Symptomatic Scoliosis Research Articles

Lumbosacral Transitional Disorder as a Missing Link in Symptomatic Scoliosis

Back pain in the presence of LSTVs (lumbosacral transitional vertebrae) was originally noted by Mario Bertolotti in 1917. The Lenke classification for scoliosis forms the current international standard. However, the connection between LSTVs and scoliosis is still poorly understood. The aim of this study is to show the connection between scoliosis and LSTVs in terms of their frequency and impact on further development. Our scoliosis outpatient clinic has an examination period that covers the years from 2014 to 2021. If LSTVs are radiologically suspected (AP and lateral X-ray of the spine) according to the Castellvi classification (II–IV), a further MRI investigation is initiated. Scoliosis shape is assigned according to the Lenke classification. Sagittal segmental differences are observed according to the vertical mean vertebral angle (VMVA) and its difference (Diff-VMVA). Assignment to the lumbar pain group is made in cases of a history of chronic or recurrent pain of more than 6 months. Differentiation is made at the initial presentation according to gender (male–female) and age (children and adults). Other associated diagnoses such as family correlations and the question of brace fitting are cited. Finally, the literature is reviewed from a scoliosis perspective and compared with the findings of the authors of this paper. A total of 1332 patients were evaluated, and LSTV Castellvi II–IV was confirmed in 72 of them (58 female and 14 male). The curvature extent of scoliosis in children and adults had a mean Cobb angle of 24.3° with a range from 11° to 55° (n-42) and 32.4° with a range from 12° to 66° (n-30), respectively. This indicates that 75% of n-54 patients were mostly classified as Castellvi II (pseudarthrosis) (IIA, 54.2%; IIB, 20.8%) in the total data. There were few patients classified with Castellvi III (22.2%) and IV (2.8%). A proportion of 87.5% of 72 patients were mostly classified as Lenke 1 (25.0% n-18) and Lenke 5 (62.5% n-45). According to the literature, the Diff-VMVA shows Cobb angles of 9.3° for Castellvi III and 5.3° for Castellvi IV. Half of the patients complain of chronic low back pain for at least 6 months or have recurrent complaints (48.6%). The complaints are mostly classified as Castellvi IIA (27.8%) and B (9.7%). The association of scoliosis and LSTVs yields only 13 studies (PubMed 04/18/2022) that focus on spine surgery issues and not on diagnostics. Attention should be given to the lumbosacral junction in Lenke 1 and Lenke 5. Nearly half of the patients in each category complain of chronic lumbar symptoms. This is notable in individual cases due to its rounding and thus its increased Diff-VMVA. Since only Castellvi II–IV is considered, a comparison of the frequency with other studies is not permissible. In conclusion, for scoliosis Lenke 5 and Lenke 1, the lumbosacral junction should be examined.

Scoliosis in Shprintzen–Goldberg Syndrome

We report a case of scoliosis in a 12-year-old girl with Shprintzen–Goldberg syndrome. She was diagnosed with Shprintzen–Goldberg syndrome at birth. She was hospitalized for a surgical treatment because scoliosis gradually progressed. Preoperative X-ray confirmed 80° symptomatic scoliosis in T10–L5. Posterior correction and fusion were performed, and postoperative X-ray showed a correction to 43°in T10-L5. Limited subcutaneous tissues and fragile bones must be considered when selecting the appropriate surgical method. Accurate placement of a screw into thin pedicle is essential to obtain sufficient correction and fusion. The use of a navigation system is recommended.

133. Cost effectiveness of adult lumbar scoliosis surgery: an as-treated analysis from the adult symptomatic scoliosis surgery trial with five-year follow-up

