Does adolescent idiopathic scoliosis relate to vestibular disorders? A systematic review.

UNLABELLED: Adolescent idiopathic scoliosis (AIS) is a tridimensional deformity of the spinal column. This frequent disease, which has no clearly identified pathogenic mechanism, can have serious consequences. It has been hypothesized that unilateral and isolated vestibular disorders could be the origin of AIS. The objective of this work is to verify this hypothesis and to establish a pathophysiological model. METHOD: We performed a Pubmed-NCBI search, for the period 1966-2013, crossing the keyword scoliosis with the following keywords: vestibular, labyrinthine, postural control. RESULTS: This search retrieved 66 articles. Twenty controlled studies were considered for study. Their analysis showed discordant results. This review cannot confirm a link between isolated vestibular disorder and occurrence of development of scoliosis. CONCLUSIONS: There is not enough evidence to show a link between unilateral, isolated, vestibular dysfunction and AIS. From these findings, we propose a more global pathophysiological concept, which involves a trouble of the orthostatic postural control, with disturbance in the multisensory integration of vestibular, visual and somesthesic inputs. AIS could be the consequence of a reorientation of the longitudinal body axis in accordance with an erroneous central representation of verticality. An assessment of the sense of verticality would allow evaluate this hypothesis.

[French translation and validation of a functional disability scale for neck pain]. / Traduction et validation dune échelle algofonctionnelleadaptée aux cervicalgies.

OBJECTIVES: To translate and to assess the reliability and the construct validity of the French translation of the Neck Pain and Disability Scale (NPDS), an American functional disability scale for neck pain. PATIENTS AND METHODS: Non randomised prospective study, where patients with neck disorders were included. Impairment outcomes measures (VAS Pain, range of motion of neck, score of neck sensitivity, radiologic score of Kellgren) and patientsperceived handicap (VAS) were recorded at the baseline visit. Disability was assessed with the NPDS, that was recorded twice, at baseline visit and 24 hours later. Reliability was assessed using the intraclass correlation coefficient (ICC) and the Bland and Altman method. Construct (convergent and divergent) validity was investigated using the Spearman rank correlation coefficient and a factor analysis was performed. RESULTS: One hundred and one patients were included. French versions were obtained using the "translation/backward translation" method. Expected convergent (r = 0.51 with VAS Pain, 0.63 with VAS Functional Disability, 0.67 with VAS Handicap) and divergent (r = 0.39 and 0.49 respectively for the anxiety and depression scores of HAD, palpation sensitivity r = 0.31, neck mobility r = - 0.45 and 0.28, and Kellgrens radiologic score r = 0.04) validity were observed, suggested good construct validity. Test-retest was excellent for NPDS with ICC = 0.91. The Bland and Altman method showed distribution of differences homogenous and no systematic trend. Three mains factors were extracted by factors analysis of the NPDS, and explained 78% of the cumulative variance. CONCLUSION: The French version of NPDS has good metrologic qualities. This scale can be used in clinical practice to assess disability in neck pain and to normalise disability assessment.

Visual deficiency and scoliosis.

STUDY DESIGN: A transversal study involving group comparison was performed. OBJECTIVE: To investigate whether children who are visually impaired have a higher rate of spinal deformity. SUMMARY OF BACKGROUND DATA: Evidence has accumulated pointing to an association between idiopathic scoliosis and postural control in which vision is involved. An association between scoliosis and ocular troubles is present in many diseases, but no study on a large blind population has yet been undertaken. METHODS: Data was obtained from an official school screening campaign involving two consecutive classes in a regional school for the visually handicapped and from two consecutive classes in three public vocational schools. This study included 75 children who were visually handicapped (mean age, 11 years and 7 months) and 728 healthy control participants (mean age, 10 years 2 months). Trunk deformity was assessed by Moire topography and measurement of any trunk hump by the forward bending test. The children with visual impairment who had evidence of trunk deformity underwent radiographs of the spine a few months after the back surface assessment, then again 12 to 24 months later. RESULTS: Occurrences of trunk deformity were significantly different in the two groups (P < 0.0001), with five times more back surface abnormalities in the blind population. Of the 26 children with both visual impairment and trunk deformity, 18 had a structural scoliosis on radiographs, with an average Cobb Meyer angle of 14.1 degrees (range, 10-28 degrees ), but there was evidence of an evolving condition in only three cases. CONCLUSIONS: These findings are compatible with a postural etiology of scoliosis in the visually impaired population.

[Stiff-Man syndrome with late onset]. / Stiff-Man syndrom. Début tardif.

We report a case of Stiff-Man syndrome according to Gordon, Januszko and Kaufman's criteria. Onset at age 76, association with insomnia and a rapid course leading to death within 2 years were the characteristic features. CSF data, electromyographic and immunological findings suggest abnormalities of catecholaminergic and GABA ergic systems, with release of segmental or suprasegmental inhibitory influence. The presence of antibodies against glutamic acid decarboxylase, considered a useful marker of this syndrome, raises the possibility of an autoimmune pathogenesis.