Clinical value of routine preoperative magnetic resonance imaging in adolescent idiopathic scoliosis. A prospective study of three hundred and twenty-seven patients

BACKGROUND: The prevalence of intraspinal pathology associated with scoliosis has been reported to be as high as 26% in some series, and, on the basis of this finding, preoperative magnetic resonance imaging is used in the screening of patients with adolescent idiopathic scoliosis. However, this practice continues to be highly controversial. In order to better resolve this issue, we performed what we believe to be the largest prospective study to evaluate the need for preoperative magnetic resonance imaging in patients with adolescent idiopathic scoliosis requiring arthrodesis of the spine. METHODS: A total of 327 consecutive patients with adolescent idiopathic scoliosis were evaluated between December 1991 and March 1999. All patients in the study presented with an adolescent idiopathic scoliosis curve pattern and had a complete physical and neurologic examination. Magnetic resonance imaging of the brain and the spinal cord were performed as part of their preoperative work-up. RESULTS: Seven patients had an abnormality noted on magnetic resonance imaging. These abnormalities included a spinal cord syrinx in two patients (0.6%) and an Arnold-Chiari type-I malformation in four (1.2%). One patient had an abnormal fatty infiltration of the tenth thoracic vertebral body. No patient required neurosurgical intervention or additional work-up. All patients who underwent spinal arthrodesis with segmental instrumentation tolerated the surgery without any immediate or delayed neurologic sequelae. CONCLUSIONS: The fact that magnetic resonance imaging did not detect any important pathology in the large number of patients in this study strongly suggests that magnetic resonance imaging is not indicated prior to arthrodesis of the spine in patients with an adolescent idiopathic scoliosis curve pattern and a normal physical and neurologic examination.     

Video-assisted thoracoscopic surgery: the Cincinnati experience

Video-assisted thoracoscopic surgery is an alternative to open thoracotomy. We analyzed our experience during a consecutive series of 100 patients who had this procedure and who were available for study at 3-year followup. Video-assisted thoracoscopic surgery was done on patients with the following diagnoses: idiopathic scoliosis (n = 49), neuromuscular spinal deformity (n = 15), Scheuermann kyphosis (n = 15), congenital and infantile scoliosis (n = 5), neurofibromatosis (n = 5), Marfan (n = 1), postradiation scoliosis (n = 1), and repair of pseudoarthrosis (n = 1). Four patients had excision of the first rib to treat thoracic outlet syndrome. One patient had excision of an intrathoracic neurofibroma and one a benign rib tumor. One had anterior arthrodesis after fracture-dislocation of the thoracic spine and another had anterior fusion for vertebral osteomyelitis. The average operative time for the thoracoscopic anterior release with discectomy and arthrodesis was 253 minutes. The average number of discs excised was 8. Final postoperative scoliosis and kyphosis corrections were 68% and 90%, respectively. Complications related to thoracoscopy occurred in eight patients. Video-assisted thoracoscopic surgery provides a safe and effective alternative to open thoracotomy in the treatment of thoracic pediatric spinal deformities.     

Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure

BACKGROUND: The long-term pulmonary function of patients with adolescent idiopathic scoliosis undergoing surgical correction is uncertain. To our knowledge, no report has demonstrated the changes in pulmonary function five years or more following spinal arthrodesis with use of modern segmental spinal instrumentation techniques for the treatment of all types of adolescent idiopathic scoliosis in a similar adolescent population. METHODS: One hundred and eighteen patients with adolescent idiopathic scoliosis undergoing surgical treatment at a single institution were evaluated with pulmonary function tests to assess the absolute and percent-predicted value of forced vital capacity and forced expiratory volume in one second at the preoperative examination and at regular intervals postoperatively. The patients were divided into four groups depending upon the surgical procedure: Group 1 comprised forty-nine patients who had posterior spinal arthrodesis with iliac crest bone graft; Group 2, forty-one patients who had posterior spinal arthrodesis with thoracoplasty; Group 3, sixteen patients who had open anterior spinal arthrodesis with a rib resection thoracotomy; and Group 4, twelve patients who had combined anterior and posterior spinal arthrodesis with a rib resection thoracotomy and iliac crest bone graft, respectively. RESULTS: A comparison of absolute pulmonary function values from the preoperative and final follow-up evaluations demonstrated a significant (p < 0.0001) increase in both the forced vital capacity and the forced expiratory volume in one second for Group 1, whereas no change was seen in those values for Groups 2, 3, and 4. A comparison of the changes in the percent-predicted pulmonary function values demonstrated significant (p < 0.05) decreases in forced vital capacity and forced expiratory volume in one second for Groups 2, 3, and 4, except for the latter value for Group 4, whereas Group 1 had no change. CONCLUSIONS: Patients who have had any type of chest cage disruption during the surgical treatment of adolescent idiopathic scoliosis demonstrate no change in the absolute value and a significant decline in the percent-predicted value of pulmonary functions at five years following surgery. Chest cage preservation is recommended to maximize both absolute and percent-predicted pulmonary function values after surgical treatment of adolescent idiopathic scoliosis.     

