Researchers compared a combined anterior and posterior approach to a posterior approach for
severe scoliosis treatment, in a study published in Spine.

The study included patients with idiopathic scoliosis undergoing operations with Cotrel–
Dubousset hybrid instrumentation with pedicle screw and hooks. Thirty patients underwent the
two-stage surgery and 46 underwent posterior surgery.

Here are five observations:

1. Researchers did not find significant correction differences between the two-stage
surgery group with an average correction of 69 percent and the posterior group, with an average correction of 66
percent.

2. The study revealed hospitalization time was higher for the two-stage group compared to the
posterior group.

3. Additionally, surgery duration was significantly longer for the two-stage surgery group.

4. Researchers concluded the posterior approach and the two-stage approach are “equally
effective for operative treatment of severe idiopathic scoliosis in terms of regaining good balance,
achieving maximal possible correction with minimal complications, and good long-term clinical
result.”

5. Based on the two-stage group’s longer surgery duration and hospital stay, however, the
posterior approach may be the preferred treatment method for severe idiopathic scoliosis.

A North Augusta High student will be recognized throughout the state this month as part of a photo exhibit project in Columbia.

Elisabeth Harkins, a junior at the high school, will be part of Family Connection of South Carolina’s Look! Forward photo exhibit, which showcases children and young adults who have overcome disabilities.

Harkins, who was diagnosed with scoliosis eight years ago, was one of 50 selected throughout the state to be a part of the exhibit at the Tapp’s Arts Center and is the only person selected from Aiken County.

When Harkins first discovered she had scoliosis, she said it was by accident during a routine visit to the doctor. She said that during the visit, she bent over to tie her shoe and after her shirt lifted a tad, the doctor noticed an irregularity in her back.

“We found out by accident, which blows my mind sometimes because I was tying my shoe and they just noticed my back,” she said. “Sometimes I think what would have happened if I had never done that.”

Harkins’ grandmother Lisa added, “It kind of just blows your mind a little bit. If she hadn’t happened to bend over and do that, we might not have ever found out, and then as they grow a lot of times their curves will get worse.”

Since then, Harkins has worked to spread awareness for scoliosis, having former South Carolina Governor Nikki Haley and North Augusta Mayor Lark Jones issue proclamations in June for Scoliosis Awareness Month the past four and three years, respectively.

In addition to raising awareness to the disability throughout the state and CSRA, Harkins also founded a Curvy Girls group for girls with scoliosis in South Carolina and parts of Georgia. Curvy Girls is a national network of peer-led support groups that reduce the emotional impact of scoliosis by empowering girls through mutual support and acceptance to become leaders, make healthy lifestyle choices and improve self-esteem, according to the organization’s website.

“It has been carving who I am, kind of,” said Elisabeth. “I’m glad that I’ve been able to help the girls and to see that they’re actually improving is pretty good.”

Lisa said that since Elisabeth was diagnosed she has noticed her become more vocal about the disability, and her work in advocating for scoliosis awareness has led to her taking leadership roles in other areas of her life.

“I’ve noticed with her she’s more willing now to take on a leadership role in different things,” she said. “She doesn’t mind talking about the scoliosis. For her, it hasn’t really stopped her from doing what she does.”

Outside of her work with scoliosis, Elisabeth is involved with North Augusta’s NJROTC program and band, and also started a sign language club this school year. She also serves as the president of the Aiken County Red Cross Youth Board.

“I don’t think she would’ve taken that kind of initiative maybe five or six years ago, so in a weird way the scoliosis, even though it’s a negative thing, it has kind of had a positive impact on her,” said Lisa.

Elisabeth said that what she’s been most proud of throughout her battle with scoliosis is how she has been able to reach out to other girls with the disability and help them.

“There are people with scoliosis, but not a lot of them talk about it a lot, so for me to say something could start off everybody else,” she said. “It’s something really big and some people just mistake it for something that’s small and doesn’t mean anything.”

Elisabeth’s exhibit will be on display throughout April at the Tapp’s Arts Center, 1644 Main Street in Columbia. The Center is open 10 a.m. to 6 p.m. Tuesday through Saturday.

LANSING, Kan. — She’s lettered in swim, cross-country and power lifting, but that’s not why she’s this week’s Reaching for Excellence young achiever.

Lansing High School junior Leah Wiegers is being recognized for her determination to get mandatory scoliosis testing in schools.

The 17-year-old calls herself: “Someone who just stands up for what’s right.”

She was diagnosed with scoliosis when she was 12, and has become an advocate. Part of her treatment involves wearing a hard brace.

“Just open it up like this and then you just put it on. It was like having a shell on me for 20 hours a day for two years,” she described.

Look at her five years later, and although she is not healed, per say, she’s doing much better! Better, she believes, because doctors caught it early.

“It really empowered me to speak up for what I believe in,” she said.

And that — she did. Currently, the state of Kansas does not require schools to screen for scoliosis. Lansing Unified School District 469 does not… well, did not, until Leah spoke up.

“Leah is outstanding. She is doing the work of what really we see in college-prepared persons or really persons of myself who are doing post maters work, Ph.D work or even doctoral work,” Jill Ariagno said.

Ariagno is Leah’s nurse and has been with her from the very beginning.

“Just quite an exceptional kid,” she said of Leah.

Recently, Leah put together a presentation and met with school officials,  local medical experts, even a state senator and representative. She took her experience and findings to her school board.

“It was unanimous. They didn’t really have to vote on it because there was already a policy that allowed them to screen at our school, but nobody was doing it for the past few years,” Leah said.

Phase one of training nurses is already done. Beginning later this year, or early next — schools within her district will now screen all kids for scoliosis.

Leah wants to get an ROTC scholarship and attend a military academy. She dreams of one day following in her mother’s footsteps, and becoming an officer in a military branch.

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
Abstract
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

Benjamin B¹, Caroline S¹, Roussouly P¹, Laouissat F¹, Obeid I¹, Boissière L¹, Parent FH¹, Schuller S¹, Steib JP¹, Pascal-Moussellard H¹, Guigui P¹, Stéphane W¹, Guillaume R²; Study Group on Scoliosis (GES)¹.

Author information

Abstract

INTRODUCTION:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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 OF EVIDENCE:

Level IV (e.g. Case Series).

Copyright © 2017. Published by Elsevier Masson SAS.

KEYWORDS:

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

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

Ye X¹, Lou D^1,2, Ding X^1,3, Xie C^1,4, Gao J¹, Lou Y^1,5, Cen Z^1,5, Xiao Y⁶, Miao Q^1,7, Xie F^1,8, Zheng X¹, Wu J⁹, Li F¹⁰, Luo W¹¹.

Author information

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

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

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

Chan CY¹, Chiu CK, Lee CK, Gani SM, Mohamad SM, Hasan MS, Kwan MK.

Author information

Abstract

STUDY DESIGN:

Randomized controlled trial.

OBJECTIVE:

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.

SUMMARY OF BACKGROUND DATA:

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

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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

LEVEL OF EVIDENCE:  1.

PMID:  28248896   DOI:  10.1097/BRS.0000000000002135

Chan P¹, Skaggs D, Sanders A, Villamor GA, Choi PD, Tolo V, Andras LM.

Author information

Abstract

STUDY DESIGN:

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

SUMMARY OF BACKGROUND DATA:

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

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

LEVEL OF EVIDENCE: 3.

PMID: 28263228     DOI:  10.1097/BRS.0000000000002147

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

Reference:

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. 

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 40^th 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.