Showing papers on "Cobb angle published in 2005"

Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population

Abstract: Study design A prospective self-assessment analysis and evaluation of nutritional and radiographic parameters in a consecutive series of healthy adult volunteers older than 60 years. Objectives To ascertain the prevalence of adult scoliosis, assess radiographic parameters, and determine if there is a correlation with functional self-assessment in an aged volunteer population. Summary of background data There exists little data studying the prevalence of scoliosis in a volunteer aged population, and correlation between deformity and self-assessment parameters. Methods There were 75 subjects in the study. Inclusion criteria were: age > or =60 years, no known history of scoliosis, and no prior spine surgery. Each subject answered a RAND 36-Item Health Survey questionnaire, a full-length anteroposterior standing radiographic assessment of the spine was obtained, and nutritional parameters were analyzed from blood samples. For each subject, radiographic, laboratory, and clinical data were evaluated. The study population was divided into 3 groups based on frontal plane Cobb angulation of the spine. Comparison of the RAND 36-Item Health Surveys data among groups of the volunteer population and with United States population benchmark data (age 65-74 years) was undertaken using an unpaired t test. Any correlation between radiographic, laboratory, and self-assessment data were also investigated. Results The mean age of the patients in this study was 70.5 years (range 60-90). Mean Cobb angle was 17 degrees in the frontal plane. In the study group, 68% of subjects met the definition of scoliosis (Cobb angle >10 degrees). No significant correlation was noted among radiographic parameters and visual analog scale scores, albumin, lymphocytes, or transferrin levels in the study group as a whole. Prevalence of scoliosis was not significantly different between males and females (P > 0.03). The scoliosis prevalence rate of 68% found in this study reveals a rate significantly higher than reported in other studies. These findings most likely reflect the targeted selection of an elderly group. Although many patients with adult scoliosis have pain and dysfunction, there appears to be a large group (such as the volunteers in this study) that has no marked physical or social impairment. Conclusions Previous reports note a prevalence of adult scoliosis up to 32%. In this study, results indicate a scoliosis rate of 68% in a healthy adult population, with an average age of 70.5 years. This study found no significant correlations between adult scoliosis and visual analog scale scores or nutritional status in healthy, elderly volunteers.

The adult scoliosis

Abstract: Adult scoliosis is defined as a spinal deformity in a skeletally mature patient with a Cobb angle of more than 10 degrees in the coronal plain. Adult scoliosis can be separated into four major groups: Type 1: Primary degenerative scoliosis, mostly on the basis of a disc and/or facet joint arthritis, affecting those structures asymmetrically with predominantly back pain symptoms, often accompanied either by signs of spinal stenosis (central as well as lateral stenosis) or without. These curves are often classified as "de novo" scoliosis. Type 2: Idiopathic adolescent scoliosis of the thoracic and/or lumbar spine which progresses in adult life and is usually combined with secondary degeneration and/or imbalance. Some patients had either no surgical treatment or a surgical correction and fusion in adolescence in either the thoracic or thoracolumbar spine. Those patients may develop secondary degeneration and progression of the adjacent curve; in this case those curves belong to the type 3a. Type 3: Secondary adult curves: (a) In the context of an oblique pelvis, for instance, due to a leg length discrepancy or hip pathology or as a secondary curve in idiopathic, neuromuscular and congenital scoliosis, or asymmetrical anomalies at the lumbosacral junction; (b) In the context of a metabolic bone disease (mostly osteoporosis) combined with asymmetric arthritic disease and/or vertebral fractures. Sometimes it is difficult to decide, what exactly the primary cause of the curve was, once it has significantly progressed. However, once an asymmetric load or degeneration occurs, the pathomorphology and pathomechanism in adult scoliosis predominantly located in the lumbar or thoracolumbar spine is quite predictable. Asymmetric degeneration leads to increased asymmetric load and therefore to a progression of the degeneration and deformity, as either scoliosis and/or kyphosis. The progression of a curve is further supported by osteoporosis, particularly in post-menopausal female patients. The destruction of facet joints, joint capsules, discs and ligaments may create mono- or multisegmental instability and finally spinal stenosis. These patients present themselves predominantly with back pain, then leg pain and claudication symptoms, rarely with neurological deficit, and almost never with questions related to cosmetics. The diagnostic evaluation includes static and dynamic imaging, myelo-CT, as well as invasive diagnostic procedures like discograms, facet blocks, epidural and root blocks and immobilization tests. These tests may correlate with the clinical and the pathomorphological findings and may also offer the least invasive and most rational treatment for the patient. The treatment is then tailored to the specific symptomatology of the patient. Surgical management consists of either decompression, correction, stabilization and fusion procedures or a combination of all of these. Surgical procedure is usually complex and has to deal with a whole array of specific problems like the age and the general medical condition of the patient, the length of the fusion, the condition of the adjacent segments, the condition of the lumbosacral junction, osteoporosis and possibly previous scoliosis surgery, and last but not least, usually with a long history of chronified back pain and muscle imbalance which may be very difficult to be influenced. Although this surgery is demanding, the morbidity cannot be considered significantly higher than in other established orthopaedic procedures, like hip replacement, in the same age group of patients. Overall, a satisfactory outcome can be expected in well-differentiated indications and properly tailored surgical procedures, although until today prospective, controlled studies with outcome measures and pre- and post-operative patient's health status are lacking. As patients, who present themselves with significant clinical problems in the context of adult scoliosis, get older, minimal invasive procedures to address exactly the most relevant clinical problem may become more and more important, basically ignoring the overall deformity and degeneration of the spine.

Dual growing rod technique for the treatment of progressive early-onset scoliosis: a multicenter study.

