Quality of life and functional disability in skeletally mature patients with myelomeningocele-related spinal deformity (original) (raw)
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Orthopaedics and Trauma, 2011
Children and adolescents with neurological conditions develop severe spinal deformities at a high frequency due to muscle weakness and poor neuromuscular control, frequently associated with spasticity. Scoliosis is the most common type of deformity, occasionally associated with increased kyphosis or lordosis and commonly extending to the sacrum and pelvis. The development of severe spinopelvic imbalance can cause back or costo-pelvic impingement pain, affects the patient's ability to function, impacts on the patient's quality of life and maximizes the need for nursing care. It may give rise to significant respiratory compromise. Surgical correction is indicated in the presence of a progressive deformity that produces functional limitations and severe symptoms especially in growing children. This, by necessity, involves a major procedure with considerable risk of intraoperative and postoperative complications directly related to the severity of deformity, but also to the presence of associated co-morbidities and the degree of neurological disability. A thorough medical assessment is critical in order to establish each patient's suitability for such major surgery. A well-coordinated multidisciplinary approach will reduce the risks of significant morbidity and mortality, which can occur either during scoliosis surgery, often related to excessive blood loss, or post-surgery, mainly due to pulmonary complications, as well as the risk of infection and generalized sepsis in patients with inherently poor immunological response. Deformity correction and spinal fusion should only be performed in major centres with adequate medical support and by well-trained surgeons who are familiar with the surgical techniques in order to minimize the risk of complications and produce an optimum outcome. This review summarizes the current knowledge on neuromuscular deformities of the spine and provides a rational approach to the evaluation and management of this group of patients.
Scoliosis, 2014
O1 Evaluation of pelvic asymmetry and lower limb functional shortening in a cohort of children re-examined after a ten-year observation Anna Kluszczynska, Adam Kluszczynski, Jan Raczkowski, Piotr Siwik Troniny Children Rehabilitation Center, Częstochowa, Poland; Medical Sciences University, Lodz, Poland; Medical Sciences University of Varmia and Masuria, Olsztyn, Poland Scoliosis 2014, 9(Suppl 1):O1
Management of Spinal Deformities and Evidence of Treatment Effectiveness
The open orthopaedics journal, 2017
The review evaluates the up-to-date evidence for the treatment of spinal deformities, including scoliosis and hyperkyphosis in adolescents and adults. The PubMed database was searched for review articles, prospective controlled trials and randomized controlled trials related to the treatment of spinal deformities. Articles on syndromic scoliosis were excluded and so were the articles on hyperkyphosis of the spine with causes other than Scheuermann's disease and osteoporosis. Articles on conservative and surgical treatments of idiopathic scoliosis, adult scoliosis and hyperkyphosis were also included. For retrospective papers, only studies with a follow up period exceeding 10 years were included. The review showed that early-onset idiopathic scoliosis has a worse outcome than late-onset idiopathic scoliosis, which is rather benign. Patients with AIS function well as adults; they have no more health problems when compared to patients without scoliosis, other than a slight increase...
Radiographical Spinopelvic Parameters and Disability in the Setting of Adult Spinal Deformity
Spine, 2013
, * and the International Spine Study Group (ISSG) Study Design. Prospective multicenter study evaluating operative (OP) versus nonoperative (NONOP) treatment for adult spinal deformity (ASD). Objective. Evaluate correlations between spinopelvic parameters and health-related quality of life (HRQOL) scores in patients with ASD. Summary of Background Data. Sagittal spinal deformity is commonly defi ned by an increased sagittal vertical axis (SVA); however, SVA alone may underestimate the severity of the deformity. Spinopelvic parameters provide a more complete assessment of the sagittal plane but only limited data are available that correlate spinopelvic parameters with disability. Methods. Baseline demographic, radiographical, and HRQOL data were obtained for all patients enrolled in a multicenter consecutive database. Inclusion criteria were: age more than 18 years and radiographical diagnosis of ASD. Radiographical
Correlation of radiographic and clinical findings in spinal deformities
Neurosurgery clinics of North America, 2007
Operative treatment for spinal deformities can be undertaken to halt progression of deformity or to treat a patient's clinical complaints. New emerging research using validated health outcomes instruments has begun to investigate which radiographic parameters of spinal deformity correlate with clinical symptoms. Adolescent idiopathic scoliosis tends to present without complaints of pain, and studies have demonstrated that health-related outcomes measures do not correlate with the degree of deformity correction. Clinical complaints in adult scoliosis show a poor correlation with curve magnitude. Studies of adult scoliosis demonstrate that positive sagittal balance is poorly tolerated and correlates with suboptimal health outcomes. Further studies are needed to clarify the clinical significance of radiographic features of spinal deformities further.
