Lumbar Side Flexion Research Articles

Validity and feasibility of remote measurement systems for functional movement and posture assessments in people with axial spondylarthritis.

This study aimed to estimate the criterion validity of functional movement and posture measurement using remote technology systems in people with and without Axial spondylarthritis (axSpA). Validity and agreement of the remote-technology measurement of functional movement and posture were tested cross-sectionally and compared to a standard clinical measurement by a physiotherapist. The feasibility of remote implementation was tested in a home environment. There were two cohorts of participants: people with axSpA and people without longstanding back pain. In addition, a cost-consequence analysis was performed. Sixty-two participants (31 with axSPA, 53% female, age = 45(SD14), BMI = 26.6(SD4.6) completed the study. In the axSpA group, cervical rotation, lumbar flexion, lumbar side flexion, shoulder flexion, hip abduction, tragus-to-wall and thoracic kyphosis showed a significant moderate to strong correlation; in the non-back pain group, the same measures showed significant correlation ranging from weak to strong. Although not valid for clinical use in its current form, the remote technologies demonstrated moderate to strong correlation and agreement in most functional and postural tests measured in people with AxSA. Testing the CV-aided system in a home environment suggests it is a safe and feasible method. Yet, validity testing in this environment still needs to be performed.

Development of an Automatic Instrument for Efficient Measuring the Joint’s Range of Motion

A range of motion (ROM) has been measured using several indices to judge the progress of ankylosing spondylitis (AS). However, measuring and calculating the ROM is time-consuming & labor-intensive and it would be even difficult to measure accurately. Thus, an automated measurement system (AMS) is proposed & developed to measure the ROM more easily without any restraint sensor, and to recognize changes in the ROM more constantly with the same standard of measurement. The measurement items are neck cervical rotation, cervical lateral flexion, finger-to-floor distance, intermalleolar distance, and lumbar side flexion. Data from 30 healthy subjects were collected by the AMS and their motions were recorded simultaneously by installed webcams to acquire gold-standard data compared with the measurement value of the AMS. The accuracy was determined by calculating the standard error of estimation (SEE) and a possibility of replacement of measurement obtained by a physician using a protractor & ruler has been assessed by pattern recognition of Bland-Airman plots. These statistical results exhibit a significant degree of agreement with the novel AMS. The total measurement time for the 5 items using the proposed AMS was less than 5 min, which is faster than manual measurement. However, the measurement was conducted against only healthy subjects; therefore additional tests with AS patients will be required for utilization in clinical practice.

Effect of Dry Needling in Quadratus Lumborum on Cricket Fast Bowlers Suffering From Non Specific Low Back Pain

Objective: To determine the effect of dry needling in quadratus lumborum on cricket fast bowlers suffering from non specific low back pain. Subjects and Method: In this pre and post experimental study, 36 cricket fast bowlers with Non specific LBP were treated.they were randomely distributed into two treatment groups:One taking DN on QL and conventional treatment and other taking only conventional treatment.Four variables were measured: For Pain using visual analog scale(VAS)scale, Pain pressure threshold(PPT) on QL muscle TrPs with an Algometer, Contralateral Lumbar side flexion(LSF) range with an Inclinometer and quality of life measure assessed with an Oswestry Disability Index(ODI). Results: There were significant improvement in VAS,PPT,Contralateral LSF and ODI with in the group at first,second and third week of post intervention.Group 1 showed more significant improved than group 2. Conclusion: Both the group Experimental and control are comparable in their effectiveness in reducing pain,improving pain pressure threshold, lumbar side flexion range and in Quality of life.Each group was individually effective but experimental group was comparatively more effective than conventional.

Effectiveness of ultrasound treatment applied with exercise therapy on patients with ankylosing spondylitis: a double-blind, randomized, placebo-controlled trial.

