Showing papers in "Scoliosis in 2007"

SOSORT consensus paper: school screening for scoliosis. Where are we today?

Abstract: This report is the SOSORT Consensus Paper on School Screening for Scoliosis discussed at the 4th International Conference on Conservative Management of Spinal Deformities, presented by SOSORT, on May 2007. The objectives were numerous, 1) the inclusion of the existing information on the issue, 2) the analysis and discussion of the responses by the meeting attendees to the twenty six questions of the questionnaire, 3) the impact of screening on frequency of surgical treatment and of its discontinuation, 4) the reasons why these programs must be continued, 5) the evolving aim of School Screening for Scoliosis and 6) recommendations for improvement of the procedure.

Postural effects of symmetrical and asymmetrical loads on the spines of schoolchildren

Abstract: The school backpack constitutes a daily load for schoolchildren: we set out to analyse the postural effects of this load, considering trunk rotation, shoulder asymmetry, thoracic kyphosis, lumbar lordosis, and sagittal and frontal decompensation from the plumbline. A group of 43 subjects (mean age = 12.5 ± 0.5 years) were considered: average backpack loads and average time spent getting to/from home/school (7 min) had been determined in a previous study conducted on this population. Children were evaluated by means of an optoelectronic device in different conditions corresponding to their usual everyday school backpack activities: without load; bearing 12 (week maximum) and 8 (week average) kg symmetrical loads; bearing an 8 kg asymmetrical load; after fatigue due to backpack carrying (a 7-minute treadmill walking session bearing an 8 kg symmetrical load). Both types of load induce changes in posture: the symmetrical one in the sagittal plane, without statistical significant differences between 8 and 12 kg, and the asymmetrical one in all anatomical planes. Usual fatigue accentuates sagittal effects, but recovery of all parameters (except lumbar lordosis) follows removal of the load. The backpack load effect on schoolchildren posture should be more carefully evaluated in the future, even if we must bear in mind that laws protect workers to carry heavy loads but not children, and results in the literature support the hypothesis that back pain in youngsters is correlated with back pain in adulthood

Melatonin the "light of night" in human biology and adolescent idiopathic scoliosis

Abstract: Melatonin "the light of night" is secreted from the pineal gland principally at night. The hormone is involved in sleep regulation, as well as in a number of other cyclical bodily activities and circadian rhythm in humans. Melatonin is exclusively involved in signalling the 'time of day' and 'time of year' (hence considered to help both clock and calendar functions) to all tissues and is thus considered to be the body's chronological pacemaker or 'Zeitgeber'. The last decades melatonin has been used as a therapeutic chemical in a large spectrum of diseases, mainly in sleep disturbances and tumours and may play a role in the biologic regulation of mood, affective disorders, cardiovascular system, reproduction and aging. There are few papers regarding melatonin and its role in adolescent idiopathic scoliosis (AIS). Melatonin may play a role in the pathogenesis of scoliosis (neuroendocrine hypothesis) but at present, the data available cannot clearly support this hypothesis. Uncertainties and doubts still surround the role of melatonin in human physiology and pathophysiology and future research is needed.

Estimation of the stress related to conservative scoliosis therapy: an analysis based on BSSQ questionnaires

Abstract: Adolescent girls treated with a brace for scoliosis are submitted to prolonged stress related to both the disease and the therapy. Currently proposed quality of life questionnaires are focused on the outcome of therapy. Bad Sobernheim Stress Questionnaire (BSSQ) enables monitoring of patients being under treatment with a brace or exercises. The aim of the study was to assess the stress level in conservatively managed scoliotic girls using BSSQ. 111 girls, aged 14,2 ± 2,2 years, mean Cobb angle of the primary curve 42,8° ± 17,0° and mean Bunnell angle of 11,4° ± 4,5° were examined with two versions of BSSQ (Deformity and Brace). The analysis considered the type of treatment, curve location, correlation of the total score with age, Cobb angle and Bunnell rotation angle. The BSSQ Deformity revealed the median of 17 points in patients managed with exercises (from 4 to 24 points), 18 in patients managed with a brace (from 8 to 24 points) and 12 in patients before surgery (from 3 to 21 points). Braced patients who completed both questionnaires (n = 50) revealed significantly higher score with BSSQ Deformity (median = 18) comparing to BSSQ Brace (median = 9). There was a correlation between the total score of BSSQ Deformity and the Cobb angle (r = -0,34), Bunnell primary curve rotation (r = -0,34) and Bunnell sum of rotation (r = -0,33) but not with the age of patients. Scoliotic adolescents managed with exercises and brace suffered little stress from the deformity. The brace increased the level of stress over the stress induced by the deformity. The stress level correlated with clinical deformity (Bunnell angle), radiological deformity (Cobb angle) and the type of treatment (exercises, bracing, surgery). Bad Sobernheim Stress Questionnaires are simple and helpful in the management of girls treated conservatively for idiopathic scoliosis.

