Scoliosis Psychic Functions in Patients Treated Conservatively or Operatively

I was contacted by a Dr who is interested in Scoliosis Overcompensation Syndrome, as defined by the author Elisabeth Mina. Dr Ewa Misterska is a psychologist from the Department of Pediatric Orthopaedics, Poznan University of Medical Sciences, Poland. She received her doctor's degree from Characteristics of selected psychic functions in patients treated conservatively or operatively for idiopathic scoliosis. Below is a white paper she has sent me for publication.

Author: Ewa Misterska
Characteristics of selected psychic functions in patients treated conservatively or operatively for adolescent  idiopathic scoliosis.

Department of Pediatric Orthopaedics

Karol Marcinkowski University of Medical Sciences, Poznan

The objective of the paper was to evaluate differences in the functioning of patients with idiopathic scoliosis shortly after taking up various forms of treatment as compared to a group of healthy volunteers. The evaluation concerned the level of social competences and selected aspects of the Carnal Self and features of personality, as well as specific problems occurring in patients with scoliosis. Additionally, it was checked if a correlation exists between the Body Mass Index, size of the Cobb angle before and after performing the surgery, degree of apical vertebral translation, location of the primary curve, % of postoperative correction, scope of instrumentation measured by the vertebrae it covers, duration of bracing (orthosis wearing) measured monthly and daily, and the social competences, dimensions of Corporal Self and features of personality, as well as specific problems characteristic to patients with scoliosis. The evaluation concerned also the internal relations between the variables listed above.

Material:
The evaluated group was composed of 104 people, of which 35 were patients subject to conservative treatment (group A), 34 were patients subject to operative treatment who after undergoing the scoliosis correction surgery wore orthoses in the post-operative period (group B). The patients were treated at the Department and Clinic of Children Orthopedics and Traumatology of University of Medical Sciences in Poznań. The third group was composed of 35 healthy girls and was the control group (group C) in the study. The age range for the evaluated group was 12-18 years. Only female patients participated in the study.

In the conservative treatment group orthoses were worn for the minimum time of 12 hours per day for not less than 3 months. The average age of patients was 14.8 years SD 1.4, while the average value of Cobb angle of the primary curve was 27.7 degrees SD 7.5. The average time for which orthoses were worn was 14.9 hours per day SD 3.2 for 16 months SD 11.5. In the examined group thoracic scoliosis prevailed (48.6% of all the patients).

In the group subject to surgical treatment combined with resection of fragments of ribs on the top of rib hump, the patients used the Cheneau orthosis for 3 months following the surgery. The average age of patients was 16.1 years SD 1.4, while the average value of Cobb angle of the primary curve prior to operative treatment was 54.6 degrees SD 9.0 and after the treatment 21.1 degrees SD 9.9. 64.7 % of patients had curves in the thoracic part of the spine. In the examined group, type II scoliosis according to King’s scale prevailed (41.2% of all the patients).

The control group of healthy girls was selected according to the average age and the sex as compared to the groups of patients with scoliosis. Any conditions in the spinal area or other serious diseases confirmed in a clinical examination were an exclusion criterion. The average age was 15.7 years SD 0.4.

Methods:
All the examined people have filled in: the Personality Test (dimensions: self-criticism, social approach, extraversion, neurotics, maniac disposition, depressive disposition, schizoid disposition, paranoid disposition, vegetative stability); Carnal Self Questionnaire (dimensions: increased and decreased threshold of sensations, interpretation of emotions, physical conditions and sensations in the categories of sense of identity, control of emotions and physical conditions, emotional perception of the body, comfort in a close physical relation and body protection); J-C Scale (exhibition of femininity, acceptance of the body); Social Competences Questionnaire (dimensions: competences that condition effectiveness of behaviors in intimate situations, meaning close interpersonal contacts, in situations of social exhibition and situations that require assertiveness); additionally, patients with scoliosis have filled in the Bad Sobberheim Stress Questionnaire – Deformity (evaluation of the level of stress in patients with scoliosis felt in relation to deformations of their bodies) and Bad Sobberheim Stress Questionnaire - Brace (evaluation of the level of stress in patients wearing braces).

For the radiological examination images made in the standing position with the Ala ossis ilii in the frontal-rear projection were used.  For evaluation of the operatively treated group radiograms were used which had been made before and after the surgery, while in case of the conservatively treated group pre-treatment radiograms were used. In the analysis the following aspects were accounted for: value of the Cobb angle of the scoliosis in the primary curve and the distance (measured in centimeters) of the center of the uppermost vertebra involved from the central vertical spine line described as the degree of translation.  Also the following factors were taken into consideration as the location and the uppermost vertebra of the primary curve, the range of scoliosis, and in case of surgically treated patients also the range of the instrumentation and % of the scoliosis correction.

Results:
In the Personality Test, the patients with scoliosis obtained results which prove an average intensification of features tested, i.e. in the range between 25 and 75%. However, the conservatively treated patients may show the tendency for manic or hypomanic behavior, and the operatively treated patients for the neurotic behavior (results close to high: 73% and 74.4 % respectively).

The patients in all study groups do not show any abnormalities in respect of individual dimensions of the Corporal Self, and their results are interpreted as average (Corporal Self Questionnaire) or high (J-C Scale). The patients have a strong sense of identity, accept their bodies and the manner it functions, do not assume any autodestructive actions and take care of their health. The results prove a strong Corporal Self.

In the Social Competences Questionnaire, the patients obtained scores in the range of 4-7 stens, which prove an average level of competences that condition the efficiency of behaviors in close interpersonal contact situations and in social exhibition situations, as well as the efficiency of behaviors in situations that require assertiveness.

The level of stress caused by bracing was average for both conservatively and operationally treated patients (in the range of 9-16 points). Deformations caused a low level of stress (scores in the range of 17-24 points) in conservatively treated patients, a moderated level of stress (scores in the range 9-16 points) in operationally treated patients.

Compared with healthy peers, the patients with scoliosis and the conservatively treated patients had a higher level of self-criticism, but a stronger Corporal Self (relevant statistical differences at the level p<0.05).

Compared with healthy peers, the patients with scoliosis who were subject to operational treatment had a higher level of self-criticism, neurotism, depressiveness, but at the same time also a stronger Corporal Self (relevant statistical differences at the level p<0.05).

The conservatively treated patients, when compared to the operationally treated patients, showed a higher level of maniac disposition, but at the same time a lower level of neurotic disposition and of stress due to bodily deformations  (relevant statistical differences at the level p<0,05).

In reference to the level of functioning of conservatively treated patients important were: age at which their treatment commenced, degree of apical vertebral translation, location and direction of the primary curve, duration of bracing per day and the Body Mass Index; while for the operatively treated patients such relevant factors included: degree of apical vertebral translation prior to the surgery, location and direction of the primary curve, and also the Body Mass Index.

Conclusions:1. Adolescent patients with scoliosis, irrespective of the treatment method applied, show no abnormalities in most of the psychic functions analyzed, as compared to healthy peer group.
2. The issue, which treatment method has a bigger negative influence on the psychic condition of patients with scoliosis, remains undecided. The patients who received conservative treatment showed a higher level of maniac disposition, whilst those treated surgically showed a higher level of neurotic disposition and stress due to bodily deformations.
3. There is a relation between the degree of apical vertebral translation before the operation, Body Mass Index and the psychic and social functioning in the group of patients treated surgically.
4. There is a relation between the degree of apical vertebral translation, Body Mass Index, the period for which orthosis is worn per day, the age at the moment when treatment commences and the psychic and social functioning in the group of patients treated conservatively.

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