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PubMedDate not supplied

Juvenile-onset scoliosis followed up to adulthood: orthopaedic and functional outcomes.

This retrospective review describes 52 children with juvenile-onset scoliosis followed up for at least 2 years after skeletal maturity and completion of treatment. The purpose was to compare clinical and radiographic characteristics and curve progression, as well as orthopaedic, functional, and psychosocial outcomes in children treated by observation, bracing, or surgery. Seventeen percent of patients were treated with observation and 33% with bracing; and 50% required surgery. Median rib-vertebral angle difference and mean level of apical vertebra differed by treatment group. Neither brace nor surgical treatment negatively affected self-esteem. Results suggest that juvenile scoliosis is more likely to progress, less likely to respond to bracing, and more likely to require surgical treatment than adolescent idiopathic scoliosis.

Braces↗
PubMed2002

[Infections in surgery of idiopathic scoliosis].

PURPOSE OF THE STUDY: In this retrospective study, we evaluated infectious complications in the patients undergoing surgical treatment for idiopathic scolions in order to identify risk factors for postoperative infections. MATERIAL: A total of 786 patients with idiopathic scoliosis were operated on during 24 years. In 754 (96%) cases, we used the posterior approach, involving posterior fusion and internal fixation, and subsequent immobilization in a brace. During that period, we recorded 15 (1.9%) deep wound infections in the area of fusion. Early infections were treated by debridement and lavage, with targeted administration of antibiotics, while instrumentation was kept in place. In late und recurrent infections, instrumentation was always removed. METHODS: We investigated a relationship between the infectious agent and the device used, the length of period between surgery and the onset of infection, the effect of device removal on curve progression, the agent causing infection and the effect of allergy to metal or infectious lesions at other body sites on the outbreak of infection. RESULTS: Early infections (within 6 weeks) were observed in six, late in nine patients. Repeat operations were necessary on average after 487 days. Staphylococcus aureus, the most frequent infectious agent, was isolated from four patients; on four occasions, cultivation was negative. Allergy to nickel was found in four patients. Infection was most often associated with the most frequently used Harrington Instrumentation (six cases, 1.1%). However, in relation to the number of patients treated, infection frequency was highest in TSRH (5.0%) and Isola (4.8%) devices. When Miami Moss fixation or the anterior approach was used, no infection was recorded. In comparison with the non-infected cases, the patients with infectious complications showed the same average values for the curve before and after surgery. At a check up, however, the loss of correction increased to 6 degrees and, after instrumentation removal, to 10 degrees as against 3 degrees in the non-infected patients. Pseudoarthrosis developed in two cases. DISCUSSION: The incidence of deep wound infections in patients who had surgery for idiopathic scoliosis was comparable with the data in the relevant literature. A higher number of infections, particularly late ones, in patients treated with the use of modern instrumentation is probably related to a higher volume of these implants. Early infections are a rare feature and their cause is known (allergy, sepsis). Treatment involves surgical intervention; in early infections, instrumentation is retained but is removed in late infections. CONCLUSIONS: Even though our group included a low number of patients with infections, we can conclude that risk factors for the development of infectious complications associated with surgical treatment of idiopathic scoliosis are as follows: allergy, higher age, large volume of metal used for stabilization and the presence of another infectious lesion.

Adolescent↗
PubMedDate not supplied

[Medical gymnastics in "surgical scoliosis"].

After simple premises on scoliosis and on physiotherapy, we design the evolution of the illness in: physiotherapic, orthopaedic and surgical scoliosis, connected with the therapeutic moment. Then we underline the necessity of surgical scoliosis to sustain it adequately with a careful physiotherapic treatment either for the preparation to the operation or in the stage following the operation.

Adolescent↗
PubMedDate not supplied

Scoliosis screening revisited: findings from the District of Columbia.

The authors performed a retrospective review of scoliosis screening data collected by school health nurses annually from 1985 to 1996. The data collected included 20 variables for all in the sixth and eighth grades and follow-up data for a portion of the referred students in the District of Columbia's public schools. During the school years 1989 to 1990 and 1995 to 1996, 52,300 students were screened for scoliosis. Of those screened, only 1,218 (2%) were referred for further evaluation. Only 47% of these students reported for care. Only 223 students (18%) provided any definitive information on the type of care or degree of curve. Findings indicate that many of the referred cases are never followed up. Thus, it is difficult to know the true prevalence of scoliosis or types of treatments provided in this population. Although the District of Columbia is modest in its referral rate, students referred are not being tracked for further diagnosis or treatment.

