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PubMedDate not supplied

[Preoperative halo-traction in severe paralytic scoliosis].

AIM: During the past decades the treatment of severe paralytic scoliosis has developed towards surgical treatment. However there is controversial discussion about the need of pre-operative Halo-traction. The aim of this study was to built two groups of patients -- one group with and another one without pre-operative Halo-traction -- and to compare the results after surgical correction of scoliotic deformity with data from literature. METHOD: Between 2000-2003 twenty-five patients with severe neuromuscular spine deformity were treated surgically. Eight patients had preoperative Halo-traction, seventeen patients underwent directly operative correction and instrumentation. The evaluation included the pre- and postoperative X-rays as well those after Halo-traction before surgery. RESULTS: In the group without Halo-traction the scoliotic angle according to Cobb was reduced from 77 degrees to 33 degrees on average (mean correction of 44 degrees [57 %]). In the group with Halo-traction scoliosis was reduced from 85 degrees to 33 degrees on average (mean correction of 52 degrees [61 %]). CONCLUSION: The preoperative Halo-traction in patients with severe neuromuscular scoliosis indeed leads to radiologically higher correction, but this is not significant (p = 0.19) and only in single cases clinically relevant. In our point of view except from specific indications Halo-traction should not be applied in general as a standard procedure.

Adolescent↗
PubMed2006

[Recommendations on sport activities for patients with idiopathic scoliosis].

The idiopathic scoliosis is a three dimensional spinal deformity mostly occurring in female adolescents. Untreated it can progress and result in back pain, impaired lung capacity and psychosocial disorders due to the cosmetic appearance of the deformed trunk. The treatment depends on the severity of the curve and ranges from physiotherapy and observation, brace treatment to surgical treatment with partial correction and fusion of the primary curve. Patients with an idiopathic scoliosis should be encouraged to actively take part in sports activities. Positive influences on the general fitness including the lung function, on the trunk muscles and on the psyche can be expected. There are no scientific data indicating that any kind of sport activities alter the natural history of idiopathic scoliosis.

Adolescent↗
PubMedDate not supplied

[Computerized tomography monitoring of the position of pedicle screws in scoliosis surgery].

With the increasing use of pedicle screws in instrumented spine surgery the neurological risk must be evaluated critically. Studies, which evaluated the accuracy of pedicle screw placement in scoliosis surgery, have not been published up to date to our knowledge. In 25 consecutive patients with idiopathic scoliosis, who underwent posterior instrumented curve correction and stabilization, the accuracy of pedicle screw placement was evaluated using axial computed tomography. There was a total of 178 screws between T5 and L4. The preoperative Cobb angle of the curve averaged 60.7 degrees, the mean rotation of the instrumented vertebrae was 19.1 degrees according to Perdriolle. 145 pedicle screws (81.5%) were placed correctly within the pedicles, of which 4 screws (4.5%) penetrated the anterior aspect of the vertebral body with a mean of 0.9 mm. 22 screws (12.4%) showed lateral penetration of the pedicle with a mean of 1.9 mm, of which one screw was placed completely lateral of the pedicle. 8 screws (4.5%) penetrated the medial wall of the pedicle by 1.3 mm on average. One screw each penetrated the cranial and caudal border of the pedicle. Statistical analysis did not reveal any significant relationships between pedicle screw misplacement and grade of vertebral rotation or site of instrumentation. Neurological complications were not noted in any of the cases. In our mind the risk of pedicle screw threaded curve correction and fusion in scoliosis surgery in the hands of an experienced spine surgeon is calculated acceptably low.

Bone Screws↗
PubMedDate not supplied

[Primary correction of scoliosis with the Wilmington corset].

