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PubMed1988

Biomechanical basis of optimal scoliosis surgical correction.

For an optimal approach to surgical correction of scoliosis, it was deemed desirable to biomechanically simulate the set of corrective forces applied by alternative internal fixation systems, so as to determine and apply the internal fixation system producing the best correction under safe levels of forces applied by the fixation systems to the spinal structures. To this end, we have developed, and presented here, (1) a spinal finite-element model relating the applied corrective forces to the corrected spinal configurations, (2) a method for determining the stiffness of the patient's spine prior to surgery, (3) computerized finite-element analysis simulation of alternative internal correction-fixation systems, so as to determine the most efficacious system, (4) instrumentations for surgically implementing the recommendations of the surgical simulation analysis and (5) comparisons of the model-simulated and surgically-obtained corrected spinal configurations. These procedures together constitute the biomechanical foundations of scoliosis surgical correction.

Biomechanical Phenomena↗
PubMed1976

Spinal muscle in scoliosis. Part 1. Histology and histochemistry.

Histological and histochemical techniques were employed in a study of the spinal muscles from 35 adolescent scoliotic patients. Many abnormalities were found and, in general, the changes were indicative of denervation and neuropathy. None of the abnormalities were found at any one site more frequently than at any other, nor were they more often seen on one side or the other. None of the patients examined were normal at all sites of biopsy. These findings provide evidence of a neuropathic process being involved in the aetiology or progression of scoliosis. So-called "idiopathic" scoliosis may, perhaps, be the result of an otherwise sub-clinical lower motor neurone disorder.

Adolescent↗
PubMed1981

Instrument for distraction by limited surgery in scoliosis treatment.

A principle for secondary instrumental spinal distraction by a rod appliance of the Knodt and Harrington types is described. The principle entails of the rotation of the screw rod by wire traction. The wire is, in a secondary procedure, unwound from a wire barrel mounted onto the screw rod in the primary operative procedure. The study describes the devices employed, modified according to the wire traction--instrument distraction principle. Previous results from intra-vital studies of the Harrington instrumentation have been reported from experiments performed. Thus, a final distraction force of 18 kp effected for correction of a scoliosis curvature, was taken as a value of distraction prior to secondary instrumental distraction by wire traction. In the extra vital study, the wire traction was adjusted to surmount a compressive force of 20 kpby means of a Bessmann weight scale. Wire traction created a distraction force of 39.5 kp, and a metric distraction, from the position resulting from 20 kp distraction to that resulting from 39.5 kp distraction, of 2.8 mm, which was considered to affect the prevailing scoliosis geometry to a considerable and sufficient extent.

Humans↗
PubMed1992

A video digitizer for analysis of trunk deformity in scoliosis.

Scoliosis is a deformity characterized by lateral curvature of the spine and accompanied by axial rotation of the vertebrae; it often causes varying degrees of trunk deformity. Research has indicated that topographic techniques can be used to describe the disorder and monitor its progression. A video image acquisition system has been designed which reduces the time required to quantify topographic details of the trunk and aids in the diagnosis, monitoring and research of scoliosis. This system integrates the capability of large, expensive grey-scale image acquisition equipment into a small, low-cost diagnostic imaging tool using current technologies and design techniques. The video digitizer accepts a standard NTSC monochromatic video signal as input and the unit is connected to a computer via an IEEE-488 bus from which the ditigizer is controlled. The digitizer samples the video signal in real time using a high-speed flash converter controlled by an application-specific integrated circuit; the digital samples are stored in memory until the host computer requests that the information be transferred.

Adolescent↗
PubMed1989

Are pulmonary factors responsible for the direction of the spinal curvature in idiopathic scoliosis?

In idiopathic scoliosis the convexity of the thoracic curve of the vertebral column is most commonly directed toward the right side. The right lung is normally larger than the left lung. This asymmetry acting through chest wall movement is hypothesized to exert rotatory forces on the vertebral column. The result, in persons predisposed to scoliosis by genetic and other factors, is a rightward convexity of the thoracic spine.

Humans↗
PubMed1996

No diffuse osteoporosis in lumbar scoliosis but lower femoral bone density on the convexity.

The aims of our study were to find out, in 15 female volunteers with untreated structural lumbar idiopathic scoliosis, through dual-photon X-ray absorptiometry measurements, whether femoral bone mineral density (BMD) was different between the right and the left side and whether this difference was related to scoliosis convexity. We showed that no statistical significant difference between femoral neck BMD measured on both sides of the same patient (p = 0.6). However, neck BMD from the same side as the convexity side was significantly lower than the opposite one.

