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PubMed1989

Lateral electrical surface stimulation in idiopathic scoliosis. Experience in two private practices.

One hundred twenty-six patients with idiopathic scoliosis were treated by lateral electrical surface stimulation. Of these, 39 patients satisfied a strict set of protocols and were evaluated as a group. In this subgroup, curves averaged 28 degrees (range, 20-38 degrees). Thirty-eight percent exhibited initial curves greater than 30 degrees. Thirty percent of patients had a Risser sign of 0. Follow-up was from 6 months to 6 years. Progression was greater than 5 degrees in 48% and greater than 10 degrees in 35%. The final curve was greater than 40 degrees in 30%. Twenty-eight required fusion. Compared with natural history studies, these results are acceptable, and the authors continue to offer lateral electrical surface stimulation as a method of nonoperative care for progressive idiopathic scoliosis.

Bone Development↗
PubMed1990

Harrington-Luque and Cotrel-Dubousset instrumentation for idiopathic thoracic scoliosis. A postoperative comparison using segmental radiologic analysis.

This article reports a comparison of the Cotrel-Dubousset (CD) operation with the Harrington-Luque (HL) procedure for the treatment of adolescent idiopathic thoracic scoliosis. Thirty-nine patients were studied preoperatively and postoperatively using segmental radiologic measurements including Cobb angle, end-vertebra angles (EVAs), surgical flexibility index, vertebral rotation, displacement and tilt, convex and concave rib-vertebra angles (RVAs), and kyphosis and lordosis. Cotrel-Dubousset is not significantly different from HL with respect to Cobb angle (%), surgical flexibility index, apical vertebral displacement, apical vertebral rotation, apical rib-vertebra angles, kyphosis, and lordosis. It is significantly better than the HL with respect to the correction of vertebral displacement at T10-11; lower EVA of the thoracic curve; vertebral rotation mainly above the apex; convex RVAs above the apex; and concave RVAs at T10. The surgical correction of vertebral tilt above and below the apex of the thoracic curve is significantly related to the correction of convex and concave RVAs. The view that persistent deformity of ribs is a factor needing surgical correction in some patients with adolescent idiopathic thoracic scoliosis having posterior instrumentation and fusion needs further evaluation.

Adolescent↗
PubMed1990

Cobb angle versus spinous process angle in adolescent idiopathic scoliosis. The relationship of the anterior and posterior deformities.

The standard clinical measurement for adolescent idiopathic scoliosis is the Cobb angle, measured from the end-plates of the end vertebral bodies in a standing radiograph. This measurement of anterior column structures describes the anterior spinal deformity. The posterior spinal deformity can be described by the "spinous process angle," measured from a curve joining the tips of the spinous processes. A computer model, and a radiographic study of Cobb angle, spinous process angle and vertebral rotation show that adolescent idiopathic scoliosis results in larger angulations of the anterior elements than posterior elements. This helps to explain some of the inherent limitations of posterior instrumentation, including Cotrel-Dubousset instrumentation, and of noninvasive posterior surface measurement systems.

Adolescent↗
PubMed1990

Digital radiography can reduce scoliosis x-ray exposure.

Digital radiology is a new computerized system of acquiring x-rays in a digital (electronic) format. It possesses a greatly expanded dose response curve that allows a very broad range of x-ray dose to produce a diagnostic image. Potential advantages include significantly reduced radiation exposure without loss of image quality, acquisition of images of constant density irrespective of under or over exposure, and reduced repeat rates for unsatisfactory films. The authors prospectively studied 30 adolescents with scoliosis who had both conventional (full dose) and digital (full, one-half, or one-third dose) x-rays. They found digital made AP and lateral image with all anatomic areas clearly depicted at full and one-half dose. Digital laterals were better at full dose and equal to conventional at one-half dose. Cobb angles were easily measured on all one-third dose AP and on 8 of 10 one-third dose digital laterals. Digital clearly depicted the Risser sign at one-half and one-third dose and the repeat rate was nil in this study, indicating digital compensates well for exposure errors. The study indicates that digital does allow radiation dose to be reduced by at least one-half in scoliosis patients and that it does have improved image quality with good contrast over a wide range of x-ray exposure.

