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Khani M, Cheriet F, Seoud L, Debanné P, Parent S, Labelle H. Changes in trunk appearance following surgical correction of adolescent idiopathic scoliosis. Spine Deform 2024; 12:1071-1077. [PMID: 38520644 DOI: 10.1007/s43390-024-00843-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/09/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE To assess the postoperative appearance of the trunk in surgically treated scoliosis patients after a 2 year follow-up using reliable indices and compare the results with 6-month follow-up. METHODS Forty-six Adolescent Idiopathic Scoliosis (AIS) patients (female; preop mean age 14.4 ± 2.4 years) who underwent a posterior spinal fusion from 2009 to 2018 were included in this study. All had Lenke 1A thoracic curves, with surface topography taken preoperatively, 6 months and 2 years postoperatively. To assess spinal deformity, we measured the proximal thoracic, main thoracic and thoracolumbar/lumbar Cobb angles in the frontal plane from spinal X-rays and inclinometer angles in the thoracic and lumbar regions. To assess trunk deformity, Back Surface Rotation (BSR) and Trunk Lateral Shift (TLS) were computed along the trunk. We analysed the effect of age, height, weight, Cobb angle, length of follow-up, and surgical technique. We also compared correction rates (CRs) of the spinal and trunk measurements after 6 months and 2 years. RESULTS Good spinal correction was achieved, with Cobb angles decreasing in the whole cohort. CRs for TLS and BSR were positive (denoting improvement) for 76% and 48% of patients, respectively, after 2 years. Compared with 6 months, the mean TLS CR increased while there was no improvement for BSR on average. We found no significant association after 2 years between truncal index CRs and clinical variables (age, height, weight, preoperative Cobb angles) or surgical technique. However, there were significant correlations between the CRs of TLS and the main thoracic Cobb angle (r = 0.35), and between the CRs of BSR and thoracic inclinometer angle. CONCLUSION Although more than 55% of the TLS was corrected after 2 years of follow-up, the BSR remained stable over time and the persistence of rib hump on the back surface could be observed. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Maryam Khani
- Department of Computer and Software Engineering, Polytechnique Montréal, P.O. Box 6079, Montréal, QC, H3C 3A7, Canada.
- Sainte Justine Hospital Research Center, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
| | - Farida Cheriet
- Department of Computer and Software Engineering, Polytechnique Montréal, P.O. Box 6079, Montréal, QC, H3C 3A7, Canada.
- Sainte Justine Hospital Research Center, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
| | - Lama Seoud
- Department of Computer and Software Engineering, Polytechnique Montréal, P.O. Box 6079, Montréal, QC, H3C 3A7, Canada
- Sainte Justine Hospital Research Center, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Philippe Debanné
- Department of Computer and Software Engineering, Polytechnique Montréal, P.O. Box 6079, Montréal, QC, H3C 3A7, Canada
- Sainte Justine Hospital Research Center, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Stefan Parent
- Sainte Justine Hospital Research Center, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Hubert Labelle
- Sainte Justine Hospital Research Center, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
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Khani M, Debanné P, Guibault F, Labelle H, Parent S, Cheriet F. Automatic assessment of scoliosis surgery outcome on trunk shape using left-right trunk asymmetry. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1691-1699. [PMID: 38267735 DOI: 10.1007/s00586-023-08122-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 07/27/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE To present a novel set of Left-Right Trunk Asymmetry (LRTA) indices and use them to assess the postoperative appearance of the trunk in Adolescent Idiopathic Scoliosis (AIS) patients. METHODS We hypothesize that LRTA measurements provide complementary information to existing trunk asymmetry indices when documenting the outcome of scoliosis surgery. Forty-nine AIS patients with thoracic curves who underwent posterior spinal fusion were included. All had surface topography scans taken preoperatively and at least 6 months postoperatively. We documented spinal curvature using Radiographic Cobb angles, scoliometer readings and coronal balance. To evaluate Global Trunk Asymmetry (GTA), we used the standard measures of Back Surface Rotation (BSR) and Trunk Lateral Shift (TLS). To measure LRTA, we identified asymmetry areas as regions of significant deviation between the left and right sides of the 3D back surface. New parameters called Deformation Rate (DR) and Maximum Asymmetry (MA) were measured in different regions based on the asymmetry areas. We compared the GTA and LRTA changes with those in spinal curvature before and after surgery. RESULTS The GTA indices, mainly TLS, showed improvement for more than 75% of patients. There was significant improvement of LRTA in the shoulder blades and waist regions (95% and 80% of patients respectively). CONCLUSION We report positive outcomes for LRTA in the majority of patients, specifically in the shoulder blades and waist, even when no reduction of BSR is observed. The proposed indices can evaluate local trunk asymmetries and the degree to which they are improved or worsened after scoliosis surgery.
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Affiliation(s)
- Maryam Khani
- Department of Computer and Software Engineering, Polytechnique Montréal, P.O. Box 6079, Montreal, QC, H3C 3A7, Canada.
- Sainte Justine Hospital Research Center, 3175, Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
| | - Philippe Debanné
- Department of Computer and Software Engineering, Polytechnique Montréal, P.O. Box 6079, Montreal, QC, H3C 3A7, Canada
- Sainte Justine Hospital Research Center, 3175, Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - François Guibault
- Department of Computer and Software Engineering, Polytechnique Montréal, P.O. Box 6079, Montreal, QC, H3C 3A7, Canada
| | - Hubert Labelle
- Sainte Justine Hospital Research Center, 3175, Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Stefan Parent
- Sainte Justine Hospital Research Center, 3175, Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Farida Cheriet
- Department of Computer and Software Engineering, Polytechnique Montréal, P.O. Box 6079, Montreal, QC, H3C 3A7, Canada
- Sainte Justine Hospital Research Center, 3175, Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
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Hammad AM, Emar M, Shahin F, Aljuba A, Hasani A, Awad M, Abdelnabi S, Gayaswal D, Armouti M, Shekhar S, Garg B, Ahmad AA. A Prospective Multicenter ≥2 Years Clinical Study of the Active Apex Correction (APC) Technique in Early Onset Scoliosis (EOS) Patients. Global Spine J 2024:21925682241229677. [PMID: 38266098 DOI: 10.1177/21925682241229677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
STUDY DESIGN prospective multicenter study. OBJECTIVES Active apex correction (APC) is posterior tethering technique for correction of early onset scoliosis (EOS) via reverse modulation at the apex. Active apex correction has been increasingly used worldwide. This study aimed to assess short-term outcomes of multicenter study with ≥2 years of APC on spine length, curve correction, complications, unplanned surgeries, and proposed low crankshaft phenomena incidence. METHODS Prospective multicenter study including 24 EOS patients treated by APC; involves inserting and compressing pedicle screws on convex side of apex proximal and distal to most wedged vertebra allowing apex modulation according to Hueter-Volkmann law. Excluded patients with <2 years follow-up whom APC was not primary surgery. RESULTS Mean age 85.97 ± 32.43 months, 71% congenital scoliosis, mean follow-up 35.54 ± 12.36 months. At final follow-up, statistically significant improvement in Cobbs angle (∆ = 23.96%, P < .0001), spinal length T1-T12 (∆ = 12.83%, P < .0001), T1-L5 (∆ = 13.41%, P < .0001) but not in apical vertebral translation (AVT) albeit clinical improvement (∆ = 7.9%, P = .36) compared to preoperative measurements. Comparing immediate postoperative measurements to >2 years follow-up, statistically significant improvement in spinal length T1-T12 (∆ = 6.03%, P = .0002) and T1-L5 (∆ = 6.26%, P < .0001) but not in Cobbs angle (∆ = 4.93%, P = .3) or AVT (∆ = 14.77%, P = .25). 9 complications requiring 3 unplanned surgeries recorded in all patients including 2 broken rods, 2 adding-on and 4 screw dislodgement. CONCLUSION Active apex correction is a novel technique that has been incorporated in several countries as treatment modality for EOS. Short-term outcomes are promising in terms of clinical improvement, complication rates and decreased need for multiple operations or unplanned surgeries.
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Affiliation(s)
- Ahmad M Hammad
- Department of Orthopedics Surgery, American University of Beirut (AUB), Beirut, Lebanon
| | - Mohammad Emar
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Farah Shahin
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Ayat Aljuba
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Asala Hasani
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Mohammad Awad
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Siraj Abdelnabi
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Daksh Gayaswal
- Department of Orthopedics Surgery, University of Toledo, Toledo, OH, USA
| | - Mohammad Armouti
- Department of Orthopedics Surgery, Abdali Hospital, Amman, Jordan
| | - Shubhankar Shekhar
- Department of Orthopedics Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Bhavuk Garg
- Department of Orthopedics Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Alaaeldin A Ahmad
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
- Department of Orthopedics Surgery, University of Toledo, Toledo, OH, USA
- Department of Orthopedics Surgery, Abdali Hospital, Amman, Jordan
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Weiss HR, Lay M, Best-Gittens T, Moramarco M, Jimeranez M. Conservative treatment of a scoliosis patient after two heart surgeries in early childhood - A case report. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1588. [PMID: 34917835 PMCID: PMC8661293 DOI: 10.4102/sajp.v77i2.1588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction This is a case report of a juvenile female patient with scoliosis following two heart surgeries for congenital heart disease (CHD). Patient presentation, management and outcome Initially, the premenarchial female was 9 years old and had a Tanner stage 2–3 with a single thoracic curve of 65° Cobb. Because of the high risk for progression, immediate brace treatment was proposed as the father declined surgery. The patient received intensive treatment according to the Schroth Best Practice® programme and a Gensingen Brace® designed for large thoracic curves. Over the 18 months following the initial visit, she received two additional braces. As a result, the progression of the main curve was prevented. The patient continues to maintain an improved cosmetic result and is currently at a Risser 2. Conclusion Surgery performed for CHD in rare cases may lead to stiff spinal deformity as a consequence of that surgery. Progression of a severe and stiff curve was prevented during the most vulnerable phase of the pubertal growth spurt with an improved clinical result. Therefore, we assume that the patient may have a normal life in adulthood with minor restrictions only. Supported by pattern-specific high correction exercises and braces, these typical single thoracic curves can be re-compensated to a more balanced appearance, less prone to progression in adulthood. Clinical implications Because of the relative high risks of spinal fusion and the long-term unknowns of such an intervention, high-impact conservative treatment should be implemented first before surgical correction is considered.
