Showing papers on "Cobb angle published in 2006"

A clinical impact classification of scoliosis in the adult.

Abstract: STUDY DESIGN Multicenter, prospective, consecutive clinical series. OBJECTIVES To establish and validate classification of scoliosis in the adult. SUMMARY OF BACKGROUND DATA Studies of adult scoliosis reveal the impact of radiographic parameters on self-assessed function: lumbar lordosis and frontal plane obliquity of lumbar vertebrae, not Cobb angle, correlate with pain scores. Deformity apex and intervertebral subluxations correlate with disability. METHODS A total of 947 adults with spinal deformity had radiographic analysis: frontal Cobb angle, deformity apex, lumbar lordosis, and intervertebral subluxation. Health assessment included Oswestry Disability Index and Scoliosis Research Society instrument. Deformity apex, lordosis (T12-S1), and intervertebral subluxation were used to classify patients. Outcomes measures and surgical rates were evaluated. RESULTS Mean maximal coronal Cobb was 46 degrees and lumbar lordosis 46 degrees . Mean maximal intervertebral subluxation (frontal plane) was 4.2 mm (sagittal plane, 1.2 mm). In thoracolumbar/lumbar deformities, the loss of lordosis/higher subluxation was associated with lower Scoliosis Research Society pain/function and higher Oswestry Disability Index scores. Across the study group, lower apex combined with lower lordosis led to higher disability. Higher surgical rates with decreasing lumbar lordosis and higher intervertebral subluxation were detected. CONCLUSIONS A clinical impact classification has been established based on radiographic markers of disability. The classification has shown correlation with self-reported disability as well as rates of operative treatment.

Radiographic measurement parameters in thoracolumbar fractures: a systematic review and consensus statement of the spine trauma study group.

Abstract: STUDY DESIGN Systematic review. OBJECTIVES To review the various radiographic parameters currently used to assess traumatic thoracolumbar injuries, emphasizing the validity and technique behind each one, to formulate evidence-based guidelines for a standardized radiographic method of assessment of these fractures. SUMMARY OF BACKGROUND DATA The treatment of thoracolumbar fractures is guided by various radiographic measurement parameters. Unfortunately, for each group of parameters, there has usually been more than 1 proposed measurement technique, thus creating confusion when gathering data and reporting outcomes. Ultimately, this effect results in clinical decisions being based on nonstandardized, nonvalidated outcome measures. METHODS Computerized bibliographic databases were searched up to January 2004 using key words and Medical Subject Headings on thoracolumbar spine trauma, radiographic parameters, and methodologic terms. Using strict inclusion criteria, 2 independent reviewers conducted study selection, data abstraction, and methodologic quality assessment. RESULTS There were 18 original articles that ultimately constituted the basis for the review. Of radiographic measurement parameters, 3 major groups were identified, depicting the properties of the injured spinal column: sagittal alignment, vertebral body compression, and spinal canal dimensions, with 14 radiographic parameters reported to assess these properties. CONCLUSIONS Based on a systematic review of the literature and expert opinion from an experienced group of spine trauma surgeons, it is recommended that the following radiographic parameters should be used routinely to assess thoracolumbar fractures: the Cobb angle, to assess sagittal alignment; vertebral body translation percentage, to express traumatic anterolisthesis; anterior vertebral body compression percentage, to assess vertebral body compression, the sagittal-to-transverse canal diameter ratio, and canal total cross-sectional area (measured or calculated); and the percent canal occlusion, to assess canal dimensions.

An Analysis of Sagittal Spinal Alignment Following Long Adult Lumbar Instrumentation and Fusion to L5 or S1 : Can We Predict Ideal Lumbar Lordosis?

Abstract: STUDY DESIGN A retrospective study. OBJECTIVE To determine factors controlling sagittal spinal balance after long adult lumbar instrumentation and fusion from the thoracolumbar spine to L5 or S1. SUMMARY OF BACKGROUND DATA To our knowledge, no study on postoperative sagittal balance following long adult spinal instrumentation and fusion to L5 or S1 has been published. METHODS A clinical and radiographic assessment of 80 patients with adult lumbar deformity (average age 53.4 years) who underwent long (average 7.6 vertebrae, 5-11 vertebrae) segmental posterior spinal instrumentation and fusion from the thoracolumbar spine to the L5-S1 (average 4.5 years, 2-15.8-year follow-up) was performed. We defined the optimal sagittal balance (n = 42) group, the distance from C7 plumb to superior posterior endplate of S1 3.0 cm at ultimate follow-up. RESULTS The optimal sagittal balance group (C7 plumb, average -0.6 +/- 2.5 cm) had the larger average angle differences between lumbar lordosis and thoracic kyphosis (P or = 45 degrees) before surgery (vs. or = 20 degrees, P = 0.013), and older than 55 years of age at surgery (vs. 55 years or younger, P = 0.024). CONCLUSION A sagittal Cobb angle difference between lumbar lordosis and thoracic kyphosis of > 20 degrees (higher lumbar lordosis) is advisable in most circumstances to achieve optimal sagittal balance.

Progression risk of idiopathic juvenile scoliosis during pubertal growth.

