Scoliosis: Aesthetics in scoliosis patients

Trunk Aesthetic Clinical Evaluation

Routine clinical tool to evaluate aesthetics in scoliosis patients: development from the Aesthetic Index (AI) and repeatability

Authors: Fabio Zaina, Stefano Negrini, Salvatore Atanasio

Published: 20 January 2009

Background
Aesthetic appearance is of primary importance in the treatment of adolescent idiopathic scoliosis (AIS), but to date tools for routine clinical practice have not become available. The aim of the present study is to develop such a tool and to verify its repeatability.

Methods
Instrumentation: At first we developed the Aesthetic Index (AI), based on a three-point scale for asymmetry of the shoulders, scapulae and waist that we tested for 5 years. From this experience we developed another tool we called TRACE, the acronym of Trunk Aesthetic Clinical Evaluation; TRACE is a 12-point scale based on four sub-scales, shoulders (0-3), scapulae (0-2), hemi-thorax (0-2) and waist (0-4). Population: Posterior-anterior (PA) photographs of one hundred-sixty AIS patients Procedures: Each photograph was scored in two independent tests by four observers using AI, and subsequently TRACE. Data analysis: Kappa statistical analysis and 95% level of agreement were used; we also identified the minimum significant change (95% confidence level).

Results
We found the intra- and inter-raters repeatability of AI to be fair. Three points out of seven was the minimum significant change between two different evaluations. For TRACE, intra-rater repeatability was fair and inter-raters poor; but the minimum significant change was three (intra-rater), or four (inter-raters) out of twelve points.

Conclusions
Widening the scale from 7 (AI) to 12 points (TRACE) increased the clinical sensitivity to changes of the aesthetic scale, even if TRACE has only a fair repeatability. TRACE is a no-cost tool for routine clinical practice in AIS patients. Due to the absence of other comparable validated tools, once the inherent measurement error is known and understood, its routine clinical use by physicians is advised.

Scoliosis: Medtronic Infuse Bone Graft

I have been seeing pòsts around and about on the web about Medtronic's Infuse Bone Graft.

They are facing a lawsuit from a woman in Texas who is blaming them for off label use and for the injuries she has suffered after her cervical spine surgery!

Mary Selke who is the claimant has saud that she suffered from breathing problems and was unable to swallow due to bone that formed in her neck!

Mark Selke has also got her physician on side who will provide testimony about Medtronic and the promotion of their product.

We would love to hear from any InFuse Bone Graft patients, have you had problems similar to Mary?

There is an estimated half a million people each year that undergo spinal surgery to repair/correct/fuse patients who experience damage to discs or to stablise Scoliosis.

The InFuse Bone Graft is a device to help fuse vertebrae in the lower spine in order to treat degenerative disc disease. It differs from other, similar devices in that it uses genetically engineered protein to help build bone tissue in the fusion process, instead of using a graft of the patient's own bone (an autograft).

According to the Wall Street Journal, Medtronic estimated to have brough in $816 million in the fiscal year, April 2008.

Although Drs are free to use medical devices off-label at their discretion, InFuse Bone Graft is not approved to be used in the neck.

Off-label use of these medical products should be investigated by the U.S. Department of Justice to prevent more people from dying of suffering after their surgery, there was a report in August of 2008, of a lady in California who died after having the InFuse inserted into her neck, the suit claims that Ms Nisbet went into respiratory arrest and a coma, she was kept alive by artificial means.

However, the Hospital of California (where Ms Nisbet had surgery) did not report to Medtronic that the device was the cause of death.

Until this claim can be resolved and some further measures are put into place regarding off-label products, patients need to be aware of the complications that InFuse Bone Graft COULD possibly hold for the patient.

What is Off-Label Use?
In the United States, new drugs and devices cannot be marketed until the Food and Drug Administration finds that they are safe and effective for their intended use. To obtain FDA approval, pharmaceutical and device manufacturers must submit extensive animal, in vitro, and human study data demonstrating safety and effectiveness. Agency staff members—often joined by an external interdisciplinary advisory committee—review the research reports to evaluate the quality of the data and make the essential risk-benefit judgments that determine whether a medical product is safe and effective.