Abstract: Study design A retrospective case review of children treated with dual growing rod technique at our institutions. Patients included had no previous surgery and a minimum of 2 years follow-up from initial surgery. Objectives To determine the safety and effectiveness of the previously described dual growing rod technique in achieving and maintaining scoliosis correction while allowing spinal growth. Summary of background data Historically, the growing rod techniques have used a single rod and the reported results have been variable. There has been no published study exclusively on the results of dual growing rod technique for early-onset scoliosis. Methods From 1993 to 2001, 23 patients underwent dual growing rod procedures using pediatric Isola instrumentation and tandem connectors. Diagnoses included infantile and juvenile idiopathic scoliosis, congenital, neuromuscular, and other etiologies. All had curve progression over 10 degrees following unsuccessful bracing or casting. Of 189 total procedures within the treatment period, 151 were lengthenings with an average of 6.6 lengthenings per patient. Analysis included age at initial surgery and final fusion (if applicable), number and frequency of lengthenings, and complications. Radiographic evaluation included measured changes in scoliosis Cobb angle, kyphosis, lordosis, frontal and sagittal balance, length of T1-S1 and instrumentation over the treatment period, and space available for lung ratio. Results The mean scoliosis improved from 82 degrees (range, 50 degrees-130 degrees) to 38 degrees (range, 13 degrees-66 degrees) after initial surgery and was 36 degrees (range, 4 degrees-53 degrees) at the last follow-up or post-final fusion. T1-S1 length increased from 23.01 (range, 13.80-31.20) to 28.00 cm (range, 19.50-35.50) after initial surgery and to 32.65 cm (range, 25.60-41.00) at last follow-up or post-final fusion with an average T1-S1 length increase of 1.21 cm per year (range, 0.13-2.59). Seven patients reached final fusion. The space available for lung ratio in patients with thoracic curves improved from 0.87 (range, 0.7-1.1) to 1.0 (range, 0.79-1.23, P = 0.01). During the treatment period, complications occurred in 11 of the 23 patients (48%), and they had a total of 13 complications. Four of these patients (17%) had unplanned procedures. Following final fusion, 2 patients required extensions of their fusions because of curve progression and lumbosacral pain. Conclusion The dual growing rod technique is safe and effective. It maintains correction obtained at initial surgery while allowing spinal growth to continue. It provides adequate stability, increases the duration of treatment period, and has an acceptable rate of complication compared with previous reports using the single rod technique.

Proximal Junctional Kyphosis in Adult Spinal Deformity Following Long Instrumented Posterior Spinal Fusion : Incidence, Outcomes, and Risk Factor Analysis

Abstract: Study design To analyze patient outcomes and risk factors associated with proximal junctional kyphosis (PJK) in adults undergoing long posterior spinal fusion. Objectives To determine the incidence of PJK and its effect on patient outcomes and to identify any risk factors associated with developing PJK. Summary of background data The incidence of PJK and its affect on outcomes in adult deformity patients is unknown. No study has concentrated on outcomes of patients with PJK. Risk factors for developing PJK are unknown. Methods Radiographic data on 81 consecutive adult deformity patients with minimum 2-year follow-up (average 5.3 years, range 2-16 years) treated with long instrumented segmental posterior spinal fusion was collected. Preoperative diagnosis was adult scoliosis, sagittal imbalance or both. Radiographic measurements analyzed included the sagittal Cobb angle at the proximal junction on preoperative, early postoperative, and final follow-up standing long cassette radiographs. Additional measurements used for analysis included the C7-Sacrum sagittal plumb and the T5-T12 sagittal Cobb. Postoperative SRS-24 scores were available on 73 patients. Results Incidence of PJK as defined was 26%. Patients with PJK did not have lower outcomes scores. PJK did not produce a more positive sagittal C7 plumb. PJK was more common at T3 in the upper thoracic spine. Conclusions Incidence of proximal junctional kyphosis was high, but SRS-24 scores were not significantly affected in patients with PJK. The sagittal C7 plumb was not significantly more positive in PJK patients. No patient, radiographic, or instrumentation variables were identified as risk factors for developing PJK.

Balloon kyphoplasty is effective in deformity correction of osteoporotic vertebral compression fractures.

Abstract: STUDY DESIGN A prospective radiographic analysis of deformity correction during the balloon kyphoplasty procedure. OBJECTIVE To determine the spontaneous reduction of the deformity in prone position, the subsequent deformity correction by the inflatable bone tamp, and the overall deformity correction after deposition of the cement. SUMMARY OF BACKGROUND DATA Fracture mobility has been shown to contribute to fracture reduction in vertebroplasty. Spontaneous reduction has not been taken into account in recently published series of balloon kyphoplasty, but it must be considered when performing vertebral augmentation and when reporting and interpreting the significance of vertebral height restoration. METHODS A consecutive series of 39 osteoporotic vertebral compression fractures were treated in 30 patients. Lateral radiographs were taken and analyzed at six different time points: 1) Preoperative standing. During the kyphoplasty procedure, four consecutive radiographs were obtained: 2) after placing the patient in prone position on the operation table, 3) after inflation of the bone tamp (IBT), 4) after deflation and removal of the IBT, and 5) after deposition of the cement. 6) Standing lateral radiographs were taken after the procedure. All fractures were analyzed for improvement in sagittal alignment (Cobb angle, kyphotic angle, sagittal index, vertebral height), complications, and reduction of pain (VAS). RESULTS Placement of the patient in prone position displayed a significant spontaneous reduction in deformity of 6.5 degrees +/- 4.1 degrees Cobb angle. Inflation of the IBT demonstrated a further reduction of the fracture and a significant improvement of the Cobb angle of 3.4 degrees compared with baseline prone. After deflation and removal of the IBT and placement of the cement, no significant loss of fracture reduction was seen. Postoperative measurement of the Cobb angle by means of standing radiographs demonstrated a 3.1 degrees significant loss of reduction compared with the intraoperative measurement in prone position after cement application. Cement leaks occurred in 9 of 39 vertebral fractures. All patients subjectively reported immediate relief of their typical fracture pain. The VAS score significantly improved from 8.7 +/- 1.4 before surgery to 2.3 +/- 0.9. CONCLUSION The restoration of height in kyphoplasty is attributed to dynamic fracture mobility as well as to the expansion of the inserted balloon tamp.

The treatment of spine and chest wall deformities with fused ribs by expansion thoracostomy and insertion of vertical expandable prosthetic titanium rib: growth of thoracic spine and improvement of lung volumes.

Abstract: Study design Prospective clinical trial of vertical expandable prosthetic titanium rib (VEPTR) in patients with combined spine and chest wall deformity with scoliosis and fused ribs. Objective Report the efficacy and safety of expansion thoracostomy and VEPTR surgery in the treatment of thoracic insufficiency syndrome (TIS) associated with fused ribs. Summary of background data Traditional attitudes toward early-onset combined chest and spine deformity assume that thoracic deformity is best controlled by treatment directed at spine deformity, often involving early spinal arthrodesis. Campbell and others have heightened awareness of the interrelationship between lung, chest, and spine development during growth and characterized TIS as the inability of the thorax to support normal respiration or lung growth. Expansion thoracostomy and VEPTR insertion was developed to directly control both spine and chest wall deformity during growth, while permitting continued vertebral column and chest growth at an early stage. Methods Multidisciplinary evaluation of children with combined spine and chest wall deformity included pediatric pulmonologist, thoracic, and orthopedic surgeon evaluations. One or more opening wedge expansion thoracostomies and placement of VEPTR devices were performed as described by Campbell, with repeated device lengthenings during growth. Parameters measured included Cobb angle, length of thoracic spine, CT-derived lung volumes, and in older children pulmonary function tests. Results Thirty-one patients with fused ribs and TIS were treated, 4 of whom had undergone prior spinal arthrodesis at other institutions with continued progression of deformity. In 30 patients, the spinal deformity was controlled and growth continued in the thoracic spine during treatment at rates similar to normals. Increased volume of the constricted hemithorax and total lung volumes obtained during expansion thoracostomy were maintained at follow-up. Complications included device migration, infection, and brachial plexus palsy. Conclusions Expansion thoracostomy and VEPTR insertion with serial lengthening may be the preferred treatment for young children with chest wall deformity and scoliosis associated with fused ribs but requires multidisciplinary care and attention to details of soft tissue management. When indicated, surgical intervention with VEPTR can be considered early in growth, before deformity is severe, since spinal growth will continue with treatment.

