Thoracolumbar Curves Research Articles

Association Between Sagittal Balance and Scoliosis in Patients with Parkinson Disease: A Cross-sectional Study.

The aim of this study was to describe the association between scoliosis and sagittal balance parameters in Parkinson disease patients. This is a cross-sectional study. Fifty percent of the cohort presented a scoliosis larger than 11 degrees; 84% of the patients with scoliosis presented a thoracolumbar curve, 10% presented a thoracic one, and 6% presented a lumbar one. The group with scoliosis curves presented a lower spinosacral angle (111.6 [21.9] degrees vs. 121.7 [9.8] degrees, P < 0.05), whereas thoracic kyphosis, lumbar lordosis, and spinopelvic angle were similar. Pelvic incidence, pelvic tilt, and sacral slope were not statistically different. In the scoliosis group, the authors found negative correlations for lumbar lordosis/spinopelvic angle, sacral slope/spinosacral angle, and lumbar lordosis/pelvic tilt. Moreover, the sacral slope/pelvic tilt correlation was positive in patients without scoliosis and negative in others. The two groups did not present differences regarding age, years of disease, Hoehn-Yahr score, and Unified Parkinson Disease Rating Scale-motor section. Pelvic parameters were similar in the two groups, whereas spinosacral angle was lower in patients with scoliosis. The prevalence of scoliosis in Parkinson disease was higher than what was previously described and the thoracolumbar spine was the mostly affected.

Surgical treatment of Lenke 5 adolescent idiopathic scoliosis: Comparison of anterior vs posterior approach.

AIMTo compare the posterior vs anterior approaches for fusion of Lenke 5 adolescent idiopathic scoliosis curves, matched for curve magnitude and for the distal level of fixation (dLOF) standardized to the third lumbar vertebrae (L3).METHODSA prospectively collected multicenter database was used for this retrospective comparative study. Our dependent variables included sagittal and coronal radiographic measurements, number of fused vertebrae, estimated blood loss, length of hospitalization and SRS total and individual domain scores at the two-year follow-up. Subject demographics were similar for all group comparisons. Independent t-test was used to compare groups for all analyses at P < 0.01.RESULTSFor all matched cases of Lenke 5 curves, a selective approach was used only 50% of the time in cases undergoing a posterior fusion. When comparing a posterior selective approach to an anterior selective approach, surgeons utilizing a posterior approach fused significantly more levels than surgeons using an anterior approach with no other significant differences in radiographic or SRS outcomes (Ant = 4.8 ± 1.0 levels vs post = 6.1 ± 1.0 levels, P < 0.0001). When the dLOF was standardized to L3, the anterior approached provided significantly greater lumbar Cobb percent correction than the posterior approach (Ant = 69.1% ± 12.6% vs post = 54.6% ± 16.4%, P = 0.004), with no other significant radiographic or SRS score differences between approaches.CONCLUSIONSurgeons treating Lenke 5c curves with a posterior instrumentation and fusion vs an anterior approach include more motion segments, even with a selective fusion. When controlled for the distal level of fixation, the anterior approach provides greater correction of the thoracolumbar curve.

Adult degenerative scoliosis associated with increased aortic diameter and plaque burden and composition.

In this study, we aimed to investigate the relationship between adult degenerative scoliosis (ADS) and the aortic plaques and diameters. We included 219 patients with ADS and 100 control patients without ADS. Diameters of ascending, arch, descending and abdominal aorta and number, localization and types of the aortic plaques, and the Cobb angles of all patients were measured from computed tomography (CT) images. We divided the patients with ADS into three groups according to the Cobb angle, and divided them into four groups according to level of spine deformity. The patients with ADS had a larger aorta and more aortic plaques (both, p < 0.001). The patients with ADS had more fibro-fatty and mix plaques (both, p < 0.001). The patients with severe ADS had larger diameters of the ascending and arch of the aorta (p = 0.026 and p = 0.027, respectively). The patients with the main thoracic curve had a larger ascending aorta and the patients with a thoracolumbar curve had more aortic plaques (p = 0.035 and p = 0.029, respectively). In multivariate regression analysis, the ADS was an independent risk factor for both aortic dilatation (>3.6 cm) and aortic plaque build-up (both, p < 0.001). The ADS may be a risk factor for aortic dilatation and aortic atherosclerosis.