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Affiliation(s)
- Hans-Rudolf Weiss
- Schroth Best Practice Academy, Neu-Bamberg, Germany.,Koob Scolitech GmbH, Neu-Bamberg, Germany
| | - Manuel Lay
- Orthopedic Technology, Orthopädietechnik Lay GmbH, Zell-Barl, Germany
| | | | - Marc Moramarco
- Scoliosis3DC/Private Practice, Woburn, United States of America
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Weiss HR, Nan X, Potts MA. Is there an indication for surgery in patients with spinal deformities? - A critical appraisal. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1569. [PMID: 34859161 PMCID: PMC8603189 DOI: 10.4102/sajp.v77i2.1569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 08/11/2021] [Indexed: 11/01/2022] Open
Abstract
Background High-quality evidence exists to support physiotherapy and brace treatment for scoliosis and other spinal deformities. However, according to previous systematic reviews, it seems that no evidence exists for surgery. Nevertheless, the number of research articles focussing on spinal surgery highly exceeds the number of articles focussing on conservative treatment. Objective The purpose of this study is to conduct an updated search for systematic reviews providing high-quality evidence for spinal surgery in patients with spinal deformities. Method A narrative review including PubMed and the Cochrane database was conducted on April 12, 2020, with the following search terms: (1) spinal deformities, surgery, systematic review and outcome; (2) kyphosis, surgery, systematic review and outcome; (3) Scheuermann's disease, surgery, systematic review and outcome, and (4) scoliosis, surgery, systematic review and outcome. Results No reviews containing prospective controlled or randomised controlled studies were found providing evidence for surgery. Conclusions A general indication for spine surgery just based on the Cobb angle is not given. In view of the long-term unknown variables and the possible long-term complications of such treatment, a surgical indication for patients with spinal deformities must be reviewed on an individual basis and considered carefully. A current systematic review appears necessary in order to be able to draw final conclusions on the indication for surgery in patients with spinal deformities. Clinical implications In view of the increasing number of surgeons with an affiliation to industry, the indication for surgery needs to be given by independent conservative specialists for spinal deformities in order to provide an objective recommendation.
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Affiliation(s)
| | - Xiaofeng Nan
- Nan Xiaofeng's Spinal Orthopedic Workshop, Xi 'an, China
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Latalski M, Fatyga M, Sowa I, Wojciak M, Starobrat G, Danielewicz A. Complications in growth-friendly spinal surgeries for early-onset scoliosis: Literature review. World J Orthop 2021; 12:584-603. [PMID: 34485105 PMCID: PMC8384615 DOI: 10.5312/wjo.v12.i8.584] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/12/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The treatments for early-onset scoliosis (EOS), defined as curvature of the spine with onset before 10 years of age, continue to pose a great challenge for pediatric orthopedics. The treatment goals for EOS include minimizing spinal deformity while maximizing thoracic volume and pulmonary function. Different surgical techniques have different advantages and drawbacks; however, the two major concerns in the management of EOS are repeated surgeries and complications.
AIM To review the current literature to assess the safety of EOS surgical treatment in terms of the rate of complications and unplanned surgeries.
METHODS In January 2021 two independent reviewers systematically searched three electronic medical databases (PubMed, the Cochrane Library, and Embase) for relevant articles. Every step of the review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Due to the heterogeneity of articles and topics after data analysis, a descriptive (synthetic) analysis was performed.
RESULTS A total of 2136 articles were found. Forty articles were included in this systematic review, after applying our inclusion and exclusion criteria. EOS surgery has a varying but high rate of complications. The most frequent complications were categorized as implant (54%), general (17%), wound (15%) and alignment (12%). The rate of complications might have been even higher than reported, as some authors do not report all types of complications. About 54% of patients required unplanned surgeries due to complications, which comprised 15% of all surgeries.
CONCLUSION The literature concerning the definitions, collection, and interpretation of data regarding EOS surgery complications is often difficult to interpret. This creates problems in the comparison, analysis, and improvement of spine surgery practice. Additionally, this observation indicates that data on the incidence of complications can be underestimated, and should be interpreted with caution. Awareness of the high rate of complications of EOS surgery is crucial, and an optimal strategy for prevention should become a priority.
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Affiliation(s)
- Michał Latalski
- Children Orthopaedic Department, Medical University of Lublin, Lublin 20-093, Poland
| | - Marek Fatyga
- Children Orthopaedic Department, University Hospital for Children, Lublin 20-093, Poland
| | - Ireneusz Sowa
- Department of Analytical Chemistry, Medical University of Lublin, Lublin 20-093, Poland
| | - Magdalena Wojciak
- Department of Analytical Chemistry, Medical University of Lublin, Lublin 20-093, Poland
| | - Grzegorz Starobrat
- Children Orthopaedic Department, University Hospital for Children, Lublin 20-093, Poland
| | - Anna Danielewicz
- Children Orthopaedic Department, Medical University of Lublin, Lublin 20-093, Poland
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Borysov M, Nan X, Weiss HR, Turnbull D, Kleban A. Reliability of the original Lehnert-Schroth (LS) scoliosis classification in physiotherapy practice. J Phys Ther Sci 2020; 32:647-652. [PMID: 33132524 PMCID: PMC7590844 DOI: 10.1589/jpts.32.647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 07/17/2020] [Indexed: 12/04/2022] Open
Abstract
[Purpose] The foundations of the scoliosis specific and evidence-based physiotherapy program according to Schroth is the original the Lehnert-Schroth (LS) classification which is still in use today. The purpose of this paper is to test the reliability of the LS classification system, using clinical and radiological images of scoliosis patients as classified by specialist experienced clinicians. [Participants and Methods] A list of 40 pictures of X-Rays and a list of 40 clinical pictures (all posterior trunk images) of patients with idiopathic scoliosis were provided by the second author. Three specialist professional physiotherapists or orthotists rated all clinical and radiological pictures according to these two patterns of the LS classification. [Results] The intra-observer Kappa value was 0.90 (clinical) and 1.00 (x-rays). The inter-observer Kappa values at average was 0.65 (clinical) and 0.71 (x-rays). [Conclusion] For the application of classifying the patients when prescribing postural advice and exercises from the Schroth program the LS-classification seems an easy to use and highly reliable tool. This test demonstrated sufficient reliability with respect to the x-rays, but the tests of the clinical pictures alone, demonstrated fair levels of reliability, which indicates that it is an appropriate tool for physiotherapists when an x-ray is not available.
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Affiliation(s)
| | - Xiaofeng Nan
- Nan Xiaofeng's Spinal Orthopedic Workshop, China
| | - Hans-Rudolf Weiss
- Orthopedic Rehabilitation Service: Alzeyer Str. 23, D-55457 Gensingen, Germany
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Han KS, Kim GW, Kang SR, Ko MH, Seo JH. Clinical evaluation of the effectiveness of a new orthotic device for the non-operative treatment of scoliosis. Technol Health Care 2020; 28:229-236. [PMID: 32364155 PMCID: PMC7369089 DOI: 10.3233/thc-209023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bracing is one of the oldest non-operative treatments for patients with scoliosis. However, a wide variety of braces is used, and some show no effect, while others show conflicting results. OBJECTIVE We aimed to evaluate the effectiveness of a new orthotic device for the treatment of adult scoliosis. METHODS Twenty adult patients who were diagnosed with scoliosis and qualified for the study were selected and all participants were treated for 12 hours/day for 12 weeks using a new orthotic device. Various efficacy assessments (Cobb's angle, spine length, pelvic angle, shoulder angle, thoracic angle, lumbar angle, pelvic sacral angle) were performed before and after the 12-week treatment. The values at each time point were compared. RESULTS There were significant treatment effects in a time-dependent manner on every efficacy assessment (p< 0.05) after 12 weeks of bracing. CONCLUSION In this clinical study, it was demonstrated that a new brace that is more comfortable for the wearer reduced scoliosis and may be a useful option for non-operative treatment of scoliosis.
