To systematically evaluate whether bracing can effectively achieve curve regression in patients with adolescent idiopathic scoliosis (AIS), and to identify any predictors of curve regression after bracing. Two independent reviewers performed a comprehensive literature search in PubMed, Ovid, Web of Science, Scopus, and Cochrane Library to obtain all published information about the effectiveness of bracing in achieving curve regression in AIS patients. Search terms included “brace treatment” or “bracing,” “idiopathic scoliosis,” and “curve regression” or “curve reduction.” Inclusion criteria were studies recruiting patients with AIS undergoing brace treatment and one of the study outcomes must be curve regression or reduction, defined as > 5° reduction in coronal Cobb angle of a major curve upon bracing completion. Exclusion criteria were studies including non-AIS patients, studies not reporting p-value or confidence interval, animal studies, case reports, case series, and systematic reviews. The GRADE approach to assessing quality of evidence was used to evaluate each publication.Aims
Methods
This study aimed to evaluate rasterstereography of the spine as a diagnostic test for adolescent idiopathic soliosis (AIS), and to compare its results with those obtained using a scoliometer. Adolescents suspected of AIS and scheduled for radiographs were included. Rasterstereographic scoliosis angle (SA), maximal vertebral surface rotation (ROT), and angle of trunk rotation (ATR) with a scoliometer were evaluated. The area under the curve (AUC) from receiver operating characteristic (ROC) plots were used to describe the discriminative ability of the SA, ROT, and ATR for scoliosis, defined as a Cobb angle > 10°. Test characteristics (sensitivity and specificity) were reported for the best threshold identified using the Youden method. AUC of SA, ATR, and ROT were compared using the bootstrap test for two correlated ROC curves method.Aims
Methods
The prevalence of scoliosis is not known in patients with idiopathic short stature, and the impact of treatment with recombinant human growth hormone on those with scoliosis remains controversial. We investigated the prevalence of scoliosis radiologically in children with idiopathic short stature, and the impact of treatment with growth hormone in a cross-sectional and retrospective cohort study. A total of 2,053 children with idiopathic short stature and 4,106 age- and sex-matched (1:2) children without short stature with available whole-spine radiographs were enrolled in the cross-sectional study. Among them, 1,056 with idiopathic short stature and 790 controls who had radiographs more than twice were recruited to assess the development and progression of scoliosis, and the need for bracing and surgery.Aims
Methods
Significant correction of an adolescent idiopathic scoliosis in the coronal plane through a posterior approach is associated with hypokyphosis. Factors such as the magnitude of the preoperative coronal curve, the use of hooks, number of levels fused, preoperative kyphosis, screw density, and rod type have all been implicated. Maintaining the normal thoracic kyphosis is important as hypokyphosis is associated with proximal junctional failure (PJF) and early onset degeneration of the spine. The aim of this study was to determine if coronal correction per se was the most relevant factor in generating hypokyphosis. A total of 95 patients (87% female) with a median age of 14 years were included in our study. Pre- and postoperative radiographs were measured and the operative data including upper instrumented vertebra (UIV), lower instrumented vertebra (LIV), metal density, and thoracic flexibility noted. Further analysis of the post-surgical coronal outcome (group 1 < 60% correction and group 2 ≥ 60%) were studied for their association with the postoperative kyphosis in the sagittal plane using univariate and multivariate logistic regression.Aims
Methods
Severe spinal deformity in growing patients often requires surgical management. We describe the incidence of spinal deformity surgery in a National Health Service. Descriptive study of prospectively collected data. Clinical data of all patients undergoing surgery for spinal deformity between 2005 and 2018 was collected, compared to the demographics of the national population, and analyzed by underlying aetiology.Aims
Methods
In the United Kingdom, lower incidences of intraspinal abnormalities
in patients with early onset idiopathic scoliosis have been observed
than in studies in other countries. We aimed to determine the rates
of these abnormalities in United Kingdom patients diagnosed with idiopathic
scoliosis before the age of 11 years. This retrospective study of patients attending an urban scoliosis
clinic identified 71 patients satisfying a criteria of: clinical
diagnosis of idiopathic scoliosis; age of onset ten years and 11 months
or less; MRI screening for intraspinal abnormalities. United Kingdom
census data combined with patient referral data was used to calculate
incidence.Aims
Patients and Methods
To clarify the asymmetrical ossification of the epiphyseal ring
between the convex and concave sides in patients with adolescent
idiopathic scoliosis (AIS). A total of 29 female patients (mean age, 14.4 years; 11 to 18)
who underwent corrective surgery for AIS (Lenke type 1 or 2) were
included in our study. In all, 349 vertebrae including 68 apical
vertebrae and 87 end vertebrae in the main thoracic (MT) curve and
thoracolumbar/lumbar (TL/L) curve were analysed. Coronal sections
(anterior, middle and posterior) of the vertebral bodies were reconstructed
from pre-operative CT scans (320-row detector; slice thickness,
0.5 mm) and the appearances of the ossification centre in the epiphyseal
ring at four corners were evaluated in three groups; all vertebrae
excluding end vertebrae, apical vertebrae and end vertebrae. The appearance
rates of the ossification centre at the concave and convex sides
were calculated and compared.Aims
Patients and Methods
A self-control ratio, the spine-pelvis index
(SPI), was proposed for the assessment of patients with adolescent idiopathic
scoliosis (AIS) in this study. The aim was to evaluate the disproportionate
growth between the spine and pelvis in these patients using SPI.