Abstract: Study design A retrospective study investigated the progression risk of juvenile scoliosis until skeletal maturity or spinal fusion. Objectives To define risk factors of curve progression during pubertal growth and analyze the timing of arthrodesis. Summary of background data Juvenile scoliosis is characterized by a major, extremely variable progression risk. Peak growth velocity is the most critical period. Curve progression related to growth needs to be analyzed critically for an adequate treatment. Methods A total of 205 patients, including 163 girls and 42 boys, with juvenile scoliosis were reviewed at skeletal maturity. The scoliosis was divided into juvenile I with an onset of 4-7 years (52 patients) and juvenile II with an onset of 8-10 years (153). Standing and sitting height, weight, Tanner signs, skeletal age, and menarche were regularly assessed. Topographies and Cobb angles of primary and secondary curves were referred to the pubertal growth diagram. Results Of 205 patients, 99 (48.3%) were operated on. Of 109 curves 45 degrees and were fused. Of 56 curves of 21 degrees to 30 degrees, the surgical rate increased to 75.0%. It was 100% for curves > 30 degrees . Curves > 20 degrees, which increased and were operated on, progressed significantly during peak growth velocity (P = 0.0014). Curves that progressed by 6 degrees to 10 degrees/y were fused in 70.9%, curves which increased > 10 degrees/y in 100% of cases (P = 0.0001). This risk was highest for primary thoracic curves: King V, III, and II (P = 0.0001). There was no difference between males and females or juvenile I and II. Conclusions Curve pattern, Cobb angle at onset of puberty, and curve progression velocity are strong predictive factors of curve progression. Juvenile scoliosis > 30 degrees increases rapidly and presents a 100% prognosis for surgery (curve > 40 degrees to 45 degrees ). Anticipation is necessary if the scoliosis progresses during the first year of puberty. The prediction is difficult for curves of 21 degrees to 30 degrees during the first 2 years of puberty. Curve pattern and curve progression velocity are useful to detect which curves are likely to progress. From this retrospective analysis, spinal fusion could have been indicated earlier sometimes. An earlier intervention is probably preferable to obtain better curve reduction on a supple spine, even if a perivertebral fusion is necessary. We use the 3 parameters for operative indications. If an early spinal fusion leads to better curve correction needs to be verified on prospective data.

Association of estrogen receptor gene polymorphisms with susceptibility to adolescent idiopathic scoliosis.

Abstract: STUDY DESIGN A case-control study is presented. OBJECTIVE To investigate the association of estrogen receptor gene polymorphisms with adolescent idiopathic scoliosis (AIS) risk. SUMMARY OF BACKGROUND DATA Previous studies have shown that genetic factors are important in the pathogenesis of idiopathic scoliosis. Only 1 publication suggested that XbaI site polymorphism was associated with curve severity of idiopathic scoliosis. However, to our knowledge, the relationship of estrogen receptor gene polymorphisms and the individual susceptibility to idiopathic scoliosis has not been studied. METHODS This study included 202 patients with AIS and 174 healthy controls. Height, menarche status, curve pattern, Cobb angle, and Risser sign in female patients were recorded. There were 2 polymorphic loci, PvuII and XbaI locus, of estrogen receptor analyzed by restriction fragment length polymorphisms. RESULTS The frequency of XX genotype was significantly higher in patients than that in controls (P = 0.005). The X allele appeared to be overrepresented in patients compared with controls (P = 0.001). Furthermore, the frequencies of XX genotype in female patients whose height was > or = 160 cm and Cobb angle > or = 40 degrees were higher than those whose height was <160 cm and Cobb angle <40 degrees (P = 0.001 and P < 0.001, respectively). CONCLUSIONS The XbaI site polymorphism of estrogen receptor gene may be associated with a risk of AIS.

Reliabilities of and correlations among five standard methods of assessing the sagittal alignment of the cervical spine.

Abstract: Study design The reliabilities of and correlations among 5 standard methods of assessing cervical sagittal alignment were evaluated. Objective To investigate the reliabilities of and correlations among 5 standard methods of assessing cervical sagittal alignment. Summary of background data Although various cervical sagittal alignment assessment methods are widely used, their relative reliability and intercorrelation have not been reported. Methods From 442 lateral cervical radiographs, 40 with lordotic, 40 with straight or sigmoid, and 40 with kyphotic alignment were selected. Two orthopedic surgeons independently evaluated the sagittal alignment in each group twice using CCL, C1-C7 Cobb, C2-C7 Cobb, sagittal tangent, and the Ishihara methods. Intraobserver and interobserver reliabilities were confirmed and the correlations among the 5 methods were measured. Results Intraobserver and interobserver reliabilities for all 5 methods were good. In the lordotic group, the correlations among all 5 methods were consistently strong (r = 0.731 to 0.922). In the straight or sigmoid group, the correlations were weak to moderate among the CCL, C2-C7 Cobb, sagittal tangent, and Ishihara methods but tended to be weak between these 4 methods and the C1-C7 Cobb method (r = -0.245 to 0.777). In the kyphotic group, the correlations were also weak to moderate among the same 4 methods, and were statistically insignificant between them and the C1-C7 Cobb. Conclusions The correlations among the CCL, C1-C7 Cobb, C2-C7 Cobb, sagittal tangent, and Ishihara methods are strong when lordosis is retained; otherwise, they are moderate to poor. In the kyphotic group, C1-C7 Cobb has no significant correlation with the other 4 methods.

