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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Author's opinion is that the disease will very slightly progrediate after adolescent age. Greater progression can be observed only in scoliosis cases higher than 50 degrees. The grown up patient get used to this physical state and it doesn't mean cosmetical handicap. Side effects of adult scoliosis can be pain and less frequently cardio-respiratoric problems. This latter can result in patient's being unable to continue working. Side effects are related to the degree of curving but mainly they come about in cases with more than 50-60 degrees of scoliosis. Consequently much effort should be made by the traditional way or by surgical treatment to stop children patients developing serious curve. Moderate scoliosis can be no handicap for grown ups.
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PMID:[Idiopathic scoliosis in adults]. 239 28

We have evaluated the role of radiotherapy in providing local control of primary tumors and to palliate metastases from neuroblastoma (NB). Fifty-five children with histologically verified NB were evaluated and treated from 1967 to 1984. In univariate analysis, the actuarial survival of eight children with thoracic primaries (85%) was significantly better than the survival of 39 children with intra-abdominal primaries (35%, p = 0.0287). The survival of 28 children less than or equal to 18 months of age at diagnoses was 73%, whereas 27 children older than 18 months had a survival probability of 10% (p = 0.0001). The survival by Evans stage was: I 100% (2 patients), II 85% (7), III 60% (13), IV 4% (27) and IV-S 100% (6). According to the Pediatric Oncology Group (POG) staging system, the survival was: A 100% (3), B 66% (9), C 66% (9), D 23% (34). A multivariable analysis indicated that the Evans staging system was a more powerful indicator of prognosis than the POG system. The analysis also indicated that Evans stage and patient age were independent determinants of survival. The primary tumor site did not add significant prognostic information beyond these two factors. Children with Stage I disease were treated with surgery alone. Most children with Stages II and III disease were treated with surgery, irradiation, and Cyclophosphamide or Cyclophosphamide plus Vincristine. All seven patients with Stage II disease received post-operative irradiation to the primary tumor and were locally controlled with doses of 4.8 to 26.5 Gy. Eleven of the 13 patients with Stage III disease were irradiated post-operatively. Seven of these 11 patients were locally controlled with doses of 12 to 48.4 Gy. The four Stage III patients with in-field recurrences were older children with large radiotherapy fields and/or low doses administered. The Radiation Therapy Oncology Group pain score system was used to evaluate response of painful bony metastases to irradiation. A response was observed in 65% of the sites irradiated. A response was observed at 67% of the soft tissue metastases irradiated. Hepatomegaly causing respiratory embarrassment or inferior vena cava obstruction was treated with irradiation in seven patients. All patients responded with doses ranging from 5 to 24.4 Gy. Five of the 17 children who survived for more than 5 years following treatment had significant scoliosis or kyphosis secondary to vertebral body abnormalities in irradiated bones. All five children were irradiated at a young age with megavoltage equipment.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Radiation therapy in the management of neuroblastoma: the Duke University Medical Center experience 1967-1984. 242 88

Instability of the spine caused by metastatic spread of primary tumors represents a serious risk for spinal cord or nerve root compression. In order to restore stability and relieve neural compression, a variety of surgical techniques originally used for reduction of nonpathologic spinal fractures have been applied to the problem of spinal metastases. Recently, we have utilized a technique developed primarily for correction of scoliosis to the treatment of metastatic spinal fractures. Six patients with spinal instability and neural compression secondary to metastatic tumors had segmental spinal stabilization with Luque rods, sublaminar wiring, and methyl methacrylate. Restoration of stability was successful in all cases with alleviation of preoperative pain and return to full activity. No evidence of instability occurred in this group of patients. As demonstrated by this experience and that of a few other small series, Luque rod stabilization provides a valuable addition to the techniques available for stabilization of metastatic fractures of the spine. Although the precise role of Luque rod segmental spinal stabilization in treatment of metastatic disease of the spine continues to be defined, thus far it has proved beneficial for cases of multiple vertebral body involvement or instability beyond one vertebral level.
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PMID:Luque rod stabilization for metastatic disease of the spine. 244 24

Three patients developed lumbar radicular pain after Harrington instrumentation and posterior spinal fusion for idiopathic scoliosis. They required a second surgical procedure for nerve root decompression. The presenting complaint after the initial procedure was persistent radicular and buttock pain. Subsequent evaluation revealed direct compression by the inferior hook. At surgery the inferior hook was noted to be encased in bone and had imploded into the canal after a stress fracture of the lamina. Removal of the entire Harrington instrumentation resulted in effective relief of nerve root compression and resolution of radicular pain. To avoid this occurrence the addition of a leg extension to a postoperative brace has been instituted for procedures involving instrumentation to L5 and occasionally to L4.
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PMID:Radicular pain after Harrington instrumentation. 252 54

Surface EMG recordings of bilateral paraspinal muscle tension were measured on 207 subjects (29 non-back pain controls, 20 individuals with spondyloarthritis, 52 with intervertebral disk disorders, 66 with unspecified musculoskeletal backache, 17 with some combination of the above 3 groups and 23 subjects with other types of back pain, including unknown, scoliosis and psychogenic) in 6 positions: standing, bending from the waist, rising, sitting with back unsupported, sitting with back supported and prone. Results of both individual and group analyses revealed a significant main effect of diagnosis. Post hoc analyses (Duncan's) revealed controls to have significantly lower overall EMG levels than the intervertebral disk disorders and unspecified musculoskeletal backache groups. A significant diagnosis by position interaction was observed. Analysis of simple main effects revealed this to be due primarily to control subjects during the standing position having lower EMG levels than all other groups, and intervertebral disk disorder subjects having higher EMG levels than all other groups during the supported sitting position. The importance of clearly defined diagnostic categories in low back pain research and the utility of measuring subjects in various positions are discussed.
Pain 1989 Apr
PMID:Electromyographic recordings of 5 types of low back pain subjects and non-pain controls in different positions. 252 11

