Management Of Adolescent Idiopathic Scoliosis Research Articles

Spinal Manipulative Therapy for Adolescent Idiopathic Scoliosis: A Systematic Review

ObjectiveThe purpose of this study was to perform a systematic review of clinical trials of spinal manipulative therapy for adolescent idiopathic scoliosis. MethodsSearch strategies were developed for PubMed, CINHAL, and CENTRAL databases. Studies were included through June 2016 if they were prospective trials that evaluated spinal manipulative therapy (eg, chiropractic, osteopathic, physical therapy) for adolescent idiopathic scoliosis. Data were extracted and assessed by 2 independent reviewers. Cochrane risk of bias tools were used to assess the quality of the included studies. Data were reported qualitatively because heterogeneity prevented statistical pooling. ResultsFour studies satisfied the inclusion criteria and were critically appraised. The findings of the included studies indicated that spinal manipulative therapy might be effective for preventing curve progression or reducing Cobb angle. However, the lack of controls and small sample sizes precluded robust estimation of the interventions’ effect sizes. ConclusionThere is currently insufficient evidence to establish whether spinal manipulative therapy may be beneficial for adolescent idiopathic scoliosis. The results of the included studies suggest that spinal manipulative therapy may be a promising treatment, but these studies were all at substantial risk of bias. Further high-quality studies are warranted to conclusively determine if spinal manipulative therapy may be effective in the management of adolescent idiopathic scoliosis.

National Trends in the Surgical Management of Adolescent Idiopathic Scoliosis: Analysis of a National Estimate of 60,108 Children From the National Inpatient Sample Over a 13-Year Time Period in the United States

Study DesignAnalysis of Nationwide Inpatient Sample (NIS). ObjectiveEvaluate evolution of operative treatment of adolescent idiopathic scoliosis (AIS). Summary of Background DataSpinal surgery is one of the most rapidly evolving branches of surgery. Changes in AIS operations are incompletely defined. MethodsChildren (10–18 years) with ICD-9 diagnosis of idiopathic scoliosis who underwent thoracic and/or lumbar spinal fusion identified in the NIS (1998–2011) were analyzed. Population-based utilization rates were calculated from US Census data. Patient demographics, surgical approach, operative techniques, complications during hospitalization, hospital stay length, and charges were analyzed. Results60,108 children (46,256 girls, 13,776 boys, 76 gender not specified; average age 14.1 years) were identified. Thoracic fusions were the majority. Number of operations increased over time. For thoracic fusions, posterior operations significantly increased, whereas anterior and anterior/posterior operations decreased significantly. Although anterior operations for lumbar fusions declined, this was not as steep as thoracic. Use of autogenous bone graft (including iliac crest) significantly increased, which mirrored significant decreases in alternative fusion agents. Thoracoplasty significantly decreased, whereas osteotomy significantly increased. The average complication rate was 3.7%. Rates of blood transfusions, infection, and neural injury did not differ significantly from 1998 to 2011. Device-related complications increased significantly over time. Average lengths of hospital stay decreased significantly, whereas average total hospital charges increased significantly. ConclusionsIn a representative sample of the US population from 1998 to 2011, operative approaches and techniques for AIS significantly changed. Anterior procedure is rarely performed for thoracic curves; lumbar curves continue to be treated with anterior and posterior approaches. Osteotomy and autogenous bone graft increased, while thoracoplasty decreased. Overall complication rates remain stable, whereas hospital lengths of stays decreased and charges increased.

Minimally Invasive Surgery in Patients With Adolescent Idiopathic Scoliosis: Is it Better than the Standard Approach? A 2-Year Follow-up Study.

