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Idiopathic Spinal Deformity And Electrical Stimulation References
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Allington N.J. and Bowen J.R.
(1996) Adolescent idiopathic scoliosis: treatment with the Wilmington brace. A
comparison of full-time and part-time use. J. Bone Joint Surg. Am. 78,
1056-1062.
Abstract: We reviewed the clinical records and the radiographs of 188 patients
who had adolescent idiopathic scoliosis. Our purpose was to determine whether
part-time and full-time bracing had been equally effective in preventing
progression of the curve. Full-time bracing had been used for ninety-eight
patients; part-time bracing, for forty-nine; and electrical stimulation, for
forty-one. Eighty-eight patients had had a curve of less than 30 degrees and 100
patients, a curve of 30 to 40 degrees. The treatment was considered a failure if
the curve had increased 5 degrees or more. The curve progressed 5 degrees or
more in thirteen (36 per cent) of the thirty-six patients who had had full-time
bracing for a curve of less than 30 degrees, in thirteen (41 per cent) of the
thirty-two who had had part-time bracing for such a curve, and in fourteen (70
per cent) of the twenty who had had electrical stimulation for such a curve.
Compared with electrical stimulation, both full-time and part-time bracing
prevented progression significantly more effectively (p < 0.02 and p < 0.04,
respectively). With the numbers available, the difference in progression between
the groups that had had full-time and parttime bracing was not significant (p <
0.18). The curve progressed 5 degrees or more in thirty-six (58 per cent) of the
sixty-two patients who had had full-time bracing for a curve of 30 to 40
degrees, in ten of the seventeen who had had part- time bracing for such a
curve, and in eighteen (86 per cent) of the twenty-one who had had electrical
stimulation for such a curve. The difference in progression between each bracing
program and electrical stimulation was significant (p < 0.03 for the full-time
program and p < 0.05 for the part-time program). With the numbers available, the
difference in progression between full-time and part-time bracing was not
significant (p < 1.14)
Anciaux M., Lenaert A., Van
Beneden M.L., Blonde W., and Vercauteren M. (1991) Transcutaneous electrical
stimulation (TCES) for the treatment of adolescent idiopathic scoliosis:
preliminary results. Acta Orthop. Belg. 57, 399-405.
Abstract: The authors report on the results of a preliminary study on the
treatment of progressive idiopathic scoliosis by electrical surface stimulation.
The study, involving 30 spinal curvatures, showed stabilization of the median
primary curvature (30 degrees) in the course of treatment, the median duration
of which was 12 months. Overall, 73.2% of the curvatures treated, responded
favorably (stabilization or regression of the curve); however, 26.8% of the
curvatures progressed in spite of the transcutaneous electrical stimulation
treatment. The only complication noted was contact eczema in 20% of the cases.
The authors feel that surface electrical stimulation treatment can be regarded
as an acceptable alternative to a brace in the treatment of idiopathic
scoliosis, and at this stage it deserves a place in the conservative therapeutic
approach to idiopathic scoliosis
Andonian A.T. (1984) Detection
of stimulated back muscle contractions by moire topography. J. Biomech. 17,
653-661.
Abstract: The ability to treat scoliosis via surface stimulated trunk muscle
contractions is now being evaluated at several treatment centers. In order to
make biomechanical analysis of the procedure, so that the technique can be used
optimally, data are needed to quantify the muscle contractions and structural
changes by different electrode locations. This paper presents the use of a
modified shadow moire technique to quantify geometric changes resulting from
electrical stimulation applied to the surface of the back in a healthy subject
Axelgaard J., Brown J.C. (1983)
Lateral electrical surface stimulation for the treatment of progressive
idiopathic scoliosis. Spine 8:242-260.
Axelgaard J., Nordwall A.,
Brown J.C. (1983) Correction of spinal curvatures by transcutaneous electrical
muscle stimulation. Spine 8, 463-481.
Bertrand S.L., Drvaric D.M.,
Lange N., Lucas P.R., Deutsch S.D., Herndon J.H., and Roberts J.M. (1992)
Electrical stimulation for idiopathic scoliosis. Clin. Orthop. 176-181.
