Are trunk muscles weaker in adolescents females with adolescent idiopathic scoliosis compared with their healthy counterparts?

BACKGROUND: Adolescent Idiopathic Scoliosis (AIS) requires complex medical care because of multiple consequences especially on daily activities. Muscular involvement is part of the problem and may be treatable. OBJECTIVE: To analyze trunk muscle strength using an isokinetic dynamometer in female adolescents with AIS one year after orthopedic treatment by brace and compare the findings to a matched group of an asymptomatic cohort. METHODS: The trunk flexors and extensors strength was measured using an isokinetic dynamometer at 60, 90 and 120∘/s. Peak Moment (PM), Mean Power (MP) and the flexor/extensor ratio in 100 patients aged 14 to 18 years old were compared to a control group (N= 32) of asymptomatic age-matched females. In the AIS group, correlation analyses were computed to search for contributing factors to isokinetic performances, including morphological characteristics of patients, as well as clinical and radiological characteristics of the scoliosis. RESULTS: The trunk flexors in the AIS group were significantly but moderately (15%) weaker across speeds compared to their control counterparts at all speeds. No parallel weakness was noted for the extensors. While the MP of AIS patients was significantly weaker than that of the controls, 33% for flexors and by 31% for extensors, no significant differences were observed for the F/E ratios. The correlational analyses has indicated that weight and BMI were contributing factors at all speeds. CONCLUSION: Adolescents with AIS had weaker trunk extensors and mostly flexors compared to healthy females. Within this AIS population, weight and BMI seem to have a negative impact on muscular performances, whereas clinical and radiological characteristics of the scoliosis do not seem to contribute.

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Magnitude of thoracic spine deformity affecting morphologial characteristics of paraspinal muscles in patients with severe idiopathic scoliosis

Genij Ortopedii ◽

10.18019/1028-4427-2021-27-1-68-73 ◽

2021 ◽

Vol 27 (1) ◽

pp. 68-73

Author(s):

E.N. Shchurova ◽

◽

G.N. Filimonova ◽

S.O. Ryabykh ◽

◽

...

Keyword(s):

Idiopathic Scoliosis ◽

Thoracic Spine ◽

Light Microscope ◽

Structural Changes ◽

Morphological Characteristics ◽

Surgical Correction ◽

Control Group ◽

Special Focus ◽

Spine Deformity ◽

Paraspinal Muscles

Introduction Morphological, biochemical and histopathological characteristics of paraspinal muscles have been well described in patients with idiopathic scoliosis. However, there is a paucity of literature on morphological picture of paraspinal muscles in patients with severe idiopathic scoliosis. Objective To explore how the magnitude of thoracic spine deformity affects morphological characteristics of paraspinal muscles in patients with severe idiopathic scoliosis. Material and methods A total 21 patients with idiopathic scoliosis were reviewed. The patients were assigned to two groups depending on magnitude of preoperative thoracic spine deformity. A major group consisted of patients with scoliosis of ≥ 60º (n = 11) and control group included patients with a curve < 60º (n=10). Biopsy samples were taken from muscle fragments (multifidus muscle) at the apex of the curve (major arc) at the Th6-Th10 level on the convex side while approaching to the posterior spinal structures during surgical correction of kyphoscoliosis using light microscope. The specimens were examined histologically with light microscope. Results Patients with severe idiopathic scoliosis (≥ 60º) showed evident muscle fiber atrophy and dystrophy of different extent. There were nucleus free areas and homogenized muscle fragments observed with connective tissue layers being swollen and frayed with multiple fibroblasts seen in nearly all the samples. Arterial walls were normally fibrotized. Structural changes ranged from minimal with a curve of 60º to degrading muscles with the fibers replaced by fat and connective tissues with a curve angle of 145º. Conclusion Morphological characteristics of paraspinal muscles have been shown to be severely affected by the magnitude of thoracic spine deformity in patients with severe idiopathic scoliosis. The findings should be considered in surgical correction of kyphoscoliosis with special focus on postoperative vascular and neurotropic therapy to allow wound healing and lower complication rate.

