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PubMed1992

Soft tissue release on the concave side in the treatment of scoliosis. A preliminary report of 23 cases.

Since February 1982, 23 patients with scoliosis were treated by releasing the soft tissues on the concave side and plaster spinal fusion jacket. Of these patients, 13 had congenital scoliosis and 10 idiopathic scoliosis. Follow-up for 1 to 8.5 years showed that the results of correction were satisfactory. The maximum degree of correction of the main curve in this series was from 74 degrees (Cobb method) before treatment to 3 degrees after treatment. The maximum rate of correction was 97.3%.

Adolescent↗
PubMed2005

Significant scoliosis regression following syringomyelia decompression: case report.

We present the case of a 5-year-old boy presenting with a 54-degree scoliosis secondary to a Chiari I malformation with a holocord syringomyelia extending from C1 to T10. Neurosurgical treatment involved posterior fossa craniectomy with decompression, and partial C1 laminectomy. At follow-up 7 years later, at age 12, radiographs revealed only a 4-degree scoliosis, and follow-up MRI revealed a deflated syrinx. We report this case to reveal the most significant scoliosis regression seen in our experience that may occur in younger patients after neurosurgical syringomyelia decompression for Chiari I hindbrain herniation.

Cervical Vertebrae↗
PubMed2005

Effects of short term cast wearing on respiratory and cardiac responses to submaximal and maximal exercise in adolescents with idiopathic scoliosis.

AIM: Bracing is widely used to treat adolescent scoliosis. However, bracing may also affect respiratory and cardiovascular function. In this thirteen-weeks longitudinal study we evaluated the effect of brace wearing on maximal and submaximal cardiorespiratory capacity in adolescents with moderate idiopathic scoliosis. METHODS: Eight boys and 8 girls (12-18 years) with scoliosis of the thoracic spine (Cobb angle range 32 degrees - 42 degrees in boys and 32 degrees - 60 degrees in girls) were enrolled. Respiratory basal function (forced vital capacity, FVC, and forced expired volume in 1 s, FEV(1)) and cardiorespiratory adjustments to submaximal and maximal cycle ergometer exercise (heart rate, HR, pulmonary ventilation, VE, and oxygen consumption, VO(2)) were measured a week before fitting a brace, after 1 and 12 weeks of brace wearing, and a week after brace removal. RESULTS: With respect to pretreatment values: a) after 1 week of brace wearing FVC and FEV(1) were significantly reduced in both genders; b) after 12 weeks of bracing the amount of oxygen consumed per heart beat was reduced during maximal and submaximal exercises in females only; c) ventilatory efficiency was unchanged in both genders in each condition; d) oxygen uptake during maximal exercise was decreased (by about 10-20%) in females only; e) after brace removal all variables tended to regress to pretreatment values. CONCLUSIONS: Although data are preliminary and need to be confirmed on larger samples of patients, the brace appears to limit maximal exercise performance especially in girls, where it affects the cardiopulmonary efficiency. Thus, moderate physical exercise during brace wearing is advised to counteract respiratory, cardiovascular and muscle inefficiency due to ribcage movement limitations.

Adolescent↗
PubMed2005

Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: a systematic review of clinical trials.

BACKGROUND AND PURPOSE: Many conservative treatments are available for adolescents with idiopathic scoliosis, but the evidence for their accepted use is still unclear. The purpose of this study was to evaluate the effectiveness of braces and other conservative treatments of idiopathic scoliosis in adolescents by systematically reviewing the literature. METHODS: The literature was searched in the PubMed, CINAHL, Cochrane, and PEDro databases. Studies were selected if the design was a randomized clinical trial or a controlled clinical trial, if all patients had an idiopathic scoliosis, if all patients were less than 18 years of age during the intervention, and if the type of intervention was a conservative one. Two reviewers independently assessed the methodological quality using the Delphi list and performed data extraction. Analysis was based on the levels of evidence. RESULTS: Thirteen studies met the final inclusion criteria, showing a wide range of interventions such as bracing, electrical surface stimulation, and exercises. DISCUSSION AND CONCLUSION: The authors conclude that the effectiveness of bracing and exercises is not yet established, but might be promising. They found no evidence of the effectiveness of electrical stimulation.

Adolescent↗
PubMed2005

[The effect of titanium mesh cage on maintenance of thoracolumbar and lumbar lordosis in anterior instrumentation for thoracolumbar and lumbar scoliosis].