Absorptiometry, Photon↗
PubMed2006

The potential use of axial spinal unloading in the treatment of adolescent idiopathic scoliosis: a case series.

OBJECTIVE: To assess potential benefits of axial spinal unloading (LTX 3000 Lumbar Rehabilitation System) over a brief 3-month period. DESIGN: Before-after pilot study. SETTING: University research laboratory. PARTICIPANTS: Five adolescent girls with scoliosis. INTERVENTIONS: Three laboratory sessions: (1) initial baseline, (2) immediately after 3-month treatment period (axial unloading by using LTX 3000 for two 10-minute treatments daily), and (3) 1 month posttreatment. MAIN OUTCOME MEASURES: Initial baseline postural data were obtained from 2 sets of radiographs (standing anteroposterior [AP] and lateral, sitting AP and lateral), back range of motion measurements, and numeric pain scales. The following were assessed: static postural changes; potential functional benefits; and therapeutic compliance. RESULTS: All subjects elicited reductions in lumbar Cobb angles immediately after 3 months of treatment; initial average scoliotic curves of 13.7 degrees were reduced 42% to 8 degrees (alpha = .05, P = .004). Additionally, such reductions were evident 1 month posttreatment; average original curves were reduced by 27%. Subjects' range of motion and lumbar lengthening were not significantly altered by this therapeutic protocol. Reported subject compliance was high (95%). CONCLUSIONS: The LTX 3000 is a potential adjunct therapy for the treatment of adolescent scoliosis. This therapy resulted in curvature reductions and was widely accepted by subjects that were compliant with self-administration.

Adolescent↗
PubMed2004

Intraoperative neurophysiologic discovery of uncrossed sensory and motor pathways in a patient with horizontal gaze palsy and scoliosis.

OBJECTIVE: To report the intraoperative neurophysiologic discovery of clinically unsuspected non-decussation of the somatosensory and motor pathways. METHODS: We performed somatosensory evoked potential (SEP) and transcranial electric stimulation (TES) muscle motor evoked potential (MEP) monitoring during scoliosis surgery for a 16 year old patient with familial horizontal gaze palsy and progressive scoliosis. Our routine procedures included optimizing tibial cortical SEP monitoring derivations through saggital and coronal (C4', C2', Cz', C1', C3'-mastoid) P37 mapping, which surprisingly indicated non-decussation. Consequently, we also obtained coronal median nerve SEPs and simultaneous bilateral muscle recordings to lateralized TES (C3-Cz, C4-Cz) intraoperatively and focal hand area transcranial magnetic stimulation (TMS) postoperatively. RESULTS: For each nerve, tibial P37/N37 distribution was contralateral/ipsilateral and median N20 ipsilateral. For each hemisphere, ipsilateral TES MEPs had lower thresholds and TMS MEPs were exclusively ipsilateral. Accurate monitoring required reversed montages. Reevaluation of an MRI (previously reported normal) disclosed a ventral midline cleft of the medulla. CONCLUSIONS: The results indicate uncrossed dorsal column-medial lemniscal and corticospinal pathways due to brain-stem malformation with absent internal arcuate and pyramidal decussations. SIGNIFICANCE: Simultaneous bilateral recording to unilateral stimulation demonstrates SEP/MEP hemispheric origin and is important for accurate interpretation and monitoring because decussation anomalies exist.

Adolescent↗
PubMed2004

Nicardipine versus nitroprusside for deliberate hypotension during idiopathic scoliosis repair.

STUDY OBJECTIVE: To compare coagulation, blood loss, and transfusion requirements between patients receiving nicardipine and nitroprusside for deliberate hypotension during idiopathic scoliosis repair. DESIGN: Prospective, randomized study. SETTING: University hospital. PATIENTS: 51 ASA physical status I patients presenting for spine fusion for idiopathic adolescent scoliosis. INTERVENTIONS: Patients were randomized to two groups to receive nicardipine or nitroprusside to maintain mean arterial pressure (MAP) between 55 and 65 mmHg. MEASUREMENTS: Blood loss, blood transfusions, and coagulation studies (thromboelastogram and platelet aggregation) before starting vasodilator, 30 minutes and 90 minutes after starting vasodilator, and 30 minutes after stopping vasodilator, were all recorded. MAIN RESULTS: There was no difference between the groups in blood loss [nicardipine = 1,129 cc (893 to 1,480), nitroprusside = 960 cc (704 to 1,473)] and only one patient required a nonautologous transfusion. There were no differences in prothrombin time (pT, partial thromboplastin time (pTT), platelet count, or platelet aggregation between groups. There were more episodes of severe hypotension (MAP <45 mmHg) in the nitroprusside group (0% vs. 28%, p = 0.0175). On average, patients in the nicardipine group spent 21 minutes less in the recovery room than did the nitroprusside group (p = 0.043). CONCLUSIONS: Nitroprusside's effect on platelet aggregation produces no increase in blood loss compared with nicardipine. Nicardipine causes less transient severe hypotension than nitroprusside, although both drugs are acceptable choices for obtaining the goals of deliberate hypotension.

