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Search Results for : Scoliosis
Merck Online Lab
Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
Efficacy and safety of VEPTR instrumentation for progressive spine deformities in young children without rib fusions.
Author(s): Hasler, CC; Mehrkens, A; Hefti, F
Journal: Eur Spine J 2010 Jun 3; Vol. 19, Issue 3; Page(s) 400-8
[Medline ID - 20041270]

This retrospective study analyses 23 children treated with vertical expandable prosthetic titanium rib (VEPTR) for correction of non-congenital early onset spine deformities. After the index procedure (IP), the device was lengthened at 6-month intervals. The average (av) age at the time of IP was 6.5 years (1.11-10.5). The av follow-up time was 3.6 years (2-5.8). Diagnosis included 1 early onset idiopathic scoliosis, 11 neuromuscular, 2 post-thoracotomy scoliosis, 1 Sprengel deformity, 2 hyperkyphosis, 1 myopathy and 5 syndromic. Surgeries (187) included 23 IPs, av 6.5 (4-10) device expansions per patient (149) and 15 unplanned surgeries. 23 complications (0.13 per surgery) included 10 skin sloughs, 5 implant dislocations, 2 rod breakages and 6 infections. Coronal Cobb angle was av 68 degrees (11 degrees -111 degrees ), at follow-up av 54 degrees (0 degrees -105 degrees). Pelvic obliquity was av 33 degrees (13 degrees -60 degrees ), at follow-up av 16 degrees (0 degrees -42 degrees ). T1 tilt was av 29 degrees (5 degrees -84 degrees ), two remained unchanged, the remainder improved 10 degrees -68 degrees. Sagittal plane: All but two had stable profiles, two hyperkyphosis of 110 degrees /124 degrees improved to 56 degrees /86 degrees. Space available for lung ratio was less than 90% in ten before the IP, improved in nine and deteriorated in one. Originally designed for thoracic insufficiency syndromes related to rib and vertebral anomalies, VEPTR proved to be a valuable alternative to dual growing rods for non-congenital early onset spine deformities. The complication rate was lower, the control of the sagittal plane and the pelvic obliquity was as good, but the correction of the coronal plane deformity was less than growing rods. However, VEPTR's spine-sparing approach might provoke less spontaneous spinal fusion and ease the final correction at maturity.

Prediction equations for human thoracic and lumbar vertebral morphometry.
Author(s): Kunkel, ME; Schmidt, H; Wilke, HJ
Journal: J Anat 2009 Dec 31; Vol. 216, Issue 3; Page(s) 320-8
[Medline ID - 20039978]

Statistical correlations between anatomical dimensions of human vertebral structures have indicated a potential for the prediction of vertebral morphometry, which could be applied to the creation of simplified geometrical models of the spine excluding the need for preliminary processing of medical images. The aim of this study was to perform linear and nonlinear regressions with published anatomical data to generate prediction equations for 20 vertebral parameters of the human thoracic and lumbar spine as a function of only one given parameter that was measured by X-ray. Each parameter was considered individually as a potential predictor variable in terms of its correlation with all of the other parameters, together with the readiness with which lateral X-rays could be obtained. Based on this, the parameter vertebral body height posterior was chosen and the statistical analyses described here are related to this parameter. Our linear, exponential and logarithmic regressions provided significant predictions of anterior vertebral structures. However, third-order polynomial prediction equations allowed an improvement on these predictions (P-values < 0.001), e.g. endplates and spinal canal (R(2), 0.970-0.995) as well as pedicle heights and the spinous process (R(2), 0.811-0.882), in addition to a reasonable prediction of the posterior vertebral structures, which have shown a low or no correlation in previous studies, e.g. pedicle inclination and transverse process (R(2), 0.514-0.693) (anova). Comparisons of the theoretical predictions with two other sets of experimental data indicated that the predictions generally agree well with the experimental data. A time-efficient approach for obtaining anatomical data for the description of human thoracic and lumbar geometry was provided by this method, which requires the measurement of only one parameter per vertebra (vertebral body height posterior) from a lateral X-ray and the set of developed prediction equations. Vertebral models based on this type of parameterized geometry could be used in biomechanical studies that require geometry variation, such as in spinal deformations, including scoliosis.

