Scoliosis Research Papers - Academia.edu (original) (raw)

Objective To define the origin of radiculopathy of patients with degenerative lumbar scoliosis and to assess the correlation between percentage of radiculating pain relief with selective nerve root injections and lateral canal dimensions.... more

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- Clinical Sciences, Scoliosis
- by Virginie Lafage
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- Surgery, Neurosurgery, Treatment Outcome, Prospective studies

Degenerative scoliosis is a prevalent issue among the aging population. Controversy remains over the role of surgical intervention in patients with this disease. The authors discuss a suitable approach to help guide surgical treatment, including decompression, instrumented posterior spinal fusion, anterior spinal fusion, and osteotomy. These treatment options are based on clinical analysis, radiographic analysis of the mechanical stability of the deformity, given pain generators, and necessary sagittal balance. The high potential complication rates appear to be outweighed by the eventual successful clinical outcomes in patients suitable for operative intervention. This approach has had favorable outcomes and could help resolve the controversy.

- by Fernando Silva
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- Treatment Outcome, Fusion, Clinical Sciences, Scoliosis

Session 1 5:00-6:30 p.m. Interactive poster session and social reception Bialek M. Functional Individual Therapy of Scoliosis -FITS Botens-Helmus C, Klein R, Stephan C, Hans-Rudolf Weiss. Reliability of the Bad Sobernheim Stress Questionnaire (BSSQbrace) Brooks WJ, Krupinski EA, Hawes MC. Reversal of curvature magnitude in response to physical methods: a 15year followup in an adult female diagnosed with moderately severe scoliosis at age eleven. Correia KA, Megna J. The effect of physical therapy on computerized dynamic posturography of an adolescent with idiopathic scoliosis: A case study. Durmala J. 'Dobosiewicz's method Ferguson L. An artist's inquiry into scoliosis. Karski T, Kalakucki J, Karski J. Patient-specific exercise programs in the conservative management of the so-called idiopathic scoliosis Maruyama T. 'Short and long term objectives of conservative management of IS''. Miller E. Yoga for scoliosis: an adult case approach. Monroe M. Yoga and Somatic Therapy for the treatment of adolescent idiopathic scoliosis: Adult case report. Negrini S. The evidence based ISICO approach to rehabilitation of spinal deformities. Nieh MT. Exercise-based methods to treat adult scoliosis: a case report. Rensselaer NY. O'Brien JP. Retrospective review of a single case of surgically treated AIS over a 40-year period. Rigo M. Conservative approach for the treatment of idiopathic scoliosis in the ' E. Salva Institute' of Barcelona Shawafaty N, Cheriet F, Coillard C, Rhalmi S, Labelle H, Rivard CH. Non invasive evaluation of SpineCor brace correction from surface topography Sherman K. Pilot Study to Validate a Scoliosis-Specific Instrument that Measures Quality of Life and Treatment Effect. Stokes IAF. Analysis and simulation of progressive adolescent scoliosis by biomechanical growth modulation Torres B. Katharina Schroth Method for treatment of post-polio scoliosis in an adult.

- by Fabio Zaina
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- Adolescent Idiopathic Scoliosis, Clinical Sciences, Scoliosis, Indexation

Objectives: The lumbar kyphosis in patients with myelomeningocele is a complex deformity whose treatment is mainly surgical. The objective of this study is to summarize the results and complications obtained by the group in 2012 with respect to this group of patients. Method: Performed a retrospective analysis of the medical records and radiographs of patients consecutively operated in 2012. The technique was originally described by Dunn-McCarthy and consists of kyphectomy and posterior fixation using S-shaped Luque rods through the foramina of S1 associated with pedicle screws in the thoracic spine. Results: Six patients were included in the study. The age at surgery was 11 years and 7±22 months and the weight was 29.1±11.9 kg. The procedure lasted 271±87 minutes, with the removal of one or two (mean 1.5) vertebrae from the apex of the kyphosis. Hospitalization time was 10±9 days. The lumbar kyphosis measuring 116.3±37 degrees preoperatively was reduced to 62.5±21 degrees. All patients began to sit without support and to lie in the supine position. Four patients developed postoperative infection and required surgical debridement at the follow-up. One patient had the implant removed after a year due to loosening of the rod in the sacrum. Conclusion: The surgical technique allows excellent functional results in the correction of lumbar kyphosis in patients with myelomeningocele despite high complication rates. It is necessary to conduct studies with a larger number of patients and duration of follow-up to assess whether the use of pedicle screws will decrease the rate of loosening and pseudoarthrosis.

- by Olavo Letaif
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- Medicine, Child, Three Dimensional Imaging, Young Adult

We studied the results in 46 patients with neuromuscular and neurogenic scoliosis (average age 13.5 years, range 6-19 years) who had had posterior fusion with a modified Luque technique between May 1985 and June 1992. The main criteria to recommend surgery were curve progression, loss of balance when sitting, control of the head and difficulties in wearing an external orthotic support. The mean preoperative curve was 63 ~ , the postoperative value was 24 ~ representing a correction of about 62%. The average number of stabilized segments was 13. In 39 out of 46 patients, lumbosacral fixation was included in the construct. Failure of implants, pseudarthroses and major losses of correction in purely neuromuscular scolioses could be avoided by using rigid segmental fixation and a dorsolateral fusion with a mixture of autologous and allogenous bone. The scoliosis most difficult to influence was found to be Friedreich's ataxia. In Duchenne muscular dystrophy the best method of treatment was surgery performed as early as possible, i.e. at the time of loss of walking capacity in the case of a scoliosis exceeding 20 ~ and with two consecutive X-rays proving curve progression. Analysis of our series does not confirm the morbidity and complication rates of previous studies.

