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PubMedDate not supplied

Lumbar spine and femoral neck bone mineral density in idiopathic scoliosis: a follow-up study.

A follow-up study of the bone mineral densities (BMD) of 22 female subjects with idiopathic scoliosis was performed using dual-photon absorptiometry at an average follow-up period of 30.8 months. Compared to the initial scans, statistically significant increases in lumbar spine and femoral neck BMD were observed. When compared to normal subjects, approximately half of the scoliotic subjects were markedly osteoporotic, having BMD measurements at least two standard deviations below the expected value. Scoliotic curvature data could not be correlated with the BMD data. The observed osteoporosis is not transient and appears characteristic of idiopathic scoliosis.

Absorptiometry, Photon↗
PubMedDate not supplied

Untreated scoliosis in severe cerebral palsy.

An institutionalized adult cerebral palsy (CP) population was studied to evaluate the orthopaedic, functional, and cardiopulmonary status of 14 residents with untreated scoliosis greater than 45 degrees as compared with 42 residents with mild or no curves. Both groups were comparable in age, sex distribution, percentage of quadriplegics, and extent of mental retardation. Patients in the scoliosis group had more orthopaedic deformities involving the pelvis and hips and needed modified wheelchairs more often than did those without curves. There were no differences in incidence of decubiti, highest functional level achieved, functional loss, oxygen saturation, or pulse.

Adult↗
PubMedDate not supplied

Soft Boston orthosis in management of neuromuscular scoliosis: a preliminary report.

Collapsing neuromuscular spinal curvature is extremely difficult to manage with standard rigid orthoses owing to skin breakdown and patient intolerance. Experience with a new, more malleable type of spinal brace (the "soft Boston orthosis") has been very rewarding in 55 children with neuromuscular scoliosis with an average curvature of 42 degrees. Patient tolerance was improved in 38%, patient handling was facilitated in 68%, and postural positioning was enhanced in 79%. Although improvement in the scoliosis averaged only 15 degrees, the major advantage of this orthosis was a marked improvement in sitting stability in 80% of patients.

Activities of Daily Living↗
PubMedDate not supplied

Syringomyelia and scoliosis: a review of twenty-five pediatric patients.

A retrospective review of 25 patients with scoliosis secondary to syringomyelia was conducted. All patients had large syrinxes, but only 10 patients had abnormal neurologic findings, suggesting that subtle neurologic findings in patients with scoliosis should not be underestimated and supporting liberal use of magnetic resonance imaging (MRI). The results of three approaches to the care of these patients were reviewed: passive observation, bracing, and spinal fusion. Curves progressed > or = 5 degrees in patients aged < 10 years who were observed, but in children aged > 10 years, curves progressed > or = 10 degrees. Curves responded well to bracing, but correction was not maintained out of brace for patients with progressive and/or severe curves. Good corrective was achieved safely during operation.

Adolescent↗
PubMedDate not supplied

Effect of spinal fusion on growth of the spine and lower limbs in girls with adolescent idiopathic scoliosis: a longitudinal study.

Two-hundred thirty-eight Southern Chinese girls, aged 10 to 14 years, treated previously for adolescent idiopathic scoliosis were studied longitudinally from the commencement of their treatment until maturity. Their standing, sitting, and suprasternal heights were measured at each follow-up visit, and their lower limb, head-neck, and spinal lengths were calculated. The results in 113 girls treated by posterior spinal fusion and Harrington instrumentation were compared with those of 125 girls who were treated with a brace. At maturity, the mean standing height of girls who underwent spinal fusion was not significantly different from that of patients treated with a brace. The fusion group had significantly shorter spinal lengths (p = 0.001), but significantly greater leg lengths (p = 0.001) compared to those of the brace group. Their arm lengths were similar, however. The girls who underwent spinal fusion had progressively increasing leg/arm ratios postoperatively from bone age 14-15 years onward compared to those treated with a brace, which indicated disproportionately longer legs in the girls who had spinal fusion. These findings suggest that spinal fusion performed on the girls with adolescent idiopathic scoliosis did retard the longitudinal growth of the spine. The standing height was unaffected, however, as the loss in spinal length was compensated by an increase in leg length.

Adolescent↗
PubMedDate not supplied

Boston brace in the treatment of idiopathic scoliosis.