The aim of our study was to evaluate effectiveness of ultrasound treatment applied with exercise therapy in patients with ankylosing spondylitis. Fifty-two patients, who were diagnosed according to modified New York criteria, were aged 25-60, and have spine pain, were randomly assigned to two groups. Ultrasound (US) and exercise therapy were applied to treatment group (27); placebo US treatment and exercise therapy were applied to control group (25). Patients were evaluated before treatment, at the end of treatment, and 4 weeks after the treatment. Daily and night pain, morning stiffness, patient global assessment (PGA), doctor global assessment (DGA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire, Ankylosing Spondylitis Disease Activity Score (ASDAS) erythrocyte sedimentation rate (ESR), and ASDAS C-reactive protein (CRP) were used as clinical parameters. In US group, all parameters showed significant improvements at 2 and 6 weeks, in comparison with the baseline. In placebo US group, significant improvement was obtained for all parameters (except tragus-to-wall distance and modified Schober test at 2 weeks and lumbar side flexion and modified Schober test at 6 weeks). Comparison of the groups showed significantly superior results of US group for parameters of BASMI (p < 0.05), tragus-wall distance (p < 0.05), PGA (p < 0.01), and DGA (p < 0.05) at 2 weeks as well as for the parameters of daily pain (p < 0.01), PGA (p < 0.05), DGA (p < 0.01), BASDAI (p < 0.05), ASDAS-CRP (p < 0.05), ASDAS-ESR (p < 0.01), lumbar side flexion (p < 0.01), the modified Schober test (p < 0.01), and ASQoL (p < 0.05) at 6 weeks. Our study showed that ultrasound treatment increases the effect of exercise in patients with ankylosing spondylitis.

Comparison of three methods for calculating the Bath Ankylosing Spondylitis Metrology Index in a randomized placebo‐controlled study

To compare 3 methods for calculating the Bath Ankylosing Spondylitis Metrology Index (BASMI) score using patients who participated in the GO-RAISE study. Patients with active ankylosing spondylitis (AS) were randomly assigned in a 1:1.8:1.8 ratio to receive subcutaneous injections of placebo, golimumab 50 mg, or golimumab 100 mg every 4 weeks. Lumbar flexion, tragus-to-wall distance, lumbar side flexion, intermalleolar distance, and cervical rotation angle measurements at baseline, week 14, and week 24 were used to calculate the BASMI 2-step (BASMI(2) ), 10-step (BASMI(10) ), and linear (BASMI(lin) ) scores. BASMI(2) scores were generally lower than BASMI(10) and BASMI(lin) scores, which were nearly identical. Median changes from baseline to week 14 in the combined golimumab group were similar to those in the placebo group when using the BASMI(2) calculation method (0.00 versus 0.00; P = 0.288). The combined golimumab group showed significantly greater improvement from baseline to week 14 than the placebo group when using the BASMI(10) (-0.20 versus 0.00; P = 0.018) and BASMI(lin) (-0.31 versus -0.07; P = 0.015) calculation methods, with the latter showing the greatest difference between golimumab and placebo. Guyatt's effect size was better for the BASMI(lin) and the BASMI(10) versus the BASMI(2) in the combined golimumab group at week 14 (0.58 and 0.53 versus 0.42, respectively) and week 24 (0.76 and 0.69 versus 0.61, respectively), despite the relatively short period to assess changes in spinal mobility. The BASMI(lin) method was the most sensitive to changes in range of motion exhibited by patients with AS who received golimumab.

An exploration of the inter- and intra-rater reliability of the Bath Ankylosing Spondylitis Metrology Index

