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

The natural history presented in this chapter applies only to AIS. Other types of scoliosis have their own natural history and associated problems that may significantly affect the ability of the patient to meet the demands of daily life. Increased public awareness and screening clinics have resulted in an increased number of children referred for orthopaedic opinion, less severe curve magnitude at initial detection, and earlier institution of treatment. Treatment of each patient must be individualized, taking into consideration the probability of curve progression based on curve magnitude, skeletal maturity, sexual maturity, and age (Table 6-7). Overdiagnosis and unnecessary treatment must be avoided. As our knowledge of the natural history of AIS expands, treatment decisions can be based on objective rather than subjective data. Any proposed treatment of this condition must have a reasonable chance of altering the natural history in a positive way. The information available on natural history has been accumulated on relatively small groups of patients and the conclusions presented represent generalities. There are probably many "natural histories" for AIS, especially with reference to curve progression; therefore, treatment decisions must be individualized. Long-term results of various treatments for scoliosis must take into consideration the natural history of the disorder.
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PMID:Adolescent idiopathic scoliosis: prevalence and natural history. 264 64

Current knowledge on the association between back pain and idiopathic scoliosis is often contradictory. The presence, localisation and importance of pain was evaluated for a cohort of 426 adolescents with AIS. Patients were recruited from a scoliosis clinic in a pediatric hospital. A questionnaire and an analogue visual scale graduated from 0 (no pain) to 100 (maximal pain) were used in order to verify more precisely, the importance of the association between AIS and back pain. Chisquare, linear regression and Student T-test were used for statistical analysis. 239 patients with right thoracic and left lumbar curves (RTLL) had a prevalence of pain of 54%. The mean of maximum pain intensity was 49 mm +/- 20. No relation was found between the severity of the scoliosis and back pain. The two groups (with and without pain) were comparable. Cobb angles were about the same for the thoracic and lumbar regions, as well as kyphosis and lordosis, weight, height and age. Risser sign, sex, brace and pelvic tilt were the only variables associated with pain (p < 0.0001). Association between AIS and pain is more frequent than generally reported. Pain appears to be more related with pelvic tilt than severity of the scoliosis.
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PMID:[Dorso-lumbal pain and idiopathic scoliosis in adolescence]. 903 37

Pinealectomy in young chickens consistently results in scoliosis, which has many characteristics similar to those seen in adolescent idiopathic scoliosis. The mechanism underlying this phenomenon remains a mystery and it is not yet entirely clear whether some unidentified aspect of the extensive surgery is the major factor rather than the removal of the pineal gland. Four different types of pinealectomy surgery were performed on young chickens as well as deliberate damage to the cerebral cortex which simulated the extreme of any accidental damage that might occur during surgery. Scoliosis was assessed from weekly radiographs. No differences in incidence of scoliosis, degree of severity, or pattern of curve development were observed for any of the experimental groups when compared with controls. In all groups approximately 55% of the chickens developed scoliosis that progressed rapidly. Different pinealectomy procedures and deliberate damage to the cerebral cortex produce scoliosis in young chickens with the same incidence and characteristics. This suggests strongly that the mechanism behind the phenomenon is due to the removal of the pineal gland and not some artifact of the extensive surgery. The pinealectomy model in young chickens is proving to be a good model for studying AIS in humans. An understanding of the mechanism underlying this phenomenon has the potential to provide further insights into the etiology of AIS and can lead to the development of novel treatment methods.
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PMID:Development of scoliosis following pinealectomy in young chickens is not the result of an artifact of the surgical procedure. 1127 73

There is no generally accepted scientific theory for the etiology of idiopathic scoliosis, and treatment is pragmatic and unrelated to such knowledge. As part of its mission to widen understanding of scoliosis etiology, the International Federated Body on Scoliosis Etiology (IBSE) introduced the electronic focus group (EFG) as a means of increasing debate of extant knowledge on important topics. This has been designated as an on-line Delphi discussion, and has proven very successful. The text for this EFG was written by Professor Sevastik and drawn from the extensive research carried out by himself and his co-workers. The thoracospinal concept of etiopathogenesis applies only to girls with right thoracic adolescent idiopathic scoliosis (Rcx-T-AIS-F). According to this concept, increased longitudinal growth of the left periapical ribs triggers the thoracic curve simultaneously in the three cardinal planes. The concept does not deal with factors involved in curve progression. Sevastik advocates mini-invasive operations on the ribs as a treatment for early progressive thoracic curves. Areas of controversy include whether or not there is overgrowth of the left periapical ribs in Rcx-T-AIS-F, and the question of whether there should be a clinical trial of mini-invasive operations on the ribs.
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PMID:A new concept for the etiopathogenesis of the thoracospinal deformity of idiopathic scoliosis: summary of an electronic focus group debate of the IBSE. 1295 11

