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PubMed2001

Idiopathic scoliosis in three dimensions: a succession of two-dimensional deformities?

STUDY DESIGN: A geometric analysis of computerized three-dimensional (3-D) reconstructions of the spine of adolescents with idiopathic scoliosis. OBJECTIVES: To analyze and describe the 3-D location of scoliotic curves with respect to the global frontal, sagittal, and transverse planes of each subject. SUMMARY OF BACKGROUND DATA: Clinical two-dimensional (2-D) measurements cannot fully describe the 3-D deformity of a scoliotic spine because they are done in the 2-D frontal or sagittal plane projection of a subject and do not correspond to the actual deformity. METHODS: The spinal deformity from T1 to L5 of 50 adolescents with thoracic idiopathic scoliosis was reconstructed in 3-D using a multiplanar digital radiographic technique allowing the visualization of the vertebral line of the spine in any projection using auto CAD software. The curvature was segmented in three distinct curves for each subject: a high thoracic, a thoracic, and a lumbar. A regional plane passing through the two end-vertebrae and the apical vertebra was defined, and a series of geometric manipulations were performed to realign each regional plane with the global axis system of each subject. RESULTS: A total of 91% of the 147 curves studied were found to be entirely contained within its 2-D regional plane, and all scoliotic curves were found to be oriented in a 3-D location different from the classic frontal, sagittal, and transverse orthogonal planes of each subject. CONCLUSION: In thoracic idiopathic scoliosis the deformity of the spine is 3-D, but the regional deformity of each high thoracic, thoracic, or lumbar curve is almost always 2-D. The orientation in space of each 2-D plane is such that it cannot be seen in its true frontal or sagittal projection using standard frontal or sagittal radiologic views of the subject.

Adolescent↗
PubMed2002

Upper extremity functional assessment after anterior spinal fusion via thoracotomy for adolescent idiopathic scoliosis: prospective study of twenty-five patients.

STUDY DESIGN: A prospective review of upper extremity function in 25 patients after anterior thoracotomy for instrumentation and fusion of thoracic adolescent idiopathic scoliosis was conducted. OBJECTIVE: To assess the effects of anterior spinal fusion with open thoracotomy on upper extremity function. SUMMARY OF BACKGROUND DATA: The treatment of idiopathic scoliosis through anterior thoracotomy and spinal fusion using instrumentation is a new method for correcting and stabilizing patients with major thoracic and thoracolumbar curves. No studies have assessed the functional outcome for the upper extremities after anterior open thoracotomy that involves splitting through the latissimus dorsi and serratus anterior muscles. METHODS: For this study, 25 adolescent patients with idiopathic scoliosis treated surgically were examined over a 3-year period. The average patient age was 15 years and 3 months, with a range of 11 years and 11 months to 20 years and 9 months. Preoperative activities of daily living, active range of motion, and strength were recorded by an independent occupational therapist (L.P.) for both upper extremities. Postoperative measurements were assessed at 1, 3, 6, 12, and 24 months. All the patients underwent a right thoracotomy with ribs used for autograft. The left upper extremity served as the control limb. No patients had associated anomalies or previous upper extremity surgery. All the patients underwent an upper extremity postoperative stretching and strengthening protocol. RESULTS: At 1 month, 35% of the patients had some difficulty with activities of daily living, primarily in tying their shoes and cutting meat with a knife during meals (P = 0.03). However, by 3 months, all the patients could equivocally and independently perform activities of daily living: dressing, bathing, grooming, attending to hygiene, and feeding (P = 1). Full active range of motion in their upper extremities and shoulder was achieved in all the patients by 1 month (P = 1). All 25 patients had regained normal, bilaterally symmetric strength by 3 months (P = 0.25). No postoperative complications occurred. CONCLUSIONS: Patients undergoing anterior spinal fusion with instrumentation after open thoracotomy can expect to regain full function of the ipsilateral upper extremity in terms of strength, active range of motion, and activities of daily living within 3 months. Compliance with a structured postoperative flexibility and strengthening protocol is recommended to optimize functional outcomes. A novel rehabilitation protocol for the upper extremities is presented.

Activities of Daily Living↗
PubMed2002

Treatment of adult lumbar scoliosis with axial spinal unloading using the LTX3000 Lumbar Rehabilitation System.

