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PubMedDate not supplied

The incidence of spina bifida occulta in idiopathic scoliosis.

A review of the roentgenograms of the spine of 100 patients with idiopathic scoliosis and 371 parents and siblings used as controls, showed an incidence of spina bifida occulta of 34 per cent and 41 per cent in their siblings. There was no increase in the incidence of spina bifida occulta in the patients with idiopathic scoliosis as compared with the control group. A review of the parents of these patients showed an incidence of spina bifida occulta of the lumbosacral area of 9 per cent in the mothers, and 13 per cent in the fathers, thus showing a decrease in the incidence of spina bifida occulta in the adult as compared with the teenager. The studies in the adult confirm the finding in the teenagers. There is no increased incidence of spina bifida occulta in idiopathic scoliosis.

Adolescent↗
PubMed1994

The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study. Part II: Perception of health, self and body image, and participation in physical activities.

OBJECTIVES: This study determined the health and well being of persons with adolescent idiopathic scoliosis (AIS) more than 10 years after referral. This communication will present results related to the perception of health, self and body image, and difficulty with selected physical activities. STUDY DESIGN: The study was designed as a comparative retrospective cohort study. Subjects referred for AIS between 1960 and 1979 to a large pediatric hospital in Montreal, Quebec were entered in the cohort. A population-based control group was selected from the general population of Quebec at the time of survey. METHODS: Health outcomes were assessed by a postal questionnaire administered to the AIS cohort and to the control group. Most outcomes were ordinal and, thus, odds ratios were estimated using ordinal regression while adjusting for potential confounding factors. RESULTS: AIS subjects, particularly those who were surgically treated, had a significantly higher prevalence of self-reported arthritis. Scoliosis subjects perceived themselves to be less healthy than other persons the same age and, particularly among women, scoliosis subjects had a poorer perception of body image, and had more physician visits and days ill than control subjects. In addition, male and female AIS subjects had more difficulty with physical activities. This rather negative perception of health could be a result of actual illness or a result of more concern about illness. Nevertheless, they had a more positive perception of self and appeared to be able to cope with their affliction and disfigurement in a positive way.

Adolescent↗
PubMed1976

[Diastematomyelia--its importance in the treatment of congenital scoliosis].

The risk of neurologic complications following corrective surgery in congenital scoliosis is ten times greater than in idiopathic scoliosis, the main reasons being transfixation of the spinal cord by diastematomyelia or by other adhesions of the spinal cord. Therefore preoperative myelography is advisable in congenital scoliosis. The typical findings from 3 cases of diastematomyelia, as shown by myelography and by operation, are presented. The clinical and x-ray features are shown as well as neurological signs, which are easily overlooked.

Child↗
PubMedDate not supplied

Scoliosis surgery: a risk factor for cholelithiasis?

Scoliosis surgery has been associated with pancreatitis and acalculous cholecystitis, and also has been implicated as a risk factor for cholelithiasis. A prospective study of 36 children and adolescents undergoing scoliosis surgery was performed using ultrasound to determine the incidence of cholelithiasis following spine surgery. The patients underwent abdominal ultrasound exams preoperatively, immediately postoperatively, and then at intervals following surgery with 2-5-year follow-up. Four of 36 patients (11.1%) (one male, three female) developed gallstones, although all had been free of gallstones after surgery. The gallstones appeared between 2 + 5 and 5 years after surgery. Those with gallstones were not different from those without with respect to 14 factors. It is concluded that scoliosis surgery is not a risk factor for gallstones, because of the delay in onset of cholelithiasis after surgery. Furthermore, the prevalence of gallstones in this study sample is not greater than that reported in historical control studies of European young adults.

Adolescent↗
PubMed1994

Vertebral growth after posterior spinal fusion for idiopathic scoliosis in skeletally immature adolescents. The effect of growth on spinal deformity.

We studied 29 girls and one boy with adolescent idiopathic scoliosis who were at Risser grade 0 at the time of posterior spinal fusion and were followed until maturity (mean 7.8 years). We used serial radiographs to measure the ratio of disc to vertebral height in the fused segments and to detect differential anterior spinal growth and assess its effect on scoliosis, vertebral rotation, kyphosis, and rib-vertebral-angle difference (RVAD). From one year after surgery to the latest review, the percentage anterior disc height decreased by nearly one-half and the percentage posterior disc height by nearly one-third in the fused segments (p < 0.001). There was a 4 degree increase in mean Cobb angle (p < 0.001), 11 patients (37%) having an increase of between 6 degrees and 10 degrees. There was a significant increase in mean apical rotation by 2 degrees (p = 0.003), and four patients (13%) had an increase of between 6 degrees and 16 degrees. There was little change in kyphosis. There was an increase in mean RVAD by 4 degrees (p = 0.003), seven patients (23%) showing a reduction by 1 degree to 7 degrees, and 11 (37%) increases of between 6 degrees and 16 degrees. Spinal growth occurs after posterior fusion in adolescents who are skeletally immature, as a result of continued anterior vertebral growth. There is some progression of scoliosis, vertebral rotation, and RVAD, but little change in kyphosis. The increase in deformity is not enough to warrant the use of combined anterior and posterior fusion. The findings are relevant to the management of progressive curves, the timing and extent of surgery, and the prognosis for progression of deformity in this group of patients.

