Changing curve pattern in infantile idiopathic scoliosis: family report with a follow-up of 15 years.

STUDY DESIGN: The authors monitored a father and his six children, all of whom had idiopathic scoliosis for more than 13 years. OBJECTIVE: To analyze the similarities and differences in curve pattern between the family members. SUMMARY OF BACKGROUND DATA: The etiology and pathogenesis of idiopathic scoliosis are not well understood. Genetic factors play an important role, as is shown by the high concordance in monozygotic twins. METHODS: Radiographs from all family members were analyzed. Location and direction of the curve, Cobb angle, location of the apex, and rib-vertebra angle difference were compared. RESULTS: A father and his six children had idiopathic scoliosis. The curves differed within the family and changed during follow-up. The father had a left convex thoracic scoliosis of 42 degrees. Only three of the children had a curve of similar severity, and only four children had a left convex thoracic scoliosis. In three children the curve pattern changed during follow-up. CONCLUSIONS: This report of idiopathic scoliosis in a father and six children supports the present theories on a genetic origin of the disorder but also stresses the importance of dynamic processes in the development of scoliosis.

Curve characteristics in monozygotic twins with adolescent idiopathic scoliosis: 3 new twin pairs and a review of the literature.

Most authors state that there is strong evidence for a genetic origin of adolescent idiopathic scoliosis (AIS). This conclusion is mainly based on the fact that the rate of concordance for AIS in monozygotic twins is significantly higher than that in dizygotic twins. However, it is of interest to determine whether all elements of scoliosis formation are genetically predetermined. If this were the case, there would perhaps be less place for closed treatment. We surveyed the literature for monozygotic twin pairs in which both members suffered from idiopathic scoliosis and added 3 pairs from our own patient group. The total group consisted of 32 twin pairs. We found that gender, direction of the convexity, the level of the apex and the kyphotic angle were determined more by genetic factors than the lateral Cobb angle of the scoliotic curve. This suggests that variations in the environment may affect the curve patterns in monozygotic twins.

Aneurysmal bone cyst of the spine: 31 cases and the importance of the surgical approach.

Thirty-one cases of aneurysmal bone cyst of the spine with a minimum follow-up of 1 year as registered by the Netherlands Committee for Bone Tumors are reported. Aneurysmal bone cyst is a benign, sometimes expansive and destructive, lesion frequently occurring between the ages of 10 and 20 years. Located in the vertebral column, it undermines the structural integrity of the spine, and neurologic complications can occur. In all cases the posterior elements were involved, with extension into the vertebral body occurring in 22 cases. Extension to adjacent vertebra occurred 5 times, but the intervertebral disc appeared to be left intact. Twenty-nine of 31 cases were treated surgically. Posterior approaches provided insufficient access to lesions also located to the vertebral body and were associated with a higher recurrence rate (5 of 18 cases) than anterior approaches (1 of 11 cases). Of 10 cases in which the surgical removal was incomplete, 4 healed and 6 had a local recurrence. Selective embolization was used twice, and its application is discussed. On the basis of this material and a review of the literature, treatment by intralesional curettage combined by adjuvant therapy such as preoperative embolization is advised.

[One hundred years of orthopedics in the Netherlands. IV. Spinal abnormalities]. / Honderd jaar orthopedie in Nederland. IV. Wervelkolomaandoeningen.

In recent years there has been spectacular progress in the approach to various disorders of the spinal column. Owing to improved methods of osteosynthesis there is no longer so much need for long periods of postoperative bed rest. Of all the scolioses, idiopathic scoliosis is most common. The vast majority of these cases are not clinically significant. What is seen in the remaining cases if left untreated is a progression in the curvature during growth. Progressive idiopathic scoliosis can be effectively treated using conservative methods. Screening at school is an important part of this process. If the curvature proves progressive and skeletal growth is not complete a brace can be prescribed. Use of this strategy and form of treatment can avoid progression of the curvature and development of serious deformities. This conservative therapy has markedly reduced the need for corrective surgery. Scheuermann's disease is characterized by a fixed dorsal thoracic kyphosis. Progressive Scheuermann's kyphosis can be effectively treated using a brace. The majority of fractures of the vertebral bodies can be treated conservatively. However, serious fractures normally require surgical intervention. In the industrialised Western world, low back pain is a major health problem and the foremost cause of disability and unfitness for work. Low back pain caused by degenerative disease of the spinal column should be treated using a multidisciplinary approach. The development of advanced operative techniques and osteosynthesis methods has made it possible to treat metastases of the spine surgically. The effects of this treatment on the quality of life are encouraging.

[Metal detectors for security checks mostly insensitive for metal implants]. / Metaaldetectoren bij veiligheidscontroles doorgaans ongevoelig voor metalen implantaten.

OBJECTIVE: To determine whether metal implants may cause problems at security checks (e.g. at airports). SETTING: Amsterdam, Schiphol. METHOD: Fifty operated scoliosis patients chosen at random were asked by questionnaire whether they had ever been checked with a metal detector at an airport and whether the detector had reacted to the implant. In addition, several types of implants were tested with two types of detectors in collaboration with the airport State Police. RESULTS: Forty-six questionnaires were returned. Twenty-two respondents stated having been checked with a metal detector gate at least once. In three cases the detector had sounded. During the Schiphol trial it was found that the metal detector gate did not react to various types of osteosynthesis material nor to a Harrington rod. CONCLUSION: Metal detectors may be expected as a rule not to react to medical implants. This is due among other things to the relative insensitivity of metal detectors to the alloy used in the implant and to their being adjusted to react only to metal in quantities above a certain minimum.

[Backache in children and adolescents]. / Rugpijn bij kinderen en adolescenten.

Although backpain during childhood is uncommon serious diseases feature high on the list of differential diseases. Often the correct diagnosis in the young is made late or missed in the first instance. During the adolescent period the incidence of backpain rises to include mechanical or osteochondritic conditions and the early problems of a degenerative back such as disc protrusion. It has to be stressed that infection and neoplasma although rare can be a cause of backache at any age. If after thorough investigation no abnormalities has been detected, one should keep in mind that serious mental problems can be the cause of backpain.

Bone scintigraphy in patients with juvenile kyphosis (M. Scheuermann).

A group of 32 patients between 10 and 16 years of age with a positive history and physical examination of juvenile kyphosis were studied. Both radiological and nuclear bone scanning studies of the spinal column were performed. Despite gross radiological abnormalities of the spinal column due to M. Scheuermann the bone scan was always negative. In 2 patients increased radionuclide accumulation was found due to active spondylodiscitis and a healing discitis. Our conclusion is that when a positive bone scan of a patient with M. Scheuermann is found one should consider other causes of involvement of the spinal column than juvenile kyphosis.

Pulmonary bone embolism after total hip replacement.

Numerous intravascular bony spicules were found at necropsy in both lungs of an 84-year-old patient who had undergone total hip replacements three and 10 months before death. It is suggested that acetabular grindings enter the damaged venous system at operation and are filtered out by the lungs.