[Early-onset scoliosis: pathophysiology, diagnosis and treatment]. / Escoliosis de inicio temprano: fisiopatología, diagnóstico y tratamiento.

Early-onset scoliosis corresponds to a group of heterogeneous spinal conditions that present before 10 years of age with a curvature in the coronal plane of 10° or more. Regardless of the etiology, adequate control of the deformity is required to avoid cardiopulmonary deterioration and preserve quality and life expectancy. Diagnosis can be difficult and is usually incidental at a young age. To choose the best treatment, it is important to consider the patient's age, etiology, and rate of progression. Among the non-operative treatments, the most effective are the use of serial casts or brace, whose main objective is to stop the progression of the deformity and thus delay surgical treatment. Among the surgical treatments the distraction based systems and definitive arthrodesis have proven to be most effective. Early surgery leads to multiple complications, which is why, if feasible, non surgical management should be sought and fusion postponed till skeletal maturity. Due to the life-threatening risks associated with the deformity and treatment, it is important to educate the patient and family members about the importance of treatment adherence and follow-up.

La escoliosis de inicio temprano corresponde a un grupo heterogéneo de padecimientos de la columna, la cual se presenta antes de los 10 años de edad con una curvatura en el plano coronal de 10° o más. Independientemente de la etiología requiere un adecuado control de la deformidad para evitar deterioro cardiopulmonar, disminución en la calidad y expectativa de vida. El diagnóstico puede ser difícil y habitualmente se da de forma incidental. Para el tratamiento, es importante considerar la edad del paciente, la etiología y la velocidad de progresión. Dentro de los tratamientos conservadores, se encuentra el uso de yesos seriados o el corsé, cuyo objetivo principal es detener la progresión de la deformidad y con ello retrasar la cirugía a una edad mayor. Dentro de los tratamientos quirúrgicos se encuentran el uso de barras de crecimiento tradicionales, las barras de crecimiento magnéticas y la artrodesis definitiva. Se ha observado que realizarlos de forma temprana condiciona múltiples complicaciones por lo cual, de ser posible, debe optarse por el manejo no quirúrgico y postergar el tratamiento definitivo. Debido a los riesgos potencialmente mortales que conlleva la deformidad y el tratamiento, es de importancia educar al paciente y sus familiares sobre la importancia del apego y el seguimiento.

Does Transitioning to a Brace Improve HRQoL After Casting for Early Onset Scoliosis?

BACKGROUND: Serial casting is favored for the initial treatment of early onset scoliosis (EOS), but there is concern about significant morbidity and caregiver burden. Studies have examined the utility of bracing as an alternative to casting, but little is known about differences in health-related quality of life (HRQoL) between treatments. We hypothesized that patients with a diagnosis of idiopathic EOS experience an improvement in HRQoL when transitioning from serial casting to bracing as measured by the 24-Item Early Onset Scoliosis Questionnaire (EOSQ). METHODS: Subjects with idiopathic EOS were retrospectively identified from a multicenter database. EOSQ scores were compared before treatment, after index casting, after transition out of cast to brace, and at the most recent follow-up. Available major curve magnitudes were also compared during these time points. Data were compared using repeated-measures ANOVA with post hoc Bonferroni correction. RESULTS: Sixty-six subjects met the inclusion criteria. Thirty-seven (56%) subjects were male and the average age at the time of index treatment was 1.9 (0.37-6.4) years. The average follow-up was 3.2 (0.90-6.8) years. In 57 subjects, the major curve magnitude improved from a mean of 33 (CI 28-37) degrees before treatment initiation to 27 (CI 23-30) degrees after casting and to 24 (CI 20-29) degrees at the most recent follow-up. The HRQoL subdomain showed a significant decrease in HRQoL during casting treatment 75.7 (CI 72.9-78.5) from pre-index treatment 84.9 (CI 81.4-88.5), during brace treatment 84.8 (CI 81.8-88.0) and at most recent follow-up 87.0 (CI 83.6-90.3) ( P <0.001). The parental impact subdomain improved from the beginning to the end of treatment (77.7 to 87.7, P =0.001) (n=64). Satisfaction improved from casting to bracing (73.4 to 86.7, P <0.001) (n=63) and to the most recent follow-up (73.4 to 87.9, P <0.001). CONCLUSION: Patients treated with casting for EOS experience reversible declines in HRQoL. After patients transition from casting to bracing, EOSQ scores recover to pretreatment baseline levels and are maintained at follow-up. This information must be balanced with the effectiveness of treatment for EOS with either method and customized for each patient. LEVEL OF EVIDENCE: Level III-retrospective comparative study.

Why Don't Adolescents Wear Their Brace? A Prospective Study Investigating Psychosocial Characteristics That Predict Scoliosis Brace Wear.

