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PubMed1997

A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis.

With use of data culled from twenty studies, members of the Prevalence and Natural History Committee of the Scoliosis Research Society conducted a meta-analysis of 1910 patients who had been managed with bracing (1459 patients), lateral electrical surface stimulation (322 patients), or observation (129 patients) because of idiopathic scoliosis. Three variables - the type of treatment, the level of maturity, and the criterion for failure - were analyzed to determine which had the greatest impact on the outcome. We also examined the effect of the type of brace that was used and the duration of bracing on the success of treatment. The number of failures of treatment in each study was determined by calculating the total number of patients who had unacceptable progression of the curve (as defined in the study), who could not comply with or tolerate treatment, or who had an operation. The percentage of patients who completed a given course of treatment without failure, adjusted for the sample sizes of the studies in which that treatment was used, yielded the weighted mean proportion of success for that treatment. The weighted mean proportion of success was 0.39 for lateral electrical surface stimulation, 0.49 for observation only, 0.60 for bracing for eight hours per day, 0.62 for bracing for sixteen hours per day, and 0.93 for bracing for twenty-three hours per day. The twenty-three-hour regimens were significantly more successful than any other treatment (p < 0.0001). The difference between the eight and sixteen-hour regimens was not significant, with the numbers available. Although lateral electrical surface stimulation was associated with a lower weighted mean proportion of success than observation only, the difference was not significant, with the numbers available. This meta-analysis demonstrates the effectiveness of bracing for the treatment of idiopathic scoliosis. The weighted mean proportion of success for the six types of braces included in this review was 0.92, with the highest proportion (0.99) achieved with the Milwaukee brace. We found that use of the Milwaukee brace or another thoracolumbosacral orthosis for twenty-three hours per day effectively halted progression of the curve. Bracing for eight or sixteen hours per day was found to be significantly less effective than bracing for twenty-three hours per day (p < 0.0001).

Adolescent↗
PubMed2002

Analysis of vertebral morphology in idiopathic scoliosis with use of magnetic resonance imaging and multiplanar reconstruction.

BACKGROUND: Several studies have provided data on the vertebral morphology of normal spines, but there is a paucity of data on the vertebral morphology in patients with idiopathic scoliosis. METHODS: The morphology of the pedicles and bodies of 307 vertebrae as well as the distance between the pedicles and the dural sac (the epidural space) in twenty-six patients with right-sided thoracic idiopathic scoliosis were analyzed with use of magnetic resonance imaging and multiplanar reconstruction. RESULTS: A distinct vertebral asymmetry was found at the apical region of the thoracic curves, with significantly thinner pedicles on the concave side than on the convex side (p < 0.05). The degree of intravertebral deformity diminished farther away from the apex, with vertebral symmetry restored at the neutral level. In the thoracic spine, the transverse endosteal width of the apical pedicles measured between 2.3 mm and 3.2 mm on the concave side and between 3.9 mm and 4.4 mm on the convex side (p < 0.05). In the lumbar spine, the pedicle width measured between 4.6 mm at the cephalad part of the curve and 7.9 mm at the caudad part of the curve. The chord length and the pedicle length gradually increased from 34 mm and 18 mm, respectively, at the fourth thoracic vertebra to 51 mm and 25 mm, respectively, at the third lumbar vertebra. The transverse pedicle angle measured 15 in the cephalad aspect of the thoracic spine, decreased to 7 at the twelfth thoracic vertebra, and increased again to 16 at the fourth lumbar vertebra. The width of the epidural space was <1 mm at the thoracic apical vertebral levels and averaged 1 mm at the lumbar apical vertebral levels on the concave side, whereas it was between 3 mm and 5 mm on the convex side (p < 0.05). CONCLUSION: Idiopathic scoliosis is associated with distinctive intravertebral deformity, with smaller pedicles on the concave side and a shift of the dural sac toward the concavity.

Adolescent↗
PubMed2006

Temporary internal distraction as an aid to correction of severe scoliosis.

