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Thread: Research Help Please!

  1. #1
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    Research Help Please!

    Hi, I am looking for research evidence to support that breathing issues are caused by Adolescent idiopathic scoliosis. I’m specifically looking for how severe the degree of the thoracic curve needs to be before issues are noted and specifically the severity of the breathing problems encountered. I’m not interested in opinions published on surgeon web sites; I am looking for EVIDENCE based research. I am also interested in Evidence based research that demonstrates that spinal fusion surgery improves breathing issues. I have access to a College Library, so Titles and year published only are ok. Any help will be appreciated.
    Last edited by Roxanne1979; 11-25-2011 at 12:23 PM. Reason: left off word
    Roxanne
    Milwaukee Brace 2 years
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    Fusion Repair 1979

  2. #2
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    Hi Roxanne...

    A search of idiopathic scoliosis and pulmonary brought up 277 citations. For example, "Spinal factors affecting pulmonary function in patients with Scoliosis" or "Scoliosis on pulmonary function". You can do your own search at http://www.ncbi.nim.nih.gov/pubmed/. If you go back to the studies done prior to 1980, there are a lot of studies addressing the issues you mentioned.

    Regards,
    Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
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  3. #3
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    I also find it useful to get on scholar.google.com and type in what you are looking for, in this case maybe idiopathic scoliosis pulmonary. Unfortunately if you do not have access to online journals (ie not at a hospital or academic institution), you can't really read much more than the abstract, though some are published as free articles.

  4. #4
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    Now I'm confused ?

    Thank you both for the research tips. It also turns out I was using the advance search tool incorrectly. Plus I think using the word “pulmonary” is helpful.
    I’m not a professional research scientist, nor a doctor. However, it seems to me that there is a plethora of data out there that contradicts. I had a highly respected doctor make the following statements to me, which basically challenged what I thought I knew about AIS. (I had been referred to him because my thoracic curve is now measuring 90 degrees, when last measured in 1990 it was 72 degrees)
    1. Studies that linked breathing issues to scoliosis included all types of scoliosis and were not just AIS.
    Here’s what I’ve found so far:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2572584/ Full text, appears to support that early studies included all types of scoliosis when studying pulmonary function.

    http://www.actacams.com/Jwk_yxkxy/EN...umn_1186.shtml Full text (thank you Linda) appears to show a correlation between Idiopathic scoliosis and pulmonary function, however it does not specify if the idiopathic scoliosis subjects are Adolescent cases (not that I can see)


    2. I understood him to say if I had any breathing issues they were not related to the scoliosis.

    Here’s what I’ve found so far:
    http://www.ncbi.nlm.nih.gov/pubmed/16140807 - quote from abstract “but the majority of the observed variability in pulmonary function was not explained by the radiographic characteristics of the deformity.” I have access to the full text, and this article does in part seem to support my doctor’s view.
    http://www.ncbi.nlm.nih.gov/pubmed/21270699 - I don’t have access to the full text on this article and I’d really like to see it.
    http://jama.ama-assn.org/content/289....full.pdf+html Full text “Health and Function of Patients With Untreated Idiopathic Scoliosis A 50-Year Natural History Study”

    3. Progressive curves have pain associated with them. – I’m still trying to find data on this one.

    Another preliminary observation that I’ve made is there seem to be two diametrically opposed medical communities, SOSORT and SRS. SOSORT’s papers seem to be much easier to access.

    Roxanne
    Roxanne
    Milwaukee Brace 2 years
    Fused 1976
    Fusion Repair 1979

  5. #5
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    Quote Originally Posted by Roxanne1979 View Post
    Thank you both for the research tips. It also turns out I was using the advance search tool incorrectly. Plus I think using the word “pulmonary” is helpful.
    I’m not a professional research scientist, nor a doctor. However, it seems to me that there is a plethora of data out there that contradicts. I had a highly respected doctor make the following statements to me, which basically challenged what I thought I knew about AIS. (I had been referred to him because my thoracic curve is now measuring 90 degrees, when last measured in 1990 it was 72 degrees)
    1. Studies that linked breathing issues to scoliosis included all types of scoliosis and were not just AIS.
    Here’s what I’ve found so far:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2572584/ Full text, appears to support that early studies included all types of scoliosis when studying pulmonary function.

    http://www.actacams.com/Jwk_yxkxy/EN...umn_1186.shtml Full text (thank you Linda) appears to show a correlation between Idiopathic scoliosis and pulmonary function, however it does not specify if the idiopathic scoliosis subjects are Adolescent cases (not that I can see)
    I'm 98% sure they used adolescent patients in the second study you listed.


    Quote Originally Posted by Roxanne1979 View Post
    2. I understood him to say if I had any breathing issues they were not related to the scoliosis.

    Here’s what I’ve found so far:
    http://www.ncbi.nlm.nih.gov/pubmed/16140807 - quote from abstract “but the majority of the observed variability in pulmonary function was not explained by the radiographic characteristics of the deformity.” I have access to the full text, and this article does in part seem to support my doctor’s view.
    This study was designed to test the hypothesis that increasing curve magnitude would negatively affect pulmonary function compared to age matched controls. They found their hypothesis to be true. That the radiographic measurements don't completely explain the decreased PFT (pulmonary function testing) isn't hugely surprising. To take this low predictability between x-rays and PFT to imply that AIS doesn't affect PF would be a misrepresentation of the findings.