Abstract: To evaluate the effectiveness of lateral electrical spinal stimulation
for idiopathic scoliosis, 87 patients treated with this modality were reviewed
retrospectively. All patients had no prior treatment, had a documented
progression of more than 5 degrees, and were skeletally immature. Forty-seven
patients were compliant and followed until skeletal maturity or institution of
other treatment. Fifty percent of patients with a high probability of
progression required surgery. For compliant patients, 51% progressed 5 degrees
or more and 36% progressed 10 degrees or more or required a change to another
treatment modality. Statistical analysis demonstrated no significant difference
in the probability of progression between this group of treated patients and
previously published groups of untreated patients
Bradford D.S., Tanguy A., and
Vanselow J. (1983) Surface electrical stimulation in the treatment of idiopathic
scoliosis: preliminary results in 30 patients. Spine 8, 757-764.
Abstract: From 1978 to 1981, 30 patients have been treated for idiopathic
scoliosis with surface electrical stimulation using the E.S.O. (Electro Spinal
Orthosis) Single Channel designed by Medtronics. The criteria for selection
were: patients who were skeletally immature; single thoracic, thoracolumbar or
lumbar curvatures between 30 degrees and 40 degrees; or the same curve pattern
greater than 20 degrees with 5 degrees of documented progression in one year;
patient and family reliability. Patients with previous treatment were excluded
from the study. No one was more than 15 years of age. Curve amplitude was
between 25 degrees and 35 degrees in 72% of the patients. Curve pattern was
single thoracic in 28 patients, thoracolumbar in one, and lumbar in one. Five
patients were excluded from the evaluation of the results of stimulation of the
correction of the curve. Of the 25 patients remaining, one was improved, 14 were
stable, two had mild acceptable progression (less than 10 degrees with no need
for further treatment), and eight had an unacceptable progression greater than
10 degrees requiring some form of alternative treatment. The authors conclude
that significant improvement in the curvatures under treatment was extremely
unlikely, that progression may have been stopped in some curves, that the
curvatures under 30 degrees had the best results, and that curvatures that do
not respond to surface electrical stimulation are not likely to respond to a
Milwaukee brace treatment
Brown J.C., Axelgaard J.,
Howson D.C. (1984) Multicenter trial of a noninvasive stimulation method for
idiopathic scoliosis. Spine 9,382-387.
Bunnel W.P. (1986) The natural
history of idiopathic scoliosis before skeletal maturity. Spine 11,
773-776.
Campbell J.M., Meadows P.M.
(1992) Therapeutic FES: From Rehabilitation to Neural Prosthetics. Assistive
Technology 4, 4-18.
Chen P.Q. (1990) Spinal
deformities among children under 10 years old: a clinical analysis of 41 cases.
J. Formos. Med. Assoc. 89, 772-776.
Abstract: In order to investigate the number, types, severity and the various
treatments of spinal deformity among children under 10 years old, a
retrospective survey of registered patients in the scoliosis clinic at the
National Taiwan University Hospital was performed. Between August 1982 and
December 1988, there were 41 children who had scoliosis with a Cobb angle larger
than 10 degrees and the onset was before 10 years of age. This number accounted
for 3.8% of all scoliotic patients during the same time period. Of these
children, 19 had idiopathic scoliosis (46.3%), 7 with infantile and 12 with
juvenile; the other 19 were due to congenital, and the remaining 3 were
postradiation, a resection of Wilms' tumor in 2 and neuroblastoma in 1. In the
congenital group, hemivertebra (13 patients) outnumbered other causes. Twenty
three patients (56%) underwent surgical correction, the rest were either under
regular observation (9 patients), bracing (7 patients) or electrical stimulation
(2 patients). The average preoperative Cobb angle in the operated groups was
much larger, being 67.6 degrees in the infantile; 52.4 degrees in the juvenile;
57 degrees in the congenital; and 62 degrees in the postradiation. For those
without an operation, the angles were smaller than 30 degrees. The indications
for surgery were that the curvature was in progression, which could not be
controlled by conservative means, or that in some congenital cases, the curve
had the potential tendency to exacerbate. From the present study, the percentage
of scoliosis under 10 years of age was far less than the adolescent group in our
clinic.(ABSTRACT TRUNCATED AT 250 WORDS)
Durham J.W., Moskowitz A., and
Whitney J. (1990) Surface electrical stimulation versus brace in treatment of
idiopathic scoliosis. Spine 15, 888-892.
