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PubMed1994

The relationship between pes cavus and idiopathic scoliosis.

STUDY DESIGN: The incidence of pes cavus and scoliosis was studied in three groups of patients. Group A contained 130 patients with idiopathic scoliosis, Group C contained 210 patients with idiopathic pes cavus, and Group B (control) contained 200 patients of similar age. OBJECTIVES: To investigate the joint presentation of pes cavus and idiopathic scoliosis, because both deformities may share a common etiology linked to muscle imbalance. SUMMARY OF BACKGROUND DATA: Sixty five percent of Group A patients (85 of 130) had an abnormally high plantar arch, compared to only 9.5% (19 of 200) of Group B control subjects. Nine percent (20 of 210) of the patients in Group C had scoliosis curves, compared to only four patients in Group B. METHODS: Radiographs were taken to determine the type of scoliosis curve, its location, and its magnitude, and to identify the incidence of spina bifida occulta in the three groups. The incidence and degree of pes cavus were established by means of foot prints. Statistical analyses were performed on all results. RESULTS: A statistically significant relationship (P < 0.01) was found for the incidence of pes cavus between Group A (scoliosis) and Group B (control), and for the incidence of scoliosis between Group C (pes cavus) and Group B (control). No statistical significance was observed for the other relationships investigated (sex, curve location, magnitude, spina bifida). CONCLUSIONS: There was a significant correlation between scoliosis and pes cavus--spina bifida was not an etiologic factor. Therefore, in certain patients where scoliosis and pes cavus present jointly, deformity may be secondary to altered balance or to disorders of the central nervous system.

Adolescent↗
PubMed1995

Effects of the combined VDS-Zielke and Harrington operation on the frontal rib cage deformity of double major curves in idiopathic scoliosis.

STUDY DESIGN: This study analyzed the changes in the frontal plane of the deformed lower rib cage and the scoliosis-related alterations on the spine in patients with double major curve-pattern idiopathic scoliosis. OBJECTIVES: The results obtained preoperatively, after the Zielke operation, postoperatively after the Harrington instrumentation, and at the follow-up evaluation were compared to investigate which changes of the elements of the rib cage deformity are caused by each of the two instrumentations. SUMMARY OF BACKGROUND DATA: Previously, Wojcik reported on the effects of a Zielke operation on the lower rib in mild S-shaped idiopathic scoliosis. No previous data exist regarding the lower rib cage deformities in severe idiopathic double major-pattern scoliosis and their changes after combined VDS-Zielke and Harrington instrumentation. METHODS: Fifteen patients who underwent the staged Zielke operation followed by Harrington rod instrumentation were followed-up for an average period of 31.1 months. The methods used in our study included Cobb angle and a segmental analysis (T7-T12) of each of convex and concave rib-vertebra angles, rib-vertebra angle differences, vertebral rotation, and vertebral tilt. RESULTS: In this series, the apical convex ribs showed an increased droop preoperatively compared with the concave apical ribs. The VDS-Zielke operation corrected the lumbar scoliosis in an average of 63% of patients, whereas the thoracic scoliosis showed an immediate spontaneous correction of 30%. The VDS-Zielke operation also produced a significant correlation of the scoliosis-related vertebral tilt (T10-T12), derotated the lumbar vertebrae and the T12 vertebra significantly, elevated the "mobile" concave ribs, and increased the droop of the lower (T11, T12) "mobile" convex ribs. The Harrington instrumentation did not change the vertebral rotation, the vertebral tilt, the convex rib-vertebra angle, or the L4 obliquity, but significantly changed the apical concave rib-vertebra angle. The combined Zielke-Harrington instrumentation reduced the thoracic kyphosis and the thoracolumbar junction-kyphosis significantly, whereas the lumbar lordosis remained practically unchanged. CONCLUSIONS: Only the anterior VDS-Zielke instrumentation significantly corrects severe spinal deformities, elevates the three lower ribs on the concavity, and increases the droop of the two lower ribs on the convexity in the severe idiopathic double major curve-pattern scoliosis combined operated (Zielke-Harrington). Therefore, the Harrington instrumentation should have only limited use in cosmetic scoliosis surgery and should be replaced with posterior multi-hook instrumentation with a derotation effect.