There is no generally accepted scientific theory for the etiology of idiopathic scoliosis. As part of its mission to widen understanding of scoliosis etiology, the International Federated Body on Scoliosis Etiology (IBSE) introduced the electronic focus group (EFG) as a means of increasing debate of extant knowledge on important topics. This has been designated as an on-line Delphi discussion. The text for this EFG was written by Professor Thomas G Lowe MD and drawn from research carried out by himself and his co-workers on platelet calmodulin levels in patients with adolescent idiopathic scoliosis. To explain the relationship of platelet calmodulin levels to scoliosis curve changes in AIS brought about spontaneously, by brace treatment, or surgery Dr Lowe attributes the platelet calmodulin changes to paraspinous muscle activity and suggests that the calmodulin acts as a systemic mediator of tissues having a contractile system (actin and myosin). Controversy includes: 1) the lack of normal data and the large variability in baseline levels of platelet calmodulin, necessitating the use of the AIS subjects as their own controls; 2) calmodulin is not usually used as a marker of platelet activation; 3) whether the platelet calmodulin changes which appear to reflect an abnormality of a portion of the spine are related to local and/or regional changes in muscles, nervous system, or immature vertebrae. What is not controversial is the need for more research on platelets and the immature deforming skeleton in relation to etiology and prognosis.
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PMID:Platelet calmodulin levels in adolescent idiopathic scoliosis (AIS): can they predict curve progression and severity? Summary of an electronic focus group debate of the IBSE. 1471 44

Pinealectomy in young chickens consistently results in scoliosis which has many characteristics similar to those seen in adolescent idiopathic scoliosis. The mechanism underlying this phenomenon remains a mystery and it is not yet entirely clear whether some unidentified aspect of the extensive surgery is the major factor rather than the removal of the pineal gland. Four different types of pinealectomy surgery were performed on young chickens as well as deliberate damage to the cerebral cortex which simulated the extreme of any accidental damage that might occur during surgery. Scoliosis was assessed from weekly radiographs. No differences in incidence of scoliosis, degree of severity or pattern of curve development were observed for any of the experimental groups when compared with controls. In all groups approximately 55% of the chickens developed scoliosis that progressed rapidly. Different pinealectomy procedures and deliberate damage to the cerebral cortex produce scoliosis in young chickens with the same incidence and characteristics. This suggests strongly that the mechanism behind the phenomenon is due to the removal of the pineal gland and not some artifact of the extensive surgery. The pinealectomy model in young chickens is proving to be a good model for studying AIS in humans. An understanding of the mechanism underlying this phenomenon has the potential to provide further insights into the aetiology of AIS and can lead to the development of novel treatement methods.
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PMID:The development of scoliosis following pinealectomy in young chickens is not the result of an artifact of the surgical procedure. 1545 95

Despite much evidence of its existence, the relation between impaired ANS function and the aetiopathogenesis of AIS has attracted surprisingly little attention. Studies have shown that the left breast of girls with right convex thoracic AIS is significantly more vascular than the right one and that the mean concave minus convex rib length in women with thoracic IS is significantly greater than the left minus right rib length in normal women. Moreover in growing rabbits unilateral regional sympathectomy by resection of intercostal nerves carrying sympathetic fibers results in hypervascularity of the soft tissues, increased rib growth on the side of the operation and thoracic scoliosis convex to the opposite side. The results of these and of other reports provide sufficient indication of a relation between ANS dysfunction and IS, and open new views for research on the connection between the aetiology and pathogenesis of the thoracospinal deformity.
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PMID:Dysfunction of the autonomic nerve system (ANS) in the aetiopathogenesis of adolescent idiopathic scoliosis. 1545 99

