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The aim of school screening is to identify most or all the individuals with unrecognized idiopathic scoliosis (IS) at an early stage when a less invasive treatment is more effective. However like other medical screening programs it has not escaped controversy about its value. The present study summarises the contribution of school screening in research of IS epidemiology, natural history and aetiology. Such contribution is beyond the original aim of school screening but is very important to expand our knowledge and adequately understand the pathogenesis of IS. The role of biological factors such as the menarche, the lateralization of the brain, the handedness, the thoracic cage, the intervertebral disc, the melatonin secretion, as well as the role of environmental factors such as the light and the impact of the geographical latitude in IS prevalence were studied in children referred from school screening. The present study provides evidence to support that school screening programs should be continued not only for early detection of IS but also as a basis for epidemiological surveys until we learn much more about the aetiology of IS. [ABSTRACT FROM AUTHOR]

The value of school screening for idiopathic scoliosis (IS) has been questioned recently, because of its high false positive referrals and its excessive cost, although in areas where screening programs exist, fewer patients ultimately require surgery for IS. In a typical school screening setting there are numerous factors which can determine the effectiveness. The present study identifies some of these factors and provides evidence based recommendations for the improvement of school screening effectiveness. After reviewing all the research papers which originated from the Thriasio school screening program and published in peer-review journals, specific suggestions for the organization, the optimal age of screening according to the geographical latitude, the best examined position, the standardization of referrals, the follow up of younger referrals with trunk asymmetry and the reduction of the financial cost are made. We strongly suggest the introduction of these recommendations to all the existing school screening programs in order to improve their effectiveness and to reduce the negative impact they may have on families and on the health system. [ABSTRACT FROM AUTHOR]

Improved cosmesis is a major concern for the adolescents with Idiopathic Scoliosis (IS). We hypothesized that if we correct the rotation simultaneously to the lateral curvature of the spine with a dynamic brace we may decrease the asymmetry of the back and ultimately improve the cosmetic appearance of the scoliotic child. Thirty six scoliotic children (32 girls and 4 boys) with a mean age of 13.9 (range 12–17) years, a mean Cobb angle of 28,2° (range 19–38°) and a mean ATI 7,8° (range 4°–17°) were studied. The examined children were divided in 3 subgroups according to the curve type. All children wore the Dynamic Derotation Brace (DDB), which is a modified Boston brace with antirotatory blades, for 23 hours per day, for a minimum duration of 2 years. The ATI was assessed using the Pruijs scoliometer at baseline and at the end of treatment. ATI was improved statistically significant in the thoracolumbar (p<0.01) and lumbar region (p<0.013) of double curves and in the thoracolumbar (p<0.018) and lumbar region (p<0.027) of thoracolumbar curves. ATI improvement in the thoracic region was not statistically significant either in double curves (p<0.088) or in thoracolumbar curves (p<0.248). For right thoracic curves, ATI improvement was not statistically significant for all the examined regions. The above findings indicate that in double and thoracolumbar curves, a deforming torsional force is present, blocked by the antirotatory action of the blades of the DDB, and seems to be more active in the “lower” spine. In conclusion, DDB improves the cosmetic appearance of the back of IS children with all but right thoracic curves. [ABSTRACT FROM AUTHOR]

As an important consideration in medical care, health-related quality of life (HRQoL) refers to the patient's ability to enjoy normal life activities. When assessing the effectiveness of conservative treatment of AIS, HRQoL variables are more important than the radiographic results or pulmonary function. The present study examines the impact of conservative treatment in HRQoL of the AIS patients. Thirty-two female patients with a mean age of 13.5 (range 12–16) years, a mean Cobb angle of 29.4° (range 21–38°) and a mean angle of trunk inclination (ATI) 7.9° (range 5°–18°) were treated with a full time application of a modified Boston brace and occasionally physiotherapy, for a minimum of 2 years. HRQoL was measured with the Brace Questionnaire (BrQ) at baseline and at the end of treatment. Correlations were determined by the Pearson correlation coefficient, with p<0.05 considered significant. AIS patients scored lower in all the domains of BrQ at the end of treatment. This difference was statistically significant for the mean overall score of BrQ and for the domains of general health perception, physical functioning, emotional functioning, self-esteem and aesthetics, bodily pain and social functioning. The scores in the domains of vitality and school activity were not affected. The HRQoL immediately after the end of conservative treatment of AIS is found to have been negatively affected. Because of limitations in study design, this finding does not necessarily implicate the conservative treatment itself, but highlights the importance of HRQoL measurement in assessing how AIS patients perceive the impact of their disease. [ABSTRACT FROM AUTHOR]