- by max aebi
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- Biomedical Engineering, Treatment Outcome, Adolescent, Medicine

Neurofibromatosis 1 (NF1) is a common autosomal dominant disorder with high penetrance but extreme variability of expression. Monozygotic (MZ) twins with NF1 who have phenotypic discordances are a useful tool in evaluating which traits are influenced by non-hereditary influences such as second hit somatic events, environmental agents, epigenetic modification, or post-zygotic mutations. We evaluated nine sets of MZ twins and one set of MZ triplets, ages 4-18 years, for NF1 features and calculated probandwise concordance (P C ) for each feature. MZ twins were highly concordant in numbers of caf e-au-lait spots (P C ¼ 0.89) and cutaneous neurofibromas. IQ scores were within 10 points for all twin pairs tested, and similar patterns of learning disabilities and speech disorders were observed. Twin pairs showed significant discordance for tumors, particularly plexiform neurofibromas (P C ¼ 0.40) and malignant peripheral nerves sheath tumors (MPNST), as expected if post-natal second -hit events were contributing to these features. One set of twins was concordant for multiple, large paraspinal neurofibromas, suggesting that there may be more hereditary factors involved in production of paraspinal neurofibromas. Four sets were concordant for pectus deformities of the chest (P C ¼ 0.80). Three sets of twins were discordant for scoliosis (P C ¼ 0.40); an additional set was concordant for scoliosis but differed in presence of dystrophic features and need for surgery. Our data suggest there are additional non-hereditary factors modifying the NF1 phenotype and causing discordancies between MZ twins. Future studies may focus on differences in epigenetic changes or somatic mosaicism which have been documented for other disease genes in MZ twins.

- by Brad Tinkle
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- Genetics, Adolescent, Gene expression, NF

Plain film imaging remains important for the diagnosis and surveillance of scoliosis, as well as for the detection of complications after surgery. Advances in CT and MR imaging have greatly improved the ability to detect or confirming nonidiopathic causes of scoliosis, including abnormalities within the spinal canal. Three-dimensional thinking has become more important in evaluating and understanding scoliosis.

- by Alan Oestreich
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- Spine, Magnetic Resonance Imaging, Adolescent, Child

Study Design. Retrospective case control study.Objective. To evaluate the hemostatic benefits of using a kaolin impregnated dressing during pediatric spinal deformity correction surgery.Summary of Background Data. Minimizing blood loss and transfusions are clear benefits for patient safety. A technique common in both severe trauma and combat medicine that has not been reported in the spine literature is wound packing with a kaolin impregnated haemostatic dressing.Methods. Estimated blood loss and transfusion amounts were analyzed in a total of 117 retrospectively identified cases. The control group included 65 patients (46F, 19M, 12.7±4.5 years, 10.2± 4.8 levels fused) who received standard operative care with gauze packing between June 2007 and March 2010. The treatment group included 52 patients (33F, 19M, 13.9±3.2 years, 10.4 ± 4.3 levels fused) who underwent intra-operative packing with QuikClot Trauma Pads (QCTP, Z-Medica Corporation) for all surgeries from July 2010 to August ...

- by Emily Abbott
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- Biomedical Engineering, Spine, Adolescent, Child

Familial dysautonomia is a hereditary multisystemic disease primarily affecting people of Ashkenazi Jewish descent. Musculoskeletal problems are related to gait disorders, spinal deformities, foot deformities, fractures, and arthropathies. The charts and radiographs of 136 patients who ranged in age from three months to forty-six years (mean, sixteen years) were reviewed. Sixty-four patients were available for follow-up examination. Spinal deformity was the most common orthopaedic problem and was diagnosed in seventy-eight patients starting at the age of four years, with a prevalence of 86 percent (forty-eight of fifty-six) by the age of fifteen years. Forty-one (53 percent) of the seventy-eight patients had scoliosis only, thirty-four (44 percent) had kyphoscoliosis, and three (4 percent) had kyphosis only. Bracing was accompanied by emotional, pulmonary, and skin problems, leading to a high rate of noncompliance and progression of the curve. Twenty-four patients had an operation a...

- by Elhanan Bar-on
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- Biomedical Engineering, Adolescent, Braces, Follow-up studies
- by S. Donzelli
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- Library and Information Studies, Arm, Artifacts, Posture

The diagnostic study of spinal deformities has long been a focus of medical science. For a clear condition assessment of scoliotic patients X-ray images are used. Disadvantages of X-ray inspections, however, make methodological research, which can lead to fast and cost-efficient examinations without harmful radiation, reasonable. HISTORY: In 1874, after LORD RAYLEIGH had studied the resultant pattern, the so-called moiré fringes of two overlapping grids, he concluded that the phenomenon could be useful for measurement purposes. Beyond industrial applications further research, about a hundred years later, proposed moiré topography for measurement of the human body. AIMS AND METHODS: The aim of this publication, based on thorough study of resources, is to present the basic theory of the moiré method and its application in scoliosis. The two main methods − the shadow and projection moiré − of moiré technique are described in detail. Moreover, the paper presents KAMAL's algorithm suggesting to calculate the plane angle of curvature in single-curve scoliosis cases and proposes directions for further research and developments. RESULTS: The significant advantages of the moiré method are that it is fast, non-invasive, portable, cost-efficient and has no harmful radiation. A moiré technique chosen and algorithmized well can be convenient for substitution or as a complement of X-ray images in scoliosis. However, it is a limitation that a methodological standard which could lead to generally reliable results has not been created yet. Furthermore, the amount of labour required for the evaluation of moiré images is not inconsiderable. To achieve further success of the moiré method a dedicated partnership of engineers and physicians, respectively the application of technical-biomedical knowledge is needed.

- by Csaba Bogdán
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- Surface topography, Moire Grating, Scoliosis, Moiré Technique
- by Pierre Maroteaux
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- Genetics, Child, American, Clinical Sciences

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

- by Sonia Pineda
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- X Rays, Clinical Sciences, Scoliosis, Correlation coefficient

Diagnostic testing. The goal of this study is to measure the accuracy and reliability of the Orthoscan (Orthoscan Technologies, Inc.) and to determine whether it can be substituted for radiographs in the surveillance of adolescent idiopathic scoliosis (AIS). AIS is usually followed using scoliosis radiographs, which offer the most reliable way to quantify the curve, but carry the risk of exposure to ionizing radiation. The Orthoscan is a nonradiographic topographic method for measuring spinal curves. There were 5 phases of this study that measured: the accuracy and reliability of the machine when used with a plastic model; the variability with a real patient; the intraobserver variability; the correlation between the measurements of the machine and that of the radiograph; and the correlation between the change in radiograph measurement over time and the change in Orthoscan measurement over time. In measurement of a static plastic model, the machine measured curves with a standard de...

