Thoracolumbar Curves Research Articles

Are Thoracic Curves With a Low Apex (T11 or T11/T12) Really Thoracic Curves?

Study DesignMulticenter; review of prospectively collected data. ObjectivesTo determine whether curves with an apex at T11 or T11/T12 represent a combination of thoracic and thoracolumbar curves or constitute their own class of curves. Summary of Background DataCurves with an apex at T11 and T11/T12 are classified by the Scoliosis Research Society and Lenke classification as thoracic curves. MethodsWe reviewed 1,835 adolescent idiopathic scoliosis cases from a multicenter database. Based on the most common curve apex levels (thoracic [TH] curves, T9; thoracolumbar/lumbar [TL/L] curves, L1), we created 2 comparison groups that represented classic examples of TH and TL/L curves. We identified 66 cases with an apex at T11–T11/T12 and compared them with 320 cases with a T9 apex, and 126 cases with an L1 apex. We compared characteristics of these 3 groups (p < .05) and completed a radiographic review of the T11–T11/T12 group. ResultsThe curve direction of the 3 groups was significantly different (TL/L, 84% left; TH, 3% left; and T11–T11/T12, 16% left) (p < .001). The mean number of vertebrae in curves for the T11–T11/T12 group (7.1 ± 1.2) fell between the value for the TL/L (5.7 ± 0.8) and TH (7.3 ± 1.0) groups. The T11–T11/T12 curves had a greater trunk shift than TL/L (p = .002) and TH (p = .011) curves. There was no difference among the 3 groups in terms of major curve Cobb magnitude (p = .09) or age at surgery (p = .76). Radiographic review of the T11–T11/T12 curves revealed 3 curve patterns: 21 long single curves (32%), 28 short single curves (42%), and 17 double thoracic curves (26%). ConclusionsWe suggest caution in lumping curves with an apex at T11 or T11–12 disc together with other thoracic apices in studies involving primary thoracic curves, because some of these curves have features much more typical of thoracolumbar curves.

Progressive Early-onset Scoliosis in Conradi Disease

Conradi-Hunermann syndrome (CHS) is a rare metabolic syndrome with several orthopaedic problems. Early-onset scoliosis is of great importance because of often rapidly progressive nature and high risk of postoperative complications. To report the 34-year follow-up and outcome of a patient with CHS treated with combined anterior and posterior fusion without instrumentation. All available clinical and radiographs of a female patient with CHS retrospectively reviewed. Overall health status, sagittal and coronal deformity, pulmonary function test, and outcome questionnaires were evaluated. Initial films at the age of 4 months showed a curve of 37 degrees from T6-T11 and a curve of 17 degrees from T11-L2. Thoracic kyphosis was measured at 43 degrees. Standing films at the age of 2 years and 2 months showed progression of both the curves to 50 and 66 degrees, respectively, and a significant spinal imbalance. The kyphosis also progressed to 57 degrees. She underwent a staged anterior inlay graft spinal fusion with autograft and allograft ribs from T8-L1 and posterior in situ fusion from T6-L1 with corticocancellous allograft. Solid radiographic fusion was observed 18 months after surgery. She was 36 years old at her latest follow-up, 34 years after surgery, with neutral clinical coronal and sagittal balance. No significant pain and respiratory complaint at moderate sports and normal daily life activity. "Vital capacity" and "total lung capacity" were 65% and 75%, respectively, of the normal. Thoracic curve of 35 degrees (T6-T11) and right thoracolumbar curve of 53 degrees from T11-L2 with a solid fusion fromT6-L1 with kyphosis measured over the fused area of 40 degrees were observed. Her overall mean Scoliosis Research Society-22 score was 3.68. She is an MBA graduate from a competitive school and currently works full-time. Although the treatment of early-onset scoliosis has significantly evolved over the past 3 decades, the traditional method of anterior release and fusion and staged in-situ posterior fusion posterior fusion with postoperative immobilization showed acceptable deformity correction and maintenance of the pulmonary function over the 34 years.