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Affiliation(s)
- Kap-Soo Han
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, Korea
| | - Gi-Wook Kim
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, Korea
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Jeonbuk, Korea
| | - Seung-Rok Kang
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, Korea
| | - Myoung-Hwan Ko
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, Korea
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Jeonbuk, Korea
| | - Jeong-Hwan Seo
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, Korea
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Jeonbuk, Korea
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Ghandhari H, Ameri E, Nikouei F, Haji Agha Bozorgi M, Majdi S, Salehpour M. Long-term outcome of posterior spinal fusion for the correction of adolescent idiopathic scoliosis. SCOLIOSIS AND SPINAL DISORDERS 2018; 13:14. [PMID: 30123840 PMCID: PMC6090875 DOI: 10.1186/s13013-018-0157-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/17/2018] [Indexed: 12/18/2022]
Abstract
Background Adolescent idiopathic scoliosis (AIS) is the most common form of idiopathic scoliosis, and surgery is considered as one of the therapeutic options. However, it is associated with a variety of irreversible complications, in spite of the benefits it provides. Here, we evaluated the long-term outcome of posterior spinal fusion (PSF) of AIS to shed more light on the consequences of this surgery. Methods In a cross-sectional study, a total of 42 AIS patients who underwent PSF surgery were radiographically and clinically inspected for the potential post-operative complications. Radiographic assessments included the device failure, union status, and vertebral tilt below the site of fusion. Clinical outcomes were evaluated using the Oswestry disability index (ODI) and visual analogue scale (VAS). Results The mean age of the surgery was 14.4 ± 5.1 years. The mean follow-up of the patients was 5.6 ± 3.2 years. Complete union was observed in all patients, and no device failure was noticed. Pre- and post-operative vertebral tilt below the site of fusion were 11.12° ± 7.92° and 6.21° ± 5.73°, respectively (p < 0.001). The mean post-operative ODI was 16.7 ± 9.8. The mean post-operative VAS was 2.1 ± 0.7. ODI value was positively correlated with follow-up periods (p = 0.04, r = 0.471). New degenerative disc disease (DDD) was observed in 6 out of 37 (16%) patients. Conclusion In spite of the efficacy and safety of PSF surgery of AIS, it might result in irreversible complications such as DDD. Moreover, the amount of post-operative disability might increase over the time and should be discussed with the patients.
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Affiliation(s)
- Hasan Ghandhari
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Ameri
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Nikouei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Haji Agha Bozorgi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shoeib Majdi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Salehpour
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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Affiliation(s)
- Hans-Rudolf Weiss
- Gesundheitsforum Nahetal, Alzeyer Str. 23, D-55457 Gensingen, Germany.,Scoliosis 3DC, 3 Baldwin Green Common, Woburn, MA, 01801, USA
| | - Marc Moramarco
- Gesundheitsforum Nahetal, Alzeyer Str. 23, D-55457 Gensingen, Germany.,Scoliosis 3DC, 3 Baldwin Green Common, Woburn, MA, 01801, USA
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Moramarco M, Moramarco K, Fadzan M. Cobb Angle Reduction in a Nearly Skeletally Mature Adolescent (Risser 4) After Pattern-Specific Scoliosis Rehabilitation (PSSR). Open Orthop J 2018; 11:1490-1499. [PMID: 29399225 PMCID: PMC5759093 DOI: 10.2174/1874325001711011490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 01/25/2023] Open
Abstract
Introduction It has long been said that exercise-based rehabilitation for scoliosis is ineffective, however, these reports studied general exercises. This case report is a prospective one-year follow-up of a nearly skeletally mature adolescent female (Risser 4) with idiopathic scoliosis treated with Pattern-Specific-Scoliosis Rehabilitation (PSSR). Methods The 15-year old patient recommended for surgery (initial Cobb angle of 45°) completed a 16-hour scoliosis-specific back school (according to Schroth Best Practice®), over the course of five weeks. She continued with her program at home, and followed up with the lead author after 6 months and 1 year. Results The patient achieved a 13° reduction in her primary thoracic Cobb angle. Postural improvement and reduction in trunk rotation (ATR) was also achieved (-4° in the thoracic spine, and -5° in the lumbar spine). Conclusion Pattern-specific scoliosis rehabilitation (PSSR) works to reduce the asymmetrical load caused by scoliosis. PSSR is effective in stabilizing Cobb angle, and can, in some cases, reduce Cobb angle in adolescents. Patients recommended for surgery may be candidates for conservative treatment. This case suggests that the practice of discontinuing conservative treatment at Risser stage 4 should be re-evaluated.
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Affiliation(s)
- Marc Moramarco
- Scoliosis 3DC, 3 Baldwin Green Common, Suite 204, Woburn, MA 01801
| | | | - Maja Fadzan
- Scoliosis 3DC, 3 Baldwin Green Common, Suite 204, Woburn, MA 01801
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Weiss HR, Tournavitis N, Seibel S, Kleban A. A Prospective Cohort Study of AIS Patients with 40° and More Treated with a Gensingen Brace (GBW): Preliminary Results. Open Orthop J 2017; 11:1558-1567. [PMID: 29399229 PMCID: PMC5759097 DOI: 10.2174/1874325001711011558] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/06/2017] [Accepted: 09/11/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction: There is a growing resistance from patients and their families to spinal fusion surgery for scoliosis. Due to inconclusive evidence that surgery has a long-term effect on scoliosis and/or improves the quality of life for patients with scoliosis, there is a need to extend the conservative perspective of treatment to patients with curvatures greater than 40 degrees. For that reason, a prospective cohort study was initiated to determine the effectiveness of the Gensingen brace (a Cheneau-style TLSO) in preventing progression in skeletally immature patients. Materials and Methods: Since 2011, fifty-five patients have been enrolled in this prospective cohort study. This report includes the mid-term results of twenty-five of these patients, who have a minimum follow-up of 18 months and an average follow-up of 30.4 months (SD 9.2). The twenty-five patients had the following characteristics at the start of treatment: Cobb angle: 49° (SD 8.4; 40º-71º); 12.4 years old (SD 0.82); Risser: 0.84 (SD 0.94; 0-2). A z-test was used to compare the success rate in this cohort to the success rate in the prospective braced cohort from BrAIST. Results: After follow-up, the average Cobb angle was 44.2° (SD 12.9). Two patients progressed, 12 patients were able to achieve halted progression, and eleven patients improved. Angle of trunk rotation (ATR) decreased from 12.2 to 10.1 degrees in the thoracic spine (p = 0.11) while the ATR decreased from 4.7 to 3.6 degrees in the lumbar spine (p = 0.0074). When comparing the success rate of the BrAIST cohort with the success rate of patients in this cohort, the difference was statistically significant (z = -3.041; p = 0.01). Conclusion: Conservative brace treatment using the Gensingen brace was successful in 92% of cases of patients with AIS of 40 degrees and higher. This is a significant improvement compared to the results attained in the BrAIST study (72%). Reduction of the ATR shows that postural improvement is also possible.
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Affiliation(s)
- Hans-Rudolf Weiss
- Gesundheitsforum Nahetal, Alzeyer Str. 23, D-55457 Gensingen, Germany
| | - Nicos Tournavitis
- Scoliosis Best Practice Rehab Services, Aristotelous 5, GR 54624, Thessaloniki, Greece
| | - Sarah Seibel
- Gesundheitsforum Nahetal, Alzeyer Str. 23, D-55457 Gensingen, Germany
| | - Alexander Kleban
- Lomonosov Moscow State University, 119234, Leninskie Gory 1, Moscow, Russia
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Ahmad O, Lombaert H, Parent S, Labelle H, Cheriet F. Spectral Shape Analysis of Human Torsos: Application to the Evaluation of Scoliosis Surgery Outcome. IEEE J Biomed Health Inform 2017; 22:1552-1560. [PMID: 29028215 DOI: 10.1109/jbhi.2017.2759804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper aims at evaluating the effect of spinal surgery on the torso shape appearance of adolescent patients. Current methods that assess the surgical outcome on the trunk shape are limited to its global asymmetry or rely on unreliable manual measurements. We introduce a novel framework to evaluate pre- to postoperative local asymmetry changes using a spectral representation of the torso shape, more specifically, the Laplacian spectrum (eigenvalues and eigenvectors) of a graph. We conduct a statistical analysis on the eigenvalues to efficiently select the spectral space and determine the significant components between preop and postop groups. On the selected eigenvectors, we propose a local analysis based on the concept of Euler characteristic to detect their local maxima and minima, which are then used to compute local left-right (L-R) asymmetries of torso shape. On 49 patients with a thoracic spinal deformity, the method captures significant pre- to postoperative changes of asymmetry at the waist, shoulder blades, shoulders, and breasts. We have evaluated average correction rates for L-R asymmetry of the waist height (67%), shoulder-blade height (64%) and depth (67%), lateral offset between shoulder and neck (61%), and breast height (52%). Spectral torso shape analysis provides a novel approach to quantify the surgical correction of the scoliotic trunk from local shape asymmetry. The proposed method could help the surgeon to understand the impact of different spinal surgery strategies on the postoperative appearance and choose the one that should provide better patient's satisfaction.
