日本側彎症学会編：側弯のしおり 知っておきたい脊柱側弯症（改訂第4版）. インテルナ出版. 2020.
日本側彎症学会編：小児脊柱変形治療の最前線. 南江堂. 2021.
Yohei Takahashi, Ikuyo Kou, Atsushi Takahashi, Todd A Johnson, Katsuki Kono, Noriaki Kawakami, Koki Uno, Manabu Ito, Shohei Minami, Haruhisa Yanagida, Hiroshi Taneichi, Taichi Tsuji, Teppei Suzuki, Hideki Sudo, Toshiaki Kotani, Kota Watanabe, Kazuhiro Chiba, Naoya Hosono, Naoyuki Kamatani, Tatsuhiko Tsunoda, Yoshiaki Toyama, Michiaki Kubo, Morio Matsumoto, Shiro Ikegawa
A genome-wide association study identifies common variants near LBX1 associated with adolescent idiopathic scoliosis.
Nat Genet. 2011 Oct 23;43(12):1237-40. doi: 10.1038/ng.974. Epub 2011 Oct 23.
Abstract/Text
Adolescent idiopathic scoliosis is a pediatric spinal deformity affecting 2-3% of school-age children worldwide(1). Genetic factors have been implicated in its etiology(2). Through a genome-wide association study (GWAS) and replication study involving a total of 1,376 Japanese females with adolescent idiopathic scoliosis and 11,297 female controls, we identified a locus at chromosome 10q24.31 associated with adolescent idiopathic scoliosis susceptibility. The most significant SNP (rs11190870; combined P = 1.24 × 10(-19); odds ratio (OR) = 1.56) is located near LBX1 (encoding ladybird homeobox 1). The identification of this susceptibility locus provides new insights into the pathogenesis of adolescent idiopathic scoliosis.
S L Weinstein
Natural history.
Spine (Phila Pa 1976). 1999 Dec 15;24(24):2592-600.
Abstract/Text
Stuart L Weinstein, Lori A Dolan, Kevin F Spratt, Kirk K Peterson, Mark J Spoonamore, Ignacio V Ponseti
Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study.
JAMA. 2003 Feb 5;289(5):559-67.
Abstract/Text
CONTEXT: Previous long-term studies of idiopathic scoliosis have included patients with other etiologies, leading to the erroneous conclusion that all types of idiopathic scoliosis inevitably end in disability. Late-onset idiopathic scoliosis (LIS) is a distinct entity with a unique natural history.
OBJECTIVE: To present the outcomes related to health and function in untreated patients with LIS.
DESIGN, SETTING, AND PATIENTS: Prospective natural history study performed at a midwestern university with outpatient evaluation of patients who presented between 1932 and 1948. At 50-year follow-up, which began in 1992, 117 untreated patients were compared with 62 age- and sex-matched volunteers. The patients' mean age was 66 years (range, 54-80 years).
MAIN OUTCOME MEASURES: Mortality, back pain, pulmonary symptoms, general function, depression, and body image.
RESULTS: The estimated probability of survival was approximately 0.55 (95% confidence interval [CI], 0.47-0.63) compared with 0.57 expected for the general population. There was no significant difference in the demographic characteristics of the 2 groups. Twenty-two (22%) of 98 patients complained of shortness of breath during everyday activities compared with 8 (15%) of 53 controls. An increased risk of shortness of breath was also associated with the combination of a Cobb angle greater than 80 degrees and a thoracic apex (adjusted odds ratio, 9.75; 95% CI, 1.15-82.98). Sixty-six (61%) of 109 patients reported chronic back pain compared with 22 (35%) of 62 controls (P =.003). However, of those with pain, 48 (68%) of 71 patients and 12 (71%) of 17 controls reported only little or moderate back pain.
CONCLUSIONS: Untreated adults with LIS are productive and functional at a high level at 50-year follow-up. Untreated LIS causes little physical impairment other than back pain and cosmetic concerns.
Demura S, Yaszay B, Carreau JH, Upasani VV, Bastrom TP, Bartley CE, Newton PO.
Maintenance of Thoracic Kyphosis in the 3D Correction of Thoracic Adolescent Idiopathic Scoliosis Using Direct Vertebral Derotation.
Spine Deform. 2013 Jan;1(1):46-50. doi: 10.1016/j.jspd.2012.06.001. Epub 2013 Jan 3.
Abstract/Text
OBJECTIVES: Through a review of prospectively collected data, we sought to analyze the outcomes related to 3-dimensional correction of adolescent idiopathic scoliosis (AIS) after posterior spinal fusion (PSF) and instrumentation using an aggressive combination of correction strategies.
BACKGROUND SUMMARY: New techniques have been used to address sagittal plane deformity while maximizing coronal and axial correction, including Ponte osteotomy, differential rod over-contouring, and direct vertebral rotation with uniplanar screws.
METHODS: This is a consecutive single-center series of AIS patients with thoracic curves (Lenke 1 and 2) with 2-year follow-up who underwent PSF and instrumentation with the use of the following correction strategies: segmental uniplanar screws, ultra high-strength 5.5 mm steel rods, aggressive differential rod contouring, periapical Ponte osteotomies, and segmental direct vertebral derotation. Scoliosis Research Society (SRS)-22, radiographic and clinical parameters were evaluated at preoperative and 2-year time points.
