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PubMed2002

The early detection of adolescent idiopathic scoliosis in three positions using the scoliometer and real-time ultrasound: should the prone position also be used?

The standing forward bending position is in general use for the early detection of adolescent idiopathic scoliosis. It also reveals humps caused by leg-length inequality and for this reason some workers have advocated using the sitting forward bending position. Most recently the prone position has been evaluated and even recommended. The introduction of B-mode and subsequently real-time ultrasound to measure rib rotation and spinal rotation has involved using the prone position. The numerical description of back humps in scientific studies requires measurements at several levels on the back from T1-S1. This paper utilizes 30 subjects referred by school screening for scoliosis from whom 10-level Scoliometer Angle of Trunk Inclinations (ATIs) were obtained twice in each of three positions--standing forward bending, sitting forward bending and prone. The ATIs were converted to 18 levels and (1) analysed for reproducibility, (2) compared in the three positions, and (3) compared with real-time ultrasound data of rib rotation obtained in the prone position. Several statistical methods are used. The reproducibility is best in the sitting and prone positions. While the prone position produces lower ATI readings, R squared values are significantly higher and Residual Mean Square (RMS) values significantly lower than those for each of the standing and sitting forward bending positions. Though the prone position has clear advantages, it is not advocated in clinical practice for various reasons. More research is needed. The evidence supports the view that the sitting forward bending position has advantages for the early detection of adolescent idiopathic scoliosis.

Adolescent↗
PubMed2002

Adolescent idiopathic scoliosis: is the search for aetiology constrained by the orthosis?

While the aetiology of adolescent idiopathic scoliosis is unknown, it is widely believed that the deformity can be controlled by mechanical forces applied by a corset and acting, via skin and soft tissues, to exert pressure on vertebral growth-plates (Hueter-Volkmann Law). The reported efficacy of bracing in reducing the incidence of small degrees of progression reinforces this concept. The supposed mode of action conditioned the model of pathomechanism and precludes other hypotheses. Since the critical Cobb angle changes are usually less than the probable measurement error, another criterion (treatment outcome) is also relevant. At our centre, bracing for adolescent idiopathic scoliosis has not been practised for 9 years. Out of the 153 untreated, unselected patients presenting to the general scoliosis clinic in that time and who were at least 15 years old at the last review, 43 (27.6%) of them have undergone surgery. This does not differ statistically from 22.45% (229 of 1,020) braced patients reported by Lonstein and Winter in 1994. If bracing does not significantly improve prognosis, its efficacy cannot be accepted and the hypothesis of aetiology which it underpins has no greater standing than any other.

Adolescent↗
PubMed2002

Rehabilitation of scoliosis patients with pain after surgery.

In our centre, the postoperative scoliosis rehabilitation consists in stabilizing postural and respiratory exercises lasting several hours a day (5 1/2 to 7 hours). Additionally to pain treatment, we apply pain physiotherapy, physical therapy, acupuncture and besides manual medicine, also a psychological intervention and pain treatment by medication. 46 patients suffered from heavier pain 10 or more years after scoliosis surgery. The patients reported their pain at the beginning and at the end of 3-6 week in-patient rehabilitation programme. We applied a visual analogous scale (VAS), a numerical scale (NS), a standardized adjective scale (VRS), and a pain frequency scale. All the patients with an average age of 36 years old (SD=16) and an average curve angle of 35 degrees thoracic (SD=36) and 26 degrees lumbar (SD=22) showed a decrease of the values on the pain intensity scale. Pain reduction was highly significant, as well as pain frequency. Chronic pain as a late result following scoliosis surgery can be reduced by an intensive in-patient rehabilitation, at least in the short term. There are further necessary studies in order to follow-up the long-term effect of postoperative rehabilitation.

Adult↗
PubMed2002

Treatment of chronic pain in adult scoliosis.

