Pre-existing Scoliosis Research Articles

Effectiveness of Integrative Korean Medicine Treatment in Patients with Traffic-Accident-Induced Acute Low Back Pain and Mild Adult Scoliosis.

We investigated the effectiveness of integrative Korean medicine treatment in patients with pre-existing scoliosis who received inpatient care for traffic-accident-induced acute LBP. We selected 674 patients diagnosed with scoliosis between 1 January 2015, and 30 June 2021, using lumbar spine (L-spine) imaging, across four Korean medicine hospitals in Korea for a retrospective chart review and sent them a questionnaire-based follow-up survey. The primary outcome was a numeric rating scale (NRS) score of LBP. The secondary outcomes were the Oswestry Disability Index (ODI), 5-level EuroQol 5-dimension (EQ-5D-5L), and patient global impression of change (PGIC) scores. In total, 101 patients responded to the follow-up survey. NRS scores decreased from 4.86 (4.71-5.02) to 3.53 (3.17-3.90) from admission to discharge, subsequently decreasing to 3.01 (2.64-3.38) (p < 0.001) at the last follow-up. Similarly, ODI scores decreased from 35.96 (33.08-38.85) to 22.73 (20.23-25.24) and 14.21 (11.74-16.67) (p < 0.001), respectively. Approximately 87.1% of patients were satisfied with their inpatient care. There were no significant differences in the degree of improvement according to the severity of scoliosis. Integrative Korean medicine treatment can improve pain, lumbar dysfunction, and quality of life in patients with traffic-accident-induced acute low back pain and pre-existing mild scoliosis.

Acute pancreatitis after gastro-jejunal tube placement in patient with severe scoliosis

We herein report a 14-year-old cerebral palsy patient with severe scoliosis who developed acute pancreatitis, just after the insertion of a gastro-jejunal tube (GJT) to carry out jejunal feeding. The patient underwent laparoscopic fundoplication and gastrostomy as a treatment for gastroesophageal reflux disease. After surgery, the patient developed leakage and gastrostomy feeding difficulty overtime, subsequently, GJT feeding through an established gastrostomy was initiated. However, the patient developed acute pancreatitis two days after the insertion of a GJT. Computed tomography showed peri-pancreas massive edema and that duodenum had become apparently displaced due to the patient's pre-existing scoliosis. Furthermore, it looked like that the direct compression to the whole pancreas had possibly been occurred by the inserted GJT. The occurrence of GJT related pancreatitis was suspected, and subsequently, the pancreatitis improved after the removal of the GJT. The patient thereafter underwent gastro-jejunal bypass surgery. A GJT is a useful device for jejunal feeding which can be inserted from an established gastrostomy, however, its usage should be limited because of a high rate of morbidity. In patient with cerebral palsy, especially combined with severe scoliosis, we should recognize that the insertion of GJT can cause acute pancreatitis due to the risk of direct compression to the patient's pancreas by the GJT.

Adult Degenerative Scoliosis.

Populational aging increases the incidence of musculoskeletal degenerative processes, such as adult scoliosis (AS). Adult scoliosis is defined as a spinal deformity in the coronal plane with a Cobb angle > 10°. Adult scoliosis may be iatrogenic or result from a degenerative process (scoliosis de novo ) or a pre-existing scoliosis. Adult scoliosis is a potentially limiting condition that affects a heterogeneous group of patients. Clinical treatment proved to be ineffective and surgery is often indicated. The present paper reviews AS pathophysiology, clinical presentation and diagnosis, in addition to surgical indications and the main techniques currently used.

Does Intrathecal Baclofen Therapy Increase Prevalence and/or Progression of Neuromuscular Scoliosis?

Study DesignRetrospective, case-matched review. ObjectivesCompare a group of individuals with cerebral palsy (CP) who had intrathecal baclofen (ITB) pumps to a group of individuals with CP who did not have ITB pumps in order to determine if there was a difference in the prevalence of new-onset neuromuscular scoliosis, an increased rate of progression of preexisting neuromuscular scoliosis, or an increased rate of posterior spine fusion surgery in skeletally immature individuals with CP who had ITB pumps. Summary of Background DataVarious authors report conflicting findings, with some reporting an increased incidence or prevalence of scoliosis in individuals with CP who have ITB pumps whereas others report no difference in the rate of scoliosis between groups. MethodsRetrospective chart and radiographic case-matched study in which individuals were matched by gender and Gross Motor Function Classification Scale (GMFCS) level. ResultsWe found no difference in the rates of new-onset neuromuscular scoliosis for those with CP and ITB pumps and those without ITB pumps. However, we did see a higher rate of progression as well as an increased rate of posterior spine fusion surgery in individuals with CP who had ITB pumps than for those with CP who did not have an ITB pump. ConclusionsWe continue to recommend ITB pump therapy for individuals with severe spasticity associated with CP (GMFCS IV and V). There is a significant risk of complications for individuals in general. The risk of neuromuscular scoliosis is relatively high in this population. Our findings suggest that individuals with CP who have ITB pumps and who do or do not have preexisting scoliosis should be monitored closely for either developing new neuromuscular scoliosis or progression of preexisting scoliosis.

