Scoliosis最新文献

To our knowledge there are no publications that have evaluated physical activities in relation to the etiopathogenesis of adolescent idiopathic scoliosis (AIS) other than sports scolioses. In a preliminary longitudinal case-control study, mother and child were questioned and the children examined by one observer. The aim of the study was to examine possible risk factors for AIS. Two study groups were assessed for physical activities: 79 children diagnosed as having progressive AIS at one spinal deformity centre (66 girls, 13 boys) and a Control Group of 77 school children (66 girls, 11 boys), the selection involving six criteria. A structured history of physical activities was obtained, every child allocated to a socioeconomic group and examined for toe touching. Unlike the Patients, the Controls were not X-rayed and were examined for surface vertical spinous process asymmetry (VSPA). Statistical analyses showed progressive AIS to be positively associated with social deprivation, early introduction to indoor heated swimming pools and ability to toe touch. AIS is negatively associated with participation in dance, skating, gymnastics or karate and football or hockey classes, which might suggest preventive possibilities. There is a significantly increased independent odds of AIS in children who went to an indoor heated swimming pool within the first year of life (odds ratio 3.88, 95% CI 1.77-8.48; p = 0·001). Furthermore fourteen (61%) Controls with VSPA compared with 9 (17%) Controls without VSPA had been introduced to the swimming pool within their first year of life (P < 0.001). Early exposure to indoor heated swimming pools for both AIS and VSPA, suggests that the AIS findings do not result from sample selection.

Objectives: To assess the reliability of intradiscal pressure measurement during in vitro biomechanical testing. In particular, the variability of measurements will be assessed for repeated measures by considering the effect of specimens and of freezing/thawing cycles.

Methods: Thirty-six functional units from 8 porcine spines (S1: T7-T8, S2: T9-T10, S3: T12-T11, S4: T14-T13, S5: L1-L2 and S6: L3-L4) have been used. The intervertebral discs were measured to obtain the frontal and sagittal dimensions. These measurements helped locate the center of the disc where a modified catheter was positioned. A fiber optic pressure sensor (measuring range: -0.1 to 17 bar) (360HP, SAMBA Sensors, Sweden) was then inserted into the catheter. The specimens were divided into 3 groups: 1) fresh (F), 2) after one freeze/thaw cycle (C1) and 3) after 2 freeze/thaw cycles (C2). These groups were divided in two, depending on whether specimens were subjected to 400 N axial loading or not. Ten measurements (insertion of the sensor for a period of one minute, then removal) were taken for each case. Statistical analyses evaluated the influence of porcine specimen and the vertebral level using a MANOVA. The effect of repeated measurements was evaluated with ANOVA. The difference between freeze/thaw cycles were analysed with U Mann-Whitney test (P≤0.05).

Results: Without axial loading, the F group showed 365 mbar intradiscal pressure, 473 mbar for the C1 group, and 391 mbar for the C2 group. With 400N axial load, the F group showed intradiscal pressure of 10610 mbar, the C1 group 10132 mbar, the C2 group 12074 mbar. The statistical analysis shows a significant influence of the porcine specimen (p<0.001), with or without axial loading and of the vertebral level with (p=0.048) and without load (p<0.001). The results were also significantly different between the freeze/thaw cycles, with (p<0.001) and without load (p=0.033). Repeated measurement (without load p = 0.82 and with p = 0.56) did not show significant influence.

Conclusions: The results tend to support that freezing/thawing cycles can affect intradiscal pressure measurement with significant inter-specimen variability. The use of the same specimen as its own control during in vitro biomechanical testing could be recommended.

Background: It is critically important for AIS patients to avoid perioperative allogeneic blood transfusions. Toward this aim, many institutes use autologous blood storage to perform perioperative transfusions. However, there is no standard timeline for collecting blood for storage. Therefore, the objective of this prospective cohort study was to compare the outcome of two different schedules for collecting autologous blood before operation in adolescent idiopathic scoliosis (AIS) patients.

Methods: Inclusion criteria are AIS patients, younger than 20 years old, female, operated between 2009 and 2013 with posterior spinal fusion and instrumentation who had 1600 mL autologous blood collected before operation. A total of 61 patients were participated in this study. They were randomly divided into 2 groups based on the storage interval. Weekly group (1W-G) consisted of 30 patients with a total of 1600mL blood collected weekly beginning 4 weeks before the operation. Biweekly group (2W-G) consisted of 31 patients with a total of 1600 mL blood collected biweekly beginning 8 weeks before the operation. The instrumented levels, total bleeding, complications during blood transfusion, and hematological examinations (RBC, Hb, Hct, MCH, MCV, MCHC) were evaluated. A hematological examination was performed before blood collection, before the operation, and on postoperative days 1, 3, and 7. Vasovagal reflex (VVR) was evaluated as complications during blood drawing.

