Non-progressive Scoliosis Research Articles

Lower Extremity Malformations.

Lower Extremity Malformations.

Association between Urinary Neurotransmitter Status and Scoliosis Progression: A Case-Controlled Series

Previous investigations into the relationship between neurotransmitter abnormalities and idiopathic scoliosis have been mixed. The purpose of the present study was to evaluate the differences in a urinary neurotransmitter profile across three different groups. These groups included a progressive scoliosis group, a non-progressive scoliosis group, and a non-scoliotic control group. When evaluating urinary neurotransmitter levels across all groups, statistically significant differences were observed between all three groups for multiple neurotransmitters. The differences seemed to increase as the scoliosis increased in Cobb angle measurement. Further studies should seek to distinguish a potential cause or effect relationship between these neurotransmitter abnormalities and idiopathic scoliosis onset and/or progression.

Physiotherapy scoliosis-specific exercises - a comprehensive review of seven major schools.

In recent decades, there has been a call for change among all stakeholders involved in scoliosis management. Parents of children with scoliosis have complained about the so-called “wait and see” approach that far too many doctors use when evaluating children’s scoliosis curves between 10° and 25°. Observation, Physiotherapy Scoliosis Specific Exercises (PSSE) and bracing for idiopathic scoliosis during growth are all therapeutic interventions accepted by the 2011 International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). The standard features of these interventions are: 1) 3-dimension self-correction; 2) Training activities of daily living (ADL); and 3) Stabilization of the corrected posture. PSSE is part of a scoliosis care model that includes scoliosis specific education, scoliosis specific physical therapy exercises, observation or surveillance, psychological support and intervention, bracing and surgery. The model is oriented to the patient. Diagnosis and patient evaluation is essential in this model looking at a patient-oriented decision according to clinical experience, scientific evidence and patient’s preference. Thus, specific exercises are not considered as an alternative to bracing or surgery but as a therapeutic intervention, which can be used alone or in combination with bracing or surgery according to individual indication. In the PSSE model it is recommended that the physical therapist work as part of a multidisciplinary team including the orthopeadic doctor, the orthotist, and the mental health care provider - all are according to the SOSORT guidelines and Scoliosis Research Society (SRS) philosophy. From clinical experiences, PSSE can temporarily stabilize progressive scoliosis curves during the secondary period of progression, more than a year after passing the peak of growth. In non-progressive scoliosis, the regular practice of PSSE could produce a temporary and significant reduction of the Cobb angle. PSSE can also produce benefits in subjects with scoliosis other than reducing the Cobb angle, like improving back asymmetry, based on 3D self-correction and stabilization of a stable 3D corrected posture, as well as the secondary muscle imbalance and related pain. In more severe cases of thoracic scoliosis, it can also improve breathing function.This paper will discuss in detail seven major scoliosis schools and their approaches to PSSE, including their bracing techniques and scientific evidence. The aim of this paper is to understand and learn about the different international treatment methods so that physical therapists can incorporate the best from each into their own practices, and in that way attempt to improve the conservative management of patients with idiopathic scoliosis. These schools are presented in the historical order in which they were developed. They include the Lyon approach from France, the Katharina Schroth Asklepios approach from Germany, the Scientific Exercise Approach to Scoliosis (SEAS) from Italy, the Barcelona Scoliosis Physical Therapy School approach (BSPTS) from Spain, the Dobomed approach from Poland, the Side Shift approach from the United Kingdom, and the Functional Individual Therapy of Scoliosis approach (FITS) from Poland.

Axial mitochondrial myopathy in a patient with rapidly progressive adult-onset scoliosis

Axial myopathy can be the underlying cause of rapidly progressive adult-onset scoliosis; however, the pathogenesis of this disorder remains poorly understood. Here we present a case of a 69-year old woman with a family history of scoliosis affecting both her mother and her son, who over 4 years developed rapidly progressive scoliosis. The patient had a history of stable scoliosis since adolescence that worsened significantly at age 65, leading to low back pain and radiculopathy. Paraspinal muscle biopsy showed morphologic evidence of a mitochondrial myopathy. Diagnostic deficiencies of electron transport chain enzymes were not detected using standard bioassays, but mitochondrial immunofluorescence demonstrated many muscle fibers totally or partially deficient for complexes I, III, IV-I, and IV-IV. Massively parallel sequencing of paraspinal muscle mtDNA detected multiple deletions as well as a 40.9% heteroplasmic novel m.12293G > A (MT-TL2) variant, which changes a G:C pairing to an A:C mispairing in the anticodon stem of tRNA LeuCUN. Interestingly, these mitochondrial abnormalities were not detected in the blood of either the patient or her son, suggesting that the patient’s rapidly progressive late onset scoliosis was due to the acquired paraspinal mitochondrial myopathy; the cause of non-progressive scoliosis in the other two family members currently remains unexplained. Notably, this case illustrates that isolated mitochondrial myopathy can underlie rapidly-progressive adult-onset scoliosis and should be considered in the differential diagnosis of the primary axial myopathy.Electronic supplementary materialThe online version of this article (doi:10.1186/s40478-014-0137-3) contains supplementary material, which is available to authorized users.

