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PubMed1986

Measurement of axial rotation of vertebrae in scoliosis.

The authors report a radiographic method for measuring the axial rotation of vertebrae in degrees and its use in 99 patients with adolescent idiopathic scoliosis. The offset of the pedicle images from the vertebral body center and a "depth" estimate measured radiographically in a population of patients with scoliosis permitted calculation of axial rotation by means of a simple mathematical formula. It was found that measurements of vertebral rotation can be made clinically from single-plane radiographs with a standard deviation of 3.6 degrees (95% confidence limit +/- 7.1 degrees) based on a study of known rotations of a radiographic phantom, and with a standard deviation of 2.44 degrees (95% confidence limit +/- 4.8 degrees) based on comparisons with three-dimensional measurements of the orientation of each vertebra derived from low-dose stereo films of a group of patients. Measurements from clinical films are unlikely to be made more accurately than this, because of inherent geometric constraints.

Adolescent↗
PubMed1986

Lateral electrical surface stimulation (LESS) compliance in adolescent female scoliosis patients.

This retrospective study of lateral electrical surface stimulation (LESS) treatment for patients with progressive idiopathic scoliosis was performed to document patient compliance in the standard electrical stimulation program and to gain objective data to perform a relative comparison of electrical stimulation and bracing compliance. Forty mothers of adolescent female patients participating in the electrical stimulation program of one of the authors (NK) were interviewed confidentially by an independent observer (SW). Patients whose compliance was rated good or total were thought to have acceptable compliance rates. Overall, 50% showed good or total compliance, 10% fair, 5% poor, and 35% failures. It appeared that the failures tended to exaggerate their symptoms and use "skin irritation" as an excuse to discontinue treatment. The longer patients used the LESS (scolitron) device, the more compliant they became (P less than 0.0). This is opposite to the findings about brace compliance. Confidence of the mother in the device showed a positive correlation (P less than 0.008) with compliance, and a mother's concern of how others would react to her child's scoliosis had a negative correlation (P less than 0.003). From the results of this study, overall compliance appears to be somewhat better for electrical stimulation programs than for bracing programs. However, the high failure rate was both disappointing and surprising.

Adolescent↗
PubMedDate not supplied

Adult idiopathic scoliosis treated by posterior spinal fusion and Harrington instrumentation.

Ninety-one patients with idiopathic scoliosis, who underwent posterior spinal fusion and instrumentation from January 1977 to December 1982, were reviewed. All patients were 20 years or older at the time of surgery and none had undergone a prior surgical procedure. Indications for surgery included pain, progressive deformity, and pulmonary symptoms. All patients had a posterior spinal fusion with Harrington instrumentation and autogenous iliac bone graft, with the addition of segmental wiring in only eight. No patient had an anterior fusion or fusion to the sacrum. Follow-up averaged 3.5 years (range: 2-7 years). The average correction at the time of surgery was 38%, and 32% at the time of last follow-up. Seventy-nine percent of the patients reported complete relief of the symptom(s) for which they had surgery. There were 34 complications in 30 (33%) patients. Pseudarthrosis occurred in 14 (15%), requiring 15 additional procedures to achieve a solid arthrodesis. Urinary tract infection occurred in 8 (9%) patients and Harrington hook dislodgement in 5 (5%). One patient sustained a partial paraparesis with recovery to a minimal deficit. No deaths occurred. Although largely successful, posterior fusion with Harrington instrumentation for adult scoliosis has a significant incidence of pseudarthrosis and instrumentation problems.

Adult↗
PubMed1987

Effects of age and sex on the external induction of scoliosis in rats.

To guide inquiries into the mechanisms for progression of mild scoliosis in humans, the authors investigated the effects of age and sex on the response of spines to externally applied deforming moments using a rat model. Groups of male and female rats, with initial ages of 3, 6, or 24 weeks, were held for five weeks in restraints that laterally deformed their trunks. In response to these deforming moments, the spine of every animal studied acquired an at-least-temporarily fixed lateral curve. Without exception, when deforming moments were applied, the rats' spines deformed. Neither age nor sex was an important factor in this response. The implications of these results to possible mechanisms of scoliosis curve progression in humans are discussed.

Aging↗
PubMed1987

Idiopathic scoliosis: transcutaneous muscle stimulation versus the Milwaukee brace.

