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PubMed2000

Risk factors for idiopathic scoliosis: review of a 6-year prospective study.

This study identified factors associated with the prevalence of idiopathic scoliosis and curve evolution in schoolchildren from northwestern and central Greece. A total of 85,627 children aged 9-15 years were screened for scoliosis. A subset of children with curves of at least 10 degrees underwent clinical and radiographic follow-up. The total population screened and the cohort followed for curve progression were evaluated according to factors associated with curve evolution. The prevalence of scoliosis was 1.7%, with most cases appearing at ages 13 and 14 years and small scoliotic curves (10 degrees-19 degrees) being most prevalent (prevalence 1.5%). Prevalence was associated with gender; age; and magnitude, apex, and direction of the curve. Progression of the curve occurred in 14.7% of 839 children, while 27.4% demonstrated spontaneous improvement of at least 5 degrees. A high risk of curve progression was associated with the following: sex--girls, curve pattern--right thoracic and double curves in girls and right lumbar in boys, maturity--girls before the onset of menses, age--time of pubertal growth spurt, and curve magnitude--curves > or = 30 degrees. Although only a small percentage of scoliotic curves undergo progression, the pattern of the curve according to curve direction and the sex of the child plays a significant role in the ability to identify which curves will progress.

Adolescent↗
PubMed2001

Adolescent idiopathic scoliosis managed by a nighttime bending brace.

This study evaluated and compared the effectiveness of managing adolescent idiopathic scoliosis with a total contact bending spine orthosis worn only during nighttime sleep with established bracing programs and electrical stimulation treatment. Brace treatment was prescribed for 30 patients with adolescent idiopathic scoliosis for the management of 50 spinal curvatures averaging 28.5 degrees (range: 13 degrees-40 degrees). Average patient age at the initiation of brace wear was 12+/-10 years (range: 9+/-10 to 16+/-8 years). All 30 patients were skeletally immature (Risser sign, 0-3) at initiation of orthotic treatment and underwent follow-up to maturity. Patients were instructed to wear the braces for at least 8-10 hours a day during nighttime sleep. Eighteen of 30 patients were compliant with the bracing program. Compliance with the nighttime bending brace was no better than the reported compliance with established thoracolumbosacral orthosis programs. Moreover, noncompliant patients and those treated by the ineffective electrical stimulation program also did not differ in curve progression. Curve progression was controlled in 56% of the compliant patients, and the nighttime bending brace was considered as effective as the Wilmington brace in controlling adolescent idiopathic scoliosis. Both braces were more effective than the ineffective electrical stimulation treatment.

Adolescent↗
PubMed1980

Scoliosis screening and growth in Western Australian students.

Scoliosis screening was combined with a study of spine and limb growth in a population sample ranging in age from four years to maturity. Scoliosis was most prevalent in females at 11 years to 12 years of age (13.9%) and in males at 13 years to 14 years of age (6.5%), but only half of the curvatures proved to be structural. Postural curves were most commonly associated with leg-length inequality (1 cm or more) which was also most prevalent at puberty. Growth studies and a follow-up survey suggest that progression of structural scoliosis is most common before puberty and is related to the rate of growth in length of the spine. The 11 years' age group appears to be ideal for screening to prevent progressive deformity. After adolescence, leg-length inequality is less prevalent and 32% of structural curves show some spontaneous regression at about 15 years.

Adolescent↗
PubMed1999

Torsional stiffness of three spine constructs for thoracic scoliosis.

The standard two-rod thoracic scoliosis construct is bulky in the thin, young patient. A single-rod construct with hooks at every level was developed. Five calf spines were tested measuring angular displacement before and after instrumentation using three scoliosis constructs: a standard two-rod construct, a single-rod construct, and a single-rod construct with crossover hooks. Rotational displacements and stiffness were compared. There was no statistical difference in rotational displacement or stiffness among the three constructs. All three constructs were significantly stiffer in torsion than the uninstrumented control. The single-rod construct and the crossover construct may offer the spine surgeon additional options in instrumenting thoracic scoliosis, if our preliminary studies are verified by others.

Animals↗
PubMed1999

[Treatment of idiopathic scoliosis in children during the growth period].

