Natural History Of Idiopathic Scoliosis Research Articles

The Natural History of Idiopathic Scoliosis During Growth: A Meta-Analysis.

The aim of the study was to provide a meta-analysis of current literature concerning the natural history of idiopathic scoliosis during growth. A comprehensive search of Medline, Embase, And Scopus databases was conducted up to November 2016. Eligible works were prospective or retrospective studies that enrolled patients with infantile idiopathic scoliosis, juvenile idiopathic scoliosis, or adolescent idiopathic scoliosis, followed up without any treatment from the time of detection. A meta-analysis for proportion was performed. The following studies were grouped per diagnosis: infantile idiopathic scoliosis, juvenile idiopathic scoliosis, and adolescent idiopathic scoliosis. Of the 1797 citations screened, we assessed 61 full-text articles and included 13 of these (2301 participants). Three studies included infantile idiopathic scoliosis patients (347 participants), five studies included a mixed population of juvenile idiopathic scoliosis and adolescent idiopathic scoliosis (1330 participants), and five studies included adolescent idiopathic scoliosis patients only (624 participants). The random pooled estimated progression rate was 49% (95% confidence interval = 1%-97%) for infantile idiopathic scoliosis, 49% in a mixed group of patients affected by juvenile idiopathic scoliosis or adolescent idiopathic scoliosis (95% confidence interval = 19%-79%), and 42% in adolescent idiopathic scoliosis (95% confidence interval = 11%-73%). During growth, idiopathic scoliosis tends to progress in a high percentage of cases. The progression rate varies according to the age at diagnosis, with infantile scoliosis being the most unpredictable. There are many confounders, such as age, Risser sign and baseline Cobb angles that were not consistent among studies, making the data very heterogeneous.

Stability of the Scoliotic Spine: Effect of Scoliosis Braces.

Orthotic treatment (braces) for scoliosis is best understood in light of the natural history of idiopathic scoliosis and the mechanics of spine stability. Idiopathic scoliosis is a spinal deformity confronted often by spine surgeons. With prompt recognition, treatment can be effective.

Tratamiento de fisioterapia de la escoliosis idiopática: Schroth versus gimnasia Abdominal Hipopresiva

IntroductionThe effectiveness of different treatments to modify the natural history of idiopathic scoliosis (IS) is currently under discussion. This paper has aimed to describe the evolution of a case series with juvenile or adolescent IS subjects who participated in two different physiotherapy treatment protocols: Schroth versus abdominal hypopressive gymnastics (AHG). Material and methodsEvolution of 29 subjects with IS (13 men and 16 women, with mean age of 12.41 years (SD 2.16), who participated in two different groups -Schroth and AHG, is described. Magnitude parameters and curve structure were determined as well as different risk factors (Risser sign, curve type, C7-S1 balance, ileo-lumbar angle) to evaluate the evolution. ResultsThe Schroth group was treated during a mean of 17.37 months (SD 11.64) and 42.1% (n=8) of the cases progressed to correction, 21.1% (n=4) to stabilization and 36.8% (n=7) to progression. The effectiveness index was 0.42 [95% CI 0.20 to 0.64]. Treatment time of the AHG group was 12.60 months (SD 7.18). A total of 30% (n=3) progressed to correction, 20% (n=2) to stabilization and 50% (n=5) to progression. The effectiveness index was 0.30 [95% CI 0.02 to 0.58]. No statistically significant differences were observed between groups. ConclusionsThe Schroth and the abdominal hypopressive gymnastics, as a physiotherapy treatment should be considered a useful conservative treatment for idiopathic scoliosis.

A prospective randomized study of the natural history of idiopathic scoliosis versus treatment with the SpineCor brace

Material and methods The inclusion criteria where: 1) High risk of evolution: family history and/or proven progressive 2) No significant pathological malformation of the spine; 3) Girl or boy; 4) Initial Cobb angle between 15° and 30°; 5) Risser 0, 1 or 2. Assessment of brace effectiveness included; 1) percentage of patients who have 5° or less curve progression and the percentage of patients who have 6° or more progression at skeletal maturity, 2) percentage of patients who have had surgery recommendation/undergone before skeletal maturity.