Superior mesenteric artery syndrome in scoliosis surgery: weight percentile for height as an indicator of risk

A retrospective analysis of charts identified cases of superior mesenteric artery (SMA) syndrome occurring after scoliosis surgery over a 23-year period. Despite numerous reports on this potentially fatal complication of scoliosis surgery, no method exists to stratify patients for risk of developing disease after spine surgery. A study of charts was performed to identify all cases of SMA syndrome occurring after scoliosis surgery from 1972 to 1995. An upper gastrointestinal study with findings specific for the syndrome was requisite for inclusion. Patients' weight and height at the time of diagnosis of SMA syndrome were recorded. Based on standard national data tables, a percentile for weight, percentile for height, and a weight percentile for height were derived for each patient. The syndrome occurred after posterior spinal fusion in six patients (three boys, three girls). The average weight percentile for height, available in five of the six patients, was 3%, significantly different from both age-matched controls in the general population and from age-matched controls undergoing posterior spinal fusion for adolescent idiopathic scoliosis. This study, the largest reported from a single institution, suggests that a weight percentile for height of 5% is the degree of asthenia that allows compromise of the duodenum. The percentile identifies patients at risk for SMA syndrome for the purposes of increasing postoperative vigilance for gastrointestinal complaints, decreasing the threshold for diagnostic workup, and guiding perioperative dietary supplementation.     

Segmental vessel ligation in patients undergoing surgery for anterior spinal deformity

Segmental vessel ligation during anterior spinal surgery has been associated with paraplegia. However, the incidence and risk factors for this devastating complication are debated. We reviewed 346 consecutive paediatric and adolescent patients ranging in age from three to 18 years who underwent surgery for anterior spinal deformity through a thoracic or thoracoabdominal approach, during which 2651 segmental vessels were ligated. There were 173 patients with idiopathic scoliosis, 80 with congenital scoliosis or kyphosis, 43 with neuromuscular and 31 with syndromic scoliosis, 12 with a scoliosis associated with intraspinal abnormalities, and seven with a kyphosis. There was only one neurological complication, which occurred in a patient with a 127 degrees congenital thoracic scoliosis due to a unilateral unsegmented bar with contralateral hemivertebrae at the same level associated with a thoracic diastematomyelia and tethered cord. This patient was operated upon early in the series, when intra-operative spinal cord monitoring was not available. Intra-operative spinal cord monitoring with the use of somatosensory evoked potentials alone or with motor evoked potentials was performed in 331 patients. This showed no evidence of signal change after ligation of the segmental vessels. In our experience, unilateral segmental vessel ligation carries no risk of neurological damage to the spinal cord unless performed in patients with complex congenital spinal deformities occurring primarily in the thoracic spine and associated with intraspinal anomalies at the same level, where the vascular supply to the cord may be abnormal.     

