Showing papers on "Cobb angle published in 2007"

Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries.

Abstract: STUDY DESIGN Randomized clinical trial (level I evidence). OBJECTIVE To compare the accuracy of non-navigation and Iso-C based navigation in pedicle screw fixation in thoracic spine deformities. SUMMARY OF BACKGROUND DATA Thoracic pedicle screw insertion for spinal deformity correction can be associated with increased pedicle breaches. Iso-C based navigation has been reported to improve the accuracy of pedicle screw placement, but its use in the presence of deformity has not been reported. METHODS Twenty-seven patients with scoliosis and 6 patients with kyphosis had a total of 478 thoracic pedicle screws. The average Cobb angle was 58.4 degrees +/- 8 degrees (range 50 degrees -80 degrees), and the mean kyphotic angle was 54.6 degrees +/- 4 degrees (range 51 degrees -76 degrees). By random allocation, 17 patients had screw insertion under navigation (242 screws) and 16 under fluoroscopic control (236 screws). The 2 groups were compared for accuracy of screw placement, time for screw insertion, and the number of times the C-arm had to be brought into the field. Two independent blinded observers determined accuracy using postoperative computed tomography assessments. RESULTS There were 54 (23%) pedicle breaches in the non-navigation group as compared to only 5 (2%) in the navigation group (P < 0.001). Thirty-eight screws (16%) in the non-navigation group had penetrated the anterior or lateral cortex compared to 2 screws (0.8%) in the navigation group. Average screw insertion time in the non-navigation group was 4.61 +/- 1.05 minutes (range 1.8-6.5) compared to 2.37 +/- 0.72 minutes (range 1.16-4.5) in navigation group (P < 0.01). The C-arm had to be moved into the operation field on an average of 1.5 +/- 0.25 times (range 1-3) per screw. With single screening data, an average of 11.4 pedicles (range 9-14) could be visualized without necessity to bring the C-arm into operating field again. CONCLUSIONS Iso-C navigation increases accuracy, and reduces surgical time and radiation in thoracic deformity correction surgeries.

Complications of thoracic pedicle screws in scoliosis treatment.

Abstract: Study design A retrospective study. Objective To analyze complications with thoracic pedicle screws in scoliosis treatment at our Department over a 3-year period (1999-2001). Summary of background data The use of pedicle screws remains controversial for thoracic scoliosis for fear of complications. Methods A total of 115 consecutive patients who underwent posterior fusion using 1035 transpedicular thoracic screws were reviewed. All patients presented a main thoracic scoliosis with a mean Cobb angle of 75.4 degrees (range, 60 degrees -105 degrees ). For thoracic screw placement, a mini-laminotomy technique was used, inserting a spatula inside the vertebral canal to palpate the borders of the pedicle. Postoperative CT scan was used in 25 patients (21.7%) to study a total of 311 screws, when the screw position was questionable. Results An independent spine surgeon retrospectively reviewed medical records and radiographs of the patients, at a mean follow-up of 4 years. There were 18 screws misplaced (1.7%) in a total of 13 patients (11.3%). Screw malposition was symptomatic only in 1 patient (pleural effusion and fever) and asymptomatic in the other 12 cases (10.4%). Other complications included intraoperative pedicle fractures in 15 patients (13%), dural tears (without neurologic complications) in 14 cases (12.1%), and superficial wound infections in 2 (1.7%). Another operation for screw removal was performed in 5 patients (4.3%), due to pleural effusion (in 1 case), asymptomatic late lateral loosening of a malpositioned screw (in 1), and the possible future risks related the intrathoracic screw position despite the lack of any symptoms (in 3). Two cases (1.7%) were retreated due to wound infection, without removing instrumentation. There was no loss of correction at follow-up. Conclusions The thoracic pedicle screw placement in scoliosis patients requires utmost caution. The mini-laminotomy technique was beneficial in increasing safety of the procedure with an acceptable incidence of complications.

Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review.

Abstract: STUDY DESIGN : Systematic review of clinical studies. OBJECTIVES : To develop a pooled estimate of the prevalence of surgery after observation and after brace treatment in patients with adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA : Critical analysis of the studies evaluating bracing in AIS yields limited evidence concerning the effect of TLSOs on curve progression, rate of surgery, and the burden of suffering associated with AIS. Many patients choose bracing without an evidence-based estimate of their risk of surgery relative to no treatment. Therefore, such an estimate is needed to promote informed decision-making. METHODS : Multiple electronic databases were searched using the key words "adolescent idiopathic scoliosis," "observation," "orthotics," "surgery," and "bracing." The search was limited to the English language. Studies were included if observation or a TLSO was evaluated and if the sample closely matched the current indications for bracing (skeletal immaturity, age <15 years, Cobb angle between 20 degrees and 45 degrees ). One reviewer (L.A.D) selected the articles and abstracted the data, including research design, type of brace, minimum follow-up, and surgical rate. Additional data concerning inclusion criteria and risk factors for surgery included gender, Risser, age and Cobb angle at brace initiation, curve type, and dose (hours of recommended brace wear). RESULTS : Eighteen studies were included (observation = 3, bracing = 15). All were Level III or IV clinical series. Despite some uniformity in surgical indications, the surgical rates were extremely variable, ranging from 1 surgery of 72 patients (1%) to 51 of 120 patients (43%) after bracing, and from 2 surgeries of 15 patients (13%) to 18 of 47 patients (28%) after observation. When pooled, the bracing surgical rate was 23% compared with 22% in the observation group. Pooled estimates for surgical rate by type of brace, curve type, Cobb angle, Risser sign, and dose were also calculated. CONCLUSION : Comparing the pooled rates for these two interventions shows no clear advantage of either approach. Based on the evidence presented here, one cannot recommend one approach over the other to prevent the need for surgery in AIS. This recommendation carries a grade of D, indicating that the use of bracing relative to observation is supported by "troublingly inconsistent or inconclusive studies of any level." The decision to brace for AIS is often difficult for clinicians and families. An evidence-based estimate of the risk of surgery will provide additional information to use as they weigh the costs and benefits of bracing.