Idiopathic scoliosis

Idiopathic scoliosis is a structural and lateral curvature of the spine for which a currently recognizable cause has not been found and there is no basic evidence for physical and radiographic pathology. Scoliosis could be a cause of the back pain, deformities, respiratory and cardiology problems. There is a higher risk for decreasing of bone mineral density. Physical examination, radiography and stereophotogrametry are used in diagnostics of idiopathic scoliosis. The management of idiopathic scoliosis can be conservative or operative. The main forms of conservative management are: therapy exercises, electrical stimulation and spinal orthosis. The primary aim of scoliosis management is to stop curvature progression. The improvement of pulmonary function (vital capacity) and treatment of pain are also of major importance. THE GUIDELINES FOR CONSERVATIVE MANAGEMENT OF SCOLIOSIS: The International Society on Scoliosis Orthopaedic and Rehabilitation Treatment gave the guidelines for conservative management of scoliosis. Conservative management of scoliosis includes: a) Lyonaise, Side-Shift, Dobosiewicz, Schroth and other kinesitherapy methods, b) scoliosis intensive rehabilitation which appears to be effective with respect to many signs and symptoms of scoliosis and with respect to impeding curvature progression and c) brace treatment, which has been found to be effective in preventing curvature progression and thus in altering the natural history of idiopathic scoliosis. The International Society has given the standards for kinesitherapy, intensive rehabilitation and spinal orthosis in clinical practice and clinical investigations. Surgical procedures can improve curves in the frontal plane, but have important limitations in maintaining fixation and achieving correction in other planes.

Curve Progression in Idiopathic Scoliosis

This is a follow-up study to skeletal maturity on a cohort of students screened for a 1-year prospective epidemiological prevalence study for scoliosis. This study aims to identify the prognostic factors for curve progression to a magnitude of 30 degrees at skeletal maturity in skeletally immature patients with adolescent idiopathic scoliosis. The natural history of idiopathic scoliosis is not well understood. Previous reports have focused on the characteristics of curve progression where progression has been predefined at specific angles of 5 degrees to 6 degrees. However, the absolute curve magnitude at skeletal maturity is more predictive of long-term curve behavior rather than curve progression of a defined magnitude over shorter periods of skeletal growth. It is generally agreed that curves less than 30 degrees are highly unlikely to progress after skeletal maturity. Hence, defining the factors that influence curve progression to an absolute magnitude of more than 30 degrees at skeletal maturity would more significantly aid clinical practice. One hundred eighty-six patients who fulfilled the study criteria were selected from an initial 279 patients with idiopathic scoliosis detected by school screening, and who were followed-up till skeletal maturity. The initial age, gender, pubertal status, and initial curve magnitude were used as risk factors to predict the probability of curve progression to more than 30 degrees at skeletal maturity. Curve magnitude at first presentation was the most important predictive factor for curve progression to a magnitude of more than 30 degrees at skeletal maturity. An initial Cobb angle of 25 degrees had the best receiver-operating characteristic of 0.80 with a positive predictive value of 68.4% and a negative predictive value of 91.9% for curve progression to 30 degrees or more at skeletal maturity. Initial Cobb angle magnitude is the most important predictor of long-term curve progression and behavior past skeletal maturity. We suggest an initial Cobb angle of 25 degrees as an important threshold magnitude for long-term curve progression. Initial age, gender, and pubertal status were less important prognostic factors in our study.

Scoliosis

This article reviews the nonoperative and operative decision making process in idiopathic scoliosis in the adolescent and adult with additional comments about degenerative scoliosis. Because knowledge of the natural history of idiopathic scoliosis is essential for decision making, this will be covered first, as will the current knowledge concerning the long term outcomes of nonoperative and operative treatment. With the natural history as a background, I will discuss how the factors that are important in natural history effect decision making in the adolescent and adult. By using an evidence-based approach, hopefully a better decision-making process will result in improved outcomes. Additional treatment decisions regarding the choice of the specific nonoperative treatment methods as well as surgical decisions (fusion levels, approach, choice of implants) will not be covered. Therapeutic study, level V (expert opinion). See the Guidelines for Authors for a complete description of the levels of evidence.