One-Stage Correction Surgery of Scoliosis Associated With Syringomyelia

Retrospective study. To investigate the safety to leave a syrinx untreated in 1-stage correction surgery of scoliosis associated with syringomyelia without progressive neurological symptom. The present protocol for patients with scoliosis secondary to syringomyelia advocated to treat the syrinx first because of the increased risk in correction surgery. However, in daily life, these patients could still do lateral bending, in which spinal cord distracted albeit without any neurological symptom occurred. Twenty-one consecutive patients with scoliosis associated with syringomyelia with or without Chiari malformation underwent surgery in our department from 2003 to 2010 were included in this study. Patients with progressive neural deficits were excluded. Every patient received detailed neurological and radiologic examination before the surgery, including whole spine films, lateral-bending and fulcrum-bending films, 3-dimensional computed tomography scan, and magnetic resonance imaging. All the patients underwent 1-stage correction surgery without treatment of syrinx. During the surgery, Spinal Cord Monitor (SCM) and wake-up test were used to prevent serious neurological complications. At follow-up, patients received neurological examination and whole spine x-ray films. There were 13 male and 8 female patients. Before the surgery, 3 patients complained wasting of the intrinsic muscles of hand, 1 complained numbness of left upper extremity, and 4 complained back pain. Negative abdomen reflex occurred on 12 of 21 patients. All the patients were single major curve, including 14 thoracic curves and 7 thoracolumbar curves. The mean preoperative Cobb angle of scoliosis was 68.05±20.1 degrees, on bending films was 39.48±21.56 degrees, postoperative was 23.19±14.14 degrees, at final follow-up was 25.76±14.46 degrees. The mean flexibility was 0.452±0.158, correction ratio was 0.685±0.140. During the operation, SCM showed motor evoked potential (MEP) loss transiently in 2 patients, and somatosensory evoked potential (SEP) was normal in all the patients. Wake-up test was normal for all the patients. No neurological complication was observed after the surgery and at follow-up; 2 patients complained back pain and 1 patient got early postoperative infection. The mean follow-up time was 4.5 years (1.6∼8.5 y). For scoliosis patients associated with syringomyelia without neurological deficits, it might be safe and could be an option to leave a syrinx untreated before 1-stage correction surgery. Besides, a residual scoliosis was important to make sure the neural safety. The correction procedure during the surgery should be controlled by about 15 degrees or 50% more than on the bending film. Not placing the pedicle screw in the apical region was beneficial for controlling the correction rate.

Development and application of a multifunctional thoracolumbar fixation rescue vest

Objective To develop an all-in-one multifunctional thoracolumbar fixation rescue vest for land and water rescue of thoracolumbar injury and investigate its application effect. Methods According to the thoracolumbar physiological curve, type Ⅰ thoracolumbar fixation rescue vest with keel and inflatable airbag and type Ⅱ thoracolumbar fixation rescue vest with additional lifesaving balloon and inflatable cylinder were developed using thermoplastic polyurethane (TPU)-nylon composites and polycarbonate (PC) as the main materials. Clinical application of type Ⅰ thoracolumbar fixation rescue vest in 532 cases of thoracolumbar injury was discussed. Type Ⅱ thoracolumbar fixation rescue vest were tested at marine rescue and related parameters measured were automatic inflation time, buoyancy force, floating time, floating condition and victims' face orientation. Clinical outcome was quantified by the MacNab standard, and VAS for pain was recorded. Results According to the MacNab standard, excellent outcome was achieved for all cases. VAS improved from 8.2 points to 2 points after the bracing was applied, showing 100% improvements. The brace into the water showed automatic inflation time of 3-5 seconds and maximum buoyancy force of 100 kg, and ensured a 90 kg dummy of floating over 96 hours. At marine rescue, the wounded in braced condition showed face upward with 24-hour buoyancy loss ≤5% and freedom of movement. Conclusions The multifunctional thoracolumbar fixation rescue vest provides dual immobilization and ensures marine rescue for its automatic inflation device. This invention provides the feasibility to remove, transport and evacuate the thoracolumbar fracture patients in cabin. Key words: Spinal injuries; Thoracic vertebrae; Lumbar vertebrae; Emergency medical services

Anthropometric estimation of body height after surgical correction of scoliosis.

