Lumbar Idiopathic Scoliosis Research Articles

Letter to the Editor: "Do different pathologies of adult spinal deformity (idiopathic lumbar scoliosis against de novo lumbar scoliosis) affect preoperative and postoperative selfimage?

Letter to the Editor: "Do different pathologies of adult spinal deformity (idiopathic lumbar scoliosis against de novo lumbar scoliosis) affect preoperative and postoperative selfimage?

Do different pathologies of adult spinal deformity (idiopathic lumbar scoliosis against de novo lumbar scoliosis) affect preoperative and postoperative selfimage?

Retrospective single-center study. This study aimed to examine the factors associated with the self-image domain of the Scoliosis Research Society-22 revised (SRS-22r) in patients who underwent corrective surgery for adult idiopathic scoliosis (AdIS). Adult spinal deformity (ASD) can be classified into AdIS and de novo scoliosis. However, no studies have investigated the effect of different ASD pathologies on self-image. This study enrolled 60 patients who underwent corrective surgery and were followed up for >2 years postoperatively. AdIS was defined as adolescent idiopathic scoliosis in patients who had no history of corrective surgery, had a primary thoracolumbar/lumbar (TL/L) curve, and were ≥30 years old at the time of surgery. The AdIS (n=23; mean age, 53.1 years) and de novo (n=37; mean age, 70.0 years) groups were significantly different in terms of the main thoracic and TL/L curves, sagittal vertical axis, thoracic kyphosis, and thoracolumbar kyphosis preoperatively. The scores in the self-image domain of the SRS-22r (before surgery/2 years after surgery [PO2Y]) were 2.2/4.4 and 2.3/3.7 in the AdIS and de novo groups, respectively, and PO2Y was significantly different between the two groups (p<0.001). Multivariate regression analysis revealed that AdIS was an independent factor associated with self-image at PO2Y (p=0.039). AdIS, a spinal deformity pathology, was identified as a significant factor associated with the self-image domain of SRS-22r in patients who underwent corrective surgery. AdIS is not solely classified based on pathology but also differs in terms of the clinical aspect of self-image improvement following corrective surgery.

Incobotulinumtoxin A and Yoga-like Isometric Exercise in Adolescent Idiopathic Lumbar Scoliosis—A Randomized Pilot Study

Background: Approximately 90% of scoliosis cases are adolescent-idiopathic (AIS). From the first appearance of scoliosis at 10–14 years of age until the age of 18, the spine is most vulnerable to deterioration; young, growing people are most susceptible to the worsening of one or more scoliotic curves. An effective non-surgical means of remediation would be welcome. Design: This was a randomized, controlled, two-arm study assessing the safety and efficacy of combining incobotulinum injections with yoga to reverse lumbar and thoracolumbar AIS. Methods: In a private clinic setting, non-pregnant, healthy 12–18 year-olds were either taught a symmetrical “placebo” yoga pose (control sub-group 1), performed the side plank (Vasisthasana) three times daily with a placebo injection (control sub-group 2) or performed the three-times-daily side plank with a botulinum injection (intervention group 3). Injection: For the injection, 33 IU of incobotulinumtoxin type A (Xeomin) was injected into the concave-side lumbar paraspinals and quadratus lumborum at L2–3 and the psoas muscle at L3–4, or participants were injected similarly with a placebo. Randomization was achieved using random.org. Objective: The objective was to determine whether the treatment of muscular asymmetry with botulinum toxin injections and side planks is safe and effective in AIS. Results/Outcome: Eleven intervention and thirteen placebo patients (Groups 1 + 2), who were 12–18 years old, completed the three-month study. Mean daily side plank time = 165 s. The mean initial lumbar curvature was 36.9 degrees (SD 14.36), (p &lt; 0.0001); the mean Group 3 curvature at 3 weeks was 29.5 degrees (SD 14.23) (p &lt; 0.0001); and the mean Group 3 curvature at 3 months was 26.0 degrees (SD 12.81). Onset vs. 3-month value: p &lt; 0.0001. Harms were limited to one patient in Group 2 and one in Group 3, who complained of transient shoulder pain and supported themselves temporarily on their forearm instead of the palm of the extended hand. Conclusion: Muscle strength asymmetry appears to be relevant to AIS treatment. Incobotulinum injections combined with side planks performed with the convex side downward may be more effective in reversing lumbar AIS than placebo exercises or side planks and placebo injections.

