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At least 19 recordsLinked to original sources
PubMed2006

The transformation of spinal curvature into spinal deformity: pathological processes and implications for treatment.

BACKGROUND: This review summarizes what is known about the pathological processes (e.g. structural and functional changes), by which spinal curvatures develop and evolve into spinal deformities. METHODS: Comprehensive review of articles (English language only) published on 'scoliosis,' whose content yielded data on the pathological changes associated with spinal curvatures. Medline, Science Citation Index and other searches yielded > 10,000 titles each of which was surveyed for content related to 'pathology' and related terms such as 'etiology,' 'inheritance,' 'pathomechanism,' 'signs and symptoms.' Additional resources included all books published on 'scoliosis' and available through the Arizona Health Sciences Library, Interlibrary Loan, or through direct contact with the authors or publishers. RESULTS: A lateral curvature of the spine-'scoliosis'-can develop in association with postural imbalance due to genetic defects and injury as well as pain and scarring from trauma or surgery. Irrespective of the factor that triggers its appearance, a sustained postural imbalance can result, over time, in establishment of a state of continuous asymmetric loading relative to the spinal axis. Recent studies support the longstanding hypothesis that spinal deformity results directly from such postural imbalance, irrespective of the primary trigger, because the dynamics of growth within vertebrae are altered by continuous asymmetric mechanical loading. These data suggest that, as long as growth potential remains, evolution of a spinal curvature into a spinal deformity can be prevented by reversing the state of continuous asymmetric loading. CONCLUSION: Spinal curvatures can routinely be diagnosed in early stages, before pathological deformity of the vertebral elements is induced in response to asymmetric loading. Current clinical approaches involve 'watching and waiting' while mild reversible spinal curvatures develop into spinal deformities with potential to cause symptoms throughout life. Research to define patient-specific mechanics of spinal loading may allow quantification of a critical threshold at which curvature establishment and progression become inevitable, and thereby yield strategies to prevent development of spinal deformity.Even within the normal spine there is considerable flexibility with the possibility of producing many types of curves that can be altered during the course of normal movements. To create these curves during normal movement simply requires an imbalance of forces along the spine and, extending this concept a little further, a scoliotic curve is produced simply by a small but sustained imbalance of forces along the spine. In fact I would argue that no matter what you believe to be the cause of AIS, ultimately the problem can be reduced to the production of an imbalance of forces along the spine 1.

Journal Article↗
PubMed1994

Change in spinal curvature following release of tethered spinal cord associated with spina bifida.

Changes in spinal curvature, scoliosis, kyphosis and lordosis are associated with the growth of patients with myelomeningocele. Previous investigators have stated that progressive developmental scoliosis is related to tethered spinal cord. In order to investigate the relationship of tethered spinal cord release to progression of spinal curvature, we surveyed the medical records of 262 patients with a history of one or more tethered spinal cord release. For 216 of these patients, a total of 2,369 serial spine x-rays, obtained over a 20-year period, were reviewed by the standard Cobb method for progression of scoliosis, thoracic kyphosis and lordosis. In addition, the serial spine x-rays of 74 patients without clinical findings of tethered spinal cord were collected and reviewed for comparison of progressive scoliosis and kyphosis. One hundred and sixty normal lumbar x-rays were evaluated to compare the progression of the lordotic curve in patients with tethered cord release with a normal population. Progression of scoliosis plateaued or declined following release of tethered cord in patients with lumbar and sacral level lesions, however, tether release did not halt the progression of scoliosis in the thoracic level group. Tethered cord release altered the course of lordosis in L1 through L3 level lesions, but had little affect on the normal progression of lordosis in patients with L4, L5 or sacral level lesions. Finally, tethered spinal cord release appears to be associated with a decrease in the incidence and magnitude of kyphosis.

Adolescent↗
PubMed2004

Postoperative changes of spinal curvature and range of motion in adult patients with cervical spinal cord tumors: analysis of 51 cases and review of the literature.