To estimate the height loss in 28 patients who had undergone surgery for scoliosis before skeletal maturity. 28 women patients aged 11 to 18 (mean, 15) years underwent Harrington instrumentation, segmental sublaminar wiring, and posterior spinal fusion for idiopathic scoliosis. The patients' mean age at menarche was 13 (range, 10-16) years. Pre- and post-operative radiographs of the spine were taken to determine curve types, the Cobb angle, and the degree of correction. The standing and sitting heights were measured using a flexible steel tape, and the expected standing and sitting heights were derived using formulae. At the final follow up, the mean patient age was 20 (16-32) years. The mean standing height was 155.2 cm and the mean sitting height was 77.4 cm. Using the formulae, the mean expected standing height was 158.4 cm, indicating height loss of 3.2 cm (t=4.6, p=0.0001), and the mean expected sitting height was 79.9 cm, indicating height loss of 2.6 cm (t=3.84, p=0.001). The curve types of the 28 patients were sub-divided as thoracic (n=7), thoracolumbar (n=18), and double major (n=3). Patients with thoracolumbar curves achieved better correction and less loss of standing and sitting heights. Percentage loss of standing and sitting heights were not correlated with the apex of the curve or the degree of correction. Height loss after surgery was acceptable in comparison with height loss associated with progression of scoliosis without surgery.

Corrélation entre les mesures de déformation et le score SRS-22 de perception de soi chez les adolescentes porteuses d’une scoliose idiopathique

BackgroundAdolescent idiopathic scoliosis (AIS) is a pathology which affects the individual's functioning in the widely understood physical, psychic, and social aspects. More attention should be paid to patients’ perception of self-image when evaluating the spine deformity. The present retrospective study evaluated the associations between the deformity measures and self-image score as determined by the SRS-22 questionnaire in Chinese female AIS patients. HypothesisThe self-image score correlates significantly with deformity measures. The location of main curve apex and the number of curve could affect the self-image score. Materials and methodsWe retrospectively reviewed the records of 202 female patients, collected data on patient's age, body mass index, radiographic and physical measures and self-image score of SRS-22 questionnaire. According to the location of main curve apex and the number of curve, the patients were divided to different subgroups. Correlations between deformity measures and self-image score of different groups were evaluated by the Spearman correlation test. ResultsThe self-image score correlated negatively with the main Cobb angle, apical vertebral translation (AVT), and razor hump height. There is no significant difference of self-image score between thoracic curve (TC) and thoracolumbar curve (TL/LC) subgroups. And the self-image scores of one-curve, two-curve and three-curve subgroups are similar. DiscussionFor Chinese female AIS patients in our study, self-image was found to correlate negatively with the main Cobb angle, AVT and razor hump height. And the location of scoliosis apex and the number of curve are not influencing factors of self-image perception. Level of evidenceIV. Retrospective study.

Relation between self-image score of SRS-22 with deformity measures in female adolescent idiopathic scoliosis patients

BackgroundAdolescent idiopathic scoliosis (AIS) is a pathology which affects the individual's functioning in the widely understood physical, psychic, and social aspects. More attention should be paid to patients’ perception of self-image when evaluating the spine deformity. The present retrospective study evaluated the associations between the deformity measures and self-image score as determined by the SRS-22 questionnaire in Chinese female AIS patients. HypothesisThe self-image score correlates significantly with deformity measures. The location of main curve apex and the number of curve could affect the self-image score. Materials and methodsWe retrospectively reviewed the records of 202 female patients, collected data on patient's age, body mass index, radiographic and physical measures and self-image score of SRS-22 questionnaire. According to the location of main curve apex and the number of curve, the patients were divided to different subgroups. Correlations between deformity measures and self-image score of different groups were evaluated by the Spearman correlation test. ResultsThe self-image score correlated negatively with the main Cobb angle, apical vertebral translation (AVT), and razor hump height. There is no significant difference of self-image score between thoracic curve (TC) and thoracolumbar curve (TL/LC) subgroups. And the self-image scores of one-curve, two-curve and three-curve subgroups are similar. DiscussionFor Chinese female AIS patients in our study, self-image was found to correlate negatively with the main Cobb angle, AVT and razor hump height. And the location of scoliosis apex and the number of curve are not influencing factors of self-image perception. Level of evidenceLevel IV, retrospective study.

