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PubMed2006

A prospective study of de novo scoliosis in a community based cohort.

STUDY DESIGN: A 12-year prospective study of de novo scoliosis in a community based cohort. OBJECTIVE.: To investigate factors associated with development of de novo scoliosis. SUMMARY OF BACKGROUND DATA: De novo scoliosis is becoming one of the most prevalent findings in the aging spine, and this condition is associated not only with severe back or leg symptoms but also with complicated surgical outcomes. Cross-sectional studies were limited in distinguishing de novo scoliosis from preexisting deformities, and there had been controversies over the etiology of degenerative scoliosis. METHODS: Community based volunteers were recruited, then examined by orthopedic physicians. Radiologic measurements using entire spine radiographs included the angle of scoliosis and sagittal spinal curvatures, sagittal spinal balance, grade of bone atrophy, number of degenerated discs, and vertebral fractures. We defined radiologic parameters, the disc index, and lateral osteophyte difference to evaluate the asymmetrical spinal degeneration. RESULTS: A total of 60 subjects aged 50-84 years and without scoliosis at baseline were selected and followed for a mean of 12.0 years. De novo scoliosis >or=10 degrees developed in 22 subjects, and logistic regression analysis revealed that the baseline disc index and lateral osteophyte difference values were independent predictors (P < 0.05). CONCLUSIONS: Incidence of de novo scoliosis was predictable by assessing asymmetric disc degeneration in frontal radiograph. More than 20% decrease in unilateral disc height or more than 5 mm longer osteophyte on one side led to increased incidence of de novo scoliosis, which might also influence long-term results of spinal surgery.

Aged↗
PubMed2006

Changes in melatonin receptors in relation to the development of scoliosis in pinealectomized chickens.

STUDY DESIGN: The 2[125I]iodomelatonin binding assay was used to investigate the involvement of melatonin receptors in the development of scoliosis in pinealectomized chickens. OBJECTIVE: To compare the binding properties of melatonin receptors in the thoracic spinal cord between pinealectomized chickens that had scoliosis develop and those that did not. SUMMARY OF BACKGROUND DATA: Surgical pinealectomy in young chickens induced scoliosis with a reported incidence of 50% to 100%. The factors regulating the development of scoliosis in this animal model are unclear. Melatonin receptors have been shown in the spinal cord of chickens, but their functions are still unknown. This study addresses the question as to whether spinal cord melatonin receptors are related to the pathogenesis of scoliosis in pinealectomized chickens. METHOD: Control and pinealectomized chickens were kept under controlled lighting conditions and monitored for scoliosis development. At 9-11 weeks after pinealectomy, thoracic spinal cords were removed for 2[125I]iodomelatonin binding assay, and blood was collected for serum melatonin assay at either the middle of the light period or middle of the dark period. RESULTS: Pinealectomy in young chickens produced: (1) loss of diurnal variations in serum melatonin levels, (2) 50% incidence of scoliosis, and (3) attenuation in the diurnal variations in the receptor affinity to melatonin. No differences were detected in the serum melatonin levels or binding of spinal cord melatonin receptors between the pinealectomized chickens that had scoliosis develop and those that did not. CONCLUSION: Changes are detected in melatonin receptor binding after pinealectomy. However, these changes cannot account for the reason why scoliosis develops in some chickens after pinealectomy, while it does not in others. Neither low melatonin serum level nor changes in spinal cord melatonin binding can be a sole etiologic factor in the pathogenesis of scoliosis in pinealectomized chickens.

Animals↗
PubMed2006

A review of quality of life and psychosocial issues in scoliosis.