Thoracic Insufficiency Syndrome and Exotic Scoliosis

Abstract: Most spinal curves can be described as standard scoliosis and are due to adolescent idiopathic scoliosis. In patients with standard scoliosis, the thorax is usually spacious, having achieved most of its adult volume through growth, and has near normal vital capacity. Standard scoliosis is characterized on an anteroposterior radiograph by the level and degree of the curve and is treated by bracing or definitive spinal fusion to effect a decrease in the Cobb angle. Treatment has a negligible effect on thoracic growth or long-term pulmonary outcome. Exotic scoliosis describes an early-onset spinal deformity that is more complex in nature, often associated with a thorax that has been distorted by spinal lordosis and curve rotation, thus having a volume-depletion deformity as well as thoracic growth inhibition with indirect adverse effects on lung growth (Fig. 1). Exotic means “foreign,” “outlandish,” or “alien,” and the curves of exotic scoliosis are easily recognizable. In the coronal plane, this scoliosis is not only a “lateral curve” but, from a three-dimensional thoracic viewpoint, can be considered a lateral flexion contracture of the thorax with volume depletion on the concave side and often additional volume depletion on the convex side, in the transverse plane, from a windswept deformity of the thorax. Primary rib-cage abnormalities, such as absent or fused ribs, add further thoracic disability. The typical treatment approaches to spine deformity may be impractical for the treatment of exotic scoliosis because of potential spine and thoracic growth inhibition from early fusion or because of additional comorbidities (e.g., the bone stock may be insufficient or too osteopenic to hold the instrumentation, the patient may be too small for standard spinal implants, or the lung function may be so poor that the patient would not survive surgery). In addition, a spine fusion may be unable to address the three-dimensional …

A pedicle screw construct gives an enhanced posterior correction of adolescent idiopathic scoliosis when compared with other constructs: myth or reality.

Abstract: Study design Tricenter retrospective cohort study of 72 patients who underwent posterior correction of Lenke 1 adolescent idiopathic scoliosis (AIS). Each center represented a single surgeon using only one type of construct. Objective Compare the initial postoperative and 2-year follow-up correction of Lenke 1 AIS curves, after accounting for the preoperative flexibility of the curves. Summary of background data There are multiple reports in literature of the enhanced posterior corrective ability of the pedicle screw in the treatment of AIS. Unfortunately, none of these reports took into account the preoperative flexibility of the curve. It stands to reason that rigid curves will not correct as much as flexible curves irrespective of the nature of the construct. Methods Groups were as follows: Group 1 (proximal and distal hooks and segmental intraspinous collar button wires), 24 patients; Group 2 (proximal hooks, distal screws, and apical sublaminar wires), 23 patients; and Group 3 (pedicle screws only), 25 patients. The postoperative correction percentage was expressed as a ratio of the preoperative flexibility and was termed Cincinnati correction index (CCI). Mathematically speaking the CCI equals (postoperative correction/preoperative erect Cobb angle) divided by (supine bending preoperative correction/preoperative erect Cobb angle). The postoperative sagittal correction was also measured. Results CCI 2 (at 2-year follow-up) for Group 1 was 1.71, for Group 2 was 1.34, and for Group 3 was 1.41. The differences were not statistically significant. Within Group 1, however, there was a statistically significant difference between CCI (1.95) and CCI 2 (1.71), indicating a statistically significant loss of correction over 2 years. However, in terms of absolute values, there was only a 4 degree (average) difference between the initial and the 2-year postoperative Cobb measurement, rendering the loss off correction clinically insignificant. No such statistically or clinically significant differences were noted within Groups 2 and 3. Group 1 and Group 3 constructs further lordosed the curve by 8 degrees and 11 degrees, respectively, whereas the Group 2 construct retained or marginally increased the preoperative kyphosis. Conclusion The Group 3 (pedicle screw only) construct did not give an enhanced correction of Lenke 1 AIS, when the preoperative flexibility of the curve was considered. Also, contrary to popular belief, the pedicle screw construct has a lordosing effect on the thoracic spine. Therefore, we think that there is no significant advantage in using a relatively expensive pedicle screw construct in the correction of Lenke 1 AIS.

Inter- and intraobserver reliability assessment of the Cobb angle: manual versus digital measurement tools.

Abstract: The objective of this study is to determine the intraobserver and interobserver reliability of end vertebra definition and Cobb angle measurement using printed and digital radiographs of 48 patients with scoliosis. The Cobb angle and the end vertebra were assessed by six observers in 48 patients with scoliosis using printed and digital radiographs. Definition of end vertebra and measurement of the Cobb angle was repeated three times with a 3 week interval. Intraclass correlation coefficients (ICC) were used to determine the interobserver and intraobserver reliabilities. 95% prediction limits for the errors in measurements are provided. For the Cobb angle a mean ICC of 0.97 was determined for intra- and interobserver reliability measurement of the printed radiographs. For the electronic radiographs a mean ICC value of 0.93 was determined for interobserver reliability and a mean ICC value of 0.96 for intraobserver reliability. Intraobserver ICC for definition of end vertebrae was 0.8 for both methods. Interobserver ICC was 0.83 for the manual and 0.74 in the digital method. One pitfall in angle measurement implies the Cobb method itself which measures in two dimensions. Until we develop a proper tri-dimensional measuring system an error is introduced. For the Cobb angle measurement the definition of end vertebrae introduces the main source of error. Digital radiography does not improve the measurement accuracy.

