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Vasilyev V, Begidova T, Mukina E, Shvachun O, Prytkova E. Correlation of the lower limb anatomical shortening with scoliotic deformity of the spine. BIO WEB OF CONFERENCES 2020. [DOI: 10.1051/bioconf/20202600069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The article deals with the analysis of the correlation between the anatomical shortening of the lower limb and the formation of a scoliotic curve. Despite the fact that the subject matter lacks sufficient research, an attempt is made to consider the data of domestic and foreign scientific studies that shed light on the issue. Within the framework of data analysis in an independent study of a group of 47 patients with shortening of the lower limb combined with vertebral scoliotic deformity, 4 different types of compensatory deformities of the spine were determined. Variants of possible correction were suggested depending on the type and complexity of the deformity. The conducted study stresses the importance of further theoretical and practical development of the subject matter and improvement of therapeutic and preventive measures for scoliosis.
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Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, Lebel A, Marti C, Maruyama T, O’Brien J, Price N, Parent E, Rigo M, Romano M, Stikeleather L, Wynne J, Zaina F. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. SCOLIOSIS AND SPINAL DISORDERS 2018; 13:3. [PMID: 29435499 PMCID: PMC5795289 DOI: 10.1186/s13013-017-0145-8] [Citation(s) in RCA: 412] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/06/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) produced its first guidelines in 2005 and renewed them in 2011. Recently published high-quality clinical trials on the effect of conservative treatment approaches (braces and exercises) for idiopathic scoliosis prompted us to update the last guidelines' version. The objective was to align the guidelines with the new scientific evidence to assure faster knowledge transfer into clinical practice of conservative treatment for idiopathic scoliosis (CTIS). METHODS Physicians, researchers and allied health practitioners working in the area of CTIS were involved in the development of the 2016 guidelines. Multiple literature reviews reviewing the evidence on CTIS (assessment, bracing, physiotherapy, physiotherapeutic scoliosis-specific exercises (PSSE) and other CTIS) were conducted. Documents, recommendations and practical approach flow charts were developed using a Delphi procedure. The process was completed with the Consensus Session held during the first combined SOSORT/IRSSD Meeting held in Banff, Canada, in May 2016. RESULTS The contents of the new 2016 guidelines include the following: background on idiopathic scoliosis, description of CTIS approaches for various populations with flow-charts for clinical practice, as well as literature reviews and recommendations on assessment, bracing, PSSE and other CTIS. The present guidelines include a total of 68 recommendations divided into following topics: bracing (n = 25), PSSE to prevent scoliosis progression during growth (n = 12), PSSE during brace treatment and surgical therapy (n = 6), other conservative treatments (n = 2), respiratory function and exercises (n = 3), general sport activities (n = 6); and assessment (n = 14). According to the agreed strength and level of evidence rating scale, there were 2 recommendations on bracing and 1 recommendation on PSSE that reached level of recommendation "I" and level of evidence "II". Three recommendations reached strength of recommendation A based on the level of evidence I (2 for bracing and one for assessment); 39 recommendations reached strength of recommendation B (20 for bracing, 13 for PSSE, and 6 for assessment).The number of paper for each level of evidence for each treatment is shown in Table 8. CONCLUSION The 2016 SOSORT guidelines were developed based on the current evidence on CTIS. Over the last 5 years, high-quality evidence has started to emerge, particularly in the areas of efficacy of bracing (one large multicentre trial) and PSSE (three single-centre randomized controlled trials). Several grade A recommendations were presented. Despite the growing high-quality evidence, the heterogeneity of the study protocols limits generalizability of the recommendations. There is a need for standardization of research methods of conservative treatment effectiveness, as recognized by SOSORT and the Scoliosis Research Society (SRS) non-operative management Committee.