Adolescent↗
PubMed1990

Surface electrical stimulation versus brace in treatment of idiopathic scoliosis.

Surface electrical stimulation using the ScoliTron device was applied to 40 adolescent patients for treatment of idiopathic scoliosis. Adequate follow-up was available for 30 of these patients. The overall failure rate was 15 of 30 or 50%. Due to curve progression while using the ScoliTron, these patients either went on to a fusion (9 of 15) or were changed to a brace (6 of 15). The remaining 15 patients were considered successes with no curve progression (10 of 30 or 33%) or successful/failures with slight curve progression not requiring a change in treatment (5 of 30 or 17%). None of the various parameters analyzed were found to be useful indicators of successful treatment using the ScoliTron device. Electrical stimulation was found to be ineffective in preventing curve progression for idiopathic scoliosis.

Adolescent↗
PubMed1990

The use of fibrin sealant to reduce blood loss during Cotrel-Dubousset instrumentation for idiopathic scoliosis.

The increased complexity of Cotrel-Dubousset instrumentation has, as an unexpected side effect, a potential increase in blood loss. A prospective randomized study was undertaken to test the hypothesis that application of a fibrin sealant to exposed cancellous bone can significantly reduce blood loss during Cotrel-Dubousset instrumentation for idiopathic scoliosis. A significant difference was demonstrated in total body loss, loss per level fused, and loss per kilogram of body weight when comparing the sealant group with random controls. A significant difference was demonstrated in loss per level fused when comparing the sealant control with a historical control group. Thirty-three patients were randomly assigned to the fibrin sealant or nonsealant groups; another 10 patients operated on before planning the study were included as historical controls. The sealant was used to control bleeding at the bone graft donor site and in the spine after decortication. All patients underwent Cotrel-Dubousset instrumentation for idiopathic scoliosis. There were no significant differences between groups with respect to degree of curvature, number of levels fused, age or weight of patient, or operating time. Total blood loss in the sealant group averaged 672 ml compared with 894 ml in the sealant control group. No patient in the sealant group required homologous blood. Given the increasing awareness of the complications of blood transfusion, the authors conclude that fibrin sealant is a useful adjunct to spinal surgical technique.

Adolescent↗
PubMed1990

Nighttime bracing for adolescent idiopathic scoliosis with the Charleston bending brace. Preliminary report.

The authors report their preliminary experience with the Charleston bending brace for the treatment of adolescent idiopathic scoliosis. This brace holds the patient in the position of maximum side bend correction and is worn only at night. Patients in this prospective multicentered study met all the following criteria: skeletal immaturity (Risser 0, 1+, or 2+), curvature greater than 25 degrees before bracing, no prior treatment, and greater than 1-year follow-up since initiation of treatment. There were 191 structural curves in the 139 patients. One hundred fifteen patients (83%) showed improvement or less than 5 degree change in curvature. Twenty-four patients (17%) demonstrated an increase in curvature greater than 5 degrees. Based on these preliminary results, continued use of bending brace treatment at nighttime only is justified for adolescent idiopathic scoliosis. Patients with double curves should be observed closely for increase in compensatory curves.

Adolescent↗
PubMed1991

The effect of an exercise program on vital capacity and rib mobility in patients with idiopathic scoliosis.

All 813 patients with idiopathic scoliosis who completed their first Schroth physiotherapeutic rehabilitation program at the Katharina Schroth Hospital between 1984 and 1987 were reviewed. The patients were divided into four age groups. In Group I (10-13 years, N = 278), vital capacity in patients treated for the first time improved by 18.94% (445 ml). In Group II (14-17 years, N = 264), the average increase in vital capacity after initial treatment was 16.33% (497 ml). In Groups III (18-24 years, N = 123) and IV (greater than 24 years, N = 148), the corresponding increases were 15.11% (501) and 13.77% (394 ml), respectively. In the 256 patients receiving repeat treatment, the increases in vital capacity in the respective age groups amounted to just more than half those in the patients treated for the first time. The average increase in chest expansion was more than 20% in all groups at all measuring points. These findings show that a course of inpatient treatment by the Schroth method can lead to an increase in vital capacity and chest expansion so that, even in adult scoliosis patients, effective treatment of the associated restrictive ventilatory disorder is possible.