Idiopathic infantile and juvenile scoliosis have potential for extreme worsening. Orthopaedic treatment should be started as soon as the progressivity of the scoliosis is proven. In some infantile curves healing is possible, but in most cases the aim of the orthopaedic treatment will be to avoid spinal fusion at the end of growth. In some malignant infantile scoliosis, curves are rapidly out of the orthopaedic treatment control, and in such cases early surgery could be discussed.

Child↗
PubMed1999

[New models of inheritance of complex characteristics and their use in segregation analysis of idiopathic scoliosis].

New methods of segregation analysis of alternative traits have been developed. These methods make it possible to take into account the sex and age specificity of the disease manifestation. Hence, they extend the range of genetic hypotheses to be tested and ensure the correct analysis of inheritance of complex pathologies in humans. Segregation analysis of idiopathic scoliosis performed in this study demonstrates the possibilities of the new methods. Based on pedigrees of 93 probands, it has been demonstrated for the first time that the inheritance of severe (degrees II to IV) forms of this disease can be described by a model that assumes a dominant major gene with incomplete, sex- and age-dependent penetrances of all genotypes. According to this model, severe forms of idiopathic scoliosis do not develop if the mutant allele is absent (the penetrance of genotype A1A1 is zero). The probabilities of the disease for subjects with genotypes A1A2 and A2A2 are similar and approximately equal to 0.3 and 0.5 for males and females, respectively. Mild (degree I) forms of idiopathic scoliosis are heterogeneous. A progressive disease may be expected only in the patients that carry the mutant allele.

Adolescent↗
PubMed1999

[Experimental scoliosis in the minipig: study of vertebral deformations].

UNLABELLED: The purpose of this study was to attempt an induction of a scoliotic deformation in the minipig by means of unilateral epiphysiodesis of the neurocetral cartilage (NCC) of 5 consecutive vertebrae, in order to understand the vertebral deformities genesis in the scoliotic pathology. The vertebral deformities induced in this quadruped have been compared to those of the pseudo-biped (chicken: induction of the scoliosis by means of pinealectomy) and to the known vertebral deformities in the human idiopathic scoliosis. MATERIAL AND METHODS: Eight Yucatan minipigs (1 month old) have been used. In the tested group (4 minipigs) underwent an epiphysiodesis (compression with a screw) on the NCC from T5 to T9. The control group (2 minipigs) underwent a perforation of the NCC without a screw placement from T5 to T9. The sham group (2 minipigs) underwent only a sus-periosted vertebral muscles clearing on the right side at the thoracic level. An X-ray follow-up at 1, 6 and 12 months has been performed. The minipigs have been sacrificed between 12 an 13 months post-operatively. The vertebrae were dissected for the macroscopic anatomic analysis. RESULTS: The X-ray follow-up shows an unfinished resorption of the curvature after one year post-operatively. The horizontal deformity of the vertebrae was more marked in those with the compressed (screw) NCC. The vertebral deformities in the minipig are similar to those found in the human and chicken. CONCLUSIONS: Although the curvatures are benign and often spontaneously resolvent, the comparison of the induced vertebral deformities to those obtained in a chicken (post-pinealectomie) and the human suggest that the NCC is likely involved in the vertebral deformities in the horizontal plan. Therefore the minipig does not seem to be a good experimental model for the scoliosis.

Animals↗
PubMed1999

[Reductibility of idiopathic scoliosis during orthopedic treatment].

Non-operative treatment of idiopathic scoliosis is long and difficult. For the patient and the therapist it is particularly important to define early the therapeutic prognosis. The goal of this study is to verify if the initial reducibility at the beginning of treatment with the dynamic corrective brace (Spinecor) would be valid as a prognostic factor, allowing a more effective prognostic judgement of the final outcome treatment. This is a prospective study which includes 99 scoliosis patients (88 female, 11 male), with a mean age of new 12.6 years, treated by the dynamic corrective brace for progressive idiopathic scoliosis curves (29 degrees mean Cobb angle). The initial Cobb angle was compared to the pre-therapeutic Cobb angle. The results demonstrate that the reducibility of the scoliotic curves with the brace at the beginning of treatment provides a significant global prognostic index but is difficult to apply individually. Other factors should be considered, such as the impact of growth velocity on the spinal deformity at the onset of the adolescent growth spent as well as vertebral deformities diagnosed around the apex.

Adolescent↗
PubMedDate not supplied

The effect of tethered cord release on scoliosis in myelomeningocele.