BACKGROUND: Halo traction is a well-recognized adjunct for correcting severe complex rigid scoliotic curves, but it is associated with complications and is contraindicated in the presence of fixed cervical instability, kyphosis, or stenosis. In addition, halo traction often requires prolonged hospital stays and is not welcomed by all families. These limitations led to consideration of temporary internal distraction as an alternative. METHODS: We retrospectively reviewed the records of children in whom severe scoliosis had been treated with temporary internal distraction. Our goals were to (1) assess whether the use of temporary internal distraction can aid in the correction of severe scoliosis and (2) identify complications associated with temporary internal distraction and compare them with those associated with halo traction. The mean preoperative curve was 104 degrees . All patients underwent initial posterior release of the rigid portion of the spine (with six also having anterior release) and placement of spinal instrumentation under distraction during spinal cord monitoring. Of the ten patients, four had one distraction procedure (i.e., the initial surgery [or first distraction] followed by definitive fusion and the remaining six had two distraction procedures (i.e., the initial surgery [or first distraction] followed by the second distraction) followed by definitive fusion. After distraction, all patients underwent posterior spinal fusion with definitive dual-rod fixation. The amount of correction was determined by measuring the curve on plain radiographs made preoperatively, after each internal distraction procedure, after definitive fusion, and at the time of final follow-up. RESULTS: Curve correction after use of internal distraction, and before definitive fusion, averaged 53% (from 104 degrees to 49 degrees ) (range, 39% [from 70 degrees to 43 degrees ] to 79% [from 70 degrees to 15 degrees ]). This method facilitated safe, gradual deformity correction in all ten patients. The mean time between the initial procedure and the definitive fusion was 2.4 weeks. The mean final curve correction was 80% (from 104 degrees to 20 degrees ) (range, 73% [from 131 degrees to 35 degrees ] to 91% [from 110 degrees to 10 degrees ]). No neurologic deficits or infections resulted. CONCLUSIONS: Temporary internal distraction is a viable alternative approach to maximizing curve correction in patients undergoing spinal fusion for severe scoliosis. LEVEL OF EVIDENCE: Therapeutic Level IV.

Adolescent↗
PubMed1979

Radiographic evaluation of the spine after surgical correction of scoliosis.

Scoliosis is frequently a progressive deformity despite the best efforts at external bracing and various exercises. In childhood, scoliosis is usually insidious and is rarely symptomatic. In later years, however, scoliosis leads to cardiopulmonary compromise, neurologic dysfunction, degenerative joint disease, and cosmetic deformities. Therefore, surgical correction is indicated in selected patients. Internal fixation with spinal fusion is more effective than fusion alone. Postoperative radiographs must be examined closely for general as well as orthopedic complications. Loss of correction and failure of hardware are signs of pseudarthrosis. Radiographic follow-up evaluation should include two views whenever possible.

Bone Nails↗
PubMed2006

Acquired cervical scoliosis attributed to Parelaphostrongylus tenuis infection in an alpaca.

CASE DESCRIPTION: A 2-year-old alpaca was evaluated because of acute onset of cervical scoliosis. CLINICAL FINDINGS: Physical examination revealed severe scoliosis of the caudal portion of the cervical vertebral column with a C-shaped curvature to the right side. No gait deficits were observed. Cervical radiography confirmed severe curvature of C4 to C6 but did not reveal any bony changes. Cerebrospinal fluid had high total protein concentration and extremely high nucleated cell count with a high proportion of eosinophils, suggesting parasitic infection. TREATMENT AND OUTCOME: The alpaca was treated for suspected parelaphostrongylosis with ivermectin, fenbendazole, flunixin, vitamin E, thiamine, physical therapy, and a custom-made neck brace. The alpaca's condition continued to deteriorate, and it developed tetraparesis and ataxia and was euthanized after approximately 1 month. Microscopic evaluation of the cervical spinal cord revealed marked vacuolar changes in the left medial portion of the ventral funiculus, mild lymphoplasmacytic infiltration, and multifocal granulomas. The lesions were continuous from C1 to C7 and were compatible with parasite migration. CLINICAL RELEVANCE: To the authors' knowledge, this is the first report of acquired scoliosis in an alpaca, which appears to represent an unusual manifestation of parelaphostrongylosis that was reported in horses.

