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Spinal pathology is a major public health problem. It is sometimes referred to as the "disease of the century" due to the increasing number of people affected. It can be low back pain or neck pain, but whatever the mechanism and the age of the patient, its consequences on the quality of life are undeniable. In the case of scoliosis, which can cause an alteration in body image in young patients, treatment requires, in addition to possible surgery, long-term support.

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A pediatric hospital team in Marseille is proposing a reflection on its interventions and the coordination implemented to care for adolescent patients undergoing spinal surgery for scoliosis. In this context, the multidisciplinary component of the team allows to cover all the needs and to propose a support throughout the hospitalization, including for the parents.

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Spinal arthrodesis remains a major and decisive surgery. Faced with a constantly increasing number of operated patients, professional practices are evolving at the Robert-Debré pediatric hospital (Assistance publique - Hôpitaux de Paris). In favor of the well-being of children and their parents, the implementation of improved rehabilitation after surgery has revolutionized the accompaniment of scoliosis patients: considerable reduction in length of stay, improvement in postoperative management and parent/child satisfaction.

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A young woman, 25 years old, who had scoliosis surgery, agreed to tell her story of her life and care from the time she was diagnosed with scoliosis as a child to the post-operative period. We will call her Sabrina.

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OBJECTIVE: We aimed to identify the risk factors and clinical outcomes for post-laminectomy fracture around the isthmus, which can cause back pain or radiculopathy. METHODS: We performed a retrospective cohort study involving all patients who underwent laminectomy splitting the spinous process for lumbar spinal stenosis between 2010 and 2014. The primary outcome measure was post-laminectomy fracture around the isthmus. Clinical outcomes were evaluated based on reoperation rate. To evaluate risk factors for fracture, the following parameters were collected: (1) patient characteristics and concomitant diabetes mellitus, (2) lumbar scoliosis and sagittal alignment parameters, and (3) surgical data, such as rate of total laminectomy. Logistic regression analysis was performed to identify the independent risk factors for post-laminectomy fracture. RESULTS: Twelve of the 92 patients suffered a post-laminectomy fracture around the isthmus. Logistic regression analysis revealed that diabetes mellitus (odds ratio [OR]: 15.41; 95% confidence interval [CI]: 2.93-80.98; P=0.001), L4 total laminectomy (OR: 14.68; 95% CI: 1.51-142.76; P=0.021), and lumbar scoliosis (OR: 5.72; 95% CI: 1.16-28.21; P=0.032) were independent risk factors. The fracture group included 2 patients (16.7%) who required reoperation at the decompression level for recurrent leg pain, whereas the non-fracture group included 2 (2.5%) who underwent reoperation at a level different from the index procedure. CONCLUSIONS: Post-laminectomy fractures around the isthmus were significantly associated with scoliosis, diabetes mellitus, and total laminectomy at L4. Total laminectomy at L4 is best avoided to reduce the risk of post-laminectomy fracture in patients with scoliosis or diabetes mellitus.

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Introducción: La inestabilidad lumbar es una de las causas más frecuentes del dolor en la espalda. Las dificultades para el diagnóstico provocan que su incidencia sea menor de lo esperado en la práctica clínica y dificultan su tratamiento. Objetivo: Evaluar lo publicado relativo al proceso de degeneración discal, así como su influencia sobre la estabilidad de la columna lumbar. Métodos: Se revisaron los principales avances relacionados con la degeneración discal que guardan relación con la inestabilidad vertebral lumbar. Se consultaron artículos publicados en PubMed, en idioma inglés, desde 2012 hasta 2017. Se examinaron artículos accesibles de forma libre o a través de Clinical Key e Hinari. Se tuvieron en cuenta algunos artículos que sobrepasan los cinco años de antigüedad, pero que son claves en el tema. Resultados: Dos procesos afectan al disco intervertebral lumbar como consecuencia del envejecimiento y la degeneración: espondilosis deformante y osteocondrosis intervertebral. Los cambios degenerativos están relacionados con el tiempo. Se pueden diferenciar tres fases que, a manera de cascada, desencadenan trastornos del movimiento e inestabilidad. Conclusiones: Los cambios degenerativos vertebrales producen aumento de la movilidad segmentaria (posible causa de inestabilidad lumbar). La zona neutra es un parámetro solo medible in vitro. No existe una prueba que permita confirmar el diagnóstico de inestabilidad vertebral. Los hallazgos clínicos y por imágenes constituyen la mejor recomendación para llegar al diagnóstico. El concepto de inestabilidad vertebral lumbar y su tratamiento, a través de la fusión vertebral, no están suficientemente justificados(AU)

