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At least 1,351 records · Page 75Linked to original sources
PubMed1991

Reduction of lumbar scoliosis by use of a heel lift to level the sacral base.

The relationship between unlevelness of the sacral base and scoliosis is unclear. A method for reducing mild lateral bend of the lumbar spine by use of a heel lift to level the sacral base was tested in adults. Special methods were used to demonstrate the weight-bearing plane of the sacral base and the angle of lateral bend radiographically. The procedure significantly decreased the unlevelness of the sacral base and significantly reduced the angle of lateral bend. The results suggest that an unlevel sacral base contributes to lumbar scoliosis and that use of a heel lift to level the sacral base in mild cases of lumbar scoliosis can be beneficial.

Female↗
PubMed1990

[Experiences in general anesthesia of patients with scoliosis presupposed to have difficulties in airway maintenance].

We experienced general anesthesia of two patients with cerebral palsy presupposed to have difficulties in tracheal intubation by reason of scoliosis. Case 1 is a 26-year-old woman. Chest X-ray photography and respiratory sounds in both pulmonary areas indicated neither airway stricture nor respiratory distress, but severe scoliosis presupposed difficult tracheal intubation. However, under the impression of possible intubation obtained by preoperative laryngoscopy, orotracheal intubation was tried with rapid induction. Epiglottis deviation to the left noted upon developing larynx made the glottis direct invisible, but some compression of cricoid from outside barely succeeded in intubation. The fixation of the endotracheal tube found much difficulties in its proper positioning so as to make stethoscopy uniform in both pulmonary areas, but trial rotations of the tube both in various directions and at various depths barely managed to find a position of uniform stethoscopy in both pulmonary areas, in which position the tube was fixed as proper positioning. Anesthesia was performed by nitrous oxide.oxygen.halothane; peroperative hemodynamics remained stable and arterial blood gas analysis presented no problems. Case II is a 16-year-old man. Resting respiration presented stridor and chest X-ray photography indicated scoliosis and laryngeal stricture. Patient's lack in the degree of cooperation made laryngoscopy impossible. Thus, in view of a high possibility of difficult tracheal intubation, orotracheal intubation was tried under the control of spontaneous respiration. While the intubation was being carried out by means of a stylet without developing larynx, severe bronchostriction was palpable at the point when the tube barely passed through the glottis, making the intubation impossible. However, the tube barely managed to be inserted while rotating with the stylet being extracted. Anesthesia was carried out by nitrous oxide.oxygen.halothane; peroperative hemodynamics underwent no remarkable change and arterial blood gas analysis presented no problems.

Adolescent↗
PubMed1990

[Use of the halo-gravitation-extension in preoperative preparation in severe scoliosis].

Severe and fixed scoliosis needs a preoperative extension treatment to attain a good result of correction by spondylodesis. Halo-up-extension is a very simple, comfortable and successful method to prepare patients with a severe scoliosis for operation. From January 1981 to July 1989 we carried out the preoperative halo-up-Extension treatment at 45 patients. 39 of them had a severe scoliosis with a cobb-angle of more than 70 degrees. The correction by halo-up-Extension runs on an average of 35% of the total correction.

Adolescent↗
PubMedDate not supplied

Scoliosis in pediatric spinal cord-injured patients.

One hundred thirty children who sustained spinal cord injuries between birth and age 21 years were reviewed to determine the progression rate of paralytic scoliosis and the effects of bracing and surgery. Patients were divided into two groups: those injured before and those injured after the adolescent growth spurt. Scoliosis developed in 97 and 52%, respectively. Bracing was effective in delaying progression in the preadolescent group. The progressive paralytic spinal deformity did not appear to be related to the level of injury. The older patient is at much less risk for paralytic scoliosis, but still requires routine examination.

Adolescent↗
PubMed1990

One-stage anterior and posterior hemivertebral resection and arthrodesis for congenital scoliosis.