Safety of sublaminar wires with Isola instrumentation for the treatment of idiopathic scoliosis

STUDY DESIGN: To investigate the incidence of acute neurologic complications of use of sublaminar wires with third-generation spine instrumentation for the treatment of idiopathic scoliosis. OBJECTIVES: To assess the safety of sublaminar wires in the surgical treatment of idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: The use of sublaminar wires in spine deformity for neuromuscular scoliosis and the Luque system has been reported. Use of sublaminar wires is an integral part of the technique in the surgical treatment of spine deformity with Isola instrumentation (AcroMed, Cleveland, OH). To date, the safety of this technique has not been documented. METHODS: The average age of the patients was 37 years (range, 11-74 years). Preoperative diagnosis was adolescent idiopathic scoliosis in 75 patients and adult idiopathic scoliosis in 66. One hundred nine were primary surgeries, and 32 were revision. Detailed evaluation of the curve type, curve magnitude, number of vertebrae instrumented, level of vertebrae wired, postoperative neurologic deficit, and the findings of intraoperative spinal cord monitoring was performed. Wires were always passed just before corrective maneuvers were performed. RESULTS: A total of 1366 wires were placed, 65% (n = 888) in the thoracic region, 22% (n = 300) in the thoracolumbar, and 13% (n = 178) in the lumbar. No permanent change in intraoperative spinal cord monitoring was detected. Stagnara wake-up test was performed in all patients. No patient with adolescent idiopathic scoliosis had neurologic complication. Two adults underwent revision surgery and had transient dysesthesia in the leg, which completely resolved with observation. CONCLUSION: Despite the increasing complexity of spinal instrumentation systems, sublaminar wire placement is a safe and useful adjunct in the surgical treatment of neurologically intact patients with idiopathic scoliosis.     

Occult spinal cord abnormalities in children referred for orthopedic complaints

This study reviews spinal cord abnormalities found in children initially referred for an orthopedic problem. Over a 5-year period in an academic pediatric orthopedic referral clinic, 167 children aged 3 months to 18 years (average, 9.4 years) underwent spine magnetic resonance imaging (MRI) scans and had records available for review. The patients were divided into 7 major groups based on the primary indication for the MRI. The frequency of spinal cord pathology was as follows: 3 of 35 patients with atypical idiopathic scoliosis, 1 of 19 with neuromuscular scoliosis, 6 of 18 with congenital scoliosis, 1 of 50 with unexplained back pain, 3 of 17 with gait abnormality, 5 of 14 with limb pain or weakness, and 4 of 8 with rigid or recurrent foot deformity. Spine MRI was not very helpful in evaluating children who had some degree of back pain without neurological signs or symptoms. However, the spine MRI was helpful in evaluating children with atypical idiopathic scoliosis or congenital scoliosis, gait abnormality, limb pain or weakness, or rigid or recurrent foot deformities. Given the high frequency of occult spinal cord abnormality in children with severe foot deformity, the use of screening spine MRI may be especially useful in this group.     

Cortical somatosensory-evoked potentials during spine surgery in patients with neuromuscular and idiopathic scoliosis under propofol-remifentanil anaesthesia

BACKGROUND: Intraoperative monitoring of the spinal cord via cortical somatosensory-evokedpotentials (SSEP) is a routine during spinal surgery. However,especially in neuromuscular scoliosis, the reliability of corticalSSEP has been questioned. Therefore, we compared the feasibilityof cortical SSEP in idiopathic and neuromuscular scoliosis usinganaesthetics known to have only minimal effect on SSEP recordings. METHODS: Total intravenous anaesthesia with propofol and remifentanilas continuous infusion was standardized for all the patients.Median and tibial nerve cortical SSEP were monitored in 54 patientswho underwent surgery for spinal deformity. Twenty-seven hadidiopathic scoliosis and 27 had neuromuscular scoliosis. Theportion of reproducible results and intraoperative changes werecompared between the groups. RESULTS: In both groups, cortical SSEP could be monitored with sufficientreliability. Only in two patients with idiopathic and four patientswith neuromuscular scoliosis no reproducible traces could beobtained. The amplitudes in patients with neuromuscular scoliosiswere lower than in those with idiopathic scoliosis, but notstatistically significant. There were no postoperative neurologicaldeficits. The number of false positive and true positive didnot differ between the groups. CONCLUSIONS: Assessment of cortical SSEP during spine surgery was equallyeffective and reliable in patients with neuromuscular scoliosisand in patients with idiopathic scoliosis, possibly as a resultof propofol–remifentanil anaesthesia.     