Adolescent↗
PubMed1992

Growth in girls with adolescent idiopathic scoliosis.

The height development during childhood and puberty was analyzed in 54 girls with adolescent idiopathic scoliosis by the use of the Infancy Childhood Puberty growth model, which is based on healthy Swedish children. This model adjusts adolescent reference values for height for individual age at pubertal maturation. The scoliotic girls had an above-average height 2 years before the onset of the pubertal growth spurt. However, because they displayed an early pubertal maturation as well as a low pubertal gain in height, their values were only slightly higher than the reference mean values at maturity. The results indicate an increased growth hormone activity in childhood in girls with adolescent idiopathic scoliosis.

Adolescent↗
PubMed1992

Diagnostic findings in painful adult scoliosis.

The purpose of this study was to document the diagnostic findings in a group of adult patients presenting with both scoliosis and pain. Fifty-five adults were evaluated by medical history, physical examination, radiography, myelography followed by computed tomography, discography followed by computed tomography, and single- and dual-photon densitometry. Curves were 49% adult degenerative onset, 44% idiopathic. The older degenerative patients had myelographic defects most commonly within the primary curve and multiple abnormal, not necessarily painful, discs throughout the lumbar spine on discography. The idiopathic group had myelographic defects most commonly in a compensatory lumbar or lumbosacral curve. On discography, all idiopathic patients had at least one abnormal, painful disc, and 88% had their pain reproduced. Pain-producing pathology was frequently identified in areas that would not have been included in the fusion area according to accepted rules for treatment of idiopathic scoliosis.

Adult↗
PubMed1992

Spinal stenosis with scoliosis.

A retrospective review was carried out on 40 patients who met the criteria of 1) having a significant lumbar scoliosis associated with spinal stenosis, with symptoms of neurogenic claudication; and 2) having been treated with posterior decompression and pedicular screw fixation techniques. The average age of the patients was 61.5 years (range, 38-77 years), and 25 of the 40 patients were female. Eighty-eight percent of the patients had significant back pain in addition to lower extremity pain. All patients had pedicular screw fixation at all levels. Zielke instrumentation was used in 24 patients, Cotrel-Dubousset instrumentation in 8 patients, and Texas Scottish Rite Hospital instrumentation in the remaining 8 patients. After surgery, there was marked improvement in regard to pain status: 34 patients (83%) had severe pain before surgery, with 38 patients (93%) reporting mild or no pain at follow-up. Average length of follow-up was 44 months (range, 24-61 months). There were no deaths and no instrument-related failures or pseudarthroses noted in this series. A mean correction of the deformity of 19 degrees was obtained. Average scoliosis was 37 degrees before surgery and 18 degrees at follow-up.

Bone Screws↗
PubMed1992

Prevalence of scoliosis in neurofibromatosis.

Experience in a comprehensive, multispecialty neurofibromatosis clinic leads the authors to suggest that the association of spinal deformity with neurofibromatosis is less frequent than usually assumed. Previously reported statistics may be partly attributed to preselection of patients seen by spinal surgeons, and to the predominant referral of patients having severe manifestations of neurofibromatosis. A diagnosis of neurofibromatosis 1, based on National Institutes of Health criteria, is confirmed for two hundred twenty patients at the clinic. Twenty-three of these patients have structural scoliosis. Nine patients have idiopathic type curves, eight have dystrophic scoliosis, four have dystrophic kyphoscoliosis, and two have dystrophic lordoscoliosis. The authors believe that 10% is representative of the true prevalence of spinal deformity in an otherwise unselected cross section of neurofibromatosis patients.

Adolescent↗
PubMed1992

Pedicle fixation devices in the treatment of adult lumbar scoliosis.

