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Nonfusion treatment of adolescent idiopathic scoliosis by growth modulation and remodeling. | LitMetric

Nonfusion treatment of adolescent idiopathic scoliosis by growth modulation and remodeling.

J Pediatr Orthop

Department of Orthopaedics and Rehabilitation, McClure Musculoskeletal Research Center, University of Vermont College of Medicine, Burlington, VT 05405, USA.

Published: April 2011

AI Article Synopsis

  • - Adolescent idiopathic scoliosis (AIS) is a spinal disorder affecting youth aged 11-17, typically treated with bracing or surgery, but the effectiveness of braces is questioned due to low patient compliance and surgery leading to a rigid spine.
  • - The study investigates the link between laboratory findings and clinical practices, showing that mechanical loading can cause and correct scoliosis, as well as noting the challenges with bracing in older kids and the limited use of derotational casting for younger patients.
  • - While laboratory experiments demonstrated how growth plates adapt to mechanical stress, clinical interventions like bracing and newer techniques such as convex vertebral stapling show varying degrees of success, particularly in mild scoliosis cases, but challenges remain in

Article Abstract

Background: Adolescent idiopathic scoliosis (AIS) is a common disorder in which the spine gradually develops a curvature that is first detected in patients between 11 and 17 years of age. The only accepted treatment methods are bracing and surgery. Whether brace treatment alters the natural history is being questioned, and patient compliance is low. Surgery usually includes a spinal fusion that creates a rigid spine and concentrates stresses at the ends.

Methods: This study focuses on correlating the laboratory results with clinical reports for treating patients with AIS. In the laboratory, scoliosis with vertebral wedging has been created by asymmetric mechanical loading and has been corrected by reversing the loading. In the clinic, bracing and derotational casting have been successful in some reports, but compliance has been a problem with bracing and derotational casts have mainly been used in young children. Operative treatment has been successful, but a nonfusion operation remains elusive. FINDINGS AND RESULTS: In the laboratory, axial loading of growth plates altered growth according to the Hueter-Volkmann law, which states that compression decreases and distraction increases growth. Asymmetric loading of the spine caused asymmetric growth resulting in scoliosis with vertebral wedging. Asymmetric loading of tail vertebrae created vertebral wedging according to Wolff's law, which states that the bone remodels over time in response to prevailing mechanical demands. In the clinic, studies have shown that bracing may work if patients wore the brace as prescribed. Derotational casting in young children has been shown to prevent progression and even correct the scoliosis in some patients. Convex vertebral stapling has been successful in mild curves, but the results in larger curves have been disappointing. Anterolateral tethering has been successful in mild curves in young patients, but there is limited experience with this technique in patients with large curves.

Conclusions: A brace that applies the appropriate loading and is worn as prescribed may dramatically improve the results of brace treatment. A procedure using external fixation or adjustable anterolateral tethering may achieve a nonfusion correction of AIS.

Level Of Evidence: Level II.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3086537PMC
http://dx.doi.org/10.1097/BPO.0b013e318203b141DOI Listing

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