Madera M , Brady J , Deily S , McGinty T , Moroz L , Singh D , Tipton G , Truumees E ; for the Seton Spine
Rehabilitation Study Group.

Author Information
OBJECTIVE The purpose of this study was to provide a systematic and comprehensive review of the
existing literature regarding postfusion rehabilitation. METHODS Using the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors conducted an
exhaustive review of multiple electronic databases. Potential articles were screened using
inclusion/exclusion criteria. Two authors independently analyzed these studies using predefined data
fields, including study quality indicators such as level of evidence and availability of accepted patient-reported
outcomes measures. These findings were synthesized in a narrative format. A third author
resolved disagreements regarding the inclusion of a study. RESULTS Twenty-one
articles with I or II levels of evidence were included in the review. The authors divided the findings of the literature
review into several groups: rehabilitation terminology, timing and duration of postfusion rehabilitation,
the need for rehabilitation relative to surgery-related morbidity, rehabilitation’s relationship to outcomes, and cognitive and psychosocial aspects of postsurgical rehabilitation. Current evidence generally supports formal rehabilitation after lumbar fusion surgery. Starting physical therapy at the
12-week postoperative mark results in better outcomes at lower cost than an earlier, 6-week start.
Where available, psychosocial support improves outcomes. However, a number of the questions could not be answered with high-grade
evidence. In these cases, the authors used “best evidence available” to make recommendations. There are many cases in which different types of caregivers use clinical terminology differently. The data supporting an optimal protocol for postfusion
rehabilitation remains elusive but, using the data available, the authors have crafted
recommendations and a model protocol, which is currently undergoing prospective study.
CONCLUSIONS Rehabilitation has long been a common feature in the postoperative management
of patients undergoing spinal fusion. Although caregivers from multiple disciplines agree that the
majority of their patients will benefit from this effort, the supporting data remain sparse. In creating a
model protocol for postlumbar fusion rehabilitation, the authors hope to share a starting point for
future postoperative lumbar fusion rehabilitation research.
CBT = cognitive behavioral therapy; LOE = level of evidence; LOS = length of stay; NASS = North
American Spine Society; ODI = Oswestry Disability Index; PRISMA; ROM = range of motion; degenerative; lumbar
fusion surgery; outcome; physical therapy; rehabilitation; systematic review
PMID: 28291412 DOI: 10.3171/2016.10.SPINE16627


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Benjamin B1Caroline S1Roussouly P1Laouissat F1Obeid I1Boissière L1Parent FH1Schuller S1Steib JP1Pascal-Moussellard H1Guigui P1Stéphane W1Guillaume R2Study Group on Scoliosis (GES)1.

Author information



Surgical treatment of spinal deformity is high risk in patients suffering from Parkinson’s disease (PD). Several series have already reported a high rate of complications. However, none of these studies included more than 40 patients and none of the risk factors of complications were described. The aim of this study was to describe the rate and risk factors of revision surgery as well as the clinical outcome at the last visit in a large multicenter study of PD patients operated for spinal deformities.


A multicenter retrospective study included arthrodesis for spinal deformity in patients with PD. Clinical and surgical data including revision surgeries were collected. Assessment of functional outcomes at last follow-up was classified in 3 grades and spinal balance was assessed on anteroposterior and lateral plain X-rays of the entire spine.


Forty-eight patients were included. Median age was 67 years old (range 41-80). Median follow-up was 27 months. The rate of surgical revision was 42%. Eighty per cent of revisions were performed for chronic mechanical complication. Global results were considered to be good in 17 patients (35%), doubtful in 17 patients (35%) and a failure in 14 patients (30%), for the whole series.


The results of surgery for spinal deformities in patients with Parkinson disease vary with a high rate of complications and revisions. Nevertheless, these results should be seen in relation to the natural progression of these spinal deformities once spinal imbalance has developed. The association between preoperative clinical balance and final outcome suggests that early surgery can probably play a role in treatment.


Level IV (e.g. Case Series).

Copyright © 2017. Published by Elsevier Masson SAS.


Parkinson’s disease; Sagittal balance; complications; revision rate; spinal deformity

PMID: 28285031 DOI: 10.1016/j.otsr.2016.12.024


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Ye X1Lou D1,2Ding X1,3Xie C1,4Gao J1Lou Y1,5Cen Z1,5Xiao Y6Miao Q1,7Xie F1,8Zheng X1Wu J9Li F10Luo W11.

Author information



Postural deformities in the coronal plane were frequent and disabling complications of PD, which reduces the quality of life of patients. This study aimed to garner greater attention to the Parkinson disease (PD)-related postural trunk deviations in the coronal plane by exploring a method for diagnosis because of the lack of any uniform diagnostic criteria and epidemiological studies. It also aimed to provide correlation data in the Chinese PD patients.


