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PubMed1983

Congenital upper limb anomalies and scoliosis.

In 104 children with various forms of congenital upper limb anomalies the incidence of idiopathic scoliosis was 6,7%. This is significantly higher than the 2,5% incidence in the general population. Patients with more severe anomalies such as amelia, phocomelia, hemimelia and thumb anomalies had a 40% incidence of scoliosis. With the current emphasis on early detection of scoliosis by the screening of schoolchildren, the obvious clue offered by a congenital abnormality of an arm or a hand should not be ignored.

Adolescent↗
PubMed1983

Changes in respiratory function in disorders of the thoracic cage. With special reference to the ventilatory mechanism and the regulation in scoliosis.

After describing the clinical and functional effects of pathological changes in the thoracic cage ("mechanical syndrome" and "neuromuscular syndrome"), the authors discuss the disorders of respiratory function observed in a group of patients with poliomyelitic scoliosis. The aim was to establish the type and nature of these changes with a view to clarifying certain pathogenetic aspects. Two factors suggest that the altered geometry of the thoracic cage in scoliosis is responsible for the mechanical inefficiency of the thoracopulmonary apparatus, namely: 1. changes in respiratory function, since there was a strict correlation between the severity of the scoliosis and the degree of change in certain indices of respiratory function (vital capacity, maximum expiratory volume per second, maximum ventilation per minute); 2. changes in the regulation of ventilation, indicated by: a) good correlation between the ventilatory response to CO2 and the severity of the anatomical lesion; b) a reduction in the occlusion pressure, which is regarded as the pressure available to produce ventilation.

Adolescent↗
PubMed1978

[Prognosis of idiopathic scoliosis].

The prognosis of the scoliosis is determined by early and exact treatment, which depends on the degree of curvature, age, localization and expected of deviation. Scoliosis up to 30 degrees is treated by physical therapy. Between 30-50 degrees an active treatment with the Milwaukee-brace is recommended. Over 50 degrees surgery is required, because further progression is to be expected. The Harrington procedure should now be used in all centers of scoliosis. Paraplegia is seen in 0,5%. Minor complications and better correction can be expected by surgery carried out in special centers.

Braces↗
PubMed1982

Surgical treatment of paralytic scoliosis associated with myelomeningocele.

The spines of forty patients with myelomeningocele and paralytic scoliosis were surgically stabilized at the Twin Cities Scoliosis Center between 1960 and 1979. Treatment with posterior spine fusion and Harrington instrumentation extending to the sacrum, combined with anterior fusion using either Dwyer or Zielke instrumentation, gave the best results, correcting scoliosis by an average of 45 degrees (comparing preoperative values with those at the last visit), lordosis by an average of 20 degrees, torso decompensation by an average of 5.7 centimeters, and pelvic obliquity by an average of 7 degrees. This combined fusion method reduced the rate of pseudarthrosis to 23 per cent (compared with 46 per cent when only posterior fusion and instrumentation were used). Prophylactic antibodies (selected on the basis of preoperative cultures of urine) reduced the infection rate to 8 per cent. Posterior fusion or anterior fusion alone was inadequate, even with instrumentation. Early mobilization wearing a bivalved polypropylene body jacket minimized osteoporosis, pressure sores, and social isolation. Unsolved technical problems remain, however, especially in relation to obtaining fusion across the lumbosacral joint.

Bone Transplantation↗
PubMed1982

The correlation of idiopathic lumbar scoliosis and lumbar lordosis.

A definite correlation exists between the presence of idiopathic lumbar scoliosis and hyperlordosis of the lumbar spine. Present data do not reveal whether hyperlordosis constitutes an element which makes a "spine at risk" for developing scoliosis. However, the presence of an extreme lordosis suggests that in any comprehensive plan of treatment of idiopathic lumbar scoliosis, provision should be made for correction of severe deformities of the lumbar spine.

Child↗
PubMed1978

Scoliosis, spondylolysis, and spondylolisthesis. Their relationship as reviewed in 539 patients.