Growth as a corrective force in the early treatment of progressive infantile scoliosis

Abstract: This prospective study of 136 children with progressive infantile scoliosis treated under the age of four years, and followed up for nine years, shows that the scoliosis can be reversed by harnessing the vigorous growth of the infant to early treatment by serial corrective plaster jackets.In 94 children (group 1), who were referred and treated in the early stages of progression, at a mean age of one year seven months (6 to 48 months) and with a mean Cobb angle of 32° (11° to 65°), the scoliosis resolved by a mean age of three years and six months. They needed no further treatment and went on to lead a normal life. At the last follow-up, their mean age was 11 years and two months (1 year 10 months to 25 years 2 months), 23 (24.5%) were at Risser stages 4 and 5 and 13 girls were post-menarchal.In 42 children (group 2), who were referred late at a mean age of two years and six months (11 to 48 months) and with a mean Cobb angle of 52° (23° to 92°), treatment could only reduce but not reverse the deformity. A...

Pseudarthrosis in primary fusions for adult idiopathic scoliosis: incidence, risk factors, and outcome analysis.

Abstract: Study design A retrospective study. Objective To analyze the incidence, characteristics, risk factors, and Scoliosis Research Society Instrument-24 (SRS-24) outcome scores of pseudarthrosis in adult idiopathic scoliosis primary fusions. Summary of background data The healing of spinal fusion is complex and difficult to study in a clinical setting. There are no detailed reports on pseudarthrosis in primary fusion for adult idiopathic scoliosis since the introduction of "modern" segmental fixation techniques. Methods A retrospective chart and radiographic review of 96 patients (average age 42.2 years; range 18.2-62.9 years) with adult idiopathic scoliosis undergoing first time (primary) spinal instrumentation and fusion with a minimum 2-year follow-up (average 5.9 years; range 2-16.8 years) treated at a single institution between 1985 and 2001 were analyzed. Results Sixteen patients had pseudarthroses (17%). Fifty-nine percent of the pseudarthroses occurred between T9 and L1, and 81% presented with multiple levels involved (2-6 levels). The site of crosslinks or dominoes correlated with pseudarthrosis site in 69%. Pseudarthroses were detected radiologically at 32.4 months (range 12-67 months) postoperatively. Patient age at surgery more than 55 years significantly correlated with pseudarthrosis (P = 0.007). The number of fused levels more than 12 vertebrae is also significantly correlated with pseudarthrosis (P = 0.03). Smoking history and comorbidity did not increase the pseudarthrosis rate (P = 0.71 and 0.19, respectively). A larger preoperative Cobb angle (> or =70 degrees) and a greater thoracic kyphosis (T5-T12 >40 degrees) did not correlate with a higher pseudarthrosis rate (P = 0.76 and 0.73, respectively). Thoracolumbar kyphosis (T10-L2 > or =20 degrees) correlated with a significantly higher pseudarthrosis rate (P 55 years), longer fusion (>12 vertebrae), and those with thoracolumbar kyphosis (> or =20 degrees) demonstrated increased risk for pseudarthrosis. Patients' outcomes as measured by the SRS-24 were "negatively" affected by the pseudarthrosis.

Balloon vertebroplasty in combination with pedicle screw instrumentation: a novel technique to treat thoracic and lumbar burst fractures.

Abstract: Study design Clinical trial (phase II). Objectives To assess the feasibility and safety of balloon vertebroplasty after posterior short-segment reduction and fixation for the treatment of traumatic burst fractures. Summary of background data Hardware failure and loss of reduction after posterior short-segment instrumentation are complications caused by insufficiency of anterior column support. This is due to migration of disc tissue through the endplate into the fractured vertebral body that cannot be restored with posterior instrumentation. Methods Patients with traumatic thoracolumbar burst fractures without neurologic deficits were included. After posterior reduction and fixation, bilateral transpedicular balloon reduction of the endplate was performed, and calcium phosphate cement was injected. Preoperative and postoperative Cobb angle and central and anterior height were assessed with radiographs and MRI. Results Twenty patients underwent surgery without technical difficulties, and a substantial reduction of the endplates could be achieved with the technique. All patients recovered uneventfully, and the neurologic examination revealed no deficits. The postoperative radiographs and magnetic resonance images demonstrated a good fracture reduction and filling of the bone defect without unwarranted bone displacement. The central and anterior height of the vertebral body could be restored to 78 and 91% of the estimated intact height, respectively. Complications were cement leakage in five cases without clinical implications and one wound hematoma. Conclusions Transpedicular balloon vertebroplasty for the direct restoration of burst fractures seems feasible in combination with posterior instrumentation. Cement leakage occurred but had no clinical consequences.