This paper compared 3-year results of electrical stimulation with the Milwaukee brace for the treatment of idiopathic scoliosis. Fifty patients in each group were compared retrospectively and matched for age, sex, Risser sign, and curve morphology. Evaluations were performed at 6-month intervals with radiographs and examinations. Skin irritation was the most common complication with electrical stimulation. Using survivorship analysis methods, no significant differences were found in rates of curve progression or failure. Overall, 70% of the patients in each group were successfully maintained over a course of 3 years. Electrical stimulation is comparable to the Milwaukee brace in managing idiopathic scoliosis.

Adolescent↗
PubMed1988

Hump changes on forward flexion of the lumbar spine in patients with idiopathic scoliosis. A study using ISIS and the Scoliometer in two standard positions.

A detailed study of the effects of forward flexion in the spine on back shape is reported. ISIS and the Scoliometer were used to record angle of trunk inclinations (ATIs) in 13 patients with idiopathic scoliosis. Two standard positions were used: standing erect (for ISIS) and sitting forward bending (for the Scoliometer). In the lumbar region, a positional change in ATI between standing erect and sitting forward is revealed; it is related to the type and side of mainly compensatory spinal curves. It does not correlate with Cobb angle but it does correlate with each of spinous process rotation (Bunnell) and pedicular rotation (Perdriolle). In the thoracic region, the change from a standing-erect to a sitting-forward-bending position, in contrast, shows a statistically significant reduction of the hump on the convexity of the spinal curve. The findings have relevance to screening tests for scoliosis.

Child↗
PubMed1988

The sagittal configuration and mobility of the spine in idiopathic scoliosis.

The aim of this study is to see how the spinal sagittal configuration and mobility in 127 patients with idiopathic scoliosis are influenced by increasing scoliotic deformity and to determine when this deformity gets clinically significant compared to controls (n = 92). In patients with thoracic curves the degrees of thoracic kyphosis and lumbar lordosis were significantly less than those of the controls. Neither the kyphosis nor the lordosis were correlated to the Cobb angles. Even patients with small curves have straight spines in the sagittal plane; there is no tendency for the kyphosis and lordosis to decrease when the scoliotic deformity increases. This indicates that it is especially individuals with straight spines in the sagittal plane who are prone to develop scoliosis. It is also suggested that the limitation in spinal function for curves with Cobb angles below 50 degrees may be neglected.

Adolescent↗
PubMed1988

Muscle spindles in the paraspinal musculature of patients with adolescent idiopathic scoliosis.

Electromyographic studies have determined that muscle imbalance and asymmetry of stretch receptors in the paraspinal muscle of patients with idiopathic scoliosis may have a large role to play in the development and production of the deformity. This project consisted of a detailed histologic and histochemical analysis of the distribution of muscle spindles in paraspinal musculature of patients suffering from idiopathic scoliosis, using the reduced form of nicotinamide-adenine dinucleotide (NADH), adenosine triphosphatase (ATPase), and Tri-chrome stain techniques. Muscle biopsy samples were taken at operation for spinal instrumentation from each of 13 patients (mean age: 16.2 years; 3 males, 10 females) with all but one female exhibiting right thoracic curves. The samples were collected from two specific sites (superficial and deep) on both sides of the vertebral column at the level of the apex of the primary curve and two vertebral levels above and below the apex. From the results there appear to be few muscle spindles in the scoliotic muscle of this region. All of the patients from whom muscle samples were taken possessed at least one sample with a muscle spindle. However, each patient had very few samples which contained a minimum of one muscle spindle (mean: 20.3%; SD: 12.6). It is clear that further examination is necessary, particularly in the area of comparison with 'normal' standards when these standards become available.

Adolescent↗
PubMed1988

Induction of scoliosis in the growing rabbit by unilateral rib-growth stimulation.

Growing rabbits were subjected to surgical resection of the intercostal nerves on the right side, posteriorly or anteriorly. Two other groups of animals were used as sham and as normal controls. Six months after the nerve resection, there was no electromyographic evidence of denervation of the involved muscles. Radiologic examinations revealed progressive development of a curve, convex to the left, in each animal of the two resection groups. Analysis of structural changes by computed tomography showed rotation of the apical vertebra about the longitudinal axis. Rib cage deformity was diagnosed in 82% of the rabbits. The experimental model developed for induction of scoliosis is simple. The surgical procedure involves just one selected and easily recognized anatomic structure, leaving the vertebral structures and their vicinity intact. Reliable analysis of the underlying mechanism of the developing scoliosis is thereby assured.

Animals↗
PubMed1988

The use of the ISIS optical scanner in the management of the braced adolescent idiopathic scoliosis patient.