STUDY DESIGN: Repeated-measures analysis of variance: within-subject study using six adult subjects with varying degrees of scoliosis. OBJECTIVES: To develop methodology to measure the effects of axial spinal unloading using the LTX3000 Lumbar Rehabilitation System (Spinal Design International Inc., Minneapolis, MN) over a 3-month period on subjects with idiopathic scoliosis. To look for sustained treatment benefits, thus measuring the duration of changes induced on lateral scoliotic curves over the 3-month period after intervention with the LTX3000 Lumbar Rehabilitation System. SUMMARY OF BACKGROUND DATA: Current treatments for idiopathic scoliosis have shown mixed results in managing curve progression. Little research has been done to show the effectiveness of axial spinal unloading in changing the curvature of the spine. METHODS: Baseline data were obtained from four radiographs (two frontal plane, two sagittal plane), surface electromyograms, and back range of motion measurements. Data were collected at four laboratory sessions (baseline, 3 months, 4 months, and 6 months), and the intervention was given between baseline and the 3-month sessions. The intervention phase consisted of axial unloading, two treatments a day for 10 minutes per session, using the LTX3000 Lumbar Rehabilitation System. RESULTS: Static change of Cobb angle values over time showed statistical significance (P = 0.02, alpha = 0.05). Dynamic change of Cobb angle values within sessions showed statistical significance (P = 0.036, alpha = 0.05). CONCLUSIONS: Results from this study showed a significant decrease in Cobb angle measurements in the lumbar curvature during the intervention phase. Once the home intervention program was terminated, the lateral lumbar curvature reverted to baseline values (pre-intervention).

Adult↗
PubMed2002

Multisurgeon assessment of coronal pattern classification systems for adolescent idiopathic scoliosis: reliability and error analysis.

STUDY DESIGN: Three scoliosis surgeons and one orthopedic fellow were presented the anteroposterior radiographs of 70 patients with adolescent idiopathic scoliosis. All the reviewers assigned a type to each curve according to the classification systems of H. A. King and R. W. Coonrad. OBJECTIVES: To compare multisurgeon reliability in applying the classification systems of H. A. King and R. W. Coonrad, and to analyze controversially classified curve patterns. SUMMARY OF BACKGROUND DATA: The system most commonly used to classify adolescent idiopathic scoliosis is King's classification. However, because of poor interobserver reliability, the validity of this system is questioned. In contrast, high interobserver reliability is reported for Coonrad's classification system, which is used less frequently in clinical practice. METHODS: Interobserver agreement and intraobserver reproducibility were tested. Kappa coefficients were used to test reliability. Between the observers, the divergent assignments to curve patterns were analyzed in both quantitative and qualitative terms. An error analysis was performed. RESULTS: Paired comparisons showed a mean interobserver kappa coefficient of 0.45 for King's and 0.38 for Coonrad's classification systems. According to Svanholm et al, these values indicate poor reliability in terms of interobserver agreement. Error analyses for both classification systems showed that the reason for poor reproducibility is disagreement among the observers about structural upper thoracic and structural lumbar curves. CONCLUSIONS: Neither the King nor the Coonrad method appears to have sufficient interobserver reliability. To improve reliability, the authors recommend that the structural stigmas of the upper thoracic and lumbar curves be unequivocally described.

Adolescent↗
PubMed2002

Prospective evaluation of trunk range of motion in adolescents with idiopathic scoliosis undergoing spinal fusion surgery.

STUDY DESIGN: Prospective evaluation of spinal range of motion in patients with adolescent idiopathic scoliosis undergoing a spinal fusion. OBJECTIVE: Evaluate changes in triplanar spine range of motion following spinal fusion. SUMMARY AND BACKGROUND DATA: Preoperative and postoperative radiographs have been the major form of outcome analysis of adolescent idiopathic scoliosis fusions. Although the radiographs document static positions of the skeletal system, they do not document dynamic changes. METHODS: Thirty patients with adolescent idiopathic scoliosis undergoing an instrumented spinal fusion underwent triplanar range of motion tests before surgery and at 12 and 24 months after surgery. Videography with reflective surface markers was used to capture the motions. A fused region, unfused regions above and below the fusion, and a global spinal measure were used to assess changes. RESULTS: Results indicated a loss of motion in the coronal and sagittal planes for the fused and unfused spinal regions and a loss of motion in the coronal, sagittal, and transverse planes for the global measurements. Results also indicated preoperative and continued postoperative right and left lateral flexion asymmetries. No significant correlations were found between the total fused levels and changes in range of motion. No significant correlations were found between the lowest instrumented vertebra and changes in range of motion. CONCLUSIONS: Whereas range of motion was reduced in the fused regions of the spine, it was also reduced in unfused regions. The lack of compensatory increase in motion at unfused regions contradicts current theory and suggests early postoperative range of motion therapy to facilitate motion in unfused regions.