Preliminary clinical application of the new instrumentation growing rods of sliding pedicle screw system for scoliosis in children

Objective To evaluate the primary clinical outcome of the new instrumentation growing rods of sliding pedicle screw system in the treatment of scoliosis in children.Methods From January 2009 to July 2011,10 patients with idiopathic scoliosis were treated using a new instrumentation growing rods of sliding pedicle screw system.There were 3 males and 7 females,aged from 4 to 12 years (average,7.8 years).Risser sign was grade 0 in all patients.There were 3 cases of single thoracic curve,6 cases of single thoracolumbar or lumbar curve,and 1 case of double thoracic curve.Before operation,the average coronal Cobb angle was 66.8°(range,38° to 85°),the average sagittal Cobb angle was 45.5°(range,38° to 66°),and the average sitting height was 48.6 cm (range,36 cm to 64 cm).During the follow-up period,some parameters were observed,such as coronal and sagittal Cobb angles,sitting height,complications and so on.Result Immediately after operation,the average coronal Cobb angle was 28°(range,17°to 39°) with the average correction rate of 56％(range,48％ to 65％),the average sagittal Cobb angle was 31° (range,25°to 39°),and the average sitting height was 56.8 cm (range,40 cm to 70 cm).All patients were followed up for 12 to 44 months (average,26.5 months).At final follow-up,the average sitting height increase by 2 cm,skin infection at the end of the rod occurred in 3 cases,which recovered after local dressing change,and shoulder imbalance occurred in 1 cases.There were no broken screws,broken rods and other internal fixation-related complications.Conclusion The new instrumentation growing rods of sliding pedicle screw system is effective and safe in the treatment of scoliosis in children. Key words: Scoliosis; Child; Spinal fusion; Internal fixators

Comparison of trunk and spine deformity in adolescent idiopathic scoliosis.

BackgroundCobb measurement of standing radiographs is the standard for clinical assessment of coronal spinal deformity. Angle of trunk inclination (ATI) is an accepted clinical measurement of trunk asymmetry, and has variable reported correlations with Cobb angles. Transverse plane spine deformity is most accurately measured using axial computed tomography. Aaro and Dahlbourn’s technique for quantifying apical vertebral rotation with respect to the sagittal plane (RAsag) is commonly reported in the literature. To our knowledge no study has correlated ATI with RAsag. The purpose of this study was to determine the relationship between commonly used measures of trunk and spine deformity.MethodsSixteen females that underwent preoperative apical vertebra(e) CT scans were retrospectively studied. Thoracic and thoracolumbar RAsag measurements were date-matched to clinically obtained ATI and Cobb measurements. Two-tailed Pearson correlations were calculated; α = 0.01.ResultsMedian patient age was 14.6 years (11–19); BMI 19.4 (16.0-25.5). Curve patterns: Lenke 1 (5); 2 (5); 3 (1); 4 (1); 5 (2): 6 (2). Twenty-six curves (15T; 11TL) with complete, date-matched data points were analyzed. In thoracic curves, ATI correlated with Cobb (r = 0.711, P < 0.004) and RAsag (r = 0.730, P <0.003). ATI was inversely correlated with Cobb flexibility (r = −0.647, P < 0.01). In thoracolumbar curves, ATI correlated with Cobb (r = 0.789, P < 0.005), and RAsag (r = 0.771, P < 0.006) but not Cobb flexibility (r = −0.452, P = 0.190).ConclusionsTrunk and spine thoracic and thoracolumbar transverse plane deformity are correlated, as are trunk transverse plane and spine coronal plane deformity. Increasing trunk deformity limits thoracic, but not thoracolumbar spine flexibility.

Indication for preoperative MRI of neural axis abnormalities in patients with presumed thoracolumbar/lumbar idiopathic scoliosis

The purpose of this study was to investigate the incidence of neural axis abnormalities in patients with presumed "idiopathic" thoracolumbar or lumbar scoliosis by magnetic resonance imaging (MRI) and try to determine which clinical and radiographic characteristics correlate with neural axis abnormalities on MRI in these patients. The database of a single spinal deformity center was retrospectively reviewed to identify all patients with a primary diagnosis of idiopathic scoliosis (IS) between January 2003 and August 2011. A total of 446 patients with main thoracolumbar or lumbar curves were identified. Radiographic parameters including main curve Cobb angles, location of curve apex, span of main curve, thoracic kyphosis (T5-T12), thoracolumbar junction kyphosis (T10-L2), lumbar lordosis (L1-S1), and sagittal and coronal balance were measured. Neural axis abnormalities were detected in 35 (7.8 %) patients. For patients with neural axis abnormalities, a higher proportion of male gender and long thoracolumbar curves were presented. In these patients, the mean age was smaller and the mean Cobb angle of main curve was larger. Greater thoracic kyphosis (≥ 30°) was more frequently found in those with neural axis abnormalities. The incidences of thoracolumbar junction hyperkyphosis were similar between two groups (P > 0.05). There was no difference between two groups as to lumbar lordosis and coronal and sagittal balance. We recommend the routine use of MRI in the patients with one or more of the following characteristics: right curves, long curve span, apex at thoracolumbar spine and hyperthoracic kyphosis.