- by Megan Dunn
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- Biomedical Engineering, Spine, Anthropometry, Adolescent

SIR IR-Thank you for giving us the opportunity to respond to the letter of Shah and Preciado. The effects of perioperative peritonsillar infiltration of drugs prior to tonsillectomy on postoperative analgesia have not been well evaluated. Apart from published case reports about the complications of peritonsillar space injections, there are also many studies in the literature reporting no complication related to injection of various drugs into the peritonsillar space for postoperative pain relief.

- by Alain Borgeat
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- Paediatric Anaesthesia, Ketamine, Postoperative pain, Scoliosis

Outcome study to determine the internal consistency, and validity of adapted Turkish version of Scoliosis Research Society-22 (SRS-22) Instrument. To evaluate the validity and reliability of adapted Turkish Version of SRS-22 questionnaire. The SRS-22 questionnaire is a widely accepted questionnaire to assess the health-related quality of life for scoliotic patients in the United States. However, its adaptation in languages other than the source language is necessary for its multinational use. Translation/retranslation of the English version of the SRS-22 was done, and all steps for cross-cultural adaptation process were performed properly by an expert committee. Later, SRS-22 questionnaires and previously validated Short Form-36 (SF-36) outcome instruments were mailed to 82 patients who had been surgically treated for idiopathic scoliosis. All patients had a minimum of 2 years follow-up. Fifty-four patients (66%) responded to the first set of questionnaires. Forty-seven of the first...

- by Dilek Yapar
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- Biomedical Engineering, Spine, Culture, Quality of life

To determine whether implant density impact three-dimensional deformity correction in posterior spinal fusion (PSF) without Ponte osteotomies (POs) for patients with Lenke 1 and 2 adolescent idiopathic scoliosis (AIS). Overview of Literature: Currently, the optimal pedicle screw (PS) density for flexible moderate-sized thoracic AIS curve correction is still controversial. There are limited data regarding the impact of implant density on three-dimensional correction in PSF without the use of PO for thoracic AIS surgery. Methods: A database of patients with AIS with Lenke 1 and 2 curves treated with PSF without PO and instrumented with PSs and ≥2-year follow-up was reviewed. The preoperative, immediate, and final follow-up postoperative radiographs were analyzed. The correlation between PS density and the following factors were determined: major curve correction (MCC), correction index (CI; MCC/ curve flexibility), kyphosis angle change, and rib index (RI) correction. Then, patients were divided into low-density (LD) and highdensity (HD) groups according to mean PS density for the entire cohort (1.5 PS per level). Demographics and radiographic and clinical outcomes were compared between groups. Results: The study included 99 patients with Lenke 1 and 23 patients with Lenke 2 AIS. The average MCC was 67.2%. There was no correlation between screw density and these parameters: MCC (r=0.10, p=0.26), CI (r=0.16, p=0.07), change in T2-T12 kyphosis angle (r=−0.13, p=0.14), and RI correction (r=−0.09, p=0.37). Demographic and preoperative radiographic parameters were similar between the LD and HD groups. At the latest follow-up, there were no differences between the two groups in regard to MCC, CI, change in T2-T12 kyphosis angle, RI correction, and Scoliosis Research Society-30 scores (all p>0.05). Conclusions: This study revealed no significant correlation between screw density and curve correction in any planes. HD construct may not provide better deformity correction in patients with flexible and moderate thoracic AIS undergoing PSF without PO.

Background: Recent reports have suggested a rotational strength weakness in rotations to the concave side in patients with idiopathic scoliosis. There have been no studies presenting normative values of female adolescent trunk rotational strength to which a comparison of female adolescents with idiopathic scoliosis could be made. The purpose of this study was to determine trunk rotational strength asymmetry in a group of female adolescents with AIS and a comparison group of healthy female adolescents without scoliosis.

- by wenyu liu
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- Clinical Sciences, Scoliosis, Observational Study

Background context: Ketorolac Tromethamine (ketorolac) is a nonsteroidal anti-inflammatory drug (NSAID) with proven efficacy in decreasing postoperative pain in various surgical settings, including the treatment of spine deformities. However, some studies have raised questions regarding the potential side effects of this agent, such as increased bleeding and inhibition of bony fusion.Purpose: This study was conducted to determine whether there is

- by Joshua Hyman and +1
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- Spine, Logistic Regression, Multivariate Analysis, Erythropoietin

Background: Scoliosis is present in 3-5% of the children in the adolescent age group, with a higher incidence in females. Treatment of adolescent idiopathic scoliosis is mainly dependent on the progression of the scoliotic curve. There is a close relationship between curve progression and rapid (spinal) growth of the patient during puberty. However, until present time no conclusive method was found for predicting the timing and magnitude of the pubertal growth spurt in total body height, or the curve progression of the idiopathic scoliosis. The goal of this study is to determine the predictive value of several maturity indicators that reflect growth or remaining growth potential, in order to predict timing of the peak growth velocity of total body height in the individual patient with adolescent idiopathic scoliosis. Furthermore, different parameters are evaluated for their correlation with curve progression in the individual scoliosis patient.