Adolescent↗
PubMed2002

Relations between standing stability and body posture parameters in adolescent idiopathic scoliosis.

STUDY DESIGN: A retrospective study of standing imbalance and body posture in 71 able-bodied girls and subjects with adolescent idiopathic scoliosis was conducted. OBJECTIVE: To test the hypothesis that postural parameters are related to standing stability parameters. SUMMARY OF BACKGROUND DATA: Spinal deformity not only modifies the shape of the trunk, but also changes the relations between body segments affecting posture in scoliotic children. These postural adaptations to the scoliotic curve progression could be linked in part to increased body sway in upright standing. This has not yet been related to specific postural parameters involving the head, trunk, and pelvis in nontreated idiopathic scoliosis. METHODS: The head, trunk, and pelvis orientations of each subject were measured by a Flock of Bird system. An AMTI force platform was used to assess quiet standing stability and to monitor the position and displacement of the center of pressure (COP). The center of mass (COM) excursion was estimated from a biomechanical model using force plate information only. Analyses of variance (ANOVAS) were performed to determine the statistical differences between the scoliotic and nonscoliotic subjects, and backward stepwise multiple regression analyses were performed to identify any correlation between measures of quiet standing stability and body postural parameters RESULTS: The scoliotic group was characterized by a decrease in standing stability. There was an increase in the sway areas measured by the variations of the COP and COM. From the backward stepwise multiple regression analysis, it appears that for the able-bodied girls, the body posture parameters were correlated only with the mean anteroposterior center of pressure (COP(AP)) position. For the scoliotic group, the sway areas and the mean position of the centers of pressure and the COP(AP)-COM(AP) were correlated significantly with body posture parameters. The higher COP-COM differences for the scoliotic group were attributed to a greater neuromuscular demand to maintain standing balance. The coefficients of correlation of the multiple regression analyses ranged from 0.64 to 0.85 for the nonscoliotic group and from 0.55 to 0.72 for the scoliotic group. CONCLUSIONS: The use of backward stepwise multiple correlations highlighted the interaction between several body parameters and their relation to standing stability in both able-bodied girls and scoliotic subjects. The scoliotic group displayed a much larger number of correlations between standing stability and body posture parameters than the nonscoliotic group. Standing imbalance was related to altered body posture parameters measured in the frontal and horizontal planes only. Although the correlation coefficients were relatively high, factors other than body posture parameters appeared related to standing imbalance in adolescent idiopathic scoliosis. These findings support the concept of either a primary or a secondary dysfunction in the postural regulation system of scoliotic subjects.

Adolescent↗
PubMed2002

Correction of thoracic adolescent idiopathic scoliosis with segmental hooks, rods, and Wisconsin wires posteriorly: it's bad and obsolete, correct?

STUDY DESIGN: Forty-four consecutive thoracic idiopathic adolescent curves surgically treated between 1995 and 1999 at one institution were analyzed. All were thoracic curves; there were no lumbar curves, double major curves, or triple major curves. OBJECTIVES: To study the clinical and radiographic results for these 44 patients. SUMMARY OF BACKGROUND DATA: There is currently ongoing discussion regarding the "best treatment" for right thoracic idiopathic scoliosis. METHODS: Patients were administered preoperative and postoperative Scoliosis Research Society questionnaires. Radiographs were studied for coronal correction, sagittal correction, junctional deformities two segments above/two segments below, fusion status, loss of correction status, complications, and imbalance of curves above and below. Radiographic analysis was by two independent observers. All patients were treated with bilateral 5.5-mm CD Horizon (M-10) instrumentation. Corrective forces were translational and in situ contouring. An average of 10 hooks and 4 Wisconsin wires were used for an average of 14 fixation points per 11 segments. Follow-up was minimum 2 years to maximum 5 years, with an average of 3-year, 10-month follow-up. RESULTS: All were out of bed on postoperative day 1; none was braced after surgery. The average preoperative thoracic curve was 56 degrees; the average ultimate postoperative curve was 31 degrees (P = 0.0001). In the sagittal plane T5-T12 averaged 22 degrees preoperation and 20 degrees postoperation. For the complete study group (n = 44), the Cobb measurement (P = 0.001) and apical vertebral translation of the lumbar curve (P = 0.001) below improved. For the false double major curve (n = 11) patterns, the unfused lumbar curve averaged preoperation 46 degrees and postoperation 27 degrees (P = 0.0001). There were no neurologic deficits, no wound infections, and no respiratory complications. In regards to the Scoliosis Research Society questionnaires, significant (P < 0.05) changes preoperative to ultimate postoperative were found for questions 3, 5, 11, and 14. CONCLUSION: "Satisfactory" results were obtained in 44 patients treated with this technique. The complication rate was low and the fusion rate was high. Posterior treatment as described above produces reasonable and dependable results.

