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PubMed1997

Pregnancy and delivery in patients operated by the Harrington method for idiopathic scoliosis.

The course and outcome of 142 pregnancies in 146 patients operated between 1970 and 1975 by the Harrington method for idiopathic scoliosis were studied to determine the effects of scoliosis on pregnancy and childbirth and the effects of pregnancy on the remaining fused and unfused scoliotic curvatures. Occurrence of and sick leave due to low back pain during pregnancy was determined. The patients, all originally treated at the Orthopaedic Hospital of the Invalid Foundation (Orton) in Helsinki, Finland, were invited to a clinical and radiological re-examination on average 19 years following surgery. The results show that pregnancy does not significantly increase fused scoliotic curvatures nor the remaining unfused curvatures. A somewhat higher proportion of children (23%) were delivered by cesarean section than in the general population (15%; P < 0.01), but this result should only be taken as suggestive. Rates of complications of pregnancy and in labor did not differ from those in the background population. The offspring were healthy. Low back pain during pregnancy occurred in about 40% of our patients, but was severe enough to cause sick leave only in 11% of the pregnancies.

Adolescent↗
PubMed1997

Rib-vertebral angle asymmetry in idiopathic, neuromuscular and experimentally induced scoliosis.

The concave and convex rib-vertebral angle (RVA) at levels T2-T12 was measured on AP radiographs of 19 patients with right convex idiopathic thoracic scoliosis and 10 patients with major thoracic right convex neuromuscular scoliosis. The difference between the angles on the concave and the convex sides, the RVAD, was calculated. The RVAs were also measured on radiographs from three animal groups in which spinal curves had been induced experimentally in a variety of ways. Group 1 comprised 16 rabbits that had been subjected to selective electrostimulation of the latissimus dorsi, the erector spinae and the intercostal muscles. Group 2 comprised four dead rabbits whose spines had been subjected to manual bending. Group 3 comprised eight rabbits that had undergone mechanical elongation of one rib. In both the idiopathic and the neuromuscular group, the convex RVA was smaller than the concave RVA between levels T2 and T8, with a maximal difference between T4 to T5. From T9 to T12 the concave RVA was smaller than the convex. The RVA in relation to the scoliotic segment, i.e. the apex level of the curve and the two neighbouring vertebrae above and below this level, showed similar results. With increasing Cobb angle the RVADs increased linearly with the greatest difference at the second vertebra above the apex. In the three experimental groups the pattern of the RVADs between T6 to T12 was basically similar to the findings of the clinical study. From the results of these clinical and experimental studies, it is concluded that the typical pattern of the RVAs on the concave and convex sides seems to be independent of the underlying cause of the spinal curvature. It is likely that the RVADs result from a passive mechanical adaptation of the ribs to the lateral curvature of the spine.

Adolescent↗
PubMed1989

Low dose imaging of scoliosis: use of a computed radiographic imaging system.

A digital radiographic system using the technology of laser stimulated luminescence has been utilized for the evaluation of scoliosis at reduced exposure levels. A total of 412 examinations have been performed on children with scoliosis. Diagnostic images were produced at significantly reduced radiation exposures when compared to standard radiographic techniques. Exposure reductions of 92% to 95% were consistently achieved. Since the potential for multiple examinations and considerable radiation exposure in this patient population is high, this is a significant application in the developing technology of digital radiography.

Adolescent↗
PubMed1994

Comparison of stimulable phosphor technology and conventional screen-film technology in pediatric scoliosis.

One hundred consecutive patients being investigated for scoliosis were studied using a double cassette containing a conventional film screen and a stimulable phosphor plate. The images were separated, randomised and scored thrice by three radiologists for anatomic structure visualisation. The exposure to the plate and film and repeat rate were measured. Scoliosis angles were comparable on both sets of images, however, visualisation of vertebrae, vertebral end plates, pedicles, spinous processes and other structures were significantly improved (p < 0.0001). Intra- and inter-observer reliability was high with good intraclass correlation. There was a 40% potential exposure reduction, and retakes were decreased from 3 to 0%. We conclude that stimulable phosphor images give better anatomic structure visualisation with potential radiation exposure reduction and lower repeat rate.

Child↗
PubMed1994

Prevention of the crankshaft phenomenon with anterior spinal epiphysiodesis in surgical treatment of severe scoliosis of the younger patient.