BACKGROUND: Although bracing for adolescent idiopathic scoliosis can prevent curve progression and reduce the risk for future surgery, children frequently do not wear their braces as prescribed. The purpose of this study is to investigate how a broad array of psychosocial characteristics predict future compliance with scoliosis brace wear. METHODS: This was a single institution, prospective cohort study. All adolescents prescribed a first-time brace for adolescent idiopathic scoliosis were eligible. Patients and their parents completed a separate series of questionnaires that assessed baseline psychosocial characteristics across 6 domains: (1) brace-specific attitudes; (2) body image and self-esteem; (3) school performance and social relationships; (4) psychological health; (5) family functioning; and (6) demographics and scoliosis-specific details (242 total questions across 12 validated questionnaires). Objective brace compliance was collected using temperature-sensitive monitors. Defining compliance as percentage of brace prescription completed, comparative analyses were performed to identify baseline psychosocial characteristics that were associated with future wear. A composite measure (Bracing Fidelity Follow-Up Scale [BFFS]) of the 12 most predictive individual questions across all domains (both parent and adolescent) was constructed to help assess which adolescents were at highest risk of failure to wear their brace. Total BFFS score for each parent-adolescent dyad who completed all the included surveys was then determined by awarding one point for each factor that positively influenced future brace wear (maximum 12 points), and a correlation was calculated between total score and percent adherence to prescribed brace wear. RESULTS: A total of 41 patients were included. On average, patients with high self-esteem, above average peer relationships and poor brace-specific attitudes had lower brace compliance, although patients with increased loneliness and parental religiousness had higher compliance. Body image, socioeconomic status, family dynamics, and school performance had no significant relationship with brace use. Total score on the Bracing Fidelity Follow-Up Scale (BFFS) was significantly associated with improved brace wear (r=0.687, P <0.001). Those with a score of 6 or above (n=15/33 [45%], median compliance 96%) were more reliable users (15/15 with compliance >75%), and those with a score of 5 or less (n=18/33 [55%], median compliance 50%) had less consistent brace wear (9/18 with compliance <50%). CONCLUSION: This prospective study identifies numerous baseline psychosocial factors that are associated with future compliance with scoliosis brace wear. Although in need of further validation before widespread clinical application, the novel BFF scale offers a potential opportunity to partially discriminate between compliant and noncompliant scoliosis brace users such that supportive resources (eg, supportive counseling, peer-support groups, additional provider-based education, etc.) can be targeted to those patients most likely to benefit. LEVEL OF EVIDENCE: II.

The Effects of Short- and Long-Term Spinal Brace Use with and without Exercise on Spine, Balance, and Gait in Adolescents with Idiopathic Scoliosis.

Background and Objectives: Adolescent idiopathic scoliosis (AIS) is a prevalent spinal disorder in adolescents. Previous studies have shown biomechanical changes of the gait in the lower limb of AIS patients. To minimize the progression of scoliotic curvature, a spinal brace is used, which has been shown to be efficient. Usually, a brace is worn strictly for 20-22 h every day. To our knowledge, no study has assessed the short- and long-term effects of spinal brace use with or without an exercise program (6 months) to improve clinical and biomechanical parameters. The aim of our study was to verify the effects of short- and long-term spinal brace use, with or without an exercise program on the spine, body balance, and plantar load distribution during gait in AIS. Materials and Methods: A prospective randomized study was conducted with intention-to-treat analysis in forty-five adolescents diagnosed with AIS undergoing conservative treatment at a center specialized in spinal rehabilitation. Adolescents were evaluated at two stages of intervention: (1) spinal orthopedic brace, with acute use 24 h/day (n = 22) and (2) spinal orthopedic brace, with acute use between 15-18 h/day associated with a specific rehabilitation exercise protocol for six consecutive months (six months and 12 total sessions, n = 23). The evaluated parameters were: spine pain, using a visual analog scale (VAS); Cobb angle measurement using radiograph exams, as well as the Risser sign; and static balance and plantar pressure of the feet during gait, carried out using a pressure platform. Results: AIS patients showed significant improvements in the main scoliotic curvature, with a 12-degree reduction in Cobb angle pre- and post-short-term immediate use of spinal brace and a 5.3 degree correction after six months of spinal brace use in combination with specific exercises (long term). In addition, short- and long-term brace use with an exercise program showed a significant increase in anteroposterior and mediolateral balance and a reduction in plantar overload on the heel during gait, with an effect size between moderate and high. Conclusions: Intervention via the short- or long-term use of a spinal brace combined with specific exercises in adolescents with idiopathic scoliosis proved to be effective for correcting scoliotic curvature. In addition, intervention also showed improvements to the antero-posterior and mediolateral body balance and a reduction in the plantar load on the rearfoot region during gait, demonstrating effective mechanical action on the spine.

Risk of Scoliosis Progression in Nonoperatively Treated Adolescent Idiopathic Scoliosis Based on Skeletal Maturity.