Adolescent↗
PubMed1995

Adolescent idiopathic scoliosis and cerebral asymmetry. An examination of a nonspinal perceptual system.

STUDY DESIGN: This study analyzed the asymmetry of a nonspinal sensory system, comparing healthy children and those with adolescent idiopathic scoliosis. OBJECTIVES: To test the hypothesis that differences in neurologic functioning that have been observed in idiopathic scoliosis are confined to motor organization and that the etiology thus is a defect solely of the motor cortex. SUMMARY OF BACKGROUND DATA: Recent reports associating scoliosis convexity with equilibrium control, central processing, handedness, and motor lateralization have suggested that idiopathic scoliosis is connected causally with the motor cortex. METHODS: Dichotic listening tests were performed on 20 healthy children and 31 children with adolescent idiopathic scoliosis. This tests perceptual asymmetry, and thus the organization of cognitive processing in the brain, a higher function that is not associated with posture or motor function. RESULTS: Subjects with scoliosis were significantly more lateralized for linguistic processing than the control group, indicating they had a greater degree of left-right asymmetry throughout their cortical organization. CONCLUSION: In adolescent idiopathic scoliosis, the organization of the entire brain was more strongly lateralized than in subjects without scoliosis. It is unlikely that this caused or was caused by the spinal curvature. Subjects with adolescent idiopathic scoliosis showed generalized asymmetry of many functions and structures. An examination at the level of morphology and development is proposed.

Adolescent↗
PubMed1997

Structural scoliosis model in dogs with experimentally induced syringomyelia.

STUDY DESIGN: Animal scoliosis model associated with syringomyelia. OBJECTIVE: To investigate the pathogenesis of scoliosis produced in dogs with kaolin-induced syringomyelia. SUMMARY OF BACKGROUND DATA: Kaolin injected into the cisterna magna produces basilar arachnoiditis, leading to hydrocephalus and syringomyelia. There have been no reports on scoliosis associated with kaolin-induced syringomyelia. METHODS: Kaolin was injected percutaneously into the cisterna magna of 11 beagles 6-8 weeks after birth. Roentgenograms, computed tomography, and magnetic resonance imaging were obtained. The spinal cord and the paraspinal muscles were examined histologically. Structural changes of the vertebral column were analyzed with calcein and tetracycline labeling. RESULTS: Hydrocephalus occurred in nine dogs. A communicating syringomyelia appeared in five dogs. Mild scoliosis developed in two dogs, and severe cervical scoliosis in one dog. In the syringomyelia cases, acute or subacute inflammatory changes were found in the spinal cord. Damage of the anterior and posterior horn cells was more marked in the scoliotic animals than in the nonscoliotic animals. In three of the syringomyelia cases, including two scoliosis cases, the paraspinal muscles revealed neurogenic changes. The deformed vertebrae appeared to diminish rather than to increase the deformity in severe scoliosis. CONCLUSION: The exact mechanism of the development of scoliosis could not be identified, although an etiologic relation with malfunction of the central nervous system was noted. This model may be useful to study scoliosis experimentally.

Animals↗
PubMed1997

Anterior correction of thoracic scoliosis with Kaneda anterior spinal system. A preliminary report.