The aim of this study was to determine whether an anterior approach to the spine with a fusion of the growth centers of the anterior column of the spine, simultaneous by with a posterior fusion and instrumentation of the spine, in young patients with severe scoliosis who have considerable remaining growth, leads to prevention of the crankshaft phenomenon. Twelve patients who have had anterior fusion of the spine associated with posterior fusion and instrumentation of the spine were studied. In 10 of them, growth progression was demonstrated by modification of the Risser sign; for these patients no important progression of the spinal deformity was noted. One patient had no progression of the Risser sign and no progression of spinal deformity. One patient had progression of spinal deformity due to the disruption of the sacral anchorage of instrumentation. We think that this procedure leads to the prevention of the crankshaft phenomenon, and we recommend this procedure in young patients with severe scoliosis and considerable remaining growth. It must include all intervertebral levels of the rigid segment of the curve.

Adolescent↗
PubMed2004

Desflurane accelerates patient response during the wake-up test for scoliosis surgery.

PURPOSE: To evaluate if desflurane possesses a shorter wake-up onset time and less incidence of recall than fentanyl-based anesthesia. METHODS: Forty ASA class I-II adolescents, were enrolled into either a desflurane (DES) group, or a fentanyl (FEN) group for scoliosis surgery. Bispectral index (BIS) was monitored continuously in all patients throughout the procedure; the relationship between the wake-up time and BIS value was evaluated. RESULTS: Patients in the DES group had a significantly shorter wake-up onset than patients in the FEN group (4.1 +/- 0.6 vs 8.9 +/- 2.1 min, P < 0.01). No recall occurred during the wake-up test in the DES group, while five patients had recall in the FEN group, including two patients who recalled a given colour. Extubation time was significantly shorter in the DES group than in the FEN group (7.2 +/- 0.6 vs 16 +/- 11.9 min, P < 0.01). BIS values were significantly higher in the FEN group than in the DES group during anesthesia. (62 +/- 4.5 vs 42 +/- 5.3, P < 0.05) BIS after the wake-up test was similar in both groups (90 +/- 2.9 vs 93.8 +/- 2.5). There was a latency period (3.3 +/- 1.2 min) between the maximal BIS value and wake-up time in the FEN group but not in the DES group. CONCLUSIONS: DES provides a significantly shorter onset time during the wake-up test and a rapid emergence after scoliosis surgery. BIS monitoring during the wake-up test was more informative when anesthesia was maintained with DES compared to FEN infusion.

Adolescent↗
PubMed1996

The position of the aorta in relation to the vertebra in patients with idiopathic thoracic scoliosis.

One CT-scan at the central part of the vertebral body of the apical vertebra of 32 patients with right convex thoracic idiopathic scoliosis and one CT-scan of either T8 or T9 of 22 normal subjects are included in this study. The position of the aorta in relation to the apical vertebra of the scoliotic patients and the corresponding vertebra of the normal subjects was determined at the horizontal plane. The mean lateral translation of the aorta in relation to the mid axis of the vertebral body increased from 19.7 +/- 4.3 mm in the normal group to 26.4 +/- 4.1 mm in the scoliotic group (p = 0.0001). In the normal group the aorta was located 41.7 +/- 8.6 mm in front of a perpendicular line to the mid axis of the vertebral body and in the scoliotic group this distance was reduced to 30.0 +/- 9.0 mm making the position of the aorta more posterior in the scoliotic group (p = 0.0001). This was in accordance with a decreased mean kyphosis-lordosis index from 0.53 +/- 0.06 in the normal group to 0.46 +/- 0.07 in the scoliotic group (p = 0.01). The position of the aorta, also expressed as the angle formed between the aorta and the vertebral body, the "aorto-vertebral angle", was increased from 24.4 degrees +/- 6.9 degrees in the normal group to 41.4 degrees +/- 8.4 degrees the scoliotic patients, (p = 0.0001). The aorto-vertebral angle did not change significantly with increasing Cobb angle (p = 0.26) but was positively correlated to the vertebral rotation (p = 0.0001). An estimation of the length of the intercostal arteries revealed a significantly greater R (right)/L (left) index in the scoliotic patients 1.18 +/- 0.11 than in the normal subjects 1.08 +/- 0.06 (p = 0.0003). It is concluded that the rotation and the anterior displacement of the vertebral body in scoliosis result in a deviation of the aorta along the left (concave) side of the vertebral body to a more posterior position relative to the vertebral body with a possible increased length of the intercostal artery on the right (convex) side.