Animals↗
PubMed1975

A study of height, weight and menarche in girls with idiopathic structural scoliosis.

In a series of girls with idiopathic structural scoliosis the height, weight and age at menarche were studied. It was found that the girls were on the average taller than a control population and that except for the most severe cases their height was greater even if the trunk shortening caused by the deformity was not accounted for. The girls with scoliosis were also somewhat leaner. They did not deviate in age at menarche from normal girls in Sweden but there was a positive relationship between the age at diagnosis of the deformity and the age at menarche. When assessed together with previous data on the subject of height in children with scoliosis in Sweden it must be concluded that children with this deformity have a growth pattern which deviates significantly from that of the normal population.

Adolescent↗
PubMed1979

Electroencephalographic investigation of patients with adolescent idiopathic scoliosis.

An EEG study was carried out on 57 children, aged 10--16 years, with idiopathic scoliosis. Treatment (brace or surgery) was required in 37 cases; 20 were being observed only. Controls were 10- to 16-year-old healthy children meeting well-defined criteria of normality. Thirty-four of the scoliotics fulfilled these criteria, thus providing a group matching the controls except for the presence of scoliosis. Thus, any differences occurring could, with reasonable probability, be referred to the disease in question. The comparison with healthy children showed a generally greater EEG pathology in the scoliotics. This was the case in all patients, even those meeting the same criteria of normality as the controls. A highly significant difference was noted in the occurrence of paroxysmal activity. Type and localization of abnormally (bilaterally synchronous discharges) indicated involvement of subcortical structures. Comparison within the scoliotic group showed that EEG abnormalities were not correlated with the magnitude of the disease except for the variable "paroxysmal activity at rest". Patients submitted to observation only presented paroxysmal activity significantly more often than patients requiring treatment. The localization of abnormality within the hemispheres did not agree or disagree systematically with the convexity of the curve. A possible relationship between the higher incidence of scoliosis in females and the higher sensitivity to afferent stimuli as found in the female EEG is also discussed.

Adolescent↗
PubMed1980

Collagen changes in congenital and idiopathic scoliosis.

Collagen abnormalities in adolescent idiopathic scoliosis have been recorded. In this condition the platelet aggregating power of collagen is decreased and the amount of collagen in suspensions prepared from fascia is increased. We found the same abnormalities in two out of four patients with congenital scoliosis, operated on according to Harrington. In idiopathic as well as in congenital scoliosis the decrease in the platelet aggregating power was more conspicuous in the younger patients.

Adolescent↗
PubMed1980

Growth related hormones in idiopathic scoliosis. An endocrine basis for accelerated growth.

In a total of 95 children with idiopathic scoliosis and 60 controls between the ages of 7 and 17 years, a prospective study of hormones related to growth and maturation was carried out. The pituitary release mechanism for growth hormone was evaluated using the propanolol/L-dopa stimulation test. In addition the blood levels of testosterone, sex hormone binding globulin, oestradiol, thyroxin, prolactin, cortisol, follicle stimulating hormone and luteinizing hormone were determined. The girls were divided into age groups and all results were evaluated according to chronological and skeletal age. The number of boys was too small (25) to allow subdivision into age groups. The girls with idiopathic scoliosis had a significantly higher response to the growth hormone stimulation test than had the controls between the ages of 7 and 12 years whereas no significant difference could be found for the older girls. In girls with a skeletal age between 9 and 12 years a significantly higher mean serum level of testosterone was found (P less than 0.05). No significant differences could be demonstrated for the remaining hormones. Growth hormone and testosterone are the most important growth factors in prepubertal and pubertal children. Thus, the present findings suggest a hormonal basis for the increased stature in children with idiopathic scoliosis which has previously been reported.

Adolescent↗
PubMed1981

The length and proportions of the thoracolumbar spine in children with idiopathic scoliosis.

