[Modern therapy of scoliosis and kyphosis, (Report on the 5th International Symposium on Scoliosis and Kyphosis].
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Adolescent↗
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[Orthopedic treatment of Scheuermann's juvenile kyphosis].
The authors establish some indications, depending on several criteria, of the treatment of cases of juvenile kyphosis of the Scheuermann type. These are based on their experience acquired in the therapy of 26 cases of juvenile kyphosis in which orthopaedic procedures have been applied -- plaster cast for recovery in two stages, followed by an orthopaedic corset and careful follow-up for at least one year after the end of the treatment. The criteria suggested as being important are: the severity of the kyphosis, the mobility of the spine, the severity of the kyphosis, the mobility of the spine, the severity of the vertebral structural lesions and the bone age. In cases of kyphosis under 40 degrees with a mobile spine, with minimal radiological lesions, detected before the end of growth, kinesitherapy is indicated and repeated clinico-radiological follow-up. The progression of the kyphosis under treatment or the existance of important vertebral structural lesions make necessary the performance of an orthopaedic treatment, the same as the severe cases of kyphosis, over 40 degrees, with median or severe vertebral lesions.
Adolescent↗
Juvenile and idiopathic kyphosis. Long-term follow-up of 20 cases.
Twelve patients with juvenile kyphosis and eight patients with idiopathic kyphosis were reviewed at an average follow-up of 19 years. The average age of the patients at follow-up was 33 years (range 26-45 years). All the patients but one, who had a posterior fusion of the dorsal spine, had been treated with a plaster cast jacket followed by a plastic brace. At the end of treatment there had been an improvement of about 30% on the original curves in both juvenile and idiopathic kyphosis. At follow-up, however, all the patients had lost the correction obtained and the curves had become worse than originally, those in idiopathic kyphosis more so than those in juvenile kyphosis. Despite the increase in their angular deformity, all the patients managed fairly well and only two complained of distressing back pain.
Adolescent↗
Kyphosis in childhood and adolescence.
Kyphosis has become an increasingly important problem to the surgeon interested in the management of significant spinal deformity. As scoliosis has become better understood, the more difficult problems have become apparent and one of the most difficult of these is kyphosis. Kyphosis is the deformity which can produce paraplegia if it progresses to a significant degree and remains untreated. Contrary to scoliosis, in which bracing and posterior fusion alone are usually quite sufficient, kyphosis sometimes responds to bracing and other times it does not. If surgical treatment is necessary it quite often requires an anterior fusion. The purpose of this presentation is to give an overall review of the various etiologies of kyphosis and the current status of management of these various problems.
Adolescent↗
Measurement of scoliosis and kyphosis radiographs. Intraobserver and interobserver variation.
Interobserver variations for measurements of the Cobb angle on radiographs of patients who had kyphosis were comparable with those on the radiographs of patients who had scoliosis. Four staff orthopaedists and one physical therapist measured eight radiographs that showed scoliosis and twenty that showed kyphosis. The measurements were made on two occasions and in random order. For scoliosis, the average difference between readings was 3.8 degrees, and 95 per cent of the differences were 8 degrees or less (range, 0 to 10 degrees). These findings were in keeping with those of other published reports. For kyphosis, the average difference between readings was 3.3 degrees, and 95 per cent of the differences were 7 degrees or less (range, 0 to 30 degrees). One investigator rated the kyphosis radiographs with respect to clarity. There was a trend to less variation with clearer radiographs, but this was not significant. The end-vertebrae were pre-selected for some radiographs and were freely chosen by the interpreter for others. Reliability was not significantly improved when the end-vertebrae of the curve had been pre-selected. Using the statistical method called tolerance limits, we determined that if one were to be 95 per cent confident that a measured difference represented a true change, the difference would have to be 10 degrees for scoliosis radiographs and 11 degrees for kyphosis radiographs. The probability that a measured difference is due to measurement error alone (that is, a false-positive reading) was calculated.
Analysis of Variance↗
[Epidemiology of kyphosis in school children].
At five schools in the city of Bochum a serial study was carried out with regard to pathological posture of the spine. In total 2075 pupils from 10 to 17 years of age were examined and the degree of kyphosis was determined using Debrunner's kyphometer. An angle of 40 degrees or more was supposed to be a pathological kyphosis. The rate of this kyphosis was 12 p.c. in girls and 15.3 in boys. The children with pathological curvature were compared with a group of children inconspicuous with regard to posture and selected by random. The two groups were questioned using a halfstandardized questionnaire. This was designed to obtain details of general circumstances of life, attitude in sports and medical history either in orthopedics and diseases in the family. Thereby was seen that children with pathological kyphosis practised less sports and had more orthopedic diseases, and also in their families more orthopedic problems and back pain occurred.
Child↗
Short segmental kyphosis following fusion for Scheuermann's disease.