Effectiveness of the Spinecor Brace Based on the New Standardized Criteria Proposed by the Scoliosis Research Society for Adolescent Idiopathic Scoliosis

Abstract: The purpose of this prospective observational study was to evaluate the effectiveness of the Dynamic SpineCor brace for adolescent idiopathic scoliosis in accordance with the standardized criteria proposed by the Scoliosis Research Society Committee on Bracing and Nonoperative Management. They proposed these guidelines to make the comparison among studies more valid and reliable. From 1993 to 2006, 493 patients were treated using the SpineCor brace. Two hundred forty-nine patients met the criteria for inclusion, and 79 patients were still actively being treated. Overall, 170 patients have a definitive outcome. All girls were premenarchal or less than 1 year postmenarchal. Assessment of brace effectiveness included (1) percentage of patients who have 5 degrees or less curve progression, and percentage of patients who have 6 degrees or more progression; (2) percentage of patients who have been recommended/undergone surgery before skeletal maturity; (3) percentage of patients with curves exceeding 45 degrees at maturity (end of treatment); and (4) Two-year follow-up beyond maturity to determine the percentage of patients who subsequently underwent surgery. Successful treatment (correction, >5 degrees, or stabilization, +/-5 degrees) was achieved in 101 (59.4%) of the 170 patients from the time of the fitting of the SpineCor brace to the point in which it was discontinued. Thirty-nine immature patients (22.9%) required surgical fusion while receiving treatment. Two (1.2%) of 170 patients had curves exceeding 45 degrees at maturity. One mature patient (2.1%) required surgery within 2 years of follow-up beyond skeletal maturity. The conclusion drawn from these findings is that the SpineCor brace is effective for the treatment of adolescent idiopathic scoliosis. Moreover, positive outcomes are maintained after 2 years because 45 (95.7%) of 47 patients stabilized or corrected their end of bracing Cobb angle up to 2 years after bracing. Therapeutic study-investigating the results of treatment: level II.

Natural history of progressive adult scoliosis.

Abstract: STUDY DESIGN A retrospective analysis of the progression of adult scoliosis. OBJECTIVE To establish an individual prognosis. SUMMARY OF BACKGROUND DATA Most studies have investigated the adolescent scoliosis after skeletal maturity, but the results are discordant. METHODS Two senior physicians measured all the radiographs of 51 adults who had a progressive scoliosis. The mean delay between the first and last radiograph was 27 years. For each patient, a diagram was established with the Cobb angle on the y-axis and the corresponding age on the x-axis. We noted the age and Cobb angle of the first radiograph showing a rotatory subluxation and the age of menopause. We used linear regression and the analysis of variance test. RESULTS The mean number of radiographs per patient was 6. The linear test was significant in 46 patients. Two main types exist. Type A is an adolescent scoliosis that continues to progress after skeletal maturity, whereas type B appears or progresses late. There were 13 type A and 20 type B of which 11 progressed around menopause. Significant differences were noted between groups A and B regarding loss of body height (group A, 5 cm and group B, 9.5 cm; P < 0.001), rate of progression in lumbar single and thoracolumbar single curves (group A, 0.82 degrees/y and group B, 1.64 degrees/y; P < 0.004), Cobb first radiograph (group A, 37 degrees and group B, 20 degrees; P < 0.0001), age rotatory subluxation (group A, 42 years and group B, 56 years; P < 0.0001), and Cobb rotatory subluxation (group A, 52 degrees and group B, 29 degrees; P < 0.0001). CONCLUSIONS The originality of our study is the diagram. We demonstrated that the rate of progression was linear, and it can be used to establish an individual prognosis. The diagrams visualized 2 main distinct types. There was a significantly faster rate of progression in type B. In type A, rotary subluxation occurs during progression of the curvature. In type B, it seems to be the initial event. Menopause is a period of deterioration in type B.

Radiographic measures of thoracic kyphosis in osteoporosis: Cobb and vertebral centroid angles

Abstract: Objective Several measures can quantify thoracic kyphosis from radiographs, yet their suitability for people with osteoporosis remains uncertain. The aim of this study was to examine the validity and reliability of the vertebral centroid and Cobb angles in people with osteoporosis.

Is the T9, T11, or L1 the more reliable proximal level after adult lumbar or lumbosacral instrumented fusion to L5 or S1?

Abstract: Study design A retrospective comparison study. Objective To compare the postoperative proximal junctional change and revision prevalence as influenced by 3 different proximal levels after adult lumbar deformity instrumented fusion from the distal thoracic/upper lumbar spine (T9-L2) to L5 or S1. Summary of background data Few comparative studies on postoperative sagittal plane change and revision prevalence as influenced by 3 different proximal levels after adult lumbar deformity instrumented fusion from the distal thoracic/upper lumbar spine (T9-L2) to L5 or S1 have been published. Many surgeons have hypothesized that stopping proximally in the upper lumbar spine (L1 or L2) or the thoracolumbar junction (T11 or T12) would lead to a high percentage of rapid proximal degeneration, kyphosis, and decompensation because of the concentration of stress on these relatively mobile segments. Therein, many surgeons have felt it is unsafe to stop at these regions of the spine and it is better to always stop proximally at T9 or T10. Methods A clinical and radiographic assessment in addition to revision prevalence of 125 adult lumbar deformity patients (average age 57.1 year) who underwent long (average 7.1 vertebrae) segmental posterior spinal instrumented fusion from the distal thoracic/upper lumbar spine (T9-L2) to L5 or S1 with a minimum 2-year follow-up (2-19.8 year follow-up) were compared as influenced by T9-T10 (group 1, n = 37), T11-T12 (group 2, n = 49), and L1-L2 (group 3, n = 39) proximal fusion levels. The revision prevalence and sagittal Cobb angle change at the proximal junction after surgery were compared. Results Three groups demonstrated nonsignificant differences in the prevalence of proximal junctional kyphosis (group 1 51% vs. group 2 55% vs. group 3 36%, P = 0.20) and revision (group 1 24% vs. group 2 24% vs. group 3 26%, P = 0.99) at the ultimate follow-up. Subsequent proximal junctional angle and sagittal vertical axis changes between the ultimate follow-up and preoperative (P = 0.10 and 0.46 respectively) were not significantly different. The SRS total and all subscale outcomes scores among the 3 groups did not demonstrate significant differences (P > 0.50). Conclusion Three different proximal fusion levels did not demonstrate significant radiographic and clinical outcomes or revision prevalence after surgery. Therefore the more distal proximal fusion level at a neutral and stable vertebra may be satisfactory.

