A study of trunk muscle in idiopathic scoliosis

Isometric and isokinetic parameters related to trunk muscle function in patients with idiopathic scoliosis were measured by Cybex dynamometer with a trunk stabilization system. Activities of the paraspinal muscles were also determined by electromyographic observations. In scoliotic patients some parameters, especially endurance in lateral bending to the concave side of the trunk, were predominant. In electromyographic analysis, neurogenic changes were observed in 25.9% of patients with idiopathic scoliosis. In nonprogressive scoliosis, the mean amplitude of EMG did not differ between the convex and the concave. In progressive scoliosis, however, the mean amplitude of EMG was higher on the convex side than on the concave side. Thus, the compensatory reaction on the curvature of the spine caused higher amplitude of action potential of the back muscles on the convex side than in the concave side. These data suggest that the trunk muscle imbalance is one of the most important factors in the onset and progression of idiopathic scoliosis.     

A study on platelet function in idiopathic scoliosis

Because platelets and muscle cells share the same contractile proteins--actin and myosin--platelets may serve as a model for muscle research. To study the functional abnormalities and ultrastructural changes of platelets and to determine whether or not abnormalities in muscle contractile proteins and collagen play an important role in the pathogenesis of idiopathic scoliosis, the bleeding time, the platelet aggregation test, and the titers of platelet plasminogen activator inhibitors were measured and the electron microscopic findings were examined in 52 idiopathic scoliosis patients aged 7 to 28 years and in 49 normal individuals aged 8 to 38 years as a control group. We found no statistically significant difference between the two groups in the bleeding time, the platelet aggregation test, and the titers of platelet plasminogen activator inhibitors. In the electron microscopic findings, no specific abnormalities were found in platelets of idiopathic scoliosis patients. We concluded that idiopathic scoliotic patients have normal morphology and function of platelets, and there is no important role of contractile proteins in the pathogenesis of idiopathic scoliosis. In addition, since the bleeding time was in the normal range, no evidence of subendothelial collagen dysfunction was found in the idiopathic scoliosis patients.     

Reliability and concurrent validity of postural asymmetry measurement in adolescent idiopathic scoliosis

AIM To investigate the reliability and concurrent validity of the Baseline~? Body Level/Scoliosis meter for adolescent idiopathic scoliosis postural assessment in three anatomical planes.METHODS This is an observational reliability and concurrent validity study of adolescent referrals to the Orthopaedic department for scoliosis screening at KarolinskaUniversity Hospital, Stockholm, Sweden between MarchMay 2012. A total of 31 adolescents with idiopathic scoliosis(13.6 ± 0.6 years old) of mild-moderate curvatures(25°± 12°) were consecutively recruited. Measurement of cervical, thoracic and lumbar curvatures, pelvic and shoulder tilt, and axial thoracic rotation(ATR) were performed by two trained physiotherapists in one day. The intraclass correlation coefficient(ICC) was used to determine the inter-examiner reliability(ICC2,1) and the intra-rater reliability(ICC3,3) of the Baseline~? Body Level/Scoliosis meter. Spearman's correlation analyses were used to estimate concurrent validity between the Baseline~? Body Level/Scoliosis meter and Gold Standard Cobb angles from radiographs and the Orthopaedic Systems Inc. Scoliometer.RESULTS There was excellent reliability between examiners for thoracic kyphosis(ICC2,1 = 0.94), ATR(ICC2,1 = 0.92) and lumbar lordosis(ICC2,1 = 0.79). There was adequate reliability between examiners for cervical lordosis(ICC2,1 = 0.51), however poor reliability for pelvic and shoulder tilt. Both devices were reproducible in the measurement of ATR when repeated by one examiner(ICC3,3 0.98-1.00). The device had a good correlation with the Scoliometer(rho = 0.78). When compared with Cobb angle from radiographs, there was a moderate correlation for ATR(rho = 0.627).CONCLUSION The Baseline~? Body Level/Scoliosis meter provides reliable transverse and sagittal cervical, thoracic and lumbar measurements and valid transverse plan measurements of mild-moderate scoliosis deformity.     

Effectiveness of audio-biofeedback in postural training for adolescent idiopathic scoliosis patients.

The possibility of using learned physiological responses in control of progressive adolescent idiopathic scoliosis (AIS) was investigated. Sixteen (16) AIS patients with progressing or high-risk curves (Cobb's angle between 25 degrees and 35 degrees at start and reducible by lateral bending) were fitted with a device with tone alarm for poor posture. In the first 18 months of application, 3 patients defaulted and 4 showed curve progression > 10 degrees (2 changed to rigid spinal orthoses and 2 underwent surgery). The curves for the other 9 patients were kept under control (within +/- 5 degrees of Cobb's angle) and 5 of them have reached skeletal maturity and terminated the application. The remaining 4 patients were still using the devices until skeletal maturity or curve progression. The curve control rate was 69%. A long-lasting active spinal control could be achieved through the patient's own spinal muscles. Nevertheless, before the postural training device could become a treatment modality, a long-term study for more AIS patients was necessary. This project is ongoing in the Duchess of Kent Children's Hospital, Sandy Bay, Hong Kong.     