The impact of direct vertebral body derotation on the lumbar prominence in Lenke Type 5C curves

The thoracic rib hump, caused by axial rotation of the spine, is one of the most dissatisfying cosmetic features associated with adolescent idiopathic scoliosis (AIS). However, advances in instrumentation and surgical techniques, such as direct vertebral body derotation (DVBD), have allowed improved correction in the axial plane and the rib hump. In cases of thoracolumbar/lumbar curves (Lenke Type 5), the lumbar prominence can be equally disfiguring and is often associated with waist asymmetry, another cosmetic concern. Although DVBD has been evaluated in the thoracic spine, little is known about its impact on the lumbar spine. The authors investigated the outcomes of DVBD on the lumbar prominence. A prospectively collected multicenter database was queried for pediatric patients with AIS and Lenke Type 5 curves. All patients who underwent thoracoplasty procedures were excluded. A total of 34 patients underwent surgical correction via a posterior-only approach using pedicle screw constructs. Nineteen patients underwent concurrent DVBD, and the remaining 15 patients served as a control group and did not undergo DVBD. All patients had a minimum of 2 years of follow-up. The mean age of the entire cohort was 14.9 ± 2.3 years, and the majority of patients were female (88%). All patients had Lenke Type 5C curves with a mean major curve of 46.0° ± 8.7°, which corrected to 13.7° ± 7.2° (70% correction). A mean of 10.7 ± 3.0 levels were fused. Only thoracic kyphosis was significantly different between the groups preoperatively. Similarly, postoperative radiographic parameters were comparable between the groups, with equivalent percentages of correction. Although improvement in the thoracic rib hump was comparable between the groups, the DVBD group had 56.2% correction of the lumbar prominence, and the control group had 76% improvement (p = 0.05). Although DVBD has been a valuable tool in the management of AIS, the authors' results suggest that its application for thoracolumbar curves may be limited. Further analysis with a larger cohort is required to better ascertain the impact of DVBD on thoracolumbar curves.

Risk factors of thoracic curve decompensation after anterior selective fusion in adolescent idiopathic scoliosis with major thoracolumbar or lumbar curve

To investigate the incidence of thoracic curve decompensation or proximal adding-on phenomenon after anterior selective fusion of thoracolumbar or lumbar curve in Lenke type 5 adolescent idiopathic scoliosis (AIS), and to identify its risk factors. From June 2001 to December 2008, 130 Lenke type 5 AIS patients with a Cobb angle of 40° - 73° treated with anterior selective thoracolumbar or lumbar fusion, and with a minimum 2-year postoperative regular follow-up were recruited in this study. The average age, Cobb angle and Risser sign of all patients was 14.8 ± 1.6 years, 46° ± 6° of major thoracolumbar or lumbar curve (TL or L), 25° ± 7° of proximal thoracic curve and 0-5, respectively. The patients were grouped according to the relationship between the upper instrumented vertebrae (UIV) and the upper end vertebrae (UEV), the patients' Risser sign and the relationship between UIV and C(7) plumb line (C(7)PL). The radiographic data of the patients were compared between patients with and without proximal adding-on by using t test, and the incidence of proximal adding-on was analyzed in terms of determination of UIV and Risser sign to identify the risk factors of this phenomenon by using Fisher's exact test. Eleven patients were identified with proximal adding-on, thus the incidence of it was 8.5%. At last follow-up postoperatively, the average Cobb angle of TL or L and proximal thoracic curve was 9° ± 4° and 11° ± 5°, respectively. Moreover, the incidence of adding-on in Rissex sign grade 0 to 1 (3/8) was higher than that of grade 2 to 3 (12.1%) and grade 4 to 5 (4.5%). In addition, the incidence of adding-on in UIV lower than UEV group (20.6%) was obviously higher than that of UIV higher than or equal to UEV group (4.2%). The incidence of adding-on for patients with C(7)PL falls away from UIV (19.5%) were obviously higher than that of patients with C(7)PL falls between the pedicle and lateral margin of UIV (3.6%) and between bilateral pedicles of UIV (3.0%). Each group showed significant difference for the incidence of adding-on by Fisher's exact test (P < 0.05). There exists the risk of proximal thoracic curve decompensation, with a not low rate, after anterior selective fusion for major TL or L curve AIS. The determination of UIV relative to UEV and the skeletal maturity of the patient are the two factors closely associated with the presence of such a phenomenon.

