Types Of Idiopathic Scoliosis Research Articles

Posterior vertebrodesis and Ponte osteotomies in surgical treatment of adolescent idiopathic scoliosis type Lenke 1-4

The purpose of the study is to present the results of the application of posterior vertebrodesis with Ponte osteotomies (PO) in the operative treatment of adolescent idiopathic scoliosis /AIS/, Lenke 1-4. The study encompasses patients with more than 60 degrees Cobb angle rigid deformities in the frontal plane with correction below 40% percents in the bending tests. Patients with both hyperkyphosis reported in the T5-T12 segment and marked hypokyphosis in the same area of the thoracic zone were also included in the study.
 Material and methods
 The study encompasses 38 patients (men 11, women 27) with adolescent idiopathic scoliosis type Lenke 1-4 and has been conducted in the period 2010-2018 The patients, included in the study, were of the age between 10 and 18 years, average age: 14.2±0.5.
 Results
 The following results were reported: Correction at one level osteotomy - 8-11 degrees in kyphosis and less than 5 degrees in the coronal plane; Blood loss at one level osteotomy: 50-95 ml; Time for osteotomy at one level:19-28 min.
 Conclusion
 Ponte osteotomy and posterior instrumentation with pedicle screws is an effective and relatively safe surgical method to achieve good sagittal and frontal correction in cases with pronounced and rigid thoracic deformities. The performance of osteotomies is associated with increased blood loss and operative time, but it is of key importance in achieving an important correction of the sagittal disorder in hyper or hypokyphosis cases.

Associations of physical activity and screen time with adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS) is the most common type of idiopathic scoliosis, affecting approximately 0.61%-6.15% adolescents worldwide. To date, the results on the relationship between moderate-to-vigorous physical activity (MVPA) and AIS were inconsistent, and the association between screen time (ST) and AIS remained unclear. This study aimed to describe MVPA and ST among adolescents, and to explore the independent and joint associations between PA, ST, and AIS. A frequency-matched case-control study based on the 2021 Chinese School-based Scoliosis Screening Program in Shenzhen city, south China, was conducted. The research involved 494 AIS patients (aged 9-17 years) and 994 sex- and age-matched healthy controls. MVPA and ST were measured using a self-administered questionnaire. Logistic regression models estimated associations between PA, ST, and AIS. Compared to subjects meeting the recommended 60-min daily of MVPA, adolescents reporting daily MVPA time less than 60 min had 1.76 times higher odds of experiencing AIS (95% CI: 1.32-2.35) and adolescents reporting daily MVPA in inactive status had 2.14 times higher odds of experiencing AIS (95% CI: 1.51-3.03). Moreover, participants reporting ST for 2 hours or more had 3.40 times higher odds of AIS compared with those reporting ST less than 2 hours (95% CI: 2.35-4.93). When compared with the adolescents reporting both ST and MVPA meeting the guidelines recommended times (ST < 2 h and MVPA ≥ 60 min/day), those reporting both ST ≥ 2 h and MVPA in inactive status are 8.84 times more likely to develop AIS (95% CI: 3.99-19.61). This study reported that the insufficient MVPA, especially MVPA in inactive status, and excessive ST were risk factors for AIS. Additionally, the joint effects of insufficient MVPA and excessive ST probably increase the risk of AIS.

How can postoperative shoulder imbalance be prevented in adolescent idiopathic scoliosis type 2?