QUESTION: As part of our study, the effectiveness and patient's acceptance of the Wilmington-brace is to be evaluated. The effectiveness can be documented with the help of the primary correction achieved, especially in light of the fact, that the primary correction and the long-term results are directly dependant upon one another. MATERIAL AND METHOD: We examined a total of 52 patients with an idiopathic scoliosis treated in a thermoplast brace. The group consisted of 38 female and 14 male patients (average age 11.6 years). The angulation was measured with the help of the Cobb-angle and the rotation with the method described by Nash and Moe. The skeletal age was classified according to Risser's-sign. The angle determinations were carried out at three separate points in time--at first presentation, prior to bracing and four to six weeks following bracing. RESULTS: The patients presented with an average angulation of 31 degrees. The average correction achieved in the Wilmington-brace was 41%. This corresponds to a correction of 13 degrees. The best primary correction (45%) was obtained in the thoracolumbar spine. Those patients with the smallest deformity at the onset of treatment showed the best results. The scoliosis with a large primary deformity and a marked rotation of the vertebral bodies responded poorly to correction. Advanced age or skeletal maturity were also limiting factors. Physical therapy had a positive influence on the amount of primary correction obtained. CLINICAL RELEVANCE: The Wilmington-brace (thermoplast) allows for a good primary correction of idiopathic scoliosis. The simplicity of application and the low production costs are also positive attributes.

Adolescent↗
PubMedDate not supplied

[Surgical treatment of idiopathic thoracolumbar scoliosis: Contrell-Dubousset instrumentation versus ventral derotation spondylodesis].

Especially in idiopathic thoracolumbar scoliosis the approach and sort of instrumentation have controversially been discussed over the past years. Since 1986 32 patients with adolescent thoracolumbar scoliosis underwent operative treatment, 20 patients were treated with Cotrel-Dubousset Instrumentation (CDI), 10 patients underwent Ventral Derotation Spondylodesis (VDS). In 2 cases a combined two-stage VDS and CDI were performed. The follow-up was 38 months in the CDI-group and 19 months in the VDS-group. Length of the curve and the fusion were identical in the VDS-group. In the CDI-group, however, length of the fusion exceeded curve length by 4 segments on average. With CDI the fusion was carried down to L4 in most cases, in some cases to L5. Curve correction of the primary curve averaged 70% with VDS (preoperative mean 84 degrees) and 64% with CDI (preoperative mean 65 degrees). We observed a spontaneous correction of the secondary curve of 38% after VDS. With CDI the correction of the secondary curve averaged 42%, however, in secondary curves measuring more than 50 degrees primary and secondary curve were fused. A preoperatively physiological sagittal plane in the CDI-group remained unchanged after operative treatment. With VDS an average kyphosis of the thoracolumbar junction of +22 degrees was corrected to +7 degrees. We conclude that in the operative treatment of severe thoracolumbar scoliosis VDS offers significant advantages compared to CDI and should therefore be preferred. In moderate scoliotic deformities, where the number of caudally unfused segments is equal in both systems, CDI is justified.

Adolescent↗
PubMedDate not supplied

[Characteristics in the treatment of scoliosis in muscular diseases].