BACKGROUND: Hand radiographs for skeletal maturity staging are now frequently used to evaluate remaining growth potential for patients with adolescent idiopathic scoliosis (AIS). Our objective was to create a model predicting a patient's risk of curve progression based on modern treatment standards. METHODS: We retrospectively reviewed all AIS patients presenting with a major curve <50 degrees, available hand radiographs, and complete follow up through skeletal maturity at our institution over a 3-year period. Patients with growth remaining underwent rigid bracing of curves >25 degrees, whereas patients between 10 and 25 degrees were observed. Treatment success was defined as reaching skeletal maturity with a major curve <50 degrees. Four risk categories were identified based on likelihood of curve progression. RESULTS: Of 609 AIS patients (75.4% female) presenting with curves over 10 degrees and reaching skeletal maturity at most recent follow up, 503 (82.6%) had major thoracic curves. 16.3% (82/503) of thoracic curves progressed into surgical treatment range. The highest risk group (Sanders 1 to 6 and curve 40 to 49 degrees, Sanders 1 to 2 and curve 30 to 39) demonstrate a 30% success rate with nonoperative treatment. This constitutes an 111.1 times (95% confidence interval: 47.6 to 250.0, P<0.001) higher risk of progression to surgical range than patients in the lowest risk categories (Sanders 1 to 8 and curve 10 to 19 degrees, Sanders 3 to 8 and curve 20 to 29 degrees, Sanders 5 to 8 and curve 30 to 39 degrees). CONCLUSIONS: Skeletal maturity and curve magnitude have strong predictive value for future curve progression. The results presented here represent a valuable resource for orthopaedic providers regarding a patient's risk of progression and ultimate surgical risk. LEVEL OF EVIDENCE: Level III-retrospective cohort study.

Adult Degenerative Scoliosis / Escoliose degenerativa do adulto

Abstract Populational aging increases the incidence of musculoskeletal degenerative processes, such as adult scoliosis (AS). Adult scoliosis is defined as a spinal deformity in the coronal plane with a Cobb angle > 10º. Adult scoliosis may be iatrogenic or result from a degenerative process (scoliosis de novo) or a pre-existing scoliosis. Adult scoliosis is a potentially limiting condition that affects a heterogeneous group of patients. Clinical treatment proved to be ineffective and surgery is often indicated. The present paper reviews AS pathophysiology, clinical presentation and diagnosis, in addition to surgical indications and the main techniques currently used.

Resumo O envelhecimento da população aumenta a incidência dos processos degenerativos osteomusculares, como a escoliose do adulto (EA). A EA é definida como uma deformidade da coluna no plano coronal com ângulo de Cobb > 10º e pode ocorrer devido a um processo degenerativo (escoliose de novo), evolução de uma escoliose pré-existente ou de forma iatrogênica. A EA é uma doença potencialmente limitante que acomete um grupo heterogêneo de pacientes. O tratamento clínico se mostrou pouco efetivo e a indicação cirúrgica é frequente. No presente artigo, é apresentada uma revisão sobre a fisiopatologia, a manifestação clínica e o diagnóstico da EA. Também são apresentadas as indicações cirúrgicas e as principais técnicas utilizadas atualmente.

Finite Element Analysis of a Controlled Dynamization Device for External Circular Fixation / Análise de elementos finitos de um dispositivo de dinamização controlada para fixação circular externa

Abstract Objective To virtually prototype a device for external circular fixation of long bone fractures with controlled dynamization made of two different materials and predict their mechanical behavior by using the finite element analysis (FEA) method. Method A software was used for 3D modeling two metal parts closely attached by a sliding dovetail joint and a high-density silicone damper. Distinctive FEAs were simulated by considering two different materials (stainless steel or titanium), modes (locked or dynamized) and loading conditions (static/point or dynamic/0.5 sec) with uniform 150 kg axial load on top of the device. Results The finite elements (FEs) model presented 81,872 nodes and 45,922 elements. Considering stainless steel, the maximum stress peak (140.98 MPa) was reached with the device locked under static loading, while the greatest displacement (2.415 × 10−3 mm) was observed with the device locked and under dynamic loading. Regarding titanium, the device presented the maximum stress peak (141.45 MPa) under static loading and with the device locked, while the greatest displacement (3.975 × 10−3 mm) was found with the device locked and under dynamic loading. Conclusion The prototyped device played the role of stress support with acceptable deformation in both locked and dynamized modes and may be fabricated with both stainless steel and titanium.

Resumo Objetivo Construir um protótipo virtual de um dispositivo de fixação circular externa para fraturas em ossos longos com dinamização controlada a partir de dois materiais diferentes e prever seu comportamento mecânico por meio da análise de elementos finitos AEF). Método Modelos tridimensionais compostos de duas peças metálicas unidas por uma junta deslizante em rabo de andorinha e um amortecedor de silicone de alta densidade foram criados em um software. Análises de elementos finitos distintas foram simuladas considerando dois materiais (aço inoxidável ou titânio), modos (bloqueado ou dinamizado) e condições de carregamento (estático/pontual ou dinâmico/0,5 segundo) diferentes com carga axial uniforme de 150 kg na porção superior do dispositivo. Resultados O modelo de elementos finitos (EFs) apresentou 81.872 nós e 45.922 elementos. Com aço inoxidável, o pico de tensão máxima (140,98 MPa) foi alcançado com o dispositivo bloqueado e sob carga estática, enquanto o maior deslocamento (2.415 × 10−3 mm) foi obtido com o dispositivo bloqueado e sob carga dinâmica. Com titânio, o pico de tensão máxima (141,45 MPa) ocorreu com o dispositivo bloqueado e sob carga estática, enquanto o maior deslocamento (3.975 × 10−3 mm) foi observado com o dispositivo bloqueado e sob carga dinâmica. Conclusão O protótipo do dispositivo desempenhou o papel de suporte de tensão com deformação aceitável nos dois modos, bloqueado ou dinamizado, e pode ser fabricado com aço inoxidável ou titânio.

Role of Body Cast Application for Scoliosis Associated With Prader-Willi Syndrome.