Postoperative shoulder imbalance (PSI) is a common complication following adolescent idiopathic scolio- sis (AIS) surgery. There is little data available in literature on prediction of PSI. Prospectively collected data of AIS with thoracic curve (Lenke 2), operated in 2014-2018 at a single scoliosis-center, were analyzed retrospectively using X-rays of whole spine and traction films (TA): age, Cobb-angle of proximal (PC), major thoracic (MC) and lumbar curve (LC), shoulder height [mm], clavicle angle [°], T1-tilt [°], plumb line [mm]. Results as mean ± standard deviation. Change over time (postOP- FU) compared using t-test (≥=0.05). Correlation of preOP parameters and curve correction with PSI (|≥|15mm) was analyzed by correlation (Pearson)- and regression-classification-analysis. 32 AIS, average age of 14±1.3 yrs. FU 16 months (84%). Curve correction was 52.5% (PC), 70.1% (MC), 69.9% (LC), significant change in FU for PC (-2.4°, p>0.05), not for MC, LC (p=0.2, p=0.6). Shoulder height was negative if right- side up: 2.9±15.1mm (preOP), 5.5±15.0 mm (TA), 17.9±14.9mm (postOP), 17.4±8.4mm (FU). 28% had preOP shoulder imbalance, 69% postOP and 44% FU had PSI. Shoulder height on TA correlated to change preOP to FU (r=0.62) and preOP shoulder height (r=-0.85), clavicle angle had strong correlation (r=- 0.81). Regression-classification-analysis: correction of MC>62.4%, 81.5% of cases had PSI; with correction of MC>64.9% and LC>93.2%, 51.9% of cases had PSI. PSI is a common in Lenke2 AIS. In preOP planning TA, shoulder position and clavicle angle should be considered to prevent PSI. Correction of MC should be moderate, overcorrection of the LC avoided.

Shared Decision-Making for Juvenile Scoliosis.

Shared Decision-Making for Juvenile Scoliosis.

The safety and efficacy of one-stage posterior surgery in the treatment of presumed adolescent idiopathic scoliosis associated with intraspinal abnormalities a minimum 3-year follow-up comparative study.

Adolescent idiopathic scoliosis (AIS) is a common type of idiopathic scoliosis. Previous studies reported that the incidence of intraspinal abnormalities among the presumed idiopathic scoliosis was 13-43%. Intraspinal abnormalities were also considered increasing the risks of progressing of scoliosis and neurological complications following scoliosis corrective surgery. The surgical strategy of presumed adolescent idiopathic scoliosis (PAIS) associated with intraspinal abnormalities remains controversial. The purpose of this study was to investigate whether one-stage posterior surgery safe and effective for the PAIS patients associated with intraspinal abnormalities. One hundred and thirteen consecutive patients who underwent one-stage posterior correction surgery were included. Thirty PAIS patients with intraspinal abnormalities without preoperative neurological symptoms were matched with eighty-three AIS patients for sex, age, blood loss, operating time, number of levels and location of instrumentation and curve magnitude. Radiographic and clinical parameters of the patients were evaluated before surgery, within 1 week after surgery, and more than 3 years at the last follow-up for complications and changes in main curve correction, global coronal balance, thoracic kyphosis, sagittal vertical axis, and ODI scores. On average, the duration of follow-up was 51.5months in the PAIS group compared to 52.5months in the AIS group. The preoperative mean major coronal curve was 79.6° (ranged 56.2°-106.7°) and improved to 22.4° (ranged 6.4°-58.1°) at the last follow-up for a 71.9% of correction in the AIS group. The preoperative mean major coronal curve was 80.4° (ranged 63.4°-108.1°) and improved to 23.2° (ranged 4.8°-66.2°) at the last follow-up for a 71.1% of correction in PAIS group. The preoperative ODI score was 32.4 (10-42) in the PAIS group and improved to 11.4 (4-22) at last follow-up, 33.4 (12-42) in the AIS group and improved to 11.5 (5-22) at last follow-up. The global coronal balance, TK and SVA were all significantly improved after surgery and maintained to the last follow-up in the two groups. The neurological complications were observed in 3.3% of PAIS patients and 3.6% of AIS patients. No statistical difference in the parameters between the two groups was observed at the last follow-up. One-stage posterior corrective surgery is safe and effective in PAIS patients associated with intraspinal abnormalities without preoperative neurological symptoms. Surgical guidelines of AIS are appropriate for the treatment of PAIS patients associated with intraspinal abnormalities.

