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Query: UMLS:C0700208 (scoliosis)
 8,574 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Degenerative lumbar scoliosis is a lateral deviation of the spine that typically develops after age 50 years. Clinical presentation varies, but the deformity frequently is associated with loss of lordosis, axial rotation, lateral listhesis, and spondylolisthesis. Although the etiology is unclear, degenerative scoliosis is associated with degenerative disk disease, facet incompetence, and hypertrophy of the ligamenta flava, typically leading to neurogenic claudication and back pain. Rarely, sagittal or coronal imbalance may develop. Indications for treatment include pain, progressive deformity, radiculopathy or myelopathy, and cosmetic deformity. Nonsurgical care focuses on patient education, exercise, and nonnarcotic medication. Surgical management should be considered carefully, balancing the benefits and risks for the patient.
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PMID:Degenerative lumbar scoliosis: evaluation and management. 1282 47

The unrelenting changes associated with aging progressively affects all structures of the spinal units. The degenerative process starts early during the first decade of life at the disc level. Discal degeneration is associated with biochemical changes followed by macroscopic alterations including tears and fissures, which may lead to discal herniation, the main cause of radiculopathy in the young adult. Moreover, nociceptive nerve fibers have been demonstrated in degenerated discs. They may be a source of nociception and of pure low-back pain. Facet joint changes are usually secondary to discal degeneration. They include subluxation, cartilage alteration and osteophytosis. Facet hypertrophy and laxity, associated with discal degeneration, and enlargement of the ligamentum flavum progressively create narrowing of the spinal canal as well as degenerative instabilities such as spondylolisthesis and scoliosis, which are the main causes of neurogenic claudication and radiculopathy in old persons. Vertebral bodies are the static elements of the spinal unit. With advancing age, osteoporosis weakens the bony structures and facilitates bone remodeling and rotatory deformities. Finally, aging of bone, discs, facets, ligaments, and muscles may ultimately lead to rotatory scoliosis, destabilization, and rupture of equilibrium.
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PMID:Natural history of the aging spine. 1296 Oct 79

Stenosis is the narrowing of a hollow tube, in this case the central lumbar spinal canal, lateral recess, or foramen. Clinically, this narrowing produces neurovascular compression that may lead to pain. Lumbar spinal stenosis may be classified by etiology (for example, congenital or acquired) or by symptom complex (radiculopathy, neurogenic claudication, or mechanical back pain). Stenosis can also be classified radiographically, by the location of the stenosis (for example, central canal, lateral recess, or intervertebral foramen) or by the presence of deformity such as spondylolisthesis or scoliosis. Overlap occurs in these schemes of classification in that central stenosis with thecal sac compression typically leads to neurogenic claudication, whereas lateral recess compression is associated with compression of an individual nerve root and, therefore, radiculopathy. Because radiographic changes associated with stenosis are very common with aging, understanding the pathophysiology of lumbar spinal stenosis is critical in the assessment and management of related symptom complexes. Although symptoms may arise from narrowing of the spinal canal, not all patients with narrowing develop symptoms. The reason why some patients develop symptomatic stenosis and others do not is still unknown. Therefore, the term lumbar spinal stenosis refers not to the pathoanatomic finding of spinal canal narrowing, but rather to a clinical syndrome of lower extremity pain caused by mechanical compression on the neural elements or their blood supply.
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PMID:Spinal stenosis: pathophysiology, clinical and radiologic classification. 1594 57

A 37-year-old female presented with a history of lumbar intraspinal glass fragments due to an accident in childhood. The patient developed progressive right convexity thoracolumbar scoliosis during puberty. Twenty-eight years after the accident, horizontalization of this deformity was performed by dorsal stabilization. Postoperatively the patient complained of acute L-5 radiculopathy. Radiological examination detected multiple glass fragments intra- and extradurally around the L3-4 levels with compression of the dural sac. Microsurgical removal of the extra- and intradural glass fragments led to complete relief of the radicular pain. Foreign bodies can become symptomatic due to changes in the status of the spine, especially during growth in young patients.
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PMID:Long-standing intraspinal glass fragments causing subsequent radiculopathy after dorsal stabilization. 1699 82