This is a retrospective controlled study. To compare the safety and efficacy of minimally invasive surgery (MIS) for the surgical management of adolescent idiopathic scoliosis (AIS) to the standard open posterior approach (PSF). MIS approaches offer the potential to reduce soft-tissue trauma, intraoperative blood loss, and surgical-site infection. Thus far, MIS has been successfully utilized for the surgical correction of multilevel spine pathology in adults. It is not yet known if these results can be replicated in the surgical management of AIS. Seven MIS patients were compared with 15 PSF patients using minimum 2-year follow-up data. Parameters studied included preoperative patient and deformity characteristics, perioperative details, extent of deformity correction, and complications. Data were compared using Mann-Whitney tests for continuous variables and Fisher exact tests for categorical variables. The MIS and PSF groups were similar for all preoperative characteristics collected (P>0.05). MIS patients had fewer fixation points (P=0.015), but a longer median operative time (P=0.011). There was no significant difference in estimated blood loss (EBL) (P=0.051), EBL/fixation point (P=0.204), or amount of fluids administered (P=0.888). Postoperative recovery did not differ between the 2 groups in number of intensive care unit days (P=0.362), length of hospital stay (P=0.472), time to mobilization (P=1.00), Visual Analogue Scale pain scores (P=0.698), or patient-controlled analgesia (P=1.00). The MIS technique had similar deformity correction, screw placement accuracy, and fusion status when compared with the PSF group. MIS patients had lower blood transfusion rate (P=0.02), shorter fusion (P=0.046) and fewer pedicle screws (P=0.015). The short-term advantages seen in MIS for adult scoliosis were not as obvious in our series. We found similar deformity correction and adequate fusion, however shortcomings related to learning curve, and instrumentation persist. MIS surgery is an innovative treatment for AIS that is technically feasible with significantly lower transfusion rate, shorter fusion lenghts and lesser pedicle screw fixation. Despite these advanatges, its role in AIS is currently difficut to define.

Does a dual attending surgeon strategy confer additional benefit for posterior selective thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis (AIS)? A prospective propensity matching score analysis

Background ContextWith an increased cost of adolescent idiopathic scoliosis (AIS) surgery over the past 10 years, improvement of patient safety and optimization of the surgical management of AIS has become an important need. A dual attending surgeon strategy resulted in reduction of blood loss and complication rate. PurposeThis study aimed to investigate the perioperative outcome of posterior selective thoracic fusion in Lenke 1 and 2 AIS patients comparing a single versus a dual attending surgeon strategy. Study DesignA prospective cohort study was carried out. Patient SampleThe study sample comprised 60 patients Outcome MeasureOperative duration, blood loss, postoperative hemoglobin, need for transfusion, morphine usage, and duration of hospital stay were the outcome measures. MethodsA total of 116 patients who underwent posterior selective thoracic fusion from two centers were prospectively recruited. The patients were grouped into Group 1 (single surgeon) and Group 2 (two surgeons). One-to-one matching analysis using “propensity score-matched cohort patient sampling method” was done for age, gender, height, weight, preoperative Cobb angle, number of fusion level, and Lenke classification. The outcome measures included operative duration, blood loss, postoperative hemoglobin, need for transfusion, morphine usage, and duration of hospital stay. This study was self-funded with no conflict of interest. ResultsFrom 86 patients who were operated by the two surgeons (Group 2), 30 patients were matched with 30 patients who were operated by a single surgeon (Group 1). Group 2 (164.0±25.7 min) has a significantly shorter operation duration (p=.000) compared with Group 1 (257.3±51.4 min). The total blood loss was significantly more (p=.009) in Group 1 (1254.7±521.5 mL) compared with Group 2 (893.7±518.4 mL). There were seven patients (23.3%) in Group 1 who received allogenic blood transfusion (p<.05). The morphine usage and average hospital stay were significantly lower in Group 2, 22.4±10.7 mg and 3.4±0.7 days, respectively (p<.05). In Group 1, there was one patient who developed a superficial wound infection. No other major complications were noted. ConclusionsA dual attending surgeon strategy was superior to a single surgeon strategy in posterior selective thoracic fusion in Lenke 1 and 2 AIS patients and will lead to a faster operation, reduced intraoperative blood loss, reduced risk of allogenic transfusion, reduced morphine requirement, and shorter hospital stay.

