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PubMed1989

Axial rotation component of thoracic scoliosis.

The axial rotation (rotation about a vertical axis) of the vertebrae, of the ribs, and of the back surface are components of the deformity recognized clinically as the "rib hump" in thoracic scoliosis. Relationships of these rotations to the lateral deviation and lateral curvature of the spine were studied in 40 patients with idiopathic scoliosis. Stereoradiographs of the spine and rib cage were used to measure three components of axial rotation: rotation of the vertebrae, of the rib cage, and of the plane of maximum curvature of the spine. Stereotopographs of the back surface were digitized to measure the axial rotation of the back surface. In individual patients, there were high correlations of all components of axial rotation at each spinal level with the corresponding vertebral lateral deviation from the spinal axis. By regression analyses of the maximum values of each rotation in each curve, the rotation of the apex vertebra was found to be generally of lesser magnitude than the rotation of the plane of maximum curvature of the spine and in an opposite sense in kyphotic curves. The rib cage rotation was generally of lesser magnitude than the vertebra rotation, and the back surface rotation was less than both of these skeletal rotations. Vertebra rotation correlated most closely with lateral deviation of the spine. Simple segmental coupling of axial rotation and lateral bending could not be responsible for this axial rotation.

Humans↗
PubMed1994

Sagittal configuration of the spine and growth of the posterior elements in early scoliosis.

The early changes of the sagittal alignment of the spine and the asymmetry between the posterior and anterior elements were determined on the basis of 134 lateral and 167 anteroposterior radiographs obtained from a control group and from patients with early scoliosis. The radiographs were allocated into four groups according to the degree of the Cobb angle. In thoracic curves with a Cobb angle of more than 8 degrees, the kyphosis and the vertebral sagittal wedge angle decreased in comparison with the control group. The sagittal-wedge angle of the disc did not change significantly with increasing Cobb angle. The pedicle height in relation to the vertebral height, considered to represent the growth of the posterior element in relation to the growth of the anterior element, was not significantly different in the scoliotic groups as compared with the control group. The results indicate that changes of the sagittal configuration of the spine occur early in idiopathic scoliosis and that they are associated with disturbed growth of the vertebral body but not of the posterior elements. These findings seem to reflect a simultaneous deformation in the coronal and sagittal planes rather than a single growth disturbance in any specific plane.

Adolescent↗
PubMed1988

Single fiber EMG in juvenile idiopathic scoliosis.

A single fiber EMG (SFEMG) study was performed in 51 patients with idiopathic juvenile scoliosis of moderate degree (mean 23.8 degrees of Cobb), aged 7-18 years (mean 13.2 years). The findings in the extensor digitorum communis muscle (EDC) include a moderate but significant increase in fiber density (mean 2.02, +/- 0.21, P less than 0.001), a mild but significant (P less than 0.001) neuromuscular transmission abnormality (7.6% of fibers showed increased jitter and 4.5% intermittent blocking), and a moderately prolonged mean interspike interval (mean 0.98 msec, +/- 0.20, P less than 0.005) in EDC. Five of the patients had normal fiber density, 9 had a normal jitter study, and further 7 had a normal mean interspike interval. However only one had all the parameters normal. The paraspinal and intercostal muscles at the apex of the scoliotic curvature examined in some of the patients showed similar abnormalities. The study thus suggests the existence of a subclinical systemic neuromuscular disorder in nearly all of our patients with idiopathic scoliosis, which might have a pathogenetic significance.

Adolescent↗
PubMed1988

Lumbar radiculopathy after spinal fusion for scoliosis.

In 184 patients with no preoperative neurologic deficit who underwent operation for idiopathic scoliosis, somatosensory evoked potential monitoring was used. Four patients had neurologic deficits postoperatively. Two patients developed mild signs of intraspinal lesions involving upper motor neurons at high lumbar levels that resolved over 3-5 months. These patients and two others developed evidence of unilateral, moderate, lower motor neuron damage that was confirmed on electromyography. No changes in somatosensory evoked potentials occurred in these patients. Lumbar root damage may be difficult to recognize after operation and should be considered in patients with neurologic deficit after scoliosis surgery.