STUDY DESIGN: Analysis of the clinical results of 20 patients with thoracic scoliosis treated by anterior procedure with Kaneda anterior spinal system. OBJECTIVES: To evaluate the efficacy of the anterior surgical correction procedure with a new anterior instrumentation in thoracic scoliosis. SUMMARY OF BACKGROUND DATA: Posterior correction and fusion with posterior instrumentation has been a main component of the surgical management of thoracic scoliosis. However, to the best of the authors' knowledge, no clinical results of anterior instrumentation surgery for thoracic scoliosis have been published in the English literature. METHODS: Anterior correction and fusion using Kaneda anterior spinal system was performed in 20 patients with thoracic scoliosis (3 patients with King Type II curve, 13 with Type III, and 4 with Type IV). The average follow-up was 3 years, with a range of 2 years, 3 months to 4 years, 1 month. There were 1B patients with idiopathic scoliosis (13 adolescents and 5 adults) and 2 patients with a single thoracic curve caused by other etiologies. All patients had correction of scoliosis by fusion within the major thoracic curve. Radiographic evaluations were performed to analyze frontal, sagittal, and rotational deformities of the spine. RESULTS: The average correction rate of scoliosis was 71%. Above the instrumented levels, the correction rate was 75%. Preoperative kyphosis of the instrumented levels of 7 degrees was corrected to 14 degrees of kyphosis. The trunk shift was improved from 17 mm before surgery to 9 mm at final follow-up evaluation. The average improvement of the tilt-angle in the lower and vertebra of fusion was 81%, and was 83% in the stable vertebra. Apical vertebral rotation showed correction rate of 15% in patients without performing resection of the rib head joints and rod rotation maneuver (n = 6). However, the correction rate was improved to 58% after introduction of the technique discussed (n = 14). The angle of tangential rib deformity (rib hump) showed a correction rate of 50%. There was 1.2 degrees of frontal plane and 1.0 degree of sagittal plane correction loss within the instrumented area at final follow-up evaluation. At final follow-up, nonunion at the uppermost segment of the fusion range developed in one patient, and decompensation in the lumbar spine was observed in one patient with Type II curve. CONCLUSIONS: Anterior correction with Kaneda anterior spinal system provides excellent correction of the frontal curvature and sagittal alignment by fusing within the range of the major curve, without a significant loss of correction and implant failure. Rigid rotational deformity of the thoracic scoliosis is effectively corrected by resection of the rib head joints and rod rotation maneuver. However, too much correction of the thoracic curve should be avoided, to prevent decompensation of the lumbar curve, especially in Type II curves.

Adolescent↗
PubMed1999

Persistent osteopenia in adolescent idiopathic scoliosis. A longitudinal follow up study.

STUDY DESIGN: A follow-up study assessing the bone mineral dynamics in adolescent patients with idiopathic scoliosis and associated osteopenia. OBJECTIVES: To investigate whether osteopenia in patients with adolescent idiopathic scoliosis is a transient phenomenon or a persistent problem. SUMMARY OF BACKGROUND DATA: Investigators have suggested a significant correlation of osteopenia with adolescent idiopathic scoliosis. Because one half of the skeletal mass is acquired during the adolescent years, it is of importance to know whether the osteopenia is transient or persistent. METHODS: Using dual-energy x-ray absorptiometry, bone mineral density of bilateral proximal femurs was studied longitudinally in 70 healthy control subjects and 14 patients with adolescent idiopathic scoliosis with significant osteopenia more than 2 standard deviations below the mean normal value. RESULTS: The 14 girls with osteopenic adolescent idiopathic scoliosis who were followed up longitudinally for up to 3 years showed persistent and significantly lower bone mineral density when compared with normal age-, sex- and maturity-matched control subjects. CONCLUSIONS: Patients with adolescent idiopathic scoliosis are at increased risk of osteoporosis than are healthy adolescents. The lower rate of increase of bone mineral density in patients with adolescent idiopathic scoliosis who have low bone mineral density could predict a significantly lower peak bone mass in adulthood, with all the associated problems of osteoporosis. Further investigation is needed to define whether osteopenia-associated scoliosis has the same cause, pathogenetic mechanism, and risk of progression when compared with adolescent scoliosis without osteopenia.

Absorptiometry, Photon↗
PubMed1999

Pathogenesis of idiopathic scoliosis. Experimental study in rats.