STUDY DESIGN: Recent literature regarding the psychological impact of scoliosis was reviewed. OBJECTIVE: To determine the impact of scoliosis on health-related quality of life (HRQL), psychosocial functioning, and body image to improve patient outcomes. SUMMARY OF BACKGROUND DATA: Adolescents and adults with adolescent idiopathic scoliosis have been known to score lower than healthy controls on HRQL measures. However, HRQL instruments may not adequately capture psychological distress experienced by patients. METHODS: Research papers concerning HRQL and psychosocial factors in patients with scoliosis were reviewed. RESULTS: Studies of psychosocial health and body image have revealed that functioning in these domains may affect compliance behavior and satisfaction with treatment outcomes among adolescent patients. Psychosocial and body image disturbance is less marked in patients with good social or family functioning, or patients who exercise regularly or are psychologically healthy. Adults with scoliosis generally display fewer psychological problems than adolescents. However, adults with scoliosis may experience psychosocial limitations due to poor physical health or body image disturbance. Support group membership can improve psychosocial health in adults with scoliosis. CONCLUSIONS: Adolescent patients with scoliosis may experience psychosocial difficulties, especially while undergoing treatment for scoliosis. Interventions aimed at managing psychosocial or body image disturbances may help to ameliorate the potentially negative impact of scoliosis on these facets of life.

Adolescent↗
PubMed2006

Altered sensory-weighting mechanisms is observed in adolescents with idiopathic scoliosis.

BACKGROUND: Scoliosis is the most common type of spinal deformity. In North American children, adolescent idiopathic scoliosis (AIS) makes up about 90% of all cases of scoliosis. While its prevalence is about 2% to 3% in children aged between 10 to 16 years, girls are more at risk than boys for severe progression with a ratio of 3.6 to 1. The aim of the present study was to test the hypothesis that idiopathic scoliosis interferes with the mechanisms responsible for sensory-reweighting during balance control. METHODS: Eight scoliosis patients (seven female and one male; mean age: 16.4 years) and nine healthy adolescents (average age 16.5 years) participated in the experiment. Visual and ankle proprioceptive information was perturbed (eyes closed and/or tendon vibration) suddenly and then returned to normal (eyes open and/or no tendon vibration). An AMTI force platform was used to compute centre of pressure root mean squared velocity and sway density curve. RESULTS: For the control condition (eyes open and no tendon vibration), adolescent idiopathic scoliosis patients had a greater centre of pressure root mean squared velocity (variability) than control participants. Reintegration of ankle proprioception, when vision was either available or removed, led to an increased centre of pressure velocity variability for the adolescent idiopathic scoliosis patients whereas the control participants reduced their centre of pressure velocity variability. Moreover, in the absence of vision, adolescent idiopathic scoliosis exhibited an increased centre of pressure velocity variability when ankle proprioception was returned to normal (i.e. tendon vibration stopped). The analysis of the sway density plot suggests that adolescent idiopathic scoliosis patients, during sensory reintegration, do not scale appropriately their balance control commands. CONCLUSION: Altogether, the present results demonstrate that idiopathic scoliosis adolescents have difficulty in reweighting sensory inputs following a brief period of sensory deprivation.

Adolescent↗
PubMed2002

[Pelvic obliquity and scoliosis in non-ambulatory patients with cerebral palsy: a descriptive study of 234 patients over 15 years of age].

PURPOSE OF THE STUDY: Children with cerebral palsy who cannot walk have an oblique pelvis and scoliosis. There is a certain degree of controversy in the literature on the best way to manage this difficult situation. We present a descriptive analysis of a population of non-ambulatory adults with cerebral palsy in order to formulate hypotheses concerning the factors determining scoliosis. MATERIAL AND METHODS: This descriptive cross-sectional study was conducted in 234 patients aged over 15 years who had cerebral palsy and could not walk. Physical examination and an x-ray of the pelvis and spine in the reclining position were obtained for all patients. The following variables were recorded: luxation and subluxation of the hip, spontaneous deviation attitude, ability or not to turn over in bed, pelvic obliquity, history of bone surgery, defective hip abduction. The statistical analysis accounted for laterality and pelvis obliquity to the scoliosis convexity and the laterality of the hip excentration. RESULTS: Scoliosis was observed in 66.2% of the patients; it was more than 60 degrees in 34.5%. Two basic groups were distinguished: thoracolumbar scoliosis (41.6%) and lumbar scoliosis (41.6%). The prevalence of oblique pelvi was 59.9% with important difference by side: 31.6% right oblique and 68.4% left oblique pelvi. We were unable to find any relationship between the side of the pelvic obliquity and the side of the scoliosis convexity, the side of the hip excentration, or the deviation attitude, but the deviation attitude appeared to be a risk factor for pelvic obliquity, which itself was a risk factor for excentration, which was a risk factor for scoliosis. DISCUSSION: Scoliosis is an important problem in this population. Hip luxation is a direct risk factor for scoliosis, but the deviation attitude and pelvic obliquity are intermediary stages. The prevalence of oblique pelvi was greater on the left than the right. This finding should be confirmed in other series before hypotheses can be formulated concerning this difference.