OBJECTIVE: To evaluate the clinical importance of titanium mesh cage (TMC) in anterior instrumentation for scoliosis. METHODS: Thirty-six consecutive patients with thoracolumbar/lumbar adolescent idiopathic scoliosis were treated with anterior derotation and instrumentation using autologous bone grafting and TMC for interbody fusion. The average age of patients was 17 years (ranged from 14 to 22 years), in which 5 cases were male and 31 cases were female. RESULTS: The coronal Cobb angle before surgery, 2 weeks after surgery, and 13 months at the follow-up was measured as 56 degrees , 15 degrees , and 18 degrees respectively, while the thoracic kyphosis from T(5) to T(12) was 30 degrees , 33 degrees , and 37 degrees respectively, and the lumbar lordosis from L(1) to S(1) was 46 degrees , 56 degrees , 51 degrees . There were no death, infection, implant failures or collapse of intervertebral space. Intraoperative injury of lacteal occurred in one patient, but no postoperative complications happened. One of two patients who had pleural effusion was managed with close drainage. Exudative pleurisy occurred in one patient, the sympathectomy effect occurred in three patients who presented asymmetry of skin temperature and resolved in short term. CONCLUSIONS: Coronal and sagittal alignment can be well corrected and maintained with TMC in anterior scoliosis surgery, collapse of intervertebral space and lumbar kyphosis can be prevented.

Adolescent↗
PubMed2006

[Clinical outcome of anterior corrective surgery for thoracolumbar scoliosis: mini-open approach without diaphragm dissection versus open approach].

OBJECTIVE: To investigate the feasibility and clinical results of a new mini-open approach in the anterior instrumentation of thoracolumbar scoliosis by comparing with traditional open approach. METHODS: Seventy-two patients with the idiopathic thoracolumbar scoliosis underwent one stage anterior instrumentation and spinal fusion. In group A, the patients received anterior mini-open approach without dissecting diaphragm. There were total 34 cases with average age of 16 years old, ranging from 12 to 25 years. The average Cobb angle was 58 degrees with a range of 42 degrees to 76 degrees pre-operatively. The instrumentation levels were from T(11) to L(3) in 18 cases, T(11) to L(2) in 6 cases, T(11) to L(4) in 10 cases. In group B, the patients were treated with traditional open approach. Total 38 cases with average age of 17 years old, ranging from 13 to 26 years, were included. The average Cobb angle was 54 degrees with a range of 40 degrees to 74 degrees pre-operatively. The instrumentation levels were from T(10) to L(3) 7 cases, T(11) to L(3) 20 cases, T(11) to L(4) 11 cases. RESULTS: In group A, the average curve correction was 81% with post-operative Cobb angle 12 degrees ranging from 4 to 16 degrees . Sagittal alignment restoration was satisfied in this group. In group B, the average curve correction was 73% with post-operative Cobb angle 15 degrees . The rehabilitation time was shorter in group A than in group B. No death, vascular injury and neurological complication occurred. Exudative pleurisy occurred in two patients in each group and cured very well. CONCLUSIONS: Mini-open anterior instrumentation for thoracolumbar scoliosis without diaphragm dissection is proved to have the same outcomes as the traditional anterior approach, without the increase of complication.

Adolescent↗
PubMedDate not supplied

MR imaging features of brain stem hypoplasia in familial horizontal gaze palsy and scoliosis.

We report the case of a child with horizontal gaze palsy, pendular nystagmus, and discrete thoracolumbar scoliosis. MR imaging of the brain depicted pons hypoplasia with an absence of the facial colliculi, hypoplasia, butterfly configuration of the medulla, and the presence of a deep midline pontine cleft (split pons sign). These MR imaging findings suggest familial horizontal gaze palsy with progressive kyphoscoliosis, a rare congenital disorder. To the best of our knowledge, MR imaging findings of only 4 similar cases, with or without progressive idiopathic scoliosis, have been reported. We discuss the pathogenesis substratum of this entity. Early recognition of this rare entity is important if supportive therapeutic measures in progressive scoliosis are to be applied.

Brain Stem↗
PubMed2006

Asymmetric expression of melatonin receptor mRNA in bilateral paravertebral muscles in adolescent idiopathic scoliosis.

