Tag Archive for: Idiopathic

Assessment in adolescent scoliosis

Volume 6 | Issue 1 | Jan – April 2020 | Page 2-6 |  Connor J. S. McKee.

Authors : Connor J. S. McKee [1]

[1] Royal Victoria Hospital, 274 Grosvenor Rd, Belfast BT12 6BA, Belfast, Northern Ireland.

Address of Correspondence
Dr. Connor J. S. McKee,
Royal Victoria Hospital, 274 Grosvenor Rd, Belfast BT12 6BA, Belfast, Northern Ireland.
E-mail: connor.mckee@ntlworld.com,
cmckee43@qub.ac.uk

Abstract

Background: Adolescent idiopathic scoliosis is associated with lateral spinal curvature, vertebral rotation and rib cage distortion which disrupts normal, symmetrical thoracic movement leading to restriction of lung expansion and impaired pulmonary function. The effects of scoliosis on lung growth, airway function and exercise capacity are well documented but it is unclear how altered rib positioning affects lung function. This paper compares two different radiological measurements with pulmonary function.
Methods: The study compared two measures of deformity: Cobb angle and average rib-vertebral angle difference with pulmonary functioning. Existing literature describes Cobb angle as a useful indicator of pulmonary dysfunction. However, there are few reports on the use of rib-vertebral angle difference and these are limited to a single measurement taken at the apical vertebrae. This study of 53 patients used an average rib-vertebral angle difference over five vertebral levels. This measure gives a more representative measurement of the scoliotic deformity. This measure was then correlated with the patient’s Cobb angle and pulmonary function.
Results: Using Spearman’s rank correlation coefficient, average rib-vertebral angle difference correlated strongly with Cobb angle (0.83), forced vital capacity (-0.81), forced expiratory volume in 1 second (-0.76), and peak expiratory flow (-0.60).
Conclusions: The study found that measurement of Cobb angle is superior to average rib-vertebral angle difference across five vertebral levels.
Keywords: Idiopathic, scoliosis, RVAD, Cobb, measurement.
Study design: Retrospective correlation of pre-operative pulmonary function tests and radiological measurements