Anterior instrumentation (dual screws single rod system) for the surgical treatment of idiopathic scoliosis in the lumbar area: a prospective study on 33 adolescents and young adults, based on a new system of classification

The choice of anterior instrumentation in the treatment of lumbar scoliosis in adolescents and young adults is not a new topic for the authors. The first results achieved using the Dwyer surgical modality were reported by one of the authors followed by the results achieved using Zielke (VDS) instrumentation. Today, new techniques and new instrumentations have been developed that challenge the instrumentation choices. Here we describe how the new system of classification of scoliotic curves we developed has been used as a basis for treating idiopathic scoliosis in lumbar area in adolescents and young adults using an anterior approach. A prospective study was carried out between 1998 and 2010 at two hospital centers on 33 adolescents and young adult with idiopathic lumbar scoliosis involving curves of three kinds, on whom surgical treatment was performed using a single solid rod. Topography of curves: our system of classification includes curves corresponding to the following three type of scoliosis: Type K I: double thoracic and lumbar curves (lumbar predominant) scoliosis (17 cases) mean age 16 years all female patients. Mean Cobb angle of lumbar curve 41°. Mean Cobb angle of thoracic curve 28°. The lumbar curve was left hand convex in 15 cases and right hand convex in 2 cases. Horizontal tilting of L4 mean value 22°. C7 offset mean value 3 cm. Type K IV A: unbalanced thoracolumbar scoliosis (13 cases) mean age 17 years, ten female patients and three male patients. Mean Cobb angle of thoracolumbar curve 39°. The thoracolumbar curve was left hand convex 4 times and right hand convex 9 times. Horizontal tilting of L4 mean value 18°. C 7 offset mean value 2.5 cm. Type K VI A: real lumbar (three cases). Age: 17, 15 and 13 years; all female patients. Cobb angle of the lumbar curve 66°, 29° and 70° (all LH convex). Horizontal tilting of L4: 40°, 20° and 46°. C 7 offset: 7 cm, 1 cm and 4 cm. Surgical instrumentation: We used the EUROS AZUR anterior instrumentation for all the procedures. Cages have been used on five patients at the lower stages. Number of vertebrae instrumented: mean five vertebrae. The patients did not wear postoperative orthosis. Mean duration of procedure: 3 h 50 min. Mean blood loss: 350 cm(3). Type K I scoliosis (17 cases): Mean follow-up: 6 years. Correction of the lumbar curve Cobb angle: the mean angle has been corrected from 41° to 21°. Number of vertebrae instrumented: 4:6 times and 5:11 times. Correction of the upper thoracic curve Cobb angle: mean angle corrected from 28° to 19°. Correction of L4 horizontal tilting: mean residual was 7°. Correction of C 7 offset: mean 0.7 cm. Type K IV A scoliosis (13 cases): mean follow-up: 4 years. Correction of the lumbar curve Cobb angle: the mean angle has been corrected from 39° to 16°. Mean number of instrumented vertebrae: 5 (4:4 times, 5:6 times and 6:3 times.) Correction of L4 horizontal tilting: mean residual 5°. Correction of C 7 offset: mean 0.7 cm. Type K VI A scoliosis (three cases): mean follow-up: 7, 2 and 4 years; Correction of the lumbar curve Cobb angle: the angles have been corrected from 66° to 15°, from 29° to 11° and from 70° to 28°. Number of instrumented vertebrae: 5, 4 and 6. Correction of L4 horizontal tilting: residual tilting of 8°, 7° and 17°. Correction of C 7 offset: 1 cm, 0 cm and 1 cm. There has been no report early or late septic or vascular or neurological complications. Instrumentation failure: there were three cases of screw breakage, all occurred on the lowest implant. Revision surgery was undertaken in both cases, only the last plate needed to be replaced and the rod could be kept without any other modification of the construct. In both cases, fusion has been achieved without any loss of correction. The mean loss of correction of the main curve was 2.5° for the three series. Anterior instrumentation of lumbar idiopathic scoliosis gives highly satisfactory morphological and functional results, since the lumbar musculature is spared and the instrumentation placed at the apex of the curvature has selective effects. Despite our preference and that of other surgeons throughout the world for anterior instrumentation, we are still a minority in comparison with the users of posterior instrumentation. There are several reasons for this reticence, including surgeons' training and ideas about pedicular screw fixation, but the main reason has been the lack of a sufficiently exact system of classification. Previous comparative studies between the anterior and posterior approaches have been biased by the use of an excessively restrictive mode of classification (lumbar/thoracolumbar) of the curves. Real lumbar scoliosis, unbalanced thoracolumbar scoliosis and thoracic and lumbar double curve (lumbar predominant) scoliosis should be properly defined before being compared.

