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

Authors present current knowledge about incidence and etiologic factors in idiopathic scoliosis (IS). Most data about incidence are based on screening examination in school children. Amount of patient with IS is related to the method of evaluation and experience of examiner. There is 1.9% to 3% cases in whole population if scoliosis is assumed as much as 10 degrees of Cobb angle (SRS). Etiology of IS is still in doubt despite of many investigations. There are many abnormalities in tissues but most of them probably secondary to this process. Etiology is multifactorial with dominance of inheritance. There are many genes responsible for occurrence of IS but genetic trait is still unknown.
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PMID:[Idiopathic scoliosis: epidemiology and etiology]. 985 48

The authors analysed 841 patients (83% girls and 17% boys) with adolescent idiopathic scoliosis. 678 patients (group I) were treated with the Harrington technique and 163 patients (group II) were treated using multisegmental instrumentation. Follow-up time in group I was on average 14.2 years, and 28 months in group II. Preoperative assessment of patients in group was based on clinical and radiological examination. Assessment of the spine was mainly based on coronal radiogram done in an upright position and lateral side-bending radiograms in a supine position. Traction and lateral X rays were rarely taken into account in this study. The fusion area was decided according to the end vertebrae of the structural curves. The caudal end of the fusion area was identified using Harrington's stable zone. The curves were classified in accordance with the SRS suggestions. Taking into account the apex of the curve, the deformations were classified into: cervico-thoracic, thoracic, thoraco-lumbar, lumbar and lumbo-sacral curves. In group II the triplanar (3D) character of the deformity was taken into account. In the coronal plane the upper and lower stable vertebra of the major structural curves were identified using the CSVL (Central Sacral Vertical Line) based on long films (70 cm x 110 cm) with and without traction. Lumbar curve was classified as mild, moderate, severe according to CSVL. In the axial plane vertebral rotation was assessed according to Nash and Moe method. A careful analysis of lateral radiograms in the upright standing position was performed. Lateral radiograms were performed also in maximal flexion and hyperextension of the spine to obtain a dynamic evaluation of the sagittal plane. Conoral radiograms with maximal rotation of the trunk to assess mobility of the caudad segments of the deformity. Classification of the scoliotic deformity based on its triplanar character included: thoracic curves (King III, IV, V types), double major (thoracic and lumbar), "false" double major curve (thoracic and lumbar) King type II, thoracolumbar/lumbar curves--the main curve is thoracolumbar lumbar/thoracolumbar curves--the main curve is lumbar--10 degrees the thoracolumbar component--King type I triple major curve--all curves have similar structural changes. Correct identification of the type of scoliosis, assessment of structural changes in the frontal, sagittal and axial plane (three dimensional 3D) and analysis of the size and correctiveness of the lumbar curve and all parameters which play a key role in rational preoperative planning. Redefining or at least maintaining lumbar lordosis is far more important than correction of thoracic kyphosis.
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PMID:[Classification of the adolescent idiopathic scoliosis and preoperative strategy]. 1049 56

No results on long-term outcome in terms of health-related quality of life (HRQL) have previously been presented for patients treated for adolescent idiopathic scoliosis. A consecutive series of patients with adolescent idiopathic scoliosis, treated between 1968 and 1977 before the age of 21, either with distraction and fusion using Harrington rods [surgical treatment group (ST), n=156; 145 females and 11 males] or with a brace [brace treatment group (BT), n=127; 122 females and 5 males] were followed at least 20 years after completion of the treatment. Ninety-four percent of ST and 91% of BT patients filled in a questionnaire comprising the SF-36, Psychological General Well-Being Index (PGWB), Oswestry Disability Back Pain Questionnaire, parts of SRS/MODEM'S questionnaire and study-specific questions concerning the treatment, as a part of an unbiased personal follow-up examination including radiography and clinical examination. An age- and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations. The results showed no differences in terms of sociodemographic data between the groups. Both ST and BT patients had a slightly, but significantly, reduced physical function using the SF-36 subscales, SF-36/Physical Component Summary (PCS) score as well as the Oswestry Disability Back Pain Questionnaire compared to the controls. Neither the mental subscales and the Mental Component Summary (MCS) score of SF-36 nor the PGWB index showed any significant difference between the groups. Forty-nine percent of ST, 34% of BT and 15% of controls admitted limitation of social activities due to their back [P<0.001 ST vs controls, P=0.0010 BT vs controls, and n.s. (P=0.024) ST vs BT], mostly due to difficulties with physical participation in activities or self-consciousness about appearance. Pain was a minor reason for limitation. No correlation was found between the outcome scores and curve size after treatment, curve type, total treatment time or age at completed treatment. Patients treated for adolescent idiopathic scoliosis were found to have approximately the same HRQL as the general population. A minority of the patients (4%) had a severely decreased psychological well-being, and a few (1.5%) were severely physically disabled due to the back.
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PMID:Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery. 1156 12

