INTRODUCTIONScreening for scoliosis started in Singapore schools in 1982 and is currently being done for both boys and girls, as part of the annual school-based health screening programme in all primary and secondary schools. The screening levels in the current protocol were based on the 1997 prevalence study by Wong et al. In the study, it appeared that there was a significant increase in prevalence rates between 9- and 11-year-old girls (i.e. between Primary 4 and Primary 6) but there was no data on the prevalence rates of scoliosis in 10-year-old girls (Primary 5) and in 12-year-old girls (Secondary 1). In order to decide on whether to make changes to the screening levels, a review was conducted to determine the prevalence of scoliosis among the 10-year-old girls (in Primary 5) and 12-year-old girls (in Secondary 1).

MATERIALS AND METHODSA total of 93,626 female students, aged between 9 and 13 years old were screened. The study covered all of the 183 primary schools and only 83 of the 165 secondary schools due to a disruption of health screening in schools during the outbreak of SARS (severe acute respiratory syndrome). In mid-2003, schools in Singapore were closed because Singapore was one of the countries affected by SARS. Scoliosis screening was done for all female students in the Primary 4, 5 and 6 levels as well as in the Secondary 1 and 2 levels. Male students were routinely screened for scoliosis in the Primary 6 and Secondary 2 levels. Scoliosis screening was done by measuring the angle of trunk rotation (ATR) using a scoliometer. All students with ATR >or=5 degrees were referred to the Student Health Centre (SHC) where second-tier screening was done. At SHC, if ATR >or=5 degrees , postero-anterior radiograph of the spine was done. Of the 3186 female students in the primary level, aged between 9 and 13 years old who were referred to SHC for the second-tier screening, 2438 attended, and for secondary students aged between 12 and 13 years old, 1587 out of 1720 students attended.

RESULTSThe prevalence rates of idiopathic adolescent scoliosis for the 9- to 13-year-old female students were 0.27%, 0.64%, 1.58%, 2.22% and 2.49%, respectively, which showed an increasing trend in the prevalence rates with increasing age. There was a significant increase in the prevalence rates of adolescent idiopathic scoliosis (AIS) in the 10- to 11-year-old females compared to the 9-year-old females (OR, 1.7; 95% CI, 1.1-2.4; P = 0.010). There was also a significant increase in the prevalence rates in the 12- to 13-year-old females (OR, 2.2; 95% CI, 1.4-3.3; P = 0.001).

CONCLUSIONSThe study showed a significant increase in the prevalence rates of scoliosis in the 10- to 11-year-old female students and again a significant increase in the prevalence rates in the 12- to 13-year-old female students. Since the prevalence rate for the 9-year-old females was quite low (0.27%), and there was a significant increase in the prevalence rates in the 10- to 11-year-old and 12- to 13-year-old females, it was recommended that screening for females be performed every year commencing at 10 years old (Primary 5) until 13 years old (Secondary 2).

Adolescent ; Child ; Female ; Humans ; Prevalence ; Scoliosis ; epidemiology

PURPOSE: School screening allows for early detection and early treatment of scoliosis, with the purpose of reducing the number of patients requiring surgical treatment. Children between 10 and 14 years old are considered as good candidates for school screening tests of scoliosis. The purpose of the present study was to assess the epidemiological findings of idiopathic scoliosis in 11-year-old Korean adolescents. MATERIALS AND METHODS: A total of 37856 11-year-old adolescents were screened for scoliosis. There were 17110 girls and 20746 boys. Adolescents who were abnormal by Moire topography were subsequently assessed by standardized clinical and radiological examinations. A scoliotic curve was defined as 10degrees or more. RESULTS: The prevalence of scoliosis was 0.19% and most of the curves were small (10degrees to 19degrees). The ratio of boys to girls was 1:5.5 overall. Sixty adolescents (84.5%) exhibited single curvature. Thoracolumbar curves were the most common type of curve identified, followed by thoracic and lumbar curves. CONCLUSION: The prevalence of idiopathic scoliosis among 11-year-old Korean adolescents was 0.19%.
Child ; Female ; Humans ; Male ; Prevalence ; Republic of Korea/epidemiology ; Scoliosis/*epidemiology

OBJECTIVE: To provide a perspective on the recent trends in the etiologies and levels of lower limb amputations in Korea. METHOD: Medical records of 284 patients discharged from Seoul National University Hospital between 1990 and 1999 who had amputation related procedure codes were reviewed. Data were used to calculate ratios of congenital anomaly, trauma related, tumor related, diabetes related, and vascular insufficiency related amputations, and ratios of each level of amputations. Trends over time were examined by comparing data from 1990 to 1994 with those from 1995 to 1999 using chi square tests. RESULTS: Dysvascular amputations accounts for 53.5% of lower limb loss in recent 10 years, and tumor (18.9%), congenital anomaly (14.5%), and trauma (6.1%) ranked the next common etiologies. The proportion of dysvascular amputations since 1995 was found to be significantly greater than the ratio before 1995 (p<0.05), and the ratio of amputations secondary to congenital anomaly was lower (p<0.05). There was no significant change in the level of amputations. CONCLUSION: Over recent 10 years, the risk of amputation secondary to dysvascular conditions has been increased, which warrants further investigations and efforts to improve our management of amputees.
Adolescent* ; Amputation ; Amputees ; Epidemiology ; Humans ; Korea ; Lower Extremity ; Medical Records ; Scoliosis* ; Seoul

OBJECTIVETo describe the occurrence of various spinal deformations in a captive-bred wild line of Poecilia wingei (P. wingei).