181 Spinal deformities (SD) in young CF patients: two years experience of screening and follow up

Background: Increased survival in CF patients (pts) requires assessment of extrapulmonary morbidities, as SD. Scoliosis (S) is more frequent in CF than in general population; it causes functional spinal disorders and restrictive pulmonary disease and may be influenced by CF musculoskeletal involvement. Aims: To describe: • SD distribution in a group of CF pts • SD and clinical status relationship • 2 years follow up in a subgroup Methods: Respiratory therapist measured the angle of trunk rotation (ATR) with scoliometer in the Adams forward bending test position in CF pts, 6−19 years old (yrs). Results: 58 pts (M 46.55%, aged 12.45±3.61 yrs, median %ile for weight 39.22 and for height 49.12, mean FEV1 91.79±16.94%pred) were enrolled. No difference at baseline existed between males and females. Pts were divided in: (1) Negative group (N): ATR 0−4o (n = 48); (2) Positive group (P): ATR 5o (n = 10). Pts in P were older (p = 0.001); N had greater FVC%pred (p = 0.008). 6 thoracic (60%), 3 lumbar (30%) and 1 thoracolumbar (10%) curves (70% with right convexity) were found. Specialized physician prescribed 10 spine x-ray diagnosing S (>10o Cobb) in 3 pts (5.17%) with indication of brace. ATR correlated with height %ile (r = 0.7; p = 0.02) in P; no relationship with lung function was found. 36 pts were reassessed 2 years after the 1st evaluation. ATR was the same in 52.78% of pts, while it increased in 25%. Changes in ATR didn’t correlate with respiratory and nutritional status. Conclusion: Our data justify SD early screening and at least yearly reassessment because of their possible progression and lack of correlation with clinical data. A study to assess S and back pain prevalence in adult CF pts is ongoing. 183 Mycobacterium abscessus: stand alone hospital admission for agressive physiotherapy and nutritional review can extend periods between toxic IV antibiotic treatments J. Tame1, A. Turnbull1, J. Forton1,2. 1Noah’s Ark Children’s Hospital for Wales, University Hospital of Wales, Department of Paediatric Respiratory Medicine, Cardiff, United Kingdom; 2Cardiff University, Department of Child Health, Cardiff, United Kingdom

183 Mycobacterium abscessus: stand alone hospital admission for agressive physiotherapy and nutritional review can extend periods between toxic IV antibiotic treatments

Background: Increased survival in CF patients (pts) requires assessment of extrapulmonary morbidities, as SD. Scoliosis (S) is more frequent in CF than in general population; it causes functional spinal disorders and restrictive pulmonary disease and may be influenced by CF musculoskeletal involvement. Aims: To describe: • SD distribution in a group of CF pts • SD and clinical status relationship • 2 years follow up in a subgroup Methods: Respiratory therapist measured the angle of trunk rotation (ATR) with scoliometer in the Adams forward bending test position in CF pts, 6−19 years old (yrs). Results: 58 pts (M 46.55%, aged 12.45±3.61 yrs, median %ile for weight 39.22 and for height 49.12, mean FEV1 91.79±16.94%pred) were enrolled. No difference at baseline existed between males and females. Pts were divided in: (1) Negative group (N): ATR 0−4o (n = 48); (2) Positive group (P): ATR 5o (n = 10). Pts in P were older (p = 0.001); N had greater FVC%pred (p = 0.008). 6 thoracic (60%), 3 lumbar (30%) and 1 thoracolumbar (10%) curves (70% with right convexity) were found. Specialized physician prescribed 10 spine x-ray diagnosing S (>10o Cobb) in 3 pts (5.17%) with indication of brace. ATR correlated with height %ile (r = 0.7; p = 0.02) in P; no relationship with lung function was found. 36 pts were reassessed 2 years after the 1st evaluation. ATR was the same in 52.78% of pts, while it increased in 25%. Changes in ATR didn’t correlate with respiratory and nutritional status. Conclusion: Our data justify SD early screening and at least yearly reassessment because of their possible progression and lack of correlation with clinical data. A study to assess S and back pain prevalence in adult CF pts is ongoing. 183 Mycobacterium abscessus: stand alone hospital admission for agressive physiotherapy and nutritional review can extend periods between toxic IV antibiotic treatments J. Tame1, A. Turnbull1, J. Forton1,2. 1Noah’s Ark Children’s Hospital for Wales, University Hospital of Wales, Department of Paediatric Respiratory Medicine, Cardiff, United Kingdom; 2Cardiff University, Department of Child Health, Cardiff, United Kingdom