INTRODUCTION: Patients suffering from the most frequent muscle disorders Duchenne muscular dystrophy (DMD) and spinal muscular atrophies (SMA), who ceased walking respectively are confined from the outset to the wheel-chair, are developing commonly a progressive scoliosis (collapsing spine) due to an increasing muscle weakness. Basing on the pelvic obliquity these scolioses are leading first of all to problems in sitting as well as difficulties in trunk and head control. Along with the increasing weakness of respiratory muscles these phenomena entail a restrictive respiratory insufficiency. CONSERVATIVE TREATMENT: An effective conservative treatment is not available for these scolioses. The use of a corset, however, can only be taken into consideration as a compromise, either for very young patients or those who refused an operation respectively who have reached an inoperable stage. The exclusive use of so-called "anatomic sitting supports" in the wheel-chair in order to treat or prevent a progressive scoliosis in DMD or SMA is absolutely to be rejected. They should only be applied for very young patients with SMA type II as a transitional solution until a corset or better an surgical stabilisation of the spine will be effected, or as a palliative measure in late stages. SURGICAL TREATMENT: Only the early as possible performed surgical stabilisation of the spine using adequate instrumentation (Luque, CD or modifications), enabling an early mobilization without corset or cast, is the most effective treatment of these scoliosis. Patients with DMD or SMA type III should be stabilized after loss of walking ability and definitive confinement to wheel-chair, if the curve is more than 20 degrees-30 degrees Cobb and progressive and forced vital capacity (FVC) is > 35%. The instrumentation should be applied between D3 or D4 and sacrum. The bony fusion mass should include the lumbar and lumbosacral region. The unfused instrumentation with the telescope-rod after Naumann is a good solution for patients with SMA type II and progressive curves already in the early childhood from ca. 5 years of age. First of all surgical spinal stabilisation improves the sitting comfort. Over and above this the improved cosmetic appearance should not be underestimated for the psychological condition of these patients. Additionally it is proved, that surgical stabilisation of the spine prolongs the life expectancy of patients with DMD. Furthermore stabilization of lung function can be achieved for both DMD and SMA patients in comparison to the natural history of these diseases. Altogether a decisive improvement of quality of life can be reached for all these patients.

Adolescent↗
PubMedDate not supplied

[The effect of halo-gravity traction in the preoperative treatment of neuromuscular scoliosis].

The purpose of this study is to evaluate the influence of halo-gravity-traction on paralytic scoliosis in various neurologic diseases. Between 1980 and 1993 preoperative halo-gravity-traction was applied in 32 patients with paralytic scoliosis (23 patients with myelomeningocele, 6 patients with poliomyelitis, 3 patients with cerebral palsy). In the myelomeningocele group the average curvature before treatment was 97.8 degrees, after surgery 45.1 degrees; which is an improvement of 53.9%. Halo-gravity-traction accounted for 12.8% improvement. In the poliomyelitis group the average curvature before treatment was 104.3 degrees, after surgery 58.0 degrees; which is an improvement of 44.4%. Halo-gravity-traction accounted for 16.9% improvement. In the cerebral palsy group the average curvature before treatment was 75.0 degrees, after surgery 39.0 degrees; which is an improvement of 48.0%. Halo-gravity-traction accounted for -2.7% improvement. If there is an effect the question remains, whether this will have consequences for the surgical outcome. The comparison between good and bad responders with the surgical result shows, that this result is independent of the halo-gravity-traction. From this results we draw the conclusion, that preoperative halo-gravity-traction can not be recommended in paralytic scoliosis.

Adolescent↗
PubMedDate not supplied

[Spatial orientation and postural regulation in patients with idiopathic scoliosis].

QUESTION: Etiology of idiopathic scoliosis is unknown. In literature a primarily neurogenic disturbance of postural regulation is discussed with subsequent changes of the spine. In the present paper, individual functions of postural regulation in patients with idiopathic scoliosis were examined by neurophysiologic investigations and compared to a normal population. METHOD: The body sway of 28 patients was investigated in upright position under various testing conditions by means of a force measuring platform, allowing examination of the efferent part of postural regulation as well as the sensory systems involved. Registration of the eye movements (ENG) made it possible to investigate the function of the vestibulo-cerebellar system. Furthermore the optokinetic capability of scoliotic patients was tested by determination of the subjective visual vertical (SVV). RESULTS: It turned out that none of the neurophysiologic test procedures showed clearly pathological findings in scoliotic patients as compared to a normal population. CONCLUSION: It has not to be considered as probable that idiopathic scoliosis is caused by a disturbance of postural regulation.

Adolescent↗
PubMedDate not supplied

[Radiologic measurement of the behavior of lumbar intervertebral disks in idiopathic scoliosis based on so-called "bending" images].