Assessment of curve flexibility in adolescent idiopathic scoliosis

Abstract: Study design A prospective comparative evaluation of the commonly accepted or described radiologic techniques to determine curve flexibility in adolescent idiopathic scoliosis (AIS), comparison of the results to those obtained by supine traction radiographs taken with the patient under general anesthesia (UGA) just before surgery and correlation of all findings to surgical correction. Objective To determine if supine traction radiographs taken with the patient UGA help provide better assessment of curve flexibility and better predicting surgical correction. Summary of background data Supine lateral bending radiographs are the standard methods of evaluating curve flexibility before surgery in idiopathic scoliosis. Supine traction radiographs have also been used at the authors' institution in addition to the supine lateral bending radiographs before surgery, believing that it is usually more helpful to analyze the response of the main and compensatory curves to corrective forces. Methods A total of 34 consecutive patients with AIS who had surgical treatment were studied. Preoperative radiologic evaluation consisted of standing anteroposterior and lateral, supine lateral bending and traction, fulcrum bending radiographs, and also supine traction radiographs taken with the patient UGA just before surgery. All structural curves were measured, and the flexibility ratio was determined on each radiograph. The amount of correction obtained by all radiographic methods was compared with the amount of surgical correction by evaluating the differences from surgery as absolute values. Mean absolute differences from surgery were used to determine the confidence intervals. Statistical differences were calculated with the comparison of the exact 95% confidence intervals for the mean. Results Curves were accepted to be moderate if between 40 degrees and 65 degrees (29 patients) and severe if >65 degrees (5 patients). In these 29 patients, average frontal Cobb angle of the thoracic and lumbar curves were 49.7 degrees (range 40 degrees-60 degrees) and 39.4 degrees (range 22 degrees-58 degrees), respectively. For the moderate thoracic curves, fulcrum radiographs provided the best amount of flexibility, with no significant difference from traction with the patient UGA but with significant difference from bending radiographs. For the moderate lumbar curves, flexibility obtained by fulcrum and bending radiographs were significantly better than traction radiographs with the patient UGA. For the lumbar and thoracic curves more than 65 degrees, traction radiographs with the patient UGA provided clearly better flexibility compared to bending and fulcrum radiographs, however, the number of patients is not enough to determine whether the differences are statistically significant. Better flexibility in traction radiographs with the patient UGA helped us eliminate the need for anterior release in all 5 patients who had severe and rigid curves more than 65 degrees, which did not bend to less than 40 degrees and were planned to have anterior release. Conclusion Fulcrum higher than bending higher than traction with the patient UGA is the order of radiographs for better predicting flexibility and correction in curves between 40 degrees and 65 degrees. Flexibility obtained at traction radiographs with the patient UGA is clearly better in numerical values, and closer to the amount of surgical correction than the amount of flexibility at fulcrum and side-bending radiographs for curves larger than 65 degrees, although not statistically significant as a result of the small number of patients in this group. However, pedicle screw instrumentation provides even more correction than the traction radiographs with the patient UGA. Thus, traction radiographs with the patient UGA may show much better flexibility, especially in more than 65 degrees and rigid curves.

Association of osteopenia with curve severity in adolescent idiopathic scoliosis: a study of 919 girls

Abstract: Generalized osteopenia and spinal deformity occur concomitantly in adolescent idiopathic scoliosis (AIS) during the peripubertal period. No large-scale study has been performed to reveal the link between scoliotic deformity and bone-mineral status in AIS. In a cross-sectional study, the extent of scoliotic-curve severity in relation to bone-mineral status was examined for 619 AIS girls and compared with those of 300 healthy non-AIS counterparts aged 11-16 years. Curve severity was categorized into a moderate (10-39 degrees) and a severe group (> or = 40 degrees) based on Cobb angle. Anthropometric parameters, bone mineral-density (BMD) and bone mineral-content (BMC) of lumbar spine, proximal femur and distal tibia were determined by dual-energy X-ray absorptiometry and peripheral QCT. Differences in anthropometric parameters and bone mass among control and the AIS-moderate and AIS-severe groups were tested by one-way ANOVA. Association between Cobb angle and bone mass was determined by univariate and multivariate analyses. Mean Cobb angle of the moderate and severe groups were 25+/-6.3 degrees and 50.2+/-11.3 degrees, respectively. Arm span and leg length among the moderate and severe AIS subjects were almost all longer than for the controls from age 13 years. Age-adjusted arm span and leg length were significantly correlated with curve severity (p < 0.015). Starting from age 13 years, most axial and peripheral BMD and BMC of the moderate or severe AIS group was significantly lower than for the controls (p < 0.029). Age-adjusted Cobb angle was inversely correlated with BMD and BMC of the distal tibia and lumbar spine among AIS subjects (p < or = 0.042). The proportion of osteopenic AIS girls in the severe group was significantly higher than that in the moderate group (p < or = 0.033). Multivariate analysis indicated that Cobb angle was inversely and independently associated with axial and peripheral BMD and BMC (p < or = 0.042). To conclude, curve severity was an inverse and independent associated factor on bone mineral mass of AIS during peripuberty. The study implied that prevention of osteopenia could be as important as controlling spinal progression in the management of AIS.

A lumbar classification of scoliosis in the adult patient : Preliminary approach

Abstract: STUDY DESIGN Retrospective consecutive clinical review of 98 patients. OBJECTIVE To create a preliminary approach to a clinically important classification of scoliosis in adult patients. SUMMARY OF BACKGROUND DATA There is currently no accepted classification of scoliosis in adults. High prevalence rates of scoliosis in the elderly and recent studies of health impact support the need for a clinically relevant classification. METHODS A total of 98 adult patients with scoliosis with a 2-year minimum treatment/follow-up were included. Patients were classified into one of 3 types of deformity based on the degree of lordosis (L1-S1) and frontal plane endplate obliquity of L3 on standing radiographs: type I = lordosis > 55 degrees, L3 obliquity 25 degrees. RESULTS Curve patterns included thoracic, thoracolumbar, lumbar, thoracic, and lumbar (mean Cobb angle 30 degrees, standard deviation 19 degrees). Cobb angle revealed no correlation to visual analog pain score (VAS) or general health (36-Item Short-Form Health Survey). Significant correlation between endplate obliquity L3, L1-S1 lordosis and VAS was noted (P < 0.05). Mean pain scores of classified patients were: type I, VAS = 27.7; type II, VAS = 43.3; and type III, VAS = 47.1 (type I vs. III, P < 0.05). Surgical rates (failed minimum 3-month conservative care, including bracing, physical therapy, and pharmacological treatment) by group were: type I, 0%; type II, 9%; and type III, 22.7% (P = 0.002). CONCLUSIONS A simple classification of adult scoliosis was developed based on frontal and sagittal plane standing radiographs. With increasing type (from I to III), self-reported pain and disability increased. This result was reflected in the treatment approach as well, with surgical rates increasing from types I to III. Further refinement is important to develop an all inclusive and sufficiently descriptive system.

Correction of adolescent idiopathic scoliosis using thoracic pedicle screw fixation versus hook constructs.