Result: Mean age, height, and weight did not differ significantly between the 2 groups. There were no significant differences in instrumented levels, bleeding during operation, after operation, and collected blood during operation. With the autologous blood, allogeneic blood transfusion was completely avoided. VVR was more frequent in the biweekly group significantly (1W-G 4.2% vs 2W-G 15.3%). In terms of hematological examination, all values showed no significant differences between two groups in the pre-drawing and the pre-operation stage. However, the postoperative Hb and Hct values were higher in the weekly group. Also, MCV and MCHC showed the same behavior with higher values in the weekly group.

Conclusion: A weekly schedule of autologous blood storage is better than a biweekly storage schedule.

Introduction: Health-related quality of life (HRQoL) outcome questionnaire, Scoliosis Research Society (SRS)-30, had been well received since its establishment in 2003. Literatures from Asia on the use of SRS-30 mainly focused on the translation process and validation process, but not on measuring outcomes, particularly in the Chinese community. We carried out a prospective cohort study to evaluate the HRQoL of Chinese AIS adolescents with severe scoliosis after surgery.

Methods: One hundred and four Chinese AIS patients with severe scoliosis undergoing posterior spinal fusion between 2009 and 2013 were recruited in this study. They completed SRS-30 questions before surgery, before hospital discharge, and at follow-up. Mean scores and percentages of individual scores in different domains, and composite scores in terms of subtotal and total scores were calculated referring to the scoring system. Gender-specific and period-specific descriptive analyses were described. Correlation of mean domain scores at the three time points were explored to look for any time-specific relationship. Linear regression analysis looking for potential risk factors on domain scores at different time points by gender were also carried out.

Results: Mean age was 16.28 at surgery, and 83.6% were female. Significant correlations between pre-op scores and scores after surgery were observed in function/activity domain (p=0.05) in males, and pain (p=0.04) and satisfaction with management (p=0.04) domains in females. No gender difference in all 5 domain scores at the 3 time points was found. Pre-op maximum Cobb angle and corrected angle were found to be risk factors on self-image, as well as satisfaction with management, in male and female patients.

Conclusions: This is the first report on the evaluation of the clinical HRQoL outcomes of Chinese AIS patients with severe scoliosis after surgery. Medical professionals should pay attention to take care of the difference in personal perceptions of feelings between boys and girls. Special care should also be allocated to AIS patients, and try to arrange earlier surgical intervention.

Background: Prescriptive analytics is a concept combining statistical and computer sciences to prescribe an optimal course of action, based on predictions of possible future events. In this simulation study we investigate using prescriptive analytics to recommend optimal in-brace corrections for braced Adolescent Idiopathic Scoliosis (AIS) patients. The objectives were to estimate the efficacy of these recommendations, ultimately working toward improved brace design protocols.

Methods: Data was obtained for 90 AIS patients who had finished brace treatment at our center (60 full-time and 30 nighttime braces). Rates of ≥6 degree progression were 53% for daytime and 30% for nighttime braces. A modeling technique previously developed by our group was used to predict these patients' likely treatment outcomes given a range of in-brace corrections - the model was blinded to the true outcomes during this process. Each patient's 'recommended' correction was identified as the least aggressive correction resulting in a desirable predicted outcome. The efficacy of these recommendations was estimated using a technique called "clinical trial simulation" (CTS). This technique used a statistical model to predict progression rate under the model-recommended treatment, and compared it to the true progression rate, observed retrospectively, under the actual treatment. Significance was calculated using a permutation test.

Results: Model-recommended corrections ranged from 20%-58% for daytime and 65%-130% for nighttime braces, roughly corresponding with previous literature. Interestingly, in 37% of cases the recommended correction was less than that which had actually been applied, suggesting some opportunity for less aggressive (more comfortable) braces without compromising treatment outcome. The CTS estimated 26% fewer progressive cases using the model-recommended in-brace correction, over the actual correction observed retrospectively in the charts (p=0.05). The patients whose correction decreased under the model's recommendation did not show an increased progression rate.

Conclusions: Optimal correction may be less than the maximum achievable correction. The preliminary results suggest that considering model-generated recommendations during brace fitting could improve outcomes. Future work will expand the system to recommend wear-times as well as corrections, improving its clinical relevance. We envision this pilot demonstration to promote development of model-based decision support in scoliosis treatment, and prompt discussion on its future role.

Background: Review of literature reveals that in Idiopathic Scoliosis (IS) children, the post-operative rib hump (RH) correction using full transpedicular screw construct has never been compared to hybrid constructs, applying the Rib-Index (RI) method. Therefore the aim of this report is to study which of the above two constructs offers better postoperative Rib Hump Deformity (RHD) correction.