Total disc mobility, segmental mobility, both depending upon location of the disc and upon its position within the scoliotic curve as well as the opening angle of the disc in the ap x-ray were measured in the so-called "bending-test" x-rays of the lumbar curve of 40 patients with idiopathic scoliosis. The measurements showed a maximum of mobility in the segments L2/3, L3/4 and L4/5. In no direct dependence an increased mobility of the most proximal motion segment against the next lower one of the lumbar curve was found. No direct relation between lateral flexion and degree of scoliosis was measurable. Mobility towards the convexity increases directly with the opening angle of the disc concerned while mobility towards the concavity decreases; lateral flexion remains constant altogether. The results achieved might become quite relevant in connection with the possible therapeutic progress in the treatment of lumbar scoliosis with enzymatic dissolution of nucleus pulposus.

Adolescent↗
PubMedDate not supplied

[Initial experiences with subcutaneous Harrington distraction without spondylodesis in scoliosis].

We report on a special method in the treatment of scoliosis using subcutaneous Harrington-distraction without spondylodesis. We operated 14 patients in all who were between 7 and 12 years old, in average 10 2/12 years Indication is made if scoliosis is extremely progressive, if Cobb's measure is above 50 degrees, after unsuccessful conservative treatment also including orthosis and physiotherapy, or if patients appeared to late in our department. In this technique only two incisions to make are necessary to place the Harrington roots to the cranial and caudal end of the scoliosis curve. The Harrington root can be 'needled' in subcutaneously. When in times of further growth the amount of correction gets noticeably lost the cranial hook could be tightened or the Harrington root could be changed easily. We need an orthosis (Cheneau or Milwaukee) for after treatment until in a final operation with spinal fusion is made. This method has showed good results although we had to cope with a bad prognostic starting position.

Adolescent↗
PubMedDate not supplied

[Follow-up problems in scoliosis patients].

With reference to 4 different methods - theoretical derivation, computed model, recent radiological analysis based on 120 scoliosis patients and measurement of the posterior median line in 40 scoliosis patients - the unreliability of follow-up in scoliosis patients is illustrated. The results are compared with previous publications by other authors and discussed. A method of determining spinal geometry three-dimensionally by means of topometric methods (5) is described. The validity of this measuring method is demonstrated in the patient by geometrical measurement of the posterior median line without treatment, under halo gravity extension and in movement.

Anthropometry↗
PubMedDate not supplied

[Scoliosis as a concomitant disease of syringomyelia].

Three long-time and two ore three respectively shorter observations of scoliotics with syringomyelia are presented and the pertinent literature is discussed including the complex etiopathogenesis. An attempt is made to describe the concomitant scoliosis. The older the patients with syringomyelia so more frequently scolioses appear, up to about two thirds of all cases, resembling a deformity due to paralysis: Dorsal kyphoscoliosis with lumbar countercurve and lordosis, tendency towards a list of the trunk, eventually rapid progression not only in the growing age but also in adulthood. The scoliosis may preceed the neurologic symptoms for years as well as follow later. Spontaneous fusion of the curves may occur by broad based flat bony appositions to the vertebrae with round prominences as well, aetiologically probably due to syringomyelia: "dystrophic". Since the spinal cord of these cases is more ore less pre-damaged and does react very sensible to progression of the scoliosis, in this phase mainly laminectomy for decompression is indicated whereas treatment otherwise is administered with the help of a Milwaukee brace. If one decides exceptionally to perform a fusion operation the application of any essentional distraction force and contusion is to be avoided.

Adolescent↗
PubMedDate not supplied

[Results of conservative treatment of scoliosis using the Milwaukee corset].

