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PubMed2000

Three-dimensional rotations of the thoracic spine after distraction with and without rib resection: a kinematic evaluation of the apical vertebra in rabbits with induced scoliosis.

An experimental model of induced scoliosis in New Zealand rabbits was studied to evaluate the effects of rib resection on the apical vertebra during distraction for scoliosis surgery. After concave distraction, three-dimensional rotations of the apical vertebra were measured using a motion analysis system, which included three cameras and six reflective markers. Distraction with rib resection on the convexity produced minimal rotations in the coronal plane (0.77 degrees), sagittal plane (0.96 degrees), and transverse plane (0.61 degrees) compared with no rib resection. The distraction maneuver with rib resection has no significant effect on derotation of the apical vertebra in the coronal and transverse plane, but slightly greater forward rotation was apparent in the sagittal plane (p < 0.05). Resection of three convex ribs directly corrects the rib prominence and does not seem to improve derotation.

Animals↗
PubMed2001

Surgical treatment of adolescent idiopathic scoliosis: a comparative study of two segmental instrumentation systems.

This study compares two different surgical techniques and instrumentation types in the treatment of adolescent idiopathic scoliosis. The charts and radiographs of 116 patients with adolescent idiopathic scoliosis treated by posterior spine fusion with Isola or Cotrel-Dubousset instrumentation were reviewed. Patients were separated into two equivalent groups matched for age, sex, curve type, and curve magnitude. All patients had a minimum of 2 years follow-up. The instrumentation in group 1 consisted of hooks, wires, and pedicle screws. That used in group 2 was limited to hooks and rods. The Mann-Whitney, Wilcoxin, and the paired Student t tests for matched pairs were used for statistical analysis. Patients in group 1 had increased curve correction (66% vs. 52%), apical vertebral translation (63% vs. 30%), and correction of the end vertebral tilt angle (11 degrees vs. 3 degrees) (p < 0.001). The percentage of coronal curve correction in curves larger than 65 degrees also was greater in group 1 (59% vs. 40%). Physiologic sagittal alignment was obtained in 80% of the patients in group 1 and 25% in group 2. No major complication or pseudoarthrosis occurred in either group. This study supports improved correction of curve magnitude, apical translation, and end vertebral tilt angle with the use of multiple anchor types compared with the correction achieved with standard hook-and-rod constructs.

Adolescent↗
PubMed1998

Neuromuscular scoliosis: a case of the pediatric patient in the adult ICU.

Neuromuscular scoliosis can be a problem in children with underlying neuromuscular conditions such as cerebral palsy, spina bifida, and muscular dystrophy. A comprehensive preoperative assessment is essential to provide comprehensive postoperative care. Surgical procedures to correct neuromuscular scoliosis include anterior spinal fusion, posterior spinal fusion, or a combined anterior-posterior spinal fusion. Postoperative problems can include respiratory failure, hemodynamic instability, neurovascular compromise, and pain control. With an understanding of the developmental status of these patients, pediatric patients can be safely managed in an adult ICU.

Adolescent↗
PubMedDate not supplied

Early ambulation following spinal fusion and Harrington instrumentation in idiopathic scoliosis.

Eighty-six patients with idiopathic scoliosis managed by Harrington instrumentation and spinal arthrodesis were ambulated 10 days following surgery. Preoperative reduction of the curves was obtained by Cotrel traction and modified Cotrel localizer cast. Patients were kept immobilized in plaster cast for 7 months following operation. No significant loss of correction was found in these patients ambulated early as compared to a previous group kept recumbent for 3 to 6 months and reported by the authors (DBL). The only exception to this was a patient with double structural curve patterns. A successful surgical program for most cases of idiopathic scoliosis included: (1) Preoperative reduction and balancing of curves by non-skeletal traction and/or correction body cast; (2) Meticulous spinal arthrodesis and employment of Harrington distraction internal fixation; (3) Autogenous iliac bone graft; (4) Ambulation at two weeks following surgery in a well fitting body cast and removal of this cast after 7 months. Deep infection rate was 1 per cent without the use of routine prophylatic antibiotics. One neurological complication resulted from the use of a single distraction rod bridging two curves where the rod was not prebent to allow for kyphosis. There were no pseudarthroses. The average follow-up was 28 months with a range of 18-39 months.

Adolescent↗
PubMed1998

Etiology of idiopathic scoliosis. Computational study.