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Hey HWD, Wong GC, Chan CX, Lau LL, Kumar N, Thambiah JS, Ruiz JN, Liu KPG, Wong HK. Reproducibility of sagittal radiographic parameters in adolescent idiopathic scoliosis-a guide to reference values using serial imaging. Spine J 2017; 17:830-836. [PMID: 28065817 DOI: 10.1016/j.spinee.2017.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/18/2016] [Accepted: 01/03/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Knowledge of sagittal radiographic parameters in adolescent idiopathic scoliosis (AIS) patients has not yet caught up with our understanding of their roles in patients with adult spinal deformity. It is likely that more emphasis will be placed in restoring sagittal parameters for AIS patients in the future. Therefore, we need to understand how these parameters may vary in AIS to facilitate management plans. PURPOSE This study aimed to determine the reproducibility of sagittal spinal parameters on lateral film radiographs in patients with AIS. STUDY DESIGN/SETTING This was a retrospective, comparative study conducted in a tertiary health-care institution from January 2013 to February 2016 (3-year period). PATIENT SAMPLE All AIS patients who underwent deformity correction surgery from January 2013 to February 2016 and had two preoperative serial lateral radiographs taken within the time period of a month were included in the study. OUTCOME MEASURES Radiographic sagittal spinal parameters including sagittal vertical axis (SVA), cervical lordosis (CL), thoracic kyphosis (TK), thoracolumbar alignment (TL), lumbar lordosis (LL); standard spinopelvic measurements such as pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS); as well as end and apical vertebrae of cervical, thoracic, and lumbar curves were the outcome measures. METHODS All patient data were pooled from electronic medical records, and X-ray images were retrieved from Centricity Enterprise Web. Averaged X-ray measurements by two independent assessors were analyzed by comparing two radiographs of the same patients performed within a 1-month time period. Chi-squared and Wilcoxon signed-rank tests were used for categorical and continuous variables. RESULTS The study cohort comprised 138 patients, 28 men and 110 women, with a mean age of 15 years (range 11-20). Between the two lateral X-rays, there was a mean difference of 0.79 cm in SVA (p<.001), 0.70° in LL (p=.033), and 0.73° in PT (p=.010). In the combined Lenke 1 and 2 subgroup, there was a similar 0.77 cm (p=.002), 0.79° (p=.009), and 1.49° (p=.001) mean difference in SVA, LL, and PT, respectively. Additionally, there was also a 1.85° (p=.009) and 1.76° (p=.006) mean difference seen in TL and SS, respectively. The overall profile of the sagittal curves remained largely similar, with only the lumbar apex shifting from L3 to L4 during the first and the second X-rays, respectively (p<.001). This occurred for the combined Lenke 1 and 2 subgroup as well (p<.001). CONCLUSION Most radiographic sagittal spinal parameters in AIS patients are generally reproducible with some variations up to a maximum of 4°. This natural variation should be taken into account when interpreting these radiographic sagittal parameters so as to achieve the most accurate results in surgical planning.
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Affiliation(s)
- Hwee Weng Dennis Hey
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, 119228 Singapore.
| | - Gordon Chengyuan Wong
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore 119228, Singapore
| | - Chloe Xiaoyun Chan
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore 119228, Singapore
| | - Leok-Lim Lau
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, 119228 Singapore
| | - Naresh Kumar
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, 119228 Singapore
| | - Joseph Shantakumar Thambiah
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, 119228 Singapore
| | - John Nathaniel Ruiz
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, 119228 Singapore
| | - Ka-Po Gabriel Liu
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, 119228 Singapore
| | - Hee-Kit Wong
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, 119228 Singapore
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Weiss HR. Scoliosis in adulthood-a case with untreated early onset scoliosis presenting at the age of 76 years. J Phys Ther Sci 2017; 28:3483-3486. [PMID: 28174478 PMCID: PMC5276787 DOI: 10.1589/jpts.28.3483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 08/23/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Untreated early-onset scoliosis may eventually progress to more than 90° after
growth, cause severe health problems, and increase chance of mortality. Therefore,
surgical intervention is often indicated prior to the development of a life-threatening
deformity. This case report aims to reveal how a 76-year-old male patient with curves
exceeding 110° is functioning with minimal difficulty. [Subject and Methods] The patient,
who has never had surgical intervention for scoliosis, can perform his everyday
activities. His curves were 111° thoracic and 118° lumbar when he presented at the
author’s office in January 2015. [Results] The patient reported that he rarely needs a
physician and participates in endurance sports like jogging. Despite this, the patient
recognizes his restrictive ventilation disorder (shortness of breath) when he is inactive.
The patient complained of shortness of breath and cosmetic concerns. [Conclusion] The
current guidelines indicate that early-onset scoliosis should be operated at a young age;
however, this protocol is not supported by high-quality evidence. Notably, patients with
curvatures exceeding 100° after puberty may have a reasonable quality of life when they
lead an active life with regular participation in endurance sports and physical
rehabilitation.
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Long-Term Effects of Untreated Adolescent Idiopathic Scoliosis: A Review of the Literature. Asian Spine J 2016; 10:1163-1169. [PMID: 27994795 PMCID: PMC5165009 DOI: 10.4184/asj.2016.10.6.1163] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 11/16/2022] Open
Abstract
Currently, adolescent idiopathic scoliosis (AIS) is principally regarded as benign, but some researchers have cited serious or extreme effects, including severe pain, cardiopulmonary compromise, social isolation, and even early death. Therefore, exploration of the long-term effects of AIS, the most common type of idiopathic scoliosis, is warranted. The purpose of this review was to examine the long-term studies on the natural history of AIS and/or reviews concerning the long-term effects of untreated AIS. A PubMed search was conducted using the key words idiopathic scoliosis, long-term effects and idiopathic scoliosis, natural history. For further analysis, references cited in those studies were reviewed for additional, related evidence not retrieved in the initial PubMed search. A review of the pertinent bibliography showed that older natural history studies did not distinguish between late-onset scoliosis (referred to in this paper as AIS) and early-onset scoliosis (EOS). The more recent studies offer such important distinction and reach to the general conclusion that untreated AIS does not lead to severe consequences with respect to signs and symptoms of scoliosis. It is possible that earlier studies may have included patient populations with EOS, leading to the perception of untreated scoliosis as having an unusually high morbidity rate. Studies on the long-term effects of AIS that specifically excluded EOS patients conclude that AIS is a benign disorder. This indicates that for research and reporting purposes, it is important to distinguishing between AIS and EOS. This will allow the practitioner and patient and their families to decide on an optimal treatment plan based on the most appropriate prognosis.
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A Comparison of Patient-Reported Outcome Measures Following Different Treatment Approaches for Adolescents with Severe Idiopathic Scoliosis: A Systematic Review. Asian Spine J 2016; 10:1170-1194. [PMID: 27994796 PMCID: PMC5165010 DOI: 10.4184/asj.2016.10.6.1170] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/30/2016] [Accepted: 04/03/2016] [Indexed: 11/08/2022] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine which is usually not symptomatic and which can progress during growth and cause a surface deformity. In adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. Although surgery is usually recommended for curvatures exceeding 40° to 50° to stop curvature progression, recent reviews have shed some light on the long-term complications of such surgery and to the lack of evidence for such complicated procedures within the scientific literature. Furthermore, a number of patients are very fearful of having surgery and refuse this option or live in countries where specialist scoliosis surgery is not available. Other patients may be unable to afford the cost of specialist scoliosis surgery. For these patients the only choice is an alternative non-surgical treatment option. To examine the impact of different management options in patients with severe AIS, with a focus on trunk balance, progression of scoliosis, cosmetic issues, quality of life, disability, psychological issues, back pain, and adverse effects, at both the short-term (a few months) and the long-term (over 20 years). We searched CENTRAL, MEDLINE, EMBASE, CINHAL and two other databases up to January 2016 with no language limitations. We also checked the reference lists of relevant articles and conducted an extensive hand search of the grey literature. We searched for randomised controlled trials as well as prospective and retrospective controlled trials comparing spinal fusion surgery with no treatment or conservative treatment in AIS patients with a Cobb angle greater than 40°. We did not identify any evidence of superiority of effectiveness of operative compared to nonoperative interventions for patients with severe AIS. Within the present literature there is no clear evidence to suggest that a specific type of treatment is superior to other types of treatment.
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Weiss HR, Moramarco K, Moramarco M. Scoliosis bracing and exercise for pain management in adults-a case report. J Phys Ther Sci 2016; 28:2404-7. [PMID: 27630444 PMCID: PMC5011608 DOI: 10.1589/jpts.28.2404] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/25/2016] [Indexed: 12/22/2022] Open
Abstract
[Purpose] For adult patients with late-onset idiopathic scoliosis, cosmetic concerns and
pain are the main reasons for seeking treatment at a physician’s office. The purpose of
this paper was to describe the mid-term effect of physical rehabilitation and part-time
bracing on an adult scoliosis patient who had been suffering from chronic low back pain
for fourteen years. [Subject and Methods] Case description: A 37-year-old female patient
with late-onset idiopathic scoliosis presented in the office of the first author in
January 2014. She reported having chronic pain (low back pain) since the age of 23 and
reported daily pain at a level of 5–7 on average on a Visual Analogue Scale of 0 to 10.
She received a short scoliosis-specific Schroth exercise program and was also fitted with
a Gensingen brace for part-time wear. [Results] At a 16 month follow-up, the patient no
longer suffered from daily low back pain (with heavy lifting only) and was fully active.
Additionally, her lumbar Cobb angle and angle of trunk rotation improved. [Conclusion]
Patients with late-onset idiopathic scoliosis and pain may benefit from a pattern-specific
conservative treatment approach. In this population, surgical intervention should be
regarded as the last resort, since there are many long-term unknowns with surgery.