Altered sensory-weighting mechanisms is observed in adolescents with idiopathic scoliosis

Abstract: Background Scoliosis is the most common type of spinal deformity. In North American children, adolescent idiopathic scoliosis (AIS) makes up about 90% of all cases of scoliosis. While its prevalence is about 2% to 3% in children aged between 10 to 16 years, girls are more at risk than boys for severe progression with a ratio of 3.6 to 1. The aim of the present study was to test the hypothesis that idiopathic scoliosis interferes with the mechanisms responsible for sensory-reweighting during balance control.

Comparison of Cobb angles in idiopathic scoliosis on standing radiographs and supine axially loaded MRI.

Abstract: Study design Prospective, patient controlled. Objective To compare Cobb angles in idiopathic scoliosis between standing radiographs and a nonradiographic procedure. Summary of background data Repeated radiographic examinations at young age may increase the risk for breast cancer in adulthood. MRI images the spine satisfactorily but is cumbersome in standing. A harness supplying axial load to a lying subject simulates the standing radiograph appearance of the lumbar spine. Methods Thirty patients with idiopathic scoliosis greater than 20 degrees performed a routine posteroanterior and lateral standing thoracolumbar spine radiograph and an MRI in supine position without and with axial loading. Results Mean Cobb angle for the major curve was 31 degrees on standing radiographs, 23 degrees on nonloaded supine MRI, and 31 degrees on supine loaded MRI. Axially loaded, compared with nonloaded, MRI increased the Cobb angle by 8 degrees. The mean difference between standing radiograph and supine axially loaded MRI was 0 degrees, with an intermethodologic variation(s) of 3.4 degrees. Radiographic and MRI (axially loaded) Cobb angles correlated positively (r = 0.78). Conclusions Axial loading on supine MRI produces coronal Cobb angles similar to standing radiographs. This is a way to acquire reliable Cobb angles without radiation in the monitoring of idiopathic scoliosis.

Degenerative lumbar scoliosis: radiographic correlation of lateral rotatory olisthesis with neural canal dimensions.

Abstract: Study design A radiographic review of 78 consecutive patients with degenerative rotatory lumbar scoliosis. Objective To assess the correlation between rotary olisthesis and neural canal dimensions using radiographic indexes and to establish a gradation system of lateral rotatory olisthesis. Summary of background data Degenerative scoliosis is a three-dimensional deformity often associated with spinal stenosis, although the association is not well defined. Methods A total of 78 consecutive patients (average age, 69 years) with de novo degenerative scoliosis (79% lumbar, 21% thoracolumbar; average curve, 25 degrees) were studied with plain radiographs and MRI at presentation. Radiographic measurements included lateral translation, anteroposterior olisthesis, Cobb angle, and intervertebral rotation (Nash-Moe grade difference). Computerized measurements of MRI included dural sac cross-sectional area and anteroposterior diameter, minimum subarticular height, and foramen cross-sectional area bilaterally (convexity and concavity). Measurements were conducted twice on each lumbar level (total, 312) and the average was recorded. Results Lateral translation 5 mm or less (Grade I) was associated with Nash-Moe change 0 (23%) or I (77%), lateral translation 6-10 mm (Grade II) was coupled with Nash-Moe change 0 (20%) or I (80%) and lateral deviation more than 11 mm (Grade III) was associated with I (76%) or II (24%) Nash-Moe change. Maximum intervertebral rotation tended to be at either L2-L3 (48%) or L3-L4 (39%). Increased lateral translation was associated with increased intervertebral rotation (r = 0.37, P 0.05) between indexes of rotary olisthesis and foraminal area or subarticular height. Cross-sectional foraminal area and subarticular height were significantly larger in the convexity than in the concavity of the scoliotic levels. Conclusions In degenerative scoliotic curves, lateral translation is associated with rotation. Increased rotary olisthesis does not lead to decreased dural sac area. Anteroposterior olisthesis is inversely correlated to the dural sac anteroposterior diameter and cross-sectional area. With increased segmental Cobb angle, foraminal cross-sectional area enlarges in the convexity and does not decrease in the concavity. Presence of intervertebral rotation alone does not appear to be associated with reduced neural canal dimensions. Ligamentum flavum hypertrophy, posterior disc bulging, and bony overgrowth are more likely to contribute to stenosis irrespective of scoliosis.

Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis.

Abstract: A prospective clinical and radiographic evaluation of 33 consecutive patients with severe and rigid idiopathic scoliosis (average Cobb angle 93°, flexibility on bending films 23%) were treated with combined anterior and posterior instrumentation with a minimum follow-up of 2 years. All patients underwent anterior release and VDS-Zielke Instrumentation of the primary curve. In highly rigid scoliosis, this was preceded by a posterior release. Finally, posterior correction and fusion with a multiple hook and pedicle screw construct was performed. Thirty patients were operated in one stage, three patients in two stages. Preoperative curves ranged from 80 to 122° Cobb angle. Frontal plane correction of the primary curve averaged 67% with an average loss of correction of 2°. The apical vertebral rotation of the primary curve was corrected by 49%. In all but three patients, sagittal alignment was restored. There were no neurological complications, deep wound infections or pseudarthrosis. Combined anterior and posterior instrumentation is safe and enables an effective three-dimensional curve correction in severe and rigid idiopathic scoliosis.

