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ACCURATE VESTIBULAR ASSESSMENT: INTEREST IN THE ADOLESCENT IDIOPATHIC SCOLIOSIS.



Abstract

The assessment of vestibular function throws new light on scoliosis. Vestibular morphological anomalies are frequent in scoliosis. This communication has two aims:

  • to correlate the dysfunctions of the semi-circular canal system with morphological anomalies.

  • to include the vestibular assessment in the management of the scoliotic subject.

These anomalies are demonstrated by graphic modelling from MRI images (see abstract of Dr. Rousié). The examination of the proprio-oculo-labyrinthine system is done by Videonystagmography (VNG) and Videooculography (VOG). We able to test both horizontal and vertical canal function to give a 3D vestibular assessment. We use these tests to measure primitive vestibular dissymmetry (PVD). We compare the 3D endolymphatic morphology with the 3D vestibular function.

Results: The study comprises more than 100 cases. Inclusion criteria: scoliosis and cranio-facial asymmetry (CFA); Exclusion criteria: previous history of vestibular pathology or head injury.

In the horizontal plane the correlations are: with caloric test over 80%; with kinetic test around 70%;

In the vertical plane the correlation is around 70%. The figures will be detailed in the communication.

The difference between the results obtained with the caloric test and the kinetic tests is in connection with the phenomena of central compensation. On the vestibular level there is a close connection between the scoliosis, the vestibular morphological anomalies and the vestibular examination.

Clinical application: We proceed systematically to a vestibular assessment, even in absence of vestibular complaints or disequilibrium. We have found in certain cases where there has been a poor response to treatment or a defect of compliance, there has been an anomaly of vestibular function. After vestibular rehabilitation we observe an improvement of the effectiveness and acceptance of the treatment. We analyse the proprio-oculo-labyrinthin system by VNG, VOG, fundus (asymmetry of static ocular torsion) and the vestibulo-spinal system by posturography. The main anomalies concern vertical semi-circular canals function, otolithic system and vertical ocular smooth pursuit. The vestibular rehabilitation rebuilds a coherence between these three systems. This is possible in the child of more than six years. For us the vestibular assessment and vestibular rehabilitation are the first step of the management of the treatment.

The vestibular assessment and vestibular rehabilitation are necessary because of the close connections between the anomalies of the proprio-oculo-labyrinthin and the scoliosis.

Correspondence should be addressed to Jeremy C T Fairbank at The Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX7 7LD, UK