Double crush syndrome (DCS) was first described by Upton and McComas who proposed that focal compression of an axon often occurs at more than one level. The aim of the study was to support the hypothesis of DCS of the median nerve on the basis of available diagnostic methods. 30 patients (25 F and 5 M aged 33-73, mean 54.6+/-8.2 years) with coexisting carpal tunnel syndrome (CTS) and cervical radiculopathy (CR) were examined. Control group included 40 healthy volunteers (27 F and 13 M aged 17-82, mean 43.1+/-11 years). Medical evaluation comprised clinical examination, X-ray and MR imaging of the cervical spine, electroneurography (ENG) with F-wave and somatosensory evoked potentials (mSEPs) of median nerves. In clinical examination 96.6% of patients suffered from cervical spine pain and nocturnal paresthesies of at least one hand. Muscular atrophy was present in 43.3% in the proximal and in 70% in the distal part of the upper extremity. 30.3% of patients presented with a thoracic scoliosis. On X-ray examination, all patients showed cervical discopathy, mostly C5-C6 (70%) and C6-C7 (53.3%). Using MR investigation, the narrowing of intervertebral foramina was present in 81.25% and narrowing of vertebral canal in 37.5%. On ENG all patients presented with CTS, bilaterally in 73.3%. The F wave was abnormal in 73.3% and mSEPs in 66.7% of patients. Coincidence of MR and mSEPs in view of lateralization was observed in 71.4%. Results supported the DSC hypothesis. DCS evaluation requires both structural and functional diagnosis of peripheral neurones using MRI and electrophysiological examination.
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PMID:Double crush syndrome evaluation in the median nerve in clinical, radiological and electrophysiological examination. 1710 65

The objective of this study was to improve upon leg somatosensory-evoked potential (SEP) monitoring that halves paraplegia risk but can be slow, miss or falsely imply motor injury and omits arm and decussation assessment. We applied four-limb transcranial muscle motor-evoked potential (MEP) and optimized peripheral/cortical SEP monitoring with decussation assessment in 206 thoracolumbar spine surgeries under propofol/opioid anesthesia. SEPs were optimized to minimal averaging time that determined feedback intervals between MEP/SEP sets. Generalized changes defined systemic alterations. Focal decrements (MEP disappearance and/or clear SEP reduction) defined neural compromise and prompted intervention. They were transient (quickly resolved) or protracted (>40 min). Arm and leg MEP/SEP monitorability was 100% and 98/97% (due to neurological pathology). Decussation assessment disclosed sensorimotor non-decussation requiring ipsilateral monitoring in six scoliosis surgeries (2.9%). Feedback intervals were 1-3 min. Systemic changes never produced injury regardless of degree. They were gradual, commonly included MEP/SEP fade and sometimes required large stimulus increments to maintain MEPs or produced >50% SEP reductions. Focal decrements were abrupt; their positive predictive value for injury was 100% when protracted and 13% when transient. Six transient arm decrements predicted one temporary radial nerve injury; five suggested arm neural injury prevention (2.4%). There were 15 leg decrements: six MEP-only, four MEP before SEP, three simultaneous and two SEP-only. Five were protracted, predicting four temporary cord injuries (three motor, one Brown-Sequard) and one temporary radiculopathy. Ten were transient, predicting one temporary sensory cord injury; nine suggested cord injury prevention (4.4%). Two radiculopathies and one temporary delayed paraparesis were unpredicted. The methods are reliable, provide technical/systemic control, adapt to non-decussation and improve spinal cord and arm neural protection. SEP optimization speeds feedback and MEPs should further reduce paraplegia risk. Radiculopathy and delayed paraparesis can evade prediction.
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PMID:Four-limb muscle motor evoked potential and optimized somatosensory evoked potential monitoring with decussation assessment: results in 206 thoracolumbar spine surgeries. 1763 28

Marfan syndrome is a inherited connective tissue disorder due to mutations in fibrillin-1. It presents with cardiovascular, ocular, skeletal, pulmonary and dural signs and symptoms. Some of the symptoms of later onset are those associated with scoliosis and dural ectasia. This is the enlargement of the neural canal especially in the lower lumbar and sacral region and occurs in over 90% of Marfan patients. We here report three patients with lumbar and/or sacral radiculopathy due to (kypho)scoliosis and dural ectasia with spinal meningeal cysts. The pain, muscle weakness, muscle atrophy, and sensory disturbances illustrate the severe neurological complications which may occur in Marfan syndrome, especially at later age. Awareness of these complications and development of management protocols is essential since life expectancy of Marfan patients has increased. Marfan syndrome might gradually become recognized as an inherited connective tissue disorder with potentially severe neurological complications during ageing.
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PMID:Radicular dysfunction due to spinal deformities in Marfan syndrome at older age: three case reports. 1987 83