Early Detection of Idiopathic Scoliosis in Adolescents

The early detection of idiopathic scoliosis has been advocated since the 1950s and ’60s, concurrent with the development in the modern era of ambulatory spinal orthoses to treat scoliosis in adolescents. This led to the development of screening programs for specific populations, as evidenced by school screening programs in the United States and public health systems in Europe and Asia. Over time, the value of population screening in terms of optimal health care and economics has been debated in the popular press, by the U.S. Preventive Services Task Force, and by professional societies. Recent studies on the effectiveness of bracing to prevent the progression of scoliosis, improved delineation of “at-risk populations,” and refined orthotic management programs with emphasis on the use of compliance monitors have influenced the American Academy of Orthopaedic Surgeons (AAOS), the Scoliosis Research Society (SRS), the Pediatric Orthopaedic Society of North America (POSNA), and the American Academy of Pediatrics (AAP) to update their position on screening for scoliosis and has led to a joint position statement on the topic. ### Screening for the Early Detection of Idiopathic Scoliosis in Adolescents This Statement was developed as an educational tool based on the opinion of the authors. It is not a product of a systematic review. Readers are encouraged to consider the information presented and reach their own conclusions. The AAOS, SRS, POSNA, and AAP believe that there has been additional useful research in the early detection and management of adolescent idiopathic scoliosis (AIS) since the review performed by the U.S. Preventive Services Task Force (USPSTF) in 2004. This information should be available for use by patients, treating health care providers, and policy makers in assessing the relative risks and benefits of the early identification and management of AIS. The AAOS, SRS, POSNA, and AAP believe that there are documented benefits of earlier detection and non-operative management of AIS, earlier …

Nonsurgical Management of Adolescent Idiopathic Scoliosis.

Pediatric patient visits for spinal deformity are common. Most of these visits are for nonsurgical management of scoliosis, with approximately 600,000 visits for adolescent idiopathic scoliosis (AIS) annually. Appropriate management of scoliotic curves that do not meet surgical indication parameters is essential. Renewed enthusiasm for nonsurgical management of AIS (eg, bracing, physical therapy) exists in part because of the results of the Bracing in Adolescent Idiopathic Scoliosis Trial, which is the only randomized controlled trial available on the use of bracing for AIS. Bracing is appropriate for idiopathic curves between 20° and 40°, with successful control of these curves reported in >70% of patients. Patient adherence to the prescribed duration of wear is essential to maximize the effectiveness of the brace. The choice of brace type must be individualized according to the deformity and the patient's personality as well as the practice setting and brace availability.

What matters to patients and their families in the management of adolescent idiopathic scoliosis?

What matters to patients and their families in the management of adolescent idiopathic scoliosis?

Postural Rehabilitation for Adolescent Idiopathic Scoliosis during Growth.

Long-term follow-up of untreated patients with adolescent idiopathic scoliosis (AIS) indicates that, with the exception of some extremely severe cases, AIS does not have a significant impact on quality of life and does not result in dire consequences. In view of the relatively benign nature of AIS and the long-term complications of surgery, the indications for treatment should be reviewed. Furthermore, recent studies have shown that scoliosis-specific exercises focusing on postural rehabilitation can positively influence the spinal curvatures in growing adolescents. Experiential postural re-education is a conservative, non-invasive approach, and its role in the management of AIS warrants further study. This article reviews current evidence for the inclusion of various forms of postural reeducation in the management of AIS. Recent comprehensive reviews have been researched including a manual and PubMed search for evidence regarding the effectiveness of physical/postural re-education/physiotherapy programs in growing AIS patients. This search revealed that there were few studies on the application of postural re-education in the management of AIS. These studies revealed that postural re-education in the form of exercise rehabilitation programs may have a positive influence on scoliosis; however, the various programs were difficult to compare. More research is necessary. There is at present Level 1 evidence for the effectiveness of Schroth scoliosis exercises in the management of AIS. Whether this evidence can be extrapolated to include other forms of scoliosis- pattern-specific exercises requires further investigation. Because corrective postures theoretically reduce the asymmetric loading of the spinal deformities and reverse the vicious cycle of spinal curvature progression, their integration into AIS programs may be beneficial and should be further examined.