Abstract: Surface electrical stimulation using the ScoliTron device was applied
to 40 adolescent patients for treatment of idiopathic scoliosis. Adequate
follow-up was available for 30 of these patients. The overall failure rate was
15 of 30 or 50%. Due to curve progression while using the ScoliTron, these
patients either went on to a fusion (9 of 15) or were changed to a brace (6 of
15). The remaining 15 patients were considered successes with no curve
progression (10 of 30 or 33%) or successful/failures with slight curve
progression not requiring a change in treatment (5 of 30 or 17%). None of the
various parameters analyzed were found to be useful indicators of successful
treatment using the ScoliTron device. Electrical stimulation was found to be
ineffective in preventing curve progression for idiopathic scoliosis
Fisher D.A., Rapp G.F., and
Emkes M. (1987) Idiopathic scoliosis: transcutaneous muscle stimulation versus
the Milwaukee brace. Spine 12, 987-991.
Abstract: This paper compared 3-year results of electrical stimulation with the
Milwaukee brace for the treatment of idiopathic scoliosis. Fifty patients in
each group were compared retrospectively and matched for age, sex, Risser sign,
and curve morphology. Evaluations were performed at 6-month intervals with
radiographs and examinations. Skin irritation was the most common complication
with electrical stimulation. Using survivorship analysis methods, no significant
differences were found in rates of curve progression or failure. Overall, 70% of
the patients in each group were successfully maintained over a course of 3
years. Electrical stimulation is comparable to the Milwaukee brace in managing
idiopathic scoliosis
Friedman H.G., Herbert M.A.,
and Bobechko W.P. (1982) Electrical stimulation for scoliosis. Am. Fam.
Physician 25, 155-160.
Abstract: Scoliosis is detectable in 6 to 14 percent of school-age children. An
estimated 0.1 percent of the curvatures are progressive and require treatment.
The usual method of treatment consists of a restrictive brace worn most of the
time. A successful and nonrestrictive technique utilizing electrical stimulation
of the deep paraspinal muscles has been developed. Therapy involves night-time
use of an implanted stimulator system. It places no restrictions on the child's
activities, while producing results that are superior to bracing
Grimby G., Nordwall A., Hulten
B., and Henriksson K.G. (1985) Changes in histochemical profile of muscle after
long-term electrical stimulation in patients with idiopathic scoliosis. Scand.
J. Rehabil. Med. 17, 191-196.
Abstract: Adolescent patients with idiopathic scoliosis were treated with long-
term electrical stimulation (30 Hz) at the posterior axillary line on the convex
side of the curvature in order to correct the spinal deformity. The patients
were also followed with muscle biopsies from the latissimus dorsi of the
stimulated side taken before, after 3 and 6 months of electrical stimulation.
There was a tendency for an increase in the percentage of type I and especially
the type II C (undifferentiated) fibers after stimulation. The mean muscle fiber
area and the fiber areas of the various fiber types did not change
significantly. Histopathological findings were generally rare before as well as
after 3 months of electrical stimulation, the only noticeable finding being a
somewhat increased frequency of atrophic fibers in groups after 6 months of
stimulation. In all studied patients the enzymatic activity of citrate synthase
increased after 3 months and further in three studied patients after 6 months of
stimulation. The present study gives some evidence of an adaptive process caused
by electrical stimulation towards a more fatigue-resistant muscle
Goldberg C., Dowling F.E.,
Fogarty E.E., Regan B.F., Blake N.S. (1988) Electro-spinal stimulation in
children with adolescent and juvenile scoliosis. Spine 13, 482-484.
Herbert M.A. and Bobechko W.P.
(1987) Paraspinal muscle stimulation for the treatment of idiopathic scoliosis
in children. Orthopedics 10, 1125-1132.
Abstract: More than 12 years ago, we began to investigate the potential use of
electrical stimulation of the paraspinal muscles to control scoliosis in
children. Animal experimentation showed that unilateral stimulation of these
muscles will cause the spine to grow toward the stimulated side. It was also
shown that the stimulation need only be carried on for part of the day. We have
developed a treatment for scoliosis based on night-time use of stimulation
either with an implantable or surface system. Both single and dual channel
systems are available for the treatment of single or double scoliotic curves.
Treatment is carried on at night while the child is asleep, and there are no
exercises or brace programs associated with it. Approximately 75% of the curves
are either improved significantly, or maintained at their starting value. Only
about 15% of the curves fail to respond and require a spinal fusion to stabilize
them. Patient acceptance and compliance has been excellent
Herndon W.A. (1984) Spinal
deformities in children. The improving picture. Postgrad. Med. 76, 67-76.