Thirty-four adolescent female patients with right thoracic idiopathic scoliosis were followed for a mean of 8.6 months to document progression of scoliosis curvature during bracewear. Prediction of change by deviation of the lateral asymmetry index on ISIS examination were compared with measured change on standard upright roentgenograms. A one-to-one correlation was found in 50% of the patients; five patients were predicted to have stayed the same or decreased by ISIS and showed increase on x-ray measurement. Eight patients were predicted to have stayed the same or decreased by x-ray measurement and showed increase by ISIS. Although a weak positive correlation exists between change by x-ray examination and change by ISIS examination in a braced population, the clinical usefulness of the ISIS method in following a braced population has not been proven.

Adolescent↗
PubMed1988

Clinical and radiological evaluation of lumbosacral motion below fusion levels in idiopathic scoliosis.

The purpose of this study was to evaluate the unfused segments of the lumbar spine in patients who had Harrington instrumentation and fusion for idiopathic scoliosis. Forty-eight patients, with an average follow-up of 11 years, were evaluated. The translational motion in the unfused segments below the instrumented levels was measured, using lateral flexion and extension radiographs of the lumbar spine. This motion was compared with values obtained from an earlier study of asymptomatic nonscoliotic individuals. The amount of disc space narrowing, retrolisthesis, length and level of the fusion, and the presence of traction spurs also were recorded. The incidence of low-back pain was highest in those patients fused to L4 (62%). Individuals instrumented and fused to L3 or L4 had significantly more translational motion in the adjacent lower interspace when compared with the control group (P = 0.05 and P = 0.001, respectively). Increased translational motion correlated with the presence of low-back pain in patients fused to L4. Retrolisthesis occurred in 81% of patients instrumented to L4, in 40% of those fused to L3, and was not found in patients fused to high levels. Its presence was strongly associated with low-back pain. There was no relationship between low-back pain and traction spurs, length of the fusion mass, lumbar lordosis, or width of the disc space in the unfused lower levels. The authors conclude that retrolisthesis and increased translational motion are important factors in determining low-back pain following surgery for idiopathic scoliosis. Instrumentation to L4 should be avoided if possible.

Adolescent↗
PubMed1988

Observer variation in assessing spinal curvature and skeletal development in adolescent idiopathic scoliosis.

Accurate measurements of spinal curvature and skeletal development are crucial in planning treatment and assessing curve progression in adolescent idiopathic scoliosis (AIS). An inter-rater agreement trial was undertaken to estimate the reliability of measuring these spinal parameters. Two orthopaedic surgeons and two trained technicians from a scoliosis clinic independently read 30 anteroposterior roentgenograms of AIS patients. Skeletal maturity was assessed using the six-point Risser sign scale, and spinal curvature was measured using the method of Cobb. Excellent agreement was observed in evaluating Risser signs (Kappa = 0.8) and primary Cobb angles (intra-class correlation coefficient, Rho = 0.98). The standard deviation of inter-observer error in measuring primary Cobb angles was 2.5 degrees, and the intra-reader error, based on one observer's reassessments of 15 films, was 1.9 degrees. Inter-rater agreement for assessing secondary Cobb angles was much lower (Rho = 0.52) because small curves (less than 20 degrees) were often not noticed. Differences in agreement between surgeons and technicians were relatively minor. These results indicate that personnel trained at this clinic are able to assess these spinal parameters reliably.

Adolescent↗
PubMed1988

Rotatory olisthesis in idiopathic scoliosis.

Lateral subluxation of one vertebral body upon another (rotatory olisthesis) has been associated with increased incidence of back pain in scoliosis. This study was undertaken to identify the presence of and characterize rotatory olisthesis and its association with the following parameters: age, sex, curve type, curve magnitude, level of occurrence, region within curves, primary vs. secondary curves, severity of slip, and association with pain. Charts of 636 patients were reviewed for the presence or absence of pain. Curve measurements and the occurrence of rotatory olisthesis were noted. Rotatory olisthesis was statistically unrelated to the occurrence of pain associated with idiopathic scoliosis. It was significantly associated with increasing age and curve magnitude. Lumbar curves with rotatory olisthesis were more likely to be associated with radicular pain.

Adolescent↗
PubMed1989

The comparative results of treatment in idiopathic thoracolumbar and lumbar scoliosis using the Harrington, Dwyer, and Zielke instrumentations.

