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

Seventy-eight unfused patients with idiopathic scoliosis were followed from skeletal maturity over a mean period of 17 years (range 10 to 27 years) with a mean age at follow up of 33.7 years. The following aspects were investigated: curve deterioration, back pain incidence, and psychosocial details. There was considerable variation in the progression rate of similar deformities but on average significant deterioration occurred when the Cobb angle was over 55 degrees with a maximum deterioration approaching 1.5 degrees per year in the thoracic curves between 90 degrees and 100 degrees mature Cobb angle. Thoracolumbar and lumbar curves were slightly more benign with a maximum progression rate of about 1 degree when the mature angle was 80 degrees to 90 degrees. The thoracic component of double curves progressed least. Rotation increased in proportion to the Cobb angle progression except in some lumbar curves where lateral subluxation occurred with a disproportionate amount of rotation. The incidence of back pain in relation to pain in the general population and in fused patients remains uncertain. Eighty-two percent of patients had married and 87% had job satisfaction; 10% received treatment for depression.
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PMID:The natural history of unfused scoliosis. 295 82

In the last two decades, the concept of spinal stenosis and its treatment by surgical decompression has been widely accepted. Complications such as olisthy, disc rupture, facet fracture, and intractable back pain began to appear postoperatively, suggesting instability as their cause. A retrospective study of 344 patients treated surgically for lumbar stenosis revealed a 17% reoperation rate for complications resulting from obvious or suspected instability. Sixteen cases of postdecompression olisthy, 14 cases of fresh disc herniation, and 27 cases of intractable back pain required further surgery. Preoperative indicators of potential instability are degenerated discs as evidenced by traction spurs or diminished disc height, olisthy, and scoliosis or asymmetrically narrowed discs. Total facetectomy and pars excision at surgery destabilize the spine and must be added to the preoperative risk factors for instability. Calcified annulus, capsule and ligamentum flavum, or complete disc resorption may offer some protection from postoperative instability. The level of instability may be preselected by the proximity to the intercrestal line. It is recommended that during surgical decompression for spinal stenosis, the posterior elements be spared as much as possible to avoid instability after surgery. Factors suggesting instability noted preoperatively or decompression which produces instability suggest that fusion should be combined with decompression. Spinal fusion is the treatment for postoperative instability.
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PMID:Postdecompression lumbar instability. 296 98

The effect on the lumbosacral spine of long spinal fusion in adolescent idiopathic scoliosis was studied in 22 patients. The average duration of follow-up was 12.8 years. Corrections of the coronal curves through instrumentation were satisfactory. However, a kyphosis was produced at the fused segment of the lumbar spine in more than half of the cases. The unfused intervertebral spaces distally were hypermobile in extension, which probably indicated early disc degeneration. The incidences of back pain and radiological degeneration were found to be low. There was no relationship between back symptoms and type of employment, pregnancies or radiological degeneration. Preservation of normal lumbar lordosis during spinal fusions was emphasized.
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PMID:The effect on the lumbosacral spine of long spinal fusion for idiopathic scoliosis. A minimum 10-year follow-up. 296 30

Adult patients with scoliosis often have back pain, but that pain may or may not be due to the curvature. A careful history, physical examination, routine radiographic examination, and, on some occasions, specialized radiographs, CT, myelography, discography, and facet joint injection will help the physician or surgeon separate out those pain syndromes owing to the curvature versus those not owing to the curvature. Only after these critical evaluations have been done can a decent decision be made as to the area of the spine to be treated, either surgically or nonsurgically.
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PMID:Pain patterns in adult scoliosis. 296 4

The purpose of this study was to evaluate the unfused segments of the lumbar spine in patients who had Harrington instrumentation and fusion for idiopathic scoliosis. Forty-eight patients, with an average follow-up of 11 years, were evaluated. The translational motion in the unfused segments below the instrumented levels was measured, using lateral flexion and extension radiographs of the lumbar spine. This motion was compared with values obtained from an earlier study of asymptomatic nonscoliotic individuals. The amount of disc space narrowing, retrolisthesis, length and level of the fusion, and the presence of traction spurs also were recorded. The incidence of low-back pain was highest in those patients fused to L4 (62%). Individuals instrumented and fused to L3 or L4 had significantly more translational motion in the adjacent lower interspace when compared with the control group (P = 0.05 and P = 0.001, respectively). Increased translational motion correlated with the presence of low-back pain in patients fused to L4. Retrolisthesis occurred in 81% of patients instrumented to L4, in 40% of those fused to L3, and was not found in patients fused to high levels. Its presence was strongly associated with low-back pain. There was no relationship between low-back pain and traction spurs, length of the fusion mass, lumbar lordosis, or width of the disc space in the unfused lower levels. The authors conclude that retrolisthesis and increased translational motion are important factors in determining low-back pain following surgery for idiopathic scoliosis. Instrumentation to L4 should be avoided if possible.
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PMID:Clinical and radiological evaluation of lumbosacral motion below fusion levels in idiopathic scoliosis. 297 26

