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.

[Chronicity, recurrence, and return to work in low back pain: common prognostic factors]. / Chronicité, récidive et reprise du travail dans la lombalgie: facteurs communs de pronostic.

OBJECTIVE: To determine the common risk factors of recurrence, chronicity and non return to work in low back pain. MATERIAL AND METHOD: A systematic review of the literature was done by searches of Medline, Embase, Pascal, the Cochrane database and also in the unindexed literature. Keywords used were low back pain, chronic, risk factors, recurrence, predictive value of tests, prognosis, confounding factors. Studies were assessed by two readers using the ANAES (French Agency for Health Assessment) scale allowing classification into high-, moderate- and low-quality trials. The scientific evidence level of the identified risk factors depend on the methodological quality of the studies, the number of studies in agreement, the coherence of their results and their clinical relevance. RESULTS: Fifty-four high quality studies were included. Several prognostic factors are common to the three described clinical situations. A history of low back pain (including the concept of pain severity, duration, disability, leg pain, related sickness leave and a history of spinal surgery), low level of job satisfaction and poor general health are highlighted with a strong level of evidence. Socioprofessionel and psychological factors including employment status, amount of wage, workers' compensation, and depression were found but with moderate level of evidence. Physical factors including lifting time per day and work postures were also found with moderate level of evidence. CONCLUSION: This study confirm that several prognostic factors are commun to recurrence, chronicity and non return to work in low back pain. Early identification of these factors is important in understanding, and hopefully preventing, the recurrence or the progression to chronicity and disability in low back trouble.

[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.