Obliged Removal of the Percutaneous Fixation System on the Thoracolumbar Junction in Patients with Idiopathic Scoliosis

Introduction: Minimally invasive percutaneous surgery of the spine is used to treat thoracolumbar junction and lumbar spine fractures by percutaneous fixation. Once fusion has been obtained, it is possible to remove the percutaneous instrumentation after 6 - 12 months. We report the case of an obliged removal of the fixation system at 12 months following operation in a patient with a pre-existing compensated and asymptomatic idiopathic scoliosis. Case Presentation: A 48-year-old patient affected by a compensated asymptomatic idiopathic scoliosis with an L3 type A3 fracture. The patient underwent a percutaneous short fixation L2 - L4. In the following months the patient presented progressive worsening of the low back pain and walking difficulties. The percutaneous fixation system was then removed using the same surgical access. Conclusions: This particular case explains well the importance of biomechanical balance when a spinal fixation should be perform, and demonstrate how an underestimation of this aspect may cause a worsening of symptoms even if the surgical procedure was correctly performed. It is evident that the removal procedure can lead clinical benefit to a patient, in which the fixation system created a decompensation of the curvature of the spine, thus causing biomechanical alterations and generating pain. In these cases, it may be opportune to limit the fracture reduction during the surgical procedure to modify the least possible the pre-existing scoliosis and to increase the patient’s comfort after the operation. The biomechanical behaviour of the spine is specific for each patient so only a careful detection of it could lead to an optimal therapeutic result.

Spinal stability after resection of nerve sheath tumors.

The aim of this paper was to present a generalizable group of patients who have undergone resection of spinal nerve sheath tumors and attempt to identify factors that may be predictive of the need for intraoperative fusion. We conducted a retrospective review of patients who underwent excision of spinal nerve sheath tumors performed by the senior author at the University of Miami/Jackson Memorial Medical Center. Out of the 48 cases reviewed in this study, a total of 7 (14.6%) underwent fusion at the same time as decompression and tumor excision. Fusion was deemed necessary in these cases for a number of different reasons, including preexisting scoliosis, cervical instability, preexisting listhesis, and tumor size and/or aggressiveness warranting more extensive bony exposure. Cervical tumors in patients with NF-1 and total facetectomy being performed were both factors found to be predictive of the decision to perform intraoperative fusion with instrumentation (P values of 0.009 and <0.001, respectively). There were seven cases in which partial facetectomies were performed without fusion, none of which later developed instability. Finally, excision of malignant peripheral nerve sheath tumors was also associated with the decision to perform fusion (P=0.008). The average length of follow‑up was 2 years, 11 months (SEM 8 months). Most patients can undergo resection of spinal nerve sheath tumors without fusion. Patients with pre‑existing deformity or instability, a history of NF-1 together with the tumor in the cervical region, malignant nerve sheath tumors, or those who undergo a total facet resection may require instrumented spinal fusion during tumor excision. We also observed that removal of one third or even half of a facet joint complex appears to be well tolerated with no instability seen on follow‑up.

Hybrid Stabilization of Thoracic Spine Fractures with Sublaminar Bands and Transpedicular Screws: Description of a Surgical Alternative and Review of the Literature.

Stabilization of unstable thoracic fractures with transpedicular screws is widely accepted. However, placement of transpedicular screws can cause complications, particularly in the thoracic spine with physiologically small pedicles. Hybrid stabilization, a combination of sublaminar bands and pedicle screws, might reduce the rate of misplaced screws and can be helpful in special anatomic circumstances, such as preexisting scoliosis and osteoporosis. We report about two patients suffering from unstable thoracic fractures, of T5 in one case and T3, T4, and T5 in the other case, with preexisting scoliosis and extremely small pedicles. Additionally, one patient had osteoporosis. Patients received hybrid stabilization with pedicle screws adjacent to the fractured vertebral bodies and sublaminar bands at the level above and below the pedicle screws. No complications occurred. Follow-up was 12 months with clinically uneventful postoperative courses. No signs of implant failure or loss of reduction could be detected. In patients with very small thoracic pedicles, scoliosis, and/or osteoporosis, hybrid stabilization with sublaminar bands and pedicle screws can be a viable alternative to long pedicle screw constructs.

Biomechanical spinal growth modulation and progressive adolescent scoliosis--a test of the 'vicious cycle' pathogenetic hypothesis: summary of an electronic focus group debate of the IBSE.

