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PubMed2001

Treatment of idiopathic scoliosis with CD-instrumentation: lumbar pedicle screws versus laminar hooks in 66 patients.

We studied whether the pedicle screw is better than laminar hooks for fixation of the lumbar spine in the treatment of idiopathic scoliosis. 66 consecutive patients with idiopathic scoliosis (King I and II) were studied retrospectively. Group S included 33 patients (25 females) treated with pedicle screws. Their mean age at operation was 17 (13-54) years. Group H included 33 patients (30 females) treated exclusively with hooks. Their mean age at operation was 16 (1140) years. The preoperative mean angles of the thoracic curve in group S was 66 (42.115) degrees, and in group H 65 (42-121) degrees. The lumbar curve averaged 46 (20-85) degrees in group H and 53 (33-86) degrees in group S. All patients were fused only posteriorly with Cotrel-Dubousset instrumentation and an autogenic bone graft. The mean follow-up time was 4 (2-7) years. Mean correction of the thoracic curve was 45% in group S and 50% in group H. The lumbar curve was corrected by 50% in group S and 51% in group H. Loss of correction of the thoracic curve occurred in 5% in group S and 6% in group H and of the lumbar curve in 3% in group S and 10% in group H (p = 0.04). Group S better maintained the correction of the lateral tilt of the uninstrumented segment adjacent to the fusion (p = 0.04). Derotation, according to Perdriolle, in the distal segment adjacent to the fusion was 6% in group S and 2% in group H. We found no difference between correction of the thoracic and lumbar curves using pedicle screws and laminar hooks in the lumbar spine. Pedicle screws better maintained the correction of the lumbar curve and the lateral tilt in the distal segment adjacent to fusion.

Adolescent↗
PubMed1988

Diagnosis and treatment of spinal deformities. What to do for the patient with scoliosis.

Evaluation of scoliosis should include a careful medical history and a complete physical and neurologic assessment. Standing posteroanterior and lateral radiographs of the spine should be obtained and every effort made to arrive at an accurate diagnosis that pinpoints the cause of the spinal deformity. Special attention should be paid to painful spinal deformities in the pediatric population because they represent a potentially serious medical condition. Painful spinal deformities in adults usually respond to conservative therapy. Use of a spinal orthosis may help control pain in an adult and may prevent progression of a spinal deformity in a child or adolescent. Regardless of the patient's age, however, progressive or painful scoliosis may necessitate surgical treatment.

Adolescent↗
PubMed2003

Effect of different casting methods on adolescent idiopathic scoliosis.

Scoliosis is a three-dimensional spinal deformity. Although orthotic treatment for moderate adolescent idiopathic scoliosis (AIS) has been well recognized, there are few studies documenting the effectiveness of different casting methods in the fabrication of thoracolumbo-sacral orthoses (TLSO). The current study was a retrospective clinical evaluation of the effectiveness of two commonly used casting methods namely, the frame casting method and the supine with traction casting method in the treatment of AIS. Eighty (80) female patients with AIS were recruited and they were all treated by TLSOs. The frame casting method was used in 37 patients while the remaining 43 patients were under the supine with traction casting method. The responses of spinal deformities under the two different casting methods were analyzed for the period from pre-brace to 2 years after bracing. The studied parameters included the AP Cobb's angle, the apical vertebral rotation and the trunk listing (cervico-sacral lateral offset). The results of the current study showed that the orthoses manufactured from the two casting methods could provide an effective control of AIS (change of Cobb's angle within (+/- 5 degrees). For the frame casting, the Cobb's angles at pre-brace and 2 years after off-brace were 36.0 degrees and 33.8 degrees respectively while for the supine with traction casting, the corresponding Cobb's angles were 32.7 degrees and 34.0 degrees. The frame casting method could give a better control of the apical vertebral rotation at the early stage of treatment (pre-brace = 18.2 degrees and the 4th month = 13.8 degrees while the supine with traction casting method was more effective in the long-term control of the trunk listing (pre-brace = 10mm and 2 years after off-brace = 3.3mm).

