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PubMedDate not supplied

Effects of preemptive analgesia using continuous subcutaneous morphine for postoperative pain in scoliosis surgery: a randomized study.

The authors evaluated prospectively the efficacy and safety of continuous subcutaneous morphine administration for postoperative analgesia after posterior spinal fusion and instrumentation for idiopathic scoliosis. Thirty patients were given the subcutaneous morphine infusion (20 mg/day), and 20 patients were not given morphine (control group). Postoperative pain control was assessed using a verbal response score (VRS) and a visual analog pain scale (VAS). The number of times the patient requested supplemental analgesics was also evaluated. VRS and VAS measurements were significantly lower in the continuous subcutaneous morphine group compared with the control group. Also, analgesic consumption in the continuous subcutaneous morphine group was lower than that of the control group. There was no respiratory depression or constipation. Preemptive analgesia using continuous subcutaneous infusion of morphine is a simple, safe, and effective method to control postoperative pain after posterior instrumentation and spinal fusion for idiopathic scoliosis.

Adolescent↗
PubMedDate not supplied

The relationship between function, self-perception, and spinal deformity: Implications for treatment of scoliosis in children with spina bifida.

The purpose of this study was to determine the relationship of spinal deformity with physical function and self-perception in children with spina bifida. Ninety-eight eligible children with scoliosis and spina bifida were identified; 80 of them (82%) consented to participate. Spinal deformity was measured in many ways, including scoliosis, coronal balance, and pelvic obliquity. Measures of physical function included the Sitting Balance Scale, Jebsen Hand Scale, Hoffer Ambulation Scale, the Spine Bifida Spine Questionnaire, and the Activities Scale for Kids (ASK). Self-perception was determined with Harter's Self-Perception Profile. No relationship was found between spinal deformity and overall physical function (ASK). Of all aspects of spinal deformity, only coronal imbalance was significantly related to only one aspect of physical function (ie, sitting imbalance). No aspect of spinal deformity was related to self-perception. In conclusion, surgeons should be clear in their indications for surgery and recognize that in the short term the potential benefit of surgery may be, at best, to improve only sitting balance.

Activities of Daily Living↗
PubMed1997

Evaluation of pulmonary ventilation and diaphragmatic movement in idiopathic scoliosis using radioaerosol ventilation scintigraphy.

Regional distribution of lung ventilation and diaphragmatic movement were evaluated using a non-invasive scintigraphic method in patients with idiopathic scoliosis. Twenty-four non-smoking patients aged 20 +/- 9 years (mean +/- S.D.), all with a right convex dorsal curve (mean Cobb's angle of 65.1 +/- 26.4 degrees), underwent lung ventilation scintigraphy after inhalation of 99Tcm-labelled human albumin microspheres. The distribution of the inhaled aerosol was assessed and scored based on four scintigraphic patterns, ranging from homogeneous distribution (score = 1) to diffuse severe hypoventilation (score = 4). Diaphragmatic movement, evaluated in 11 of the 24 patients, was assessed using an index (DM-Index) computed for each hemi-diaphragm by the normalization and subtraction of two digital scans obtained during maximal inspiration and expiration respectively. The left lung, situated on the concave side of the scoliotic curve, showed a more uneven distribution of ventilation (scintigraphic score: 2.62 +/- 1.17 vs 1.50 +/- 1.02, P < 0.01) and a reduced hemi-diaphragm movement (DM-Index: 29.2 +/- 4.0 vs 35.9 +/- 2.9, P < 0.001). A significant inverse correlation was found between Cobb's angle and both the right and left DM-Index (r = -0.82 and -0.66 respectively). In a stepwise multiple-regression analysis, the scintigraphic score correlated significantly with the functional index of distribution of inspired gas (IDI) derived from the multiple-breath nitrogen washout curve (P = 0.02). We conclude that lung ventilation scintigraphy provides information on the regional distribution of ventilation and on diaphragmatic movement in idiopathic scoliosis. The pulmonary function derangements in scoliotic patients were mainly localized in the lung on the concave side of the scoliotic curve and were related to the severity of the spinal curvature.