References 

1. Konieczny M, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2012;7(1):3-9.
2. Koumbourlis AC. Scoliosis and the respiratory system. Paediatric respiratory reviews. 2006 Jun 1;7(2):152-60.
3. Tsiligiannis T, Grivas T. Pulmonary function in children with idiopathic scoliosis. Scoliosis. 2012 Dec;7(1):7.
4. Grauers A, Einarsdottir E, Gerdhem P. Genetics and pathogenesis of idiopathic scoliosis. Scoliosis and spinal disorders. 2016 Dec;11(1):45.
5. Lenke LG. Pulmonary and chest cage physiology. In: Spinal deformities. The comprehensive text. New York, NY: Thieme. 2003:126-34.
6. Bowen RM. Respiratory management in scoliosis. In: Moe JH, Bradford DS, Eds., Moe’stextbookofscoliosis and other spinal deformities. Philadelphia: Saunders. p 572.
7. Johnston CE, Richards BS, Sucato DJ, et al. Correlation of preoperative deformity magnitude and pulmonary function tests in adolescent idiopathic scoliosis. Spine. 2011; 36, 1096-1102.
8. Loder RT, Urquhart A, Steen H, et al. Variability in Cobb angle measurements in children with congenital scoliosis. The Journal of bone and joint surgery. British volume. 1995 Sep;77(5):768-70.
9. Praud JP, Canet E. Chest wall function and dysfunction. In: Kendig’s Disorders of the Respiratory Tract in Children (Seventh Edition) 2006. p 733-746.
10. Mehta M. The rib-vertebra angle in the early diagnosis between resolving and progressive infantile scoliosis. The Journal of bone and joint surgery. 1972. 54, 230-243.
11. Rimmer KP, Ford GT, Whitelaw WA. Interaction between postural and respiratory control of human intercostal muscles. Journal of Applied Physiology. 1995 Nov 1;79(5):1556-61.
12. Upadhyay SS, Mullaji AB, Luk KD, Leong JC. Relation of spinal and thoracic cage deformities and their flexibilities with altered pulmonary functions in adolescent idiopathic scoliosis. Spine. 1995 Nov;20(22):2415- 20.
13. Canavese F, Turcot K, Holveck J, Farhoumand AD, Kaelin A. Changes of concave and convex rib–vertebral angle, angle difference and angle ratio in patients with right thoracic adolescent idiopathic scoliosis. European Spine Journal. 2011 Jan 1;20(1):129-34.
14. Ferreira JH, de Janeiro R, James JI. Progressive and resolving infantile idiopathic scoliosis: the differential diagnosis. The Journal of bone and joint surgery. British volume. 1972 Nov;54(4):648-55.
15. Kristmundsdottir F, Burwell RG, James JI. The rib-vertebra angles on the convexity and concavity of the spinal curve in infantile idiopathic scoliosis. Clinical orthopaedics and related research. 1985 Dec(201):205-9.
16. Burwell RG, Cole AA, Cook TA, et al. Pathogenesis of idiopathic scoliosis. The Nottingham concept. Acta OrthopaedicaBelgica. 1992;58:33-58.
17. Xiong B, Sevastik JA, Hedlund R, Sevastik B. Radiographic changes at the coronal plane in early scoliosis. Spine. 1994 Jan;19(2):159-64.
18. Sevastik B, Xiong B, Sevastik J, Lindgren U, Willers U. Rib-vertebral angle asymmetry in idiopathic, neuromuscular and experimentally induced scoliosis. European Spine Journal. 1997 Mar 1;6(2):84-8.
19. Modi HN, Suh SW, Song HR, Yang JH, Ting C, Hazra S. Drooping of apical convex rib-vertebral angle in adolescent idiopathic scoliosis of more than 40 degrees: a prognostic factor for progression. Clinical Spine Surgery.
2009 Jul 1;22(5):367-71.
20. Widmann RF, Bitan FD, Laplaza FJ, Burke SW, DiMaio MF, Schneider R. Spinal deformity, pulmonary compromise, and quality of life in osteogenesis imperfecta. Spine. 1999 Aug 15;24(16):1673.
21. Newton PO, Faro FD, Gollogly S, Betz RR, Lenke LG, Lowe TG. Results of preoperative pulmonary function testing of adolescents with idiopathic scoliosis: a study of six hundred and thirty-one patients. JBJS. 2005 Sep 1;87(9):1937-46.
22. Boyer J, Amin N, Taddonio R, Dozor AJ. Evidence of airway obstruction in children with idiopathic scoliosis. Chest. 1996 Jun 1;109(6):1532-5.
23. Farrell J, Garrido E. Effect of idiopathic thoracic scoliosis on the tracheobronchial tree. BMJ open respiratory research. 2018 Mar 1;5(1):e000264.
24. Kearon C, Killian J. Factors Determining Pulmonary Function in Adolescent Idiopathic Thoracic Scoliosis. American Journal of Respiratory and Critical Care Medicine. 1993;148:288-94.
25. Pehrsson K, Danielsson A, Nachemson A. Pulmonary function in adolescent idiopathic scoliosis: a 25 year follow up after surgery or start of brace treatment. Thorax. 2001 May 1;56(5):388-93.
26. Lenke LG, Bridwell KH, Baldus C, Blanke K. Analysis of pulmonary function and axis rotation in adolescent and young adult idiopathic scoliosis patients treated with Cotrel-Dubousset instrumentation. Journal of spinal disorders. 1992 Mar;5(1):16-25.
27. Vedantam R, Lenke LG, Bridwell KH, Haas J, Linville DA. A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis relative to the surgical approach used for spinal arthrodesis. Spine.
2000 Jan 1;25(1):82.
28. Lenke LG, Bridwell KH, Blanke K, Baldus C. Analysis of pulmonary function and chest cage dimension changes after thoracoplasty in idiopathic scoliosis. Spine. 1995 Jun;20(12):1343-50.

How to Cite this Article: McKee C J S Assessment in adolescent | scoliosis | International Journal of
Paediatric Orthopaedics | Jan-April 2020; 6(1):- .