BACKGROUND: Prader-Willi syndrome (PWS) is a rare genetic syndrome, with a prevalence of infantile scoliosis of ~23%. These curves are likely related to severe hypotonia. Approximately 15% of children with PWS will need surgical intervention for their scoliosis. The purpose of this study was to evaluate the effectiveness of curing or controlling moderate and severe infantile scoliosis curves in children with PWS. METHODS: This single institution, retrospective study of patients with PWS and infantile scoliosis reviewed 34 consecutive children with >24 months follow-up from initiation of serial spinal casting. Cobb angle comparison measurements of radiographs taken precasting, during treatment, and at follow-up were performed. Rib-vertebral angle difference, Nash-Moe rotation, and space available for lung measurements were followed. Outcomes were stratified as "Cured," "Braced," and "Surgery." RESULTS: Average age for first cast for the entire study was 32 months (range, 14 to 64), undergoing 8 casts (range, 3 to 18) over 25 months (range, 9 to 57) for an initial curve of 54 degrees (range, 27 to 106 degrees), which improved to 27 degrees (range, 11 to 78 degrees). In total, 12 patients (35%) were in the Cured group, following 6 casts over 17 months, with an initial curve of 44±14 degrees improving to 17±5 degrees at the end of treatment, and 20±18 degrees at 68-month follow-up. In total, 18 patients were in the Braced group, with curves initially improving from 55±14 degrees to 35±14 degrees, but at 47±20 degrees at 51-month follow-up. Four patients needed surgery, with initial curves 85 degrees (range, 54 to 106 degrees), but surgery could be postponed 56 months (range, 40 to 73) by casting. Rib-vertebral angle difference was not prognostic. CONCLUSIONS: Serial spinal casting is effective in for treating infantile scoliosis in children with PWS. One third of patients had their curve resolved, at least temporarily, where they were braced and cast free. The others were able to delay surgery for a number of years. Initial curves <50 degrees in children <3 years of age seem to have the best prognosis. LEVEL OF EVIDENCE: Level IV.

Escoliosis idiopática del adolescente de bajo grado / Low grade adolescent idioaphic scoliosis

La escoliosis idiopática del adolescente (eia) es la forma de escoliosis más frecuente, afecta al 1 a 3% de los adolescentes. Su etiología aún no está totalmente definida siendo la causa genética la más probable. El objetivo principal del tratamiento es evitar la progresión de la curva y por ende prescindir del tratamiento quirúrgico. Tratamiento en curvas no severas dependerá de la madurez esquelética del paciente y de la magnitud de la curva, siendo la observación en curvas leves y el uso de corsé en las moderadas los tratamientos más aceptados.

Adolescent idiopathic scoliosis (ais) is the most frequent form of scoliosis, affecting 1 to 3% of adolescent. Its etiology is not yet fully defined, being the genetic factor the most important. The main objective of the treatment is to avoid the progression of the curve and therefore dispense with surgical treatment. Treatment in non-severe curves will depend of the skeletal maturity of the patient and the magnitude of the curve, being the observation in slight curves and the use of corset in the moderate ones the most accepted treatments.

Expert Consensus for Early Onset Scoliosis Surgery.

BACKGROUND: Despite a validated classification system, high-quality multicenter research databases (CSSG/GSSG), and a recent proliferation in publications, early-onset scoliosis (EOS) surgeons have no consensus on standards for surgical treatment. The 21st-century revolution in EOS care has only accelerated, with the arrival of a classification system, magnetically controlled growing rod, nusinersen, and improved nonoperative care (Mehta or Risser casting and compliance-monitored braces). This dizzying pace of change may have outstripped our ability to develop best-practice standards for EOS surgical indications. To learn where consensus is best (and worst) at this moment, we surveyed EOS world thought-leaders on a collection of representative cases. METHODS: A 6-case survey was constructed and sent to 20 EOS world thought-leaders. The cases were selected to be representative of the major treatment categories: idiopathic, neuromuscular, syndromic, congenital, thoracic dysplasia, and spinal muscular atrophy (specifically to assess the impact of nusinersen and parasol deformity on surgical planning). Respondents were queried regarding treatment with specific attention to instrumentation and construct when surgery was selected. Responses regarding surgical timing and technique were analyzed for consensus (defined as >80%). χ analysis was performed to evaluate for differences in treatment preferences based on years of experience. RESULTS: The survey response was 100%. Clinical experience ranged from 8 to 40 years (average 23.9 y). There was no consensus on any case. The greatest variability was on the congenital case; the closest to consensus was on the spinal muscular atrophy case. Three or more approaches were selected for all 6 cases; >4 approaches were selected for 5 cases. There is a trend towards screw fixation for proximal anchors. The management of thoracic dysplasia and parasol deformity is far from consensus. CONCLUSION: The lack of consensus for surgical treatment of 6 representative EOS cases demands a renewed effort and commitment to develop best-practice guidelines based on multicenter outcome data. LEVEL OF EVIDENCE: Level V-Expert Opinion.

Combined aerobic and resistance training improves respiratory and exercise outcomes more than aerobic training in adolescents with idiopathic scoliosis: a randomised trial.