Adult↗
PubMedDate not supplied

Revision surgery in adult scoliosis patients.

Surgical management of the scoliosis patient has evolved significantly in recent years. We are now seeing patients who were operated on 15-20 years ago return with problems distal to the fusion. These adults have unique problems that need to be managed by many disciplines. This article describes current problems in the adult scoliosis patients who have had previous surgery, current treatments, and nursing management of these patients.

Adult↗
PubMed1978

Occurrence of cold agglutinins in congenital scoliosis.

Eighty-seven patients undergoing spinal surgery for a variety of conditions were surveyed for the presence of cold agglutinins. Patients with congenital scoliosis or metastatic lesions of the spine were found to have a frequency of cold agglutinins that was 250 to 1000 times greater than that in the general population. This greater frequency was independent of ABO blood group, sex, or age. Pre-admission screening of congenital scoliosis patients is urged.

ABO Blood-Group System↗
PubMedDate not supplied

Preoperative personality characteristics as predictors of postoperative physical and psychological patterns in scoliosis.

Four adaptive personality characteristics (trait anxiety, active--independent orientation, emotional poise, and level of cognitive development) were evaluated preoperatively in 50 adolescent idiopathic scoliosis patients undergoing spinal surgery. Postoperatively, three indices of physical recovery (quantity of analgesics taken, elimination difficulties, and number of days to discharge) and two of psychological state (anxiety and depression) were rated. Two of the four adaptive personality characteristics correlated significantly with postoperative physical and psychological reactions. Quantity of analgesics taken, elimination difficulties, anxiety, and depression were significantly related to (viz., predicted by) preoperative trait anxiety. Quantity of analgesics taken and anxiety were significantly related to level of cognitive development. Preoperative degree of curvature was significantly related to postoperative quantity of analgesics taken. Duration of the scoliosis was significantly associated with level of cognitive development, but not with postoperative physical or psychological adjustment.

Adolescent↗
PubMedDate not supplied

Congenital scoliosis. A histopathologic study.

A histopathologic study of the spine from a child with congenital scoliosis indicates that the major problems relate to the vertebral bodies, which are irregular in size, shape, and position, and to the adjacent intervertebral discs, which are always abnormal. Bone and cartilage as tissues, however, are histologically and histochemically unremarkable; it is their positioning which is irregular. No molecular abnormality of collagen could be found in bone, cartilage, or skin. Pathogenesis is discussed in reference to theories of general and vertebral morphogenesis. The findings of abnormal spatial deposition of histologically and biochemically unremarkable tissue are consistent with inductive abnormalities of the notochord. The clinical and radiologic manifestations in congenital scoliosis are a combination of primary embryologic abnormalities, secondary developmental abnormalities which spring from the, and tertiary developmental irregularities.

Collagen↗
PubMedDate not supplied

Radiation exposure during scoliosis screening radiography.

Screening programs to detect scoliosis in the adolescent population are active in most communities. Two percent of children screened will be referred for treatment or observation. Increasing concern has been voiced regarding the amount of the potential effects of the radiation administered in such screening programs. Radiation dosage was directly measured on 19 children participating in an established school scoliosis screening program, using lithium fluoride thermoluminescence dosimeters. The mean gonadal doses are measured to be 19 mrem in males and estimated at a maximum 95 mrem in females. The mean entrance skin dose was 174 mrem. A lack of uniformity in the radiographic techniques employed by individual technician was identified. The measured doses were within established acceptable limits and are comparable or below the average dose of 100 mrem received annually by the general public from the environment.

Adolescent↗
PubMedDate not supplied

Post-poliomyelitis paralytic scoliosis. A review of curve patterns and results of surgical treatments in 118 consecutive patients.

Curve patterns and surgical treatment in 118 consecutive patients with post-poliomyelitic paralytic scoliosis are reviewed. The typical curve pattern was double structural curves, usually including the lumbar spine. Modifying the incision and altering the sequence of instrumentation facilitated both the exposure and instrumentation of the fourth and fifth lumbar bodies. Anterior fusion and Dwyer's instrumentation yield most of the correction of pelvic obliquity and significant correction of both the upper and lower curves. Two weeks of halofemoral traction did not achieve significant curve correction. It is suggested that staged anterior and posterior procedures result in structural correction of pelvic obliquity and paralytic scoliosis in severe deformities equal to the degree of correction obtained using posterior fusion and instrumentation alone in less severe cases.