Methods: Twenty five patients with Adolescent Idiopathic Scoliosis (AIS) were operated using full pedicle screw construct or hybrid construct. Sixteen underwent full screw instrumentation (group A) and nine an hybrid one (group B). The median age for group A was 15 years and for group B 17.2 years. The RHD was assessed on the lateral spinal radiographs using the RI. The RI was calculated by the ratio of spine distances d1/d2, where d1 is the distance between the most extended point of the most extending rib contour and the posterior margin of the corresponding vertebra on the lateral scoliosis films and d2 is the distance from the least projected rib contour and the posterior margin of the same vertebra. Moreover the amount of RI correction was calculated by subtracting the post-operative RI from the pre-operative RI.

Results: Although within group A the RI correction was statistical significant (the pre-op RI was 1.93 and the post-op 1.37; p<0.001) and similarly in group B (the mean pre-op RI was 2.06 while the mean post-op 1.51; p=0.008), between group A and B the post-operative RI correction mean values were found to be no statistically significant, (p=0.803).

Conclusion: Although the pre- and post-operative RI correction was statistically significant within each group, this did not happen post-operatively between the two groups. It appears that the RHD correction is not different, no matter what the spinal construct type was used. Provided that the full screw construct is powerful, the post-operative derotation and RHD correction was expected to be better than when an hybrid construct is applied, which is not the case in this study. It is therefore implied that the RHD results more likely from the asymmetric rib growth rather than from vertebral rotation, as it has been widely believed up to now. In 2013 Lykissas et al, reported that costoplasty combined with pedicle screws and vertebral derotation significantly improved RH deformity as opposed to pedicle screws and vertebral derotation alone. Another interesting implication is that the spinal deformity is the result of the thoracic asymmetry, implication in line with the late Prof. John Sevastikoglou's (Sevastik's) thoracospinal concept.

Background: Coronal imbalance of the pelvis is recognized to lead to the development of degenerative lumbar scoliosis. We hypothesized that an abrupt change of pelvic obliquity may show a reproducible trend of coronal compensation in the lumbosacral spine. The aim of the study was to classify the change of coronal alignment of spine after THA.

Methods: This is a retrospective study based on the radiological analysis of 195 patients who underwent THA between 2009 and 2010. The mean age at surgery was 61.5 years old, and minimum follow up period was 24 months. Pelvic obliquity (POb) and Cobb's angle of lumbar scoliosis (LS) in coronal plane were measured. Over 3.5 degrees of change in POb was regarded as ΔPOb(+) and over 10 degrees of lumbar scoliosis was regarded as LS(+). The change of LS were classified into 3 subtypes; ΔLS(+), over 5 degrees of progress in LS, ΔLS(-), over 5 degrees of improvement in LS, and ΔLS(n), changes in LS within 5 degrees.

Results: Over 3.5 degrees of change in POb was significantly correlated with the change in LS. Among195 patients, 120 patients improved their pelvic obliquity (ΔPOb(+)), and 75 patients did not have an improved pelvic obliquity (ΔPOb(-)). 99 patients out of 120 ΔPOb(+) patients did not show changes (54, ΔLS(n)) or improvement in scoliosis (45, ΔLS(-)).The remaining 21 patients showed progress or development of de novo scoliosis. Patients who failed to compensate for the POb change at lumbosacral area developed de novo lumbar scoliosis (7 cases), showed progression in lumbar scoliosis (7 cases) or developed coronal trunk shift over 20mm (7 cases).

Conclusions: The patterns of compensation in lumbar or lumbosacral spine in coronal plane after leg lengthening THA were classified with regards to pelvic obliquity and Cobb's angle. 89.2% of 195 patients showed acceptable compensation in lumbar spine, 21 patients developed coronal imbalance. THA therefore is considered to be safe, as regards to spinal balance in coronal plane. However we have to keep in mind that preoperative rigid scoliosis could have a risk in progress for spinal imbalance.

Background: Axial vertebral rotation (AVR) is one of the important parameters to evaluate the severity and predict the progression of scoliosis. However, the AVR measurements on radiographs may underestimate its actual value. This pilot study investigated a new three-dimensional (3D) ultrasound method to measure AVR.