A versatile 3D reconstruction system of the spine and pelvis for clinical assessment of spinal deformities

Abstract: This paper presents a three-dimensional (3D) reconstruction system of the human spine for the routine evaluation of musculoskeletal pathologies like idiopathic scoliosis. The main objective of this 3D reconstruction system is to offer a versatile and robust tool for the 3D analysis of spines in any healthcare centre with standard clinical setup using standard uncalibrated radiographic images. The novel system uses a self-calibration algorithm and a weak-perspective method to reconstruct the 3D coordinates of anatomical landmarks from bi-planar radiographic images of a patient’s trunk. Additionally, a small planar object of known dimensions is proposed to warrant an accurately scaled model of the spine. In order to assess the validity of the 3D reconstructions yielded by the proposed system, a clinical study using 60 pairs of digitized X-rays of adolescents was conducted. The subject cohort in the study group was composed of 51 scoliotic and 9 non-scoliotic patients, with an average Cobb angle on the frontal plane of 25°. For each case, a 3D reconstruction of the spine and pelvis was obtained with the previous system used at our hospital (which requires a positioning apparatus and a calibration jacket), and with the proposed method. Results show that 3D reconstructions obtained with the new system using uncalibrated X-ray images yield geometrically accurate models with insignificant differences for 2D and 3D clinical indexes commonly used in the evaluation of spinal deformities. This demonstrates the system to be a viable and accurate tool for clinical studies and biomechanical analysis purposes, with the added advantage of versatility to any clinical setup for routine follow-ups and surgical planning.

Comparison of Cobb Angle Measurement of Scoliosis Radiographs With Preselected End Vertebrae: Traditional versus Digital Acquisition

Abstract: STUDY DESIGN Prospective study. OBJECTIVE To compare variability in Cobb angle between digitally and traditionally acquired scoliosis radiographs. SUMMARY OF BACKGROUND DATA Previous studies have shown that the 95% confidence interval for Cobb angle can vary from 2.6 degrees to 8.8 degrees. No study directly comparing Cobb angles measured from traditional and digitally acquired radiographs has been reported. METHODS A spine model simulating 25 single right thoracic curves (range, 20 degrees-60 degrees) was imaged using traditional and digital techniques. Traditional films and miniaturized printed digital films were each measured twice manually. Digital films were also measured twice using computer imaging software. RESULTS Overall mean angle and (95% confidence interval) were 41.7 degrees (39.1 degrees-44.3 degrees) for traditional, 40.6 degrees (37.4 degrees-43.8 degrees) for digital, and 39.7 degrees (36.3 degrees-43.1 degrees) for computer measurements. Overall correlation was 0.994 for traditional and digital, 0.987 for traditional and computer, and 0.993 for digital and computer. Fixed effect model analysis demonstrated that, although a statistically significant difference existed between the 3 methods of measuring the Cobb angle (P < 0.0001), the difference between methods was less than 2 degrees. CONCLUSIONS Any of the 3 evaluated methods of measurement can be used to measure Cobb angles. Additionally, the methods can be used interchangeably.

Risk factors for progressive spinal deformity following resection of intramedullary spinal cord tumors in children: an analysis of 161 consecutive cases.

Abstract: Object. Gross-total resection of pediatric intramedullary spinal cord tumors (IMSCTs) can be achieved in the majority of cases, with preservation of long-term neurological function. However, progressive spinal deformity requiring subsequent fusion occurs in many cases. It remains unknown which subgroups of patients have the greatest risk for progressive spinal deformity. Methods. Data for 161 patients undergoing resection of IMSCTs at a single institution were retrospectively collected and analyzed with regard to the development of progressive spinal deformity requiring fusion and patient functional status (based on the modified McCormick Scale [mMS] and Karnofsky Performance Scale [KPS]) by conducting telephone interviews corroborated by medical records. The independent association of all clinical, radiographic, and operative variables to subsequent progressive spinal deformity was assessed using multivariate logistic regression analysis. Results. Patients were a mean of 8.6 6 5.7 years old at the time of surgery. The tumor spanned a mean of six 6 three spinal levels. Preoperative scoliotic deformity was present in 56 cases (35%). Seventy-six patients (47%) had undergone a previous biopsy procedure, and 28 (17%) a prior resection. Gross-total resection (. 95%) was achieved in 122 cases (76%). A median of 9 years (range 1‐21) after surgery, progressive spinal deformity requiring fusion developed in 43 patients (27%). The median functional scores at the last follow-up were worse in patients who required fusion compared with those who did not (mMS: 3 compared with 2, p = 0.006; KPS: 80 compared with 90, p = 0.04) despite similar mMS scores between the groups at 3 months postoperatively. An age less than 13 years, preoperative scoliotic deformity (Cobb angle . 10˚), involvement of the thoracolumbar junction, and tumor-associated syrinx independently increased the odds of a postoperative progressive deformity requiring fusion 4.4-, 3.2-, 2.6-, and 3.4-fold, respectively (p , 0.05). Each subsequent resection increased the odds of a progressive deformity 1.8-fold (p , 0.05). Symptoms lasting less than 1 month before resection decreased the odds of spinal deformity requiring fusion ninefold (p , 0.05). Conclusions. Progressive spinal deformity requiring fusion occurred in 27% of children undergoing resection of an IMSCT and was associated with a decreased functional status. Preoperative scoliotic deformity, an increasing number of resections, an age less than 13 years, tumor-associated syrinx, and surgery spanning the thoracolumbar junction increased the risk for progressive spinal deformity. Patients possessing one or more of these characteristics should be monitored closely for progressive spinal deformity following surgery. (DOI: 10.3171/PED-07/12/463)

