Adolescent Idiopathic Scoliosis

Aim and Purpose: It is very difficult to manage the treatment of early onset scoliosis (EOS). It is necessary to start the diagnosis and
treatment of patients with EOS as early as possible and to plan the treatment well. We investigated the pathologies seen in spinal,
orthopedic, cardiovascular and the other organ systems caused by different etiologies in EOS with the help of magnetic resonance
imaging (MRI) and other diagnostic methods based on etiologic reasons.
Material and Method: We evaluated 62 EOS patients (with 26 congenital, 21 neuromuscular, 10 syndrome and 5 idiopathic reasons)
whose spines were investigated with MRI that were operated and/or managed due to having scoliosis between the years of 2005-
2011. The evaluation mean age with MRI was about 4.3 years (3 months-11 years 10 months) and 38 of them were females and 24 of
whom were males. In all patients, we investigated the intraspinal, extraspinal and additional organ anomalies with MRI. We measured
the coronal and sagittal plain deformity of the spine with the Cobb method. We also investigated the orthopedic pathologies clinically,
radiologically and the additional organ anomalies with abdominal ultrasound and echocardiogram.
Results: We found intraspinal anomalies in 48 patients (77.4%), intraspinal anomalies in 46 patients (74.1%), and additional organ
anomalies in 9 patients (14.5%). We saw 98 intraspinal and 101 extraspinal pathologies with MRI. When evaluated according to the
spinal regions, 50 (80.6%) patients had thoracic, 38 (61%) had lumbar, 28 (45%) cervical, 4 (6.4%) sacral areas. There was syringomyelia at most as intraspinal anomalies in 54.8% (34 patients). We found intraspinal anomalies in neuromuscular scoliosis mostly 55.1% (54 pathologies). The most extraspinal was hemivertebra 38.7% (in 24 patients) and the most frequent was congenital scoliosis 62.37% (63 pathologies). The mean Cobb angle in all cases was measured as 46.6° (10-113°). We found kyphosis increase in 18 (29%) cases and lordosis increase in 4 (6.4%) cases. Additionally in 37 (59.6%) patients 56 orthopedic pathologies were found. The problems seen together most were motor weakness in lower extremities in 12 patients (21%), hip dysplasia in 9 (16%) patients and thorax deformities in 9 (16%) patients. Orthopedic pathologies were seen in neuromuscular scoliosis in 19 (32%) patients. We found cardiovascular anomalies in 7 (11.2%) patients (at most ASD), urogenital anomalies in 11 (17.74%) patients (at most bowel and bladder incontinence), other organic defects in 12 (%19.35) patients (at most inguinal hernia). 33 (53.2%) patients were operated. 18 (29%) of them had been operated before because of intraspinal anomaly, 15 (24.1%) were operated due to orthopedic or other organ anomalies, only in 7 (11.2%) cases VEPTR (4), growing rod (1), epiphysiodesis (1) and hemivertebra (1) excision were applied.
Discussion: Even though scoliosis has differences based on its causes, all spinal and other organ anomalies will probably accompany
EOS. While the intraspinal anomaly of the spine is seen in NS, syringomyelia is the most common reason of intraspinal anomalies.
The extraspinal anomaly of the spine is CS and the most common cause is hemivertebra. Thoracic vertebra is mostly affected. The
orthopedic pathologies are mostly seen in NS. As a cardiovascular anomaly mostly ASD is seen together with SS. In addition to careful
clinical and radiologic investigations, with an early MRI we can understand better the other anomalies that are seen together.