STUDY DESIGN: A radiographic examination of pinealectomized rats to observe the development of scoliosis and halt the condition by administration of melatonin. OBJECTIVES: To discover whether pinealectomy has the same effect in mammals as shown in the chicken, and to determine whether the bipedal condition is important for development of scoliosis. SUMMARY OF BACKGROUND DATA: Pinealectomizing chickens shortly after hatching consistently resulted in scoliosis closely resembling human idiopathic scoliosis. It has not been determined whether this phenomenon is restricted solely to chickens, or if this experimental model is applicable to other animals, especially those more closely related to humans. METHODS: A sham operation in five bipedal rats served as the control in this study. Pinealectomy was performed in 10 quadrupedal rats, pinealectomy in 20 bipedal rats, and pinealectomy with implantation of melatonin pellet in 10 bipedal rats. Spinal radiographs were used to measure the degree of scoliosis at 3 months after surgery. RESULTS: Scoliosis developed only in pinealectomized bipedal rats and not in quadrupedal rats. It developed in none of the sham operation group and in only 1 of 10 pinealectomized bipedal rats with melatonin treatment. CONCLUSIONS: Melatonin deficiency secondary to pinealectomy alone does not produce scoliosis if the quadrupedal condition is maintained. The bipedal condition, such as that in chickens or humans, plays an important role in the development of scoliosis. The findings suggest a critical influence of a postural mechanism for the development of scoliosis.

Animals↗
PubMed2001

Pathologic mechanism of experimental scoliosis in pinealectomized chickens.

STUDY DESIGN: This study was designed to investigate the pathologic mechanisms of idiopathic scoliosis using experimentally induced scoliosis in chickens. OBJECTIVE: To understand the process of producing a scoliotic deformity in pinealectomized chickens. SUMMARY OF BACKGROUND DATA: Pinealectomy in chickens consistently produces scoliosis with anatomic characteristics similar to those of human idiopathic scoliosis. Pinealectomized chickens are an important animal model for the study of idiopathic scoliosis. METHODS: In this study, 40 chickens were divided into two groups; 20 chickens treated with pinealectomy and 20 with a sham operation as control subjects on the second after hatching. The chickens in both groups then were killed at intervals ranging from 1 to 20 weeks after surgery. Their spines were examined visually and radiologically for the presence of a scoliotic curve and vertebral deformities. RESULTS: Rotational lordoscoliosis developed in pinealectomized chickens. The chickens with severe scoliosis were characterized by apically wedge-shaped vertebrae. In contrast, no scoliosis with any vertebral deformity developed in any of the chickens that received a sham operation. CONCLUSIONS: Because there normally is evidence of lordosis in the thoracic spine of chickens, the rotational instability of the spine induced by pinealectomy may produce a scoliotic deformity as a secondary phenomenon. Pinealectomy in chickens consistently produces scoliosis with anatomic characteristics similar to those of human idiopathic scoliosis. The authors believe that disturbance of the equilibrium and the posture mechanism associated with a defect in melatonin synthesis after pinealectomy may promote the development of rotational lordoscoliosis.

Animals↗
PubMed2002

Paraspinal muscle activities of patients with scoliosis after spine fusion: an electromyographic study.

STUDY DESIGN: This prospective study compared the electromyographic activities of paraspinal muscles between normal subjects and patients with scoliosis before and after spine fusion. OBJECTIVE: To investigate the functional changes of paraspinal muscles before and after spine fusion using surface electromyography. SUMMARY OF BACKGROUND DATA: Idiopathic scoliosis is a common spine deformity. Surgical correction followed by spine fusion is the basic method of treatment, but the functional changes in paraspinal muscles after spine fusion still are unknown. METHODS: For this study, 15 healthy subjects and 19 patients with idiopathic scoliosis were recruited. All 19 patients received posterior spine fusion from T2 to T5 to T12. The surface electromyography for normal subjects and for patients before and after spine fusion was recorded bilaterally along the thoracic and lumbar paraspinal muscles for different postures. Root mean square and median frequency values of electromyographic activities were used to compare results between normal subjects and patients with scoliosis before and after spine fusion. RESULTS: Electromyographic activities showed significant differences between normal control subjects and patients with pre- or postoperative scoliosis. After spine fusion, electromyography showed lower root mean square activity in the thoracic region and higher root mean square activity in the lumbar region. Patients with preoperative scoliosis showed lower median frequency in the thoracic region and higher median frequency in the lumbar region than normal subjects and patients with postoperative scoliosis. The group with preoperative scoliosis showed the least symmetrical paraspinal muscle activity, followed by the postoperative and normal groups. CONCLUSIONS: Patients with scoliosis present unbalanced electromyographic activity in the paravertebral muscles, which is diminished by spine fusion, but does not return to the values found in normal subjects. The paraspinal muscles in the thoracic region showed lower activity after spine fusion, probably because of atrophy. Higher muscular activity was found in the lumbar region, which may lead to muscle hypertrophy.