This article was written not with the intent of establishing a comprehensive list of all problems seen in the trunk and spine of athletes nor as a cookbook for the treatment of these problems. In addition to the simple muscular strains and contusions of the back the physician must be aware of the possibility of underlying spondylolysis, spondylolisthesis, Scheuerman's kyphosis, and variants of Scheuerman's. In addition to these basic pain-related problems the team doctor should keep the possibility of spinal deformities such as scoliosis and silent kyphosis in mind and observe for those during team physicals. Finally, we note that there are several entities such as disc protrusion, infection, tumors, and fractures that are not frequently seen in athletes but must be considered in the workup of those patients who are refractory to the usual simple conservative treatment.
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PMID:Evaluation and treatment of common spine and trunk problems. 252 19

One hundred one referred adult patients (ages 20-63; mean, 36 years) with painful idiopathic scoliosis were evaluated. None had prior surgical treatment. Severity of pain was graded and localized over radiographic deformities in the coronal and sagittal planes. Radiographic changes in primary as well as full and fractional compensatory curves were studied. Degrees of scoliosis, percent correction on side bending, vertebral body rotation at curve apex, spinal balance, and lateral olisthesis in the coronal plane, degenerative disc disease, and other degenerative changes in all curves were measured and graded in both the coronal and sagittal planes. Lordosis and kyphosis were measured on all standing sagittal radiographs. Forty-one patients had pulmonary function studies. Multiple variable statistical analysis (Spearman correlation coefficients) of the data found fractional lumbosacral curves most painful and disabling. Scoliosis greater than 40 degrees and kyphosis greater than 50 degrees correlated with increasing pain and decreasing forced vital capacity. Reduction in forced vital capacity also correlated with curve rigidity. Rotation correlated closely with degrees of scoliosis (r = 0.70; P less than 0.0001) and had the highest correlation with pain (r = 0.59; P less than 0.0001) of all radiographic findings and deformities studied.
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PMID:Coronal and sagittal plane spinal deformities correlating with back pain and pulmonary function in adult idiopathic scoliosis. 253 6

Postoperative pain is a distressing and disabling feature of scoliosis surgery. Epidural morphine has recently been advocated to reduce the frequency and severity of postoperative pain in adults. A retrospective study of 35 patients was conducted to determine whether epidural administration of morphine is useful in the management of postoperative pain in children and adolescents following posterior spinal fusion. The derived data included dose and frequency of narcotic administration on the day of surgery and during the subsequent three days. On the first postoperative day, the total morphine given averaged only 16.4 mg in patients receiving epidural morphine compared to 27 mg in those receiving only conventional parenteral morphine. Similar significant differences persisted through the second postoperative day. Intermittent epidural injection of small doses of morphine can give satisfactory and prolonged analgesia for early postoperative pain management.
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PMID:Efficacy of intermittent epidural morphine following posterior spinal fusion in children and adolescents. 258 72

The effects of chronic hypervitaminosis A and long-term isotretinoin treatment on bone include cortical hyperostosis, ligament calcification and premature epiphyseal closure. Similar effects have now been reported in patients under maintenance treatment with etretinate in high doses. Etretinate, an oral, aromatic, synthetic vitamin A derivative, is widely used in Europe for disorders of keratinization. We report the cases of two patients--one with lamellar ichthyosis, the other with pachyonychia congenita--who developed such bone diseases during treatment with etretinate over 2 and 6 years respectively. The doses ranged from 0.5 to 1 mg/kg/day. Two years after starting treatment (total dose 25 g), the patient with lamellar ichthyosis complained of mechanical pain in the lumbar region and hips. Radiography showed calcification of the extraspinal tendons and ligaments and hyperostosis of the calcaneus bone at the insertion of the plantar ligament. After six years of etretinate treatment (total dose 50 g), the patient with pachyonychia congenita presented with scoliosis and limb length discrepancy. The musculoskeletal abnormalities resembled chronic hypervitaminosis A, with such osseous changes as demineralization, thinning and increased curvature of long bones with osteopenia, and premature closure of the epiphyses. Acroosteolysis was also present. Etretinate has been implicated in the formation of spinal hyperostoses and calcification of extraspinal ligaments in patients who had taken the drug for many years. The occurrence of premature epiphyseal closure in children certainly is a consequence of therapy with relatively high doses of etretinate for six years. But premature epiphyseal closure may also result from trauma to a fragile bone.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Rheumatologic effects of etretinate]. 266 Jul 11

From our patients who had idiopathic scoliosis, we identified a subset of eighteen in whom Harrington rods were used for fixation down to the fifth lumbar vertebra. In five of these patients, low-back pain, sciatica, and other neurological problems developed at two to thirty-two months after arthrodesis. These complications were caused by migration of the caudad hook into the spinal canal. The migration was probably caused by a combination of lumbosacral lordosis and mobility of the fifth lumbar vertebra (the most caudad mobile segment) on the segment below, resulting in weakening of the lamina of the fifth lumbar vertebra. After removal of the hardware, all patients had improvement of the lumbosacral and radicular pain as well as resolution of the neurological abnormalities.
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PMID:Late neurological complications of Harrington-rod instrumentation. 266 93


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