Adolescent↗
PubMed2006

Reversible pelvic asymmetry: an overlooked syndrome manifesting as scoliosis, apparent leg-length difference, and neurologic symptoms.

OBJECTIVE: The objective of this study was to investigate the occurrence of pelvic asymmetry in neurologic patients with symptoms not explained by their neurologic diagnosis. METHODS: We analyzed 150 consecutive neurologic patients referred to physiatric consultation based on their clinical examination findings. RESULTS: We observed pelvic asymmetry associated with either C-type or S-type scoliosis and apparent leg-length difference in 87% of the patients. Symmetry could be reestablished by all patients, although 15% showed immediate or imminent relapse. Maintenance of symmetry showed a highly significant (P < .001) correlation with improvement in functional ability and reduction of pain as evaluated during the last visit to the physiatrist. In the follow-up questionnaire, 78% of the patients reported improvement in functional ability and reduced pain. CONCLUSIONS: Our results support the view that leg-length difference and scoliosis may be more often of reversible nature than previously considered. Acquired postural asymmetry of the sacroiliac joint may be a neglected cause of several neurologic and other pain-related symptoms that can be relieved by a simple and safe treatment.

Biomechanical Phenomena↗
PubMed2006

Degenerative lumbar scoliosis.

In adults, symptomatic scoliosis is usually a de novo primary degenerative deformity that develops in the fifth or sixth decade or an unrecognized or untreated idiopathic deformity with superimposed degeneration. The evaluation and treatment of adult scoliosis must focus on addressing patient symptoms while limiting the consequences of the treatment. The presence of neurological deficits, the flexibility of the deformity, the coronal and sagittal balance, and status of spinal segments outside of the main deformity are all important considerations when planning surgery. The complication rate of deformity surgery in adults is potentially high; but excellent functional outcome and patient satisfaction can occur with thorough preoperative patient education and meticulous surgical technique.

Adult↗
PubMed2006

Sexual dimorphism in adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS) is one of the orthopedic disorders in which clinical evidence of sexual dimorphism is most marked. Sexual dimorphism in spine growth, morphology, stiffness, curve pattern, and hormones may be the environment in which genetic factors combine to produce the phenotype of a scoliosis patient. These factors also may play a role in the curve progression despite treatment and may help explain why some patients' curves never change and others are recalcitrant to nonoperative treatments. There are important differences in male and female AIS that impact diagnosis, treatment, and outcomes.

Adolescent↗
PubMed1999

[Surgical treatment of scoliosis due to Duchenne muscular dystrophy].

PURPOSE OF THE STUDY: The purpose of this retrospective study is to demonstrate the advantages of early surgical operation for patients suffering from Duchenne muscular dystrophy scoliosis. PATIENTS AND METHODS: Since 1992, 37 patients suffering from Duchenne muscular dystrophy were operated on for scoliosis. Mean age was 12 years. Vital capacity was 62 +/- 17% and left ventricular ejection fraction 55 +/- 7%. Insertion of flexible vertebral instrumentation included a pedicular screwing system in the lumbo-sacral area and transversal attachments with steel threads at the thoracic level. A sub-laminar fastening was placed at L1. Bone bank arthrodesis was performed only at lumbo-sacral level, in order to maintain flexibility in the thoracic part of the assembly and to enable growth. RESULTS: Assisted ventilation was necessary in three children during 1.5 month. Superficial sepsis was treated locally with an antibiotherapy without the removal of material in four patients. There was one stem rupture two years after operation, caused by a road traffic accident. No further procedure was necessary for technical reasons. There was no death during the longest follow-up period among the first 24 patients (mean follow-up: 57 months). In the frontal plane, the preoperative Cobb angle, which was 19 degrees, was brought to 5.2 degrees at the postoperative stage, and 9.5% at the latest measurement, i.e., a loss of angular correction of 4.3 degrees. In the sagittal plane, there were physiological curvatures. Pelvic balancing was correct and results have held over time. Vital capacity was reduced by 3.6% per year. CONCLUSION: These results encourage early operation on these patients in order to avoid anaesthetic, peri- and postoperative complications. Likewise, giving support to minor curves reduces mechanical constraints during the first postoperative years. The absence of thoracic arthrodesis enables growth of about 5 cm when patients are operated on at about the age of 12 years. Stabilization of the myopath's spine enables the child to remain in an upright sitting position. The assembly's thoracic suppleness enables an increase in the range of movement in the upper limbs. It seems appropriate to operate on such patients when they cease walking, around the age of 12 years. Cardiorespiratory function and life expectancy are not improved, but most patients and families are very satisfied by the comfort brought about by the surgical operation.