Activities of Daily Living↗
PubMed2003

The position of the aorta relative to the spine: a comparison of patients with and without idiopathic scoliosis.

BACKGROUND: There is little information documenting the relationship of the aorta to the thoracic scoliotic spine. Recent studies have suggested that the ends of screws placed during an anterior spinal arthrodesis, and pedicle screws used for the treatment of right thoracic scoliosis, may be in proximity to the aorta. The purpose of this study was to analyze the anatomical relationship between the aorta and the spine in a comparison of patients with idiopathic right thoracic scoliosis and patients with a normal spine. METHODS: Thirty-six patients with adolescent idiopathic scoliosis with a right thoracic curve and forty-three with a normal straight spine were studied. Radiographs were analyzed to determine the Cobb angle, the apex of the curve, and the apical vertebral rotation for the patients with scoliosis. Axial magnetic resonance images from the fourth thoracic vertebra to the third lumbar vertebra at the midvertebral body level were used to measure the distance from the aorta to the closest point of the vertebral body cortex, the distance from the posterior edge of the aorta to the spinal canal, and the aorta-vertebral angle. RESULTS: No differences were found between the groups with respect to age or sex distribution. For the scoliosis and normal groups, boys had greater average vertebral body width and depth for all levels than did girls (p < 0.05). For the scoliosis group, the most common apical vertebra was the eighth thoracic vertebra, the average coronal curve measurement was 55.2 degrees, and the average apical rotation was 17.3 degrees. The average distance from the aortic wall to the vertebral body cortex at the apex of the curve was greater in the patients with scoliosis (4.0 mm) than at similar levels in the normal group (2.5 mm) (p < 0.05). The distance from the posterior aspect of the aorta to the anterior aspect of the spinal canal was less in the scoliosis group (11.1 mm) than in the normal group (19.2 mm) for the fifth to the twelfth thoracic level (p < 0.05). The aorta was positioned more laterally and posteriorly adjacent to the vertebral body at the fifth to the twelfth thoracic level in patients with scoliosis compared with that in normal patients as reflected in a smaller aorta-vertebral angle (p < 0.05). With an increasing coronal Cobb angle in the thoracic curve and apical vertebral rotation, the aorta was positioned more laterally and posteriorly (p < 0.05). CONCLUSION: In patients with right thoracic idiopathic scoliosis, the aorta is positioned more laterally and posteriorly relative to the vertebral body compared with that in patients without spinal deformity.

Adolescent↗
PubMed2004

Fibrous dysplasia in the spine: prevalence of lesions and association with scoliosis.

BACKGROUND: Lesions of fibrous dysplasia involving the spine and scoliosis are thought to be uncommon entities in patients with polyostotic fibrous dysplasia and McCune-Albright syndrome. By examining bone scans of a relatively large cohort of patients with these disorders, we sought to determine the prevalence of spinal involvement and any association with scoliosis. METHODS: Sixty-two patients with polyostotic fibrous dysplasia were studied. There were twenty-three male and thirty-nine female patients, and they had a mean age of twenty-five years (range, four to eighty years). Technetium-99m-methylene diphosphonate (MDP) bone scans of the patients were evaluated for evidence of increased uptake in the spine. The presence or absence of scoliosis or a level pelvis and the distribution of other lesions in the skeleton were noted. RESULTS: Thirty-nine (63%) of sixty-two patients were found to have seventy-six lesions of fibrous dysplasia in the spine. Fifty-four lesions (71%) demonstrated increased uptake in the posterior aspects of the spine. Most lesions were located in the lumbar spine (thirty-two lesions) and the thoracic spine (twenty-seven), with less frequent involvement in the sacrum (ten) and cervical spine (six). Twenty-five (40%) of the sixty-two patients had scoliosis; seventeen had a thoracolumbar curve; six, a lumbar curve; and two, a thoracic curve. Seven patients had curves that could not be accurately measured by bone scanning and, therefore, could not be classified. Thirty patients (48%) had no evidence of scoliosis. Thus, the prevalence of scoliosis in patients with polyostotic fibrous dysplasia was between 40% and 52%. There was a strong correlation between spinal lesions and scoliosis (p < 0.001) and pelvic asymmetry (p < 0.05). Back pain was an uncommon symptom. Two patients had a neurologic abnormality; neither abnormality was related to the location of the lesions or the curve. CONCLUSIONS: Spinal lesions and scoliosis may be more common in patients with polyostotic fibrous dysplasia than has been previously reported. Since there is a strong correlation between a spinal lesion and scoliosis, these patients should be screened clinically for scoliosis. LEVEL OF EVIDENCE: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2006