When I was twelve years old, I attended a routine school posture screening.
Following an orthopaedic examination, I was diagnosed with adolescent
idiopathic scoliosis. Although it turned out for me that it was not
a serious and progressive form of scoliosis, the diagnosis impacted my life
in a disabling way, resulting in feelings of fear, anxiety, and losing a sense
of trust in my own body. I experienced bodily doubt. This was also
accompanied by me negatively objectifying my body. This article is an
evocative autoethnography presenting my personal story of experiencing
a medical diagnosis of scoliosis. The health of my spine was evaluated
purely by comparison to a desired aesthetical straight line. The way I felt in
my body was never taken into consideration during this process. It is also
a story of finding my own ways of healing, which was possible through
engaging in dance and somatic practices. They allowed me to experience
my body as a living subject – a soma. I was able to find ways to positively
objectify my body through practices of deep body listening and developing
greater bodily awareness. My healing was also connected to regaining
a sense of bodily certainty and trust, through experiencing
moments of wholeness in spontaneous expressive self-movement.
Dance is also vital in my story. The personal evolution of approaching
dance presents a healing potential of this art, allowing for the conscious,
expressive, and therapeutic nature of the living body to be unveiled.

Dubrovnik  2018 Poster presentation
Background: Elastic therapeutic Taping (ETT) has become a promising resource for treating many symptoms. Its effects on pain, posture, balance, gait, strength, endurance, swelling and ROM are well documented. It is also known under the names Kinesio Taping and Kinesiology Taping. In the last decade colleagues have started using ETT on people with scoliosis and kyphosis. A variation of applications to address pain, postural control, pulmonary function, functional re-education and balance are described but the clinical reasoning behind specific applications and their effects are not clear.
Objective: To systematically review the literature of clinical tape applications and the evidence of the effects of ETT on people of all ages with kyphosis and scoliosis types. To critically analyse the applications used and results obtained.
Method: Searches were conducted in electronic databases, Facebook groups and online papers in every language. Every article published and found until December 2017, involving the use of ETT on patients with spinal disorders was included. Results presented in all studies are discussed. As taping goals, tape application, patient age groups, classification and assessment tools differed, main results of all studies are presented.
Results: Positive results were associated with taping application: even though tape was very often used as an adjunct to therapy. Clinical reasoning behind applications was not clear, nor mentioned in many cases. As the original hypothesis into the effects of this method is under debate, the actual effects of the applications are not always reliable.
Conclusion: Elastic therapeutic taping seems to be a promising adjunct but results and treatment goals vary. As it often used in conjunction with standard treatment, its’ specific effects are difficult to surmise. Using tape without sufficient knowledge of skin movement might prove useless or possible harmful. More research into the effects of adding ETT as adjunct treatment of spinal disorders of all age groups is badly needed.

Background: Adolescent idiopathic scoliosis (AIS) remains the most common deforming orthopedic condition in children. Increasingly, both adults and children are seeking complementary and alternative therapy, including chiropractic treatment, for a wide variety of health concerns. The scientific evidence supporting the use chiropractic intervention is inadequate. The purpose of this study was to conduct a pilot study and explore issues of safety, patient recruitment and compliance, treatment standardization, sham treatment refinement, interprofessional cooperation, quality assurance, and outcome measure selection.

The aim of this study was to determine the influence of the severity of the spinal curve on the postural regulation when self-imposed disturbances occur in a seated position in anteroposterior (AP) and mediolateral (ML) orientations. Twelve female adolescents with a right thoracic scoliosis (Cobb = 30.4°± 9.7) were included in this study. The ground reaction forces (GRF) were studied while the subjects were maintaining their sitting on a seesaw (ML or AP destabilisation). Five conditions were tested: eyes open; with additional loads placed onto the subject's right or left shoulder; or onto the subject's right or left pelvis. We tested the correlation between the Cobb angle and the postural parameters (index of performance and GRF variability) for each condition. When the destabilisation was AP, the Cobb angle was significantly correlated with GRF variability and anterior and concavity index of performance. Two conditions showed higher correlations: stabilisation with the concavity pelvis load (GRF variability) and the open eyes (index of performance). In contrast, whatever the condition tested was, no link was found when the destabilisations were applied in ML direction. The destabilisation in a seated position highlights the influence of the curve severity on the postural organisation. In seated position, the postural control strategies specific to the scoliotic patients were always correlated by severity of curve, especially when the destabilisation is applied in AP directions. This study showed that the unstable seating position can be considered as a pertinent paradigm to help finding a postural clinical index for adolescent idiopathic scoliosis.