Adolescent↗
PubMed2002

Chiari I malformation associated with syringomyelia and scoliosis: a twenty-year review of surgical and nonsurgical treatment in a pediatric population.

STUDY DESIGN: Retrospective review of patients with Chiari I malformation with or without associated scoliosis. OBJECTIVES: Determine the effect of decompression of Chiari I malformation with syringomyelia on stabilization or improvement of associated scoliosis. SUMMARY OF BACKGROUND DATA: Chiari malformations are often associated with spinal deformities, including scoliosis. Studies have suggested a causal relation between syringomyelia and scoliosis. METHODS: Patients with Chiari I malformation and syringomyelia with or without scoliosis treated over the last 20 years were reviewed. Patients with any other anomalies were excluded. Scoliotic curves were classified by magnitude and curve type. All patients were treated with surgical decompression of the Chiari malformation with or without drainage of the syringomyelia. RESULTS: Twenty-five patients were identified, ranging in age from 19 months to 16.5 years. Nineteen patients (76%) had associated scoliosis. The majority of the patients with scoliosis (13 of 19) sought treatment for spinal deformity, and only 6 had for pain or neurologic symptoms. Eleven of 19 patients with scoliosis (58%) underwent fusion. Eight of 19 (42%) patients have not undergone fusion: 3 have experienced progress, 1 remains in a stable condition, and 4 have experienced improvement of curvature since undergoing decompression. The mean age of patients who experienced progress after decompression was 14.5 years, compared to 6 years for patients who experienced improvement. CONCLUSION: Early decompression of Chiari I malformation with syringomyelia and scoliosis resulted in improvement or stabilization of the spinal deformity in 5 cases. Each of these patients underwent decompression before 8 years of age and before the curve was severe. However, this series represents a few patients demonstrating this trend, and further follow-up and investigation are warranted.

Adolescent↗
PubMed2004

The influence of spine and trunk deformity on preoperative idiopathic scoliosis patients' health-related quality of life questionnaire responses.

STUDY DESIGN: Retrospective case series. OBJECTIVES: To determine the influence of spine and trunk deformity on preoperative idiopathic scoliosis patients' health-related quality of life questionnaire responses. SUMMARY OF BACKGROUND DATA: Management recommendations for patients with idiopathic scoliosis during adolescence are based heavily on spine deformity and to some extent trunk deformity magnitude. However, the manner in which these objective measures influence the patients' perception of their condition is unclear. METHODS: Of 67 consecutive preoperative patients, 61 (91%) had completed the Scoliosis Research Society-22 health-related quality of life questionnaire and had been studied with posterior exposure surface topography. Their average age was 15 years, 6 months (range 10 years, 10 months-20 years, 10 months), and the average maximum Cobb was 63 degrees (range 40-137 degrees). Correlations between spine and trunk deformity measures and Scoliosis Research Society-22 scores were determined by the Pearson correlation coefficient, with P < 0.01 considered significant. RESULTS: For the study group, spine deformity (Cobb) correlated significantly only with Scoliosis Research Society-22 function (r = -0.39, P = 0.0022) domain. Neither coronal nor transverse plane trunk deformity composite scores correlated with any Scoliosis Research Society-22 scores. The Hump Index component of the transverse plane Suzuki Hump Sum composite score was the only trunk measurement to correlate significantly (function r = -0.45, P = 0.003; self image, r = -0.36, P = 0.0040). The strongest correlations occurred when the single thoracic curves, King classifications III and IV, were combined: Cobb versus function r = -0.53, P = 0.0027; Cobb versus self-image r = -0.46, P = 0.0099; and Hump Index versus function r = -0.60, P = 0.0005. There were no significant correlations between either spine deformity or any trunk deformity measure with Scoliosis Research Society-22 responses for either the double or thoracolumbar curve pattern groups. CONCLUSION: Both spine and upper thoracic transverse plane trunk deformity significantly influenced preoperative idiopathic scoliosis patients' perception of function and self-image, but not pain or mental health. However, in spite of a fairly rigorous standard of proof, P < or = 0.01, the significant r values ranged from -0.33 to -0.68, suggesting that there are factors other than spine and trunk deformity influencing the idiopathic scoliosis patients' health-related quality of life questionnaire responses. Future studies are necessary to define these factors.