Brace technology thematic series: the progressive action short brace (PASB)

BackgroundThe Progressive Action Short Brace (PASB) is a custom-made thoraco-lumbar-sacral orthosis (TLSO), devised in 1976 by Dr. Lorenzo Aulisa (Institute of Orthopedics at the Catholic University of the Sacred Heart, Rome, Italy). The PASB was designed to overcome the limits imposed by the trunk anatomy. Indeed, the particular geometry of the brace is able to generate internal forces that modify the elastic reaction of the spine. The PASB is indicated for the conservative treatment of lumbar and thoraco-lumbar scoliosis. The aim of this article is to explain the biomechanic principles of the PASB and the rationale underlying its design. Recently published studies reporting the results of PASB-based treatment of adolescent scoliotic patients are also discussed.Description and principlesOn the coronal plane, the upper margin of the PASB, at the side of the curve concavity, prevents the homolateral bending of the scoliotic curve. The opposite upper margin ends just beneath the apical vertebra. The principle underlying such configuration is that the deflection of the inferior tract of a curved elastic structure, fixed at the bottom end, causes straightening of its upper tract. Therefore, whenever the patient bends towards the convexity of the scoliotic curve, the spine is deflected. On the sagittal plane, the inferior margins of the PASB reach the pelvitrochanteric region, in order to stabilize the brace on the pelvis. The transverse section of the brace above the pelvic grip consists of asymmetrical ellipses. This allows the spine to rotate towards the concave side only, leading to the continuous generation of derotating moments. On the sagittal plane, the brace is contoured so as to reduce the lumbar lordosis. The PASB, by allowing only those movements counteracting the progression of the curve, is able to produce corrective forces that are not dissipated. Therefore, the brace is based on the principle that a constrained spine dynamics can achieve the correction of a curve by inverting the abnormal load distribution during skeletal growth.ResultsSince its introduction in 1976, several studies have been published supporting the validity of the biomechanical principles to which the brace is inspired. In this article, we present the outcome of a case series comprising 110 patients with lumbar and thoraco-lumbar curves treated with PASB brace. Antero-posterior radiographs were used to estimate the curve magnitude (CM) and the torsion of the apical vertebra (TA) at 5 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), 2-year minimum follow-up from t4 (t5). The average CM value was 29.3°Cobb at t1 and 13.0°Cobb at t5. TA was 15.8° Perdroille at t1 and 5.0° Perdriolle at t5. These results support the efficacy of the PASB in the management of scoliotic patients with lumbar and thoraco-lumbar curves.ConclusionThe results obtained in patients treated with the PASB confirm the validity of our original biomechanical approach. The efficacy of the PASB derives not only from its unique biomechanical features but also from the simplicity of its design, construction and management.

Study of the corrective forces applied by a dynamic derotation brace (DDB)

Background and purpose The direct forces exerted by the brace pad were analysed, on 44 idiopathic scoliotic patients (38 girls, 6 boys) treated with a DDB [1]. Twenty seven patients had a single right thoracic curve and 17 had a single left or right thoracolumbar curve. The aim was the analysis of the corrective forces, exerted at the skin-brace interface, by altering the posture, activity and strap tension [2-7].

A statistic approach to electronic moulding versus traditional plaster moulding

Results 1) The average initial angle is: 28,19 (+-9,21) for thoracic, 28,11 (+-9,34) for thoraco-lumbar and 25,86 (+-7,04) for lumbar curves. 2) The angular reducibility is 54 % in braces for the thoracic curvatures, 69 % for the thoraco-lumbar curvatures and of 73 % for the lumbar curvatures, which corresponds to the usual results of the Lyon management. If we select curves of 30° and more the reducibility is respectively: 48,5 % for thoracic, 67 % for thoraco-lumbar and lumbar curves. 3) The reducibility in brace is better for the group of the electronic moulding than for the group in plaster cast. For all cases, the improvement of reducibility is 3,63° for thoracic, 3,02 for thoraco-lumbar and 2,14° for lumbar curves. This improvement is better if we select the initial curves of 30° and more: respectively 5,44° for thoracic, 4,75° for thoraco-lumbar and 3,89° for lumbar curves. This difference is however not statistically significant. Conclusions Such results are in favour of the electronic moulding, which remains however delicate and require a precise position of the patient during the surface topography and well trained orthotic technicians.