To investigate the change of melatonin receptor mRNA expression in bilateral paravertebral muscles in AIS, congenital scoliosis (CS) and controls in order to analyze its relationship to the pathogenesis of AIS. 20 cases with average age of 15.1 +/- 2.2 years and average Cobb angle of 56.2 degrees +/- 16.1 degrees were included in AIS group. 12 cases with average age of 11.6 +/- 3.2 years and average Cobb angle of 59.2 degrees +/- 33.3 degrees were included in congenital scoliosis (CS) group. 10 cases without scoliosis comprised a control group. The mRNA expression of melatonin receptor subtype MT1 and MT2 were detected by RT-PCR method. The MT2 mRNA expression on the concave side of paravertebral muscle was higher than that on the convex side in AIS and CS groups (p<0.05), but the MT1 mRNA expression showed no significant difference. In the AIS group, the ratio of MT2 mRNA expression on the concave side compared with the convex side in cases with a Cobb angle less than 50 degrees and cases with a Cobb angle greater than 50 degrees showed no significant difference. The melatonin receptor expression in bilateral paravertebral muscles in AIS is asymmetric, which may be a secondary change.

Adolescent↗
PubMed2006

Adolescent scar contracture scoliosis caused by back scalding during the infantile period.

To investigate the pathogenesis, clinical manifestation and treatment of the adolescent scar contracture scoliosis caused by back scalding during infancy. From August 1997 to May 2005, about 1300 patients with scoliosis received surgery in our department. Only four of them were diagnosed with adolescent scar contracture scoliosis. One patient was first treated with skin expansion, back scar excision, and skin flap transfer, followed with anterior correction with TSRH instrumentation. Two patients were first treated with back scar excision and anterior spinal release, then treated with posterior correction with TSRH instrumentation; thoracoplasty was performed after 50 days in halo-wheelchair traction. The other patient was treated with posterior correction with TSRH instrumentation. No management of scalding was performed on the fourth patient. Anterior release and posterior correction were performed at intervals of 3 weeks. The deformities of four patients were well corrected. The trunk balance was restored and the pelvis leveled. The skin incision wounds healed well. Minor loss of correction was recorded during the last follow-up.

Adolescent↗
PubMed2006

Radiological results of Dobosiewicz method of three-dimensional treatment of progressive idiopathic scoliosis.

UNLABELLED: The aim of the study was the radiological evaluation of the three-dimensional asymmetric treatment of scoliosis in strict symmetric initial positions. MATERIAL AND METHOD: 152 Patients (137 F and 15 M) with idiopathic progressive scoliosis (85 single scoliosis cases and 67 double-major) with proven curve progression were retrospectively analysed on the basis of radiological evaluation in the period of years 1999-2004. Mean age of assessed group was 14.22 years (range 7/21, SD=2.57), mean time of observation 31.80 months (range 18/63, SD=10.75). All children were treated with Dobosiewicz method of three-dimensional asymmetric correction in strict symmetric initial positions and with rigid Cheneau brace when indicated. RESULTS: Mean initial value of Cobb angle was 25.92 degrees (range 9/62, SD=10.59), mean initial rotation of apical vertebra was 9.55 degrees (range 0/30, SD=7.66). The outcome values were 31.04 degrees (range 5/76, SD=13.96) and 12.97 degrees (range 0/35, SD=8.41), respectively. Mean progression of Cobb angle during entire period of observation was 5.12 degrees (range -21 / +38, SD=9.62), mean progression of apical vertebra rotation was 3.42 degrees (range -21 / +25, SD=6.03). Further multi-factor analysis is discussed in full text. Results are also presented in the form of radiograms. CONCLUSION: The radiological results demonstrated prevalent stabilisation of scoliotic curves in children treated with Dobosiewicz method between October 1999 and December 2004.

Adolescent↗
PubMed2006

Validity and reliability of SRSI and SF-36 in Japanese patients with scoliosis.

We have examined the validity and reliability of Japanese SRS-24 and SF-36 in patients with scoliosis. 278 patients with scoliosis were recruited. Their average age was 24.8 years (range 17-84 years) and 83% of patients had idiopathic curves. The major coronal curve averaged 43 degrees (range 10 degrees -114 degrees). Questionnaires surveyed were SRS-24 and SRS-22, and SF-36. Only domains applicable to untreated patients were analyzed. Scale level analysis was evaluated by the ceiling and floor effect. The Cronbach alpha and item-scale correlations were calculated as representatives of internal consistency reliability and item internal consistency, respectively. Most domains of SF-36 had large ceiling effects. Both the SRS questionnaires had limited ceiling/floor effects. SRS-22 had a better internal consistency than SRS-24. Low item-scale correlations (<0.25) were found in question 14, 15, and 18 of SRS-22. The Japanese version of SRS-22 was the most useful measure for patients with scoliosis. However, some questions have low item-scale correlations, lowering reliability of the Function domain.

