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Scoliosis is a condition in which a person's spine has an abnormal curve. The curve is usually S- or C-shaped over three dimensions. In some, the degree of curve is stable, while in others, it increases over time. Mild scoliosis does not typically cause problems, but more severe cases can affect breathing and movement. Pain is usually present in adults, and can worsen with age. As the condition progresses, it may impact a person's life and hence, can also be considered a disability.
Kyphosis is an abnormally excessive convex curvature of the spine as it occurs in the thoracic and sacral regions. Abnormal inward concave lordotic curving of the cervical and lumbar regions of the spine is called lordosis. It can result from degenerative disc disease; developmental abnormalities, most commonly Scheuermann's disease; Copenhagen disease, osteoporosis with compression fractures of the vertebra; multiple myeloma; or trauma. A normal thoracic spine extends from the 1st thoracic to the 12th thoracic vertebra and should have a slight kyphotic angle, ranging from 20° to 45°. When the "roundness" of the upper spine increases past 45° it is called kyphosis or "hyperkyphosis". Scheuermann's kyphosis is the most classic form of hyperkyphosis and is the result of wedged vertebrae that develop during adolescence. The cause is not currently known and the condition appears to be multifactorial and is seen more frequently in males than females.
The Harrington rod is a stainless steel surgical device. Historically, this rod was implanted along the spinal column to treat, among other conditions, a lateral or coronal-plane curvature of the spine, or scoliosis. Up to one million people had Harrington rods implanted for scoliosis between the early 1960s and the late 1990s.
A back brace is a device designed to limit the motion of the spine in cases of bone fracture or in post-operative spinal fusiona, as well as a preventative measure against some progressive conditions or to correct patient posture.
Kyphoscoliosis describes an abnormal curvature of the spine in both the coronal and sagittal planes. It is a combination of kyphosis and scoliosis. This musculoskeletal disorder often leads to other issues in patients, such as under-ventilation of lungs, pulmonary hypertension, difficulty in performing day-to-day activities, psychological issues emanating from anxiety about acceptance among peers, especially in young patients. It can also be seen in syringomyelia, Friedreich's ataxia, spina bifida, kyphoscoliotic Ehlers–Danlos syndrome (kEDS), and Duchenne muscular dystrophy due to asymmetric weakening of the paraspinal muscles.
Scheuermann's disease is a self-limiting skeletal disorder of childhood. Scheuermann's disease describes a condition where the vertebrae grow unevenly with respect to the sagittal plane; that is, the posterior angle is often greater than the anterior. This uneven growth results in the signature "wedging" shape of the vertebrae, causing kyphosis. It is named after Danish surgeon Holger Scheuermann.
The Milwaukee brace, also known as a cervico-thoraco-lumbo-sacral orthosis or CTLSO, is a back brace most often used in the treatment of spinal curvatures in children but also, more rarely, in adults to prevent collapse of the spine and associated pain and deformity. It is a full-torso brace that extends from the pelvis to the base of the skull. It was originally designed by Blount and Schmidt in 1946 for postoperative care when surgery required long periods of immobilization.
The Boston brace, a type of thoraco-lumbo-sacral-orthosis (TLSO), is a back brace used primarily for the treatment of idiopathic scoliosis in children. It was developed in 1972 by M.E "Bill" Miller and John Hall at the Boston Children's Hospital in Boston, Massachusetts.
Axial Biotech, Inc. was a privately held molecular diagnostics company based in Salt Lake City, Utah. It was founded in 2002.
The Scoliosis Research Society (SRS) is a non-profit, professional, international organization made up of physicians and allied health personnel, whose purpose is to "care for those with spinal deformity throughout life by patient care, education, research and patient advocacy." It was founded in 1966 with 37 members, and now has grown to include over 1300 spinal deformity surgeons and allied health personnel in 41 countries, with a primary focus on providing continuing medical education for health care professionals, and funding/support for research in spinal deformities. Among the founding members were Dr. Paul Randall Harrington, inventor of the Harrington rod treatment for scoliosis, and Dr. David B. Levine, spine surgeon at Hospital for Special Surgery. Harrington later served as President of the SRS from 1972 to 1973, and Levine was President of the Society from 1978 to 1979. Current membership primarily includes spinal deformity surgeons, as well as some researchers, physician assistants, and orthotists who are involved in research and treatment of spinal deformities. Strict membership criteria ensure that the individual SRS Fellows are dedicated to the highest standards of care for adult and pediatric spinal deformities, utilizing both non-operative and operative techniques.