Adolescent↗
PubMed2006

Human platelet Ca2+-ATPases: new markers of cell differentiation as illustrated in idiopathic scoliosis.

The aetiology of adolescent idiopathic scoliosis (AIS), the most common form of scoliosis, is unclear. Previous studies showed controversial platelet abnormalities including intracellular calcium. Platelet Ca2+ homeostasis is controlled by a multi-Ca2+-ATPase system including SERCA (sarco/endoplasmic reticulum Ca2+-ATPase) and PMCA (plasma membrane Ca2+-ATPase) isoforms. Here, we first investigated the expression of PMCA4b, SERCA3a and SERCA2b isoforms in platelets of 17 patients with AIS. Patients presenting thoracic curves were found to present a higher PMCA4b expression coupled to a lower SERCA3a one in agreement with an abnormality in platelet maturation. Indeed, using PMA-treated MEG 01 cells, an in vitro model of megakaryocytopoiesis, we found an increase in SERCA3a expression, associated to a caspase-3 mediated C terminal proteolysis of PMCA4b. To look whether platelets reflect a basic defect in cell differentiation, we next identified osteoblast Ca2+-ATPases and studied their expressions in AIS. Major expressions of PMCA4b and SERCA2b were found in normal osteoblasts. Comparing platelets and osteoblasts in two additional patients with AIS, we found opposite and concerted regulations of the expressions of PMCA4b and caspase-3 substrate, PARP in both cell types. A systemic defect in cell differentiation involving caspase-3 can be proposed as a novel mechanism in the etiopathogenesis of the most frequent type of AIS. *R. Bredoux and E. Corvazier contributed equally to this work.

Adolescent↗
PubMed2000

Reconstruction of laser-scanned 3D torso topography and stereoradiographical spine and rib-cage geometry in scoliosis.

Assessments of scoliosis are routinely done by means of clinical examination and full spinal x-rays. Multiple exposure to ionization radiation, however, can be hazardous to the child and is costly. Here, we explain the use of a noninvasive imaging technique, based on laser optical scanning, for quantifying the three-dimensional (3D) trunk surface topography that can be used to estimate parameters of 3D deformity of the spine. The laser optical scanning system consisted of four BIRIS laser cameras mounted on a ring moving along a vertical axis, producing a topographical mapping of the entire torso. In conjunction with the laser scans, an accurate 3D reconstruction of the spine and rib cage were developed from the digitized x-ray images. Results from 14 scoliotic patients are reported. The digitized surfaces provided the foundation data to start studying concordance of trunk surface asymmetry and spinal shape in idiopathic scoliosis.

Calibration↗
PubMedDate not supplied

Physical exercises as a treatment for adolescent idiopathic scoliosis. A systematic review.

Our purpose was, through an extensive and systematic review of the literature, to verify the effectiveness of physical exercises in the treatment of adolescent idiopathic scoliosis. We performed a search of different databases (Medline, Cochrane Library, Embase, Cinhal), and a hand-search of the non-indexed pertinent literature, and found 11 papers: none of the studies was randomized, six were prospective, seven were controlled, and two compared their results to historical controls; one paper had both a prospective design and a concurrent control group. The methodological quality of the retrieved studies was reviewed and found to be very poor. With one exception, the published studies demonstrated the efficacy of physical exercises in reducing both the rate of progression or the magnitude of the Cobb angle at the end of treatment. However, being of poor quality, the literature failed to provide solid evidence for or against the efficacy of physical exercises in the treatment of adolescent idiopathic scoliosis. Nevertheless, considering that exercises could also be proposed on the basis that benefits rather than to avoid progression have been shown in the literature, and that the results contained in published studies here reviewed suggest an effect on the primary goal of preventing progression, there is a basis for discussion of this option with patients and their families, which in turn allows decisions to be made according to their preferences.

Adolescent↗
PubMedDate not supplied

Estimating the final outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up.