Biomechanical modeling and assessment of lumbar vertebral body tethering configurations.

Vertebral body tethering (VBT) is a fusionless spinal growth modulation technique, which shows promise for pediatric idiopathic scoliosis (IS) curve correction. This technique, mainly used for thoracic curves, is increasingly being used to treat lumbar curves in order to preserve spine flexibility. It remains necessary to adequately define the cord tension to be applied during the operation and the instrumented levels to biomechanically predict correction over time for the lumbar spine. Twelve pediatric patients with lumbar IS, treated with lumbar-only or lumbar and thoracic VBT, were selected for this study. Three independent variables were tested alternately using a patient-specific finite element model (FEM), which includes an algorithm modeling vertebra growth and spinecurvechanges due to growth modulation for 24months post-operatively according to the Hueter-Volkmann principle. Parameters included cable tensioning (150N/250N), upper instrumented level (actual UIV, UIV-1) and lower instrumented level (actual LIV, LIV + 1). Each FEM was personalized using 3D radiographic reconstruction and flexibility supine radiographs. An increase in cord tension (from 150 to 250N) had significant effects on main thoracic and thoraco-lumbar/lumbar Cobb angles, as well as on lumbar lordosis, after surgery (supplementary average correction of 3° and 8°, and increase of 1.4°, respectively) and after 24months (4°, 10° and 1.1°) (p < 0.05). Adding a level to the actual UIV or LIV did not improve correction. This parametric study showed that cord tension is the most important biomechanical parameter on the simulated immediate and 2-year increase in lumbar curve correction. Our preliminary model suggests that it is not advantageous to add additional instrumented levels. This computational study uses a retrospective validation cohort (level of evidence 3).

A Systematic Review on Spinal Asymmetries in Case Studies of Unilateral Nephroptosis from a Viscerosomatic Point of View.

The assessment of posture and asymmetries is common in musculoskeletal clinical practice, and correction is a frequent goal. In this setting, posture and asymmetries are usually interpreted in terms of musculoskeletal issues. This study aimed to evaluate spinal asymmetries in case studies of unilateral nephroptosis. A systematic review was performed using PubMed, CINAHL, Scopus and Web of Science. We included case reports and case series of nephroptotic patients which showed diagnostic imaging that allowed us to assess the presence of spinal asymmetries in the frontal plane. The methodological quality of the selected studies was assessed by using Case Report (CARE) checklist. Nineteen studies were included, with a total number of 78 reported patients (69 women) ranging 22 to 44 years old (mean: 29). Only one patient presented with medial nephroptosis, while the rest presented with caudal migration. Ninety-one percent of the cases affected to the right kidney. All cases but two showed homolateral flank closure (lower rib descent, iliac crest raise and/or homolateral side-bending). The correction of nephroptosis, either by supine position or surgical treatment, removed asymmetries in some cases while other cases improved only partly. Manual therapists must consider visceral implications while assessing body posture. Further, since the most common symptom of nephroptosis is loin pain, and it has been claimed that loin pain is underdiagnosed, manual therapists should consider its potential presence during clinical practice. Finally, being that nephroptosis shares several features with idiopathic lumbar scoliosis (type of patient, postural adaptation), more research is needed regarding any possible relation between them.