The effect of growth on the correlation between the spinal and rib cage deformity: implications on idiopathic scoliosis pathogenesis

Abstract: Background: Numerous studies have attempted to quantify the correlation between the surface deformity and the Cobb angle without considering growth as an important factor that may influence this correlation. In our series, we noticed that in some younger referred children from the school-screening program there is a discrepancy between the thoracic scoliometer readings and the morphology of their spine. Namely there is a rib hump but no spinal curve and consequently no Cobb angle reading in radiographs, discrepancy which fades away in older children. Based on this observation, we hypothesized that in scoliotics the correlation between the rib cage deformity and this of the spine is weak in younger children and vice versa. Methods: Eighty three girls referred on the basis of their hump reading on the scoliometer, with a mean age of 13.4 years old (range 7–18), were included in the study. The spinal deformity was assessed by measuring the thoracic Cobb angle from the postero-anterior spinal radiographs. The rib cage deformity was quantified by measuring the rib-index at the apex of the thoracic curve from the lateral spinal radiographs. The rib-index is defined as the ratio between the distance of the posterior margin of the vertebral body and the most extended point of the most projecting rib contour, divided by the distance between the posterior margin of the same vertebral body and the most protruding point of the least projecting rib contour. Statistical analysis included linear regression models with and without the effect of the variable age. We divided our sample in two subgroups, namely the younger (7–13 years old) and the older (14–18 years old) than the mean age participants. A univariate linear regression analysis was performed for each age group in order to assess the effect of age on Cobb angle and rib index correlation. Results: Twenty five per cent of patients with an ATI more than or equal 7 degrees had a spinal curve under 10 degrees or had a straight spine. Linear regressions between the dependent variable "Thoracic Cobb angle" with the independent variable "rib-index" without the effect of the variable "age" is not statistical significant. After sample split, the linear relationship is statistically significant in the age group 14–18 years old (p < 0.03). Conclusion: Growth has a significant effect in the correlation between the thoracic and the spinal deformity in girls with idiopathic scoliosis. Therefore it should be taken into consideration when trying to assess the spinal deformity from surface measurements. The findings of the present study implicate the role of the thorax, as it shows that the rib cage deformity precedes the spinal deformity in the pathogenesis of idiopathic scoliosis.

Brace related stress in scoliosis patients – Comparison of different concepts of bracing

Abstract: The BSSQbrace questionnaire has been shown to be reliable with good internal consistency and reproducibility estimating the stress scoliosis patients have whilst wearing their brace. Eight questions are provided focussing on this topic. A max. score of 24 can be achieved (from 0 for most stress to 24 for no stress). The subdivision of the score values is: 0–8 (strong stress), 9–16 (medium stress) and 17–24 (little stress). Two BSSQbrace questionnaires have been posted to 65 patients under brace treatment from our Cheneau light data base. All patients had another kind of brace prior to the Cheneau light. The patients have been asked to rate their stress level using one questionnaire for the current brace and the other for the previous one. 63 Patients (59 girls and 4 boys) returned their fully completed questionnaires (average age 13,6 years, average Cobb angle 43,7 degrees). Stress level in the previous brace was 11,04 and in the Cheneau light(r) 13,87. The differences were highly significant in the t-test; t = -4,67; p < 0,001. The use of the Cheneau light® brace leads to reduced stress and/or impairment for the patients under treatment compared to heavier brace models used so far.