QUESTION: In adolescents with idiopathic scoliosis, does combined aerobic and resistance training improve respiratory function, perceived exertion and functional exercise capacity more than aerobic training only? DESIGN: Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS: Forty adolescents with idiopathic scoliosis and formal indication for surgical correction (spinal curvature ≥ 45 deg). INTERVENTION: Both groups undertook three 60-minute training sessions per week for 12 weeks. The experimental group performed combined aerobic and resistance training and the control group performed only aerobic training. OUTCOME MEASURES: At baseline and upon completion of treatment, participants completed: a 6-minute walk test with Borg scale (0 to 10) rating of exertion, spirometry, maximal respiratory pressures and peak expiratory flow measurement. RESULTS: After 12 weeks of training, the experimental group improved more than the control group on the 6-minute walk test (MD 22 m, 95% CI 4 to 40), with lower perceived exertion at the end of the test (MD -1.2, 95% CI -1.9 to -0.4). The experimental group also improved more than the control group on several respiratory measures, including: FEV1 (MD 270 ml, 95% CI 30 to 510), maximal inspiratory pressure (MD 4 cmH2O, 95% CI 1 to 8) and peak expiratory flow (MD 33 l/minute, 95% CI 7 to 58). CONCLUSION: In adolescents with idiopathic scoliosis, combined aerobic and resistance training improves functional exercise capacity and several respiratory outcomes more than a similar training regimen with aerobic training only. It is unclear whether the magnitude of the benefits is large enough to be worthwhile. TRIAL REGISTRATION: NCT02413788.

Symmetric-electromyographic analysis in the evaluation of scoliosis treatment / Análise por simetrografia e eletromiografia na avaliação de tratamento da escoliose / Análisis por simetrografía y electromiografía en la evaluación de tratamiento de la escoliosis

INTRODUCTION: Scoliosis is a three-dimensional deformity of the spine, characterized by a lateral shift that affects body posture. The Pilates Method (PM) promotes alterations in the biomechanics and neuromuscular activation pattern. OBJECTIVE: The aim of this study was to analyze electromyography (EMG) and symmetrography (SMTG) technologies applied in the evaluation of neuromuscular and postural effects on right convex thoracolumbar scoliosis (RCTS) after applying a PM therapeutic protocol. METHODS: This is an exploratory study of 5 male and female adolescents, with an average age of 14.4 years. The subjects underwent postural asymmetry assessments through SMTG and neuromuscular assessment through surface EMG of the trapezius (TRAP), erector spinae (ERE), oblique (OBLI) and rectus abdominis (RA) muscles. The electromyographic signals were processed in the temporal (EMGAmp) and spectral (EMGFmed) domains. The therapeutic protocol consisted of 24 sessions of Pilates floor exercises held twice a week with a duration of 45 minutes. RESULTS: There was an improvement in scoliosis and asymmetric shoulders in one subject (20%) and in three other subjects with hip asymmetry. There was an improvement in one subject (33.33%), as demonstrated by SMTG. EMGAmp measurements demonstrated a significant difference between before and after (p≈0) and among the muscles (p≈0). EMGFmed measurements demonstrated that there was only a difference between before and after (p≈0). It was verified that the most noteworthy muscles in terms of EMGAmp were TRAP and ERE, emphasizing the existence of an increase in the mean EMGAmp for ERE. Muscle behavior for measurements in EMGFmed demonstrated a higher mean increase for RA and OBLI muscles. CONCLUSION: It is concluded that the EMG and SMTG technologies are important tests for monitoring the progress of scoliosis and in treatment decisions. Level of Evidence III; Diagnostic Studies - Investigating diagnostic tests.

INTRODUÇÃO: A escoliose é uma deformidade tridimensional da coluna vertebral, caracterizada por um desvio lateral que afeta a postura corporal. O método Pilates (MP) promove alterações na biomecânica e no padrão de ativação neuromuscular. OBJETIVO: O objetivo deste estudo foi analisar a eletromiografia (EMG) e a simetrografia (SMTG) aplicadas na avaliação dos efeitos neuromusculares e posturais sobre a escoliose toracolombar destro-convexa (ETLDC), após aplicação de um protocolo terapêutico do MP. MÉTODOS: Trata-se de um estudo exploratório com cinco adolescentes de ambos os sexos, com média de idade de 14,4 anos. Os pesquisados foram submetidos a avaliações de assimetria postural por meio da SMTG e avaliação neuromuscular por meio da EMG de superfície dos músculos trapézio (TRAP), eretores da espinha (ERE), oblíquos (OBLI) e reto do abdome (RA). Os sinais eletromiográficos foram processados nos domínios temporal (EMGAmp) e espectral (EMGFmed). O protocolo terapêutico foi constituído por 24 sessões do MP de solo, aplicado duas vezes por semana, com duração de 45 minutos. RESULTADOS: Houve melhora da escoliose e dos ombros assimétricos em um indivíduo (20%) e em três outros com assimetria de quadril; houve melhora em um indivíduo, (33,33%), de acordo com a SMTG. As medidas da EMGAmp demonstraram diferença significativa entre antes e depois (p≈0) e entre os músculos (p≈0). As medidas da EMGFmed demonstraram que houve diferença apenas entre antes e depois (p≈0). Verificou-se que os músculos de maior destaque para EMGAmp foram TRAP e ERE, ressaltando que houve um aumento na média de EMGAmp para ERE. O comportamento da musculatura para as medidas em EMGFmed demonstrou aumento médio superior para os músculos RA e OBLI. CONCLUSÃO: Conclui-se que as tecnologias da EMG e a SMTG são importantes exames no acompanhamento do quadro evolutivo da escoliose e nas decisões de tratamento. Nível de Evidência III; Estudos Diagnósticos - Investigação de testes diagnósticos.