Shear wave elastography of the lateral abdominal muscles in C-shaped idiopathic scoliosis: a case\u2013control study

Considering that knowledge about lateral abdominal muscles (LAM) in idiopathic scoliosis (IS) is still very limited, the aims of this study were: (a) to compare LAM thickness and elasticity between C-shaped IS and non-scoliotic population; and (b) to compare LAM thickness and elasticity between C-shaped thoracic, thoracolumbar, and lumbar IS. A total of 259 adolescents were included in the final analysis; among these, 108 were IS and 151 were non-IS. LAM thickness and elasticity were measured at rest and during isometric contraction by an Aixplorer ultrasound scanner. Out of all LAM, only OE thickness was higher on the convex body side compared to the concave side in lumbar and thoracolumbar scoliosis. It may be related with muscle’s atrophy/hypertrophy or other tissues displacement rather than different force generated by the muscle on both body sides, because an asymmetry in the elasticity of the LAM between the convex and concave side was not presented. The only TrA was stiffer in lumbar scoliosis compared to thoracolumbar and thoracic scoliosis. LAM elasticity was similar in IS and non-IS adolescents.

Comparative Study of the Spinopelvic Alignment in Patients With Idiopathic Lumbar Scoliosis Between Adulthood and Adolescence

Understanding the natural history of the spinopelvic alignment in adolescent idiopathic scoliosis (AIS) is important in developing surgical strategies for patients with adult idiopathic lumbar scoliosis (AdLS). Because it is challenging to follow individuals without any treatments, we sought to estimate its natural history by comparing radiographic characteristics of patients with AIS and AdLS. We included patients with Lenke 5 AIS and patients with AdLS who were diagnosed with Lenke 5 AIS in adolescence. The Cobb angle of the curve and spinopelvic parameters were measured by whole spine radiographs. The AdLS patients were divided into 2 groups according to age <50 years (AdLS<50) or ≥50 years (AdLS≥50). Radiographic parameters were compared among the AIS, AdLS<50, and AdLS≥50 groups. The relationship between age and each parameter was analyzed using nonlinear regression analysis. We analyzed 40 patients with AIS (all female, mean age 16.8 ± 3.2 years) and 35 patients with AdLS (34 female and 1 male, mean age 55.4 ± 12.1 years). Thoracolumbar/lumbar curve and thoracolumbar kyphosis was significantly greater in the AdLS<50 group compared with the AIS group, without progression after age 50 years. Lumbar lordosis and pelvic tilt deteriorated linearly with age. AIS and AdLS<50 patients maintained sagittal balance, which deteriorated in AdLS≥50 patients. Our results may predict the following natural course of Lenke 5 AIS: (1) progression of scoliotic deformity of thoracolumbar/lumbar curve with increased thoracolumbar kyphosis; (2) subsequent lumbar hypolordosis followed by pelvic retroversion; and (3) sagittal imbalance after failure of compensation.

Effects of Schroth exercise therapy on curvature and body appearance of patients with lumbar idiopathic scoliosis

Effects of Schroth exercise therapy on curvature and body appearance of patients with lumbar idiopathic scoliosis

Pelvic rotation parameters related to in-brace correction in patients with idiopathic scoliosis

BackgroundTo identify the pelvic parameters affecting in-brace correction (IBC) in patients with idiopathic scoliosis (IS).MethodsPatients with IS receiving Chêneau brace treatment in our scoliosis center from January 2019 to November 2019 were retrospectively analyzed. Pelvic rotation parameters, including pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), L/R ratio, were collected. Other radiographic data, such as Risser sign, coronal and sagittal balance, curve location, kyphosis, lordosis of each patient were also recorded to analyze their correlations with IBC. Correlation analyses were performed to identify the classified variables influencing IBC. The principal component analysis was used to extract common factors of radiographic parameters to eliminate interaction effects. The linear regression equation was established using principal components, the variables influencing IBC were identified.ResultsA cohort of 44 patients with IS (36 girls and 8 boys) were included in the present study. The mean IBC was 49.87% (range, 3%–100%). IBC of lumbar IS was negatively correlated with apical rotate factor (ARF, B = –0.385), mainly consisted of pelvic coronal plane rotation (PCPR, 0.449), Cobb angle (CA, 0.575), apical vertebral rotation (AVR, 0.918), and pelvic rotate factor (PRF, B = –0.387), mainly consisted of PT (0.861), PI (0.728), PCPR (–0.570). The regression equation of lumbar IS had statistical significance (F = 6.500, P = 0.005, R2 = 0.317), whereas statistically significance was not found in the regression equation of thoracic IS (F = 2.913, P = 0.106). The remaining parameters were not related to IBC.ConclusionsFor lumbar IS, ARF and PRF have negative effects on IBC, coronal and sagittal rotation of the pelvis is related to IBC.