A review of the literature on the mechanical aspects of the etiology for idiopathic scoliosis reveals that the buckling hypothesis has been presented as a purely mechanical phenomenon. In an attempt to confirm the buckling hypothesis, a numerical simulation of growth and the resulting buckling phenomena was done by means of finite element analysis. It previously was observed that growth was induced in the T4 to T10 vertebrae. Only the sacrum was assumed to be stationary. From the growth analysis, a deformation process that mitigated thoracic kyphosis was obtained as observed in healthy children during early adolescence. From the buckling analysis, the first to the fourth buckling modes that correspond to the first side bending, first forward bending, first rotation, and second side bending modes were obtained. The shape of the fourth buckling mode (second side bending mode) was in good agreement with the clinical shape. Considering the potential for controlling these modes by posture change, it is concluded that the second bending mode in the coronal plane is one of the most likely etiologic candidates in the mechanics of thoracic idiopathic scoliosis.

Adolescent↗
PubMed1999

Short posterior fusion for patients with thoracolumbar idiopathic scoliosis.

Fifteen percent of all scolioses are idiopathic thoracolumbar and are characterized by significant imbalance in the frontal plane. A large curve of more than 40 degrees creates a trunk shift and under these circumstances an active correction is necessary. It is this imbalance that is the cause of increasing muscular fatigue. Arthritic changes may appear later which also are responsible for pain. The aim of a surgical procedure is to stop the progression of scoliosis, to obtain the reequilibrium of the spine in a frontal and a sagittal plane, and to correct the deformity. During the 1960s Dwyer6 developed his anterior instrumentation mainly for thoracolumbar and lumbar curves. In 1980 Hall developed the concept of a short anterior fusion with overcorrection for patients with thoracolumbar curves. In the present study 10 patients are presented who were operated on for thoracolumbar adolescent idiopathic scoliosis using short posterior fusion instrumented by segmental convex transpedicle screw fixation and concave hook stabilization. With a mean followup of 49 months, the results show that frontal and sagittal balances are restored. In the present study all patients achieved frontal and sagittal balances at the last followup. The angular correction achieved by surgery always is more effective than what is visualized in radiographs of the patient in the bending position obtained before surgery. The correction of the major curve in the frontal plane improved from a mean angle of 47 degrees preoperatively to 14 degrees postoperatively and to 17 degrees at the last followup. In all cases, mobile discs in the lower lumbar area are open. The posterior short fusion has the same power of correction as the anterior fusion with the advantage of an easier surgical approach and a better control of the lordosis. This paper will describe the operative indications, the choices of instrumented levels, and the medium term followup results.

Adolescent↗
PubMed1999

Anterior only fusion for scoliosis in patients with myelomeningocele.

A series of patients with single major scoliosis curvatures attributable to spina bifida treated by anterior only spinal fusion was studied for 2 years to determine whether the infection rate could be decreased, adequate correction and pelvic balance could be provided, and posterior surgery could be avoided in these patients. Anterior surgery alone was performed for thoracolumbar scoliosis greater than 45 degrees if the compensatory thoracic curve was less than 40 degrees and there was no significant junctional kyphosis. Fourteen patients were treated at a mean age of 11.9 years (range, 7-16 years), with a mean curve of 64 degrees (range, 51 degrees-85 degrees), and motor levels distributed from T10-L4. Thirteen patients had prior neurosurgery for tether, syrinx, or Arnold-Chiari malformation. The spine was fused over a mean of seven vertebrae. A 3/16 inch Texas Scottish Rite Hospital rod was used most commonly (10 patients). Blood loss averaged 1100 cc. The mean curve correction was 57% at 40 months after surgery. Loss of correction occurred primarily by adding on outside the instrumented area. Mean pelvic obliquity was improved from 16 degrees to 9 degrees. There was one superficial infection. Results were good in five patients, fair in four, and poor in five. Failures were attributable to proximal decompensation in two patients who required revision surgery (two), neurologic deterioration in two, and screw pullout in one. Both patients with decompensation had syringomyelia. Both patients with neurologic deterioration had large curves (> 75 degrees). Both patients recovered after rod removal. Retrospectively, by eliminating patients with syrinx or with a curve greater than 75 degrees, all poor results would be eliminated. Anterior only fusion and instrumentation may have significant advantages, but only for selected patients with thoracolumbar curves less than 75 degrees, compensatory curves less than 40 degrees, no increased kyphosis, and no syrinx. Quadriceps function should be monitored. On the basis of this preliminary experience, continued use of this approach using stricter selection seems warranted.

Activities of Daily Living↗
PubMed2000

Idiopathic scoliosis and spondylolysis in the female athlete. Tips for treatment.

Idiopathic scoliosis and spondylolysis can be common back problems in female athletes. Diagnosis and treatment can be difficult. With the notable trend toward increasing participation of women and girls in organized sports, it is necessary to know which sports carry additional risks for participants to have these two conditions develop and to determine treatment modalities. In general, idiopathic scoliosis is more prevalent in females and even may be higher in the athletes. Treatment options may include observation, the use of a brace, and surgery. In determining treatment, the type of sport and caliber of athlete must be considered in conjunction with the severity of the curve. Spondylolysis or a stress fracture of the posterior vertebral elements can be a common cause of back pain in an athlete. In many sports that are dominated by females (gymnastics, dancing, figure skating), the athletes carry a high risk of having spondylolysis or a stress fracture. Knowing the risk factors permits precise diagnosis and appropriate treatment. Treatment options include the use of a brace and surgery. In the current study, an extensive review of the literature in conjunction with the extensive experience of a well-established sports medicine clinic at the authors' institution is presented.