To understand better the effects of detethering on scoliosis in persons with myelomeningocele, 21 patients with spinal dysraphism and scoliosis who had undergone a detethering procedure were retrospectively reviewed. Fourteen girls and seven boys were followed for an average of 5 years (range, 2-10). Three patients had thoracic, 12 had lumbar, and six had sacral level myelomeningocele. Three patients (14%) had curves that improved, and six (29%) stabilized. Twelve patients (57%) progressed >10 degrees. Eighty-six percent of patients with initial curves of >40 degrees and 100% of thoracic level patients went on to require spinal fusion. Eight complications occurred in six patients. Although patients with curves <40 degrees may have some improvement after a detethering procedure, those presenting with curves >40 degrees or thoracic neurologic levels had no improvement in their scoliosis.

Adolescent↗
PubMed1975

[Results of surgical management of scoliosis and kyphoscoliosis in adults (author's transl)].

Report about 60 operated scoliosis and kyphoscoliosis experienced at adults above 18 years. After separating the patients into male and female groups, age and localisation the most severe preoperative findings which make the operative treatment more difficult, will be described. Much impact will be put on pre-operative respiratoric and cardial impairment. The evaluation of scoliosis in adults will be proofed by examples. The operative technique, whose basis is the Harrington instrumentation in the modification by Stagnara, will be described also. 72 operative treatments have been necessary at 60 patients. In many cases rip-resections and dorsal osteotomies of the spine have been done. In oposition to the correction results of 46.2% on scoliosis and 56.5% on kyphoscoliosis there is one pulmonary embolism ending deadly and one irreversible paraplegia.

Adolescent↗
PubMed2000

HUKM instrumentation system in surgical treatment of adolescent idiopathic scoliosis--an early experience.

Between May 1992 through October 1998, twenty-two patients who had adolescent idiopathic scoliosis were treated using Universiti Kebangsaan Malaysia (UKM) spinal instrumentation and fusion. The minimum length of follow-up was 2 years with an average of 2.9 years. Nineteen patients were female and three patients were male. The mean age at the time of the operation was 16.2 years (range, 13 to 24 years). The average blood loss was 1,878 ml and the average operating time was 291 minutes. The mean pre-operative curve was 61.2 degrees, with a range of 40 degrees to 90 degrees. The average post-operative correction of the Cobb's angle was 53.5 per cent, with a range of 33 per cent to 81 per cent. Post-operative immobilization consisted of a maximum of six months in a body cast. There were no neurological injuries, no deep wound infections, and no evidence of pseudoarthroses. Only three complications occurred and these did not disturb the progress of the fusion. This technique safely achieves the objectives of scoliosis correction, and is cost-effective in the treatment of adolescent idiopathic scoliosis.

Adolescent↗
PubMed1975

The association of scoliosis and congenital heart defects.

The effects of cardiac surgery on patients with congenital heart defects and the subsequent development of scoliosis were studied. A group of 998 patients with congenital heart defects who were less than sixteen years old were operated on at the Mayo Clinic during the ten-year period 1950 through 1959. Standing roentgenograms of the spine were made of 377 of the patients ten years or more after surgery. The ages of the patients at follow-up ranged from ten years and seven months to thirty-five years and three months, with a mean age of twenty-one years and four months. The average length of follow-up was fourteen years and eleven months. Of the 377 patients, thirty-two (8.5 per cent) had curves greater than 20 degrees. The female:male ratio of patients with congenital heart defects was 1:1, whereas of those who developed scoliosis it was 5:3. There was no correlation between scoliosis and the following: patient's sex, cardiac abnormality, size or side of the heart, side of the aortic arch, presence of cyanosis, age at surgery, number and type of surgical incisions, number and side of ribs removed, or number and type of surgical procedures.

Adolescent↗
PubMed1975

Progression of congenital scoliosis due to hemivertebrae and hemivertebrae with bars.

From 315 cases of congenital scoliosis seen from 1925 to 1970, sixty cases of scoliosis or kyphoscoliosis due only to a hemivertebra, hemivertebrae, or a unilateral bar associated with the hemivertebrae were selected, classified into six types, and analyzed. Progression occurred in all but the balanced hemivertebrae group in two patients with cervical-high thoracic curves due to multiple hemivertebrae. Location of the hemivertebra or hemivertebrae and the presence of unilateral bars are the major determinants of deformity. The rate of progression of the scoliosis was variable, ranging from 1 to 33 degrees per year (average, 4 degrees per year).