Anatomical and Anthropometric Features of Bone Bodies Structures in Children with Idiopathic Scoliosis of Lenke III Type

Objective. Lenke III type spinal curvature occurs in 11% of all types of deformities in idiopathic scoliosis. Knowledge of the features of the structure of the bone structures throughout the main curve of the deformity allows you to properly plan the installation of transpedicular supporting elements during the operation and carry out a specific sequence of correcting manipulations in order to achieve the optimal result.Purpose. To study the anatomical and anthropometric features of the bone structures of the vertebrae in children with idiopathic scoliosis, type lenke III, using a navigation device.Materials and Methods. The study included 23 patients with S-type idiopathic scoliosis type III according to the classification of L. Lеnke aged 14 to 18 years, of which 22 are female patients and 1 male. All children carried out spinal X-rays in standard projections (direct and lateral), multislice computed tomography, according to msct in the navigation unit measured anatomical and anthropometric indicators, certain parameters and coefficients were calculated mathematically.Results. The following patterns were determined: pronounced asymmetry of both the width and height of the bases of the arches of the vertebrae along the concave and convex sides of the deformity in the thoracic spine and moderately pronounced structural changes in the bone structures in the lumbar spine. Strong direct correlations between the asymmetry coefficient of the base areas of the arcs and the asymmetry coefficients of the width and height of the base of the arcs, as well as a direct correlation between the values of the rotational value of the apical vertebra and the asymmetry coefficient of the base areas of the arcs in the thoracic region were revealed. In the lumbar spine, only a directly proportional relationship was found between the asymmetry coefficient of the areas of the bases of the arches of the vertebrae and the coefficient of asymmetry of the heights of the bases of the arcs of the vertebrae.Conclusion. Ап analysis of the anatomical and anthropometric parameters of the bony structures of the vertebrae in children with idiopathic scoliosis of the lenke III type has made it possible to identify certain features, to establish patterns and correlations that characterize this variant of deformity.

Prevalence, Risk Factors, and Characteristics of the "Adding-On" Phenomenon in Idiopathic Scoliosis After Correction Surgery: A Systematic Review and Meta-Analysis.

A systematic review and meta-analysis. To discuss the prevalence, risk factors, and characteristics of the "adding-on" phenomenon in idiopathic scoliosis (IS). There are controversies on the prevalence and risk factors of the "adding-on" phenomenon. In addition, there is no comprehensive study to describe the characteristics of "adding-on" in IS patients. We performed a systematic online search using PubMed, EMBASE, Web of Science, the Cochrane Library, and China WeiPu Library to identify eligible studies. Effect size (ES), odds ratios (OR), and weight mean difference (WMD) with 95% confidence interval (CI) were used to evaluate the incidence, characteristics, and risk factors for "adding-on," respectively. The overall pooled prevalence of "adding-on" was 14%. Subgroup analysis showed that the prevalence of "adding-on" in Lenke 1A adolescent idiopathic scoliosis (AIS), Lenke 2 AIS, Lenke 5 AIS, and mixed AIS was 15%, 12%, 9%, and 16%, respectively. AIS patients with the "adding-on" phenomenon had smaller proximal thoracic curve (PTC), main thoracic curve (MTC), clavicle angle, T1 tilt angle and radiographic shoulder height (RSH), and larger correction of PTC. Age, Risser sign, preoperative PTC, preoperative MTC, preoperative lumbar curve (LC), preoperative coronal balance and sagittal balance, and T4 tile were identified as risk factors of "adding-on." Selection of lower instrumented vertebra (LIV) was also an important risk factor as LIV-Center Sacral Vertical Line (CSVL), LIV-end vertebra, LIV-Stable Vertebra, and LIV-Neutral vertebra, and deviation of LIV+1 was found to be significantly associated with "adding-on." Besides, postoperative MTC was also significantly different between patients with and without "adding-on." The pooled prevalence varied differently in different types of IS. Patients with "adding-on" had smaller PTC, MTC, angle, T1 tilt angle and RSH, and larger correction of PTC. Younger age, less skeletal maturity, smaller preoperative PTC, smaller preoperative MTC, smaller preoperative LC, larger preoperative coronal, sagittal imbalance, selection of LIV, and overcorrection of coronal and sagittal alignment were risk factors for "adding-on." 4.

