To analyze clinical and radiological outcomes of posterior-only (post-only) surgical techniques consisting of full lumbar pedicle screws, osteotomies, transforaminal lumbar interbody fusion. Degenerative scoliosis is a slow progressing type of scoliosis resulting from the disc and fascet joint degeneration and is usually seen among adults aged ≥40 years. Low back pain aggravated by movement is the typical clinical manifestation of the disease; however other neurological symptoms may be present as well. The Surgical treatment of the degenerative scoliosis is an issue of debate. When patients are considered for surgical treatment, evaluation of existing comorbidities and the use of proper surgical technique are of crucial importance. 23 patients who have undergone surgery for lumbar degenerative scoliosis between 2010 and 2012 have been evaluated retrospectively. There were 18 female and 5 male patients respectively with a mean age of 57 (46-82) years. Low back pain and neurologic claudication were the most common clinical complaints. Radiological data are based on full-length standing spine x-rays, dynamic lumbar x-rays, computerized tomography scans and magnetic resonance imaging. All patients underwent bone densitometry measurement. For the patients with a T-score lower than -2.5, cement augmented pedicle screws were considered.. Radiographic findings, clinical results, and short-term outcome data were obtained by using the Modified Scoliosis Research Society outcome instrument, Visual Analog Score and the Oswestry Disability Back Pain Questionnaire. The mean follow-up time was 34.7(25-60) months, preoperative cobb angle was measured with a mean of 47 (22-71) degrees when postoperative was 6 (0-15) degrees. Cement augmentation was used in nine patients. In 15 patients, distal screws were placed to iliac wings. The mean VAS score was 7.8 (7-9) preoperatively, which decreased to 2.4 (0-4) postoperatively. The mean ODI score was 46% (35-64) preoperatively, which was reduced to 22% (18-34) postoperatively. Restoration of coronal and sagittal balance, or improvement thereof, was achieved in all the patients with balance problems. There was significant improvement in all outcome domains. Overall, all of the patients were satisfied with the surgery. One major complication occurred in patients required additional surgery. There was one minor complication. Surgery for adult idiopathic scoliosis using full pedicle screw instrumentation technique provides significant clinical improvement, scoliosiscorrection, maintenance of sagittal alignment, and patient satisfaction, with an acceptable complication rate in adequately selected patients.
We performed scoliosiscorrection using pedicle screws and rod by posterior approach. The surgical steps for treating the scoliosis are shown in Figure 3. Intra-operatively the blood loss was 1900cc, with additional transfusion of 750cc of packed red cell and 500 cc of fresh frozen plasma. After the operation on the third day, more transfusion was given due to a drop in the hemoglobin. Immediately after the operation, patient complained of weakness on both of her legs; however, the weakness improved. On the seventh day, she was able to stand on both of her legs and walk with the help of assisted walking device. The postoperative X-ray is shown in Figure 4. The comparison of Cobbs’ angle pre- and postoperative is shown in Table 2. Three months after the operation the patient was able to walk without assisted device, without complaint of shortness of breath or back pain.
patterns and their effects on scoliotic curves [13-21]. It has been hypothesised that forces which deliver small initial correction will achieve a larger correction in the long term with continuing treatment . Computational studies for scoliosiscorrection have, therefore, assumed a force pattern which will deliver the best possible immediate correction to the curve [17,20]. The majority of modelling studies which have considered treatments for scoliosis have focused on bracing and surgery [20,23,24]. To examine the corrective potential of muscle forces on a scoliotic curve, Wynarsky et al.  applied an optimization to a computer model of a curve, comparing simulations of muscle forces and brace forces. It was suggested that within the defined constraints, muscle activation is more effective at correcting the curve than passive brace forces. However it was also noted that it was not possible to reproduce the specific optimal muscle activation patterns in vivo . The conclusion of the modelling study presented in  is in contrast to the findings of , and poses the question as to whether muscle forces elicited by electrical stimulation or targeted physical therapy could potentially deliver a more effective corrective treatment than can be achieved by bracing or postural control alone.
Background: Osteoblastoma is a rare and benign tumor which requires early diagnosis and surgical excision. Scoliosis is a common presentation following osteoblastoma. It is considered due to pain-provoked muscle spasm on the side of the lesion. Few researches about osteoblastoma combined with severe scoliosis have been reported. Case presentation: A 14-year-old girl presents with progressive scoliosis deformity for 3 years, with gradually appeared low back pain and numbness of left leg. Radiographic results showed osteoblastic mass at the left side of L3-L4 with severe scoliosis deformity, pelvic obliquity and spinal imbalance. The patient underwent posterior tumor excision, spinal decompression, scoliosiscorrection, spinal fusion with auto-graft and instrumentation from T8-S1. The mass was found to be osteoblastoma. The patient had a full neurological recovery with no aggravate of scoliosis or spinal imbalance during the follow-up.