Five hundred consecutive idiopathic scoliosis patients in whom routine oblique roentgenograms of the lumbosacral area were obtained, plus 39 patients with a presenting problem of spondylolisthesis, were reviewed in an attempt to answer questions concerning the best therapeutic approaches in patients having coincident scoliosis and pars defects. The incidence of pars defects in patients with idiopathic scoliosis was found to be 6.2%, slightly higher than in the white female population at large. The indications for a surgical approach to the pars defect and/or the spinal curvature parallel the indications for each problem arising independently.

Adolescent↗
PubMedDate not supplied

Progression of idiopathic scoliosis: an analysis of muscle actions and body weight influences.

The tendencies of lateral curves in the spine to increase were analyzed using biomechanical models. The effects of contractions of the trunk muscles and of use of different strategies to support upper body segment weights in upright positions of the trunk were investigated in model spines with five structurally normal initial configurations and 13 different initial configurations of scoliosis. Forces that represented these trunk muscle contractions and body weight applications were applied to the model spines, and the resulting configurational changes were computed. These changes were then examined to see to what extent altered loads on the spine might plausibly explain lateral curve progression tendencies in idiopathic scoliosis. The study findings suggest that if the progression of idiopathic scoliosis results from trunk neuromuscular system malfunctions, the malfunctions are more likely to be in the neural systems that control trunk muscle contractions and body weight support strategies than in the functional capabilities of the muscles themselves.

Biomechanical Phenomena↗
PubMed1980

Congenital non-progressive myopathy, associated with scoliosis--clinical, histological, histochemical and electron microscopic studies of seven cases.

Five cases of central core disease, one case of multicore disease and one case of non-specific myopathy, all of which were associated with scoliosis, were studied in regard to clinical features, histology, histochemistry and electron microscopy. The characteristic clinical features were non-progression, delayed motor development and proximal muscle weakness. Muscle biopsy was the most important diagnostic procedure. Routine histology might not reveal core regions where oxydative enzymatic activity was decreased or was absent in the muscle fibers, but histochemistry disclosed clearly single or multiple core regions. Electron microscopy showed a structured or unstructured core in central core disease. Scoliosis was commonly associated and was very similar to idiopathic scoliosis. Some curves did not progress while others progressed and did not cease progression with maturation. Surgical correction and stabilization was carried out on two cases without complication. The importance of recognition of these myopathies was emphasized.

Adolescent↗
PubMed1980

The effect of pregnancy on idiopathic scoliosis.

To study the effect of pregnancy on idiopathic scoliosis, ten patients were followed through nineteen pregnancies. Three patients lost 2, 6, and 18 degrees of correction during their initial pregnancies, but the curves remained the same or improved with later pregnancies. The curves of the remaining seven patients, which had stabilized before conception, did not progress. The stability of the scoliosis was not related to the age of the patient. Stable scoliotic curves did not progress with pregnancy in patients in the second decade of life, while unstable scolioses progressed in patients as old as the third decade. The amount that the curve increased was not associated with the initial size of the curve. We hope that our experience will aid orthopaedists in counseling their patients regarding the effect of pregnancy on the magnitude of scoliosis.

Adolescent↗
PubMed1980

Equilibrium factors as predictors of the prognosis in adolescent idiopathic scoliosis.

Postural equilibrium factors were evaluated as indicators of the prognosis in 52 patients with adolescent idiopathic scoliosis. The hypothesis was that dysfunction in these equilibrium factors might imply a higher risk for the curve to progress. The postural equilibrium was studied by stabilometry, and the function of the central nervous system was assessed by electoencephalography (EEG) and the vestibular function by electronystomography (ENG). During a follow-up period averaging 2.9 years, ten patients showed progression of the scoliosis. No differences were found in the distribution and frequency of abnormalities between the patients with progressive and nonprogressive scoliosis. Stabilometry, electroencephalography, and electronystomography as used in this study did not seem to be of predictive value for the outcome in the individual case.

Adolescent↗
PubMed1980

Combined radionuclide phlebography and lung scanning in patients operated on for scoliosis with the Harrington procedure.

