURPOSE: To optimize construct design and enhance implant survival until a successful spinal arthrodesis is achieved. STUDY DESIGN: This study evaluated the effect of rod diameter and intervertebral cages on construct stiffness and rod strain using a long-segment, anterior thoracic scoliosis model with varying levels of intervertebral reconstruction. METHODS: Sixteen fresh-frozen calf spine specimens (T1 to L1) were divided into two groups based on rod diameter reconstruction (4 mm and 5 mm). Testing included axial compression, anterior flexion, extension and lateral bending with variations in the number and level of intervertebral cage reconstructions: apical disc (one), end discs (two), apical and end discs (three), all seven levels (seven). Multisegmental construct stiffness and rod strain were determined and normalized to the intact specimen for analysis. RESULTS: The seven-level intervertebral cage construct showed significantly greater stiffness in axial compression for both the 4-mm (366% increased stiffness) and 5-mm (607% increased stiffness) rod groups (p<.001). The remaining constructs were not significantly different from each other (p>.05). In flexion, similar results were obtained for the 4-mm construct (p<.001) but not the 5-mm construct, because the reconstruction-alone, one-, two- and three-cage constructs were all significantly stiffer than the intact specimen (p<.05). Multisegmental construct stiffness under extension loading, as well as right and left lateral bending, also exhibited significant differences between the seven-level interbody cage reconstructions and the remaining constructs. Apical rod strain for both the 4-mm-rod and 5-mm-rod groups were significantly higher for the two cage constructs (a cage at either end but not the apex where the strain gauges were located) as compared with the other constructs (p<.05). These differences were more pronounced in the 4-mm-rod group. Similar results were obtained in anterior flexion, extension and lateral bending. CONCLUSIONS: Intervertebral cages at every level significantly improved construct stiffness compared with increasing rod diameter alone. Moreover, cages markedly decreased rod strain, and when structural interbody supports were not used, axial compression created the greatest rod strain.

Animals↗
PubMedDate not supplied

Scoliosis associated with lumbar spondylolisthesis: a case presentation and review of the literature.

BACKGROUND CONTEXT: The association between scoliosis and spondylolisthesis is well documented, but criteria and methods for managing the deformity in patients with debilitating pain are not clear. PURPOSE: To describe correction of scoliosis by internal fixation of the spondylolisthesis. STUDY DESIGN: Case report of a patient with scoliosis developing in association with spondylolisthesis. METHODS: A 17-year-old female presented with a 6-month history of back and leg pain. No spinal curvature was noted in radiographs taken at the onset of symptoms. Significant curvature appeared during the 6-month history of pain in association with an L5-S1 spondylolisthesis. The spondylolisthesis was repaired with posterior pedicle screw instrumentation. RESULTS: The pain and the spinal curvature almost completely resolved after surgery, and the outcome remained excellent 14 months after surgery. CONCLUSION: In the properly diagnosed patient, surgical repair of the spondylolisthesis can relieve pain and correct spinal curvature.

Adolescent↗
PubMedDate not supplied

[Surgical correction and stabilization of neuromuscular scoliosis--2-4-year results of dorsal and one-stage ventro-dorsal operated patients].

QUESTION: In order to evaluate the outcome of the operative treatment of neuromuscular scoliosis 45 patients were studied prospectively. METHODS: 27 Patients were operated by posterior correction and fusion using the Münster Posterior Doublerod-System (MPDS) (GI). 18 Patients were treated with one-stage ventro-dorsal procedure in combination of VDS with MPDS (GII). For all patients, medical and radiographic records were available, with a minimum follow-up of 2 years. Postoperative management, bloodloss and complications will be discussed. RESULTS: In group I the main curve (76.3 degrees), by an average flexibility of 36.1%, were corrected by 53.5% and 52.3% at follow up. The mean pelvic obliquity (7.7 degrees) averaged 53.8%. The mean major scoliosis of group II (107.1 degrees), by an average flexibility of 25%, gets improved by 61%. At most recent follow-up, the mean correction was 61.5%. The mean pelvic obliquity (23.1 degrees) averaged 73.2% and 70.6% respectively. The mean bloodloss in group I was 1840 ml and in group II 2180 ml. CONCLUSION: The data in the current study support the benefit of the operative treatment of patients with severe neuromuscular scoliosis. The quality of life gets improved by stability in seating and standing by correction of pelvic obliquity and trunk instability.

Adolescent↗
PubMedDate not supplied

[Butterfly vertebrae and scoliosis: Alagille syndrome].

INTRODUCTION: Alagille syndrome is a dominantly inherited disorder affecting the liver (arteriohepatic dysplasia), the heart, the eyes and the face. Butterfly vertebrae in the thoracic and lumbar spine are detectable in 50 to 80 per cent of the patients; most of them remain asymptomatic. The management of progressive cholestasis in early childhood is the main aspect of therapy. CASE: A 14-year-old female patient with Alagille syndrome was referred to our hospital for examination of a right thoracic scoliosis. Magnetic resonance imaging verified butterfly deformity in thoracic vertebrae 2, 4, 6, 7, 8, 10, 11, and lumbar vertebra 3. Asymmetries of thoracic vertebrae 6, 8 and especially, 7 were responsible for the scoliosis. CONCLUSION: The highly variable expression of these typical characteristics in mildly affected patients can cause some difficulties. When diagnosing a scoliosis with asymmetric butterfly vertebrae, an Alagille syndrome should be considered, especially if the patient shows a liver dysfunction.

Adolescent↗
PubMedDate not supplied

[Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrumentation and their relevance for expert evidence].

AIM: The expert evidence of operated patients with idiopathic scoliosis is determined by functional and pulmonary restriction. The degree of deformity and the extent of fusion is crucial for grading disability. In a retrospective study on the quality of life (SF-36) and low back pain (Roland-Morris Score) of 82 patients (22 - 40 years) with idiopathic scoliosis treated with Harrington instrumentation the grading was registered. METHOD: An average of 16.7 years after the surgery, these data were correlated with the type and size of curve and to the extension of fusion. RESULTS: Compared to the age-matched healthy population, there was no significant difference in the physical SF-36 scale (P = 0.98). Surgically treated patients showed significantly lower scores than at baseline in the psychological SF-36 scale (P = 0.005). Sixty-five (79.3 %) of the eighty-two patients reported no or occasional back pain in the Roland Index. Five patients (6.1 %) complained of chronic back pain. 33 patients (40 %) were legally defined in their rate of disability as severely handicapped patients. The grading disability was associated with the physical SF-36 scale (P < 0.001) and the low back pain (P = 0.02). A significant correlation between the grading disability and the extent of fusion (P = 0.53) or the size of curve (p = 0.4) could not be proven. CONCLUSION: Despite good long-term outcomes, 40 % of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons. The additional measurements of quality of life and low-back pain can improve legal assessment in orthopaedics.

Adolescent↗