Abstract: Significant advances have been made in knowledge of the natural
history and treatment of spinal deformities. Early diagnosis remains the key to
successful treatment. Newer techniques of bracing, electrical stimulation, and
surgery have led to a satisfactory outcome in the majority of patients. Smaller
scoliotic curves (less than 20 degrees) may be treated by observation, but for
more significant curves prompt referral is best
Hopf C., Sandt E., and Heine J.
(1989) [The progression of untreated idiopathic scoliosis in the x-ray image].
Rofo Fortschr. Geb. Rontgenstr. Neuen Bildgeb. Verfahr. 151, 311-316.
Abstract: The natural history of scoliosis, or lateral curvature of the spine,
was followed up in 135 patients (111 girls, 24 boys) for a total average period
of 52.4 months. We observed patients with a curvature of between 5 degrees and
30 degrees none of whom had been treated specifically as orthotics or with
electrical stimulation or by surgery. Two groups of patients with progressive
curvature were differentiated: 1) in 62.2% of the patients the curvature
progressed by more than 5 degrees during the entire observation period; 2) in
36% of the patients we found an increase in curvature by more than 5 degrees
within one year. Another result of our study was that idiopathic scoliosis is
particularly dangerous in young patients with a "0" Risser sign. Thoracic
curvatures and double major curvatures were more liable to progress than lumbar
and thoracolumbar curvatures. Even a small angle of curvature in young patients
must be taken seriously
Hsu J.D., Slager U.T., Swank
S.M., and Robinson M.H. (1988) Idiopathic scoliosis: a clinical, morphometric,
and histopathological correlation. J. Pediatr. Orthop. 8, 147-152.
Abstract: At the time of spinal fusion, muscle biopsies were taken from both the
convex and concave side at the apex of the curve from 27 patients with
idiopathic scoliosis. Histochemical and morphometric studies showed generally
small and atrophic type 1 muscle fibers on both sides, with preservation of the
normal type 1 predominance. The most striking abnormality was a type 2A
predominance over type 2B fibers, the reverse of normal in the paraspinous
muscle. These changes showed no correlation with sex, age, or electrical
stimulation but showed a significantly greater severity with the duration and
severity of the curve. We conclude that these changes are a secondary muscle
adaptation to the curve and not its primary etiology
Kahanovitz N., Snow B., and
Pinter I. (1984) The comparative results of psychologic testing in scoliosis
patients treated with electrical stimulation or bracing. Spine 9, 442-444.
Abstract: Proponents of the surface stimulation treatment of idiopathic
scoliosis have reported approximately 75-85% success rates in arresting
progressive curvatures. Although encouraging, these results do not appear to be
better than those of the more traditional brace programs. Now recognizing
electrical stimulation as a viable alternative to bracing, supporters have
advocated the psychologic and physical freedom with electrical stimulation as a
major advantage over brace treatment. However, to date, there have been no
objective psychologic studies to substantiate these claims. This prospective
study was devised to detect any significant differences between a group of
patients treated in a TLSO or Milwaukee brace and a group of patients treated
with lateral electrical surface stimulation (LESS) (ScoliTron). The study
consisted of 40 female private patients with idiopathic scoliosis treated for a
minimum of 3 months. Each patient was given a set of seven standardized
psychologic tests and an observer rating by the treating physician or physical
therapist working with the patient. Results of the Psychological Epidemiology
Research Interview (PERI) revealed that the LESS group had significantly higher
self esteem than the brace group. The brace patients demonstrated a much greater
perception of directed hostility than the LESS group. The coping response
inventory showed the brace group to manifest a more primitive coping mechanism
than the LESS group. The brace group attempted to avoid problems associated with
their disease, rather than cope with them as the LESS group was better able to
do. The brace group focused more on their emotions than the realistic problems
of their disease.(ABSTRACT TRUNCATED AT 250 WORDS)
Kahanovitz N. and Weiser S.
(1986) Lateral electrical surface stimulation (LESS) compliance in adolescent
female scoliosis patients. Spine 11, 753-755.
