scholarly journals The Role of Correction in the Conservative Treatment of Adolescent Idiopathic Scoliosis

2017 ◽  
Vol 11 (1) ◽  
pp. 1548-1557 ◽  
Author(s):  
Shu-Yan Ng ◽  
Xiao-feng Nan ◽  
Sang-Gil Lee ◽  
Nico Tournavitis
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Key Words ◽  
Treatment Success ◽  
Brace Treatment ◽  
Curve Correction ◽  
Manual Search ◽  
Scoliosis Correction ◽  
The Difference

Introduction: Physiotherapeutic Scoliosis-Specific Exercises (PSSE) and bracing have been found to be effective in the stabilization of curves in patients with Adolescent Idiopathic Scoliosis (AIS). Yet, the difference among the many PSSEs and braces has not been studied. The present review attempts to investigate the role of curve correction in the outcome of treatment for PSSEs and braces. Material and Methods: A PubMed manual search has been conducted for studies on the role of correction in the effectiveness of PSSE and bracing. For the PSSEs, the key words used were “adolescent idiopathic scoliosis, correction, physiotherapy, physical therapy, exercise, and rehabilitation.” For bracing, the key words used were “adolescent idiopathic scoliosis, correction and brace”. Only papers that were published from 2001-2017 were included and reviewed, as there were very few relevant papers dating earlier than 2001. Results: The search found no studies on the role of correction on the effectiveness of different PSSEs. The effectiveness of different PSSEs might or might not be related to the magnitude of curve correction during the exercises. However, many studies showed a relationship between the magnitude of in-brace correction and the outcome of the brace treatment. Discussion: The role of correction on the effectiveness of PSSE has not been studied. In-brace correction, however, has been found to be associated with the outcome of brace treatment. An in-brace correction of < 10% was associated with an increased rate of failure of brace treatment, whereas an in-brace correction of >40-50% was associated with an increased rate of brace treatment success (i.e. stabilization or improvement of curves). Thus, in the treatment of AIS, patients should be advised to use highly corrective braces, in conjunction with PSSE since exercises have been found to help stabilize the curves during weaning of the brace. Presently, no specific PSSE can be recommended. Conclusion: Braces of high in-brace correction should be used in conjunction with PSSEs in the treatment of AIS. No specific PSSE can be recommended as comparison studies of the effectiveness of different PSSEs are not found at the time of this study.

scholarly journals Spinal deformity in adolescent idiopathic scoliosis at the end of Chêneau brace treatment

2020 ◽  
Vol 8 (3) ◽  
pp. 269-274
Author(s):  
Konstantinos Tsaknakis ◽  
Lena Braunschweig ◽  
Heiko M. Lorenz ◽  
Anna K. Hell
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Spinal Deformity ◽  
Long Term Results ◽  
Brace Treatment ◽  
Scoliotic Curve ◽  
Radiological Data ◽  
End Of Treatment ◽  
Scoliosis Correction ◽  
Curve Patterns

Background. Brace treatment is frequently used in adolescent idiopathic scoliosis (AIS). However, due to different brace models, long-term results on spinal deformity development at the end of Chneau brace treatment are not often described and differ in results. Aim. The aim of this work was to analyze clinical and radiological data of AIS patients treated with Chneau braces from the beginning of treatment until the end of growth and brace therapy in order to define realistic treatment results and expectations in an everyday setting. Materials and methods. 52 AIS patients with Chneau brace treatment were followed from the beginning of treatment until the end of growth. Clinical data such as the initial Risser sign, age at treatment, gender, curve patterns and body mass index were analyzed. Results. At the beginning of brace therapy, the average age was 13.1 years and patients showed a mean scoliotic curve angle of 30.9. Four months of brace use reduced the scoliotic curve to 20.1. Nine months after the end of brace treatment and an average treatment duration of 17 months, scoliosis has increased up to 30.3 again. In children with a lower maturity status, the initial scoliotic curve was less than in more mature patients leading to less spinal deformity at the end of treatment. In addition, obese children had less scoliosis correction during brace therapy than normalweight children. Conclusion. In patients with AIS treated with a Chneau brace, the initial curvature correction was 35%. Nine months after the end of brace treatment, scoliotic curves identical to the deformities at the beginning of treatment could be observed.

scholarly journals Impact of Various Weights in the Intraoperative Skull-Skeletal Traction on Correction of Adolescent Idiopathic Scoliosis

2019 ◽  
Vol 10 (8) ◽  
pp. 1015-1021
Author(s):  
So Kato ◽  
Stephen J. Lewis ◽  
Ohm Sharma ◽  
Sooyong Chua ◽  
Doron Rabin ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
High Weight ◽  
Motor Evoked Potential ◽  
Consecutive Series ◽  
Curve Correction ◽  
Skeletal Traction ◽  
Neurological Risk ◽  
Scoliosis Correction ◽  
The Impact