Adolescent↗
PubMed1988

Investigation of scoliosis in Duchenne dystrophy using computerized tomography.

In order to determine the role of the spinal muscles in the etiology of the scoliosis associated with Duchenne muscular dystrophy, we carried out a study of 16 children using computerized tomography. Scans were taken at the level of the 9th dorsal and the 3rd lumbar vertebrae. Density readings were taken in the medial and lateral portions of the erector spinae. The results confirmed the loss of muscle and replacement by fat which was greater on the concave side. The density differences between the convex and concave sides correlated with the degree of curvature measured by Cobb's method. Computed tomography may offer a prognostic indicator in the development of scoliosis.

Adolescent↗
PubMed1995

Direct spinal stimulation for intraoperative monitoring during scoliosis surgery.

Intraoperative electrophysiological monitoring of the spinal cord has traditionally been done by recording somatosensory evoked potentials (SEP). There is a risk that SEPs can be unaltered when significant injury to the anterior spinal cord has occurred. The purpose of this report is to describe a simple technique for intraoperative spinal cord stimulation which monitors descending pathways in the anterior spinal cord. Stimulation occurs through needle electrodes inserted into spinous processes in the rostral surgical wound, and recordings are made from electrodes in the popliteal spaces. We report our experience in monitoring spinal instrumentation in 45 patients with idiopathic scoliosis and 20 with some form of neurological disease causing scoliosis. The neurogenic motor evoked potentials (NMEP) are stable and easily recorded from the popliteal spaces in the majority of patients. We describe the case of 1 patient with Friedreich's ataxia in whom no SEPs could be recorded, but NMEPs were used successfully for monitoring. We have fond that combining traditional SEP monitoring with NMEP recording provides a safe and effective method to monitor the spinal cord during surgical procedures where it is at risk.

Adolescent↗
PubMed2004

Adolescents' coping with surgery for scoliosis: effects on recovery outcomes over time.

Surgery for adolescent idiopathic scoliosis is painful and stressful and has a long and demanding recovery. The purpose of this study was to examine pre- and postoperative avoidant/vigilant coping and long-term activity outcomes through 9 months postsurgery for adolescents (11-18 years, N = 113) undergoing scoliosis surgery. Generally, more vigilant copers (preoperatively and 1 month postoperatively) participated in more activities (usual, new, and social) and had higher academic performance during recovery. Several moderation effects indicated these relationships were stronger for older adolescents and those more internal in locus of control. Adolescents were more vigilant in the hospital, became more avoidant 1 month after surgery, and remained at these levels 6 months postsurgery. Understanding coping processes and individual factors is necessary to develop interventions to help adolescents cope successfully with recovery demands.

Adaptation, Psychological↗
PubMed1991

Hereditary orthodontic anomalies and idiopathic scoliosis.

Our study of 202 patients aged from 7 to 17 years treated for idiopathic scoliosis, and with a Cobb angle from 20 degrees to 50 degrees, showed a higher frequency of hereditary orthodontic anomalies than those in the control group. There was unmistakable evidence that acquired orthodontic anomalies occurred in both groups at the same rate of frequency. Our study demonstrated unequivocally that the detection of hereditary orthodontic anomalies in young children allows the identification of a group of children who have a high risk of developing scoliosis in later years.

Adolescent↗
PubMed1989

Reducing the radiation dosage in patients with a scoliosis.

A significant number of girls develop an adolescent idiopathic scoliosis and require repeated full-length radiographs of the spine. Since Nash's publication in 1979 [16], there has been considerable concern expressed about protecting them from excessive radiation, and particularly from the development of radiation-induced breast tumours. We present a study which compares the differences in radiation dose using different techniques, specifically, the use of a posteroanterior projection, very fast rare earth screens and progressive wedge-shaped filtration. The use of a posteroanterior projection reduced the sternal exposure by 98.9% and the breast skin exposure by 92%. A combination of all three techniques reduced the sternal exposure by 99.5%. We recommend that these should be used routinely to reduce the radiation hazard to children with an adolescent idiopathic scoliosis.