Thoracoplasty in combination with spine fusion is an established method to address the rib cage deformity in idiopathic scoliosis. Most reports about thoracoplasty and scoliosis correction focused on Harrington or CD instrumentation. We report a retrospective analysis of 21 consecutive patients, who were treated with pedicle screw instrumentation for idiopathic thoracic scoliosis and concomitant thoracoplasty. Minimal follow up was 24 (24-75) months. Indication for thoracoplasty was clinical rib prominence of more than 15 degrees . In average there was a 44% correction of clinical rib hump, from 18 (15-25 degrees ) to 10 degrees (0-18 degrees ) (p<0.0001) and a 40% correction of radiological rib hump, from 15 (5-20 degrees ) to 9 degrees (2-15 degrees ) (p<0.0001). The preoperative pulmonary function, accessed by forced vital capacity (FVC) and one-second forced expiratory volume (FEV1), remained unchanged at the last follow up. The distal end of fusion was the end vertebra of the curve in 83.3% and the end vertebra plus one in 16.7% of the patients. There was a 68% correction of instrumented primary thoracic curves, from 60 (45-85 degrees ) to 19 degrees (5-36 degrees ) (p<0.0001), and a 45% correction of non-instrumented secondary lumbar curves, from 40 (28-60 degrees ) to 22 degrees (8-38 degrees ) (p<0.0001). Apical vertebral rotation (AVR) of the thoracic curves improved 54%, from 24 (10-35 degrees ) to 11 degrees (5-20 degrees ) (p<0.0001). The tilt of lowest instrumented vertebra (LIV) improved 68%, from 28 (20-42 degrees ) to 9 degrees (3-20 degrees ) (p<0.0001). There was no significant change in sagittal profile of the spine. Analysis with SRS-24 questionnaire showed that the majority of the patients were very satisfied with the outcome. A matched control group (n=21) operated by the same surgeon with the same operation technique but without concomitant thoracoplasty was chosen for comparison. The scoliosis correction in the two groups was comparable. The patients without thoracoplasty had 37% spontaneous improvement of the clinical rib hump.
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PMID:Primary thoracoplasty and pedicle screw instrumentation in thoracic idiopathic scoliosis. 1609 73

A retrospectively designed long-term follow-up study of adolescent idiopathic scoliosis (AIS) patients who had completed treatment, of at least 2 years, by means of brace, surgery, or both brace and surgery. This study is to assess the outcome after treatment for AIS by means of the Scoliosis Research Society Outcome Instrument 24 (SRS 24). One hundred and eighteen AIS patients (99 females and 19 males), treated at the Aarhus University Hospital from January 1, 1987 to December 31, 1997, were investigated with at least 2 years follow-up at the time of receiving a posted self-administered questionnaire. Forty-four patients were treated with Boston brace (B) only, 41 patients had surgery (S), and 33 patients were treated both with brace and surgery (BS). The Cobb angles of the three treatment groups did not differ significantly after completed treatment. The outcome in terms of the total SRS 24 score was not significantly different among the three groups. B patients had a significantly better general (not treatment related) self-image and higher general activity level than the total group of surgically treated patients, while surgically treated patients scored significantly better in post-treatment self-image and satisfaction. Comparing B with BS we found a significantly higher general activity level in B patients, while the BS group had significantly higher satisfaction. There were no significant differences between BS and S patients in any of the domain scores. All treatment groups scored "fair or better" in all domain scores of the SRS 24 questionnaire, except in post-treatment function, where all groups scored worse than "fair". Improvement of appearance by means of surgical correction increases mean scores for post-treatment self-image and post-treatment satisfaction. Double-treatment by brace and surgery does not appear to jeopardize a good final outcome.
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PMID:Outcome in adolescent idiopathic scoliosis after brace treatment and surgery assessed by means of the Scoliosis Research Society Instrument 24. 1630 24

