Non-idiopathic Scoliosis Research Articles

Scoliosis

Scoliosis

Complex congenital scoliosis: brace treatment. What can we expect?

Background Complex Congenital Scoliosis (CCS) is the most frequent cause of non-idiopathic Scoliosis. CCS is a frequent condition in Algeria, and is associated with severe spinal deformities due to failures of formation and segmentation. To date, there is no single treatment that can correct all the deformities in CCS, and the value of Brace Treatment (BT) is still debated. We report our experience in the use of BT in CCS.

The utility of superficial abdominal reflex in the initial diagnosis of scoliosis: a retrospective review of clinical characteristics of scoliosis with syringomyelia

BackgroundWith increasing use of magnetic resonance imaging (MRI), underlying syringomyelia is increasingly found in patients with presumed idiopathic scoliosis. To determine the indications for MRI in the differential diagnosis of scoliosis, several clinical characteristics of syringomyelia have been reported. Neurological signs, particularly abnormal superficial abdominal reflex (SAR), are important in establishing the initial diagnosis of scoliosis. However, the prevalence of abnormal SAR in patients with scoliosis and the sensitivity of this sign in predicting syringomyelia are not well known. We aimed to determine the diagnostic utility of SAR and other characteristics of syringomyelia in patients with scoliosis.MethodsWe reviewed the medical records of 93 patients with scoliosis, 90 of whom underwent corrective surgery. All patients underwent MRI to determine the presence of syringomyelia. Mean age at surgery was 12.5 years. Abnormal SAR was defined as unilateral or bilateral absence or hyporeflexia of SAR. We calculated indices of diagnostic utility of abnormal SAR for non-idiopathic scoliosis and for syringomyelia. Abnormal SAR, left thoracic curve pattern, gender, and curve flexibility were compared between scoliosis with syringomyelia and idiopathic scoliosis. Logistic regression analysis was performed with the existence of syringomyelia as the dependent variable and curve flexibility as the independent variable.ResultsAbnormal SAR was observed in 20 patients (prevalence 22%). All 6 patients with myopathic scoliosis displayed bilateral absence of SAR. The sensitivity of abnormal SAR for non-idiopathic scoliosis was 38%, with 96% specificity, 90% PPV (positive predictive value), and 60% NPV (negative predictive value). Syringomyelia was identified in 9 of the 93 patients (9.7%); 8 of these had abnormal SAR. The sensitivity of abnormal SAR for syringomyelia in presumed idiopathic scoliosis was 89%, with 95% specificity, 80% PPV, and 98% NPV. Gender, abnormal neurological findings, and curve flexibility differed significantly between patients with syringomyelia and those with idiopathic scoliosis (P < 0.05). In the logistic regression model, the area under the receiver operating characteristic (ROC) curve was 0.79 and the cut-off value of curve flexibility for syringomyelia was 50% (P = 0.08).ConclusionAbnormal SAR was a useful indicator not only for syringomyelia, but also for myogenic scoliosis.

Seat load characteristics in children with neuromuscular and syndrome-related scoliosis: effects of pathology and treatment

The amount of correction from spine deformity surgery that is required to avoid asymmetric and unbalanced sitting is not known, and methods sensitive enough to document moderate changes in pressure distribution over time are few, as the commonly used methods are qualitative or semiquantitative. The aim was to analyse seating pressure distribution with a pressure sensor mat system in patients with nonidiopathic scoliosis and to compare the pressure distribution with that in able-bodied controls. The aim was also to apply the method in a surgically treated scoliosis group before and after the spine fusion. Peak pressure, contact area of the entire and the maximum pressure surface, and three measures of asymmetry were calculated. Patients had higher peak pressure and more asymmetric loading than controls. Significant difference was indicated in contact area. After the spine fusion, all asymmetry indices improved. The method fulfilled clinical needs to detect the differences from normal controls as well as the surgery-dependent changes.

Spinal fusion surgery in children with non-idiopathic scoliosis: is there a need for routine postoperative ventilation?

The perioperative management of children with non-idiopathic scoliosis undergoing spinal deformity surgery has not been standardized and the current practice is to routinely ventilate these patients in the postoperative period. This study reports the experience from a single institution and evaluates the need and reasons for postoperative ventilation. Details of ventilated patients are presented. All patients undergoing spinal fusion surgery for non-idiopathic scoliosis were recorded prospectively (2003-4). Patients were anaesthetized according to a standardized technique. Physical characteristics, cardiopulmonary function, intraoperative blood loss and fluid requirement, postoperative need for ventilation and all perioperative adverse events were recorded on a computer database. A total of 76.2% of patients were safely extubated at the end of surgery without any further complications or need for re-ventilation; 23.8% of patients required postoperative ventilation with half of the cases being planned before operation and 40% of all patients with Duchenne muscular dystrophy (DMD) required postoperative ventilation. There were no specific factors that could predict the need for postoperative ventilation, although an increased tendency for children with DMD and those with a preoperative forced vital capacity <30% towards requiring postoperative ventilation was observed. Early extubation can be safely performed after spinal deformity surgery for non-idiopathic scoliosis. The use of short-acting anaesthetics, drugs to reduce blood loss, experienced spinal anaesthetists and the availability of intensive care support are all essential for a good outcome in patients with neuromuscular disease and cardiopulmonary co-morbidity.