Recent observations in the biomechanical etiology of so-called idiopathic scoliosis. New classification of spinal deformity--I-st, II-nd and III-rd etiopathological groups.

The article examines the biomechanical etiology of so-called idiopathic scoliosis (AIS). It describes I-st, II-nd and III-rd etiopathological groups (epg) of spine deformity which were developed during the years 2001/2004/2005. All children with so-called idiopathic scoliosis had an abduction contracture of the right hip, often connected with a flexion and external rotation contracture. In other cases we found only limited range of adduction of the right hip in comparison to the left hip. We maintain that children with this real abduction contracture of the right hip constitute the first etiopathological group of the development of scoliosis (I-st epg). This group has an "S" double shaped scoliosis with the rib hump on the right. Other patients, with only limited adduction of right hip in comparison to the left hip, constitute the second etiopathological group of development of scoliosis (II-nd epg). This group has a "C" shaped lumbar, sacro-lumbar or lumbo-thoracic left convex scoliosis. The third etiopathological group (III-rd epg) shows either no or a minimal curve on X-ray with either no rib hump or a very minor one but have a "stiffness of spine". Such patients have problems with sporting activities and, as adults, the spinal stiffness leads to considerable "back pain". The right hip structural abduction contracture, or the differences in adduction, is connected with the "syndrome of contractures" in neonates and babies described by many authors and in depth by Mau. How does scoliosis develop? Our explanation is as follows. Asymmetry of movement of the hips during gait provokes asymmetry of loading and asymmetry of growth of both sides - left and right - and the gradual development of scoliosis. In I-st epg, the scoliosis is a secondary compensation for deformities in the pelvis and spine. The II-nd epg is linked to a permanent standing posture maintained on a free right leg during the first years of life. The III-rd epg comprises of patients from the boarder groups of I-st and II-nd epg. This classification establishes a clear therapeutic approach to every etiopathological group of scoliosis and allows for the possibility of introduction of causative prophylaxis.

Adolescent↗
PubMed1979

[Idiopathic scoliosis and equilibrium disturbance (author's transl)].

UNLABELLED: The body balance is maintained by the complexed nervous system in the brain stem and the cerebellum. However, the amount of neurological information obtained from this area is relatively small, so that a fine abnormality is easily overlooked or could not be definitely elicited. Examination of the ocular movement becomes often a powerful tool to detect an indiscrete lesion in the brain stem and the cerebellum which otherwise fails to be demonstrated neurologically. METHOD: With a hypothesis that equilibrium disturbance might be playing a role in the development of idiopathic scoliosis, extensive neuro-otological studies were carried out in three groups of individuals: 169 cases of idiopathic scoliosis, 19 cases of congenital scoliosis and 488 young girls with no scoliosis. The examination included Mann's test, deviation tests and other neuro-otological tests with the special reference to the observation of the ocular movement. RESULTS: 1. There was no case in the entire groups which presented positive Mann's test or deviation abnormality. 2. With the aid of electronystagmography (ENG), the presence of nystagmus was detected in 71 out of 169 cases (42.0%) with idiopathic scoliosis, 9 out of 19 cases (46.7%) with congenital scoliosis and 5 out of 488 girls (1.0%) with no scoliosis. This fact was highly suggestive of the possibility of equilibrium disturbance in the background of scoliosis. 3. However, even with positive ENG findings, few cases showed abnormality on optokinetic nystagmus (OKN) test or eye tracking test, so that definite localization of the lesion was impossible in the majority of the cases with the abnormal ocular movement. 4. There was no significant correlation between the rate of the abnormal ocular movement and the age of the patient, the magnitude of the spinal curve or the curve pattern. CONCLUSION: The co-existence of abnormal ocular movement and scoliosis was proved to be statistically significant, suggesting that equilibrium disturbance might be playing a role in the multifactorial etiology of idiopathic scoliosis, although the real pathomechanism still remains to be studied.