Study Design: A retrospective study. Objectives: Intraoperative skull-skeletal traction (ISST) facilitates the surgical scoliosis correction, but it is also associated with neurological risk. The objective of the present study was to investigate the impact of various traction weights on neurophysiological change and curve correction in surgery for adolescent idiopathic scoliosis (AIS). Methods: A retrospective review of a consecutive series of posterior spinal fusions for AIS patients undergoing corrections with the use of ISST by 2 surgeons in one institution was performed. Intraoperative prone, post-traction radiographs were performed on all cases. The cases were divided into 2 groups, high and low traction weights, based on whether the weight used was ≥35% or <35% of body weight. The frequency of neurophysiological changes and the curve correction were compared between the 2 groups. Results: The intraoperative correction magnitudes by ISST were significantly larger in the high ISST group than in the low ISST group (35° vs 26°, P < .001). Changes in motor-evoked potential (MEP) were more frequently observed in the high ISST group (47% vs 26%, P = .049). A multivariate analysis showed that high ISST was associated with 3 times higher risk of MEP change (95% confidence interval = 1.1-8.0, P = .03) and higher final postoperative correction rates (68% vs 60%, P = .001). Conclusions: The high ISST for AIS was associated with increased intraoperative and ultimate curve corrections, and potentially facilitated better final correction. However, the high weight group was associated with an increased frequency of intraoperative MEP changes.

Dynamic Scoliosis Correction as Alternative Treatment for Patients with Adolescent Idiopathic Scoliosis: a Non-Fusion Surgical Technique

2019 ◽  
Vol 158 (06) ◽  
pp. 641-646 ◽  
Author(s):  
Per David Trobisch ◽  
Philipp Kobbe ◽  
Alice Baroncini
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Surgical Technique ◽  
Idiopathic Scoliosis ◽  
Treatment Algorithm ◽  
Curve Correction ◽  
Short Term ◽  
Growth Modulation ◽  
Scoliosis Correction ◽  
Perioperative Complication ◽  
New Treatment

AbstractAnterior dynamic scoliosis correction is an innovative non-fusion option in the treatment of patients with severe adolescent scoliosis. Growth modulation and sometimes intraoperative curve correction is achieved by convex insertion of segmental screws and a flexible polyethylene cord. The present review analyses and discusses the current literature and proposes a new treatment algorithm that is based on our own experience. Short term results are published for approximately 100 patients from different institutions. Fusion could be prevented in the vast majority of patients. Perioperative complication rate is very low but a few cases of cord rupture and overcorrection are reported. Anterior dynamic scoliosis correction has promising short term results but there is a paucity of literature and optimal criteria for the best candidate has yet to be defined.

scholarly journals Does Posterior Scoliosis Correction Improve Respiratory Function in Adolescent Idiopathic Scoliosis? A Systematic Review and Meta-analysis

2018 ◽  
Vol 9 (8) ◽  
pp. 866-873
Author(s):  
So Kato ◽  
Jean-Christophe Murray ◽  
Mario Ganau ◽  
Yongyao Tan ◽  
Yasushi Oshima ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Respiratory Function ◽  
Meta Analysis ◽  
Scoliosis Surgery ◽  
Scoliosis Correction ◽  
Predicted Values

Study Design: A systematic review and meta-analysis. Objectives: Pulmonary dysfunction is often advocated among the indications for surgical correction of adolescent idiopathic scoliosis (AIS). Previous studies have discussed the effect of scoliosis correction on respiratory function without reaching a definitive conclusion: Some showed that the respiratory function can improve after scoliosis surgery without defining the precise role of anterior, posterior, and combined approaches on this improvement; furthermore, the majority of these studies did not take normal growth into account. As a result, the role of surgery remains to be clarified. The object of the present study was to synthesize the current knowledge regarding changes in respiratory function after posterior corrective surgery for AIS. Methods: A comprehensive systematic search was performed to identify all relevant studies in the following electronic databases: MEDLINE, EMBASE, CINAHL (EBSCO). We focused on the studies (1) that discussed posterior fusion surgery for AIS without thoracoplasty, (2) that discussed comparisons of pre- and postoperative percent-predicted values of forced vital capacity (%FVC) or forced expiratory volume (%FEV), and (3) with minimum 2-year follow-up. Forest plots were depicted and Z value was calculated as a test for overall effect. Results: Ten studies (6 prospective and 4 retrospective studies) met our inclusion criteria. The overall effect showed that there was no significant difference in %FVC or %FEV between pre- and postoperative measurements (very low evidence). Conclusions: Posterior correction surgery for mild to moderate AIS patients showed no significant improvement of postoperative respiratory function measured by relative, percent-predicted values at minimum 2-year follow-up.