Adolescent↗
PubMedDate not supplied

Leg-length discrepancy and scoliosis in Marfan syndrome.

Leg-length discrepancy (LLD) greater than 2 cm is rare in the general population and is associated with a lumbar postural scoliosis; it has not been studied in the setting of Marfan syndrome. Thirteen LLDs of 2 cm or more were recorded from a group of 250 Marfan patients visiting a medical genetics clinic for complete care. Diagnosis was confirmed by standing anteroposterior pelvic radiograph and/or scanogram. Records and anteroposterior radiographs of the spine were reviewed to obtain Cobb angles for spinal curvatures. A mean discrepancy of 3.2 +/- 1.0 cm and a Cobb angle of 37.0 degrees +/- 28.4 degrees were found. Twelve of 13 curves were convex toward the shorter leg, caudally. Twelve patients had scoliosis greater than 10 degrees. Five curves were severe and progressive, suggesting the need for spinal fusion and prior equalization of leg lengths. LLD correlated weakly with Cobb angle. LLD is more common in individuals with Marfan syndrome than in the general population and is associated with increased structural scoliosis.

Adolescent↗
PubMed2003

Comparison of bone grafts for posterior spinal fusion in adolescent idiopathic scoliosis.

STUDY DESIGN: A retrospective comparison of three different types of bone grafts for posterior spinal fusion in adolescent idiopathic scoliosis. OBJECTIVE: To determine the efficacy of bone marrow and demineralized bone matrix as a bone graft substitute for spinal fusion. SUMMARY OF BACKGROUND DATA: Several reports have documented a high morbidity associated with harvesting autologous iliac crest bone graft (ICBG) for spinal fusion. Composite bone graft consisting of demineralized bone matrix and aspirated bone marrow may reduce the morbidity and still retain the osteoinductive properties of iliac crest autograft. METHODS: Three different bone grafting techniques were used by a single surgeon in 88 consecutive patients who had posterior spinal fusion for adolescent idiopathic scoliosis. Segmental instrumentation with dual-rod fixation was used in all cases. Selection of type of graft was determined historically by the time when the operations were performed. Autologous ICBG was used in Group A, freeze-dried corticocancellous allograft in Group B, and composite graft of autologous bone marrow and demineralized bone matrix in Group C. Seventy-seven patients were reviewed, with a minimum of 2 years' follow-up (mean, 3 years 7 months; range, 2 years-9 years 5 months). Radiographs were assessed for pseudarthrosis and loss of correction of 10 degrees or more. Loss of 10 degrees of correction has been previously identified as an indicator of potential pseudarthrosis or fusion instability. Both of these criteria were used to compare success of fusion. RESULTS: Failure caused by pseudarthroses was seen in two patients (2.6%), one in Group A and one in Group B. Eleven patients lost greater than 10 degrees of correction, but only one demonstrated pseudarthroses. The 13 patients with pseudarthroses or loss of correction constitute the failure group for purposes of graft assessment. The failure rate was 12.5% in Group A (ICBG), 28% in Group B (freeze-dried corticocancellous allograft), and 11.1% in Group C (composite graft of autologous bone marrow and demineralized bone matrix). Eliminating patients with crankshaft phenomenon did not substantially change the results. There was no morbidity associated with bone marrow aspiration. CONCLUSIONS: Fusion rates were comparable for GroupA (ICBG) and Group C (composite graft of autologous bone marrow and demineralized bone matrix). The composite graft is our preferred graft for fusions in adolescent idiopathic scoliosis.

Adolescent↗
PubMed2002

Wound infection after scoliosis surgery: an analysis of 15 cases.

OBJECTIVE: To discuss the causes and treatments of wound infections after scoliosis surgery. METHODS: Nine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative infection were analysed retrospectively. RESULTS: All 15 cases underwent spinal posterior fusion with autologous bone graft using instrumentations. Seven were diagnosed as early infection, and 8 were delayed infection. Radical debridement was performed in all 15 cases. The duration of antibiotics administration was 10 to 34 days with continuous closed irrigation for 2 to approximately 4 weeks and primary closure for the wounds. All patients were followed up for an average of 3.5 years (2 to 7.5 years) with good outcomes and no recurrence. CONCLUSION: Wound infection following surgical correction of scoliosis primarily results from intraoperative seeding, although host-related and operation-related factors may contribute to its development. Once the infections are diagnosed, good results can be achieved by prompt surgical debridement, irrigation and reasonably administered antibiotics. Removal of hardware may be necessary in deep infections.

Adolescent↗
PubMed1992

[Mechanism to induce scoliosis in Duchenne muscular dystrophy--a study of paraspinal muscle by X-ray computed tomography].