The length of the thoracolumbar spine was measured on standardized X-ray films from 274 children (6 1/2--18 1/2 years) with idiopathic scoliosis and 212 controls. Where possible, the height and width (traverse diameter) of two vertebral bodies (T-6 and L-4) were also measured. Although a tendency towards longer spines in the scoliotics could be found, there was no significant difference between children with idiopathic scoliosis and controls in this respect. In girls the pubertal growth-spurt of the spine was found to start about 1 year earlier than in the controls and the growth of the spine seemed to cease later in the scoliotics. The height and width of T-6 was significantly greater in the scoliotics than in the controls for girls under 13 years of age. In the older girls and in the boys no significant difference could be demonstrated. The height of L-4 tended to be greater in the scoliotic boys and younger girls, though the differences were not statistically significant. The index height/width was calculated for T-6 and L-4 in all groups of patients and higher values could be demonstrated in the scoliotics for all test groups. The greatest height of T-6 in scoliotics might indicate a longer thoracic spine in these children. The higher values of the height/width indices suggest that the thoracolumbar spine in children with idiopathic scoliosis has an increased slenderness compared with the spine in non-scoliotic children.

Adolescent↗
PubMed1982

A comparative study of the efficiency of different types of school screening for scoliosis.

The efficiency of scoliosis screening was studied among school children in the city of Malmö during the seventies. All children were investigated annually during this decade. The efficiency of the screening varied, however, from one in which no specific information at all was given to the school health authorities to the other extreme where a specially trained school nurse carried out a combined moiré -- clinical screening programme. A significant decrease in the mean value of the degree of scoliosis was recorded when diagnosis was made with more effective screening. The best result was achieved when using the combined moiré - clinical screening programme. Furthermore, with this method, the scoliosis was diagnosed at an earlier age and consequently, the number of cases operated on decreased. Thus the cost of effective school screening will be covered merely by avoiding operation in a few cases.

Adolescent↗
PubMed1983

Scoliosis and growth. Patterns of asymmetry in normal vertebral growth.

This study reviews published observations of asymmetrical appearance of primary ossification centres in human fetal vertebral arches. It reports studies of vertebral asymmetry in 39 vertebral columns of infants and children including asymmetry in pedicle length and vertebral arch height, asymmetry in neurocentral fusion, and vertebral body flattening on its left anterior aspect. It relates these patterns of asymmetry to the commonly observed left thoracic scoliosis of infancy and right thoracic scoliosis of adolescents and adults. It discusses the implications of these observed asymmetries of normal vertebral growth in the aetiology of scoliosis, and the possible influences of handedness and aortic pressure in the production of these vertebral asymmetries in adolescence.

Adolescent↗
PubMed1985

Experimental scoliosis in monkeys.

Scoliosis was produced experimentally in monkeys, by excision of ribs and costo-transverse ligaments. Unilateral excision of these structures produced mild reversible scoliosis, while bilateral excision caused a severe structural curve. We feel that scoliosis so produced is due to instability of the spine which is more pronounced in bilateral operations.

Animals↗
PubMed1986

Normal electroencephalograms in idiopathic scoliosis.

Twenty-five children with idiopathic scoliosis and without known neurologic disease and 25 age- and sex-matched controls had a standard electroencephalogram (EEG) performed and scrutinised blind. The EEGs were normal in the 25 children with idiopathic scoliosis and 24 controls were normal. Our study does not support the view that idiopathic scoliosis has a central neurologic cause.

Adolescent↗
PubMed1996

Scoliosis elasticity assessed by manual traction: 49 juvenile and adolescent idiopathic cases.

We assessed preoperative curve elasticity in 49 consecutive patients with juvenile or adolescent idiopathic scoliosis who were operated on with Harrington distraction rods. Preoperatively, the curve was determined from posteroanterior radiographs taken in the standing position and in the supine position, with traction. In the latter, the radiographs were taken at the moment of maximal traction when one technician applied traction to the ankles and another to the wrists. The scoliotic curve in the 10 patients with juvenile scoliosis averaged 59 degrees and 32 degrees in the standing and supine positions with traction, respectively. Immediately postoperatively, the curve averaged 19 degrees. 39 patients with adolescent scoliosis had a scoliotic curve which averaged 58 degrees in the standing position and 32 degrees in the supine position with traction. The mean postoperative measurement was 21 degrees. These findings suggest that manual traction is a simple and reliable means of predicting the minimal correction of the scoliotic curve to be expected, using Harrington distraction rods.