Fourteen patients with degenerative spondylolisthesis and three patients with degenerative scoliosis, all of whom experienced low-back pain, lumbar radiculopathy, and/or intermittent claudication were treated with posterolateral fusion and correction of deformities using a new instrumentation system. This new spinal fixation system combines the advantages of a rod for scoliotic deformities and a plate for sagittal plane disorders. The combination rod-plates can apply multiple forces to facilitate correction of complex deformities as well as enable indirect neurologic decompression. The system allows segmental rigid fixation via transpedicular screws that is limited only to the abnormal vertebral levels to preserve the maximum number of uninvolved lumbar motion segments. The physiologic lumbar lordotic curvature is also preserved. The minimum follow-up period was 1 year. Satisfactory results were obtained in 15 patients (88%). No intraoperative complications occurred. Screw fatigue occurred in two patients at 1-year follow-up examination with no sequelae. The scoliotic and spondylolisthetic deformities were reduced significantly in all patients. This method appears to assist in reducing pathologic motion and deformities that contribute to low-back pain. Compression on neural structures is relieved by thorough decompression and distraction; spinal canal anatomy is also restored.
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PMID:Degenerative spondylolisthesis and degenerative scoliosis treated with a combination segmental rod-plate and transpedicular screw instrumentation system: a preliminary report. 298 Feb 52

Lumbar disc herniation in young adolescent is uncommon. Twelve patients of 13 to 16 years old (4 boys and 8 girls) are reported. Traumatic history is encountered only in 1/3 of cases and any spinal abnormality is noted in this series. The rapidity in clinical course is the main difference compared with the lumbosciatalgia of the adult. The mean interval of time between the beginning of clinical signs and surgery is 5 months and a half. A positive straight leg raising test is always present as well as antalgic pseudo-scoliosis. The radiculalgia without lumbalgia is the essential sign in on fourth of cases. The myelography and C.T. scan revealed lumbar disc herniation 5 times in L4-L5 intervertebral space and 7 times in L5-S1 space. The intervertebral disc is reached by unilateral interlaminal approach. The complete removal of the disc is always difficult as the disc is not dehydrated at this age. The radiculalgia disappears immediately in the postoperative period as well as the lumbalgia. The back pain persist some months following the surgery. Up the date any response is noted but the authors think that some prudence is necessary in the evaluation of the results especially because of the incomplete removal of disc in young patients. The authors think also that well hydrated and simply protruded disc of young adolescent may constitute an excellent indication for chemonucleolysis.
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PMID:[Lumbar disk hernia in children. Apropos of 12 cases]. 307 Apr 21

Osteoblastoma as a cause of back pain, scoliosis, and reversible neurological deficit has received scant attention in the neurosurgical literature. The tumor has a predeliction for the spine, occurs in young people, and may undergo sarcomatous change. Total removal is necessary for cure. Eight cases of spinal osteoblastoma in children and adults are reported, demonstrating the spectrum of the disease, pitfalls of diagnosis and treatment, and prognosis.
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PMID:Spinal osteoblastoma in children and adolescents. 315 54

Ninety-five patients from the Gothenburg Scoliosis Data Base were studied. They met the following criteria: adolescent idiopathic scoliosis, completion of Milwaukee brace treatment before age 20, a minimum follow-up period of 5 years thereafter, minimum age of 22 years at final follow-up examination. Of these, 85 (90%) were examined personally by an independent investigator, including anteroposterior and lateral full-length spinal roentgenograms. The average length of follow-up was 7.5 years (range, 5-12 yrs). These patients who successfully completed the brace treatment program, in their mid-twenties ended up with curves that were of equal size (33 degrees +/- 3 degrees) as when the treatment started (30 degrees +/- 3 degrees). In the sagittal plane, the spines were normal; none exhibited hypokyphosis (less than 20 degrees). Compared with the straight control group and to a previously reported group of operated patients, the brace group functioned at the same level in regard to marriage, child bearing, sports activities, and job performance. Overall back pain was also reported at a normal rate, with low-back pain significantly less frequent than the control group. Ten patients showed an increase of their curves exceeding 5 degrees; eight of these had been pregnant multiple times before age 25. None of the patients pregnant after that age increased their curve size. This study demonstrates that those patients who complete a Milwaukee brace treatment for adolescent idiopathic scoliosis from a functional and social point of view do very well. Early pregnancy is a significant risk factor for progression after maturity.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated with the Milwaukee brace. 315 1

The Back School program consists of exercises and education designed to reduce back pain. Sixty-six percent of the patients had too much back pain to participate. The purpose of this clinical report is to describe how 24-hour burst transcutaneous electrical nerve stimulation (TENS) treatment enabled these patients with severe back pain to participate in the Back School. Patients recovering from a laminectomy, chemonucleolysis, or scoliosis surgery were used to determine that 24-hour burst TENS was the most effective TENS protocol for reducing pain. Twenty-four-hour burst TENS was then prescribed for 129 patients with severe back pain to enable them to complete the Back School program. Eighty percent of these patients returned to their usual activities within 12 months. The Back School program has been shown to be an effective and safe treatment for back pain, and 24-hour burst TENS treatment allows patients with severe back pain to participate in it.
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PMID:Application of 24-hour burst TENS in a back school. 316 80


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