(Abstract)      (Full Text HTML)      (Download PDF)

 

The Role of Pirani Scoring in Predicting the Frequency of Casting and the Need for Percutaneous Achilles Tenotomy in the Treatment of Idiopathic Clubfoot Using the Ponseti Method

Volume 4 | Issue 2 | July-December 2018 | Page: 15-19 | Chukwuemeka O. Anisi, Joseph E. Asuquo, Innocent E. Abang, Michael E. Eyong, Onyebuchi G. Osakwe, Ngim E. Ngim

DOI- 10.13107/ijpo.2018.v04i02.013

Authors: Chukwuemeka O. Anisi, Joseph E. Asuquo, Innocent E. Abang, Michael E. Eyong [1], Onyebuchi G. Osakwe, Ngim E. Ngim

Departments of Orthopaedics and Traumatology, University of Calabar, Cross River State, Nigeria. [1] Departments of Paediatrics, University of Calabar, Cross River State, Nigeria.

Address of Correspondence
Dr. Chukwuemeka Okechukwu Anisi,
Department of Orthopaedics and Traumatology, University of Calabar Teaching Hospital, PMB 1278-Calabar, Cross River State, Nigeria.
E-mail: iall4him@yahoo.co.uk

Abstract

Background: The Pirani scoring system is a simple tool widely used for grading the severity of clubfoot. This study was designed to objectively assess its value in predicting the total number of casts required, and the need for percutaneous Achilles tenotomy to achieve correction of the idiopathic clubfoot treated by the Ponseti method. Patients and Methods: All patients with idiopathic clubfoot, who attended our clubfoot clinic between January, 2013 and December, 2015, were prospectively studied. Each clubfoot was scored at presentation and at each visit by the first and second authors, using the Pirani scoring system. All patients were treated by the first and second authors by weekly stretching and cast application following the Ponseti treatment protocol until correction was achieved (with or without percutaneous Achilles tenotomy). Chi-square tests were applied to establish any existing relationship between the Pirani scores and the need for percutaneous tenotomy as well as the number of casts required to achieve correction.
Results: A total of 69 patients with 108 idiopathic clubfeet wer recruited into the study. In that, 14 patients defaulted, leaving the study with 81 clubfeet belonging to 55 patients. The median total Pirani score (TPS), midfoot contracture score and hindfoot contracture score at presentation were 4.0, 2.0 and 2.0, respectively. A total of 57 (70.4%) feet required percutaneous Achilles tenotomy to achieve correction. The average number of casts (including casts after tenotomy) required to achieve correction was 4.9 (2–10). The average number of casts required to achieve correction was 4.1 (2–10) for the no tenotomy group and 5.4 (3–10) for the tenotomy group. Statistically significant relationship was established between the TPS and number of casts required to achieve correction for both the tenotomy group (P=0.039) and no tenotomy group (P=0.05).
Conclusion: High Pirani scores were associated with increased number of casts and percutaneous Achilles tenotomy for the correction of idiopathic clubfoot using the Ponseti method.
Keywords: Achilles tenotomy, clubfoot, idiopathic, Pirani scoring system, Ponseti method