Adolescent↗
PubMed2002

Pelvic or lumbar fixation for the surgical management of scoliosis in duchenne muscular dystrophy.

STUDY DESIGN: This retrospective study evaluates two groups of patients with scoliosis and Duchenne muscular dystrophy, treated with two different surgical stabilization methods. OBJECTIVE: To determine whether fixation to the sacropelvis is always necessary for adequate stabilization of scoliosis in Duchenne muscular dystrophy. SUMMARY OF BACKGROUND DATA: Pelvic fixation is generally recommended for scoliosis in Duchenne muscular dystrophy. Recent studies describe a more selective approach toward lumbar or pelvic fixation. Pelvic fixation is reserved for larger curves and established pelvic tilt. METHODS: Fifty cases of Duchenne muscular dystrophy, operated in two different centers and followed up for a minimum of 3 years, were reviewed. In the first group (Oswestry), 31 patients had fixation to the pelvis, using standard Luque instrumentation and pelvic fixation. The Galveston technique was used in 9 cases and L-rod configuration in 22 cases. In the second group (Nottingham), 19 cases had fixation to L5 using pedicle screws in the lumbar spine and sublaminar wires in the thoracic spine. These cases were operated on early, usually shortly after becoming wheelchair dependent. RESULTS: In the pelvic fixation group, the mean age at the time of surgery was 14 years, and forced vital capacity was 44%. The mean Cobb angle and pelvic obliquity were 48 degrees and 19.8 degrees at the time of surgery, 16.7 degrees and 7.2 degrees immediately after surgery, and 22 degrees and 11.6 degrees at the final follow-up (mean 4.6 years), respectively. The mean blood loss was 4.1 L, and the average hospital stay was 17 days. There were five major complications, including a deep wound infection in one case, revision of instrumentation prominence at the proximal end in two cases, and loosening of pelvic fixation in two cases. In the lumbar fixation group, the mean age at the time of surgery was 11.7 years, and forced vital capacity was 58%. The mean Cobb angle and pelvic obliquity were 19.8 degrees and 9 degrees at the time of surgery, 3.2 degrees and 2.2 degrees immediately after surgery, and 5.2 degrees and 2.9 degrees at the final follow-up (mean 3.5 years), respectively. The mean estimated blood loss (3.3 L) and mean hospital stay (7.7 days) were much less compared with the pelvic fixation group. Pelvic obliquity was corrected and maintained below 10 degrees in all but two cases, who had an initial pelvic obliquity exceeding 20 degrees. One patient had instrumentation failure at the proximal end, and one had a deep wound infection. CONCLUSION: Lumbar fixation to L5 is adequate if the surgery is performed early, soon after becoming wheelchair bound, and with smaller curves and minimal pelvic obliquity. Use of pedicle screws in lumbar spine provides a solid foundation to maintain the correction over the period of relatively short life expectancy of these children. Pelvic fixation may be necessary in older children, who have larger curves and established pelvic obliquity. In the presence of deteriorating lung function, this is associated with a greater morbidity and higher complication rate.

Adolescent↗
PubMed2003

Monitoring scoliosis surgery with combined multiple pulse transcranial electric motor and cortical somatosensory-evoked potentials from the lower and upper extremities.