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

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

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

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

Minimum 10 years follow-up surgical results of adolescent idiopathic scoliosis patients treated with TSRH instrumentation

Abstract: Last two decades witnessed great advances in the surgical treatment of idiopathic scoliosis. However, the number of studies evaluating the long-term results of these treatment methods is relatively low. During recent years, besides radiological and clinical studies, questionnaires like SRS-22 assessing subjective functional and mental status and life-quality of patients have gained importance for the evaluation of these results. In this study, surgical outcome and Turkish SRS-22 questionnaire results of 109 late-onset adolescent idiopathic scoliosis patients surgically treated with third-generation instrumentation [Texas Scottish Rite Hospital (TSRH) System] and followed for a minimum of 10 years were evaluated. The balance was analyzed clinically and radiologically by the measurement of the lateral trunk shift (LT), shift of head (SH), and shift of stable vertebra (SS). Mean age of the patients was 14.4±1.9 and mean follow-up period was 136.9±12.7 months. When all the patients were included, the preoperative mean Cobb angle of major curves in the frontal plane was 60.8°±17.5°. Major curves that were corrected by 38.7±22.1% in the bending radiograms, postoperatively achieved a correction of 64.0±15.8%. At the last follow-up visit, 10.3°±10.8° of correction loss was recorded in major curves in the frontal plane with 50.5±23.1% final correction rate. Also, the mean postoperative and final kyphosis angles and lumbar lordosis angles were 37.7°±7.4°, 37.0°±8.4°, 37.5°±8.7°, and 36.3°±8.5°, respectively. A statistically significant correction was obtained at the sagittal plane; mean postoperative changes compared to preoperative values were 7.9° and 12.9° for thoracic and lumbar regions, respectively. On the other hand, normal physiological thoracic and lumbar sagittal contours were achieved in 83.5% and 67.9% of the patients, respectively. Postoperatively, a statistically significant correction was obtained in LT, SH, and SS values (P<0.05). Although, none of the patients had completely balanced curves preoperatively, in 95.4% of the patients the curves were found to be completely balanced or clinically well balanced postoperatively. This rate was maintained at the last follow-up visit. Overall, four patients (3.7%) had implant failure. Early superficial infection was observed in three (2.8%) patients. Radiologically presence of significant consolidation, absence of implant failure, and correction loss, and clinical relief of pain were considered as the proof of a posterior solid fusion mass. About ten (9.2%) patients were considered to have pseudoarthrosis: four patients with implant failure and six patients with correction loss over 15° at the frontal plane. About four (3.7%) patients among the first 20 patients had neurological deficit only wake-up test was used for neurological monitoring of these patients. No neurological deficit was observed in the 89 patients for whom intraoperative neurological monitoring with SSEP and TkMMEP was performed. Overall, average scores of SRS-22 questionnaire for general self-image, function, mental status, pain, and satisfaction from treatment were 3.8±0.7, 3.6±0.7, 4.0±0.8, 3.6±0.8, and 4.6±0.3, respectively at the last follow-up visit. Results of about 10 years of follow-up these patients treated with TSRH instrumentation suggest that the method is efficient for the correction of frontal and sagittal plane deformities and trunk balance. In addition, it results in a better life-quality.

Clinical and radiographic results after implant removal in idiopathic scoliosis.

Abstract: Study design Prospective radiographic and clinical analysis of patients with idiopathic scoliosis who had complete implant removal following posterior spinal fusion (PSF) at least 2 years previously. Objective To evaluate the clinical and radiographic effect of implant removal after PSF for idiopathic scoliosis. Summary of background data Occasionally, implants must be removed following instrumented PSF. Indications for removal include infection and late operative site pain. Previously, it has been thought that there was little morbidity associated with implant removal in the presence of a solid fusion. However, recent studies have reported loss of coronal correction after implant removal in patients who had a PSF for adolescent idiopathic scoliosis. Few long-term studies have assessed the clinical or radiographic results of complete implant removal after PSF. Methods We identified 56 patients who had undergone PSF for idiopathic scoliosis and subsequently had complete removal of all instrumentation. None of these patients had a pseudarthrosis at the time of implant removal. After IRB approval, 43 of 56 (77%) patients returned for new standing posteroanterior and lateral spine radiographs and completion of an SRS-22 questionnaire. Results For the 43 patients who had new radiographs and completed an SRS-22, the time from the original PSF to complete implant removal averaged 2.9 years (range, 7 months to 7.25 years). Twenty-two patients had implants removed because of infection, and 21 patients had implants removed secondary to pain. The average time from implant removal to completion of the most recent radiographs and SRS-22 questionnaire was 9.5 years (range, 3.2-17.9 years). Patients were considered to have had progression of deformity after implant removal if their Cobb angle measurements increased by more than 10 degrees . Two patients had 11 degrees to 20 degrees of coronal plane progression of their main thoracic curve. No patient had more than 10 degrees of coronal plane progression of a lumbar curve. Sagittal curve progression was identified more frequently. Nineteen patients had between an 11 degrees and 20 degrees increase in thoracic kyphosis, and 5 patients had >20 degrees of thoracic kyphosis progression. Patients with >20 degrees of thoracic kyphosis progression after implant removal had greater thoracic kyphosis before surgery and larger main thoracic and lumbar coronal curves at the time of implant removal. Progressive kyphosis did not correlate with: reason for implant removal, length of follow-up, or time from fusion to implant removal. Although total SRS-22 scores correlated inversely with increased thoracic kyphosis, this trend did not reach statistical significance. Conclusion Implant removal after PSF for idiopathic scoliosis may be complicated by progression of deformity. Patients requiring implant removal should be appropriately counseled and monitored.

Iliac screw fixation in neuromuscular scoliosis.