Abdomen↗
PubMed2003

Scoliosis in an Orangutan.

STUDY DESIGN: The first case of scoliosis in an Orangutan spine is reported. OBJECTIVES: To study the nature of scoliosis in the spinal specimen, and to determine the etiologic significance to human idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Idiopathic scoliosis has not been observed in primates other than man. Previous studies highlighted the importance of erect posture in the development of idiopathic scoliosis in man. METHODS: A spinal model of an orangutan spine was studied in great detail to determine its nature. The methods used included plain radiographs, computed tomography scans, a three-dimensional plastic model using rapid prototyping, and dissection of the frozen specimen. RESULTS: Features similar to human idiopathic scoliosis were noted including a right-side curve, vertebral rotation to convexity, displacement of the spinal cord to the concavity, and an equal number of ribs on either side. No evidence of congenital anomaly was found. Atypical findings included male gender, a short curve, and kyphosis at the apex. CONCLUSIONS: Although scoliosis found in the orangutan has features similar to idiopathic scoliosis, there also are some dissimilar features, making this diagnosis unlikely. The features observed in this spine suggest that erect posture is important in the morphology of human idiopathic scoliosis.

Animals↗
PubMed2003

Effect of melatonin suppression on scoliosis development in chickens by either constant light or surgical pinealectomy.

STUDY DESIGN: This study was designed to compare the effect of suppression of melatonin secretion by bright light in chickens with that of surgical pinealectomy. OBJECTIVE: To determine whether suppression of melatonin secretion without surgery in chickens can result in scoliosis development. SUMMARY OF BACKGROUND DATA: Pinealectomy in chickens consistently produces scoliosis with anatomic characteristics similar to those of human idiopathic scoliosis. Conversely, cutting of the pineal stalk without removal of the pineal gland will also result in scoliosis. This study addresses the question of whether constant bright light can induce scoliosis formation, because it is well known that 24-hour bright lighting conditions can suppress the secretion of melatonin to an equivalent level as pinealectomy. MATERIALS AND METHOD: Seventy-seven newborn Nihon chickens were separated into three groups. A control group (n = 21) with no surgery performed; a pinealectomy group (n = 15) that served as surgical controls; and a constant light group (n = 41). The first two groups were kept together in a strict 12-hour light-dark cycle, whereas the third group was separately kept with constant lighting conditions (>100 lux). All the chickens were radiographed at two weekly intervals, and blood was taken during the middle of the light and dark cycles for serum melatonin assay using ELISA. RESULTS: Fifty-four percent of the pinealectomized chickens had scoliosis develop by 6 weeks. None of the constant-light chickens or controls had scoliosis develop for up to 11 weeks. Measurements of serum melatonin levels of the constant light group confirm that secretion is suppressed. CONCLUSION: This study suggests that for scoliosis to develop in chickens, the surgical operation itself is important and challenges the role of melatonin as an isolated etiological factor in the development of scoliosis.

Animals↗
PubMed2006

Three-dimensional analysis of 2 fusionless scoliosis treatments: a flexible ligament tether versus a rigid-shape memory alloy staple.