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EFFECTS OF THE SCHROTH METHOD FOR TRUNK MUSCLES’ STATIC ENDURANCE AND SPINE MOBILITY IN GIRLS WITH IDIOPATHIC SCOLIOSIS

Visuomenės sveikata ◽

10.5200/sm-hs.2017.081 ◽

2017 ◽

Vol 27 (5) ◽

pp. 71-75

Author(s):

Vaiva Strukčinskaitė ◽

Juozas Raistenskis ◽

Aurelija Šidlauskienė ◽

Birutė Strukčinskienė ◽

Sigitas Griškonis

Keyword(s):

Idiopathic Scoliosis ◽

Treatment Method ◽

University Hospital ◽

Trunk Muscles ◽

Control Group ◽

Abdominal Muscles ◽

Study Group ◽

Trunk Flexion ◽

Rehabilitation Centre ◽

Spine Mobility

The prevalence of scoliosis in the paediatric population is increasing every year. The treatment of idiopathic scoliosis in Lithuania is based on traditional physical therapy, and it is not always the most effective. Schroth method recently is widely globally used evidence-based conservative scoliosis treatment method. The aim of the study was to assess the effects of the Schroth method treatment for trunk muscles’ static endurance and spine mobility in girls with idiopathic scoliosis. The study was conducted in 2016-2017 at the Physical Medicine and Rehabilitation Centre, Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos. In the study participated 50 girls aged 9-17 years with idiopathic scoliosis. The patients were divided into two groups: the study group (n = 25) and the control group (n = 25). Schroth treatment method for the study group and a traditional physiotherapy for the control group were used. For patients were applied 10 procedures of physiotherapy (for 30 minutes, 5 times a week). The study showed that trunk muscles’ static endurance results after rehabilitation were significantly higher in the study group than in the control group (p<0.05). The analysis of the average changes in the results between the groups revealed that in the study group the results of abdominal muscles (16.08 s more), left side trunk muscles (6.98 s more), and right side trunk muscles (7.84 s more) had changed significantly. Results of spine mobility significantly improved in both groups after rehabilitation (p<0.05). Trunk flexion amplitude estimated to have significantly greater improvement in the study group. The treatment using Schroth method had significantly improved the indicators of trunk muscles’ static endurance and mobility of the spine during spinal flexion. When compare the results inside the groups, the significant change was shown in the majority of spine and posture-related parameters in the study group. Special physiotherapy, especially Schroth method for children with idiopathic scoliosis have been shown to be an effective conservative treatment for scoliosis.

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FUNCTIONAL CAPACITY IN ADOLESCENT IDIOPATHIC SCOLIOSIS DURING THE POSTOPERATIVE PERIOD

Revista Brasileira de Medicina do Esporte ◽

10.1590/1517-869220192502185369 ◽

2019 ◽

Vol 25 (2) ◽

pp. 127-132

Author(s):

Geferson da Silva Araujo ◽

Bruna Marques de Almeida Saraiva ◽

Evandro Fornias Sperandio ◽

Marcos de Toledo Filho ◽

Jaqueline de Mesquita Freira ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Exercise Capacity ◽