Abstract: This retrospective study was undertaken to determine the effectiveness and cost of thoracic pedicle screws versus laminar and pedicle hooks in patients undergoing surgical correction of adolescent idiopathic scoliosis (AIS). Immediate preoperative and 6-week postoperative radiographs were examined in 25 consecutive cases of children with AIS who were divided into two groups, those with thoracic pedicle screw constructs and those with thoracic hook constructs. Endpoints collected included radiographic measures, complications, surgical time, implant cost, and quality-of-life measures. Ten children underwent spinal fusion using thoracic pedicle screw fixation and 15 underwent thoracic constructs composed of hooks. Similar sex and age distribution were noted in both groups, and among the 20 girls and 5 boys the average age was 14.5. The mean preoperative Cobb angle was 53.5 degrees for the screw group and 52.5 degrees for the hook group. Correction averaged 70.2% for the screw group and 68.1% for the hook group. There were no significant differences between the two patient groups in terms of percentage of or absolute curve change after surgery. The apical vertebral translation, end vertebral tilt angle, and coronal balance did not differ significantly between the two patient groups. Comparison of operative time and quality of life revealed no significant differences. Screw constructs were significantly more expensive than hook constructs. The correction obtained from thoracic pedicle screw fixation is comparable to traditional hook constructs in AIS. Surgery using either construct effectively corrects AIS.

Brace treatment during pubertal growth spurt in girls with idiopathic scoliosis (IS): A prospective trial comparing two different concepts

Abstract: Study design: Prospective comparison of the survival rates of two different bracing concepts with respect to curve progression and duration of treatment during pubertal growth spurt in two cohorts of patients followed up prospectively. Objectives: To determine whether the results obtained by the use of a soft brace (SpineCor) is comparable to the results of the Cheneau derived TLSO during pubertal growth spurt. Background data: In recent peer reviewed literature, the SpineCor is described as an effective method of treatment for patients with scoliosis. However, until now, no controlled study has been presented comparing the results obtained with this soft brace to a sample treated with other bracing concepts proven effective. Methods: Twelve patients with Cobb angles between 16-32 � during pubertal growth spurt are presented as a case series treated with the SpineCor. The survival rate of this sample is described and compared to a matched group of patients treated with the Cheneau brace of the same age group. All girls treated in both studies were pre-menarchial with the first clinical signs of maturation (Tanner 1-3). Results: During the pubertal growth spurt, most of the patients (11/12) with SpineCor progressed clinicly and radiologicly as well (at least 5 � ). Progression could be stopped changing SpineCor to the Cheneau brace in most of the samples described (7/10). The avarage Cobb angle at the start of treatment with the SpineCor was 21.3 � , after an avarage observation time of 21.5 months, 31 � . The control sample, primarily treated with the Cheneau brace (n ¼ 15), showed at average no progression. Cobb angle at the start of treatment was 33.7 � and after the observation time of 37 months, 33.9 � . Radiological improvements can be reported for some of the cases (3/15) as well as progressions (3/15). At 24 months of treatment time, 73% of the patients with a Cheneau brace and 33% of the patients with the SpineCor where still under treatment with their original bracing concept, at 42 month follow-up time 80% of the patients with Cheneau braces and 8% of the patients with the SpineCor survived with respect to curvature progression. The differences of the proportions statisticly where highly significant. Conclusions: The SpineCor does not change natural history of idiopathic scoliosis during the pubertal growth spurt. The use of the Cheneau brace seems to do so. Oncoming studies with the aim to test the efficiency of braces should be based on samples at immediate risk for progression (only girls with first signs of maturation but pre-menarchial).

Severe Thoracic Kyphosis in the Older Patient in the Absence of Vertebral Fracture: Association of Extreme Curve with Age

Abstract: BACKGROUND AND PURPOSE: Limited data exist on the natural history of thoracic kyphosis in elderly patients. The purpose of this study was to determine the statistical distribution of the thoracic kyphotic angle (TKA) measurement in older patients without vertebral body abnormalities when compared with a young population. METHODS: The TKA was measured by Cobb angle on digital lateral chest radiographs in 90 patients >65 years of age, 60 patients 51–65 years of age, 67 patients 36–50 years of age, and 63 patients 18–35 years of age. Patients with vertebral compression, vertebral body angulation, congenital anomaly, or significant scoliosis were excluded. RESULTS: In patients >65 years of age, average TKA was 41.9°, but the distribution was unexpectedly bimodal, with a low mode at 28.3° and an upper mode at 51.5° (P 40° (upper mode). In young patients, average TKA was 26.8°. In middle-aged patients, TKA was intermediate and nonbimodal. CONCLUSION: The TKA distribution in elderly patients (>65 years) without vertebral body abnormality is unexpectedly bimodal (non-normal distribution) with a subpopulation of patients significantly more affected by extreme kyphosis. Extreme thoracic kyphosis therefore occurs independently in a large subset of people, in the absence of vertebral wedge compression. The development of extreme thoracic kyphosis might contribute to excess biomechanical stress in the spine and may identify a population at risk for future vertebral compression fracture in particular at the thoracolumbar junction.

The efficacy of Schroth s 3-dimensional exercise therapy in the treatment of adolescent idiopathic scoliosis in Turkey.

Abstract: OBJECTIVES To determine the effectiveness of 3-dimensional therapy in the treatment of adolescent idiopathic scoliosis. METHODS We carried out this study with 50 patients whose average age was 14.15 +/- 1.69 years at the Physical Therapy and Rehabilitation School, Hacettepe University, Ankara, Turkey, from 1999 to 2004. We treated them as outpatients, 5 days a week, in a 4-hour program for the first 6 weeks. After that, they continued with the same program at home. We evaluated the Cobb angle, vital capacity and muscle strength of the patients before treatment, and after 6 weeks, 6 months and one year, and compared all the results. RESULTS The average Cobb angle, which was 26.1 degrees on average before treatment, was 23.45 degrees after 6 weeks, 19.25 degrees after 6 months and 17.85 degrees after one year (p<0.01). The vital capacities, which were on average 2795 ml before treatment, reached 2956 ml after 6 weeks, 3125 ml after 6 months and 3215 ml after one year (p<0.01). Similarly, according to the results of evaluations after 6 weeks, 6 months and one year, we observed an increase in muscle strength and recovery of the postural defects in all patients (p<0.01). CONCLUSIONS Schroth s technique positively influenced the Cobb angle, vital capacity, strength and postural defects in outpatient adolescents.

Variability in Cobb angle measurements using reformatted computerized tomography scans.

