Adolescent Idiopathic Scoliosis Deformity Research Articles

The effect of the Relton-Hall operative frame on trunk deformity in adolescent idiopathic scoliosis.

The prone operative position affects the geometry of the scoliotic spine. However, the literature provides little information concerning the effect of operative position on the scoliotic trunk geometry. This study compared the trunk deformity of 31 adolescent idiopathic scoliosis patients in two standardized positions: standing and prone on a Relton-Hall frame. The geometry of the trunk was assessed using 11 magnetic sensors placed on anatomical landmarks. Eight geometric indices of the trunk were compared using paired Student t-tests (alpha=0.01). The transverse rotation of shoulders, the coronal rotation of shoulders, the lateral shift of C7 with respect to S1, and the thoracic and lumbar angles of trunk rotation assessed in the operative position did not show any significant change compared to the standing position. Therefore, operative positioning using the Relton-Hall frame did not lead to an overall reduction in the scoliotic trunk deformity. Modifications to the Relton-Hall frame are required for optimal presurgical correction of the scoliotic trunk deformity.

Progression of vertebral and spinal three-dimensional deformities in adolescent idiopathic scoliosis: a longitudinal study.

The evolution of scoliotic descriptors was analyzed from three-dimensionally reconstructed spines and assessed statistically in a group of adolescents with progressive idiopathic scoliosis. To conduct an intrasubject longitudinal study quantifying evolution of two- and three-dimensional geometrical descriptors characterizing the scoliotic spine and vertebral deformities. The data available on geometric descriptors usually are based on cross-sectional studies comparing scoliotic configurations of different individuals. The literature reports very few longitudinal studies that evaluated different phases of scoliotic progression in the same patients. The evolution of regional and local descriptors between two scoliotic visits was analyzed in 28 adolescents with scoliosis. Several statistical analyses were performed to determine how spinal curvatures and vertebral deformities change during scoliosis progression. At the thoracic level, vertebral wedging increases with curve severity in a relatively consistent pattern for most patients with scoliosis. Axial rotation mainly increases toward curve convexity with scoliosis severity, worsening the progression of vertebral body deformities. No consistent evolution is associated with the angular orientation of the maximum wedging. Thoracic kyphosis varies considerably among subjects. Both increasing and decreasing kyphosis are observed in nonnegligible proportions. A decrease in kyphosis is associated with a shift in the plane of maximum deformity toward the frontal plane, which worsens the three-dimensional shape of the spine. The results of this study challenge the existence of a typical scoliotic evolution pattern and suggest that scoliotic evolution is quite variable and patient specific.

The relationship between surface and radiological deformity in adolescent idiopathic scoliosis: effect of change in body position.

Three-dimensional (3D) surface deformity of the trunk in adolescent idiopathic scoliosis (AIS) is affected by changes in patient position. Initial quantification of the curve and its associated deformity, as well as subsequent monitoring, relies on both radiological and surface measurements. However, there is often a discrepancy between radiological and apparent surface deformity. The present investigation studied the dynamics of the 3D deformity associated with changes in patient position on 27 patients with AIS. The trunk deformity was quantified in three positions by measuring the angle of thoracic inclination at each vertebral level using a scoliometer. The patients all had full spine radiography in the antero-posterior erect position. Vertebral rotation and lateral spinal curvature were measured from the radiographs. Body position altered the magnitude of the surface deformity over the whole trunk, with the prone position offering the optimum relationship between 3D trunk shape and radiological deformity. This could be attributed to the ease and standardisation of positioning for prone measurements, together with increased patient comfort. It is suggested that adoption of standardised positioning and measurement of surface and radiological deformity will permit consistency of clinical judgement based on these parameters.

Cardiorespiratory status in relation to mild deformity in adolescent idiopathic scoliosis

We assessed the cardiorespiratory function in young persons with adolescent idiopathic scoliosis as they entered adult life; the condition had been detected and managed through a Montreal area school screening program in the years 1975 to 1979, and all patients had been discharged with stable condition. Thirty-two youths (average age 17.7 years) with Cobb angle from 3 to 32 degrees and 93 girls (average age 17.3 years) with Cobb angle from 3 to 46 degrees did not differ from their unaffected school friends in smoking habit, respiratory symptoms, lung volumes, expiratory flow rates, diffusing capacity, maximal respiratory pressures, or submaximal exercise results. When expressed as percent predicted, pulmonary functions were within the normal range in all but one patient. Normal results were also recorded in a subsample of 20 girls undergoing a more detailed progressive maximal exercise test. This information is pertinent for counseling the adolescent with scoliosis but needs to be supplemented by prospective measurements to determine the natural history of mild scoliosis in later adult life.