OBJECTIVE: The study was conducted on the possibility of predicting the final outcome of bracing for idiopathic scoliosis at a follow-up period of 6 months. METHODS: In a retrospective study, 62 adolescent female patients with right thoracic scoliosis (20-40 degrees Cobb angle) treated with a brace were examined. A new compliance score was developed. The sample was divided into four groups based on compliance (compliance score) and initial correction (half-year after start bracing): group A, good compliance/high initial correction; group B, good compliance/low initial correction; group C, bad compliance/high initial correction; group D, bad compliance/low initial correction. The final outcome (1 year after weaning) was defined as successful if a curve correction of at least 5 degrees was achieved. The influence of factors on final outcome was analysed by ANOVA. Differences between continuous data were analysed by a two-sample Wilcoxon test. RESULTS: The overall final outcome was not successful (thoracic curve -3 degrees). However, the average outcome of the compliant group was successful (-5 degrees), while no success was achieved without good compliance (+5 degrees). High initial correction of more than 40% (p < 0.002) and good compliance (p< 0.004) were of significant impact for the outcome. Patients showing good compliance and high initial correction presented a successful outcome of 7 degrees Cobb angle. CONCLUSION: Compliant patients with a high initial correction can expect a final correction of around 7 degrees, while compliant patients with low initial correction may maintain the curve extent. Bad compliance is always associated with curve progression.

Adolescent↗
PubMedDate not supplied

Conservative treatment for adolescent idiopathic scoliosis: can it reduce the incidence of surgical treatment?

Since 1986, the authors have been conducting conservative treatment for idiopathic scoliosis with the combination of brace treatment and physical treatment (side shift exercise and hitch exercise). A total of 328 female patients with adolescent idiopathic scoliosis who were at least 10 years of age at the first visit, with Cobb angle of 10 degrees at the minimum and followed until after 15 years of age or skeletal maturity were included. The average Cobb angle was 32.4 degrees and the average age was 13.8 years at the first visit. Surgery was recommended when curvature progressed to >50 degrees. Twenty of 328 patients (6.1%) with more severe curves to begin with (mean Cobb angle at admission of 48.5 +/- 9.3 degrees ) progressed to 62.2 +/- 8.5 degrees and were treated with spinal fusion by the age of 16.0 +/- 2.6 years. The remaining 308 patients, of comparable age at inception of treatment but with a smaller original mean Cobb angle (32.4 +/- 11.1 degrees ), showed no significant increase in magnitude of curvature (mean 33.6 +/- 11.5 degrees ) by the time of discharge (18.6 +/- 3.1 years). The fact that curvature magnitude was maintained at <35 degrees means that these patients will have a good prognosis for avoiding dramatic progression during adulthood.

Adolescent↗
PubMedDate not supplied

Aetiology of idiopathic scoliosis: current concepts.

The aetiology of the three-dimensional spinal deformity of idiopathic scoliosis (IS) is unknown. Progressive adolescent idiopathic scoliosis (AIS) that mainly affects girls is generally attributed to relative anterior spinal overgrowth from a mechanical mechanism (torsion) during the adolescent growth spurt. Established biological risk factors to AIS are growth velocity and potential residual spinal growth assessed by maturity indicators. Spine slenderness and ectomorphy in girls are thought to be risk factors for AIS. Claimed biomechanical susceptibilities are (1) a fixed lordotic area and hypokyphosis and (2) concave periapical rib overgrowth. MRI has revealed neuroanatomical abnormalities in approximately 20% of younger children with IS. A neuromuscular cause for AIS is probable but not established. Possible susceptibilities to AIS in tissues relate to muscles, ligaments, discs, skeletal proportions and asymmetries, the latter also affecting soft tissues (e.g. dermatoglyphics). AIS is generally considered to be multi-factorial in origin. The many anomalies detected, particularly left-right asymmetries, have led to spatiotemporal aetiologic concepts involving chronomics and the genome altered by nurture without the necessity for a disease process. Genetic susceptibilities defined in twins are being evaluated in family studies; polymorphisms in the oestrogen receptor gene are associated with curve severity. A neurodevelopmental concept is outlined for the aetiology of progressive AIS. This concept involves lipid peroxidation and, if substantiated, has initial therapeutic potential by dietary anti-oxidants. Growth saltations have not been evaluated in IS.