Adolescent↗
PubMed2006

Intra-operative spinal load and displacement monitoring: towards a better understanding of scoliosis correction mechanics.

Surgical correction of scoliosis reduces deformation and improves overall function and esthetics. Understanding and monitoring of mechanics during scoliosis surgery is an invaluable tool to optimize correction without compromising patient safety. Our objective was to use intra-operative monitoring tools to study how spinal load and displacement relates to obtained correction and chosen instrumentation. Instrumented pedicle screws, a "gripper" and active markers were developed. Instrumented pedicle screws provided three-dimensional forces at the screw-vertebra interface while the instrumented "gripper" measured the force and the rotation applied by the surgeon to the rod rotator. Vertebral displacement was monitored with light-emitting diodes and motion capture technology. These instruments were used successfully with 16 scoliosis subjects. Analysis of applied force, displacement, and curve flexibility influence on correction percentage is the long term goal. Raw results for instrumented screws and gripper showed that recorded force decreased with respect to percentage of correction obtained. Measured force increased with respect to the pre-surgical Cobb angle while percentage of correction obtained decreased as pre-surgical Cobb angle increased. Active marker results showed three-dimensional vertebral rotation and translation during correction, with axial rotation and caudal-cranial translation having the greatest magnitudes. Using greater correction forces does not necessarily result in an increased correction; flexibility and Cobb angle also play a role in the mechanics of correction. Further data collection will provide better understanding of the interconnected role between these factors helping complete the description of surgery mechanics.

Biomechanical Phenomena↗
PubMed2006

[Kinesiological examinations and cutaneous EMG with integrated 3D UH system in adolescent idiopathic scoliosis (type: King 1-13)].

UNLABELLED: The origin of idiopathic scoliosis is unknown however there are many hypothesis. One of them is the biomechanic theory. The cause of spreading the cutaneous EMG is: noninvasive, and can be used during movements. AIM: Authors find by CMS system in their earlier examination, that range of right rotation (of idiopathic scoliotic spine King 1-3 type) increased. They supposed that the change of spine motion cause change in muscle functions also. To verify this hypothesis above: they made examinations by cutaneous EMG parallel to the kinesiological examinations.(CMS system, 3D ultrasound movement analyse). METHOD: Kinesiological examinations on 25 girls with idiopathic scoliosis (King 1-3) were performed parallel to examining cutaneous bilateral EMG on eight spinal close muscles. RESULT AND CONCLUSION: They established that beside functional movements there were a so called non-functional movement however this component were small. Analysing the results, they used phase and amplitude analysis. In the course of phase- and amplitude analysis, they took only those changes into consideration which were significantly different of the two side compared with to healty groups. In the course of phase- and amplitude analysis, they found: that muscle erector spine was weakened in strength and decreased in movement range. They intend to make clear the etiology part in idiopathic scoliosis.

Adolescent↗
PubMed1991

Transcutaneous electrical stimulation (TCES) for the treatment of adolescent idiopathic scoliosis: preliminary results.

The authors report on the results of a preliminary study on the treatment of progressive idiopathic scoliosis by electrical surface stimulation. The study, involving 30 spinal curvatures, showed stabilization of the median primary curvature (30 degrees) in the course of treatment, the median duration of which was 12 months. Overall, 73.2% of the curvatures treated, responded favorably (stabilization or regression of the curve); however, 26.8% of the curvatures progressed in spite of the transcutaneous electrical stimulation treatment. The only complication noted was contact eczema in 20% of the cases. The authors feel that surface electrical stimulation treatment can be regarded as an acceptable alternative to a brace in the treatment of idiopathic scoliosis, and at this stage it deserves a place in the conservative therapeutic approach to idiopathic scoliosis.

Adolescent↗
PubMed1991

Disproportionate body growth in girls with adolescent idiopathic scoliosis. A longitudinal study.