- by Iris Busscher
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- Radiology, Research Design, Spine, Aging

BACKGROUND CONTEXT: Laminectomy is an effective surgical technique for the treatment of cervical OPLL along multilevel. However, postoperative kyphosis and probable neurological deterioration have been frequently reported after laminectomy. PURPOSE: We analyzed the changes in the cervical curvature after laminectomy and subsequent changes in neurological status in treating ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. STUDY DESIGN/SETTING: Retrospective study. PATIENT SAMPLE: The authors reviewed the 38 patients who underwent cervical laminectomy between 1999 and 2003. OUTCOME MEASURES: The preoperative symptoms, Japanese Orthopedic Association (JOA) score and recovery rate was reviewed using medical records. The OPLL type was classified to continous, segmental, mixed and local type. The cervical global angle and range of motion (ROM) was measured by posterior tangent method at preoperation and the last follow-up. METHODS: According to the cervical global angle, the cervical curvature was distributed into three types; lordosis, straight, and kyphosis. The change in cervical curvature was also reviewed in lateral radiographs. RESULTS: A total 19 patients were available to review medical records. There were 14 male and 5 female, whose mean age at the time of surgery was 61.26 years. The mean follow-up period was 68.57 months. OPLL classification scheme, continous type was in 8 patients, mixed and segmental type was 5 patients each, and others type was in one patient. The preoperative JOA score was 10.21 6 3.08, postoperative JOA score was significantly improved to 13.73 6 2.9 (p !0.001) and the recovery rate at the last follow-up was 51.95%. The preoperative global angle was -10.61 and postoperative global angle was -10.31 . The preoperative ROM was 31.0 and postoperative them was 23.4 . There was no statistical significance in change of cervical curvature and ROM. A 16 of the 19 patients were preoperatively shown lordotic cervical curvature, and 3 patients were straight. At last follow-up, 14 patients kept the lordotic curvature, 2 patients changed from lordosis to kyphosis. One patient who cervical curvature was changed from lordosis to kyphosis during follow-up period underwent cervical fusion operation after 9 years of operation. CONCLUSIONS: Through the long-term results of laminectomy in treating cervical OPLL, the postoperative kyphosis was not common in patient with OPLL. The OPLL itself may serve as supporter of spinal column. For patients with maintained cervical lordosis, cervical laminectomy can be advocated.

- by Charles Ledonio and +1
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- Biomedical Engineering, Spine, Treatment Outcome, Adolescent

Study Design. Prospective observational study. Objective. To determine the typical trajectory of pain during the fi rst 6 months after spinal fusion surgery for adolescent idiopathic scoliosis (AIS) and the extent to which certain demographic, medical, and psychological variables modify this trajectory. Summary of Background Data. Pain after spinal fusion surgery for AIS may not improve predictably with elapsed healing time, and limited data exist on predictors of the course of pain during the initial months after surgery. Methods. Fifty patients ages 11 to 17 (mean = 14.5, standard deviation = 1.9) with AIS and undergoing posterior spinal fusion surgery comprised the study sample. Pain outcomes were assessed at 4 time points after surgery (2-week, 6-week, 3-month, and 6-month postsurgery). Preoperative predictor variables comprising demographics, baseline Cobb angle, body mass index, baseline pain, and psychological variables (anxiety, negative mood, and confi dence in ability to control pain) were assessed 2 weeks before surgery. Perioperative predictor variables comprising pain, pain coping effi cacy, negative mood, surgery length, length and lowest level of fusion, and analgesic use were assessed by self-report or record review. Multilevel growth models were used to evaluate hypotheses pertaining to predictors of pain trajectories. Results. Pain level on average declined predictably with days since surgery ( b = − 0.14 to − 0.19, P < 0.01).

- by Nigel Price and +2
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- Biomedical Engineering, Spine, Adolescent, Prospective studies

Introduction: Correct-level surgery is one of the most important concerns in the treatment of patients with adolescent idiopathic scoliosis (AIS). Variations in vertebral number can potentially result in wrong-level surgery. It is possible that the incidence and type of these variations be affected by different factors such as ethnicity. In the current retrospective study, the prevalence of these variations in Iranian AIS patients was investigated.
Methods: Between 2012 to 2017, spinal fusion was performed for the treatment of AIS in 125 patients. The thoracic and lumbar vertebrae were enumerated on posteroanterior radiographs. The first thoracic vertebra was the one attached to the first pair of ribs. Enumeration was continued in a caudal direction. The lumbar level initiated just below the last vertebra with a pair of associated ribs.
Results: Abnormal vertebral enumeration was found in 18 patients (14.4%). The prevalence of abnormal lumbar enumeration was higher than thoracic vertebrae (10.4% versus 4%). Eleven thoracic vertebrae were found in 5 patients (4%). Four lumbar vertebrae were found in eleven patients (8.8%). There were two patients with six lumbar vertebrae (1.6%). There was no patient with abnormal enumeration of both thoracic and lumbar vertebrae.
Conclusion: The current study showed a relatively high rate of atypical number of thoracic and lumbar vertebrae in Iranian AIS patients. It is necessary to enumerate the vertebrae on the basis of an organized protocol preoperatively to prevent wrong-level surgery in AIS patients.

- by Iranian Journal of Orthopaedic Surgery
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- Adolescent, Scoliosis, Spinal Fusion, Vertebra

In adolescent idiopathic scoliosis (AIS) there has been a shift towards increasing the number of implants and pedicle screws, which has not been proven to improve cosmetic correction. To evaluate if increasing cost of instrumentation correlates with cosmetic correction using clinical photographs. 58 Lenke 1A and B cases from a multicenter AIS database with at least 3 months follow-up of clinical photographs were used for analysis. Cosmetic parameters on PA and forward bending photographs included angular measurements of trunk shift, shoulder balance, rib hump, and ratio measurements of waist line asymmetry. Pre-op and follow-up X-rays were measured for coronal and sagittal deformity parameters. Cost density was calculated by dividing the total cost of instrumentation by the number of vertebrae being fused. Linear regression and spearman's correlation were used to correlate cost density to X-ray and photo outcomes. Three independent observers verified radiographic and cosmetic parameters for inter/interobserver variability analysis. Average pre-op Cobb angle and instrumented correction were 54°(SD 12.5) and 59% (SD 25) respectively. The average number of vertebrae fused was 10

- by Wendy Novicoff
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- Biomedical Engineering, Health Care, Spine, Adolescent

