Idiopathic scoliosis under 30 degrees in growing patients. A comparative study of the F.E.D. method and other conservative treatments.
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Treatment of scoliosis under 30 degrees Cobb in growing patients remains controversial. Different orthopaedic devices have been developed and used with satisfactory results, alone or in combination with a variety of physiotherapy programs. The F.E.D. method is a dynamic three-dimensional therapy consisting in the application of derotational forces under spine stretching. This method offers some advantages over conventional conservative treatment for scoliosis: shorter treatment period, no use of plasters in many cases, better psychological tolerance, etc.In this work, the results of the F.E.D. method were compared to other conservative treatment techniques in scoliosis under 30 degrees Cobb angle and Risser 3 or less.Both the F.E.D. group and the group of patients treated by traditional orthopaedic methods included 30 children. Patients were divided on the basis of the type of scoliotic deformity: thoracic, thoracolumbar or lumbar. SUMMARY OF RESULTS AND FINDINGS: The results obtained showed that patients treated with the F.E.D. method had a significantly better outcome than the other methods in terms of angle correction and shorter period of treatment necessary to reach correction.The F.E.D. method can be considered as the elective treatment in growing adolescents with scoliosis under 30 degrees.Keywords:
Conservative Treatment
Cobb angle
Idiopathic scoliosis
Spinal Deformity
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BackgroundStanding spinal radiographs have been the primarymethod of spinal deformity evaluation in patients withscoliosis. During periods of patient surveillance, the clin-ician compares radiographs over a period of time toassess the progression of the deformity [1-3]. One of thepotential problems in comparing one radiograph toanother is difference in positioning [4-6]. The goal ofthis study is to quantify the effect of trunk rotation onCobb angle measurements, and provide an algorithm todescribe this relationship.Material and methodsCT scans of three patients with Adolescent Idiopathic Sco-liosis were used retrospectively. Three-dimensional recon-structions of the images were created by CT scan software.Cobb angles were drawn for scoliosis curves in the anteriorplane. The 3-D image was then rotated two degrees to theright, and Cobb angle measurements were repeated. Thisprocedure was repeated through 14 degrees of right rota-tion, and then subsequently through 14 degrees of leftrotation.ResultsThe effect of trunk rotation on Cobb angle measure-ments is directly related to the location of the scoliosiscurves, the magnitude of those curves, and the magnitudeof lumbar lordosis and thoracic kyphosis. In general how-ever, a two degree rotation of the patient’s trunk whilepositioning results in a one degree change in themeasured Cobb angle (in patients with larger scoliosiscurves, and in the first six degrees of trunk rotation).ConclusionsPatient positioning can have a significant effect on thecalculation of scoliosis measurements, and this needs tobe considered when evaluating the progression of spinaldeformity.
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Electrotherapy
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The shape of a curved line that passes through thoracic and lumbar vertebrae is often used to study spinal deformity with -measurements in "auxiliary" planes that are not truly three-dimensional (3D). Here we propose a new index, the geometric torsion, which could uniquely describe the spinal deformity. In this study we assessed whether geometric torsion could be effectively used, to predict spinal deformity with the aid of multiple linear regression. Anatomical landmarks were obtained from multi-view radiographic reconstruction and used to generate 3D model of the spine and rib cage of 28 patients. Fourier series best fitted to the vertebral centroids approximated the spinal shape. For each patient, spinal deformity indices were computed. Torsion was calculated and 20 derived parameters were recorded. Torsion inputs were used in a multiple linear regression model for prediction of key spinal indices. The primary clinical Cobb angle (mainly thoracic) was predicted well, with r=0.89 using all 20 inputs of torsion or r=0.83 using just two. Torsion was also well related to the Orientation of plane of maximal deformity (r=0.87). Torsion was less accurate but still significant in predicting maximal vertebral axial rotation (r=0.77). This preliminary study showed promising results for the use of geometric torsion as an alternative 3D index of spinal deformity.
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The premise behind most noninvasive techniques for the measurement of scoliotic conditions of the spine is that the lateral distortion of the spine relates directly to transverse rib cage deformity within the transverse plane. The focus of this study was to examine this assumption by comparing different noninvasive methods for the assessment of scoliotic curves. The three techniques examined were (1) use of the Scoliometer (SCOL), (2) use of the back-contour device (BCD), and (3) use of moiré topographic imaging (MTI). Fourteen subjects (10 female, 4 male) with idiopathic adolescent scoliosis were measured. Posterior-anterior radiographs were obtained for the clinical assessment of all subjects and were subsequently used to determine Cobb angles. Significant correlations between axial trunk rotation and Cobb-angle measurements were observed in the thoracic region (MTI, r = .80, df = 10, P less than .005; BCD, r = .70, df = 10, P less than .025; SCOL, r = .59, df = 10, P less than .025) but were not found within the lumbar region (MTI, r = .42; BCD, r = .17; SCOL, r = .20). Factors other than trunk deformity, such as the posture assumed by the subject during measurement, may have influenced axial trunk rotation. Hence, the techniques appear to provide valid estimations of lateral curvature of the spine in the thoracic region of the trunk but not the lumbar region. The results suggest that the measurement techniques cannot be used interchangeably in clinical recording.
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Adult scoliosis is defined as a spinal deformity in a skeletally mature patient with a Cobb angle of more than 10 degrees in the coronal plain. Posterior-only approach with rod and screw corrective manipulation to add strength of contra bending manipulation has correction achievement similar to that obtained by conventional combined anterior release and posterior approach. It also avoids the complications related to the thoracic approach. We reported a case of 25-year-old male adult idiopathic scoliosis with double curve. It consists of main thoracic curve of 150 degrees and lumbar curve of 89 degrees. His curve underwent direct contra bending posterior approach using rod and screw corrective manipulation technique to achieve optimal correction. After surgery the main thoracic Cobb angle becomes 83 degrees and lumbar Cobb angle becomes 40 degrees, with 5 days length of stay and less than 800 mL blood loss during surgery. There is no complaint at two months after surgery; he has already come back to normal activity with good functional activity.
