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PubMed1986

The clinical value of Moiré topography in the management of scoliosis.

An analysis of the diagnostic reliability and the clinical value of moiré topography is presented. Moiré topography was used as an adjunct to clinical assessment and roentgenographic examination in a consecutive series of 139 scoliosis observations. In 17%, the moiré pattern lateral to the scapulae was impossible to analyze. One false negative finding and 23 false positive findings were observed. There was no correlation between the moiré asymmetry and the Cobb angle. An asymmetry of one contour line implied a curve less than 25 degrees. (The location of the maximal moiré asymmetry did not necessarily coincide with the apex of the scoliosis.) It is concluded that moiré topography is loaded with pitfalls that must be considered. However, used in a designed way, the method is of clinical value, complementing physical examination in screening and longitudinal observation of scoliosis.

Adolescent↗
PubMed1987

Scoliosis induced by medullary damage: an experimental study in rabbits.

To date, there have been no reports of experiments designed to induce scoliosis by direct damage of different areas of the spinal cord. In a series of rabbits with medullary damage, the authors attempted selectively to interrupt the pathways that mediate proprioceptive input. Unilateral lesion of the dorsal column and posterior horn of the spinal cord was performed using three different techniques: coagulation with laser, stereotaxic microcoagulation, and longitudinal electrocoagulation. Of 32 operated rabbits, 17 developed scoliosis, exhibiting clear pathologic damage of the spinal cord. Electrophysiologic study, including EMG and analysis of the tonic -- vibratory reflex, was performed on 10 rabbits with medullary damage (scoliotic and non-scoliotic) and 12 matched controls. The data suggest disturbance of the sensory afferences that control the postural tone and consequent muscular imbalance, expressed as reduced activity in the muscles of the convex side. This work supports the view that loss of proprioceptive neural impulses caused by medullary damage can induce scoliosis.

Animals↗
PubMed1987

Relationship between kyphosis, scoliosis, and osteoporosis in the elderly population.

In 56 valid subjects 60 years old or more, bone mineral content (BMC) of the second, third, and fourth lumbar vertebrae and of femoral neck was measured by dual-photon absorptiometry. Dorsal kyphosis and lumbar and dorso-lumbar scoliosis were determined from radiographs using the Cobb methods. Kyphosis was positively correlated with low BMC but not with scoliosis. Scoliosis was positively correlated with femoral neck BMC but not with vertebral BMC.

Aged↗
PubMed1988

The natural history of idiopathic scoliosis. A study of the incidence of treatment.

The natural history of idiopathic scoliosis has been studied between 1969 and 1985 in a well-controlled population of school children, 66,200 cases, between 7 and 16 years of age. The incidence of scoliosis needing treatment (25 degrees or more in progress in growing children) was studied with a cross-sectional as well as a longitudinal survey. When using a cross-sectional technique, a decrease of cases being treated was seen after the introduction of a conventional screening program--thus indicating a change in the natural history of moderate scoliosis. This could, however, be explained by the consequence of an accumulation of treated cases, formerly diagnosed and treated later on, seen immediately after the introduction of screening. When the longitudinal method was used, this trend could not be observed. And finally, when taking changes of indication of treatment and of the population into consideration, no tendency at all toward a change in the natural history could be seen.

Adolescent↗
PubMed1988

Reduction of radiation dose and imaging costs in scoliosis radiography. Application of large-screen image intensifier photofluorography.

Photofluorography using a large-field image intensifier (Siemens Optilux 57) was applied to scoliosis radiography and compared with a full-size rare-earth screen/film technique. When scoliosis radiography (PA-projection) was performed on 25 adolescent patients, the photofluorographs were found to be of comparable diagnostic quality with full-size films. A close correspondence between the imaging techniques was found in the Cobb angle measurements as well as in the grading of rotation with the pedicle method. The use of photofluorography results in a radiation dose reduction of about one-half and considerable savings in direct imaging costs and archive space. In our opinion the method is particularly well-suited for follow-up and screening evaluation of scoliosis, but in tall patients the image field size of 40 x 40 cm restricts its usefulness as initial examination.