Methods: Three cadaveric vertebrae T7, L1, and L3 were scanned with a 3D medical ultrasound system. Nine sets of ultrasound data, the vertebral rotation from 0 to 40° with 5° increments, were recorded from each vertebra. An in-house program was developed to reconstruct and measure the 3D vertebral images. The rotation of each reconstructed vertebra was determined by the angle between the line going through the centres of either laminae (L-L) or transverse processes (TP-TP) and a reference vertical plane. Three raters measured the rotation in 3 sessions, in which they used the mouse pointer to select the L-L or TP-TP according to their knowledge of vertebral anatomy. The program detected the 3D coordinates of these points and calculated the AVR. The intra-class correlation coefficients (ICCs) were used to calculate the intra-reliability and inter-reliability. The mean absolute difference (MAD±SD) and the range of difference (RD) between the actual values and the average measurements of each rater were computed to evaluate the accuracy of methods.

Results: When rotation was greater than 30° for both L1 and L3, all raters found it difficult to determine one of the lamina areas due to the lack of ultrasound information in an area behind the spinous process. Therefore, the corresponding measurements were excluded. The ICC values of the intra-reliability (L-L, TP-TP) for the three raters were (0.987, 0.991), (0.989, 0.998) and (0.997, 1.000), respectively; meanwhile, the inter-reliability were 0.991 for (L-L) and 0.992 for (TP-TP). All ICC values were greater than 0.98 indicating both methods were highly reliable. The MAD±SD values (L-L, TP-TP) for the three raters were (1.5±0.3°, 1.2±0.2°), (1.6±0.3°, 1.3±0.3°), and (1.7±0.5°, 0.9±0.2°), respectively. The RD (L-L, TP-TP) were (0-4.5°, 0-3.5°), (0-5.1°, 0-4.3°), and (0-5.1°, 0-2.8°) for the three raters, respectively.

Conclusions: The (L-L) and (TP-TP) methods could be used to measure AVR reliability from the 3D ultrasound images.

Introduction: The quantification of internal joint efforts could be essential in the development of rehabilitation tools for patients with musculo-skeletal pathologies, such as scoliosis. In this context, the aim of this study was to compare the hips joint mediolateral forces during gait, between healthy subjects and adolescents with left lumbar or thoracolumbar scoliosis (AIS), categorized by their Cobb angle (CA).

Material and methods: Twelve healthy subjects, 12 AIS with CA between 20° and 40° and 16 AIS in pre-operative condition (CA : > 40°) walked at 4 km/h on an instrumented treadmill. The experimental set-up include six infrared cameras allow the computation of the tridimensional (3D) angular displacement and strain gauges located under the motor-driven treadmill allow the computation of ground reaction forces (GRF). The hips joint mediolateral forces were calculated using a 3D inverse dynamic of human body. One-way ANOVA was performed for the maximum, the minimum and the range of medio-lateral forces at each joint of the lower limbs. When appropriate, a Tukey's post hoc was performed to determine the differences.

Results: The mediolateral forces were significantly lower at the right hip for AIS with CA between 20° and 40° compared to healthy subject.

Conclusion: The spinal deformation leads to a reduced medio-lateral force at the right hip, which could gradually change the scheme of postural adjustments for AIS during gait. Further research on the quantification of the joint lower limb efforts should include the knee and ankle joints to evaluate the impact of spinal deformation on the lower limb dynamic behaviour in AIS patients.

Background: All lateral spinal radiographs in idiopathic scoliosis (IS) show a Double Rib Contour Sign (DRCS) of the thoracic cage, a radiographic expression of the rib hump. The outline of the convex overlies the contour of the concave ribs. The rib index (RI) method was extracted from the DRCS to evaluate rib hump deformity in IS patients. The RI was calculated by the ratio of spine distances d1/d2 where d1 is the distance between the most extended point of the most extending rib contour and the posterior margin of the corresponding vertebra on the lateral scoliosis films, while d2 is the distance from the least projection rib contour and the posterior margin of the same vertebra, (Grivas et al 2002). In a symmetric thorax the "rib index" is 1. This report is the validity study of DRCS, ie how the rib index is affected by the distance between the radiation source and the irradiated child.

Methods: The American College of Radiology's (2009) guidelines for obtaining radiographs for scoliosis in children recommends for the scoliotic - films distance to be 1,80 meters. Normal values used for the transverse diameter of the ribcage in children aged 6-12 years were those reported by Grivas in 1988.

Results: Using the Euclidean geometry, it is shown that in a normal 12-year old child d1/d2 = 1.073 provided that the distance ΔZ ≈ 12cm (11,84) and EA = 180cm, with transverse ribcage diameter of the child 22 cm.

Conclusions: This validity study demonstrates that the DRCS is substantially true and the RI is not practically affected by the distance between the radiation source and the irradiated child. The RI is valid and may be used to evaluate the effect of surgical or conservative treatment on the rib cage deformity (hump) in children with IS. It is noted that RI is a simple method and a safe reproducible way to assess the rib hump deformity based on lateral radiographs, without the need for any other special radiographs and exposure to additional radiation.