The Risser sign is an indirect measure of skeletal maturity, whereby the degree of ossification of the iliac apophysis by x-ray evaluation is used to judge overall skeletal development. Mineralization of the iliac apophyses begins at the anterolateral crest and progresses medially towards the spine. Fusion of the calcified apophyses to the ilium then progresses in opposite direction, from medial-to-lateral.
The neuromechanics of idiopathic scoliosis is about the changes in the bones, muscles and joints in cases of spinal deformity consisting of a lateral curvature scoliosis and a rotation of the vertebrae within the curve, that is not explained by either congenital vertebral abnormalities, or neuromuscular disorders such as muscular dystrophy. The idiopathic scoliosis accounts for 80–90% of scoliosis cases. Its pathogenesis is unknown. However, changes in the vestibular system, a lateral shift of the hand representation and abnormal variability of erector spinae motor map location in the motor cortex may be involved in this disease. A short spinal cord and associated nerve tensions has been proposed as a cause and model for idiopathic scoliosis. Besides idiopathic scoliosis being more frequent in certain families, it is suspected to be transmitted via autosomal dominant inheritance. Estrogens could also play a crucial part in the progression of idiopathic scoliosis through their roles in bone formation, growth, maturation and turnover. Finally, collagen, intervertebral disc and muscle abnormalities have been suggested as the cause in idiopathic scoliosis, although these are perhaps results rather than causes.
Lateral electrical surface stimulation is a neuromuscular stimulation treatment for idiopathic scoliosis. It is also known as the LESS treatment, and was invented by Dr. Jens Axelgaard in 1976. It is a non-invasive scoliosis treatment that utilizes electrical muscle stimulation, which is also known as neurostimulation or neuromuscular stimulation.
The management of scoliosis is complex and is determined primarily by the type of scoliosis encountered: syndromic, congenital, neuromuscular, or idiopathic. Treatment options for idiopathic scoliosis are determined in part by the severity of the curvature and skeletal maturity, which together help predict the likelihood of progression. Non-surgical treatment should be pro-active with intervention performed early as "Best results were obtained in 10-25 degrees scoliosis which is a good indication to start therapy before more structural changes within the spine establish." Treatment options have historically been categorized under the following types:
- Observation
- Bracing
- Specialized physical therapy
- Surgery
Katharina Schroth was a German physiotherapist, best known for developing the Schroth Method to treat scoliosis.
Anterior vertebral body tethering (AVBT) is a relatively new surgery for the treatment of scoliosis in pediatric patients. Left untreated, severe scoliosis can worsen and eventually affect a person's lungs and heart.
Nachiappan Chockalingam, professionally known as Nachi Chockalingam is a British scientist, academic practitioner and expert in Clinical Biomechanics. He is a professor at Staffordshire University and a Fellow of the Institute of Physics and Engineering in Medicine and has been appointed to a panel of experts for the Research Excellence Framework. He was elected as a Fellow of the International Society of Biomechanics in 2023. Between 2016 and 2022, he has contributed to the NIHR Research for Patient Benefit Panel and serves in multiple other review panels of global grant awarding bodies including the EPSRC, MRC and the European Commission. He contributed to development of podiatric biomechanics in the UK and played a pivotal role in the establishment of the journals such as the Footwear Science and is on the editorial panel for a number of scientific and clinical journals.
Adolescent idiopathic scoliosis is a rather common disorder in which the spine starts abnormally curving sideways (scoliosis) at the age of 10–18 years old. This disorder generally occurs during the growth spurt that happens right before and during adolescence. In some teens, the curvature is progressive, meaning that it gets worse over time, however this is rare, since it is more common for this variant of scoliosis to show itself as a mild curvature.