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Affiliation(s)
- Stefano Negrini
- Clinical and Experimental Sciences Department, University of Brescia Viale Europa 11, Brescia, Italy
- IRCCS Fondazione Don Gnocchi, Milan, Italy
| | - Sabrina Donzelli
- ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, 20141 Milan, Italy
| | - Angelo Gabriele Aulisa
- U.O.C. of Orthopedics and Traumatology, Children’s Hospital Bambino Gesù, Institute of Scientific Research, 00165 Rome, Italy
| | - Dariusz Czaprowski
- Center of Body Posture, Olsztyn, Poland
- Department of Physiotherapy, Józef Rusiecki University College, Olsztyn, Poland
| | - Sanja Schreiber
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
- Alberta Health Services, Department of Surgery, Edmonton, Canada
| | | | - Helmut Diers
- Department of Orthopedics and Trauma Surgery, University Medical Center, Mainz, Germany
| | - Theodoros B. Grivas
- Department of Orthopaedics and Traumatology, “Tzaneio” General Hospital of Piraeus, Piraeus, Greece
| | - Patrick Knott
- Rosalind Franklin University of Medicine and Science, North Chicago, IL USA
| | - Tomasz Kotwicki
- Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, Poznan, Poland
| | - Andrea Lebel
- Scoliosis Physiotherapy & Posture Centre, 231 McLeod Street, Ottawa, Ontario K2P0Z8 Canada
| | - Cindy Marti
- Schroth-Barcelona Institute, LLC, Spinal Dynamics of Wisconsin, SC., Barcelona, Spain
| | - Toru Maruyama
- Saitama Prefectural Rehabilitation Center, Saitama, Japan
| | - Joe O’Brien
- National Scoliosis Foundation, Stoughton, MA USA
| | - Nigel Price
- Section of Spine Surgery, Children’s Mercy Hospitals and Clinics, UMKC Orthopedics, Kansas City, MO USA
| | - Eric Parent
- Department of Physical Therapy, 2-50 Corbett Hall, Edmonton, AB T6G 2G4 Canada
| | - Manuel Rigo
- Salvá SLP (E. Salvá Institute), Vía Augusta 185, 08021 Barcelona, Spain
| | - Michele Romano
- ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, 20141 Milan, Italy
| | - Luke Stikeleather
- National Scoliosis Center, 3023 Hamaker Court, Suite LL-50, Fairfax, VA 22124 USA
| | - James Wynne
- Boston Orthotics & Prosthetics, Boston, MA USA
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, 20141 Milan, Italy
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Dudin M, Baloshin Y, Popov I, Lisitsa N, Bober S. On the linear sizes of vertebrae and intervertebral discs of children in the beginning of puberty. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2018; 9:246-249. [PMID: 30783348 PMCID: PMC6364363 DOI: 10.4103/jcvjs.jcvjs_91_18] [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] [Indexed: 11/04/2022] Open
Abstract
Study Design We collected experimental data concerning vertebrae sizes and performed an investigation of these data for different patient ages by methods of mathematical statistics. Purpose The standard dimensions of vertebrae and intervertebral discs are of major importance for obtaining a comprehensive understanding of spine diseases and their successful treatment. The purpose is to study these sizes for children at the age of 9-14 years. Overview of Literature Unfortunately, this issue is poorly presented in the corresponding literature. There are no systematic results. Only particular cases are presented. Materials and Methods Experimental is based on the: results of X-ray investigations of children spines. Theoretical background is given by methods of mathematical statistics. Results Systematic description of vertebrae sizes for children of age 9-14 is given. This specific age interval is the most common period of initiation of various pathological deformations of human spine. Conclusions The acquired data both reflect the process of spine growth and can serve for building correct mathematical models of a healthful or diseased spine.