INTRODUCTION: One of the most important sequels of scoliosis in adults is pain, caused either by muscular overuse and imbalance or by nerve root compression. This is a very difficult sequel to treat because of the failure of the common analgesic drugs and physiotherapy treatments. MATERIAL AND METHOD: We studied 30 patients with degenerative scoliosis of different origins. There were 24 women and 6 men. Patient age ranged from 25 to 55 years old. The initial Cobb angle ranged from 25 degrees to 65 degrees with a mean of 35 degrees. The mean Schöber back score* at the beginning of treatment was 1.32. The number of sessions with the F.E.D. method were between 20 and 60 with a mean of 45 sessions. All the patients had a case history of NSAIDs, muscle relaxants and physiotherapy. RESULTS: The final average Cobb angle was 33 degrees and Schöber score* 2.88. After treatment, only two cases required NSAIDs, muscle relaxants and physiotherapy. CONCLUSIONS: The F.E.D. method seems to be a promising alternative for treatment of painful sequels in adult scoliosis, since in our study disappearance of symptomatology was seen in the majority of cases. The F.E.D. method also had a permanent effect over time if patients followed a home physiotherapy program. This analgesic effect has a direct relation with the improvement achieved in the flexibility index.

Adult↗
PubMed2002

Torsional deformity of apical vertebra in adolescent idiopathic scoliosis.

CT scans of structural thoracic idiopathic scoliosis were reviewed in nine patients admitted to our department for scoliosis surgery. The apical vertebra scans were chosen and the following parameters were evaluated: 1) alpha angle formed by the axis of vertebra and the axis of spinous process 2) beta concave and beta convex angle between the spinous process and the left and right transverse process, respectively, 3) gamma concave and gamma convex angle between the axis of vertebra and the left and right transverse process, respectively, 4) the rotation angle to the sagittal plane. The constant deviation of the spinous process towards the convex side of the curve was observed. The vertebral body itself was distorted towards the concavity of the curve. The angle between the spinous process and the transverse process was smaller on the convex side of the curve. The torsional, intravertebral deformity of the apical vertebra was a factor acting in the direction opposite to the rotation, in the sense to reduce the deformity of the spine in idiopathic scoliosis.

Adolescent↗
PubMed2002

Etiologic theories of idiopathic scoliosis: neurodevelopmental concepts to be evaluated.

There is increasing interest in the concept that neuromuscular mechanisms and the central nervous system (CNS) are somehow involved in the etiology and pathogenesis of idiopathic scoliosis (IS). Yet in the extensive neuroscience research of idiopathic scoliosis certain neurodevelopmental concepts have been neglected. These include: (1) a CNS body schema for posture and movement control generated during development and growth by establishing a long-lasting memory; (2) pruning of cortical synapses at puberty; and (3) neuromorphic engineering. Memory of developing posture and movement might be established in neurons of the CNS body schema in the form of novel proteins; these could be coded by modified genes obtained by the recombination (crossing over) of DNA in a similar way to that in the production of immunological antibodies and during meiosis. These concepts need evaluation in relation to (1) the etiopathogenesis of IS and (2) a possible new treatment approach to idiopathic scoliosis involving a neuromorphic device to control the output for muscle stimulators that are inserted and driven with telemetry.

Adolescent↗
PubMed2002

Study of the rib cage deformity in children with 10 degrees-20 degrees of Cobb angle late onset idiopathic scoliosis, using rib-vertebra angles--aetiologic implications.

UNLABELLED: The aim of the study is to compare the rib-vertebra angles (RVAs) between children with 10 degrees - 20 degrees of Cobb angle late onset idiopathic scoliosis (LOIS) and non-scoliotic children. MATERIALS AND METHOD: The RVAs of 47 children, with mean age 12.4 years, who presented LOIS with a Cobb angle 10 degrees - 20 degrees, were studied. The children were classified into three groups according to the site of the scoliotic curve: 17 children had thoracic (T), 14 children had thoracolumbar (TL) and 16 children had lumbar (L) curves. The RVAs of the scoliotic children were compared to the RVAs of 60 non-scoliotic children of a similar age group, who were studied in the past. RESULTS: The comparison of the right and left RVAs within each group showed that the children who had: T curves differ at the level T4, T5, T6, T7 and T8, TL curves differ at the level T3, and L curves differ at the level T7 and T12. The comparison of the ipsilateral RVA's between the scoliotic groups showed that between: T and TL curves there are no differences at any thoracic level, between T and L curves the RVAs differ at the T7 level on the right side, whereas there are no differences between the RVAs on the left side, between TL and L curves the RVAs differ at the level T5, T6, and T7 on the right and at the level T5 on the left side. Comparing the RVAs between the scoliotic and nonscoliotic children, it was apparent that the scoliotic children rib cage had lower RVAs (p<0.01) at almost all thoracic levels. DISCUSSION: It has been reported that RVAs is an expression of the resultant muscle forces, which act on each rib. It was also suggested that RVA asymmetries by weakening the spinal rotation-defending system are aetiological for idiopathic scoliosis, (Burwell et al 1992). This study shows that scoliotic children with small curves have underdeveloped thoracic cage compared to nonscoliotic counterparts. The differences are more apparent in the scoliotic children with thoracic curves. It is suggested that the differences of the RVAs between right and left side in this group are an expression of asymmetric muscle forces acting on the thoracic cage. It is concluded that asymmetric muscle forces participate in the pathogenesis of idiopathic scoliosis on the thoracic cage, which deforms early.

Adolescent↗
PubMed2002

Lateral spinal profile in school-screening referrals with and without late onset idiopathic scoliosis 10 degrees-20 degrees.

INTRODUCTION: The aim of this report is a) to study the lateral spinal profile, (LSP), in school-screening referrals with and without late onset idiopathic scoliosis of small curves 10 degrees - 20 degrees Cobb angle and b) to validate LSP's aetiological importance in idiopathic scoliosis pathobiomechanics. METHODS AND MATERIAL: The spinal radiographs of 133 children, 47 boys and 86 girls with a mean age of 13.28 and 13.39 years respectively and Axial Trunk Inclination (ATI) > or = 7 degrees, were examined. The Cobb angle was appraised from the anteroposterior standing radiographs and the segmental spinal profile was assessed. A line was drawn down the posterior surface of each vertebral body from T1 to L5 on lateral standing radiographs, and the angle of this line from the vertical was recorded. Intervertebral values for LSP, (ILSP), that is the result of the subtraction of two consecutive spinal levels LSP, were also calculated. The data were then statistically analyzed. RESULTS: The statistical descriptives of LSP and intervertebral LSP are presented for several groups of children, namely in those: 1) with straight spines, 2) with spinal curvature having a Cobb angle less than 10 degrees, and 3) in scoliotic children with a) thoracic, b) thoracolumbar and c) lumbar curves of 10 degrees-20 degrees. A correlation of the LSP with Cobb angle for the various types of curves for boys and girls is also presented. It is shown that the kyphotic segmental angulation is slightly less and the lordotic one almost normal in scoliotics, compared with the values of normal children. It is interesting to note that the LSP correlated with Cobb angle shows: a) a positive correlation pattern at T6, T7, T8 and T9 for thoracic curves of scoliotic boys and b) a negative correlation pattern at T3, T4 and T5 spinal levels of lumbar curves for scoliotic girls. DISCUSSION: The observed differences of the LSP are mainly located at the lumbar spine, suggesting that factors acting on the lumbar spine in sagittal plane contribute to the development of AIS. The minor hypokyphosis of the thoracic spine and its minimal differences observed in the studied small curves with nonscoliotics in this report add to the view that the reduced kyphosis, by facilitating axial rotation, could be viewed as being permissive, rather than as aetiological, in the pathogenesis of idiopathic scoliosis.

Adolescent↗
PubMed2002

Etiologic theories of idiopathic scoliosis: the apical spinal deformity--relevance to surgical practice.