Study of the rib cage deformity in children with 10°-20° of Cobb angle Late Onset Idiopathic Scoliosis, using Rib-Vertebra Angles Aetiologic implications

The aim of the study is to compare the rib-vertebra angles (RVAs) between children with 10 degrees - 20 degrees of Cobb angle late onset idiopathic scoliosis (LOIS) and non-scoliotic children. The RVAs of 47 children, with mean age 12.4 years, who presented LOIS with a Cobb angle 10 degrees - 20 degrees, were studied. The children were classified into three groups according to the site of the scoliotic curve: 17 children had thoracic (T), 14 children had thoracolumbar (TL) and 16 children had lumbar (L) curves. The RVAs of the scoliotic children were compared to the RVAs of 60 non-scoliotic children of a similar age group, who were studied in the past. The comparison of the right and left RVAs within each group showed that the children who had: T curves differ at the level T4, T5, T6, T7 and T8, TL curves differ at the level T3, and L curves differ at the level T7 and T12. The comparison of the ipsilateral RVA's between the scoliotic groups showed that between: T and TL curves there are no differences at any thoracic level, between T and L curves the RVAs differ at the T7 level on the right side, whereas there are no differences between the RVAs on the left side, between TL and L curves the RVAs differ at the level T5, T6, and T7 on the right and at the level T5 on the left side. Comparing the RVAs between the scoliotic and nonscoliotic children, it was apparent that the scoliotic children rib cage had lower RVAs (p<0.01) at almost all thoracic levels. It has been reported that RVAs is an expression of the resultant muscle forces, which act on each rib. It was also suggested that RVA asymmetries by weakening the spinal rotation-defending system are aetiological for idiopathic scoliosis, (Burwell et al 1992). This study shows that scoliotic children with small curves have underdeveloped thoracic cage compared to nonscoliotic counterparts. The differences are more apparent in the scoliotic children with thoracic curves. It is suggested that the differences of the RVAs between right and left side in this group are an expression of asymmetric muscle forces acting on the thoracic cage. It is concluded that asymmetric muscle forces participate in the pathogenesis of idiopathic scoliosis on the thoracic cage, which deforms early.

A REVIEW ON KINEMATIC PARAMETERS IN SCOLIOTIC PATIENTS

Introduction: Scoliosis is one the most common orthopedic problems in children and adults which is still idiopathic. Scoliosis is a three planar deformity and results in changes in anatomy of spine and pelvic that alters gait parameters. The purpose of this study was to evaluate changes in kinematic parameters in lower limb, upper limb, and trunk in scoliosis patients compared with normal subjects. Determining the exact pattern of these changes and the effect of it's severity on this parameters can be used to check the progression or improvement of scoliosis. Materials and Methods: To find and collect suitable articles some key words like scoliosis, gait, and kinematics were used in data bases such as Google Scholar, Pubmed, Elsevier, Ovid and Springer. Papers were selected based on identified inclusion and exclusion criteria. Then articles were scored by Downs and black tool. Results: Among of twenty five articles, 9 articles were selected on basis of inclusion and exclusion criteria from 1998 to 2012. Step length was the only temporospatial parameter that showed a significant reduction. Kinematic parameters in Lower limb identified reduced range of motion, but motion pattern did not show any significant difference. The most differences in data were observed in trunk and pelvic rotation. It was cleared only in person who has a large curvature of the thoracic spine and the same direction of pelvic rotation. Pelvic changes were not predicted in other cases. Pelvic also indicated some changes in x-ray and according to anatomical relation between pelvic and lumbar, thoracolumbar and lumbar curves had the most effect on the pelvic changes. Conclusion: The majority of these articles investigated walking parameters in different speeds. In order to achieve the comprehensive outcomes, the standard model should exist with regarding a curve type and test condition, especially in the upper limb that has been paid low attention, so far. Keywords: Scoliosis, Gait, Kinematics, Lower limb

Rate of surgery in patients treated with a Chêneau light brace using the SRS inclusion criteria

Abstract Introduction Studies investigating the outcome of conservative scoliosis treatment differ widely with respect to the inclusion criteria used. Prospective cohort studies are available using the Scoliosis Research Society (SRS) inclusion criteria for studies on bracing. These seem to provide a great advantage in comparing different strategies of bracing against each other. Because we had gathered all data pertaining to patients treated with a Cheneau light brace between June 2005 and November 2007, it was possible to identify that sample of patients fulfilling the SRS inclusion criteria from the entire sample. Aim The aim of this study was to investigate treatment outcomes in patients treated with Cheneau light brace, who met the SRS inclusion criteria for studies on bracing. Materials and methods In total, 34 patients (of 152) fulfilled the SRS inclusion criteria having an average age of 12.06 years (10–13 years), an average Cobb angle of 31°(25–40°), an average Risser stage of 0.35, an average in-brace Cobb angle of 13° (i.e., 59% of in-brace correction). There were 17 thoracic, 10 double major, 6 lumbar and 2 thoracolumbar curve patterns. After a change of workplace concerning the first author, patients could not be followed up on as originally planned. Therefore, telephone interviews were performed by the second author. Results In total, 28 patients (average age of 16.5 years) have been contacted, 9 of them still undergoing their treatment. No patient has been operated on (rate of surgery is 0%) and only 1 was not satisfied with the cosmetic outcome of the treatment. Discussion The rate of surgery was far less than reported in recent studies using the same inclusion criteria even when all drop outs were rated as failures. Conclusions The rate of surgery can be reduced with the help of Cheneau braces of the latest standard and satisfactory in-brace correction. Brace treatment employing the Cheneau brace seems to be effective and, therefore, is clearly recommended. Clinical outcomes may be more important for a patient than radiological outcomes.