Scoliosis Research Society: 2005 and beyond.
Author(s): Thompson, GH
Journal: Spine (Phila Pa 1976) 2010 Jun 2; Vol. 35, Issue 2; Page(s) 134-7
[Medline ID - 20038870]

ABSTRACT NOT AVAILABLE

Health-related quality of life in untreated versus brace-treated patients with adolescent idiopathic scoliosis: a long-term follow-up.
Author(s): Danielsson, AJ; Hasserius, R; Ohlin, A; Nachemson, AL
Journal: Spine (Phila Pa 1976) 2010 Mar 17; Vol. 35, Issue 2; Page(s) 199-205
[Medline ID - 20038869]

STUDY DESIGN: The previous Scoliosis Research Society brace study (JBJS-A, 1995) included patients with adolescent idiopathic scoliosis (AIS) with moderate curve sizes (25 degrees -35 degrees). The Swedish patients in this study were examined in a long-term follow-up. OBJECTIVE: The aim was to analyze and compare quality of life in adulthood between AIS patients who were only observed or treated with a brace during adolescence. SUMMARY OF BACKGROUND DATA: Quality of life as measured by the SRS-22 has not previously been presented for adult untreated AIS patients. METHODS: Forty patients who were only observed (due to a curve increase of less than 6 degrees until maturity), and 37 brace-treated patients attended the complete follow-up, including clinical and radiologic examination, and answered 2 quality of life questionnaires (SRS-22 and Short Form-36 [SF-36]). RESULTS: No differences were found between the groups in terms of age at follow-up (mean: 32 years), follow-up time after maturity (mean: 16.0 years), and curve size at inclusion (mean: 30 degrees) or at follow-up (mean: 35 degrees). The SRS-22/total score was a mean of 4.2 for braced patients and 4.1 for only observed patients. Neither total scores/subscales of the SRS-22 or SF-36 differed significantly between the groups. For the SF-36, no differences in relation to the Swedish age-matched norm scales were found for either group. CONCLUSION: Patients with moderate AIS report good quality of life in their 30s, as measured by both the SRS-22 and SF-36, regardless of whether they received no active treatment or were brace treated during adolescence. Neither of the groups displayed any difference compared with the age-matched norm groups for the SF-36.

Can posterior-only surgery provide similar radiographic and clinical results as combined anterior (thoracotomy/thoracoabdominal)/posterior approaches for adult scoliosis?
Author(s): Good, CR; Lenke, LG; Bridwell, KH; O'Leary, PT; Pichelmann, MA; Keeler, KA; Baldus, CR; Koester, LA
Journal: Spine (Phila Pa 1976) 2010 Mar 17; Vol. 35, Issue 2; Page(s) 210-8
[Medline ID - 20038868]

STUDY DESIGN: Retrospective matched cohort analysis. OBJECTIVE: To determine if posterior-only (post-only) surgical techniques consisting of pedicle screws, osteotomies, transforaminal lumbar interbody fusion, and bone morphogenetic protein-2 may provide similar results as compared anterior (thoracotomy/thoracoabdominal)/posterior surgical approaches for the treatment of adult spinal deformity with respect to correction, fusion rates, or outcomes. SUMMARY OF BACKGROUND DATA: Combined anterior/posterior (A/P) fusion has traditionally been used to treat many adult scoliosis deformities. Anterior approaches negatively impact pulmonary function and require additional operative time and anesthesia. METHODS: Twenty-four patients who had A/P fusion for primary adult scoliosis (16 staged, 8 same-day) were matched with a cohort of 24 patients who had post-only treatment. Anterior fusion was performed via a thoracotomy (n = 1)/thoracoabdominal (n = 23) approach. All post-only surgeries were under one anesthesia. Minimum 2-year follow-up included radiographic, clinical, and outcomes data. RESULTS: There were no significant differences between groups for age, gender, diagnosis, comorbidities, preoperative curve magnitudes, or global balance. Postoperative radiographic correction and alignment were similar for both groups except for thoracolumbar curve percent improvement which was statistically better in the post-only group (P = 0.03). The average surgical time was higher in A/P versus post-only group (11.6 vs. 6.9 hours, P < 0.0001) as was total estimated blood loss (1330 vs. 980 mL, P = 0.04). Hospital length of stay (LOS) was longer in A/P versus post-only group (11.9 vs. 8.3 days, P = 0.03). There were no significant differences between postoperative complications. Revision surgery was performed in 5 A/P and 2 post-only patients. Higher pseudarthrosis rates found in the A/P versus post-only (17 vs. 0%) were not significant (P = 0.11). SRS-30 and Oswestry scores reflected a similar patient assessment before surgery, and improvement between groups at follow-up. CONCLUSION: Post-only adult scoliosis surgery achieved similar correction to A/P surgery while decreasing blood loss, operative time, length of stay, and avoiding additional anesthesia. Complications, radiographic, and clinical outcomes were similar at over 2-year follow-up.