Introduction: Lumbar instability is one of the most frequent causes of back pain. Difficulties in diagnosis result its incidence to be lower than expected in clinical practice and make it difficult to treat. Objective: To characterize and evaluate what is published regarding the process of disc degeneration, as well as its influence on the stability of the lumbar spine. Methods: We reviewed the main advances related to disc degeneration that cause vertebral instability. Articles published in PubMed, in English, from 2012 to 2017 were consulted. Articles in open access or through Clinical Key and Hinari were studied. Some articles older than 5 years were taken into account, because they are relevant to the subject. Results: Two processes affect the lumbar intervertebral disc because of aging and degeneration: deforming spondylosis and intervertebral osteochondrosis. The degenerative changes occur related to time and three phases can be differentiated that cascade triggers movement disorders and instability. Conclusions: Vertebral degenerative changes produce increased segmental mobility, a possible cause of lumbar instability. The neutral zone is a parameter only measurable "in vitro". There is no evidence to confirm the diagnosis of vertebral instability. Clinical and imaging findings are the best recommendation to reach to a diagnosis. The concept of lumbar vertebral instability and its treatment through vertebral fusion are not sufficiently justified(AU)

Introduction: L'instabilité lombaire est l'une des causes les plus fréquentes du mal au dos. Son diagnostic s'avère difficile, ce qui provoque une incidence plus faible qu'attendu dans la pratique clinique, et empêche son traitement. Objectif: Évaluer tout ce qui a été publié en relation avec le processus de dégénérescence discale, ainsi que son influence sur la stabilité de la colonne lombaire. Méthodes: Une revue des principales avancées relatives à la dégénérescence distale qui sont en rapport avec l'instabilité vertébrale lombaire a été effectuée. On a consulté des articles publiés sur PubMed, en langue anglaise, depuis 2012 jusqu'à 2017. On a examiné des articles accessibles de manière libre ou à travers Clinical Key et Hinari. Si bien que certains articles surpassaient les cinq ans de publication, ils ont été pris en compte, parce qu'ils étaient essentiels pour ce thème. Résultats: Deux processus affectent le disque intervertébral lombaire comme conséquence du vieillissement et de la dégénérescence -la spondylose déformante et l'ostéochondrose intervertébrale. Les changements dégénératifs sont en relation avec le temps. On peut distinguer trois phases qui, en guise de cascade, déclenchent les troubles du mouvement et l'instabilité. Conclusion: Les changements dégénératifs vertébraux entrainent une augmentation de la mobilité segmentaire (possible cause d'instabilité lombaire). La zone neutre est un paramètre qui ne peut être mesuré qu'in vitro. Il n'existe aucune preuve permettant de confirmer le diagnostic d'instabilité vertébrale. Les constatations cliniques et par imagerie constituent la meilleure recommandation pour aboutir à un diagnostic. La notion d'instabilité vertébrale lombaire et son traitement, à travers la fusion vertébrale, ne sont pas suffisamment justifiés(AU)

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Background: Spinal fusion for scoliosis generates moderate to severe pain intensity. There are currently no instruments available to measure adolescents' satisfaction regarding post-spinal fusion pain management. Aims: To develop and validate a scale on satisfaction of adolescents regarding pain management following spinal fusion for scoliosis. Methods: A methodological design was used to develop and validate the French-Canadian scale "Satisfaction des Adolescents de la gestion de la Douleur postopératoire - Scoliose idiopathique (SAD-S)". A modified Delphi method, with seven healthcare professionals and 10 adolescents, was used to establish content validity of the SAD-S. A pre-test of the scale was conducted with 10 adolescents post-spinal fusion. The final version of the scale was validated through a pilot study with 98 adolescents following their surgery. Results: The SAD-S scale includes a total of 13 items. Principal component analysis yielded a two-factor structure (2 subscales): 1) Pain management education and 2) Education regarding medication. These two factors explained 47,8% of the total variance for satisfaction. A Cronbach's alpha of 0,84 was obtained for internal consistency. Conclusion: Validation of the SAD-S scale showed that it has good psychometric properties with this population. Further validation is required with a larger sample to pursue its validation.