OBJECTIVE: We sought to determine factors likely to influence postoperative changes in cervical spinal curvature and range of motion (ROM) in patients with cervical spinal cord tumors. METHODS: Fifty-one patients who underwent tumor excision via a single posterior approach were examined. Surgical methods were classified as follows: group A, expansive open-door laminoplasty (ELAP); group B, conventional laminectomy; and group C, hemilaminectomy (HL). Pre- and postoperative cervical spinal curvature, cervical curvature type, and ROM were evaluated using lateral radiographs. RESULTS: Worsening of cervical curvature type was statistically less frequent in group C than in group A or B (P < 0.05), although no significant difference was evident overall between pre- and postoperative cervical curvature indexes or ROM in any group. Cases of C2 surgery showed more frequent curvature worsening (80%) in group A than in other groups (P < 0.05). Postoperative changes of the cervical curvature in patients with cervical spinal cord tumors were greatly influenced by the surgical method; the cervical curvature was particularly unfavorable when patients had C2 decompression. CONCLUSIONS: Careful attention to postoperative changes in the spinal curvature is needed when ELAP is performed, especially if surgery involves C2. HL is the best posterior approach for resection of cervical spinal cord tumors from the viewpoint of postoperative spinal curvature and ROM.

Adult↗
PubMed2002

Influence of age on cervicothoracic spinal curvature: an ex vivo radiographic survey.

OBJECTIVE: To define the post-mortem cervicothoracic spinal curvature relative to age. DESIGN: Spinal curvature assessment of lateral cervicothoracic radiographs. BACKGROUND: A late consequence of age is the progressive accentuation of spinal curvatures, particularly the thoracic kyphosis. Little is known about the influence of the kyphosis on the alignment of the cervical spine. METHOD: One hundred and seventy two lateral spinal radiographs (113 males, 59 females) were analysed using two procedures: (1) sagittal curve deformation angles were derived, according to the method of Cobb, for thoracic (T1-T12), cervical (C2-C7) and cervicothoracic junctional regions (C6-T4); and (2) the cervicothoracic curvatures were digitised (C2-T12), to derive the apex of both curves and the inflexion point. RESULTS: A significantly increasing thoracic spinal curvature was determined for both genders, with the mean apex of the kyphosis close to T6. The cervical lordosis tended to flatten with increasing age, particularly in males, with the cervical apex location shifting cranially. This association was significant in older males and females. The mean location of the cervicothoracic curve inflexion point moved from T3 towards C7-T1 with increasing age. CONCLUSION: The cervicothoracic spinal curvature undergoes progressive change through the lifespan with a subsequent cranial migration of the inflexion point between the thoracic kyphosis and cervical lordosis, accompanied by a similar shift in the cervical apex. RELEVANCE: Sensitive measures of spinal curvature have utility in determining changes attributed to age, deformity or trauma on cervicothoracic spinal alignment. The value of assessing the location of curve inflexion lies in the ability to quantify changes in the relationship between different regions of the human spine without problems associated with identifying specific vertebral landmarks.

Age Factors↗
PubMed2000

Abnormal spinal curvature and its relationship to pelvic organ prolapse.

OBJECTIVE: Intra-abdominal vector forces have been implicated in the development of genital prolapse. Because the normal spinal curvature appears to protect the pelvic cavity from direct upper abdominal forces, variations in spinal curvature may alter these vector forces and possibly potentiate the development of pelvic organ prolapse. This study was undertaken to evaluate the relationship of spinal curvature and pelvic organ prolapse, specifically, the loss of lumbar lordosis or pronounced thoracic kyphosis. STUDY DESIGN: A total of 363 patients referred for various complaints of urinary incontinence or pelvic organ prolapse were included in this multicenter, prospective, case-control study. All patients underwent a detailed history with site-specific examinations; pelvic organ prolapse was quantitatively assessed according to the POPQ (pelvic organ prolapse quantitation) staging system. Spinal curvature was measured with a flexi-curve malleable rod when patients were in a fully erect position. Spinal curvature was then transferred to graph paper by tracing the flexi-curve. Thoracic and lumbar curvatures were determined by measuring thoracic and lumbar lengths and widths, respectively. RESULTS: Ninety-two patients had abnormal spinal curvature according to the study criteria. Complete loss of lumbar lordosis was found in 69 patients. Of the 92 patients with an abnormal curvature, 84 currently had or previously had pelvic organ prolapse (sensitivity, 91%). When compared with patients with a normal curvature, patients with an abnormal spinal curvature were 3. 2 times more likely to have development of pelvic organ prolapse (odds ratio, 3.18; 95% confidence interval, 1.46 to 6.93; P =.002). There was no difference in the number of vaginal deliveries, weight of largest vaginally delivered infant, or body mass index. Only 11% (8/72) of patients with stage 0 prolapse had an abnormal spinal curvature, which increased to 30% (28/99) in patients with stage III prolapse (P =.042). CONCLUSION: An abnormal change in spinal curvature, specifically, a loss of lumbar lordosis, appears to be a significant risk factor in the development of pelvic organ prolapse.

Adult↗
PubMed2003

Spinal osteochondroma presenting as atypical spinal curvature: a case report.

