Adölesan idiyopatik skolyoz tedavisinde radyografik başarı ile klinik sonuçlar uyumlu mudur?

Yıl 2017, Cilt: 4 Sayı: 2, 54 - 60, 01.08.2017

Gözde Yağcı Yavuz Yakut

Öz

Amaç: Bu çalışmanın amacı adölesan idiyopatik skolyozlu (AİS) kızlarda, klinik sonuçların, radyografik olarak eğride düzelme
veya kötüleşmeye göre değişip değişmediğini araştırmaktı.

Yöntem: Yaşları 10 ve 16 arasında değişen 76 AİS'li hasta konservatif olarak tedavi edildi. 76 bireyin dört aylık tedavi öncesi
ve sonrasını içeren, radyografik Cobb açısı, skolyometre ile gövde rotasyon açısı, Posterior Gövde Simetri Endeksi (Posterior
Trunk Symmetry Index) ile gövde asimetrisi, Walter Reed Görsel Değerlendirme Ölçeği (The Walter Reed Visual Assessment
Scale) ile gövde simetrisi verileri retrospektif olarak incelendi. Bireyler, Skolyoz Araştırma Derneği (Scoliosis Research
Society) tarafından kararlaştırılan radyografik başarının varlığı ve yokluğuna göre eğride iyileşme (N=38) ve kötüleşme (N=38)
olarak adlandırılan iki gruba ayrıldı (Cobb açısı ≥6º). Sonuçlar iki grup arasında karşılaştırıldı.

Bulgular: Her iki grupta da bireylerin torasik ve lumbar Cobb ve rotasyon açılarında, gövde simetrisi ve kozmetik gövde
deformitelerinde iyileşme elde edildi. Sadece lumbar Cobb açısında, eğride iyileşme grubunda eğride kötüleşme grubuna
göre daha fazla gelişme görüldü.

Sonuç: Bu çalışma, radyografik olarak eğri progresyonu olan bireyler ile eğrilerinde iyileşme olan bireylerin, gövde rotasyonu,
vücut simetrisi ve kozmetik gövde deformitesi gibi klinik değerlendirme sonuçlarında benzerlik gösterdiğini göstermiştir.

Anahtar Kelimeler

Skolyoz, Tedavi, Değerlendirme çalışmaları.

Does radiographic success correspond with the clinical outcomes in the treatment of idiopathic scoliosis?

Öz

Purpose: The aim of this study was to determine whether clinical outcomes change according to radiographical curve
improvement or progression in females with adolescent idiopathic scoliosis (AIS).

Methods: Seventy-six patients with AIS, between 10 and 16 years, were conservatively treated. The Cobb angle on radiograph,
angle of trunk rotation with scoliometer, body asymmetry with Posterior Trunk Symmetry Index (POTSI) and cosmetic trunk
deformity with the Walter Reed Visual Assessment Scale (WRVAS) were retrospectively examined in 76 patients before and
after four-month conservative treatment. Patients were divided into two groups based on the presence or absence of the
radiographic success (change in Cobb angle ≥6º) for Scoliosis Research Society as curve improvement (N=38) or curve
progression (N=38) group. Results were compared between two groups.

Results: It was found that thoracic and lumbar Cobb angles and rotations, body symmetry and cosmetic trunk deformity
showed improvement in both groups. There was greater improvement in only Lumbar Cobb angle in the curve improvement
group than the curve progression group.

Conclusion: This study showed that patients who had radiographical curve progression showed similar improvement in clinical
outcomes such as, trunk rotation, body symmetry and cosmetic trunk deformity with patients who had curve improvement with
conservative treatment.