Introduction: La chirurgie correctrice de la scoliose génère de la douleur postopératoire d'intensité modérée à sévère. Il n'existe pas d'instruments sur la satisfaction d'adolescents ayant eu recours à ce type de chirurgie quant à la gestion de leur douleur.Objectifs: Développement et validation d'une échelle pour mesurer la satisfaction d'adolescents ayant subi une chirurgie correctrice de la scoliose quant à la gestion de leur douleur postopératoire.Méthodes: Un devis méthodologique a été utilisé pour développer l'Échelle de Satisfaction des Adolescents de la gestion de la Douleur postopératoire ­ Scoliose idiopathique (SAD-S). La validité de contenu du SAD-S a été évaluée selon la méthode Delphi modifiée avec sept professionnels de la santé et 10 adolescents. Un pré-test de l'instrument a été effectué auprès de 10 autres adolescents ayant subi cette chirurgie. Une étude de validation a ensuite été menée auprès de 98 adolescents en phase postopératoire.Résultats: Le SAD-S comprend 13 énoncés. L'analyse en composantes principales a permis de déterminer une structure à deux facteurs (sous-échelles): 1) enseignement sur la gestion de la douleur et 2) enseignement sur la médication. Ces facteurs permettent d'expliquer 47,8 % de la variance totale pour la satisfaction. Un alpha de Cronbach de 0,84 a été obtenu pour la consistance interne de l'échelle.Conclusion: Le SAD-S possède de bonnes propriétés psychométriques pour la mesure de la satisfaction auprès de cette clientèle. La validation de cet instrument devra être poursuivie à l'aide d'un échantillon plus grand.

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Scoliosis in adulthood : a constant evolution. Scoliosis are increasing after the end of growth. The average rate of worsening is one degree per year for a scoliosis beyond 30°. Well tolered during young adulthood, the scoliosis become symptomatic over 40 years with back pain, radiculalgia, aesthaetic and functionnal discomfort. Severe form could lead to respiratory insufficency. Adolescents and young adults, after surgery, have, most often, a normal life. Neurological complications, severe and exceptional shall be discussed. Over 50 years, the rate of surgical complications increase with long fusion often required and a less robust bone. The knowledge of scoliosis natural evolution and studies about long term surgical results allow the choice between medical treatment and surgery. To establish a prognosis, scoliosis over 20° should be monitored with X-rays, each five years.

Scolioses à l'âge adulte : une évolution constante. Les scolioses évoluent après la fin de la croissance. Le rythme d'aggravation est variable, il est en moyenne de 1° par an pour les scolioses de plus de 30°. Bien tolérées dans la vie d'adulte jeune, les scolioses deviennent après 40 ans symptomatiques, avec des douleurs rachidiennes, des radiculalgies, une gêne esthétique et fonctionnelle. Les formes les plus graves peuvent aboutir à une insuffisance respiratoire. Les adolescents et adultes jeunes opérés mènent une vie le plus souvent normale. Les complications neurologiques graves et exceptionnelles existent et doivent être évoquées. Après 50 ans, les arthrodèses ont un taux de complications qui augmente, avec des montages plus longs dans un os moins solide. La connaissance de l'évolution spontanée des scolioses et des suites à long terme des arthrodèses permet de choisir le mode de traitement médical ou chirurgical. La nécessité d'un consentement le plus éclairé possible est indispensable. Pour établir un pronostic, les scolioses de plus de 20° doivent être surveillées avec des radiographies tous les 5 ans.

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UNLABELLED: The progression of adolescent idiopathic scoliosis is typically monitored via regular radiographic follow-up. The Cobb angle (as measured on whole-spine radiographs) is considered as the gold standard in scoliosis monitoring. OBJECTIVE: To determine the sensitivity and specificity of back surface topography parameters, with a view to detecting changes in the Cobb angle. PATIENT AND METHOD: One hundred patients (mean age: 13.3) with Cobb angles greater than 10 degrees were included. Topographic parameters were measured in a standard position and in a position with hunched shoulders. Gibbosities and spinal curvatures were evaluated. RESULTS: An increase of more than 2 degrees in any one gibbosity or in the sum of the gibbosities (in either of the two examination positions) enabled the detection of a five-degree increase in the Cobb angle with a sensitivity of 86% and a specificity of 50%. CONCLUSION: If the present results are confirmed by other studies, analysis with back surface topography parameters may reduce the number of X-ray examinations required to detect increases in the Cobb angle.

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UNLABELLED: Adolescent idiopathic scoliosis (AIS) is a tridimensional deformity of the spinal column. This frequent disease, which has no clearly identified pathogenic mechanism, can have serious consequences. It has been hypothesized that unilateral and isolated vestibular disorders could be the origin of AIS. The objective of this work is to verify this hypothesis and to establish a pathophysiological model. METHOD: We performed a Pubmed-NCBI search, for the period 1966-2013, crossing the keyword scoliosis with the following keywords: vestibular, labyrinthine, postural control. RESULTS: This search retrieved 66 articles. Twenty controlled studies were considered for study. Their analysis showed discordant results. This review cannot confirm a link between isolated vestibular disorder and occurrence of development of scoliosis. CONCLUSIONS: There is not enough evidence to show a link between unilateral, isolated, vestibular dysfunction and AIS. From these findings, we propose a more global pathophysiological concept, which involves a trouble of the orthostatic postural control, with disturbance in the multisensory integration of vestibular, visual and somesthesic inputs. AIS could be the consequence of a reorientation of the longitudinal body axis in accordance with an erroneous central representation of verticality. An assessment of the sense of verticality would allow evaluate this hypothesis.