A total of 64 female patients with thoracic AIS were randomly enrolled
between December 2010 and October 2012 (mean age 13 years, standard
deviation ( No significant difference in SPI was found in different age groups
in the control group, making the SPI an age-independent parameter
with a mean value of 2.219 (2.164 to 2.239). We also found that
the SPI was not related to maturity in the control group. This study, for the first time, used a self-control ratio to
confirm the disproportionate patterns of growth of the spine and
pelvis in patients with thoracic AIS, highlighting that the SPI
is not affected by age or maturity. Cite this article:
Back pain is a common symptom in children and
adolescents. Here we review the important causes, of which defects
and stress reactions of the pars interarticularis are the most common
identifiable problems. More serious pathology, including malignancy
and infection, needs to be excluded when there is associated systemic
illness. Clinical evaluation and management may be difficult and
always requires a thorough history and physical examination. Diagnostic
imaging is obtained when symptoms are persistent or severe. Imaging
is used to reassure the patient, relatives and carers, and to guide
management. Cite this article:
We investigated the incidence of anomalies in
the vertebral arteries and Circle of Willis with three-dimensional
CT angiography in 55 consecutive patients who had undergone an instrumented
posterior fusion of the cervical spine. We recorded any peri-operative and post-operative complications.
The frequency of congenital anomalies was 30.9%, abnormal vertebral
artery blood flow was 58.2% and vertebral artery dominance 40%. The posterior communicating artery was occluded on one side in
41.8% of patients and bilaterally in 38.2%. Variations in the vertebral
arteries and Circle of Willis were not significantly related to
the presence or absence of posterior communicating arteries. Importantly,
18.2% of patients showed characteristic variations in the Circle
of Willis with unilateral vertebral artery stenosis or a dominant
vertebral artery, indicating that injury may cause lethal complications.
One patient had post-operative cerebellar symptoms due to intra-operative
injury of the vertebral artery, and one underwent a different surgical
procedure because of insufficient collateral circulation. Pre-operative assessment of the vertebral arteries and Circle
of Willis is essential if a posterior spinal fusion with instrumentation
is to be carried out safely. Cite this article:
Adolescent idiopathic scoliosis affects about
3% of children. Non-operative measures are aimed at altering the natural
history to maintain the size of the curve below 40° at skeletal
maturity. The application of braces to treat spinal deformity pre-dates
the era of evidence-based medicine, and there is a paucity of irrefutable
prospective evidence in the literature to support their use and
their effectiveness has been questioned. This review considers this evidence. The weight of the evidence
is in favour of bracing over observation. The most recent literature
has moved away from addressing this question, and instead focuses
on developments in the design of braces and ways to improve compliance. Cite this article:
We reviewed 212 consecutive patients with adolescent
idiopathic scoliosis who underwent posterior spinal arthrodesis
using all pedicle screw instrumentation in terms of clinical, radiological
and Scoliosis Research Society (SRS)-22 outcomes. In Group 1 (51
patients), the correction was performed over two rods using bilateral
segmental pedicle screws. In Group 2 (161 patients), the correction
was performed over one rod using unilateral segmental pedicle screws
with the second rod providing stability of the construct
through two-level screw fixation at proximal and distal ends. The
mean age at surgery was
14.8 years in both groups. Comparison between groups showed no significant
differences with regard to age and Risser grade at surgery, pre-
and post-operative scoliosis angle, coronal Cobb correction, length
of hospital stay and SRS scores. Correction of upper thoracic curves
was significantly better in Group 1 (p = 0.02). Increased surgical time
and intra-operative blood loss was recorded in Group 1 (p <
0.001
and p = 0.04, respectively). The implant cost was reduced by mean
35% in Group 2 due to the lesser number of pedicle screws. Unilateral and bilateral pedicle screw techniques have both achieved
excellent deformity correction in adolescent patients with idiopathic
scoliosis, which was maintained at two-year follow-up. This has
been associated with high patient satisfaction and low complication
rates.
