[Conservative treatment of idiopathic scoliosis with effective braces: early response to trunk asymmetry may avoid curvature progress]

Ultrasound supports clinical decision-making in determining the Sanders' skeletal maturity score of the hand

PURPOSE

The Sanders Scoring System has revolutionized the way we assess the remaining growth potential of the skeleton. However, because it involves radiation exposure, it must be used with caution in children. The purpose of the study was to evaluate whether the Sanders skeletal maturity score (SMS) could be accurately determined using ultrasound (U).

METHODS

We took radiographs (R) of the hand and performed U of the thumb and index finger in 115 patients between six and 19 years of age who were undergoing treatment for scoliosis or limb deformities. Paediatric orthopaedic surgeons, a paediatrician, and a paediatric radiologist were evaluated the blinded images. Those classified images are based on the SMS and the Thumb Ossification Composite Index (TOCI).

RESULTS

Intrarater reliability was high for SMS and slightly weaker for TOCI, but still significant. Interrater reliability was clear for R and weaker for U in both staging systems. Ultimately, SMS 3 and 7 achieved the highest percentage of concordance (P) of 71.7% and 66.0%, respectively, when U was performed. Combining the clinically relevant groups of SMS 3&4 and SMS 7&8 also significantly increased peak scores (SMS 3 and 4 P = 76.7%; SMS 7 and 8 P = 79.7%). The probabilities of peak scores were significantly weaker when the TOCI score was examined.

CONCLUSION

Our study shows that U can be used effectively especially to measure stages 3 and 4 and stages 7 and 8 of SMS. The U method is easy to use and therefore may offer advantages in clinical practice without the need for radiation exposure.

[Conservative treatment of idiopathic scoliosis : Influence of archetypical Cheneau-Corsets on trunk asymmetry]

BACKGROUND

The vertical posture of the growing child requires minute central nervous control mechanisms to maintain the symmetry of the torso in its various activities. Measuring only static parameters such as the Cobb angle does not describe the dynamic changes of scoliotic deformities in gait. A constant deviation in the frontal, transverse, and sagittal planes from the dynamic symmetry of the trunk is described in motion analysis and the surface changes of the spinopelvic complex.

METHODS

Early intervention with effective bracing, physiotherapy and sport can reverse curve progression in growth spurts, once these are identified by screening. Modern braces have a derotating and reducing effect ("mirror effect") on asymmetric body volumes, thus influencing the growing torso and restoring lasting symmetry. These braces can be reduced for archetypical designs. Latest data support the use of braces to reverse progressing scoliosis.

[Surgical treatment of scoliosis in childhood and adolescence: Age group and etiology-related indications and choice of instrumentation]

The indications for a corrective surgical procedure for the complex 3-dimensional deformations of the spine collectively known under the term scoliosis, essentially depend on knowledge of the underlying etiology, the time of initial diagnosis in relation to the growth curve of the child and on considerations about the general operability of the patient. An early onset of scoliosis in childhood under defined diagnostic criteria is usually associated with a fast progression of spinal curvature and requires early surgical intervention during the growth period, while scoliosis in adolescence often allows a delayed surgical intervention until all conservative means have been taken into consideration. Corrective measures in the growing spine require procedures and adjustable hardware which can be adapted to vertebral and thoracic growth and thus anticipate the threat of pulmonary insufficiency due to postural and spinal collapse. Towards the end of puberty when spinal growth slowly comes to an end, corrective spinal fusion procedures are considered in those cases of early and late onset scoliosis, where curvature progression is likely to occur.

[Adolescent scoliosis : From deformity to treatment]

Scoliosis affects up to 6 % of the population. The resulting spine deformity, the increasing risk of back pain, cosmetic aspects, pulmonary disorders if the Cobb angle is > 80°, and the progress of the deformity to > 50° after the end of growth indicate non-operative or operative therapy. In daily clinical practice, the classifications of scoliosis allow the therapy to be adapted. Classifications consider deformity, topography of the scoliosis, and the age at diagnosis. This publication gives an overview of the relevant and most common classifications in the treatment of adolescent scoliosis. For evaluation, the deformity measurement on the coronary radiographic projection of the total spine (Cobb angle) is relevant to therapy. The classification of topography, form, and the sagittal profile of the deformity of the spine are useful for preoperative planning of the fusion level. Classifications that take into account the age at the time of the diagnosis of scoliosis differentiate among early onset scoliosis (younger than 10 years of age), adolescent scoliosis (up to the end of growth), and adult scoliosis. Early onset scoliosis is subdivided by age and etiology. Therapy is derived from the classification of clinical and radiological findings. Classifications that take into account clinical and radiological parameters are essential components of modern scoliosis therapy.