Age Factors↗
PubMedDate not supplied

Duane anomaly, congenital myopathy and severe scoliosis in sibs: new AR syndrome?

We report on two sisters who show a similar pattern of anomalies consisting of bilateral Stilling-Türk-Duane retraction syndrome (type 3), non-progressive hypotonia with delayed motor milestones but normal intelligence, severe, early onset scoliosis, and short stature. Muscular biopsy revealed numerous regenerating fibers, but no specific abnormalities among the non-regenerating fibers. This combination of anomalies has not been previously reported, and could represent a new autosomal recessive syndrome. The only differential diagnosis is Crisfield-Dretakis-Sharpe syndrome, a combination of lateral gaze palsy, ptosis, and scoliosis without hypotonia, recessively inherited.

Body Height↗
PubMed1990

The psoas sign in normal subjects without bowel preparation: the influence of scoliosis on visualisation.

The lumbar spine films of 1494 subjects who were examined for low back pain or prior to job placement were studied to assess psoas muscle visualisation. The study group were almost all aged 18-39 years. None of the subjects had prior bowel preparation for a contrast examination. In the subjects without scoliosis only 36% had well seen psoas shadows on both sides. Taking the psoas shadows separately, 72% of left psoas shadows were well seen, while only 40% were seen on the right side. In the scoliotic group, the psoas shadow was seen bilaterally in 30% of subjects while in another 50% the muscle was seen only on the convex side of the curve. In no case was it seen only on the concave side. The direction of the curve to left or right did not influence visualisation. Thus in 80% of subjects with scoliosis of 5 degrees or more, the psoas was seen on the convex side, while in only 30% was it seen on the concave side.

Adolescent↗
PubMed1978

Radiological features of vascular compression of the duodenum occurring as a complication of the treatment of scoliosis (the cast syndrome).

The application of a body cast or the surgical correction of scoliosis is occasionally associated with acute obstructive vascular compression of the duodenum. The clinical and radiological manifestations observed in 10 such patients are described. All cases manifested abdominal distension and vomiting, while epigastric pain was present in 50%. Plain radiographs of the abdomen demonstrated duodenal distension with little gas in the remainder of the bowel in three cases. Barium studies in nine patients demonstrated an intact mucosal pattern and a duodenum dilated proximal to the site where the superior mesenteric vessels crossed it. All cases recovered with non-operative treatment which included nasogastric suction, intravenous fluids, change in position, particularly nursing in the prone position, and, occasionally, cast removal. The obstruction may sometimes persist or recur and then duodenojejunal side-to-side anastomosis is the surgical procedure of choice. The term "cast syndrome" is a misnomer as vascular compression of the duodenum may also occur in patients who are undergoing treatment for scoliosis without the use of a body cast.

Adolescent↗
PubMed2003

Pathogenesis of idiopathic scoliosis revisited.

Scoliosis, a lateral deviation of the spine frequently associated with rotation, is not a specific disease but a deformity complicating many diseases. Curve progression is the major concern irrespective of the initiating cause. Idiopathic scoliosis is arguably postural in nature and in some subjects develops from intrauterine compression. Analysis of the pathogenesis leads to the conclusion that progression is due to an accelerated premature osteoarthrosis induced by insidious tissue fatigue of biomechanical origin. The chronic cumulative effect of repetitive tensile stresses applied asymmetrically to the postural deformity, manifested by loss of tensile strength and tissue cohesion, leads to fragility and eventual tissue disintegration of vertebrae, intervertebral discs, and laxity of ligaments. Early treatment, prevention, and avoidance of stresses that accentuate progression are of paramount import.

Animals↗
PubMed1999

Cause and natural history of adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis is a highly prevalent disorder of the spine, occurring in phenotypically normal individuals for unknown reasons. The role of genetic factors in this condition has been widely documented through clinical observations and population studies. Multiple areas of research, including connective tissue, neuromotor mechanisms, hormonal system, and biomechanics, have been explored for a potential relationship to the cause of idiopathic scoliosis; however, no clear evidence supports any one area as a etiologic factor of this disorder. The main difficulty of most investigations is to determine whether the observed abnormalities are primary or secondary features in the scoliotic deformity. It is hoped that continued research efforts will aid in the understanding of this disorder in an effort to improve the ability to assign a more specific prognosis.

Adolescent↗