Acute postural adaptations induced by a shoe lift in idiopathic scoliosis patients

The objective of this study was to identify acute spinal and three-dimensional postural adaptations induced by a shoe lift in a population of idiopathic scoliosis (IS) patients. Forty-six IS patients (mean age: 12 +/- 2 years) were evaluated radiologically and with a stereovideographic system for pelvic obliquity. Based on the initial postural and radiological evaluation, a pertinent shoe lift height was chosen for each with the result that 12 patients were tested with 5-mm (S5) lifts, 20 patients were tested with 10-mm (S10) lifts, and 14 patients with 15-mm (S15) lifts. The posture for all 46 patients was then re-evaluated and a spinal radiograph obtained for 14 patients. The implementation of a shoe lift independent of the type of curve and amplitude significantly decreased the Cobb angle. As expected there was a change in the vertical height of the left tibial plateau and greater trochanter that induced a change in pelvic tilt. There was also a significant increase in the vertical height of S1 and T1. There was a significant change in the left and right iliac bone version, as well as a decrease in the difference in version between these two bones. The implementation of the shoe lifts also changed the lateral shift of the pelvis. A relative change between the shoulders and pelvis for tilt and anteroposterior shift was also found to be significant. In conclusion, using a shoe lift resulted in acute postural adaptations which specifically affected the spine and the three-dimensional position and orientation of the pelvis and shoulder girdle.     

Stature and idiopathic scoliosis. A prospective study

A study of 130 scoliotic children with curves measuring 10 degrees or more has been performed in order to elucidate the importance of stature, growth and development. Girls with adolescent idiopathic curves measuring 15 degrees or more were taller than girls with smaller idiopathic curves and taller than those whose scoliosis was secondary to leg-length inequality (pelvic tilt scoliosis). No differences were observed as regards growth velocity or development. The increased standing height may be genetic but the uncoiling effect of the normal kyphosis to give a flat lateral profile is a more likely cause. The familial trend in idiopathic scoliosis may therefore be explained by the genetically determined shape of the spine in the median (sagittal) plane.     

CD-Horizon器械治疗特发性脊柱侧凸的临床研究

[目的]探讨特发牲脊柱侧凸治疗方法,总结应用CD-Horizon(CD-H)钉-棒系统与钉-钩-棒系统的治疗效果。[方法]自2000年1月~2004年1月,采用CD-H器械治疗85例特发性脊柱侧凸患者,其中钉-棒系统51例(A组),钉-钩-棒系统34例(B组),比较术前、术后与随访2年冠状面与矢状面的角度及旋转度。[结果]85例患者平均随访3年半,术后及随访2年时冠状面及矢状面矫正率A组明显优于B组(P<0.05)。术后2年2组冠状面矫正度的丢失有明显的差异。2组患者旋转矫正Ⅰ~Ⅱ度。术前、术后及术后2年,2组Cobb s角自身得分显示术后明显低于术前(P<0.05),与术后2年随访得分相比无差异(P>0.05)。[结论]CD-Horizon器械是治疗特发性脊柱侧凸比较有效的方法,钉-棒系统较钉-钩-棒系统相比效果更佳。     

Multiparameter pilot study of adolescent idiopathic scoliosis

Seventy-two adolescent females with idiopathic scoliosis were studied to determine the possible relationships between parameters previously studied by others, as well as several new parameters. Dichotic listening tests showed that patients with less right-ear advantage for language were more likely to have progressive curves than patients with greater right-ear advantage, implying a difference in hemispheral dominance between the two groups. This finding, if confirmed with larger populations, could lead to a prognostic test for the determination of therapeutic modality. Platelet aggregation was found to be lower than in a group of controls; however, similar findings were also obtained from a group of patients with chronic orthopaedic conditions. Mitral valve prolapse, the electroencephalogram and the mother's age at patient's birth were all found to be nonspecific for the patients as compared to control groups. The level of autonomic system activity in the patients was found to be higher than that observed in controls.     

Curve patterns in idiopathic scoliosis. A clinical and radiographic study

We have developed a simple technique for demonstrating the sagittal profile of each rotated level of a scoliotic spine and used it to determine the patterns of lordosis and kyphosis in each of six clinical types of idiopathic scoliosis. The currently accepted classification of scoliosis is inaccurate and a modification is proposed. The three main types of scoliosis were shown to have sagittal profiles distinctly different from each other and from normal. Single structural curves had short lordotic sections at their apices, limited above and below by kyphosis. Double curves showed longer lordotic sections limited only by one area of kyphosis. Lordosis throughout the thoracic and lumbar spine was associated with triple curve patterns. The biomechanical effects of the abnormal sagittal profiles provide a simple explanation for the genesis and progression of the different types of scoliosis, and the recognition of the pattern of the sagittal abnormalities permits treatment to be designed on a sound anatomical basis for individual cases.     