The Prevalence of Idiopathic Scoliosis in Eleven Year-Old Korean Adolescents: A 3 Year Epidemiological Study

PurposeSchool screening allows for early detection and early treatment of scoliosis, with the purpose of reducing the number of patients requiring surgical treatment. Children between 10 and 14 years old are considered as good candidates for school screening tests of scoliosis. The purpose of the present study was to assess the epidemiological findings of idiopathic scoliosis in 11-year-old Korean adolescents.Materials and MethodsA total of 37856 11-year-old adolescents were screened for scoliosis. There were 17110 girls and 20746 boys. Adolescents who were abnormal by Moiré topography were subsequently assessed by standardized clinical and radiological examinations. A scoliotic curve was defined as 10° or more.ResultsThe prevalence of scoliosis was 0.19% and most of the curves were small (10° to 19°). The ratio of boys to girls was 1:5.5 overall. Sixty adolescents (84.5%) exhibited single curvature. Thoracolumbar curves were the most common type of curve identified, followed by thoracic and lumbar curves.ConclusionThe prevalence of idiopathic scoliosis among 11-year-old Korean adolescents was 0.19%.

Spine curvature analysis between participants with obesity and normal weight participants: a biplanar electromagnetic device measurement.

To analyse and compare standing thoracolumbar curves in normal weight participants and participants with obesity, using an electromagnetic device, and to analyse the measurement reliability. Material and Methods. Cross-sectional study was carried out. 36 individuals were divided into two groups (normal-weight and participants with obesity) according to their waist circumference. The reference points (T1–T8–L1–L5 and both posterior superior iliac spines) were used to perform a description of thoracolumbar curvature in the sagittal and coronal planes. A transformation from the global coordinate system was performed and thoracolumbar curves were adjusted by fifth-order polynomial equations. The tangents of the first and fifth lumbar vertebrae and the first thoracic vertebra were determined from their derivatives. The reliability of the measurement was assessed according to the internal consistency of the measure and the thoracolumbar curvature angles were compared between groups. Results. Cronbach's alpha values ranged between 0.824 (95% CI: 0.776–0.847) and 0.918 (95% CI: 0.903–0.949). In the coronal plane, no significant differences were found between groups; however, in sagittal plane, significant differences were observed for thoracic kyphosis. Conclusion. There were significant differences in thoracic kyphosis in the sagittal plane between two groups of young adults grouped according to their waist circumference.

Should Shoulder Balance Determine Proximal Fusion Levels in Patients With Lenke 5 Curves?

