Quantification of the effects of operative management for idiopathic scoliosis : implications for pathogenesis, pathomechanisms and future management
Idiopathic scoliosis (lS) is a structural lateral curvature of the spine with rotation for which no cause is established. Surgical treatment for scoliosis focuses on the spine and achieves only partial correction of spine and trunk deformity. This correction deteriorates with time. Some pathomechanisms of deteriorating body shape are suggested from sequential anthropometry. The correction and prevention of future deterioration in body shape are the aims of any scoliosis treatment. Application of knowledge of pathomechanisms to treatment may improve outcome. Section 1: Infantile and juvenile idiopathic scoliosis: long-term follow-up and effects of Luque trolley instrumentation and anterior release and convex epiphysiodesis. Patients with infantile (IIS) and juvenile idiopathic scoliosis (JIS) are evaluated by radiological examination before surgery and at intervals after surgery. The patients are also reviewed clinically at longest follow-up by surface and ultrasound methods. Appropriate non-parametric and parametric tests and multivariate analysis are used to evaluate results. Factors important in curve progression are identified and new strategies for treatment suggested. Section 2: Adolescent Idiopathic Scoliosis: 2 year follow-up and effects of each of posterior and anterior instrumentation with the Universal Spine System. Patients with adolescent idiopathic scoliosis (AIS) are evaluated before surgery and at intervals after surgery. Data from surface, anthropometry, questionnaire and plain radiography are considered. Statistical analyses were performed using parametric and nonparametric tests where appropriate. Attention is directed at factors that determine rib-hump progression post-operatively. Aims of studies: The aims of these studies are to quantitate the change in surface and skeletal morphology after surgery and after follow-up, to infer pathogenesis and pathomechanisms for each of infantile and adolescent idiopathic scoliosis, to consider new strategies for the treatment of IS and to quantify the subjective experience of scoliosis and surgery and compare with established objective measurements of scoliosis deformity.