STUDY DESIGN: The case of an 8-year-old girl with hereditary multiple exostosis presenting with atypical spinal curvature is reported. OBJECTIVE: To describe a case of spinal curvature caused by an osteochondroma, illustrating the need for careful evaluation of patients with hereditary multiple exostosis presenting with "scoliosis." SUMMARY OF BACKGROUND DATA: Osteochondromas have been known to arise in the spinal canal and to present with symptoms of neural compression. Spinal curvature is a rare presenting sign of osteochondromas. METHODS: The patient's medical and radiographic history is reviewed as well as the medical literature. RESULTS: An 8-year-old girl with hereditary multiple exostosis was referred for possible thoracotomy and anterior decompression of a T4 osteochondroma thought to be causing an atypical "scoliosis." Further examination, review of the radiographs, and computed tomography scan showed a large L4 osteochondroma encroaching on the neural elements. The patient's neurologic symptoms and spinal curvature resolved in the 2 years after surgical excision of the lumbar osteochondroma. CONCLUSIONS: Patients with hereditary multiple exostosis and spinal curvature require further diagnostic evaluation to ensure that an osteochondroma in the spinal canal is not the cause of that curvature.

Child↗
PubMed2006

The spinal curvature irregularity index independently identifies vertebral fractures.

INTRODUCTION AND HYPOTHESIS: The spinal curvature irregularity index (SCII) is a quantitative measure of the irregularity of the spinal curvature. We evaluated the predictive ability of SCII to identify subjects with vertebral fractures (VF). METHODS: Vertebral heights were measured by quantitative vertebral morphometry in 461 Lebanese women 20-89 years of age and VFs were ascertained by the grade 1 Eastell method. SCII scores were log-transformed and expressed as Z-SCII, the number of standard deviations above or below the mean ln(SCII) of young patients without VF. Univariate and multivariate binary logistic regression models were used to identify clinical predictors of VF. RESULTS: Women with a higher SCII were more likely to have prevalent VF. A higher SCII was associated with a greater prevalence of VF within each category of femoral neck BMD (normal, osteopenia, osteoporosis). In univariate analysis, predictors of VF included Z-SCII (odds ratio, OR: 2.21, 95% CI: 1.80-2.71) and femoral neck T-score (OR: 1.35, 95% CI: 1.12-1.63). In multivariate analysis, predictors of VF were: Z-SCII (OR: 1.54, 95% CI: 1.02-2.32), femoral neck T-score (OR: 1.41, 95% CI: 1.11-1.78) and age(3) (OR: 1.40, 95% CI 1.10-1.82). At a cutoff SCII of 9.5%, the sensitivity and specificity of SCII for VF were 71 and 64% respectively, and higher SCII cutoffs identified VFs with greater specificity. CONCLUSION: The SCII is a robust, simple and independent indicator of the presence of VFs.

Adult↗
PubMed1988

Computerized ultrasonic digitization in the measurement of spinal curvature.

A major concern in school screening programs as well as in the clinical assessment of spinal curvature has been the frequent radiation exposure required to ascertain curve progression. Various techniques have been developed to identify scoliosis such as the Moire and ISIS techniques, but these are very sophisticated and expensive. The authors have developed a simple procedure of identifying and documenting spinal curvature during the performance of the Adams forward bend test, using an ultrasonic sound probe, four sound receivers, and a micro-computer. The probe is run along the spinous processes emitting an ultrasonic sound, which is picked up by four receivers mounted at the corners of a rectangle above the patient. The signal is fed into a micro-computer and the spinal curvature is plotted out. The magnitude of the curve is calculated by the computer, and the actual curve plus the magnitude is printed in hard copy to be placed in the chart. The reproducibility error and intermeasurer error has been less than 5%. A series of 30 patients with varying magnitudes of scoliosis from 15 degrees to 73 degrees were examined. The results of the ultrasonic digitization were compared with standard scoliosis radiographs of the patient taken the same week. The average curvature measured from the radiographs was 38 degrees, and from the ultrasonic digitization technique, 30 degrees: The forward bend position contributed to smaller curvature measurement, and measurement in the standing position was thought to be a better technique. Ultrasonic digitization as a method of curve measurement is most accurate in curves over 30 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis, Computer-Assisted↗
PubMed1983

A high incidence of spinal curvature. A study of 100 young female students.