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Affiliation(s)
- Mikhail Dudin
- Center for Rehabilitation for Children's Orthopaedic Diseases, St. Petersburg, Russia
| | - Yuri Baloshin
- Department of Higher Mathematics, ITMO University, Kronverkskiy, St. Petersburg, Russia
| | - Igor Popov
- Department of Higher Mathematics, ITMO University, Kronverkskiy, St. Petersburg, Russia
| | - Nikita Lisitsa
- Department of Higher Mathematics, ITMO University, Kronverkskiy, St. Petersburg, Russia
| | - Stepan Bober
- Center for Rehabilitation for Children's Orthopaedic Diseases, St. Petersburg, Russia
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Silva JS, Morita ÂK, Pachioni CAS, Fregonesi CEPT, Faria CRSD, Ferreira DMA. Idiopathic scoliosis: Static analysis of the influence of shim use on postural angles. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.002.ao10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Scoliosis is characterized as a three-dimensional deformity. In this scenario, the use of shims can promote correction of postural imbalances. Objective: To verify the static changes associated with unilateral manipulation of shims in idiopathic scoliosis. Methods: Two experimental groups composed of participants with scoliosis with double and single curves, and a control group of participants without scoliosis. 10 reflective markers were used, filmed for 15 seconds in the static position in three conditions (no shim; low shim of 1 cm, and high shim of 3 cm) on the right and left foot. The following postural angles were calculated: alpha 1, alpha 2, alpha 3, and alpha 4. Results: There were differences in the shim condition between the control group (CG) and experimental scoliosis with “S” (GES) for alpha 2 and 4 and Scoliosis “C” (GEC) for alpha 2. For shims under the right foot, there were differences between the control group and GES for alpha 4 and the GEC for alpha 1, 2 and 4, and between shims for the GES for alpha 3 and 4. Shims under the left foot were responsible for significant differences between the control group and the GES and GEC groups. Conclusion: These static postural changes indicate that scoliosis curves show adaptability and postural reorganization in response to manipulation with shims, and the greatest influence is seen in the lower segments, both in simple and double curves. According to the results it is concluded that residual scoliotic curvatures have flexibility that allows postural adjustment with shims.
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Nowak R, Kwiecien M, Tkacz M, Mazurek U. Transforming growth factor-beta (TGF- β) signaling in paravertebral muscles in juvenile and adolescent idiopathic scoliosis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:594287. [PMID: 25313366 PMCID: PMC4181945 DOI: 10.1155/2014/594287] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 07/19/2014] [Accepted: 08/20/2014] [Indexed: 12/31/2022]
Abstract
Most researchers agree that idiopathic scoliosis (IS) is a multifactorial disease influenced by complex genetic and environmental factors. The onset of the spinal deformity that determines the natural course of the disease, usually occurs in the juvenile or adolescent period. Transforming growth factors β (TGF-βs) and their receptors, TGFBRs, may be considered as candidate genes related to IS susceptibility and natural history. This study explores the transcriptional profile of TGF-βs, TGFBRs, and TGF-β responsive genes in the paravertebral muscles of patients with juvenile and adolescent idiopathic scoliosis (JIS and AIS, resp.). Muscle specimens were harvested intraoperatively and grouped according to the side of the curve and the age of scoliosis onset. The results of microarray and qRT-PCR analysis confirmed significantly higher transcript abundances of TGF-β2, TGF-β3, and TGFBR2 in samples from the curve concavity of AIS patients, suggesting a difference in TGF-β signaling in the pathogenesis of juvenile and adolescent curves. Analysis of TGF-β responsive genes in the transcriptomes of patients with AIS suggested overrepresentation of the genes localized in the extracellular region of curve concavity: LTBP3, LTBP4, ITGB4, and ITGB5. This finding suggests the extracellular region of paravertebral muscles as an interesting target for future molecular research into AIS pathogenesis.