Adolescent↗
PubMedDate not supplied

Biomechanics of scoliosis correction by segmental spinal instrumentation.

The mechanical effectiveness of applying transverse forces by segmental spinal instrumentation to correct scoliosis is examined in this paper. Comparisons with traditional Harrington instrumentation are made on the basis of each method's potential to produce corrective bending moments and their ability to transfer this correction to the spine. Recognizing the scoliosis is a three-dimensional deformity, biomechanical evaluations are performed in each of the three anatomic planes, with special attention paid to maintaining normal sagittal plane contour and transverse plane derotation. Such an analysis indicates that segmental spinal instrumentation has a clear mechanical advantage over traditional Harrington instrumentation in providing and maintaining correction. Proposed improvements include the development of instrumentation which can be segmentally attached to the vertebra without invading the spinal canal.

Biomechanical Phenomena↗
PubMedDate not supplied

Intraoperative force measurements during correction of scoliosis.

Intraoperative forces applied to the spine were measured during the routine application of Harrington instrumentation for correction of scoliosis. This was accomplished by instrumenting the outrigger and distractor with strain gauges. Measurements were obtained in 16 patients undergoing their first operative procedure for scoliosis. Outrigger forces employed by two surgeons unapprised of the force data were not significantly different. Outrigger forces were significantly different for adolescent and adult groups of idiopathic scoliotics. Unusually low initial outrigger forces appeared to correlate with lower final correction obtained. In addition, in several cases transient distractor forces were observed that exceeded average levels at which bone failure is postulated to occur.

Adolescent↗
PubMedDate not supplied

Deltoid pathology in idiopathic scoliosis.

Histographic analyses of deltoid, trapezius, and quadriceps muscles have been performed in patients with scoliosis of different kinds and in nonscoliotic controls. The results point towards specific pathology in the deltoids, especially on the concave side of the curvature in idiopathic scoliosis. The pathology consists of an overall fiber "hypotrophy" and a type 1 area decrease, often with frank atrophy. Electromyographic examination confirmed the deltoid pathology, showing a myopathic pattern in all the concave-side deltoids and often in the convex ones as well. The cause of the cephalocaudal and side-to-side asymmetry is possibly connected to developmental and neurotrophic factors that may be operative in the complex etiology of the disease.

Adolescent↗
PubMedDate not supplied

A new orthosis for immediate postoperative bracing in idiopathic scoliosis.

The "crutch-type scoliosis brace" and the KSO are leather covered aluminum braces, which have been successfully used in treating scoliosis patients at the Kosair Spinal Deformity Center both nonoperatively and postoperatively. This report defines the measurements, materials, and construction details for effective use of these braces and reports the very encouraging results of the KSO in a group of instrumented idiopathic scoliotic patients.

Adolescent↗
PubMedDate not supplied

The incidence of Klippel-Feil syndrome in patients with congenital scoliosis and kyphosis.

A retrospective review of the radiographs of 1215 patients with congenital scoliosis and kyphosis disclosed 298 (25%) to have segmentation defects in the cervical spine. A single level defect was seen in 82 patients, 52 of which were at C2-C3. Of the 298 patients, 235 had scoliosis, (6 cervical, 42 cervicothoracic, 75 thoracic, 4 thoracolumbar, and 1 lumbar), 36 had kyphoscoliosis, 10 lordoscoliosis, and 17 pure kyphosis.

Child↗
PubMedDate not supplied

Paraspinal muscle imbalance in adolescent idiopathic scoliosis.

Twelve muscle biopsy samples were taken at operation for spinal instrumentation from each of seven patients suffering from idiopathic scoliosis (one male and six female patients; mean age 14.3 years). The samples were collected from two specific sites (superficial and deep) on both sides on the vertebral column at the level of the apex of the primary curve and two vertebral levels above and below the apex. The results of this study support and extend the findings of other workers. Not only was a significantly larger percentage of Type I fibers found in multifidus muscle at the apex on the curve on the convex side as other workers have found but also in the superficial muscles above and below the apex of the curve on the convex side. These results present a complex picture of muscle fiber characteristics associated with idiopathic scoliosis.