In this cross-sectional study, 503 consecutive outpatients with PD were enrolled who underwent standardized clinical evaluation. The study recruited 83 PD patients diagnosed with Pisa syndrome (PS). Scoliosis and coronal imbalance were diagnosed accurately by radiographic data. The PD patients were compared based on the Cobb angle and coronal balance for several demographic and clinical variables.


PD patients with PS had a prevalence of 16.5%. The prevalence of coronal imbalance and scoliosis was 10.34 and 7.75%, respectively. PD patients with PS were older and had a more severe disease, significantly longer disease duration and treatment duration, and reduced quality of life. The most important finding was that the different morphology of the spinal level had an effect on the severity of coronal balance or Cobb angle.


The present study indicated that the postural deformities in the coronal plane were related to the morphology of the spinal level, especially the position of the Cobb angle. To benefit the PD patients with PS, the full-length standing spine radiographs should be performed as early as possible.


Cobb angle; Coronal imbalance; Parkinson disease; Pisa syndrome; Scoliosis



PMID: 28281005 DOI: 10.1007/s00586-017-5018-6

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Chan CY1Chiu CKLee CKGani SMMohamad SMHasan MSKwan MK.

Author information



Randomized controlled trial.


This study investigated on the effectiveness of chewing gum on promoting faster bowel function and its ability to hasten recovery for adolescent idiopathic scoliosis (AIS) patients following posterior spinal fusion (PSF) surgery.


Sham feeding with chewing gum had been reported to reducethe incidence of post-operative ileus by accelerating recovery of bowel function.


We prospectively recruited and randomized 60 AIS patients scheduled for PSF surgery into treatment (chewing gum) and control group.The patient controlled anesthesia usage, wound pain score, abdominal pain score, nausea score and abdominal girth were assessed and recorded at 12, 24, 36, 48 and 60 hours post-operatively. The timing for the first fluid intake, first oral intake, sitting up, walking, first flatus after surgery, first bowel opening after surgery and duration of hospital stay were also assessed and recorded.


We found that there were no significant differences (p > 0.05) patient controlled anesthesia usage, wound pain score, abdominal pain score, nausea score and abdominal girth between treatment (chewing gum) and control groups. We also found that therewere no significant difference (p > 0.05) in post-operative recovery parameters which were the first fluid intake, first oral intake, sitting up after surgery, walking after surgery, first flatus after surgery, first bowel opening after surgery and duration of hospital stay between both groups. The wound pain was the worst at 12 hours post-operatively which progressively improved in both groups. The abdominal pain progressively worsened to the highest score at 48 hours in the treatment group and 36 hours in the control group before improving after that. The pattern of severity and recovery of wound pain and abdominal pain were different.


We found that chewing gum did not significantly reduce the abdominal pain, promote faster bowel function or hasten patient recovery.


PMID:  28248896   DOI:  10.1097/BRS.0000000000002135


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Chan P1Skaggs DSanders AVillamor GAChoi PDTolo VAndras LM.

Author information



Prospective cross-sectional study OBJECTIVE.: To evaluate patients’ and parents’ concerns so they can be addressed with appropriate preoperative counseling.


Despite much research on outcomes for posterior spinal fusion (PSF) in adolescent idiopathic scoliosis (AIS), little is available about preoperative fears or concerns.


AIS patients undergoing PSF, their parents, and surgeons, were prospectively enrolled and asked to complete a survey on their fears and concerns about surgery at their preoperative appointment.


Forty-eight patients and parents completed surveys. Four attending pediatric spine surgeons participated and submitted 48 responses. Mean age of patients was 14.2 years. On a scale of 0-10, mean level of concern reported by parents (6.9) was higher than that reported by patients (4.6). Surgeons rated the procedure’s complexity on a scale of 0-10 and reported a mean of 5.2. Neither patients’ nor parents’ level of concern correlated with the surgeons’ assessment of the procedure’s complexity level (R = 0.19 and 0.12, p = 0.20 and p = 0.42 respectively). Top 3 concerns for patients were pain (25%), ability to return to activities (21%), and neurologic injury (17%). Top 3 concerns for parents were pain (35%), neurologic injury (21%), and amount of correction (17%). Top 3 concerns for surgeons were postoperative shoulder balance (44%), neurologic injury (27%), and LIV selection (27%). Patients reported the same concerns 23% of the time as parents, and 17% of the time as surgeons. Parents and surgeons reported the same concerns 21% of the time.


Pain was the greatest concern for both patients and parents but was rarely listed as a concern by surgeons. Parent and patient level of concern did not correlate to the surgeon’s assessment of the procedure’s complexity. Neurologic injury was a top concern for all groups, but otherwise there was little overlap between physician, patient and parent concerns.