Posterior Spinal Fusion With Multilevel Posterolateral Convex Disc Releases for the Treatment of Severe Thoracolumbar Scoliosis.

Severe, rigid thoracolumbar scoliosis presents a surgical challenge to achieve 3-dimensional correction, maximize distal motion segments, and avoid operative morbidity conferred by combined anterior-posterior approaches or 3-column osteotomies. We present a new approach for releasing these curves, using multilevel posterolateral convex disc release (PCDR) and posterior instrumented fusion. There were 3 adults and 1 adolescent (mean age, 31.8 years; 2 females) with severe progressive thoracic and transforaminal lumbar (major) idiopathic scoliosis (IS) who were treated with 3-level PCDR, multiple posterior column osteotomies, and posterior instrumented thoracolumbar fusion with all-pedicle screw constructs. Restoration of global coronal and sagittal alignment was achieved for all patients (minimum 2-year follow-up). Lowest instrumented vertebra (LIV) was L4 in 2 patients and L3 in the remaining 2. All except 1 were fused to the lower end vertebra. Postoperatively, mean thoracolumbar curve was reduced from 77.3° (range, 69°-91°) to 21.8° (72%Δ), LIV tilt decreased from 26.8° to 8.3°, and LIV translation improved (2.5-1.2 cm; 58%Δ), whereas lumbar lordosis remained unchanged. Average central sacral vertical line shift measured via C7 sagittal vertical axis changed from 1.4 to -0.7 cm. There were no complications except for dysesthesias in the lower extremity on the side of the PCDR in 1 patient, which resolved after 3 months. Severe thoracolumbar IS presents a surgical challenge to achieve 3-dimensional correction, minimize fusion levels, and avoid procedural morbidity. PCDR is a novel technique that may facilitate this correction with minimal procedure-related morbidity.

Idiopathic and normal lateral lumbar curves: muscle effects interpreted by 12th rib length asymmetry with pathomechanic implications for lumbar idiopathic scoliosis.

BackgroundThe historical view of scoliosis as a primary rotation deformity led to debate about the pathomechanic role of paravertebral muscles; particularly multifidus, thought by some to be scoliogenic, counteracting, uncertain, or unimportant. Here, we address lateral lumbar curves (LLC) and suggest a pathomechanic role for quadrates lumborum, (QL) in the light of a new finding, namely of 12th rib bilateral length asymmetry associated with idiopathic and small non-scoliosis LLC.MethodsGroup 1: The postero-anterior spinal radiographs of 14 children (girls 9, boys 5) aged 9–18, median age 13 years, with right lumbar idiopathic scoliosis (IS) and right LLC less that 10°, were studied. The mean Cobb angle was 12° (range 5–22°). Group 2: In 28 children (girls 17, boys 11) with straight spines, postero-anterior spinal radiographs were evaluated similarly to the children with the LLC, aged 8–17, median age 13 years. The ratio of the right/left 12th rib lengths and it’s reliability was calculated. The difference of the ratio between the two groups was tested; and the correlation between the ratio and the Cobb angle estimated. Statistical analysis was done using the SPSS package.ResultsThe ratio’s reliability study showed intra-observer +/−0,036 and the inter-observer error +/−0,042 respectively in terms of 95 % confidence limit of the error of measurements. The 12th rib was longer on the side of the curve convexity in 12 children with LLC and equal in two patients with lumbar scoliosis. The 12th rib ratios of the children with lumbar curve were statistically significantly greater than in those with straight spines. The correlation of the 12th rib ratio with Cobb angle was statistically significant. The 12th thoracic vertebrae show no axial rotation (or minimal) in the LLC and no rotation in the straight spine group.ConclusionsIt is not possible, at present, to determine whether the 12th convex rib lengthening is congenitally lengthened, induced mechanically, or both. Several small muscles are attached to the 12th ribs. We focus attention here on the largest of these muscles namely, QL. It has attachments to the pelvis, 12th ribs and transverse processes of lumbar vertebrae as origins and as insertions. Given increased muscle activity on the lumbar curve convexity and similar to the interpretations of earlier workers outlined above, we suggest two hypotheses, relatively increased activity of the right QL muscle causes the LLCs (first hypothesis); or counteracts the lumbar curvature as part of the body’s attempt to compensate for the curvature (second hypothesis). These hypotheses may be tested by electrical stimulation studies of QL muscles in subjects with lumbar IS by revealing respectively curve worsening or correction. We suggest that one mechanism leading to relatively increased length of the right 12 ribs is mechanotransduction in accordance with Wolff’s and Pauwels Laws.