Abstract: This retrospective study of lateral electrical surface stimulation
(LESS) treatment for patients with progressive idiopathic scoliosis was
performed to document patient compliance in the standard electrical stimulation
program and to gain objective data to perform a relative comparison of
electrical stimulation and bracing compliance. Forty mothers of adolescent
female patients participating in the electrical stimulation program of one of
the authors (NK) were interviewed confidentially by an independent observer
(SW). Patients whose compliance was rated good or total were thought to have
acceptable compliance rates. Overall, 50% showed good or total compliance, 10%
fair, 5% poor, and 35% failures. It appeared that the failures tended to
exaggerate their symptoms and use "skin irritation" as an excuse to discontinue
treatment. The longer patients used the LESS (scolitron) device, the more
compliant they became (P less than 0.0). This is opposite to the findings about
brace compliance. Confidence of the mother in the device showed a positive
correlation (P less than 0.008) with compliance, and a mother's concern of how
others would react to her child's scoliosis had a negative correlation (P less
than 0.003). From the results of this study, overall compliance appears to be
somewhat better for electrical stimulation programs than for bracing programs.
However, the high failure rate was both disappointing and surprising
Keller R.B. (1989) Nonoperative
treatment of adolescent idiopathic scoliosis. Instr. Course Lect. 38, 129-135.
Abstract: Nonoperative treatment of spinal deformity will continue to change. In
recent years, many long-held tenets regarding the natural history and response
to various treatment methods have been challenged, and we do not yet have
answers to many of the questions that have been raised. New orthotic devices and
electrical stimulation have multiplied treatment approaches. From this array of
options, the clinician must decide whom to treat and what method to use. On the
basis of the current consensus, patients who have significant, progressive
deformity and an immature spine should be treated by one of the nonoperative
techniques. The various TLSOs are most favored, although the Milwaukee brace
still has a definite role in certain curve patterns and remains the standard of
braces. The role of electrical spinal stimulation is uncertain at present, and
further research is necessary. We have learned that only appropriate orthotic
treatment of scoliosis produces long-term stabilization of deformity. Impressive
initial curve correction does not signify the end result, and patients who have
curves that are unacceptable when the patient is first seen should be considered
for surgical treatment. Thus, while questions remain, the guidelines for
treatment outlined in this chapter are appropriate for the present
Lonstein J.E., Carlson J.M.
(1984) The prediction of curve progression in untreated idiopathic scoliosis
during growth. J Bone Joint Surg 66A, 1061-1071.
Lonstein J.E. (1988) Natural
history and school screening for scoliosis. Orthop. Clin. North Am. 19, 227-237.
Abstract: In light of the questions and controversy regarding school screening
for spinal deformities, should the programs be dropped? The natural history is
not completely known and the results of nonoperative treatment questioned. The
costs are high due to over-referral and numerous physician visits and
radiographs. Would it not be best to wait until the epidemiologic questions are
answered? The best approach is one in the middle ground. The program needs to be
organized and strengthened. With the education of screeners, over-referral can
be reduced. The treating physician must confirm the physical finding, take
appropriate radiographs, and plan appropriate follow-up. In this way, the costs
will be reduced. In addition, with knowledge regarding natural history, only
larger curves or progressive curves will be treated. Nonoperative treatment of
idiopathic scoliosis is effective. It can control progression and even result in
correction of some curves. The overall effectiveness of braces and electrical
stimulation needs to be constantly reviewed. How do these forms of nonoperative
treatment affect the progressive curve, and do they reduce the need for surgery
in idiopathic scoliosis? Only after we have more studies on natural history and
on the results of nonoperative treatment can screening for scoliosis be
reassessed to determine its role in the overall treatment program of spinal
deformities
Macek C. (1982) Electrical
stimulation of muscles replaces braces for scoliosis. JAMA 247, 1097-1098.
McCollough N.C., III (1985)
Electrical stimulation in management of idiopathic scoliosis. Instr. Course Lect.
34, 119-126.
McCollough N.C., III (1986)
Nonoperative treatment of idiopathic scoliosis using surface electrical
stimulation. Spine 11, 802-804.
Nachemson A.L. and Peterson L.E.
(1995) Effectiveness of treatment with a brace in girls who have adolescent
idiopathic scoliosis. A prospective, controlled study based on data from the
Brace Study of the Scoliosis Research Society. J. Bone Joint Surg. Am. 77,
815-822.