To read more about off-label use and the FDA (Food and Drugs Administration) visit the MedScape website: At Law - The Curious Case of Off-Label Use

Scoliosis: Management of AIS with Bracing

Scoliosis Journal posted the following information regarding: Guidelines on "Standard of management of idiopathic scoliosis with corrective braces in everyday clinics and in clinical research": SOSORT Consensus 2008

Published: 16 January 2009

Authors: Stefano Negrini, Theodoros B Grivas, Tomasz Kotwicki, Manuel Rigo and Fabio Zaina

Background
Reported failure rates,(defined based on percentage of cases progressing to surgery) of corrective bracing for idiopathic scoliosis are highly variable. This may be due to the quality of the brace itself, but also of the patient care during treatment. The latter is sometimes neglected, even though it is considered a main determinant of good results among conservative experts of SOSORT. The aim of this paper was to develop and verify the Consensus on management of scoliosis patients treated with braces

Methods
We followed a Delphi process in four steps, distributing and gradually changing according to the results a set of recommendations: we involved the SOSORT Board twice, then all SOSORT members twice, with a Pre-Meeting Questionnaire (PMQ), and during a Consensus Session at the SOSORT Athens Meeting with a Meeting Questionnaire (MQ). We set a 90% agreement as the minimum to be reached.

Results
We had a 71% response rate to PMQ, and 66.7% to MQ. Since the PMQ we had a good agreement (no answers below 72%, 70.2% over 90%). With the MQ the agreement consistently increased for all the answers previously below 90% (no answers below 83%, 75% over 90%). With increasing experience in bracing all numerical criteria tended to become more strict. We finally produced a set of 14 recommendations, grouped in 6 Domains (Experience/competence, Behaviours, Prescription, Construction, Brace Check, Follow-up).

Conclusions
The Consensus permits establishment of recommendations concerning the standards of management of idiopathic scoliosis with bracing, with the aim to increase efficacy and compliance to treatment. The SOSORT recommends to professionals engaged in patient care to follow the guidelines of this Consensus in their clinical practice. The SOSORT criteria should also be followed in clinical research studies to achieve a minimum quality of care. If the aim is to verify the efficacy of bracing these criteria should be companions of the methodological research criteria for bracing proposed by other societies.

Hey everyone!

So, first of all...
Confession. :)
Well... I have been a member of this blog for a while now but haven't really gotten around to posting. Sorry! But for now... here's a little intro on me!

Name (For this blog, anyway): Tiz
Age: 13
Scoli type: Adolescent Idiopathic
Scoliosis treatment: bracing for 10 months now, still ongoing :(
Scoliosis curve before treatment: 31 degrees
Scoliosis curve at last check-up: 20 degrees! (Both lumbar and thoracic, by the way)
Brace type: Boston (could be much worse, I guess)
Estimated time to continue bracing: 2 years, until I stop growing at least
Next scoli appointment: 5th Feb, update will be posted hopefully, if I remember

COOL scoli sites for teens:
www.spinekids.com --> good place to post scoli story and excellent forums, mostly girls
That's it for now!

Thank you heaps, Simone and Judith, for letting me be a part of such a cool blog!

Two and a Half Men: Thank God for Scoliosis

Remember I posted yesterday about an episode coming on TV called Two and a Half Men: Thank God for Scoliosis?

Well, I watched Paramount Comedy last night on the look out for this episode, however, I was unable to see any reference to Scoliosis, and in fact I don't think the UK have the new episodes out yet, I have crawled the internet and yes I have found videos titled this but not one of them makes any reference to Scoliosis at all...... confused.

If anyone has seen this episode and knows why they called it "Thank God for Scoliosis", please let me know, I am interested to know about this episode and what happens, even better if you can send me a clip of this episode.

I will continue my search for this and report my findings when I can :)

Be well and stay safe

Two and a Half Men: Thank God for Scoliosis

I keep seeing this mentioned on various blogs about Two and a Half Men, I have never watched this before but tonight they appear to have an episode entitled "Thank God for Scoliosis"

Now, I can't say that I have ever thought "Thank God for Scoliosis" so I am intrigued as to why they would title their episode with these words. I will watch tonight and report back tomorrow.

I am not certain at what time this episode is on, cannot find much information but I think for those of us in the UK, Two and a Half Men is shown on Paramount Comedy, if anyone manages to see this and I don't please do stop by and let me know what it is all about - thanks!

For those who have not heard of Two and a Half Men, here is some blurb.