Estudio preliminar sobre la acción de la gimnasia hipopresiva en el tratamiento de la escoliosis idiopática

Our goal is to describe the results of a hypopressive gymnastics (HG) program applied to 3 children with idiopathic scoliosis. Three children (ages ranging from 8 to 15 years) suffering from idiopathic scoliosis were recruited for this study. Thoracic or thoracolumbar curves showed between 15° and 40° Cobb degrees. The evolutionary character of the curves had been confirmed. A study of different clinical and radiological parameters was carried out to compare the measurements before and after (3 months later) the application of a 5 HG daily exercises programme: A radiological study of the spine was carried out to compare the measurements of the vertebral rotation. A radiological study, a plumb line and a measuring tape were used to assess the vertebral tilt in this study. A Scoliometer was used to measure the deformation of the rib cage (gibbosity). The most significant results were: a trend to reach stabilisation in the vertebral tilt and rotation, and stabilisation of gibbosity, which probably might improve the respiratory function of these subjects. Finally, the performance of an ordinary HG exercise program shows a trend to control and stabilise dorsal idiopathic scoliosis progression.

Scoliotic posture as the initial symptom in adolescents with lumbar disc herniation: its curve pattern and natural history after lumbar discectomy

BackgroundThere have been few studies focusing on the curve pattern of scoliosis caused by lumbar disc herniation (LDH) in adolescents and the natural history of scoliosis after discectomy. The current study was carried out to identify the curve pattern of scoliosis and investigate the effect of posterior discectomy on the curve improvement in adolescents with LDH.MethodsThis review focused on a group of 26 adolescents with LDH who initially presented to our clinic for evaluation of scoliosis, followed by posterior discectomy between 2000 and 2009. Radiographic measurements included curve pattern, specific curve features, trunk shift, and sagittal profile. The correlation between the side of disc herniation and the direction of lumbosacral curve and the trunk shift was evaluated.ResultsA typical curve pattern was initially identified in all of the patients as a short lumbosacral curve accompanied with a long thoracic or thoracolumbar curve toward the opposite side. 23 of 26 patients (88.5%) had a trunk shift more than 2.0 cm away from the midline, showing a poor coronal balance. A relatively straight sagittal profile was noted in all the patients. 84.6% (22/26) patients had a disc herniation at the convex side of lumbosacral curve. Similarly, 73.1% (19/26) patients showed a trunk shift toward the opposite side of disc herniation. All of the patients had an marked curve improvement immediately after discectomy. In the 17 patients with a more than 2-year follow-up, only two had a residual lumbosacral curve greater than or equal to 20 degrees. The mean ODI improved from 21.4% before surgery to 7.3% at the final follow-up.ConclusionsA short lumbosacral curve accompanied with a long thoracic or thoracolumbar curve toward the opposite side, and a relatively straight sagittal profile have been noted in all the patients. The direction of lumbosacral curve and trunk shift was related to the side of disc herniation. A majority of patients have a small curve size while assosiated with a significant coronal imbalance. Earlier decompression can provide a greater opportunity for spontaneous correction of scoliosis.

Analysis of the corrective forces exerted by a dynamic derotation brace (DDB)

Discrepancies exist in the current literature for bracing of spinal curvature conditions. This can be explained by the diversity of brace types, the different curve patterns and the various measurement methods and instruments. The aim of this study was the analysis of the corrective forces exerted by a dynamic derotation brace (DDB), at the skin-brace interface, altering the strap tension and body posture. We analysed the direct forces exerted by a DDB's main pad, on 44 (38 girls, 6 boys) idiopathic scoliotic patients. Twenty-seven patients had a single right thoracic and 17 a single left or right thoracolumbar curve. We used the F-Socket 9801 pressure sensor and the MatScan Research BETA STAM 6.30 software, while patients adopted nine different postures. The patients were divided into three different groups: those who wore the brace for the first time, those who were changing their brace for a new one, and those who were having adjustments made to their existing brace. These patients who were having adjustments made to their existing brace caused the highest mean exerted force. Changes in strap tension and body posture resulted in statistically significant alterations of the interface pressure and the forces exerted on the patient's body. Tightening the brace's straps always produces a significant force increase, independent of the body posture and the curve type. Also there are some body postures which significantly modify the exerted force. The body posture of maximum inspiration for thoracolumbar curves and, additionally, prone and lying left for thoracic curves.