BACKGROUND CONTEXT Adult spinal deformity is a relatively prevalent condition for which surgical treatment has become increasingly common but concerns surrounding complications, revision rates and cost-effectiveness remain unresolved. Of these issues, cost-effectiveness is perhaps the most difficult to quantify as the requisite data is difficult to obtain. PURPOSE The purpose of this study is to report on the cost-effectiveness of surgical vs nonsurgical treatment for adult symptomatic lumbar scoliosis (ASLS) using the as-treated data and provide a comparison to previously reported intent-to-treat (ITT) analysis. STUDY DESIGN/SETTING Secondary analysis of data from the NIH sponsored study on ASLS that included randomized and observational arms. PATIENT SAMPLE Patients enrolled in the NIH sponsored study on ASLS that included randomized and observational cohorts with at least five-year follow-up data within the same treatment arm. OUTCOME MEASURES Quality Adjusted Life Years (QALY) derived from the SF-6D. METHODS Patients with at least five-year follow-up data within the same treatment arm were included. Data collected every three months included use of nonoperative modalities, medications and employment status. Costs for surgeries and nonoperative modalities were determined using Medicare allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on reported employment status and income. Quality Adjusted Life Years (QALY) was determined using the SF-6D. RESULTS Of 286 patients, 195 patients (73 Nonop, 122 Op) met inclusion criteria. At five years, 29 (24%) patients in the Op group had a revision surgery of whom two had two revisions and one had three revisions. The cumulative cost for the Op group was $111,451 with a cumulative QALY gain of 2.29. The cumulative cost for the Non-Op group was $29,124 with a cumulative QALY gain of 0.41. This results in an ICER of $44,033 in favor of Op treatment. CONCLUSIONS This as-treated cost effectiveness analysis demonstrates that surgical treatment for adult lumbar scoliosis becomes favorable at year-three, one year earlier than suggested by a previous intent-to-treat analysis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

DIFFERENTIAL DIAGNOSIS IN AXIAL BACK PAIN AT CHILD

Most cases of back axial pain of the child, are lying on the border between pathology and surgical medical specialties. Continuous pain lasting more than two weeks can be a sign of severe pathologies, imposing the urgent clinical, laboratory and imaging investigation. It identifies several causes that can produce axial back pain in childhood: Scheuermann’s disease, symptomatic scoliosis (secondary), spondylolysis, spondylolisthesis, spondylodiscitis, sacroileitis, fractures of the column, spine tumors and rheumatic spondyloarthropathies.

Difficult tracheal intubation in a patient with maternal uniparental disomy 14.

BackgroundMaternal uniparental disomy 14 (UPD(14)mat) is an imprinting disorder. It is a rare disease, but there is the possibility that more undiagnosed patients might exist because the clinical features of UPD(14)mat resemble those of the Prader-Willi syndrome or other congenital diseases. We performed anesthetic management for an 8-year-old girl with UPD(14)mat.Case presentationsShe was admitted to undergo correction surgery due to symptomatic scoliosis. Preoperative examination revealed that she had a restricted mouth opening and retrognathia, as well as some typical characteristics of UPD(14)mat, such as small hands, growth retardation, and precocious puberty. We induced general anesthesia using sevoflurane without any problems. However, the tracheal intubation was difficult because of the restricted mouth opening. We used the McGRATHR MAC videolaryngoscope to overcome this problem.ConclusionsWe speculate that the craniofacial deformity in case of UPD(14)mat patients may lead to difficulty in tracheal intubation.

Trends of Posterior Long Segment Fusion with and without Recombinant Human Bone Morphogenetic Protein 2 in Patients with Scoliosis.

Study Design Retrospective study.Objective Symptomatic scoliosis can be a source of severe pain and disability. When nonoperative treatments fail, spine fusion is considered as an effective procedure in scoliosis management. The purpose of this study was to evaluate the trends of patients with scoliosis undergoing posterior long segment fusion (PLSF) with and without recombinant human bone morphogenetic protein 2 (rhBMP-2).Methods Patients within the orthopedic subset of Medicare database undergoing PLSF from 2005 to 2011 were identified using the PearlDiver Patient Records Database. Both diagnosis and procedural International Classification of Diseases, ninth edition and Current Procedural Terminology codes were used. The year of procedure, age, sex, region, and rhBMP-2 use were recorded.Results In total, 1,265,591 patients with scoliosis were identified with 29,787 PLSF surgeries between 2005 and 2011. The incidence of PLSF procedures increased gradually from 2005 to 2009, decreased in 2010 (p < 0 0.01), and grew again in 2011. Patients over age 84 years had the highest incidence of PLSF. The lowest incidence of the procedures was in the Northeast, 5.96 per 100,000 patients. Sex differences were observed with a male-to-female ratio of 0.40 (p < 0.01). The use of rhBMP-2 for PLSF increased steadily from 2005 to 2009; the numbers dropped dramatically in 2010 and returned by 2011.Conclusions According to our study, patients with scoliosis demonstrated a 0.6575 average incidence increase of PLSF treatments annually. There were significant differences in incidence of PLSF procedure and patient demographics. Additionally, rhBMP-2 consumption significantly changed when we stratified it by sex, age, and region respectively.