Adolescent↗
PubMed1988

Reproductive outcomes in scoliosis patients.

In a retrospective cohort study of 1,409 persons diagnosed with scoliosis between 1927 and 1965 in Minneapolis and St. Paul, Minnesota, mailed questionnaires were obtained for 846 white women. Six hundred and eight (72%) of these women had ever been pregnant, and they reported a total of 1,733 pregnancies and 1,413 livebirths. Adverse outcomes among the pregnancies and livebirths of the 608 women were reported, including spontaneous abortion, stillbirth, low birth weight, prematurity, congenital anomalies, and complications of pregnancy or delivery. Rates of these events for the scoliosis patients were compared with corresponding expected rates. Comparison of the overall rates suggested that the scoliosis patients had more premature births than expected, but their rates of other adverse reproductive events did not differ from expected.

Adult↗
PubMed1989

Pulmonary function test study and after spinal fusion in young idiopathic scoliosis.

A homogeneous population of 42 women with idiopathic scoliosis (mean age, 20.8 years and mean major thoracic curve of 58.2 degrees) had a complete pulmonary function test (PFT) at rest before, and a minimum of 3 years after, spinal fusion (mean, 7.7 years) to evaluate the effect of scoliosis and its surgical correction on PFT at rest. A multifactorial analysis showed that only the vital capacity (VC) was significantly lowered to 81% of predicted value (P less than 0.05). All of the other parameters of pulmonary volumes, flow, and gas exchanges, where corrected for the loss of lung volume, were within normal limits, showing pure restrictive changes in this population. Double-major curves were more severe, but no significant difference in PFTs were found with single thoracic curves. Curves over 50 degrees had significantly lower VC. The surgical correction of 40% is permanent and the functional improvement in postoperative vital capacity (VC) of 12% is significant (P less than 0.05). Other factors, such as the time between the two evaluations, the age of the patient, pelvic obliquity, trunk imbalance, and degree of kyphosis did not have any correlation with the observed changed on any of the PFT results. Therefore, early correction by spinal fusion in idiopathic scoliosis brings on some improvement of the vital capacity at rest and may prevent deterioration with progression of the curve.

Adolescent↗
PubMed1989

Peak skeletal mass assessment in young adults with idiopathic scoliosis.

In 52 adult women with ages ranging from 20 to 35 years (mean age, 26.5 +/- 4.9 years) with scoliosis of the idiopathic type (mean, 44.7 +/- 17.4 Cobb degrees), bone density was assessed by conventional grading of the relative vertebral density (RVD) and the Singh trabecular index (STI). In vivo determinations of the bone mineral content (BMC) were performed in the radius, femur, and lumbar vertebrae by new noninvasive techniques of single (SPA)- and dual (DPA)-photon absorptiometry. Frequency distributions of scoliosis vs. control subjects with respect to RVD and STI grades showed interdependence to the P less than 0.01 level of significance. The mean BMC determinations of the radius (0.685 +/- 0.061 gm/sq cm) of the femur (0.947 +/- 0.110 gm/BA/sq cm) and of the vertebrae (1.091 +/- 0.105 gm/BA/sq cm) were markedly reduced compared with published control values (P less than 0.001). In comparison with the authors' institutional controls, mean BMC measurements were significantly lower for the radius (P less than 0.05) and for the femur (P less than 0.001). These results conclusively demonstrated that assessment of peak skeletal mass in a population of adult premenopausal women with idiopathic scoliosis showed significant decrease in average BMC measurements compared with control values. Maximal bone accretion was best evaluated at locations unaffected by deformity such as the radial diaphysis and the femoral neck.

Adult↗
PubMed1990

Surgical treatment of scoliosis in a spinal muscular atrophy population.

Seventy-eight patients were diagnosed with spinal muscular atrophy between 1969 and 1988. Scoliosis developed in 34 of these patients, an incidence of 60%. Thirty-one patients could be retrospectively reviewed by chart review or interview. The average follow-up was 11.5 years. Onset of scoliosis averaged 8.8 years. Twenty-two patients were treated nonsurgically and nine surgically. Patients had improved sitting balance and endurance after surgery. Complications of surgery included loss of correction in one patient, one pseudarthrosis, and one patient who required prolonged ventilatory support. The prolonged survival of patients with spinal muscular atrophy justifies aggressive orthopaedic management of scoliosis to prevent progression of deformity and improve sitting comfort.

