Scoliosis

Objective To define the origin of radiculopathy of patients with degenerative lumbar scoliosis and to assess the correlation between percentage of radiculating pain relief with selective nerve root injections and lateral canal dimensions. Methods Ninety-three consecutive ...

Study Design. Retrospective case control study.Objective. To evaluate the hemostatic benefits of using a kaolin impregnated dressing during pediatric spinal deformity correction surgery.Summary of Background Data. Minimizing blood loss and transfusions are clear benefits for patient safety. A technique common in both severe trauma and combat medicine that has not been reported in the spine literature is wound packing with a kaolin impregnated haemostatic dressing.Methods. Estimated blood loss and transfusion amounts were analyzed in a total of 117 retrospectively identified cases. The control group included 65 patients (46F, 19M, 12.7±4.5 years, 10.2± 4.8 levels fused) who received standard operative care with gauze packing between June 2007 and March 2010. The treatment group included 52 patients (33F, 19M, 13.9±3.2 years, 10.4 ± 4.3 levels fused) who underwent intra-operative packing with QuikClot Trauma Pads (QCTP, Z-Medica Corporation) for all surgeries from July 2010 to August ...

Familial dysautonomia is a hereditary multisystemic disease primarily affecting people of Ashkenazi Jewish descent. Musculoskeletal problems are related to gait disorders, spinal deformities, foot deformities, fractures, and arthropathies. The charts and radiographs of 136 patients who ranged in age from three months to forty-six years (mean, sixteen years) were reviewed. Sixty-four patients were available for follow-up examination. Spinal deformity was the most common orthopaedic problem and was diagnosed in seventy-eight patients starting at the age of four years, with a prevalence of 86 percent (forty-eight of fifty-six) by the age of fifteen years. Forty-one (53 percent) of the seventy-eight patients had scoliosis only, thirty-four (44 percent) had kyphoscoliosis, and three (4 percent) had kyphosis only. Bracing was accompanied by emotional, pulmonary, and skin problems, leading to a high rate of noncompliance and progression of the curve. Twenty-four patients had an operation a...

The diagnostic study of spinal deformities has long been a focus of medical science. For a clear condition assessment of scoliotic patients X-ray images are used. Disadvantages of X-ray inspections, however, make methodological research, which can lead to fast and cost-efficient examinations without harmful radiation, reasonable. HISTORY: In 1874, after LORD RAYLEIGH had studied the resultant pattern, the so-called moiré fringes of two overlapping grids, he concluded that the phenomenon could be useful for measurement purposes. Beyond industrial applications further research, about a hundred years later, proposed moiré topography for measurement of the human body. AIMS AND METHODS: The aim of this publication, based on thorough study of resources, is to present the basic theory of the moiré method and its application in scoliosis. The two main methods − the shadow and projection moiré − of moiré technique are described in detail. Moreover, the paper presents KAMAL's algorithm suggesting to calculate the plane angle of curvature in single-curve scoliosis cases and proposes directions for further research and developments. RESULTS: The significant advantages of the moiré method are that it is fast, non-invasive, portable, cost-efficient and has no harmful radiation. A moiré technique chosen and algorithmized well can be convenient for substitution or as a complement of X-ray images in scoliosis. However, it is a limitation that a methodological standard which could lead to generally reliable results has not been created yet. Furthermore, the amount of labour required for the evaluation of moiré images is not inconsiderable. To achieve further success of the moiré method a dedicated partnership of engineers and physicians, respectively the application of technical-biomedical knowledge is needed.

Diagnostic testing. The goal of this study is to measure the accuracy and reliability of the Orthoscan (Orthoscan Technologies, Inc.) and to determine whether it can be substituted for radiographs in the surveillance of adolescent idiopathic scoliosis (AIS). AIS is usually followed using scoliosis radiographs, which offer the most reliable way to quantify the curve, but carry the risk of exposure to ionizing radiation. The Orthoscan is a nonradiographic topographic method for measuring spinal curves. There were 5 phases of this study that measured: the accuracy and reliability of the machine when used with a plastic model; the variability with a real patient; the intraobserver variability; the correlation between the measurements of the machine and that of the radiograph; and the correlation between the change in radiograph measurement over time and the change in Orthoscan measurement over time. In measurement of a static plastic model, the machine measured curves with a standard de...

Outcome study to determine the internal consistency, and validity of adapted Turkish version of Scoliosis Research Society-22 (SRS-22) Instrument. To evaluate the validity and reliability of adapted Turkish Version of SRS-22 questionnaire. The SRS-22 questionnaire is a widely accepted questionnaire to assess the health-related quality of life for scoliotic patients in the United States. However, its adaptation in languages other than the source language is necessary for its multinational use. Translation/retranslation of the English version of the SRS-22 was done, and all steps for cross-cultural adaptation process were performed properly by an expert committee. Later, SRS-22 questionnaires and previously validated Short Form-36 (SF-36) outcome instruments were mailed to 82 patients who had been surgically treated for idiopathic scoliosis. All patients had a minimum of 2 years follow-up. Fifty-four patients (66%) responded to the first set of questionnaires. Forty-seven of the first...