STUDY DESIGN: A retrospective case review was performed. OBJECTIVE: To assess the value, rapidity, and safety of combined multiple-pulse transcranial electric stimulation motor-evoked potential and somatosensory-evoked potential monitoring during scoliosis surgery. SUMMARY OF BACKGROUND DATA: Leg somatosensory-evoked potentials can miss motor deficits, and a 50% amplitude warning criterion can produce false alarms. METHODS: For this study, 33 scoliosis surgeries in neurologically normal patients under propofol/fentanyl anesthesia omitting neuromuscular blockade were monitored with four-extremity multiple-pulse transcranial electric stimulation muscle motor-evoked potentials and cortical somatosensory-evoked potentials. Instead of amplitude criteria, parallel (same-direction) change was used to identify systemic alteration and nonparallel (one- or two-limb) deterioration to identify focal neurologic compromise. Clinical observation and intraoperative electroencephalography were used to assess adverse effects. RESULTS: Instantaneous motor-evoked potentials and rapidly reproducible cortical somatosensory-evoked potentials provided comprehensive feedback every 0.8 to 6.7 minutes (median, 2.4 minutes) without adverse effects. Parallel (systemic) changes without alarm or deficit included motor-evoked potential fading or temporary loss and leg somatosensory-evoked potential amplitudes below 50% of initial, maximum, or median intraoperative values in 10% to 37% of the cases. Three nonparallel changes occurred: 1) abrupt bilateral leg somatosensory-evoked potential 20% to 30% reduction without motor-evoked potential change during instrumentation resolving spontaneously over 30 minutes, with transient postoperative sensory symptoms; 2) right-arm somatosensory-evoked potential and motor-evoked potential reduction during hyperabduction restored after repositioning, without deficit; 3) abrupt bilateral leg motor-evoked potential loss preceding 30% to 60% somatosensory-evoked potential reduction during derotation rapidly restored after instrumentation release, without deficit. CONCLUSIONS: In neurologically normal patients, the combined methods are safe and rapid, and could improve the sensitivity and specificity of scoliosis monitoring. Arm controls facilitate differentiation between systemic alterations and focal neurologic compromise.

Adolescent↗
PubMed2006

Scoliosis: surgical versus nonsurgical treatment.

UNLABELLED: This article reviews the nonoperative and operative decision making process in idiopathic scoliosis in the adolescent and adult with additional comments about degenerative scoliosis. Because knowledge of the natural history of idiopathic scoliosis is essential for decision making, this will be covered first, as will the current knowledge concerning the long term outcomes of nonoperative and operative treatment. With the natural history as a background, I will discuss how the factors that are important in natural history effect decision making in the adolescent and adult. By using an evidence-based approach, hopefully a better decision-making process will result in improved outcomes. Additional treatment decisions regarding the choice of the specific nonoperative treatment methods as well as surgical decisions (fusion levels, approach, choice of implants) will not be covered. LEVEL OF EVIDENCE: Therapeutic study, level V (expert opinion). See the Guidelines for Authors for a complete description of the levels of evidence.

Age Factors↗
PubMed2003

Juvenile and adolescent idiopathic scoliosis: magnetic resonance imaging evaluation and clinical indications.

The aims of this study were (1) to determine the rate of 'idiopathic' scoliosis associated with neuroanatomical abnormalities of the posterior cerebral fossa (PCF), spinal canal (SC) or central nervous system (CNS), and (2) to identify any clinical, neuro-orthopedic criteria, radiological curve pattern or other variable which could justify magnetic resonance imaging (MRI) as complementary study. Fifty-six patients with juvenile and adolescent scoliosis, were prospectively evaluated with MRI of the PCF and SC. All the patients were categorized into four different groups according to neuro-anatomical abnormalities on MRI (groups A, B, C and D). Eleven patients (19.6%) presented neuroanatomical abnormalities of the PCF and SC (group A), four patients (7.1%) presented pathological conditions of the CNS (group B) and three patients (5.4%) presented anomalies at the osseous spine and abdomen (group C). The remaining 38 patients (67.9%) presented with normal MRI results (group D). Of the patients in group A, 81.8% were neurologically normal. In this group, the right and left thoracic curve patterns were seen in the same number of patients (four of 11 each). Early diagnosis of neuroanatomical abnormalities of the PCF, SC and CNS could be achieved in 26.7% of cases (groups A and B). The most significant finding was the chronological age: 36.4% of patients in group A were under the age of 11 years. In addition, it would be recommended that in patients with scoliosis and a surgical indication, MRI results should be to take into consideration as a complementary preoperative evaluation because four of 15 patients (26.7%) with an indication for spinal fusion and who were neurologically normal, sustained some of the conditions included in groups A and B.