Adolescent↗
PubMed2006

Association between adolescent idiopathic scoliosis prevalence and age at menarche in different geographic latitudes.

BACKGROUND: Age at menarche is considered a reliable prognostic factor for idiopathic scoliosis and varies in different geographic latitudes. Adolescent idiopathic scoliosis prevalence has also been reported to be different in various latitudes and demonstrates higher values in northern countries. A study on epidemiological reports from the literature was conducted to investigate a possible association between prevalence of adolescent idiopathic scoliosis and age at menarche among normal girls in various geographic latitudes. An attempt is also made to implicate a possible role of melatonin in the above association. MATERIAL-METHODS: 20 peer-reviewed published papers reporting adolescent idiopathic scoliosis prevalence and 33 peer-reviewed papers reporting age at menarche in normal girls from most geographic areas of the northern hemisphere were retrieved from the literature. The geographic latitude of each centre where a particular study was originated was documented. The statistical analysis included regression of the adolescent idiopathic scoliosis prevalence and age at menarche by latitude. RESULTS: The regression of prevalence of adolescent idiopathic scoliosis and age at menarche by latitude is statistically significant (p < 0.001) and are following a parallel declining course of their regression curves, especially in latitudes northern than 25 degrees. CONCLUSION: Late age at menarche is parallel with higher prevalence of adolescent idiopathic scoliosis. Pubarche appears later in girls that live in northern latitudes and thus prolongs the period of spine vulnerability while other pre-existing or aetiological factors are contributing to the development of adolescent idiopathic scoliosis. A possible role of geography in the pathogenesis of idiopathic scoliosis is discussed, as it appears that latitude which differentiates the sunlight influences melatonin secretion and modifies age at menarche, which is associated to the prevalence of idiopathic scoliosis.

Journal Article↗
PubMed2002

Prognostic significance of the Nasca classification for the long-term course of congenital scoliosis.

AIM: The aim of our investigations was to answer the question of whether the radiologic classification according to the investigations of Nasca has prognostic relevance for congenital scoliosis. Based on our results, a therapeutic concept was given. PATIENTS AND METHODS: Radiographs of 49 patients with a congenital scoliosis were classified according to Nasca. The progression of the malformation was analyzed by regarding the changes over a period of 8.3 years on average. RESULTS: Of the analyzed patients with congenital scoliosis, 73% showed a mean progression rate of 1.8 degrees per year. The most advanced progress of the Cobb angle per year was seen in patients with unilateral unsegmented bars with or without additional hemivertebrae (type 4 according to the Nasca classification) and patients with wedge-formed vertebrae (type 2a according to the Nasca classification). The presence of unilateral bars and the location of the hemivertebra or hemivertebrae (type 4) and wedge-formed vertebrae (type 2a) are the major determinants of deformity. Within the scope of our investigations, the following three factors were seen as deleterious when combined: thoracolumbal and long-distance scoliosis, female gender, and prepubertal growth period. CONCLUSION: From our analysis of 49 patients, we can propose the following therapeutic system for congenital scoliosis. Sole treatment with physiotherapy should only be recommended with congenital scoliosis curves ranging from 0 degrees to 20 degrees according to the Cobb method. With a Cobb angle smaller than 40 degrees and some flexibility remaining in the spine, the congenital scoliosis should be treated additionally with corrective casts. For congenital scoliosis with a Cobb angle of more than 50 degrees, as well as for congenital scoliosis with a poor prognosis (for example unilateral bars), a spondylodesis of the spine should be done before reaching the age of 5 years.

Casts, Surgical↗
PubMed2002

Scoliosis in children with osteogenesis imperfecta: influence of severity of disease and age of reaching motor milestones.