In a retrospective follow-up study of 64 patients with adolescent idiopathic scoliosis, the initial correction of Boston brace with straight lumbar profile strongly predicted good treatment results at follow-up (mean, 4.8 years). If the initial correction was > 50%, the curve was permanently reduced with an average of 7.2 degrees. The average initial correction was 62%. This initial brace effect was preserved in another comparable group of 60 patients treated with a Boston brace with 15 degrees lumbar lordosis. It is concluded that the Boston brace is effective in the conservative treatment of idiopathic scoliosis, and the corrective ability seemingly does not deteriorate with a change in the brace design from 0 to 15 degrees lordosis.

Adolescent↗
PubMed2006

A support vector machines classifier to assess the severity of idiopathic scoliosis from surface topography.

A support vector machines (SVM) classifier was used to assess the severity of idiopathic scoliosis (IS) based on surface topographic images of human backs. Scoliosis is a condition that involves abnormal lateral curvature and rotation of the spine that usually causes noticeable trunk deformities. Based on the hypothesis that combining surface topography and clinical data using a SVM would produce better assessment results, we conducted a study using a dataset of 111 IS patients. Twelve surface and clinical indicators were obtained for each patient. The result of testing on the dataset showed that the system achieved 69-85% accuracy in testing. It outperformed a linear discriminant function classifier and a decision tree classifier on the dataset.

Adolescent↗
PubMed2004

The locus responsible for horizontal gaze palsy/progressive scoliosis and brainstem hypoplasia is refined to a 9-cM region on chromosome 11q23.

Horizontal gaze palsy associated with progressive scoliosis (HGPS) is a rare autosomal recessive condition that has been recently mapped to a 30-cM region on chromosome 11q23-25. In this report, we describe a consanguineous family in which three of five sibs are affected with HGPS. In two of the affected sibs, there was significant cognitive delay in addition to congenital horizontal gaze palsy and childhood onset scoliosis. In all three affected sibs, magnetic resonance imaging (MRI) scans revealed brainstem hypoplasia, a finding that has recently been associated with HGPS. Clinical examination of the family showed no significant dysmorphic features, while karyotyping, EMG, nerve conduction, and muscle biopsies were unrevealing. Homozygosity mapping was performed to narrow the disease locus on 11q23-25. A recombination event was observed in one affected sib between markers D11S1345 and D11S4464, which further refined the region to a 9-cM interval. Since the MRI results provide support for the theory that maldevelopment of neurons in the abducens nuclei and caudal longitudinal fascicle is the cause for HGPS, we speculate on the existence of a gene in this 9-cM interval on chromosome 11q23, which is critical for brainstem development.

Adolescent↗
PubMed1996

Peri-operative hypoxaemia in children undergoing application of a plaster jacket for scoliosis.

Twenty children (six female), median age 24 months (range 12-156) who presented for application of a plaster jacket for scoliosis were studied pre-operatively with pulse oximetry overnight and on the first postoperative night. Pre-operatively the median (range) arterial oxygen saturation was 97 (95-98)%, although eight children had short episodes of desaturation to < 90%. Postoperatively the median saturation was unchanged, and nine children had short episodes of desaturation. Neither the presence of episodes of desaturation pre-operatively, nor the median or lowest saturation recorded were predictors of postoperative median saturation or the presence of episodes of desaturation. Despite the presumed reduction in chest wall compliance, the application of a plaster jacket for scoliosis in these young children was not associated with a significant change in their oxygenation.

Adolescent↗
PubMed1998

Midazolam-flumazenil versus propofol anaesthesia for scoliosis surgery with wake-up tests.

BACKGROUND: Wake-up tests may be necessary during scoliosis surgery to ensure that spinal function remains intact. METHODS: Intra- and postoperative wake-up tests were performed together with somatosensory cortical evoked potentials (SCEPs) monitoring in 40 patients randomized to either midazolam (M) or propofol (P) infusions for scoliosis surgery. Other anaesthetic medication was similar in both groups. At the surgeon's request, N2O was turned off and midazolam or propofol infusions were discontinued. In the M group, flumazenil was given in refracted doses. Patients were asked to move hands and feet. The test was repeated immediately after the end of surgery. RESULTS: The median intraoperative wake-up times were 2.9 min in the M group and 16.0 min in the P group. The respective postoperative wake-up times were 1.8 and 13.9 min. The quality of both intra- and postoperative arousals was significantly better in the M group. Twelve patients in the P group could not be awakened intraoperatively within 15 min and were given naloxone. One of these patients woke up violently and dislodged the endotracheal tube. Another patient in the P group had explicit recall of the test, but no pain. Five patients in the M group became resedated in the recovery room. Cost of anaesthetic drugs was similar in both groups. Satisfactory intraoperative SCEPs were recorded from 17 patients in each group. There were no neurological sequelae. CONCLUSIONS: Wake-up tests can be conducted faster and better with midazolam-flumazenil sequence compared with propofol.