Iliac vein thrombosis is an uncommon type of deep vein thrombosis (DVT) that occurs in young patients following surgical procedures for scoliosis. The symptomatology is diffuse and this type of DVT carries a risk for fatal pulmonary embolism as well as the development of a postphlebitic syndrome. Combined radionuclide phlebography and lung scanning were performed in 16 patients operated on for scoliosis with the Harrington procedure. In three patients with diffuse pain in the inguinal region, iliac vein thrombosis was easily visualized in the radionuclide phlebogram and confirmed by conventional phlebography in two cases. Six patients without lung symptoms had perfusion defects typical for pulmonary embolism. It is concluded that radionuclide phlebography can be recommended as a diagnostic procedure for iliac vein thrombosis in patients with diffuse symptoms in the inguinal region or the lower abdomen after scoliosis surgery. Advantages include the ease of performance, good patient acceptance and low radiation dose compared with conventional phlebography. Asymptomatic pulmonary embolism as diagnosed by the perfusion lung scan was an unexpected finding which raised clinical considerations that require further investigations.

Adolescent↗
PubMed1980

[Scoliosis and mitral valve prolapse. An epidemiological and etiopathogenetic screening (author's transl)].

The Authors have developed an epidemiologic screening among 299 subjects girl's secondary school (average 16.5 years) to verify the incidence of idiopathic mitral valve prolapse (MVP) and associated thoracic-skeletal abnormalities in young female people. The MVP was assessed in 10 subjects (3.3%), scoliosis in 41 subjects (13.7%). The MVP incidence among scoliotic subjects was 19.5% (8 among 41). To verify a possible common systemic connective tissue disorder between scoliosis and MVP, three groups of subjects (control, scoliosis, MVP), were visited by orthopedist, considering the incidence of following clinic parameters: recurvated knee, flat or valgus foot, pectus excavatum, lofty scapulas, joint and skin laxity. A significative increasing incidence of these parameters was found from the control group to the MVP group. Considering these parameters as index of a probable systemic connective tissue disorder, the hypothesis of a mesenchimal etiopathogenesis of MVP is confirmed.

Adolescent↗
PubMed1994

Manipulation for the control of back pain and curve progression in patients with skeletally mature idiopathic scoliosis: two cases.

OBJECTIVE: This report of two cases illustrates the potential effect of chiropractic manipulative therapy on back pain and curve progression in the at-risk, skeletally mature patient with adolescent idiopathic scoliosis. CLINICAL FEATURE: Two patients suffering from lumbar scoliosis and chronic back pain. Both had scoliosis that had progressed after skeletal maturity. INTERVENTION AND OUTCOME: Diversified type chiropractic manipulative therapy was used palliatively for back pain relief in one case, and routinely 1-2 times per month in the other case. The manipulation was applied manually, with the patients in the prone and side-posture positions. Vertebral levels manipulated were identified as fixated/dysfunctional segments based on static and/or motion palpation. They were generally applied to areas above and/or below the curve apex. When applied at the apex, cavitation was more easily achieved when the direction of thrust was into the concave side. This was also tolerated better by the patient. No attempt was made to "straighten the curve" by thrusting into the convex side. Gentle manual intersegmental mobilization, stretching and muscle massage techniques were also applied. The case treated palliatively had curve progression consistent with the literature over an 8-yr period. The case treated routinely did not. The procedure was effective in both cases for subjective relief of back pain. CONCLUSIONS: Diversified-type CMT has a favorable effect on acute back pain when used palliatively. The procedure may also have a favorable long term effect of preventing recurrence of back pain and on retarding curve progression when used routinely 1-2 times per month.

Adult↗
PubMed1995

Absent superficial abdominal reflexes in children with scoliosis. An early indicator of syringomyelia.