The Health Impact of Symptomatic Adult Spinal Deformity
Spine, 2015
International Spine Study Group Study Design. A retrospective analysis of a prospective, multicenter database. Objective. The aim of this study was to evaluate the health impact of symptomatic adult spinal deformity (SASD) by comparing Standard Form Version 2 (SF-36) scores for SASD with United States normative and chronic disease values. Summary of Background Data. Recent data have identified radiographic parameters correlating with poor health-related quality of life for SASD. Disability comparisons between SASD patients and patients with chronic diseases may provide further insight to the disease burden caused by SASD. Methods. Consecutive SASD patients, with no history of spine surgery, were enrolled into a multicenter database and evaluated for type and severity of spinal deformity. Baseline SF-36 physical component summary (PCS) and mental component summary (MCS) values for SASD patients were compared with reported U.S. normative and chronic disease SF-36 scores. SF-36 scores were reported as normative-based scores (NBS) and evaluated for minimally clinical important difference (MCID). Results. Between 2008 and 2011, 497 SASD patients were prospectively enrolled and evaluated. Mean PCS for all SASD was lower than U.S. total population (ASD ¼ 40.9; US ¼ 50; P < 0.05). Generational decline in PCS for SASD patients with no other reported comorbidities was more rapid than U.S. norms (P < 0.05). PCS worsened with lumbar scoliosis and increasing sagittal vertical axis (SVA). PCS scores for patients with isolated thoracic scoliosis were similar to values reported by individuals with chronic back pain (45.5 vs 45.7, respectively; P > 0.05), whereas patients with lumbar scoliosis combined with severe sagittal malalignment (SVA >10 cm) demonstrated worse PCS scores than values reported by patients with limited use of arms and legs (24.7 vs 29.1, respectively; P < 0.05). Conclusions. SASD is a heterogeneous condition that, depending upon the type and severity of the deformity, can have a debilitating impact on health often exceeding the disability of more recognized chronic diseases. Health care providers must be aware of the types of SASD that correlate with disability to facilitate appropriate diagnosis, treatment, and research efforts.
Orthopaedics and Trauma, 2017
Scoliosis affects very commonly children with neurological or myopathic conditions. It can be associated with increased kyphosis or lordosis. The coronal curve extends to the sacrum producing pelvic obliquity. The deformity develops due to poor muscle control and spasticity as the spine cannot resist forces against gravity. It can produce severe problems including spino-pelvic imbalance causing back pain, costo-pelvic impingement pain on the concave side of the curve which can both affect sitting ability and posture, as well as respiratory complications and difficulties in provision of patient care. There is no conservative measure that can stop deformity progression. Surgical intervention is indicated in the presence of a progressive and symptomatic deformity which affects the patient's quality of life. The degree of neurological disability and associated co-morbidities must be taken into account during decision-making as these are directly correlated with the risk of perioperative complications. Thorough preoperative assessment should be undertaken by a multidisciplinary medical, surgical and allied health professional team in a centre with experience in the global management of such patients. This will reduce the risk of complications and improve patient outcomes. This review gives an overview of neuromuscular spinal deformity focussing on assessment and treatment.
