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At least 1,063 records · Page 59Linked to original sources
PubMed2001

The prevalence of disc aging and back pain after fusion extending into the lower lumbar spine. A matched MR study twenty-five years after surgery for adolescent idiopathic scoliosis.

PURPOSE: To determine the long-term outcome after fusion for adolescent idiopathic scoliosis in terms of degenerative disc findings diagnosed using MR imaging and to elucidate the clinical consequences. MATERIAL AND METHODS: Thirty-two patients with adolescent idiopathic scoliosis, who had undergone spinal fusion using Harrington rods to the lower lumbar spine with one or two unfused discs below the fusion, were re-examined 25 years after the fusion. The re-examinations included validated questionnaires, clinical examination, full standing frontal and lateral radiographs and MR examination of the lower lumbar region. Curve size and degenerative findings on MR images were evaluated by two unbiased radiologists, blinded to the clinical findings. A matched control group of 32 persons without scoliosis was subjected to the same examinations. RESULTS AND CONCLUSION: There were significantly more degenerative disc changes (p<0.0001), disc height reduction (p=0.0010) and end-plate changes (p<0.0001 for both upper and lower end-plates) in the lowest unfused disc in the patient group compared with the control group. The MR findings in the lowest unfused disc, but not the one above, in the patient group correlated to lumbar pain intensity as well as to the diminished lumbar lordosis.

Adolescent↗
PubMed2006

Spinal fusion surgery in children with non-idiopathic scoliosis: is there a need for routine postoperative ventilation?

BACKGROUND: The perioperative management of children with non-idiopathic scoliosis undergoing spinal deformity surgery has not been standardized and the current practice is to routinely ventilate these patients in the postoperative period. This study reports the experience from a single institution and evaluates the need and reasons for postoperative ventilation. Details of ventilated patients are presented. METHODS: All patients undergoing spinal fusion surgery for non-idiopathic scoliosis were recorded prospectively (2003-4). Patients were anaesthetized according to a standardized technique. Physical characteristics, cardiopulmonary function, intraoperative blood loss and fluid requirement, postoperative need for ventilation and all perioperative adverse events were recorded on a computer database. RESULTS: A total of 76.2% of patients were safely extubated at the end of surgery without any further complications or need for re-ventilation; 23.8% of patients required postoperative ventilation with half of the cases being planned before operation and 40% of all patients with Duchenne muscular dystrophy (DMD) required postoperative ventilation. There were no specific factors that could predict the need for postoperative ventilation, although an increased tendency for children with DMD and those with a preoperative forced vital capacity <30% towards requiring postoperative ventilation was observed. CONCLUSIONS: Early extubation can be safely performed after spinal deformity surgery for non-idiopathic scoliosis. The use of short-acting anaesthetics, drugs to reduce blood loss, experienced spinal anaesthetists and the availability of intensive care support are all essential for a good outcome in patients with neuromuscular disease and cardiopulmonary co-morbidity.

Adolescent↗
PubMed1984

Adolescent idiopathic scoliosis: epidemiology and treatment outcome in a large cohort of children six years after screening.

A prospective study was carried out in a cohort of 6873 children to determine diagnosis and treatment rates for adolescent idiopathic scoliosis (AIS) and to establish the distribution of parameters related to bracing. The follow-up completion rate was 85%, and prevalence rates were adjusted accordingly. The prevalence of AIS of 6 degrees or more at time of diagnosis was 8.1%. The female to male ratio for curves of 6 degrees or more was 1.07:1 with an increase to 6:1 for curves greater than 21 degrees. The rate of brace treatment was 2.8 per 1000. Deterioration, defined as progression of a scoliosis curve to the point where a brace was prescribed, was found in 3.7% of the scoliosis group. Fifteen children were prescribed braces: eight did not follow the treatment plan adequately (non-compliers), and five among these abandoned the follow-up programme. However, none of the non-compliers deteriorated to the point where spinal fusion was required.

Adolescent↗
PubMed1989

Breast cancer in women with scoliosis exposed to multiple diagnostic x rays.