Study DesignMulticenter review of prospectively collected data. ObjectivesTo identify the frequency of an opposite high shoulder in Lenke 5 patients and evaluate factors that influence preoperative and postoperative shoulder balance. Summary of Background DataA high left shoulder is an indication to extend the fusion proximally in a right thoracic curve. Some apply a similar rule to high right shoulders in patients with left thoracolumbar/lumbar curves. MethodsA prospective multicenter adolescent idiopathic scoliosis database was queried for patients with Lenke 5 curves and minimum 2-year follow-up. Preoperative and postoperative shoulder height differences were recorded and categorized by the opposite shoulder (right shoulder in a left thoracolumbar curve) as high (greater than 1 cm), level (0–1 cm), and low (less than 1 cm). Preoperative and postoperative radiographic variables and Scoliosis Research Society questionnaire scores were evaluated. ResultsOf the 104 patients identified, 37% had level shoulders and 53% had a high opposite shoulder. A high shoulder was associated with a greater mean thoracic Cobb (31°) than a level (24°) or low shoulder (26°) (p = .008). Postoperatively, 64% of patients had level shoulders (less than 1 cm); 93% had a shoulder difference less than 2 cm. Preoperative lumbar Cobb was a significant predictor of postoperative shoulder height (p = .051). A slightly greater proportion of preoperative high shoulders (36%) had a nonselective fusion than those with level (27%) or low (9%) shoulders. Among the 29 patients with a preoperative moderate or significant high shoulder (greater than 2 cm), 3 continued to have a high shoulder greater than 2 cm that was not influenced by fusing the thoracic spine. There were no significant differences in preoperative or postoperative Scoliosis Research Society scores based on shoulder height (p > .05). ConclusionsHalf of all Lenke 5 curves have a high opposite shoulder that is influenced by the size of the compensatory thoracic curve. Postoperatively, most patients had level shoulders. Inclusion of the thoracic spine did not influence postoperative shoulder balance.

A prospective study in adolescent idiopathic scoliosis affected by thoracolumbar and lumbar curves in treatment with a progressive action short brace (PASB): assessment of results according to the SRS committee on bracing and nonoperative management standardization criteria

Methods We have carried out a prospective study of 197 adolescents (mean age 11.8 ± 0.5 years) treated from 1993 to 2012 with thoracolumbar and lumbar curve and a pretreatment Risser scores ranging from 0 to 2. To evaluate the effectiveness of treatment and standardize the results, SRS criteria were used. All patients were prescribed a full-time PASB. The minimum duration of follow-up was 24 months. Anteroposterior radiographs were used to estimate the curve magnitude (CM) and the torsion of the apical vertebra (TA) at five time points: beginning of treatment (t1), one year after the beginning of treatment (t2), intermediate time between t1 and t4 (t3), end of weaning (t4), and 2-year minimum follow-up from t4 (t5). Three outcomes were distinguished: curve correction, curve stabilization and curve progression. Statistical analyses were performed with GraphPad Prism 6.

Predictability of spontaneous thoracic curve correction after anterior thoracolumbar correction and fusion in adolescent idiopathic scoliosis. A retrospective study on a consecutive series of 29 patients with a minimum follow-up of 2 years

Background contextAccording to the Lenke classification, a Type 5 adolescent idiopathic scoliosis can be surgically treated with selective anterior thoracolumbar or lumbar fusion. PurposeThis study aims to predict the spontaneous correction of the unfused thoracic curve after anterior thoracolumbar fusion and to study whether age is of influence on this predictability. Study designRetrospective study on a consecutive series of patients. Patient sampleOf a consecutive series of 38 patients with idiopathic thoracolumbar scoliosis, Lenke type 5, 29 patients were included in the study. All patients were treated with anterior spinal fusion and instrumentation. A minimum follow-up of 2 years was available for all patients (mean, 4 years; range, 2–17 years). To investigate the influence of age on the outcome, we divided the group into two subgroups: an adolescent (n=13) and an adult age group (n=16). The mean age in the adolescent group was 17 (range, 13–21 years) and 38 years (range, 22–54 years) in the adult group. Outcome measuresPhysiological measures include coronal Cobb angle, apical vertebral translation (AVT) and apical vertebral rotation (AVR), shoulder tilt, trunk shift, L4 tilt, and pelvic tilt. Relative corrections were computed for the thoracolumbar and thoracic curves in each patient using the following formula: (preoperative curve−postoperative curve)/preoperative curve×100 (%). The correlation coefficient between the relative (%) corrections of the thoracic and thoracolumbar curves was calculated for the whole group as for the two age subgroups. MethodsFor radiographic evaluation, we used standing anteroposterior and lateral projections of the thoracolumbar spine to determine Cobb angle, AVT and AVR, and coronal balance. ResultsBoth the thoracolumbar and thoracic curves in the whole group improved after surgery (45% and 19%, respectively, p<.01). In the adolescent age group, a significant correlation between the relative (%) correction of the thoracolumbar curve and the relative (%) correction of the thoracic curve was found (R=0.704; p=.01) and between age and relative (%) correction of the thoracic curve (R=−0.805; p<.01). ConclusionsThese results show that the spontaneous correction of the thoracic curve is a reflection of the thoracolumbar curve correction in adolescent thoracolumbar idiopathic scoliosis. Moreover, the predictability of the thoracic curve correction in the individual patient seems to decrease with increasing age of the patient.