Abstract: Study Design. Survey of intraobserver and interobserver measurement variability. Objective. To assess the use of reformatted computerized tomography (CT) images for manual measurement of coronal Cobb angles in idiopathic scoliosis. Summary of Background Data. Cobb angle measurements in idiopathic scoliosis are traditionally made from standing radiographs, whereas CT is often used for assessment of vertebral rotation. Correlating Cobb angles from standing radiographs with vertebral rotations from supine CT is problematic because the geometry of the spine changes significantly from standing to supine positions, and 2 different imaging methods are involved. Methods. We assessed the use of reformatted thoracolumbar CT images for Cobb angle measurement. Preoperative CT of 12 patients with idiopathic scoliosis were used to generate reformatted coronal images. Five observers measured coronal Cobb angles on 3 occasions from each of the images. Intraobserver and interobserver variability associated with Cobb measurement from reformatted CT scans was assessed and compared with previous studies of measurement variability using plain radiographs. Results. For major curves, 95% confidence intervals for intraobserver and interobserver variability were +/- 6.6 degrees and +/- 7.7 degrees, respectively. For minor curves, the intervals were +/- 7.5 degrees and +/- 8.2 degrees, respectively. Intraobserver and interobserver technical error of measurement was 2.4 degrees and 2.7 degrees, with reliability coefficients of 88% and 84%, respectively. There was no correlation between measurement variability and curve severity. Conclusions. Reformatted CT images may be used for manual measurement of coronal Cobb angles in idiopathic scoliosis with similar variability to manual measurement of plain radiographs.

Scheuermann's kyphosis: surgical management.

Abstract: Indications for surgery in Scheuermann disease are not well codified and remain rare, as the natural history of the disease is in most cases benign. In the immature adolescent, conservative treatment, such as bracing or casting, can be tried for moderate curves. For larger curves, or in the adult, conservative treatment is usually not effective, and surgery can be considered. Such indications are mostly cosmetic for large curves above 75°. Pain over the deformity or in the low back may represent another surgical indication, especially in the adult group. The question of anterior release or straight posterior fusion has become more of an actuality with the advent of powerful, third-generation stiff segmental instrumentation. However, the long-term results of a modern, posterior-only instrumentation fusion are not known. Concern about loss of correction, late pseudarthrosis or the need to remove instrumentation for infected hardware or due to late pain at the operative site must make us careful about choosing this method. Very rigid and large curves still require an anterior release, either done in a conventional or mini-open fashion, or through video-assisted thoracoscopic surgery. The extent of the posterior instrumentation has now been better defined. One must fuse the whole Cobb angle without hypercorrection and stop distally, above the first lordotic disc, to avoid sagittal decompensation. New approaches such as short anterior fusion with bone-on-bone techniques and pedicle substraction osteotomies have not yet been reported in the literature as having been used for treating Scheuermann’s kyphosis. These should be considered experimental.

Use of the scoliosis research society outcomes instrument to evaluate patient outcome in untreated idiopathic scoliosis patients in Japan: part I: comparison with nonscoliosis group: preliminary/limited review in a Japanese population.

Abstract: STUDY DESIGN: This preliminary study evaluates untreated Japanese patients with idiopathic scoliosis using the Scoliosis Research Society Outcomes Instrument (SRS-24). OBJECTIVES: To determine the baseline patient outcome score using the SRS-24 for untreated Japanese scoliosis patients compared with a nonscoliosis group. SUMMARY OF BACKGROUND DATA: The SRS instrument with 24 questions was developed to help evaluate patient-perceived outcomes of idiopathic scoliosis treatment. Evaluation of untreated Japanese idiopathic scoliosis patients using the SRS instrument has not been reported. METHODS: Japanese idiopathic scoliosis patients (n = 141) (mean age, 13.6 years; range, 10-17 years) with a Cobb angle of more than 20 degrees who were not treated with a brace or surgery, were evaluated in comparison with a nonscoliosis group (healthy junior high school students; n = 72) using the SRS-24. The scoliosis group was categorized as mild deformity group with a major curve Cobb angle of less than 30 degrees, moderate deformity group with 30 degrees to 49 degrees, and severe deformity group with more than 50 degrees. The patients were evaluated using section 1 (15 questions) of the SRS-24, which was divided into four domains: total pain, general self-image, general function, and activity. Reliability, as determined by internal consistency, was validated using Cronbach's alpha for these domain scales. RESULTS: The severe deformity group had the lowest scores compared with the other deformity groups and the nonscoliosis group in pain (P < 0.0001) and self-image (P < 0.05) domains. The scores for questions 3 (P < 0.0001) and 5 (P < 0.0001), evaluation of self-image of back appearance, were significantly lower in the scoliosis group than those in the nonscoliosis group. This tendency was more significant in the patients with greater curve magnitude. Scores for questions 14 and 15, evaluation of general self-image, in the scoliosis group were, however, higher than those in the nonscoliosis group. Internal consistency using Cronbach's alpha was 0.57 (pain), 0.27 (general self-image), -0.08 (general function), and 0.15 (overall level of activity). CONCLUSION: Untreated scoliosis patients with severe deformity were inclined to complain of being self-conscious or distressed regarding their back appearance compared with age- and sex-matched control adolescents. The control group was inclined to have, however, a negative general self-image compared with the patients group. Internal consistency using Cronbach's alpha for all domains was considerably low. The baseline of the SRS-24 scores in the Japanese population might differ from that of the Western population because of differences in national culture. Therefore, further study is necessary to clarify the validity of the SRS-24 domains for Japanese patients.

Minimum 20-year follow-up results of Harrington rod fusion for idiopathic scoliosis.

Abstract: We evaluated the outcome of spinal fusion with a single Harrington distraction rod in patients with idiopathic scoliosis. At follow-up visits a minimum of 20 years post-surgery, we studied 24 patients who had been operated on by the same surgeon. The Scoliosis Research Society (SRS) Instrument and an additional questionnaire of our own, along with an invitation for a follow-up visit, were originally mailed to 28 consecutive patients of the surgeon. The SRS Instrument has seven domains dealing with back pain, general self-image, self-image after surgery, general function, function in terms of level of activity, function after surgery, and degree of satisfaction with the surgery. The length of time between surgery and the follow-up visit averaged 22.9 years (20.2–27.3). The mean age at surgery and follow-up were 15.8 (13–22) and 38.8 (35–48) years, respectively. Twenty-four patients sent back the completed questionnaires and 16 of them participated in the clinic and radiographic follow-up. To assess the meaning of the questionnaires’ results, a control group of the same sex, age and geographic provenance was selected from our outpatients without scoliosis. The average follow-up score on the SRS Instrument for the patients was 100.8 (78–110). When we compared the study and control groups, no significant differences in the single SRS domain scores were observed. The mean Cobb angle and rib cage deformity before surgery were 70.46° (40–120) and 36.4 mm (20–60 mm), respectively, whereas on follow-up they were 41.23° (16–75) and 22.3 mm (5–50 mm), respectively. These long-term results lead us to consider Harrington fusion a procedure that produces a long-lasting high degree of self-reported post-operative satisfaction.

Growth and curve stabilization in girls with adolescent idiopathic scoliosis.

