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PubMedDate not supplied

Adult scoliosis and back pain.

From available long-term follow-up studies of untreated scoliosis, there seems to be minimal risk of disabling back pain in adult patients who have lumbar curves. A review of all Swedish patients who in 1971 received disability pension because of scoliosis showed very few who had lumbar curves, significantly fewer and with curves of lesser degrees than patients who had thoracolumbar and thoracic curves. Those exhibiting lumbar curves were mostly 60 years of age or older and had curves around 25 degrees only, of the type that can arise as a result of osteoporosis and disc degeneration. Whether severe low-back pain occurs more often in adults who have lumbar curves than in those whose spines are straight is open to question, since calculations presented show approximately the same incidence of surgery performed for back pain in scoliotic patients and in those whose spines are straight. Because scoliosis surgery in the adult carries a high risk and long-term efficacy is unproved, all types of conservative measures must be tried before discussing an operation. Prophylactic surgery to prevent future back pain in young patients who have lumbar curves is not justified.

Adult↗
PubMedDate not supplied

Adult lumbar scoliosis.

This report details the expierience with adult lumbar scoliosis among patients at a scoliosis center. Some curves are shown to progress in the adult, while others appear de novo. Pain arising in adult scoliosis may reflect root compression or segmental degeneration. Once pain arises in an adult lumbar curve, it is likely to be progressive and often requires surgical treatment.

Adult↗
PubMedDate not supplied

Symptomatic lumbar scoliosis with degenerative changes in the elderly.

Lumbar scoliosis with degenerative changes in the elderly presents with spondylosis, variable apophyseal joint arthrosis, laminar hypertrophy, and marginal osteophytos most prominent within the scoliotic apex. Resultant lumbar stenosis, alone or with ventral spurs and herniated discs as isolated or associated lesions, can produce disabling low-back and lower extremity pain, weakness, and neurogenic claudication relievable by appropriate decompressive surgery. Myelography is essential as a preoperative measure. Whether such scoliosis is superimposed on adolescent thoracolumbar scoliosis or arises anew in later life remains an open question.

Adult↗
PubMedDate not supplied

The incidence of low-back pain in adult scoliosis.

To date no knowledge of the incidence of scoliosis in adults and its relationship to low-back pain is available. In order to arrive at an understanding of low-back pain in adult scoliosis, a study of 5000 intravenous pyelograms was performed. The incidence of lumbar and thoracolumbar curves was 2.9%. One hundred and fifty-nine of the 189 patients found to have scoliosis were contacted. The incidence of back pain was 59% (similar to that in the general population). Back pain was subdivided into mild (44%), moderate (49%), or severe (7%). The curve was subdivided into three categories: 10-24 degrees, 25-44 degrees, and 45+ degrees. Of the 82 idiopathic curves with pain, 64 were in group 1, 15 in group 2, and 3 in group 3. Forty-three percent had mild pain, 50% had moderate pain, and 7% had severe pain. As the degree of curvature increased, the severity of pain increased, especially for curves of more than 45 degrees. Patients without back pain tended to have smaller curves. the presence of facet sclerosis correlated with a history of pain in 64%. There was a high correlation between radiologic changes at the curve apex and pain. Age bore no relationship to the incidence of pain.

Adult↗
PubMedDate not supplied

The role of scoliosis and pelvic obliquity on functional disability in myelomeningocele.

A retrospective analysis of 39 patients with myelomeningocele over age 16 was done to determine the effects of scoliosis and pelvic obliquity on their ambulatory ability and function. Although primarily dependent on neurologic level, prevention of an unbalanced spine and maintenance of ambulatory status also appeared to correlate closely with a curvature less than 40 degrees and a pelvic obliquity less than 25 degrees. All ambulators, regardless of neurologic level, had a pelvic obliquity of 25 degrees or less. Of the 19 ambulators, all but two had curvatures of 40 degrees or less. Ten of the 11 unbalanced sitters had a curvature of 35 degrees or more and a pelvic obliquity greater than 25 degrees. The quality of life style also appeared to correlate well with the severity of scoliosis and pelvic obliquity. Sixteen untreated patients with progressive curvatures prior to age 16 appeared to have insignificant curve progression past age 16. Twelve patients underwent posterior fusion in situ. This procedure alone is not recommended for the treatment of scoliosis associated with myelomeningocele because of the high morbidity.

Adolescent↗
PubMedDate not supplied

Proprioceptive function in children with adolescent idiopathic scoliosis.