Although exposure to ionizing radiation is a recognized risk factor for breast cancer, the potential hazard from low-dose, fractionated exposures during early breast development has not been thoroughly evaluated. Women with scoliosis represent a valuable population for studying this issue because they are exposed to multiple diagnostic x rays during childhood and adolescence, times when the breast may be highly sensitive to the carcinogenic effects of radiation. A study was conducted of 1,030 women with scoliosis who were seen at four Minneapolis area medical facilities between 1935 and 1965. The average age at diagnosis was 12.3 years; 60% of the women had idiopathic scoliosis. Individual x-ray films were counted and the number per patient ranged from 0 to 618 films (mean, 41.5). On average, the x-ray exposures were given over an 8.7-year period. Ninety percent of the women were located, of whom over 92% responded to a mail questionnaire or telephone interview. The average period of observation was 26 years. Overall, 11 cases of breast cancer were reported, compared with six expected (standardized incidence ratio = 1.82, 90% confidence interval = 1.0-3.0). Excess risk increased with time since exposure and was highest among those followed for more than 30 years (standardized incidence ratio = 2.4). Risk also increased with the number of x rays and with the estimated radiation dose to the breast (mean, 13 rad). These data suggest that frequent exposure to low-level diagnostic radiation during childhood or adolescence may increase the risk of breast cancer.

Adult↗
PubMed2001

A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery.

UNLABELLED: Pediatric patients who undergo posterior spinal fusion surgery to correct scoliosis often require multiple blood transfusions. Tranexamic acid is a synthetic antifibrinolytic drug that reduces transfusion requirements in cardiac surgery and total knee arthroplasty. We evaluated the efficacy of prophylactic tranexamic acid to reduce perioperative blood transfusion requirements in a prospective, double-blinded, placebo control study. Forty patients, 9-18 yr of age, were randomized to either tranexamic acid (initial dose of 10 mg/kg and infusion of 1 mg. kg(-1). h(-1)) or placebo (isotonic saline). Perioperative management was standardized. A uniform transfusion threshold for noncell saved red blood cells was 7.0 g/dL. The total amount of blood transfused in the perioperative period was significantly reduced in the Tranexamic group (P = 0.045). No thrombotic complications were detected in either group. The administration of prophylactic tranexamic acid in patients with scoliosis undergoing posterior spinal fusion surgery has the potential to reduce perioperative blood transfusion requirements. IMPLICATIONS: The administration of prophylactic tranexamic acid in patients with scoliosis who are undergoing posterior spinal fusion surgery has the potential to reduce perioperative blood transfusion requirements.

Adolescent↗
PubMed2005

Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery.

BACKGROUND: Excessive bleeding often occurs during pediatric scoliosis surgery and is attributed to numerous factors, including accelerated fibrinolysis. The authors hypothesized that administration of tranexamic acid would reduce bleeding and transfusion requirements during scoliosis surgery. METHODS: Forty-four patients scheduled to undergo elective spinal fusion were randomly assigned to receive either 100 mg/kg tranexamic acid before incision followed by an infusion of 10 mg . kg . h during surgery (tranexamic acid group) or 0.9% saline (placebo group). General anesthesia was administered according to a standard protocol. Blood loss, transfusion requirements, coagulation parameters, and complications were assessed. RESULTS: In the tranexamic acid group, blood loss was reduced by 41% compared with placebo (1,230 +/- 535 vs. 2,085 +/- 1,188 ml; P < 0.01). The amount of blood transfused did not differ between groups (615 +/- 460 vs. 940 +/- 718 ml; P = 0.08). Administration of tranexamic acid was a multivariate predictor of blood loss, as was American Society of Anesthesiologists physical status and preoperative platelet count. No apparent adverse drug effects occurred in any patient. CONCLUSION: Intraoperative administration of tranexamic acid significantly reduces blood loss during spinal surgery in children with scoliosis.

Adolescent↗
PubMedDate not supplied

Combined staged anterior and posterior correction and fusion of the spine in scoliosis following poliomyelitis.

The problems with severe forms of scoliosis following poliomyelitis include the associated muscle imbalance, soft tissue contractures and pelvic obliquity. Such deformities militate against optimal correction and maintenance of that correction and their treatment is often marred by pseudarthroses. Seventeen patients with an average curve of 93 degrees have been treated and followed for up to 38 months. Preliminary traction was used in 8 patients, then a staged anterior and posterior correction and fusion was done, using Dwyer's instrumentation of the major curve in all and a Harrington rod to supplement the posterior fusion in eleven patients. With this technique the major curve was corrected by 80 per cent with an average 2 per cent loss over 18 months. No pseudarthroses were seen when the Harrington rod was used. Great care must be taken if halo-pelvic traction is to be used for patients with pelvic obliquity, for preliminary correction halo-femoral traction will often be adequate. In the more severe forms of paralytic scoliosis a combined staged anterior and posterior correction and fusion should be considered if the aim is maximal correction of the scoliosis and avoidance of pseudarthroses.

Adolescent↗
PubMed1999

A concept of idiopathic scoliosis deformities as imperfect torsion(s).