Adolescent Idiopathic Scoliosis: An in Depth Analysis and Historical Review

Adolescent idiopathic Scoliosis (AIS) is a common disorder of children about which there is a vast amount of research available for review. This manuscript aims to discuss significant classic and modern literature regarding this spinal deformity. An organized review of topics including the definition, epidemiology, etiology, physiology, diagnosis, and management of adolescent idiopathic scoliosis has been included herein. In this review, it is first explained that AIS now falls under the definition of late-onset idiopathic scoliosis. Epidemiologic discussion then reveals the relatively high prevalence of this disorder in children and lists the variations seen in prevalence by gender. Etiologic review explores the multifactorial nature of AIS and describes various conditions implicated in AIS pathogenesis including abnormalities in connective tissue structure, neuro-osseous development, platelet chemistry and hormone levels. The discussion of physiology explains the three dimensional structure of the AIS deformity and reviews long term complications such as back pain and compromised self-image. The section covering diagnostic methods highlights the physical exam for AIS and details important radiographic measurements including the Cobb angle, clavicle angle, and sagittal balance. Finally, the review of management emphasizes the importance of individualized therapy for AIS and discusses techniques involved in the non-operative and operative treatment of this spinal deformity.

Selection of Fusion Levels Using the Fulcrum Bending Radiograph for the Management of Adolescent Idiopathic Scoliosis Patients with Alternate Level Pedicle Screw Strategy: Clinical Decision-making and Outcomes.

ObjectiveSelecting fusion levels based on the Luk et al criteria for operative management of thoracic adolescent idiopathic scoliosis (AIS) with hook and hybrid systems yields acceptable curve correction and balance parameters; however, it is unknown whether utilizing a purely pedicle screw strategy is effective. Utilizing the fulcrum bending radiographic (FBR) to assess curve flexibility to select fusion levels, the following study assessed the efficacy of pedicle screw fixation with alternate level screw strategy (ALSS) for thoracic AIS.MethodsA retrospective study with prospective radiographic data collection/analyses (preoperative, postoperative 1-week and minimum 2-year follow-up) of 28 operative thoracic AIS patients undergoing ALSS was performed. Standing coronal/sagittal and FBR Cobb angles, FBR flexibility, fulcrum bending correction index (FBCI), trunkal shift, radiographic shoulder height (RSH), and list were assessed on x-rays. Fusion level selection was based on the Luk et al criteria and compared to conventional techniques.ResultsIn the primary curve, the mean preoperative and postoperative 1 week and last follow-up standing coronal Cobb angles were 59.9, 17.2 and 20.0 degrees, respectively. Eighteen patients (64.3%) had distal levels saved (mean: 1.6 levels) in comparison to conventional techniques. Mean immediate and last follow-up FBCIs were 122.6% and 115.0%, respectively. Sagittal alignment did not statistically differ between any assessment intervals (p>0.05). A decrease in trunkal shift was noted from preoperative to last follow-up (p = 0.003). No statistically significant difference from preoperative to last follow-up was noted in RSH and list (p>0.05). No "add-on" of other vertebra or decompensation was noted and all patients achieved fusion.ConclusionsThis is the first report to note that using the FBR for decision-making in selecting fusion levels in thoracic AIS patients undergoing management with pedicle screw constructs (e.g. ALSS) is a cost-effective strategy that can achieve clinically-relevant deformity correction that is maintained and without compromising fusion levels.

Surgical management of adolescent idiopathic scoliosis

Without a complete understanding of the natural history of adolescent idiopathic scoliosis (AIS), the treating spine surgeon will be unable to effectively appreciate the indications for surgery nor will the long-term management plan be appropriate. Basic evaluation of the patient with AIS should center on a thorough history and physical examination. It is crucial that applicable radiographic imaging is obtained as well, which must be tailored to each individual patient given the findings on history and physical examination. For patients in whom surgical correction is indicated, many factors comprise the ultimate treatment plan. The goals of surgery center on prevention of curve progression, adequate coronal and sagittal realignment, and the preservation of as much motion as possible. Vertebral-level selection, curve-reduction techniques, fixation strategies, postoperative protocols, and potential complications each play a vital role in the successful surgical treatment of AIS. With an in-depth understanding of all of these variables, the spine surgeon can achieve excellent outcomes for his or her AIS patients.