Scoliosis Associated With Airflow Obstruction Due to Endothoracic Vertebral Hump

A retrospective clinical study of scoliosis-associated airflow obstruction due to endothoracic vertebral hump. The purpose of this study was to evaluate and present anatomical features of patients with scoliosis who showed airflow obstruction caused by endothoracic vertebral hump. It is well known that severe scoliosis causes airflow restriction due to thoracic cage deformity. There have been few reports of clinical data and anatomical features on scoliosis associated with airflow obstruction due to endothoracic vertebral hump. The subjects were 6 patients. The diagnoses were idiopathic scoliosis in 3 patients, symptomatic scoliosis in 2 patients, and thoracogenic scoliosis in 1 patient. The radiological outcome, comorbidities, pre- and postoperative respiratory function, and surgical complication were analyzed. Four patients had preoperative atelectasis on the convex side of the lower lobe and improved after the operations. All patients showed main thoracic curves and their apex was located at T7-T9. All patients had lordoscoliosis except 1, who demonstrated kyphosing scoliosis. The correction rate was 78% (62.8%-83.5%). Preoperative thoracic lordosis within the range of -5° to -47° was postoperatively corrected to a substantially normal kyphosis within the range of 9° to 24°. The average vital capacity, percent VC improved from 0.72 L (0.33-1.17 L) to 1.21 L (0.82-1.71 L) and 45.5% (37.3%- 50.8%) to 63.7% (41.0%-88.6%) relatively. Spine Penetration Index improved from 23% (18%-35%) to 16% (13%-19%). Endothoracic hump ratio improved from 1.34 (0.98-1.93) to 1.12 (0.86-1.28). Each patient with symptomatic scoliosis and thoracogenic scoliosis required relatively long periods of respiration management. Patients having lordoscoliosis with an apex located between T7 and T9 may develop airflow obstruction due to an endothoracic vertebral hump. Correction of lordoscoliosis through anterior and posterior approaches successfully improved endothoracic hump ratio and atelectasis in all patients.

Consensus conference on Chiari: a malformation or an anomaly? Scoliosis and others orthopaedic deformities related to Chiari 1 malformation

In this article, we analysed the orthopaedic malformation in patients affected by Chiari I malformations as well as conservative or surgical treatment. The most common deformity in these patients is scoliosis. Different studies suggest a causal relation between syringomyelia and spinal deformities that differ by the type of deformities: asymptomatic scoliosis is characterized by a higher incidence of a single curve and convexity to the left, while symptomatic scoliosis is characterized by a double thoracolumbar curve. The conservative treatment with brace in these patients is not effective and scoliosis is typically evolutive. The evidence of the international data is that in patients without myelomeningocele or congenital scoliosis, but with Arnold Chiari I malformation and syringomyelia, suboccipital craniectomy gives the best chance for syrinx reduction and scoliosis improvement, particulary in children younger than 10 years and below a Cobb angle of 30°. The orthopaedic treatment in late decompression or in progressive curve is spine arthrodesis.

Scoliosis After Extended Hemipelvectomy

Retrospective review plus 2 representative case reports. To evaluate the prevalence of scoliosis after extended hemipelvectomy (EH) and illustrate the problem's severity. No published series has analyzed this problem. Data are needed to decide the potential need for and timing of spine fusion in these patients. We treated 14 patients with EH over 10 years. Mean age was 47 years. Diagnoses included osteosarcoma (6); chondrosarcoma (4); metastatic cancer (2); and MFH and undifferentiated sarcoma (1 each). Operating time ranged from 7 to 15 hours, and mean estimated blood loss was 8 L. Patients were observed for scoliosis, functional results, and for oncological outcome (survival, disease progression). Two patients who became scoliotic after EH illustrate the problem: a 31-year-old man underwent EH for pelvic osteosarcoma and progressively developed a painful 44° scoliotic curve; and a 27-year-old woman who developed a 60° painful scoliotic curve and radiculopathy years after EH including L5-S1 disc disruption. Of 12 patients, 8 died within 7 months of EH. Only 2 of 12 patients are long-term survivors free of disease (3 and 6 years after surgery), and 2 are alive with disease more than 1 year after surgery. In patients >1 year survival, 3 of 4 patients had curves greater than 20°. Of 10 evaluable patients, 2 developed a curve greater than 30° that warranted fusion. Four others had curves between 20° and 30°. Of these 6, 5 developed a sharp-angled lumbar curve with the concavity away from the operated side. Risk factors for symptomatic scoliosis after EH include disc disruption, paraspinal muscle/ligament resection, or facetectomies in ambulatory patients with a lengthy survival. Primary spinal fixation should be avoided because of the high morbidity and early mortality of EH. Selected high-risk patients can be stabilized later if they develop painful instability.