Breathing Pattern ◽

Control Group ◽

Walk Test ◽

Level Of Evidence ◽

Know How ◽

Spinal Curve ◽

Oxygen Uptake Efficiency Slope

ABSTRACT Introduction: Patients with Adolescent Idiopathic Scoliosis (AIS) show reduced exercise capacity during the Incremental Shuttle Walk Test (ISWT). However, we not know how patients behave in the late postoperative (LPO) period. Objective: The aim of this study was to evaluate the ISWT distance (ISWTD) and physiological responses during ISWT in AIS patients during the LPO period. Methods: We included 22 patients with AIS in the LPO period (SG) and 21 adolescents in the Control Group (CG). We assessed pulmonary function (FVC and FEV1). During ISWT, a gas analyzer was used to assess peak oxygen (VO2) and submaximal relations: Oxygen Uptake Efficiency Slope (OUES) and the breathing pattern (ΔVT/ΔlnVE). Results: Significantly lower values were observed in SG: VO2 (22 ± 5 vs. 27 ± 4), ISWTD (567 ± 94 vs.604 ± 86), FVC (2.70 ± 0.47 vs. 3.33 ± 0.52) and FEV1 (2.41 ± 0.46 vs. 2.84 ± 0.52). There were significant correlations between ISWTD and VO2/Kg (r = 0.80); between OUES and ΔVT/ΔlnVE (r = 0.65); and between the main thoracic curve with VO2/Kg (r= −0.61). Conclusion: AIS patients in the LPO period have significantly reduced exercise capacity associated with reduced lung function, residual spinal curve and cardiovascular deconditioning. Level of Evidence III; Prognostic Studies - Investigation of the effect of characteristic of a patient on the outcome of the disease.

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Selective thoracolumbar/lumbar fusion for Syringomyelia-associated scoliosis: a case-control study with Lenke 5C adolescent idiopathic scoliosis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03779-0 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Fan Feng ◽

Hongxing Shen ◽

Xiuyuan Chen ◽

Zude Liu ◽

Jianwei Chen ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Thoracic Kyphosis ◽

Case Control Study ◽

Lumbar Fusion ◽

Neurological Deficits ◽

Control Group ◽

Control Study

Abstract Background Selective thoracolumbar/lumbar fusion technique was introduced to treat adolescent idiopathic scoliosis (AIS) patients with major thoracolumbar/lumbar curves. Theoretically, this surgical strategy could also be applied to syringomyelia patients. No previous study has specifically addressed the effectiveness of selective thoracolumbar/lumbar fusion for patients with syringomyelia-associated scoliosis. The aim of the study was to investigate the effectiveness of selective thoracolumbar/lumbar fusion for the surgical treatment of patients with syringomyelia-associated scoliosis. Methods From February 2010 to September 2016, 14 syringomyelia-associated patients with major thoracolumbar/lumbar curves were retrospectively reviewed. Besides, 30 Lenke 5C AIS patients were enrolled as a control group. Posterior selective thoracolumbar/lumbar fusion was performed for both groups. Patients’ demographic, operative, radiological, and quality of life data were reviewed with follow-up. Intragroup comparisons were performed for each parameter. Results The two groups were matched by age, gender, curve characteristics, duration of follow-up, and all preoperative radiographic parameters except for thoracic kyphosis. After surgery, the average correction rate of the major thoracolumbar/lumbar curve was 82.2 ± 7.8% in the syringomyelia group, which was not significantly different from that of AIS group (82.5 ± 10.6%, P = 0.47). A similar improvement of unfused thoracic curve was observed between the two groups (50.1 ± 16.5% vs. 48.5 ± 26.9%, P = 0.29). During the follow-up, the correction effect of scoliosis was well maintained, without aggravation of the original neural symptoms or fresh permanent neurological deficits. Of note, the number of fusion levels was significantly larger in syringomyelia group than that in AIS group (7.6 ± 1.4 vs. 6.5 ± 1.2, P < 0.01). The average follow up was 47.6 months (36–81 months). Conclusion Similar to AIS cases, syringomyelia-associated scoliosis can be effectively and safely corrected by selective thoracolumbar/lumbar fusion with satisfactory surgical outcomes. However, the syringomyelia group, on average, required an additional fused segment for treatment as compared to the AIS group (7.6 versus 6.5 in the AIS group).