We studied mechanism to induce scoliosis in Duchenne muscular dystrophy (DMD) by use of X-ray computed tomography (CT) of paraspinal muscles. CT examination of paraspinal muscles was performed on 15 DMD patients at the following six levels; 1. Th3 vertebrae (upper thoracic spine level) 2. Th6 vertebrate (middle thoracic spine level) 3. Th10 vertebrae (lower thoracic spine level) 4. L1 vertebrae (upper lumbar spine level) 5. L3 vertebrae (middle lumbar spine level) 6. L5 vertebrae (lower lumbar spine level). We evaluated the degeneration of paraspinal muscle by a decrease in radio-density of the muscle which indicates infiltration of fatty tissue. The degeneration of the lateral portion of paraspinal muscle was more marked than that of the medial portion. The muscle was most severely affected at the middle lumbar spine level, showing a tendency to increase degeneration at the lower level of the spine. In cases showing laterality of the degeneration of paraspinal muscle, the less affected muscle on CT was located at the convex site of scoliosis. We speculate that the scoliosis occurs when DMD patients have asymmetrical paraspinal muscle degeneration, leading them to take compensatory posture.

Adolescent↗
PubMed1992

Segregation of structural collagen genes in adolescent idiopathic scoliosis.

The etiology of idiopathic scoliosis remains unknown. The condition results in a characteristic deformity of the spine and surrounding tissues. Both Types I and II collagen are important constituents of the affected tissues, and thus defective collagens are reasonable candidates for the primary abnormality in adolescent idiopathic scoliosis (AIS). Direct analyses of the amount and solubility of collagen have revealed differences between normal individuals and those with AIS. However, these changes may be secondary to the mechanical effects of the spinal deformity. Segregation analysis was done of genetic markers linked to the structural genes encoding Types I and II collagen to test these candidate loci in four pedigrees with dominantly inherited AIS. In one pedigree, markers linked to both of the Type I collagen loci (COL1A1 and COL1A2) were found to be inherited independently of the abnormal phenotype. Two pedigrees were discordant at one of the Type I loci. The condition also segregated independently of the locus for Type II collagen (COL2A1) in three pedigrees. This is evidence against idiopathic scoliosis generally being caused by mutations in the Types I and II collagen genes.

Adolescent↗
PubMed2003

Pulmonary compensatory indexes in children and adolescents with idiopathic scoliosis I degree.

Spirometric and plethysmographic examinations were performed in two groups of children. Group I: 23 children with scoliosis I degree by the Cobb (spinal curvature 17.2 degree) which comprised 12 girls and 11 boys at the age of 8-16 years (the mean age was 11.4 +/- 2.4 yr). The Control Group consisted of 20 children--13 girls and 7 boys at the age of 8-16 years (the mean age was 13.77 +/- 1.72 yr). The measurements were performed using Body-plethysmograph with pneumotachograph Jaeger. Total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), residual volume (RV), intrathoracic gas volume (ITGV) and at the same time curve indexes, dependence of maximum expiratory flow lung volume, MEF75%VC, MEF50%VC, MEF25%VC were determined. Maximum expiratory flows in relation to vital capacity and total lung capacity were defined as so called compensatory indexes. Slightly decreased values of total lung capacity (TLC) and statistically significantly decreased intrathoracic gas volume (ITGV) as well as residual volume (RV) were found in children with scoliosis in early stage. Forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV1) were statistically significantly higher in comparison to the control group. Compensatory index MEF50%VC/FVC in children in the early stage of scoliosis was statistically significantly decreased in comparison to the control group (p < 0.02).

Adolescent↗
PubMed1992

Calculation of 3-D deformity in scoliosis by standard roentgenograms.

The standard radiological diagnosis of advanced scoliosis consists of roentgenograms of the total spine in anterior-posterior and lateral views. The deformity of the spine is measured by using the Cobb angle, thus only giving the projected angle of deformity, without showing the true 3-dimensional aspect. The 3-D calculation of the deformity is relevant to diagnosis and therapy of scoliosis. In this paper we define angles according to the Cobb definition, evaluate them trigonometrically and show them in two tables. These angles allow the 3-dimensional deformity in scoliosis to be calculated using the standard roentgenograms in two perpendicular views. This procedure enables us to avoid techniques costly in time and effort in hospital routine, such as stereo radiography, computer-analysis or 3-dimensional reconstruction of CT- and MRI-investigations.

Biometry↗
PubMed1992

The conservative management of Juvenile Idiopathic Scoliosis.