A Change of Pulmonary Function in the Patients with Severe Non-Idiopathic Scoliosis Following Reconstructive Spine Surgery

A Change of Pulmonary Function in the Patients with Severe Non-Idiopathic Scoliosis Following Reconstructive Spine Surgery

Relative anterior spinal overgrowth in adolescent idiopathic scoliosis—result of disproportionate endochondral-membranous bone growth?

There is no generally accepted scientific theory for the etiology of adolescent idiopathic scoliosis (AIS). As part of its mission to widen understanding of scoliosis etiology, the International Federated Body on Scoliosis Etiology (IBSE) introduced the electronic focus group (EFG) as a means of increasing debate on knowledge of important topics. This has been designated as an on-line Delphi discussion. The text for this EFG was written by Professor Jack Cheng and his colleagues who used whole spine magnetic resonance imaging (MRI) to re-investigate the relative anterior spinal overgrowth of progressive AIS in a cross-sectional study. The text is drawn from research carried out with his co-workers including measurement of the height of vertebral components anteriorly (vertebral body) and posteriorly (pedicles) in girls with AIS and in normal subjects. The findings confirm previous anatomical studies and support the consensus view that in patients with thoracic AIS there is relatively faster growth of anterior and slower growth of posterior elements of thoracic vertebrae. The disproportionate anteroposterior vertebral size is associated with severity of the scoliotic curves. In interpreting the findings they consider the Roth/Porter hypothesis of uncoupled neuro-osseous growth in the spine but point out that knowledge of normal vertebral growth supports the view that the scoliosis deformity in AIS is related to longitudinal vertebral body growth rather than growth of the canal. In the mechanical mechanism (pathomechanism) they implicitly adopt the concept of primary skeletal change as it affects the sagittal plane of the spine with anterior increments and posterior decrements of vertebral growth and, in the biological mechanism (pathogenesis) propose a novel histogenetic hypothesis of uncoupled endochondral-membranous bone formation. The latter is viewed as part of an 'intrinsic abnormality of skeletal growth in patients with AIS which may be genetic'. The hypothesis that AIS girls have intrinsic anomalies (not abnormalities) of skeletal growth related to curve progression and involving genetic and/or environmental factors acting in early life is not original. While the findings of Professor Cheng and his colleagues have added MRI data to the field of relative anterior spinal overgrowth in AIS their interpretation engenders controversy. Three new hypotheses are proposed to interpret their findings: (1) hypoplasia of articular processes as a risk factor for AIS; (2) selection from the normal population to AIS involves anomalous vertebral morphology and soft tissue factors--this hypothesis may also apply to certain types of secondary scoliosis; and (3) a new method to predict the natural history of AIS curves by evaluating cerebro-spinal fluid (CSF) motion at the cranio-cervical junction. What is not controversial is the need for whole spine MRI research on subjects with non-idiopathic scoliosis.

Pathology and morphometry of the paraspinous muscles in nonidiopathic scoliosis.

The muscle fibers in 19 patients with nonidiopathic scoliosis were generally small, especially on the concave side of the curve. Type 1 fibers were more frequently atrophic than type 2 fibers, but the former usually remained larger than the latter. Type 1 preponderance was greater on the convex side of the curve; type 2A preponderance occurred bilaterally. These changes are similar to those of idiopathic scoliosis. They resemble those of endurance training or stretch and are interpreted as secondary to the curve.

Postoperative Respiratory Complications in Non‐Idiopathic Scoliosis

The medical records of 303 patients undergoing fusions for scoliosis correction were retrospectively reviewed. The frequency and type of postoperative respiratory complications were compared in idiopathic versus non-idiopathic scoliosis patients in relation to age, type of spinal fusion procedure, pulmonary function test (PFT) results and preoperative diagnoses. The following factors were found to increase the incidence of problems in the postoperative period: a non-idiopathic type of scoliosis, mental retardation, anterior spinal fusion procedures, age of 20 or more years, a relative arterial hypoxemia and an obstructive component to the PFT's. Topics for further investigation are suggested.

Transcutaneous electrical muscle stimulation for the treatment of progressive spinal curvature deformities.

Transcutaneous electrical muscle stimulation has been used to treat spinal curvature. Electrically induced muscle contractions cause partial straightening of the spinal column while the patients sleep. Long-term treatment of 107 patients with progressive idiopathic scoliosis shows a 93% success rate in preventing further progression for curves below 30 degrees while the rate drops to 73% for curves above 30 degrees. In non-idiopathic scoliosis the outcome varied with aetiology and curve magnitude. All kyphosis patients stopped progression.