Recent studies have demonstrated poor reliability of the King et al. classification of idiopathic scoliosis. The purpose of the present work was to determine whether the reliability of the King classification would be improved by employing unambiguous rules for classification encoded in a computer program. Thus the only possible source of variability in classifying a given radiograph would be variable landmark identification on the radiograph. Coordinates of the four comers of each thoracic and lumbar vertebra were obtained by digitizing radiographs, using the central sacral line to define the y-axis. A computer algorithm located curve apices as the most laterally deviated vertebra in a range of two above to two below a change in the sign of vertebral tilt. End vertebrae of each curve were located as those with the greatest tilt of the superior (proximal end vertebra) or inferior (distal end vertebra). In a lumbar curve, the apical vertebra was defined as 'crossing the midline' if all four corners laid on one side of the vertical central sacral line. Curves were defined as in Table I in King et al., except that curve flexibility data were not used. The algorithm was verified on the five examples in King et al. It then classified the six examples in Lenke et al. and Cummings et al. which were classified unreliably by human observers. The algorithm was also tested on 33 radiographs of 17 patients with AIS, 8 radiographs were repeat marked by two observers. The algorithm overcame accuracy and reliability problems, except in rare cases when it was borderline whether or not a lumbar curve crossed the midline, when the apex level was ambiguous, or when a Cobb angle was close to 10 degrees.
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PMID:Rule-based algorithm for automated King-type classification of idiopathic scoliosis. 1545 21

The goal of this clinical trial was to measure patient geometry on a dynamic positioning frame in various prone positions. Fourteen subjects (2 males and 12 females) were recruited from the scoliosis clinic at Ste-Justine Hospital on a volunteer basis. The subjects were AIS patients who were potential candidates for surgery. The Cobb angle, averaged 50 degrees (32 degrees-64 degrees). The mean age was 14.1 years (11-17). A Polaris system (Northern Digital inc, Canada) with 10 passive reflective markers was used to measure various indices of the patient's trunk geometry. Acquisitions were made while the unanaesthetized patient was in five different prone positions: I similar to the standard positioning on a Relton-Hall frame; II addition of a force applied to the ribcage at the apex of the curve; III application of a force at the apex of the curve in the lumbar region; IV, the shoulder pads were elevated to increase the patient's kyphosis; V adjustment of each pad and the application of thoracic and lumbar forces to obtain an optimal correction. The measurements of trunk geometry at each position were compared using position I as a base. A paired student t-test determined a significant difference between positions. When comparing position I to position II there was a significant difference and correction of the rib hump. There was also a significant change in shoulder angle that resulted in over correction. Position III had a significantly negative change in the rib hump. During position IV, there was a measurable increase in kyphosis. During the optimal correction, position V, a significant increase in spine length was observed as well as a significant correction in rib hump and shoulder angle. Patient trunk geometry can be improved by the application of different forces on a dynamic positioning frame. Caution is necessary as over correction and unintended negative effects were observed. The optimal patient position has not yet been found and future studies are directed at determining this.
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PMID:Study of patient positioning on a dynamic frame for scoliosis surgery. 1545 12

This paper evaluates a new real-time ultrasound method to assess the difference between axial spinal (laminal) rotation and rib rotation at the apex of the scoliosis curve. An Aloka SSD 500 portable ultrasound machine with a veterinary long (172mm) 3.5 MHz linear array transducer was used to assess the reproducibility of the method in 13 preoperative patients with AIS. With the subject in a prone position and her head supported, readings of laminal and rib rotation were made directly on the back at 18 and 12 levels respectively The subject was repositioned after walking around the room and a second set of spinal and rib rotations obtained (repeats). All the readings were made by one observer (ASK). After plotting on graphs three levels of maximal difference between spine rotation and rib rotation about the apex were chosen visually by one observer (RGB) for which the mean apical spine-minus-rib rotation difference (SRRD) was calculated for each repeat. Findings for apical SRRDs. The mean apical SRRDs for the two repeats are 7.1 degrees and 6.9 degrees (range 2-18 degrees) with coefficients of variation of 49% and 62% respectively. Reproducibility. Graphic representation of spinal and rib rotation by 12 levels shows a fairly good agreement between repeats for most subjects. Spinal rotation is always greater than rib rotation. A paired t-test for the mean apical SRRD of the repeats shows no significant difference. Linear regression analysis of the mean apical SRRD repeats correlate significantly (r=0.70, P=0.008) with a residual mean square of 6.9 degrees (rms = 2.6 degrees). The technical error of the measurement (TEM) is 2.3 degrees and coefficient of reliability (R) 0.66. Conclusions. Real-time ultrasound can assess the difference between spinal and rib rotation about the apex of the scoliosis curve without the altered position detectably affecting the findings. The error (2-3 degrees) is high relative the mean apical SRRD (6-7 degrees). The apical SRRD findings have relevance to the pathogenesis of AIS.
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PMID:Spine-rib rotation differences at the apex in preoperative patients with adolescent idiopathic scoliosis: evaluation of a three-level ultrasound method. 1545 31


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