ANALYSIS OF ANATOMICAL AND ANTHROPOMETRIC PARAMETERS OF VERTEBRAE IN CHILDREN WITH THORACIC IDIOPATHIC SCOLIOSIS USING 3D-CT-NAVIGATION

Objective. To analyze anatomical and anthropometric parameters of vertebrae measured by a navigation system in children with thoracic idiopathic scoliosis. Material and Methods . A total of 20 patients aged 14-18 years with Grade 3 and 4 (according to V.D. Chaklin classification) right-sided thoracic idiopathic scoliosis were examined. Anatomical and anthropometric features of the thoracic and lumbar vertebrae were assessed using CT data in the navigation system. The total Cobb angle of scoliotic curve, rotation of apical and periapical vertebrae, external transverse and longitudinal diameters of the roots of vertebral arches at the T 2 -L 5 levels, and the coefficients of asymmetry of vertebral bone structures were determined. Results . The angle of scoliosis deformity ranged from 33.7° to 107.9° (mean: 61.4°), the angle of rotation of the apical vertebra - from 9.3° to 40.2° (mean: 21.09°). Positive correlation between the magnitude of scoliotic arch deformity and asymmetry coefficients of longitudinal diameter of the arch roots of the apical vertebrae was found. A pronounced asymmetry of right and left transverse diameters of arch roots of the T 3 -T 4 vertebrae, despite the absence of structural compensatory counter curve and torsional changes in these vertebrae. Conclusion . There are certain regularities and correlations between the type of idiopathic scoliosis and the absolute and relative values of vertebral parameters not only at the top of the curve, but also throughout the whole curvature arch.

Evaluation of idiopathic scoliosis by anterior and posterior arthrodesis

&lt;sec&gt;&lt;title&gt;OBJECTIVE:&lt;/title&gt;&lt;p&gt; To evaluate comparatively surgical treatment of adolescent idiopathic scoliosis type 5CN by anterior and posterior approach.&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;METHODS:&lt;/title&gt;&lt;p&gt; The study consists of a comparative retrospective study of two groups of patients with the thoracolumbar spine arthrodesis technique by anterior and posterior approach. Twenty and two patients were sequentially selected, 11 operated by anterior approach - called Group I - and 11 by posterior approach - Group II. Anamnesis and physical examination were performed, as well as length of hospital stay and ICU stay, degree of correction, comorbidities and pre and postoperative radiographic images data were gathered.&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;RESULTS:&lt;/title&gt;&lt;p&gt; The mean age was 13.7 years in Group I and 14 years in Group II. The average hospital stay was 5.81 days for Group I and 5 for Group II. The average ICU stay was 2.81 and 2 days, respectively. Considering the operated levels, Group I presented an average of 4.81 vertebrae (4-6 levels), and Group II presented an average of 6.36 vertebrae (5-11 levels). Complications did not show statistically significant difference.&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;CONCLUSION:&lt;/title&gt;&lt;p&gt; Despite the limited number of patients in groups, it was demonstrated that the posterior approach reduces the number of days of hospitalization and ICU stay. However, it was found increased levels included in the arthrodesis.&lt;/p&gt;&lt;/sec&gt;

Dynamics of changes in symmetry of the body after surgical treatment in patients with idiopathic scoliosis

Improving of the shape of the body is the main aim of conservative or surgical treatment of scoliotic curvature. Topicality ofour work is in comparison of the cosmetic outcomes of surgical treatment of idiopathic scoliosis. Objective: To determine and compare the dynamics of changes in the symmetry of the body in patients with idiopathic scoliosis after anterior and posterior corrective spinal fusion. Methods: A prospective study was performed in 36 patients aged from 12 to 28 years with idiopathic scoliosis type Lenke 1A and 5C. Patients were divided into two groups (18 people in each) depending on the method of treatment: I group — anterior spinal fusion (ASF), II — posterior spinal fusion (PSF). We performed an assessment of the cosmetic outcome of treatment using the posterior symmetr y index trunk (PSIT) before, immediately after and after 1 and 2 years after surgery. Results: the same changes in dynamics of PSIT during the observation period were defined in both groups of patients. Prior to surgery PSIT in group I was 19,7 ± 12,69, in II — 18,7 ± 11,5, and after correction of the curvature index turned out well to improve by 41.3 and 41 %, respectively. One year after surgery PSIT in group I was 6,4 ± 4,3, in II — 5,4 ± 3,2, and after 2 years — 5,4 ± 3,2 and 4,5 ± 3,3, respectively. Conclusions: The use of ASF and PSF allows to reach an identical cosmetic outcome and dynamics of changes in the symmetry of the trunk in patients with idiopathic scoliosis. Under identical indications for corrective ASF or PSF an advantage of the first one is the reduction in the length of fixation of the spine in combination of the same cosmetic effect.