Adult Spinal Deformity: Epidemiology, Health Impact, Evaluation, and Management
Spine deformity, 2016
Spinal deformity in the adult is a common medical disorder with a significant and measurable impact on health-related quality of life. The ability to measure and quantify patient self-reported health status with disease-specific and general health status measures, and to correlate health status with radiographic and clinical measures of spinal deformity, has enabled significant advances in the assessment of the impact of deformity on our population, and in the evaluation and management of spinal deformity using an evidence-based approach. There has been a significant paradigm shift in the evaluation and management of patients with adult deformity. The paradigm shift includes development of validated, disease-specific measures of health status, recognition of deformity in the sagittal plane as a primary determinant of health status, and information on results of operative and medical/interventional management strategies for adults with spinal deformity. Since its inception in 1966, the Scoliosis Research Society (SRS) has been an international catalyst for improving the research and care for patients of all ages with spinal deformity. The SRS Adult Spinal Deformity Committee serves the mission of developing and defining an evidence-based approach to the evaluation and management of adult spinal deformity. The purpose of this overview from the SRS Adult
Scoliosis and Spinal Disorders
sagittal balance and predictive equations to determine lumbopelvic compensatory patterns (LPCP). These equations are used to guide surgical decision making and technique selection. Although other lumbopelvic compensation equations are available, these have not been compared with the SRS-Schwab equation. Objectives The aim was to evaluate sagittal balance and LPCP in younger and older adults with scoliosis and to compare the two most commonly used LPCP predictive equations (SRS-Schwab and Legaye). Methods EOS radiographic data from 41 adults with scoliosis (coronal Cobb > 10°; 51 ± 19 years) stratified into younger (n = 20) and older (n = 21) groups above and below the mean age was retrospectively analysed. T-tests were used to compare group characteristics and Fisher's exact tests were used to evaluate differences in SVA (sagittal vertical axis), PT (pelvic tilt) and PI (pelvic incidence)-LL (lumbar lordosis) mismatch thresholds. Agreement between SRS-Schwab and Legaye classification was evaluated using Kappa tests and Bland Altman plots. Results and discussion 62% of the older group and 10% of the younger group exceeded the SVA threshold of 40 mm (p < .001). 86% of the older group and 20% of the younger group exceeded the 20°pelvic retroversion threshold (p < 0.001). Normal PILL mismatch ranges were more prevalent in the younger group (70%) than the older group (28%) (p < .001) when analysed through the SRS-Schwab equation. Legaye equation analysis revealed no difference in the prevalence of normal PILL ranges between the younger (15%) and older group (10%) (P = .66). Lumbar hyperlordosis was more prevalent in the younger (25%) than older group (5%) (p < .001) when analysed through the SRS-Schwab equation but no difference was observed between the younger (10%) and older group (0%) (p > .05) when analysed through the Legaye equation. Lumbar hypolordosis was more prevalent in the older (67%) than the younger group (5%) (p < .001) but no difference was observed between the older (90%) and younger group (75%) when analysed through the Legaye predictive equation (P = .33). Agreement between the SRS-Schwab and Legaye equations was poor for the whole (κ = 0.148), older (κ = 0.277) and young groups (κ = 0.039). Conclusion and significance This study confirms that older patients more often exhibit higher SVA and pelvic retroversion than younger patients. Whilst analysis through SRS-Schwab classification reveals that younger patients more often exhibit lumbar hyperlordosis than older patients who more often exhibit lumbar hypolordosis, analysis through the Legaye equations revealed no differences. There is poor agreement between the SRS-Schwab and Legaye classification equations. Clinicians are cautioned to exercise clinical judgement when evaluating their patients with these equations until more research is done. O3 Correlation between surface topography measurements and largest Cobb angle vary depending on adolescent idiopathic scoliosis curve type