Braces↗
PubMed1991

Mechanism of production of scoliosis. A hypothesis.

On the basis of previous studies on the vertebral column and thoracic skeleton, the author generated a hypothesis for the mechanism of production of scoliosis. According to this hypothesis, vertical stability of the thoracic spine is maintained by equal support through the ribs from both sides due to the equal load brought to the lamin by both the ribs through the costotransverse articulations and ligaments. Any interference in this balancing mechanism will disturb the mechanism of spinal stability, and the spine will bend toward the more heavier loaded side at the intervertebral joints. On the basis of this hypothesis, mechanisms of production of scoliosis (both in experimental animals and humans) after removal of ribs on one side can be explained. Removal of the ribs from one side produces an imbalance in the symmetric weight transmission through the ribs on the two sides. Pathologic deformations within the vertebrae in scoliosis results from the asymmetric load and the altered route of the load transmission on the convex side of the curve.

Animals↗
PubMed1991

Thoracotomy and scoliosis.

The incidence of thoracic scoliosis after completion of growth was studied in a group of patients operated on in childhood with a lateral thoracotomy for esophageal atresia and cardiac and pulmonary disorders. Twenty of 61 patients had a thoracic scoliosis exceeding 10 degrees. The curves were mostly convex toward the operated side except in patients treated surgically for esophageal atresia, in which they were concave toward the operated side. None of the curves exceeded 25 degrees, and no therapy was needed. Thoracic scoliosis should, however, be remembered as a possible complication after lateral thoracotomy in childhood.

Adult↗
PubMed1991

The transverse plane deformity of structural scoliosis.

An examination of the transverse plane aspect of deformed vertebrae from specimens of both human and animal scoliosis identified a consistent pattern of intravertebral deformity. In the animal model, dynamic bone growth studies illustrated bone drift in the opposite direction to the rotation of the scoliosis, suggesting that the bone growth in the transverse plane was attempting to correct rather than produce the deformity. The observed pattern of vertebral deformity can be explained in simple terms because it obeys the standard laws of bone growth and remodeling. This observed growth pattern is consistent only with the production of idiopathic scoliosis by the rotation of a primary lordosis.

Animals↗
PubMed1992

Proprioceptive accuracy in idiopathic scoliosis.

Defects in proprioceptive postural control have been linked to the etiology of idiopathic scoliosis. In particular, a rearrangement of the internal representation of the body has been proposed in these cases. In this study, upper-extremity proprioceptive accuracy was compared among the following groups: 1) patients with idiopathic scoliosis (n = 25); 2) subjects with nonprogressive spinal asymmetry detected by screening in school (n = 23); 3) subjects undergoing behavioral training for nocturnal enuresis (n = 17); and 4) normal subjects (n = 134). A significant inaccuracy was found among the right-handed subjects of the scoliosis and spinal asymmetry groups as compared to the normal group. It is postulated that proprioceptive dysfunction, or borderline function, is a causative factor of spinal asymmetry, which is often observed in early adolescence and which in some cases may be progressive.

Adolescent↗
PubMed1992

Neurologic testing with somatosensory evoked potentials in idiopathic scoliosis.

A study was undertaken to determine if a somatosensory conduction delay is present in the posterior columns of adolescents with idiopathic scoliosis. Somatosensory evoked potentials were recorded after median and posterior tibial nerve stimulation in 12 adolescent subjects being followed for idiopathic scoliosis with an average age of 14.6 years (range, 12.0-16.6 years). Twelve normal controls matched for age, sex, race, and height underwent identical testing. Evoked potential peak latencies were measured and conduction velocities calculated. Results showed no difference between scoliotics and normal controls. Comparable posterior column conduction velocities were recorded in both groups. If a defect in posterior column function does exist in adolescent idiopathic scoliosis, as previously postulated, it is not reflected by a conduction delay as measured by somatosensory evoked potential testing.