Effectiveness of the Providence nighttime bracing in adolescent idiopathic scoliosis: a comparative study of 36 female patients

Abstract: The aim of the study was to assess the results of treatment of adolescent idiopathic scoliosis (AIS) with the Providence nighttime brace at 1.8 years after discontinuation of bracing. A total of 36 consecutive female patients with an average Cobb angle of 28.4° and an apex below T 10 were studied prospectively. For comparisons, 36 matched patients treated with the Boston full-time brace were studied retrospectively. With the Providence night brace an average of 92% for brace correction of the primary curve was achieved and during follow-up progression of the curve >5° occurred in 27% of the patients. In the control group of the Boston full-time brace patients, brace correction was 50% and the progression of the major curve occurred in 22% of the patients. We conclude that the Providence night brace may be recommended for the treatment of AIS with curves less than 35° in lumbar and thoracolumbar cases.

Improving excellence in scoliosis rehabilitation: A controlled study of matched pairs

Abstract: Objectives: Physiotherapy programmes so far mainly address the lateral deformity of scoliosis, a few aim at the correction of rotation and only very few address the sagittal profile. Meanwhile, there is evidence that correction forces applied in the sagittal plane are also able to correct the scoliotic deformity in the coronal and frontal planes. So it should be possible to improve excellence in scoliosis rehabilitation by the implementation of exercises to correct the sagittal deformity in scoliosis patients. An exercise programme (physio-logic® exercises) aiming at a physiologic sagittal profile was developed to add to the programme applied at the centre or to replace certain exercises or exercising positions.Material and methods: To test the hypothesis that physio-logic® exercises improve the outcome of Scoliosis Intensive Rehabilitation (SIR), the following study design was chosen: Prospective controlled trial of pairs of patients with idiopathic scoliosis matched by sex, age, Cobb angle and curve pat...

Correction of Neuromuscular Scoliosis in Patients With Preexisting Respiratory Failure

Abstract: STUDY DESIGN: A prospective observational study in scoliosis patients who were on noninvasive night ventilation for respiratory failure. OBJECTIVE: To report the results of spinal deformity correction in a group of patients with progressive scoliosis and rare forms of muscular dystrophy/myopathy with respiratory failure who were on nocturnal ventilatory support at the time of surgery. SUMMARY OF BACKGROUND DATA: This is the first study on the results of deformity correction in a series of patients on ventilatory support. MATERIALS AND METHODS: Eight patients (6 males, 2 females) presented with progressive scoliosis and respiratory failure. The mean age at surgery was 12 years (range, 8-15 years). The mean follow-up was 48 months (range, 12-80 months). Outcome measures include lung function (spirometry), overnight pulse oximetry, Cobb angles, duration of stay in Intensive care (ICU), and the total hospital stay. RESULTS: The mean stay in the ICU was 2.7 days (range, 2-5 days). The mean hospital stay was 14.2 days (range, 10-21 days). The mean preoperative Cobb angle was 70.2 degrees (55 degrees -85 degrees ). This changed to 32 degrees (16 degrees -65 degrees ) after surgery (P = 0.0002). The mean vital capacity at the time of surgery was 20% (range, 13%-28%). The mean vital capacity of patients at last follow-up was 18% (range, 10%-31%). The desaturation noted on the preventilation overnight oximetry was reversed by nocturnal ventilation. All patients recovered well following surgery with no major cardiac or pulmonary complications. CONCLUSION: Patients with preexisting respiratory failure on nocturnal noninvasive ventilation can be safely operated for deformity correction. This can help to significantly improve their quality of life.

Comparing a supine radiologic versus standing clinical measurement of kyphosis in older women: the Fracture Intervention Trial.

Abstract: Study Design A study of agreement between different measures of kyphosis, a clinical standing measure (Debrunner kyphometer; Protek AG, Bern, Switzerland) versus a supine radiologic measure (Cobb angle).

Computer-assisted algorithms improve reliability of King classification and Cobb angle measurement of scoliosis.

Abstract: Study design Interobserver and intraobserver reliability study of improved method to evaluate radiographs of patients with scoliosis. Objective To determine the reliability of a computer-assisted measurement protocol for evaluating Cobb angle and King et al classification. Summary of background data Evaluation of scoliosis radiographs is inherently unreliable because of technical and human judgmental errors. Objective, computer-assisted evaluation tools may improve reliability. Methods Posteroanterior preoperative radiographic images of 27 patients with adolescent idiopathic scoliosis were each displayed on a computer screen. They were marked 3 times in random sequence by each of 5 evaluators (observers) who marked 70 standardized points on the vertebrae and sacrum in each radiograph. A computer program (Spine 2002;27:2801-5) that identified curves, calculated Cobb angles, and generated the King et al classification automatically analyzed coordinates of these points. The interobserver and intraobserver variability of the Cobb angle and King et al classification evaluations were quantified and compared with values obtained by unassisted observers. Results Average Cobb angle intraobserver standard deviation was 2.0 degrees for both the thoracic and lumbar curves (range 0.1 to 8.3 degrees for different curves). Interobserver reliability was 2.5 degrees for thoracic curves and 2.6 degrees for lumbar curves. Among the 5 observers, there was an inverse relationship between repeatability and time spent marking images, and no correlation with image quality or curve magnitude. Kappa values for the variability of the King et al classification averaged 0.85 (intraobserver). Conclusions Variability of Cobb measurements compares favorably with previously published series. The classification was more reliable than achieved by unassisted observers evaluating the same radiographs. The same principles may be applicable to other radiographic measurement and evaluation procedures.

