摘要:

Spinal screening using the Scoliometer was performed on one thousand high school students to determine the prevalence of spinal deformity and the appropriate degree of deformity to be used as a selection criterion. Eighty percent of student were found to have 3$$ or more angle of trunk rotation (ATR), This new Information predicts a referral rate of three percent if 7$$ degrees ATR is used as referral criterion (12% referral if 5$$ ATR is the criterion). A paradigm using the best available information on natural history and screening allows a comparison of the outcomes of screened versus non-screened school populations. Spinal screening appears to be affective in reducing the need for surgical treatment of scoliosis, but does not decrease the total cost of care for this problem, An appropriate referral criterion for spinal screening appears to be 7$$ ATR at any lavel of the spine.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

To investigate the possible influence of gravity on daily variations of curve magnitude in adolescent idiopathic scoliosis, standardized anteroposterior standing radiographs of the spine were taken at 8:00 AM and repeated in the same conditions at 8:00 PM on the same day, 19 girls with idiopathic scoliosis, aged 10–16 years were included. The Cobb angle of the primary thoracic curve was measured blindly by four skilled orthopaedic surgeons. The mean interobserver variation in measuring Cobb angles on the 38 radiographs was 1.6$$. The average Cobb angle on morning radiographs was 60$$ (range, 42–91$$) as compared to 65$$ (range, 47–89$$) in the afternoon, a significant (P< 0.001) difference using a paired two-sided Student t test. It was concluded that there isastatistically and clinically significant dally increase of curve severity in moderate to severe idiopathic scoliosis.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Wisconsin segmental spinal instrumentation was developed by Drummond et al to provide rigid fixation for correction of spinal deformities without the risk of neurologic injury associated with the passage of sublaminar wires. Up to this point, there have been no outcome studies with follow-up of longer than 2 years. Thirty-five patients with adolescent idiopathic scoliosis treated by the Wisconsin procedure between 1984 and 1987 were reviewed by radiographs, physical examination, and an outcome scale. Minimum length of follow-up was 5 years with an average of 6.3 years. Curves were corrected from a mean of 59$$ preoperatively to 32$$ postoperatively (46%), and 36$$ at final follow-up (39%). Wisconsin segmental spinal instrumentation did not increase thoracic kyphosis. There was evidence of slight lumbar flattening in long fusions. According to the criteria described, 92% had a successful outcome. Camplications of the procedure included two wound infections (one superficial, one deep), one rod displacement, and two wire breakages. No pseudarthroses or neurologic complications were identified in this series. Wisconsin segmental spinal instrumentation safely achieves the objectives of partial correction, arthrodesis, and early return to function. The technique may still havearole, particularly in the thoracic region, in selective thoracic fusion of King type II curves, rigid curves, and double thoracic curves.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

From January 1986 to December 1991, 1,059 patients with scoliosis of 20$$ or more were reviewed, By magnetic resonance imaging, 43 patients were found to have syringomyelia. Thirty-eight patients had Chiarl type 1 malformation. Twenty-two of the patients were younger than 10 years, Scoliosis was the only presenting symptom in 32 patients, All patients had some neurologic abnormalities, Fifteen patients had left thoracic curves, The incidence of scoliosis with syringomyalia in our outpatient clinic was 4,0%: 18.4%in bays, and 2.6% in girls, Magnetic resonance imaging should be performad in patients who have abnormal reurologic findings.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