UNLABELLED: The current successful management of idiopathic scoliosis is an orthopaedic and not a paediatric responsibility. Hence the immediate aim of etiologic research is to improve surgical treatments based on a better understanding of the causation of the deformity. This focuses attention on the pathomechanisms of the spinal and ribcage deformities. The mechanisms of spinal deformity about the apex are unresolved but may be caused by forces created in the anterior spinal column. Some current theories with practical application involve (1) front-back spinal growth mechanisms, (2) rib growth asymmetry and (3) muscles. CONCLUSIONS: The application of theory to surgical practice is advanced for concepts of front-back spinal growth asymmetry but rib hump reassertion occurs after surgery and these concepts ignore the ribcage as a possible factor in scoliosis pathogenesis. A theory of ribcage asymmetry involving concave rib overgrowth is beginning to be evaluated surgically. After surgery for IIS and AIS reassertion of the deformity has been shown to involve preoperative spinal and concave rib factors; the larger the concave rib-spinal angle the better results at 2-5 year. Muscular factors that may trigger/exacerbate the apical spinal deformity of scoliosis need more research. The concept that AIS pathogenesis involves putative neuromuscular dysfunction that deforms an immature spine is considered likely by several workers.

Adolescent↗
PubMed2002

Positional cloning strategies for idiopathic scoliosis.

AIM: Idiopathic scoliosis (IS) affects approximately 1-2% of the population and has a heritable component. It is clear that in general IS displays the features of a complex genetic disorder; however families displaying a Mendelian inheritance pattern have been described. Our aim is to identify families segregating rare, highly penetrant loci. In the case described here the disorder appears to cosegregate with a chromosomal rearrangement. METHODS AND MATERIALS: We have studied a family in which a pericentric inversion of chromosome 8 appears to cosegregate with idiopathic scoliosis in three generations. We have used fluorescent in situ hybridization (FISH) to identify cloned DNAs that span the breakpoints on the two arms of the chromosome. These clones allow the recovery of sequence information from the breakpoint region and identification of candidate genes. RESULTS: We have identified a YAC of 1190kb that spans the p arm breakpoint and from this a cosmid of 35kb that also identifies the break. We have derived DNA sequence information on this region. We have identified a BAC of 150kb that crosses the q arm breakpoint. The complete genomic DNA sequence of this BAC is being analyzed to identify candidate genes and to further localize the precise breakpoint. CONCLUSION: We have sublocalized within two small genomic regions the position of a possible locus for idiopathic scoliosis.

Adolescent↗
PubMed2002

Sagittal and transversal plane deformity in thoracic scoliosis.

UNLABELLED: The aim of the study was to assess the sagittal and transversal plane deformity of the spine in thoracic scoliosis by the mean of 3-D radiographic analysis. 46 patients admitted for surgery for thoracic idiopathic scoliosis underwent preoperative radiographic assessment. All patients presented the same pattern of the coronal plane deformity: single right thoracic curve (Lenke 1, King 3). Neither lumbar nor proximal thoracic structural curve were present. The Cobb angle varied from 41gamma to 77 gamma (mean 55,4 gamma +/- 8,6 gamma). Long cassette standing antero-posterior and lateral radiographs were analysed. Three-dimensional reconstruction with Rachis 91TM software was performed for each pair of radiographs. The following parameters were assessed: sagittal thoracic Cobb angle (Th4-Th12), upper thoracic kyphosis angle (Th5-Th8), lower thoracic kyphosis angle (Th9-Th12), superior and inferior hemi-curve sagittal angles, lumbar lordosis, sacral slope, sacral incidence, vertebral plate index, segmental vertebral axial rotation throughout the thoracic and lumbar spine. Results showed great variability of parameters assessed. The non-harmonious distribution of kyphosis was demonstrated in the thoracic spine. Local Th9-Th12 hypokyphosis and adjacent local Th5-Th8 hyperkyphosis constitute the most typical sagittal pathologies. So called normokyphotic curves were composed of one hyperkyphotic and one hypokyphotic zone. Th1-Th4 segment revealed two patterns of segmental rotation distribution: a purely compensatory curve with no vertebral axial rotation or a rotated curve presenting the morphology intermediate between Lenke 1 and Lenke 2 types (or King 3 and King 5). IN CONCLUSION: curves presenting the same coronal plane deformity differ in their morphology assessed in the two other planes; global thoracic kyphosis angle is a misleading parameter because it covers hypo- and hyperkyphotic zones; local distal thoracic (Th9-Th12) hypokyphosis is present in idiopathic thoracic scoliosis.