Abstract: STUDY DESIGN A retrospective study of a cohort of 132 girls with adolescent idiopathic scoliosis (AIS). OBJECTIVES Evaluate the changes in height and scoliosis angle over time by the use of a mathematical model and determine a relationship between height and angle values in patients with AIS. SUMMARY OF BACKGROUND DATA The influence of growth on idiopathic scoliosis (IS) is still not fully understood. Although it has not been completely demonstrated, it is accepted that a relationship exists between height growth and curve progression, as well as that curve stabilization occurs when growth ends, but it has not yet been demonstrated whether both occur at the same time. METHOD One hundred thirty-two girls were included in a retrospective study. Inclusion criteria were: adolescent IS, Cobb angle > or =10 degrees , menarche age well documented, and follow-up of at least 2 years in 6-month controls. Main variables were: menarche age, height, Cobb angle, and treatment. Height and angle changes over the time were adjusted by several curvilinear regression models. Calculations were made of the gradient between each consecutive time point (first derivative function). Growth was considered as tending to stabilize when the function gradient changed its sign or was negligible. Height and Cobb angle correlation coefficients for repeated measures were estimated within patients for curves managed with observation and curves managed with a brace. Comparisons among these correlations were based on the Fisher-Z transformation. RESULTS Height function gradient changed sign at 1 year postmenarche, and Cobb angle function gradient was negligible around menarche. There was a correlation between mean heights and mean angles, being higher for girls managed only with observation. When comparing mean heights in one semester with the mean heights of the previous one, there were statistically significant differences until 2.5 years postmenarche, although after the first year, these differences were clinically irrelevant. A significant increase for angle values was observed in the same period for the group of girls managed with observation and in the 6 months before menarche for the girls managed with a brace. CONCLUSIONS A mathematical model was used to demonstrate when height and angle growths tend to stabilize (1 year after menarche for height values and at the time of menarche for angle values) in AIS. In the absence of a brace effect, a significant correlation between both growth rates was noted up until 2.5 years after menarche.

Hemivertebra resection in the cervical spine.

Abstract: Study design Retrospective study with clinical and radiologic evaluation of hemivertebra resection in children with congenital cervical scoliosis. Objective Assessment of hemivertebra resection in the treatment of congenital cervical scoliosis. Summary of background data To our knowledge, this is the first report on hemivertebra resection in the midcervical spine. Methods Three patients with torticollis due to a cervical hemivertebra were operated on by hemivertebra resection and fusion of the adjacent vertebrae. Resection was performed by a posterior-anterior (-posterior) approach. Mean age at time of surgery was 9 years 3 months. They were retrospectively studied with a mean follow-up of 4.8 years. Results Mean segmental Cobb angle at the hemivertebra was 29 degrees before surgery, 5 degrees after surgery, and 6 degrees at latest follow-up. Head tilt improved from 17 degrees before surgery to 1 degrees after surgery, and 3 degrees at latest follow-up. Bony fusion was achieved in all cases. There was weakness of the left deltoid muscle in 1 case due to C5 root compression by a facet screw, which resolved completely after revision with change of the screw. Conclusions Resection of a cervical hemivertebra may be an option in the treatment of congenital cervical scoliosis. A good correction of the local deformity and a complete correction of head tilt are achieved. By early operation in young children, the development of severe secondary deformities in the upper thoracic spine can be avoided.

Use of the scoliosis research society outcomes instrument to evaluate patient outcome in untreated idiopathic scoliosis patients in Japan: part II: relation between spinal deformity and patient outcomes.

Abstract: STUDY DESIGN This study clarifies the relation between the results of the Scoliosis Research Society Outcomes Instrument (SRS-24) and radiographic parameters of back deformity in Japanese idiopathic scoliosis patients. OBJECTIVES To investigate the relation between magnitude of back deformity and results of the SRS-24 in untreated patients. SUMMARY OF BACKGROUND DATA In idiopathic scoliosis, it is necessary to clarify the relation between patient-perceived outcomes of the deformity and magnitude of back deformity before considering treatment. The relation between the magnitude of spinal deformity and outcomes of untreated patients, however, has not been fully investigated. METHODS Patients (n = 166) under 30 years of age with untreated scoliosis were evaluated. Radiologic examination included Cobb angle, rotation angle of apical vertebrae, and translation of C7 vertebra from the central sacral line (C7 translation) on the coronal plane. Patient evaluation using section 1 (15 questions) of the SRS-24 was compared with radiologic findings using Spearman's correlation coefficient by rank (rs). RESULTS The average pain domain score was 27.0 +/- 2.2 points, general self-image 9.9 +/- 1.7 points, general function 12.7 +/- 1.1 points, and overall level of activity 14.9 +/- 0.6 points. In radiologic deformity, the average Cobb angle and rotation angle of the thoracic curve were 35.8 degrees +/- 12.1 degrees (range, 17 degrees-73 degrees) and 13.9 degrees +/- 8.2 degrees (range, 0 degrees-38 degrees), respectively. The average Cobb and rotation angle of the lumbar curve were 31.4 degrees +/- 9.3 degrees (range, 13 degrees-56 degrees) and 15.4 degrees +/- 9.7 degrees (range, 2 degrees-36 degrees), respectively. The mean C7 translation was 12.4 +/- 9.7 mm (range, 0-48 mm). Comparison between individual domains and radiologic measurements revealed that the total pain (rs = -0.33; P < 0.0001) and general self-image (rs = -0.25; P = 0.0024) domain scores had a significant inverse correlation with thoracic curve Cobb angle. Comparison between the scores of individual questions and radiologic measurements revealed that the scores of question 3 (total pain domain) had a significant inverse correlation with thoracic curve Cobb angle (rs = -0.36; P < 0.0001). The scores of question 5 (general self-image domain) had a significant inverse correlation with thoracic curve Cobb angle (rs = -0.41; P < 0.0001) and rotation angle (rs = -0.30; P = 0.0006). CONCLUSION The patients did not have negative self-image regarding back appearance when the thoracic curve Cobb angle was less than 30 degrees but had a negative self-image when the thoracic curve Cobb angle was more than 40 degrees and the rotation angle was more than 20 degrees. On the other hand, the lumbar curve Cobb angle and the rotation angle did not correlate with patient self-image. The results of the present study will help to define the parameters for the initiation of active treatment and physicians should maintain or reduce scoliotic deformity so that the thoracic curve Cobb angle is less than 40 degrees and the rotation angle is less than 20 degrees in idiopathic scoliosis.