Adolescent↗
PubMed2000

[Ventral and dorsal correcting and stabilizing methods in idiopathic scoliosis. Long-term outcome].

The age of standardized instrumented scoliosis correction and stabilization began with Harrington instrumentation (HI). With HI, satisfactory long-term correction of the frontal plane averaged approximately 50%, but without notable derotational capabilities. The distraction of the concavity leads to reduction of the sagittal contour of the spine (flat back), which is biomechanically disadvantageous. The newer multisegmentally attached implant systems avoid this disadvantage. The first prototypes of these systems were Luque- (SSI) Cotrel-Dubousset instrumentation. Ideal indications for posterior instrumented curve correction are structural idiopathic double major curves and flexible single curves. However, even with these newer doublerod systems derotation is low, because derotation is, without any doubt, related to anterior release and thus decoupling of the segments by means of disc resection. The optimum method of correction and stabilization of scoliosis using the anterior approach is the ventral derotation spondylodesis (VDS), according to Zielke, who considers it to be a major improvement over Dwyer instrumentation. VDS is the first implant system with which true three-dimensional, segmental curve correction was made possible. Long term correction of the frontal plane and derotation averages approximately 70% and 50%, respectively. Ideal indications are single lumbar, thoracolumbar and thoracic curves. In our experience, the so-called kyphogenic effect of VDS due to anterior convex compression, can be counteracted by derotation and preserving disc space height with weight bearing bone grafts or cages. The low internal stabilizing capabilities with the risk of rod fracture and pseudarthrosis are unfavorable. They make long term cast or brace treatment necessary postoperatively. Meanwhile, the disadvantage of the low internal stabilizing capabilities of VDS has been overcome with the development of the primary stable Halm-Zielke instrumentation and other primary stable anterior fixation systems.

Equipment Design↗
PubMedDate not supplied

Prevalence of asymptomatic cardiac valve anomalies in idiopathic scoliosis.

The prevalence of asymptomatic cardiac valve anomalies was determined in 82 patients (69 females and 13 males) diagnosed as having idiopathic scoliosis and scheduled for corrective surgery (mean age at surgery 16.3 years). The preoperative study in each patient included echocardiography and ultrasound Doppler. Twenty-three valvular anomalies were found in 20 patients (24.4%). The most frequent was mitral valve prolapse. The occurrence of valvular anomalies did not correlate with sex, curve magnitude, or age at diagnosis. Eighteen patients presented a total of 20 comorbid conditions: positive family history of scoliosis (five cases), isthmic spondylolisthesis (five cases), nervous anorexia (two cases), hereditary exostosis, cystic fibrosis, ureteral stenosis, mammary hypoplasia, slipped capital femoral epiphysis, psoriasis, celiac disease, and lactose intolerance. A significant relationship was found between valvular anomalies and comorbidity. Valvular anomalies were detected in 11 out of 64 patients (17.2%) with no comorbidity and in nine out of 18 patients (50%) with a comorbid condition (Chi-square 8.2, p = 0.004). In this latter group of patients, routine echocardiographic study seems advisable in the preoperative evaluation.

Adolescent↗
PubMed2003

Optimisation of scoliosis examinations in children.

OBJECTIVE: To present results of optimising scoliosis examination by changing from a conventional film/grid (F/G) to air-gap technique using computed radiography (CR), and to evaluate different methods for estimating effective radiation doses. MATERIALS AND METHODS: Forty-nine children and adolescents were examined with an F/G technique, and 21 with air-gap and CR techniques. Entrance surface doses (ESD) were determined with lithium fluoride thermoluminescence dosimeters. For all patients, the effective radiation doses were determined using a hermaphrodite PCXMC computer program. For all F/G radiographs, the effective doses were also determined according to the NRPB-R279 report, and for 22 children (>9 years and/or >40 kg) also with the ODS-60 program, which allows separate gender calculations. Accumulated doses for 37 children examined more than once with F/G examinations were assessed. RESULTS: For F/G techniques, the ESDs for both frontal and lateral views varied with age and were significantly correlated to the patients' thickness. The calculated effective doses using the PCXMC program and the NRPB-R279 did not differ significantly for all frontal and lateral radiographs, respectively, but ODS-60 gave significantly higher values in female subjects. With air-gap and CR techniques, the mean effective doses were reduced by a factor over 10. The mean accumulated effective dose for 37 children with a mean of seven F/G examinations was 6.1 mSv, implying a risk of death of about 1:2,000 for boys and at least 1:1,000 for girls. CONCLUSIONS: Paediatric scoliosis radiography should be considered a specialised procedure, which has to be optimised using a non-grid technique.