Seven children who had congenital scoliosis due to a single, fully segmented lumbar hemivertebra were treated with single-stage anterior and posterior vertebral resection and arthrodesis. The scoliosis averaged 47 degrees preoperatively, 14 degrees postoperatively, and 15 degrees (approximately 70 per cent correction) after an average follow-up of 45.6 months. Four patients had thoracolumbar kyphosis preoperatively, and it remained unchanged at the most recent follow-up examination. Postoperatively, a cast was worn for twelve to sixteen weeks, after which a brace was applied. There were no neurological deficits, infections, deaths, or pseudarthroses. The combined procedure was well tolerated and, in the limited period of follow-up, the congenital scoliosis did not progress.

Child↗
PubMedDate not supplied

Radiation exposure to patients receiving routine scoliosis radiography measured at depth in an anthropomorphic phantom.

Concern about the amount of radiation received during scoliosis evaluation and treatment led us to measure radiation exposure in an anthropomorphic phantom to determine the increased risk of breast cancer in young women with scoliosis. Assuming that 22 radiographic examinations were performed over the course of scoliosis treatment, the increased relative risk of breast cancer was determined to be 0.22% in these patients.

Adolescent↗
PubMedDate not supplied

[Genitourinary anomalies in children with congenital scoliosis].

Congenital scoliosis has been associated with malformations of several systems but little attention has been paid to those of the urinary tract. Thirty five patients among 100 children with congenital scoliosis were included in this review because they had been further explored by abdominal ultrasonography or excretory urography. There were 19 female patients (54%). Age ranged from 3 months to 11 years when images were taken. Twelve patients (34%) had 15 urological abnormalities, the most frequent of these was unilateral renal agenesis (36%). In 9 of 12 affected children there were additional defects in a third system (central nervous, cardiovascular or gastrointestinal). On this basis routine abdominal ultrasonography for children with congenital scoliosis seems justified.

Child↗
PubMed1989

Scoliosis surgery in neurofibromatosis.

Twenty-three patients who were treated by posterior spinal fusion with neurofibromatous scoliosis were reviewed to study the adequacy of spinal fusion, rate of pseudarthrosis, and incidence of complications. Twenty patients achieved a solid fusion with posterior surgery alone. Thirteen patients required one or more posterior augmentation procedures because of progressive deformity. Three patients with dystrophic kyphoscoliosis required an anterior spinal fusion in addition to the posterior fusion to achieve a solid fusion mass. The type of graft material, Harrington instrumentation, and degree of kyphosis or scoliosis had no effect on the rate of pseudarthrosis. Preoperative neuroradiographic evaluation was found to be warranted for all patients with neurofibromatous scoliosis.

Adolescent↗
PubMed1989

[Personal experience with the Milwaukee orthosis in the treatment of idiopathic scoliosis].

The authors evaluate the results of treatment of idiopathic scoliosis by a Milwaukee brace in 192 patients with treatment initiated and terminated in 1975 to 1985. In the group of 116 juvenile scolioses at the end of the investigation 26 had improved, 53 did not improve and 37 deteriorated. In the group of adolescent scoliosis 18 improved, 44 did not improve and 11 deteriorated. In the group of improved patients the number of persons declines with the time interval after completed treatment. With the increasing severity of the initial curve the effect of treatment by a brace diminishes. The percentage of non-cooperating patients is substantially higher in the group of not improved and deteriorated cases. In 26 selected patients the authors investigated the lordosis-promoting effect of the brace on the thoracic spine. Because of progression of the deformity the authors operated 12 patients with juvenile and one patients with adolescent scoliosis.

Adolescent↗
PubMed1988

TLSO treatment of idiopathic scoliosis. An analysis of the Wilmington jacket.