RESULTS: Twenty-six patients were included (mean age 13.6 ± 1.5 years). Preoperative thoracic Cobb measured 52 ± 9°, which improved to 17 ± 4° at 2-year follow-up, resulting in 68 ± 9% correction. The average thoracic kyphosis from T5-T12 did not significantly change (21 ± 10° to 22 ± 5° at 2 years); however, in patients with kyphosis less than 20° preoperatively (avg. 13 ± 5°) kyphosis increased significantly at 2-year follow-up (avg. 20 ± 4°, p<.05). Preoperatively, axial rotation was more than 13° in 21 of 26 cases. At 2-year follow-up, axial rotation remained more than 13° in 4 of 26 cases (p<.01). Rib hump prominence was 17 ± 5° preoperatively, which improved significantly to 10 ± 4° at 2-year follow-up (p<.05). Postoperative SRS domain scores significantly improved in pain (4.3 to 4.7), self-image (3.7 to 4.3), and satisfaction (3.3 to 4.6) (p<.05).
CONCLUSION: A high degree of coronal correction can be achieved in association with vertebral derotation without sacrificing sagittal plane alignment. High-strength rods aggressively bent to create kyphosis allow both restoration of kyphosis and axial plane derotation in thoracic idiopathic scoliosis.
Copyright © 2013 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.
Demura S, Murakami H, Kato S, Yoshioka K, Fujii M, Igarashi T, Yonezawa N, Takahashi N, Tsuchiya H.
Posterior curve correction using convex posterior hemi-interbody arthrodesis in skeletally immature patients with scoliosis.
Spine J. 2016 Sep;16(9):1152-6. doi: 10.1016/j.spinee.2016.05.019. Epub 2016 May 30.
Abstract/Text
BACKGROUND CONTEXT: Deformity progression after posterior fusion in skeletally immature patients with scoliosis has remained a topic of debate. It occurs when the anterior segment of the apical zone continues to grow after successful posterior fusion, resulting in progressive bending and rotation of the vertebral bodies. For this reason, circumferential fusion using a combined anterior-posterior approach has been used to prevent this occurrence.
PURPOSE: The aim of this study was to report instrumented spinal fusion with convex hemi-interbody arthrodesis using a posterior-only approach in Risser stage 0 or 1 scoliosis patients.
STUDY DESIGN: This is a retrospective study.
PATIENT SAMPLE: Three patients presenting scoliosis in Risser stage 0 or 1 were enrolled.
OUTCOME MEASURES: Postoperative correction rate, bone union, and pulmonary function were examined.
METHODS: Premenarchal girls aged 11.3-12.2 years underwent surgical procedure. Follow-up after surgery was on 25, 30, and 36 months. The surgical procedure included soft tissue, costotransverse ligament and facet releases, and Ponte osteotomies. Discectomy followed by intervertebral bone grafting were performed across the periapical zone on the convex side. After placement of segmental pedicle screws, deformity correction was achieved by rod derotation, cantilever reduction, direct vertebral derotation distraction and compression technique.
RESULTS: Preoperative thoracic Cobb angle measured 81° (range 64-107), which improved to 23° at final follow-up, resulting in a 72% correction. Solid posterior bony fusion was achieved in all cases at final follow-up. No case showed deterioration of axial rotation at the apex radiographically. Postoperative pulmonary function showed increases in forced vital capacity (preoperation: 1.86±0.2L; at 2 years: 2.48±0.1L) and forced expiratory volume in 1 second (preoperation: 1.58±0.2L; at 2 years: 2.11±0.1L).
CONCLUSIONS: This posterior-only procedure should be considered a suitable option in skeletally immature scoliosis patients where circumferential fusion is indicated and avoiding an anterior thoracotomy is preferable.
Copyright © 2016 Elsevier Inc. All rights reserved.
Demura S, Murakami H, Kato S, Yoshioka K, Yonezawa N, Takahashi N, Tsuchiya H.
Spontaneous derotation of compensatory lumbar curve after thoracic fusion in adolescent idiopathic scoliosis.
Spine Surg Relat Res. 2017;1(1):27-30. doi: 10.22603/ssrr.1.2016-0006. Epub 2017 Dec 20.
Abstract/Text
INTRODUCTION: Currently, excellent three-dimensional correction can be achieved with use of segmental pedicle screw fixation in adolescent idiopathic scoliosis (AIS). In the majority of patients with major thoracic curves, selective thoracic fusion (STF) may be considered to maximize motion segment of the unfused lumbar spine. This study aimed to investigate the extent of spontaneous derotation of the lumbar curve following STF.
METHODS: AIS patients who underwent STF using posterior pedicle screw fixation were retrospectively reviewed. Angle of vertebral rotation was defined as the difference between the axial rotation angles of the apical vertebra and S1 vertebra on axial CT images. Radiographic measurements included major thoracic curve, thoracolumbar/lumbar curve (preoperative and postoperative), and side-bending curve. The relationships between the axial rotation of the lumbar spine and radiographic measurements were also analyzed.
RESULTS: Thirty patients (all females) were included. Preoperative thoracic Cobb measured 62.1±9°, which improved to 20.3±5° at 2 years postoperatively, resulting in 67% correction. Preoperative lumbar Cobb measured 38.0±9°, which spontaneously improved to 19.0±7°, indicating a 50% correction. Preoperatively, the axial rotation of apical lumbar vertebra was 10.2±5.5°, which changed to 7.0±4.8° (32% spontaneous correction). Comparing the correction between the axial rotation of the lumbar spine and other parameters, postoperative angle of axial rotation correlated well with preoperative (r=0.79) and postoperative (r=0.82) lumbar Cobb angle. Meanwhile, the improvement of axial rotation of the lumbar spine correlated with postoperative thoracic curve (r=－0.42), postoperative lumbar curve (r=－0.57), and thoracic apical translation change (r=0.43).
CONCLUSIONS: In AIS patients with major thoracic curves, spontaneous axial derotation of the lumbar curves occurred with a mean correction rate of 32% after STF. A greater spontaneous derotation of the lumbar curve would be related to correction of the thoracic curve.