The role of routine magnetic resonance imaging in the preoperative evaluation of adolescent idiopathic scoliosis

The routine use of magnetic resonance imaging (MRI) in adolescent idiopathic scoliosis remains controversial, and current indications for MRI in idiopathic scoliosis vary from study to study. The purpose of this study was to demonstrate the prevalence of neural axis malformations and the clinical relevance of routine MRI studies in the evaluation of patients with adolescent idiopathic scoliosis undergoing surgical intervention without any neurological findings. A total of 249 patients with a diagnosis of idiopathic scoliosis were treated surgically between the years 2002 and 2007. A routine whole spine MRI analysis was performed in all patients. On the preoperative clinical examination, all patients were neurologically intact. There were 20 (8%) patients (3 males and 17 females) who had neural axis abnormalities on MRI. Three of those 20 patients needed additional neurosurgical procedures before corrective surgery; the remaining underwent corrective spinal surgery without any neurosurgical operations. Magnetic resonance imaging may be beneficial for patients with presumed idiopathic scoliosis even in the absence of neurological findings and it is ideally performed from the level of the brainstem to the sacrum.     

Comparison of single- and dual-rod techniques for posterior spinal instrumentation in the treatment of adolescent idiopathic scoliosis

STUDY DESIGN: Two groups of patients undergoing posterior spinal instrumentation and arthrodesis for treatment of adolescent idiopathic scoliosis were reviewed retrospectively. OBJECTIVE: To compare intraoperative concerns (operative time and blood loss), complications, and outcome in patients undergoing single or double posterior rod instrumentation for treatment of adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: The current treatment of idiopathic scoliosis includes posterior spinal instrumentation and arthrodesis. The standard configuration is a rectangular construct of dual rods connected by cross-links. Use of a single rod with multiple fixation points has been proposed as an alternative method to decrease operative time and blood loss, and to avoid late deep infections. METHODS: In this study, 21 patients underwent posterior instrumentation using a standard dual-rod construct, and 25 patients underwent posterior instrumentation using a solitary rod with multiple fixation points. Patients were assessed after a minimum 2-year follow-up period. RESULTS: No significant differences were found in blood loss, operative time, or overall frequency of long-term complications. Although not statistically significant, the trend was toward implant prominence in the double-rod group and implant failure in the single-rod group. Implant failure occurred only in instrumentations extending into the lumbar spine. There was no statistical difference in curve progression. CONCLUSIONS: Single-rod instrumentation and dual-rod constructs offered similar curve correction, blood loss, and operative time. However, single-rod instrumentation may be more prone to implant failure when extended into the lumbar spine.     

Restrictive pattern of pulmonary functions in idiopathic and congenital scoliosis following spinal fusion