The aim of the present study is to investigate whether the deformation of the intervertebral disc contributes to the progression of idiopathic scoliotic curves. In the standing posteroanterior x-rays of 92 scoliotic curves the following readings were obtained: Cobb angle (CA), apical vertebral rotation (AVR), apical vertebral wedging (AVW) and the adjacent to the apical vertebra Upper (UIVDW) and Lower (LIVDW) InterVertebral Discs Wedging. The statistical analyses included inter - intraobserver reliability test, descriptives, monofactorial linear regression and Pearson correlation coefficient, with p<0.05 considered statistical significant (SS). The mean thoracic CA was 13.4°, lumbar CA 13.8°, thoracic AVR 5.3°, lumbar AVR 4.7°, thoracic AVW 1.4°, lumbar AVW 1.5°, thoracic UIVDW 1.6°, thoracic LIVDW 1°, lumbar UIVDW 1.3° and lumbar LIVDW 2°. Both thoracic and lumbar CA regressed SS with lumbar LIVDW, lumbar UIVDW, thoracic LIVDW and thoracic AVW. Lumbar LIVDW correlates SS with thoracic CA, lumbar CA and thoracic LIVDW. An inter and intra-observer error was below 1°. The eccentric intervertebral disc in the scoliotic spine, through variation in its water concentration produces asymmetrically cyclical load during the 24-hour period and an asymmetrical growth of the vertebral body (Hueter-Volkman's law). The statistical analysis revealed that AVW appears later when already CA increases, the IVDW is more important than AVW and the LIVDW, which is greater than UIVDW, is the most frequent correlated radiographic parameter. The deformation of the apical intervertebral disc seems to be an important contributory factor in the progression of a scoliotic curve. [ABSTRACT FROM AUTHOR]

Whether visual impairment influences the prevalence of scoliosis in humans or not remains controversial. The purpose of this study was to assess the prevalence of scoliosis in blind women in a Mediterranean region. Material and Method: A total of 26 blind women aged 40 years (median, range 20 – 67) were screened for scoliosis. The existence of a possible trunk hump was measured by the forward bending test using the Pruijis Scoliometer. Reading of an Angle of Trunk Inclination (ATI) greater or equal to 7 degrees was used as a cut-off criterion for radiological examination. Standing postero-anterior and lateral spinal radiographs were obtained. Menarche and circadian rhythm was recorded. Results: 11 out of 26 women had a scoliosis with an average Cobb angle of 19 degrees (range 12 – 28). The average ATI was 8 degrees. Thoracolumbar was the most common type of curve identified (9 out of 11, 6 were to the right and 3 to the left). The median age of menarche was 13 years (range, 11 – 15). None of the blind women reported any difficulty sleeping and had a circadian rhythm related to a 24-hour day. Discussion: The prevalence of scoliosis was 42.3%, while the prevalence in the general population in the same regime is 2.9%. Blind women had a later age of menarche (13 versus 12.58 yrs) compared with normal girls. The postural etiology of scoliosis in blind people has been reported. The possible role of light in association to melatonin production, age at menarche and high prevalence of scoliosis in blind women is presented and discussed. [ABSTRACT FROM AUTHOR]

