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1.
Bone Joint J ; 102-B(2): 254-260, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009436

RESUMO

AIMS: The aim of this study was to assess whether supine flexibility predicts the likelihood of curve progression in patients with adolescent idiopathic scoliosis (AIS) undergoing brace treatment. METHODS: This was a retrospective analysis of patients with AIS prescribed with an underarm brace between September 2008 to April 2013 and followed up until 18 years of age or required surgery. Patients with structural proximal curves that preclude underarm bracing, those who were lost to follow-up, and those who had poor compliance to bracing (<16 hours a day) were excluded. The major curve Cobb angle, curve type, and location were measured on the pre-brace standing posteroanterior (PA) radiograph, supine whole spine radiograph, initial in-brace standing PA radiograph, and the post-brace weaning standing PA radiograph. Validation of the previous in-brace Cobb angle regression model was performed. The outcome of curve progression post-bracing was tested using a logistic regression model. The supine flexibility cut-off for curve progression was analyzed with receiver operating characteristic curve. RESULTS: A total of 586 patients with mean age of 12.6 years (SD 1.2) remained for analysis after exclusion. The baseline Cobb angle was similar for thoracic major curves (31.6° (SD 3.8°)) and lumbar major curves (30.3° (SD 3.7°)). Curve progression was more common in the thoracic curves than lumbar curves with mean final Cobb angles of 40.5° (SD 12.5°) and 31.8° (SD 9.8°) respectively. This dataset matched the prediction model for in-brace Cobb angle with less mean absolute error in thoracic curves (0.61) as compared to lumbar curves (1.04). Reduced age and Risser stage, thoracic curves, increased pre-brace Cobb angle, and reduced correction and flexibility rates predicted increased likelihood of curve progression. Flexibility rate of more than 28% has likelihood of preventing curve progression with bracing. CONCLUSION: Supine radiographs provide satisfactory prediction for in-brace correction and post-bracing curve magnitude. The flexibility of the curve is a guide to determine the likelihood for brace success. Cite this article: Bone Joint J 2020;102-B(2):254-260.


Assuntos
Amplitude de Movimento Articular/fisiologia , Escoliose/diagnóstico por imagem , Escoliose/terapia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/fisiopatologia , Decúbito Dorsal/fisiologia , Adolescente , Axila , Braquetes , Criança , Progressão da Doença , Feminino , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Escoliose/fisiopatologia
2.
Spine (Phila Pa 1976) ; 45(2): E83-E89, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31899691

RESUMO

STUDY DESIGN: A retrospective long-term follow-up study. OBJECTIVE: To investigate the health-related quality of life (HRQOL) status in middle-aged patients with adolescent idiopathic scoliosis (AIS) treated non-surgically. SUMMARY OF BACKGROUND DATA: The HRQOL status using various established questionnaires for non-operated AIS patients has not been fully investigated in long-term follow-up surveys. METHODS: Inclusion criteria were non-surgical treatment for AIS, more than or equl to 30° major scoliosis at skeletal maturity (Risser grade ≥4), and age more than or equl to 30 years at the time of the survey. A total of 107 AIS patients were included and divided into three groups (single main thoracic [MT] curve group; n = 50, single thoracolumbar/lumbar [TL/L] curve group; n = 19, and double-major [DM] curve group; n = 38) based on curve location at skeletal maturity. Age- and sex-matched volunteers were selected as the control group. RESULTS: There were no significant differences in age at survey, body mass index, bone mineral density of the femoral neck, and skeletal muscle mass index among the groups. In all groups, major scoliosis progressed by approximately 0.5°/yr from the time of skeletal maturity to the survey. The thoracolumbar (TL/L) and double-major (DM) groups showed significantly worse visual analog scale scores for low back pain compared with the main thoracice (MT) group (P < 0.05). The all-scoliosis groups showed significantly worse scores for self-image domain of the Scoliosis Research Society Outcome Instrument-22 (SRS-22) than the control group (P < 0.0001). The TL/L group showed significantly worse scores for walking ability and social function domains of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) (P < 0.05). There were no significant differences in Oswestory Disability Index and Short-Form-12 among the four groups. CONCLUSION: AIS patients with single MT curve maintain equal HRQOL status compared with healthy controls. Patients with structural TL/L curves are likely to experience greater annual TL/L curve progression and have substantial low back pain or worse low back pain-specific HRQOL status during middle age. LEVEL OF EVIDENCE: 4.


Assuntos
Dor Lombar/etiologia , Qualidade de Vida , Escoliose/complicações , Escoliose/terapia , Adolescente , Adulto , Estudos de Casos e Controles , Progressão da Doença , Feminino , Seguimentos , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Estudos Retrospectivos , Escoliose/psicologia , Autoimagem , Inquéritos e Questionários , Vértebras Torácicas
3.
J Pediatr Orthop ; 40(2): 60-64, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923164