Functional Outcomes and Complications After Primary Spinal Surgery for Scoliosis in Adults Aged Forty Years or Older

A prospective study. Our purpose was to evaluate prospectively the complications, clinical outcomes, and self-reported quality of life in a relatively homogenous group of adults aged ≥ 40 years undergoing primary surgical treatment for scoliosis. Relatively few reports have examined surgical outcomes in adult patients with scoliosis, especially adults aged ≥ 40 years, whose outcomes may differ because of more rigid curves and more frequent and severe comorbidities. Although most studies have shown patient benefits despite high complication rates after such surgery, most were retrospective and conducted before the introduction of third-generation instrumentation techniques. We prospectively studied a consecutive series of 35 patients of age ≥ 40 years (average age, 56.3 years) undergoing primary surgery for scoliosis by one surgeon. Most of our patients (86%) had at least one comorbidity. We collected complete radiographic measurements and Oswestry Disability Index, Short Form 36, and Scoliosis Research Society 22 questionnaires before surgery and at each follow-up, and recorded the number and type of complications. Outcomes were assessed in the context of complications, degree of correction, and procedure characteristics to detect significant (P < 0.05) correlations. The overall complications rate was 49%; 26% of the patients had a major complication and 31% had a minor one. There were no deaths. Coronal curve correction was 30.8° (61%) on average. There were statistically significant postoperative improvements in Oswestry Disability Index, Short Form 36, and Scoliosis Research Society 22 scores. Patients whose fusions ended at L4 or L5 showed greater improvements in some of the Short Form 36 component scores than patients whose fusions involved the sacrum (P = 0.041). There were no significant differences in outcomes related to presence of complications or operative staging. Adults ≥ 40 years with symptomatic scoliosis benefit from surgical treatment, despite the high complication rate.

Quality control and quality assurance of medical committee performance in the Israel Defense Forces

The paper aims to focus on a unique quality control system that was set up ten years ago to evaluate Medical Classification Committee decision-making processes at the Israel Defense Forces (IDF) conscription center. Two main approaches were deployed by the control system to assess medical classification committees' performance. The first was direct assessment of the medical committees' clinical work and decision-making processes. The second applied data mining procedures to the computerized medical databases. The functional classification codes (FCCs)--codes for the most common medical disorders assigned to male recruits from the central computerized central IDF database, the sub-districts comprising the recruitment centers, and the chairmen assigning the FCCs to recruits--were all analyzed. A total of 26 FCCs, each indicating a common medical problem and its severity, constituted approximately 90 percent of all FCCs assigned at recruitment centers between 2001 and 2006. Major contributors to medical profiling outcomes were underweight, asthma, chronic headache, mental illness, symptomatic scoliosis, hypnosis, chronic back pain, knee joint disorders, allergic rhinitis and sinusitis. Evaluating the computerized medical database revealed significant differences in: medical profile prevalence; recruitment center FCCs; different sub-districts in a given recruitment center; and profiling by medical committee chairmen. Findings indicate disparities between recruitment centers and their chairmen in the medical profiling process owing to variations in recruitment center working methods and medical history taking, physical examinations, interpreting medical information and individual differences in the chairmen's decision-making process. Other reasons include technician and laboratory staff inaccuracies. These significant discrepancies highlighted the need for an intervention program. To minimize variations and create a uniform work platform, an orderly instruction system and training programs for the committee chairmen, technicians and laboratory staff were established. These actions resulted in improved performance in 2007 as confirmed by a decreased variability in the assignment of medical FCCs. The paper highlights methods that can be used to assess disability screening, sports medicine committees and primary care setting procedures.

Quality of Life in Patients Treated Surgically for Scoliosis

A retrospective study. To evaluate the long-term quality of life (QOL) of patients treated surgically for scoliosis. Measures of long-term outcome after surgery for scoliosis have focused mainly on radiologic changes. However, QOL issues such as working status and marital status are the subjects of greatest concern for patients who will undergo surgical treatment for scoliosis. Thirty-two patients treated surgically for scoliosis between 1976 and 1989 were included in this study. The mean duration of follow-up was 21.1 years. Eighteen patients had adolescent idiopathic scoliosis, 8 congenital scoliosis, and 6 symptomatic scoliosis. We evaluated long-term outcome by direct interview with patients. Working status, marital status, and childbearing were determined in addition to clinical and radiologic evaluation. Patients were also asked to fill out the short form (SF)-36 and Scoliosis Research Society (SRS)-22 questionnaires. Twenty-seven patients (84.4%) were or had been engaged in various occupations without marked difficulty. Although none of the male patients was married, 62.5% of the female patients were married. Half of the female patients had delivered babies after surgery, and the mean number of such children was 1.83. On the SF-36, none of the scores for subjects with idiopathic or congenital scoliosis were markedly different from those for age-matched healthy controls. Multivariate logistic regression analysis revealed that marked preoperative Cobb angle and positive sagittal balance at the most recent follow-up were significantly associated with increased odds ratio for poor scores on the SRS-22. We evaluated long-term QOL in patients treated surgically for scoliosis, and found that it was not impaired, particularly in the case of patients with idiopathic or congenital scoliosis. Larger preoperative Cobb angle and positive sagittal balance at the most recent follow-up were related to poor outcome in QOL as assessed by the SRS-22.