Six of 14 patients surgically treated for Scheuermann's disease developed a short segmental kyphosis adjacent to the fusion. In four patients, the original fusion had incorporated the end vertebrae of the curves. However, there was mild wedging of the end vertebra, which led to a loss of correction occurring at the junction between fused and unfused segments. These losses averaged 13 degrees (range, 6-29 degrees) at follow-up, ranging from 1 to 5.5 years (average, 2.8 years). The resultant short segmental kyphosis ranged in magnitude from 15 degrees to 34 degrees (average, 23 degrees). The kyphosis occurred distally in five patients and proximally in one patient. The risk of developing a short segmental kyphosis may be minimized if the fusion and instrumentation extend beyond all wedged vertebrae to the first "square" vertebra. This will necessitate fusing into the upper lumbar spine for many patients.
Adolescent↗
Kyphosis secondary to infectious disease.
Infections of the spine usually involve the vertebral body and therefore by definition produce a kyphosis. Non-tuberculous infection usually staphylococcal and in the lumbar spine, is often diagnosed late and can involve the cord. Open exploration and stabilization with graft should therefore be considered. The destruction is usually less extensive and therefore the kyphosis less severe than in late neglected tuberculous infections. Tuberculous spinal infection accounts for 59% of all orthopedic tuberculosis. It invariably involves vertebral bodies and is progressive. Destruction of the bodies is by infection and avascular necrosis, kyphosis is inevitable and cord compression a common threat. While L-1 is the most commonly affected body T-10 is statistically the most commonly associated with cord compression. The treatment of spinal tuberculosis should be aimed at correcting 5 basic defects associated with the disease and the deformity: mechanical instability; chronic smoldering infection; spinal cord and nerve root compression; disturbance of spinal growth; depressed lung function. The cornerstone to effective treatment for spinal tuberculosis is drug therapy and the anterior fusion operation. For the established tuberculous kyphosis, which is always a fixed deformity, multiple staged operations and gradual correction used the Halo-pelvic apparatus is the best treatment available at present.
Acute Disease↗
Post-laminectomy kyphosis.
Post-laminectomy spinal deformity occurs in 50% of children undergoing laminectomies for cord tumors. Kyphosis is the most frequent deformity found. The integrity of the facet joints appears to be one of the most important factors in the development of this kyphosis. More children are surviving after treatment of these tumors and a pessimistic attitude is not warranted. Observation of a progressing deformity is not acceptable treatment. When kyphosis develops, early prompt bracing must be started. For a progressive or severe kyphosis, an anterior spine fusion is indicated. This is reinforced by a posterior fusion with Harrington instrumentation. Surgical reconstruction is indicated in children recovering from extensive laminectomies but with a good prognosis.
Adolescent↗
Wrist fracture, heel bone density and thoracic kyphosis: a case control study.
The heel bone density measured by Broadband Ultrasound Attenuation (BUA), the thoracic kyphosis measured by a Kyphometer, height, and weight were compared between 294 women over 49 years of age who sustained a wrist fracture and 294 age-matched women who had not previous wrist, hip or spine fracture. The BUA was significantly less in the women who had wrist fracture (p less than 0.0005), though there was a considerable overlap between the two populations. The women with wrist fracture had significantly greater thoracic kyphosis (p less than 0.0005) and smaller stature (p less than 0.0005). There was no significant difference in weight. There was a significant tendency (p less than 0.0005) for women in the fracture patient group to have both poor BUA and greater kyphosis.
Aged↗
Lumbar kyphosis in Hunter's disease (MPS ii).
Although radiological involvement of the lower dorsal and upper lumbar vertebrae is common in the severe form of Hunter's disease (MPS II), there are reports in the literature that clinical kyphosis does not occur. We report a boy with marked clinical kyphosis in whom the diagnosis of MPS II was proved by demonstrating a severe deficiency of serum and leucocyte iduronate-sulphate sulphatase and an accelerated incorporation of radiosulphate into his cultured fibroblast glycosaminoglycans, which could not be corrected by the product of other typed reference MPS II cells. The existence of several other genetic diseases, sometimes complicated by kyphosis, was excluded by assay of fibroblast lysosomal enzymes.
Adolescent↗
Myelodysplasia: the natural history of kyphosis and scoliosis. A preliminary report.
The results of this study support the concept that the levels of the bifid vertebral arch and of functional motor activity are significant influences on the development of scoliosis and kyphosis in patients born with myelodysplasia. 'Significant' degrees of scoliosis and kyphosis may appear at any time during life, but most frequently occur during late childhood or adolescence. Not all 'significant' curvatures require treatment, nor do all children with myelodysplasia and factors predisposing to kyphosis and scoliosis develop these complications. It is believed that the preliminary cumulative percentage curves presented in this study will be of value in counselling parents of afflicted newborn infants, and in planning the management of patients born with myelodysplasia.
Adolescent↗
[The influence of kyphosis on lung function in young scoliotic patients (author's transl)].
By assessment of partial correlation in the field of lung function in kypho-scoliosis, the direct influence of kyphosis on the upward-shift of the mid-respiratory level (FRC% TLC) can be documented. It is shown that several other lung function parameters are dependent more or less on a change of volume balance in the deformed chest and, thus, indirectly on the degree of kyphosis. The degree of scoliosis which was the presenting symptom in our series, shows, of course, a highly significant direct correlation to vital capacity, which in itself is the source of changes in several other lung function parameters. The role of kyphosis in the development of lung function during therapy is being discussed.