Juvenile Idiopathic Scoliosis is not a single diagnostic entity but comprises a number of different types of scoliosis. Although detected in the juvenile years, the study of 56 cases shows that in the majority the onset of the scoliosis can be traced back to infancy. It is proposed that the aim of conservative treatment should be to eradicate the deformity and not be content with preventing progression. The principle of using the child's growth as a corrective force to eradicate the deformity is described. An outline of early treatment by corrective plaster jackets is given.

Braces↗
PubMed2003

[An evaluation of the types and the results of surgical treatment for congenital scoliosis].

OBJECTIVES: We evaluated the types and the results of surgical treatment performed for congenital scoliosis. METHODS: Forty-one patients (26 females, 15 males; mean age 12.8 years) with congenital scoliosis were included. The patients were classified according to the Winter's system. Transpedicular hemiepiphysiodesis, "egg shell" procedure, and anterior hemiarthrodesis and posterior convex fusion were performed in infantile (n=1) and juvenile (n=8) patients. In the adolescent (n=32) group, posterior in situ fusion was performed for rigid curves (n=15), posterior fusion after correction with posterior instrumentation for moderate curves (n=8), and posterior fusion and correction with posterior instrumentation after an anterior osteotomy for segmentation failures (n=6). Five patients with unincarcerated fully segmented hemivertebrae had anterior or posterior instrumentation following anterior-posterior hemivertebrectomy. The mean follow-up was 51.8 months (range 26 to 132 months). RESULTS: Fourteen patients (34.2%) had formation failures, 19 patients (46.2%) had segmentation failures, and eight patients (19.6%) had mixed types of deformities. Klippel-Feil syndrome was detected in two patients, and heart valve abnormality was found in two patients. Although the infantile patient who underwent transpedicular hemiepiphysiodesis showed no improvement after surgery, a spontaneous correction rate of 60% was found during her final controls. Patients who underwent anterior hemiarthrodesis obtained a final correction rate of 54.3% following a 42% of correction at surgery. The correction rates for posterior instrumentation were 26.2% with translation and 49.3% after an anterior osteotomy. Patients who had anterior or posterior instrumentation after anterior-posterior hemivertebrectomy had final correction rates of 73.3% and 59.2%, respectively. Final evaluations showed that nine patients (21.9%) had no change in their curves, while 10 patients (24.4%) had spontaneous correction. Four patients developed superficial (n=2) and deep (n=2) infections following posterior instrumentation. Of these, three patients were successfully treated with debridement and antibiotic therapy, whereas one patient required implant removal in the eighth month. No neurologic deficits or systemic complications occurred during or after surgery. CONCLUSION: Surgical treatment may yield successful results in progressive congenital scoliosis when an appropriate surgical technique is selected based on the patient's age and the type of deformity.

Adolescent↗
PubMed2003

Management of scoliosis.

The etiology and nature of truncal deformity in idiopathic scoliosis remains unclear. Only 2 methods are effective to halt or correct the spinal deformity. The first is bracing in young patients and the second is surgical correction for severe curve. Bracing is feasible for children with a Cobb angle between 20 degrees to 35 degrees, while surgical correction is the only choice if the Cobb angle is greater than 40 degrees. Recent surgical developments have led to good correction results with reduced operative scale through continuous spinal cord monitoring, evolution of spinal implants, and better perioperative and postoperative care. The newer spinal systems can produce 3-dimensional reconstruction of the deformity and maintain truncal balance afterwards. The newer implants are user-friendly and low-profile. The combined hook/screw application (hybrid) and the all-screw placement methods have become quite popular. With these methods, the correction rate is increased with reduced loss of correction at follow-up. Navigation systems facilitate accurate insertion of pedicle screws into the vertebral bodies, while video-assisted endoscopic instruments allow early ambulation. These methods are useful in cases of thoracic scoliosis. In the future, in order to minimize the operative scale and prevent deformity, important goals are elucidation of the real nature and the causes of scoliosis and restriction of the number of fusion levels by use of emerging technologies.

Bone Screws↗
PubMed2004

Congenital scoliosis.

The management of congenital scoliosis requires a systematic approach with careful attention to detail. Any fortuitous diagnosis of vertebral anomalies in infancy, even if there is no significant scoliosis at that time on x-ray, requires frequent clinical and radiographic follow-up to detect progression. The presence of associated anomalies of the spinal cord, the kidneys and the heart should be evaluated by MRI, renal ultrasound or IVP, with cardiology evaluation as indicated. Curve progression or severe vertebral anomalies known to cause curve progression require immediate treatment to prevent deformity. Significant thoracic deformity, especially in a patient with thoracic insufficiency syndrome, is best treated with expansion thoracoplasty. The patient with congenital scoliosis requires a long term commitment to care with frequent orthopaedic follow-up throughout the growing years along with routine pulmonary function assessment once the patient is able to cooperate with testing.