High pressures and asymmetrical stresses in the scoliotic disc in the absence of muscle loading

Abstract: Loads acting on scoliotic spines are thought to be asymmetric and involved in progression of the scoliotic deformity; abnormal loading patterns lead to changes in bone and disc cell activity and hence to vertebral body and disc wedging. At present however there are no direct measurements of intradiscal stresses or pressures in scoliotic spines. The aim of this study was to obtain quantitative measurements of the intradiscal stress environment in scoliotic intervertebral discs and to determine if loads acting across the scoliotic spine are asymmetric. We performed in vivo measurements of stresses across the intervertebral disc in patients with scoliosis, both parallel (termed horizontal) and perpendicular (termed vertical) to the end plate, using a side mounted pressure transducer (stress profilometry) Stress profilometry was used to measure horizontal and vertical stresses at 5 mm intervals across 25 intervertebral discs of 7 scoliotic patients during anterior reconstructive surgery. A state of hydrostatic pressure was defined by identical horizontal and vertical stresses for at least two consecutive readings. Results were compared with similar stress profiles measured during surgery across 10 discs of 4 spines with no lateral curvature and with data from the literature. Profiles across scoliotic discs were very different from those of normal, young, healthy discs of equivalent age previously presented in the literature. Hydrostatic pressure regions were only seen in 14/25 discs, extended only over a short distance. Non-scoliotic discs of equivalent age would be expected to show large centrally placed hydrostatic nuclear regions in all discs. Mean pressures were significantly greater (0.25 MPa) than those measured in other anaesthetised patients (<0.07 MPa). A stress peak was seen in the concave annulus in 13/25 discs. Stresses in the concave annulus were greater than in the convex annulus indicating asymmetric loading in these anaesthetised, recumbent patients. Intradiscal pressures and stresses in scoliotic discs are abnormal, asymmetrical and high in magnitude even in the absence of significant applied muscle loading. The origin of these abnormal stresses is unclear.

Correction effects of the ScoliOlogiC® „Chêneau light" brace in patients with scoliosis

Abstract: Background Different bracing concepts are used today for the treatment of scoliosis. The plaster cast method worldwide seems to be the most practiced technique at the moment. CAD (Computer Aided Design) systems are on the market which allow brace adjustments without plaster. The latest development however, is the use of the ScoliOlogiC™ off the shelf system enabling the orthopaedic technician to construct a light brace for scoliosis correction from a variety of pattern specific shells to be connected to an anterior and a posterior upright. This „Cheneau light" brace, developed according to the Cheneau principle, promises a reduced impediment of quality of life in the brace. However, material reduction should not result in reduced effectiveness. Therefore the primary correction effect in the „Cheneau light" brace has been evaluated and compared with that of other braces used today.

Discrepancy in clinical versus radiological parameters describing deformity due to brace treatment for moderate idiopathic scoliosis

Abstract: Background The shape of the torso in patients with idiopathic scoliosis is considered to reflect the shape of the vertebral column, however the direct correlation between parameters describing clinical deformity and those characterizing radiological curvature was reported to be weak. It is not clear if the management proposed for scoliosis (physiotherapy, brace, surgery) affects equally the shape of the axial skeleton and the surface of the body. The aim of the study was to compare clinical deformity of (1) idiopathic scoliosis girls being under brace treatment for radiological curves of 25 to 40 degrees and (2) non treated scoliotic girls matched for age and Cobb angle.

Further evaluation of the Walter Reed Visual Assessment Scale: correlation with curve pattern and radiological deformity

Abstract: Background The Walter Reed Visual Assessment Scale (WRVAS) was designed to measure physical deformity as perceived by patients with idiopathic scoliosis. Previous studies have shown that the instrument has excellent internal consistency and a high correlation with the radiological magnitude of scoliotic curves. Nonetheless, it is not known whether the scale can discriminate between the various curve patterns of the deformity, or whether the deformities represented in the scale's drawings relate to the corresponding radiological deformities.