RESUMO

BACKGROUND: Despite known limitations, Risser staging has traditionally been the primary marker of skeletal maturity utilized in decision-making for treatment of adolescent idiopathic scoliosis (AIS). The purpose of this study is to assess the incidence and factors associated with mismatch between Risser Staging and Sanders classification, and determine interobserver reliability. METHODS: We reviewed the medical records of consecutive patients aged 10 to 18 referred to our institution for evaluation of AIS from January to June 2016 with a closed triradiate cartilage. Data collected included sex, age, race, height, weight, body mass index percentile, menarchal status, Risser stage, Sanders classification, and major curve. Risser and Sanders stage was determined by 2 fellowship-trained pediatric spine surgeons and 1 pediatric orthopaedic nurse practitioner. Mismatch was defined as Risser stage 2 to 4 corresponding to Sanders 3 to 5, and Risser 0 to 1 corresponding to Sanders 6 to 7. RESULTS: A total of 165 consecutive patients were identified (mean age: 13.9±1.7 y, major curve 28.2±15.4 degrees, 76% female). The risk of skeletal maturity mismatch, based on the criteria of Risser 2 to 5 (limited growth remaining) corresponding to Sanders 3 to 5 (significant growth remaining) was 21.8%, indicating that 1 of 5 patients would be undertreated if managed by Risser criteria. Conversely, the mismatch risk for Risser 0 to 1 corresponding to Sanders 6 to 7 was 3.6%, leading such patients to be treated conservatively longer than necessary. Males and those of Hispanic ethnicity were at a higher risk of mismatch (23.1% vs. 11.9%, P=0.08; 33.3% vs. 8.8%, P=0.04, respectively). Body mass index percentile, race, and major curve were not associated with mismatch. The unweighted and weighted interobserver κ for Risser staging was 0.74 and 0.82, respectively, and 0.86 and 0.91 for Sanders classification, respectively. CONCLUSION: Given the limited sensitivity of Risser staging during peak growth velocity, high mismatch risk, and lower interobserver reliability, the Sanders classification should be utilized to guide treatment options in patients with AIS. Compared with Sanders, utilizing Risser staging results in mistreatment in a total of 1 of 4 patients, with the vast majority being undertreated. LEVEL OF EVIDENCE: Level II.


Assuntos
Cartilagem/diagnóstico por imagem , Cartilagem/crescimento & desenvolvimento , Escoliose/classificação , Escoliose/diagnóstico por imagem , Adolescente , Determinação da Idade pelo Esqueleto , Criança , Feminino , Humanos , Ílio/diagnóstico por imagem , Ísquio/diagnóstico por imagem , Masculino , Variações Dependentes do Observador , Ortopedia/métodos , Osso Púbico/diagnóstico por imagem , Reprodutibilidade dos Testes , Escoliose/terapia , Fatores Sexuais
4.
Am Fam Physician ; 101(1): 19-23, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31894928

RESUMO

Adolescent idiopathic scoliosis affects 1% to 3% of U.S. adolescents. It is defined by a lateral curvature of the spine (Cobb angle) of at least 10 degrees in the absence of underlying congenital or neuromuscular abnormalities. Adolescent idiopathic scoliosis may be detected via the forward bend test and should be confirmed with scoliometer measurement. Mild scoliosis is usually asymptomatic; it may contribute to musculoskeletal back pain, but there is no evidence that it causes disability or functional impairment. Patients with severe scoliosis (Cobb angle of 40 degrees or more) may have physical pain, cosmetic deformity, psychosocial distress, or, rarely, pulmonary disorders. Several studies have shown modest benefit from bracing and scoliosis-specific physical therapy to limit progression in mild to moderate scoliosis, but there were no effects on quality of life. Because no high-quality studies have proven that surgery is superior to bracing or observation, it should be reserved for severe cases. There is little evidence that treatments improve patient-oriented outcomes. The U.S. Preventive Services Task Force and the American Academy of Family Physicians found insufficient evidence to assess the balance of benefits and harms of screening for adolescent idiopathic scoliosis in children and adolescents 10 to 18 years of age.


Assuntos
Escoliose/diagnóstico , Escoliose/terapia , Adolescente , Criança , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Exame Físico/métodos , Guias de Prática Clínica como Assunto
5.
Orthopade ; 49(1): 59-65, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-30899990

RESUMO

BACKGROUND: It is understood that an effective brace therapy requires a primary curve angle reduction of 50% after administering the first orthotic brace. OBJECTIVES: The aim of the study was to determine the efficacy of conservative brace therapy for scoliosis with a curve angle above 20° and to determine possible influencing factors. MATERIALS AND METHODS: The current study included a cohort of 110 scoliosis patients with conservative brace therapy. The development of the scoliotic curve during brace therapy was documented for an average of 40 months. Influencing factors such as the initial Risser sign, age at the start of treatment, gender, curve patterns and body mass index were analyzed. RESULTS: The collective consisted of 88 patients with idiopathic and 22 with neuromuscular spinal deformities. At the beginning of the brace therapy, the average age was 12.2 ± 2.8 years with a mean scoliosis curve angle of 30.4°â€¯± 12.5°. The primary brace reduced the scoliotic curve by 31% to 20.9°. In children and adolescents with lower maturity status, the success of the brace therapy was greater than in patients with a higher Risser sign. In addition, children with obesity had less success during brace therapy than normal- or underweight children. CONCLUSIONS: The initial curvature correction of 50% required for effective brace therapy could only be achieved in one third of the patients. On average, the correction was 31%.