The second step is dividing the problem into subunits, which simplify the focus on a smaller set of the decision (Hummel, 2001). This is realized by making pair wise comparisons on a nine-point scale by the participants (figure 12). Finally all the answers were analysed. The software package Expert Choice is used because it is suitable in combination with the AHP 4 . An advantage of this software is the user friendliness. There were 6 participants included; the project leader of the non-fusion scoliosiscorrection system, a manager from the UMCG, two orthopedic surgeons and two manufacturers of scoliosiscorrection systems. The manager of the UMCG has only answered the first part (parameters) of the survey, because she was not a member of the project group of the University of Twente.
Furthermore, whether a spinal cord might be changed is also concerned during the correction of a spinal de- formity. If there exist some changes of spinal cord after scoliosiscorrection, then surgeons have to pay more at- tention to this phenomenon because this a correction procedure can cause some changes of the neurological status, which can lead to possible new symptoms and spinal cord injury. A study from Jae-Young Hong et al.  found that the conus medullaris level changed post- operatively in patients with severe scoliosis, and the spinal cord level changed after a large amount of correc- tion. They also stated that the patients with scoliosis or lordosis had longer spinal column length to cord ratios, which meant a relative stretching of the cord. If the scoliosis or lordosis is corrected, then the length of spinal column can be decreased, following the decrease of the upward tethering force. In this study, all the pa- tients were mild to moderate scoliosis (the cobb angle of major curve is less than 90 degrees), which means a limitation of correction, the conus medullaris probably will not be changed after a correction procedure, which means no excessive traction during correction procedure and after surgery.
From January 2008 to January 2014, 22 consecutive patients with ALDS, treated with MIS-TLIF in our hospital, were retrospectively analyzed. They were followed up at least 2 years. There were 8 males and 14 females, with an average age of 63.7 years (range 47–79 years). Inclusion criteria were (1) Cobb angle above 10°, (2) posterior-only procedure for adult scoliosiscorrection, (3) suffered from one-level lumbar stenosis and the nerve root block was performed to make sure the exact level, (4) treated with MIS-TLIF technique, (4) availability of radiographic examinations (full-length AP and lateral radiographs) and clinical data (inpatient medical records and questionnaire), (5) participated in non-operative therapies, including bracing, resting, physiotherapy, and analgesics, without adequate relief of their symptoms. Exclusion criteria were (1) idio- pathic curves; (2) prior lumbar fusion surgery; (3) other comorbidities, such as neoplasia, trauma, and infection; (4) patients whose symptoms are mainly dynamic or fatigue back pain.
patients, followed by thoracolumbar or lumbar (type 5) in 14 (14%) patients, major thoracic and lumbar (type 3) in 5 (5%) patients, thoracolumbar/lum- bar and main thoracic (type 6) in 5 (5%) patients, double thoracic (type 2) in 4 (4%) patients, and 2 (2%) patients had triple major curves (type 4) (Fig 1). Two (2%) patients showed a long C-type curve. There were 17 patients with left thoracic curves and 11 pa- tients with right thoracic curves. Six (6%) patients showed midcervical ky- phosis (mean: 26°; range: 10°–50°), which was associated with anteriorly fused cervical vertebrae in 2 (2%) pa- tients. In addition, 7 (7%) patients had right cervical curve in addition to tho- racic or lumbar curve. A total of 18 (18%) patients had both postoperative rib fusions and scoliosis, 9 (9%) pa- tients had signiﬁcant vertebral anom- aly and scoliosis, and 2 (2%) patients had a unilateral bar and scoliosis. Sco- liosis with vertebral anomaly and rib fusion was noted in 5 (5%) patients.
postoperative pain, sensory dysfunction or motor disabil- ities . This is temporary in most cases, but can per- sist if nerves have been damaged . With regard to the present results, TLIF did not seem to be a cause of major neurological complications, but should be recog- nised as a possible cause of minor neurological compli- cations (transient paresis or hypoesthesia). The present results show that postoperative weakness or sensory dys- functions resolved, in most cases, within three to 6 months after the operation. But, TLIF-technique in- creased operation times and blood loss, possibly leading to further postoperative complications. TLIF is not the only operation technique that may increase complication risks. Ventral surgery with support of the anterior col- umn (ALIF) can enhance the posterior fusion stability and reconstruction of lumbar lordosis significantly , but the anterior approach is acquainted with an in- creased numbers of vascular injuries [12, 30]. However, the development of posterior fusion with TLIF tech- niques improved and now shows equally good results re- garding fusion. But, posterior lumbar interbody fusion (PLIF) and TLIF are less effective than anterior methods in reconstructing lumbar lordosis. . The selection of an operation procedure depends on the scoliosis length and severity, previous surgeries and/or bone quality and other possible confounders . Therefore, each tech- nique (e.g. ALIF) needs to be individually described to the patient carefully and explicitly explained regarding possible complications.