INTRODUCCIÓN: La escoliosis es una deformidad tridimensional de la columna vertebral, caracterizada por un desvío lateral que afecta la postura corporal. El método Pilates (MP) promueve alteraciones en la biomecánica y en el patrón de activación neuromuscular. OBJETIVO: El objetivo de este estudio fue analizar la electromiografía (EMG) y la simetrografía (SMTG) aplicadas en la evaluación de los efectos neuromusculares y posturales sobre la escoliosis toracolumbar dextroconvexa (ETLDC) después de aplicación de un protocolo terapéutico del MP. MÉTODOS: Se trata de un estudio exploratorio con cinco adolescentes de ambos sexos con edad promedio de 14,4 años. Los encuestados fueron sometidos a evaluaciones de asimetría postural por medio de la SMTG y evaluación neuromuscular por medio de la EMG de superficie de los músculos trapecio (TRAP), erectores espinales (ERE), oblicuos (OBLI) y recto abdominal (RA). Las señales electromiográficas fueron procesadas en los dominios temporal (EMGAmp) y espectral (EMGFmed). El protocolo terapéutico fue constituido por 24 sesiones de MP de suelo, aplicado dos veces por semana, con duración de 45 minutos. RESULTADOS: Hubo mejora de la escoliosis y de los hombros asimétricos en un individuo (20%) y en tres otros con asimetría de cadera; hubo mejora en un individuo, (33,33%), de acuerdo con la SMTG. Las medidas de la EMGAmp demostraron diferencia significativa entre antes y después (p≈0) y entre los músculos (p≈0). Las medidas de la EMGFmed demostraron que hubo diferencia sólo entre antes y después (p≈0). Se verificó que los músculos de mayor destaque para EMGAmp fueron TRAP y ERE, resaltando que hubo un aumento en el promedio de EMGAmp para ERE. El comportamiento de la musculatura para las medidas en EMGFmed demostró un aumento promedio superior para los músculos RA y OBLI. CONCLUSIÓN: Se concluye que las tecnologías de la EMG y la SMTG son importantes exámenes en el acompañamiento del cuadro evolutivo de la escoliosis y en las decisiones die tratamiento. Nivel de evidencia III, Estudios Diagnósticos - Investigación de Exámenes Diagnósticos.

Effects of corrective, therapeutic exercise techniques on adolescent idiopathic scoliosis. A systematic review. / Efectos de las técnicas de ejercicio terapéutico correctivo en la escoliosis idiopática del adolescente. Revisión sistemática.

The objective of this study was to determine the effects of corrective, therapeutic exercise techniques on subjects with adolescent idiopathic scoliosis. A systematic review was conducted by searching the Cochrane Library Plus, Pubmed, PEDro, and SCOPUS databases. Studies in patients diagnosed with adolescent idiopathic scoliosis that considered corrective, therapeutic exercise as an independent outcome measure and symptoms, functional capacity, Cobb's angle and/or other angles or body asymmetries as dependent outcome measures were included. A total of 9 controlled clinical trials that carried out corrective, therapeutic exercise were included. Corrective, therapeutic exercise appears to have positive effects by reducing symptoms and improving function, as well as various angles and body asymmetries. However, further studies with better methodological quality are required to confirm these outcomes and determine the best therapeutic exercise intervention.

El objetivo del estudio fue determinar los efectos de las técnicas de ejercicio terapéutico correctivo en sujetos con escoliosis idiopática del adolescente. Se realizó una revisión sistemática realizando búsquedas en Biblioteca Cochrane Plus, Pubmed, PEDro y SCOPUS. Se incluyeron estudios de pacientes con diagnóstico de escoliosis idiopática del adolescente, que consideraron, como variable independiente, ejercicio terapéutico correctivo y, como variables dependientes, síntomas, capacidad funcional, ángulo de Cobb y/u otros ángulos o asimetrías corporales. Se incluyeron un total de 9 ensayos clínicos controlados que utilizaron ejercicio terapéutico correctivo. El ejercicio terapéutico correctivo parece tener efectos positivos en la disminución de síntomas, mejora de la función y mejora de diferentes ángulos y asimetrías corporales. Sin embargo, son necesarios estudios con mejor calidad metodológica para confirmar estos resultados y determinar la mejor intervención mediante ejercicio terapéutico.

Efeitos da técnica isostretching em pacientes com escoliose: uma revisão sistemática / Isostretching technique effects in patients with scoliosis: systematic review

Introdução: O isostreching é uma modalidade terapêutica onde o tratamento é focado na melhora dos desequilíbrios posturais. Objetivo: Identificar os efeitos da técnica isostreching no tratamento da escoliose. Métodos: Trata-se de uma revisão sistemática de estudos publicados entre os anos de 1997 e 2017. Foram utilizados os termos de busca: escoliose, isostretching, isolados e associados em português e em inglês nas bases de dados Google acadêmico, SciELO; PEDro; PubMed; Bireme e Cochrane. Resultados: Durante a pesquisa foram encontrados 314 artigos, após a leitura e os critérios estabelecidos, foram selecionados para compor a revisão 6 estudos. A técnica apresentou resultados positivos em relação ao padrão postural, gibosidade e ângulo de Cobb. Conclusão: Pode-se concluir que a técnica de isostretching na escoliose teve resultados positivos, entretanto os resultados ainda são bastante discutíveis, haja visto que a quantidade de ensaios clínicos que abordaram o tema é baixa.