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Affiliation(s)
- Roman Nowak
- Department of Orthopedics, School of Medicine with the Division of Dentistry, Medical University of Silesia, Wojewódzki Szpital Specjalistyczny nr 5 Plac Medyków 1, 41-200 Sosnowiec, Poland
| | - Magdalena Kwiecien
- Department of Molecular Biology, Medical University of Silesia, Ulica Narcyzów 1, 41-100 Sosnowiec, Poland
| | - Magdalena Tkacz
- Institute of Computer Science, Division of Information Systems, University of Silesia, Ulica Będzińska 39, 41-200 Sosnowiec, Poland
| | - Urszula Mazurek
- Department of Molecular Biology, Medical University of Silesia, Ulica Narcyzów 1, 41-100 Sosnowiec, Poland
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Adolescent Idiopathic Scoliosis: A 71 Cases Study Ascertaining that Straightening Is Possible, and a New Etiological Hypothesis. Asian Spine J 2013; 7:282-8. [PMID: 24353844 PMCID: PMC3863653 DOI: 10.4184/asj.2013.7.4.282] [Citation(s) in RCA: 5] [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: 05/01/2013] [Revised: 05/23/2013] [Accepted: 05/23/2013] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Seventy-one children (23 boys and 48 girls, aged 6 to 18 year-old) with adolescent idiopathic scoliosis (AIS) between 11° and 62°, without braces, have been treated manually, only at the level of the neck. PURPOSE To ascertain that non-surgical straightening of AIS is possible (without brace). OVERVIEW OF LITERATURE So far no disease modifying treatment for AIS existed. Braces can only slow down worsening (and this can only be achieved if they are worn 23 hours a day). Surgery is not without important risks. METHODS All patients have been treated exclusively with a manual therapy called Brachy-Myotherapy. This method treats spasmed (contractured) muscles by placing them in a shortening position according to a specific protocol. RESULTS An average straightening of 8° of AIS was observed, with a maximum of 25°. 94% of cases improved, 67 out of 71. The worst prognosis was, the better results. The more advanced AIS was, the better the results. CONCLUSIONS A simple and reliable treatment of AIS is possible. AIS seems to be a compensation mechanism of the body, with the aim of keeping the ears, and thus the labyrinths, at a horizontal level for correct equilibrium. When lasting post-traumatic neck muscle contractures causing a permanent side-bending of the skull have been treated, this compensation mechanism becomes irrelevant and scoliosis tends to subside.
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Nowak R, Szota J, Mazurek U. Vitamin D receptor gene (VDR) transcripts in bone, cartilage, muscles and blood and microarray analysis of vitamin D responsive genes expression in paravertebral muscles of juvenile and adolescent idiopathic scoliosis patients. BMC Musculoskelet Disord 2012; 13:259. [PMID: 23259508 PMCID: PMC3532837 DOI: 10.1186/1471-2474-13-259] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 12/17/2012] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND VDR may be considered as a candidate gene potentially related to idiopathic scoliosis susceptibility and natural history. Transcriptional profile of VDR mRNA isoforms might be changed in the structural tissues of the scoliotic spine and potentially influence the expression of VDR responsive genes. The purpose of the study was to determine differences in mRNA abundance of VDR isoforms in bone, cartilage and paravertebral muscles between tissues from curve concavity and convexity, between JIS and AIS and to identify VDR responsive genes differentiating juvenile and adolescent idiopathic scoliosis in paravertebral muscles. METHODS In a group of 29 patients with JIS and AIS, specimens of bone, cartilage, paravertebral muscles were harvested at the both sides of the curve apex together with peripheral blood samples. Extracted total RNA served as a matrix for VDRs and VDRl mRNA quantification by QRT PCR. Subsequent microarray analysis of paravertebral muscular tissue samples was performed with HG U133A chips (Affymetrix). Quantitative data were compared by a nonparametric Mann Whitney U test. Microarray results were analyzed with GeneSpring 11GX application. Matrix plot of normalized log-intensities visualized the degree of differentiation between muscular tissue transcriptomes of JIS and AIS group. Fold Change Analysis with cutoff of Fold Change ≥2 identified differentially expressed VDR responsive genes in paravertebral muscles of JIS and AIS. RESULTS No significant differences in transcript abundance of VDR isoforms between tissues of the curve concavity and convexity were found. Statistically significant difference between JIS and AIS group in mRNA abundance of VDRl isoform was found in paravertebral muscles of curve concavity. Higher degree of muscular transcriptome differentiation between curve concavity and convexity was visualized in JIS group. In paravertebral muscles Tob2 and MED13 were selected as genes differentially expressed in JIS and AIS group. CONCLUSIONS In Idiopathic Scolioses transcriptional activity and alternative splicing of VDR mRNA in osseous, cartilaginous, and paravertebral muscular tissues are tissue specific and equal on both sides of the curve. The number of mRNA copies of VDRl izoform in concave paravertebral muscles might be one of the factors differentiating JIS and AIS. In paravertebral muscles Tob2 and Med13 genes differentiate Adolescent and Juvenile type of Idiopathic Scoliosis.