Humans↗
PubMed2002

Scoliosis study using finite element models.

Finite element models have been used for many years to study scoliosis biomechanics. This paper presents some of the work done in our institution over the last decade in this area. It covers the simulations of scoliosis treatment (orthotics, surgical instrumentation), muscle and control, as well as the growth process. The models presented in this paper are of clinical interest because they have the capacity to simulate an unlimited number of variables to investigate scoliosis biomechanics. Current developments are directed toward the integration and validation of specific models (muscle, control, and growth modeling) into a unified refined model of the trunk, thus allowing a more complete understanding of scoliotic spine pathomechanicsms, as well as to predict in advance what would be the resulting shape of the spine in response to the application of a treatment

Adolescent↗
PubMed2002

Pathomechanic basics of conservative treatment of progressive idiopathic scoliosis according to Dobosiewicz method based upon radiologic evaluation.

Conservative treatment of idiopathic scoliosis, especially kinesitherapy, is not widely appreciated due to its suspected low effectiveness in relation to a surgical treatment. After long-year assessment of patomechanics of scoliosis in Department of Rehabilitation of Medical University of Silesia a conservative method of treatment, asymmetric trunk mobilization in strictly symmetric positions, was developed. This method enables to detain progression of scoliosis, or even decrease lateral curvature of a spine and angle of rotation assuming adequate cooperation of patient and its family.

Adolescent↗
PubMed2004

[Freeze-dried allograft of posterior spinal fusion in patients with scoliosis].

OBJECTIVE: To observe the effectiveness and safety of allograft in posterior spinal fusion in patients with scoliosis. METHODS: 41 cases of 54 scoliosis patients with allograft for spinal fusion were followed up. The mean follow-up time is 16 months. Foreign body reaction was studied clinically and fusion status was assessed radiographically. RESULTS: There was no foreign body reaction significantly in all patients. Acute deep wound infection happened in one patient and no chronic deep wound infection occurred. There was no disease transferred by allograft in followed patients. New bone formation appeared after 4 months postoperatively in radiogram. At final follow-up, the mean angle of 3.4 degrees lost and minimal -1 degrees and maximal 6 degrees . Implants were fastened and did not loosen and fracture. CONCLUSIONS: Allograft for posterior spinal fusion in scoliosis patients was useful and safe.

Adolescent↗
PubMed2004

[Selection of surgical procedure for the treatment of idiopathic scoliosis].

OBJECTIVES: To discuss and evaluate the selection of surgical procedure for the treatment of idiopathic scoliosis according to the location and degree of the deformity. METHODS: 175 patients with idiopathic scoliosis underwent surgical treatment with correction and fusion. The patients were divided into four groups according to the location and degree of the deformity and four different procedures were used for each group. For each group, the blood loss, surgery time, correction rate, loss of correction at final follow up and complications were compared and analyzed. RESULTS: All patients underwent surgery safely and no neurological complication occurred. The correction rate was 81% for Group I, 86% for Group II, 68% for Group III and 72% for Group IV. All patients were followed up at least 2 years and the average time was 38 months (24 approximately 52). CONCLUSION: Proper selection of surgical procedure according to the location and degree of the scoliotic deformity, satisfactory results can be achieved in the treatment of idiopathic scoliosis.