STUDY DESIGN: Experimental scoliosis was created and subsequently corrected in goats. The 3-dimensional (3-D) effects of the treatments were analyzed. OBJECTIVE: To analyze the 3-D effect of 2 different fusionless scoliosis treatment techniques on an experimental idiopathic-type scoliosis using plain radiographs and computerized tomography. SUMMARY OF BACKGROUND DATA: Scoliosis is a complex 3-D spinal deformity with limited treatment options. By preserving growth, motion, and function of the spine, fusionless scoliosis surgery provides theoretical advantages over current forms of treatment. METHODS: Scoliosis was created in 24 Spanish cross-X female goats using a flexible, left posterior asymmetric tether from the T5 to L1 laminae, with convex rib resection and concave rib tethering from T8 to T13. After 8 weeks of posterior tethering, goats were randomized into 3 treatment groups: group 1, no treatment; group 2, anterior-shape memory alloy staple; and group 3, anterior ligament tether with bone anchor. The 6 levels of maximal curvature were instrumented in groups 2 and 3. All goats were observed for an additional 12-16 weeks. Serial radiographs and computerized tomography were used to document progression/correction of coronal, sagittal, and transverse plane deformities throughout the study. RESULTS: There were 20 goats that had progressive, structural, idiopathic-type, lordoscoliotic curves convex to the right in the thoracic spine over the 8-week tethering period. An overall deformity score equaling the sum of the scoliosis, lordosis, and axial rotation measurements was calculated for each goat at 3 times. CONCLUSION: The data in this study show the ability of a ligament tether attached to a bone anchor to correct scoliosis modestly in the coronal plane, but not in the sagittal or transverse plane. In addition, although a significant decrease in the deformity score was shown initially in this group (P < 0.001), the effect was lost over time. The final deformity in the bone anchor/ligament tether group wassignificantly less than either the stapled or untreated groups (P < 0.03). Further study is warranted to provide a better understanding of the 3-D effects of fusionless scoliosis treatments.

Alloys↗
PubMed2006

Experimental scoliosis in melatonin-deficient C57BL/6J mice without pinealectomy.

The etiology of idiopathic scoliosis is unknown. Scoliosis with many characteristics closely resembling those seen in idiopathic scoliosis has been produced in young chickens and bipedal rats after pinealectomy. In this study, we induced experimental scoliosis in C57BL/6J mice without pinealectomy and melatonin treatment suppressed the development of scoliosis. A total of 100 mice were divided into four groups: 20 quadrupedal mice served as controls; 30 mice underwent resection of two forelegs and tail at 3 wk of age (bipedal mice); the remaining 20 quadrupedal and 30 bipedal mice received intraperitoneal melatonin (8 mg/kg BW) at 19:00 hr daily. Before killing, blood samples were collected in the middle of dark cycle and melatonin levels were measured by radioimmunoassay. Spine X-ray and helical 3D-CT were examined after killing at 5 months of age. The bipedal mice without a tail were able to walk with standing posture, whereas the quadrupedal mice did not walk with standing posture. In C57BL/6J mice, the serum melatonin was reduced to nearly zero; however, the normal level was restored in both bipedal and quadrupedal mice after the injection of melatonin. Scoliosis with rib humps developed in 29 of 30 bipedal and in five quadrupedal mice. None of mice with melatonin treatment developed scoliosis. The results suggest that melatonin deficiency in bipedal mice appears to play crucial role for development of scoliosis. Also the restoration of melatonin levels prevents the development of scoliosis.

Animals↗
PubMed2004

Steroid treatment and the development of scoliosis in males with duchenne muscular dystrophy.