To determine whether implant density impact three-dimensional deformity correction in posterior spinal fusion (PSF) without Ponte osteotomies (POs) for patients with Lenke 1 and 2 adolescent idiopathic scoliosis (AIS). Overview of Literature: Currently, the optimal pedicle screw (PS) density for flexible moderate-sized thoracic AIS curve correction is still controversial. There are limited data regarding the impact of implant density on three-dimensional correction in PSF without the use of PO for thoracic AIS surgery. Methods: A database of patients with AIS with Lenke 1 and 2 curves treated with PSF without PO and instrumented with PSs and ≥2-year follow-up was reviewed. The preoperative, immediate, and final follow-up postoperative radiographs were analyzed. The correlation between PS density and the following factors were determined: major curve correction (MCC), correction index (CI; MCC/ curve flexibility), kyphosis angle change, and rib index (RI) correction. Then, patients were divided into low-density (LD) and highdensity (HD) groups according to mean PS density for the entire cohort (1.5 PS per level). Demographics and radiographic and clinical outcomes were compared between groups. Results: The study included 99 patients with Lenke 1 and 23 patients with Lenke 2 AIS. The average MCC was 67.2%. There was no correlation between screw density and these parameters: MCC (r=0.10, p=0.26), CI (r=0.16, p=0.07), change in T2-T12 kyphosis angle (r=−0.13, p=0.14), and RI correction (r=−0.09, p=0.37). Demographic and preoperative radiographic parameters were similar between the LD and HD groups. At the latest follow-up, there were no differences between the two groups in regard to MCC, CI, change in T2-T12 kyphosis angle, RI correction, and Scoliosis Research Society-30 scores (all p>0.05). Conclusions: This study revealed no significant correlation between screw density and curve correction in any planes. HD construct may not provide better deformity correction in patients with flexible and moderate thoracic AIS undergoing PSF without PO.

Introduction: Correct-level surgery is one of the most important concerns in the treatment of patients with adolescent idiopathic scoliosis (AIS). Variations in vertebral number can potentially result in wrong-level surgery. It is possible that the incidence and type of these variations be affected by different factors such as ethnicity. In the current retrospective study, the prevalence of these variations in Iranian AIS patients was investigated. 
Methods: Between 2012 to 2017, spinal fusion was performed for the treatment of AIS in 125 patients. The thoracic and lumbar vertebrae were enumerated on posteroanterior radiographs. The first thoracic vertebra was the one attached to the first pair of ribs. Enumeration was continued in a caudal direction. The lumbar level initiated just below the last vertebra with a pair of associated ribs.
Results: Abnormal vertebral enumeration was found in 18 patients (14.4%). The prevalence of abnormal lumbar enumeration was higher than thoracic vertebrae (10.4% versus 4%). Eleven thoracic vertebrae were found in 5 patients (4%). Four lumbar vertebrae were found in eleven patients (8.8%). There were two patients with six lumbar vertebrae (1.6%). There was no patient with abnormal enumeration of both thoracic and lumbar vertebrae.
Conclusion: The current study showed a relatively high rate of atypical number of thoracic and lumbar vertebrae in Iranian AIS patients. It is necessary to enumerate the vertebrae on the basis of an organized protocol preoperatively to prevent wrong-level surgery in AIS patients.

We reviewed retrospectively our patients with thoracic lordoscoliosis and conducted a conceptual analysis of the patients with airway compression and atelectasia due to anterior protrusion of the vertebral bodies in order to describe the pathological conditions involved and the management methods used. Our goal was to develop a new concept for quantifying thoracic deformation. The individual cases discussed here have been reported earlier, but this is the first series analysis to date. Eighteen patients, aged 7.3 to 18 years, with thoracic lordoscoliosis due to a variety of causes, mostly neuromuscular disorders (12 cases), are described. Most patients were treated by anterior subtotal periosteal resection of the vertebral body followed by posterior instrumentation and arthrodesis. Atelectasia disappeared with a normalization of blood gases but the effect was variable on vital capacity. The analysis of the CT studies led to the concept of spinal deformity as an endothoracic deformat...