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Affiliation(s)
- Roman Nowak
- Orthopaedics Clinic Medical University of Silesia, Wojewódzki Szpital Specjalistyczny nr5 41-200 Sosnowiec, Pl. Medyków 1, Poland
| | - Justyna Szota
- Department of Molecular Biology Medical University of Silesia, 41-100 Sosnowiec, ul.Narcyzów 1, Poland
| | - Urszula Mazurek
- Department of Molecular Biology Medical University of Silesia, 41-100 Sosnowiec, ul.Narcyzów 1, Poland
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Negrini S, Aulisa AG, Aulisa L, Circo AB, de Mauroy JC, Durmala J, Grivas TB, Knott P, Kotwicki T, Maruyama T, Minozzi S, O'Brien JP, Papadopoulos D, Rigo M, Rivard CH, Romano M, Wynne JH, Villagrasa M, Weiss HR, Zaina F. 2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth. SCOLIOSIS 2012; 7:3. [PMID: 22264320 PMCID: PMC3292965 DOI: 10.1186/1748-7161-7-3] [Citation(s) in RCA: 251] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 01/20/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS). METHODS All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting. RESULTS The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D. CONCLUSION These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.
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Affiliation(s)
- Stefano Negrini
- Physical and Rehabilitation Medicine, University of Brescia, Italy
- Don Gnocchi Foundation, Milan, Italy
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | - Angelo G Aulisa
- Orthopaedics and Traumatology Division, Bambino Gesù Children's Hospital, Institute of Scientific Research, Piazza San Onofrio 4, 00165, Rome, Italy
| | - Lorenzo Aulisa
- Department of Orthopaedics, Catholic University of the Sacred Heart, University Hospital 'Agostino Gemelli', L.go F. Vito, 1-00168 Rome, Italy
| | - Alin B Circo
- Sainte Justine Hospital, University of Montreal, Canada
| | | | - Jacek Durmala
- Department of Rehabilitation, Medical University of Silesia and University Hospital, Katowice, Poland
| | - Theodoros B Grivas
- Department of Trauma and Orthopaedics, "Tzanio" General Hospital, Tzani and Afendouli 1 st, Piraeus 18536, Greece
| | - Patrick Knott
- Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, 60064, USA
| | - Tomasz Kotwicki
- Spine Disorders Unit, Department of Pediatric Orthopedics and Traumatology, University of Medical Sciences, Poznan, Poland
| | - Toru Maruyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Japan
| | - Silvia Minozzi
- Cochrane Review Group on Drugs and Alcohol. Department of Epidemiology. Lazio Region. Via di Santa Costanza, 53. 00198 Rome. Italy
| | | | - Dimitris Papadopoulos
- Spondylos Laser Spine Lab, Orthopaedic Facility and Rehabilitation Center, 74, Messogion Ave, 115 27, Athens, Greece
| | - Manuel Rigo
- Institut Elena Salvá. Vía Augusta 185. 08021 Barcelona, Spain
| | | | - Michele Romano
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | | | | | - Hans-Rudolf Weiss
- Gesundheitsforum Nahetal. Alzeyer Str. 23. D-55457 Gensingen, Germany
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Milan, Italy
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Maruyama T, Grivas TB, Kaspiris A. Effectiveness and outcomes of brace treatment: a systematic review. Physiother Theory Pract 2011; 27:26-42. [PMID: 21198404 DOI: 10.3109/09593985.2010.503989] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Bracing has been widely used for the treatment of adolescent idiopathic scoliosis (AIS). However, effectiveness of brace treatment remains controversial. A systematic review was conducted to investigate evidence that brace treatment is effective in the treatment of AIS. A total of 20 studies, including randomized controlled trials, nonrandomized clinical controlled trials, or case-control studies, were included. Studies comparing the results of brace treatment with no-treatment, other conservative treatments, or surgical treatment were included. Outcomes of the studies included radiological curve progression, incidence of surgery, pulmonary function, quality of life (QOL), and psychological state. The results from the