Adolescent↗
PubMed1994

[Natural course in idiopathic scoliosis].

We still do not know enough about the natural course of untreated idiopathic scoliosis although more knowledge would be desirable from the point of view of deciding on adequate conservative treatment or operative therapy. We present the natural course of 110 cases of marked scoliosis and 135 cases of slight, untreated scoliosis with respect to age, sex and localization of the curve. The results are compared to those of other authors.

Adolescent↗
PubMed1994

Congenital scoliosis of the cervical or cervicothoracic spine.

Congenital cervical or cervicothoracic scoliosis is an unusual but potentially severe disfiguring cause of spinal deformity in the growing child and adolescent. These forms of scoliosis are among the most infrequently encountered, and therefore, relatively little literature is available to guide the orthopedic surgeon. This article presents a brief overview of the etiology and epidemiology of these rare forms of scoliosis, defines the pathoanatomic variants, reviews the nonoperative treatment methods available, and discusses the role of early recognition and recommendation for spinal arthrodesis of those curves that clearly need surgical stabilization.

Cervical Vertebrae↗
PubMed1993

[The development of spinal movements and sagittal curves in postural defects, idiopathic scoliosis and Scheuermann disease (results of longitudinal studies on 5, 10 and 14 year old subjects)].

A given population was followed by authors for 10 years. Children suffering from postural defects, structural scoliosis, spinal osteochondrosis were separated from a normal group. Spinal mobility and posture were compared with the mobility of normal, healthy boys and girls aged 5-14 years. In postural defects physiologically curves could be seen. The range of motion hasn't been physiologic in structural scoliosis. The rotation and flexion of the spine were increased while the lumbar flexion was decreased. Physiologic trend was found in Scheuermann disease, however high values of spinal rotation wasn't found. Extremely increased thoracic kyphosis was found only in children aged 14 years. Perhaps the change of motion is an etiologic factor in structural scoliosis.

Adolescent↗
PubMed1993

Correction of scoliosis with shape-memory alloy.

Using NiTi shape-memory alloy, we devised an instrument for correction of scoliosis. Our instrument is characterized by gradual correction of the spine. Restoration power of the alloy was 25 kgcm in a rod with a diameter of 3 mm, 45 kgcm in a 4-mm rod, and 110 kgcm in a 5-mm rod. Spinal cord injuries on heating the rod were observed at an epidural temperature of 48 degrees C or more, suggesting that 48 degrees C is the critical temperature. The blood Ni concentration after implantation of the NiTi alloy rod reached a level twice normal after 6-9 hours. After 4 weeks, the Ni concentration increased 4-fold in the kidneys, 2-fold in the liver, and 10-fold in the urine. Alloy rods were attached to a scoliosis monkey and heated gradually. Scoliosis with a Cobb angle of 43 degrees was completely corrected.

Alloys↗
PubMed1995

[Possible relationship between idiopathic scoliosis and morphologic somatotypes in adolescent females].

This retrospective study was conducted to verify the possibility of a relationship between morphological somatotypes and Adolescent Idiopathic Scoliosis (AIS). The sample was composed of 77 adolescent girls presenting Idiopathic Scoliosis. In every case, scoliosis was important enough to necessitate a corrective surgery. The control group (historical type) was taken from an anthropometric study done in 1990 [5]. Morphotypes were evaluated from medical slides with pre-established criteria based on Sheldon's technique [3, 4]. Three somatotype values were obtained: One for ectomorphism, a second for mesomorphism and a third for endomorphism. This classification system is calibrated in a way that the summation of these 3 values necessarily gives 7. AIS patients appear less mesomorphic with a mean value of 1,208 +/- 1.03 than the control group with a mean value of 1,923 +/- 0.89 (Student "t" test: 6,149, p < 0.0001). Based on these results, a relationship between morphological somatotypes and the presence of AIS appears possible. A more elaborate prospective study will be needed to support this hypothesis.

Adolescent↗
PubMed1996

Adolescent idiopathic scoliosis: an update.

Adolescent idiopathic scoliosis is defined as a lateral spinal curvature of greater than 10 degrees, for which no pathologic cause can be determined. The initial assessment of adolescents with scoliosis focuses on identification of any treatable underlying pathology. Adolescents with scoliosis typically are asymptomatic and have normal neurologic and physical examinations, with the exception of curvature of the spine. Treatment strategies are determined by the risk of progression. This risk depends on the extent of the curvature and anticipated future spinal growth. The extent of the curvature may be estimated by use of a scoliometer and verified by calculation of the Cobb angle on radiographic evaluation. Skeletal maturity may be estimated by several methods, including radiologic estimates of ossification by bone atlas or Risser sign. Treatment strategies include bracing and surgery.

Adolescent↗
PubMed1996

[Present views on nonoperative treatment for idiopathic scoliosis].