Segmental pedicle screw instrumentation in adult lumbar scoliosis allows better curve correction and restoration of lumbar lordosis. In a retrospective study, to assess the value of this fixation, 9 patients treated with the AO Internal Fixator and 18 with Cotrel-Dubousset instrumentation were reviewed. Mean age at surgery was 60 years (range, 40-88), and curves were measured between 22 degrees and 82 degrees. At follow-up (mean of 56 months for the AO Internal Fixator and 42 months for Cotrel-Dubousset instrumentation), the average curve correction was better than 50% Overall satisfactory clinical results with pain relief and improved walking distance were noted in 86% of the patients. Using this technique no postoperative deaths or neurologic deficits occurred. Only a few complications and a 4% pseudarthrosis rate could be observed. Our study shows that the age of the patients with degenerative scoliosis is not a contraindication for major surgery. Meticulous posterior spine release before instrumentation is essential for curve correction and bone fusion. Lumbar lordosis is more easily restored with Cotrel-Dubousset instrumentation, which seems to correspond to the incidence of low back pain. Cases with evident neurologic deficits are best treated by additional nerve decompression.

Adult↗
PubMed1993

Family stature in idiopathic scoliosis.

The standing heights of 40 children with scoliosis and 110 persons from their immediate families were compared with those of a group of 349 contemporary control subjects. Skeletal bone ages and puberty ratings did not differ from normal, but the children with scoliosis were found to be significantly taller than the controls. They were also taller than their unaffected relatives, suggesting that the increased stature is not due to genetic factors alone. Scoliotic children with an affected immediate-family member were of normal height, which suggests that growth is of less etiological importance in children with a strong genetic susceptibility.

Adolescent↗
PubMed1993

Progressive scoliosis with vertebral rotation after lumbar intervertebral disc herniation in a 10-year-old girl.

A case report of a 10-year old girl with a herniated disc is presented. The most significant symptoms were progressive scoliosis with a flat back and paravertebral muscle spasm. An absent H reflex on the left and an increased latency of the somatosensory-evoked potentials of the left posterior tibial nerve were found. The computed tomographic scan of the lumbar spine showed a large central left-sided disc protrusion at the L5-S1 level. Our case presents the youngest patient with documented intervertebral disc herniation and the only one with severe scoliosis and vertebral rotation. The curve was not structural because it improved with surgery and an orthosis was not necessary.

Child↗
PubMed1993

Mechanical process and growth cartilages. Essential factors in the progression of scoliosis.

This study showed that the worsening of scoliosis was the result of a mechanical phenomenon. The key feature in this mechanical process was the finding that cuneal deformation affects only part of the vertebral body. The onset of scoliotic curvature occurred as a result of intervertebral motions. However, the worsening was essentially caused by deformation of the vertebral bodies. After the onset of scoliosis, the orientations of the vertebrae were modified in all three planes, and as a result, the spine became mechanically unstable. As a result of this mechanical instability, intervertebral pressures no longer were distributed equally but were concentrated at the junction of the growth cartilages of the vertebral body, near the pedicle on the concave side. Osseous growth was perturbed in this area, the vertebra became deformed, and the vertebral body became wedge shaped. These cuneal deformations resulted in a relative change of position between adjacent vertebral bodies and led to a worsening of the scoliotic curve without involving any articular motion. This phenomenon occurred mostly in the apical region because of the geometric shape of the curvature.

Biomechanical Phenomena↗
PubMed1993

Degenerative symptomatic lumbar scoliosis.

Scoliosis with progressive deformity can develop late in life. The authors studied 200 patients older than age 50 years with back pain and recent onset of scoliosis. Seventy-one percent of patients were women, and no patient had undergone spinal surgery. The curves involved the area from T12 to L5 with the apex at L2 or L3 and did not exceed 60 degrees. Degenerative facet joint and disc disease always were present, and the curves were associated with a loss of lumbar lordosis. Forty-five patients with severe pain and neurologic deficits were studied using myelography. Indention of the column of contrast medium was seen at several levels but was most severe at the apex of the curve. It was least severe at the lumbosacral joint. The curves progressed an average of 3 degrees per year over a 5-year period in 73% of patients. Grade 3 apical rotation, a Cobb angle of 30 or more, lateral vertebral translation of 6 mm or more, and the prominence of L5 in relation to the intercrest line were important factors in predicting curve progression.

Aged↗