Revision rates following primary adult spinal deformity surgery: six hundred forty-three consecutive patients followed-up to twenty-two years postoperative.
Author(s): Pichelmann, MA; Lenke, LG; Bridwell, KH; Good, CR; O'Leary, PT; Sides, BA
Journal: Spine (Phila Pa 1976) 2010 Mar 17; Vol. 35, Issue 2; Page(s) 219-26
[Medline ID - 20038867]

STUDY DESIGN: Retrospective study. OBJECTIVE: To analyze the prevalence of and reasons for unanticipated revision surgery in an adult spinal deformity population treated at one institution. SUMMARY OF BACKGROUND DATA: No recent studies exist that analyze the rate or reason for unanticipated revision surgery for adult spinal deformity patients over a long period. METHODS: All patients presenting for primary instrumented spinal fusion with a diagnosis of adult deformity at a single institution from 1985 to 2008 were reviewed us ing a prospectively acquired database. All surgical patients with instrumented fusion of > or =5 levels using hooks, hybrid, or screw-only constructs were identified. Patient charts and radiographs were reviewed to provide information as to the indication for initial and any subsequent reoperation. A total of 643 patients underwent primary instrumented fusion for a diagnosis of adult idiopathic scoliosis (n = 432), de novo degenerative scoliosis (n = 104), adult kyphotic disease (n = 63), or neuromuscular scoliosis (n = 45). The mean age was 37.9 years (range, 18-84). Mean follow-up for the entire cohort was 4.7 years, and 8.2 years for the subset of the cohort requiring reoperation (range, 1 month-22.3 years). RESULTS: A total of 58 of 643 patients (9.0%) underwent at least one revision surgery and 15 of 643 (2.3%) had more than one revision (mean 1.3; range, 1-3). The mean time to the first revision was 4.0 years (range, 1 week-19.7 years). The most common reasons for revision were pseudarthrosis (24/643 = 3.7%; 24/58 = 41.4%), curve progression (13/643 = 2.0%; 13/58 = 20.7%), infection (9/643 = 1.4%; 9/58 = 15.5%), and painful/prominent implants (4/643 = 0.6%; 4/58 = 6.9%). Uncommon reasons consisted of adjacent segment degeneration (3), implant failure (3), neurologic deficit (1), and coronal imbalance (1). Revision rates over the follow-up period were: 0 to 2 years (26/58 = 44.8%), 2 to 5 years (17/58 = 29.3%), 5 to 10 years (7/58 = 12.1%), > 10 years (8/58 = 13.8%). CONCLUSION: Repeat surgical intervention following definitive spinal instrumented fusion for primary adult deformity performed at a single institution demonstrated a relatively low rate of 9.0%. The most common reasons for revision were predictable and included pseudarthrosis, proximal or distal curve progression, and infection.

3D postural balance with regard to gravity line: an evaluation in the transversal plane on 93 patients and 23 asymptomatic volunteers.
Author(s): Steffen, JS; Obeid, I; Aurouer, N; Hauger, O; Vital, JM; Dubousset, J; Skalli, W
Journal: Eur Spine J 2010 Jul 16; Vol. 19, Issue 5; Page(s) 760-7
[Medline ID - 20035359]

Relevance of posture assessment has been reported in case of spine disorders. This study explores the interest in quantifying posture using 3D reconstruction from biplanar X-rays in free standing position and a force plate. 93 patients consulting for spine disorders were divided ('3D deformity', 'sagittal imbalance' and 'mild deformity') and compared with 23 asymptomatic volunteers. Registration of the gravity line (GL) in reconstruction yielded transversal position of the center of acoustic meati (CAM) T1, T4, T9, L3, S1 and hip axis (HA) with regard to GL. Transversal position of CAM and L3 appeared as relevant parameters to discriminate patients from volunteers. Sagittal inclination of the axis linking the CAM to HA was correlated with position of the CAM to GL (r = 0.92 for patients). In conclusion, observing posture in 3D with regard to GL provides clinical relevant information. CAM-HA inclination may improve postural evaluation without force plate.