Assuntos
Escoliose/terapia , Adolescente , Braquetes , Criança , Estudos de Coortes , Tratamento Conservador , Humanos , Resultado do Tratamento
6.
J Pediatr Orthop ; 40(1): e49-e52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30994578

RESUMO

BACKGROUND: Hip dysplasia, congenital muscular torticollis, plagiocephaly, and metatarsus adductus are known to be associated. The etiology of infantile idiopathic scoliosis and its association with the aforementioned conditions is unknown. This study reviews a series of infantile scoliosis patients to address this gap. METHODS: The medical records of all patients treated with casting for early-onset scoliosis (EOS) from 2001 to 2016 were retrospectively reviewed. Inclusion criteria were a diagnosis of idiopathic EOS and age below 4 years at the time of the first cast. Demographic information, comorbid conditions, and radiographic measurements including Cobb angle and acetabular index (AI) were collected. The first acceptable anteroposterior pelvis radiograph for each patient was measured. An AI≥30 degrees was defined as hip dysplasia. A measurement between 25 and 30 degrees was defined as a "hip at risk." RESULTS: Between 2001 and 2016, 142 patients were treated with casting. Eighty-one patients met the inclusion criteria. The mean age at the first cast was 19.3 (±7.5) months and the mean Cobb angle was 53.6 (±18.8) degrees. There was no significant correlation between Cobb angle and AI. Nine patients met radiographic criteria for hip dysplasia (11.1%), only 4 of whom had been previously diagnosed. Thirty-six patients (44.4%) met the criteria of having at least 1 hip "at risk" of hip dysplasia. Ten patients (12.3%) had been diagnosed with torticollis and 13 patients (16.0%) with plagiocephaly. Three patients (3.7%) had been diagnosed with metatarsus adductus or clubfoot. In total, 30.9% of patients (25/81) had at least one of the above comorbid conditions. CONCLUSIONS: In a large group of children treated for idiopathic EOS, we found a high prevalence of commonly associated conditions-hip dysplasia, torticollis, plagiocephaly, metatarsus adductus, and clubfoot. In 6.2% of our sample, a diagnosis of hip dysplasia was not made in a timely manner despite routine radiographic spine follow-up. With increasing subspecialization within pediatric orthopaedics, surgeons need to maintain vigilance in assessing the entire child. LEVEL OF EVIDENCE: Level IV.


Assuntos
Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/epidemiologia , Escoliose/diagnóstico por imagem , Escoliose/epidemiologia , Idade de Início , Moldes Cirúrgicos , Pré-Escolar , Pé Torto Equinovaro/epidemiologia , Comorbidade , Feminino , Humanos , Lactente , Masculino , Plagiocefalia/epidemiologia , Prevalência , Radiografia , Estudos Retrospectivos , Escoliose/terapia , Torcicolo/epidemiologia , Estados Unidos/epidemiologia
7.
Pediatr Clin North Am ; 67(1): 185-204, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31779832

RESUMO

Pediatric spine disorders are numerous and are quite different when compared with the adult population. This article focuses on some of the more common pediatric spine disorders. This article summarizes such disorders and discusses typical treatment options in the pediatric orthopedic armamentarium.


Assuntos
Doenças da Coluna Vertebral , Criança , Humanos , Doença de Scheuermann/diagnóstico , Doença de Scheuermann/terapia , Escoliose/diagnóstico , Escoliose/terapia , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/terapia , Espondilólise/diagnóstico , Espondilólise/terapia
8.
Bone Joint J ; 101-B(11): 1370-1378, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674249

RESUMO

AIMS: The aim of this study was to determine the influence of pelvic parameters on the tendency of patients with adolescent idiopathic scoliosis (AIS) to develop flatback deformity (thoracic hypokyphosis and lumbar hypolordosis) and its effect on quality-of-life outcomes. PATIENTS AND METHODS: This was a radiological study of 265 patients recruited for Boston bracing between December 2008 and December 2013. Posteroanterior and lateral radiographs were obtained before, immediately after, and two-years after completion of bracing. Measurements of coronal and sagittal Cobb angles, coronal balance, sagittal vertical axis, and pelvic parameters were made. The refined 22-item Scoliosis Research Society (SRS-22r) questionnaire was recorded. Association between independent factors and outcomes of postbracing ≥ 6° kyphotic changes in the thoracic spine and ≥ 6° lordotic changes in the lumbar spine were tested using likelihood ratio chi-squared test and univariable logistic regression. Multivariable logistic regression models were then generated for both outcomes with odds ratios (ORs), and with SRS-22r scores. RESULTS: Reduced T5-12 kyphosis (mean -4.3° (sd 8.2); p < 0.001), maximum thoracic kyphosis (mean -4.3° (sd 9.3); p < 0.001), and lumbar lordosis (mean -5.6° (sd 12.0); p < 0.001) were observed after bracing treatment. Increasing prebrace maximum kyphosis (OR 1.133) and lumbar lordosis (OR 0.92) was associated with postbracing hypokyphotic change. Prebrace sagittal vertical axis (OR 0.975), prebrace sacral slope (OR 1.127), prebrace pelvic tilt (OR 0.940), and change in maximum thoracic kyphosis (OR 0.878) were predictors for lumbar hypolordotic changes. There were no relationships between coronal deformity, thoracic kyphosis, or lumbar lordosis with SRS-22r scores. CONCLUSION: Brace treatment leads to flatback deformity with thoracic hypokyphosis and lumbar hypolordosis. Changes in the thoracic spine are associated with similar changes in the lumbar spine. Increased sacral slope, reduced pelvic tilt, and pelvic incidence are associated with reduced lordosis in the lumbar spine after bracing. Nevertheless, these sagittal parameter changes do not appear to be associated with worse quality of life. Cite this article: Bone Joint J 2019;101-B:1370-1378.