We studied the relationship between the age of reaching motor milestones, especially anti-gravity activities, and the age of development of pathological spinal curvatures in children with osteogenesis imperfecta (OI). We hypothesized that earlier achievement of anti-gravity motor milestones predicts a later development of pathological spinal curvatures. Ninety-six children participated in this retrospective study. The severity of the disease was classified according to Sillence into types I-IV. Spinal radiography was performed annually and spinal deformities were measured according to the Cobb angle. Scoliosis was defined as a Cobb angle exceeding 9 degrees. Pathological thoracic kyphosis was defined as a Cobb angle exceeding 40 degrees. The parents were asked to report the age at which the child achieved motor milestones, and data were checked against health care records. Thirty-seven of 96 children (39%) developed a scoliosis of more than 9 degrees. Nine of 96 children (9%) developed a pathological kyphosis. The age of developing scoliosis was significantly lower than the age of development of the pathological kyphosis (P=0.01). Bone mineral density was measured by dual energy X-ray absorptiometry (DEXA) in 53 children, 28 of whom developed scoliosis, and 25 of whom did not. The mean DEXA Z-score of the 28 children with scoliosis was significantly lower than that of the 25 children without (-5.2, SD 1.3 vs -3.2, SD 1.9; P-value <0.001). Children with OI type IV, but particularly OI type III, reached motor milestones much later than children with OI type I. The motor milestone "supported sitting" showed a significant inverse association with time of the first presence of scoliosis with a Cobb angle greater than 9 degrees (linear regression coefficient: -1.3, 95% confidence interval: -2.6 to -0.03). The age of achieving the motor milestones "lifting the head to 45 degrees in prone position", "rolling", and "supported-" and "unsupported standing" were not significantly associated with age of the first presence of scoliosis with a Cobb angle greater than 9 degrees. However, the directions of associations suggest that here, too, there is a tendency for later development of scoliosis in those who reach milestones at earlier ages. Multivariable analyses showed that the motor milestone "sitting with support" was significantly associated with age of first achieving scoliosis, independent of gender and type of OI (linear regression coefficient: -0.9, 95% confidence interval: -1.3 to -0.5). We conclude that in children with OI, the age of anti-gravity motor milestones was associated with the age of development of pathological spinal curvatures. Earlier achievement of the motor milestone "supported sitting" predicted significantly a later development of pathological spinal curvatures, independent of gender and type of OI.

Bone Density↗
PubMed2005

Validation, reliability, and complications of a tethering scoliosis model in the rabbit.

This study was conducted to refine a small animal model of scoliosis, and to quantify the deformities throughout its growth period. Subcutaneous scapula-to-contralateral pelvis tethering surgery was selected due to its minimally invasive nature and potential applicability for a large animal model. The procedure was performed in 7-week-old New Zealand white rabbits. Group A animals (n=9) underwent the tethering procedure with a suture that spontaneously released. Group B animals (n=17) had the identical procedure with a robust tether and pelvic fixation, which was maintained for 2 months during growth. All animals developed immediate post-operative scoliosis with a Cobb angle of 23 degrees (range, 6-39 degrees) in group A and 59 degrees (range, 24-90 degrees) in group B animals. During the 2 month post-tethering, group A animals lost their tether and scoliosis resolved, whereas all animals in group B maintained their tether until scheduled release at which time the mean scoliosis was 62 degrees. Immediately after tether release, group B scoliosis decreased to a mean 53 degrees. Over the following 4 months of adolescent growth, the scoliosis decreased to a mean of 43 degrees at skeletal maturity; the decrease usually occurred in animals with less than 45 degrees curves at tether release. Radiographs revealed apical vertebral wedging (mean 19 degrees ) in all group B animals. Sagittal spinal alignment was also assessed, and for group B animals, the scoliotic segment developed mild to moderate kyphosis (mean 28 degrees) and torsional deformity, but the kyphosis resolved by 4 months after tether-release. Complications specific to this technique included a high rate of transient scapulothoracic dissociation and cases of cor pulmonale. In conclusion, this tethering technique in immature rabbits consistently produced scoliosis with vertebral wedging when the tether was intact through the first 2 months of the protocol. The transient exaggeration of kyphosis suggests that the production of scoliosis is not necessarily dependent on lordosis in this model. Because this technique does not violate thoracic or spinal tissues, it may be useful in the investigation of secondary physiologic effects of mechanically-induced scoliosis, and may be scalable to larger animal species.