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A method of calculation of biplanar spinal deformity in which the frontal Cobb angle is added to the deviation from normal sagittal alignment is presented. Three equivalent groups of adolescent idiopathic scoliosis treated by different surgical methods are presented. When only the frontal Cobb method of comparison was used, results were similar. When the composite measurement that takes into account sagittal changes was used, the Harrington instrumentation group showed significantly poorer results than the Luque rod and Cotrel-Dubousset rod groups. The composite measurement, considering sagittal alignment, is a significantly more valid method of description of the scoliotic deformity and of comparison of treatment methods.
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The standard clinical measurement for adolescent idiopathic scoliosis is the Cobb angle, measured from the end-plates of the end vertebral bodies in a standing radiograph. This measurement of anterior column structures describes the anterior spinal deformity. The posterior spinal deformity can be described by the "spinous process angle," measured from a curve joining the tips of the spinous processes. A computer model, and a radio-graphic study of Cobb angle, spinous process angle and vertebral rotation show that adolescent idiopathic scoliosis results in larger angulations of the anterior elements than posterior elements. This helps to explain some of the inherent limitations of posterior instrumentation, including Cotrel-Dubousset instrumentation, and of noninvasive posterior surface measurement systems.
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Study Design. Prospective study in 150 consecutive outpatients affected by adolescent idiopathic scoliosis (AIS). Objectives. The purposes were to (1) identify a correlation between hump dimensions and the severity of scoliotic curve, and (2) evaluate how the treatment influenced the main parameters of scoliosis. Summary of Background Data. The existence of a relationship between clinical deformities and curve severity in AIS is still debated. Furthemore, only a few studies have investigated the effectiveness of conservative treatment for idiopathic scoliosis taking into account both clinical and radiologic factors. Methods. 150 consecutive outpatients (mean age 12.8 ± 1.9 years) affected by AIS were subjected to conservative brace-based treatment. 134 participants completed the treatment protocol. Two parameters were considered to evaluate the treatment progress: the hump and the Cobb angle. Measurements were determined at the beginning and the end of treatment. Statistical analyses were performed in the whole sample and after dividing the study participants into 4 subgroups: patients with lumbar (n = 66) or thoracic curves (n = 68), patients ranging in age between 6 and 13 years (n = 89) and patients ≥ 14 years of age (n = 45). Results. A positive correlation was detected between the hump dimension and curve severity at the beginning and the end of treatment, except for lumbar curves at baseline. The deformity was effectively corrected by the orthotic treatment (Cobb angle: 29.4 ± 8.5° at baseline and 19.3 ± 9.8° at the end of treatment; hump severity: 11.6 ± 5.6 mm at baseline and 6.2 ± 4.6 mm at the end). In addition, our data indicate that the hump correction is more evident than that of the curve registered in Cobb degrees. Conclusion. A significant correlation exists between the hump dimension and curve severity both at the beginning and the end of treatment, except for lumbar curves at baseline. The brace treatment confirmed its effectiveness in arresting the deformity progression and inducing a remodeling both of the scoliotic curve and the hump.
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In the current study, 98 patients with idiopathic scoliosis were selected for analysis. The object of this study was to determine whether threedimensional variability exists within each class of the King classification, and to evaluate the currently used King classification in its ability to categorize different scolioses adequately. Anteroposterior and lateral radiographs were digitized, and three-dimensional models were reconstructed for each spine. Several parameters were recorded for each individual: age, gender, four Cobb angles, (1) anteroposterior, (2) lateral, (3) maximum (Cobb angle at the plane of maximum deformity), and (4) minimum (Cobb angle at the plane of minimum deformity), and the orientation of the planes of maximum and minimum deformity. Most of the curves were kyphotic, but a small percentage in each class were hypokyphotic or lordotic. This was not seen in the analysis in which the individual King classes were compared. It was seen, however, when the authors reanalyzed the data after having pooled the subjects and reclassified them according to presence or absence of kyphosis. The King classification was shown to be inadequate for describing spinal deformities in three dimensions, because different variants of sagittal spine configurations were seen which can look identical on the anteroposterior view. Therefore, the need for a new three-dimensional classification, which takes this variability into account, is established.
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Treatment of scoliosis under 30 degrees Cobb in growing patients remains controversial. Different orthopaedic devices have been developed and used with satisfactory results, alone or in combination with a variety of physiotherapy programs. The F.E.D. method is a dynamic three-dimensional therapy consisting in the application of derotational forces under spine stretching. This method offers some advantages over conventional conservative treatment for scoliosis: shorter treatment period, no use of plasters in many cases, better psychological tolerance, etc.In this work, the results of the F.E.D. method were compared to other conservative treatment techniques in scoliosis under 30 degrees Cobb angle and Risser 3 or less.Both the F.E.D. group and the group of patients treated by traditional orthopaedic methods included 30 children. Patients were divided on the basis of the type of scoliotic deformity: thoracic, thoracolumbar or lumbar. SUMMARY OF RESULTS AND FINDINGS: The results obtained showed that patients treated with the F.E.D. method had a significantly better outcome than the other methods in terms of angle correction and shorter period of treatment necessary to reach correction.The F.E.D. method can be considered as the elective treatment in growing adolescents with scoliosis under 30 degrees.
Conservative Treatment
Cobb angle
Idiopathic scoliosis
Spinal Deformity
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