Trunk rotational strength asymmetry in adolescents with idiopathic scoliosis: an observational study

Abstract: Recent reports have suggested a rotational strength weakness in rotations to the concave side in patients with idiopathic scoliosis. There have been no studies presenting normative values of female adolescent trunk rotational strength to which a comparison of female adolescents with idiopathic scoliosis could be made. The purpose of this study was to determine trunk rotational strength asymmetry in a group of female adolescents with AIS and a comparison group of healthy female adolescents without scoliosis. Twenty-six healthy adolescent females served as the healthy group (HG) (average age 14 years) and fourteen otherwise healthy adolescent females with idiopathic scoliosis served as the idiopathic scoliosis group (ISG) (average age 13.5 years, average Cobb 28°). Participant's isometric trunk rotational strength was measured in five randomly ordered trunk positions: neutral, 18° and 36° of right and left pre-rotation. Rotational strength asymmetry was compared within each group and between the two groups using several different measures. The HG showed strength asymmetry in the 36° pre-rotated trunk positions when rotating towards the midline (p < 0.05). The ISG showed strength asymmetry when rotating towards the concavity of their primary curve from the neutral position (p < 0.05) and when rotating towards the concavity from the 18° (p < 0.05) and 36° (p < 0.05) concave pre-rotated positions. The ISG is significantly weaker than the HG when rotating away from the midline toward the concave (ISG)-left (HG) side from the concave/left pre-rotated 18° (p < 0.05) and 36° (p < 0.05) positions. The AIS females were found to be significantly weaker when contracting toward their main curve concavity in the neutral and concave pre-rotated positions compared to contractions toward the convexity. These weaknesses were also demonstrated when compared to the group of healthy female adolescent controls. Possible mechanisms for the strength asymmetry in ISG are discussed.

Is there a body of evidence for the treatment of patients with Adolescent Idiopathic Scoliosis (AIS)

Abstract: Historically, the treatment options for AIS, the most common form of scoliosis are; exercises; in-patient rehabilitation; braces and surgery. While there is evidence in the form of prospective controlled studies that Scoliosis Intensive Rehabilitation (SIR) and braces can alter the natural history of the condition, there is no prospective controlled study comparing the natural history with surgical treatment.

Growth rates and the prevalence and progression of scoliosis in short-statured children on Australian growth hormone treatment programmes

Abstract: This was a longitudinal chart review of a diverse group (cohort) of patients undergoing HGH (Human Growth Hormone) treatment. Clinical and radiological examinations were performed with the aim to identify the presence and progression of scoliosis. 185 patients were recruited and a database incorporating the age at commencement, dose and frequency of growth hormone treatment and growth charts was compiled from their Medical Records. The presence of any known syndrome and the clinical presence of scoliosis were included for analysis. Subsequently, skeletally immature patients identified with scoliosis were followed up over a period of a minimum four years and the radiologic type, progression and severity (Cobb angle) of scoliosis were recorded. Four (3.6%) of the 109 with idiopathic short stature or hormone deficiency had idiopathic scoliosis (within normal limits for a control population) and scoliosis progression was not prospectively observed. 13 (28.8%) of 45 with Turner syndrome had scoliosis radiologically similar to idiopathic scoliosis. 11 (48%) of 23 with varying syndromes, had scoliosis. In the entire cohort, the growth rates of those with and without scoliosis were not statistically different and HGH treatment was not ceased because of progression of scoliosis. In this study, there was no evidence of HGH treatment being responsible for progression of scoliosis in a small number of non-syndromic patients (four). An incidental finding was that scoliosis, similar to the idiopathic type, appears to be more prevalent in Turner syndrome than previously believed.

Rare causes of scoliosis and spine deformity: experience and particular features

Abstract: Background Spine deformity can be idiopathic (more than 80% of cases), neuromuscular, congenital or neurofibromatosis-related. However, there are many disorders that may also be involved. We present our experience treating patients with scoliosis or other spine deformities related to rare clinical entities.

The direct cost of "Thriasio" school screening program.

Abstract: There is great diversity in the policies for scoliosis screening worldwide. The initial enthusiasm was succeeded by skepticism and the worth of screening programs has been challenged. The criticisms of school screening programs cite mainly the negative psychological impact on children and their families and the increased financial cost of visits and follow-up radiographs. The purpose of this report is to evaluate the direct cost of performing the school screening in a district hospital. A cost analysis was performed for the estimation of the direct cost of the "Thriasio" school-screening program between January 2000 and May 2006. The analysis involved all the 6470 pupils aged 6–18 years old who were screened at schools for spinal deformities during this period. The factors which were taken into consideration in order to calculate the direct cost of the screening program were a) the number of the examiners b) the working hours, c) the examiners' salary, d) the cost of transportation and finally e) the cost of examination per child. During the examined period 20 examiners were involved in the program and worked for 1949 working hours. The hourly salary for the trainee doctors was 6.80 euro, for the Health Visitors 6.70 euro and for the Physiotherapists 5.50 euro in current prices. The cost of transportation was 32 euro per year. The direct cost for the examination of each child for the above studied period was calculated to be 2.04 euro. The cost of our school-screening program is low. The present study provides a strong evidence for the continuation of the program when looking from a financial point of view.