Adolescent↗
PubMed2003

Congenital and idiopathic scoliosis: clinical and genetic aspects.

OBJECTIVE: Genetic and environmental factors influencing spinal development in lower vertebrates are likely to play a role in the abnormalities associated with human congenital scoliosis (CS) and idiopathic scoliosis (IS). An overview of the molecular embryology of spinal development and the clinical and genetic aspects of CS and IS are presented. Utilizing synteny analysis of the mouse and human genetic databases, likely candidate genes for human CS and IS were identified. DESIGN: Review and synteny analysis. METHODS: A search of the Mouse Genome Database was performed for "genes," "markers" and "phenotypes" in the categories Neurological and neuromuscular, Skeleton, and Tail and other appendages. The Online Mendelian Inheritance in Man was used to determine whether each mouse locus had a known human homologue. If so, the human homologue was assigned candidate gene status. Linkage maps of the chromosomes carrying loci with possibly relevant phenotypes, but without known human homologues, were examined and regions of documented synteny between the mouse and human genomes were identified. RESULTS: Searching the Mouse Genome Database by phenotypic category yielded 100 mutants of which 66 had been mapped. The descriptions of each of these 66 loci were retrieved to determine which among these included phenotypes of scoliosis, kinky or bent tails, other vertebral abnormalities, or disturbances of axial skeletal development. Forty-five loci of interest remained, and for 27 of these the comparative linkage maps of mouse and human were used to identify human syntenic regions to which plausible candidate genes had been mapped. CONCLUSION: Synteny analysis of mouse candidate genes for CS and IS holds promise due to the close evolutionary relationship between mice and human beings. With the identification of additional genes in animal model systems that contribute to different stages of spine development, the list of candidate genes for CS and IS will continue to grow.

Animals↗
PubMed2005

Paraparesis caused by an angiolipomatous hamartoma in an adolescent with Proteus syndrome and scoliosis.

This 16-year-old boy with Proteus syndrome suffered acute spinal cord compression secondary to hemorrhage into an extradural paraspinal angiolipomatous hamartoma. A magnetic resonance (MR) imaging study performed 12 years earlier had revealed the presence of this tumor at the apex of a mild thoracic scoliosis, which had been stable during the intervening decade. Spinal cord neurological deficit in Proteus syndrome is rare. It can arise either from vertebral abnormalities and kyphoscoliotic deformities or from tumor encroachment. The authors describe the temporal evolution of scoliosis and acute spinal cord compression caused by a paraspinal angiolipomatous hamartoma over a period of 12 years. A review of the literature suggests that regular follow up, including serial MR imaging, is indicated in children with Proteus syndrome and scoliosis. Earlier resection of extradural tumor mass encroaching on the cord is warranted in the treatment of these children.

Adolescent↗
PubMed1987

Morphology of scoliosis: three-dimensional evolution.

The clinical examination of the scoliotic child's profile shows that it does not correspond to the physiological curvatures. This three-dimensional study of scoliosis shows evidence of the existence of three components, frontal, sagittal, and axial. Each generates a pathological displacement of the vertebrae maximal at the apical vertebral level. Because of rotation, in order to analyze each of the components, radiographs must be taken along the frontal or sagittal plane of the vertebrae. A comparative study of the sagittal and frontal components during progression of scoliosis indicates that the apical vertebrae are displaced not only laterally but also forward and then backward. The apical vertebrae are situated anteriorly with respect to the end vertebrae. If the scoliotic curves progress, the apical vertebrae eventually become displaced backward. During this displacement at a given moment they are situated in the frontal plane of the child at the same level as the upper end vertebra; then they come to lie behind this if the scoliosis continues to progress. This explains why, when observed from the side, the appearance changes and passes through three successive stages, lordosis, flat back, and kyphosis.

Adolescent↗