PMID: 28263228     DOI:  10.1097/BRS.0000000000002147


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CHICAGO — A speaker here at the American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium developed a survey to poll spinal orthotists and to identify areas of agreement or disagreement regarding orthotic biomechanical correction theory of adolescent idiopathic scoliosis.

Sun Hae Jang, MSc, CO, FAAOP, a PhD candidate at Eastern Michigan University, and colleagues polled 46 certified orthotists and certified prosthetist-orthotists with at least 2 years of experience in scoliosis-orthotic treatment. Overall, 21 multiple-choice questions were developed that focused on general concepts and case examples in the orthotic-biomechanical field. Researchers calculated the number of participants who picked each multiple-choice option and identified the ratio of agreement vs. disagreement.

Researchers found agreement on 11 biomechanical-orthotic correction topics. There were seven topics on which participants did not find clear agreement, and the most disagreement occurred on questions regarding the sagittal plane.

Using the collected data, researchers conducted a review of literature on each area of disagreement. Jang said most studies supported that the superior edge of a thoracic pad should be placed on the rib attached at the apex of the thoracic curve or on the levels caudal to the apex.

“We found that abdominal compression has the function of superimposing a longitudinal stretch on the lumbar and thoracic spines by increasing intra-abdominal pressure,” Jang said. “Abdominal pressure is also related to reducing lumbar lordosis. However, most articles proposed that if someone has a thoracic scoliosis curve, unnecessary reduction of lumbar lordosis, including abdominal compression, could be contraindicated.”

Jang said evidence shows that cervical-thoracic-lumbar-sacral orthoses are the best option for T2-T6 curvatures. “However, patient compliance issues have been noted,” she said. “A shoulder ring is recommended to control cervico-thoracic scoliotic curves, and a trapezius pad is recommended to control high thoracic curves.”

According to Jang, more quantitative research is needed to understand biomechanical correction concepts and orthotists should treat patients based on generally defined concepts – by Shawn M. Carter


Jang SH. Current Practice in Orthotic Treatment of Adolescent Idiopathic Scoliosis. Presented at: American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium; March 1-4, 2017; Chicago.

Disclosure: Jang reports no relevant financial disclosers. 

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On Tuesday, December 1, 2015, The National Scoliosis Foundation is participating in #GivingTuesday, a global day dedicated to giving. Last year, more than 30,000 organizations in 68 countries came together to celebrate in this philanthropic campaign.

We invite you to join the movement through your donation to support our mission which was born in 1976 out of a labor of love and assistance for Atlabachew Tedla, an Ethiopian teenager with a severe 145 ° spinal curve.

In 2016, we celebrate our 40th Anniversary of compassionate service to help people in need, and our dedicated awareness/screening/advocacy campaigns for preventive measures to minimize the impact scoliosis may have in their life.

We have accomplished much; however, we cannot rest until all children, regardless of race, creed, residence and/or socioeconomic condition, have access to early detection, diagnosis, and optimal treatment. Your donation on this#GivingTuesday will make a positive difference in someone’s life.

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USPSTF Public Comment Deadline is October 28, 2015

The US Preventive Services Task Force has published it’s draft research plan on Screening for Adolescent Idiopathic (AIS). To comment on the USPSTF draft plan please click here.

Draft: Proposed Key Questions to Be Systematically Reviewed

  1. Does screening for adolescent idiopathic scoliosis improve: a) health outcomes and b) the degree of abnormal curve in childhood or adulthood?
  2. What is the accuracy of screening for adolescent idiopathic scoliosis?
  3. Does treatment of adolescent idiopathic scoliosis with a Cobb angle of less than 50° at diagnosis improve: a) health outcomes and b) the degree of spinal curve in childhood or adulthood?
  4. What is the association between Cobb angle measurement in adolescence and health outcomes in adulthood?
  5. What are the harms of screening for adolescent idiopathic scoliosis?
  6. What are the harms of treatment of adolescent idiopathic scoliosis with a Cobb angle of less than 50° at diagnosis?

Draft: Proposed Research Approach

The proposed Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions (KQs).

Include Exclude
Populations KQs 1, 2, 5: Asymptomatic children and adolescents ages 10 to 18 years

KQs 3, 6: Persons with adolescent idiopathic scoliosis diagnosed at ages 10 to 18 years with a Cobb angle of 10° to 50° detected through screening

KQ 4: Persons with adolescent idiopathic scoliosis diagnosed at ages 10 to 18 years with a Cobb angle of 10° to 50°

Persons with scoliosis of:

  • Neuromuscular etiology (e.g., cerebral palsy, myelomeningocele, muscular dystrophy, spinal muscular atrophy, spina bifida, spinal cord injuries)
  • Congenital etiology (e.g., hemivertebrae, failure of segmentation)
  • Mesenchymal/syndromic etiology (e.g., Marfan syndrome, mucopolysaccharidosis, osteogenesis imperfecta, inflammatory diseases, postoperative)
  • Early-onset idiopathic etiology (infantile [ages 0 to 3 years] or juvenile [ages 4 to 9 years])
  • Primary care or generalizable to primary care
  • School-based screening programs
  • Countries categorized as “High” on the Human Development Index (as defined by the United Nations Development Programme)
Specialty care (e.g., surgical clinics and clinics for conditions known to be associated with scoliosis) and other settings with a symptomatic population
Screening tests KQs 1, 2, 5: Forward bend test (with or without scoliometer/inclinometer), surface topography, or other methods (e.g., back-contour device), followed by x-ray for confirmation

KQ 2: Studies with a reference standard

KQs 1, 2, 5:

  • X-ray alone
  • Selective screening
Treatments KQs 3, 6:

  • Surgery
  • Nonoperative treatment, including but not limited to: bracing, physical therapy/exercise therapy, and electrical muscle stimulation
Comparison KQs 1, 2, 5: Usual care

KQs 3, 6: Observation, usual care

KQs 1, 2, 5: Studies with no comparator

KQs 3, 6: Comparative effectiveness studies

Harms KQ 5: Any screening harms, including but not limited to: labeling, radiation exposure

KQ 6: Any treatment harms, including but not limited to: psychosocial harms, physiological harms, functioning, or pain

KQs 5, 6: Studies with no comparator
Outcomes Intermediate outcomes: Cobb angle measurement

Health outcomes:

  • Morbidity (e.g., pulmonary symptoms, hypertension, lumbar radiculopathy)
  • Quality of life
  • Functional outcomes (e.g., pain, musculoskeletal function, activity restriction)
  • Mortality
Study design KQs 1–4: Randomized, controlled trials; controlled trials; cohort studies

KQs 5, 6: Randomized, controlled trials; controlled trials; cohort studies; case series

All KQs: Studies rated as poor quality

KQs 1–4: Case series, cost-effectiveness studies, qualitative study designs

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The is pleased to report that the U.S. Preventive Services Task Force will be reviewing screening for . We encourage everyone to sign up per the notification below to follow this very important effort, which we hope will lead to an evidence based decision to replace their 2004 statement with a posiitve recommendation for early detection of AIS.

“Soon, the U.S. Preventive Services Task Force (USPSTF, Task Force) will be posting for public comment our draft research plan on screening for adolescent idiopathic scoliosis on our Web site. We thought that you and members of your organization might be interested in providing feedback on this draft research plan and receiving periodic updates on this topic. As such, I invite you to sign up for the USPSTF email list to receive announcements and updates on this and other Task Force recommendations about clinical preventive services. The USPSTF email list is open to anyone with interest in our work, so please let members of your organization know about this opportunity to offer comments on our research plan and the ability to sign up to receive updates from the Task Force.

As you may know, the Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine. Our mission is to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications. The Task Force believes that the recommendation development process should be clear and transparent and, in an effort to ensure this, has implemented public comment periods throughout the recommendation process. The purpose of the public comment process is to seek feedback from organizations like yours, along with the general public, at each stage of development. The Task Force believes that our recommendations are ultimately improved when groups who care about and are knowledgeable about particular topics share their expertise. We solicit outside input to ensure that final recommendations are valid, reliable, and useful to health professionals, patients, and family members.

Individuals who sign up for the USPSTF email list will be alerted about opportunities to provide public comment on draft materials for screening for adolescent idiopathic scoliosis and other Task Force topics. Email alerts will also be sent when final materials are posted or published, including the release of final recommendation statements. For each topic, an email announcement will be sent at the following stages of the recommendation development process:

  • Posting of the draft research plan for public comment
  • Posting of the final research plan
  • Posting of the draft recommendation statement and draft evidence review for public comment
  • Publication and posting of the final recommendation statement and the evidence summary

We hope that you will widely disseminate the final recommendation statement, following the rigorous, evidence-based recommendation development process and public comment periods, among your membership and encourage your members to implement it once it becomes available.

As I noted earlier, the USPSTF email list is open to all interested organizations and individuals. If you know of any other national or local organizations, subject matter experts, or individuals who are interested in learning about Task Force recommendations, like screening for adolescent idiopathic scoliosis, public comment opportunities, and other Task Force activities, please encourage them to sign up as well.

To learn more about the Task Force, you can view a Task Force 101 slideshow or visit our Web site.

Together, we can work to improve the health of all Americans.


Albert L. Siu, M.D., M.S.P.H.

Chair, U.S. Preventive Services Task Force”

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Fond Memories of Herb Homer

On this anniversary of 9/11 we express our gratitude for everyone who keeps us safe and protects our freedom in our daily lives. We also remember the people and families greatly impacted by this terrible tragedy, especially for our friend and fellow Board Member, Herb Homer, who was aboard United Flight 175. May he forever rest in peace.

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