A hundred adult female students were clinically examined for scoliosis and other spinal abnormalities. Ninety-nine per cent of them participated voluntarily in X-ray examination of the spine. Of the X-rays only 34 per cent were classified into group without spinal curvature. Mild curvature (3-10 degrees) was observed in 51 per cent and a curvature of 11 degrees or more in 15 per cent. The average angle of curvatures was 7.7 degrees. The incidence of 66 per cent of spinal curvatures exceeds what has been observed before. Rotation was observed in spinal X-ray in 86 per cent, but the average of rotation was the same both in spines with curvature or without. In grades of kyphosis and lordosis no difference was observed between the groups with spinal curvature and without. Mild scoliotic curvature and rotation of the spine must be seen as a normal phenomenon at least in females. What makes these curvatures progress during the growth period in idiopathic scoliosis remains to be clarified.

Adult↗
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↗
PubMed1981

Influence of spinal curvature on exercise capacity.

It is well recognized that scoliosis in excess of 65 degrees results in cardiorespiratory impairment. Lesser degrees of spinal curvature have been noted to have near normal respiratory function studies at rest. Because of the great cardiorespiratory reserve, decreases in function secondary to scoliosis may be masked in studies conducted at rest. To study this concept, an investigation of the work capacity of 38 adolescent children with varying degrees of adolescent idiopathic scoliosis was undertaken. The maximal oxygen capacity and endurance time was measured and compared with a group of normal controls. A significant negative correlation between percentile endurance time and degree of spinal curvature was found showing a reduction in endurance time with every 20 degrees increase in spinal curvature (p less than 0.006). The application of "the exercise capacity test" as an investigative tool for scoliosis was found to be practical, since endurance time is a reliable index of the cardio-pulmonary status.

Adolescent↗
PubMed2004

The effects of load carriage on spinal curvature and posture.

STUDY DESIGN: This is a repeated-measures design where the subjects acted as their own controls. Curvature of the spine, as well as mean trunk and head flexion were noted twice during 21 minutes of load carriage: in rested and fatigued conditions. OBJECTIVE: To determine if spinal curvature and posture were affected by mild fatigue in load carriage. SUMMARY OF BACKGROUND DATA: Researchers have found a link between load carriage and low back problems. Changes in gait and posture resulting from load carriage are largely a result of the body's attempt to increase stability. METHODS: Apparently healthy females (n = 25) carried a 9-kg backpack at 1.79 m/s for 21 minutes around a 200-m circuit. The pack had spring-loaded displacement rods intended to measure displacement from the pack to the spine. Subjects were filmed (60 Hz) and displacement data were collected during minute 3 (rested condition) and minute 18 (fatigued condition). RESULTS: The MANOVA revealed that the thoracic to lumbar region cubic curve significantly increased as subjects fatigued. Rested trunk and head angles were not significantly different from the fatigued condition. Trunk and head angles were not indicative of spinal curvature at 18 minutes; therefore, they may not be the best measures of fatigue during load carriage. CONCLUSIONS: Spine and back health may be adversely affected by load carriage sooner than was previously thought, and it may be important to use spinal curvature as a measure of posture for future load carriage studies.

Adult↗
PubMed1992

Abnormal spinal curvature in the fetus.

We reviewed 20 cases of sonographically detected abnormal fetal spinal curvature to help determine the significance of this finding. Both marked (13 cases) and mild (7 cases) curves were diagnosed sonographically. Sonography showed associated anomalies in 19 fetuses, including neural tube and ventral wall defects. Outcomes were poor, with only three infants surviving. Isolated scoliosis was identified prenatally in one neurologically normal infant with hemivertebrae. We conclude that abnormal spinal curvature in the fetus is a significant finding, whether mild or severe. Even as an isolated finding, it is significant, as prenatal detection assists postnatal management.

Female↗
PubMed1999

Spinal curvatures and quality of life in women with vertebral fractures secondary to osteoporosis.