Adolescent↗
PubMedDate not supplied

Brace treatment during pubertal growth spurt in girls with idiopathic scoliosis (IS): a prospective trial comparing two different concepts.

STUDY DESIGN: Prospective comparison of the survival rates of two different bracing concepts with respect to curve progression and duration of treatment during pubertal growth spurt in two cohorts of patients followed up prospectively. OBJECTIVES: To determine whether the results obtained by the use of a soft brace (SpineCor) is comparable to the results of the Chêneau derived TLSO during pubertal growth spurt. BACKGROUND DATA: In recent peer reviewed literature, the SpineCor is described as an effective method of treatment for patients with scoliosis. However, until now, no controlled study has been presented comparing the results obtained with this soft brace to a sample treated with other bracing concepts proven effective. METHODS: Twelve patients with Cobb angles between 16-32 degrees during pubertal growth spurt are presented as a case series treated with the SpineCor. The survival rate of this sample is described and compared to a matched group of patients treated with the Chêneau brace of the same age group. All girls treated in both studies were pre-menarchial with the first clinical signs of maturation (Tanner 1-3). RESULTS: During the pubertal growth spurt, most of the patients (11/12) with SpineCor progressed clinicly and radiologicly as well (at least 5 degrees ). Progression could be stopped changing SpineCor to the Chêneau brace in most of the samples described (7/10). The avarage Cobb angle at the start of treatment with the SpineCor was 21.3 degrees , after an avarage observation time of 21.5 months, 31 degrees. The control sample, primarily treated with the Chêneau brace (n=15), showed at average no progression. Cobb angle at the start of treatment was 33.7 degrees and after the observation time of 37 months, 33.9 degrees . Radiological improvements can be reported for some of the cases (3/15) as well as progressions (3/15). At 24 months of treatment time, 73% of the patients with a Chêneau brace and 33% of the patients with the SpineCor where still under treatment with their original bracing concept, at 42 month follow-up time 80% of the patients with Chêneau braces and 8% of the patients with the SpineCor survived with respect to curvature progression. The differences of the proportions statisticly where highly significant. CONCLUSIONS: The SpineCor does not change natural history of idiopathic scoliosis during the pubertal growth spurt. The use of the Chêneau brace seems to do so. Oncoming studies with the aim to test the efficiency of braces should be based on samples at immediate risk for progression (only girls with first signs of maturation but pre-menarchial).

Braces↗
PubMedDate not supplied

Sagittal counter forces (SCF) in the treatment of idiopathic scoliosis: a preliminary report.

BACKGROUND: In patients with idiopathic scoliosis (IS), reduced thoracic kyphosis and reduced lumbar lordosis frequently occur in correlation with the lateral spinal curvature. Normalization of the sagittal profile and hyper-correction of the deviation in frontal and coronal plane are the main issues of the latest concept of bracing. The purpose of this study was to investigate the influence of of sagittal counter forces (SCF) on the scoliotic deformity. STUDY DESIGN: A case series of four patients with IS treated with two braces designed to improve the sagittal profile (Rigo-System-Chêneau-brace and with a sagittal counter force brace, SCF-brace). METHODS: The short-term effect (30 min) of both braces was evaluated using surface topography (Formetric surface topography system, Diers International, Wiesbaden). RESULTS: One patient (Cobb angle 92 degrees ) showed no short-term correction in the frontal and coronal planes; others (Cobb angles between 39 and 48 degrees ) exhibited valuable correction in frontal and coronal planes. There was no short-term correction in the sagittal plane for either brace. CONCLUSION: The application of sagittal counter forces (SCF) seems to have similar short-term effects as 3D correction and should be addressed more in future concepts of scoliosis bracing.

Adolescent↗
PubMed1984

The hemi 3 syndrome. Hemihypertrophy, hemihypaesthesia, hemiareflexia and scoliosis.

