ABSTRACT
STUDY DESIGN: Prospective study. PURPOSE: To determine the role of routine preoperative magnetic resonance imaging (MRI) to detect the incidence and risk factors for intraspinal anomalies in patients with idiopathic scoliosis. OVERVIEW OF LITERATURE: The incidence and risk factors for intraspinal anomalies in patients with idiopathic scoliosis are controversial, and the indications for preoperative MRI in these patients vary among centers. METHODS: Information on patients with idiopathic scoliosis who were surgical candidates over 10 years (age at presentation, sex, magnitude and apex of major curve, intraspinal anomalies detected by MRI, and neurological examination results) were recorded, the patients were grouped according to the intraspinal anomaly, and the data were analyzed. RESULTS: Of the 271 patients with idiopathic scoliosis, 27 had neuroaxial abnormalities (9.9%). Of these 27 patients, 14 (52%) underwent a neurosurgical procedure. Significant differences were observed in the frequency of early disease onset and male sex (p<0.05) between the group of patients with neuroaxial abnormalities on preoperative MRI and those who did not have a cord anomaly. No difference was detected in the magnitude or direction of the curve. CONCLUSIONS: Neuroaxial abnormalities in patients with idiopathic scoliosis and a normal neurological examination were highly frequent (9.9%). Missing these abnormalities before surgery could inflict catastrophic postoperative complications. The incidence of neuroaxial abnormalities was higher in male patients and in those with early onset disease. Thus, MRI is essential for all patients with idiopathic scoliosis who require medical intervention.
Subject(s)
Humans , Male , Congenital Abnormalities , Incidence , Magnetic Resonance Imaging , Neurologic Examination , Neurosurgical Procedures , Postoperative Complications , Prospective Studies , Risk Factors , Scoliosis , Spinal CordABSTRACT
Restoration of the sagittal alignment is one of the fundamental goals in scoliosis correction surgery. Having an increase in popularity of segmental spinal instrumentation, thoracic kyphosis [TK] is often sacrificed to achieve frontal and axial plane correction. Patients with a Lenke type 1 deformity underwent selective thoracic fusion [lowest instrumented vertebra of T12 or L1] using corrective segmental spinal instrumentation [Hook-Rod] and were followed up for 2 years. They were evaluated before and after operation for coronal and sagittal alignments using standing anteroposterior and lateral radiographs. There were 63 patients [21 male, 42 female] with a mean age of 15.8 +/- 2.1 years included to this study. TK reduction had significant correlation [P
ABSTRACT
Several studies have suggested higher incidence of osteoporosis in patients with idiopathic scoliosis in comparison with the normal population. The aim of this study was to assess the prevalence of low bone mass among adolescent girls with idiopathic scoliosis. In this cross-sectional study performed in shafa Hospital in Tehran, Iran during 2011-2012, we recruited fifty-seven 12- to-20-year old girls with idiopathic scoliosis and compared them with 100 age-matched healthy girls. The patients had no other diseases including neuromuscular disorders, congenital vertebral anomalies or a history of spinal surgery. Bone mineral densities [BMD] of the hip and spine were evaluated and compared in all 157 participants using dual X-ray absorptiometry [DXA]. Standard BMD [sBMD] was also calculated at the lumbar spine. Analysis of the data revealed that hip BMD was significantly [P=0.004] lower in patients with idiopathic scoliosis versus the controls. Moreover, BMD and sBMD of the Spine were also significantly lower in the patients [respectively, P=0.030 and P=0.030]. Curve location had no effect on the values of hip BMD, spine BMD or spine sBMD [respectively, P=0.061 and P=0.274 and P=0.208]. Finally, with more severe curves a lower bone mass was detected for sBMD and spine BMD [respectively, P=0.017 and P=0.016], but it was not significant for hip BMD [P=0.069]. Adolescent girls with idiopathic scoliosis had lower bone mass compared with their healthy peers. The lower bone mass was correlated with the severity of the curve but not its location.