Eigenspine: Computing the correlation between measures describing vertebral pose for patients with adolescent idiopathic scoliosis

This paper describes the concept of eigenspine, a concept applicable for determining the correlation between pair-wise combinations of measures useful for describing the three-dimensional spinal deformities associated with adolescent idiopathic scoliosis. The proposed data analysis scheme is based upon the use of principal component analysis (PCA) and canonical correlation analysis (CCA). PCA is employed to reduce the dimensionality of the data space, thereby providing a regularization of the measurements, and CCA is employed to determine the linear dependence between pair-wise combinations of different measures. The usefulness of the eigenspine concept is demonstrated by analyzing the position and the rotation of all lumbar and thoracic vertebrae as obtained from 46 patients suffering from adolescent idiopathic scoliosis. The analysis showed that the strongest linear relationship is found between the lateral displacement and the coronal rotation of the vertebrae, and that a somewhat weaker but still strong correlation is found between the coronal rotation and the axial rotation of the vertebrae. These results are well in-line with the general understanding of idiopathic scoliosis. Noteworthy though is that the correlation between the anterior–posterior displacement and the sagittal rotation was not as strong as expected and that the obtained results further indicate the need for including the axial vertebral rotation as a measure when characterizing different types of idiopathic scoliosis. Apart from analyzing pair-wise correlations between different measures, the method is believed to be suitable for finding a maximally descriptive low-dimensional combination of measures describing spinal deformities in idiopathic scoliosis.

Differences in early sagittal plane alignment between thoracic and lumbar adolescent idiopathic scoliosis

Background contextIt has previously been shown that rotational stability of spinal segments is reduced by posteriorly directed shear loads that are the result of gravity and muscle tone. Posterior shear loads act on those segments of the spine that are posteriorly inclined, as determined by each individual's inherited sagittal spinal profile. Accordingly, it can be inferred that certain sagittal spinal profiles are more prone to develop a rotational deformity that may lead to idiopathic scoliosis; and lumbar scoliosis, on one end of the spectrum, develops from a different sagittal spinal profile than thoracic scoliosis on the other end. PurposeTo examine the role of sagittal spinopelvic alignment in the etiopathogenesis of different types of idiopathic scoliosis. Study design/settingMulticenter retrospective analysis of lateral radiographs of patients with small thoracic and lumbar adolescent idiopathic scoliotic curves. Patients sampleWe included 192 adolescent idiopathic scoliosis patients with either a thoracic (n=128) or lumbar (n=64) structural curve with a Cobb angle of less than 20° were studied. Children with other spinal pathology or with more severe idiopathic scoliosis were excluded, because this disturbs their original sagittal profile. Subjects who underwent scoliosis screening and had a normal spine were included in the control cohort (n=95). Outcome measuresThoracic kyphosis, lumbar lordosis, T9 sagittal offset, C7 and T4 sagittal plumb lines, pelvic incidence, pelvic tilt, and sacral slope, as well as parameters describing orientation in space of each individual vertebra between C7 and L5 and length of the posteriorly inclined segment. MethodsOn standardized lateral radiographs of the spine, a systematic, semi-automatic measurement of the different sagittal spinopelvic parameters was performed for each subject using in-house developed computer software. ResultsEarly thoracic scoliosis showed a significantly different sagittal plane from lumbar scoliosis. Furthermore, both scoliotic curve patterns were different from controls, but in a different sense. Thoracic kyphosis was significantly decreased in thoracic scoliosis compared with both lumbar scoliosis patients and controls. For thoracic scoliosis, a significantly longer posteriorly inclined segment, and steeper posterior inclination of C7–T8 was observed compared with both lumbar scoliosis and controls. In lumbar scoliosis, the posteriorly inclined segment was shorter and located lower in the spine, and T12–L4 was more posteriorly inclined than in the thoracic group. The lumbar scoliosis cohort had a posteriorly inclined segment of the same length as controls, but T12–L2 showed steeper posterior inclination. Lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope, however, were similar for the two scoliotic subgroups as well as the controls. ConclusionsThis study demonstrates that even at an early stage in the condition, the sagittal profile of thoracic adolescent idiopathic scoliosis differs significantly from lumbar scoliosis, and both types of scoliosis differ from controls, but in different aspects. This supports the theory that differences in underlying sagittal profile play a role in the development of different types of idiopathic scoliosis.