Assuntos
Braquetes/efeitos adversos , Cifose/etiologia , Lordose/etiologia , Escoliose/terapia , Adolescente , Criança , Feminino , Humanos , Cifose/diagnóstico por imagem , Lordose/diagnóstico por imagem , Vértebras Lombares , Masculino , Estudos Retrospectivos , Vértebras Torácicas
9.
J Bone Joint Surg Am ; 101(17): 1530-1538, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31483395

RESUMO

BACKGROUND: With the exception of Mehta's 2005 report on her experience treating early-onset scoliosis with serial casting, all subsequent studies have had limited follow-up. This current study sought to assess the results of serial casting at a minimum 5-year follow-up and to identify the predictors of the sustained resolution of scoliosis. METHODS: This study is a retrospective review of children treated for idiopathic early-onset scoliosis with serial casting at a children's hospital between 2001 and 2013 with a minimum 5-year follow-up. A Cobb angle of ≤15° and a decrease in the Cobb angle of >20° at the most recent follow-up were separately assessed. The differences between groups based on these criteria were tested with Student t tests with alpha = 0.05. RESULTS: Fifty-four children were treated during the study period; of these, 38 had at least 5 years of follow-up and comprised the study sample. The mean follow-up (and standard deviation) was 8 ± 2 years (range, 5 to 13 years). The mean patient age at the time of the first cast was 24 ± 15.1 months (range, 9 to 63 months), with a mean Cobb angle of 56.2° ± 20.1° (range, 22° to 109°). Forty-nine percent of children had scoliosis of ≤15° at the time of the most recent follow-up, and 73% of children were improved by at least 20°. Children with ≤15° scoliosis, compared with children with >15° scoliosis, had significantly lower initial Cobb angle (48.2° compared with 63.7°; p = 0.016), supine traction Cobb angle (22.5° compared with 33.2°; p = 0.048), first-in-cast Cobb angle (24.1° compared with 37.6°; p = 0.01), and first-in-cast rib-vertebral angle difference (12.8° compared with 26.2°; p < 0.01). Age at the time of the first cast, initial rib-vertebral angle difference, flexibility, and body mass index were not significantly different (p > 0.05) between the groups. Three children who initially achieved scoliosis of ≤15° after casting substantially relapsed. CONCLUSIONS: At a minimum follow-up of 5 years, the initial Cobb angle, first-cast Cobb angle, rib-vertebral angle difference, and traction Cobb angle were all predictive of sustained scoliosis of ≤15°. However, with continued growth, relapse of scoliosis was seen in 3 patients. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Moldes Cirúrgicos , Escoliose/terapia , Adolescente , Idade de Início , Criança , Pré-Escolar , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
10.
J Orthop Surg Res ; 14(1): 290, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481082

RESUMO

PURPOSE: To evaluate the predictive effect of lumbar lordosis minus thoracic kyphosis (LL-TK) in the surgical outcome of adult degenerative scoliosis (ADS) patients and explore the optimum target base on it. METHODS: The preoperative and postoperative data including radiographic image and functional evaluation (Visual Analog Scale, VAS; Oswestry Disability Index, ODI; Japanese Orthopaedic Association, JOA) of 130 patients with ADS who underwent corrective surgery was retrospectively reviewed. The relationship between sagittal parameters and surgical outcome was assessed by using the Pearson correlation analysis. Receiver operating characteristic (ROC) curve was used to define the optimum cutoff value of LL-TK. Patients were divided into two groups based on LL-TK to compare the preoperative and postoperative status. RESULTS: LL-TK assessed soon after surgery strongly correlated with health-related quality of life (HRQOL) and sagittal vertical axis (SVA) at last follow-up. The cutoff value of LL-TK was set at 10° to determine a good clinical outcome (ODI < 20) and sagittal balance (SVA < 50 mm). Patients with LL-TK > 10° presented significantly better postoperative VAS, ODI, JOA, and SVA than patients with LL-TK < 10°. CONCLUSION: LL-TK could effectively predict postoperative HRQOL and sagittal balance for patients with ADS. Patients with LL-TK > 10° showed a better clinical outcome and sagittal balance, so LL-TK > 10° could be the optimum corrective target for these patients.


Assuntos
Cifose/diagnóstico por imagem , Lordose/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Escoliose/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Cifose/terapia , Lordose/terapia , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/diagnóstico por imagem , Doenças Neurodegenerativas/terapia , Valor Preditivo dos Testes , Estudos Retrospectivos , Escoliose/terapia , Resultado do Tratamento
11.
J Pediatr Orthop ; 39(8): e597-e601, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393296