Abstract: Study Design. A retrospective review of children with neuromuscular scoliosis treated at our institution with posterior spinal fusion and instrumentation including iliac screws. Objectives. To determine the safety and effectiveness of iliac screws in neuromuscular scoliosis constructs. Summary of Background Data. The Galveston technique has been a standard method of impacting rods in the iliac wings to provide anchorage for neuromuscular scoliosis constructs. Numerous studies have shown the increased strength of constructs using screws as part of segmental spinal instrumentation. The ideal method of caudal anchorage is still unclear, and the role of iliac screws has yet to be defined. Methods. The medical records and radiographs of 50 patients with neuromuscular scoliosis treated with a modified Luque-Galveston posterior spinal fusion and instrumentation technique were reviewed. The instrumentation was anchored to the pelvis via iliac screws: Group A constructs included 2 screws; Group B constructs included 4 screws. The radiographs were analyzed for Cobb angle and pelvic obliquity before surgery and after surgery. Complications were recorded, including infections and implant-related problems. Results. The average curve correction was 48%. The average pelvic tilt correction was 59%. Complications included 4 deep infections requiring reoperation (8%), 10 screw-related complications (7 in Group A, 3 in the Group B), and 12 non–screw-related implant complications (11 in the Group A, 1 in the Group B). Conclusions. The use of screw fixation in the ilium as a means of spinopelvic anchorage is safe and effective in the treatment of neuromuscular scoliosis. The use of 2 screws in each iliac wing provides more stable fixation with fewer implant-related complications than using a single screw.

Risk factors affecting the immediate postoperative course in pediatric scoliosis surgery.

Abstract: Study design A retrospective analysis of pediatric records of idiopathic scoliosis (IS) and neuromuscular scoliosis (NMS) etiology, in a search for complications and their risk factors immediately following surgical repair. Objective To evaluate the influence of pre- and intraoperative parameters on the postoperative course and lay the cornerstone for a course-prediction model. Summary of background data Only a few studies have addressed the immediate postoperative complications of pediatric scoliosis surgery. Methods Our study included all children who underwent spinal fusion for scoliosis in our hospital between 1998 and 2006. The following data were collected: curve etiology, Cobb angle, number of fused vertebrae, fusion approach, and the addition of thoracoplasty. We evaluated the influence of this data on the rate of delayed extubations, length of intensive care unit (ICU) hospitalization, and the presence of major and minor immediate postoperative complications. Results The study included 126 children (95 IS and 31 NMS). Delayed extubations were recorded in 17 children (3% of IS vs. 45% of NMS). The most common major and minor complications were pulmonary and hematological-biochemical, respectively. Overall pulmonary complications (major and minor) were recorded in 38 children. Major complications (of any category) were recorded in 19 children. Average length of ICU hospitalization was 3.8 days. The rate of complications in the NMS group was significantly higher than in the idiopathic group. Posterior fusions were associated with a significantly lower rate of pulmonary complications and shorter ICU hospitalizations, in comparison to anterior and combined fusions. Cobb angle, number of fused vertebrae, and the addition of thoracoplasty did not correlate with any postoperative parameters. Conclusion While NMS etiology, anterior and combined fusions correlated with a worse course, the Cobb angle, number of fused vertebrae, and the addition of thoracoplasty did not. Optimization of postoperative care should be carried out accordingly. Scoliosis surgery is safe even in extreme curves and long fusions. Thoracoplasty can be added whenever indicated, in order to improve the overall outcome.

A comparison of changes over time in cervical foraminal height after tricortical iliac graft or polyetheretherketone cage placement following anterior discectomy.

Abstract: Object The authors prospectively evaluated cervical foraminal height changes after anterior cervical discectomy and fusion. To their knowledge, this prospective study is the first in which foraminal height changes over time are compared following the placement of a tricortical graft or a polyetheretherketone (PEEK) cage. Methods The patients were randomly divided in two groups. In one group, 30 patients underwent anterior cervical microdiscectomy and free bone graft (FBG) insertion at 46 levels via the Smith–Robinson technique. The FBG was harvested from the right iliac crest. Another 35 patients underwent the same operation, but fusion was provided by the insertion of PEEK intervertebral cages at 41 levels. Fusion status and the C2–7 Cobb angle, interspace height, and foraminal height changes were observed on anterior, lateral, and oblique radiographs obtained at the 18-month follow-up examination. There were no differences between the groups with regard to clinical recovery, fusion status, and Cobb angl...

Pedicle growth asymmetry as a cause of adolescent idiopathic scoliosis: a biomechanical study

Abstract: Over the last century the neurocentral junction (NCJ) has been identified as a potential cause of adolescent idiopathic scoliosis (AIS). Disparate growth at this site has been thought to lead to pedicle asymmetry, which then causes vertebral rotation and ultimately, the development of scoliotic curves. The objectives of this study are (1) to incorporate pedicle growth and growth modulation into an existing finite element model of the thoracic and lumbar spine already integrating vertebral body growth and growth modulation; (2) to use the model to investigate whether pedicle asymmetry, either alone or combined with other deformations, could be involved in scoliosis pathomechanisms. The model was personalized to the geometry of a nonpathological subject and used as the reference spinal configuration. Asymmetry of pedicle geometry (i.e. initial length) and asymmetry of the pedicle growth rate alone or in combination with other AIS potential pathogenesis (anterior, lateral, or rotational displacement of apical vertebra) were simulated over a period of 24 months. The Cobb angle and local scoliotic descriptors (wedging angle, axial rotation) were assessed at each monthly growth cycle. Simulations with asymmetrical pedicle geometry did not produce significant scoliosis, vertebral rotation, or wedging. Simulations with asymmetry of pedicle growth rate did not cause scoliosis independently and did not amplify the scoliotic deformity caused by other deformations tested in the previous model. The results of this model do not support the hypothesis that asymmetrical NCJ growth is a cause of AIS. This concurs with recent animal experiments in which NCJ growth was unilaterally restricted and no scoliosis, vertebral wedging, or rotation was noted.