Skoliose

Scoliosis, a permanent abnormal curvature of the spine to the side, is divided into four forms: idiopathic (infantile, juvenile and adolescent, accounting for 80% of cases), neurogenic, congenital and adult scoliosis. Most patients with adolescent idiopathic scoliosis initially have mainly cosmetic problems. However, neurogenic, congenital and adult scoliosis can lead to severe clinical symptoms. The leading symptom is back pain caused by secondary changes. In recent years the Lenke classification has been proven to be a reliable tool for disease classification. Non-progressive scoliosis is usually treated conservatively. In the case of Cobb angles of greater than 50°, surgical therapy is recommended in patients presenting before adulthood. Technical improvements in implants and the optimisation of surgical methods have set a trend in the direction of surgical therapy.

Diffuse Skull Base/Cervical Fusion Syndromes in Two Siblings With Spondylocostal Dysostosis Syndrome

A study on a pair of male sibs to reach for the etiological understanding of unusual skull base/spine maldevelopment. Previously, radiographs alone were used to formulate this diagnosis. Here, three-dimensional computed tomography (3D CT) studies further clarified the typical diagnostic findings associated with spondylocostal dysostosis (SCD). Interestingly, patients with SCD are at increased risk for diffuse skull base/cervical fusion syndromes and can result in severe neurologic deficits associated with any degree of trauma. Classically SCD is defined as a skeletal dysplasia with clinical and radiologic manifestations, consisting of short neck and trunk, nonprogressive scoliosis and abnormalities of vertebral segmentation and of the ribs. Radiograms have been adopted as the only modality for the classification and prognostication of patients with SCD. Detailed clinical and radiographic examinations were undertaken with emphasis on the significance of the 3D CT scanning. We observed extensive fusion of the clivus with the cervical/entire spine, resulting in a remarkable solid, immobile, and fixed bony ankylosis of extremely serious outcome. Patients with spondylcostal dysostosis are predisposed to develop extensive skull-base-cervical spine fusion. The latter might lead to the development of a solid, immobile, and fixed bony ankylosis. In children/adults trivial injuries and/or high-energy trauma can lead to serious intracranial and spinal cord injury. Comprehensive orthopedic and neurosurgeons management must follow the recognition of these anomalies. To the best of our knowledge, no previous CT studies of the spine have been published in patients with SCD.

Analysis and simulation of progressive adolescent scoliosis by biomechanical growth modulation

Scoliosis is thought to progress during growth because spinal deformity produces asymmetrical spinal loading, generating asymmetrical growth, etc. in a ‘vicious cycle.’ The aim of this study was to test quantitatively whether calculated loading asymmetry of a spine with scoliosis, together with measured bone growth sensitivity to altered compression, can explain the observed rate of scoliosis progression in the coronal plane during adolescent growth. The simulated spinal geometry represented a lumbar scoliosis of different initial magnitudes, averaged and scaled from measurements of 15 patients’ radiographs. Level-specific stresses acting on the vertebrae were estimated for each of 11 external loading directions (‘efforts’) from published values of spinal loading asymmetry. These calculations assumed a physiologically plausible muscle activation strategy. The rate of vertebral growth was obtained from published reports of growth of the spine. The distribution of growth across vertebrae was modulated according to published values of growth sensitivity to stress. Mechanically modulated growth of a spine having an initial 13° Cobb scoliosis at age 11 with the spine subjected to an unweighted combination of eleven loading conditions (different effort direction and magnitude) was predicted to progress during growth. The overall shape of the curve was retained. The averaged final lumbar spinal curve magnitude was 32° Cobb at age 16 years for the lower magnitude of effort (that produced compressive stress averaging 0.48 MPa at the curve apex) and it was 38° Cobb when the higher magnitudes of efforts (that produced compressive stress averaging 0.81 MPa at the apex). An initial curve of 26° progressed to 46° and 56°, respectively. The calculated stresses on growth plates were within the range of those measured by intradiscal pressures in typical daily activities. These analyses predicted that a substantial component of scoliosis progression during growth is biomechanically mediated. The rationale for conservative management of scoliosis during skeletal growth assumes a biomechanical mode of deformity progression (Hueter-Volkmann principle). The present study provides a quantitative basis for this previously qualitative hypothesis. The findings suggest that an important difference between progressive and non-progressive scoliosis might lie in the differing muscle activation strategies adopted by individuals, leading to the possibility of improved prognosis and conservative or less invasive interventions.