This is a retrospective clinical, radiological and patient outcome assessment of 21 consecutive patients with King 1 idiopathic adolescent scoliosis treated by short anterior selective fusion of the major thoracolumbar/lumbar (TL/L) curve. Three-dimensional changes of both curves, changes in trunk balance and rib hump were evaluated. The minimal follow-up was 24 months (max. 83). The Cobb angle of the TL/L curve was 52 degrees (45-67 degrees) with a flexibility of 72% (40-100%). The average length of the main curve was 5 (3-8) segments. An average of 3 (2-4) segments was fused using rigid single rod implants with side-loading screws. The Cobb angle of the thoracic curve was 33 degrees (18-50 degrees) with a flexibility of 69% (29-100%). The thoracic curve in bending was less than 20 degrees in 17 patients, and 20-25 degrees in 4 patients. In the TL/L curve there was an improvement of the Cobb angle of 67%, of the apex vertebral rotation of 51% and of the apex vertebral translation of 74%. The Cobb angle of the thoracic curve improved 29% spontaneously. Shoulder balance improved significantly from an average preoperative imbalance of 14.5-3.1 mm at the last follow-up. Seventy-five percent of the patients with preoperative positive shoulder imbalance (higher on the side of the thoracic curve) had levelled shoulders at the last follow-up. C7 offset improved from a preoperative 19.8 (0-40) to 4.8 (0-18) mm at the last follow-up. There were no significant changes in rotation, translation of the thoracic curve and the clinical rib hump. There were no significant changes in thoracic kyphosis or lumbar lordosis. The average score of the SRS-24 questionnaire at the last follow-up was 91 points (max. 120). We conclude that short anterior selective fusion of the TL/L curve in King 1 scoliosis with a thoracic curve bending to 25 degrees or less (Type 5 according to Lenke classification) results in a satisfactory correction and a balanced spine. Short fusions leave enough mobile lumbar segments for the establishment of global spinal balance. A positive shoulder imbalance is not a contraindication for this procedure. Structural interbody grafts are not necessary to maintain lumbar lordosis.
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PMID:Short anterior correction of the thoracolumbar/lumbar curve in King 1 idiopathic scoliosis: the behaviour of the instrumented and non-instrumented curves and the trunk balance. 1654 58

For treatment of teenagers with progressive adolescent idiopathic scoliosis in an early stage, two options are generally considered: treatment with a brace or observation followed by surgery if necessary. Many doctors and patients prefer conservative treatment (i.e. brace treatment) to surgical treatment, because surgery of the spine is generally considered a drastic intervention. Because potential differences in health-related quality of life (HRQoL) after treatment between braced and surgically treated patients are not well explored, this study aimed to determine whether short-term differences exist in HRQoL between adolescents treated with a brace or treated surgically. A cross-sectional analysis of HRQoL was made of 109 patients with adolescent idiopathic scoliosis who, after completing treatment, filled out the Dutch SRS-22 Patient Questionnaire. All patients had been treated either with a brace or surgery, or with a brace followed by surgery. Patients treated surgically had significantly higher mean scores in the satisfaction with management domain than those treated with a brace. No other consistent differences in HRQoL were found between patients treated with a brace and patients treated surgically. Gender, curve type and curve size had no relevant effect on HRQoL. We conclude that short-term differences in HRQoL after treatment in adolescent patients with idiopathic scoliosis are negligible and cannot support preference of one treatment above the other.
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PMID:Health-related quality of life in patients with adolescent idiopathic scoliosis after treatment: short-term effects after brace or surgical treatment. 1766 49

The SRS-22 questionnaire is specifically designed for the assessment of quality of life in spinal deformity patients. This study is the first to use it to assess the quality of life of adolescent idiopathic scoliosis patients under brace treatment and compares the results with an observational group matched by age and curve magnitude. Forty-six patients were enrolled into each group. Overall, it was found that patients under observation had a significantly better quality of life than braced patients. Specifically, the domains for function/activity and self-image were most affected. This effect was most apparent in those with a curve magnitude of under 20 degrees . The scores did not improve significantly with the duration of brace wear, suggesting little adaptation. This study has implications for treatment, and more attention will need to be given to those with mild but progressive curves to help improve patients' understanding of their treatment and hence their compliance and satisfaction.
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PMID:Outcome assessment of bracing in adolescent idiopathic scoliosis by the use of the SRS-22 questionnaire. 1689 64