Geometric and Electromyographic Assessments in the Evaluation of Curve Progression in Idiopathic Scoliosis

The natural history of patients with idiopathic scoliosis was analyzed radiographically and electromyographically in a prospective longitudinal study. To identify changes in geometric variables and the sequence in which these changes occur during curve progression in the natural history of patients with idiopathic scoliosis. In addition, to study the relationship between several geometric variables and electromyographic (EMG) measurements to determine their predictive value as risk factors to curve progression of the scoliotic deformity. The main area of concern in treating children with adolescent idiopathic scoliosis is the unpredictability of curve progression during the early development of the deformity. The changes in radiographic geometric and EMG variables between the first presentation and consecutive 4-6-month follow-up periods were analyzed in 105 patients with idiopathic scoliosis. Statistical analyses were performed to elucidate in more detail how spinal geometry evolves during curve progression. Curve severity was associated with remaining growth potential expressed as an increasing spinal growth velocity (SGV). With increasing SGV, an enhanced EMG activity at the lower part on the convex side of the curve expressed as EMG ratio was found. High EMG ratio was associated with increased axial rotation and diminished kyphosis before the rapid increase in Cobb angle. Lateral deviation, wedge angle, and axial rotation all increased during periods of progression. Changes in tilt angle and lordosis were not associated with curve progression. In the natural history of idiopathic scoliosis, SGV and EMG ratio at the lower end vertebra are prominent risk factors of curve progression. The asymmetric muscle activity is associated with increased axial rotation, which in its turn is associated with increasing Cobb angle and diminishing kyphosis. The combination of these variables provides insight in the physiologic and 3-dimensional biomechanical evolution of the natural history of curve progression in idiopathic scoliosis.

Empfehlungen zur Sportausübung bei Patienten mit idiopathischer Skoliose

The idiopathic scoliosis is a three dimensional spinal deformity mostly occurring in female adolescents. Untreated it can progress and result in back pain, impaired lung capacity and psychosocial disorders due to the cosmetic appearance of the deformed trunk. The treatment depends on the severity of the curve and ranges from physiotherapy and observation, brace treatment to surgical treatment with partial correction and fusion of the primary curve. Patients with an idiopathic scoliosis should be encouraged to actively take part in sports activities. Positive influences on the general fitness including the lung function, on the trunk muscles and on the psyche can be expected. There are no scientific data indicating that any kind of sport activities alter the natural history of idiopathic scoliosis.

Brace treatment during pubertal growth spurt in girls with idiopathic scoliosis (IS): A prospective trial comparing two different concepts

Prospective comparison of the survival rates of two different bracing concepts with respect to curve progression and duration of treatment during pubertal growth spurt in two cohorts of patients followed up prospectively. To determine whether the results obtained by the use of a soft brace (SpineCor) is comparable to the results of the Chêneau derived TLSO during pubertal growth spurt. In recent peer reviewed literature, the SpineCor is described as an effective method of treatment for patients with scoliosis. However, until now, no controlled study has been presented comparing the results obtained with this soft brace to a sample treated with other bracing concepts proven effective. Twelve patients with Cobb angles between 16-32 degrees during pubertal growth spurt are presented as a case series treated with the SpineCor. The survival rate of this sample is described and compared to a matched group of patients treated with the Chêneau brace of the same age group. All girls treated in both studies were pre-menarchial with the first clinical signs of maturation (Tanner 1-3). During the pubertal growth spurt, most of the patients (11/12) with SpineCor progressed clinicly and radiologicly as well (at least 5 degrees ). Progression could be stopped changing SpineCor to the Chêneau brace in most of the samples described (7/10). The avarage Cobb angle at the start of treatment with the SpineCor was 21.3 degrees , after an avarage observation time of 21.5 months, 31 degrees. The control sample, primarily treated with the Chêneau brace (n=15), showed at average no progression. Cobb angle at the start of treatment was 33.7 degrees and after the observation time of 37 months, 33.9 degrees . Radiological improvements can be reported for some of the cases (3/15) as well as progressions (3/15). At 24 months of treatment time, 73% of the patients with a Chêneau brace and 33% of the patients with the SpineCor where still under treatment with their original bracing concept, at 42 month follow-up time 80% of the patients with Chêneau braces and 8% of the patients with the SpineCor survived with respect to curvature progression. The differences of the proportions statisticly where highly significant. The SpineCor does not change natural history of idiopathic scoliosis during the pubertal growth spurt. The use of the Chêneau brace seems to do so. Oncoming studies with the aim to test the efficiency of braces should be based on samples at immediate risk for progression (only girls with first signs of maturation but pre-menarchial).