Supine Traction Versus Prone Bending Radiographs for Assessing the Curve Flexibility in Spinal Deformity

2021 ◽  
pp. 219256822097913
Author(s):  
Niek te Hennepe ◽  
Maarten Spruit ◽  
Martin H. Pouw ◽  
Marco Hinderks ◽  
Petra Heesterbeek
Keyword(s):  
Idiopathic Scoliosis ◽  
Spinal Deformity ◽  
Retrospective Cohort ◽  
De Novo ◽  
Traction Force ◽  
Degenerative Lumbar Scoliosis ◽  
Curve Correction ◽  
Subgroup Analyses ◽  
The Difference ◽  
Side Bending

Study Design: Retrospective cohort study. Objectives: No consensus exists among surgeons on which radiologic method to prefer for the assessment of curve flexibility in spinal deformity. The objective of this study was to evaluate the difference in curve correction on supine traction radiographs versus prone side bending radiographs. Methods: A retrospective analysis of idiopathic scoliosis (IS), degenerative idiopathic scoliosis (DIS) and de novo degenerative lumbar scoliosis (DNDLS) patients was performed on supine traction as well as prone bending films (when available). Age, weight, traction force, diagnosis and Cobb angles of the primary and secondary curves were extracted. Differences in curve correction (percentages) on traction versus prone bending radiographs were analyzed for the primary and secondary curve. Subgroup analyses were performed for the 3 different diagnoses. Results: In total, 170 patients were eligible for inclusion. 43 were diagnosed with IS, 58 with DIS and 69 with DNDLS. For the primary curve, greater curve correction was obtained with bending in the DNDLS group ( P < 0.001). In the DIS group, there was a trend toward more correction on bending ( P = 0.054). In de IS group no difference was found. For the secondary curve, bending showed more curve correction in the IS and DIS group ( P = 0.002 and P <0.001). No difference was found in the DNDLS group. Conclusion: Compared to traction radiographs, bending radiographs better serve the purpose of curve flexibility assessment of IS, DIS and DNDLS spinal deformity, despite the fact that patients are exposed to more radiation.

What happens to the unfused upper thoracic curve after posterior spinal fusion for adolescent idiopathic scoliosis?

2021 ◽  
pp. 1-7
Author(s):  
M. Omar Iqbal ◽  
Amer F. Samdani ◽  
Joshua M. Pahys ◽  
Peter O. Newton ◽  
Suken A. Shah ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Univariate Analysis ◽  
Posterior Spinal Fusion ◽  
Research Society ◽  
Curve Correction ◽  
Scoliosis Research Society ◽  
Lenke Classification ◽  
Upper Instrumented Vertebra ◽  
Upper Thoracic

OBJECTIVE Spontaneous lumbar curve correction after selective thoracic fusion in surgery for adolescent idiopathic scoliosis (AIS) is well described. However, only a few articles have described the course of the uninstrumented upper thoracic (UT) curve after fusion, and the majority involve a hybrid construct. In this study, the authors sought to determine the outcomes and associated factors of uninstrumented UT curves in patients with AIS. METHODS The authors retrospectively reviewed a prospectively collected multicenter AIS registry for all consecutive patients with Lenke type 1–4 curves with a 2-year minimum follow-up. UT curves were considered uninstrumented if the upper instrumented vertebra (UIV) did not extend above 1 level from the lower end vertebra of the UT curve. The authors defined progression as > 5°, and divided patients into two cohorts: those with improvement in the UT curve (IMP) and those without improvement in the UT curve (NO IMP). Radiographic, demographic, and Scoliosis Research Society (SRS)–22 survey outcome measures were compared using univariate analysis, and significant factors were compared using a multivariate regression model. RESULTS The study included 450 patients (370 females and 80 males). The UT curve self-corrected in 86% of patients (n = 385), there was no change in 14% (n = 65), and no patients worsened. Preoperatively, patients were similar with respect to Lenke classification (p = 0.44), age (p = 0.31), sex (p = 0.85), and Risser score (p = 0.14). The UT curves in the IMP group self-corrected from 24.7° ± 6.5° to 12.6° ± 5.9°, whereas in the NO IMP group UT curves remained the same, from 20.3° ± 5.8° to 18.5° ± 5.7°. In a multivariate analysis, preoperative main thoracic (MT) curve size (p = 0.004) and MT curve correction (p = 0.001) remained significant predictors of UT curve improvement. Greater correction of the MT curve and larger initial MT curve size were associated with greater likelihood of UT curve improvement. CONCLUSIONS Spontaneous UT curve correction occurred in the majority (86%) of unfused UT curves after MT curve correction in Lenke 1–4 curve types. The magnitude of preoperative MT curve size and postoperative MT curve correction were independent predictors of spontaneous UT curve correction.

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