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Impact of Scoliosis Severity on Functional Capacity in Patients With Adolescent Idiopathic Scoliosis

Pediatric Exercise Science ◽

10.1123/pes.2017-0080 ◽

2018 ◽

Vol 30 (2) ◽

pp. 243-250 ◽

Cited By ~ 7

Author(s):

Bruna M.A. Saraiva ◽

Geferson S. Araujo ◽

Evandro F. Sperandio ◽

Alberto O. Gotfryd ◽

Victor Z. Dourado ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Tidal Volume ◽

Functional Capacity ◽

Forced Vital Capacity ◽

Vital Capacity ◽

Physiological Responses ◽

Spinal Curvature ◽

Control Group ◽

Walk Test

Purpose: The aim of this study is to evaluate the walked distance and physiological responses during incremental shuttle walk test in patients with different degrees of adolescent idiopathic scoliosis (AIS). Methods: We evaluated 20 healthy teenagers and 46 patients with AIS; they were divided into 2 groups: AIS > 45° and AIS < 45°. The volunteers performed an incremental shuttle walk test, and the following physiological responses were quantified: oxygen consumption, tidal volume, ventilation, and the incremental shuttle walked distance. Respiratory muscle strength was quantified, pulmonary function test was performed, and the forced vital capacity and expiratory volume in the first second were obtained. Results: Patients with AIS > 45° presented significant reduced incremental shuttle walked distance compared with the AIS < 45° and control group [447 (85), 487 (95), and 603 (85), respectively]. Patients with AIS also showed reduced forced vital capacity (P = .001) and expiratory volume in the first second (P = .005) compared with control group. Moderate correlations between forced vital capacity (r = −.506) and tidal volume (r = −.476) with scoliosis angles were found. Conclusions: The incremental shuttle walk test was capable of identifying reduced functional capacity in patients with different degrees of AIS. Moreover, the severity of spinal curvature may exert influence on ventilatory and metabolic variables.

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Disordered leptin and ghrelin bioactivity in adolescent idiopathic scoliosis (AIS): a systematic review and meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01988-w ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Qi Wang ◽

Chi Wang ◽

Wenhao Hu ◽

Fanqi Hu ◽

Weibo Liu ◽

...

Keyword(s):

Systematic Review ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Leptin Receptor ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Mean Difference ◽

Control Group ◽

Mineral Density ◽

Soluble Leptin Receptor

Abstract Background Adolescents with scoliosis consistently demonstrate lower body weight, lean muscle mass, and bone mineral density than healthy adolescent counterparts. Recent studies have focused on understanding how leptin and ghrelin signaling may play a role in adolescent idiopathic scoliosis (AIS). In our current study, we aim to evaluate the serum levels of leptin, soluble leptin receptor (sOB-R), and ghrelin in AIS patients through systematic review and meta-analysis. Methods We conducted our systematic review by searching the keywords in online databases including PubMed, Embase, Cochrane, Elsevier, Springer, and Web of Science from the time of database inception to January 2020. Inclusion criteria were studies that measure leptin, soluble leptin receptor (sOB-R), and ghrelin levels in AIS patients. Selection of studies, assessment of study quality, and data extraction were performed by two reviewers independently. Then, data was analyzed to calculate the mean difference and 95% confidence interval (CI). Results Seven studies concerning leptin/sOB-R and three studies concerning ghrelin were qualified for meta-analysis (one study concerning both leptin and ghrelin). Serum leptin of patients with AIS were significantly lower when compared with healthy controls, with the weighted mean difference (WMD) of − 0.95 (95% CI − 1.43 to − 0.48, p < 0.0001) after reducing the heterogeneity using six studies for meta-analysis, while sOB-R and ghrelin level was significantly higher in AIS group when compared with control group, with the WMD of 2.64 (95% CI 1.60 to 3.67, p < 0.001) and 1.42 (95% CI 0.48 to 2.35, p = 0.003), respectively. Conclusion Our current meta-analysis showed that serum level of leptin in AIS patients was significantly lower when compared with control subjects, while serum sOB-R and ghrelin levels were significantly higher in AIS patients. More clinical studies are still required to further validate the predictive value of leptin or ghrelin for the curve progression for AIS patients.