Athletic Injuries↗
PubMed2002

Pulmonary function after thoracoplasty in adolescent idiopathic scoliosis.

The current study evaluated sequential pulmonary function tests prospectively at a minimum of 2 years after thoracoplasty in adolescent patients with idiopathic scoliosis. Twenty patients were divided into two groups: Group I (n=12) was comprised of patients who had posterior instrumented fusion with external thoracoplasty, and Group II (n=8) was comprised of patients who in addition to a posterior instrumented fusion, had an anterior release and fusion via video-assisted thoracoscopic surgery (n=4) or open thoracotomy (n=4) because of rigid severity. Forced vital capacity and forced expiratory volume in 1 second of percent predicted values in Group I declined 9% at 3 months postoperatively and returned to the preoperative baseline at 1 year. However, forced vital capacity and forced expiratory volume in 1 second of percent predicted values in Group II declined 11% to 18% postoperatively and did not return to the preoperative baseline at 2 years. Posterior instrumented fusion with thoracoplasty in adolescent patients with idiopathic scoliosis significantly decreased pulmonary function at 3 months, but returned to the preoperative baseline at 1 year. The addition of an anterior releasing procedure resulted in poorer pulmonary function, which did not return to the preoperative baseline by the 2-year followup.

Adolescent↗
PubMed1994

Projecting the lifetime risk of cancer from exposure to diagnostic ionizing radiation for adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS) is a disorder characterized by lateral curvature of the spine and is the most prevalent orthopedic disorder in this age group. The diagnosis and management of AIS requires multiple full-spinal radiographs, leading to potentially high doses of ionizing radiation. The purpose of this study was to estimate in a cohort of subjects with AIS the organ-specific doses of x-ray radiation from spinal radiographs and to calculate the lifetime number of cancers attributable to these exposures. The cohort consisted of AIS patients referred from 1960 to 1979 to a large pediatric hospital in Montreal, Quebec. Organ-specific x-ray doses were estimated using a Monte Carlo procedure that accounted for the radiant energy of the x-ray beam. Cumulative doses for each subject were obtained by summing the estimated doses over all radiographs. These estimates of dose and published estimates of risk from the U.S. National Academy of Sciences Fifth Committee on the Biological Effects of Ionizing Radiation were then incorporated into a life table procedure to project the excess lifetime risk of cancer. About 85% of the 2,181 subjects in the cohort were first referred for scoliosis between the ages of 11 and 17 y. The mean number of radiographs over an average 3-y follow-up period was 12. Organs receiving the highest mean cumulative doses (about 0.03 Gy) were the thyroid gland and the female breast. About 10 excess incident cancer cases (out of a total of 399 projected) and about four excess deaths (out of a total of 247 projected) were estimated to occur over the lifetime of the 1,847 women in the cohort. This is equivalent to an excess lifetime risk of about 1 to 2% (12-25/1,000) among women. Although doses today from spinal radiographs are considerably lower than two decades ago, doses and risks can be further reduced through the use of the posteroanterior view in place of the more traditional anteroposterior view.

Adolescent↗
PubMedDate not supplied

A revised estimate of the risk of carcinogenesis from x-rays to scoliosis patients.

A considerable amount of concern has been felt recently for the risk of carcinogenesis from x-rays to scoliosis patients. This paper re-evaluates risk in quantitative terms by using some data measured by us and other data recently published in the literature. The risks are considerably smaller than had been estimated earlier. Compared with the natural incidence of cancer in the general population, the cumulative additional risk for scoliosis patients varies from 0.2% for breast carcinoma to 5% for leukemia.

Adolescent↗
PubMedDate not supplied

Routine preoperative MRI and SEP studies in adolescent idiopathic scoliosis.

In this prospective study, 72 patients with the clinical diagnosis of adolescent idiopathic scoliosis underwent routine preoperative magnetic resonance imaging (MRI) scans and neurologic consultations. Forty-eight patients also had preoperative somatosensory evoked potentials (SEPs). All patients had normal neurologic examinations. Abnormal findings included two patients with Chiari type I malformation and one with a finding of a fatty collection in a vertebral body. In four cases, interpretation of the MRI was suspicious or equivocal, necessitating a computed tomography myelogram or other additional studies for clarification. Abnormal preoperative SEP results were obtained in three patients, none of which proved significant. All surgical patients underwent instrumentation and fusion without incident. The results indicate that routine preoperative SEP is not necessary. Routine preoperative MRI is probably not indicated in adolescent idiopathic scoliosis if the patient has a normal neurologic examination.