Analysis and simulation of progressive adolescent scoliosis by biomechanical growth modulation

Scoliosis is thought to progress during growth because spinal deformity produces asymmetrical spinal loading, generating asymmetrical growth, etc. in a 'vicious cycle.' The aim of this study was to test quantitatively whether calculated loading asymmetry of a spine with scoliosis, together with measured bone growth sensitivity to altered compression, can explain the observed rate of scoliosis progression in the coronal plane during adolescent growth. The simulated spinal geometry represented a lumbar scoliosis of different initial magnitudes, averaged and scaled from measurements of 15 patients' radiographs. Level-specific stresses acting on the vertebrae were estimated for each of 11 external loading directions ('efforts') from published values of spinal loading asymmetry. These calculations assumed a physiologically plausible muscle activation strategy. The rate of vertebral growth was obtained from published reports of growth of the spine. The distribution of growth across vertebrae was modulated according to published values of growth sensitivity to stress. Mechanically modulated growth of a spine having an initial 13 degrees Cobb scoliosis at age 11 with the spine subjected to an unweighted combination of eleven loading conditions (different effort direction and magnitude) was predicted to progress during growth. The overall shape of the curve was retained. The averaged final lumbar spinal curve magnitude was 32 degrees Cobb at age 16 years for the lower magnitude of effort (that produced compressive stress averaging 0.48 MPa at the curve apex) and it was 38 degrees Cobb when the higher magnitudes of efforts (that produced compressive stress averaging 0.81 MPa at the apex). An initial curve of 26 degrees progressed to 46 degrees and 56 degrees, respectively. The calculated stresses on growth plates were within the range of those measured by intradiscal pressures in typical daily activities. These analyses predicted that a substantial component of scoliosis progression during growth is biomechanically mediated. The rationale for conservative management of scoliosis during skeletal growth assumes a biomechanical mode of deformity progression (Hueter-Volkmann principle). The present study provides a quantitative basis for this previously qualitative hypothesis. The findings suggest that an important difference between progressive and non-progressive scoliosis might lie in the differing muscle activation strategies adopted by individuals, leading to the possibility of improved prognosis and conservative or less invasive interventions.

Electromyographic Responses of Paraspinal Muscles to Postural Disturbance with Special Reference to Scoliotic Children

Background Electromyographic (EMG) responses of erector spinae to a postural perturbation have been described and interpreted as an unloading reflex. Moreover, these responses have been found clearly and constantly abnormal in subjects presenting a progressive idiopathic scoliosis when compared with responses observed in subjects presenting a nonprogressive scoliosis or in normal subjects. Objective To investigate responses to obtain more precise information on their components, on their origin, and on their variations in scoliotic children. Subjects Thirteen scoliotic children, with 3 cases of fast progressive idiopathic scoliosis, as well as 3 healthy subjects. Setting The study was carried out at the Swiss Institute of Chiropractic in Bern Switzerland. Methods The subjects were standing on a specially constructed platform that could be suddenly tilted either to the right or to the left. Thoracic and lumbar paraspinal muscle activity was recorded with pairs of self-adhesive surface bipolar EMG electrodes. The responses were analyzed to detect components and study their time course and relative amplitude in successive trials; characteristics common to different subjects were looked for. Results The presence of short-latency responses and later activities following a postural perturbation was confirmed. In a given subject, these components vary in amplitude and time course from one trial to another. On the other hand, the differences found across subjects are not significantly different from those found within the various subjects. Conclusion Our results exhibit some differences with previous data. They lead to a different neurophysiological interpretation and they indicate that the stimulus and the responses need more precise analysis before being used as a diagnostic and prognostic tool in evolutive scoliosis.

Equilibrium Factors as Predictors of the Prognosis in Adolescent Idiopathic Scoliosis

Postural equilibrium factors were evaluated as indicators of the prognosis in 52 patients with adolescent idiopathic scoliosis. The hypothesis was that dysfunction in these equilibrium factors might imply a higher risk for the curve to progress. The postural equilibrium was studied by stabilometry, and the function of the central nervous system was assessed by electoencephalography (EEG) and the vestibular function by electronystomography (ENG). During a follow-up period averaging 2.9 years, ten patients showed progression of the scoliosis. No differences were found in the distribution and frequency of abnormalities between the patients with progressive and nonprogressive scoliosis. Stabilometry, electroencephalography, and electronystomography as used in this study did not seem to be of predictive value for the outcome in the individual case.