The aim of this study was to explore the inter- and intra-observer reliability of the Bath Ankylosing Spondylitis Metrology Index (BASMI) across raters from different clinical centres using a consensus-based standardised approach to assessment. One hundred thirty BASMI assessments were completed on the same day using a partially balanced incomplete block design. Thirteen physiotherapists from 10 hospitals assessed 26 participants (19 patients, 7 healthy volunteers). Each therapist assessed six participants and, to assess intra-observer reliability, performed repeat assessments on four. Overall, the mean (standard deviation; SD) BASMI total score was 3.11 (2.04). The constituent components of SD were 0.37 ('residual' inconsistency, i.e. between observer), 0.34 (between replicates), at least 0.06 (between observer means) and 2.03 (between participants). This suggests that the repeatability of BASMI assessments is 0.95 if the same observer is used and 1.05 if different observers are used. Inter-physiotherapist residual SDs for individual constituent component scores were largest for the modified Schober measurement and lumbar side flexion; intra-observer SDs showed similar patterns, although they were smaller for tragus to wall and lumbar side flexion. We found excellent inter-observer and intra-observer reliability, with most of the variability in BASMI scores being between participants. However, for repeat assessments of the same participant by the same physiotherapist, differences in BASMI of 1.0 or less are within bounds of error; likewise, differences of 1.0 or less are within the bounds of error if different physiotherapists perform the assessments. Only changes above these limits can be confidently interpreted as true clinical changes.

Evaluation of spinal mobility measurements in predicting axial psoriatic arthritis

Axial psoriatic arthritis (PsA) represents a more severe form of disease than peripheral PsA. We evaluate the usefulness of various spinal mobility measurements in predicting a radiographically defined axial PsA. A cross-sectional study on PsA patients with spinal mobility measurement performed. PsA were classified to axial or peripheral PsA by the presence of sacroiliitis. Three Bath Ankylosing Spondylitis Metrology Indexes (BASMIs) were calculated. The sensitivity, specificity, and area under receiver operator curves (AUC) of each spinal mobility measurement in prediction of axial PsA were analyzed. A total of 125 subjects studied (males 52%) with mean age and duration of illness of 47.5 ± 12.4 and 9.2 ± 6.7years. Twenty-nine patients (17 males and duration of illness 12 females) had axial PsA. Axial PsA patients had longer disease duration (p = 0.05) and more limitation in spinal mobility. Axial PsA patients had higher inflammatory markers and a trend towards poorer global health, higher damaged joint count, and poorer physical function. The tragus-to-wall distance, modified schober test, and lumber side flexion had good sensitivity and specificity in predicting axial PsA. In the logistic regression model, the lumbar side flexion (OR 0.82, 95% CI 0.72-0.92) was independently associated with axial PsA. All three sets of composite scores BASMI(2), BASMI(10), and BASMI (lin) had good prediction for axial PsA (AUC 0.619, 0.626, and 0.618). Spinal mobility measurements and BASMI were useful in differentiating axial and peripheral PsA. Lumber side flexion and modified schober test best differentiate axial and peripheral PsA.

Evaluation of ankylosing spondylitis spinal mobility measurements in the assessment of spinal involvement in psoriatic arthritis

To determine the clinical usefulness of spinal mobility measurements used for ankylosing spondylitis (AS) to assess spinal involvement in patients with psoriatic arthritis (PsA). We assessed 100 patients with PsA and 103 patients with AS. Patients were classified as having axial PsA if they had grade 2 or higher unilateral sacroiliitis in the presence of spinal symptoms. All PsA patients, without taking the degree of joint involvement into consideration, were evaluated using several measurements for AS. Spinal measurements were compared with axial and peripheral forms of PsA, and the ability of the techniques to discriminate between the 2 forms of PsA was analyzed using the Mann-Whitney U test and the area under the receiver operating characteristic (ROC) curve. A logistic regression model was used to determine the best measurements for evaluating axial PsA. Finally, the results of measurements for axial PsA were compared with those for AS. Of the 100 PsA patients, 46 met the classification criteria for axial PsA, which presented more severe spinal measurement assessments compared with peripheral PsA. Modified Schober test, lumbar side flexion, chest expansion, and cervical rotation measurements performed best under the ROC curve. Modified Schober test, lumbar side flexion, and cervical rotation were the more suitable measurements for assessing axial PsA. There were only minor differences between axial PsA and AS. The spinal measurements used to evaluate AS performed well to assess spinal involvement in PsA. These measurements, notably the modified Schober test, lumbar side flexion, and cervical rotation, should be used in daily clinical practice to assess PsA patients with spinal involvement.