Irrepressible pain treatment in a subject treated with posterior vertebral arthrodesis for a chest lumbar idiopathic scoliosis

We present a case of a 56-year old woman with chest lumbar idiopathic scoliosis treated with an oxygen-ozone therapy cycle (10-μg paravertebral and 3-μg subcutaneous infiltrations) for irrepressible pain, as a consequence of a vertebral posterior arthrosis surgery.

Adult scoliosis: age-related deformity and surgery.

We retrospectively analyzed our results in thoracolumbar and lumbar adolescent idiopathic scoliosis treated during adulthood. Fifty-two thoracolumbar and 30 lumbar idiopathic scoliosis surgically treated were reviewed. Mean follow-up was 9.5±6.6years. All the subjects were analyzed by visual analog scale, Oswestry Disability Index (ODI), and SF-36 scores before and after surgery and at follow-up. The scoliotic curve, thoracic kyphosis, lumbar lordosis, pelvic incidence (PI), pelvic tilt (PT), sacral slope, and C7 plumb line were measured. For the statistical analysis, multivariate multiple regression models were formulated, considering as significative a P<0.05. A statistically significant clinical and radiological amelioration was noted after surgery and at final follow-up. According to the logistic regression model, ODI was related to lumbar lordosis and spino-pelvic parameters at follow-up. The only determinant of failure was age. Spino-pelvic recovery is easier in patients aged less than 60years with PI<55° and PT<25°.

Analysis of the sagittal plane in standing and sitting position in girls with left lumbar idiopathic scoliosis

Abstract Introduction Current development of civilization and technology makes a sitting position dominant in everyday life. This applies also to patients with spinal deformities. Aim The aim of this study was to analyze the size of physiological spinal curvatures in standing and sitting posture in girls with left lumbar scoliosis and evaluate usefulness of Zebris CMS-10 System in the assessment of physiological curvatures in both positions. Material and methods A group of 30 girls aged 11–17 years with left lumbar idiopathic scoliosis, with a Cobb angle in the range of 10°–21°, was examined. Control group consisted of 30 healthy girls aged 10–17 years. Studies were conducted with the use of ZEBRIS CMS-10 System (Zebris Medical, Germany) in a standardized standing (P1) and sitting (P2) position. Mean kyphosis and lordosis angle and differences between kyphosis and lordosis angle dependent upon positional changes were analyzed in each of the groups. Results and discussion Mean kyphosis angle in both positions showed no statistically significant differences between the study group and control group. Mean lordosis angle in P1 position in the study group was statistically significantly higher than in control group. Differences between mean kyphosis angle in P1 and P2 position in the study group in comparison with control group were not statistically significant. Differences between mean lordosis angle in P1 and P2 position in comparison with control group showed a statistical significance. Conclusions The presence of low degree lumbar scoliosis can result in deepening of lumbar lordosis in the standing posture, but it does not significantly affect kyphosis angle measured in standing and sitting position. Zebris CMS 10 System is a useful tool for the assessment of physiological spinal curvatures in standing and sitting position.