Three unrelated girls presented with a developmental syndrome of hypertrophy involving half or a quadrant of the body and not involving the face. The appearance was one of inappropriately large size of the affected side rather than contralateral atrophy. On the larger side, there was hypertrophy of muscle and increased power as well as an increase in diameter, but not in length, of long bones. There was areflexia and decreased pain and temperature sensation on that side. The patients also had progressive scoliosis and foot deformities on the enlarged side. One patient had a lumbar myelomeningocoele , and all 3 had a family history of neural tube closure defects. EMG, nerve conduction studies, EEG, skull x-rays, PEG, and cerebral CT scans were normal. Myelography did not demonstrate an enlarged cord, and in particular there was no evidence for syringomyelia. Chromosome studies revealed normal karyotypes. Sex chromatin was female on both sides in one patient. A defect of the dorsal lip of the neural tube or the neural crest is postulated to explain the abnormality. The association with closure defect in one patient and a positive family history of other neural tube defects in all 3 patients suggests that the developmental defect occurs at an early embryonic stage. Recognition of the syndrome is important. It can be distinguished clinically from hemiatrophy of cerebral origin. The neurological abnormalities are static, but the scoliosis is progressive and requires correction. The condition is associated with an increased prevalence of neural tube closure defects in the family, and forms part of a spectrum of genetically and embryologically related CNS malformations with multifactorial inheritance. Probands, parents, siblings and parents' siblings should be counselled that the risks of spina bifida and anencephaly in their offspring are the same as those in relatives of probands with classical neural tube defects, and should be offered prenatal diagnosis.

Adult↗
PubMed1979

The effect of an exercise program on change in curve in adolescents with minimal idiopathic scoliosis. A preliminary study.

Forty-two adolescents with minimal idiopathic scoliosis, who had been on an exercise program for 9 to 15 months, were evaluated to determine the influence of exercise on change in their curvatures. A difference of 4 degrees or greater between initial and final curve measurements was considered to be a change. Five percent of the curves increased, 74% remained the same, and 21% decreased. Change in curvature for these patients was also compared with that of a matched retrospective group of adolescents with scoliosis who had not had the exercise program. No significant difference in change in curve between the two groups was found. For patients who had been on the exercise program, there was no significant relationship between change in curve and extent of physical activity or between change in curve and exercise recall, correct performance, or frequency. Limitations in the study design and possible explanations for the results are discussed.

Adolescent↗
PubMed1984

Lateral electrical surface stimulation as an alternative to bracing in the treatment of idiopathic scoliosis. Treatment protocol and patient acceptance.

The purpose of this article is twofold. The first is to describe the management by physical therapists of patients using lateral electrical surface stimulation (LESS) for the treatment of progressive idiopathic scoliosis. In this treatment, electrodes are placed on the convex side of the curve in the region of the posterior to midaxillary line to produce a corrective force. Stimulation is applied nightly as the patient sleeps. Treatment is monitored by regular checkups and is stopped at achievement of skeletal maturity. No other treatment or exercises are necessary. The second purpose is to present the results of a questionnaire given to patients who had used LESS for at least six months. Fifty-seven patients and their parents responded to questions on scoliosis, acceptance of LESS treatment, and comparison of LESS treatment with previous brace treatment, if appropriate. Results indicated that many of the brace-associated problems were eliminated, and patient acceptance was high.

Electric Stimulation Therapy↗
PubMed1996

Effects of isoflurane and desflurane on neurogenic motor- and somatosensory-evoked potential monitoring for scoliosis surgery.