Abstract: In a prospective study by the Scoliosis Research Society, 286 girls
who had adolescent idiopathic scoliosis, a thoracic or thoracolumbar curve of 25
to 35 degrees, and a mean age of twelve years and seven months (range, ten to
fifteen years) were followed to determine the effect of treatment with
observation only (129 patients), an underarm plastic brace (111 patients), and
nighttime surface electrical stimulation (forty-six patients). Thirty-nine
patients were lost to follow-up, leaving 247 (86 per cent) who were followed
until maturity or who were dropped from the study because of failure of the
assigned treatment. The end point of failure of treatment was defined as an
increase in the curve of at least 6 degrees, from the time of the first
roentgenogram, on two consecutive roentgenograms. As determined with use of this
end point, treatment with a brace failed in seventeen of the 111 patients;
observation only, in fifty-eight of the 129 patients; and electrical
stimulation, in twenty-two of the forty-six patients. According to survivorship
analysis, treatment with a brace was associated with a success rate of 74 per
cent (95 per cent confidence interval, 52 to 84) at four years; observation
only, with a success rate of 34 per cent (95 per cent confidence interval, 16 to
49); and electrical stimulation, with a success rate of 33 per cent (95 per cent
confidence interval, 12 to 60).(ABSTRACT TRUNCATED AT 250 WORDS)
O'Donnell C.S., Bunnell W.P.,
Betz R.R., Bowen J.R., and Tipping C.R. (1988) Electrical stimulation in the
treatment of idiopathic scoliosis. Clin. Orthop. 107-113.
Abstract: Sixty-two fully compliant patients (with 94 curves) met protocol
criteria of 20 degree-39 degree curves, Risser iliac crest signs of 0, 1, or 2,
and no prior treatment. Both clinical and roentgenographic examinations were
performed before, during, and after treatment. The follow-up periods averaged
2.3 years, with a 3.2-year average follow-up period for patients who completed,
rather than failed, Electro Spinal Orthosis (ESO) treatment. Seventy-one percent
of the 20 degree-29 degree curves and 66% of the 30 degree-39 degree curves had
progressed 5 degrees or more at follow-up evaluation. Fifty percent of the
patients had a follow-up curve of at least 40 degrees or were treated by
posterior spinal fusion and were considered treatment failures. The curve
progression paralleled that found in natural history studies, and the rate of
failure exceeded that found in orthotic treatment studies
O'Malley T.J. (1992) A review
of the functional electrical stimulation equipment market. Assist. Technol. 4,
40-45.
Abstract: The market for functional electrical stimulation (FES) equipment for
use in rehabilitation is growing as increasingly sophisticated products enter
the market each year. Factors that impact the availability of FES equipment
include technological limitations, government regulation, reimbursement status,
and clinician training. New products have become available in the last decade
with many innovative applications available under investigational status. The
current availability of FES equipment for selected applications such as
therapeutic muscle stimulation, cardiovascular exercise, restoration of function
in the lower and upper extremities, respiratory assist, restoration of bladder
function, electroejaculation, and scoliosis correction is reviewed. A review of
FES equipment for nonneuromuscular applications such as control of epilepsy,
cochlear implants, electrotactile stimulation, and systems to enhance wound
healing and bone growth is also included. Key manufacturers are identified
Peterson L.E. and Nachemson A.L.
(1995) Prediction of progression of the curve in girls who have adolescent
idiopathic scoliosis of moderate severity. Logistic regression analysis based on
data from The Brace Study of the Scoliosis Research Society. J. Bone Joint Surg.
Am. 77, 823-827.
Abstract: In a study conducted by the Scoliosis Research Society, 159 girls with
a mean age of thirteen years (range, ten to fifteen years) who had adolescent
idiopathic scoliosis were followed prospectively until skeletal maturity or
until the curve had increased 6 degrees or more. All patients had had an initial
curve of 25 to 35 degrees and an apical level between the eighth thoracic and
first lumbar vertebrae, inclusive. Of the 159 patients, 120 were observed
without treatment and thirty-nine were managed with lateral electrical surface
stimulation. The curve progressed at least 6 degrees in eighty patients. There
was no apparent difference in the outcome between the patients who were managed
with observation only and those who were given electrical stimulation. Logistic
regression analysis was performed to determine which of eleven factors were
predictive of progression of the scoliotic curve. A Risser sign of 0 or 1, an
apical level cephalad to the twelfth thoracic vertebra, and an imbalance of ten
millimeters or less were found to be independently prognostic of progression of
more than 6 degrees. A prognostic model that included these three factors and
chronological age allowed correct classification of the curve as either
progressive or non-progressive in 81 per cent of these patients who had a
thoracic or thoracolumbar adolescent idiopathic scoliosis. The positive
predictive value was 82 per cent, the negative predictive value was 80 per cent,
and the sensitivity and specificity were each 81 per cent
Rab G.T. (1979) Muscle forces
in the posterior thoracic spine. Clin. Orthop. 28-32.