Recent studies in Japan and in Sweden have suggested that a disturbance of postural equilibrium exists in idiopathic scoliosis. Proprioceptive function is one of the factors involved, and therefore a study of proprioception in patients with adolescent idiopathic scoliosis (AIS) was carried out. No difference was noted in joint position sense and in fine motor control between 24 scoliotics and matched controls taken from a group of 70 normal children of the same age group. Blindfold weight discrimination, a test of muscle spindle and tendon stretch receptor function, also showed no abnormality in scoliotic children. The Charpentier test, thought to be a test of control of muscle spindle function, showed a tendency to an infantile response in patients with adolescent idiopathic scoliosis, while the control subjects showed a normal size-weight response.l This suggests that the muscle spindle system may be at fault in AIS and supports the suggestion that postural equilibrium reactions may be abnormal in this disease.

Adolescent↗
PubMedDate not supplied

Laboratory testing of segmental spinal instrumentation versus traditional Harrington instrumentation for scoliosis treatment.

The authors have tested 51 instrumented calf spines in vitro, using a scoliosis simulator, to evaluate the adequacy of fixation and nature of acute failure seen with various methods of scoliosis instrumentation. Tests were performed in compressive loading, rotation, and forward bending on the following instrumentation systems: (I) Harrington distraction, (II) Harrington distraction plus compression connected by transverse approximators, (III) Harrington distraction plus segmental laminar wires, and (IV) Luque double "L" rods plus segmental laminar wires. The study demonstrated that the addition of segmental fixation to scoliosis instrumentation provides improved stability because of (a) multiple fixation sites and (b) prevention of deformity, especially kyphosis, within the instrumented segment (an important contributor to hook cutout when a single Harrington distraction rod is tested). Failure with the Harrington rod was always by fracture at the metal-bone interface, while failure with the Luque method always occurred outside the instrumented segment.

Animals↗
PubMedDate not supplied

Scoliosis and cor pulmonale.

Twenty patients with cor pulmonale due to scoliosis and associated spine deformities seen at the Twin Cities Scoliosis Center in the past 20 years have been reviewed. The average age was 37 years. The average scoliosis was 135 degrees and ranged from 90 degrees to 200 degrees. Fifteen patients were placed in halo traction, nine of whom went on to surgical stabilization. Of the nine patients having surgical treatment, five had postpoliomyelitis curves, two had congenital, one had infantile idiopathic, and one had frontometaphyseal dysplasia. The best results were in the postpoliomyelitis group, with an average pretreatment vital capacity of 595 cc and posttreatment vital capacity of 1071 cc; the average PaO2 increased from 55 to 64 mm Hg, and the average PaCO2 decreased from 52 to 43 mm Hg. The only death in the postpoliomyelitis group occurred six years postoperatively. Of the four nonpoliomyelitis patients having surgery, only one survived, the patient with frontometaphyseal dysplasia. The difference between the poliomyelitis and nonpoliomyelitis groups was striking. Patients with cor pulmonale due to spine deformity should have careful evaluation and a trial of halo traction. If the vital capacity improves, the PaO2 increases, and the PaCO2 decreases, then surgical stabilization can often be successfully accomplished. If these parameters do not improve in traction, then surgical treatment can be abandoned.

Adult↗
PubMedDate not supplied

Trunk strengths in structurally normal girls and girls with idiopathic scoliosis.

Maximum voluntary isometric strengths of the trunk were measured in 93 girls who had mild idiopathic scoliosis and 109 girls who had structurally normal spines. Subject ages ranged from 10 to 16 years, and the mean Cobb measurement in the girls with scoliosis was approximately 22 degrees. Strengths were measured in attempted trunk flexion, attempted extension, ad attempted left and right lateral bending. No consistent differences appeared in performance between the girls with scoliosis and the structurally normal girls.

Adolescent↗
PubMed1983

Abnormalities of aggregation, thromboxane A2 synthesis, and 14C serotonin release in platelets of patients with idiopathic scoliosis.

Platelet functions were investigated in 16 patients with idiopathic scoliosis (IS), in seven patients with congenital scoliosis (CS), and in 12 healthy individuals who served as a control group. All were females, aged 11 to 22 years. Platelet aggregation anomalies were observed in all IS patients. These constituted an impaired platelet-release reaction when aggregation was induced with ADP or epinephrine, but not with collagen or arachidonic acid. A decreased thromboxane A2 synthesis and impaired 14C-serotonin release were also observed when platelets were stimulated with ADP or epinephrine. Platelet from CS patients and the controls did not show any functional abnormalities when stimulated with the above four aggregating agents. The platelet function anomaly in IS patients was not associated with prolongation of the bleeding time, spontaneous occurrence of hemorrhagic episodes, or increased bleeding during invasive procedures, including major spinal surgery. The above findings and the recently described platelet structural anomalies in IS may imply that the pathological process operative in idiopathic scoliosis involves not only the axial skeleton, but also cellular blood elements. The similarity between blood platelets and muscle cells, and the anomalies that have been found in both systems in IS, support the notion that a muscle disorder may be involved in the pathogenesis of the disease.