Patient characteristics at the initial visit to a scoliosis clinic: a cross-sectional study in a community without school screening.

Abstract: STUDY DESIGN A cross-sectional study was conducted of all patients referred for an initial visit to the orthopedic outpatient clinic of a metropolitan pediatric hospital in Canada for suspected adolescent idiopathic scoliosis (AIS). OBJECTIVE To document the appropriateness of current referral patterns for AIS in comparison to those that were prevailing before discontinuation of school screening in Canada. SUMMARY OF BACKGROUND DATA The consequences of the discontinuation of school scoliosis screening programs on the referral patterns of AIS patients remain unknown. METHODS The clinical and radiologic charts of the 636 consecutive patients referred for scoliosis evaluation over a 1-year period were reviewed. Patients were classified according to defined criteria of appropriateness of referral based on skeletal maturity and curve magnitude. RESULTS Of the 489 suspected cases of AIS, 206 (42%) had no significant deformity (Cobb angle <10 degrees ) and could be considered as inappropriate referrals. In subjects with confirmed AIS, 91 patients (32%) were classified as late referrals with regards to brace treatment indications. CONCLUSIONS These findings suggest that current referral mechanisms for AIS are leading to a suboptimal case-mix in orthopedics in terms of appropriateness of referral.

Traction versus supine side-bending radiographs in determining flexibility: what factors influence these techniques?

Abstract: Study Design. Prospective clinical, radiologic study of adolescent idiopathic scoliosis (AIS). Objective. We evaluated a Cobb angle in standing position, patient age, the level of the apex, and the number of involved vertebrae in patients with AIS to determine whether the corrective ability of traction or side-bending radiographs was superior. of Background Data. Side-bending and traction radiographs are used to evaluate curve flexibility during corrective surgery for AIS despite notable differences in the flexibilities of identical curves. Thus, interpretation for the differences among these techniques should be investigated. Methods. A total of 229 consecutive patients with AIS who were surgically treated were evaluated. Standing, supine side-bending, and traction radiographs were obtained before surgery. Curves were divided into main thoracic (MT) or thoracolumbar/lumbar (TL/L) curves, and proximal thoracic (PT) curves. We evaluated the Cobb angle in standing position, the level of the apex, the number of involved vertebrae, kyphosis angle of main thoracic curve, and patient age in patients with AIS to determine whether the corrective ability of traction or side-bending radiographs was superior. Results. A total of 219 curves were observed in MT lesions. The traction flexibility rate (FR) was higher than the side-bending FR at angle of ≥ 60° (P = 0.02), in patients younger than 15 years (P = 0.02), in curves whose apex was located at T4-T8/T9(P = 0.01), in curves whose involved vertebrae were 6 or 7 (P = 0.02), and at kyphosis angle between 10° and 39° (P = 0.02). In 96 TL/L curves, side-bending FR was higher at angle of <60° (P< 0.01). In 163 PT curves, traction FR was higher at angles of ≥40° (P= 0.02). Conclusion. In addition to a Cobb angle, patient age, the level of the apex, and the number of involved vertebrae also influence the conditions under which the corrective ability of traction radiographs is superior to that of side-bending radiographs.

Retrospective study on the development of spinal deformities following sternotomy for congenital heart disease.

Abstract: Study design Retrospective review with a minimum of 3 years of follow-up. Objective We hypothesize that following median sternotomy there may be an increase incidence of both sagittal and coronal spinal deformity. We also think that heart size and a cyanotic cardiac condition are also risk factors for development of spinal deformity. The purpose of this study was to determine the incidence and characteristics of spinal deformity in patients following sternotomy for congenital heart disease. Summary of background data Patients with congenital heart disease are at an increased risk to develop scoliosis. Methods A total of 108 patients underwent a median sternotomy for the treatment of congenital heart disease and met inclusion criteria. The medical record was reviewed to gather demographic data and medical and surgical history. Serial chest and spine radiographs were reviewed. Results Scoliosis developed in 28% of the patients (10 males, 20 females). The mean follow-up was 13 years (range, 3-26 years). The mean coronal Cobb angle was 25 degrees (range, 11 degrees-88 degrees). Of these, 7 patients presented with curves of > or = 30 degrees. The mean age at diagnosis of scoliosis was 14 years (range, 2-33 years). A kyphotic deformity developed in 22% (24 patients). In patients with scoliosis, the mean sagittal kyphosis was 34 degrees (range, 2 degrees-73 degrees). Patients with a cyanotic cardiac condition had a trend toward severe scoliosis. There was no correlation between the development of scoliosis or kyphosis and the age at time of procedures, number of surgeries, gender, or heart size. Conclusion 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 kyphosis, were found in 34% of the patients. The sagittal alignment in scoliosis patients tends toward kyphosis.

Preliminary evaluation of a computer-assisted tool for the design and adjustment of braces in idiopathic scoliosis: a prospective and randomized study.

