Brick by brick : enhancing understanding of adolescent idiopathic scoliosis

Abstract

Adolescent Idiopathic Scoliosis (AIS) is the most common form of scoliosis, yet the mechanism of curve progression remains unclear. This may be due to a lack of extensive studies on change of spinal parameters and curve pattern during growth. Additionally, back pain is a common complaint among AIS patients, but pain management protocols are lacking. To address these issues, this thesis aimed to investigate the effect of wedging and changes in curve type on curve progression during growth and report on the back pain condition in AIS patients.

To understand the role of wedging, 32 AIS females with right-sided thoracic curves and/or left-sided lumbar curves were recruited from a tertiary scoliosis clinic. Vertebral and intervertebral disc (IVD) wedging of each segment were calculated using customized code. Radiological parameters were compared between patients with and without curve progression. The findings indicated that the vertebral and IVD wedging were influenced by the curve location rather than the presence of progression. Progressed curves exhibited greater change of wedging.

Apart from spinal parameters, curve pattern is also used to describe scoliosis. Changes in coronal curve type and curve span are not uncommon in AIS patients during puberty, but the clinical significance of these changes in brace treatment remains unknown. To investigate this, 156 patients who met the Scoliosis Research Society brace inclusion criteria were included. Radiographs at prebrace, brace weaning, and post-weaning follow-up were assessed. Parameters were compared between patients with and without changes in curve patterns. The occurrence of changes in coronal curve type was associated with curve type. No associations were found between coronal imbalance and changes in coronal curve type, or between curve progression in the major curve and changes in curve patterns at brace wean and post-weaning. Thus, brace revision is not recommended when changes in coronal curve type and curve span occur.

Maturity not only signifies the cessation of growth but also indicates a lower likelihood of experiencing curve progression. Nevertheless, this does not mark the end of the road. To understand the back pain condition of AIS patients, 203 patients with conservative treatment were included. They completed a customized pain questionnaire regarding their exercise level, prevalence and intensity of back pain, circumstances when experiencing pain, method to relieve back pain, and the location of pain, in addition to the Refined Scoliosis Research Society-22 Patient Questionnaire and EuroQoL 5-Dimension Youth 5-Level questionnaire. No association was found between the frequency of exercise and the occurrence of back pain. Back pain was more common during static motion and after dynamic motion, and scapular pain was related to major thoracic curve or double curve.

This thesis utilized customized code and questionnaires to investigate the effects of wedging and changes in curve pattern on curve progression and reported pain conditions in AIS patients. Our understanding of the disorder is gradually enhanced, brick by brick. With a better grasp of the underlying mechanisms, we can develop a more efficient management plan to improve the quality of life for patients.