RESUMO

BACKGROUND: Prader-Willi syndrome (PWS) patients can present with scoliosis which can be treated with serial cast correction (SCC) or with growth friendly surgery (GFS). This study's purpose was to describe the results of SCC as well as GFS for PWS patients with early-onset scoliosis (EOS). METHODS: PWS patients were identified from 2 international multicenter EOS databases. Scoliosis, kyphosis, spine height (T1-S1), right/left hemithoracic heights/widths (RHTH, LHTH, RHTW, LHTW) were measured pretreatment, postoperation, and at 2-year follow-up. Complications were recorded. RESULTS: Overall, 23 patients with 2-year follow-up were identified. Pretreatment; patients treated with SCC (n=10) had mean age of 1.8±0.6 years; body mass index (BMI), 16±1.5 kg/m; scoliosis, 45±18 degrees; kyphosis, 56±9 degrees; T1-S1, 22.4±2.4 cm; RHTH, 8.0±2.0 cm; LHTH, 8.5±1.7 cm; RHTW, 6.6±1.3 cm; and LHTW, 8.0±1.0 cm. Patients treated with GFS (n=13) had mean age of 5.8±2.6 years; BMI, 21±5.4 kg/m; scoliosis, 76±14 degrees; kyphosis, 59±25 degrees; T1-S1, 24.1±3.6 cm; RHTH, 10.0±1.6 cm; LHTH, 10.6±1.6 cm; RHTW, 9.4±2.5 cm; and LHTW, 8.1±2.8 cm. At 2-year follow-up, patients treated with SCC had mean scoliosis 37±11 degrees (18% correction, P=0.06); kyphosis, 42±6 degrees (NS); T1-S1, 26.4±2.1 cm (P<0.01); RHTH, 9.0±1.1 cm (13%; P=0.30); LHTH, 10.0±1.5 cm (18%, P<0.01); RHTW, 7.4±1.1 cm (12%, P<0.01); and LHTW, 8.0±1.0 cm (0%, P=0.34). At 2-year follow-up, patients treated with GFS had mean scoliosis 42±13 degrees (45% correction, P<0.000001); kyphosis, 53±13 degrees (10%, P=0.19); T1-S1, 31.5±5.4 cm (P<0.00001); RHTH, 12.0±2.4 cm (20%; P<0.01); LHTH, 12.0±1.7 cm (13%; P<0.01); RHTW, 9.8±1.3 cm (4%; P=0.27); and LHTW, 7.9±2.3 cm (3%;P=0.11). As an entire group, patients with a BMI>17 kg/m² had more device-related than disease-related complications (P=0.09). Patients treated with SCC had 0.9 complications per patient. Patients treated with GFS had 2.2 complications per patient [≤5 y more often had ≥2 complications (P=0.05)]. CONCLUSIONS: At 2-year follow-up, SCC and GFS were both effective in treating EOS in PWS patients. Patients treated with SCC had significant improvements in spine height and LHTH. Patients treated with GFS had significant improvements in scoliosis magnitude, spine height, RHTH, and LHTH. LEVEL OF EVIDENCE: Level IV-therapeutic study.


Assuntos
Moldes Cirúrgicos , Cifose/terapia , Procedimentos Ortopédicos , Síndrome de Prader-Willi/complicações , Escoliose/terapia , Índice de Massa Corporal , Pré-Escolar , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Lactente , Cifose/diagnóstico por imagem , Cifose/etiologia , Masculino , Procedimentos Ortopédicos/efeitos adversos , Período Pós-Operatório , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/etiologia , Índice de Gravidade de Doença
12.
BMC Musculoskelet Disord ; 20(1): 370, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31409412

RESUMO

BACKGROUND: Scoliosis is a serious disease that can affect all segments of society. Few studies have investigated the response to vibration of differing sinusoidal axial cyclic loading frequencies for different forms of scoliosis in the lumbar spine. METHODS: In this study, four finite element models, comprising a healthy spine, Lenke-A, Lenke-B and Lenke-C scoliosis of the lumbar S1-L1 region were developed. Modal analysis extracted resonant frequencies of the FE models with an upper body mass of 40 kg and 400 N preload. A transient dynamic analysis was performed to obtain the response to vibration of models under a sinusoidal axial loading of ± 40N at frequencies of 3, 5, 7, 9, 11 and 13 Hz using an upper body mass of 40 kg and 400 N preload. RESULTS: The first-order resonant frequencies of healthy, Lenke-A, Lenke-B and Lenke-C spines were 9.2, 3.9, 4.6 and 5.7 Hz, respectively. A Lenke-A lumbar spine was more likely to deform at a lower vibration frequency and Lenke-C deformed more easily at a higher vibration frequency. Furthermore, the vibration amplitude in the Y-direction (left-right) was greatest and least in the Z-direction (top-bottom). The frequency of cyclic loading closest to the resonant frequency resulted in a maximum value of peak-to-peak vibrational displacement. Furthermore, the vibrational amplitudes in patients with scoliosis were larger than they were in healthy subjects. In addition, axial displacement of the vertebrae in the healthy spine changed steadily whereas fluctuations in the scoliotic vertebrae in scoliosis patients were greater than that of other vertebrae. CONCLUSIONS: Different forms of scoliosis may have different vibrational characteristics, the scoliotic vertebrae being the weak link in scoliosis under loading condition of whole body vibration. Scoliosis was more sensitive to this form of vibration. Where the frequency of axial cyclic vibrational loading of the lumbar spine was closer to its resonant frequency, the vibrational amplitude was larger. These results suggest that vibration will exacerbate the degree of scoliosis and so such patients should reduce their exposure to vibration. Clinical treatment should pay attention to the scoliotic vertebrae and reduce their vibration. These findings may assist in the clinical prevention and treatment of scoliosis.


