Axial plane analysis of Lenke 1A adolescent idiopathic scoliosis as an aid to identify curve characteristics.

BACKGROUND CONTEXT: Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional (3D) deformity of the spine involving deviations in the frontal plane, modifications of the sagittal profile, and rotations in the transverse plane. Although Lenke classification system is based on 2D radiographs and includes sagittal thoracic and coronal lumbar modifiers, Lenke et al. suggested inclusion of axial thoracic and lumbar modifiers in the analysis. PURPOSE: To analyze axial plane of Lenke 1A curves to identify curve characteristics. STUDY DESIGN: Retrospective study. PATIENT SAMPLE: Seventy patients (49 women, 21 men) with Lenke Type 1A idiopathic scoliosis were analyzed. OUTCOME MEASURES: Coronal, sagittal, and axial parameters were measured from plain radiographs that were obtained at initial medical examination of the patients. METHODS: Coronal and sagittal plane and whole spine segmental vertebra rotations from thoracic 1 to lumbar 5 were evaluated in 70 AIS patients with Lenke 1A curves by using Drerup method. Three different subgroups were identified according to magnitude and direction of lower end vertebra (LEV) rotation. RESULTS: In Group 1 (Lenke 1A1), the direction of LEV rotation was same with other vertebrae in the main curve and the magnitude of the LEV rotation was less than -0.5°. In Group 2 (Lenke 1A2), the rotation of LEV was between -0.5° and 0.5° and so was accepted as neutral. In Group 3 (Lenke 1A3), the rotation of LEV had opposite direction with vertebrae in the main curve and the magnitude of LEV rotation was more than 0.5°. The mean thoracic Cobb angle of patients with Lenke 1A idiopathic scoliosis was 51.1° (range 37°-80°), whereas the mean lumbar Cobb angle was 16.4° (range 0°-32°). The mean angle of trunk rotation of the patients was 5.7° (range 1°-16°). In terms of maximum thoracic vertebra rotation, the mean rotation angle of Lenke 1A idiopathic curves was -18.9° (range -(9.8°-44.7°)). The mean maximum lumbar vertebra rotation was 4.5° (range -7.2° to 15.1°). CONCLUSIONS: Addition of axial plane analysis to conventional coronal and sagittal evaluations in patients with Lenke 1A curves may reveal inherent structural differences that are not apparent in single planar radiographic assessments and may necessitate a different surgical strategy.

Effect of spinal deformity on adolescent quality of life: comparison of operative scheuermann kyphosis, adolescent idiopathic scoliosis, and normal controls.

STUDY DESIGN: A prospective multicenter study and retrospective chart review. OBJECTIVE: To compare health-related quality of life (HRQOL) measures and sagittal deformity in operative Scheuermann kyphosis (SK), operative adolescent idiopathic scoliosis (AIS), and normal populations. SUMMARY OF BACKGROUND DATA: No study to date has evaluated patient reported HRQOL measures before surgery in operative patients with SK. METHODS: HRQOL data were prospectively collected pretreatment for operative patients with SK using the SRS-22 outcomes instrument and visual analogue scale (VAS). Comparison was made with the SRS-22 from operative AIS and normal populations. Eighty-six patients with SK enrolled in the prospective study were compared with 184 patients with AIS from a prospective database and 31 normal controls. To study the correlation between T5-T12 kyphosis magnitude and SRS-22 score, patients with AIS and SK were pooled together to create a larger continuum of kyphosis. Analysis of covariance, Pearson correlation analysis, and Bonferroni pairwise comparisons were used to determine statistical differences between group demographics, HRQOL indicators, and radiographical variables. RESULTS: Patients with SK had significantly lower scores in all domains of the SRS-22 than patients with AIS. Patients with SK with a thoracolumbar apex reported significantly lower mean scores in the pain domain than those with a thoracic apex. Significant negative correlations were found between all domains of the SRS-22 and T5-T12 kyphosis-the self-image domain demonstrated the highest correlation (r = 0.37). VAS score in the SK population correlated negatively to the pain, self-image, and mental health domains. CONCLUSION: Increasing sagittal plane deformity as a result of SK has a significant impact on HRQOL as determined by the SRS-22 outcome instrument. In this study, patients with SK reported significantly decreased (worse) scores in all subdomains of the SRS-22 compared with patients with AIS. LEVEL OF EVIDENCE: 1.