Animals↗
PubMed1982

The electrocardiogram in patients with scoliosis.

Electrocardiograms of 802 patients with isolated scoliosis followed and/or operated at Columbia Presbyterian Medical Center were reviewed. There were 586 patients younger than 18 years and 216 patients older than 18 years of age. There were 86 males and 716 females. Eleven patients had associated congenital heart disease. Effects of age, site of scoliosis, side of convexity and severity of curvature on multiple electrocardiographic variables were analysed. Electrocardiographic variables such as heart rate, Q-Tc, P wave amplitude, P-R interval, amplitude of R and S waves in V1 and V6 were similar to data reported in the normal population without scoliosis. The effect of age on these electrocardiographic variables was similar to changes reported in the normal population and were not affected by site of scoliosis or side of curvature. The frontal QRS axis was within normal limits of 94% in patients under 18 years of age with right-sided thoracic scoliosis and in 87% of patients over 18 years. Evidence of right axis deviation (5%) and right ventricular hypertrophy (2%) were present equally in patients younger and older than 18 years of age and 8% of patients over 18 years old. Since in our patient population the degree of scoliosis severity increased with age it is likely that the increasing incidence of left axis deviation found in patients over 18 years of age with scoliosis is related to scoliosis severity and the altered intrathoracic cardiac orientation. Because right axis deviation and right ventricular hypertrophy are noted occasionally in patients with scoliosis and because congenital heart disease and pulmonary disease are more prevalent in this patient population, it is recommended that the presence of right axis deviation and right ventricular hypertrophy on the ECG should lead to a complete cardiopulmonary evaluation and exclusion of possible additional cardiac or pulmonary anomalies.

Adolescent↗
PubMed2006

Management of scoliosis in Duchenne muscular dystrophy: a large 10-year retrospective study.

Scoliosis affects 75 to 90% of patients with non-ambulant Duchenne muscular dystrophy (DMD). Spinal surgery is the treatment of choice but the indication varies among centres. Some offer surgery to all non-ambulant patients, irrespective of scoliosis severity. Early surgery has the advantage of targeting DMD when cardiorespiratory function is preserved, but not all patients develop scoliosis. We report our 10-year experience of scoliosis management in 123 patients with DMD who were at least 17 years old at the time of the study. Scoliosis was absent in 10%, and mild, non-progressive (at least 30 degrees ) in 13% of patients. Another 13% had moderate scoliosis (31-50 degrees ) and were managed conservatively. Surgery was considered in 57% (70/123) of patients with scoliosis greater than 50 degrees and eventually performed in 35%. The remaining patients either refused surgery (9%) or were unfit because of cardiorespiratory compromise (13%). In a further 7%, scoliosis (greater than 50 degrees ), first noted after 14 years of age, was progressing slowly and surgery was not performed. At 17 years there was no difference in survival, respiratory impairment, or sitting comfort among patients managed conservatively or with surgery. One-third (44/123) of our patients were managed satisfactorily without receiving spinal surgery. We provide insight into the natural history of scoliosis in DMD that should help families and clinicians with decision-making when surgery is considered.

Adolescent↗
PubMed2001

Perceptions of body image, happiness and satisfaction in adolescents wearing a Boston brace for scoliosis treatment.