Geometric and electromyographic assessments in the evaluation of curve progression in idiopathic scoliosis

Abstract: Study Design. The natural history of patients with idiopathic scoliosis was analyzed radiographically and electromyographically in a prospective longitudinal study. Objectives. To identify changes in geometric variables and the sequence in which these changes occur during curve progression in the natural history of patients with idiopathic scoliosis. In addition, to study the relationship between several geometric variables and electromyographic (EMG) measurements to determine their predictive value as risk factors to curve progression of the scoliotic deformity. Summary of Background Data. The main area of concern in treating children with adolescent idiopathic scoliosis is the unpredictability of curve progression during the early development of the deformity. Methods. The changes in radiographic geometric and EMG variables between the first presentation and consecutive 4-6-month follow-up periods were analyzed in 105 patients with idiopathic scoliosis. Statistical analyses were performed to elucidate in more detail how spinal geometry evolves during curve progression. Results. Curve severity was associated with remaining growth potential expressed as an increasing spinal growth velocity (SGV). With increasing SGV, an enhanced EMG activity at the lower part on the convex side of the curve expressed as EMG ratio was found. High EMG ratio was associated with increased axial rotation and diminished kyphosis before the rapid increase in Cobb angle. Lateral deviation, wedge angle, and axial rotation all increased during periods of progression. Changes in tilt angle and lordosis were not associated with curve progression. Conclusions. In the natural history of idiopathic scoliosis, SGV and EMG ratio at the lower end vertebra are prominent risk factors of curve progression. The asymmetric muscle activity is associated with increased axial rotation, which in its turn is associated with increasing Cobb angle and diminishing kyphosis. The combination of these variables provides insight in the physiologic and 3-dimensional biomechanical evolution of the natural history of curve progression in idiopathic scoliosis.

Growth hormone therapy and scoliosis in patients with Prader-Willi syndrome.

Abstract: Growth hormone (GH) therapy for short stature in patients with Prader-Willi syndrome (PWS) has started worldwide, and various favorable effects have been reported. However, the possibility of progression of scoliosis arises as a new problem of the GH therapy. In this study, we analyzed whether 72 patients who have been followed up in our hospital have such a problem. They included 46 males and 26 females (41 patients with the GH therapy and 31 without it) aged from one to 49 years. Consequently, 33 (45.8%) of 72 patients had scoliosis with the Cobb angle of >10 degrees. Twenty (48.8%) of forty-one patients who received a GH therapy and 13 (41.9%) of 31 patients without the therapy had scoliosis, the frequency of scoliosis between the two groups showing no statistical difference (P = 0.56). Height velocity of scoliotic and non-scoliotic patients during the first year of the therapy was 8.59 +/- 1.92 and 10.70 +/- 2.54 cm, respectively, showing a significant difference (P < 0.001). This shows that accelerated height velocity may not induce scoliosis. Comparison of starting age of a GH treatment revealed that non-scoliotic patients received the therapy earlier than scoliotic patients (P = 0.021). Among 20 scoliotic patients who received the GH therapy, the degree of scoliosis progressed during the therapy in six patients, improved in three and fluctuated in one. Many patients showed progression of scoliosis with age irrespective of the use of GH, and some patients improved their scoliosis during the GH therapy. These findings showed that a GH therapy increases height velocity of PWS patients but does not necessarily develop scoliosis, and early start of the therapy may not be an exacerbating factor of scoliosis.

Dynamic magnetic resonance imaging in assessing lung volumes, chest wall, and diaphragm motions in adolescent idiopathic scoliosis versus normal controls.

Abstract: STUDY DESIGN Dynamic breath-hold (BH)- magnetic resonance (MR) imaging was used to evaluate lung function in adolescent idiopathic scoliosis (AIS). OBJECTIVES Changes in lung volume, chest wall, and diaphragmatic motions were evaluated in AIS patients and compared with normal controls. SUMMARY OF BACKGROUND DATA Little is known about whether pulmonary function impairment in AIS is related to restriction of lung volume, poor chest wall expansibility, or impaired diaphragmatic motion. This is a study on the underlying pathophysiology of the abnormal pulmonary function in AIS using the ultrafast BH-MR imaging technique. METHODS Forty-two patients with moderate to severe right thoracic scoliosis (Cobb angle, 40 degrees -98 degrees), 22 patients with mild right thoracic scoliosis (Cobb angle 10 degrees -30 degrees), and 12 healthy subjects (age ranged, 11-18 years; all girls) were recruited for the following assessments: 1) inspiratory, expiratory, and change in lung volume; 2) change in anteroposterior (AP) and transverse (TS) diameter of the chest wall at two levels: carina and apical vertebra level; and 3) change in diaphragmatic heights. RESULTS Inspiratory, expiratory lung volume and diaphragmatic heights were significantly reduced in the severe scoliosis group (P < 0.05), but the change in lung volume was not affected. There was no significant difference in the change of AP or TS diameter of the chest wall as well as diaphragmatic motions among groups. CONCLUSION Impairment in lung function in AIS patients is predominantly due to restriction of lung volume.