Adolescent↗
PubMed2003

The crankshaft phenomenon after posterior spinal arthrodesis for congenital scoliosis: a review of 54 patients.

STUDY DESIGN: Retrospective chart and radiographic reviews were conducted. OBJECTIVE: To identify the incidence of and any possible risk factors for the crankshaft phenomenon after posterior spinal arthrodesis for congenital scoliosis. SUMMARY OF BACKGROUND DATA: Studies have shown the crankshaft problem to be common after posterior arthrodesis for infantile and juvenile idiopathic scoliosis, but the few reports available show it to be much less common for congenital scoliosis. METHODS: This study chose children fused before the pubertal growth spurt, all classified as Risser 0 and with open triradiate cartilages. These children were followed to the end of their growth (mean follow-up period 12 years). Several measurement parameters were used for evaluation. RESULTS: The crankshaft problem, measured as a Cobb angle increase of more than 10 degrees, was seen in 15% of the 54 patients. There was a positive correlation with earlier surgery and larger (>50 degrees) curves. No other positive correlations could be identified. CONCLUSIONS: Crankshafting was observed in 15% of the patients, more often with larger curves and earlier fusions.

Adolescent↗
PubMed2003

Static and dynamic analysis of five anterior instrumentation systems for thoracolumbar scoliosis.

STUDY DESIGN: A nondestructive biomechanical investigation among five anterior spinal instrumentation systems for scoliosis. OBJECTIVES: The purpose of this study is to analyze the static and dynamic biomechanical stability of five different systems. SUMMARY OF BACKGROUND DATA: Although a variety of anterior spinal instrumentation systems for scoliosis are available, very few attempts have been made at comparative biomechanical studies. METHODS: Thirty calf spines were underwent static biomechanical tests, including flexion-extension, axial rotation, and lateral bending loading modes in the multisegmental spinal model. Five anterior instrumentation systems included: 1) Texas Scottish Rite Hospital system; 2) Bad Wildungen Metz; 3) anterior ISOLA; 4) Cotrel-Dubousset Hoph; and 5) Kaneda Anterior Scoliosis System. The initial and postfatigue stability after a cyclic loading test were analyzed by measuring the range of motion at instrumented segments compared to the intact within the same specimen (% to intact). RESULTS: Two-rod systems showed a significant decrease in range of motion compared to one-rod systems in flexion-extension (P < 0.001) and axial rotation (P < 0.05). In lateral bending, all systems demonstrated a significant decrease in range of motion of less than 40% to the intact (P < 0.001). After cyclical loading test, all systems increased in range of motion. In flexion-extension, one-rod systems depicted a significant increase in range of motion, compared to two-rod systems (P < 0.05). CONCLUSIONS: In the initial stability analysis, two-rod systems are superior to one-rod systems. For one-rod systems, repeated physiologic loading may result in reduced stability in flexion-extension.

Analysis of Variance↗
PubMed2003

Color Doppler ultrasonography for evaluation of internal mammary artery application in adolescent female patients with right-convex thoracic idiopathic scoliosis.

STUDY DESIGN: Prospective comparative study. OBJECTIVE: To establish the use of Color Doppler Ultrasonography to investigate internal mammary artery. SUMMARY OF BACKGROUND DATA: Breast asymmetry in female adolescents with right convex idiopathic scoliosis was supposed to be linked with anatomic and functional asymmetry of the internal mammary artery that is the main supplier to the mammary gland. However, no measurements of anatomic and hemodynamic parameters of internal mammary artery have been made to justify or to reject the hypothesis of asymmetric blood flow volume to the breasts and costosternal junction in female adolescent scoliotics. Color Doppler Ultrasonography is a well established noninvasive method to assess vessel anatomy and hemodynamics. METHODS: Twenty female adolescents with right thoracic scoliosis and 16 comparable female individuals without spine deformity were examined with Color Doppler Ultrasonography to measure at the origin of internal mammary artery lumen diameter, cross sectional area, time average mean flow and flow volume per minute and were compared each other. RESULTS: The reliability of Color Doppler Ultrasonography was high and the intraobserver variability low (ANOVA, P = 0.92-0.94). There was no statistically significant difference in the ultrasonographic parameters of the internal mammary artery between right and left side in each individual as well as between scoliotics and controls. CONCLUSIONS: Color Doppler Ultrasonography applied to assess anatomic or hemodynamic blood flow parameters at the origin of internal mammary artery was proven a highly reliable method. Color Doppler Ultrasonography disclosed no side-differences, while there were no differences between scoliotics and controls. Thus, it seems that this study cannot justify previous theories for development of right thoracic scoliosis in female adolescents.