Prognosis for Congenital Scoliosis Due to a Unilateral Failure of Vertebral Segmentation

Congenital scoliosis due to a unilateral failure of vertebral segmentation usually has a poor prognosis. However, not all curves progress to the same degree or develop the same spinal deformity. The medical records and spine radiographs of 171 patients with a scoliosis due to unilateral unsegmented bar were reviewed retrospectively. The mean patient age at diagnosis was 9.3 years. Thirty-six patients had immediate surgery, 103 immature patients were followed untreated or before surgery for a mean duration of 3.6 years, twenty-eight patients were seen untreated at skeletal maturity, and four patients had no follow-up. The unsegmented bar occurred at all levels; the mean extent was three vertebrae (range, two to eight vertebrae). Before the age of ten years, patients had a mean rate of scoliosis progression without treatment for all regions of the spine of 2° to 3° per year. By the age of ten years, seventy-three patients who had been seen untreated or prior to treatment had a mean scoliosis of 50° (range, 18° to 100°). After the age of ten years, these patients had an increase in the mean rate of scoliosis progression, but this rate varied per year depending on the affected region of the spine: 7° for the thoracolumbar curve, 5° for the midthoracic curve, and 4° for the upper thoracic curve. Spine surgery was performed on seventy-four patients who had a mean age of 12.2 years and a mean scoliosis of 78° for thoracolumbar curves, 66° for midthoracic curves, and 54° for upper thoracic curves. Of the patients with midthoracic congenital scoliosis, 24% developed a lower structural compensatory curve, which became larger and more deforming than the congenital curve, 22% had congenital rib fusions, and 16% had occult intraspinal anomalies. Prognosis depends on growth imbalance at the site of the unsegmented bar as well as the location and extent of the bar, age at diagnosis, and spinal growth remaining. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

The conservative treatment of congenital scoliosis with hemivertebra: report of three cases

Background Scoliosis is the most common congenital disorder. The vertebral disorder can be due to failure of formation, segmentation or their combination. Complete formation failure results in hemivertebra that can cause asymmetrical growth and deformity. The etiopathogenesis of congenital scoliosis is still unclear. Twenty-five percent of congenital curves do not progress, 25% undergoes mild progression, while the remaining 50% evolve rapidly and require treatment. Hemivertebra, in the thoraco-lumbar area, display faster rates of progression than those in the lumbar region. The treatment can be either conservative, or surgical. Usually, in rigid and short curves bracing is not recommended, whereas it can be useful for the treatment of secondary curves. Aim To evaluate the efficacy of bracing in congenital scoliosis with hemivertebra. Methods From our database, we identified three patients with congenital scoliosis with hemivertebra. One was 10-year-old at the time of diagnosis and had a hemivertebra localized in L4 with a thoraco-lumbar curve T11-L3. The other one was 6-years-old at the time of diagnosis and had a hemivertebra localized in L2, with a thoraco-lumbar curve T11-L4. The last one was 4-years-old at the time of diagnosis and had a hemivertebra localized in L2, with a thoraco-lumbar curve T11-L3. Results The first patient was treate dw ith aM ilwaukee brace, the second with a Boston brace and the third with a PASB brace. The Cobb angles at the beginning were 23°, 53° and 25°, respectively. At the end of treatment, the Cobb angles were18°, 33° and 11°, respectively. At 2 years of follow-up, the curves were 20°, 35° and 13° degrees, respectively. Conclusions

Everyday postures in idiopathic scoliosis: is there any correlation with curve morphology?