BACKGROUND: Most techniques used to monitor spinal cord tracts are sensitive to the effects of anesthesia, particularly to volatile anesthetic agents. The aim of this prospective study was to show that evoked potentials recorded from the peripheral nerves after spinal cord stimulation, so-called neurogenic motor evoked potentials, are resistant to clinical concentrations of isoflurane or desflurane, compared with somatosensory-evoked potentials. METHODS: Twenty-three patients were studied during surgery to correct scoliosis. The background anesthetic consisted of a continuous infusion of propofol. Isoflurane (n = 12) or desflurane (n = 11) were then introduced to achieve 0.5 and 1.0 end-tidal minimum alveolar concentrations (MAC), both in 50% oxygen-nitrous oxide and in 100% oxygen. Somatosensory-evoked potentials were elicited and recorded using a standard method, defining cortical P40 and subcortical P29. Neurogenic motor-evoked potentials were elicited by electric stimulation of the spinal cord via needle electrodes placed by the surgeon in the rostral part of the surgical field. Responses were recorded from needle electrodes inserted in the right and left popliteal spaces close to the sciatic nerve. Stimulus intensity was adjusted to produce a supramaximal response; that is, an unchanged response in amplitude with subsequent increases in stimulus intensity. Measurements were obtained before introducing volatile agents and 20 min after obtaining a stable level of each concentration. RESULTS: Isoflurane and desflurane in both 50% oxygen-nitrous oxide and 100% oxygen were associated with a significant decrease in the amplitude and an increase in the latency of the cortical P40, whereas subcortical P29 latency did not vary significantly. Typical neurogenic motor-evoked potentials were obtained in all patients without volatile anesthetic agents, consisting of a biphasic wave, occurring 15 to 18 ms after stimulation, with an amplitude ranging from 1.3 to 4.1 microV. Latency or peak-to-peak amplitude of this wave was not significantly altered with isoflurane and desflurane, either in the presence or in the absence of nitrous oxide. CONCLUSIONS: Compared with cortical somatosensory-evoked potentials, neurogenic motor-evoked potential signals are well preserved in patients undergoing surgery to correct scoliosis under general anesthesia supplemented with isoflurane or desflurane in concentrations as great as 1 MAC.

Adolescent↗
PubMed1993

Management of adolescent idiopathic scoliosis.

Knowledge regarding the etiology, natural history, evaluation, and treatment of adolescent idiopathic scoliosis continues to accumulate. Although the etiology of scoliosis remains unknown, spinal cord and brainstem pathology may play a role in its development. Natural history studies have confirmed earlier reports documenting respiratory failure in patients with curves of greater than 110 degrees. Screening tests are becoming more specific, limiting the number of unnecessary referrals. Surgical treatment has been advanced by the introduction of new instrumentation systems that attempt to correct spinal deformity in three dimensions. Unfortunately, problems such as postoperative decompensation have raised new questions that remain only partially answered.

Humans↗
PubMed1991

"Mirror image" congenital scoliosis in siblings.

Congenital scoliosis, which is caused by isolated anomalies (as opposed to multiple spinal anomalies and myelomeningocoele), is usually a nonfamilial condition. In rare instances, however, a congenital spine deformity is genetically determined. We herein report a brother and sister with a nearly identical "mirror image" congenital lumbar scoliosis. We conclude that the presence of a congenital spine deformity necessitates the screening of other siblings for a similar anomaly.

Adolescent↗
PubMed1991

Luque-Galveston procedure for correction and stabilization of neuromuscular scoliosis and pelvic obliquity: a review of 68 patients.

Sixty-eight patients with neuromuscular spine deformity were treated by posterior spine fusion with Luque-Galveston instrumentation between 1982 and 1986. The minimum follow-up was 4 years. Diagnoses included cerebral palsy in 34 patients and other neuromuscular diseases in another 34 patients. The average age was 14 years. Twenty patients also had anterior spine fusion without instrumentation. Preoperatively the average scoliosis was 73 degrees and this was corrected to 33 degrees at final follow-up. The subgroup having anterior discectomy and fusion had a more severe scoliosis and pelvic obliquity, but the percent of correction was similar to that of the group with posterior reconstruction only. Twenty-four patients who had an associated significant sagittal plane deformity were corrected to a physiologic curvature. A postoperative thoracolumbosacral orthosis was used in 27 patients, and a molded seating orthosis was used in 18. Although the rate of complications was high (62%), most of them were minor. Instrumentation problems occurred in 14 patients (21%), only 4 of them having broken rods. There were no broken wires. Pseudarthrosis occurred in seven patients (10%). Three patients had minor neurologic deficits, all transient. The "windshield-wiper" sign was defined as any radiolucency of 2 mm or greater. Twenty-six patients had this sign at follow-up, and this group had a higher percentage of complications, but the existence of this sign did not necessarily indicate a problem.

Adolescent↗