The conservative treatment of scoliosis with Milwaukeebrace has been studied in 165 patients over a period of seven years. We have shown that good results were obtained as long as the initial did not exceed angle of 40 degrees according to COBB. When the curvature exceeds 50 degrees the progression of the scoliosis was not stopped by the MILWAUKEE-brace. In our experience the latter patients should undergo an operation. An improvement of the corrections with the conservative treatment using the MILWAUKEE-brace can only be expected when the treatment was initiated in an early state. To achieve this good propose a number of screening methods to evaluate the progressive character of the scoliosis in particular during puberty; an intensive physio-therapy and careful control of the brace are required for the success of the therapy.

Adolescent↗
PubMed1981

[Observations on the ability to work surgically treated scoliosis patients during 1946-1966 (author's transl)].

Basing on follow-up observation of a group of 113 scoliosis patients who had undergone surgery during 1946 to 1966, the connection between scoliosis and ability to work is subjected to close scrutiny. The study shows that there is a connection between reduction in the ability to work and the scoliosis angle, the extent of stiffness and cardiopulmonary performance of the patients. We may well expect that improved results of surgery, as they are now obtained with the modern methods (Harrington), will result in improved physical ability and a less pronounced reduction in the patients' capacity for gainful employment.

Adolescent↗
PubMed1982

[Root compression in lumbar scoliosis--clinical picture and treatment based on 13 personal cases].

From 1971 to 1980 13 adults presented with lumbar scoliosis and radicular symptoms. The entrapment developed in nine cases on the concave side of the scoliosis, only in one case of severe degenerative hypertrophy of one apophyseal joint, on the convex side. Bilateral symptoms in two cases with scoliosis and stenosis as well, and in one case severe compression of cauda equina. Operation consisted of appropriate laminectomy, unroofing of the lateral recess and facetectomy in advanced cases. Results of operation were usually good, occasionally with improvement even of back pain.

Adult↗
PubMed1980

[A new method for measuring rotation of a vertebral scoliosis (author's transl)].

A new radiologic method for measuring the rotation of a scoliosis from CT pictures is described. Normal deviation from the 0 position at the level of the first lumbar vertebra in 50 patients without clinically demonstrable scoliosis when accurately positioned, was M = 0.06 degrees +/- 2.95 SD. Direct measurements of the rotation of the spine and of the displacement of the sternum permit serial observation of the progress of the scoliosis and of the consequent thoracic deformity, as well as the result of treatment.

Arthrography↗
PubMed2001

Curve characteristics in monozygotic twins with adolescent idiopathic scoliosis: 3 new twin pairs and a review of the literature.

Most authors state that there is strong evidence for a genetic origin of adolescent idiopathic scoliosis (AIS). This conclusion is mainly based on the fact that the rate of concordance for AIS in monozygotic twins is significantly higher than that in dizygotic twins. However, it is of interest to determine whether all elements of scoliosis formation are genetically predetermined. If this were the case, there would perhaps be less place for closed treatment. We surveyed the literature for monozygotic twin pairs in which both members suffered from idiopathic scoliosis and added 3 pairs from our own patient group. The total group consisted of 32 twin pairs. We found that gender, direction of the convexity, the level of the apex and the kyphotic angle were determined more by genetic factors than the lateral Cobb angle of the scoliotic curve. This suggests that variations in the environment may affect the curve patterns in monozygotic twins.

Adolescent↗
PubMed2002

Changes in curve pattern after brace treatment for idiopathic scoliosis.

We studied whether thoracic Boston brace treatment changes the King type of scoliotic curves in a group of 50 patients with adolescent idiopathic scoliosis. Bending radiographs showed more flexibility of the lumbar curves than that of the thoracic curves. However, after initial application of the brace, the mean lumbar correction in degrees was less than the mean thoracic correction. After brace treatment we found a slight statistically significant increase in the mean lumbar curve, but no significant change in the mean thoracic curve. In 7 of our patients, we found a change in the King classification which seemed to be related to insufficient lumbar correction at the start of brace treatment. When classifying idiopathic scoliosis, one should bear in mind that the result may be temporary because scoliosis is a dynamic process. A change in curve type can occur during brace treatment.

Adolescent↗