The biomechanical etiology of the so-called idiopathic scoliosis [adolescent idiopathic scoliosis (AIS)] was the subject of the author’s research from 1984 to 2009 in the Pediatric Orthopedic and Rehabilitation Department of Medical University in Lublin, Poland, and in years 2009-2018 in Out-Patient Orthopedic Clinic in Lublin. The basic observation about etiology, new classification and the rules of the new therapy and causal prophylaxis comes from the years 1995-2007.
Otman et al.  applied the Schroth method in patients with adolescent idiopathic scoliosis and reported a reduction in the Cobb angle. Kuru et al.  showed that patients who partici- pated in Schroth exercises in the clinic showed improvement in reducing the Cobb angle compared with a group of patients following a home Schroth program or the control group that did not participate in exercises. Schreiber et al. [11,36] also reported that the Schroth PSSE methods combined with stan- dard care is more effective in the treatment of scoliosis com- pared with standard care alone. Another study that compared the effects of Schroth exercises and back braces in adolescent idiopathic scoliosis patients reported that the group of pa- tients who participated in Schroth exercises showed better re- sults in improving the Cobb angle . Kim and Hwangbo  showed that Schroth exercises also have good results in pa- tients who had Cobb angles of 40° or higher. However, Kim and Hwangbo  in another study reported that both meth- ods, Schroth and Pilates, were effective in changing the Cobb angle, but Schroth exercises were significantly more effective than Pilates exercises. As we mentioned, our study showed a decrease in the Cobb angle in patients with adolescent idio- pathic scoliosis who were treated with a combination of Schroth and Pilates exercises. These results were similar to those of the aforementioned studies and other studies that also reported a decrease in the Cobb angle after application of the Schroth method [12,24,37,38]. It should be emphasized that most of the studies complying with our study results involved partic- ipants with moderate scoliosis curves, while the majority of our patients had mild scoliosis curves. Being aware of the fact that Schroth exercises were initially developed for patients with large Cobb angle, we wanted to evaluate the effect of com- bined Schroth and Pilates exercises in patients with mild and moderate curves, which as a result caused a positive effect. Similar findings were also reported by the study of Park et al. who found that Schroth exercises could be beneficial for pa- tients with a Cobb angle from 10° to 30° rather than for pa- tients with a Cobb angle larger than 30° .
The ganglioneuroma shows complete capsular and basal growth by expansive patterns. The most effective therapy is a surgical removal operation as soon as pos- sible, which can reduce the risk of malignant transform- ation, paraplegia, and other abnormalities. Moreover, surgery has a good prognosis. If the tumor does not affect the vital organs, it should be removed completely; however, if complete resection may cause serious com- plications, then a partial resection should be performed . In this case, the preoperative Cobb angle was 33.7°, but due to the combined thoracolumbar paravertebral giant ganglioneuroma, a complete resection required a laminectomy. To maintain the spinal stability, in this case, the patient also required a scoliosis deformity cor- rection and an internal fixation. The postoperative Cobb angle is 15.3°, and it was corrected well. Thoracolumbar paravertebral giant ganglioneuroma and scoliosis make a single surgical approach difficult to correct a spine deformity and resect the tumor completely. Therefore, the operation is divided into two stages. The interval time between two operations should be 1 to 7 weeks [2,
In patients with severe scoliosis, the preoperative pulmon- ary function is remarkably affected . Our study found that in the group of patients with extremely severe scoliosis, the FVC, FEV1, and their ratios are significantly affected. PFTs can be used to predict the incidence of postopera- tive pulmonary complications. Stein et al.  studied two groups of patients who underwent operations and found that the patients with abnormal PFTs had a higher incidence of pulmonary complications. Padman and McNamara  also reported a significant correlation between abnormal preoperative PFTs and postoperative pulmonary complications in neuromuscular scoliotic pa- tients with posterior fusion. Vedantam and Crawford  found that these two factors were significantly correlated; however, in their study, the average Cobb angle was only 48°, and most of the patients demonstrated normal pre- operative pulmonary function. Our study of patients with extremely severe scoliosis showed that the postoperative pulmonary complication rate increased with the increasing severity of preoperative restrictive pulmonary function. Moreover, as the FVC ratio worsens, the incidence of post- operative pulmonary complications increases. Within the PFT, the FVC ratio indicates the level of restriction for the pulmonary function. Thus, the presence of preoperative re- strictive pulmonary function could be a useful predictor of postoperative pulmonary complications. Postoperative pul- monary complications are thought to be associated with