Anahtar Kelimeler

Scoliosis, Therapeutics

Kaynakça

• 1. Cobb JR. Outline for the study of scoliosis. In AAOS, Instructional Course Lectures Volume 5 Edited by: Edwards JW Ann Arbor. 1948: 261- 275.
• 2. Lonstein JE, Carlson J. The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am. 1984;66:1061-1071.
• 3. Raso VJ, Lou E, Hill DL, et al. Trunk distortion in adolescent idiopathic scoliosis. J Pediatr Orthop. 1998;18:222-226.
• 4. D’andrea LP, Betz RR, Lenke LG, et al. Do radiographic parameters correlate with clinical outcomes in adolescent idiopathic scoliosis? Spine. 2000;25:1795-1802.
• 5. Richards BS, Bernstein RM, D’amato CR, et al. Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine. 2005;30:2068-2075.
• 6. Vasiliadis E, Grivas TB. Quality of life after conservative treatment of adolescent idiopathic scoliosis. Stud Health Technol Inform. 2008;135:409-413.
• 7. Rigo M. Patient evaluation in idiopathic scoliosis: Radiographic assessment, trunk deformity and back asymmetry. Physiother Theory Pract. 2011;27:7-25.
• 8. Patias P, Grivas TB, Kaspiris A, et al. A review of the trunk surface metrics used as Scoliosis and other deformities evaluation indices. Scoliosis. 2010;5:12-32.
• 9. Weiss HR. Measurement of vertebral rotation: Perdriolle versus Raimondi. Eur Spine J. 1995;4:34-38.
• 10. Upadhyay S, Burwell R, Webb K. Hump changes on forward flexion of the lumbar spine in patients with idiopathic scoliosis: a study using ISIS and the scoliometer in two standard positions. Spine. 1988;13:146-151.
• 11. Bago J, Sanchez-Raya J, Perez-Grueso FJS, et al. The Trunk Appearance Perception Scale (TAPS): a new tool to evaluate subjective impression of trunk deformity in patients with idiopathic scoliosis. Scoliosis. 2010;5:6-15.
• 12. Bago J, Climent JM, Pineda S, et al. Further evaluation of the Walter Reed Visual Assessment Scale: correlation with curve pattern and radiological deformity. Scoliosis. 2007;2:12-19.
• 13. Morrison DG, Chan A, Hill D, et al. Correlation between Cobb angle, spinous process angle (SPA) and apical vertebrae rotation (AVR) on posteroanterior radiographs in adolescent idiopathic scoliosis (AIS). Eur Spine J. 2015;24:306-312.
• 14. Yang S, Feuchtbaum E, Werner BC, et al. Does anterior shoulder balance in adolescent idiopathic scoliosis correlate with posterior shoulder balance clinically and radiographically? Eur Spine J. 2012;21:1978-1983.
• 15. Smith JS, Shaffrey CI, Glassman SD, et al. Clinical and radiographic parameters that distinguish between the best and worst outcomes of scoliosis surgery for adults. Eur Spine J. 2013;22:402-410. 16. Bunnell WP. An objective criterion for scoliosis screening. J Bone Joint Surg Am. 1984;66:1381-1387. 17. Coelho DM, Bonagamba GH, Oliveira AS. Scoliometer measurements of patients with idiopathic scoliosis. Braz J Phys Ther. 2013;17:179-184.
• 18. Inami K, Suzuki N, Ono T, et al. Analysis of posterior trunk symmetry index (POTSI) in scoliosis. Part 2. Stud Health Technol Inform. 1999:59:85-88.
• 19. Sanders JO, Polly Jr DW, Cats-Baril W, et al. Analysis of patient and parent assessment of deformity in idiopathic scoliosis using the Walter Reed Visual Assessment Scale. Spine. 2003;28:2158-2163.
• 20. Romano M, Minozzi S, Bettany-Saltikov J, et al. Exercises for adolescent idiopathic scoliosis. Cochrane Database Syst Rev. 2012;8:1-31.
• 21. Gur G, Dilek B, Ayhan C, et al. Effect of a spinal brace on postural control in different sensory conditions in adolescent idiopathic scoliosis: A preliminary analysis. Gait Posture. 2015;41:93-99.
• 22. Negrini S, Negrini A, Romano M, et al. A controlled prospective study on the efficacy of SEAS. 02 exercises in preventing progression and bracing in mild idiopathic scoliosis. Stud Health Technol Inform. 2006;123:523-526.
• 23. Grosso C, Negrini S, Boniolo A, et al. The validity of clinical examination in adolescent spinal deformities. Stud Health Technol Inform. 2001;91:123-125. 24. Kotwicki T, Kinel E, Stryla W, et al. Discrepancy in clinical versus radiological parameters describing deformity due to brace treatment for moderate idiopathic scoliosis. Scoliosis. 2007; 2:18-26.
• 25. Pratt RK, Burwell RG, Cole AA, et al. Patient and parental perception of adolescent idiopathic scoliosis before and after surgery in comparison with surface and radiographic measurements. Spine. 2002;27:1543-1550.
• 26. Wang L, Wang Y, Yu B, et al. Relation between self-image score of SRS-22 with deformity measures in female adolescent idiopathic scoliosis patients. Orthop Traumatol Surg Res. 2014;100:797-801.
• 27. Goldberg CJ, Kaliszer M, Moore DP, et al. Surface topography, Cobb angles, and cosmetic change in scoliosis. Spine. 2001;26:E55 E63.
• 28. Smith PL, Donaldson S, Hedden D, et al. Parents’ and patients’ perceptions of postoperative appearance in adolescent idiopathic scoliosis. Spine. 2006;31:2367-2374.
• 29. Matamalas A, Bagó J, D’Agata E, et al. Does patient perception of shoulder balance correlate with clinical balance? Eur Spine J. 2016;25:3560-3567.
• 30. White SF, Asher MA, Lai S-M, et al. Patients’ perceptions of overall function, pain, and appearance after primary posterior instrumentation and fusion for idiopathic scoliosis. Spine. 1999;24:1693-1700.
• 31. Misterska E, Glowacki M, Harasymczuk J. Assessment of spinal appearance in femalepatients with adolescent idiopathic scoliosis treated operatively. Med Sci Monit. 2011;17:CR404-410.
• 32. Rinella A, Lenke L, Peelle M, et al. Comparison of SRS questionnaire results submitted by both parents and patients in the operative treatment of idiopathic scoliosis. Spine. 2004;29:303-313.