Methods Through parents and scoliosis experts’ consultation, we developed and validated a questionnaire for parents evaluating 7 UEP. Inclusion criteria were IS and age between 6 and 18 years. We collected 635 questionnaires from all IS patients coming to our Institute between September and November 2011 (n=435, response rate 98.5%) and through specific emails (n=199, response rate 15.7%). Since there were no differences between these two groups in gender, age, scoliosis parameters and answers, we evaluated all questionnaires together. We had IS group (ISG: curves >10°; n=462) and controls (CG: curves <10°; n=173). We divided ISG into three pairs of subgroups: L: lumbar or thoraco-lumbar curve: left (LL-SG n=65); right (RL-SG n=56) T: thoracic curve: right (RT-SG n=79); left (LT-SG n=11) DC: double curves: left L right T (LRDC-SG: n=215); right L left T (RLDC-SG n=36) We compared ISG and all subgroups to CG, and each subgroup to its matched pair (e.g. LL-SG vs RL-SG). All answers were converted as follows: one side: +1; the other side: -1; no preference: 0. Maintaining only the UEP with statistical differences, and checking for the preferred direction, we developed three index of symmetry (IoS) (one per pair of subgroups). Finally, we checked correlations between Cobb degrees, UEPs and IoS.

Anterior Dual Rod Versus Posterior Pedicle Fixation Surgery for the Surgical Treatment in Lenke 5C Adolescent Idiopathic Scoliosis: A Multicenter, Matched Case Analysis of 42 Patients

Study DesignMulticenter matched case analysis. ObjectiveCompare patients with Lenke 5C scoliosis surgically treated with anterior spinal fusion with dual rod instrumentation and anterior column support versus posterior release and pedicle screw instrumentation. Summary of Background DataTreatment of single, structural, lumbar and thoracolumbar curves in patients with adolescent idiopathic scoliosis (AIS) has been the subject of some debate. Previous papers directly comparing these approaches are problematic because of heterogeneity of the groups, nonrandomized protocols, and surgeon bias and variation of instrumentation (upper instrumented vertebrae and lower instrumented vertebrae) in relation to the defined Cobb angle (upper end vertebra and lower end vertebrae). This report sought to remedy these flaws by analyzing a database of Lenke 5C AIS and performing matched cases. MethodsWe analyzed 96 patients with Lenke 5C AIS curves based on radiographic and clinical data at 3 institutions, surgically treated between 2001 and 2005 with minimum 2-year follow-up. Case matched criteria (age within 1 year, sex, curve within 5°, lower end vertebrae, and lower instrumented vertebrae) yielded 21 matched patient pairs. We evaluated and compared multiple clinical and radiographic parameters. ResultsWe observed no significant statistical differences between groups in any preoperative clinical or radiographic parameters. At final follow-up, the major curve measured 8° (83%) in the posterior spinal fusion group, compared with 13° (72%) in the anterior spinal fusion group (p = .002). Estimated blood loss was similar in both groups. Hospital stay was significantly shorter in the posterior spinal fusion group. There were no differences in radiographic complications, such as proximal junctional kyphosis. ConclusionsAt a minimum of 2 years' follow-up in a multicenter, matched case analysis, adolescents with Lenke 5C curves demonstrated statistically significantly better curve correction and shorter hospital stays when treated with a posterior release with pedicle screw instrumented fusion compared with an anterior instrumented fusion with dual rods for similar patient populations.

Magnetic resonance imaging of scoliosis

•. Most cases of scoliosis are idiopathic. Typically, the patient is female and there is a painless thoracolumbar curve convex to the right. •. Atypical features include a curve convex to the left, rapid progression, pain and neurological symptoms. •. MRI has a key role in evaluating scoliosis when atypical features are present to determine whether there is an underlying cause, such as a tumour, or an associated neuro-axial anomaly. •. In many institutions, MRI is routinely performed pre-operatively in all cases of scoliosis surgery to exclude an underlying anomaly. The assessment of scoliosis involves excluding a structural cause of the abnormality, determining the degree of deformity and identifying any associated anomalies. In many institutions MRI is routinely performed pre-operatively in all cases of scoliosis surgery to exclude an underlying anomaly.