Diastematomyelia is a rare congenital abnormality
of the spinal cord. This paper summarises more than 30 years’ experience
of treating this condition. Data were collected retrospectively
on 138 patients with diastematomyelia (34 males, 104 females) who
were treated at our hospital from May 1978 to April 2010. A total
of 106 patients had double dural
We reviewed seven children with torticollis due to refractory atlanto-axial rotatory fixation who were treated in a halo vest. Pre-operative three-dimensional CT and sagittal CT imaging showed deformity of the superior articular process of C2 in all patients. The mean duration of halo vest treatment was 67 days (46 to 91). The mean follow-up was 34 months (8 to 73); at the latest review six patients demonstrated remodelling of the deformed articular process. The other child, who had a more severe deformity, required C1-2 fusion. We suggest that patients with atlanto-axial rotatory fixation who do not respond to conservative treatment and who have deformity of the superior articular process of C2 should undergo manipulative reduction and halo-vest fixation for two to three months to induce remodelling of the deformed superior articular process before C1-2 fusion is considered.
Bertolotti’s syndrome is characterised by anomalous enlargement of the transverse process(es) of the most caudal lumbar vertebra which may articulate or fuse with the sacrum or ilium and cause isolated L4/5 disc disease. We analysed the elective MR scans of the lumbosacral spine of 769 consecutive patients with low back pain taken between July 2003 and November 2004. Of these 568 showed disc degeneration. Bertolotti’s syndrome was present in 35 patients with a mean age of 32.7 years (15 to 60). This was a younger age than that of patients with multiple disc degeneration, single-level disease and isolated disc degeneration at the L4/5 level (p ≤ 0.05). The overall incidence of Bertolotti’s syndrome in our study was 4.6% (35 of 769). It was present in 11.4% (20 patients) of the under-30 age group. Our findings suggest that Bertolotti’s syndrome must form part of a list of differential diagnoses in the investigation of low back pain in young people.
We carried out a study to determine the effect of facet tropism on the development of adolescent and adult herniation of the lumbar disc. We assessed 149 levels in 140 adolescents aged between 13 and 18 years and 119 levels in 111 adults aged between 40 and 49 years with herniation. The facet tropism of each patient was measured at the level of the herniated disc by CT. There was no significant difference in facet tropism between the herniated and the normal discs in both the adolescent and adult groups, except at the L4-L5 level in the adults. Facet tropism did not influence the development of herniation of the lumbar disc in either adolescents or adults.
Low back injuries account for the greatest loss of playing time for professional fast bowlers in cricket. Previous radiological studies have shown a high prevalence of degeneration of the lumbar discs and stress injuries of the pars interarticularis in elite junior fast bowlers. We have examined MRI appearance of the lumbar spines of 36 asymptomatic professional fast bowlers and 17 active control subjects. The fast bowlers had a relatively high prevalence of multi-level degeneration of the lumbar discs and a unique pattern of stress lesions of the pars interarticularis on the non-dominant side. The systems which have been used to classify the MR appearance of the lumbar discs and pars were found to be reliable. However, the relationship between the radiological findings, pain and dysfunction remains unclear.
There is ambiguity concerning the nomenclature and classification of fractures of the ring of the second cervical vertebra (C2). Disruption of the pars interarticularis which defines true traumatic spondylolisthesis of C2, is often wrongly called a pedicle fracture. Our aim in this study was to assess the influence of