Adenosine Diphosphate↗
PubMedDate not supplied

Trunk muscle myoelectric activities in idiopathic scoliosis.

Twenty adolescent girls with mild-to-moderate cases of idiopathic scoliosis and twelve adolescent girls with structurally normal spines performed 15 exercises isometrically while standing. The exercises included resisting flexion, extension, and lateral bending moments imposed on the trunk. Myoelectric activities in 12 trunk muscle groups were measured during these performances, using surface electrodes. For one set of comparisons, the patients were divided into those whose clinical records documented curve progression and those with no documented progression. No significant differences were noted in mean myoelectric activities between these two patient groups. For a second set of comparisons, the subjects were divided into patients with curves of more than 25 degrees, patients with curves of 25 or fewer degrees and normals. No significant differences in mean myoelectric activities were noted between the patients with the smaller curves, while the patients with the larger curves had significantly larger convex side myoelectric activities in their anterior, lateral and posterior muscles at lumbar levels compared to the normal girls. The findings of this study, along with biomechanical model analyses, suggest that the asymmetries in muscle actions evidenced by myoelectric measurements result from scoliosis. Scoliosis progression seems not to be caused by asymmetry in muscle contractions; rather it may be caused by a lack of adequate asymmetry.

Abdominal Muscles↗
PubMedDate not supplied

Morphology of the paravertebral muscles in adolescent idiopathic scoliosis.

Histochemical studies of paravertebral muscles in idiopathic scoliosis have shown a consistently higher proportion of type I fibers on the convex side. In this study of the transversospinal muscles in moderate idiopathic scoliosis, we could demonstrate a lower type II B/II A fiber ratio on the convex side, along with an increased proportion of type I fibers. The capillary count was also higher on the convex side, especially around the type I fibers. The few pathologic changes found were predominately seen in the gravest cases of scoliosis. It is concluded that the fiber type distribution, capillary count, and metabolic enzyme activity on the convex side resembles that seen after endurance training. This suggests a secondary adaptive origin of these changes.

Adolescent↗
PubMed1983

Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated by Harrington rod fusion.

One hundred patients from the Gothenburg Scoliosis Data Base were studied. They met the following criteria: (1) adolescent idiopathic scoliosis (2) completion of treatment before age 20, (3) a minimum follow-up of five years thereafter, (4) a minimum age of 22 years at final follow-up, and (5) operation performed by the senior author. Of these, 95 were personally examined. The surgical technique from 1968 to 1973 included a two-stage Harrington distraction, with fusion added at the second operation (52 patients). From 1973 to 1975, 48 patients were treated with a one-stage distraction and fusion after a week of preoperative Cotrel traction. Postoperatively, all patients were treated with a Milwaukee brace. A spinal examination and functional assessment, including a questionnaire and pain drawing, full standing anterior-posterior (AP), and lateral roentgenograms of the spine, was performed by independent observers. Eighty-five subjects without scoliosis served as a control group. The radiographic evaluation showed the usual nearly 50% permanent correction at the follow-up examination averaging nine years postoperatively. Lateral roentgenograms, however, demonstrated in 52% flattened or kyphotic cervical spines producing no significant complaints, non-significant flattening of the thoracic kyphosis, but significant lowering of the lumbar lordosis. Fifteen of the 24 patients with distal hook insertion and fusion including L4 or L5 demonstrated retrolisthesis. All had significant low-back pain. Degenerative facet joint changes and disc space narrowing was noted in 11 patients, again with a distal hook purchase in L4 or L5. Compared to the controls, the operated patients, as a group, revealed no lessened activity or back pain at any location.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Incidence and severity of back pain in adult idiopathic scoliosis.

Incidence of back pain in a referred and followed group of 197 adults with idiopathic scoliosis and in a comparable control group of 180 adults without known spinal deformity was the same. Severity of pain, however, was greater in scoliotic patients. The clinical course of back pain in adults without spinal deformity and in scoliotics was different: 64% improvement in adults without scoliosis versus 83% persistence and progression in adults with scoliosis. Fifty-one percent of adult scoliotics (101 patients) had significant pain. Pain increased with age and degree of scoliotic curvature (P less than 0.0005). Patients with major lumbar curves had more pain. Major complaint was frequently below major deformity. Compensatory lumbosacral fractional curves were most painful and disabling. Pain comes mainly from concavity of curves and includes discogenic, facet joint, and radicular origins. Surgery significantly reduced pain (P less than 0.0001); conservative therapy did not. Eighty-three percent of surgical patients had sufficient pain relief to make surgery worthwhile at five years average follow-up.

Adolescent↗
PubMed1983

Improvement in pulmonary function in patients having combined anterior and posterior spine fusion for myelomeningocele scoliosis.