Child↗
PubMed1998

Scoliosis circa 2000: radiologic imaging perspective. II. Treatment and follow-up.

Plain film imaging remains important for the diagnosis and surveillance of scoliosis, as well as for the detection of complications after surgery. New means of treating scoliosis have become established and should be understood by the radiologist. To the well-known postoperative complications, including pneumothorax, pneumonia, and gastrointestinal obstruction, are added new specific potential problems with the new surgical methodology.

Diagnostic Imaging↗
PubMed2004

Low back pain after spinal fusion and Harrington instrumentation for idiopathic scoliosis.

We reviewed 41 patients with adolescent idiopathic scoliosis treated with spinal fusion and Harrington instrumentation between 1973 and 1992. The mean follow-up was 23 (11-30) years. All patients completed self-administered questionnaires, Oswestry Low Back Pain Disability Score (ODS), Roland Morris score (RLS), and Visual Analog Pain Intensity Scale (VAS). We found a high degree of satisfaction with more than three quarters of the patients in work. The outcome of ODS, RLS, and VAS showed low scores. We found a significant correlation between the scores and the Cobb angle preoperatively as well as at follow-up. The patient-oriented outcome did not correlate with the type of curve, extension of vertebral fusion, tilt angle of the lowest instrumented vertebra, postoperative Cobb angle, loss of correction, or lumbar lordosis. This long-term follow-up of Harrington rod fusion for adolescent idiopathic scoliosis showed no important impairment of health-related quality of life.

Adolescent↗
PubMed1998

Infantile idiopathic scoliosis in the newborn.

We have reviewed 7 patients (5 boys and 2 girls) with infantile idiopathic scoliosis which was present at birth and was diagnosed at ages from 1 day to 1 month. The mean follow up was 16 years. The objectives were to discover whether intrauterine forces play a role in the aetiology and to determine whether early treatment of a potentially progressive curve can induce resolution. Two infants were male conjoined twins and were united by skin over the posterior sacrum. Six infants had a rib vertebral angle difference greater than 20 degrees in the first radiograph and 5 had stiff curves. In 2 with flexible curves, the deformity disappeared by the end of the first year. The 5 with stiff curves were treated conservatively for 6 to 24 months. Growth has now been completed in 5; 4 have a straight spine and one developed an adolescent curve of 26 degrees. The 2 who are still growing have no scoliosis. Intrauterine moulding was only demonstrated in the conjoined twins. There was a correlation between the rib vertebral angle difference above 20 degrees and the rigidity of the curve. Early treatment of a potentially progressive curve can lead to resolution.

Female↗
PubMed2000

Syringomyelia in children with primary scoliosis.

The clinical notes of 35 children presenting with scoliosis were reviewed; all 35 had been investigated with MRI. Seven were found to have syringomyelia, and six of these had Chiari malformation. Correction of the syrinx resulted in improvement or stabilisation of the spinal curvature. We recommend that all cases presenting with primary scoliosis should have MRI and should be treated if a syrinx is found.

Arnold-Chiari Malformation↗
PubMed1998

Compression of the esophagus by the spine and the aorta in untreated scoliosis.

An adult patient with severe scoliosis secondary to familial dysautonomia developed dysphagia and recurrent aspirations. Various imaging studies showed a mechanical obstruction of the esophagus due to compression between the spine and the aorta. The patient underwent a gastrostomy and fundoplication, with a significant decrease in symptoms. The case demonstrates one of the possible long-term consequences of untreated scoliosis.

Adult↗
PubMed2002

SSEP analysis in surgery of idiopathic scoliosis: the influence of spine deformity and surgical approach.