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Schreiber S, Parent EC, Moez EK, Hedden DM, Hill D, Moreau MJ, Lou E, Watkins EM, Southon SC. The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis-an assessor and statistician blinded randomized controlled trial: "SOSORT 2015 Award Winner". SCOLIOSIS 2015; 10:24. [PMID: 26413145 PMCID: PMC4582716 DOI: 10.1186/s13013-015-0048-5] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/28/2015] [Indexed: 11/10/2022]
Abstract
Background In North America, care recommendations for adolescents with small idiopathic scoliosis (AIS) curves include observation or bracing. Schroth scoliosis-specific exercises have demonstrated promising results on various outcomes in uncontrolled studies. This randomized controlled trial (RCT) aimed to determine the effect of Schroth exercises combined with the standard of care on quality-of-life (QOL) outcomes and back muscle endurance (BME) compared to standard of care alone in patients with AIS. Material and Methods Fifty patients with AIS, aged 10–18 years, with curves 10–45 °, recruited from a scoliosis clinic were randomized to receive standard of care or supervised Schroth exercises plus standard of care for 6 months. Schroth exercises were taught over five sessions in the first two weeks. A daily home program was adjusted during weekly supervised sessions. The assessor and the statistician were blinded. Outcomes included the Biering-Sorensen (BME) test, Scoliosis Research Society (SRS-22r) and Spinal Appearance Questionnaires (SAQ) scores. Intention-to-treat (ITT) and per protocol (PP) linear mixed effects models were analyzed. Because ITT and PP analyses produced similar results, only ITT is reported. Results After 3 months, BME in the Schroth group improved by 32.3 s, and in the control by 4.8 s. This 27.5 s difference in change between groups was statically significant (95 % CI 1.1 to 53.8 s, p = 0.04). From 3 to 6 months, the self-image improved in the Schroth group by 0.13 and deteriorated in the control by 0.17 (0.3, 95 % CI 0.01 to 0.59, p = 0.049). A difference between groups for the change in the SRS-22r pain score transformed to its power of four was observed from 3 to 6 months (85.3, 95 % CI 8.1 to 162.5, p = 0.03), where (SRS-22 pain score)4 increased by 65.3 in the Schroth and decreased by 20.0 in the control group. Covariates: age, self-efficacy, brace-wear, Schroth classification, and height had significant main effects on some outcomes. Baseline ceiling effects were high: SRS-22r (pain = 18.4 %, function = 28.6 %), and SAQ (prominence = 26.5 %, waist = 29.2 %, chest = 46.9 %, trunk shift = 12.2 % and shoulders = 18.4 %). Conclusions Supervised Schroth exercises provided added benefit to the standard of care by improving SRS-22r pain, self-image scores and BME. Given the high prevalence of ceiling effects on SRS-22r and SAQ questionnaires’ domains, we hypothesize that in the AIS population receiving conservative treatments, different QOL questionnaires with adequate responsiveness are needed. Trial registration Schroth Exercise Trial for Scoliosis NCT01610908. Electronic supplementary material The online version of this article (doi:10.1186/s13013-015-0048-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Douglas M Hedden
- University of Alberta, Alberta Health Services, Edmonton, Canada
| | - Doug Hill
- University of Alberta, Alberta Health Services, Edmonton, Canada
| | - Marc J Moreau
- University of Alberta, Alberta Health Services, Edmonton, Canada
| | - Edmond Lou
- University of Alberta, Alberta Health Services, Edmonton, Canada
| | - Elise M Watkins
- University of Alberta, Alberta Health Services, Edmonton, Canada
| | - Sarah C Southon
- University of Alberta, Alberta Health Services, Edmonton, Canada
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Dos Santos Alves VL, Stirbulov R, Avanzi O. Long-term impact of pre-operative physical rehabilitation protocol on the 6-min walk test of patients with adolescent idiopathic scoliosis: A randomized clinical trial. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:138-43. [PMID: 25926252 DOI: 10.1016/j.rppnen.2014.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 08/27/2014] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Monitored physical activities in patients with adolescent idiopathic scoliosis (AIS) have been shown to improve physical performance, endurance and cardiopulmonary function and may be assessed by the 6-min walk test (6MWT). We aimed to evaluate the long-term results of the 6MWT after a rehabilitation protocol employed before surgical correction for AIS. METHODS This prospective randomized clinical trial studied the impact of a 4-month pre-operative physical rehabilitation protocol on post-operative cardiopulmonary function and physical endurance, by using the 6MWT, in patients with AIS submitted to surgical correction, comparing them to matched controls without physical rehabilitation. Studied variables were heart and respiratory rate, systolic and diastolic blood pressure, peripheral blood oxygen saturation, Borg score, and distance walked. Patients were assessed at baseline, after 4 months of rehabilitation, and 3, 6 and 12 months post-operatively. RESULTS A total of 50 patients with AIS were included in the study and allocated blindly, by simple randomization, into either one of the two groups, with 25 patients each: study group (pre-operative physical rehabilitation) and control group. The physical rehabilitation protocol promoted significant progressive improvement in heart and respiratory rate, peripheral blood oxygen saturation, distance walked, and level of effort assessed by the Borg scale after surgery. CONCLUSIONS Post-surgical recovery, evaluated by 6MWT, was significantly better in patients who underwent a 4-month pre-operative physical rehabilitation protocol.
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Affiliation(s)
- V L Dos Santos Alves
- Physical Therapy Department, Hospital Santa Isabel, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
| | - R Stirbulov
- Pneumology Department, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - O Avanzi
- Orthopedics Department, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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Bettany‐Saltikov J, Weiss H, Chockalingam N, Taranu R, Srinivas S, Hogg J, Whittaker V, Kalyan RV, Arnell T. Surgical versus non-surgical interventions in people with adolescent idiopathic scoliosis. Cochrane Database Syst Rev 2015; 2015:CD010663. [PMID: 25908428 PMCID: PMC11167694 DOI: 10.1002/14651858.cd010663.pub2] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine. While AIS can progress during growth and cause a surface deformity, it is usually not symptomatic. However, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. Interventions for the prevention of AIS progression include scoliosis-specific exercises, bracing, and surgery. The main aims of all types of interventions are to correct the deformity and prevent further deterioration of the curve and to restore trunk asymmetry and balance, while minimising morbidity and pain, allowing return to full function. Surgery is normally recommended for curvatures exceeding 40 to 50 degrees to stop curvature progression with a view to achieving better truncal balance and cosmesis. Short-term results of the surgical treatment of people with AIS demonstrate the ability of surgery to improve various outcome measures. However there is a clear paucity of information on long-term follow-up of surgical treatment of people with AIS. OBJECTIVES To examine the impact of surgical versus non-surgical interventions in people with AIS who have severe curves of over 45 degrees, with a focus on trunk balance, progression of scoliosis, cosmetic issues, quality of life, disability, psychological issues, back pain, and adverse effects, at both the short term (a few months) and the long term (over 20 years). SEARCH METHODS We searched the Cochrane Back Review Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, four other databases, and three trials registers up to August 2014 with no language limitations. We also checked the reference lists of relevant articles and conducted an extensive handsearch of the grey literature. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) and prospective controlled trials comparing spinal fusion surgery with non-surgical interventions in people with AIS with a Cobb angle greater than 45 degrees. We were interested in all types of instrumented surgical interventions with fusion that aimed to provide curve correction and spine stabilisation. DATA COLLECTION AND ANALYSIS We found no RCTs or prospective controlled trials that met our inclusion criteria. MAIN RESULTS We did not identify any evidence comparing surgical to non-surgical interventions for AIS with severe curves of over 45 degrees. AUTHORS' CONCLUSIONS We cannot draw any conclusions.
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Affiliation(s)
- Josette Bettany‐Saltikov
- University of TeessideSchool of Health and Social CareVictoria RoadMiddlesbroughClevelandUKTS13BA
| | - Hans‐Rudolf Weiss
- Orthopedic PracticeSpinal Deformities Rehabilitation ServicesAlzeyerstr. 23GensingenRheinland‐PfalzGermanyD‐55457
| | | | - Razvan Taranu
- Northumbria Healthcare NHS Foundation TrustDepartment of Trauma and OrthopaedicsWoodhorn LaneAshingtonNorthumberlandUKNE63 9JJ
| | - Shreya Srinivas
- James Cook University HospitalNorthern DeaneryMiddlesbroughUK
| | - Julie Hogg
- University of TeessideSchool of Health and Social CareVictoria RoadMiddlesbroughClevelandUKTS13BA
| | - Victoria Whittaker
- University of TeessideSchool of Health and Social CareVictoria RoadMiddlesbroughClevelandUKTS13BA
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Rivett L, Stewart A, Potterton J. The effect of compliance to a Rigo System Cheneau brace and a specific exercise programme on idiopathic scoliosis curvature: a comparative study: SOSORT 2014 award winner. SCOLIOSIS 2014; 9:5. [PMID: 24926318 PMCID: PMC4055379 DOI: 10.1186/1748-7161-9-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 05/26/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND There is controversy as to whether conservative management that includes wearing a brace and exercises is effective in stabilising idiopathic scoliosis curves. A brace only prevents progression of the curve and has been shown to have favourable outcomes when patients are compliant. So the aim of this study was to: determine the effect of compliance to the Rigo System Cheneau (RSC) brace and a specific exercise programme on Idiopathic Scoliosis curvature; and to compare the Quality of Life (QoL) and psychological traits of compliant and non compliant subjects. METHODS A pre/post test study design was used with a post study comparison between subjects who complied with the management and those who did not. Fifty one subjects, girls aged 12-16 years, Cobb angles 20-50 degrees participated in the study. Subjects were divided into two groups, according to their compliance, at the end of the study. The compliant group wore the brace 20 or more hours a day and exercised three or more times per week. The non-compliant group wore the brace less than 20 hours a day and exercised less than three times per week. Cobb angles, vertebral rotation, scoliometer readings, peak flow, quality of life and personality traits were compared between groups, using the student's two sample t-test and an analysis of covariance. RESULTS The compliant group, wore the brace 21.5 hours per day and exercised four times a week, and significantly improved in all measures compared to non compliant subjects, who wore the brace 12 hours per day, exercised 1.7 times a week and significantly deteriorated (p < 0.0001). The major Cobb angles in the compliant group improved 10.19°(±5.5) and deteriorated 5.52°(±4.3) in the non compliant group (p < 0.0001). Compliant subjects had a significantly better QoL than the non compliant subjects (p = 0.001). The compliant group were significantly more emotionally mature, stable and realistic than the non compliant group (p = 0.03). CONCLUSIONS Good compliance of the RSC brace and a specific exercise regime resulted in a significant improvement in curvatures, poor compliance resulted in progression/deterioration. A poorer QoL in the non compliant group possibly was caused by personality traits of the group, being more emotionally immature and unstable.