STUDY DESIGN: A prospective cross-sectional case-control study. OBJECTIVES: To compare spinal curvatures in women with osteoporosis and control subjects with a new instrument, the curviscope. SUMMARY OF BACKGROUND DATA: Few instruments are available for measuring spinal curvatures in the sagittal plane. Most of them have poor reproducibility, and they have been poorly investigated in osteoporosis. METHODS: Ninety-eight postmenopausal women were evaluated. They were divided into two groups, according to their bone status: women with osteoporosis with at least one vertebral fracture (n = 51) and control subjects (n = 47). Women with osteoporosis were divided into two subgroups, according to the delay since the last vertebral fracture had occurred (i.e., more or less than 3 months). Quality of life was assessed by using a generic instrument, the Nottingham Health Profile, in patients with osteoporosis only. RESULTS: Reproducibility of the curviscope was satisfactory. For kyphosis measurements, the coefficients of variation were 2.8% and 2.4% in control subjects and women with osteoporosis, respectively. Kyphosis values were significantly higher in women with osteoporosis than in age-matched control subjects (63 degrees +/- 13 degrees vs. 52 degrees +/- 11 degrees, respectively; P < 0.005). Nottingham Health Profile scores were significantly different (P < 0.05) in women with osteoporosis with a recently diagnosed vertebral fracture, compared with other women with osteoporosis in two aspects, physical mobility and energy. Kyphosis measurements were significantly correlated with age in the whole group (r = 0.26; P < 0.05). In the Nottingham Health Profile, physical mobility was significantly correlated with kyphosis (r = 0.35; P < 0.05). CONCLUSIONS: The curviscope is a reliable tool, particularly useful in the assessment of osteoporosis. Moreover, kyphosis angles measured with the curviscope are markedly increased in women with osteoporosis, compared with control subjects. Finally, an increase of kyphosis angles is associated with decreased physical mobility.

Aged↗
PubMed2006

Quantitation of sleep and spinal curvature in an unusually longevous owl monkey (Aotus azarae).

BACKGROUND: A table summarizing the primary literature on 19 species of longevous non-human primates, other than owl monkey, is presented. METHODS: We prospectively quantitated the sleep of a longevous female owl monkey (Aotus azarae), aged >30 years, longitudinally for 2 years and also evaluated the senility-induced change in spinal curvature. RESULTS: The mean daily total sleep time (TST) of this monkey ranged between 790 and 1106 minutes, and was markedly higher in comparison with its female progeny (aged 16 years and used as a control) whose daily TST during the same experimental period ranged between 612 and 822 minutes. CONCLUSIONS: The calculated kyphotic index (KI) of 2.27 for this monkey, compared with the KIs 4.83 and 5.42, for its progeny and female grandprogeny (aged 1 year) respectively, confirmed the prominent spinal curvature.

Aging↗
PubMed1986

Comparison of roentgenography and moiré topography for quantifying spinal curvature.

The purpose of this study was to compare roentgenography and moiré topography for identification, treatment, and prevention of scoliosis at an early age. Moiré topography was used as an assessment tool for the quantitative examination of 12 children with mild-to-moderate scoliosis receiving physical therapy during a three-month period. Each child's roentgenogram also was analyzed independently by orthopedic physicians and radiologists using the Cobb method of measuring spinal curvature. Rho correlations of Cobb angles and the spinal curvature angles based on moiré photographs taken at weeks 4, 8, and 12 were found to be +.94, +.96, and +.93, respectively. The moiré method, thus, may be used as an available, inexpensive, and easily interpreted diagnostic and treatment tool in physical therapy.

Child↗
PubMed1985

[Clinical study of spondylolysis and spondylolisthesis--mainly on the spinal curvature].

The study was performed to aid in the selection of therapeutic methods for spondylolysis and spondylolisthesis. The subjects consisted of 359 cases, whose symptoms were analyzed using various X-ray examinations concerning the spinal curvature, as well as psychological tests. Age at onset of symptoms was most often in the 15-24-year range (34.7%). The symptom rate was 64.9% for spondylolysis and 75.0% for spondylolisthesis, increasing with age. The symptoms were almost all seen in the lumbar region. Abnormal mobility of the pars interarticularis was observed in 66.6% of the symptomatic group. The spinal curvature showed intensified kyphosis from the teens in the symptomatic group. Downward movement of the apex of the kyphosis and instability of the lumbar vertebral column, including abnormal mobility of the pars interarticularis, are assumed to play a major role in the appearance of symptoms. The above results seem to be helpful in deciding indications for operative therapy in cases with these diseases. From the above results, it appears that cases showing downward movement of the apex of the kyphosis and instability of the lumbar vertebral column are indicated for surgical treatment in consideration of the clinical findings, age, occupation, etc.

Adolescent↗
PubMed1984

Transcutaneous electrical muscle stimulation for the treatment of progressive spinal curvature deformities.

Transcutaneous electrical muscle stimulation has been used to treat spinal curvature. Electrically induced muscle contractions cause partial straightening of the spinal column while the patients sleep. Long-term treatment of 107 patients with progressive idiopathic scoliosis shows a 93% success rate in preventing further progression for curves below 30 degrees while the rate drops to 73% for curves above 30 degrees. In non-idiopathic scoliosis the outcome varied with aetiology and curve magnitude. All kyphosis patients stopped progression.

Adolescent↗