Adolescent↗
PubMed1984

Intra-operative spinal cord monitoring during surgery for scoliosis using somatosensory evoked potentials.

The method of intra-operative monitoring of spinal cord function by spinal somatosensory evoked potentials (SEP), as used at the Royal Alexandra Hospital for Children during surgery for scoliosis is described. Using a non-polarisable platinum spinal epidural electrode, SEP elicited by tibial and peroneal nerve stimulation in the popliteal fossa are recorded proximal to the level of spinal correction. The large amplitude and discrete waveform of the SEP enable rapid signal acquisition and easy interpretation. The spinal SEP is stable under both therapeutic hypotension and general anaesthesia. Electrophysiological monitoring has now superceded the 'wake-up' test as an index of spinal cord function during corrective surgery for scoliosis.

Adolescent↗
PubMed2006

Fatal marrow emboli in a pediatric patient having posterior spinal instrumentation for scoliosis repair.

This report describes the intraoperative course of a pediatric patient with neuromuscular scoliosis who died of massive fat and marrow emboli during posterior instrumentation for scoliosis surgery. In addition, the report describes the incidence and consequences of embolic events during spine surgery as well as the most common clinical sequelae. This patient's unique presentation is highlighted.

Child↗
PubMed1977

Non-operative treatment of scoliosis in cerebral palsy: preliminary report on the use of a plastic jacket.

The use of a removable orthoplast jacket to treat scoliosis in 48 patients with cerebral palsy is described. Because of the short follow-up period - nine to 60 months - this paper reports preliminary findings only, but it is felt that the feasibility of conservative treatment of scoliosis in such patients has been demonstrated by the low incidence of complications and patient rejection, and its effectiveness has been shown by halting the progression of curvature in 38 of 41 patients followed for an average of 26 months.

Cerebral Palsy↗
PubMed1989

Scoliosis in spinal muscular atrophy: natural history and management.

This is a report on the natural history of 109 patients with infantile spinal muscular atrophy (SMA). All 18 children with the severe form died, as did five of the 52 with the intermediate form. Functional ability was more or less stable in the 47 living patients with the intermediate form, but 16 of the 39 with mild SMA lost the ability to walk. Ventilatory function was severely impaired in those with intermediate SMA: orthopaedic treatment for scoliosis in this group did not prevent the curves from worsening with age. Scoliosis was also severe in patients with mild SMA who had stopped walking: surgical treatment in six cases resulted in stable correction of the spine, with functional and cosmetic improvement and without impairment of respiratory function.

Adolescent↗
PubMed1990

Myoglobin and enzyme adaptations in erector spinae muscles in thoracal scoliosis.

Bilateral biopsies from the erector spinae muscles were taken during surgery from 10 females and two males (mean age 14, range 13-17 years) with thoracal scoliosis for 6 years (range 2-11 years). The biopsies were analysed for myoglobin (MYO), citrate synthase (CS) and creatine kinase MB (CK-MB). The severity of scioliosis was estimated by Cobb's angle, the greater the angle the more severe the disease. The convex/concave side ratio (CVX/CCV) was for CS 1.3 +/- 0.4 (P less than 0.01), CK 0.9 +/- 0.1 (P less than 0.05), CK-MB 1.6 +/- 0.4 (P less than 0.01) and for MYO 1.1 +/- 0.2 (P greater than 0.05). No significant correlations were found between the CVX/CCV for CS, CK or CK-MB on the one hand and the Cobb's angle on the other. The CVX/CCV for MYO was, however, directly related to the angle (r = 0.80, P less than 0.01). For the lower range of angles (less than or equal to 59 degrees) the CVX/CCV for MYO was below unity (0.88, P greater than 0.05) and for the larger angles (greater than 59 degrees) above unity (1.23, P less than 0.05). In conclusion, a dissociation in the adaptive response of m. erector spinae in scoliosis between mitochondrial enzyme and myoglobin content was demonstrated.