Scoliosis is a complex three-dimensional deformity. With continued improvement in spinal implant design, the options for corrective load application have increased. Visualization of the scoliosis deformity as a torsion or torsions, similar to an elongated helical line, and integration of this visualization with current deformity classification have proven useful in developing instrumentation sequences addressing scoliosis as a three-dimensional deformity. These instrumentation sequences, which have been evolving since 1989, have been applied in more than 150 patients who show improved deformity correction without serious complications.

Biomechanical Phenomena↗
PubMed2000

Curve progression and spinal growth in brace treated idiopathic scoliosis.

The risk of progression of idiopathic scoliosis is correlated primarily to factors that predict potential remaining skeletal growth. The aim of the current study was to evaluate spinal growth, measured as the length of the scoliotic spine on serial longitudinal radiographs, and its relationship to progression of the scoliotic curve. The retrospective study was based on measurements made on standing anteroposterior radiographs of 60 patients with adolescent idiopathic scoliosis. In all patients, a Boston brace was prescribed during the followup period. Despite brace treatment, a significantly greater average progression rate of the scoliotic curve was seen in periods of rapid to moderate growth (> or = 10 mm per year) compared with periods of small or no growth (< 10 mm per year). The difference in progression rates concerned the increase of the Cobb angle and the increase of lateral deviation and axial rotation. These findings indicate the length of the spine measured on subsequent radiographs is an excellent parameter to determine spinal growth and thus an excellent predictor of scoliosis progression. With the presented growth charts, which were derived from the measured individual growth velocity values of the patients in the study, it is possible to predict future spinal growth at different chronologic ages.

Adolescent↗
PubMed2001

Characterization of idiopathic scoliosis in a clinically well-defined population.

Idiopathic scoliosis is a highly prevalent disorder, familial in nature, with marked clinical variability. The purpose of this study was to characterize idiopathic scoliosis in a large series of families to be used for a genome-wide search. One hundred thirty-one multigenerational families (892 individuals) with at least two affected individuals were studied. Data obtained included curve pattern, treatment, and back pain. Maximum curvature as a continuous variable was evaluated using t tests for dichotomous characteristics and linear correlation for continuous variables. An analysis of familial loading was done. Four hundred forty-four individuals were classified as affected (82% female; 18% male). The right thoracic and left lumbar curves had the highest mean curvature (49 degrees). Mean curve size was greater in individuals with back pain. Back pain was most prevalent in the right thoracic and left lumbar curve pattern. The Pearson correlation coefficient between the number of affected family members and the maximum degree of curvature was 0.16, suggesting that the greater the lateral curvature, the higher the proportion of family members affected with scoliosis. The sample population is consistent with those of previous studies in relation to gender and curve size. Statistically, the familial nature of this disorder is supported.

Biomechanical Phenomena↗
PubMed2002

Genetics of familial idiopathic scoliosis.

The etiology of familial idiopathic scoliosis is unknown. The role of genetic factors in the development of this disorder has been well documented; however, reports of the specific mode of genetic inheritance are inconclusive. These facts, combined with the phenotypic variability of this disorder suggest that the genetic expression of idiopathic scoliosis may be dependent on multiple factors and genetic interactions. Strategies to resolve the complex nature of this condition include genome-wide scanning of an extended family or, alternatively, a well-characterized population of families affected with idiopathic scoliosis.

Female↗
PubMedDate not supplied

Back pain during orthotic treatment of idiopathic scoliosis.

The incidence and etiology of back pain during orthotic management of idiopathic scoliosis was determined for 303 patients treated from 1980 through 1990 for a minimum of 1 year. All patients denied back pain before orthotic prescription. Thirty-four (11%) patients reported back pain after institution of brace treatment. A family history of scoliosis (p = 0.014) and vigorous sports activities (p < 0.001) were correlated with pain. Seventeen of 34 patients with pain showed >10 degrees of curve progression during bracing, whereas 67 of 269 patients without pain progressed (p = 0.002). Four patients with pain and 11 without were eventually found to have an underlying pathology (spondylolysis/listhesis). No other underlying pathologies were found. Night pain or a left thoracic curve pattern were not correlated with a serious underlying etiology. Back pain occurring after institution of brace treatment for idiopathic scoliosis is often associated with curve progression and is poorly correlated with a serious underlying pathology.

Back Pain↗
PubMedDate not supplied

Assessing physical disability in children with spina bifida and scoliosis.

The purpose of this study was to develop a valid and reliable questionnaire to assess physical disability related to the spine in children with spina bifida and scoliosis and their families. Eighty-eight items were generated from a review of the literature and interviews with clinicians, parents, and children with spina bifida and scoliosis. Items were reviewed by 40 children and ranked. After eliminating redundant items, the top 25 items were formatted into a self-administered questionnaire. The questionnaire, completed 2 weeks apart, demonstrated "excellent" test-retest reliability (intraclass correlation coefficient = 0.88). Construct validity was established by high correlation with a validated scale of overall disability: the Activities Scale for Kids (r = 0.86, p < 0.01) and by correlations with global assessment of function. In conclusion, the Spina Bifida Spine Questionnaire is a valid and reliable questionnaire and can be used to assess the outcomes of treatment for children with spina bifida and scoliosis.