systematic review are difficult to interpret. There are quite a number of varying parameters between studies that make it very difficult to reach any firm conclusions. In addition, the quality of evidence is limited because most of the studies included in this review were of low methodological quality. However, the available data suggest that, compared to observation, bracing is more potent in preventing the progression of scoliosis and may not have a negative impact on patients' QOL. Therefore, bracing can be recommended for the treatment of AIS, at least for female patients with a Cobb angle of 25-35°. Compared to other conservative treatments, bracing seems to be more effective than electrical stimulation, although an advantage of bracing over side-shift exercise or casting has not been established. Comparison between bracing and surgery is difficult because in most studies, the curve magnitude at baseline was considerably larger in the surgery group. We recommend that future studies have clearer and more consistent guidelines.
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Affiliation(s)
- Toru Maruyama
- Department of Orthopaedic Surgery, Saitama Medical Centre, Saitama Medical University, Kawagoe, Saitama, Japan.
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Gorman KF, Breden F. Idiopathic-type scoliosis is not exclusive to bipedalism. Med Hypotheses 2008; 72:348-52. [PMID: 19070438 DOI: 10.1016/j.mehy.2008.09.052] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Revised: 09/12/2008] [Accepted: 09/12/2008] [Indexed: 12/11/2022]
Abstract
Human familial/idiopathic-type scoliosis (IS) is a complex genetic disorder for which the cause is unknown. The curve phenotype characteristically demonstrates pronounced morphological and developmental variability that is likely a consequence of biomechanical, environmental, and genetic differences between individuals. In addition, risk factors that affect the propensity for curves to progress to severity are unknown. Progress in understanding the fundamental biology of idiopathic-type scoliosis has been limited by the lack of a genetic/developmental animal model. Prior to consideration of teleosts, developmental idiopathic-type scoliosis has been considered to be exclusive to humans. Consequently, there is the notion that the syndrome is a result of bipedalism, and many studies try to explain the deformity from this anthrocentric viewpoint. This perspective has been reinforced by the choice of animals used for study, in that chickens and bipedal rats and mice demonstrate idiopathic-type curvature when made melatonin-deficient, but quadrupedal animals do not. Overlooked is the fact that teleosts also demonstrate similar curvature when made melatonin-deficient. Our characterization of the guppy curveback has demonstrated that non-induced idiopathic-type curvature is not exclusive to humans, nor bipedalism. We hypothesize that unique morphological, developmental and genetic parallels between the human and guppy syndromes are due to common molecular pathways involved in the etiopathogenesis of both phenotypes. We explore established gene conservation between human and teleost genomes that are in pathways hypothesized to be involved in the IS syndrome. We present non-induced vertebral wedging as a unique shared feature in IS and curveback that suggests a similar interaction between a molecular phenotype on the level of the vertebral anatomy, and biomechanics. We propose that rather than bipedalism per se, expression of idiopathic-type scoliosis is dependent on normal spinal loading applied along the cranio-caudal axis that interacts with an unknown factor causing the primary curve. In this regard, a comparative biological approach using a simplified teleost model will promote discovery of basic processes integral to idiopathic-type scoliosis in teleosts and humans, and highlight human-specific aspects of the deformity.
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Affiliation(s)
- Kristen F Gorman
- Department of Biological Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC, Canada V5A 1S6.