A retrospective study of one hundred female patients treated for idiopathic scoliosis using an underarm plastic thoracolumbar-sacral orthosis (TLSO) jacket was undertaken. The purpose of the study was to evaluate the efficacy of the Wilmington jacket, to search for clinical variables which could statistically predict success, and to evaluate preliminary results of parttime bracing in 25 patients. The following parameters were statistically evaluated by multiple regression analysis: age, sex, curve location, number of vertebrae in curve, Cobb angle, maturity (Risser sign, menarche), curve flexibility, and hours in the jacket. The overall success rate was 81%, and onset of menarche and Risser sign were statistically significant prognostic variables. Ten patients (10%) underwent posterior spinal fusion for curve progression. Bracing with an underarm scoliosis jacket is a successful method of treatment of idiopathic scoliosis in the immature spine. We do not recommend brace treatment for postmenarchal patients or patients with a Risser sign of Grade 1 or greater until curve progression has been observed. Furthermore, the Wilmington jacket appears to give similar results for part-time brace wearers.

Adolescent↗
PubMed1988

Osteoporosis in unstable adult scoliosis.

New noninvasive techniques as well as conventional methods were used to evaluate skeletal mass in the following three populations of adult white women as follows: (1) 79 subjects with preexisting idiopathic scoliosis designated as unstable (US) because of the associated presence in the lumbar spine of lateral spondylolisthesis with segmental instability; (2) 67 subjects with preexisting idiopathic scoliosis without lateral spondylolisthesis designated as stable (SS); and (3) 248 age-matched nonscoliotic controls. Ages in all three groups were categorized into premenopausal (25-44 years), perimenopausal (45-54 years), and postmenopausal (55-84 years). The results showed higher scoliosis morbidity in the US compared to the SS populations. The prevalence and severity of osteoporosis were markedly increased in US versus SS populations. Femoral neck density determined by dual-photon absorptiometry techniques averaged 26% to 48% lower in all age categories of US patients compared to controls. These changes were found in the youngest age groups, indicating reductions in bone mineral content earlier in the adult life of white women with a specific type of high-morbidity US characterized by the marker of lateral spondylolisthesis.

Adult↗
PubMed1988

Vertebral rotation during the initial stages of scoliosis: the costovertebral interaction mechanism.

The authors analyse the costovertebral joint mechanism related to vertebral rotation in cases of idiopathic scoliosis and compare them to analogous clinical costal asymmetry caused by asymmetrical vertebral growth in the absence of scoliosis. In the opinion of the authors, it is the different mechanism of costal leverage that is the basis of the various aspects of thoracic deformity both in idiopathic scoliosis and in growth asymmetry.

Biomechanical Phenomena↗
PubMed1988

Control of blood loss during scoliosis surgery.

By combining surgical and anesthetic techniques that minimize blood loss with the use of autotransfusion, it should now be possible to complete a routine posterior spinal fusion without using allogeneic blood transfusions. Surgical efforts should include careful preoperative planning, positioning with the abdomen hanging free, use of topical hemostatic agents, and decortication late in the procedure. Preoperatively donated autogeneic blood or reclaimed red cells from suction can take the place of allogeneic transfusions. Blood loss during scoliosis surgery correlates closely with left ventricular stroke work index (LVSWI), a measure of blood flow calculated from systemic vascular resistance, cardiac output, and heart rate. All of these parameters are under the anesthesiologist's control, making him the primary determinant of blood loss in scoliosis surgery. Induced hypotensive anesthesia may be ineffective in controlling blood loss if the cardiac output or heart rate is high. Halothane, a commonly used hypotensive agent, is not very useful for scoliosis surgery because spinal cord monitoring and wake-up testing are not possible. Rebound hypertension has been noted with the use of sodium nitroprusside. Trimethaphan works well clinically but experimentally it reduces spinal cord blood flow, which may increase the risk of spinal cord injury.

Anesthesia↗
PubMed1988

Natural history and school screening for scoliosis.