    Quote Originally Posted by Roxanne1979 View Post
    http://www.ncbi.nlm.nih.gov/pubmed/21270699 - I don’t have access to the full text on this article and I’d really like to see it.
    This is a very recent study and is meant to try and determine the relationship between various x-ray measurements and PFT in the pre-surgical population. It's also based on normative PFT values. This is fairly common in this line of research. There are "predicted values" of various PFT. If you score a certain percentage below your predicted value (PV) then you have an impairment. At any rate, I found this statement in the study to be descriptive of their intentions:

    Considering that adult patients with PFTs of < 50% predicted values have an extremely guarded prognosis for respiratory failure, combined with the known deterioration of vital capacity with the normal aging process, the rather sanguine opinion provided by some investigators regarding pulmonary morbidity in later-onset or AIS seems in need of re-evaluation.
    Their patients already have surgical curves and 19% have <65% PV of various PFT measurements, i.e. 19% of pre-surgical patients have PFT impairment. I would have thought this number would be higher, but if a guarded prognosis for respiratory failure begins at PV <50%, then many patients aren't that far away from that level. Additionally, it seems to be starting with the assumptions that most surgical candidates have reduced PFT. However, it is hard to pull that specific information from the study because of the way they present the data, i.e. I can't tell how many patients have reduced PFT. 65% has become somewhat of an arbitrary number for clinically significant impairment. While I am admittedly not really familiar with these studies or the line of research it seems fairly clear that decreased pulmonary function is associated with larger curves.

    Quote Originally Posted by Roxanne1979 View Post
    http://jama.ama-assn.org/content/289....full.pdf+html Full text “Health and Function of Patients With Untreated Idiopathic Scoliosis A 50-Year Natural History Study”
    The pulmonary data from the above study is presented in this reference.
    Weinstein SL, Zavala DC, Ponseti IV.
    Idiopathic scoliosis: long-term follow-up and prognosis in untreated patients.
    J Bone Joint Surg Am. 1981 Jun;63(5):702-12. PubMed PMID: 6453874.

    It was one of the first to show a link to progressing scoliosis and pulmonary function deficit.

    Quote Originally Posted by Roxanne1979 View Post
    3. Progressive curves have pain associated with them. – I’m still trying to find data on this one.
    Using the references above will be a good starting point to finding this information. You may also look at this reference. It has a fairly extensive review of the pulmonary characteristics associated with scoliosis.

    Hawes MC, O'Brien JP.
    A century of spine surgery: what can patients expect?
    Disabil Rehabil. 2008;30(10):808-17. Review. PubMed PMID: 18432439.

    Like I said above, it seems fairly clear that larger curves negatively affect pulmonary function. There are arguments against this basic statement but they get down to somewhat semantic issues. The lack of correlation between cobb angle and decreased PF, just highlights that there are other factors in play as well, e.g. lower activity level (due to scoliosis?) or encouragement during testing. As well, these are mostly cross sectional studies. I'm sure there are longitudinal studies (Weistein certainly is). These types of studies would better show the relationship of curve progression and PF decreases.

    Quote Originally Posted by Roxanne1979 View Post
    Another preliminary observation that I’ve made is there seem to be two diametrically opposed medical communities, SOSORT and SRS. SOSORT’s papers seem to be much easier to access.

    Roxanne
    The focus of the two groups is just different. SOSORT is focused only on conservative/therapeutic interventions and SRS is focused on all aspects and types of scoliosis. Depending on the leadership of the SRS, it can shift its emphasis to more surgical or biochemical or genetic, etc... directions. SOSORT also publishes primarily in an open source journal Scoliosis. Whereas SRS seems to push publications in Spine, JBJS and JOR, which require a subscription.

  6. #6
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    Quote Originally Posted by Kevin_Mc View Post
    SOSORT also publishes primarily in an open source journal Scoliosis. Whereas SRS seems to push publications in Spine, JBJS and JOR, which require a subscription.
    This isn't my field but I am getting the distinct impression that Spine is the Science or Nature of the spinal orthopedics journals. That is, cream of the cream of the journals with the highest impact factor.

    JBJS seems to be up there also though not above Spine. I don't yet have vibe for JOR.

    I do have a vibe for certain other journals that we see posted here from time to time... they do not appear to be in the top tier when it comes to scoliosis but I don't know that.
    Sharon, mother of identical twin girls with scoliosis

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  7. #7
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    Quote Originally Posted by Pooka1 View Post
    This isn't my field but I am getting the distinct impression that Spine is the Science or Nature of the spinal orthopedics journals. That is, cream of the cream of the journals with the highest impact factor.

    JBJS seems to be up there also though not above Spine. I don't yet have vibe for JOR.

    I do have a vibe for certain other journals that we see posted here from time to time... they do not appear to be in the top tier when it comes to scoliosis but I don't know that.
    Generally you are correct. Spine, JBJS and JOR are usually in the top 10 of the orthopedics category for impact factor. Although I'm not a huge fan of the impact factor rating itself. Particularly as a means of determining the quality of a single paper or author. It certainly has its merits but I think it has some significant weaknesses as well. Notably, the size of the field will greatly influence the impact factor. As well, they are almost self-sustaining or self-fulfilling prophesies if people place too much emphasis on them, i.e. if I only have a shot at tenure or grant funding based on which journals I publish in (high impact factor) - then I know to which journals I'll submit. It can also present a catch-22 if you are trying to publish something unique or controversial. But this starts to get way off topic.

    If you are referring to Scoliosis, that journal hasn't been around long enough to get a rating yet.

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