BACKGROUND: Scoliosis due to progressive muscle weakness occurs in almost all males with Duchenne muscular dystrophy, and it progresses relentlessly. Previous studies have shown that corticosteroid treatment slows the decline in muscle strength and stabilizes muscle strength in patients with this disease. We hypothesized that steroids may also attenuate the development of scoliosis. The purpose of this study was to compare the prevalence of scoliosis in male patients with Duchenne muscular dystrophy who received steroids with a control group of such patients who did not. METHODS: A group of seven to ten-year-old boys with Duchenne muscular dystrophy who were able to walk were enrolled in a nonrandomized comparative study to determine the effect of deflazacort (a derivative of prednisone) on muscle strength and pulmonary function. Thirty patients were treated with deflazacort (treatment group), and twenty-four were not (control group). The patients were matched for age and pulmonary function at baseline. To assess the development of scoliosis, the patients in each group were followed for at least five years. Survival curves were plotted to determine the chance of scoliosis of >/==" BORDER="0">20 degrees developing. The difference between the groups with respect to the chance of scoliosis developing was determined with Kaplan-Meier analysis. RESULTS: A curve of >/==" BORDER="0">20 degrees developed during the follow-up period in sixteen (67%) of the twenty-four patients in the control group but in only five (17%) of the thirty patients in the treatment group. Fifteen of the twenty-four patients in the control group underwent spine surgery, at a mean age of thirteen years, whereas only five of the thirty patients in the treatment group underwent spine surgery, at a mean age of fifteen years. Kaplan-Meier analysis demonstrated a significant difference between the two groups with regard to development of scoliosis of >/==" BORDER="0">20 degrees (p < 0.001). Cataracts developed in ten patients in the treatment group, and stress fractures developed in three patients in the treatment group. Patients in the treatment group weighed a mean of 3.7 kg more than did those in the control group. CONCLUSIONS: Steroid treatment slows the progression of scoliosis in males with Duchenne muscular dystrophy; however, longer-term evaluation will be necessary to determine if the treatment prevents the development of scoliosis or just delays its onset. At the very least, steroid treatment delays the need for spinal surgery. LEVEL OF EVIDENCE: Therapeutic study, Level II-1 (prospective cohort study). See Instructions to Authors for a complete description of levels of evidence.

Activities of Daily Living↗
PubMed1986

Vascular causes of vertebral asymmetry and the laterality of scoliosis.

The aetiology of idiopathic scoliosis is multifactorial and complex, but the direction (laterality) of the curvature may depend on normal growth factors. It is postulated that vascular asymmetries are responsible for the left laterality of infantile thoracic scoliosis and the right laterality of adolescent thoracic scoliosis. Two hypotheses are presented. The left laterality of thoracic scoliosis in infancy may be due to the streaming of blood from the aortic arch to the right and streaming of blood from the ductus arteriosus to the left so that right vertebral arches receive better oxygenated blood, develop faster and grow larger. It is also suggested that, at a later stage, spontaneous resolution of infantile scoliosis and the right laterality of adolescent thoracic curvatures are due to the rotational force that is exerted on growing thoracic vertebrae by the asymmetrically situated descending thoracic aorta. It is emphasized that the normal growth factors that tend to a slight left thoracic scoliosis in infancy, and to a right thoracic scoliosis in adolescence, by themselves produce only a minimal scoliosis, and that progressive scoliosis involves additional unknown factors.

Adolescent↗
PubMed1999

[Idiopathic scoliosis: evaluation of the results].

Natural history studies in idiopathic scoliosis must be known to assess the effectiveness of treatment. Natural history is better known to day for mild angulations but as far as scoliosis are operated on for greater angulations natural history of scoliotic population with Cobb angle greater than fifty degrees is less and less available. Effectiveness of school screening is debated because of over-referral of either non scoliotic children or patient with mild non evolutive scoliosis. Attempt to find any criteria for evolutive scoliosis was disappointing. Only scoliosis with Cobb angle greater than thirty five degrees during growth spurt is defined as an evolutive scoliosis with a 95% confidence interval. Scoliotic curves show a tendency to progress even during adult life especially if the Cobb angle is over thirty degrees at skeletal maturity. Effectiveness of bracing is established for Cobb angle over thirty degrees. Comparing natural history and the results of bracing for mild idiopathic scoliosis controversies remain according to the effectiveness of bracing. Scoliotic population is more at risk for back pain than a population based control group. In severe idiopathic scoliosis non operated patients ar more at risk for back pain than operated one. Multi-hooks systems used for surgical correction of scoliosis are helpful in term of coronal plan correction but no system effectively derotates the spine. Scoliotic population experiences significatively more back pain than control group. There is a higher prevalence of negative perception of health but a more positive perception of self in the scoliotic population compared to a control group.

Adolescent↗