Scoliosis treatment using spinal manipulation and the Pettibon Weighting System™: a summary of 3 atypical presentations

Abstract: Given the relative lack of treatment options for mild to moderate scoliosis, when the Cobb angle measurements fall below the 25–30° range, conservative manual therapies for scoliosis treatment have been increasingly investigated in recent years In this case series, we present 3 specific cases of scoliosis Patient presentation, examination, intervention and outcomes are detailed for each case The types of scoliosis presented here are left thoracic, idiopathic scoliosis after Harrington rod instrumentation, and a left thoracic scoliosis secondary to Scheuermann's Kyphosis Each case carries its own clinical significance, in relation to clinical presentation The first patient presented for chiropractic treatment with a 35° thoracic dextroscoliosis 18 years following Harrington Rod instrumentation and fusion The second patient presented with a 22° thoracic levoscoliosis and concomitant Scheuermann's Disease Finally, the third case summarizes the treatment of a patient with a primary 37° idiopathic thoracic levoscoliosis Each patient was treated with a novel active rehabilitation program for varying lengths of time, including spinal manipulation and a patented external head and body weighting system Following a course of treatment, consisting of clinic and home care treatments, post-treatment radiographs and examinations were conducted Improvement in symptoms and daily function was obtained in all 3 cases Concerning Cobb angle measurements, there was an apparent reduction in Cobb angle of 13°, 8°, and 16° over a maximum of 12 weeks of treatment Although mild to moderate reductions in Cobb angle measurements were achieved in these cases, these improvements may not be related to the symptomatic and functional improvements The lack of a control also includes the possibility of a placebo effect However, this study adds to the growing body of literature investigating methods by which mild to moderate cases of scoliosis can be treated conservatively Further investigation is necessary to determine whether curve reduction and/or manipulation and/or placebo was responsible for the symptomatic and functional improvements noted in these cases

Anterior dual rod instrumentation in idiopathic thoracic scoliosis.

Abstract: For anterior correction and instrumentation of thoracic curves single rod techniques are widely used. Disadvantages of this technique include screw pullouts, rod fractures and limited control of kyphosis. This is a prospective study of 23 consecutive patients with idiopathic thoracic scoliosis treated with a new anterior dual rod system. Aim of the study was to evaluate the safety and efficacy of this new technique in the surgical treatment of idiopathic thoracic scoliosis. To the best knowledge of the authors, this is the largest series on dual rod dual screw instrumentation over the entire fusion length in thoracic scoliosis. Twenty-three patients with an average age of 15 years were surgically treated with a new anterior dual rod system through a standard open double thoracotomy approach. Average clinical and radiological follow-up was 28 months (24–46 months). Fusion was carried out mostly from end-to-end vertebra. The primary curve was corrected from 66.6° to 28.3° (57.5% correction) with an average loss of correction of 2.0° at Cobb levels and of 1.3° at fusion levels. Spontaneous correction of the secondary lumbar curve averaged 43.2% (preoperative Cobb angle 41.2°). The apical vertebral rotation was corrected by 41.1% with a consecutive correction of the rib hump of clinically 66.7%. The thoracic kyphosis measured 29.2° preoperatively and 33.6° at follow-up. In seven patients with a preoperative hyperkyphosis of on average 47.3° thoracic kyphosis was corrected to 41.0°. This new instrumentation enables an entire dual rod instrumentation over the whole thoracic fusion length. It offers primary stability without the need of postoperative bracing. Dual screw dual rod instrumentation offers the advantages of a high screw pullout resistance, an increased overall stability and satisfactory sagittal plane control.

The influence of brace on quality of life of adolescents with idiopathic scoliosis.

Abstract: Traditionally, the effectiveness of brace treatment on adolescents with IS is based on curve magnitude and to some extent on vertebral rotation and rib hump. QoL has been introduced in the recent years in order to evaluate the effectiveness of brace treatment. The aim of the study is to determine the influence of brace on quality of life (QoL) of adolescents with idiopathic scoliosis (IS).Thirty-six patients with a mean age of 13,9 (range 12-17) years old, a mean Cobb angle 28,2 degrees (range 19-38 degrees and a mean angle of trunk inclination (ATI) 7,8 degrees (range 4 degrees -17 degrees) who were treated conservatively with a modified Boston brace for a minimum of 2 years, filled the form of Brace Questionnaire (BrQ). BrQ is a validated, disease specific instrument, its score ranges from 20 to 100 and higher BrQ scores mean better quality of life. Correlations were determined by the Pearson correlation coefficient, with p<0.05 considered significant. Mean overall score of BrQ was 73,8 (SD 15. 8). Lower scores were observed in physical functioning (55,4, SD 15,9) and vitality (55, SD 25,9). School activity (98, SD 4,4) was affected less. The Cobb angle correlated significantly only with school activity (p<0,02). The ATI correlated significantly with social functioning (thoracolumbar ATI, p<0.038; lumbar ATI, p<0.035). There were no significant correlations between either Cobb angle or ATI with BrQ overall scores. Cobb angle and ATI significantly influenced school activity and social functioning respectively, but not general health perception, physical functioning, emotional functioning, vitality, bodily pain and self-esteem and aesthetics.

Detection of adolescent idiopathic scoliosis

Abstract: The aim of our study was to evaluate the current methods of detection of adolescent idiopathic scoliosis. Data were collected from 100 consecutive patients with adolescent idiopathic scoliosis referred to the Scoliosis clinic in 2000. The age of the patient, the Cobb angle at presentation and the person who first noticed the deformity were recorded. Sixty three percent of the cases were detected by family or friends. The number of cases being detected at school had dropped considerably to 8%. Fifty six percent of all cases presented with a Cobb angle of more than 40 degrees. Our study shows that the most common method of detection was by family and friends. Seventy percent of these cases were detected when the deformity was advanced with Cobb angles of more than 40 degrees. There was a drop in the number of cases detected at school when most of the curves are at an earlier stage. We believe that greater awareness is needed in the community, for earlier recognition of idiopathic scoliosis.