Forty-five patients with idiopathic thoracolumbar or lumbar scoliosis were treated with the Harrington, Dwyer, or Zielke instrumentation and fusion. The Harrington group achieved a 55% correction of the primary curves, while the Dwyer and the Zielke groups achieved 88 and 91%, respectively. Overcorrection of the curves occurred in a total of nine cases in the latter two groups. The Dwyer and Zielke instrumentations enabled better correction of the curves with a shorter fusion. At subsequent follow-up, the 'adding on' phenomenon as a result of the shorter fusion in the Dwyer group was unchanged, while that in the Zielke group became gradually resolved. The Zielke instrumentation appears to be the apparatus of choice for treatment of thoracolumbar and lumbar scoliosis.

Adolescent↗
PubMed1989

The psychological impact of idiopathic scoliosis on the adolescent female. A preliminary multi-center study.

Seventy-two female idiopathic scoliosis patients, ages 12 to 16, who were receiving either no treatment/observation, the Scolitron, a brace, or who had undergone surgery were tested to determine the psychological impact of scoliosis. Mothers of the patients also served as subjects. A normal group of adolescents served as control subjects. Results showed that all groups were less likely to feel that their health status was due to chance than the controls. No other psychological differences were found between treatment groups, which contradicts previous reports of greater psychological distress among brace patients as compared with Scolitron (TM) patients. It was found that mothers' attitudes toward their children's illnesses were strongly and positively related to their children's attitudes toward their illnesses, and that these attitudes were strongly correlated with psychological distress. These findings underscore the need to consider the parent-child relationship when treating the adolescent patient.

Adolescent↗
PubMed1989

The current status of scoliosis screening in North America, 1986. Results of a survey by mailed questionnaire.

In May, 1986, 374 questionnaires on the multiple aspects of school screening for scoliosis were mailed to health care professionals throughout North America. An overall response rate of 73% provided objective information about screening efforts. Results showed that although there is great variability among the programs, at least some screening is done in each of the 50 United States and the District of Columbia. Previously widespread in Canada, only two Provinces currently are officially engaged in screening, Alberta (research projects only) and Prince Edward Island. The most common target population seems to be grades five through nine for both boys and girls. Lack of funding appears to be the largest factor hampering data collection. Although many varied comments and suggestions were received, most called for: 1) new recommendations for screening boys and girls at different grade levels; 2) quantitative referral criteria; 3) improved data gathering: 4) statewide uniformity within programs; and 5) improved understanding within the medical community about indications for referral and the principles of scoliosis treatment.

Adolescent↗
PubMed1989

Scoliosis induced by anterior and posterior rhizotomy.

This paper presents the result and statistical analysis of an experiment in which selective anterior or posterior rhizotomy was carried out under microscopic surgery. The animals used for the experiment were 48 young rabbits, and they were divided into four groups. Group 1, which was used as control, was subjected to lower dorsal bilateral laminectomies with dural incision; Group II to laminectomies with three right posterior rhizotomies; Group III to laminectomies with three right anterior rhizotomies, and Group IV to laminectomies with three right anterior and posterior rhizotomies. Scoliosis was induced in Groups II, III, and IV. There was no significant statistical difference in the degree of curvatures among these three groups. The convexity of the curvature faced to the side of the divided roots. In Groups III and IV, scoliotic curvatures were obvious within 2 weeks, but there were no considerable changes thereafter. In Group II, the curves progressed slowly up to the 12th week. They were statistically significant at the fourth week and increased continuously thereafter. The histologic findings in Groups III and IV showed denervation atrophy of the paravertebral muscles at the apex of the curvature, but there was little or no muscle atrophy in Groups I and II. The experimental results indicate that scoliosis may be induced not only by anterior root paralysis but also by selective posterior root paralysis.

Animals↗
PubMed1989

Trunk muscle activities in braced scoliosis patients.

There are two theories as to why bracing may prevent the progression of idiopathic scoliosis curves, the passive and the active theories. The passive theory is that progression is prevented by the forces exerted by the brace. The active theory is that progression is prevented by muscle contractions that arise in response to wearing the brace. This study examined the active theory of brace correction. Trunk muscle myoelectric activities were measured in ten adolescent females with right thoracic idiopathic scoliosis being treated with Boston braces. Activities were both measured when wearing and when not wearing their braces. Differences in braced and unbraced myoelectric activities were seldom statistically significant and never biomechanically significant. Boston brace effectiveness seems not to result from active responses to brace wearing.

Adolescent↗