Treatment of Lumbar Curves in Scoliotic Adolescent Females With Progressive Action Short Brace

A prospective interventional study. To determine the outcomes of adolescents affected by idiopathic lumbar scoliosis treated with a progressive action short brace (PASB). The efficacy of conservative treatment of scoliosis is still debated. In a recent study, we showed that the PASB was effective in correcting deformities in adolescents with idiopathic thoracolumbar scoliosis. The purpose of the present study was to extend our preliminary findings by determining the results of PASB treatment in scoliotic adolescents with lumbar curves. Patients were 40 adolescent girls (age [mean ± SD] = 11.6 ± 0.7 yr]) with lumbar curves and a pretreatment Risser score between 0 and 2. All patients were prescribed with a full-time PASB. The minimum duration of follow-up was 24 months (mean ± SD = 41.6 ± 34.5 mo). Anteroposterior radiographs were used to estimate the curve magnitude (CM) and the torsion of the apical vertebra (TA) at 5 time points: beginning of treatment (t1), 1 year after the beginning of treatment (t2), intermediate time between t1 and t4 (t3), end of weaning (t4), and 2-year minimum follow-up from t4 (t5). Three outcomes were distinguished: curve correction, curve stabilization, and curve progression. RESULTS.: A significant reduction in CM was achieved from t1 (Cobb angle [mean ± SD] = 26.4° ± 2.8) to t5 (Cobb angle [mean ± SD] = 13.8° ± 7.9; P < 0.001). Likewise, the PASB reduced TA from Perdriolle rotation angles of 10.8° (SD = 3.7) at t1 to 7.9° (SD = 4.2) at t5 (P < 0.05). Curve correction was accomplished in 82.5% of patients, whereas curve stabilization was obtained in 17.5% of patients. None of the patients experienced curve progression. The PASB allows a complete curve correction in most cases. No patients exhibited curve progression.

Anterior instrumentation (dual screws single rod system) for the surgical treatment of idiopathic scoliosis in the lumbar area: a prospective study on 33 adolescents and young adults, based on a new system of classification