Last two decades witnessed great advances in the surgical treatment of idiopathic scoliosis. However, the number of studies evaluating the long-term results of these treatment methods is relatively low. During recent years, besides radiological and clinical studies, questionnaires like SRS-22 assessing subjective functional and mental status and life-quality of patients have gained importance for the evaluation of these results. In this study, surgical outcome and Turkish SRS-22 questionnaire results of 109 late-onset adolescent idiopathic scoliosis patients surgically treated with third-generation instrumentation [Texas Scottish Rite Hospital (TSRH) System] and followed for a minimum of 10 years were evaluated. The balance was analyzed clinically and radiologically by the measurement of the lateral trunk shift (LT), shift of head (SH), and shift of stable vertebra (SS). Mean age of the patients was 14.4+/-1.9 and mean follow-up period was 136.9+/-12.7 months. When all the patients were included, the preoperative mean Cobb angle of major curves in the frontal plane was 60.8 degrees +/-17.5 degrees . Major curves that were corrected by 38.7+/-22.1% in the bending radiograms, postoperatively achieved a correction of 64.0+/-15.8%. At the last follow-up visit, 10.3 degrees +/-10.8 degrees of correction loss was recorded in major curves in the frontal plane with 50.5+/-23.1% final correction rate. Also, the mean postoperative and final kyphosis angles and lumbar lordosis angles were 37.7 degrees +/-7.4 degrees , 37.0 degrees +/-8.4 degrees , 37.5 degrees +/-8.7 degrees , and 36.3 degrees +/-8.5 degrees , respectively. A statistically significant correction was obtained at the sagittal plane; mean postoperative changes compared to preoperative values were 7.9 degrees and 12.9 degrees for thoracic and lumbar regions, respectively. On the other hand, normal physiological thoracic and lumbar sagittal contours were achieved in 83.5% and 67.9% of the patients, respectively. Postoperatively, a statistically significant correction was obtained in LT, SH, and SS values (P<0.05). Although, none of the patients had completely balanced curves preoperatively, in 95.4% of the patients the curves were found to be completely balanced or clinically well balanced postoperatively. This rate was maintained at the last follow-up visit. Overall, four patients (3.7%) had implant failure. Early superficial infection was observed in three (2.8%) patients. Radiologically presence of significant consolidation, absence of implant failure, and correction loss, and clinical relief of pain were considered as the proof of a posterior solid fusion mass. About ten (9.2%) patients were considered to have pseudoarthrosis: four patients with implant failure and six patients with correction loss over 15 degrees at the frontal plane. About four (3.7%) patients among the first 20 patients had neurological deficit only wake-up test was used for neurological monitoring of these patients. No neurological deficit was observed in the 89 patients for whom intraoperative neurological monitoring with SSEP and TkMMEP was performed. Overall, average scores of SRS-22 questionnaire for general self-image, function, mental status, pain, and satisfaction from treatment were 3.8+/-0.7, 3.6+/-0.7, 4.0+/-0.8, 3.6+/-0.8, and 4.6+/-0.3, respectively at the last follow-up visit. Results of about 10 years of follow-up these patients treated with TSRH instrumentation suggest that the method is efficient for the correction of frontal and sagittal plane deformities and trunk balance. In addition, it results in a better life-quality.
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PMID:Minimum 10 years follow-up surgical results of adolescent idiopathic scoliosis patients treated with TSRH instrumentation. 1692 53

We have examined the validity and reliability of Japanese SRS-24 and SF-36 in patients with scoliosis. 278 patients with scoliosis were recruited. Their average age was 24.8 years (range 17-84 years) and 83% of patients had idiopathic curves. The major coronal curve averaged 43 degrees (range 10 degrees -114 degrees). Questionnaires surveyed were SRS-24 and SRS-22, and SF-36. Only domains applicable to untreated patients were analyzed. Scale level analysis was evaluated by the ceiling and floor effect. The Cronbach alpha and item-scale correlations were calculated as representatives of internal consistency reliability and item internal consistency, respectively. Most domains of SF-36 had large ceiling effects. Both the SRS questionnaires had limited ceiling/floor effects. SRS-22 had a better internal consistency than SRS-24. Low item-scale correlations (<0.25) were found in question 14, 15, and 18 of SRS-22. The Japanese version of SRS-22 was the most useful measure for patients with scoliosis. However, some questions have low item-scale correlations, lowering reliability of the Function domain.
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PMID:Validity and reliability of SRSI and SF-36 in Japanese patients with scoliosis. 1710 48


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