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Affiliation(s)
- LouAnn Rivett
- Physiotherapy Department, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aimee Stewart
- Physiotherapy Department, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joanne Potterton
- Physiotherapy Department, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Carneiro GGB, Batista Júnior JL, Jacob Júnior C, Cardoso IM, Detoni RFC, Rezende R. Análise bacterioscópica e microbiológica intraoperatória de pacientes submetidos a tratamento cirúrgico de escoliose idiopática do adolescente. COLUNA/COLUMNA 2013. [DOI: 10.1590/s1808-18512013000100009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a presença e o crescimento microbiológico no sítio operatório em pacientes submetidos a tratamento cirúrgico de escoliose idiopática do adolescente na primeira, segunda e terceira hora de cirurgia. Casuística e MÉTODO: Estudo prospectivo, de caráter descritivo e comparativo, sendo avaliados 34 pacientes portadores de escoliose idiopática do adolescente com indicação cirúrgica, analisando a contaminação no sítio cirúrgico através da bacterioscopia e cultura óssea na primeira, segunda e terceira hora de cirurgia. RESULTADOS: Houve bacterioscopia positiva crescente entre a primeira e a segunda hora de cirurgia. A cultura confirma a colonização da ferida operatória, crescente entre as horas analisadas. CONCLUSÕES: O tempo cirúrgico prolongado está diretamente relacionado ao maior crescimento microbiológico no sítio cirúrgico de pacientes submetidos à correção de escoliose vertebral.
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Affiliation(s)
| | | | | | | | | | - Rodrigo Rezende
- Santa Casa de Misericórdia de Vitória, Brazil; Hospital Vila Velha, Brazil
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Borysov M, Borysov A. Scoliosis short-term rehabilitation (SSTR) according to 'Best Practice' standards-are the results repeatable? SCOLIOSIS 2012; 7:1. [PMID: 22251672 PMCID: PMC3292465 DOI: 10.1186/1748-7161-7-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 01/17/2012] [Indexed: 11/10/2022]
Abstract
Claims have been made in a pilot study that a new form of short-term rehabilitation according to 'Best Practice' standards would change signs and symptoms of patients with scoliosis in the short-term. Aim of this study is to repeat the study published 2010 with a larger sample of patients using the same protocol. Both authors have undergone training in this special approach to scoliosis rehabilitation in 2010.
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Affiliation(s)
- Maksym Borysov
- "Biotechnika" Rehabilitation Services, Moskovsky prospekt 197, Kharkov (61037), kraine.
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Correlation of preoperative deformity magnitude and pulmonary function tests in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2011; 36:1096-102. [PMID: 21270699 DOI: 10.1097/brs.0b013e3181f8c931] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Clinical study correlating preoperative pulmonary function tests (PFTs) to radiographic measures of thoracic deformity severity in adolescent idiopathic scoliosis (AIS) patients. OBJECTIVE To determine (1) the incidence of clinically relevant (<65% predicted value) pulmonary impairment in AIS patients; (2) if patients with more severe deformity have greater impairment of PFTs than those with lesser deformity; (3) the effect, if any, of juvenile onset deformity (onset<age 10) on preoperative PFTs. SUMMARY OF BACKGROUND DATA Patients with late-onset (adolescent) spinal deformity are generally believed to have no respiratory morbidity except in severe curves exceeding 100°. METHODS A large multicenter database of surgically treated AIS patients with Lenke 1 to Lenke 4 curves was queried to report preoperative PFTs and correlate them with radiographic measures of coronal, sagittal, and axial plane deformities. RESULTS Nineteen percent of 858 patients had <65% predicted forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) before surgery, and had larger main thoracic (MT) curves and greater axial rotation than those with predicted PFT values>65%. Patients with MT curves>70°, and especially >80°; proximal thoracic (PT) curves which were >30° or structural; or T5-T12 kyphosis<10° had significantly (P≤0.001) lower FEV1 or FVC compared to those with less deformity. Axial plane deformity did not correlate with PFT impairment. Juvenile-onset patients had greater PFT impairment than AIS patients, along with slightly larger MT curves. Patients who were braced before surgery had worse PFTs than those had no treatment before surgery. CONCLUSION Preoperative PFTs are clinically impaired in 19% of AIS patients, and correlate significantly with the MT and sagittal plane deformity severity, and with PT curve severity to a lesser degree. PFTs do not correlate with degree of axial deformity. From a purely pulmonary standpoint, attention directed to coronal and sagittal plane deformity correction appears warranted, to address the specific deformities which are associated with PFT impairment.
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Kaspiris A, Grivas TB, Weiss HR, Turnbull D. Surgical and conservative treatment of patients with congenital scoliosis: α search for long-term results. SCOLIOSIS 2011; 6:12. [PMID: 21639924 PMCID: PMC3120793 DOI: 10.1186/1748-7161-6-12] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 06/04/2011] [Indexed: 12/05/2022]
Abstract
Background In view of the limited data available on the conservative treatment of patients with congenital scoliosis (CS), early surgery is suggested in mild cases with formation failures. Patients with segmentation failures will not benefit from conservative treatment. The purpose of this review is to identify the mid- or long-term results of spinal fusion surgery in patients with congenital scoliosis. Methods Retrospective and prospective studies were included, reporting on the outcome of surgery in patients with congenital scoliosis. Studies concerning a small numbers of cases treated conservatively were included too. We analyzed mid-term (5 to 7 years) and long-term results (7 years or more), both as regards the maintenance of the correction of scoliosis and the safety of instrumentation, the early and late complications of surgery and their effect on quality of life. Results A small number of studies of surgically treated patients were found, contained follow-up periods of 4-6 years that in the most cases, skeletal maturity was not yet reached, and few with follow-up of 36-44 years. The results of bracing in children with congenital scoliosis, mainly in cases with failure of formation, were also studied. Discussion Spinal surgery in patients with congenital scoliosis is regarded in short as a safe procedure and should be performed. On the other hand, early and late complications are also described, concerning not only intraoperative and immediate postoperative problems, but also the safety and efficacy of the spinal instrumentation and the possibility of developing neurological disorders and the long-term effect these may have on both lung function and the quality of life of children. Conclusions Few cases indicate the long-term results of surgical techniques, in the natural progression of scoliosis. Similarly, few cases have been reported on the influence of conservative treatment. In conclusion, patients with segmentation failures should be treated surgically early, according to the rate of deformity formation and certainly before the pubertal growth spurt to try to avoid cor- pulmonale, even though there is lack of evidence for that in the long-term. Furthermore, in patients with formation failures, further investigation is needed to document where a conservative approach would be necessary.
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Affiliation(s)
- Angelos Kaspiris
- Department of Trauma and Orthopaedics,"Thriasio" General Hospital - NHS, G, Gennimata av, Magoula 19600, Attica, Greece.
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Weiss HR, Rigo M. Expert-driven Chêneau applications: Description and in-brace corrections. Physiother Theory Pract 2011; 27:61-7. [DOI: 10.3109/09593985.2010.503991] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Albanesi F, Invernizzi V, Meucci P, Leonardi M, Caspani G, Pessina A, Brayda-Bruno M. Role of disability-case manager for chronic diseases: using the ICF as a practical background. Disabil Rehabil 2010; 31 Suppl 1:S50-4. [PMID: 19968535 DOI: 10.3109/09638280903317799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To report on the case manager's activity in a hospital setting as a supporting professional for families that need to deal with different services and professionals to get answers on their health and psychosocial needs. METHOD A qualitative analysis and interpretation based on the case manager observations and ICF checklist evaluation with medical and rehabilitation professionals were employed. RESULTS The case study presented aimed to show one of the most typical interventions of the case manager: the creation of a network around a person with complex and multifaceted needs, where this network does not exist. Case manager bridged the gap between health and social services, specifically organising home-based rehabilitation and helping to find appropriate assistive devices. CONCLUSIONS This case study showed that the case manager's role is fundamental to support patients and their families in relating to the different services and professionals they need, and illustrated one of the most typical interventions of the case manager: the creation of a network around a person with complex and multifaceted needs, where this network does not exist.