Assuntos
Vértebras Lombares/fisiopatologia , Modelos Biológicos , Sacro/fisiopatologia , Escoliose/fisiopatologia , Vibração/efeitos adversos , Fenômenos Biomecânicos , Simulação por Computador , Análise de Elementos Finitos , Voluntários Saudáveis , Humanos , Masculino , Modalidades de Fisioterapia , Escoliose/terapia , Estresse Mecânico , Suporte de Carga/fisiologia
13.
BMC Musculoskelet Disord ; 20(1): 384, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438927

RESUMO

BACKGROUND: Scoliotic braces are the standard of curve for management of moderate spinal deformities in pediatric patients. The effectiveness of this treatment method has been shown; however, the spinal and rib cage parameters, in the three anatomical planes, that are associated with bracing outcome in adolescent idiopathic scoliosis (AIS) are not fully identified. METHODS: A total number of 45 right thoracic AIS patients who had received a thoraco-lumbo-scaral brace for the first time were included retrospectively. For each patient, radiographic images at three visits, pre-brace, in-brace, and at least 1 year after the first brace fit were included. Age, sex, Risser sign, and curve type at pre-brace, and thoracic and lumbar frontal and sagittal Cobb angles, thoracic and lumbar apical rotations, sagittal and frontal balances at pre-brace and in-brace were determined. Two sagittal curve types (hypothoracolumbar and normal/hyperthoracolumbar kyphosis), two rib cage types based on the costovertebral joints (drooping and horizontal), and two axial shapes of the spine (S shaped and V shaped) were used to stratify the patients. Feature selection and linear regression with regularization determined the parameters and the interaction terms that predicted the brace effectiveness significantly. RESULTS: Smaller in-brace thoracic Cobb and larger in-brace lordosis predicted brace effectiveness, p < 0.05. Impact of the out of brace lordosis on the brace success increased as the in brace kyphosis angle decreased, p = 0.046. A larger out of brace lordosis in hypothoracolumbar sagittal profile type patients improved the outcomes, p = 0.031. A smaller out of brace thoracic rotation improved the bracing outcomes in patients with horizontal ribs, p = 0.040. CONCLUSION: Both 3D patient specific parameters (lordosis, thoracic rotation, shape of the rib cage, and sagittal profile) and brace design (which allows larger in brace lordosis, better in brace Cobb correction) are important predictors of the brace effectiveness in AIS.


Assuntos
Braquetes , Imageamento Tridimensional , Cifose/diagnóstico por imagem , Lordose/diagnóstico por imagem , Escoliose/terapia , Adolescente , Criança , Desenho de Equipamento , Feminino , Humanos , Cifose/terapia , Lordose/terapia , Região Lombossacral/diagnóstico por imagem , Masculino , Modelos Biológicos , Prognóstico , Radiografia , Estudos Retrospectivos , Caixa Torácica/diagnóstico por imagem , Escoliose/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento
14.
Klin Padiatr ; 231(5): 248-254, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31408904

RESUMO

Adolescent idiopathic scoliosis is a disease of the growing skeleton. The goal in therapy is to decelerate or to prevent progression of the spinal curve. As part of a retrospective study the patient group of the scoliosis surgery from 1995-2016 was analysed according to the inclusion criteria of the Scoliosis research Society (SRS). 159 of 643 of the patients fullfilled the specific criteria. The assessment of effectiveness was based on the progression of the angle of curvature. If it was ≤5° it was judged positively. The therapy in accordance to Cheneau is a full-time bracing orthosis. Data from 159 patients - 136 fem. (85.5%), 23 male (14.5%) was analysed. The average age at the beginning of treatment was 13.3±1.7 years. The average duration was 3.47±1.2 years. The average Cobb-angle before treatment was 28.39°±9.44°. At the completion is was 27.7°±12.34°. Stabilisation of scoliosis (≤5°) was achieved for 136 of the patients (85.5%). The final follow-up showed a progression of the Cobb angel>5° in 23 cases, of which 19 had to undergo secondary surgery. The length of therapy had a positive influence (p=0.057) on the result. Brace treatment constitutes an effective method of therapy at curvatures between 20-40°. Short duration of therapy correlates with a expressively increased risk towards progression (p=0.057). The Cheneau brace treatment constitutes an effective treatment at curvature angles between 20-40°. The risk of progression can be reduced by a timely and correct identification.


Assuntos
Braquetes , Tratamento Conservador , Escoliose/terapia , Adolescente , Criança , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
15.
BMC Musculoskelet Disord ; 20(1): 319, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286903

RESUMO

BACKGROUND: The Cobb angle is proposed as the "disease process" outcome for scoliosis research because therapies aim to correct or stop curve progression. While the Scoliosis Research Society recommends the Cobb angle as the primary outcome, the Society on Scoliosis Orthopaedic and Rehabilitation Treatment prioritises, as a general goal, patient related outcomes over Cobb angle progression. OBJECTIVE: To determine the threshold of change in the Cobb angle in adolescents with idiopathic scoliosis (AIS) who perceive improvement in a 6-months randomized controlled trial comparing a Schroth exercise intervention added to the standard of care to the standard of care alone. METHODS: This is a secondary analysis of data from a randomized controlled trial of 50 patients with AIS, with curves ranging from 10° to 45°, with or without a brace. Participants with diagnoses other than AIS, surgical candidates or patients who had scoliosis surgery were excluded. The 6-month interventions consisted of Schroth exercises added to standard-of-care (observation or bracing) with daily home exercises and weekly therapy sessions (Schroth) or standard-of-care alone (Control). The anchor method for estimating the minimal important difference (MID) in the largest Cobb angles (LC) was used. Patient-reported change in back status over the 6-month treatment period was measured using the Global Rating of Change (GRC) scale as anchor varying from - 7 ("great deal worse") to + 7 ("great deal better"). Participants were divided into two groups based on GRC scores: Improved (GRC ≥2) or Stable/Not Improved (GRC ≤1). MID was defined as the change in the LC that most accurately predicted the GRC classification as per the receiver operating characteristic curve (ROC). RESULTS: The average age was 13.4 ± 1.6 years and the average LC was 28.5 ± 8.8 °s. The average GRC in the control group was - 0.1 ± 1.6, compared to + 4.4 ± 2.2 in the Schroth group. The correlation between LC and GRC was adequate (r = - 0.34, p < 0.05). The MID for the LC was 1.0 °. The area under the ROC was 0.69 (0.52-0.86), suggesting a 70% chance to properly classify a patient as perceiving No Improvement/Stable or Improvement based on the change in the LC. CONCLUSION: Patients undergoing Schroth treatment perceived improved status of their backs even if the Cobb angle did not improve beyond the conventionally accepted threshold of 5°. Standard of care aims to slow/stop progression while Schroth exercises aim to improve postural balance, signs and symptoms of scoliosis. Given the very small MID, perceived improvement in back status is likely due to something other than the Cobb angle. This study warrants investigating alternatives to the Cobb angle that might be more relevant to patients. TRIAL REGISTRATION: ClinicalTrials.gov , NCT01610908 . Retrospectively registered on April 2, 2012 (first posted on June 4, 2012 - https://clinicaltrials.gov/ct2/keydates/NCT01610908 ).