The choice of anterior instrumentation in the treatment of lumbar scoliosis in adolescents and young adults is not a new topic for the authors. The first results achieved using the Dwyer surgical modality were reported by one of the authors followed by the results achieved using Zielke (VDS) instrumentation. Today, new techniques and new instrumentations have been developed that challenge the instrumentation choices. Here we describe how the new system of classification of scoliotic curves we developed has been used as a basis for treating idiopathic scoliosis in lumbar area in adolescents and young adults using an anterior approach. A prospective study was carried out between 1998 and 2010 at two hospital centers on 33 adolescents and young adult with idiopathic lumbar scoliosis involving curves of three kinds, on whom surgical treatment was performed using a single solid rod. Topography of curves: our system of classification includes curves corresponding to the following three type of scoliosis: Type K I: double thoracic and lumbar curves (lumbar predominant) scoliosis (17 cases) mean age 16 years all female patients. Mean Cobb angle of lumbar curve 41°. Mean Cobb angle of thoracic curve 28°. The lumbar curve was left hand convex in 15 cases and right hand convex in 2 cases. Horizontal tilting of L4 mean value 22°. C7 offset mean value 3 cm. Type K IV A: unbalanced thoracolumbar scoliosis (13 cases) mean age 17 years, ten female patients and three male patients. Mean Cobb angle of thoracolumbar curve 39°. The thoracolumbar curve was left hand convex 4 times and right hand convex 9 times. Horizontal tilting of L4 mean value 18°. C 7 offset mean value 2.5 cm. Type K VI A: real lumbar (three cases). Age: 17, 15 and 13 years; all female patients. Cobb angle of the lumbar curve 66°, 29° and 70° (all LH convex). Horizontal tilting of L4: 40°, 20° and 46°. C 7 offset: 7 cm, 1 cm and 4 cm. Surgical instrumentation: We used the EUROS AZUR anterior instrumentation for all the procedures. Cages have been used on five patients at the lower stages. Number of vertebrae instrumented: mean five vertebrae. The patients did not wear postoperative orthosis. Mean duration of procedure: 3 h 50 min. Mean blood loss: 350 cm(3). Type K I scoliosis (17 cases): Mean follow-up: 6 years. Correction of the lumbar curve Cobb angle: the mean angle has been corrected from 41° to 21°. Number of vertebrae instrumented: 4:6 times and 5:11 times. Correction of the upper thoracic curve Cobb angle: mean angle corrected from 28° to 19°. Correction of L4 horizontal tilting: mean residual was 7°. Correction of C 7 offset: mean 0.7 cm. Type K IV A scoliosis (13 cases): mean follow-up: 4 years. Correction of the lumbar curve Cobb angle: the mean angle has been corrected from 39° to 16°. Mean number of instrumented vertebrae: 5 (4:4 times, 5:6 times and 6:3 times.) Correction of L4 horizontal tilting: mean residual 5°. Correction of C 7 offset: mean 0.7 cm. Type K VI A scoliosis (three cases): mean follow-up: 7, 2 and 4 years; Correction of the lumbar curve Cobb angle: the angles have been corrected from 66° to 15°, from 29° to 11° and from 70° to 28°. Number of instrumented vertebrae: 5, 4 and 6. Correction of L4 horizontal tilting: residual tilting of 8°, 7° and 17°. Correction of C 7 offset: 1 cm, 0 cm and 1 cm. There has been no report early or late septic or vascular or neurological complications. Instrumentation failure: there were three cases of screw breakage, all occurred on the lowest implant. Revision surgery was undertaken in both cases, only the last plate needed to be replaced and the rod could be kept without any other modification of the construct. In both cases, fusion has been achieved without any loss of correction. The mean loss of correction of the main curve was 2.5° for the three series. Anterior instrumentation of lumbar idiopathic scoliosis gives highly satisfactory morphological and functional results, since the lumbar musculature is spared and the instrumentation placed at the apex of the curvature has selective effects. Despite our preference and that of other surgeons throughout the world for anterior instrumentation, we are still a minority in comparison with the users of posterior instrumentation. There are several reasons for this reticence, including surgeons' training and ideas about pedicular screw fixation, but the main reason has been the lack of a sufficiently exact system of classification. Previous comparative studies between the anterior and posterior approaches have been biased by the use of an excessively restrictive mode of classification (lumbar/thoracolumbar) of the curves. Real lumbar scoliosis, unbalanced thoracolumbar scoliosis and thoracic and lumbar double curve (lumbar predominant) scoliosis should be properly defined before being compared.