Spinal deformity after combined thoracotomy and sternotomy for congenital heart disease.

Abstract: UNLABELLED Patients with congenital heart disease are at an increased risk to develop scoliosis. The purpose of this study was to determine the incidence of spinal deformity in patients after thoracotomy and sternotomy for congenital heart disease. METHODS Sixty-eight patients underwent thoracotomy followed by a sternotomy and met inclusion criteria. The medical records were reviewed to gather demographic data and medical and surgical history. Serial radiographs were reviewed. RESULTS Scoliosis developed in 26% of the patients (10 boys, 8 girls). The mean Cobb angle was 40 degrees (range, 15-78 degrees). The mean age at diagnosis of scoliosis was 10.7 years (range, 2.9-17 years). The mean follow-up was 14.9 years (range, 5-20 years). Twelve percent (8 patients) required posterior spinal fusion. A kyphotic deformity developed in 21% (14 patients). In patients with scoliosis, the mean kyphosis was 38 degrees (range, 2-88 degrees). Patients with a cyanotic cardiac condition had a 4-fold incidence of scoliosis. There was no correlation between the development of scoliosis or kyphosis and the age at time of procedures, number of surgeries, sex, heart size, or side of the aortic arch. CONCLUSIONS The risk of developing scoliosis in children with congenital heart disease is more than 10 times that of idiopathic scoliosis. Spinal deformities, including scoliosis and/or hyperkyphosis, were found in 38% of the patients. Curves develop at a younger age, which increases the risk of progression. The sagittal alignment in scoliosis patients tends toward hyperkyphosis. The thoracic spine receives a "double hit" when both procedures are combined.

Screening for scoliosis: Do we have indications for effectiveness?

Abstract: Objective The effectiveness of screening for scoliosis has not been established. This study investigated whether patients with adolescent idiopathic scoliosis detected by screening are detected in an earlier stage of the clinical course, and whether these patients have better outcome than otherwise detected patients. Setting The study is a retrospective follow-up study of patients with adolescent idiopathic scoliosis who had completed treatment with a brace, by surgery, or with a brace followed by surgery. Of the 143 patients (born on or after 1 January 1984) consecutively recruited from 12 hospitals in the Netherlands, 125 (87%) agreed to participate. Of these, 51 patients were treated with a brace only and 74 patients were operated on. Screening for scoliosis is carried out in 80% of Dutch children. Methods Data on being screen detected or otherwise detected and Cobb angle at diagnosis were collected using youth health-care files, medical files and interviews by telephone with the patients. Results About 55% of the patients were detected by screening (programme sensitivity). Screen- detected patients had a significantly smaller Cobb angle at diagnosis (281 versus 401; Po0.01) and had a 73% lower chance of having had surgery (45% versus 75%; Po0.01) than otherwise-detected patients. Conclusion In the present study, two essential prerequisites necessary for a screening programme for scoliosis to be effective have been met. However, definite proof of the effectiveness of screening still needs to be established because length bias and over-treatment bias cannot be ruled out using this design.

Asymmetric expression of melatonin receptor mRNA in bilateral paravertebral muscles in adolescent idiopathic scoliosis.

Abstract: To investigate the change of melatonin receptor mRNA expression in bilateral paravertebral muscles in AIS, congenital scoliosis (CS) and controls in order to analyze its relationship to the pathogenesis of AIS. 20 cases with average age of 15.1 +/- 2.2 years and average Cobb angle of 56.2 degrees +/- 16.1 degrees were included in AIS group. 12 cases with average age of 11.6 +/- 3.2 years and average Cobb angle of 59.2 degrees +/- 33.3 degrees were included in congenital scoliosis (CS) group. 10 cases without scoliosis comprised a control group. The mRNA expression of melatonin receptor subtype MT1 and MT2 were detected by RT-PCR method. The MT2 mRNA expression on the concave side of paravertebral muscle was higher than that on the convex side in AIS and CS groups (p<0.05), but the MT1 mRNA expression showed no significant difference. In the AIS group, the ratio of MT2 mRNA expression on the concave side compared with the convex side in cases with a Cobb angle less than 50 degrees and cases with a Cobb angle greater than 50 degrees showed no significant difference. The melatonin receptor expression in bilateral paravertebral muscles in AIS is asymmetric, which may be a secondary change.

Deformity related stress in adolescents with AIS.

Abstract: UNLABELLED A new questionnaire (The Bad Sobernheim Stress Questionnaire BSSQ) has been developed to assess the psychological stress scoliosis patients develop as a consequence of their deformity. The aim of this study was to determine this stress level in a sample of adolescents with scoliosis. MATERIALS AND METHODS 206 Patients were recruited to the study and completed a questionnaire (8 items). The average age was 15.7 years with an average Cobb angle of 35.8 degrees. All subjects returned a fully completed questionnaire. Plausibility of the results was assessed by examining for consistent responses to two plausibility questions. RESULTS The average stress value was 19.97 / 24, which can be regarded as "low stress". The average stress value in the group meeting the plausibility threshold (n = 155) was 21 / 24 while the average stress value in the group not meeting the threshold (n = 51) was 15.9 / 24, regarded as "medium stress". This correlated negatively with the Cobb angle (r = -.54; p < 0,001). The Cobb angle / test value correlation was highest in thoracic curves (n = 87; r = -.49; p < 0,001) and lowest in double major curves (n = 46; r = -.27; p = 0,03). CONCLUSIONS Adolescents with scoliosis have on average only "low stress" associated with their deformity. Not fulfilling a plausibility threshold seems to be a predictor for more stress associated with the scoliotic deformity.