Fifteen skeletally immature patients with double major adolescent idiopathic scoliosis with large lumbar curves and notable L4 and L5 coronal plane obliquity were retrospectively studied. Seven patients who underwent anterior release and fusion of the lumbar curve with segmental anterior instrumentation and subsequent posterior instrumentation ending at L3 were compared with eight patients treated with anterior release and fusion without anterior instrumentation followed by posterior instrumentation to L3 or L4. At 4.5 years follow-up (range 2.5-7 years), curve correction, coronal balance and fusion rate were not statistically different between the two groups; however, the group with anterior instrumentation had improved coronal plane, near normalangulation in the distal unfused segment compared with the group without anterior instrumentation. In cases involving severe lumbar curva-tures in the context of double major scoliosis, when as a first stage anterior release is chosen, the addition of instrumentation appears to restore normal coronal alignment of the distal unfused lumbar segment, and may in certain cases save a level compared with traditional fusions to L4.

Adolescent idiopathic scoliosis (AIS) progression is clinically monitored by a series of full spinal X-rays. To decrease radiation exposure, an artificial progression surface (APS) is proposed to predict progression. Fifty-six acquisitions (posteroanterior radiographs, 0°and 20°) were obtained from 11 AIS patients (29.8 ± 9.6°C obb angle). Three-dimensional curves were constructed through vertebral pedicle centers. Three previous serial spinal curves (6-month intervals) were used to construct an APS with a Non-uniform Rational B-Spline surfacing technique. Future progression was achieved by aligning the curves on the APS using the generalized cross-validation extrapolation technique. With three and four previous serial spinal curves, the prediction accuracies of future progression at the next 6-month interval were 4.1 ± 3.3°for Cobb angles and 3.6 ± 3.5 mm for apex lateral deviations. Apex locations and Cobb regions varied within one vertebral level. The proposed technique shows potential as an accurate three-dimensional prediction method for AIS progression and could help pediatricians make decisions about treatment. However, it could only be applied once before more radiographic data would be needed.