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Affiliation(s)
- Francesca Albanesi
- Neurological Institute C. Besta IRCCS Foundation, Neurology, Public Health and Disability Unit - Scientific Directorate, Via Celoria 11, Milan, Italy.
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Weiss HR. Debate on: Bracing in Adolescent Scoliosis Trial (BrAIST) - will the expenditure pay? SCOLIOSIS 2009. [PMCID: PMC2793471 DOI: 10.1186/1748-7161-4-s2-o43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Seoud L, Cheriet F, Labelle H, Dansereau J. A novel method for the 3-D reconstruction of scoliotic ribs from frontal and lateral radiographs. IEEE Trans Biomed Eng 2009; 58:1135-46. [PMID: 19789100 DOI: 10.1109/tbme.2009.2032530] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Among the external manifestations of scoliosis, the rib hump, which is associated with the ribs' deformities and rotations, constitutes the most disturbing aspect of the scoliotic deformity for patients. A personalized 3-D model of the rib cage is important for a better evaluation of the deformity, and hence, a better treatment planning. A novel method for the 3-D reconstruction of the rib cage, based only on two standard radiographs, is proposed in this paper. For each rib, two points are extrapolated from the reconstructed spine, and three points are reconstructed by stereo radiography. The reconstruction is then refined using a surface approximation. The method was evaluated using clinical data of 13 patients with scoliosis. A comparison was conducted between the reconstructions obtained with the proposed method and those obtained by using a previous reconstruction method based on two frontal radiographs. A first comparison criterion was the distances between the reconstructed ribs and the surface topography of the trunk, considered as the reference modality. The correlation between ribs axial rotation and back surface rotation was also evaluated. The proposed method successfully reconstructed the ribs of the 6th-12th thoracic levels. The evaluation results showed that the 3-D configuration of the new rib reconstructions is more consistent with the surface topography and provides more accurate measurements of ribs axial rotation.
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Affiliation(s)
- Lama Seoud
- Sainte-Justine Hospital Research Center, Montreal, QCH3T 1C5, Canada.
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Dissecting the effects of spinal fusion and deformity magnitude on quality of life in patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2009; 34:E653-8. [PMID: 19680091 DOI: 10.1097/brs.0b013e3181b2008f] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review of scores from the Scoliosis Research Society outcomes instrument (SRS-24 questionnaire). OBJECTIVE To quantify the isolated effects of spinal fusion and deformity magnitude on quality of life in patients with adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Significant improvements in 2-year postoperative SRS-24 questionnaire scores have been reported despite the loss of spinal motion due to instrumentation and arthrodesis. As deformity reduction may influence patient perception, it has been difficult to isolate the effect of spinal fusion on quality of life after scoliosis surgery. METHODS SRS-24 scores were compared between 3 cohorts of AIS patients (preoperative, postoperative, and nonoperative) using an ANOVA (P < 0.05) to determine the isolated effects of spinal fusion and deformity magnitude. Preoperative SRS-24 scores were collected from a group of patients with preoperative major Cobb angles greater than 40 degrees (n = 194). Postoperative SRS-24 scores were collected from patients with preoperative major Cobb angles greater than 40 degrees and 2-year postoperative major Cobb angles between 20 degrees and 40 degrees (n = 196). Finally, SRS-24 scores were collected from a nonoperative group of patients with major Cobb angles between 20 degrees and 40 degrees (n = 112). RESULTS Spinal fusion was found to have a negative isolated effect on the Activity domain (-0.3) and on the Total score (-0.2) (P = 0.001) of the SRS-24 questionnaire (score range: 1-5). A smaller deformity magnitude, on the other hand, was found to have a significantly positive isolated effect on all 4 preoperative domains (P < 0.001) and on the Total score (P < 0.001). The combined effect of surgery (spinal fusion and deformity correction) was found to be significantly positive for the Total score (P < 0.001) and for the domains of Pain, Self-Image, and Function (P < 0.001). CONCLUSION Spinal fusion has an isolated negative effect on AIS patients' quality of life (Total score) mostly due to a decrease in scores of the Activity domain. The overall positive effect of surgery depends on the individual effects of spinal fusion (slight reduction in quality of life) and deformity reduction (modest improvement in quality of life).
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Smania N, Picelli A, Romano M, Negrini S. Neurophysiological basis of rehabilitation of adolescent idiopathic scoliosis. Disabil Rehabil 2009; 30:763-71. [DOI: 10.1080/17483100801921311] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Negrini S. Approach to scoliosis changed due to causes other than evidence: Patients call for conservative (rehabilitation) experts to join in team orthopedic surgeons. Disabil Rehabil 2009; 30:731-41. [DOI: 10.1080/09638280801889485] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ajemba PO, Durdle NG, Raso VJ. Characterizing Torso Shape Deformity in Scoliosis Using Structured Splines Models. IEEE Trans Biomed Eng 2009; 56:1652-62. [DOI: 10.1109/tbme.2009.2020333] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Weiss HR, Goodall D. Scoliosis in patients with Prader Willi Syndrome - comparisons of conservative and surgical treatment. SCOLIOSIS 2009; 4:10. [PMID: 19419581 PMCID: PMC2690578 DOI: 10.1186/1748-7161-4-10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 05/06/2009] [Indexed: 11/10/2022]
Abstract
UNLABELLED In children with Prader Willi syndrome (PWS), besides growth hormone (GH) therapy, control of the food environment and regular exercise, surgical treatment of scoliosis deformities seems the treatment of choice, even though the risks of spinal surgery in this specific population is very high. Therefore the question arises as to whether the risks of spinal surgery outweigh the benefits in a condition, which bears significant risks per se. The purpose of this systematic review of the Pub Med literature was to find mid or long-term results of spinal fusion surgery in patients with PWS, and to present the conservative treatment in a case study of nine patients with this condition. METHODS Types of studies included; all kinds of studies; retrospective and prospective ones, which reported upon the outcome of scoliosis surgery in patients with PWS.Types of participants included: patients with scoliosis and PWS.Type of intervention: surgery.Search strategy for identification of the studies; Pub Med; limited to English language and bibliographies of all reviewed articles.Nine patients with PWS from our data-base treated conservatively have been found, being 19 years or over at the time this study has been performed. The results of conservative management are described and related to the natural history and treatment results found in the Pub Med review. RESULTS From 2210 titles displayed in the Pub Med database with the key word being "Prader Willi syndrome", 5 different papers were displayed at the date of the search containing some information on the outcome of surgery and none appeared to contain a mid or long-term follow-up. The PWS patients treated conservatively from our series all stayed below 70 degrees and some of which improved. DISCUSSION If the curve of scoliosis patients with PWS can be kept within certain limits (usually below 70 degrees) conservatively, this treatment seems to have fewer complications than surgical treatments. The results of our retrospective study of nine patients demonstrate that scoliosis in this entity plays only a minor role and surgery is unnecessary when high quality conservative management exists. CONCLUSION There is lack of the long follow-up studies in post-surgical cases in patients with PWS and scoliosis. The rate of complications of spinal fusion in patients with PWS and scoliosis is very high and the death rates have been found to be higher than in patients with Adolescent Idiopathic Scoliosis (AIS). The long-term side-effects of the intervention are detrimental, so that the risk-benefit ratio favours the conservative approaches over spinal fusion surgery.
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Weiss HR, Bess S, Wong MS, Patel V, Goodall D, Burger E. Adolescent idiopathic scoliosis - to operate or not? A debate article. Patient Saf Surg 2008; 2:25. [PMID: 18826571 PMCID: PMC2572584 DOI: 10.1186/1754-9493-2-25] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 09/30/2008] [Indexed: 12/13/2022] Open
Abstract
Adolescent idiopathic scoliosis (AIS) represents a rare condition with a potentially detrimental impact on young patients. Despite vast clinical research and published treatment guidelines and algorithms, the optimal therapeutic choice for these patients remains highly controversial. While advocates of early surgery emphasize the benefits of surgical deformity correction with regard to physical and psychological outcome, the opponents base their arguments on the high risk of complications and a lack of documented subjective long-term outcome. In the present paper, the authors were invited to debate the opposite positions of "pro" versus "contra" surgical treatment of AIS, based on the currently available evidence and published guidelines.
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Affiliation(s)
- Hans-Rudolf Weiss
- Asklepios Katharina Schroth Spinal Deformities Rehabilitation Center, D-55566 Bad Sobernheim, Germany.
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Weiss HR. Adolescent idiopathic scoliosis (AIS) - an indication for surgery? A systematic review of the literature. Disabil Rehabil 2008; 30:799-807. [PMID: 18432438 DOI: 10.1080/09638280801889717] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Historically, the treatment options for AIS, the most common form of scoliosis are: Exercises, in-patient rehabilitation, braces and surgery. While there is evidence in the form of prospective controlled studies that Scoliosis Intensive Rehabilitation (SIR) and braces can alter the natural history of the condition, there is no review on prospective controlled trials for surgical treatment. The aim of this review was to perform a systematic search of the Pub Med literature to reveal the evidence on scoliosis surgery. METHODS A systematic review has been performed using the Pub Med database. Literature has been searched for the outcome parameter; 'rate of progression' and only prospective controlled studies that have considered the treatment versus the natural history have been included. RESULTS No controlled study, not in the short, mid or long term, searched within the review, has been found to reveal evidence to support the hypothesis that the effects of surgery as a treatment option for AIS is superior to natural history. CONCLUSIONS No evidence has been found in terms of prospective controlled studies to support surgical intervention from the medical point of view. In the light of the unknown long-term effects of surgery and in concluding on the lack of evidence already found that surgery might change the signs and symptoms of scoliosis, a randomized controlled trial (RCT) is long overdue. Until such a time that such evidence exists, there can be no medical indication for surgery. The indications for surgery are limited for cosmetic reasons in severe cases and only if the patient and the family agree with this.