EFFICACY OF LAMINAR AND TRANSPEDICULAR FIXATION IN SURGICAL TREATMENT OF THORACOLUMBAR AND LUMBAR IDIOPATHIC SCOLIOSIS

Objective. Comparative analysis of surgical results in patients with thoracolumbar and lumbar idiopathic scoliosis treated by laminar and transpedicular fixation. Material and Methods. Two groups of patients with lumbar and thoracolumbar idiopathic scoliosis were operated on. Patients from Group 1 underwent skeletal traction applied to calvarial bones and supramalleolar area, and correction of spinal deformity with third-generation segmental instrumentation using laminar fixation. Patients from Group 2 underwent skeletal traction applied to calvarial bones and supramalleolar area, and correction of spinal deformity with third-generation hybrid segmental instrumentation using laminar fixation in the thoracic spine and transpedicular fixation in the lumbar or thoracolumbar spine. Results. In Group 1 the scoliotic deformity was reduced from an average of 63.8° ± 21.1° to 24.7° ± 13.7°; postoperative progression was 6.8° ± 1.1° (18.6 ± 2.5 %); and tilt angle of the lower instrumented vertebra before surgery, after surgery, and at follow-up was 9.5° ± 8.4°, 8.2° ± 5.4°, and 10.0° ± 5.9°, respectively. In Group 2 the deformity was reduced from an average of 55.9° ± 16.6° to 13.4° ± 11.2°; postoperative progression was 2.4° ± 0.7° (5.8 ± 1.8 %); and tilt angle of the lower instrumented vertebra before surgery, after surgery, and at follow- up - 17.6° ± 7.6°, 5.2° ± 4.3°, and 5.6° ± 4.5°, respectively. Conclusion. Transpedicular fixation is more effective technique of surgical treatment for lumbar and thoracolumbar scoliosis than laminar fixation.

Body growth parameters in girls with adolescent idiopathic scoliosis: single thoracic idiopathic scoliosis versus single lumbar idiopathic scoliosis

Objective To investigate anthropometric and body composition parameters of girls with single thoracic idiopathic scoliosis and lumbar idiopathic scoliosis in China.Methods Three hundred and thirty-nine adolescent idiopathic scoliosis (AIS) girls and 3914 healthy girls,aged 10-17 years,were included.All AIS girls had a mean Cobb angle of 32°±10° (range,15°-63°).According to the locations of curves end vertebrae,AIS girls were divided into 2 subgroups:a single thoracic curve and a single lumbar curve.Body weight and standing height were measured,and body mass index (BMI) and leg length were calculated of each subject in three groups,and corrected height was computed in AIS group according to Bjure's formula.One-way ANOVA was used to determine the statistical differences in weight,height,corrected height and BMI between AIS and healthy girls.Results Standing height and sitting height showed no significant difference between thoracic scoliosis and lumbar scoliosis girls.Compared to healthy girls at the same age,thoracic and lumbar AIS girls had a significantly higher corrected standing and sitting height,arm span and leg length.Thoracic AIS girls had a significantly lower body weight than healthy girls at the age of 15 years.Yet,body weight showed no significant difference between lumbar AIS and healthy girls.Conclusion Compared to healthy girls at the same age,the thoracic and lumbar AIS girls had the similar abnormal growth characteristics.In addition,thoracic AIS girls are leaner than healthy girls. Key words: Scoliosis; Adolescent; Growth

Sagittal Plane Paramaters Determine Fusion Levels in Index Surgical Treatment of Thoracolumbar and Lumbar Idiopathic Scoliosis Curves >50 Degrees

Sagittal Plane Paramaters Determine Fusion Levels in Index Surgical Treatment of Thoracolumbar and Lumbar Idiopathic Scoliosis Curves >50 Degrees

Est–il trop tard pour entreprendre un traitement orthopédique pour scoliose idiopathique à Risser 4 ?

Orthopaedic treatment for idiopathic scoliosis in adolescence is indicated with a curve of ≥ 20° and a Risser score ≤ 4, because progression of curve is low with Risser scores > 4. We present the case of a young man with a left lumbar idiopathic scoliosis (T12–L4) with a curve of 10°, which was stable from 13 years (Risser 0) to 16 years old (Risser 4). The scoliosis progressed quickly after a Risser score of 4 was achieved. The man had been wearing a lift on the left foot since he was 13, because of a leg length discrepancy, and had been under clinical and radiological monitoring. When the boy reached 17 years, the scoliosis rapidly progressed, to a curve of 22° and a Risser score of > 4. The scoliosis was effectively treated with a Boston brace. At 20 years, the Risser score was 5, and the left lumbar curve was 13° after discontinuing the use of the brace. To our knowledge, no scientific reference indicates a time limit to orthopaedic treatment for idiopathic adolescent scoliosis. Despite the experts' recommendations, a brace might be indicated with a Risser score ≥ 4 to stop the progression of the curve.