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Chu WCW, Lam WMW, Ng BKW, Tze-ping L, Lee KM, Guo X, Cheng JCY, Burwell RG, Dangerfield PH, Jaspan T. Relative shortening and functional tethering of spinal cord in adolescent scoliosis - Result of asynchronous neuro-osseous growth, summary of an electronic focus group debate of the IBSE. SCOLIOSIS 2008; 3:8. [PMID: 18588673 PMCID: PMC2474583 DOI: 10.1186/1748-7161-3-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 06/27/2008] [Indexed: 12/17/2022]
Abstract
There is no generally accepted scientific theory for the causes of adolescent idiopathic scoliosis (AIS). As part of its mission to widen understanding of scoliosis etiology, the International Federated Body on Scoliosis Etiology (IBSE) introduced the electronic focus group (EFG) as a means of increasing debate on knowledge of important topics. This has been designated as an on-line Delphi discussion. The Statement for this debate was written by Dr WCW Chu and colleagues who examine the spinal cord to vertebral growth interaction during adolescence in scoliosis. Using the multi-planar reconstruction technique of magnetic resonance imaging they investigated the relative length of spinal cord to vertebral column including ratios in 28 girls with AIS (mainly thoracic or double major curves) and 14 age-matched normal girls. Also evaluated were cerebellar tonsillar position, somatosensory evoked potentials (SSEPs), and clinical neurological examination. In severe AIS compared with normal controls, the vertebral column is significantly longer without detectable spinal cord lengthening. They speculate that anterior spinal column overgrowth relative to a normal length spinal cord exerts a stretching tethering force between the two ends, cranially and caudally leading to the initiation and progression of thoracic AIS. They support and develop the Roth-Porter concept of uncoupled neuro-osseous growth in the pathogenesis of AIS which now they prefer to term 'asynchronous neuro-osseous growth'. Morphological evidence about the curve apex suggests that the spinal cord is also affected, and a 'double pathology' is suggested. AIS is viewed as a disorder with a wide spectrum and a common neuroanatomical abnormality namely, a spinal cord of normal length but short relative to an abnormally lengthened anterior vertebral column. Neuroanatomical changes and/or abnormal neural function may be expressed only in severe cases. This asynchronous neuro-osseous growth concept is regarded as one component of a larger concept. The other component relates to the brain and cranium of AIS subjects because abnormalities have been found in brain (infratentorial and supratentorial) and skull (vault and base). The possible relevance of systemic melatonin-signaling pathway dysfunction, platelet calmodulin levels and putative vertebral vascular biology to the asynchronous neuro-osseous growth concept is discussed. A biomechanical model to test the spinal component of the concept is in hand. There is no published research on the biomechanical properties of the spinal cord for scoliosis specimens. Such research on normal spinal cords includes movements (kinematics), stress-strain responses to uniaxial loading, and anterior forces created by the stretched cord in forward flexion that may alter sagittal spinal shape during adolescent growth. The asynchronous neuro-osseous growth concept for the spine evokes controversy. Dr Chu and colleagues respond to five other concepts of pathogenesis for AIS and suggest that relative anterior spinal overgrowth and biomechanical growth modulation may also contribute to AIS pathogenesis.
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Affiliation(s)
- Winnie CW Chu
- Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, PR China
| | - Wynnie MW Lam
- Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, PR China
| | - Bobby KW Ng
- Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, PR China
| | - Lam Tze-ping
- Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, PR China
| | - Kwong-man Lee
- Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, PR China
| | - Xia Guo
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, PR China
| | - Jack CY Cheng
- Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, PR China
| | - R Geoffrey Burwell
- The Centre for Spinal Studies & Surgery, Nottingham University Hospitals Trust, Queen's Medical Centre Campus, Nottingham NG7 2UH, UK
| | | | - Tim Jaspan
- Department of Radiology, Nottingham University Hospitals Trust, Queen's Medical Centre Campus, Nottingham NG7 2UH, UK
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