ABSTRACT
Distal junctional kyphosis [DJK] is a radiographic finding in patients that undergo spinal instrumentation and fusion, since there is an abrupt transition between fixed and mobile spinal segments.The true incidence of DJK is variable in literature and seems that has a multifactorial etiology. A consecutive series of 130 patients [mean age 15.6 years] with Adolescent Idiopathic Scoliosis who underwent posterior spinal fusion and instrumentation were evaluated by analyzing coronal and sagittal angulation and balance measurements from standing radiographs obtained pre-operatively, within 6 weeks post-operation, at two years postoperative and at the latest follow-up. There was 35 male and 95 female. The mean time of followup was 36 months. The incidence of DJK at latest follow-up was 6.9% [9 patients]. In DJK group, distal junctional angle from pre-operative of-12.5 lordosis [-30 to 0] reached to-5.5 [P=0.015] at 6 weeks postoperation and to-1.4 [-20 to 12] [P=0.000] at 2 years follow-up, with mean of 12.1 kyphotic change [10-20]. In non DJK group, distal junctional angle from pre-operative angle of-7.5 reached-8.1 at 2 years follow-up [P=0.43]. The mean age of DJK group at surgery was 17 years and for non-DJK group was 15.4 years [P=0.022]. Distal junctional kyphosis was less common in this study than previous reports and stabilized after two years. The magnitude of coronal cobb angles or multiplicity of coronal curves had no effect in developing DJK that may be prevented by incorporation of the first lordotic disc into the fusion construct
Subject(s)
Humans , Male , Female , Scoliosis , Adolescent , Arthrodesis , Prevalence , Spinal FusionABSTRACT
Bracing is the non-operative treatment of choice for adolescent idiopathic scoliosis [AIS] and careful application of pads on apical segment of curve is very important for correction. Control of pads' appropriate site in brace is not easy by clinical evaluation. Therefore, we decided to compare results of braces which for better control of pads by radiographs, metal marker inserted around pads with those without metal marker. We evaluated 215 consecutive cases [182 female, 33 male] of AIS with 342 major curves from 1993 to 2003. Mean initial age was, 13.2 +/- 1.8 years [9-16] and mean duration of follow-up was, 16.1 +/- 16.4 months [0-114] that treated by 4 type of brace; 89 with type 1[Milwaukee with metal pads], 87 with type 2 [Milwaukee with simple pads], 17 with type 3 [Boston with metal pads] and 22 with type 4[Boston with simple pads]. Cobb angle recorded at 5 stages [initial, best, wean, stop and final follow-up]. Mean initial Cobb was 36.2°, at stop stage, 35.2° and reached 38° at final follow-up. Overall, 21.3% improved, 42.2% were the same and 36.5% failed. Failure for braces type 1 to 4 were, 40.5%, 34%, 38% and 24% at final follow-up. A total of 59 patients [27.4%] underwent spinal fusion that for brace type 1 to 4, was, 33, 21, 2 and 3 patients respectively. From 16 cases with initial Cobb of 50°, at follow-up, 12 were >/= 50° or had spinal fusion. Correction of lumbar [P=0.008] and main thoracic curves [P=0.002] was better by Boston than Milwaukee, however, in general difference between 4 types of braces was not significant and metal marker had no significant effect on results. Two important predictors of brace failure were, initial curve magnitude and brace type, but using metal marker around pads had no effect in results. It seems that bracing did not alter the natural history of scoliosis in early Risser stages with large magnitude of initial curves. Insertion of metal marker around pads is easy and cheap way that facilitate control of pad sites well, so, we recommend to use
Subject(s)
Humans , Male , Female , Braces , MetalsABSTRACT
Scoliosis is one of the most common spinal deformities with subsequent decrease in pulmonary function. The effects of surgical correction on the pulmonary function of patients with adolescent idiopathic scoliosis are controversial. The purpose of the present study was to compare the postoperative pulmonary function changes in different surgical approaches chosen for its correction. Sixty-five patients with adolescent idiopathic scoliosis who had undergone corrective spinal surgery in Shafa Yahyaian Hospital since 1997 to 2007 and had documented preoperative pulmonary function test report, included in our study. The patients had documented preoperative pulmonary function tests and were divided into three groups based on their surgical approach. The first group was comprised of 25 patients who had undergone posterior spinal fusion [PSF], the second group included 29 patients who had anterior and posterior spinal fusion [ASF+PSF], and the third group consisted of 10 patients who had posterior spinal fusion and thoracoplasty [PSF+thoracoplasty]. The preoperative and the final follow-up values of absolute and percent predicted forced vital capacity [FVC] and forced expiratory volume in one second [FEV1] were compared and their relations with the undertaken surgical approach were evaluated. There were no significant correlations between the surgical approaches and changes in the pulmonary function tests [P>0.05]. FVC and FEV1 values were similar to preoperative values in all groups after a minimum follow-up of two years. There were no significant differences between different surgical approaches for adolescent idiopathic scoliosis regarding the pulmonary function test results after at least two years of follow-up
ABSTRACT
Congenital scoliosis occurs because of either the failure of formation or the failure of segmentation or both. Evaluation of the incidence and the types of occult intraspinal abnormalities in congenital scoliosis is the subject of this study. During a period of 29 years, 103 patients with congenital scoliosis were studied. MRI was used in 46 patients, myelography or CT myelography was used in 64 patients and both MRI and myelography or CT myelography were used in 7 patients for intraspinal abnormalities. In the MRI group, among the 46 patients, 19 patients [41.3%] had intraspinal abnormalities consisting syringomyelia in 9 [19.5%] diastematomyelia in 8 [17.4%], tethered cord syndrome in 6 [13%], low conus in 5 [10.8%] and diplomyelia in 3 [6.5%] of the patients. In the myelography group, among the 64 patients, 17 [26.5%] had intraspinal abnormalities and diastematomyelia was the most common one found in 14 [21.8%] patients. Intraspinal abnormalities are frequent in congenital scoliosis. Syringomyelia may be associated with congenital scoliosis. In congenital scoliosis, rib fusion may be an indicator of intraspinal abnormalities in MRI. A significant difference between clinical findings and intraspinal anomalies [P<0.05] was noted. Moreover, we believe that total spinal MRI with coronal, sagittal and axial views is a valuable tool in determining the intraspinal abnormalities in congenital scoliosis. This method is highly recommended for detection and neurosurgical intervention before corrective surgeries.