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.

Convex Hemiepiphysiodesis

We performed a retrospective chart review of patients with nonadolescent idiopathic scoliosis who underwent open vertebral stapling for treatment of spinal deformity. The objective of this study was to determine the efficacy of vertebral stapling in patients with scoliosis. Measurements included initial deformity correction and maintenance of correction. Growth modulation has become a topic of interest recently in the spinal deformity literature. It refers to the tethering of growth on one side of the spine to allow for compensatory growth on the contralateral side, and, in theory, correction of scoliosis. Recent studies on endoscopic vertebral stapling have shown promising early results in adolescents with idiopathic scoliosis. Little is known about its applicability in patients with more "malignant" types of scoliosis. The medical records and radiographs of 11 children who underwent open vertebral stapling between June 2003 and August 2004 were reviewed. Patients with adolescent idiopathic scoliosis (AIS) were excluded. RESULTS.: Diagnoses included myelodysplasia, congenital scoliosis, juvenile, and infantile idiopathic scoliosis, Marfan syndrome, paralytic scoliosis, and neuromuscular scoliosis. The average age at surgery was 6 + 11 year. All patients were skeletally immature. Preoperative curves averaged 68° (22°-105°). Of the 11, six thoracic curves and five thoracolumbar curves were stapled. Four patients had minor curves, which were not stapled. Initial postoperative radiographs averaged 45° (24°-88°). Average follow-up was 22 month for our series (16-28 month). At final follow-up, scoliosis averaged 69° (36°-107°). Five of the 11 patients have subsequently undergone secondary surgical procedures for progression of scoliosis, including growing rod insertion in three, combined anterior/posterior spinal fusion in another, and bilateral vertical expandable prosthetic titanium rib insertion in a patient with myelodysplasia. Three of the remaining six patients are scheduled for secondary surgery. More than half of the patients in our series have undergone or are scheduled to undergo further spinal surgery, at an average of 2 year after anterior vertebral stapling. It is unclear if progression may be related to the young age at surgery, the relatively severe average preoperative curve magnitude, the nature of the underlying scoliosis, or a combination of these.

Maximal Pulmonary Recovery After Spinal Fusion for Adolescent Idiopathic Scoliosis

Retrospective analysis of prospectively collected data. To compare the relative rates of pulmonary recovery and maximal pulmonary function with surgical approach. Anterior versus posterior spinal fusion (ASF, PSF) for the treatment of adolescent idiopathic scoliosis (AIS) has been debated. Although procedures that violate the chest wall may compromise pulmonary function, lung function continues to improve after surgery at variable rates depending upon surgical approach. We reviewed the medical records from one hundred fifty nine AIS patients (age 15.6±2.2; 113 women; 46 men) treated with spinal fusion from 2003 to 2007 by a single surgeon. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and radiographic measurements were evaluated before surgery and at 1, 3, 6, 12, and 24-months follow-up on average. Four surgical groups were compared: PSF, ASF (open thoracoabdominal approach for thoracolumbar curvature), video-assisted thoracoscopic surgical release with instrumentation (VATS-I), and VATS with PSF. FEV1 and FVC were fitted to model to evaluate the immediate postoperative pulmonary function (Yo), maximal recovery (Plateau), and rate (K) of pulmonary improvement. Patients in each surgical subgroup were as follows: PSF (Lenke 1: n=50, Lenke 2,3: n=20), ASF (Lenke 5, n=35), VATS-I (Lenke 1=31, Lenke 3=1), and VATS+PSF (Lenke1: n=9, Lenke 2-6: n=13). Early postoperative pulmonary function was higher with ASF and PSF as compared to both VATS groups (P<0.05). Comparing all curve types, VATS-I showed a small decline of absolute FEV1 compared to PSF at 2-years follow-up. Comparing thoracic curves, however, no differences in FEV1 or FVC were noted at 6 to 12 months until 2-years follow-up. The rate of recovery (K) was equivalent for all surgical approaches and curve types. Compared to ASF or PSF, VATS procedures showed an initial decline in pulmonary function, which resolved fully by 6- to 12-months follow-up. Modest declines in maximal pulmonary function with VATS-I were seen when comparing all curve types together but not when comparing Lenke 1 curves alone. VATS procedures for thoracic scoliosis and open approaches for thoracolumbar curve types were associated with minimal to no permanent deficits.