The spinal nerve can be pinched between the transverse process of the fifth lumbar vertebra and the sacral ala. The patients are divided into two types: elderly persons with degenerative scoliosis and somewhat younger adults with isthmic spondylolisthesis. For the first time, we describe extraforaminal impingement of the spinal nerve in transitional lumbosacral segment with unilateral transverse process anomaly. Selective nerve root blocks were performed in two clinical cases. One patient underwent nerve root decompression via a posterior approach. One year after operation, this patient reported no radicular or lumbar pain. The pathoanatomical study demonstrated pseudoarthrosis between the transverse process and the ala of the sacrum and showed dysplastic facet joints at the level below the transitional vertebra in all specimens. Furthermore, we present the oldest illustration of this pathological condition, published in a book by Carl Wenzel in 1824. Extraforaminal entrapment of the spinal nerve in transitional lumbosacral segment with unilateral transverse process anomaly can cause radiculopathy, and osteophytes are the cause of the entrapment. Dysplastic facet joints on the level below the transitional vertebra could be one reason for "micromotion" resulting in pseudoarthrosis with osteophytes. Sciatica relief was obtained by means of selective nerve root blocks or posterior decompression via a dorsomedial approach.
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PMID:Transitional lumbosacral segment with unilateral transverse process anomaly (Castellvi type 2A) resulting in extraforaminal impingement of the spinal nerve: a pathoanatomical study of four specimens and report of two clinical cases. 2112 90

A butterfly vertebra is a congenital anomaly often associated with a series of syndromic diseases and is often recognized incidentally without any presenting symptoms. The authors report the case of a 13-year-old girl with lumbar scoliosis and mild spondylolisthesis associated with a butterfly vertebra at L-6 causing radiculopathy. The L-5 and L-6 nerve roots were entrapped at the intervertebral foramina between L-5 and the butterfly vertebra (L-6) and between L-6 and S-1 in the concave side. To decompress and preserve the two nerve roots, correct the deformity, and obtain a solid bone fusion, surgery involving the thorough removal of the facet joints between L-5 and L-6 and between L-6 and S-1 in the concave side was performed, with a partial resection of the butterfly vertebra and the placement of a titanium mesh cage between the L-5 and S-1 pedicles dorsal to the nerve roots. Complete pain relief and correction of the deformity with solid bone fusion was obtained after a 2-year follow-up period.
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PMID:Interpedicular graft using a titanium mesh cage in a patient with lumbar scoliosis associated with a congenital butterfly vertebra. 2121 13

More adults are suffering from adult idiopathic scoliosis and seeking treatment for their spinal deformities. Adult idiopathic scoliosis can lead to painful spinal osteoarthritis, progressive deformity, spinal stenosis with radiculopathy, muscle fatigue from coronal and sagittal plane imbalance, and psychological effects with a visible deformity. Primary treatment of such conditions is conservative; however, some patients are resistant to conservative treatment or are not candidates for it, and they require surgery. Back pain is likely the most common indication for surgical treatment of scoliosis in adult patients. Pedicle screws offer 3-column purchase and a longer arm compared with hook placement on the lamina. This study is a retrospective analysis of a consecutive series of patients with adult idiopathic scoliosis who were treated with pedicle screw placement. Significant back pain relief and satisfaction can be achieved and maintained over the long term. Restoration of coronal and sagittal balance, or improvement thereof, was achieved in all patients with balance problems. This study clarified several important characteristics of adult scoliosis, and we believe that useful conclusions can be drawn regarding its surgical indications and strategies: (1) pedicle screw construct can gain effective results for treatment of adult idiopathic scoliosis due to its perceived superior power of correction; (2) younger patients present for surgery for different reasons than older patients (progressive deformity or pain); and (3) pain improvement is a more reliable outcome in older patients than younger patients, although younger patients rarely have severe pain symptoms.
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PMID:Surgical treatment of adult idiopathic scoliosis: long-term clinical radiographic outcomes. 2141 Jan 22


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