BACKGROUND CONTEXT: Concerns have been raised about the effect of backpack carrying on adolescent balance. For adolescent idiopathic scoliosis (AIS) subjects, the effect of backpack carrying method on their balance has not been determined. Our aim is to examine the effects of backpack load and carrying method on AIS subjects' balance. STUDY DESIGN/SETTING: Paired sample matched for age and sex. PATIENT SAMPLE: Twelve healthy adolescents matched for age and sex with 14 adolescents with mild AIS participated in this study. OUTCOME MEASURES: A test battery including clinical examination, radiological assessment, and stabilometric measurements of the postural sways in the upright standing posture were conducted. METHODS: Center of pressure excursions of our subjects were recorded with a stabilometric platform during the upright standing posture without a backpack and while carrying a backpack symmetrically and asymmetrically on each shoulder. For each carrying method, the backpack is loaded at 10% and 15% of body weight (BW). RESULTS: Our results indicated that postural sways increased with increasing backpack load. These postural sways were observed when normal adolescents carried a backpack loaded with 15% BW load, whereas, for age-and sex-matched AIS subjects, these postural responses were observed for the 10% BW load. The symmetrical backpack carrying induced better balance compared with the asymmetrical one. Asymmetrical carrying on the convex side of the scoliotic curve affects AIS subjects' balance more than carrying it on the concave side. CONCLUSIONS: Load carriage of 10% BW seems to alter AIS subjects' balance. Asymmetrical carrying should be avoided especially on the convex side of the scoliotic curve because it causes balance impairments that may increase spinal pain. Ó

- by Mohamed Elleuch
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- Adolescent, Clinical Sciences, Mechanical Stress, Scoliosis

A case of in utero spondylothoracic dysostoses is diagnosed during a routine third trimester ultrasound scan in a low-risk patient. Ultrasound showed spine deformation, hemivertebrae and crab-like ribs. The newborn had no other associated anomalies except inguinal hernia, and karyotype was normal. Bidimensional and 3-4D ultrasound imaging as well as radiograph of the fetus and photos of the newborn are presented and discussed. Sporadic cases are diYcult to diagnose and classify, as they are probably due to genetic heterogenicity. Sporadic cases of hemivertebrae are rare and not always lethal. Fetal ultrasound scan Wndings can help predict prognosis, enabling the parents' informed decision making.

- by jorge garcia
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- Genetics, Decision Making, Ultrasound Imaging, Spine

Current research has provided a more comprehensive understanding of Adolescent Idiopathic Scoliosis (AIS) as a three-dimensional spinal deformity, encompassing both lateral and rotational components. Apart from quantifying curve severity using the Cobb angle, vertebral rotation has become increasingly prominent in the study of scoliosis. It demonstrates significance in both preoperative and postoperative assessment, providing better appreciation of the impact of bracing or surgical interventions. In the past, the need for computer resources, digitizers and custom software limited studies of rotation to research performed after a patient left the scoliosis clinic. With advanced technology, however, rotation measurements are now more feasible. While numerous vertebral rotation measurement methods have been developed and tested, thorough comparisons of these are still relatively unexplored. This review discusses the advantages and disadvantages of six common measurement techniques based on technology most pertinent in clinical settings: radiography (Cobb, Nash-Moe, Perdriolle and Stokes' method) and computer tomography (CT) imaging (Aaro-Dahlborn and Ho's method). Better insight into the clinical suitability of rotation measurement methods currently available is presented, along with a discussion of critical concerns that should be addressed in future studies and development of new methods.

- by Doug Hill
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- Computed Tomography, Adolescent Idiopathic Scoliosis, Clinical Sciences, Scoliosis

We reviewed retrospectively our patients with thoracic lordoscoliosis and conducted a conceptual analysis of the patients with airway compression and atelectasia due to anterior protrusion of the vertebral bodies in order to describe the pathological conditions involved and the management methods used. Our goal was to develop a new concept for quantifying thoracic deformation. The individual cases discussed here have been reported earlier, but this is the first series analysis to date. Eighteen patients, aged 7.3 to 18 years, with thoracic lordoscoliosis due to a variety of causes, mostly neuromuscular disorders (12 cases), are described. Most patients were treated by anterior subtotal periosteal resection of the vertebral body followed by posterior instrumentation and arthrodesis. Atelectasia disappeared with a normalization of blood gases but the effect was variable on vital capacity. The analysis of the CT studies led to the concept of spinal deformity as an endothoracic deformat...

- by Vincent Pomero
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- Adolescent, Child, Scoliosis, Retrospective Studies

The quality of life among children with idiopathic scoliosis during their adolescence has been reported to be affected by the brace itself. However, a controversy exists whether brace treated scoliotics experience a poor quality of life, thus there is a need for the development of a brace-oriented instrument, as the now-existing questionnaires that are commonly used, such as the SRS -22, take into consideration the effects of both the conservative and the surgical treatment on quality of life of scoliotic children. The aim of the present study is to assess the validity and reliability of Brace Questionnaire (BrQ), a new instrument for measuring quality of life of scoliotic adolescents who are treated conservatively with a brace. Methodology of development involved literature review, patient and health care professionals&amp;amp;amp;amp;amp;#39; in-depth interviews and content validity analysis on patients. A validation study was performed on 28 brace treated scoliotic children aged between 9 and 18 years old. BrQ was assessed for the following psychometric properties: item convergent validity, floor and ceiling effects, internal consistency reliability, clinical validity and responsiveness to change. BrQ is self administrated and developmentally appropriate for ages 9 to 18 years old and is consisted of 34 Likert-scale items associated with eight domains: general health perception, physical functioning, emotional functioning, self esteem and aesthetics, vitality, school activity, bodily pain and social functioning of scoliotic children treated conservatively with a brace. The subscales of these eight dimensions can be combined to produce a total score. Higher scores mean a better quality of life. An item convergent validity &amp;amp;amp;amp;amp;gt;/= 0.40 was satisfied by all items in the present study. A satisfactory internal consistency reliability for the BrQ was recorded (Cronbach&amp;amp;amp;amp;amp;#39;s alpha coefficient was 0.82). There were no floor or ceiling effects. The correlation between BrQ overall scores and mild and moderate scoliosis was statistically significant (p &amp;amp;amp;amp;amp;lt; 0.001), revealing high clinical validity. An increase in effect sizes for the patient with improved scoliotic curves indicates that the BrQ is responsive to change in health status. BrQ is reliable, valid and responsive to change in adolescents with IS who are treated conservatively with a brace.