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Marfan syndrome is an autosomal dominantly inherited connective tissue disorder with a prevalence of approximately 1:5000 people. Typical manifestations affect the cardiovascular system, eyes, skeleton, lungs, skin and dura mater. Most patients have a so-called marfanoid habitus with tall stature, long and narrow limbs, a long and narrow head shape and other skeletal abnormalities. Of particular medical importance are the possible complications such as severe scoliosis or pectus excavatum, spontaneous pneumothorax, retinal detachment, or an acute glaucoma evoked by lens luxation. However, the most dangerous complication is acute dissection of the ascending aorta, which is usually the result of a slowly progressive aortic dilatation. With the introduction of therapies the average life expectancy of previously just 32 years could be raised to above 60 years.

Le syndrome de Marfan est une maladie héréditaire du tissu conjonctif qui se transmet sur le mode autosomique dominant, avec une prévalence d'environ 1:5000 personnes. Les manifestations typiques concernent le système cardiovasculaire, les yeux, le squelette, les poumons, la peau et la dure-mère. La plupart des patients ont un aspect appelé habitus marfanoïde, avec une grande taille, des membres longs et fins, une forme longue et étroite de la tête et d'autres anomalies du squelette. Les complications médicales importantes à prendre en compte sont la scoliose sévère ou le pectus excavatum, le pneumothorax spontané, le décollement de rétine, et le glaucome aigu engendré par la luxation du cristallin. Cependant, la complication la plus dangereuse est la dissection aiguë de l'aorte ascendante, qui est en général la conséquence d'une dilatation de l'aorte de progression lente. Avec l'introduction de traitements adaptés, l'espérance de vie moyenne est passée de 32 ans à plus de 60 ans.

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The objective of this work was to analyze the inter-observer reproducibility of an upright posture designed to bring out the thoracic humps by folding the upper limbs. The effect of this posture on back surface parameters was also compared with two standard radiological postures. A back surface topography was performed on 46 patients (40 girls and 6 boys) with a minimum of 15° Cobb angle on coronal spinal radiographs. Inter-observer reliability was evaluated using the typical error measurement (TEM) and Intraclass Correlation Coefficient (ICC). Variations between postures were assessed using a Student's t test. The inter-observer reproducibility is good enough for the three postures. The proposed posture leads to significant changes in the sagittal plane as well as in the identification of thoracic humps. This study shows the reproducibility of the proposed posture in order to explore the thoracic humps and highlights its relevance to explore scoliosis with back surface topography systems.

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OBJECTIVE: Transcranial electric stimulation elicited muscle motor evoked potentials (TESmMEPs) is one of the best methods for corticospinal tract's function monitoring during spine and spinal cord surgeries. A train of multipulse electric stimulation is required for eliciting TESmMEPs under general anaesthesia. Here, we investigated the best stimulation parameters for eliciting and recording tibialis anterior's TESmMEPs during paediatric scoliosis surgery. PATIENTS AND METHODS: Numbers of pulses (NOP), inter-stimulus intervals (ISI) and current intensities allowing the best size tibialis anterior muscle's TESmMEPs under general anaesthesia, were tested and collected during 77 paediatric scoliosis surgery monitoring procedures in our hospital. Individual pulse duration was kept at 0.5 ms and stimulating electrodes were positioned at C1 and C2 (International 10-20-EEG-System) during all the tests. RESULTS: The NOP used for eliciting the best tibialis anterior TESmMEPs response was 5, 6, and 7 respectively in 21 (27%), 47 (61%) and 9 (12%) out of the 77 patients. The ISI was 2, 3 and 4 ms respectively in 13 (17%), 55 (71%) and 9 (12%) of them. The current intensity used varied from 300 to 700 V (mean: 448±136 V). CONCLUSION: Most patients had 6 as best NOP (61%) and 3 ms as best ISI (71%). These findings support that a NOP of 6 and an ISI of 3 ms should be preferentially used as optimal stimulation settings for intraoperative tibialis anterior muscle's TESmMEPs eliciting and recording during paediatric scoliosis surgery.

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