The study was conducted to assess the possible impact of spine deformity in patients with idiopathic scoliosis (IS) on tibial nerve somatosensory evoked potentials (t-SSEPs) and the influence of spine correction upon postoperative SSEP recordings. In 61 consecutive patients undergoing 64 spinal instrumentations, 129 pre- and postoperative SSEPs were analyzed. The degree of spine deformity was assessed by the pre-operative Cobb angle of the major scoliotic curve. In a control group, reference values of t-SSEP latencies were established with respect to body height. In a cohort study, IS patients were compared with healthy controls with respect to t-SSEP latency, amplitude, configuration and interside difference. The results of the analysis showed that preoperative-body-height-corrected t-SSEP latencies were prolonged in 61% of patients, with a pathological interside difference in 23.4% of them. The impairment of t-SSEPs was not related to the extent of spine deformity as assessed by the Cobb angle. Even without occurrence of postoperative neurological deficits, postoperative t-SSEPs showed significantly increased latencies without changes in t-SSEP configuration. The prolongation of t-SSEP latencies was related to the surgical procedure (combined ventro-dorsal approach), but not to the extent of spine correction, level of instrumentation, or number of fused segments. The analysis of preoperative t-SSEPs was of no predictive value for intra- or postoperative neurological complications. t-SSEPs are significantly affected in IS patients, although these patients show no obvious clinical neurological deficits. The extent of t-SSEP impairment is not related to the severity of scoliosis. Even in clinically uneventful surgery, the postoperative t-SSEPs can be deteriorated depending on the surgical approach. This indicates a subclinical impact of spine surgery upon spinal cord function.

Adolescent↗
PubMed2002

Apical instrumentation alters the rotational correction in adolescent idiopathic scoliosis.

The aim of this study was to retrospectively evaluate the effect of apical vertebral instrumentation in the axial plane in the surgical treatment of idiopathic scoliosis. Seventy-six consecutive patients with King type II idiopathic scoliosis, treated with posterior spinal instrumentation, were included in the study. The mean age of the patients was 14.5 years (range 10-18 years), and the mean follow-up was 49 (range 28-74) months. Preoperative radiological evaluation was performed with postero-anterior, lateral, traction and side-bending radiographs. Vertebral rotation was measured with a Perdriolle torsion meter. Patients were retrospectively divided into two groups according to the presence of apical vertebra instrumentation. Group 1 consisted of 43 patients in whom the upper and lower neutral and intermediate vertebrae of thoracic curves had been instrumented on the concave side. Group 2 consisted of 33 patients who had received instrumentation of the apical vertebra on the concave side in addition to the instrumentation configuration of group 1. Posterior fusion was added in all patients. Cobb and Perdriolle measurements were compared between the two groups preoperatively and at the last follow-up. Preoperative age and gender distribution, Cobb angle and rotational measurements, and correction ratios on side-bending films were similar in the two groups. Although the differences between the two groups in preoperative mean values of both Cobb angle and apical rotation were not statistically significant (P>0.05), mean values of apical rotation were significantly different postoperatively (P<0.05). At the same time, apical derotation ratios differed significantly between the two groups (P=0.000). We conclude that instrumentation of the apical vertebra provides better derotation at the apex.

Adolescent↗
PubMed2003

Congenital scoliosis.

Congenital scoliosis is the most frequent congenital deformity of the spine. Congenital curvatures are due to anomalous development of the vertebrae (failure of formation and/or segmentation). Congenital scoliosis is believed to be related to an insult to the fetus during spine embryological development, and associated malformations (heart, spinal cord, kidney.) are frequently observed. A perfect understanding of the natural history of the deformity and the treatment principles will allow best management of these complex spine deformities. New imaging techniques like three-dimensional computed tomography (CT) and magnetic resonance imaging (MRI) are important tools for analyzing the underlying deformity and understanding the evolution of the complex deformities. The mainstay of treatment is either observation or, in case of curve progression (>10 degrees /year), surgery. Different surgeries are described with two main principles: (1) prophylactic surgeries like hemiepiphysiodesis or in situ fusions that will prevent worsening or allow progressive correction over time, and (2) corrective surgeries, with spinal fusion with or without spinal resection. Exceptional procedures (e.g. spinal column resection or halo distraction) can be attempted in cases of very severe deformity. Congenital curves must be carefully observed to choose the least invasive procedure at the right time and to minimize spinal cord risks.

Child↗