- by Theodoros Grivas
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- Health Care, Quality of life, Literature Review, Effect size

The promising results of Schroth scoliosis-specific exercises for adolescent idiopathic scoliosis found in low-quality studies will be strengthened by confirmation in a randomised controlled trial. Research questions: 1. Are Schroth exercises combined with standard care for 6 months more effective than standard care alone in improving radiographic and clinical outcomes for adolescents with idiopathic scoliosis? 2. Will the outcomes of the control group (who will be offered Schroth therapy delayed by 6 months) improve after 6 months of Schroth therapy? 3. Are the effects maintained 6 months after discontinuing the supervised intervention? Design: This is an assessor-blinded and statisticianblinded randomised controlled trial with transfer of the controls to the exercise group after 6 months. Participants and setting: Two hundred and fifty-eight consecutive adolescents with idiopathic scoliosis, aged 10 to 16 years, treated with or without a brace, with curves between 10 and 45 deg Cobb and Risser sign 3 will be recruited from three scoliosis clinics. Intervention: Combined with standard care, the Schroth group will receive five individual training sessions, followed by weekly group classes and daily home exercises for 6 months. Control: Controls will only receive standard care consisting of observation or bracing, and will be offered Schroth therapy 6 months later. Measurements: Curve severity (Cobb angle) and vertebral rotation will be assessed from radiographs at baseline, 6 and 12 months. Secondary clinical outcomes (back muscle endurance, surface topography measures of posture, and self-

- by Edmond Lou
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- Physiotherapy, Spine, Treatment Outcome, Adolescent

Introduction: Scoliosis is a three-dimensional deformative abnormality of the spine, defined by the Cobb's angle of spine curvature in the coronal plane, and is often accompanied by vertebral rotation in the transverse plane and hypokyphosis in the sagittal plane. Based on the age of presentation, scoliosis is further categorized as infantile, juvenile or adolescent idiopathic. Adolescent idiopathic scoliosis (AIS) has the highest prevalence of the three categories. This type of scoliosis is present at age ten and lasts till the end of growth. Its prevalence is dependent on the curvature of the spine and gender of the patient. Objective: The purpose of this review is to evaluate the role of physiotherapy in reducing curve progression and pain, postponing or avoiding invasive treatment and improve the quality of life in adolescents with AIS. Methodology: The study is a Systematic Review, meta-analytic type, consisting of 5 studies (RCT) of the last ten years, which focus on the i...

Narcotic use after spinal deformity surgery 2 STRUCTURED ABSTRACT 1 Background Context: The role of preoperative narcotic use and its influence on outcomes 2 following spinal deformity surgery is unknown. It is important to determine what patient factors 3 and co-morbidities can affect the success of spinal deformity surgery, a challenging surgery with 4 high rates of complications at baseline. 5 Purpose: Evaluate if preoperative narcotic use persists following spinal deformity surgery, and 6 whether the outcomes are adversely affected by preoperative narcotic use. 7 Study Design/Setting: Retrospective evaluation of prospectively collected data 8 Patient Sample: 253 adult patients (230 females/23 males) undergoing primary spinal deformity 9 surgery were enrolled from

- by Han Kim
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- Pain, United States, Clinical Sciences, Scoliosis

Background It has been suggested that asymmetrical positioning of an infant with reduced mobility may lead to postural deformity becoming established over time. However, evidence to support or question this line of thinking is lacking. Therefore, the aim of this retrospective cohort study was to test the association between asymmetrical positioning in the first 12 months of life and the subsequent direction of postural deformity in non-ambulant people with cerebral palsy. Methods The direction of scoliosis, pelvic obliquity and windswept hip pattern and also the side of unilateral hip subluxation/dislocation were determined for 246 young people ranging in age from 1 year and 2 months to 19 years (median age 10 years and 3 months). Parents/carers of the participants were interviewed to establish holding and feeding positions and preferred lying posture adopted in early life. Univariate analyses and multivariate logistic regression analyses were carried out. Results The study provided evidence of an association between asymmetrical lying posture adopted in the first year of life and the direction of the subsequent pattern of postural deformity. If the child's head had been rotated to the right during supine lying, it was more likely that the scoliosis would be convex to the left, pelvic obliquity would be lower on the left, windswept hip pattern would be to the right and hip subluxation/dislocation would occur on the left. The likelihood of the deformities occurring in the same direction was also increased if consistent side lying on the right had been preferred. Conclusions Clinicians should be aware of positioning for children with severe disabilities particularly those who prefer supine lying with their head rotated to the side and those who prefer consistent side lying.

- by Craig Kirkwood
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- Education, Cerebral Palsy, Adolescent, Child

Purpose Current evidence regarding the use of exercise therapy in the treatment of adolescent idiopathic scoliosis (AIS) was assessed with a review of published literature. Methods An extensive literature search was carried out with commonly used medical databases. A total of 155 papers were identified out of which only 12 papers were deemed to be relevant. Results There were nine prospective cohort studies, two retrospective studies and one case series. All studies endorsed the role of exercise therapy in AIS but several shortcomings were identified-lack of clarity of patient recruitment and in the method of assessment of curve magnitude, poor record of compliance, and lack of outcome scores. Many studies reported ''significant'' changes in the Cobb angle after treatment, which were actually of small magnitude and did not take into account the reported inter or intra-observer error rate. All studies had poor statistical analysis and did not report whether the small improvements noted were maintained in the long term. Conclusions This unbiased literature review has revealed poor quality evidence supporting the use of exercise therapy in the treatment of AIS. Well-designed randomised controlled studies are required to assess the role of exercise therapy in AIS.