AIMS: To explore the impact of bracing on the perceptions of body image, happiness and satisfaction of adolescents with scoliosis. DESIGN: The study was designed as compare of 134 girls and 16 boys who wore a Boston type brace for scoliosis treatment and a control group of 99 healthy girls and 51 healthy boys. All them were secondary school pupils living in Athens Greece and were interviewed. A semi-structured schedule included general questions, and the Piers-Harris scale was used. Data were analysed using the SPSS/PC+ software, and descriptive statistics, factor analysis and the non-parametric Mann-Whitney U-test. Statistical significance was set at P=0.05 or less. RESULTS: The scoliosis group had a poorer perception of body image in comparison to the control group (P=0.048), while boys with scoliosis (P=0.030) had a better perception of body image than girls with scoliosis. Girls with scoliosis had a statistically significant difference (P=0.0388) in perception of happiness and satisfaction, in comparison with girls in the control group. Cohabitation with the mother seemed to be negatively correlated with body image, happiness and satisfaction perceptions because adolescents with scoliosis who were not living with their mother had a better body image perception (P=0.027) as well as better perceptions of happiness and satisfaction (P=0.047). Nevertheless, only 5% of those with scoliosis declared that they had opportunities to discuss their feelings and problems with health professionals, while 90% of them declared that they wanted to have more opportunities to do this. CONCLUSION: Adolescents with scoliosis face problems during bracing and they need to be supported by health care professionals.

Adolescent↗
PubMedDate not supplied

[Surgical therapy of hemivertebrae scoliosis and kyphosis--a retrospective analysis of 53 cases].

AIM OF THE STUDY: We performed a retrospective analysis of the results of operative treatment of 53 patients with congenital scoliosis (n = 47) or kyphosis (n = 6) due to hemivertebrae. PATIENTS AND METHODS: The mean age of the patients (31 girls and 22 boys) at the time of the initial examination was 6 +/- 4 years. Surgical treatment was carried out on average at the age of 9 +/- 5 years. Follow-up examinations were carried out up to a mean age of 16 +/- 6 years. RESULTS: The results of operative treatment depended on the localization of the hemivertebrae and the surgical technique. Progression of scoliosis due to a thoracic hemivertebra was halted, but the scoliosis could not be corrected (Cobb angle at initial examination 37 +/- 17 degrees at follow-up 34 +/- 23 degrees). Scoliosis due to lumbar hemivertebrae was reduced by surgery (Cobb angle at initial examination 36 +/- 14 degrees, at follow-up 21 +/- 15 degrees). Surgery without instrumentation led to worse results than did surgery with instrumentation with thoracic as well as lumbar scoliosis. Combined dorsoventral procedures with resection of the hemivertebra seemed to be superior to spondylodesis without resection of the hemivertebra. Surgical correction of kyphosis associated with dorsal hemivertebrae was performed by means of dorsal or dorsoventral spondylodesis with hemivertebra resection (preoperative kyphosis 70 +/- 34 degrees, at follow-up 44 +/- 25 degrees). CONCLUSION: Spondylodesis without instrumentation is associated with an unsure prognosis with respect to effects on the progression of the scoliosis, even if it is performed on very young patients. In contrast, spondylodesis with instrumentation can achieve better and longer-lasting corrections of scoliosis even with larger initial curvatures. Scoliosis due to lumbar hemivertebrae is more amenable to surgical correction than thoracic scoliosis due to hemivertebrae.

Adolescent↗
PubMed1987

Prevalence rates for scoliosis in US adults: results from the first National Health and Nutrition Examination Survey.

National prevalence estimates of scoliosis in adults, based on the reading of 6594 chest X-rays from the first National Health and Nutrition Examination Survey, are presented by age, sex and race. Among US adults aged 25-74 years in 1971-75, the prevalence rate of scoliosis was 8.3%. The prevalence of scoliosis increased across age groups among women (p less than 0.001), but not among men. Women had about twice the prevalence of scoliosis as men; 10.7% versus 5.6% (p less than 0.001). Because scoliosis prevalence rates differed by age and sex, prevalence rates and means for scoliosis status subgroups were adjusted for age and sex. Blacks had a higher rate, although not statistically significant (using alpha = 0.10), of scoliosis than whites: 9.7% versus 8.1%. Bone density of the radius was lower for scoliotics than for non-scoliotics: (287.0 versus 294.0 aluminum equivalency units, p less than 0.001), suggesting a possible association between scoliosis and osteoporosis. The percentage with delayed menarche was higher for scoliotics than non-scoliotics: 37.8 versus 30.8% (p = 0.01). Scoliotic women also had a lower mean age of menstruation termination than non-scoliotic women: 43.4 years versus 44.8 years (p = 0.07). This is the first study to present national prevalence estimates for scoliosis among adults in the US.

Adult↗