Charlie is a well-to-do bachelor with a house at the beach, a Jaguar in front of the house and an easy way with women. His casual Malibu lifestyle is interrupted when his tightly wound brother, Alan who's facing a divorce, and Alan's son, Jake come to stay with him. Together, these two and a half men confront the challenges of growing up; finally.

Complicating matters are the brothers' self-obsessed, controlling mother, Evelyn, Alan's estranged wife, Judith and Charlie's crazy neighbour Rose. who wants to be a part of his life and is willing to do anything to be around.

Iggy Pop

Get this!



Does yer man have scoliosis or what? I'm afraid that for me, this ad doesn't work - I can't remember the name of the product itself and all it does is make me wonder why he never got fixed when he was younger, and (sorry) how fit he looks (from the neck down)...must get a life, get back to work, or both!!

Juvenile Idiopathic Scoliosis

Scoliosis Journal just published the latest information on Juvenile Scoliosis.

Juvenile idiopathic scoliosis treated with posterior arthrodesis and segmental pedicle screw instrumentation before the age of 9 years: a 5-year follow-up.

Published: 6 January

Authors: Ahmet Yilmaz Sarlak, Halil Atmaca, Levent Buluc, Bilgehan Tosun and Resul Musaoglu email

Study Design. Retrospective Study
To evaluate the radiological results of fusion with segmental pedicle screw fixation in juvenile idiopathic scoliosis with a minimum 5-year follow-up. Summary of Background Data. Progression of spinal deformity after posterior instrumentation and fusion in immature patients has been reported by several authors. Segmental pedicle screw fixation has been shown to be effective in controlling both coronal and sagittal plane deformities. However, there is no long term study of fusion with segmental pedicle screw fixation in these group of patients.

Methods
Seven patients with juvenile idiopathic scoliosis treated by segmental pedicle screw fixation and fusion were analyzed. The average age of the patients was 7.4 years (range 5-9 years) at the time of the operation. All the patients were followed up 5 years or more (range 5-8 years) and were all Risser V at the most recent follow up. Three dimensional reconstruction of the radiographs was obtained and 3DStudio Max software was used for combining, evaluating and modifying the technical data derived from both 2d and 3d scan data.

Results
The preoperative thoracic curve of 56+/-15degrees was corrected to 24+/-17degrees (57% correction) at the latest follow-up. The lumbar curve of 43+/-14degrees was corrected to 23+/-6degrees (46% correction) at the latest follow-up. The preoperative thoracic kyphosis of 37+/-13degrees and the lumbar lordosis of 33+/-13degrees were changed to 27+/-13degrees and 42+/-21degrees, respectively at the latest follow-up. None of the patients showed coronal decompensation at the latest follow-up. Four patients had no evidence of crankshaft phenomenon. In two patients slight increase in Cobb angle at the instrumented segments with a significant increase in AVR suggesting crankshaft phenomenon was seen. One patient had a curve increase in both instrumented and non instrumented segments due to incorrect strategy.

Conclusion
In juvenile idiopathic curves of Risser 0 patients with open triradiate cartilages, routine combined anterior fusion to prevent crankshaft may not be warranted by posterior segmental pedicle screw instrumentation.

Scoliosis: Reverse procedure

Health Central published this story about a procedure that is helping children under the age of 5 to reverse their scoliosis!

Ivanhoe Broadcast News
Tuesday, December 30, 2008; 12:00 AM

(Ivanhoe Newswire) -- A new procedure is stopping and reversing scoliosis in children -- without a brace.

Doctors at Morgan Stanley Children's Hospital of New York-Presbyterian are using a novel procedure called spinal stapling to treat scoliosis in children under 5. The procedure is not only stopping progression of the condition, but reversing it. Until now, no treatment existed to straighten the spine of children with scoliosis.

"For the first time, we have a way to potentially reverse the scoliosis," Michael Vitale, M.D., chief of pediatric spine and scoliosis surgery at Morgan Stanley Children's Hospital of New York-Presbyterian, was quoted as saying.

Spinal stapling is a two-hour, minimally invasive procedure during which doctors implant staples across the growth plates of the spine. It's available to children who are still growing and have progressive moderate scoliosis.

Normally, spinal braces are used to slow the progression of scoliosis in children with a moderate form of the condition. Dr. Vitale said braces can be uncomfortable and embarrassing for children and press against the stomach, making eating and playing sports difficult.