Clinical Follow-up Studies On Adolescents With Idiopathic Scoliosis

Adolescent idiopathic scoliosis(AIS)is defined by Scoliosis Research Society(SRS)as age greater than ten years, lateral deviation of the normal vertical line of the spine which, when measured by X-ray, is greater than ten degrees before skeletal maturity. It is one of the commonest spine deformities in adolescents.Although a lot of scientific breakthroughs on adolescent idiopathic scoliosis have been obtained in various fields, there are still many controversies, particularly for non-surgical regime. The questions need to be answered in regard to AIS during nonoperation treatment such as: Firstly, what relationships between growth and deformed change exist in AIS. Secondly, the indications of brace treatment and weaning program. Thirdly, how to predict curve progression of scoliosis; lastly, how to assess the effect of bracing in an all-round way. This investigation was designed to find the answers for above questions.1. Growth and adolescent idiopathic scoliosis1.1 Correlation of sitting height to standing height ratio with Cobb's angle in children with idiopathic scoliosis/A mathematical analysis in the cases with single curveObjective To identify any statistically significant correlation of sitting height to standing height ratio with Cobb's angle value in children with idiopathic scoliosis, and to establish a mathematical formula for the prediction of scoliosis progression in the cases with single curve. Methods The criteria for patient admission in this study include:(1)no previous history of medical treatment;(2)older than 10 years of age;(3)mild and moderate scoliosis(Cobb's angle<45°);(4)single curve;(5)no sign of degenerative disorders;(6)equal lower limbs without any anomalies. Forty-six children (38 females, 8 males) with mild or moderate idiopathic scoliosis were selected in accordance with the above criteria. The age of these patients ranged from 10 to 20 years, with the average of 13.8 years at the first examination. Chronological age, sitting height, standing height and Cobb's angle values were measured and well documented. According to the measurement of sitting height and standing height in these patients, the ratio of sitting height to standing height was calculated. Results The sitting heights in 46 patients ranged from 66.00 cm to 88.80 cm(mean±standard deviation, 80.54cm±5.75cm); The standing heights ranged from 126.00 cm to 174.80 cm(mean±standard deviation, 153.67cm±10.72cm); ratio of sitting height to standing height ranged from 0.50 to 0.55(mean±standard deviation, 0.52±0.01); The Cobb's angles ranged from 10°to 45°(mean±standard deviation, 25.70°±9.66°). There were no statistically correlation between Cobb's angle values, chronological age, sitting height, and standing height. However, a statistically significant positive correlation between the ratio of sitting height to standing height and the Cobb's angle value was demonstrated. Conclusions There is a significant positive correlation between ratios of sitting height to standing height and Cobb's angle values in children with idiopathic scoliosis. The ratio of sitting height to standing height as a useful parameter can be used to predict the development of Cobb's angle in children with mild or moderate idiopathic scoliosis.2. Clinical follow-up studies on adolescents who are bracing with idiopathic scoliosis2.1 A clinical follow-up study on treatment of adolescent idiopathic scoliosis with braceObjective:To evaluate clinical outcomes of bracing and to analyze factors that influence the effects of treatment in adolescents with idiopathic scoliosis, and to reveal or to advise the indications of bracing. Methods:Seventy-nine patients(11 males; 68 females) with AIS who had no history of prior therapy were treated with a brace. Several parameters were consecutively measured and documented during the period of follow-up including Cobb's angles, curve patterns, menarche status,sitting heights, standing heights, Risser sign, apical vertebral rotation. Results:The average duration of followed-up study was 30 months (12 months to 60 months).Twenty-one patients (26.6%) presented curve deterioration, 40 patients have no obvious curve change, 18 patients (22.8%) got a curve improvement. There was significantly lower percentage of curve progression and higher percentage of curve improvement in cases with Cobb's angle less than 35°at the first visit(P<0.05). The percentage of curve progression was significantly greater in the cases with apical vertebral rotation beyond grade III while the percentage of curve improvement was lower (P<0.05). Curve patterns, Risser sign and other parameters were also found to make their effects on the percentage of curve progression and improvement, which, however, were not statistically significant(P>0.05). Conclusion:Bracing can limit or improve mild and moderate curve of idiopathic scoliosis effectively, especially in cases with initial curve magnitude ranging from 20°to 35°, Outcome measurement for AIS can not be relied only upon Risser sign. Surgery is advised as soon as possible for the cases with initial Cobb's angles greater than 45°and initial apical vertebral rotation beyond gradeⅢwhile bracing did not result in any improvement.2.2 Prognostic factors of progression of adolescent idiopathic scoliosis in girls treated with a braceObjective: To investigate curve behavior and to analyze which of nine factors were of significant value in predicting the progression of the scoliotic curve in girls with AIS treated with a brace. Methods:sixty -five girls with AIS were braced. Cobb's angles, curve patterns, menarche status,sitting heights, standing heights, Risser sign, apical vertebral rotation, etc were consecutively measured and documented during the period of follow-up. Curve behavior between the first visit and final follow-up was analyzed. Several different parameters which may contribute to progression of curve were selected. Results:The patients aged 10-16 years(mean,13.7years) were followed for 12 months to 60 months(mean 24.1 months) .At the time of final follow-up, seventeen patients(26.15%) presented curve progress more than 5 degrees. The percentage of curve progression was significantly greater in the cases with apical vertebral rotation beyond grade III and Cobb's angle greater than 35°at the first visit(P<0.05). After performing a logistic regression analysis, initial Cobb's angles greater than 35 degrees, apical vertebral rotation beyond grade III, and standing height increasing greater than 30mm in one year were found to be prognostic for the progression of more than 5 degrees. Conclusion: Initial Cobb's angles,apical vertebral rotation , and standing height increasing velocity are important prognostic factors of progression in the girls with AIS. Risser sign was an unreliable parameter for predicting the progression of scoliosis, However, in our series, the risk of progression was higher in patients whose initial Cobb's angles greater than 35 degrees, apical vertebral rotation beyond grade III , and standing height increasing greater than 30mm in one year.3. The health-related quality of life and psychological status in AIS3. 1 SRS-22 Questionnaire for Chinese adolescents with idiopathic scoliosisObjective:To develop the SRS-22 Questionnaire for the use of Chinese adolescents with idiopathic scoliosis;To evaluate the metric qualities of this questionnaire.Methods:Transcultural adaptation of the SRS-22 Questionnaire was carried out according to the International Quality of Life Assessment Project guidelines, The final version was confirmed by a committee of experts .The Questionnaire was finished by eighty-six adolescents with idiopathic scoliosis who treated with a brace including 11 males and 75 females,aged ten to eighteen years old (mean,13.9 years). Curve magnitude ranged from 25°to 45°( mean, 35.6°). A subgroup of 30 patients completed the questionnaire again in three to four weeks. Results: The overall alpha coefficient of the questionnaire was 0.88. Coefficients for individual domains were as follows: function/activity, 0.70; pain, 0.80; self-image, 0.80; mental health, 0.88; and satisfaction, 0.81. The questionnaire as a whole had a test-retest correlation coefficient of 0.97. Test-retest correlation coefficients for individual domains were as follows: function, 0.85; pain, 0.96; self-image, 0.96; mental health, 0.95; and satisfaction, 0.91. Five common factors were acquired from factorial analysis, and the cumulative contribution rate was 67.66%. Conclusion:The Chinese Version of the SRS-22 Questionnaire has eligible reliability and validity,it can be used to measure health-related quality of life of adolescents with idiopathic scoliosis in china.