Adolescent↗
PubMed1999

Comparative study of propofol and midazolam effects on somatosensory evoked potentials during surgical treatment of scoliosis.

OBJECTIVE: Studies of the effects on lower-limb cortical somatosensory evoked potentials (CSEP) during total intravenous anesthesia are sparse for propofol and are lacking for midazolam. This study was designed to compare the effects of propofol and midazolam on CSEP under total intravenous anesthesia during intraoperative monitoring for surgical treatment of scoliosis. METHODS: CSEPs were recorded in two groups of 15 patients during posterior instrumentation for treatment of idiopathic scoliosis. The anesthesia used the combination of atracurium, alfentanil, and an hypnotic agent (propofol for Group I or midazolam for Group II). The main characteristics of the CSEPs (P40 latency and N34-P40 and P40-N50 amplitudes) were recorded using ankle posterior tibial nerve stimulation. The CSEPs were recorded before induction, 10, 70, 100, 130, and 160 minutes after induction, and before the wake-up test. The statistical analysis involved analysis of variance for repeated measures. Both groups were homogeneous before induction. RESULTS: Neither CSEP deterioration during risk-associated surgical procedures nor postoperative clinical abnormalities were observed. Both propofol and midazolam induced increases in P40 latencies, with the increases being greater and more regular for the propofol-treated group. The amplitude values changed with time for both groups, decreasing mainly after induction; in the midazolam-treated group, the amplitudes were smaller but more stable. Propofol modified the morphological characteristics of the response by decreasing the late P60 component amplitude; the W-shaped CSEP morphological pattern was maintained with midazolam. CONCLUSION: This study demonstrates the appropriate use of either propofol or midazolam in scoliosis monitoring. Preoperative small-amplitude CSEPs might favor the use of propofol anesthesia.

Adolescent↗
PubMed1997

Chest wall deformities and thoracic scoliosis after costal cartilage graft harvesting.

Donor-site complications, specifically chest wall deformities and thoracic scoliosis, occurring after harvest of costal cartilage grafts are presented and discussed. The cases of 18 patients (12 male and 6 female), who underwent costal cartilage grafts for microtia reconstruction from 1975 to 1993, were reviewed for donor-site complications using radiography and physical examination. Ribs from which costal cartilage had been harvested showed increased inward bowing on radiographs in 16 of 32 donor sites. The frequency of rib deformity in donor sites was 20.0 percent when cartilages were harvested from patients older than 10 years of age, whereas it was 63.6 percent in patients younger than 10 years old. This difference was statistically significant (p = 0.027, Fisher's exact test), although only 32 grafts were performed in 18 cases. The upper ribs demonstrate a higher incidence of deformity than lower ribs. Thoracic scoliosis was found in 4 of 16 cases. The biomechanical impact of these deformities was considered because of respiratory movement of the thorax and injury to the germinal growth center of the ribs. We recommend delaying costal cartilage grafts for as long as possible, leaving the costochondral junction intact to minimize chest wall deformity and thoracic scoliosis.

Adolescent↗
PubMed1978

Pregnancy complicated by thoracolumbar scoliosis.

Pregnancies complicated by severe thoracolumbar scoliosis may be affected by obstetric and cardiovascular complications. This case report of a pregnant woman with severe thoracolumbar scoliosis includes extensive documentation of complications by pulmonary function studies and peripartum arterial blood gas analysis. The differences between the physiologic changes of normal pregnancies and those of pregnancies with scoliosis are described.

Adult↗
PubMed1978

X-ray fluorescence analysis of muscles in scoliosis.

X-ray fluorescence spectrometry was used to determine calcium, copper, and zinc concentrations in paraspinal and gluteal muscles obtained during spinal surgery from patients with scoliosis. Samples of 1-3 mg were sufficient to demonstrate that calcium was higher in idiopathic than in other forms of scoliosis or in normal control muscles. It is suggested that a calcium-related neuromuscular defect could be an important factor in the genesis of idiopathic scoliosis.

Calcium↗
PubMed1978

Idiopathic and congenital scoliosis in twins.

This report contains a case presentation of monozygotic twins who had concordant right thoracic scoliosis of differing severities. One twin also had an associated congenital left lumbar scoliosis and urologic abnormalities. This report would suggest that the genetic basis of scoliosis may occur at multiple gene loci.

Abnormalities, Multiple↗