Adolescent↗
PubMed1975

Familial scoliosis. A clinical report.

Scoliosis appeared in fifteen members of a family in three generations. The eight members examined showed an idiopathic type of scoliosis. Father-to-son transmission occurred more than once. Although at first appearance transmission of the scoliosis is as an autosomal dominant trait, the concept of polygenic inheritance, as has been shown in previous population studies, could also explain the inheritance in this family.

Adolescent↗
PubMedDate not supplied

Cerebral microembolization during pediatric scoliosis surgery: a transcranial doppler study.

SUMMARY: The goal of this study was to identify cerebral microemboli during scoliosis surgery and their potential relationship with visual alterations. Transcranial Doppler identified high-intensity transient signals (HITS) during surgery in both middle cerebral arteries, and ophthalmologic examination assessed their potential effects on the visual system. Thirteen children (age 13-17 years) undergoing surgery for scoliosis or kyphosis with spine curvature >45 degrees were studied. HITS were identified in 92%. Eleven patients had a total count of <15 HITS, but in the remaining two the count was unexpectedly high (63 and 265 HITS). Echocardiography in these two patients indicated the presence of an atrial right-to-left shunt. Uneventful preoperative and postoperative visual function was found in 11 patients. One patient had preoperative blindness and in another ophthalmologic complications developed not related to microembolization. Scoliosis surgery is frequently associated with low counts of cerebral microemboli. It appears that such low embolic counts have no effects on postoperative visual function as determined clinically. Some patients may show high rates of microemboli, which may be related to the presence of right-to-left cardiac shunts. The impact of these signals on brain function remains to be investigated.

Adolescent↗
PubMed2001

Adolescent idiopathic scoliosis: review and current concepts.

Adolescent idiopathic scoliosis is present in 2 to 4 percent of children between 10 and 16 years of age. It is defined as a lateral curvature of the spine greater than 10 degrees accompanied by vertebral rotation. It is thought to be a multigene dominant condition with variable phenotypic expression. Scoliosis can be identified by the Adam's forward bend test during physical examination. Severe pain, a left thoracic curve or an abnormal neurologic examination are red flags that point to a secondary cause for spinal deformity. Specialty consultation and magnetic resonance imaging are needed if red flags are present. Of adolescents diagnosed with scoliosis, only 10 percent have curves that progress and require medical intervention. The main risk factors for curve progression are a large curve magnitude, skeletal immaturity and female gender. The likelihood of curve progression can be estimated by measuring the curve magnitude using the Cobb method on radiographs and by assessing skeletal growth potential using Tanner staging and Risser grading.

Adolescent↗
PubMed1998

[The effects of different instrumentation on scoliosis].

OBJECTIVE: To investigate the effectiveness of the treatment of scoliosis with different surgical methods. METHOD: 125 cases of scoliosis less than 100 degrees treated during 14 years (1984 - 1997) were analyzed. Different operative methods were compared for their advantages and disadvantages, i.e. results and complications 10 months after operation and follow-up. RESULT: Harrington instrumentation was less effective in scoliotic curve correction and had more complications than other procedures. Luque technique needed longer operation time for wire passage at each level and had risk of neurological damage. CD and Zielke method showed 10% - 20% curve correction. No dislodgment of hook and fractured rods was found in the CD group. Anterior release plus posterior instrumentation was superior to other techniques. CONCLUSION: Treatment of scoliosis with anterior release plus posterior CD is practical for children before a new technique without spinal fusion is developed.

Adolescent↗
PubMed1975

Excessive thoracic lordosis and loss of pulmonary function in patients with idiopathic scoliosis.

Idiopathic thoracic lordoscoliosis is more common and more productive of respiratory compromise than is kyphoscoliosis. In some patients with idiopathic scoliosis, thoracic lordosis is the predominant component of the disease. Five such patients, all of whom had idiopathic scoliosis with excessive thoracic lordosis, progressive deformity despite Milwaukee brace treatment, and significant compromise of pulmonary function, are presented. Harrington instrumentation (distraction rod only) and spine fusion improved the deformity and respiratory function. The recommended treatment for this type of idiopathic scoliosis is early recognition and prompt surgical correction. The Milwaukee brace should be avoided. Postoperative management must include early ambulation combined with vigorous breathing exercises.

Child↗