In adolescent idiopathic scoliosis the cosmetically, unacceptable rib prominence is one of the main reasons patients seek treatment. Ninety-eight patients were reviewed with Cotrel-Dubousset (CD) instrumentation (average follow-up, 27 months; average preoperative curve, 53$$) and 27 patients with Harrington Instrumentation and rib resection (average follow-up, 43 months; average preoperative curve, 52$$), Of the 98 patients who had CD instrumentation, 15 underwent concomitant rib resection. Of the 83 patients without rib resection, 71 (72%) were rated satisfactory and 12 unsatisfactory by cosmetic criteria based on residual rib deformity. These results were compared to those of 27 patients receiving Harrington, rod instrumentation and rib resection, of whom 23 (85%) were rated as satisfactory. All 15 patients with CD and rib resection were rated satisfactory. The CD patients were then redivided into two groups (rib resection indicated or rib resection not indicated) as follows: the 12 unsatisfactory CD patients without rib resection (in whom a rib resection should have been done) wore grouped with the 15 CD patients who underwent rib resection, for a total of 27 rib resections indicated, or 28%. This group was compared to the 71 satisfactory CD patients without rib resection (rib resection not indicated). Patients with a rib prominence of > 15$$ preoperatively had or should have had a rib resection. Patients with a higher chance of needing rib resection included those wish a curve severity greater than 60$$, curve flexibility less than 20%, a preoperative rib prominence > 10$$, or intraoperative curve correction of less than 50%.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The authors reviewed 246 idiopathic scoliosis patients with the upper thoracic curve of more than 20$$. Group I (138 patients) had positive T1 tilt and a Spiral fusion which was extended over both the upper and lower thoracic curve with the diagnosis of double thoracic curve. Group II (43 patients) had positive T1 tilt, but the fusion was limited to the lower thoracic curve. Group III (65 patients) had negative or neutral T1 tilt and the fusion was limited to the lower thoracic curve. The average age at operation was 15.9 years (range, 11,2–35 years) and the average length of follow-up was 4.8 years (range, 2–29.5 years). Positive T1 tilt did not correlate well with left shoulder elevation contrary to previous reports, The upper thoracic curve was more rigid than the lower curve in all groups and the lumbar curve was significantly more flexible than the upper and lower thoracic curves in all groups (P< 0.05). No significant difference in the flexibility of the upper thoracic curve was found between the groups regardless of the direction of T1 tilt, When only the lower curve was fused (groups II and III), progression of the upper thoracic curve was less than 5$$ and spontaneous correction of the unfused upper curve occurred in the majority of the cases following the supine bending study. Correction and fusion on the lower curve (groups II and III aggravated shoulder imbalance of all patients with left shoulder elevation. Based on the findings of this study, the authors proposed that the diagnosis of idiopathic double thoracic patterns should be limited to those patterns which require fusion of bath the upper and lower curves. This pattern of idiopathic scoliosis includes double thoracic curves with left shoulder elevation and/orarigid upper thoracic curve.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Experimentaliy induced scoliosis was investigated in pinealectomized chickens using pathologic and neurophysiologic means. A total of 90 chickens were tested; 30 served as a normal control 30 received an autografted pineal body in the intramuscular tissue of the trunk, and 30 underwent pinealectomy without autograft. Scoliosis developed in all pineslectomized chickens within 2 weeks, showing gradual progression during the next 5 or 6 weeks. At 3 months, the three-dimensional spinal deformity consisted of lateral curvature and vertebral body rotation, resulting in a praminent lordoscoliosis at the thoracic level. In contrast, scoliosis developed in only 10%of the autagrafted chickens. Histologic examination revealed no pathologic change in the brain in either the pinealectomized scoliosis group or in the autografted nonscoliosis group. Cortical potentials in the scoliosis group were delayed, thus suggesting conduction disturbance rostral to the brain stem. Although the relationship between the cause and effect is uncertain, these findings implicate neurotransmitters or neurohormonal systems in the pineal body as a major contributing factor in this type of axperimental scoliosis.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The purpose of this study is to describe the biology of spinal lengthening (vertebrodiatasis) in a juvenile goat model. A small Orthofix dynamic fixator was affixed to 5.5mm pedicular halfpins placed bilaterally at T12, L1, L5 and L6 in six juvenile goats. Distraction was performed across vertebral endplates between L1 and L5. Uninstrumented twins served as controls. Two pairs of animals were deleted due to anesthetic complications. Lumbar lengthening was successful in 3 animals resulting in an increase in length of up to 696% from L1 to L5 compared to the growth fate of the controls (mean 4.3 cm vs. mean .56 cm, respectively). Lengthening of the spinal card was not associated with brain stem migration or spinal cord injury.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Segmental reflex regulation in 37 patients with idiopathic scoliosis and 8 patents with nonidiopathic scoliosis was studied by recording evoked reflex muscle potentials from four muscle groups in each lower extremity during partial neuromuscular blockade. Effects on reflex activity mediated through descending systems arising in the brain stem ware investigated by recording from proximal-distal and flexor-extensor muscles. Ipsilateral and contralateral long-latency complex polysynaptic activity was present in all 37 patients with Idiopathic scoliosis. This reflex activity was absent in eight nonidiopathic scoliosis patients. Long-latency reflex activity may represent segmental disinhibition. The presence of long-latency reflex activity in patients with idiopathic scoliosis and the absence of this activity in nonidiopathic scoliosis patients with curves of equal magnitude demonstrates that the curve per as is not responsible for the activity This would imply that abnormal reflex processing may play a role in the development of the spinal deformity in patient with idiopathic scoliosis.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Somstoensory cortical evoked potentials (SCEPs) monitoring in neuromuscular scoliosis surgery was evaluated In a large consecutive series of spinal reconstructions us define its role in the detection and prevention of spinal cord injury; 141 procedures in 101 patients, were evaluated. In 28% a reliable tracing could not be obtained. Two postoperative neurologic deficits were missed by SCEP monitoring, Diagnosis (Duchenne muscular dystrophy and polio) was the only significant factor found to correIate with a reliable tracing. The use of sublaminar wires was associated with a higher rate of change in tracing-Transient changes were common. SCEps are unreliable and nonspecific in neuromuscular scoliosis surgery and are not efficatious in preventing or detecting spinal cord injury when used alone. Adjunctive techniques using epidural and MEPs must be studied in these patients.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID