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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVII | Pages 25 - 25
1 Jun 2012
Rousie D Joly O Deroubaix J Baudrillard J Miller N Swindle K
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Introduction

At the Zorab Symposium in Oxford, 2006, we showed that semicircular canal (SCC) anomalies occurring with posterior basicranium asymmetry affect the oculovestibular system in human beings. As a consequence, we proposed the hypothesis of a descending direct vestibulospinal and cognitive top-down effect on some scoliosis. We will show that some SCC anomalies detected with MRI modelling are malformations frequently found in scoliosis.

Methods

445 patients (323 women, mean age 21 years; 122 men, mean age 24 years) with instability, imbalance, and spatial disorientation were submitted to T2 MRI modelling. 95 of 445 patients had scoliosis: 57 thoracolumbar scoliosis, 24 thoracic scoliosis, and 14 lumbar deformation. We processed the data acquired with G.E.MRI (1.5T), T2- 3D Fiesta with a set of Brainvisa modules (http://brainvisa.info/).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVII | Pages 26 - 26
1 Jun 2012
Deroubaix J Rousie D Salvetti P Baudrillard J
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Introduction

The Proprio-oculo-vestibular system is involved in scoliosis. In Congress ZORAB, Oxford 2006, we showed correlations between morphological semicircular canals (SCC) anomalies and vestibular dysfunctions associated with oculomotor anomalies. We will describe a set of specific anomalies in adolescent idiopathic scoliosis (AIS) in favour of an altered perception of space.

Methods

The study included 95 patients with AIS: 57 had thoracolumbar scoliosis, 24 thoracic scoliosis, and 14 lumbar deformation. Patients were submitted to a set of tests: (1) three-dimensional vestibular evaluation with semicircular canal-specific horizontal and vertical stimulations; (2) measurement of the static ocular torsion; (3) ocular smooth pursuits analyses with a new automatised programme; and (4) posturographic recording (static and dynamic tests). The tests were done before and after treatment (vestibular training and oculomotor training).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVII | Pages 27 - 27
1 Jun 2012
Miller N Carry P Chan K Strain J Swindle K Rousie D
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Introduction

Studies of the vestibular system in patients with idiopathic scoliosis (IS) have shown abnormalities in the semicircular canals (SCC) and the basicranium. Rousie (2008) revealed a statistically increased incidence of structural anomalies in the SCCs with three-dimensional computer generated modelling. Some of these findings were replicated in a small population by Cheng (2010). The primary goals of this investigation are verification of SCC abnormalities of patients with IS versus controls with use of three-dimensional modelling with subsequent development of a unique phenotypical classification. Our long-term goal is to provide new direction for hypothesis directed identification and characterisation of genes causally related to IS.

Methods

20 patients with IS and 20 controls matched for age and sex will be identified through the clinic with approval from the institutional review board. Power analyses were done to detect the difference in distributions as the proportion of fisher tests with p values less than 0·05. A sample size of 20 per group gives 86–99% power to realise results under conservative assumptions. IS patients and controls undergo vestibular system examination via T2 MRI imaging. Extracted data are evaluated by a team including Dr Rousie, ENT, radiology, and orthopaedic surgery. DNA is extracted with Gentra Puregene kits from Qiagen (Valencia, CA, USA). Developmental genes related to SCC and axial somatogenesis are being identified through a bioinformatics approach, targeting known IS genomic loci. Custom single-nucleotide polymorphism panels, statistical linkage, and association will identify genes of significance for sequencing.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 432 - 433
1 Aug 2008
Deroubaix J Rousie D
Full Access

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.