Abstract: Using a three-dimensional model, the theoretical maximal forces that
can be generated by electrical stimulation of several posterior thoracic muscles
have been analyzed to investigate the kinesiology of scoliosis. None provides a
pure lateral bending moment, and most exaggerate lordosis. None satisfactorily
generates a rotary force for correction of scoliotic deformity. Although maximum
muscle contraction can ideally produce lateral bending moments of the same
magnitude as the Milwaukee brace, current techniques do not cause continuous,
complete muscle contraction. The best muscle studied for electrospinal
intrumentation is the lateral erector spinae. Multiple sites of stimulating
electrodes are probably necessary. None of the individual muscles studied is
ideal. Further investigation should be directed to the stimulation of anterior
thoracic muscles
Ray C.D. (1978) Electrical
stimulation: new methods for therapy and rehabilitation. Scand. J. Rehabil. Med.
10, 65-74.
Abstract: Electrical stimulation is emerging as a new therapeutic and
rehabilitative agent. Reviewed are pain control, restoration of lost functions
and alteration of abnormal movement and other functions using electrical
stimulation. Reported for acute and chronic pain control use are transcutaneous,
dorsal column, spinal cord, peripheral nerve, and direct brain stimulation
methods and results. Overall success ranges up to 50% for chronic pain problems
and up to 80% for acute pain; e.g., postoperative incisional pain, sports
medicine, and trauma. Restoration of lost function has broad implications for
the future. These include phrenic nerve pacing for respiration, foot drop
control, restoration of bladder function, and grasp control in the spinal
cord-injured patient. Amelioration of abnormal function includes stimulation for
epilepsy and cerebral palsy, certain symptoms of multiple sclerosis and
scoliosis. The effects of electrostimulation are completely reversible and
nondestructive. Technical details of devices and stimulus waveforms are also
briefly considered
Rogala E.J., Drummond D.S.,
Gurr J. (1978) Scoliosis: incidence and natural history. A prospective
epidemiological study. J Bone Joint Surg 60A, 173.
Schutt R.C., Jr., Brown C.W.,
Tiefel L.C., Odom J.A., and Donaldson D.H. (1982) Surface electrical stimulation
for the treatment of scoliosis. Biomed. Sci. Instrum. 18, 83-85.
Swank S.M., Brown J.C.,
Jennings M.V., Conradi C. (1989) Lateral electrical surface stimulation in
idiopathic scoliosis. Experience in two private practices. Spine 14,
1293-1295.
Velazquez R.J. (1986)
Histological and histochemical characteristics of skeletal muscle after
long-term intermittent electrical stimulation in scoliosis. Orthop Trans
10, 613.
Wright J.,
Herbert M.A., Velazquez R., and Bobechko W.P. (1992) Morphologic and
histochemical characteristics of skeletal muscle after long-term intramuscular
electrical stimulation. Spine 17, 767-770.
Abstract: The purpose of this investigation was to examine the morphologic and
histochemical characteristics of paraspinal muscles in patients with scoliosis
after long-term electrical stimulation. Thirty-six children with idiopathic
scoliosis, who had been treated with implantable muscle stimulators, had
paraspinal muscle biopsies at the time of implantable muscle stimulator removal.
Group A patients whose curve did not progress, had 2.9 years of stimulation
stopped at skeletal maturity, with a further 1.5 years of nonstimulation before
implant removal and biopsy. In group B patients, who had an average of 2.3 years
of stimulation, the curve progressed and stimulation was continued until fusion
and biopsy. Neither group showed any increase in the frequency of pathologic
changes of paraspinal muscles contrasted with values reported in the literature
for scoliotic muscle. In group A patients there was an increased proportion of
type 1 fibers on the convex side of the curve compared to the concavity. Despite
this finding the curves did not require fusion, suggesting that the increased
percentage of type 1 fibers was not the cause of the scoliosis. In group B
patients there was an even higher type 1 concentration on the convex side
contrasted to the convex side of group A patients
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