Two thousand, one hundred and eighty-nine southern Chinese women, aged 8-21 years, were studied: 541 with adolescent idiopathic scoliosis (176 treated with posterior spinal fusion and Harrington instrumentation, 150 with brace, and 215 who did not require any treatment), and 1,648 age-matched normal controls from schools and colleges. Scoliotic girls treated at Duchess of Kent Children's Hospital were examined clinically, radiologically, and anthropometrically, including a roentgenogram of the left hand for bone age, at yearly intervals from their first visit to hospital until maturity. Leg:spine and leg:arm ratios were calculated to study the proportionate body growth. The data obtained at first visit and at maturity for each treatment group were compared within treatment groups, and also with normal controls (all age-matched comparisons). The results are summarized as follows: The comparison of leg:spine ratio between fusion, brace, and untreated groups at first visit using uncorrected spinal length showed inconsistent results, but when these ratios were calculated using spinal length corrected for scoliosis, the results were all consistent, showing no significant difference between these groups at first visit. At maturity, leg:spine ratios, using either uncorrected spinal length or corrected spinal length, were highly significantly greater for the fusion group compared to the brace and untreated groups. The leg:spine ratio comparisons of scoliosis groups against normals showed that brace and fusion groups had highly significantly greater ratios at first visit and at maturity, using uncorrected spinal length. Similar comparison using corrected spinal length showed minimum or no difference at first visit, but at maturity, only the fusion group had a significantly greater ratio than normals.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

A prospective study of acute radiculopathy after scoliosis surgery.

We have prospectively studied 45 patients undergoing scoliosis surgery (48 procedures) for evidence of postoperative acute radiculopathy. Posterior spinal fusion was performed in 42 patients (Cotrel Dubousset 28, Harrington rod with wires 9, Hartshill rectangles 5); anterior spinal fusion in 5 (Webb Morley) and an anterior release procedure in 5. Fourteen patients (29%) had sensory and/or motor signs of radiculopathy post-operatively, with moderate to severe symptoms in 10 and mild symptoms in 4. The radiculopathies were considered traumatic in 7 patients, in whom radiculopathy correlated with placement of a hook or passage of a sublaminal wire. In the remaining 7 patients, traction was considered the likely mechanism of injury; in these there was a significant association with the degree of postoperative correction of the scoliosis where it was substantially beyond the preoperatively demonstrated flexible range (p = 0.008). A system of intraoperative electromyographic monitoring for possible prevention of this complication is described. Radiculopathy is a common complication of scoliosis surgery.

Acute Disease↗
PubMed1991

Vibratory response in adolescents who have idiopathic scoliosis.

The PVD Bio-Thesiometer was tested as a tool for measuring vibratory thresholds and for detecting possible differences in these thresholds between adolescents who have idiopathic scoliosis and those who do not. It was found to be limited by low reliability and large errors in measurement, with the metatarsophalangeal joint being the only reliable site for measurement. The vibratory thresholds at this site were significantly higher in the fourteen subjects who had scoliosis than in the twenty-two control subjects. No significant asymmetry in vibratory thresholds was found between the concave and convex or the right and left sides in either the scoliotic or the control group. Because there was no significant difference between the readings from the concave and convex sides, it is unlikely that a lesion of the posterior column is responsible for idiopathic scoliosis. If there is a difference, then the PVD Bio-Thesiometer is not sufficiently reliable to detect it.

Adolescent↗
PubMedDate not supplied

Anatomical leg length inequality, scoliosis and lordotic curve in unselected clinic patients.

Anatomic leg length inequality (LLI) and various mechanical measures of the lumbar spine, particularly scoliosis, lordosis and Ferguson's angle, were analyzed retrospectively from the X-rays of 106 consecutive patients in a private chiropractic practice. Results showed that 40% of the subjects had LLI greater than 6 mm while 70% had LLI greater than 3 mm. These data compared closely with studies done by other investigators, indicating that our routine diagnostic X-ray procedure is sufficient for accurately determining LLI. Our most noteworthy finding was that patients with LLI greater than 6 mm often (53% of the cases) had scoliosis and/or abnormal lordotic curves. Altered lordotic curves comprised both hypo- and hyperlordosis with about equal frequency. The correlation coefficients between the amount of LLI and any of the parameters taken singly, however, were not significant. The results of this study indicate that while there is no strong correlation between any one of the particular postural adaptations to anatomic leg length deficiency, nevertheless at least one abnormal spinal adaptation (scoliosis or hypo-hyperlordosis) occurs in over half of subjects who have LLI greater than 6 mm.

Anthropometry↗