[Adult Scheuermann's disease as cause of mechanic dorsalgia]. / La malattia di Scheuermann dell'adulto come causa di dorsalgia meccanica.

Scheuermann's disease (SD) or vertebral osteochondrosis is the most frequent cause of non postural kyphosis and one of more frequent cause of adolescent's dorsalgia. The criteria for the diagnosis are: more than 5 degrees of wedging of at least three adjacent vertebrae at the apex of the kyphosis; a toracic kyphosis of more than 45 of Cobb's degree; Schmorl's nodes and endplates irregularities. In addition to classic SD, there are radiological alterations that remain asymptomatic for a long time to reveal in adult age: in that case it speaks of adult Scheuermann's disease (ASD). We considered the diagnosis of patients came from April 2006 to April 2007 on Day Hospital in our Clinic. ASD was diagnosed, besides, in 10 of these patients. 7 patients had previous diagnosis such as: dorsal Spondiloarthrosis (4 subjects); Osteoporosis with vertebral fractures (3 subjects). All these diagnosis was not confirmed by us. In case of chronic dorsalgia of adult, ASD is rarely considered as differential diagnosis. Besides, the vertebral dorsalgia, even in absence of red flags as fever, asthenia,hypersedimetry, functional loss and aching spinal processes to tapping, could hide a serious scene that lead us to be careful in the differential diagnosis, because of similar radiological pictures of the MSA to other pathology as spondylodiscitis, primitive or metastasic spinal tumors, and brittleness vertebral fractures.

Study of vertebral morphology in Scheuermann's kyphosis before and after treatment.

Variation of vertebral morphology in Scheuermann's Kyphosis before and after orthopedic treatment is usually measured by the entity of the curve, using Cobb's method, and by vertebral wedging. But the lack of correlation between these parameters and the clinical evolution of the deformity, lead to the possibility of other alterations that can explain part of the kyphosis deformities before and after the treatment. In this group of alterations the inclination of anterior and posterior walls, that express the trapezoid deformity of vertebras, seem to be more reliable indicators of curve response to ortopedic treatment.

[3-dimensional surface measurement of spinal deformities with video rasterstereography]. / Die dreidimensionale Oberflächenvermessung von Wirbelsäulendeformitäten anhand der Videorasterstereographie.

QUESTION: Video rasterstereography is a method for back surface measurement comprising automatic back surface reconstruction and shape analysis. Aim of this prospective study was to determine the accuracy of this method in comparison to the conventional frontal and lateral standing radiographs. METHOD: 95 patients with idiopathic scoliosis or scoliotic postural abnormalities and 18 patients with thoracic hyperkyphosis and Scheuermann's disease were investigated. The Cobb angles, the sagittal profile and apical vertebral rotation as well as pelvic obliquity and trunk decompensation were measured. The analysis was carried out by two independent observers. RESULTS: The root mean square (r.m.s.) deviation of the Cobb angle in the cases of idiopathic scoliosis ranged between 7 degrees and 8 degrees. In video rasterstereography there were no false negative results and two false positive results concerning differentiation between structural scoliosis and scoliotic postural abnormality. The r.m.s. deviation of apical vertebral rotation averaged 7.9 degrees and for pelvic obliquity respectively trunk imbalance 0.65 cm respectively 1.07 cm. The thoracic hyperkyphosis in Scheuermann's disease showed a r.m.s. deviation of 5.6 degrees. CONCLUSIONS: Video rasterstereography is a reliable method in the three-dimensional evaluation of spinal deformities and constitutes a valuable additional tool to the clinical examination and can reduce the number of radiographs.

Lumbar Scheuermann's. A clinical series and classification.

Scheuermann's disease of the thoracic spine is a well-defined entity, although its exact etiology is unknown. In the thoracolumbar or lumbar spine however, the criteria are much less strict for the application of this eponym. A retrospective review of all the cases of lumbar Scheuermann's disease seen at the Texas Scottish Rite Hospital revealed two distinct radiographic pictures. These consisted of a "classic" Scheuermann's and an "atypical" type characterized by vertebral end plate changes, disc space narrowing, and anterior Schmorl's nodes, but not otherwise fulfilling Sorenson's criteria. This group tended to occur in more athletic adolescents or those with a history of increased axial stress to the spine. A subgrouping of atypical Scheuermann's disease is proposed and includes acute traumatic intraosseous disc herniation. Based on these findings, a classification of lumbar Scheuermann's disease is proposed.