Perceived level of knowledge and skills about clinical management of adolescent idiopathic scoliosis among undergraduate chiropractic students and clinical faculty at a Canadian chiropractic program: cross–sectional study

Perceived level of knowledge and skills about clinical management of adolescent idiopathic scoliosis among undergraduate chiropractic students and clinical faculty at a Canadian chiropractic program: cross–sectional study

Preoperative Variables Predicting Massive Blood Loss During Surgical Management of Adolescent Idiopathic Scoliosis

Background: Massive blood loss is one of the most important concerns in scoliosis surgery. There are some factors suggested to predict the massive blood loss in patients with adolescent idiopathic scoliosis (AIS), however, their predictive value remained unclear. Objectives: The current study aimed to investigate whether preoperative variables can predict perioperative massive blood loss in patients with AIS. Patients and Methods: There were 60 patients with AIS who underwent surgical treatment in the current retrospective study. Posterior spinal fusion (PSF) was performed on 36 patients and PSF and anterior spinal fusion (ASF) for the other 24. Estimated blood loss (EBL) was calculated intraoperative. The correlation between preoperative radiographic and demographic variables with EBL was investigated. Results: Among the variables, only AVB-R ratio positively correlated with the amount of intraoperative blood transfusion (r = 0.28; P = 0.03). Also, preoperative lateral rib hump positively correlated with blood loss in the PSF group (r = 0.39; P < 0.05). Also, the classification of the scoliosis did not affect the amount of blood loss and the number of transfused units. Conclusions: The preoperative lateral rib hump is an important factor positively correlated with the EBL.

Effects of novel corrective spinal technique on adolescent idiopathic scoliosis as assessed by radiographic imaging

To compare the therapeutic effects of a 3-dimensional corrective spinal technique (CST) and a conventional exercise program (CE) on altered spinal curvature and health related quality-of-life in patients with adolescent idiopathic scoliosis (AIS). Adolescents with idiopathic scoliosis (N=32, 6 males and 26 females) between 10 and 19 years of age (14.34 ± 2.60 years) were recruited and underwent the CST or CE for 60 minutes/day, 2-3 times a week, and an average of total 30 sessions. Diagnostic X-ray imaging technique was used to determine intervention-related changes in the Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, sacral slope, pelvic tilt, pelvic incidence, and vertebral rotation (Nash-Moe method). The Scoliosis Research Society-22 (SRS-22) health related quality-of-life questionnaire was used. Data were analysed using independent t-test, paired t-test, and non-parametric Mann-Whitney U-test at p < 0.05. CST showed greater improvements in Cobb angle (p=0.003), vertebral rotation (p=0.000), and SRS-22 scores (self-image and treatment satisfaction subscale scores and total score, p=0.026, p=0.039, and p=0.041, respectively) as compared to the controls. There were no significant changes in the other measures between the two groups. This is the first clinical trial to investigate the effects of the 3-dimensional CST on spinal curvatures and health related quality-of-life in AIS, providing the important clinical rationale and compelling evidence for the effective management of AIS.

Choosing Fusion Levels in Adolescent Idiopathic Scoliosis

Correct identification of fusion levels in surgical planning for the management of adolescent idiopathic scoliosis is a complex task. Several classification systems and algorithms exist to assist surgeons in determining the appropriate levels to be instrumented. The Lenke classification is the benchmark system. Among the many factors and measurements that are taken into account when selecting the proper upper instrumented vertebra and lower instrumented vertebra are planning for selective fusion; preserving motion segments; preventing proximal and/or distal junctional kyphosis, shoulder imbalance, and neck pain; and maintaining short fusion lengths. Existing treatment algorithms do not account for every exception, and further research is required to improve long-term surgical outcomes.

Recent Trends in Surgical Management of Adolescent Idiopathic Scoliosis: A Review of 17,412 Cases from the Scoliosis Research Society Database 2001-2008

Recent Trends in Surgical Management of Adolescent Idiopathic Scoliosis: A Review of 17,412 Cases from the Scoliosis Research Society Database 2001-2008

Is There a Global Consensus on Optimal Surgical Care for Adolescent Idiopathic Scoliosis? A Delphi Study

The surgical management of adolescent idiopathic scoliosis (AIS) has seen many developments in the last two decades including use of pedicle screws, bone substitutes, and so on. Little high-level evidence is available to support these changes and guide treatment. Therefore, the AOSpine Knowledge Forum Deformity identified a need to explore what is currently practiced and what constitutes optimal operative care for these patients.