Child↗
PubMed2004

[Expression of neuronal nitric oxide synthase and inducible nitric oxide synthase in the erector spinal muscles in idiopathic scoliosis].

OBJECTIVE: To explore the possible mechanism of the erector spinal muscles in idiopathic scoliosis by comparing the expression and localization of neuronal nitric oxide synthase (nNOS) and inducible nitric oxide synthase (iNOS) of the thoracic erector spinal muscles on convex side and concave side. METHODS: The patient group comprised 8 females and 2 males who were scheduled for spinal surgery. The apex of scoliotic curve in these patients arose between T6 and T11. The mean age was 14.3 (range 12-17) years, and the mean Cobb angle was 57.7 degrees (range 45 degrees-85 degrees). Muscle biopsies were taken bilaterally during surgery from the superficial multifidus muscle at the apex of the curve between the 6th and 11th thoracic vertebral levels. Part of the tissue was fixed in formalin and stained with hematoxylin and eosin; the remaining tissue was snap frozen and processed for immunohistochemistry and Western blot. Immunocytochemistry for nNOS and iNOS were performed using the EnVision two-step method. Western blot was done with antibodys to nNOS and iNOS. Immunoreactive bands were visualized by enhanced chemiluminescence according to the manufacturer's specifications (Amersham Corp). RESULTS: nNOS protein in the erector spinal muscles was localized at the sarcolemma. Western blot demonstrated that nNOS protein expression in the concave side of erector spinal muscles is more than that in the convex side. A significant decrease in nNOS protein and activity was found on the convex side of erector spinal muscles from idiopathic scoliosis patients; There was a little immunoreactivity to iNOS in erector spinal muscles. There was little difference in iNOS protein expression between both sides of the curve. Western blot detected the same results. CONCLUSION: There is a greater expression of nNOS and iNOS on the concave side than on the convex side, suggesting nNOS and iNOS may play a role in the pathogenesis of idiopathic scoliosis.

Adolescent↗
PubMed2004

[Expression of calmodulin and nNOS in the paraspinal muscles in idiopathic scoliosis].

OBJECTIVE: The aim of this study was to identify whether one side of the apex of the scoliotic curve showed greater muscular abnormalities than the other. This investigation sought to compare directly the expression and localization of Calmodulin (CaM) and nNOS of the thoracic spinal musculature on convex side with those on the concave side in the scoliosis patients attending for spinal surgery. METHODS: The patient group comprised 8 females and 2 males, scheduled for spinal surgery, in whom the apex of the scoliotic curve arose between T6 and T11. Muscle biopsies were taken bilaterally during surgery from the superficial multifidus muscle at the apex of the curve between the 6th and 11th thoracic vertebral levels. Part of the tissue was fixed in Formalin and stained with hematoxylin and eosin; the remaining tissue was snap frozen and processed for immunohistochemistry and western blot. The following antibodies were used for the immunohistochemistry at dilutions optimized in preliminary experiments. Goat polyclonal anti-human-CaM and mouse monoclonal anti-human-nNOS were used as primary antibodies. CaM and nNOS were detected by immunohistochemical method and Western-blot. Western blotting was done with antibodies to CaM. RESULTS: Compared with control muscle and the muscle on the concave side of the scoliotic curve, A significant decrease in CaM and nNOS was found on the convex side of paraspinal muscle from idiopathic scoliosis patients, Western blotting with an CaM antibody and nNOS antibody shows that there are more CaM and nNOS protein in the concave side of paraspinal muscle in these patients with adolescent idiopathic scoliosis than in the convex side. CONCLUSION: This asymmetry of CaM and nNOS in the paraspinal muscle may play a role in the pathogenensis of IS.

Adolescent↗
PubMed2002

The relationship between minor asymmetry and early idiopathic scoliosis.

School scoliosis screening programmes have consistently produced large numbers of referrals with minimal trunk asymmetry which then must be assessed, evaluated and perhaps investigated and monitored over a period of time before it is felt safe to discharge them as 'non-progressive.' Beyond measures to reduce their number, they have received less attention than the more interesting cases requiring treatment or surgery, which they outnumber to a significant extent. Examination of the figures from a historical database shows that the patients have no greater probability of developing significant scoliosis than their 'normal' peers . So they should not be classed as scoliosis but they are still relevant to the broader picture of aetiology.

Child↗