The quality of life among children with idiopathic scoliosis during their adolescence has been reported to be affected by the brace itself. However, a controversy exists whether brace treated scoliotics experience a poor quality of life, thus there is a need for the development of a brace-oriented instrument, as the now-existing questionnaires that are commonly used, such as the SRS -22, take into consideration the effects of both the conservative and the surgical treatment on quality of life of scoliotic children. The aim of the present study is to assess the validity and reliability of Brace Questionnaire (BrQ), a new instrument for measuring quality of life of scoliotic adolescents who are treated conservatively with a brace. Methodology of development involved literature review, patient and health care professionals' in-depth interviews and content validity analysis on patients. A validation study was performed on 28 brace treated scoliotic children aged between 9 and 18 years old. BrQ was assessed for the following psychometric properties: item convergent validity, floor and ceiling effects, internal consistency reliability, clinical validity and responsiveness to change. BrQ is self administrated and developmentally appropriate for ages 9 to 18 years old and is consisted of 34 Likert-scale items associated with eight domains: general health perception, physical functioning, emotional functioning, self esteem and aesthetics, vitality, school activity, bodily pain and social functioning of scoliotic children treated conservatively with a brace. The subscales of these eight dimensions can be combined to produce a total score. Higher scores mean a better quality of life. An item convergent validity >/= 0.40 was satisfied by all items in the present study. A satisfactory internal consistency reliability for the BrQ was recorded (Cronbach's alpha coefficient was 0.82). There were no floor or ceiling effects. The correlation between BrQ overall scores and mild and moderate scoliosis was statistically significant (p < 0.001), revealing high clinical validity. An increase in effect sizes for the patient with improved scoliotic curves indicates that the BrQ is responsive to change in health status. BrQ is reliable, valid and responsive to change in adolescents with IS who are treated conservatively with a brace.

Introduction: Scoliosis is a three-dimensional deformative abnormality of the spine, defined by the Cobb's angle of spine curvature in the coronal plane, and is often accompanied by vertebral rotation in the transverse plane and hypokyphosis in the sagittal plane. Based on the age of presentation, scoliosis is further categorized as infantile, juvenile or adolescent idiopathic. Adolescent idiopathic scoliosis (AIS) has the highest prevalence of the three categories. This type of scoliosis is present at age ten and lasts till the end of growth. Its prevalence is dependent on the curvature of the spine and gender of the patient. Objective: The purpose of this review is to evaluate the role of physiotherapy in reducing curve progression and pain, postponing or avoiding invasive treatment and improve the quality of life in adolescents with AIS. Methodology: The study is a Systematic Review, meta-analytic type, consisting of 5 studies (RCT) of the last ten years, which focus on the i...

Purpose The aim of this study was to assess the psychometric properties of a youth version of the EQ-5D five-level questionnaire (5LY) and its three-level version (3LY) in a sample of Chinese paediatric patients. Methods A consecutive sample of idiopathic scoliosis patients were recruited from a referral outpatient scoliosis center at Hong Kong, China in October 2017 and completed the two versions of EQ-5D-Y. Redistribution properties in each dimension of EQ-5D-Y were analyzed between 5LY and 3LY by logistics regressions. Absolute reduction and relative reduction in ceiling effects from the 3LY to the 5LY were calculated. Test-retest reliability was assessed by examining the Gwet's agreement coefficient (Gwet's AC) for five individual dimension responses over the 2-week period. Results A total of 129 idiopathic scoliosis patients completed the two versions of EQ-5D-Y at baseline assessment, among which 70 patients completed the test-retest interview in 2-3 weeks after baseline assessment. For redistribution properties , the proportion of inconsistency was low in all the dimensions, ranging from 0.0% ("Usual activities") to 3.9% ("Pain/ discomfort"). Ceiling effects were reduced in four dimensions. "Usual activities" dimension showed significant reduction (absolute and relative reductions: 3.9% and 4.3%; p = 0.025) and the "worried/sad/unhappy" dimension showed the largest significant reduction in ceiling effects (absolute and relative reductions: 7.8% and 9.8%; p = 0.012). The 3LY and 5LY showed very good agreement (> 80%) of individual dimension responses between two assessments, except for the "worried/ sad/unhappy" dimension in 3LY. Conclusion Through this head-to-head comparison, the 5LY had significant improvements in ceiling effects in two dimensions when compared to 3LY but other measurement properties of 3LY and 5LY performed similar in the idiopathic scoliosis patient group. Keywords EQ-5D-5L · EQ-5D-Y · Children · Youth · Psychometric properties · Idiopathic scoliosis JEL Classification I10 · J13 Key findings • This is the very first psychometric evidence of 5LY, and head-to-head comparison of the 3LY and 5LY worldwide .

The body image is to be reconstructed during adolescence, which is more difficult in the case of somatic illness and social stigma. This research aimed to study adolescents' body image with scoliosis, students of a special educational institution in Ukraine socially identified with stigma as 'a school for scoliotics'. The participants (n=104) of the research were adolescents (13-15 years old) with scoliosis from the institution mentioned above (n=52, 24 males, 28 females) and adolescents without scoliosis from the same city (n=52, 24 males, 28 females). Two methods were used to collect the data: (1) Self-portraits; (2) Dembo-Rubinstein Self-Assessment Scale. The adolescents with scoliosis and labeled as 'scoliotics' face additional obstructions in their psychic body development compared to their peers. For instance, they tend to overinvest in the desired image of a healthy body and do not feel able to get it. We found the markers of four different ways to cope with the situation by the adolescents with scoliosis: (a) identification as 'a scoliotic' instead of hope to be cured soon; (b) psychological distancing from the others to preserve the desire of a more attractive body image; (c) repression or denial of the body parts which could relate to scoliosis; (d) infantilization, aimed to slow down the discovery of their maturing corporeality. Consequently, adolescents with scoliosis affected by stigma experience the gap or conflict between their current, desired and perceived realistic body image.