Adolescent↗
PubMed2003

Respiratory function and cosmesis at maturity in infantile-onset scoliosis.

STUDY DESIGN: Retrospective review of patient records, clinical and radiographic, and patient recall for full pulmonary function studies and surface topography. OBJECTIVES: Assessment of outcome of treatment policy after age 15 during the previous 30 years to establish the efficacy of management protocols in a group that is too small and too varied for more formal assessment. BACKGROUND DATA: Spinal deformity presenting during infancy or early childhood poses a clinical problem caused by small numbers, long growth period, variable presentation and treatment methods, and, finally, the length of time that must pass before meaningful outcome results can be assessed. The aims of treatment are to preserve respiratory function and cosmetic appearance. MATERIALS AND METHODS: The records of patients with infantile onset, nonsyndromic, and noncongenital scoliosis were reviewed. Thirty two were at least age 15 years at the time of review and 21 of these agreed to attend for full pulmonary function testing (spirometry, lung volumes, gas diffusion) and surface topography, whereas two more had recent spirometry results available in their record. Treatment had been serial casting with Risser jacket, bracing, or surgery. RESULTS: Those whose scoliosis resolved or was stabilized by nonoperative means (N = 6) at an acceptable Cobb angle had normal cosmesis and pulmonary function (mean FEV1 = 98.7%, mean FVC = 96.6%). Those who were managed by casting or bracing and underwent surgery after age 10 (N = 6, mean age at surgery 12.9 y) had variable cosmesis and acceptable pulmonary function (mean FEV1 = 79%, mean FVC = 68.3%). Those whose deformity necessitated early surgery (N = 11, mean age at surgery 4.1 y) had recurrence of deformity and diminished respiratory function (mean FEV1= 41%, range 14%-72%, mean FVC = 40.8%, range 12%-67%). CONCLUSIONS: Although these are small numbers and treatment methods have changed since the beginning of the series, the results indicate that this condition is not simple to treat and for some children still has the risk for serious deformity and respiratory compromise. There is, as yet, no evidence that early surgical intervention in this group of patients with infantile scoliosis has altered their prognosis in any meaningful way.

Adolescent↗
PubMed2004

Segmental scoliosis correlation: use of the Lea Plaza Frame.

STUDY DESIGN: Patients with adolescent idiopathic scoliosis that underwent spine fusion using the principle of segmental correction and a specific instrumentation. OBJECTIVES: Evaluation of the methodology used. SUMMARY OF BACKGROUND DATA: The results of surgical correction of scoliosis today are mainly related to the popular use of the CD and other similar instrumentations. Most of its users report that the corrective mechanisms allow coronal and sagittal correction of the deformed spine but not derotation in the horizontal plane. The results of a corrective methodology using segmental correction are reviewed here to evaluate triplanar correction of the deformity. MATERIALS AND METHODS: Two hundred seventy-three adolescents with idiopathic scoliosis underwent corrective arthrodesis with the Lea Plaza Frame at the average age of 15.2 years. Coronal and sagittal values were measured with the Cobb method, rotation with the Pedrialle ruler. Trunk, shoulder imbalance and the rib prominence was documented by plain pictures. Follow-up average is 7.8 years. RESULTS: Preoperative: Coronal curves averaged 54 degrees. Associated preoperative thoracic hypokyphosis = 8 degrees. Lordosis = -3 degrees. Hyperkyphosis = 56 degrees. Apical rotation was 23 degrees. Postoperative: Long-term values: corrected coronal curves measured 20 degrees, hypokyphosis decreased to 23 degrees, and lordosis reversed to 18 degrees, whereas hyperkyphosis decreased to 41 degrees. Apical derotation is 31%. Of the patients with preoperative trunk imbalance over the pelvis, 95% were completely corrected and the 98% with shoulder unleveled had also full correction of these phenomena. CONCLUSIONS: This review shows that tridimensional correction in flexible curves can be obtained by following the principle of segmental correction.