Summary This paper presents the results of pulmonary function analysis in 141 subjects. Thirty-five of these were patients with adolescent idiopathic scoliosis, 36 had congenital scoliosis, and the remaining 70 were age-, sex-, height-, weight- and arm-span-matched normal subjects used as controls for adolescent idiopathic scoliosis. The patients with adolescent idiopathic scoliosis had their pulmonary function evaluated pre- and post-operatively. At pre-operative evaluation the mean age was 13.7 years and the mean cobb angle 48°; at post-operative evaluation the figures were 17.1 years and 36° respectively. In the congenital scoliosis group the mean age was 14.5 years and the mean Cobb angle 42°, and pulmonary functions were evaluated at a minimum of 3 years after surgery. The results are as follows: Adolescent idiopathic scoliosis: (i) Marked disproportion was found in the pulmonary volumes following spinal surgery. After taking growth of the thoracic cage into account, the total lung capacity remained unchanged whilst the vital capacity was significantly reduced and there was a significant increase in residual volume. (ii) This disproportionate increase in residual volume was further confirmed by very highly significantly increased residual volume/vital capacity and residual volume/total lung capacity ratios at post-operative evaluation compared to pre-operative ratios (Mann-Whitney test, P=0.001). (iii) The residual volume was 48% of vital capacity pre-operatively compared to 35% in normal controls. The percentages increased to 70% post-operatively, whilst it was unchanged in the matched controls. Congenital scoliosis: (i) The mean residual volume was markedly increased (154% of predicted value). (ii) Vital capacity was significantly reduced in surgically treated patients (68% of predicted values). (iii) This pattern of reduced vital capacity was more marked in those patients who had multiple thoracic anomalies and were treated surgically (46% of predicted value). However, those patients with multiple thoracic anomalies who did not require surgery did not show such reduction of vital capacity. Comparison between idiopathic and congenital scoliosis: (i) In unoperated patients, the percentages of predicted values of total lung capacity, vital capacity and residual volume were significantly greater in congenital scoliosis than in adolescent idiopathic scoliosis. (ii) Post-operatively there was no significant difference in the percentages of predicted values of total lung capacity, vital capacity and residual volume between patients with congenital scoliosis and those with adolescent idiopathic scoliosis, despite the difference in pathogenesis. These findings have relevance to scoliotic patients treated with spinal fusion with regard to their capability to perform strenuous physical activities.     

A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis relative to the surgical approach used for spinal arthrodesis

STUDY DESIGN: A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis undergoing surgical correction. OBJECTIVES: 1) To evaluate prospectively, at regular intervals, the changes in pulmonary function after surgical arthrodesis of primary thoracic and double primary thoracic-lumbar (double major) types of adolescent idiopathic scoliosis in a homogeneous population; 2) to compare the changes in pulmonary function after surgical correction relative to the surgical approach used for spinal arthrodesis; and 3) to determine if short- to midterm morbidity with respect to pulmonary function is associated with the type of surgical approach used for spinal arthrodesis. SUMMARY OF BACKGROUND DATA: The effect of surgical correction on the pulmonary function of patients with adolescent idiopathic scoliosis is controversial. Studies have shown improvement, decline, or no change in pulmonary function after surgical correction of idiopathic scoliosis. METHODS: Ninety-eight patients with adolescent idiopathic scoliosis undergoing surgical treatment at the authors' institution were prospectively evaluated with pulmonary function tests assessing volume (forced vital capacity and total lung capacity) and flow (forced expiratory volume in 1 second). Pulmonary functions were evaluated before surgery and after surgery at 3 months, 1 year, 2 years, and at the final follow-up visit. All patients were divided into four groups depending on the surgical approach used for spinal fusion: Group 1 (n = 47) underwent a posterior spinal fusion with iliac crest bone graft; Group 2 (n = 33) underwent a posterior spinal fusion with rib resection thoracoplasty; Group 3 (n = 7) underwent an anterior spinal fusion with a rib resection thoracotomy; and Group 4 (n = 11) underwent a combined anterior and posterior spinal fusion with autogenous rib and iliac crest graft used, respectively. RESULTS: Patients in Group 1 had improved pulmonary function values at 3 months after surgery, whereas patients in Groups 2, 3, and 4 showed a decline at 3 months after surgery. Two years after surgery, Group 1 had significantly improved pulmonary function values (P < 0.0001), whereas the pulmonary function values of patients in Groups 2, 3, and 4 had returned to preoperative values. CONCLUSIONS: 1) Patients with chest cage disruption during surgical treatment showed a decline in pulmonary function at 3 months after surgery. 2) In contrast, patients without chest cage disruption showed an improvement in pulmonary function at 3 months after surgery. 3) Irrespective of the surgical approach used for spinal arthrodesis, postoperative pulmonary function tests (absolute values) returned to preoperative values at 2 years after surgery. 4) Patients who had no chest cage disruption experienced a significantly greater improvement in two of their pulmonary function values at 2 years after surgery than patients with chest cage disruption.     