Choosing Fusion Levels in Adolescent Idiopathic Scoliosis

Correct identification of fusion levels in surgical planning for the management of adolescent idiopathic scoliosis is a complex task. Several classification systems and algorithms exist to assist surgeons in determining the appropriate levels to be instrumented. The Lenke classification is the benchmark system. Among the many factors and measurements that are taken into account when selecting the proper upper instrumented vertebra and lower instrumented vertebra are planning for selective fusion; preserving motion segments; preventing proximal and/or distal junctional kyphosis, shoulder imbalance, and neck pain; and maintaining short fusion lengths. Existing treatment algorithms do not account for every exception, and further research is required to improve long-term surgical outcomes.

Arachnoiditis Ossificans After Revision Adolescent Idiopathic Scoliosis Surgery

Case report. To report the clinical and imaging findings of a patient with arachnoiditis ossificans (AO) 22 years after revision surgery for adolescent idiopathic scoliosis (AIS). To our knowledge, there are no reports in the literature that describe AO developing after primary or revision surgery for AIS. Ararchnoiditis ossificans is a rare finding and we provide a review of its presentation and management. We report the patient's history, physical examination, radiographical findings, and management in addition to providing a literature review. A 43 year-old-male who underwent revision surgery for AIS due to intradural migration of a laminar hook presented 22 years after surgery with subjective leg weakness. On physical examination, no weakness was elicited and radiographs demonstrated the instrumentation to be intact. Computed tomographic imaging was performed to assess for adjacent segment disease and diffuse ossification or AO of the thecal sac from L3 to S1 was noted. We recommended observation and nonoperative management because the patient's symptoms were relatively mild. To our knowledge, this is the first report of AO after surgical management of primary or revision AIS. A discussion on the management of AO and a literature review is presented.

Clavicle Chest Cage Angle Difference (CCAD)

Retrospective case series of surgically treated patients with adolescent scoliosis. To establish a new radiographical measurement method to determine the best preoperative predictor of postoperative shoulder balance. Shoulder balance is an important aspect of the overall cosmetic balance in patients with adolescent idiopathic scoliosis. Despite recent reports, it is still difficult to estimate the postoperative shoulder balance accurately. A retrospective review of 89 consecutive patients who had thoracic fusion with a minimum 2-year follow-up (mean, 3.1 yr) was conducted to investigate the radiographical measurements and patient demographics. The shoulder height difference (SHD) was measured as the graded height difference of the soft tissue shadows. SHD more than 2 cm indicated an unbalanced shoulder. The clavicle chest cage angle difference (CCAD) was established and evaluated. The CCAD was graded as grade A: no imbalance (<0°), grade B: mild imbalance (0°-10°), and grade C: significant imbalance (>10°). Of the 89 patients, 22 patients had a moderate or significant SHD at 2 years postoperatively and were categorized as the unbalanced shoulder group (unbalanced SD). A significant difference was observed in preoperative CCAD between the balanced and unbalanced SD groups (P = 0.01). The intraclass correlation coefficient for CCAD was 0.94 among the observers. CCAD was consistent from the preoperative to the final postoperative follow-ups in both groups. The classification of the CCAD preoperatively indicated that 12 of 22 (54.4%) patients who were classified into the postoperative unbalanced SD group showed grade 3 CCAD preoperatively, whereas only 9 of 67 (13.4%) patients who were classified in the postoperative balanced SD group had grade 3 CCAD preoperatively. The developed method to predict postoperative shoulder balance was demonstrated to be easy to perform, reliable, and practical. Additionally, we classified the estimation of postoperative shoulder imbalance by preoperation CCAD. The results of this comprehensive review will guide spinal surgeons in their preoperative planning and in the surgical management of adolescent idiopathic scoliosis to reduce postoperative shoulder imbalance. 4.