The aims were to examine the effects of scoliosis (angle), and age on lung volumes, elastic properties of the respiratory system, and the ventilatory response to CO2. The mean age of the 55 patients was 25.4 plus or minus SEM 2.5 yr, and the mean angle was 80 plus or minus SEM 4.2. The mean plus or minus SEM percent predicted lung volumes were vital capacity (VC), 60.5 plus or minus 2.7; total lung capacity (TLC), 70,2 plus or minus 2.6; functional residual capacity (frc), 79.3 plus or minus 3.2; and residual volume (RV), 99.7 plus or minus 5.2. The correlation coefficients between the angle of scoliosis and each of the following were significant: TLC (-0.548), percent predicted TLC (-0.547), VC (-0.485), percent predicted VC (-0.523), FRC (-0.533), percent predicted FRC (-0.338), RV (-0.438), and percent predicted RV (-0.318). The mean compliance of the total respiratory system (Crs) was 0.049 litter/cm H2O plus or minus SEM 0.004, and the mean compliance of the chest wall (Ccw) was 0.080 liter/cm H2O plus or minus SEM 0.012. The Crs and Ccw were inversely proportional to the angle (r-0.620 and -0.721) and directly proportional to the height and the weight. The mean deltaV/deltaPco2 was 1.32 liter/min per mm Hg (SEM 0.171), and the mean deltaVt/deltaPco2 was 28.9 ml/mm Hg (SEM 3.64). The correlation […]
before bracing was 44.1 ± 12.2°, which was corrected to 41.3 ± 13.5° at the final visit (p = 0.33). Twenty (51.3%) pa- tients were found to have curve correction of more than 5° (Fig. 1). Nine (23.1%) patients were found to have curve progression of more than 5° (Fig. 2). Kyphotic deformity was observed in eight patients. The local kyphosis angle was reduced from 58.4 ± 11.3° to 52.3 ± 11.9° (p = 0.02). The mean T1 to T12 height before the brace treatment was 13.4 ± 2.5 cm. At the final visit, it significantly in- creased to a mean value of 17.1 ± 2.8 cm (p < 0.001), with an average growth rate of 1.02 ± 0.21 cm/year. Before bracing, the coronal and sagittal balance were averaged 13.4 ± 9.1 mm and 23.6 ± 13.9 mm, which were reduced to 12.1 ± 6.2 mm and 18.5 ± 13.4 mm at the latest follow- up (p = 0.46 for C7PL-CSVL; p = 0.10 for SVA), respect- ively. As shown in Table 2, patients with IIS were found to have significantly better correction rate than patients with CS (28.2% ± 11.6% vs. 14.8% ± 13.5%, p < 0.001). The inci- dence of curve progression was higher in the CS group than in the IIS group (23.1% vs. 16.7%, p = 0.54). The growth rate of thoracic spine was comparable between the two groups (1.02 ± 0.21 vs. 1.07 ± 0.18, p = 0.33).
patients [5, 6]. Moreover, the consecutive Chêneau brace tends to be better accepted by younger children com- pared to juveniles. A growth-correcting procedure estab- lished during early childhood has the most potential for correction. Mehta described growth itself as a “corrective force” . Good results with serial Risser casts have been reported in patients with idiopathic early onset scoliosis (IS) . Only few studies of serial Risser casting in EOS patients with non-idiopathic scoliosis (NIS) have been published. The benefits of nonsurgical methods in pa- tients with syndromic-associated EOS as a subgroup of EOS are poorly defined. Furthermore, treatment proto- cols for nonsurgical methods vary significantly in the lit- erature, especially in the number of castings and the wear time [9, 10].
Once a toddler can stand, every attempt is made to do a standing AP scoliosis exam with breast/gonadal shields in place and a standing lateral scoliosis exam with 1 breast shield in place. At TSRHC, we do not use gonadal shielding with the lateral spine view because we believe it does not protect the gonads effectively. It can be a challenge to do this study if the toddler cannot cooperate. Sometimes it is easier to manage a small child in the AP and lateral position, and it may require 2 to 3 people to control the child’s arms, legs, head and feet (see Box 2).
The scoliosis activity suit is a neoprene, rotation-based activity suit, composed of 4 distinct pieces. The no- velty of the scoliosis activity suit is that it creates a rotational resistance into the torso that accentuates the rota- tional displacement of the scoliosis. This increased rotational stimulus is thought to elicit a corrective postural reflex that results in de-rotation of the spine out of the scoliosis curvature.