Hip flexion contracture and lumbar spine lordosis in myelomeningocele

Abstract: The objective of this study was to assess the correlation between hip flexion contracture (HFC) and the sagittal alignment of the lumbar spine in ambulatory children with myelomeningocele. Ambulatory patients with myelomeningocele are generally free of scoliosis or kyphosis. Among them, some develop increased lumbar lordosis. It is postulated that HFC and increased lumbar lordosis may be correlated. Thirty-eight patients, with a mean age of 12.7 years, were evaluated. Standing lateral spine films were obtained and the lumbar lordosis was measured using the Cobb method. HFC was measured using the Thomas test. A statistically significant correlation was found between the lumbar curve and HFC. High values of lumbar Cobb angle (hyperlordosis) were correlated with high values of HFC. These results show a correlation between HFC and increased lumbar lordosis in ambulatory myelomeningocele patients.

A comparison of traditional protractor versus Oxford Cobbometer radiographic measurement: intraobserver measurement variability for Cobb angles.

Abstract: STUDY DESIGN A comparison between measurement of radiographs using a traditional protractor method and the Oxford Cobbometer, which has the potential to reduce error. OBJECTIVE To assess measurement variability of Cobb angles using the Oxford Cobbometer and to compare it to that of measurements made using the traditional protractor method. SUMMARY OF BACKGROUND DATA Studies of the Cobb method have multiple sources of error and subsequent intraobserver variability. Estimates of intraobserver variability are from 2.8 degrees to 10 degrees. METHOD Fifty-three scoliosis curves were measured by 3 examiners. Two measurement sets were performed using the traditional protractor method and two measurement sets performed using the Oxford Cobbometer. RESULTS For the protractor method, intraobserver variability was 9.01 degrees (95% confidence interval 7.32-10.88). For the Cobbometer method, the value was 5.77 degrees (95% confidence interval 3.25-7.63). The difference between error for construction and Cobbometer methods was significant (P < 0.001). CONCLUSIONS This study demonstrates a lower intraobserver variability for the Oxford Cobbometer compared to the traditional construction method. The Oxford Cobbometer, besides being quick and easy to use, does not require the drawing of lines on films or the use of wide diameter radiographic markers and hence removes some sources of intrinsic error incurred during the traditional method of measuring Cobb angles.

Apical lordosating osteotomy and minimal segment fixation for the treatment of thoracic or thoracolumbar osteoporotic kyphosis.

Abstract: Study design Retrospective review. Objective To assess the effectiveness of apical lordosating osteotomy (ALO) and minimal segment fixation through a posterior approach for correcting thoracic or thoracolumbar osteoporotic kyphosis (OK). Summary of background data Current surgical options for OK involve a risk of complex surgery in elderly patients, graft problems (e.g., graft dislodgement, subsidence, pseudarthrosis), and instrumentation problems (e.g., adjacent-segment failure, implant pullout). A posterior-only approach was used to make the surgery less invasive and safer. Methods A total of 26 consecutive patients (average age 71.5 years, range 65-81) with thoracic or thoracolumbar OK underwent ALO. Mean follow-up was 3.2 years (range 2.1-6.1). Radiographic studies, complications, and patient satisfaction were assessed. Results Mean operating time was 137 minutes, and mean blood loss was 717 mL. In 8 patients with thoracic hyperkyphosis, mean Cobb angle was corrected from 82.7 degrees (range 75 degrees-97 degrees) to 25.8 degrees (range 18 degrees-30 degrees), indicating normal kyphosis. In 18 patients, thoracolumbar kyphosis of 56.3 degrees (range 47 degrees-71 degrees) was corrected to -1.8 degrees (range -11 degrees to 7 degrees). Sagittal imbalance was 12.1 cm before surgery and 4.9 cm afterward. Satisfactory correction was achieved in all patients, without anterior release. Local kyphosis was corrected to -9.1 degrees from 53.6 degrees, and mean vertebral kyphosis to -26.6 degrees from 17.7 degrees. In 17 patients with neurologic deficit, Frankel grades improved after surgery. No major complication occurred. All patients had improved pain, self-image, and overall satisfaction. Conclusions ALO and minimal segments fixation appear to hold promise for the treatment of thoracic or thoracolumbar OK, and may be safer with fewer complications. A larger series with more patients and surgeons is needed for confirmation.

Low back pain after spinal fusion and Harrington instrumentation for idiopathic scoliosis.

Abstract: We reviewed 41 patients with adolescent idiopathic scoliosis treated with spinal fusion and Harrington instrumentation between 1973 and 1992. The mean follow-up was 23 (11–30) years. All patients completed self-administered questionnaires, Oswestry Low Back Pain Disability Score (ODS), Roland Morris score (RLS), and Visual Analog Pain Intensity Scale (VAS). We found a high degree of satisfaction with more than three quarters of the patients in work. The outcome of ODS, RLS, and VAS showed low scores. We found a significant correlation between the scores and the Cobb angle preoperatively as well as at follow-up. The patient-oriented outcome did not correlate with the type of curve, extension of vertebral fusion, tilt angle of the lowest instrumented vertebra, postoperative Cobb angle, loss of correction, or lumbar lordosis. This long-term follow-up of Harrington rod fusion for adolescent idiopathic scoliosis showed no important impairment of health-related quality of life.

Anatomic changes in lateral spondylolisthesis associated with adult lumbar scoliosis.

Abstract: STUDY DESIGN Prospective consecutive series. OBJECTIVE To analyze the anatomic changes in lateral spondylolisthesis. SUMMARY OF BACKGROUND DATA Previous studies have focused on the correlation between lateral spondylolisthesis, and curve progression and pain. To our knowledge, there has not been any detailed report concerning anatomic changes in lateral spondylolisthesis. METHODS We examined 24 consecutive patients (mean age 66 years), with lateral spondylolisthesis associated with lumbar scoliosis who had computerized tomography (CT) after myelography. Coronal reconstruction CT was used to measure the vertebral translation. Vertebral rotation was measured by the Aaro method using transaxial CT. RESULTS The Cobb angle averaged 26 degrees (range 13 degrees-75 degrees). Lateral spondylolisthesis was found most commonly at the lower-end vertebra. The cephalad-slipped vertebra rotated toward the convex side of the main curve, whereas the caudal vertebra rotated toward the convex side of the lumbosacral hemi (or fractional) curve below. Mean lateral translation and vertebral rotation were 7 mm and 8 degrees, respectively. There was a significant correlation between lateral translation and vertebral rotation (r = 0.49; P = 0.018). The convex superior articular process of the caudal vertebra had compressed the nerve root laterally in 21 patients, of whom 10 had radicular pain. The concave, inferior articular process of the cephalad vertebra had compressed the dural sac posteriorly, and 2 patients had radicular pain. CONCLUSIONS To our knowledge, this study has been the first attempt to analyze anatomic changes in lateral spondylolisthesis using CT. It may offer further insight into the pathogenesis of adult lumbar scoliosis.