References 

1. Solomon L,Warwick D, Selvadurai N.Appley’s Systemof Orthopaedics and Fractures. 9th ed. London: Hodder Arnold; 2010. p. 591-5.
2. Canale ST, Beaty JH. Congenital anomalies of the lower limb. Campbell’s Operative Orthopaedics. 11th ed. Philadelphia: Mosby Elsevier 2007. p. 937-55.
3. Ngim NE, Okokon E, Ikpeme IA, Udosen MA, Iya J. Profile of congenital limb anomalies in Calabar. Asian J Med Sci 2013;4:58-61.
4. Adewole AO, Giwa SO, Kayode MO, Shoga MO, Balogun RA. Congenital clubfoot in a teaching hospital in Lagos, Nigeria. Afr J Med Sci 2009;38:203-6.
5. Omololu B, Ogunlade SO, Alonge TO. Pattern of congenital orthopaedic malformations in an African Teaching Hospital. West Afr J Med 2005;24:92-5.
6. Adewole AO, Williams OM, Kayode MO, Shoga MO, Giwa SO. Early experience with Ponseti clubfoot management in Lagos, Nigeria. East Cent Afr J Surg 2014;19:72-7.
7. Ponseti IV. Current concept review. Treatment of congenital clubfoot. J Bone Joint Surg 1992; 74:448-54.
8. Sud A, Tiwari A, Sharma D, Kapoor S. Ponseti’s vs Kite’s methods in the treatment of clubfoot − A prospective randomized study. Int Orthop 2008;32:409-13.
9. Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics 2004;113:376-80.
10. Morcuende JA, Abbasi D, Dolan LA, Ponseti IV. Results of an accelerated Ponseti protocol for clubfoot. J Pediatr Orthop 2005; 25:623-6.
11. Adegbehingbe OO, Oginni LM, Ogundele OJ, Ariyibi AL, Abiola PO, Ojo OD. Ponseti clubfoot management: Changing surgical trends in Nigeria. Iowa Orthop J 2010;30:7-14.
12. Ponseti IV. Current concept review. Treatment of congenital clubfoot. J Bone Joint Surg 1992;74:448-54.
13. Pirani S, Outerbridge H, Moran M. Method of evaluating the virgin clubfoot with substantial interobserver reliability. Presented at the annual meeting of the Pediatric Orthopaedic Society of North America, Miami, FL, 1995.
14. Dimeglio A, Bensahel H, Souschet P. Classification of clubfoot. J Pediatr Orthop 1995;3:129.
15. Adegbehingbe OO, Asuquo JE, Mejabi OJ, Alzahrani M, Morcuende JA. The heel pad in congenital idiopathic clubfoot: Implications for empty heel for clinical severity assessment. Iowa Orthop J 2015; 35:169-74.
16. Haft GF, Walter CG, Crawford HA. Early clubfoot recurrence after use of the Ponseti method in a New Zealand population. J Bone Joint Surg Am 2007;89:487-93.
17. Boehm S, Limpaphayom N, Alaee F, Sinclair MF, Dobbs MB. Early result of the Ponseti treatment of clubfoot in distal athrogryposis. J Bone Joint Surg Am 2008;90:1501-7.
18. Janicki JA, Narayanan UG, Harvey BJ, Roy A, Weir S, Wright JG. Comparison of surgeon and physiotherapist-directed Ponseti treatment of idiopathic clubfoot. J Bone Joint Surg Am 2009;91:1101-8.
19. Porecha MM, Parmar DS, Charda HR. Midterm results of Ponseti method for the treatment of congenital idiopathic clubfoot. J Ortho Surg Res 2011;6:3.
20. Rijal R, Shrestha BP, Singh GK, Singh M, Nepal P, Khanal GP, et al. Comparison of Ponseti’s and Kite’s methods of treatment of idiopathic clubfoot. Indian J Orthop 2010;44:202-7.
21. Morcuende JA, Dobbs MB, Frick SL. Results of the Ponseti method in patients with clubfoot associated with athrogryposis. Iowa Orthop J 2008;28:22-6.
22. Scher DM. The Ponseti method of treatment of clubfoot. Curr Opin Pediatr 2006;18:22-8.
23. Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfoot. J Bone Joint Surg Am 2004;86:22-7.
24. Flynn JM, Donohoe M, McKenzie WG. An independent assessment of two clubfoot classification systems. J Pediatr Orthop 1998;18:223.
25. Scher DM, Feldman DS, van Bosse HJ. Predicting the need for tenotomy in the Ponseti method for correction of clubfoot. J Pediatr Orthop 2004;24:349.
26. Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone J Surg Br 2006;88:1082-4.
27. BorN,Coplan JA,Herzenberg JE.Ponseti treatment for idiopathic clubfoot: Minimum 5-year follow up. Clin Orthop Relat Res 2009;467:1263-70.

How to Cite this Article:  Anisi CO, Asuquo JE, Abang IE, Eyong EM, Osakwe OG, Ngim E | The Role of Pirani Scoring in Predicting the Frequency of Casting and the Need for Percutaneous Achilles Tenotomy in the Treatment of Idiopathic Clubfoot Using the Ponseti Method | July-December 2018; 4(2): 15-19.

 

(Article Text HTML)      (Download PDF)