Adolescent↗
PubMed2003

Selective anterior fusion and instrumentation for the treatment of neuromuscular scoliosis.

STUDY DESIGN: A retrospective cohort study was conducted. OBJECTIVE: To evaluate the results of anterior spinal fusion with anterior instrumentation alone in selected patients with neuromuscular scoliosis. SUMMARY OF BACKGROUND DATA: Traditionally posterior spinal fusion with instrumentation has been done, usually to the pelvis, to achieve correction of neuromuscular scoliosis. However, certain selected patients might benefit from shorter fusion segment to preserve some motion and yet still achieve good correction of the curve. This may serve to improve or preserve various functional abilities that might be adversely affected by a long fusion. METHOD: Patients who had anterior spinal fusion (ASF) with anterior instrumentation (AI) alone were selected from an entire group of patients with neuromuscular spinal deformity who had surgery at Shriners Hospital for Children-Chicago since January of 1988. The charts and radiographs of these patients were examined and various radiographic parameters were measured pre- and after surgery and at final follow-up. Additionally, functional level of the patients included, ambulatory status was obtained from the medical records. RESULTS: In these 21 patients excellent results were obtained with regard to primary and secondary curve correction as well as the pelvic obliquity without significant deterioration at final follow-up. Ambulatory status was not changed after surgery. This cohort of patients had various neuromuscular diseases. However, the majority of them had myelomeningocele. Few complications occurred which resulted in the reoperation of several patients who had progression of the curve around the instrumented segment which itself remained unchanged when the complication was recognized. One infection occurred requiring irrigation and debridement. CONCLUSIONS: In selected patients with neuromuscular scoliosis, even that associated with pelvic obliquity, excellent correction and maintenance correction can be obtained fusing a relatively short segment of the spine with ASF and AI rather than a long construct posteriorly to the pelvis. Maintenance of the correction of the primary curve as well as the pelvic obliquity was maintained over the period of follow-up. This approach for selected patients should be offered as a way of limiting the extend of the surgery, preserving motion segments and maintaining orenhancing functions such as activities of daily living.

Adolescent↗
PubMed2004

Can we predict the ultimate lumbar curve in adolescent idiopathic scoliosis patients undergoing a selective fusion with undercorrection of the thoracic curve?

STUDY DESIGN: Retrospective review of anterior and posterior fusions for treatment of adolescent idiopathic thoracic scoliosis. OBJECTIVES: To delineate the best factors determining final lumbar curve magnitude in patients with adolescent idiopathic scoliosis undergoing a selective thoracic anterior or posterior spinal fusion at or proximal to the first lumbar vertebra. SUMMARY OF BACKGROUND DATA: Although spontaneous lumbar curve correction occurs consistently following a selective thoracic anterior or posterior spinal fusion, the degree of correction is somewhat unpredictable. METHODS: One hundred consecutive patients with major thoracic-compensatory lumbar adolescent idiopathic scoliosis treated by a single surgeon with either selective posterior spinal fusion (n = 44) or anterior spinal fusion (n = 56) of the main thoracic region with an unfused lumbar spine with a lumbar B modifier (lumbar apex touching the center sacral vertical line) or lumbar C modifier (lumbar apex completely lateral to the center sacral vertical line) were retrospectively reviewed. RESULTS: Those patients who maintained excellent postoperative coronal balance, with spontaneous lumbar curve correction, had their thoracic Cobb corrected intraoperatively to a measurement very close to but not more than that of the preoperative thoracic push-prone Cobb. Stepwise multiple linear regression analysis was used to develop a formula to help predict lumbar response in those patients undergoing selective thoracic fusion. This is represented in the following formula: Final lumbar Cobb = 14.4 + 3.06 (lumbar modifier; 0 = B, 1 = C) + 0.30 (preoperative standing lumbar Cobb) - 0.18 (preoperative supine lower Cobb) + 0.81(preoperative push/prone lumbar Cobb) - 0.15(preoperative standing thoracic Cobb) - 0.16(% thoracic Cobb change from preoperative to immediate postoperative). Final model R2 = 0.72. CONCLUSIONS: Of the preoperative measurements examined, the preoperative push-prone is the best preoperative flexibility radiograph to predict the final lumbar curve measurement and, along with other factors, can be used to formulate a model that will help the treating surgeon more confidently predict the final lumbar curve response in patients undergoing a selective thoracic fusion.

Adolescent↗