The Etiology and Natural History of Idiopathic Scoliosis

The Etiology and Natural History of Idiopathic Scoliosis

ADOLESCENT IDIOPATHIC SCOLIOSIS

Because of the relatively recent understanding of the untreated natural history of idiopathic scoliosis, many patients do not require treatment and are simply observed. Immature patients whose curves are between 25 degrees and 40 degrees are at high risk for further progression and should be treated with a brace. Seventy percent to 80% of the time, the patient can expect that the brace will prevent further progression. Curves in growing children greater than 40 degrees require a spinal fusion. Modern scoliosis surgery provides excellent correction of deformity and allows immediate ambulation without a cast or brace. This article reviews the diagnosis, cause, and treatment recommendations for adolescent idiopathic scoliosis.

The natural history of idiopathic scoliosis. Incidence of treatment in 15 cohorts of children born between 1963 and 1977.

This study analyzed the incidence of treatment of scoliosis using a cross-sectional and a longitudinal technique. To follow the incidence of treated scoliosis in Malmö, Sweden, in children born between 1970 and 1977 and compare observations with those of a study from 1988, in which the incidence of this disorder was followed in children born between 1963 to 1969. During the late 1970s and early 1980s, the incidence of treated scoliosis decreased yearly in Malmö. This trend was supported by other reports. However, introduction of worldwide screening for scoliosis was a confounding factor. When cohorts of children born between 1963 and 1969 were analyzed, no change was found. In a study in Malmö in 1988, this was shown to be an effect of using a longitudinal instead of a cross-sectional technique of analyzing the data. In a cross-sectional study, the authors registered all new treatments for idiopathic scoliosis, brace treatments, or direct surgery, for each year between 1984 and 1993. In a longitudinal study, all new treatments in each cohort of children born between 1970 and 1977 were followed. The results were compared with figures from the 1988 study. After the introduction of school screening in 1976, a peak in the incidence of treated scoliosis was seen in 1977. After a continuous decrease in the incidence until 1983, a steady state developed. In cohorts born between 1963 and 1977, the incidence is neither increasing nor decreasing. In cohorts of children followed in a longitudinal study over a 15-year period (born between 1963 and 1977), there is no support for a change in the natural history of idiopathic scoliosis.

Point of View: The Natural History of Idiopathic Scoliosis

Point of View: The Natural History of Idiopathic Scoliosis

Late-onset idiopathic scoliosis in children six to fourteen years old. A cross-sectional prevalence study.

We performed a point-prevalence survey of 15,799 children, six to fourteen years old, who formed part of a prospective longitudinal study. Our purpose was to detect the prevalence of scoliosis and to investigate associated factors. On the basis of the initial screening, 934 children (5.9 per cent) were referred for additional clinical and radiographic examinations; 896 children returned for this second evaluation. A lateral spinal curve with a Cobb angle of more than 5 degrees was seen in 431 children (2.7 per cent of the 15,799 children). Only seventy-six children (0.5 per cent) had a curve that met our definition of idiopathic scoliosis (a curve of more than 10 degrees with concordant apical rotation). The point-prevalence rate was higher in girls, and it increased with age. The rate was 0.1 per cent (four of 5246) in the age-group of six to eight years, 0.3 per cent (sixteen of 5831) in the age-group of nine to eleven years, and 1.2 per cent (fifty-six of 4722) in the age-group of twelve to fourteen years old. With allowance for the fact that different definitions of idiopathic scoliosis have been used in earlier studies, our results suggest that the natural history of idiopathic scoliosis may be becoming more benign spontaneously.

Effect of bracing on respiratory mechanics in mild idiopathic scoliosis.