Adolescent↗
PubMedDate not supplied

Familial synspondylism: progressive scoliosis and multiple hernias in a kinship.

A new genetic syndrome is reported of congenital lordoscoliosis due to lumbar segmentation defects and incomplete formation of lumbar vertebrae. The defect arose as a spontaneous mutation and was transmitted in an autosomal dominant fashion. The kindred included a mother and her three offspring. These affected individuals had several dysmorphic features including cavus feet and micrognathia. In addition the syndrome was associated with multiple hernias including inguinal, ventral, and diaphragmatic. These associated problems led to the early death of the first child at age 7 months. The lumbar scoliosis was already evident by that time. The progressive nature of the scoliosis was documented, especially in one child who was lost to follow-up and who was initially seen with a severe spinal deformity. Surgical management was required in members of the kindred, but because of differences in age and severity at the time of surgery, the techniques varied.

Facies↗
PubMedDate not supplied

Cognitive strategies and self-esteem as predictors of brace-wear noncompliance in patients with idiopathic scoliosis and kyphosis.

Psychological determinants of brace-wear compliance were analyzed among 113 patients who used a brace because of an adolescent idiopathic scoliosis (92%), kyphosis (5%), or both (3%). The results showed that noncompliant girls did not expect to succeed in dealing with scoliosis and that they were anxious about the possibility of failure. They also had low self-esteem and did not seek social support from other people. Noncompliant boys, in contrast, had high self-esteem and high achievement success expectation. Among patients with a short time of brace use, low compliance was best predicted by low amount of reflective thinking and a good body-image. In turn, among patients who had used the brace for >6 months, low compliance was best predicted by high amount of reflective thinking, poor body-image, low social success expectation, and low master orientation in social behavior. Only sleeping problems predicted compliance across gender and the time of brace use: the more the patients experienced sleeping problems, the less they used the brace.

Adolescent↗
PubMedDate not supplied

Scoliosis in arthrogryposis multiplex congenita: results after nonsurgical and surgical treatment.

Forty-six patients (25 male and 21 female) with arthrogryposis multiplex congenita who were seen at the Alfred I. duPont Hospital for Children between the years 1940 and 1997 were evaluated to assess the prevalence and patterns of scoliosis and the long-term results after both nonsurgical and surgical treatment methods. We found the prevalence of scoliosis to be 65.9% (32 of 46 patients). A single thoracolumbar curve was the predominant curve pattern. No congenital curve types or vertebral anomalies were seen in our group of patients. In the nonsurgical group, the mean curve was <30 degrees at follow-up. In the surgical group, the mean primary curve before spinal arthrodesis was 78.5 degrees. Three patients in the surgical group who were nonambulators have become household ambulators at the most recent follow-up. We recommend bracing in patients who are ambulators and have a curve of <30 degrees. Combined anterior and posterior spinal arthrodesis gave the best results.

Adolescent↗
PubMedDate not supplied

Analysis of the STIF technique for spino-pelvic fixation: clinical results in 19 patients with neuromuscular scoliosis.

The STIF (spinopelvic transiliac fixation) technique for lumbosacral fusion was developed by the authors as an alternative to the Luque-Galveston technique. The results observed in this initial series of 27 neuromuscular scoliosis patients treated with the STIF technique are reported. With a minimum of 24 months of radiographic follow-up in 19 patients, the percentage of correction of scoliosis curvature and pelvic obliquity was superior to that reported in the literature. The rates of complications and pseudarthrosis in this series are typical for this patient population. The STIF technique facilitates compression across the sacroiliac joints, which promotes sacroiliac joint fusion and can provide a stable base for curvature correction and lumbosacral fusion. Despite the severe coronal and sagittal plane curves in this group of patients, total operative time also compares favorably to that reported in the literature. The STIF technique requires a well-developed posterior iliac apophysis, which may not be present in younger pediatric patients.

Adolescent↗
PubMedDate not supplied

Posterior spinal fusion in paralytic scoliosis and myelomeningocele.

The Shriners Hospital, Lexington, KY, experience with posterior spinal fusion for scoliosis in 50 patients with myelomeningocele was reviewed. Six patients were fused with Harrington rods and 47 of 50 patients were treated with some form of segmental fixation. The complication rate was 48% (24/50) resulting in 1.48 procedures per patient. The deep infection rate was 8% (4/50) and the pseudarthrosis rate was 16% (8/50). The use of modern segmental instrumentation systems has improved the pseudarthrosis rates for posterior spinal fusion in scoliosis associated with myelomeningocele but not to the point of displacing the current approach of an anterior and posterior spinal fusion.

Adolescent↗