Superior mesenteric artery syndrome associated with scoliosis treated by a modified Ladd procedure

A 16-year-old asthenic girl had idiopathic adolescent scoliosis and superior mesenteric artery (SMA) syndrome. After a Harrington rod procedure, the SMA syndrome produced a complete duodenal obstruction that did not resolve with nasogastric decompression, positioning, or peripheral intravenous nutrition. A complete derotation of the duodenum and the colon and stabilization of their mesentery (Ladd procedure with the Bill modification) resolved the obstruction and was considered the preferred operative treatment for this problem.     

Osteopenia: a new prognostic factor of curve progression in adolescent idiopathic scoliosis

BACKGROUND: Studies have shown that 27% to 38% of girls with adolescent idiopathic scoliosis have systemic osteopenia. The aim of this study was to investigate whether osteopenia could serve as one of the important prognostic factors in predicting curve progression. METHODS: A prospective study was performed in 324 adolescent girls with adolescent idiopathic scoliosis who had a mean age of thirteen and a half years. Bone mineral density of the spine and both hips was measured at the time of the clinical diagnosis of scoliosis. All patients were followed longitudinally until skeletal maturity or until the curve had progressed > or =6 degrees . The univariate chi-square test and stepwise logistic regression were used to predict the prevalence of curve progression, and a receiver operating characteristic curve was plotted. RESULTS: The overall prevalence of curve progression was 50%. The prevalence of osteopenia at the spine and hips was 27.5% and 23.1%, respectively. A larger initial Cobb angle (odds ratio = 4.6), a lower Risser grade (odds ratio = 4.7), premenarchal status (odds ratio = 2.5), osteopenia in the femoral neck of the hip on the side of the concavity (odds ratio = 2.3), and a younger age at the time of diagnosis (odds ratio = 2.1) were identified as risk factors in predicting curve progression. A predictive model was established, and the area under the receiver operating characteristic curve of the model was 0.80 (p < 0.01). CONCLUSION: Osteopenia may be an important risk factor in curve progression. The measurement of bone mineral density at the time of diagnosis may serve as an additional objective measurement in predicting curve progression in adolescent idiopathic scoliosis. The bone mineral density-inclusive predictive model may be used in treatment planning for patients with adolescent idiopathic scoliosis who are at high risk of curve progression.     

Anterior Zielke instrumentation for spinal deformity in adults

Fifty-eight adults who had scoliosis or hyperlordosis had anterior arthrodesis and Zielke instrumentation. Postoperatively, the curve improved 68 per cent in forty-nine patients who had idiopathic scoliosis and 40 per cent in nine patients who had paralytic scoliosis or hyperlordosis or congenital scoliosis. More correction was obtained when a derotator apparatus was used. Only one patient had failure of the instrumentation that necessitated additional surgical treatment. All of the arthrodeses resulted in osseous fusion. No patient who had idiopathic scoliosis lost correction (average follow-up, forty-two months; range, thirty to seventy-eight months). There were no serious complications. Lumbar lordosis decreased an average of 24 per cent compared with the preoperative measurement. This decrease was thought to be related to the correction of vertebral rotation in the curve and to the surgical technique. Use of the Zielke instrumentation resulted in excellent correction, which was not lost postoperatively in the patients who had an idiopathic curve and which was associated with minimum complications.     

The Cotrel-Dubousset system--results in spinal reconstruction. Early experience in 47 patients.

Forty-seven patients were treated with spinal fusion and Cotrel-Dubousset instrumentation and were followed for an average of 28 months. Spinal procedures included: 1) posterior spinal fusion for idiopathic scoliosis (26 patients); 2) posterior pseudarthrosis repair (5 patients); 3) combined anterior/posterior fusion to the sacrum (6 patients); and 4) combined anterior/posterior osteotomies (10 patients). Group 1: Partial derotational correction was achieved for adolescent idiopathic scoliosis. Group 2: Successful pseudarthrosis repair was achieved in four patients. Group 3: A solid arthrodesis was obtained in two patients, whereas the other three patients underwent revision of sacral screw fixation for pseudarthrosis. One patient died postoperatively. Group 4: Pain relief and a balanced correction was achieved in all patients. The Cotrel-Dubousset system appears to be a versatile system and provides a wide range of possibilities for a variety of spinal problems.     