Adolescent Idiopathic Scoliosis (AIS) prevalence has been reported to be different in various geographic latitudes and demonstrates higher values in northern countries. A study on epidemiological reports from the literature was conducted to record the prevalence of AIS among the general population of boys and girls, aged 10-16 years old, in different geographic latitudes, in order to test the hypothesis that the prevalence of AIS among boys and girls is different in various geographic latitudes and to examine if there is a possible association between them. Seventeen peer-reviewed published papers reporting AIS prevalence in the general population of boys and girls from most geographic areas of the northern hemisphere were retrieved from the literature. The geographic latitude of each centre where a particular study was originated was documented. The statistical analysis included a linear regression forward modeling procedure of the AIS prevalence by latitude, weighted by sample size. According to the modelling of the data, a significant positive association between prevalence of AIS and latitude was found for girls (p<0.001), following a rather curvilinear trend, but not a significant positive association was found for boys (p<0.111). A positive association between prevalence of AIS and geographic latitude is reported only for girls in the present study. Prevalence of AIS in boys is not associated significantly with geographic latitude. This differing significant association implicates the possible role of environmental factors in the pathogenesis of AIS that may act in a different way between boys and girls. [ABSTRACT FROM AUTHOR]

Traditionally, the effectiveness of brace treatment on adolescents with IS is based on curve magnitude and to some extent on vertebral rotation and rib hump. QoL has been introduced in the recent years in order to evaluate the effectiveness of brace treatment. The aim of the study is to determine the influence of brace on quality of life (QoL) of adolescents with idiopathic scoliosis (IS). Thirty-six patients with a mean age of 13,9 (range 12–17) years old, a mean Cobb angle 28,2° (range 19-38° and a mean angle of trunk inclination (ATI) 7,8° (range 4°–17°) who were treated conservatively with a modified Boston brace for a minimum of 2 years, filled the form of Brace Questionnaire (BrQ). BrQ is a validated, disease specific instrument, its score ranges from 20 to 100 and higher BrQ scores mean better quality of life. Correlations were determined by the Pearson correlation coefficient, with p<0.05 considered significant. Mean overall score of BrQ was 73,8 (SD 15. 8). Lower scores were observed in physical functioning (55,4, SD 15,9) and vitality (55, SD 25,9). School activity (98, SD 4,4) was affected less. The Cobb angle correlated significantly only with school activity (p<0,02). The ATI correlated significantly with social functioning (thoracolumbar ATI, p<0.038; lumbar ATI, p<0.035). There were no significant correlations between either Cobb angle or ATI with BrQ overall scores. Cobb angle and ATI significantly influenced school activity and social functioning respectively, but not general health perception, physical functioning, emotional functioning, vitality, bodily pain and self-esteem and aesthetics. [ABSTRACT FROM AUTHOR]

The aim is to evaluate the influence on quality of life of surgical decompression with and without instrumentation in lumbar spinal stenosis. Twenty three patients, (16 women, 7 men) with a mean age of 62,8 years old (range 44–80) who underwent a surgical decompression for lumbar spinal stenosis filled the SF-36 questionnaire pre- and postoperatively, during the follow up period which was at a mean value of 42 months (range 6 to 50 months). Spinal stenosis was degenerative in 18 patients and as a consequence of spondylolisthisis in 5. In 15 patients decompression and fusion using instrumentation (group I) was performed and in 8 patients only decompression was performed (group II). Statistical analysis was carried out using the Wilcoxon Signed Rank Test. In group I, the domains that evidenced statistical significant improvement were bodily pain (p<0,041), general health (p<0,042), vitality (p<0,042), social functioning (p<0,043), and mental health (p<0,042). Not any specific domain in group II showed a statistical significant improvement postoperatively. Comparing the two groups overall SF-36 score, a statistical significant improvement was noted for group I (p<0,001) and for group II (p<0,017). The statistical significance of improvement was stronger in patients of group I than group II. Surgical decompression for lumbar spinal stenosis reduces pain and restores significantly physical and mental health. Decompression and instrumentation presents superior results in patients' quality of life when compared to patients that single decompression was performed. [ABSTRACT FROM AUTHOR]