Halo-gravity traction (HGT) is a type of traction device utilized to treat spinal deformities such as scoliosis, congenital spine deformities, cervical instability, basilar invagination, and kyphosis. It is used prior to surgical treatment to reduce the difficulty of the following surgery and the need for a more dangerous surgery. The device works by applying weight to the spine in order to stretch and straighten it. Patients are capable of remaining somewhat active using a wheelchair or a walker whilst undergoing treatment. Most of the research suggests that HGT is a safe treatment, and it can even improve patients' nutrition or respiratory functioning. However, some patients may experience side effects such as headaches or neurological complications. The halo device itself was invented in the 1960s by doctors working at the Riancho Los Amigos hospital. Their work was published in a paper entitled "The Halo: A Spinal Skeletal Traction Fixation Device." The clinician Pierre Stagnara utilized the device to develop Halo-Gravity traction.
Pierre Stagnara was a French spinal surgeon. He has been described as a "pioneer" in the study of spinal deformities, "one of the greatest figures of French spinal surgery." Stagnara was born in January 16, 1917 in Loriol-sur-Drôme, France. He studied medicine in the city of Lyon. During World War II he was drafted into the French army. After the war, he worked in a variety of hospitals throughout Lyon. In 1959 he became the Chief of the Centre des Massues and served in this position until his retirement in 1982. Whilst working at the institution he pioneered many orthopedic techniques. Including the non-surgical management of scoliosis.
References
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- 1 2 3 4 Yrjönen, Timo; Ylikoski, Mauno; Schlenzka, Dietrich; Kinnunen, Riitta; Poussa, Mikko (January 2006). "Effectiveness of the Providence nighttime bracing in adolescent idiopathic scoliosis: a comparative study of 36 female patients". European Spine Journal. 15 (7): 1139–1143. doi:10.1007/s00586-005-0049-9. ISSN 0940-6719. PMC 3233933 . PMID 16429287.
- ↑ Sattout, Amjad; Clin, Julien; Cobetto, Nikita; Labelle, Hubert; Aubin, Carl-Eric (July 2016). "Biomechanical Assessment of Providence Nighttime Brace for the Treatment of Adolescent Idiopathic Scoliosis". Spine Deformity. 4 (4): 259. doi:10.1016/j.jspd.2015.12.004. PMID 27927513.
- 1 2 Simony, Ane; Beuschau, Inge; Quisth, Lena; Jespersen, Stig Mindedahl; Carreon, Leah Yaccat; Andersen, Mikkel Osterheden (September 2019). "Providence nighttime bracing is effective in treatment for adolescent idiopathic scoliosis even in curves larger than 35°". European Spine Journal. 28 (9): 2020–2024. doi: 10.1007/s00586-019-06077-z . ISSN 0940-6719. PMID 31342154. S2CID 198494107.
- 1 2 3 4 Weppner, Justin L.; Alfano, Alan P. (2017). "Principles and Components of Spinal Orthoses". In Webster, Joseph; Murphy, Douglas (eds.). Atlas of Orthoses and Assistive Devices E-Book. Elsevier Health Sciences. p. 87. ISBN 978-0-323-55426-8.
- ↑ Sattou et al. 2016, p. 254.
- ↑ Fayssoux, Reginald S.; Cho, Robert H.; Herman, Martin J. (March 2010). "A History of Bracing for Idiopathic Scoliosis in North America". Clinical Orthopaedics & Related Research. 468 (3): 660. doi:10.1007/s11999-009-0888-5. ISSN 0009-921X. PMC 2816759 . PMID 19462214.
- ↑ D'Amato, Charles R.; Griggs, Sean; McCoy, Barry (September 15, 2001). "Nighttime bracing with the Providence brace in adolescent girls with idiopathic scoliosis". Spine. 26 (18): 2007. doi:10.1097/00007632-200109150-00014. ISSN 0362-2436. PMID 11547201. S2CID 28789727.
- ↑ Grivas, Theodoros B.; Rodopoulos, Georgios I.; Bardakos, Nikolaos V. (2008). "Biomechanical and clinical perspectives on nighttime bracing for adolescent idiopathic scoliosis". Studies in Health Technology and Informatics. 135: 281. ISSN 0926-9630. PMID 18401098.