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.

[Assessment of chronic pain as a disability in patients with spinal cord injuries]. / Evaluation fonctionnelle de la douleur chronique chez le patient blessé médullaire.

OBJECTIVES: To evaluate pain and its impact on daily life activities in patients with spinal cord injuries. METHODS: Patients with chronic pain associated with spinal cord injuries were mailed 2 questionnaires: the multidimensional pain inventory for spinal cord injury, which includes a visual numeric scale for pain; and the quality of life questionnaire SF-36. RESULTS: Twenty-two of the 28 patients (women 9, men 19) who were mailed the questionnaires responded. The location of pain was, in decreasing order: lower limbs, upper limbs, trunk. The clinical type of pain was usually neuropathic, and the mean pain intensity was 7.2+/-2.16. Eleven patients experienced sleep disturbances. In 17 patients, daily activities were limited because of pain (not counting 2 patients who were unable to answer because of hospitalization). Among 6 working patients (of 22), 5 experienced limitations in their job because of pain. SF-36 scores, which reflect psychological and physical health, were well below those of the general population. DISCUSSION-CONCLUSION: Despite the small size of our population and lack of a French-language validation of the questionnaire, these preliminary results point out the important interference of chronic pain in functional autonomy and quality of life in patients with spinal cord injuries.

[Two cases of rehabilitation in Ehler-Danlos syndrome]. / Prise en en charge rééducative de la maladie d'Elhers-Danlos: à propos de deux cas.

PURPOSE: Ehlers-Danlos syndrome is rare and little known. It comprises a heterogeneous group of heritable connective tissue disorders characterized by articular hypermobility, skin extensibility and tissue fragility. Diagnosis may be difficult and often delayed. CASE REPORT: Here we describe 2 cases of women with Ehlers-Danlos syndrome. The first had scoliosis with back pain and joint hypermobility. The second presented with hypermobility and joint dislocation, which increased during pregnancy. In these 2 cases, rehabilitation management produced clinical improvement. DISCUSSION: Orthopaedic complications such joint pain, joint swelling, joint dislocation, back pain, with walking and hand function disability are the main problems in Ehlers-Danos syndrome. Surgery may be necessary to correct dislocated joints but is often not sufficient to resolve the handicap, and physical therapy has an important place in management. CONCLUSION: Ehlers-Danlos syndrome is an evolving disease that can lead to great impairment. Thus, physicians must be aware of this syndrome to offer the best management, with the appropriate use of orthotic devices, specific strengthening routines, education in proper body mechanics and assistive devices, to prevent joint dislocation and subluxations responsible for pain and handicap.