The expectations of both the patient and surgeon have been greatly revised in the last 10 years with the introduction of pedicle screws (PS) in spinal surgery. In this study, we have retrospectively evaluated and compared the results of PS instrumentation and the Hybrid System (HS), the latter consists of pedicle screws, sublaminar wire and hooks. The mean follow-up period was 60.1 months (range: 49–94 months) for the patients of the HS group and 29.3 months (range: 24–35 months) for those of the PS group. In the HS group, pedicle screws were used at the thoracolumbar junction and lumbar vertebra, the bilateral pediculotransverse claw hook configuration was used at the cranial end of the instrumentation, sublaminar wire was used on the concave side of the apical region and the compressive hook was used on the convex side. In the PS group, PS were used on the concave sides at all levels and on the convex side of the cranial and caudal end of instrumentation, in the transition zone and at the apex. The two groups were comparable for variables such as mean age, preoperative Cobb angle, thoracic kyphosis angle, lordosis angle, coronal balance, flexibility of the curve, apical vertebra rotation (AVR), apical vertebra rotation (AVT) and the number of vertebrae included in the fusion (p > 0.05). The parameters of values of correction, ratio of correction loss, AV derotation, AVT correction ratio, amount of blood loss, operation time, postoperative global coronal and sagittal balance, thoracic kyphosis angle and lumbar lordosis angle were measured at the last follow-up and used for comparing the HS and PS groups. There was no statistically significant difference between the groups for correction ratio, postoperative coronal balance, postoperative thoracic kyphosis and lumbar lordosis angle, operation time, amount of blood loss and number of fixation points (p > 0.05) The difference for the ratio of correction loss, AV derotation angle and the AVT correction ratio at the last follow-up visit and for the total follow-up period between the groups was found to be statistically significant (p < 0.05). Although it is possible to obtain a similar amount of correction by either instrumentation system, the loss of correction seems to be lower with the more rigid PS construction. The PS system also has a stronger effect on vertebral bodies, thereby providing better AV de-rotation. There was no significant difference (p > 0.05) between the groups in terms of correction rate, postoperative coronal and sagittal balance, operation time, blood loss and number of fixation points. This may indicate that anchor points are more important than the use – or not – of screws. Correction durability and AV de-rotation was better with PS instrumentation, while AVT was better corrected by HS instrumentation (p < 0.05). We propose that the reason for the better correction of AVT with HS instrumentation is the forceful translation offered by the sublaminar wire at the apical region, while the reason for the better correction durability of the PS instrumentation may be due to the fact that multiple pedicle screws which afford three-column control are better at maintaining the correction and preventing late deterioration. Dans la chirurgie rachidienne les attentes des patients et des chirurgiens se sont grandement modifiées depuis 10 ans, depuis l’introduction des vis pédiculaires (PS). Nous avons pour cette étude évalué de façon rétrospective et comparé les résultats de vis pédiculaires avec une instrumentation hybride (HS) utilisant à la fois des vis pédiculaires, des fils et des crochets sous laminaires. Matériel et méthode : le suivi moyen a été de 60.1 mois (49 – 94 mois) pour le groupe HS et de 29.3 mois (24 – 35 mois) pour le groupe PS. Dans le groupe HS, les vis pédiculaires ont été utilisées à la jonction dorsolombaire, thoracolombaire et au niveau lombaire avec un dispositif pédiculo transverse terminant le montage à la partie supérieure, les fils laminaires étant utilisés dans la partie concave et, dans la partie convexe avec un crochet en compression à la partie la plus apicale de la courbe. Dans le groupe vis pédiculaires, celles-ci ont été utilisées dans la partie concave à tous les niveaux et dans la partie convexe et caudale pour stabiliser l’instrumentation. Les groupes ont été très comparables en termes d’âges, d’angles de Cobb pré-opératoires, de cyphose thoracique, de lordose lombaire, de rotation et de souplesse de la courbe et de nombre de vertèbres inclus dans le montage (P > 0.05). Les valeurs de correction, de pertes de correction, de dérotation, de pertes sanguines, de temps opératoires, de cyphose thoracique et de lordose lombaire ont été mesurées à la dernière revue des patients en comparant les deux groupes HS et PS. Résultats : il n’y a pas de différences significatives entre ces deux groupes en ce qui concerne la correction post opératoire, la cyphose thoracique post opératoire, la lordose lombaire post opératoire, le temps opératoire, les pertes sanguines et le nombre de points de fixation du matériel (p > 0.05). Par contre, il existe une différence en ce qui concerne les pertes de correction et l’angle de rotation, il est possible d’obtenir une correction similaire avec chaque instrumentation. Les pertes de correction sont beaucoup moins importantes avec le système vis pédicullaires, plus rigides (PS) qui entraînent une meilleure rotation. En conclusion : pour le taux de correction post opératoire, le temps opératoire, les pertes sanguines, le nombre de points de fixation les deux groupes ne montrent pas de différences significatives (p > 0.05). Ceci nous indique que les points de fixation du matériel sont plus importants que l’utilisation de vis. La stabilité à long terme et la dérotation sont nettement améliorées avec l’instrumentation PS, l’AVT étant mieux corrigé avec l’instrumentation HS (p < 0.05). Nous pensons que pour avoir une meilleure correction de l’AVT comme réalisé avec l’instrumentation HS, il est nécessaire d’avoir une translation entraînée par les fils sous laminaires dans la région apicale. Par contre les raisons d’une meilleure correction et d’une meilleure stabilité dans le groupe PS sont secondaires aux multiples vis pédiculaires qui contrôlent beaucoup mieux les trois colonnes au niveau du montage avec une bonne stabilité empêchant une perte de correction secondaire.