Adolescent↗
PubMed1980

A case of severe scoliosis associated with cerebral palsy showing remarkable improvement following soft tissue release around the hip and axilla and transfer of m. tensor fasciae latae to the ribs.

A 21 year old Japanese male of normal intelligence with severe athetosis, scoliosis with pelvic obliquity, and a positive Galant's reflex was seen with complaint of difficulty in maintaining a sitting posture. After release of the soft tissues around the hip and axilla, followed by physiotherapy, he underwent ipsilateral transfer of the tensor fasciae latae to the rib cage. Six years after the final operation there has been remarkable improvement of his scoliosis and pelvic obliquity but also diminution of Galant's reflex. In addition his daily activities have been improved by the muscle transferred. He can sit for more than one hour.

Adult↗
PubMed1995

Spinal mobility and posture: changes during growth with postural defects, structural scoliosis and spinal osteochondrosis.

A number of case studies were followed for 10 years. Children suffering from postural defects, structural scoliosis and 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 curves similar to the physiologic one were observed. The range of motion was not physiologic in scoliosis. In this disease, rotation-flexion thoracic hypermobility with decreased lumbar flexion ability was found. A physiologic trend was found in spinal osteochondrosis, although sometimes the rotational mobility of the spine was reduced. An extremely high increase of thoracic kyphosis was found only in children aged 14 years.

Adolescent↗
PubMed1995

Scoliosis and lung function in spinal muscular atrophy.

The notes and radiographs of 43 patients with a confirmed diagnosis of spinal muscular atrophy were reviewed. A significant inverse linear relationship between the severity of scoliosis and the percentage of predicted vital capacity and peak flow was found. The patients who stood had a significantly better lung function than patients who were confined to a wheelchair, and their scoliosis deteriorated significantly more slowly. Sixteen patients underwent surgical spinal stabilisation, 4 with Harrington instrumentation and 12 with segmental spinal instrumentation, at an average age of 12 years and 11 months. The average curve correction achieved was 40%. The decline in lung function seen pre-operatively was not only reversed, but a significant improvement was found at final follow-up.

Adolescent↗
PubMed1995

Cotrel-Dubousset and Harrington Instrumentation in idiopathic scoliosis: a comparison of long-term results.

Between 1968 and 1977, 72 patients with idiopathic scoliosis underwent Harrington Instrumentation (HI). Between 1985 and 1988, 21 patients with idiopathic scoliosis had posterior spinal fusion with Cotrel-Dubousset instrumentation (CDI). All patients were operated by the same orthopedic surgeon. None of the CDI patients had postoperative brace or cast protection, the HI group had on average 6 months' postoperative brace treatment. The two groups of patients were comparable in age, sex, and type of curves. The HI group and CDI group were reexamined with clinical and radiological assessment after mean periods of 148 months and 60 months respectively. The average preoperative Cobb angle in the CDI group was 59.9 degrees (HI group 67.8 degrees), which improved to 20.8 degrees (HI group 33 degrees) postoperatively--a correction of 66.3% (HI group 51.3%). The loss of correction on reassessment amounted to 5% in the CDI group and 20.7% in the HI group. In both groups, the mean rib hump height was reduced to 2.2 cm. In 40% of the Harrington patients, a flat back was found, but this was not related to clinical back pain. The rate of complications and reintervention was 9.5% in the CDI group and 8.3% in the HI group. There were no neurological complications. Subjectively, 86% of the Harrington patients and 95.2% of the CDI patients rated the results of their operation as "good" or "very good." The CDI group showed better results in correction of the Cobb angle and loss of correction, while saving one mobile lumbar segment. The correction of the rib hump showed the same results for both techniques. Blood loss and operation time was much lower in the HI group. However, the rate of complications was similar in both groups.

Adolescent↗
PubMed1995

Long-term results of convex epiphysiodesis for congenital scoliosis.