There is no generally accepted scientific theory for the causes 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 debate was written by Dr Ian A Stokes. It evaluates the hypothesis that in progressive scoliosis vertebral body wedging during adolescent growth results from asymmetric muscular loading in a "vicious cycle" (vicious cycle hypothesis of pathogenesis) by affecting vertebral body growth plates (endplate physes). A frontal plane mathematical simulation tested whether the calculated loading asymmetry created by muscles in a scoliotic spine could explain the observed rate of scoliosis increase by measuring the vertebral growth modulation by altered compression. The model deals only with vertebral (not disc) wedging. It assumes that a pre-existing scoliosis curve initiates the mechanically-modulated alteration of vertebral body growth that in turn causes worsening of the scoliosis, while everything else is anatomically and physiologically 'normal' The results provide quantitative data consistent with the vicious cycle hypothesis. Dr Stokes' biomechanical research engenders controversy. A new speculative concept is proposed of vertebral symphyseal dysplasia with implications for Dr Stokes' research and the etiology of AIS. What is not controversial is the need to test this hypothesis using additional factors in his current model and in three-dimensional quantitative models that incorporate intervertebral discs and simulate thoracic as well as lumbar scoliosis. The growth modulation process in the vertebral body can be viewed as one type of the biologic phenomenon of mechanotransduction. In certain connective tissues this involves the effects of mechanical strain on chondrocytic metabolism a possible target for novel therapeutic intervention.

Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis.

Spinal stenosis in combination with scoliosis frequently is seen in elderly patients. Patients typically present with a combination of symptoms attributable to neurogenic claudication and radicular pain, and symptoms of lower back pain. For patients in whom conservative treatment is not sufficient, surgical treatment can be done with careful consideration of the overall patient and his or her medical status. Surgical treatment is twofold; one purpose is to decompress the neural elements, the other purpose is to stabilize and realign the spine to as great a degree as possible. Appropriate balance of the spine at the end of the procedure is more important than the absolute amount of correction obtained. Stabilization and correction of the spine is done with pedicle screw-rod instrumentation and fusion, and the procedure must be done in an efficient and timely manner to involve the least amount of morbidity. There are two types of deformity typically seen, one is a degenerative lumbar scoliosis with no or minimal rotational deformity (Type I), and the other is a degenerative scoliosis often superimposed on a preexisting scoliosis with greater rotational deformity and greater loss of lordosis (Type II). Instrumentation and correction techniques differ for these two types of deformities, with shorter instrumentation procedures usually possible for the Type I deformity and longer instrumentation with sagittal plane reconstitution necessary for Type II deformity.

Monitoring Growth Hormone Treatment

The use of growth hormone (GH) has expanded from the treatment of short stature due to GH deficiency (GHD) in children with open epiphyses to include growth failure due to chronic renal insufficiency (CRI) and Turner's syndrome (TS) as well as adults with GHD. The safety considerations in using GH differ somewhat in these diagnostic groups, and the physician caring for these patients will need to keep this in mind when monitoring patients receiving GH. Peripheral edema and carpal tunnel syndrome have been reported as side effects more frequently in adults than in children treated with GH. Idiopathic intracranial hypertension has been reported most frequently in children with CRI (31.1 cases per 1000 patient-years [pt-yrs]), although children with GHD and TS also have an increased incidence (1.6 and 3.7 cases per 1000 pt-yrs, respectively). The greatest risk is at the beginning of treatment, and complaints of headache or visual disturbance at this time should prompt careful neurologic and ophthalmologic examination. The risk of leukemia and nonleukemic extracranial neoplasms in children treated with GH seems to be confined to those with identifiable risk factors. Although numerous studies have failed to show an increased risk of brain tumor recurrence associated with GH treatment, children with a history of such tumors should have completed tumor therapy and have brain imaging studies before beginning GH. Children with CRI, GHD, and TS have an increased risk of developing slipped capital femoral epiphysis. Complaints of limping or hip or knee pain need to be evaluated with radiographic studies if there is limited hip movement. Although there is no evidence that treatment with GH causes scoliosis, children with pre-existing scoliosis should be observed for rapid progression after starting GH treatment. Most studies of the effect of GH on carbohydrate metabolism show only transient changes in insulin sensitivity. Nevertheless, patients with an increased risk of diabetes should be encouraged to modify their diet and exercise habits. Gynecomastia is a common side effect in adults receiving GH, and self-limited gynecomastia has been reported in prepubertal boys during GH treatment. Older preparations of pituitary GH contained GH oligomers and were frequently associated with high titers of GH antibodies and growth deceleration. Except for patients with GH gene deletions, antibodies are rarely a cause of poor response to GH. Other causes of poor growth should be investigated in a child who fails to respond to prescribed GH as expected. Specific recommendations for managing patients in different diagnostic categories who are treated with GH are reviewed.