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Abnormal Osteoblastic Response to Leptin in Patients with Adolescent Idiopathic Scoliosis

Scientific Reports ◽

10.1038/s41598-019-53757-3 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Gene Chi-Wai Man ◽

Elisa Man-Shan Tam ◽

Yi Shun Wong ◽

Vivian Wing-Ying Hung ◽

Zongshan Hu ◽

...

Keyword(s):

Cell Proliferation ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Leptin Receptor ◽

Unknown Etiology ◽

Control Group ◽

Functional Responses ◽

Osteoblastic Activity ◽

Significant Difference

AbstractAdolescent idiopathic scoliosis (AIS) is a complex three-dimensional structural deformity of the spine with unknown etiology. Although leptin has been postulated as one of the etiologic factors in AIS, its effects on osteoblastic activity remain unknown. Herein, we conducted this study to investigate whether there are abnormal functional responses to leptin and abnormal expression of leptin receptor in AIS osteoblasts. In vitro assays were performed with osteoblasts isolated from 12 severe AIS girls and 6 non-AIS controls. The osteoblasts were exposed to different concentrations of leptin (0, 10, 100, 1000 ng/mL). The effects of leptin on cell proliferation, differentiation and mineralization were determined. Protein expressions of leptin receptor (LEP-R) under basal and osteogenic conditions were also evaluated by Western blot. Our results showed that leptin significantly stimulated osteoblasts from non-AIS subjects to proliferate, differentiate and mineralized. However, in the AIS group, the stimulatory effects of leptin on cell proliferation, differentiation, and mineralization were not observed. In addition, no statistically significant difference in the expression of leptin receptor under both basal and osteogenic conditions was found between AIS and control group. In conclusion, these findings might help to explain the low bone mass and deranged bone quality that is clinically associated with AIS girls.

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Prevalence and Management of Back Pain in Adolescent Idiopathic Scoliosis Patients: A Retrospective Study

Pain Research and Management ◽

10.1155/2015/674354 ◽

2015 ◽

Vol 20 (3) ◽

pp. 153-157 ◽

Cited By ~ 25

Author(s):

Jean Théroux ◽

Sylvie Le May ◽

Carole Fortin ◽

Hubert Labelle

Keyword(s):

Back Pain ◽

Pain Management ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Negative Impact ◽

Treatment Plan ◽

Well Being ◽

University Teaching ◽

Care Utilization ◽

Present Sample

BACKGROUND: Back pain (BP) has often been associated with adolescent idiopathic scoliosis (AIS), which is a three-dimensional deviation of the vertebral column. In adolescents, chronic pain appears to be a predictor of health care utilization and has a negative impact on physical, psychological and family well-being. In this population, BP tends to be persistent and may be a predictor of BP in adulthood.OBJECTIVE: To document the prevalence and management of BP in AIS patients.METHODS: A retrospective chart review of AIS patients who were referred to Sainte-Justine University Teaching Hospital (Montreal, Quebec) from 2006 to 2011 was conducted.RESULTS: A total of 310 randomly selected charts were reviewed. Nearly one-half of the patients (47.3%) mentioned that they experienced BP, most commonly in the lumbar (19.7%) and thoracic regions (7.7%). The type of BP was documented in only 36% (n=112) of the charts. Pain intensity was specified in only 21% (n=65) of the charts. In approximately 80% (n=248) of the charts, no pain management treatment plan was documented.CONCLUSIONS: The prevalence of BP was moderately high among the present sample of adolescents with AIS. An improved system for documenting BP assessment, type, treatment plan and treatment effectiveness would improve pain management for these patients.