The use of a corrective orthopaedic brace is an established form of management for patients with progressive idiopathic scoliosis. Thirteen patients with mild idiopathic scoliosis were studied with and without the corrective brace applied. Lung volumes and the pattern of chest wall and abdominal movement were measured during quiet breathing. Transdiaphragmatic pressures were measured in six of the patients and upper ribcage movement in seven patients. Application of the brace resulted in a significant reduction in vital capacity (14%), functional residual capacity (22%), and total lung capacity (12%). There was no effect on respiratory rate or minute volume. In the erect position the pattern of chest wall movement was altered with a reduction in lower ribcage movement of 46% and abdominal wall of 39% and an increase in upper ribcage movement of 43%. These changes were greater in the supine position. There was at least a twofold increase in end inspiratory and end expiratory gastric pressures during tidal breathing, but oesophageal pressures were not affected by the brace. Transdiaphragmatic pressures showed a similar twofold increase, which implies a substantial increase in the work of breathing. In view of the doubts concerning the influence of bracing on the natural history of idiopathic scoliosis and the substantial functional effect of bracing on the respiratory system, it is suggested that the current practice of bracing in this condition needs to be reviewed.

Screening School Children for Scoliosis

Idiopathic scoliosis can be detected by early screening of school children in school clinics, a method which improves the detection rate. By early detection, many curves that would require surgical treatment can be prevented from reaching that severe magnitude. Much valuable data regarding the natural history of idiopathic scoliosis have been derived from screening programs. On the other hand, costs of screening are not inconsequential, and costs involved in follow-up procedures are high. Vast numbers of small, nonprogressive curves are discovered and followed. Several questions remain. (1) At what ages should school children be screened? (2) Should boys be screened? (3) What should be the criteria for referral or treatment? (4) What is a reasonable follow-up program? (5) How effective is nonoperative treatment? Careful study of the natural history and treatment of idiopathic scoliosis will help to answer these questions.

The Natural History of Idiopathic Scoliosis

A clear understanding of the natural history of idiopathic scoliosis is essential for developing effective treatment. The current information on its natural history indicates that a large number of patients have minor degrees of curvature (approximately 100 per 1000 individuals), although only about two per 1000 individuals warrant treatment because of curve progression. A large number of these curves do not increase even without treatment. Prognostic indicators such as growth, menarch, Risser sign, age at diagnosis, and sex are useful for predicting curve progression but are not always precise. Nonpredictive factors include family history, thoracic kyphosis, lumbar lordosis, lumbosacral transitional anomalies, and trunk balance. Future growth potential and curve severity remain the most reliable considerations in predicting the course of the disorder and in devising suitable approaches to treatment.

The Natural History of Idiopathic Scoliosis

Background. The natural history of idiopathic scoliosis is a crucial issue in the planning and assessment of different treatment methods. This article presents the evaluation of scoliotic deformity in immature patients who have been in observation without any treatment. Material and methods. 159 patients (128 girls, 31 boys) were examined between 1971 and 2002. Skoliosis was diagnosed at a mean age of 6 years 4 months (range 2.1-8.10), and observation was concluded at a mean age of 16 years 11 months (range 14.6-20.3). The mean follow-up was 10 years 5 months. The prognostic factors analyzed were: age, sex, Cobb angle, Mehta angle, apical vertebral rotation, specific rotation, Risser test. The progression and regression of curvature was analyzed in different biological age periods, and was measured by calculating the difference in the Cobb angle on successive x-rays divided by the interval between x-rays. Results. The mean progression of curvature before age 5 was 5.7 degrees per year; in the 6-10 age bracket, 2.3 degrees per year; in the 11-15 age bracket, 7.4 degrees per year; in the >15 age bracket, 0.3 degrees per year. The mean progression for patients with Risser 1 was 8.8 degrees per year; Risser 2, 7.3 degrees per year; Risser 3, 5.1 per year; Risser 4, 2.1 degrees per year; Risser 5, 0.3 degrees per year. Conclusions. The progression of curvature in idiopathic scoliosis is variable, and is influenced by age. Knowledge of the natural history of idiopathic scoliosis is a crucial tool in predicting the development of spinal curvature. The Risser test and biological age are the only effective predictors of progression.

Comparison of Symposium Papers on Natural History of Idiopathic Scoliosis

Comparison of Symposium Papers on Natural History of Idiopathic Scoliosis