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Affiliation(s)
- Hans-Rudolf Weiss
- Asklepios Katharina Schroth, Spinal Deformities Rehabilitation Centre, Bad Sobernheim, Germany.
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Weiss HR, Goodall D. Rate of complications in scoliosis surgery - a systematic review of the Pub Med literature. SCOLIOSIS 2008; 3:9. [PMID: 18681956 PMCID: PMC2525632 DOI: 10.1186/1748-7161-3-9] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 08/05/2008] [Indexed: 01/03/2023]
Abstract
Background Spinal fusion surgery is currently recommended when curve magnitude exceeds 40–45 degrees. Early attempts at spinal fusion surgery which were aimed to leave the patients with a mild residual deformity, failed to meet such expectations. These aims have since been revised to the more modest goals of preventing progression, restoring 'acceptability' of the clinical deformity and reducing curvature. In view of the fact that there is no evidence that health related signs and symptoms of scoliosis can be altered by spinal fusion in the long-term, a clear medical indication for this treatment cannot be derived. Knowledge concerning the rate of complications of scoliosis surgery may enable us to establish a cost/benefit relation of this intervention and to improve the standard of the information and advice given to patients. It is also hoped that this study will help to answer questions in relation to the limiting choice between the risks of surgery and the "wait and see – observation only until surgery might be recommended", strategy widely used. The purpose of this review is to present the actual data available on the rate of complications in scoliosis surgery. Materials and methods Search strategy for identification of studies; Pub Med and the SOSORT scoliosis library, limited to English language and bibliographies of all reviewed articles. The search strategy included the terms; 'scoliosis'; 'rate of complications'; 'spine surgery'; 'scoliosis surgery'; 'spondylodesis'; 'spinal instrumentation' and 'spine fusion'. Results The electronic search carried out on the 1st February 2008 with the key words "scoliosis", "surgery", "complications" revealed 2590 titles, which not necessarily attributed to our quest for the term "rate of complications". 287 titles were found when the term "rate of complications" was used as a key word. Rates of complication varied between 0 and 89% depending on the aetiology of the entity investigated. Long-term rates of complications have not yet been reported upon. Conclusion Scoliosis surgery has a varying but high rate of complications. A medical indication for this treatment cannot be established in view of the lack of evidence. The rate of complications may even be higher than reported. Long-term risks of scoliosis surgery have not yet been reported upon in research. Mandatory reporting for all spinal implants in a standardized way using a spreadsheet list of all recognised complications to reveal a 2-year, 5-year, 10-year and 20-year rate of complications should be established. Trials with untreated control groups in the field of scoliosis raise ethical issues, as the control group could be exposed to the risks of undergoing such surgery.
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Affiliation(s)
- Hans-Rudolf Weiss
- Asklepios Katharina Schroth Spinal Deformities Rehabilitation Centre, Korczakstr, 2, D-55566, Bad Sobernheim, Germany.
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Weiss HR. Is there a body of evidence for the treatment of patients with Adolescent Idiopathic Scoliosis (AIS)? SCOLIOSIS 2007; 2:19. [PMID: 18163917 PMCID: PMC2266701 DOI: 10.1186/1748-7161-2-19] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 12/31/2007] [Indexed: 11/10/2022]
Abstract
Historically, the treatment options for AIS, the most common form of scoliosis are; exercises; in-patient rehabilitation; braces and surgery. While there is evidence in the form of prospective controlled studies that Scoliosis Intensive Rehabilitation (SIR) and braces can alter the natural history of the condition, there is no prospective controlled study comparing the natural history with surgical treatment.One aim of the Scoliosis Society (SOSORT) should be; to help develop a body of research regarding the outcomes of conservative and operative treatment as well, and to highlight the problems of treatment indications in patients with AIS and other spinal deformities. Another aim is to help to improve the safety of patients who have surgery. By producing evidence-based information that can be used to develop guidelines that could aid both professionals and patients in making decisions about surgical and conservative options.Although 'Scoliosis' is the official journal of the SOSORT and is the main forum for experts in the field of conservative management of patients with spinal deformities, there needs to be more wide spread attempt to develop a fuller body of evidence focussing on spine surgery as well.
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Affiliation(s)
- Hans-Rudolf Weiss
- Asklepios Katharina Schroth, Spinal Deformities Rehabilitation Centre, Korczakstrasse 2, D-55566 Bad Sobernheim, Germany.
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Weiss HR. Adolescent Idiopathic Scoliosis - case report of a patient with clinical deterioration after surgery. Patient Saf Surg 2007; 1:7. [PMID: 18271943 PMCID: PMC2253506 DOI: 10.1186/1754-9493-1-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 12/19/2007] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although there is no evidence that the long-term effects of scoliosis surgery are superior to the long-term effects of Adolescent Idiopathic Scoliosis (AIS) itself, patients can fear the consequences of not under going this surgery due to incorrect or insufficient information. The main indication for surgical treatment in patients with AIS, is cosmetic. However spinal surgery may, along with other negative side effects, actually cause postoperative clinical deterioration. This complication of surgery has not yet been described in international literature. CASE PRESENTATION A 15-year old female patient originally presenting with a well-compensated double curve pattern scoliosis. The patient was advised to undergo surgery due to the long-term negative impact of signs and symptoms of scoliosis upon her health. The patient agreed to surgery, which was performed in one of Germanys leading centres for spinal surgery. The thoracolumbar curve was corrected and fused, while the thoracic curve, clearly showing wedged vertebrae, defined as structural scoliosis, remained untreated.This operation left the patient with an unbalanced appearance, with radiological and clinical imbalance to the right. The clinical appearance of the patient though clearly deteriorated post-surgery. Furthermore, the wedged disc space below the fusion area indicates future problems with possible destabilisation accompanied probably by low back pain. CONCLUSION Scoliosis surgery for patients with AIS is mainly indicated for cosmetic or psychological reasons. Therefore the treatment leading to the best possible clinical appearance and balance has to be chosen. Patients should be informed that surgery will not necessarily improve their health status. Clinical deterioration after surgery may occur, and such information is crucial for an adequate informed consent.
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Affiliation(s)
- Hans-Rudolf Weiss
- Asklepios Katharina Schroth, Spinal Deformities Rehabilitation Centre, Korczakstrasse 2, D-55566 Bad Sobernheim, Germany.
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Weiss HR. Clinical improvement and radiological progression in a girl with early onset scoliosis (EOS) treated conservatively--a case report. SCOLIOSIS 2006; 1:13. [PMID: 16872503 PMCID: PMC1559640 DOI: 10.1186/1748-7161-1-13] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Accepted: 07/26/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chêneau-Brace treatment of a certain standard reduces the rate of surgery, prevents progression and in a certain patient population leads to marked improvement of Cobb angle and cosmetic appearance. During the last two years a patient refusing surgery with a double major curvature of initially 60 degrees showed a clear cosmetic improvement and a clear radiological progression at the same time. The findings of this patient have been reviewed in order to find out how cosmetic appearance and Cobb angle can develop differently. METHODS The patient entered conservative treatment at the age of 13 years, premenarchial with Tanner II and a Cobb angle of 60 degrees thoracic and 59 degrees lumbar. The angle of trunk rotation (ATR; Scoliometer) was 13 degrees thoracic and 13 degrees lumbar. We have documented the findings of this patient (Surface topography, ATR, Cobb angles and angles of vertebral rotation (according to Raimondi) during the treatment period (27 Month) until 2 years after the onset of menarche. RESULTS After a treatment time of 27 Month the Cobb angle increased to 74 degrees thoracic and 65 degrees lumbar. The angles of vertebral rotation according to Raimondi increased slightly from 26 degrees thoracic and 28 degrees lumbar to 30 degrees thoracic and 28 degrees lumbar. The ATR improved to 12 degrees thoracic and 5 degrees lumbar while Lateral deviation improved from 22.4 mm to 4.6 mm and average surface rotation improved from 10.6 degrees to 6 degrees. In the X-rays a reduction of decompensation was visible. The patient felt comfortable with the cosmetic result. CONCLUSION Conservative treatment may improve cosmetic appearance while the curve progresses radiologically. This could be explained by assuming that (1) the Rigo Chêneau brace is able to improve cosmetic appearance by changing the shape of the thorax when the curve itself is too stiff to be corrected by a brace, that (2) reduction of decompensation leads to significant cosmetical improvements or (3) that the patient gained weight and therefore the deformation is masked. However, the weight the patient gained cannot explain the cosmetical improvement in this case. Conservative treatment with a certain standard of quality seems a viable alternative for patients with Cobb angles of > 60 degrees when surgical treatment is refused. Specialists in scoliosis management should be aware of the fact that curve progression can occur even if the clinical measurements show an improvement.
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Affiliation(s)
- Hans-Rudolf Weiss
- Asklepios Katharina Schroth Spinal Deformities Rehabilitation Centre, Bad Sobernheim, Germany.
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