Low Back Pain in Patients Treated Surgically for Scoliosis

A retrospective study. To evaluate long-term outcome regarding low back pain (LBP) in patients treated surgically for scoliosis. Measures of long-term outcome after surgery for scoliosis have focused mainly on radiologic changes. However, subjective symptoms such as LBP after surgical treatment are of great concern to patients who undergo surgical treatment for scoliosis. Thirty-two patients treated surgically for scoliosis between 1976 and 1989 were included in this study. The mean duration of follow-up was 21.1 years. Eighteen patients had adolescent idiopathic scoliosis, 8 had congenital scoliosis, and 6 had symptomatic scoliosis. We evaluated long-term outcome by direct interview. Degree of LBP was evaluated by visual analogue scale score and Moskowitz classification in addition to clinical and radiologic evaluation. Patients were also asked to complete the SF-36 questionnaire. Mean visual analogue scale score at the latest follow-up was 21 (0-80), and 15% of patients had occasional or frequent LBP in Moskowitz classification. On the SF-36, score for bodily pain was not markedly different from that for age-matched controls. Among radiologic findings, level of distal fusion had no effect on the incidence or severity of LBP. Furthermore, preoperative Cobb angle, latest Cobb angle, and degenerative changes of subjacent segment each exhibited no correlation with degree of LBP, either. On the other hand, sagittal balance was a factor affecting LBP following scoliosis surgery. We evaluated long-term outcomes regarding LBP following scoliosis surgery. Regardless of residual back deformity, LBP was found to be no more frequent than in the normal population in Japan. Positive sagittal balance at the latest follow-up was a factor significantly contributing to LBP following scoliosis surgery.

Síndrome de Sotos asociado a distonía focal

Sotos syndrome is a form of infantile gigantism characterized by excessive body size from the time of birth, particular facies, acromegalic changes and signs of non-progressive cerebral involvement. The etiology is unknown. Diagnosis is based on somatometric data and the particular phenotype traits. Biochemical and endocrine studies are normal. Torticollis is a focal dystonia and therefore more common in adults. A 20 year old woman with macrosomic features since birth presented with: weight 104 kg, height 182 cm; prognathism, hypertelorism, a broad over hanging forehead with a high hair line; large ears, hands and feet; torticollis towards the right with elevation and anteroversion of the right shoulder which caused symptomatic scoliosis. She was bradypsychic and rather slow in speech. The complementary tests done (cerebral and cervical CT and MR, bone gammography, evoked potentials, EMG-ENG, sural nerve biopsy, biopsy of skin and muscle, EEG and hormone and biochemistry studies) were normal. The torticollis was treated with botulinus toxin and improved considerably, as did the scoliosis. To date, dystonia has not been described in association with Sotos syndrome. This may be a causal association, or even perhaps hereditary, since the patient's mother had dystonia (in the form of blepharospasm).

抗うつ薬に反応した坐骨神経痛の１例

A 40-year-old man had been troubled by low back pain for over a year. Lumbar traction, “hot packs”, analgesic drugs and a local anaesthetic injection had all been ineffective.His low back pain and right sciatica became severe in September 1993, and he was admitted to the Department of Orthopedic Surgery at St. Mary's Hospital for investigation in November 1993.X-ray examinations, myelograms and MRI of the lumbar region revealed no particular findings to indicate the need for surgery. Subsequent conservative therapy, including epidural blocks were not effective, and he was eventually referred to our rehabilitation hospital at the end of December 1993.On admission, he limped and had severe symptomatic scoliosis. However at times he appeared to gain relief from symptoms and to have obsessive idea.He was therefore referred for a psychologic assessment and diagnosed as having masked depression.50mg of the antidepressant, “clomipramine” in two half doses, was administered in the morning and evening.He responded very well to the drug, and the complaints of pain almost stopped after one month of treatment.