Topographical, Kinesiological and Psychological Factors in the Surgical Management of Adolescent ldiopat hic Scoliosk

Abstract

Scoliosis is a three dimensional spinal deformity which is serious enough to warrant assessment and treatment in two per hundred of the population in the United Kingdom. It presents as a lateral-rotatory deformity of the spine with a resulting rib hump. Symptoms include a gross deformity in the shape of the back, decreased spinal mobility, back pain, as well as a number of psychological problems. Patients with severe scoliosis are usually referred to surgery. The purpose of this study was to investigate the topographical, kinesiological and psychological factors and interactions in the surgical management of a group of adolescent idiopathic scoliosis patients. One hundred and thirty patients with adolescent idiopathic scoliosis were included in the study. All patients had their back shape assessed by an optical computer system. Spinal mobility was measured by an electronic inclinometer and subjects were also given a questionnaire which included five sections relating to their pain, activities of daily living, body-image, self-esteem and anxiety. The patients then underwent one of five different operative procedures depending on their age, and the site and severity of their scoliosis curvature. All patients were re-assessed six months after surgery. Results demonstrated a significant improvement in the lateral curvature and rib hump of the back. Spinal balance was only improved in two-fifths of the groups following surgery and the sagittal profiles and volume difference between the two sides of the back were unchanged or worse after the operation. Thoracic and lumbar spinal mobility were significantly decreased both in the frontal and sagittal planes, except for thoracic extension and side-flexion to the convexity of the curve which were unchanged following surgery. Rod instrumentation on one side of the spine was found to limit lumbar side-flexion to that side and costoplasty on one side of the back permitted greater lumbar side flexion to the contralateral side of the spine for the patients in this study. Increasing spinal curvature and rib hump corresponded with an overall decrease in spinal mobility except for spinal extension where an overall increase in mobility was found. Most surgical techniques did not relieve the pain or the problems with activities of daily living associated with adolescent scoliosis. Patients worries were only significantly decreased in three-fifth's of the groups while self-esteem was unchanged in four-fifth's of the groups after surgery. In conclusion therefore although surgery significantly improved some aspects of the surface shape of the back it did not correct all three dimensions of the deformity. Further the mobility of the spine was severely restricted following surgery and while some psychological variables improved others were unchanged or worse.