We describe 12 children with idiopathic scoliosis who had a persistent absent superficial abdominal reflex (SAR) on routine neurological examination. MRI showed syringomyelia to be present in ten. The average age at detection of the scoliosis was 4.3 years and at diagnosis of syringomyelia 6.6 years. In all ten children the SAR was consistently absent on the same side as the convexity of the curve. In two it was the only abnormal neurological sign. An absent SAR in patients with scoliosis is an indication for investigation for underlying syringomyelia. In the children with syringomyelia, six had thoracic and four thoracolumbar curves. The clinical features differed in the two groups. Patients with thoracic curves were generally asymptomatic. Their neurological signs were subtle and none had any motor signs. By contrast, patients with thoracolumbar curves had symptoms and neurological signs. Abnormal gait was present in all four patients with thoracolumbar curves. In three this was due to considerable motor weakness. In eight children syringomyelia was associated with a Chiari-I malformation. In seven the syrinx was treated surgically by decompression of the foramen magnum.

Arnold-Chiari Malformation↗
PubMed1995

[Terminology of scoliosis].

The most important entries concerning scoliosis have been presented in an alphabetical order. Some definitions, better describing three-planar scoliosis deformity, suggested by Scoliosis Research Society have been included.

Humans↗
PubMed1995

Computed radiography in scoliosis. Diagnostic information and radiation dose.

The diagnostic information and radiation dose in scoliosis examinations performed with air-gap technique using stimulable phosphor imaging plates were determined in a prospective study. Overlapping p.a. images of the thoracic and lumbar spine in 9 patients were obtained with 4 different exposure settings according to patient size. Equal exposure settings were used for the 2 images. Two images of 18 were judged inferior in depicting the landmarks of scoliosis measurement, requiring re-exposure. Sixteen images were judged of adequate or good quality. The mean entrance doses in the central beam for the 4 patient groups were in the interval of 0.05 to 0.12 mGy for both images. The skin doses on the breasts were in the range of 0.00 to 0.03 mGy. The presented technique thus results in a low radiation dose with sufficient diagnostic information in radiography of scoliosis.

Adolescent↗
PubMed1995

[Transient tracheal obstruction during surgical correction of scoliosis in a patient with Marfan's syndrome].

A 13-yr-old male with Marfan's syndrome underwent surgical correction of severe scoliosis. He had not manifested dyspnea previously in any position. Under anesthesia with thiamylal and vecuronium, his trachea was intubated with a reinforced endotracheal tube without any difficulty. Anesthesia was maintained with nitrous oxide and fentanyl, 8 micrograms.kg-1. The patient was placed in a prone position. Thirty min after the start of operation, when orthopedists compressed the thoracic vertebrae vertically, positive pressure ventilation became impossible abruptly, even with a high airway pressure. Three min later, ventilation became possible after cessation of compression and by mouth-to-tube insufflation. SpO2 monitored with a pulse oximeter recovered immediately from 61% to 99%. A capnogram showed a lengthy retardation of an inspiratory phase. Emergency fibreoptic bronchoscopy revealed that the trachea had been compressed vertically; the compression was reduced by moving the chest supporters laterally. After the apneic episode, the operation continued uneventfully, and he was discharged a month later. A severe deformity of the thorax due to severe scoliosis and weak tracheal tissue due to connective tissue defect caused partial tracheal compression before the surgery, and made his trachea susceptible to complete obstruction by vertical external compression on the thorax. Patients with Marfan's syndrome and scoliosis should have careful preoperative airway evaluation. The selection and positioning of endotracheal tubes should be done with care. During surgery, the patient's body position and the condition of the trachea should be checked frequently. Capnography and fiberoptic bronchoscopy seem to be mandatory for early detection of tracheal stenosis and prevention of tracheal obstruction.

Adolescent↗
PubMed1995

[Principles in management of surgical treatment for idiopathic scoliosis using Cotrel-Dubousset and Texas Scottish Rite Hospital instrumentation with consideration for obligatory terminology].

The authors illustrated principles of surgical treatment for idiopathic scoliosis. Methods of vertebrae selection for hooks implantation depending on scoliosis type are discussed. Differences in surgical technique have been highlighted in respect to idiopathic lordosis-scoliosis and kyphoscoliosis.

Equipment Design↗