One-Year Follow-up of Two Exercise Interventions for the Management of Patients with Ankylosing Spondylitis

To assess the long-term effects on functional and mobility outcomes of two exercise interventions for the management of patients with ankylosing spondylitis. In an extended 12-mo follow-up of a randomized controlled trial, 40 patients who were diagnosed with ankylosing spondylitis according to the modified criteria of New York, allocated to control or experimental groups using a random numbers table, and who performed their respective exercise program at least three times per month, were included in this long-term study. The control group was treated during 15 sessions with a conventional exercise regimen in ankylosing spondylitis, whereas the experimental group received 15 sessions of exercises based on the treatment of the shortened muscle chains following the guidelines described by the Global Posture Reeducation method. These patients were followed up and assessed again 1 yr after entering the study, re-applying the same validated indexes: BASMI (Bath Ankylosing Spondylitis Metrology Index [tragus to wall distance, modified Schober test, cervical rotation, lumbar side flexion, and intermalleolar distance]), BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), and BASFI (Bath Ankylosing Spondylitis Functional Index). The intragroup comparison between follow-up and post-intervention data showed that both groups decrease their clinical and functional measures during the follow-up period. This decrease was only significant for lumbar side flexion and intermalleolar distance measurements, being more significant in the control group (P = 0.001 and P = 0.002, respectively). Intragroup differences between follow-up and pre-intervention assessments revealed that improvements in all mobility measures of the BASMI index and in the BASFI index were partially maintained at the 12-mo follow-up in the experimental group but not in the control group. The intergroup comparison (unpaired t test analysis) between changes on each outcome during the long-term follow-up (post-follow-up; and pre-follow-up) showed no significant differences in the decrease between post-intervention and follow-up data between the study groups. On the other hand, the intergroup comparison between pre-intervention and follow-up data revealed significant differences in almost all mobility measures of the BASMI index (except for cervical rotation) and in the BASFI index, in favor of the experimental group. An exercise regimen based on the Global Posture Reeducation method and focusing on specific strengthening and flexibility exercises of the shortened muscle chains offers promising short- and long-term results in the management of patients who have ankylosing spondylitis.

Relación entre movilidad, funcionalidad y calidad de vida en pacientes con espondilitis anquilosante

Objective Ankylosing Spondylitis (AS) usually conditions the quality of life (QoL) of these patients. Restricted range of motion is one of the characteristics of AS. The aim of this study was to assess the correlation among mobility, functionality, and quality of life in subjects with AS. Patients and methods A cross-sectional study was performed. Seven women and 28 men diagnosed with AS participated. Mobility outcomes were assessed by means of the Bath Ankylosing Spondylitis Metrology Index (BASMI): occiput-wall distance, modified Schöber test, cervical rotation, lumbar side-flexion and intermalleolar distance. The Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Diasease Activity Index (BASDAI) assessed the functionality and activity of these patients. Quality of life was assessed with the SF-36 questionnaire. The Pearson test (r) or the rho Spearman tests (r s) were used depending on the normal distribution of the variables. Results All mobility measures of the BASMI index showed correlations (r) among them ranging from 0.43 to 0.8; p < 0.01. Negative correlations ranging from −0.43 to −0.57; p < 0.01 were shown between occiput to wall distance and the remaining mobility measures. The BASFI and BASDAI indexes did correlate with several dimensions of the SF-36 questionnaire. Finally, few of the mobility measures did show correlation with any of the dimensions evaluated by the SF-36 questionnaire. Conclusions Quality of life was not related to restricted mobility seen in AS subjects, whereas functionality was related with quality of life.