Adolescent↗
PubMed1992

Chiba Spinal System in the operative management of scoliosis.

The Chiba Spinal System was developed for three-dimensional correction of scoliosis. The system consists of a 7-mm diameter smooth solid rod, closed and open hooks, and specially designed conical sleeves. The rod does not have ratchets or threads, thus minimizing stress concentrations. The closed and open hooks are attached to the rod using the conical sleeves. The sleeves have longitudinal slits permitting compression during insertion. The outrigger system with a torque wrench is used to correct the deformity in the frontal plane. When correcting lordosis with vertebral rotation, a sagittal correction device may be used. Fifty-two patients with idiopathic scoliosis were operated on with this system from 1986 through 1989. The average correction of the scoliosis was 58%. For the 21 patients with thoracic lordosis less than 0 degrees, the mean preoperative lordosis was -8 degrees, which was corrected to +7 degrees. The mean correction of the vertebral rotation was 24%. Two patients complained of paresthesia of the thoracic region after operation, but this disappeared within 2 weeks. In 32 patients with more than 2 years' follow-up, the mean loss of correction was 3 degrees. One case with instrumentation failure was noted.

Adolescent↗
PubMed1993

Optoelectronic evaluation of trunk deformity in scoliosis.

In this study, truncal deformity in patients with scoliosis was evaluated by circumferential scanning using an optoelectronic device (Optronic Torsograph, Anima Corp., Tokyo, Japan). This device generates cross-sectional skin surface topography at 10 axial levels to provide a three-dimensional representation of truncal shape. Ninety-three patients with suspected idiopathic scoliosis were evaluated with conventional Cobb measurements, and their parameters were computed using the device's measurements. The geometric cross-sectional indexes correlated poorly with the Cobb angle and were highly variable during repeated measurements. The optoelectronic device's angle, a measure of centroid curvature, correlated highly with the Cobb angle for primary spinal curves. The highest correlation was observed in thoracolumbar curves. This optoelectronic device has clinical relevance as a method for further scoliosis screening and monitoring the progression of spinal curvature in a patient.

Adolescent↗
PubMed1993

Adolescent idiopathic scoliosis--early menarche, normal growth.

Growth has long been known to be relevant to the development and prognosis of spinal deformity and abnormalities have been considered in the etiology of idiopathic scoliosis. Age at menarche, as an indicator of puberty, in 303 girls with idiopathic scoliosis 10 degrees or more from the Dublin school screening program was 13.13 years, 0.39 years earlier than the national mean for Irish girls. This difference is statistically significant (P < 0.01). The heights of 214 of these girls aged 10-15.5 years at diagnosis and at least 14 years at follow-up, after a minimum 6 months, were compared with the national standards. It was found that, although those diagnosed at a younger age were generally taller than their peers, this was not true for those diagnosed at a later age or for anyone at final follow-up. This points to an early pubertal growth spurt in girls with adolescent idiopathic scoliosis but not to any outright abnormality of growth or development.

Adolescent↗
PubMed1993

Diurnal variation of Cobb angle measurement in adolescent idiopathic scoliosis.

To investigate the possible influence of gravity on daily variations of curve magnitude in adolescent idiopathic scoliosis, standardized anteroposterior standing radiographs of the spine were taken at 8:00 AM and repeated in the same conditions at 8:00 PM on the same day, 19 girls with idiopathic scoliosis, aged 10-16 years were included. The Cobb angle of the primary thoracic curve was measured blindly by four skilled orthopaedic surgeons. The mean interobserver variation in measuring Cobb angles on the 38 radiographs was 1.6 degrees. The average Cobb angle on morning radiographs was 60 degrees (range, 42-91 degrees) as compared to 65 degrees (range, 47-89 degrees) in the afternoon, a significant (P < 0.001) difference using a paired two-sided Student t test. It was concluded that there is a statistically and clinically significant daily increase of curve severity in moderate to severe idiopathic scoliosis.

Adolescent↗