Thirteen patients with myelomeningocele scoliosis whose surgery necessitated anterior exposure of the thoracic spine were tested for changes in pulmonary function following spinal stabilization. The majority of patients exhibited a T12 level paralysis and a mean scoliosis of 72 degrees. Average correction of scoliosis for the series was 63%, and two cases with one level pseudarthrosis had no loss of correction. Ten of 13 patients were tested for pulmonary function one month prior to surgery and an average of ten months postoperatively. Eight of the ten patients demonstrated increase in peak flow postoperatively. Five demonstrated increase in maximum voluntary ventilation, and six cases showed increased functional residual capacity. Forced vital capacity increased in two, decreased in five, and showed no change in three patients. Improvement in peak flow, maximum voluntary ventilation, and functional residual capacity was noted in all five cases with scoliotic deformity in excess of 60 degrees (mean 93 degrees). It is postulated that, following spinal stabilization, these patients are able to improve their thoracic mechanics, enhancing greater expiratory flow with greater endurance.

Adolescent↗
PubMedDate not supplied

Multicenter trial of a noninvasive stimulation method for idiopathic scoliosis. A summary of early treatment results.

Lateral electrical surface stimulation (LESS) for the treatment of idiopathic scoliosis has been applied to 548 patients by 54 principal investigators in North America and Western Europe. The purpose of the multicenter investigation was to determine whether this noninvasive stimulation technique alone is a viable alternative to bracing in routine clinical use. Only patients with rapidly progressing scoliosis and at least one year of growth remaining were included in the study. When stimulation was applied, a pretreatment curvature progression rate of 1 degree/month reversed to a reduction rate of 0.5 degrees/month over the initial 6 months of treatment. The longest follow-up in treatment was 51 months, and the mean time in treatment was 12 months. At the time of this analysis, 72% of the patients had either reduced or stabilized their scoliosis. Thirteen percent (13%) of the patients had experienced temporary progression with subsequent stabilization and treatment continuation. Progression resulted in termination of 15% of the patients from the program. The final treatment result at skeletal maturity was maintained posttreatment.

Adolescent↗
PubMed1984

Effectiveness of braces in mild idiopathic scoliosis.

Despite the wide use of bracing for the treatment of idiopathic scoliosis, controlled studies apparently have not been performed to examine whether bracing, in fact, alters the natural history of spine lateral curves. We studied 255 female patients, ages 8-17 years, with idiopathic scoliosis who had curves with initial Cobb measures from 15-30 degrees. They were divided into two groups: one group consisted of 144 patients who had received a Milwaukee or Boston brace; and the other, a control group, consisted of 111 patients who remained untreated through a mean period of 1.9 years. The groups had similar mean ages, ages of menarche and curve severities. The results showed a slight but nonsignificant trend, suggesting that bracing reduced the overall probability of progression in the braced curves. However, noting that nearly 75% of the control group curves were nonprogressive, it is possible that a similar proportion of the braced curves need not have been braced. Moreover, bracing failed to prevent eight curves in seven patients (5%) from progressing. These curves progressed at a mean rate of 8 degrees per year. Our retrospective results suggest that bracing probably is not necessary in a large proportion of patients who meet current, clinical criteria for bracing. Given the limitations of retrospective studies like this one, a controlled prospective trial of bracing effectiveness in idiopathic scoliosis seems warranted.

Adolescent↗
PubMed1985

Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated with the Milwaukee brace.

Ninety-five patients from the Gothenburg Scoliosis Data Base were studied. They met the following criteria: adolescent idiopathic scoliosis, completion of Milwaukee brace treatment before age 20, a minimum follow-up period of 5 years thereafter, minimum age of 22 years at final follow-up examination. Of these, 85 (90%) were examined personally by an independent investigator, including anteroposterior and lateral full-length spinal roentgenograms. The average length of follow-up was 7.5 years (range, 5-12 yrs). These patients who successfully completed the brace treatment program, in their mid-twenties ended up with curves that were of equal size (33 degrees +/- 3 degrees) as when the treatment started (30 degrees +/- 3 degrees). In the sagittal plane, the spines were normal; none exhibited hypokyphosis (less than 20 degrees). Compared with the straight control group and to a previously reported group of operated patients, the brace group functioned at the same level in regard to marriage, child bearing, sports activities, and job performance. Overall back pain was also reported at a normal rate, with low-back pain significantly less frequent than the control group. Ten patients showed an increase of their curves exceeding 5 degrees; eight of these had been pregnant multiple times before age 25. None of the patients pregnant after that age increased their curve size. This study demonstrates that those patients who complete a Milwaukee brace treatment for adolescent idiopathic scoliosis from a functional and social point of view do very well. Early pregnancy is a significant risk factor for progression after maturity.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