Abstract: Study design Prospective and randomized clinical study. Objectives To evaluate the correction of the spine obtained using a 3-dimensional visualization software tool developed to assist the design and adjustment of braces compared with the correction obtained with the conventional method in a cohort of subjects with adolescent idiopathic scoliosis (AIS). Summary of background data The optimal design and adjustment of trim lines, pad placement, and areas of relief for the Boston brace system in AIS are currently done using clinical examination and coronal radiographs. Correction of spinal curves in the coronal plane has been achieved with this technique, but 3-dimensional correction has yet to be demonstrated. Methods Forty-eight consecutive subjects with AIS requiring treatment with a Boston brace were prospectively entered in the study. For 24 patients (test group), brace design and adjustment was obtained using the computer-assisted tool combining surface topography, surface pressure measurement, and 3-dimensional reconstructions of the trunk, while design and adjustment for the remaining subjects (control group) was done in the conventional manner. Immediate in-brace correction of the spine at the initial visit was compared in both groups. Results Both groups were comparable in terms of age, sex, curve type, and average deformity in both the coronal and sagittal planes. The average prebrace thoracic deformity was 35 degrees of Cobb angle, while the average lumbar curve was 32 degrees in the test group and 35 degrees in controls. A statistically and clinically significant improvement in correction of coronal curves and of curves in the plane of maximal deformity was found for both thoracic and lumbar curves in both groups, but the improvement was significantly greater in the test group. The average in-brace correction in the test group was 12 degrees +/- 7 degrees compared with 7 degrees +/- 5 degrees in the control group for thoracic curves, while the average in-brace correction in the test group was 10 degrees +/- 5 degrees compared with 6 degrees +/- 5 degrees in the control group for lumbar curves. Similar average corrections were detected in the plane of maximal deformity. In addition, a significant improvement in the orientation of the plane of maximum deformity from 37 degrees to 23 degrees for lumbar curves was noted only in the test group, indicating that true 3-dimensional correction by the brace was obtained in this group. Conclusion It is possible to improve the design and adjustment of braces in AIS and to achieve 3-dimensional correction of scoliotic curves with the use of a computer-assisted tool allowing 3-dimensional visualization of the spinal curves and the external shape of the trunk.

Surgeon reliability in rating physical deformity in adolescent idiopathic scoliosis.

Abstract: Study design Cross sectional survey. Objectives To compare pediatric spine surgeons' relative rankings of the importance of surgical considerations, and their reliability of ratings of the physical deformity of patients with adolescent idiopathic scoliosis (AIS). Summary of background data Adolescents' appearance is a factor in surgical decision-making. Although the reliability of the Cobb angle has been extensively studied, less attention has been directed toward the reliability of surgeons' assessment of physical appearance. Methods Five surgeons ranked the relative importance of 13 surgical considerations. While viewing clinical photographs of 40 patients, surgeons rated the following: shoulder blades, shoulders, waist asymmetry, and the "overall appearance" of the back. Results "Severity of deformity" was consistently ranked the most important surgical consideration. Surgeons, however, varied widely in their reliability of their ratings of physical appearance: shoulder blades (kappa = 0.34), shoulders (kappa = 0.22), waist (kappa = 0.24), and overall appearance (kappa = 0.40). Conclusion Because patients' physical appearance is an important element of surgical decision-making, differences among surgeons could be contributing to inconsistent recommendations.

Radiation-free quantitative assessment of scoliosis: a multi center prospective study.

Abstract: Accurate quantitative measurements of the spine are essential for deformity diagnosis and assessment of curve progression. There is much concern related to the multiple exposures to ionizing radiation associated with the Cobb method of radiographic measurement, currently the standard procedure for diagnosis and follow-up of the progression of scoliosis. In addition, the Cobb method relies on 2-D analysis of a 3-D deformity. The aim of this prospective study was to investigate the clinical value of Ortelius800TM that provides a radiation-free method for scoliosis assessment in three planes (coronal, sagittal, apical), with simultaneous automatic calculation of the Cobb angle in both coronal and sagittal views. Analysis of the clinical value of the device for assessing spinal deformities was performed on patients with adolescent idiopathic scoliosis, deformity angles ranging from 10° to 48°. Correlation between Cobb angles measured manually on standard erect posteroanterior radiographs and those calculated by Ortelius800TM showed an absolute difference between the measurements to be significantly less than ± 5° for coronal measurements and significantly less than ± 6° for sagittal measurements indicating good correlation between the two methods. The measurements from four independent sites and six independent examiners were not significantly different. We found the novel clinical tool to be reliable for following mild and moderate idiopathic curves in both coronal and sagittal planes, without exposing the patient to ionizing radiation. Considering the need for further validation of this new method, any change in treatment protocol should still be based on radiographic control.

Evaluation of postoperative residual spinal deformity and patient outcome in idiopathic scoliosis patients in Japan using the scoliosis research society outcomes instrument.

Abstract: Study Design. This study clarifies the correlation between the components of the Scoliosis Research Society Outcomes Instrument (SRS-24) and the radiographic parameters after surgery in Japanese idiopathic scoliosis patients. Objectives. To investigate the correlation between the magnitude of back deformity after scoliosis surgery and the components of the SRS-24. of Background Data. Patient outcomes for Japanese scoliosis patients using the SRS-24 have not been fully investigated. Methods. Idiopathic scoliosis patients (n = 81) who were treated with surgery and followed up for more than 2 years were evaluated. Radiographic examination included Cobb angle, rotation angle of apical vertebrae, and translation of the C7 vertebra from the center sacral line on the coronal plane. In addition, the score of one new question regarding postoperative scar was investigated and compared with that of the individual SRS-24 domains. Results. A comparison of the SRS-24 and radiographic results revealed a significant inverse correlation between total pain and the postoperative correction of the rotation angle in the thoracic curve (r s = 0.27; P < 0.05). General self-image was inversely correlated with the Cobb angle (r s =-0.23; P < 0.05) and the rotation angle (r s = -0.30; P < 0.01) in the thoracic curve. Self-image after surgery was positively correlated with the correction degree of the thoracic Cobb angle (r s = 0.27; P < 0.05); 60% of patients had some concerns regarding postoperative scar, and the concerned patients demonstrated significantly lower scores in the pain and general self-image domains (P< 0.05) than the unconcerned patients did. Conclusion. Patients with a greater Cobb angle or rotation angle in the thoracic curve had a negative self-image. Self-image improved after surgery by greater correction of the thoracic Cobb angle. Thoracic scoliotic deformity with prominence should be substantially reduced by the surgical treatment to improve satisfaction rates and self-image regarding back appearance. Additionally, physicians should pay more attention to patients' concern regarding their postoperative scars to obtain better outcomes.

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

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