The objective of this study was to evaluate the long term outcome of combined anterior and posterior convex spinal epiphysiodesis in the treatment of congenital scoliosis. The study covered 53 patients (27 male, 26 female) with a minimum follow up period from surgery of 3 years (mean 8.8 years, range 3-22.5 years). Of these, 34 were skeletally mature when reviewed. Clinical assessment and sequential measurement of Cobb angles were used to chart the course of the deformity following surgery. The types of vertebral anomalies encountered were: 4 unsegmented bars, 7 unsegmented bars with hemivertebrae, 30 hemivertebrae (of which 2 were double hemivertebrae) and 12 complex (unclassifiable) patterns. The severe types were concentrated in the thoracic spine. Results are presented with reference to the type and site of anomaly and to the age of the patient at the time of surgery. Where deformity was due to an unsegmented bar (with or without hemivertebra) the rate of change of Cobb angle was slowed, but not reversed, following surgery. For the complex anomalies there was a reduction in the rate of progression of deformity following surgery, however, the final Cobb angle still increased from a mean of 61 degrees to 70 degrees. In contrast, the rate of progression reversed or slowed in 97% of the hemivertebra patients following surgery, producing a change in mean Cobb angle from 41 degrees pre-operatively to 35 degrees post-operatively. For each type of anomaly the correction achieved was greater where the surgery was performed at a younger age. Final outcome was influenced by the site of anomaly, with a better correction being achieved in the lumbar than the thoracic spine. In conclusion, we feel that convex epiphysiodesis has an important role in the surgical management of congenital scoliosis and, for hemivertebrae in particular, it can produce significant correction of deformity.

Child↗
PubMed1995

School screening for scoliosis: the value of quantitative measurement.

Several studies advocate quantification of the bending test or performing surface topography to reduce the referral rate and to increase the specificity of the bending test in screening for scoliosis. Within the framework of a school screening project all children with a positive bending test were reexamined with measurement of rib hump height, angle of trunk rotation and moiré topography. In the period 1983-1986, out of three cohorts of 10,000 children of 10, 12 and 14 years of age, 3,069 were reexamined, of whom 1931 again tested positive (63%). The value of the three techniques in terms of sensitivity and specificity within the reexamined group was evaluated with regard to the Cobb angle on a spinal radiograph, which was made in 671 cases. A reduction in referrals of 37% was found. No significant difference in the ability to detect scoliosis was found between the three techniques mentioned. It is concluded that measurement techniques are valuable in school screening programmes. In particular, if instead of a single cut-off value, a range within which the examination should be repeated is chosen, high sensitivity and high specificity can be combined. Angle of trunk rotation measurement seems to be the easiest method of screening.

Adolescent↗
PubMed1982

Scoliosis in cystic fibrosis--an appraisal.

An unusually high prevalence (10%) of scoliosis is described in a series of 151 patients aged four years and older with cystic fibrosis. The scolioses were of the late onset (juvenile and adolescent) type, being typically thoracic with the curve convex to the right, although there was no significant preference for either sex. No direct relationship was found between the spinal curvature and the severity or distribution of the lung disease, although the worse scolioses tended to occur in patients with relatively severe pulmonary involvement. There was no evidence of metabolic bone disease as a predisposing cause. Some indication of a familial tendency towards scoliosis was apparent, and a genetic or constitutional basis is postulated with an unknown precipitating factor.

Adolescent↗
PubMed1980

Operative treatment of adolescent idiopathic scoliosis with follow-up study of the postoperative physical and social status.

The results of 64 posterior fusions for scoliosis are presented. Also the first detection of the curves and the preoperative treatment is discussed. Details are given about the immediate and late postoperative complications and about the correction loss. Interesting too, is an investigation of more subjective information, concerning the postoperative physical and social status. These last problems are not very often discussed in studies of scoliosis.

Adolescent↗
PubMed1988

Rapidly developing scoliosis in an adolescent due to spinal osteoblastoma. A case report.

A benign osteoblastoma of the spine should be considered a possible cause of painful scoliosis, especially in young adults. This report concerns a 17 year old patient with a lesion of the second lumbar vertebra where her painful progressive scoliosis was mistaken as idiopathic. Considering pain as a common presentation for the osteoblastoma, the diagnosis can be made early through X-rays, bone scan and computed tomography. The only adequate therapy is total removal of the tumor and the surgeon should make every effort to resect this lesion in sano to achieve permanent relief of pain and full alignment of the spine.

Adolescent↗