Reliability of a quantitative clinical posture assessment tool among persons with idiopathic scoliosis

Objective To determine overall, test–retest and inter-rater reliability of posture indices among persons with idiopathic scoliosis. Design A reliability study using two raters and two test sessions. Setting Tertiary care paediatric centre. Participants Seventy participants aged between 10 and 20 years with different types of idiopathic scoliosis (Cobb angle 15 to 60°) were recruited from the scoliosis clinic. Main outcome measures Based on the XY co-ordinates of natural reference points (e.g. eyes) as well as markers placed on several anatomical landmarks, 32 angular and linear posture indices taken from digital photographs in the standing position were calculated from a specially developed software program. Generalisability theory served to estimate the reliability and standard error of measurement (SEM) for the overall, test–retest and inter-rater designs. Bland and Altman's method was also used to document agreement between sessions and raters. Results In the random design, dependability coefficients demonstrated a moderate level of reliability for six posture indices ( ϕ = 0.51 to 0.72) and a good level of reliability for 26 posture indices out of 32 ( ϕ ≥ 0.79). Error attributable to marker placement was negligible for most indices. Limits of agreement and SEM values were larger for shoulder protraction, trunk list, Q angle, cervical lordosis and scoliosis angles. The most reproducible indices were waist angles and knee valgus and varus. Conclusions Posture can be assessed in a global fashion from photographs in persons with idiopathic scoliosis. Despite the good reliability of marker placement, other studies are needed to minimise measurement errors in order to provide a suitable tool for monitoring change in posture over time.

Pre-existent vertebral rotation in the human spine is influenced by body position

Both the humans as well as the quadrupedal spine have been shown to exhibit a pattern of pre-existent rotation that is similar in direction to what is found in the most common types of idiopathic scoliosis. It has been postulated that human bipedalism introduces forces to the spine that increase a tendency of the vertebrae to rotate. The objective of this study was to examine the effect of body position on vertebral rotation in vivo. Thirty asymptomatic volunteers underwent magnetic resonance imaging scanning of the spine (T2-L5) in three different body positions; upright, quadrupedal-like (on hands-and-knees) and supine. Vertebral rotation in the local transverse plane was measured according to a pre-established method and compared at different spinal levels between the three body positions. It was shown that in all three positions the mid- and lower thoracic vertebrae were predominantly rotated to the right. However, vertebral rotation was significantly less in the quadrupedal position than in both the standing upright and supine positions.

The practice of physical and sporting activity in teenagers with idiopathic scoliosis is related to the curve type

Idiopathic scoliosis (IS) is correlated with a muscular disequilibrium of the spine and an alteration of balance control, efficient performance of the latter being necessary for physical and sporting activities (PSA). However, the type of the IS curve has different effects on muscle and on balance control according to the primary curve location. This study aimed to determine the relationships between IS type and PSA practice. One hundred and sixty-nine girl adolescents with IS [double major curve (DMC) scoliosis: n=74; single major curve (SMC) scoliosis: n=95] and 100 age-matched control girl adolescents completed an epidemiological questionnaire informing on curricular and extracurricular PSA. Adolescents with DMC scoliosis practised more PSA than those with SMC scoliosis. Moreover, among all PSA referenced, gymnastic activities are the most practiced PSA both in IS teenagers, whatever the curve type, and in controls. Besides, teenagers practising gymnastics were more numerous in those with DMC scoliosis than those with SMC scoliosis and controls. The highest proportion of adolescents with DMC scoliosis practising PSA, especially gymnastics, could be linked to the fact that they are less subject to scoliosis-related biomechanical repercussions leading to a better balance control, which is essential in these PSA.