Computerized assessment of sagittal curvatures of the spine: comparison between Cobb and tangent circles techniques.

Abstract: Objective The tangent circles technique has been proposed as an alternative to the Cobb angle technique to assess sagittal curves of the spine. However, it has never been compared directly to the Cobb technique. This study compares the reproducibility and clinical relevance of the maximum Cobb angle and tangent circles techniques. Method Standing sagittal radiographs of the spine of 10 adolescents with idiopathic scoliosis, 10 adolescents with spondylolisthesis, and 10 healthy adolescents were used. Thoracic kyphosis (TK) and lumbar lordosis (LL) were measured by 3 observers using the maximum Cobb angle and the tangent circles techniques. Intra- and interobserver intraclass correlation coefficients (ICCs) were calculated. Result Intra- and interobserver ICCs for TK were 0.88 and 0.85, respectively, for the maximum Cobb angle technique, and 0.94 and 0.83, respectively, for the tangent circles technique. Intra- and interobserver ICCs for LL were 0.97 and 0.77, respectively, for the maximum Cobb angle technique, and 0.88 and 0.94, respectively, for the tangent circles technique. The 2 techniques were highly correlated for the measurement of the TK (r=0.93) and LL (r=0.88). Conclusion Both techniques provide excellent intra- and interobserver reproducibility. Tangent circles technique may be a good alternative to the Cobb angle technique because it allows the evaluation of the global geometry of sagittal spinal curves, especially when there is limited visibility of bony structures on radiographs.

Clinical and radiological assessment of vertebral rotation in idiopathic scoliosis.

Abstract: Background. Idiopathic scoliosis is a three-dimensional deformity of the spine and the trunk. The principle clinical method of estimation of the rotational deformity in the transversal plane of the body is the measurement of the angle of trunk rotation with a scoliometer. The aim of the study was to investigate the relationship between the angle of trunk rotation and the two radiological parameters: the Perdriolle angle of axial rotation and the Cobb angle of spinal curvature. Material and Methods. 50 children with single or double scoliosis (total of 65 curves) were examined clinically and radiologically. For each patient the angle of trunk rotation was measured with the Bunnell scoliometer, the Cobb angle and the Perdriolle angle were calculated at the a-p standing radiograph. Results. Strong positive linear correlation was found among the three parameters in thoracic curves. The correlation was less important in lumbar curves. Thoracic curves revealed superior values of the angle of trunk rotation and inferior values of the angle of Perdriolle than the lumbar curves matched for Cobb angle. Conclusions. Clinical measurement of the angle of trunk rotation with the use of a scoliometer can predict the value of the angle of the curve in thoracic scoliosis. This might replace a certain amount of radiological examination and reduce the patients' irradiation.

The reciprocal relationship between thoracic and spinal deformity and its effect on pulmonary function in a rabbit model: a pilot study.

Abstract: STUDY DESIGN Investigate the association between growth of the spine and thorax under conditions that create symmetric or asymmetric growth disturbances of the spine or thorax in a growing rabbit. OBJECTIVE Prove growth of the spine and growth of the thorax are directly related. SUMMARY OF BACKGROUND DATA Understanding the association between growth of the thorax and growth of the spine may explain the occurrence of thoracic insufficiency in patients with congenital scoliosis. METHODS Symmetric or asymmetric growth disturbances of the spine or thorax were established in 5-week-old rabbits. During growth of the rabbits, structural changes in the spine, thorax, and lung volume were assessed using serial CT scans. Measures of pulmonary function, spine, and thoracic deformity were related to one another across groups. RESULTS The mean Cobb angle and distortion of the thoracic cage were significantly greater for the unilateral tethered rib group. There were no significant differences in total lung volume among the experimental groups. However, the left/right lung volume ratio was significantly different for the unilateral tethered rib group compared with the control group. CONCLUSIONS Unilateral deformity of the spine or thorax induces both a scoliosis and thoracic cage deformity with asymmetric lung volumes.

Sagittal Configuration of the Spine in Girls with Idiopathic Scoliosis: Progressing rather than Initiating Factor

Abstract: Thoracic hypokyphosis with increasing axial rotational instability is claimed to be a primary factor for the initiation of Idiopathic Scoliosis (IS) according to some authors The objective of this study was to compare the sagittal configuration of the spine in two groups of girls with and without scoliosis in order to determine whether thoracic hypokyphosis and/or lumbar hypolordosis are initiating factors for AIS or not A group of 207 consecutive non-treated girls diagnosed with IS (127 y +/- 18) measured with the Formetric system were compared to a control group of 45 non-scoliotic girls of the same age (124 y +/- 2) The Cobb angle for the whole scoliosis sample was 26 degrees +/- 136 and the angle of axial rotation 124 degrees +/- 77 (Perdriolle) The patient group was divided into subgroups by their Cobb angle ie G1 (5 degrees -19 degrees, n=79), G2 (20 degrees -34 degrees, n=81), G3 (