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Functional deficits in post-operative adolescent idiopathic scoliosis

Physiotherapy Practice and Research ◽

10.3233/ppr-190365 ◽

2021 ◽

Vol 41 (2) ◽

pp. 133-141

Author(s):

Anthony Rafferty ◽

Bernard Donne ◽

Patrick Kiely ◽

Neil Fleming

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Lower Limb ◽

Control Group ◽

Fusion Surgery ◽

Joint Flexibility ◽

Spinal Fusion Surgery ◽

Muscle Testing ◽

And Control

BACKGROUND: Little or no research currently exists investigating musculoskeletal strength, joint flexibility and cardiopulmonary capacity post-operative adolescent idiopathic scoliosis (AIS) patients. PURPOSE: To explore if AIS patients following spinal fusion surgery have deficiencies in strength, endurance joint flexibility and pulmonary capacity (>12-month post-operative) compared to a matched sample of the general population. METHODS: This retrospective case control study; AIS group (n = 20) and control group (n = 20) matched for gender, age and anthropometrics. Participants underwent standardised tests to establish pulmonary capacity via spirometry, upper and lower limb strength via manual muscle testing, upper and lower limb endurance via press-up and wall squat tests and joint flexibility via manual goniometry. Within session reliability and reproducibility of variables were assessed. RESULTS: No significant differences between AIS and control cohorts were identified for mass (57.1±9.0 vs. 62.8±9.0kg), height (164.7±6.3 vs. 165.6±6.0cm) or BMI (21.2±4.0 vs. 22.9±2.7). Pulmonary and musculoskeletal deficiencies in the AIS cohort were identified, including significantly lower forced vital capacity (FVC; 2.6±0.5 vs. 3.3±0.5L, P < 0.001) and forced expiratory volume in 1 second (FEV1, 2.8±0.6 vs. 3.3±0.5L, P < 0.001); restrictions in shoulder flexion (P < 0.01) and internal rotation (P < 0.001) weaker bilateral pinch grip (P < 0.01) and bilateral hip adductor strength (P < 0.01). CONCLUSION: The results highlight that AIS patients still have major pulmonary and musculoskeletal impairments over a year after spinal fusion surgery. Clinicians should consider periodic assessment of pulmonary and musculoskeletal function with comparison to these age-matched reference values in order to improve the post-operative rehabilitation process.

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A comparison of foot posture and walking performance in patients with mild, moderate, and severe adolescent idiopathic scoliosis

PLoS ONE ◽

10.1371/journal.pone.0251592 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251592

Author(s):

Feilong Zhu ◽

Qianqin Hong ◽

Xiaoqi Guo ◽

Dan Wang ◽

Jie Chen ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Center Of Pressure ◽

Cross Sectional Study ◽

Spinal Curvature ◽

Control Group ◽

Cross Sectional ◽

Severe Scoliosis ◽

Foot Posture ◽

Walking Performance

Background Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis. However, the underlying mechanisms linking spinal curvature in AIS to foot characteristics and walking performance remain unclear. Objective This study aimed to compare walking performance between adolescents with mild, moderate, and severe scoliosis and matched healthy peers with foot posture as covariates. Methods This cross-sectional study of 96 adolescents was conducted between April 2020 to October 2020 in China, with 32 healthy peers in the control group and 64 patients in the AIS group. Foot posture and morphology, plantar pressure distribution, and gait characteristics were analyzed. One-way analysis of variance with Bonferroni correction and a post hoc comparison of the mean differences between the different groups was performed. Multiple analyses of covariance adjusted for age, sex, body mass index, foot posture index (FPI), arch index (AI), and walking speed were performed. Results Of the 64 adolescents with scoliosis, 18 had mild AIS, 32 had moderate AIS, and 14 had severe AIS. The AI and FPI were much higher in the moderate and severe AIS groups (p = 0.018) and the severe AIS group (p<0.001), respectively, than in the control group. The severe AIS group had advanced and longer midstance (p = 0.014) and delayed propulsion phase (p = 0.013) than the control group. Patients with moderate and severe AIS had asymmetrical gait periods in the left and right limbs (p<0.05). Significant differences in the center-of-pressure excursion index (CPEI) were found between the moderate and severe AIS and control groups (p = 0.003). Conclusion Moderate and severe AIS significantly influenced walking performance; however, no significant differences were observed between adolescents with mild AIS and healthy controls. Thus, early intervention could target the prevention of specific functional deficits and prevent it from progressing to a severe state.

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