Facet Asymmetry in Normal Vertebral Growth

The shape and orientation of the thoracic and lumbar zygapophyseal facets at the T1-L5 level in children were measured and analyzed. To detect the pattern of zygapophyseal facet asymmetry in the thoracic and lumbar spines in children. Whereas many studies have defined the pattern of zygapophyseal facet asymmetry in adults, there is insufficient data in children. A 3-dimensional digitizer was used to measure zygapophyseal facet size, topography (length, width, concavity, convexity, and lateral interfacet height), and orientation (transverse and sagittal facet angles) at the T1-L5 level. Thirty-two complete, nonpathologic skeletons of children (age range from 4 to 17 years), housed at the Hamman-Todd Human Osteological Collection (Cleveland Museum of Natural History, Cleveland, OH) were assessed. Statistical analysis included paired t tests and analysis of variance. In general, zygapophyseal facet asymmetry in children exists only in the superior facets of the thoracic spine and is independent of age: The right superior facet is significantly shorter than the left in all thoracic vertebrae T1-T12 (up to -2.91 mm at T1), and significantly wider than the left in thoracic vertebrae T1-T9 (T8 excluded) (P < 0.003). The right superior transverse and sagittal facet angles are significantly greater than the left in thoracic vertebrae T1-T11, indicating a lesser inclination (in the sagittal plane) and more frontally positioned facet (in the transverse plane) (P < 0.003). Facet asymmetry was not evident in the superior or inferior facets of the lumbar vertebrae. Facet asymmetry in thoracic vertebrae appears in early childhood. The pattern of this asymmetry differs from that reported for adults and may be considered as a possible contributing etiological factor in the development of different types of idiopathic scoliosis.

Management Themes in Early Onset Scoliosis

Children with early onset scoliosis present with the deformity in the first five years of life. Radiographic criteria may be helpful to distinguish between the curves that will progress from those that will spontaneously resolve. Severe cardiopulmonary problems can occur in patients with untreated progressive curves. A comprehensive evaluation should be performed to identify the true cause of the deformity, including any conditions that are commonly associated with early onset scoliosis. Progressive curves of ≥20° may require the use of magnetic resonance imaging to assess for occult lesions of the central nervous system. Surgical treatment of spinal deformity should be considered when nonoperative measures, including bracing and casting, are not indicated or fail to arrest curve progression. Surgical methods continue to evolve and are primarily directed at obtaining and maintaining curve correction while simultaneously preserving or encouraging spinal and trunk growth. There are three surgical options for the treatment of early onset scoliosis: spinal fusion to halt the growth of the spine entirely, hemiepiphysiodesis or temporary tethering to cause a convex arrest of growth, and the use of growing-rod instrumentation to allow spinal growth by way of distraction. In 1954, James described the three types of idiopathic scoliosis—infantile, juvenile, and adolescent—on the basis of the age of onset: infantile denotes curves that develop at three years of age or less; juvenile, those that develop between four and nine years of age; and adolescent, those that occur between ten years of age and the time at which growth is complete1. These three periods correspond to distinct periods of growth during childhood and adolescence. The infantile and adolescent periods are marked by an increased growth velocity, whereas most of the juvenile period, in contrast, correlates with a deceleration of spinal growth. Consequently, the onset of scoliosis is relatively uncommon during …

Analysis of Preexistent Vertebral Rotation in the Normal Quadruped Spine

In this CT study, vertebral rotation was analyzed in the transverse plane of the normal, nonscoliotic canine spine with a computer-based measurement method. To determine if a rotational pattern exists in the normal, nonscoliotic quadruped spine, similar to what is seen in humans. Idiopathic scoliosis does not occur in quadrupeds. In humans, the normal, nonscoliotic spine shows a preexistent pattern of vertebral rotation, which corresponds to the most prevalent curve types of idiopathic scoliosis. Since this rotational tendency has only been demonstrated in humans, it is not clear if it can be considered as a part of the pathogenesis of idiopathic scoliosis or as a normal anatomic feature. CT scans of the thorax of 42 dogs without clinical or radiologic evidence of scoliosis were used to measure axial vertebral rotation from T1-T13 with a previously developed computer-based CT measurement method. The results of this study demonstrated a predominant rotation to the right of the upper, mid, and lower thoracic vertebrae of the normal canine spine. The mean vertebral rotation angles differed significantly from zero degrees rotation at level T1, from level T4-T7, and from T11-T13. The normal spine of quadrupeds shows rotation of the thoracic vertebrae with a preferred direction to the right, similar to what is seen in humans. Since idiopathic scoliosis does not exist in quadrupeds, this preexistent rotation seems to be a physiologic process in normal spinal development, independent of the pathogenesis of scoliosis.

Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study.

Previous long-term studies of idiopathic scoliosis have included patients with other etiologies, leading to the erroneous conclusion that all types of idiopathic scoliosis inevitably end in disability. Late-onset idiopathic scoliosis (LIS) is a distinct entity with a unique natural history. To present the outcomes related to health and function in untreated patients with LIS. Prospective natural history study performed at a midwestern university with outpatient evaluation of patients who presented between 1932 and 1948. At 50-year follow-up, which began in 1992, 117 untreated patients were compared with 62 age- and sex-matched volunteers. The patients' mean age was 66 years (range, 54-80 years). Mortality, back pain, pulmonary symptoms, general function, depression, and body image. The estimated probability of survival was approximately 0.55 (95% confidence interval [CI], 0.47-0.63) compared with 0.57 expected for the general population. There was no significant difference in the demographic characteristics of the 2 groups. Twenty-two (22%) of 98 patients complained of shortness of breath during everyday activities compared with 8 (15%) of 53 controls. An increased risk of shortness of breath was also associated with the combination of a Cobb angle greater than 80 degrees and a thoracic apex (adjusted odds ratio, 9.75; 95% CI, 1.15-82.98). Sixty-six (61%) of 109 patients reported chronic back pain compared with 22 (35%) of 62 controls (P =.003). However, of those with pain, 48 (68%) of 71 patients and 12 (71%) of 17 controls reported only little or moderate back pain. Untreated adults with LIS are productive and functional at a high level at 50-year follow-up. Untreated LIS causes little physical impairment other than back pain and cosmetic concerns.

Buckling and bone modeling as factors in the development of idiopathic scoliosis.

Computational analysis using the finite-element method was used to examine a possible etiology of idiopathic scoliosis. To compare changes in the coronal and the transverse planes of idiopathic thoracic scoliosis with changes produced in a finite-element buckling model, and to investigate the influence of bone modeling on the buckling spine. Although it is now widely accepted that growth is related strongly to the onset and progression of scoliosis, the pathomechanism or etiology of idiopathic scoliosis still is not clear. A previous study showed that a buckling phenomenon caused by anterior spinal overgrowth can produce scoliosis, and that the fourth buckling mode matched the clinical characteristics associated with the thoracic type of idiopathic scoliosis. The fourth buckling mode occurs when the first, second, and third buckling modes are prevented. The spinal finite-element model used in this study consisted of 68,582 elements and 84,603 nodes. The transverse changes seen in the computed tomography images of 41 patients with idiopathic thoracic scoliosis (apex, T8; average Cobb angle, 52.5 degrees) were compared with those produced in the fourth buckling mode. Bone modeling (bone formation and resorption) was simulated as heat deformation caused by changes in temperature. The bone formation and resorption were simulated, respectively, by positive and negative volume changes in proportion to the stress that occurred in the buckling spine. Computed tomography images of scoliosis show that as the scoliosis becomes more severe, the thoracic cage decreases on the convex side of the curve and increases on the concave side. The opposite thoracic cage deformation was obtained in the fourth buckling mode. In patients with scoliosis, the sternum essentially remains in its original position with respect to the vertebrae, but in the linear buckling model, it shifted in the direction of vertebral body rotation. In contrast to clinical data, the incremental deformation resulting from bone formation corrected the original curve, and the thoracic cage distorted. On the other hand, incremental deformation resulting from bone resorption worsened the original curve, and the thoracic cage distorted in a manner similar to that described by the clinical data. This computational investigation suggests that scoliotic changes in the spinal column triggered by the buckling phenomenon are counteracted by bone formation, but worsened by bone resorption. The authors hypothesized that scoliosis progressed with resorption of loaded bone. However, it is unclear whether this hypothesis applies to a living body in practice because of the effects from additional factors.