Influence of different types of progressive idiopathic scoliosis on static and dynamic postural control

STUDY DESIGN: Balance control assessment of static and dynamic conditions was performed to study the effects of progressive idiopathic scoliosis on postural control in 102 adolescents. OBJECTIVE: To determine how the type and location of idiopathic scoliosis may affect global balance control. SUMMARY OF BACKGROUND DATA: Idiopathic scoliosis may impair postural control components, but the repercussions for global balance are relatively mild. METHODS: The following four different types of idiopathic scoliosis were compared: thoracic (n = 36), thoracolumbar (n = 22), lumbar (n = 23), and double major (n = 21) curves. Center of foot pressure displacements and electromyographic responses were recorded using static and dynamic posturographic tests (single and fast upward tilt, slow sinusoidal oscillations). RESULTS: The major criteria of postural control were better in the double major group for all the tests. In the static test, the patients with high major curves performed better than those with low major curves. In the fast dynamic test, similar latency values were observed in all the groups. In the slow dynamic test, better results were observed for the patients with low major curves. CONCLUSIONS: These data demonstrate that idiopathic scoliosis indeed alters balance control, with different hierarchies, from the best to the worst as follows: double major, thoracic, thoracolumbar, and lumbar curves in the static test and double major, lumbar, thoracolumbar, and thoracic curves in the slow dynamic test. The location of the major curve appeared to be important, with an effect on lateral disequilibrium and vestibular symmetry. The absence of anomaly in the fast dynamic test suggests that the type of scoliosis does not impair proprioception.     

青少年特发性脊柱侧凸病因学研究进展

青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）是指青春期或骨骼成熟前发生的结构性脊柱侧弯畸形（在冠状面上Cobb角〉10°,且合并有脊柱的旋转）,而无其他器质性疾病。AIS在小儿肌肉骨骼系统中是发病率较高的畸形之一,占整个脊柱侧凸的70％～80％。尽管脊柱侧凸临床上已治疗多年,但是发病机制尚不清楚。近年来就其遗传、生长发育、神经肌肉、激素、结缔组织等方向做了大量的研究,本文就其病因学研究进展予以综述。     

Electroencephalographic study of schoolchildren with adolescent idiopathic scoliosis

This study investigated the possible pathologic electroencephalographic (EEG) findings in scoliotic schoolchildren and their correlation to the degree and location of scoliosis. Sixty-seven scoliotic, healthy schoolchildren were investigated and 42 nonscoliotic, healthy schoolchildren served as controls. In the group of scoliotics the percentage of pathologic EEGs was higher than that of the control group (33% to 14%) P less than 0.05, being much higher in the EEGs taken after activation (57% to 22%) P less than 0.001. In the small curves, the percentage of pathologic EEGs was found to be higher only after activation in comparison with the percentage found in bigger curves, but without statistical significance. In lumbar, thoracolumbar, and double curves, focal EEG changes predominated. In contrast, in thoracic curves there was a higher incidence of bilaterally synchronous discharges.     

A study of the radiologic predictors of curve flexibility in adolescent idiopathic scoliosis

STUDY DESIGN: A study of flexibility of 101 idiopathic scoliosis antero-posterior radiographs. OBJECTIVE: To discover if there are any parameters on plain antero-posterior radiographs that can predict the flexibility of scoliosis curves. SUMMARY OF BACKGROUND DATA: Previously the flexibility index, generated from fulcrum bending x-rays, has been shown to be an accurate measure of curve stiffness. METHODS: Five postulated predictors of flexibility, measured on 101 immediate preoperative scoliosis radiographs, were compared with the flexibility index generated from fulcrum bending radiographs. Correlation between the 5 parameters and flexibility index was studied. Further analysis was performed to assess the significance of curve location in prediction of flexibility. Linear regression analysis was used. RESULTS: Linear regression including all 5 predictors showed Cobb angle and age to be the only significant predictors of flexibility. When Cobb angle and age were analyzed with location (thoracic, thoracolumbar) this was also found to be a significant factor. CONCLUSIONS: Cobb angle, age, and curve location are useful predictors of flexibility on antero-posterior radiographs. This may aid preoperative planning in the out-patients department.     

Proprioception in idiopathic scoliosis

Proprioception testing and gait analysis was performed on a group of 17 patients with idiopathic scoliosis. All curves had documented progression. The average curve was 26.8 degrees, all primary curves being right thoracic. The average age was 14.8 years. Twelve, healthy, age-matched controls underwent identical testing. Results showed that scoliotic subjects had asymmetry in their ability to reproduce angles between their two knees, as well as an absolute deficit in their ability to reproduce angles as compared with controls (P less than 0.01). The threshold of detection of change in angle at the knee was also quantitatively higher than controls (P less than 0.05), although asymmetry was not statistically significant. No significant differences were measured in gait parameters between scoliotics and controls. These joint position tests have been applied previously to young and elderly adults, athletes, and total joint patients. In no group has any asymmetry of response been demonstrated, both extremities showing virtually identical performance in each case. The tests administered measure sensory modalities, which are conducted through the posterior columns. Although the site of damage in the neural pathway cannot be specifically localized by these tests, results of this study support the presence of a neurologic deficit in idiopathic scoliosis.