In light of the questions and controversy regarding school screening for spinal deformities, should the programs be dropped? The natural history is not completely known and the results of nonoperative treatment questioned. The costs are high due to over-referral and numerous physician visits and radiographs. Would it not be best to wait until the epidemiologic questions are answered? The best approach is one in the middle ground. The program needs to be organized and strengthened. With the education of screeners, over-referral can be reduced. The treating physician must confirm the physical finding, take appropriate radiographs, and plan appropriate follow-up. In this way, the costs will be reduced. In addition, with knowledge regarding natural history, only larger curves or progressive curves will be treated. Nonoperative treatment of idiopathic scoliosis is effective. It can control progression and even result in correction of some curves. The overall effectiveness of braces and electrical stimulation needs to be constantly reviewed. How do these forms of nonoperative treatment affect the progressive curve, and do they reduce the need for surgery in idiopathic scoliosis? Only after we have more studies on natural history and on the results of nonoperative treatment can screening for scoliosis be reassessed to determine its role in the overall treatment program of spinal deformities.

Adolescent↗
PubMed1988

The posterior tether in scoliosis.

The hypothesis that a localized lordosis, or tethering of the posterior elements of the spine, is the primary cause of the vertebral rotation in idiopathic scoliosis was investigated in anatomic specimens of human and calf spinal columns. The specimens were axially loaded with and without a posterior tether created using Zielke instrumentation. Lateral deflection and axial rotation were monitored roentgenographically. The vertebrae of tethered spines showed increased rotation in the direction associated with idiopathic scoliosis. The spinous processes moved toward the concavity at the apex of the induced lateral curve. Conversely, untethered spines either exhibited little rotation or rotated in the opposite direction; the spinous processes moved toward the convexity of the curve. Rotations toward the convexity occur in rotational kyphosis. Thus the hypothesis that idiopathic scoliosis is a rotational lordosis is substantiated; the characteristic rotation can be explained with the aid of a geometric model.

Animals↗
PubMed1988

Screening school children for scoliosis.

Idiopathic scoliosis can be detected by early screening of school children in school clinics, a method which improves the detection rate. By early detection, many curves that would require surgical treatment can be prevented from reaching that severe magnitude. Much valuable data regarding the natural history of idiopathic scoliosis have been derived from screening programs. On the other hand, costs of screening are not inconsequential, and costs involved in follow-up procedures are high. Vast numbers of small, nonprogressive curves are discovered and followed. Several questions remain. (1) At what ages should school children be screened? (2) Should boys be screened? (3) What should be the criteria for referral or treatment? (4) What is a reasonable follow-up program? (5) How effective is nonoperative treatment? Careful study of the natural history and treatment of idiopathic scoliosis will help to answer these questions.

Adolescent↗
PubMed1988

Spine and back-shape changes in scoliosis.

Thirty-five untreated patients with scoliosis were studied by Cobb radiography and back-surface photogrammetry on each of at least two clinic visits. Also, the maximum vertebral axial rotation was measured. Each pair of patient visits was classified as showing either a progression, improvement, or no change in the scoliosis using a threshold of 5 degrees change in the Cobb angle. The computer Cobb measurement was the most precise measurement, and the back-surface measurements were the least precise. The Cobb measurement of scoliosis is the most precise for detecting small changes, but can be improved by a computerized analysis of digitized radiographs.

Adolescent↗
PubMed1988

Idiopathic scoliosis and growth--a biomechanical consideration.

Growth force proposed as an etiological factor in idiopathic scoliosis was analysed by a mathematical simulation; the results were compared with clinical roentgenograms of patients with idiopathic scoliosis. Growth force is a self-equilibrating internal stress derived from unbalanced growth between two adjacent structures with different growth rates. In the simulation, the localized growth force made the whole spinal column buckle. Two hundred anteroposterior roentgenograms were then compared with the buckling curves. The three most similar buckling curves for each roentgenogram were selected. Of the 600 selected curves, 406 were considered to have produced a high similarity. The curves produced by a growth force extending over a small area, especially at the mid-lower thoracic and lumbar regions, were qualified as curves with a high similarity. The growth force thus does not appear uniformly all over the spinal column but locally and at the mid-lower thoracic or lumbar region. This growth force may represent a factor in the etiology of idiopathic scoliosis.

Biomechanical Phenomena↗