The impact of patient self assessment of deformity on HRQL in adults with scoliosis

Abstract: Background Body image and HRQL are significant issues for patients with scoliosis due to cosmetic deformity, physical and psychological symptoms, and treatment factors. A selective review of scoliosis literature revealed that self report measures of body image and HRQL share unreliable correlations with radiographic measures and clinician recommendations for surgery. However, current body image and HRQL measures do not indicate which aspects of scoliosis deformity are the most distressing for patients. The WRVAS is an instrument designed to evaluate patient self assessment of deformity, and may show some promise in identifying aspects of deformity most troubling to patients. Previous research on adolescents with scoliosis supports the use of the WRVAS as a clinical tool, as the instrument shares strong correlations with radiographic measures and quality of life instruments. There has been limited use of this instrument on adult populations.

Lack of evidence of WNT3A as a candidate gene for congenital vertebral malformations.

Abstract: Prior investigations have not identified a major locus for vertebral malformations, providing evidence that there is genetic heterogeneity for this condition. WNT3A has recently been identified as a negative regulator of Notch signaling and somitogenesis. Mice with mutations in Wnt3a develop caudal vertebral malformations. Because congenital vertebral malformations represent a sporadic occurrence, linkage approaches to identify genes associated with human vertebral development are not feasible. We hypothesized that WNT3A mutations might account for a subset of congenital vertebral malformations. A pilot study was performed using a cohort of patients with congenital vertebral malformations spanning the entire vertebral column was characterized. DNA sequence analysis of the WNT3A gene in these 50 patients with congenital vertebral malformations was performed. A female patient of African ancestry with congenital scoliosis and a T12-L1 hemivertebrae was found to be heterozygous for a missense variant resulting in the substitution of alanine by threonine at codon 134 in highly conserved exon 3 of the WNT3A gene. This variant was found at a very low prevalence (0.35%) in a control population of 443 anonymized subjects and 1.1% in an African population. These data suggest that WNT3A does not contribute towards the development of congenital vertebral malformations. Factors such as phenotypic and genetic heterogeneity may underlie our inability to detect mutations in WNT3A in our patient sample.

Biomechanical simulations of the scoliotic deformation process in the pinealectomized chicken: a preliminary study

Abstract: Background: The basic mechanisms whereby mechanical factors modulate the metabolism of the growing spine remain poorly understood, especially the role of growth adaptation in spinal disorders like in adolescent idiopathic scoliosis (AIS). This paper presents a finite element model (FEM) that was developed to simulate early stages of scoliotic deformities progression using a pinealectomized chicken as animal model. Methods: The FEM includes basic growth and growth modulation created by the muscle force imbalance. The experimental data were used to adapt a FEM previously developed to simulate the scoliosis deformation process in human. The simulations of the spine deformation process are compared with the results of an experimental study including a group of pinealectomized chickens. Results: The comparison of the simulation results of the spine deformation process (Cobb angle of 37°) is in agreement with experimental scoliotic deformities of two representative cases (Cobb angle of 41° and 30°). For the vertebral wedging, a good agreement is also observed between the calculated (28°) and the observed (25° – 30°) values. Conclusion: The proposed biomechanical model presents a novel approach to realistically simulate the scoliotic deformation process in pinealectomized chickens and investigate different parameters influencing the progression of scoliosis.

Sforzesco brace (SPoRT Concept) versus Risser cast in adolescent idiopathic scoliosis treatment: similar efficacy, with reduced spinal side effects for the brace

Abstract: Study design From our prospective database we included all patients with AIS, followed-up for eighteen months during Risser cast (twelve months plus six month in Lyon brace full time) or Sforzesco brace treatments. Risser cast treatment [1] was our standard treatment for worst curves until January 2004. The Sforzesco brace method is our current approach. We had eighteen patients in cast (83% female, 14.3 ± 1.11 years of age, Cobb angle 39.5 ± 7.5 degrees) and thirty-three patients in brace (79% females, 14.1 ± 1.10 years of age, Cobb angle 40.9 ± 12.1). Analysis included measurement of Cobb angle, Bunnell angle of trunk rotation (ATR) [2], rib hump magnitude, aesthetic index, and sagittal distances from the plumbline.