Adolescent↗
PubMed1999

The effect of aerobic training in girls with idiopathic scoliosis.

The purpose of the present study was to investigate the effect of aerobic training in girls with idiopathic scoliosis, in selective respiratory parameters (VC, FVC, FEV1, FEV1/VC% FEV1/FVC) as well as the ability to perform aerobic work (PWC170). The training group consisted of 20 young girls with a mean age of 13.5 +/- 0.16 years. They wore a Boston-type brace for a mean period of 0.30 +/- 0.04 years and suffered from a scoliotic curve (27.4 +/- 1.9 degrees). They followed a two-month training program on the cycloergometer. Each training session lasted 30 min and was performed four times a week. The control group consisted of 20 girls with a mean age of 13.6 +/- 0.18 years and they wore the same type of brace for a mean period of 0.24 +/- 0.04 years. They also suffered from a scoliosis (29.5 +/- 1.8 degrees). The results of the study revealed that aerobic training sustained (VC, FEV1, FEV1/VC) or improved significantly (FVC, FEV1/FVC) the parameters of pulmonary function, while the respective parameters (VC, FVC) for the control group were reduced during the two-month period. The ability to perform aerobic work increased 48.1% (P < 0.01) in the training group, while it decreased 9.2% (P < 0.01) in the control group.

Adolescent↗
PubMed1976

Growth hormone and somatomedin A in girls with adolescent idiopathic scoliosis.

Girls with adolescent idiopathic scoliosis are taller than nonscoliotic girls of the same age. This observation may be related to factors regulating longitudinal growth. Plasma growth hormone was determined in a group of scoliotic girls by double antibody radioimmunoassay under the following conditions: 1) Insulin induced hypoglycemia, 2) glucose tolerance test, 3) exercise. Somatomedin A was determined by a method based on the ability of serum to stimulate the incorporation of radioactive sulphate in embryonic chick cartilage. The results were compared with those obtained in a control group of healthy nonscoliotic girls of comparable age. After overnight fasting and after at least one hour's rest the basal growth hormone level was 9.8+/-11.1 (+/-S.D.) ng/ml in the scoliotic girls (n=48) and 2.2+/-1.1 ng/ml in the controls (n=15). This difference is significant. In the hypoglycemia test the peak growth hormone level tended to be higher in the scoliotic girls but the difference is not significant. In the exercise test the maximal value was reached at different times in the two groups: at 20 min after start of the exercise in the scoliotic girls (n=14, 17.3+/-11.8 ng/ml) and at 40 min in the controls (n=9, 16.0+/-6.6 ng/ml). In the glucose tolerance test the growth hormone level was suppressed in both groups but the mean values tended to be higher during the first 120 min in the scoliotic girls. The serum somatomedin levels were higher in the group of scoliotic girls (n=19, 1.13+/-0.17 U/ml) than in the controls (n=14, 0.88+/-0.16 U/ml) and the difference is significant. The results obtained are difficult to interpret but suggest that growth hormone secretion is higher in girls with adolescent idiopathic scoliosis than in healthy girls of comparable age.

Adolescent↗
PubMed1989

Trunk asymmetry and scoliosis, Anthropometric measurements in prepuberal school children.

A total of 1060 children (515 girls, 545 boys) were examined for screening of trunk asymmetry ans scoliosis at an average age of 10.8 years. The physical examination consisted of height, sitting height, total arm length and leg length inequality determinations and moiré topography. Trunk asymmetry was measured by forward bending test and a posteroanterior standing radiograph of the spine was taken of those 188 (17.7%) children who had a trunk hump greater than or equal to 6 mm. Only 20.1% of the children were found to be exactly symmetric in the forward bending test, 47.3% had a right-sided hump and 32.6% had a left-side hump. Humps of 6 mm or more were significantly (p = 0.03) more prevalent among girls (21.7%) than boys (16.3%). Moré fringe asymmetry was provided to be common: only 9% of the material was totally symmetric, two thirds has asymmetry of less than or equal to 1 fringe, 26.6% has asymmetry greater than 1 and less than or equal or 2 and 5.4% greater than 2. The prevalence of scoliosis (trunk hump greater than or equal to 6 mm and Cobb angle less than or equal to 10 degree) was 4.1%. The majority (72.1%) of the curves were left convex.

Anthropometry↗