Assuntos
Terapia por Exercício/métodos , Equilíbrio Postural/fisiologia , Escoliose/terapia , Adolescente , Criança , Progressão da Doença , Feminino , Humanos , Masculino , Escoliose/diagnóstico por imagem , Escoliose/fisiopatologia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/fisiopatologia , Padrão de Cuidado , Resultado do Tratamento
16.
Spine (Phila Pa 1976) ; 44(18): E1075-E1082, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31261269

RESUMO

STUDY DESIGN: A retrospective, long-term follow-up study. OBJECTIVE: We aimed to investigate the long-term impacts of brace treatment for adolescent idiopathic scoliosis (AIS) on the musculoskeletal system. SUMMARY OF BACKGROUND DATA: Although full-time brace treatment is the mainstay of conservative treatment for AIS, the restrictive nature of brace treatment for lumbosacral motion might negatively affect the musculoskeletal system. METHODS: Of 319 patients treated nonoperatively for AIS, 80 patients completed clinical and imaging examinations. Body composition, including body fat mass, lean mass, fat percent, and muscle mass, was estimated via bioelectrical impedance analysis. Bone mineral density (BMD) was measured at the lumbar spine and left hip. In 73 patients, the measurement of cross-sectional area and fatty degeneration of paraspinal muscles at the superior endplate of L4 were performed using axial T2-weighted magnetic resonance imaging. Patients were divided into the full-time brace (FB; >13 hours per day) and nonfull-time brace (NFB; observation, part-time bracing, or drop out from FB within a year) groups. RESULTS: There were 44 patients in the FB group and 36 in the NFB group. Patients in the FB group were significantly younger at the initial visit (12.7 ±â€Š1.3 years) and older at the final follow-up (41.5 ±â€Š5.6 years) than those in the NFB group (14.2 ±â€Š3.2 and 37.4 ±â€Š7.1 years, respectively; P < 0.01). The rate of patients engaging in mild or moderate sports activity in adulthood tended to be higher in the FB group (47.7%) than in the NFB group (25%) (P = 0.11). However, there were no significant differences in body composition, paraspinal muscle morphology, and BMD between the two groups both before and after adjusting for age. CONCLUSION: Full-time brace wearing during adolescence did not have any negative impacts on the musculoskeletal system in adulthood. This information will be helpful for improving the compliance of full-time bracing. LEVEL OF EVIDENCE: 4.


Assuntos
Composição Corporal , Densidade Óssea , Braquetes , Músculos Paraespinais/patologia , Escoliose/terapia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Cifose/etiologia , Vértebras Lombares , Masculino , Músculos Paraespinais/diagnóstico por imagem , Estudos Retrospectivos
17.
J Pediatr Orthop ; 39(Issue 6, Supplement 1 Suppl 1): S38-S43, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31169646

RESUMO

BACKGROUND: Early-onset scoliosis (EOS) is defined as the diagnosis of a spinal deformity before the age of 5 years. It can be divided into idiopathic, neuromuscular/syndromic, and congenital etiologies. METHODS: The literature on the natural history of EOS was summarized. RESULTS: The natural history varies with the etiology of EOS. Idiopathic curves may benefit from early serial casting. The natural history of neuromuscular and syndromic scoliosis is highly dependent on the natural history of the underlying disorder. Congenital scoliosis has a variable prognosis depending on the location and extent of the congenital malformations. CONCLUSIONS: Treatment of children with EOS is customized to the particular disorder. While lack of treatment has been shown to lead to increased mortality, extensive early definitive fusion may lead to thoracic insufficiency. Delaying definitive surgery and the use of growing instrumentation may provide benefit in maintaining pulmonary health. CLINICAL RELEVANCE: Potential disturbance of growth must be considered in the treatment of young children with scoliosis.