Sitting forward bending position versus standing position for studying the back shape in scoliotic children

Abstract: Study design Cross sectional study of 113 girls with idiopathic scoliosis, aged 14.0 ± 2.1 years (range 10 to 18), mean height 160.0 ± 9.4 cm (range 121 to 184), mean weight 48.6 ± 9.2 kg (range 22 to 75) who underwent raster stereography exam of the back in standing position and in sitting forward bending position. The Cobb angle of the main curve was 41.2 ± 16.7 degrees (range 10 to 95), Risser sign value from 0 to 5, median = 2.

The three-dimensional easy morphological (3-DEMO) classification of scoliosis - Part III, correlation with clinical classification and parameters.

Abstract: In the first part of this study we proposed a new classification approach for spinal deformities (3-DEMO classification). To be valid, a classification needs to describe adequately the phenomenon considered (construct validity): a way to verify this issue is comparison with already existing classifications (concurrent and criterion validity). To compare the 3-DEMO classification and the numerical results of its classificatory parameters with the existing clinical classifications and the Cobb degrees on the frontal and sagittal planes respectively. 118 subjects (96 females) with adolescent idiopathic scoliosis (age 15.9 ± 3.1, 37.4 ± 12.5° Cobb) have been classified according to 3-DEMO, SRS-Ponseti, King and Lenke classifications as well as according to sagittal configuration. For all patients we computed the values of the 3-DEMO parameters and the classical Cobb degrees measurements in the frontal and sagittal planes. Statistical analysis comprised Chi Square and Regression analysis, including a multivariate stepwise regression. Three of the four 3-DEMO parameters (Direction, Sagittal and Frontal Shift) correlated with SRS-Ponseti, King and sagittal configuration classifications, but not with Lenke's one. Feeble correlations have been found among numerical parameters, while the stepwise regression allowed us to develop almost satisfactory models to obtain 3-DEMO parameters from classical Cobb degrees measurements. These results support the hypothesis of a possible clinical significance of the 3-DEMO classification, even if follow-up studies are needed to better understand these possible correlations and ultimately the classification usefulness. The most interesting 3D parameters appear to be Direction and mainly Phase, the latter being not at all correlated with currently existing classifications. Nevertheless, Shift cannot be easily appreciated on classical frontal and sagittal radiographs, even if it could presumably be calculated.

Effect of specific exercises on the sagittal profile of scoliotic spines

Abstract: Study design A retrospective unselected series of fifty consecutive patients (48 females, age 15.7 years) diagnosed with IS, were measured with the formetric system [3] before and after an intensive course of rehabilitation. This system provides quantitative values to asses the spine in the frontal, sagittal and transversal planes. We have designed a specific scale based on objective data in order to define the vertebral column in the sagittal plane as harmonic (minimum score 0) or disharmonic (maximum score 20).

A series of patients with adolescent idiopathic scoliosis treated with a Rigo System Chêneau (RSC) brace. Primary correction in brace improved by technical evolution

Abstract: Study design Retrospective unselected case series of thirty-two patients (29 females, 3 males) with adolescent idiopathic scoliosis (AIS). The mean age for the group was 12 ± 1.2 years, mean Risser was 0.7 ± 1.1 and mean Cobb angle was 34.1 ± 7.1 degrees. Only those patients receiving brace treatment for the first time were included, in order to minimize the influence of factors other than technical changes. They were matched to those from the previous series (n = 66, 12 ± 2.1 years, Risser 0.8 ± 1.1, Cobb angle 32.8 ± 9.4 degrees). All the patients treated during years 2005–2006 and fulfilling the following inclusion criteria were included: 1. First brace; 2. A diagnosis of AIS; 3. Age: 10– 14 years; Risser 0–3; Cobb angle > 25 degrees.