Dynamic postural balance in ankylosing spondylitis patients

In this study, our objectives were to investigate whether patients with ankylosing spondylitis (AS) have a poorer dynamic balance than normal subjects, and to study the relationship between balance and posture. Seventy patients (57 men, 13 women) with AS and 35 (31 men, 4 women) controls matched for age, weight, height and body mass index were tested using the Biodex Stability System. Anteroposterior (AP), mediolateral (ML) and overall (OA) indices were obtained with bilateral stance at platform stabilities of 8 and 4. Subjects were tested with 'eyes open' at all times. Correlation analyses were performed between stability indices (OA, AP, ML) and disease duration, cervical rotation (CR), tragus to wall distance (TWD), lumbar side flexion (LSF), lumbar flexion (LF), intermalleolar distance (IMD) and Bath Ankylosing Spondylitis Metrology Index (BASMI) total score. No significant difference was found between the AS patients and healthy subjects with respect to all three stability indices at levels 4 and 8. A positive correlation was found only between ML stability index and TWD at level 8 (r, 0.249; P = 0.038). No other positive correlation was detected between stability indices and CR, TWD, LSF, LF, IMD, total BASMI score and disease duration. AS has no negative effect on postural stability. The only clinically significant association was found between dynamic postural balance and TWD.

Two Exercise Interventions for the Management of Patients with Ankylosing Spondylitis

The purpose of this clinical trial was to evaluate the impact of a 4-month comprehensive protocol of strengthening and flexibility exercises developed by our research group versus conventional exercises for patients with Ankylosing Spondylitis (AS) on functional and mobility outcomes. Randomized controlled trial. Forty-five patients diagnosed with AS according to the modified criteria of New York were allocated to control or experimental groups using a random numbers table. The control group was treated with a conventional protocol of physical therapy in AS, whereas the experimental group was treated with the protocol suggested by our research group. The conventional intervention consisted of 20 exercises: motion and flexibility exercises of the cervical, thoracic, and lumbar spine; stretching of the shortened muscles; and chest expansion exercises. The experimental protocol is based on the postural affectation of the AS and the treatment of the shortened muscle chains in these patients according to the Global Posture Reeducation (GPR) method. This intervention employs specific strengthening and flexibility exercises in which the shortened muscle chains are stretched and strengthened. The study lasted 4 mos. During this period, patients received a weekly group session managed by an experienced physiotherapist. Each session lasted an hour, and there were 15 total sessions. Changes in activity, mobility, and functional capacity were evaluated by an assessor blinded to the intervention, using the following previously validated scores from the Bath group: BASMI (tragus to wall distance, modified Schober test, cervical rotation, lumbar side flexion, and intermalleolar distance), BASDAI (The Bath Ankylosing Spondylitis Disease Activity Index), and BASFI (The Bath Ankylosing Spondylitis Functional Index). Both groups showed an improvement (prepost scores) in all the outcome measures, mobility measures of the BASMI index, as well as in BASFI and BASDAI indexes. In the control group, the improvement in tragus to wall distance (P=0.009) and in lumbar side flexion (P=0.02) was statistically significant. Although the rest of the outcomes also improved, they did not reach a significant level (P>0.05). In the experimental group, the improvement in all the clinical measures of the BASMI index (P<0.01) and in the BASFI index (P=0.003) was statistically significant. The intergroup comparison between the improvement (prepost scores) in both groups showed that the experimental group obtained a greater improvement than the control group in all the clinical measures of the BASMI index, except in tragus to wall distance, as well as in the BASFI index. The experimental protocol developed by our research group, based on the GPR method and specific strengthening and flexibility exercises of the muscle chains, offers promising results in the management of patients suffering from AS. Further trials on this topic are required.