- by Harshad Dabke
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- Biomedical Engineering, Evidence Based Medicine, Adolescent, Exercise therapy

Purpose The aim of this study was to assess the psychometric properties of a youth version of the EQ-5D five-level questionnaire (5LY) and its three-level version (3LY) in a sample of Chinese paediatric patients. Methods A consecutive sample of idiopathic scoliosis patients were recruited from a referral outpatient scoliosis center at Hong Kong, China in October 2017 and completed the two versions of EQ-5D-Y. Redistribution properties in each dimension of EQ-5D-Y were analyzed between 5LY and 3LY by logistics regressions. Absolute reduction and relative reduction in ceiling effects from the 3LY to the 5LY were calculated. Test-retest reliability was assessed by examining the Gwet's agreement coefficient (Gwet's AC) for five individual dimension responses over the 2-week period. Results A total of 129 idiopathic scoliosis patients completed the two versions of EQ-5D-Y at baseline assessment, among which 70 patients completed the test-retest interview in 2-3 weeks after baseline assessment. For redistribution properties , the proportion of inconsistency was low in all the dimensions, ranging from 0.0% ("Usual activities") to 3.9% ("Pain/ discomfort"). Ceiling effects were reduced in four dimensions. "Usual activities" dimension showed significant reduction (absolute and relative reductions: 3.9% and 4.3%; p = 0.025) and the "worried/sad/unhappy" dimension showed the largest significant reduction in ceiling effects (absolute and relative reductions: 7.8% and 9.8%; p = 0.012). The 3LY and 5LY showed very good agreement (> 80%) of individual dimension responses between two assessments, except for the "worried/ sad/unhappy" dimension in 3LY. Conclusion Through this head-to-head comparison, the 5LY had significant improvements in ceiling effects in two dimensions when compared to 3LY but other measurement properties of 3LY and 5LY performed similar in the idiopathic scoliosis patient group. Keywords EQ-5D-5L · EQ-5D-Y · Children · Youth · Psychometric properties · Idiopathic scoliosis JEL Classification I10 · J13 Key findings • This is the very first psychometric evidence of 5LY, and head-to-head comparison of the 3LY and 5LY worldwide .

Horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare congenital disorder characterized by absence of conjugate horizontal eye movements and progressive scoliosis developing in childhood and adolescence. We present a child with clinical and neuroimaging findings typical of HGPPS. CT and MRI of the brain demonstrated pons hypoplasia, absence of the facial colliculi, butterfly configuration of the medulla and a deep midline pontine cleft. We briefly discuss the imaging aspects of this rare entity in light of the current literature.

- by Rômulo Gama
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- Brain, Child, Pediatric radiology, Eye Movement
- by Clayton Adam
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- Biomedical Engineering, Spine, Adolescent, Finite Element Analysis

Five white-beaked dolphins Lagenorhynchus albirostris with outwardly vertebral kyphosis, kyphoscoliosis or lordosis were identified during a photo-identification survey of over 400 individuals (2002−2013) in Faxaflói and Skjálfandi Bays, Iceland. In addition, 3 stranding reports from Denmark, The Netherlands and the UK were analysed, providing both external observation and post mortem details of axial deviations of the vertebral column in this species. Two of the free-ranging cases and 2 of the stranded specimens appeared to have an acquired disease, either as a direct result of trauma, or indirectly from trauma/wound and subsequent infection and bony proliferation, although we were unable to specifically identify the causes. Our data represent a starting point to understand vertebral column deformations and their implications in white-beaked dolphins from the eastern North Atlantic. We recommend for future necropsy cases to conduct macro-and microscopic evaluation of muscle from both sides of the deformed region, in order to assess chronic or acute conditions related to the vertebral deformations and cause of death.

- by carl kinze
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- Spine, Biological Sciences, Dolphins, Atlantic Ocean

The aim of the study was to investigate the mechanisms of the Cheneau-Toulouse-Munster (CTM) brace in the correction of scoliotic curves, at night in the supine position. Magnetic resonance imaging (MRI) and Computer tomography (CT) acquisitions were performed in vivo on eight girls having an idiopathic scoliosis and being treated for the first time using a personalised CTM brace. Personalised 3D finite element models of the spine were developed for each patient, and an optimisation approach was used to quantify the forces generated by each brace on each scoliotic spine. A sensitivity study was undertaken to test the assumptions about intervertebral behaviour and load transmission from the brace to the spine. The computed CTM brace forces were 9-216N in the coronal plane and 2-72N in the sagittal plane. Personalised spinal stiffness properties should be included in spine models because, in this study, partial correction resulted from the application of higher estimated forces than for total correction. Partially reduced spines should be stiffer than totally reduced spines. The sensitivity study showed that the computed brace forces were proportional to the intervertebral Young's modulus and should be analysed as estimated data. Better knowledge of brace forces should be helpful in brace design to achieve the best correction of first scoliotic deformities.

- by Marie-christine Ho Ba Tho and +1
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- Biomedical Engineering, Computed Tomography, Magnetic Resonance Imaging, Finite element method

Objective. Our objective was to assess the short-term complication rate in patients undergoing treatment of thoracolumbar fi xed sagittal plane deformity (FSPD). Summary of Background Data. The reported morbidity and mortality for the surgical treatment of thoracolumbar FSPD is varied and based on studies with small sample sizes. Further studies are needed to better assess FSPD complication rate, and the factors that infl uence it. Methods. The Scoliosis Research Society (SRS) Morbidity and Mortality Database was queried to identify cases of thoracolumbar FSPD from 2004 to 2007. Complications were analyzed based on correction technique, surgical approach, surgeon experience (SRS membership status used as a surrogate), patient age, and history of prior surgery. Results. Five hundred and seventy-eight cases of FSPD were identifi ed. Osteotomies were performed in 402 cases (70%), including 215 pedicle subtraction osteotomies (PSO), 135 Smith-Petersen osteotomies (SPO), 19 anterior discectomy with corpectomy procedures (ADC), 18 vertebral column resections (VCR), and 15 unspecifi ed osteotomies. There were 170 complications (29.4%) in 132 patients. There were three deaths (0.5%). The most common complications were durotomy (5.9%), wound infection (3.8%), new neurologic defi cit (3.8%), implant failure (1.7%), wound hematoma (1.6%), epidural hematoma (1.4%), and pulmonary embolism (1.0%). Procedures including an osteotomy had a higher complication rate (34.8%) than cases not including an osteotomy (17.0%, P Ͻ 0.001), and this remained signifi cant after adjusting for the effects of patient age, surgeon experience, and history of prior surgery (P ϭ 0.003, odds ratio ϭ 2.070, 95% CI ϭ 1.291-3.321). Not signifi cantly associated with complication rate were patient age (P ϭ 0.68), surgeon experience (P ϭ 0.18), and history of prior surgery (P ϭ 0.10). Complication rates were progressively higher from no osteotomy (17.0%), to SPO (28.1%), to PSO (39.1%), to VCR (61.1%). Conclusion. The short-term complication rate for treatment of FSPD is 29.4%. The complication rate was signifi cantly higher in patients undergoing osteotomies, and more aggressive osteotomies were associated with progressively higher complication rates.