Introduction: Isostreching is a therapeutic modality where treatment is focused on the improvement of postural imbalances. Objective: To identify the effects of the isostreching technique in the treatment of scoliosis. Methods: This is a systematic review of studies published between 1997 and 2017. The search terms were: scoliosis, isostretching, isolated and associated in Portuguese and English in the databases Google academic, SciELO; Pedro; PubMed; Bireme and Cochrane. Results: During the research, 314 articles were found, after reading and the established criteria, 6 studies were selected to compose the review. The technique presented positive results in relation to the postural pattern, gibosity and Cobb angle. Conclusion: In this way, the technique of isostretching in scoliosis had positive results, however the results are still quite controversial, since the number of clinical trials that approached the subject is very low.

Tratamiento interdisciplinario de paciente con síndrome de clase III / Interdisciplinary treatment of a class III syndrome patient

Se presenta el caso clínico de una paciente de 9 años de edad que concurre al Servicio de Abordaje Interdisciplinario para la Rehabilitación de Pacientes con Hábitos Orales Disfuncionales y Tratamientos Tempranos, facultad de Odontología, UNC. Es acompañada por su madre quien nos manifiesta su intensapreocupación por la conducta de su hija, quien no se relaciona con sus pares, sólo juega con uno de sushermanos. No se comunica ni responde a nuestras preguntas. La valoración clínica constata un perfil cóncavo, depresión del tercio medio facial en sentido anteroposterior, praxias orofaciales disfuncionales, trastornos foniátricos, y alteraciones posturales- hiperlordosis cervical y cifoescoliosis dorsolumbar. Existen antecedentes hereditarios de Clase III por líneapaterna. En el diagnóstico se comprueba el síndrome de Clase III esqueletal. Se realiza en primera instancia un tratamiento Ortopédico con Mascarilla de Tracción pósteroanterior, intraoralmente utilizamos Plan Six Helix modificadocon ganchos para la tracción. Estaasociación de aparatología permitió estimular biomecánicamente el crecimiento pósteroanterior delmaxilar superior a nivel sutural y protruyó el sector anterosuperior dentario. Posteriormente se aplicóaparatología miofuncional. Estuvo acompañada con apoyo psicológico para aceptar el tratamiento interdisciplinario y estimular su integración social. Además, se rehabilitaron las disfunciones orofaciales y la postura mediante reeducación postural y uso deplantillas ortopédicas. La rehabilitación integral logró redireccionar su crecimiento desde su base de sustentación, armonizando todas sus unidades funcionales y recuperar su autoestima y lograr su socialización.

We presented the clinical case of a 9-year-old patientwho concur to the Service of Early OrthodonticTreatment and Oral Dysfunctional Habits of theDepartment of Child and Adolescent Integral “B”,Orthodontia area. UNC. She is accompanied by hermother who shows us her intense concern for theconduct of his daughter, who isn´t related to herpeers, only plays with one of the brothers. It alsodoesn´t communicate or respond to ours questions.The girl has socio-emotional disorder.In the clinical evaluation we find a concave profilewith depressed midface, phoniatrics disorders, dysfunctionalorofacial praxis and postural changes incervical lordosis, kyphoscoliosis dorso-lumbar.Class III skeletal features. There are heredity ClassIII from the father family.An orthopedic treatment is in the first instance witha posterior-anterior mask, central rod model Pettit.Intraorally used a Six Helix Plan, modified with hooks for rubber for the mask. This association ofappliance allowed us biomechanically, stimulate anteriorposterior growth of the upper jaw in the suturalarea and protrude forward the upperanteriortooth sector. Later was applied myofunctional equipment, elastic open activator Klammt class Imodified, changed without vestibular arc to let incisorsexpress and lingual bowls. During treatment, she was accompanied with psychological support to accept it and encourage theirsocial integration. Also with phonoaudiological treatment, respiratory disorders, deglutition and foniatricswere treated.The physiatric therapy consisted in postural reeducationand using orthopedics insoles.

[Adolescent idiopathic scoliosis]. / Consenso de escoliosis idiopática del adolescente.

Adolescent idiopathic scoliosis is a 3D spinal deformity in frontal, sagittal and axial planes, with high relevance in the pediatric population especially in adolescents and females between 10 years of age and the end of growth spurt and skeletal maturity. The radiographic manifestation is a curve greater than 10° measured by Cobb method associated with vertebral rotation. "Idiopathic" diagnosis has to be done after neuroanatomical anomalies of the posterior cerebral fosa and spinal canal have been ruled out. The physical finding of a thoracic or lumbar hump is the clinical manifestation of vertebral rotation seen in a forward bending test (Adam's Test). It is recommended that all curves with a magnitude greater than 20° have to be controlled and treated by a spinal surgeon being observation, bracing and surgery the different treatment options based on the extent, progression of deformity and basically the clinical condition of the patient.