Prevalence of neural axis abnormalities in patients with infantile idiopathic scoliosis

BACKGROUND: Although reports in the literature have demonstrated an approximately 20% prevalence of neural axis abnormalities in patients with juvenile idiopathic scoliosis who have a curve of >20 degrees, the prevalence of neural axis abnormalities in patients with infantile idiopathic scoliosis is not well documented. In two previous studies involving a total of only ten patients with infantile idiopathic scoliosis, five patients were noted to have a neural axis abnormality on magnetic resonance images. METHODS: The records of forty-six consecutive patients who were seen between 1992 and 2000 at three spinal deformity clinics were retrospectively reviewed. The inclusion criteria included presumed idiopathic scoliosis at the time of presentation, an age of three years or less, a curve magnitude of > or = 20 degrees, normal neurological findings, no associated syndromes, and no congenital abnormalities. All patients were evaluated with a total spine magnetic resonance imaging protocol for examination of neural axis abnormalities from the skull to the coccyx. RESULTS: Ten (21.7%) of the forty-six patients were found to have a neural axis abnormality on magnetic resonance imaging. This group included five patients with an Arnold-Chiari malformation and an associated cervicothoracic syrinx, three with syringomyelia, one with a low-lying conus, and one with a brainstem tumor. Eight of these ten patients needed neurosurgical intervention for treatment of the abnormality. CONCLUSIONS: The 21.7% prevalence of neural axis abnormalities in this group of patients with infantile idiopathic scoliosis was found to be almost identical to that reported in the literature on patients with juvenile idiopathic scoliosis. Because of the high prevalence of abnormalities and the fact that eight of the ten patients with abnormal findings on magnetic resonance images required neurosurgical intervention, a total spine magnetic resonance imaging evaluation at the time of presentation is recommended for all patients with infantile idiopathic scoliosis who have a curve measuring > or = 20 degrees.     

Spinal disorders in childhood II: spinal deformity

Spinal deformity is a common presenting complaint in specialist paediatric spinal clinics with the most common deformity being scoliosis. The presence of a scoliosis is always abnormal and usually forms part of a 3-dimensional spinal deformity with associated rotation. The fourth dimension with regards to the scoliosis is the potential for progression with growth. Scoliosis is classified according to pathogenesis, the major groups being idiopathic (70%), congenital (15%), neuromuscular (10%) or due to miscellaneous other causes such as Marfan’s syndrome or neurofibromatosis (5%). The mainstay of treatment for significant scoliosis is surgery by way of spinal instrumentation, correction and bone grafting to achieve a selective fusion of the spine.     

Spinal disorders in childhood II: spinal deformity

Spinal deformity is a common presenting complaint in specialist paediatric spinal clinics with the most common deformity being scoliosis. The presence of a scoliosis is always abnormal and usually forms part of a three-dimensional spinal deformity with associated rotation. The fourth dimension with regards to scoliosis is the potential for progression with growth. Scoliosis is classified according to pathogenesis, the major groups being idiopathic (70%), congenital (15%), and neuromuscular (10%) or due to miscellaneous other causes such as Marfan's syndrome or neurofibromatosis (5%). The mainstay of treatment for significant scoliosis is surgery by way of spinal instrumentation, correction and bone grafting to achieve a selective fusion of the spine.     

Postural Control in Scoliosis: A Statokinesimetric Study in Patients with Scoliosis due to Neuromuscular Disorders and in Patients with Idiopathic Scoliosis

Statokinesimetric characteristics were analysed in patients with scoliosis which had developed in the course of degenerative neuromuscular disorders and in patients with adolescent idiopathic scoliosis. Patients with Duchenne and limb-girdle muscular dystrophy and spinal muscular atrophy showed markedly decreased oscillations of the body's centre of gravity, in addition to a forward shift of its mean position. Thus the postural equilibrium in neuromuscular patients with scoliosis is even more efficiently controlled than normal. On the other hand, patients with idiopathic scoliosis did not show any significant changes as compared with normal subjects. The present study therefore does not support the suggestion that the pathogenesis of scoliosis, at least in neuromuscular patients, is triggered by an impairment of descending postural control.