The authors have presented valid modern procedure principles in nonoperative treatment of idiopathic scoliosis. It was referred to classification based on infantile, juvenile and adolescent scoliosis, discussing in each of them indications and treatment modes. Beside own experiences were cited many important observations of other authors and it was pointed out, that success of nonoperative treatment is variable and is being based on individual experience of many orthopaedic surgeons, and requires critical analysis of their procedure. Long follow up period of children with scoliosis, bracing and precise X-rays evaluation requires not only surgeons patience but also that of treated children and their parents. Arduous and apparently ineffectively treatment enable in many cases avoidance of serious spine surgery.

Adolescent↗
PubMed1996

MRI of 'idiopathic' juvenile scoliosis. A prospective study.

In a prospective trial we performed MRI of the spine and hind brain in 31 patients with scoliosis of onset between the ages of four and 12 years. In eight patients (26%) there was a significant neuroanatomical abnormality; there were six cases of Chiari-1 malformation associated with a syrinx, one isolated Chiari-1 malformation and one astrocytoma of the cervical spine. Four of these patients had left-sided curves. There were no clinical features which could reliably identify those patients with abnormalities on MRI. In particular, the unilateral absence of abdominal reflexes was found to be non-specific (1 of 8 of patients with neuroanatomical abnormalities (12.5%) v 2 of 23 with normal scans (8.7%). In view of the established risks of surgical correction of scoliosis in the presence of undecompressed syringomyelia and the possible improvement that may follow decompression of the foramen magnum, we feel that MRI of all patients with scoliosis of juvenile onset should be obligatory.

Child↗
PubMed1996

Efficacy of spinal cord monitoring in scoliosis surgery in patients with cerebral palsy.

Although spinal cord monitoring is recommended during scoliosis surgery, a review from Rancho Los Amigos Medical Center stated that they were only able to obtain reproducible tracings in 53% of cerebral palsy patients. To ascertain that monitoring is both feasible and reliable in these patients, we reviewed the records of 34 consecutive patients with cerebral palsy who had scoliosis surgery at our institution. Spinal cord function was monitored by recording peripheral nerve, cervical/brainstem, and cortical somatosensory evoked potentials to posterior tibial nerve stimulation. Reproducible tracings were achieved in 31 of the 34 patients. Significant intraoperative changes were recorded in 12 of the 31 monitored patients, usually related to and requiring some modifications of the instrumentation. We conclude that with careful technique, spinal cord monitoring using cervical/brainstem somatosensory evoked potentials can be reliably achieved in most patients with cerebral palsy undergoing scoliosis surgery.

Adolescent↗
PubMed1996

[A historical review of treatment of scoliosis].

The authors present the milestones in therapy of scoliosis since antiquity till today. The arduous work of generations of researchers has allowed to define the difficulties in treating scoliosis and the modes of overcoming them. Although tremendous advances in diagnosis and treatment of scoliosis have been made, the mechanisms responsible for it still remain, unknown.

History, 16th Century↗
PubMed1996

[Scoliosis and postural defect].

The authors have analyzed the semasiology of the term scoliosis. Particular attention is given to the fact, that scoliosis is term applied only to a lateral curve of the spine (i.e.a. curve in the frontal plane). This term can be used to define, a state which is free of the structural deformities, that is a postural deformity. The authors also point out the differences in scoliosis occurring as a postural deformity and as a structural deformity.

Humans↗
PubMed1996

[Severe congenital thoracic-lumbar scoliosis in pregnancy. A case report and review of the literature].

The authors describe a case report of a patient affected by congenital thoraco-lumbar scoliosis of a severe degree, aged 32, para 0, gravida 1. She was submitted to orthopedic surgery in childhood. Cesarean section was performed at the 37th week of amenorrhoea. Pregnancy in severe defects of the spine, though becoming more and more uncommon, can still be encountered. Severe congenital scoliosis is a clinical problem; it affects not only the size and shape of the pelvis, but also sometimes results in significant maternal cardiovascular and respiratory complication. The authors, reviewing the literature, evaluate the anatomical and functional (from a biomechanical point of view) derangement of the pelvis, the problem of vaginal delivery and the clinical and radiological assessment of the problem, especially evaluating the cardio-pulmonary function. In conclusion, pregnancy in patients with severe scoliosis can be managed successfully by close monitoring especially of the respiratory function. The decision of the route of delivery is related to clinical assessment and obstetric indications.

Adult↗
PubMed1997

Counterparalysis for treatment of paralytic scoliosis with botulinum toxin type A.

In this study, botulinum toxin was used to treat paralytic scoliosis. Twelve children with paralytic scoliosis and severe, complicating additional diseases required surgical delay. Although this use of botulinum toxin is experimental, alternative treatments posed greater risks. An institutional review board protocol for nonestablished dosage and indication for treatment was initiated to monitor safety and effect. Treatment was intended to supplement, not replace, other desirable treatment modalities. The effect was to be measured by the return of efficacy of conservative treatment in halting curve progression. Short-term results show that none of the children had worsened scoliosis; all had some reduction in curve measurement (up to >50 degrees).

Adolescent↗