- by Christopher Shaffrey and +1
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- Biomedical Engineering, Spine, Treatment Outcome, Advisory Committees

Background: The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS).

- by Jean Claude de Mauroy and +6
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- Clinical Sciences, Scoliosis

The body image is to be reconstructed during adolescence, which is more difficult in the case of somatic illness and social stigma. This research aimed to study adolescents' body image with scoliosis, students of a special educational institution in Ukraine socially identified with stigma as 'a school for scoliotics'. The participants (n=104) of the research were adolescents (13-15 years old) with scoliosis from the institution mentioned above (n=52, 24 males, 28 females) and adolescents without scoliosis from the same city (n=52, 24 males, 28 females). Two methods were used to collect the data: (1) Self-portraits; (2) Dembo-Rubinstein Self-Assessment Scale. The adolescents with scoliosis and labeled as 'scoliotics' face additional obstructions in their psychic body development compared to their peers. For instance, they tend to overinvest in the desired image of a healthy body and do not feel able to get it. We found the markers of four different ways to cope with the situation by the adolescents with scoliosis: (a) identification as 'a scoliotic' instead of hope to be cured soon; (b) psychological distancing from the others to preserve the desire of a more attractive body image; (c) repression or denial of the body parts which could relate to scoliosis; (d) infantilization, aimed to slow down the discovery of their maturing corporeality. Consequently, adolescents with scoliosis affected by stigma experience the gap or conflict between their current, desired and perceived realistic body image.

BACKGROUND CONTEXT: The most common spinal deformities among adolescents are adolescent idiopathic scoliosis (AIS; 2%-3% prevalence) and Scheuermann kyphosis (SK; 1%-8% prevalence). Both are believed to have a genetic influence in their etiology. The association between body mass index (BMI) and body stature and their possible association to spinal deformities is uncertain. STUDY DESIGN: A cross-sectional prevalence study. PURPOSE: To examine the prevalence of all adolescent spinal deformities according to the extent of their severity as well as their possible association to BMI and body height.

- by Oded Hershkovich
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- Adolescent, Body Mass Index, Risk factors, Clinical Sciences

Background Context 3 Exercise limitation has been described in patients with adolescent idiopathic scoliosis 4 (AIS); however, whether the walking performance is impaired in these patients should 5 be elucidated. 6

- by Patrícia Poletto and +3
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- Adolescent, Muscle strength, Child, Walking

BACKGROUND: Assessment of skeletal maturity in patients with adolescent idiopathic scoliosis (AIS) is important to guide clinical management. Understanding growth peak and cessation is crucial to determine clinical observational intervals, timing to initiate or end bracing therapy, and when to instrument and fuse. The commonly used clinical or radiologic methods to assess skeletal maturity are still deficient in predicting the growth peak and cessation among adolescents, and bone age is too complicated to apply. PURPOSE: To address these concerns, we describe a new distal radius and ulna (DRU) classification scheme to assess skeletal maturity. STUDY DESIGN: A prospective study. PATIENT SAMPLE: One hundred fifty young, female AIS patients with hand x-rays and no previous history of spine surgery from a single institute were assessed. OUTCOME MEASURES: Radius and ulna plain radiographs, and various anthropomorphic parameters were assessed. METHODS: We identified various stages of radius and ulna epiphysis maturity, which were graded as R1-R11 for the radius and U1-U9 for the ulna. The bone age, development of sexual characteristics, standing height, sitting height, arm span, radius length, and tibia length were studied prospectively at each stage of these epiphysis changes. RESULTS: Standing height, sitting height, and arm span growth were at their peak during stages R7 (mean, 11.4 years old) and U5 (mean, 11.0 years old). The long bone growths also demonstrated a common peak at R7 and U5. Cessation of height and arm span growth was noted after stages R10 (mean, 15.6 years old) and U9 (mean, 17.3 years old). CONCLUSIONS: The new DRU classification is a practical and easy-to-use scheme that can provide skeletal maturation status. This classification scheme provides close relationship with adolescent growth spurt and cessation of growth. This classification may have a tremendous utility in FDA device/drug status: Not applicable.

- by Dino Samartzis
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- Spine, Anthropometry, Adolescent Development, Adolescent
- by Jean-marie Cuisset and +3
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- Research Design, Clinical Trial, Adolescent, France

| Background: The SRS-22r questionnaire is a well-accepted instrument used to measure health-related quality of life in patients with idiopathic scoliosis. No validated tool exists in Brazil for idiopathic scoliosis, and the use of the SRS-22r in non-English Laguage contries requires its transcultural adaptation. Objective: The objective of this study was to culturally adapt the translated Brazilian version of the SRS-22r questionnaire and to determine its reliability using statistical tests for internal consistency and test-retest reliability. Method: The transcultural adaptation process was carried out according to the recommendations of the American Academy of Orthopedic Surgeons. The pre-final version was administered to 44 patients with idiopathic scoliosis. The mean age of the participants was 18.93 years and the mean curve magnitude was 54.6°. A subgroup of 30 volunteers completed the questionnaire a second time one week later to determine the scale's reproducibility. Internal consistency was determined using Cronbach's alpha coefficient, and the test-retest reliability was determined using the Intraclass Correlation Coefficient (ICC). Results: No floor effects were observed using the Brazilian version of the SRS-22r. Ceiling effects were observed in the Pain and Satisfaction with Management domains. The internal consistency values were very good for 3 domains and good for 2 domains. The ICC values were excellent for all domains. Conclusions: The high values of internal consistency and ICC reproducibility suggest that this version of the questionnaire can be used in Brazilian patients with idiopathic scoliosis.

- by Bruna Gabriel
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- Quality of life, Brazil, Adolescent, Translations