Adolescent↗
[Physical measurement of the dorsal kyphosis in 14-17-year old patients with Scheuermann's disease and in matched healthy controls].
The modified use of the Debrunner-kyphometer (a special protractor to measure the dorsal kyphosis by an objective physical method) is presented. After proving the validity and reproducibility of the measuring method, the dorsal kyphosis of patients with Scheuermann's disease and of matched healthy controls was measured. The aim of the measurements was to assess the physiologic values of kyphosis and to investigate into the distribution of Scheuermann-patients regarding the grade of their dorsal sagittal curvature. In contrast with the everyday routine (subjective judgement of the sagittal curvatures or measuring on X-ray films), this method offers the advantage of an objective assessment without using X-rays. The presented simple method is recommended for screening school-children and for monitoring patients with Scheuermann's disease.
Adolescent↗
[Technique of surgical correction of post-traumatic kyphosis].
The correction of posttraumatic kyphosis in the thoracolumbar region almost always requires a combined anterior and posterior approach because of the particular anatomic situation and the pathomorphologic changes. We suggest that the patient be placed in a right lateral decubitus position. This allows dual access to the spine by a posterior midline approach and a retroperitoneal thoracolumbar approach, so that simultaneous anterior and posterior manipulation, correction and stabilization of the spine are possible with no need to turn the patient intraoperatively. Thus, compared with two-or three-stage procedures, the duration of the operation and of stay in hospital can be reduced. This is a retrospective review of the first six patients (average age: 35 years) treated with this approach between 1987 and 1990. All patients suffered from incapacitating back pain that was unresponsive to nonoperative treatment. The surgical procedure was performed at an average of 29 months (range, 5 months to 7 years) after fracture. The average postoperative correction of kyphosis (18 degrees to 45 degrees) was 75%. In addition, two patients had posttraumatic scoliosis (10 degrees and 12 degrees), which was completely corrected. The only complication was partial fracture of a vertebral body in one case, which occurred during the reduction manoeuvre but had no consequences. Three of the patients had complete relief of pain. The remaining three reported persistent pain, although they had good objective clinical and radiological results. The failure to eliminate pain in these patients is thought to be a result of their long-standing (2-7 years) symptomatic posttraumatic deformities. Therefore, we feel that early correction of symptomatic kyphosis is mandatory.
Adult↗
[The use of an articulated brace in the treatment of juvenile kyphosis (author's transl)].
The authors have attempted to assess the efficiency of an articulated brace in the treatment of juvenile kyphosis (Scheuermann's disease and idiopathic kyphosis). Two series of patients were compared. Patients in both series were treated in a first stage by a plaster cast and in a second stage by a bivalve brace in the first series and an articulated brace in the second series. The technique of treatment by a plaster cast and by the brace is fully described. It is concluded that control of the lumbar lordosis is of great importance. The results were better with an articulated brace. The indications for treatment are given depending on the age at the onset of treatment, the type of spine deformity and its severity. In some cases of severe dorsolumbar kyphosis, surgery may be indicated.
Adolescent↗
Treatment of severe kyphosis in myelomeningocele by segmental spinal instrumentation with Luque rods.
Myelomeningocele leads to kyphosis of the dysplastic spine in 12-20% of cases, resulting in a severe gibbus. In three patients (at the age of 9, 13 and 16 years) with a thoracolumbar kyphosis (90 degrees, 120 degrees and 95 degrees respectively), and a compensatory thoracic lordosis (35 degrees, 105 degrees and 90 degrees) a resection or a wedge osteotomy of the gibbus was performed with segmental sublaminar wire fixation to Luque rods. In addition, a spondylodesis with autogenous bone and an allograft was performed. Correction of the kyphosis (to 30 degrees, 60 degrees and 50 degrees) and lordosis (to 15 degrees, 65 degrees and 55 degrees) was attained. This posterior procedure was sufficient for correction; there was no need for an anterior release. Cord and dura were left intact. During follow-up (27, 60 and 30 months) no progression of the curves has been noted. This one-stage posterior correction with L-rod fixation proved to be a method of choice for this difficult-to-treat spinal deformity.
Adolescent↗
[Clinico-roentgenological and physiological evaluation of the spine in patients with juvenile kyphosis].
203 patients with juvenile kyphosis, aged 11-16 years, have been subjected to the complex examination, including ++clinico-roentgenologic and physiologic methods. Along with the cardinal signs, common for juvenile kyphosis diagnosis and characteristic of the dystrophic process (wedge distortion, osteoporosis of vertebra bodies and fragmentation of their apophyses, dedifferentiation of the bone structure, height reduction and pathologic restructuring of intervertebral disks following the pattern of fibrosis, presence of discal hernia), the signs of bone ++ dysplasia of spine and skeleton in general should be singled out of the roentgenologic characteristic of disease which determine the variants of pathologic process course and treatment tactics. The presence of dysontogenesis signs in patients with juvenile kyphosis is suggested.
Adolescent↗