La escoliosis es una condición patológica de la columna vertebral caracterizada por una deformidad espinal en las tres dimensiones del raquis (planos coronal, sagital y axial). Constituye una entidad de alta incidencia en la población pediátrica, especialmente en los adolescentes y en el sexo femenino. Se caracteriza por la presencia radiográfica de una curva en el plano frontal, cuya magnitud es mayor de 10° (técnica de Cobb). Puede ser idiopática o estar asociada a otras patologías. La escoliosis idiopática del adolescente (EIA) es aquella que se manifiesta entre los 10 años de edad y la madurez esquelética. Es más frecuente en mujeres (70%). Su diagnóstico de "idiopática" es de exclusión, ya que su presencia también puede ser originada por anomalías neuroanatómicas de la fosa cerebral posterior o del conducto raquídeo. En el examen físico, la presencia de giba/s visible/s con la maniobra de Adams (inclinación del tronco hacia adelante) expresa clínicamente la rotación vertebral. Toda curva mayor de 20° debe ser evaluada por el especialista. Las opciones de seguimiento y tratamiento son la observación, el tratamiento ortésico y la cirugía, dependiendo de la magnitud, de la progresión de la deformidad y, fundamentalmente, de la clínica del paciente.

Escoliosis degenerativa del adulto / Degenerative adult scoliosis

La escoliosis del adulto es una deformidad rotacional compleja tridimensional de la columna, resultado de la degeneración progresiva de los elementos vertebrales en la edad madura, en una columna previamente recta; con un ángulo de Cobb mayor de 10º en el plano coronal, que además altera los planos sagital y axial. Se origina de una enfermedad degenerativa, asimétrica del disco y las facetas articulares, creando cargas asimétricas y posteriormente deformidad. El síntoma principal es dolor axial, radicular y déficit neurológico. El tratamiento conservador incluye fármacos y terapia física. Las infiltraciones epidurales y facetarias para bloqueo selectivo de raíces nerviosas mejora el dolor a corto plazo. El tratamiento quirúrgico se reserva para pacientes con dolor intratable, radiculopatía y/o déficit neurológico. No existe un consenso para las indicaciones quirúrgicas, sin embargo, se debe tener un entendimiento claro de los síntomas y signos clínicos. La meta de la cirugía es la descompresión de elementos neurales con restauración, modificación de la deformidad en forma tridimensional y estabilización del balance coronal y sagital.

Adult scoliosis is a complex three-dimensional rotational deformity of the spine, resulting from the progressive degeneration of the vertebral elements in middle age, in a previously straight spine; a Cobb angle greater than 10º in the coronal plane, which also alters the sagittal and axial planes. It originates an asymmetrical degenerative disc and facet joint, creating asymmetrical loads and subsequently deformity. The main symptom is axial, radicular pain and neurological deficit. Conservative treatment includes drugs and physical therapy. The epidural injections and facet for selectively blocking nerve roots improves short-term pain. Surgical treatment is reserved for patients with intractable pain, radiculopathy and / or neurological deficits. There is no consensus for surgical indications, however, it must have a clear understanding of the symptoms and clinical signs. The goal of surgery is to decompress neural elements with restoration, modification of the three-dimensional shape deformity and stabilize the coronal and sagittal balance.

[Degenerative adult scoliosis]. / Escoliosis degenerativa del adulto.

Adult scoliosis is a complex three-dimensional rotational deformity of the spine, resulting from the progressive degeneration of the vertebral elements in middle age, in a previously straight spine; a Cobb angle greater than 10° in the coronal plane, which also alters the sagittal and axial planes. It originates an asymmetrical degenerative disc and facet joint, creating asymmetrical loads and subsequently deformity. The main symptom is axial, radicular pain and neurological deficit. Conservative treatment includes drugs and physical therapy. The epidural injections and facet for selectively blocking nerve roots improves short-term pain. Surgical treatment is reserved for patients with intractable pain, radiculopathy and/ or neurological deficits. There is no consensus for surgical indications, however, it must have a clear understanding of the symptoms and clinical signs. The goal of surgery is to decompress neural elements with restoration, modification of the three-dimensional shape deformity and stabilize the coronal and sagittal balance.

Effect of a preoperative protocol of aerobic physical therapy on the quality of life of patients with adolescent idiopathic scoliosis: a randomized clinical study.

Patients with adolescent idiopathic scoliosis (AIS) have lower potential for physical activity because of lung dysfunction and lower muscle strength, which can be reversed by the cardiorespiratory and musculoskeletal conditioning provided by standardized physical activities. We conducted a study to determine if a preoperative protocol of aerobic exercise would improve quality of life (QoL) both before and after training and if there would be any differences between patients who received the therapy and those who did not. Patients with the indication of surgical correction of AIS were randomized to receive or not receive a 4-month preoperative course of aerobic physical training. At baseline and after 4 months, they were evaluated with the Short Form-36 questionnaire (SF-36). QoL scores improved for the study group but did not change for the control group. In all QoL domains, the study group's mean score increased significantly between baseline and 4 months. We concluded that the proposed preoperative physical therapy protocol improved the QoL of patients with AIS.