Deterioration in Anthropometric Measures over Six Years in Patients with Ankylosing Spondylitis: An initial comparison with disease duration and reported exercise frequency

Objective: To evaluate the progression of ankylosing spondylitis (AS) as a function of disease duration and exercise frequency in a group of patients who were observed and followed up for six years. Methods: Detailed measurement of cervical, thoracic, and lumbar mobility together with measurements of posture and function were carried out in 28 patients (23 men, five women, mean age at final assessment 49.9 years) at two points separated by a period of six years. Anamnestic data on frequency of specific back and general exercises were also ascertained. Results: A significant deterioration was found in: ▪ Combined cervical rotation (initial mean 90°, final mean 36°). ▪ Cervical flexion/extension (66° to 42°). ▪ Combined cervical side flexion (41° to 24°). ▪ Tragus-to-wall distance (170 mm to 224 mm). ▪ Chest expansion (60 mm to 20 mm). ▪ Combined lumbar side-flexion (49 mm to 18 mm). ▪ Modified Schober test (37 mm to 24 mm). Although functional deterioration occurred (disability score 1.33 to 1.59) this was not significant (p = 0.07). Anthropometric deterioration occurred independent of initial disease duration and reported frequency of exercise. Conclusion: These initial findings suggest that patients with AS experience progressive loss of movement independently of the duration of the disease and the reported frequency of unsupervised exercise. Further data are required using a wider spectrum of disease expression and more explicit information on spinal exercises, both supervised and unsupervised.

An audit of anthropometric measurements by medical and physiotherapy staff in patients with ankylosing spondylitis

The main treatments for ankylosing spondylitis (AS) are physical (exercise and stretching), and one way of measuring the effectiveness of these therapies is to record spinal movements in a standardized way. Patients are often seen in both medical (rheumatology) and physiotherapy clinics where duplicate information on their progress may be obtained. The purpose of this study was to assess the completeness of data collection for patients attending both medical and physiotherapy clinics. An audit of data recorded in medical and physiotherapy notes. Patient records identified either from computerized databases (Huddersfield and Bradford) or from a clinic at which only AS patients attended (Leeds). Data from attendances over a defined period were retrieved and recorded on a standard form. All patients thus identified were then cross-matched against those patients attending for physiotherapy during the same period and, where a match occurred, the same data were retrieved from the physiotherapy notes. MINIMUM DATA SET FOR AUDIT: Before data collection started all participants agreed on the minimum data set required for adequate monitoring of patients with AS. The anthropometric measurements included height, chest expansion, cervical rotation, tragus to wall, modified Schober's flexion, extension, lumbar side flexion, intermalleolar abduction, and interfingertip abduction. Of 182 medical notes screened, 46 patients had not been seen in the defined period, leaving 136 notes to be reviewed. Of these, 52 patients had been seen in physiotherapy in the same period. In general, measurements were infrequently found in medical notes (only chest expansion in 58%, Schober's flexion in 48% and tragus to wall in 47% were measured with any regularity by medical staff). In contrast, corresponding data from physiotherapy notes were more complete (Schober's flexion and lumbar side flexion in 96%, height in 87%, intermalleolar distance in 87% and cervical rotation in 83%). Follow-up and monitoring of AS patients in these medical clinics is clearly inadequate. Physiotherapy-led clinics have already been started in one of the study hospitals and the other centres are reviewing their arrangements for AS follow-up, including the possibility of a combined approach to patient management.

Ankylosing spondylitis: the correlation between a new metrology score and radiology.

The objective was to compare the Bath Ankylosing Spondylitis Metrology Index (BASMI) with radiology as a measure of disease outcome. Fifty-three patients, covering the entire spectrum of disease severity, were blindly and independently assessed using the BASMI (total of five standardized measurements, scoring range 0-10) and a radiology score of the four main spinal areas affected by ankylosing spondylitis (AS). BASMI correlates positively with the total radiology score (r = 0.74), while the individual BASMI scores for cervical rotation (r = 0.59), wall to tragus (r = 0.61), lumbar side flexion (r = 0.56), lumbar flexion (r = 0.68) and intermalleolar distance (r = 0.50) correlate positively with their respective radiology scores. BASMI and radiology do not relate well to each other as BASMI takes account of normal physical limitation and soft tissue involvement. In addition, although radiology scores are termed a 'gold standard', they are unreliable. Therefore, BASMI may be judged to be more important in assessing AS and become a 'gold standard' itself.

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

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.