Assuntos
Pulmão/crescimento & desenvolvimento , Insuficiência Respiratória/etiologia , Escoliose/etiologia , Escoliose/terapia , Fusão Vertebral/efeitos adversos , Tórax/crescimento & desenvolvimento , Idade de Início , Pré-Escolar , Progressão da Doença , Humanos , Respiração , Escoliose/congênito , Escoliose/fisiopatologia , Coluna Vertebral/crescimento & desenvolvimento , Coluna Vertebral/cirurgia , Síndrome
18.
J Pediatr Orthop ; 39(Issue 6, Supplement 1 Suppl 1): S44-S46, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31169647

RESUMO

INTRODUCTION: Adolescent idiopathic Scoliosis (AIS) affects 2% to 3% of the population of which only 0.3% to 0.5% of affected patients will have a curvature of >20 degrees, the curve magnitude at which treatment is generally recommended. For AIS the current natural history data is limited and most of the information comes from a small body of literature from the University of Iowa. METHODS: The Iowa natural history studies began as retrospective reviews but beginning in 1976, the cohort was followed prospectively. Outcomes assessed in this group of patients included; mortality, pulmonary function, pregnancy-(effect of pregnancy on scoliosis and the effect of scoliosis on pregnancy), radiographic, curve progression, and osteoarthritis. In addition, validated questionnaires were used to evaluate back pain, pulmonary symptoms, general function, depression, and body image. RESULTS: Patients with untreated AIS can function well as adults, become employed, get married, have children, and grow to become active older adults. Unfortunately, untreated scoliosis may lead to increased back pain and pulmonary symptoms for patients with large thoracic curves. Patients with untreated AIS can also develop substantial deformity, and the cosmetic aspect of this condition cannot be disregarded. CONCLUSIONS: The summary findings of this unique lifetime natural history of AIS patients provides patients and parents a solid evidence base upon which to make informed decisions.


Assuntos
Dor nas Costas/etiologia , Progressão da Doença , Pulmão/fisiopatologia , Escoliose/complicações , Escoliose/fisiopatologia , Adolescente , Idoso , Imagem Corporal , Criança , Estudos de Coortes , Depressão/etiologia , Humanos , Iowa , Pessoa de Meia-Idade , Escoliose/psicologia , Escoliose/terapia
19.
Medicina (Kaunas) ; 55(6)2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31181685

RESUMO

Background and Objectives: The deformity in idiopathic scoliosis (IS) is three dimensional and effective correction involves all three planes. Recently, the biofeedback method has been implemented in the treatment of scoliosis. The aim of this study was to evaluate the effectiveness of an innovative biofeedback SKOL-AS® postural training among children with scoliosis. Materials and Methods: The target population for this study was 28 patients (25 girls and 3 boys) aged between 5 and 16 years old diagnosed and treated with progressing low-grade scoliosis. The postural diagnosis consisted of anthropometric measurements, posterior-anterior X-ray imaging, SpinalMeter® postural assessment and the angle of trunk rotation (ATR) assessment. The SKOL-AS® treatment comprised of 24 sessions conducted in lying and sitting positions, two times a week. Results: It has been shown that the postural training resulted in the decrease in the ATR value (pre- vs. post-exercise in younger: 5.55 vs. 3.0 and older patients: 5.2 vs. 3.0). The increase in height of the subjects seemed to confirm a positive effect of SKOL-AS® elongation treatment. In the posterior view, a statistically significant decrease in shoulder asymmetry in the sitting position in younger children has been observed. In the anterior view, the changes in the head position (based on mouth and eye symmetry) have been observed. The statistically significant increase in acromion-heel, acromion-iliac crest and posterior superior iliac spine (PSIS)-heel length values has been shown in younger children on the left side of the body. After treatment, older subjects had higher acromion-iliac crest and PSIS-heel values on the left side of the body. On the right side only PSIS-heel length was higher. In a sitting position, only a small increase in acromion-iliac crest length value has been observed. Conclusions: The SKOL-AS® biofeedback method could teach good postural habits and teach patients the auto-correction of the spine.


Assuntos
Biorretroalimentação Psicológica/métodos , Postura/fisiologia , Rotação , Escoliose/terapia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Escoliose/complicações , Escoliose/psicologia
20.
Orthopade ; 48(6): 477-485, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31172228

RESUMO

Early onset scoliosis (EOS) remains one of the most challenging aspects of pediatric spine deformity care. The management is often complex, and options are non-operative care with casting or bracing and operative interventions. Surgical treatment includes distraction-based, compression-based and growth-guided techniques. The decision making should focus on preservation of growth, control of curve progression, minimizing complications, but most importantly improvement of the quality of life. Distraction-based techniques are the most commonly used growth-friendly surgery and the magnetically controlled growing rods (MCGR) technique is being utilized increasingly more in the USA over the past 10 years. The MCGR technique was cleared by the Food and Drug Administration (FDA) and available in the USA since 2014. It is indicated for the treatment of progressive EOS in immature patients and those at risk for thoracic insufficiency syndrome (TIS) with the goal of reducing the number of planned open surgical procedures for lengthening and minimizing the complications of more conventional techniques, such as traditional growing rods (TGR). The advent of MCGR has been a game changer for patients with EOS where the distractions are non-invasive and can be performed in outpatient clinics. Long-term follow-up is essential in understanding the outcome of any new treatment method especially in a very young and growing child. Multicenter registries with prospective data collection of pediatric spine deformity patients is imperative for understanding the outcomes of different methods of treatment, minimizing the complications and improving the quality of life of these children.


Assuntos
Escoliose/terapia , Criança , Humanos , Imãs , Estudos Prospectivos , Próteses e Implantes , Qualidade de Vida , Estados Unidos
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