Adolescent↗
PubMedDate not supplied

The comparative results of psychologic testing in scoliosis patients treated with electrical stimulation or bracing.

Proponents of the surface stimulation treatment of idiopathic scoliosis have reported approximately 75-85% success rates in arresting progressive curvatures. Although encouraging, these results do not appear to be better than those of the more traditional brace programs. Now recognizing electrical stimulation as a viable alternative to bracing, supporters have advocated the psychologic and physical freedom with electrical stimulation as a major advantage over brace treatment. However, to date, there have been no objective psychologic studies to substantiate these claims. This prospective study was devised to detect any significant differences between a group of patients treated in a TLSO or Milwaukee brace and a group of patients treated with lateral electrical surface stimulation (LESS) (ScoliTron). The study consisted of 40 female private patients with idiopathic scoliosis treated for a minimum of 3 months. Each patient was given a set of seven standardized psychologic tests and an observer rating by the treating physician or physical therapist working with the patient. Results of the Psychological Epidemiology Research Interview (PERI) revealed that the LESS group had significantly higher self esteem than the brace group. The brace patients demonstrated a much greater perception of directed hostility than the LESS group. The coping response inventory showed the brace group to manifest a more primitive coping mechanism than the LESS group. The brace group attempted to avoid problems associated with their disease, rather than cope with them as the LESS group was better able to do. The brace group focused more on their emotions than the realistic problems of their disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1984

Proprioception in idiopathic scoliosis.

Proprioception testing and gait analysis was performed on a group of 17 patients with idiopathic scoliosis. All curves had documented progression. The average curve was 26.8 degrees, all primary curves being right thoracic. The average age was 14.8 years. Twelve, healthy, age-matched controls underwent identical testing. Results showed that scoliotic subjects had asymmetry in their ability to reproduce angles between their two knees, as well as an absolute deficit in their ability to reproduce angles as compared with controls (P less than 0.01). The threshold of detection of change in angle at the knee was also quantitatively higher than controls (P less than 0.05), although asymmetry was not statistically significant. No significant differences were measured in gait parameters between scoliotics and controls. These joint position tests have been applied previously to young and elderly adults, athletes, and total joint patients. In no group has any asymmetry of response been demonstrated, both extremities showing virtually identical performance in each case. The tests administered measure sensory modalities, which are conducted through the posterior columns. Although the site of damage in the neural pathway cannot be specifically localized by these tests, results of this study support the presence of a neurologic deficit in idiopathic scoliosis.

Adolescent↗
PubMed1985

Segmental spinal instrumentation in idiopathic scoliosis. A preliminary report.

Eighty-six patients with idiopathic scoliosis who underwent a posterior spinal fusion using sublaminar segmental spinal instrumentation were analyzed retrospectively. There were two operative groups: group 1, 66 patients who had Harrington rod instrumentation and segmental wiring, and group 2, 20 patients who had Luque rod instrumentation. The clinical and radiographic data of the two groups were similar except for the passage of more sublaminar wires and increased intraoperative blood loss in group 2. Twenty intraoperative or postoperative complications occurred in 19 patients (22%) including 14 neurologic complications. Three patients (3%) had major spinal cord injuries, while 11 patients (13%) had transient sensory changes. There was no significant difference in the incidence of neurologic complications between group 1 or group 2. The remaining intraoperative complications were due either to anesthesia, positioning during surgery, or technique (dural tear). Late complications occurred in two patients in group 1 only: one each with rod breakage and hook displacement. Only one patient (1%) has required additional surgery. Our results indicate that although segmental instrumentation can be beneficial in idiopathic scoliosis, the incidence of complications, primarily neurologic, will be higher than expected. The major reason appears to be surgeon inexperience with passage of sublaminar wires. As experience increases, the incidence of complications declines and becomes comparable with conventional Harrington rod instrumentation alone.

Adolescent↗