Does quality of exercises affect results in adolescent idiopathic scoliosis treatment to avoid braces? SEAS.02 results at two years

Abstract: Study design The design was a prospective controlled study of AIS patients who were prescribed exercises only, to avoid progression to brace treatment. All patients were enrolled consecutively. These results report on the second year of radiological follow-up. We had three groups: (1) SEAS exercises according to the SEAS.02 protocol (n = 20); (2) CONT, classical physiotherapy (n = 29); (3) MIX, patients who changed protocol during treatment (n = 8). Mean age was 12.7 ± 2.2 years, mean Cobb angle was 15.3 ± 5.4 degrees, and Bunnell angle of trunk rotation (ATR) [2] was 8.9 ± 2.8 degrees. There were no differences among the groups, using t-test for uncoupled data, Mann-Whitney, Fisher's Exact and chi-square with α = 0.05.

Monitoring of changes in trunk rotation during scoliosis physiotherapy

Abstract: Materials and methods Sixty-four girls with scoliosis (age 13.9 ± 1.9 years, mean Cobb angle 30.6 ± 14.7 degrees, Risser sign median 2.0), underwent a 14-day intensive in-patient physiotherapy program according to FITS. The monitoring of curve behavior was clinical, using the Bunnell scoliometer [1] to measure ATR. Measurements were performed in a relaxed and in actively corrected posture. Sum of rotation (SR) was calculated as equal to primary curve rotation (PCR) plus upper compensatory curve rotation (UCR) plus lower compensatory curve rotation (LCR). Fourteen girls were followed for one year, while undergoing outpatient FITS therapy and part-time (12 hours per day) brace treatment.

End-growth final results of an effective conservative treatment: a retrospective case series

Abstract: Study design All fifty-eight patients (17% male, 83% female) who finished their treatment in the Centre of Vigevano of our Institute were included. Mean Cobb angle at the start of treatment was 22.6 ± 10.6 degrees (see Table 1), and mean age was 13.4 ± 2.4 years. Treatment groups considered included exercises, bracing+exercises, cast+exercises. Starting Cobb degrees, by groups, were: 11–20, 21–30, 31–40, over 40 degrees (see Table 2).

Wedged vertebrae normalization in congenital scoliosis due to application of external forces by brace

Abstract: It is well documented that congenital scoliosis patientssuffering defects of segmentation, like unilateral unseg-mented bars, need early surgical treatment, as the deform-ity will malignantly progress [1]. Other similar caseshaving defects of formation such as hemivertebrae (non-incarcerated, semincarcerated, or incarcerated) receive avariety of treatments ranging from observation to bracetreatment or surgical intervention [2]. The aim is to high-light the fact that, in selected congenital scoliosis patients,the smaller side of blocks and wedged vertebrae can beexpanded due to brace treatment.

Repeatability of different methods to collect in everyday clinics the sagittal profile of patients with adolescent idiopathic scoliosis

Abstract: Study design We performed two studies. In the first one, in a medical setting, 61 patients were consecutively evaluated by two examiners (inter-observers), while one performed a second time the evaluation after 5 minutes (intra-observer); the evaluations included: sagittal and frontal distances from the plumbline of C7, sagittal distance of T12 and L3, D'Osualdo's Arcometer measurement. In the second study, in a physiotherapist setting, the sagittal distances (cervical, C7, thoracic, lumbar, sacral) have been evaluated consecutively using two different tools to identify verticality: a plumbline or a laser. Repeatability has been evaluated according to Bland and Altman, so to identify the limits of variation clinically significant. Results of the first study See Table 1.

Repeatability of the Aesthetic Index for adolescent scoliosis idiopathic evaluation

Abstract: Study design Since many years in our Institute we have used a clinical tool to evaluate the aesthetics of the trunks posteriorly. This is based on a three point scale for asymmetry (0 absent, 1 slight, 2 important) of the shoulders, scapulae and flanks; the sum of these sub-scores gives the AI. One hundred sixty posterior anterior photographs of the trunk of adolescent idiopathic scoliosis patients were scored two times independently by three observers. We used the Kappa statistics [1]: 0–0.2 poor, 0.2–0.4 fair, 0.4–0.6 moderate, 0.6–0.8 good, 0.8–1.0 very good. The 95% level of agreement was used to identify the minimum clinically significant change to be considered between two different clinical examinations. Results See Table 1.