Computer navigation-assisted spinal fusion with segmental pedicle screw instrumentation for scoliosis with Rett syndrome: a case report.
Author(s): Tanaka, M; Nakanishi, K; Sugimoto, Y; Misawa, H; Takigawa, T; Nishida, K; Ozaki, T
Journal: Acta Med Okayama 2010 Feb 26; Vol. 63, Issue 6; Page(s) 373-7
[Medline ID - 20035294]

Scoliosis is a common clinical manifestation of Rett syndrome, a neurodevelopmental disorder that almost exclusively affects females. The spinal curve in patients with Rett syndrome is typically a long C curve of a neuromuscular type. As the onset of the scoliosis is very early and shows rapid progression, early surgical intervention has been recommended to prevent a life-threatening collapsing spine syndrome. However, there are high perioperative risks in Rett syndrome patients who undergo spinal surgery, such as neurological compromise and respiratory dysfunction due to rigid spinal curve. We herein report the surgical result of treating severe rapid progressive thoracic scoliosis in a 16-year-old girl with Rett syndrome. Posterior segmental pedicle screw fixation was performed from T1 to L3 using a computer-assisted technique. Post-operative radiography demonstrated a good correction of the curve in both the sagittal and coronal alignment. There were no postoperative complications such as neurological compromise. The patient had maintained satisfactory spinal balance as of the 3-year follow-up examination.

Cartilage oligomeric matrix protein promotes cell attachment via two independent mechanisms involving CD47 and alphaVbeta3 integrin.
Author(s): Rock, MJ; Holden, P; Horton, WA; Cohn, DH
Journal: Mol Cell Biochem 2009 Dec 25; Vol. 338, Issue 1-2; Page(s) 215-24
[Medline ID - 20033473]

Cartilage oligomeric matrix protein (COMP) is a pentameric approximately 524 kDa multidomain extracellular matrix protein and is the fifth member of the thrombospondin family. COMP is abundantly expressed in proliferating and hypertrophic chondrocytes of the growth plate, articular cartilage, synovium, tendon, and ligament. The spatial localization of COMP highlights its importance in the phenotypes of pseudoachondroplasia (PSACH) and multiple epiphyseal dysplasia (MED), COMP disorders that are characterized by disproportionate short stature, brachydactyly, scoliosis, early-onset osteoarthritis, and joint hypermobility. In this study, the role of COMP in ligament was investigated with a series of cell attachment assays using ligament cells binding to COMP. A dose-dependent cell attachment activity was found, which was inhibited by a peptide containing the SFYVVMWK amino acid sequence derived from the globular C-terminal domain of COMP. This activity was independent of the recently described RGD-dependent attachment activity. Function-blocking antibodies to CD47 and alphaVbeta3 integrin reduced cell attachment to COMP, implicating the participation of these cell surface molecules in COMP cell binding. Immunofluorescence studies showed that cell attachment to COMP induced the formation of lamellae containing F-actin microspikes associated with fascin. We propose that COMP promotes cell attachment via two independent mechanisms involving cell surface CD47 and alphaVbeta3 integrin and that a consequence of cell attachment to COMP is the specific induction of fascin-stabilized actin microspikes.

Motor cortical hyperexcitability in idiopathic scoliosis: could focal dystonia be a subclinical etiological factor?
Author(s): Dom; énech, J; Tormos, JM; Barrios, C; Pascual-Leone, A
Journal: Eur Spine J 2010 Jul 16; Vol. 19, Issue 2; Page(s) 223-30
[Medline ID - 20033462]

The aetiology of idiopathic scoliosis (IS) remains unknown; however, there is a growing body of evidence suggesting that the spine deformity could be the expression of a subclinical nervous system disorder. A defective sensory input or an anomalous sensorimotor integration may lead to an abnormal postural tone and therefore the development of a spine deformity. Inhibition of the motor cortico-cortical excitability is abnormal in dystonia. Therefore, the study of cortico-cortical inhibition may shed some insight into the dystonia hypothesis regarding the pathophysiology of IS. Paired pulse transcranial magnetic stimulation was used to study cortico-cortical inhibition and facilitation in nine adolescents with IS, five teenagers with congenital scoliosis (CS) and eight healthy age-matched controls. The effect of a previous conditioning stimulus (80% intensity of resting motor threshold) on the amplitude of the motor-evoked potential induced by the test stimulus (120% of resting motor threshold) was examined at various interstimulus intervals (ISIs) in both abductor pollicis brevis muscles. The results of healthy adolescents and those with CS showed a marked inhibitory effect of the conditioning stimulus on the response to the test stimulus at interstimulus intervals shorter than 6 ms. These findings do not differ from those reported for normal adults. However, children with IS revealed an abnormally reduced cortico-cortical inhibition at the short ISIs. Cortico-cortical inhibition was practically normal on the side of the scoliotic convexity while it was significantly reduced on the side of the scoliotic concavity. In conclusion, these findings support the hypothesis that a dystonic dysfunction underlies in IS. Asymmetrical cortical hyperexcitability may play an important role in the pathogenesis of IS and represents an objective neurophysiological finding that could be used clinically.
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