Adolescent↗
PubMed2005

[Anesthesia for scoliosis surgery: preoperative assessment and risk screening of patients undergoing surgery to correct spinal deformity].

Spinal column deformity is associated with potentially serious alterations of respiratory and cardiac function. Such alterations, in association with the underlying disease that caused the deformity--such as neuromuscular disease--are risk factors that affect the prognosis for scoliosis patients undergoing anesthesia and surgery. It is important for the anesthesiologist to carry out a detailed preoperative assessment to identify patients at risk with the aim of decreasing morbidity and mortality related to surgical correction of deformities. Of paramount importance is awareness of the risk of injury to the spinal cord that will affect function. Other issues are how to manage the patient in anomalous positions, the risk associated with hypothermia secondary to exposure of a large surgical field for a long period, and bleeding, which can sometimes exceed the patient's total volume. In the case of scoliosis surgery, all those situations may converge, obliging us to provide careful intraoperative monitoring, particularly of spinal function; to choose the appropriate anesthetic technique; and to maintain vigilance during the early postoperative period to foresee possible complications. Because scoliosis surgery is multidisciplinary, several teams must work together to assure success.

Anesthesia↗
PubMed1992

[Characteristics of physical therapy of scoliosis patients in adulthood].

Rehabilitation treatment of adult patients with scoliosis essentially is of a secondary prevention orientation. Along with countering curve progression, the main focus is on improving secondary functional impairments of the cardiopulmonary system as well as on the management of scoliosis-induced pain. In-patient physiotherapy rehabilitation provides major impacts in these respects, especially since they have proven their worth in obtaining increases in vital capacity, rib mobility, cardiopulmonary functioning, and in reducing scoliosis-induced pain complaints.

Adult↗
PubMed2004

Augmentation of third generation instrumentation with sublaminar titanium wiring in late onset idiopathic scoliosis: the surgical results and analysis of trunk balance.

In recent years, third generation instrumentation systems which achieve correction by maneuvers like derotation and translation, have been widely used in the treatment of idiopathic scoliosis. To increase correction, additional procedures that increase stability, such as screw application for every segment, have been used. In this study, as a new technique, the effects of combined translation and derotation maneuver with augmentation by using titanium double crimp Songer cable applied on apical region, on trunk balance, sagittal and frontal planes have been examined. 45 idiopathic scoliosis patients operated between 1996 and 2002 have been included in the study. Mean age was 14.5+/-1.7 years and female/male ratio was 30/15. Mean follow up time was 51.9+/-22.7 months. According to King Classification, 15 patients had Type II, 18 patients Type III and 12 patients had Type IV curves. One of the apical cables has been tensioned and translation has been performed. At the second step, derotation has been applied to the vertebra, which is firmly attached to the rod. Sagittal and frontal Cobb angles have been measured in preoperative, postoperative and recent radiographic examinations. Trunk balance has been examined both clinically and radiographically. Also, secondary curves have been measured in every examination for decompensation findings. In overall frontal plane measurements, postoperative correction was 79.9+/-13.5 %, loss of correction 2.9 degrees +/-3.2 degrees and final correction 74.3 % +/-14.3 %. In postoperative measurements, normal physiological contours have been achieved in 97.8 % of the patients for the thoracic region (30 degrees -50 degrees ) and 80.7 % of the patients for the lumbar region (40 degrees -60 degrees ). In secondary curves, 75.2+/-34.4 % postoperative correction has been observed. No decompensation findings have been observed in the last examination. In postoperative and last follow up examinations, balanced and totally balanced vertebral column has been achieved in every patient of the study group. Solid fusion mass has been observed in every patient. No early or late, local or systemic postoperative complications have been observed. Given these findings, we conclude that derotation-translation combined maneuver performed with 3rd generation instrumentation reinforced sublaminar wires is a good choice in the treatment of the late-onset idiopathic scoliosis.

Adolescent↗