METHODSFish belonging to a wild line of P. wingei caught from Laguna de Los Patos, Venezuela, were bred in an aquarium home-breeding system during a period of three years (2006-2009). The spinal curvature was observed to study spinal deformities in P. wingei.

RESULTSOut of a total of 600 fish, 22 showed different types of deformities (scoliosis, lordosis, kyphosis), with a higher incidence in females. Growth, swimming and breeding of deformed fish were generally normal.

CONCLUSIONSPossible causes for spinal curvature in fish are discussed on the basis of the current literature. While it is not possible to determine the exact cause(s) of spinal deformities observed in the present study, traumatic injuries, nutritional imbalances, genetic defects or a combination of these factors can be supposed to be involved in the pathogenesis of such lesions.

Animals ; Female ; Incidence ; Kyphosis ; congenital ; epidemiology ; veterinary ; Lordosis ; congenital ; epidemiology ; veterinary ; Male ; Poecilia ; abnormalities ; growth & development ; physiology ; Reproduction ; Scoliosis ; congenital ; epidemiology ; veterinary ; Swimming

The traditional treatment of scoliosis is mainly based on open surgeries that use the anterior approach, the posterior approach, or both. These surgical procedures often lead to complications including massive blood loss, infections, and pain of incision.The minimally invasive spine surgery (MISS) was introduced in the 1990s and has shown many advantages including less blood loss, less pain, and lower infection incidences.Today MISS is mainly used in the treatment of adolescent idiopathic scoliosis and adult scoliosis. However, due to some inevitable complications, it still can not be routinely applied.This review will briefly summarize the advances in the application of MISS in surgical treatment of adolescent idiopathic scoliosis and adult scoliosis.
Adolescent ; Adult ; Humans ; Minimally Invasive Surgical Procedures ; adverse effects ; methods ; Postoperative Complications ; epidemiology ; Scoliosis ; surgery ; Spine ; surgery

OBJECTIVETo detect the prevalence of spinal cord abnormality in "idiopathic" left thoracic scoliosis and analyze its clinical significance.

METHODSFrom October 1997 to October 2003, 59 "idiopathic" left thoracic scoliosis were treated, including 31 males and 28 females. The age was from 7 to 44 years with an average of 15 years. The Cobb angle was from 15 degrees to 108 degrees with average 56 degrees . The holocord MRI was made for all patients.

RESULTSThirty-three patients were found cord abnormality, including 24 Chiari malformation with syringomyelia, 5 syringomyelia, 1 Chiari malformation with syringomyelia and diastematomyelia, 1 Chiari malformation with syringomyelia and tethered cord, 1 syringomyelia with tethered cord, and 1 Dandy-Walker malformation. The prevalence of spinal cord abnormality in left thoracic scoliosis was 56%. Compared to the left thoracic scoliosis without cord abnormality, the left thoracic scoliosis with cord abnormality had been found more in males and the patients with bigger Cobb angle (P < 0.05).

CONCLUSIONSFor left thoracic scoliosis, especially male patient or patient with bigger Cobb angle, associated cord abnormality should be highly suspected. Preoperative holocord MRI is very meaningful for this kind of patients.

Adolescent ; Adult ; Child ; China ; epidemiology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Prevalence ; Scoliosis ; complications ; surgery ; Spinal Cord Diseases ; diagnosis ; epidemiology ; etiology ; Thoracic Vertebrae

OBJECTIVETo investigate the early outcome of vertical expandable prosthetic titanium rib (VEPTR) technique in treating early-onset scoliosis.

METHODSThis study recruited 11 early-onset scoliosis patients (8 boys and 3 girls) who received VEPTR treatment from December 2006 to July 2011 with a minimum follow-up of 12 months. The average age at initial surgery was (7 ± 3) years (range, 3.1 to 9.8 years). VEPTR device, either rib to rib or rib to lumbar, was implanted at initial surgery. During the regular post-operative follow-ups, expansion surgeries were scheduled at an interval of 6 to 12 months. Measurements of primary curve magnitude, apical vertebral translation, thoracic height and T(1)-S(1) height were performed on radiographs, and were compared between those of preoperatively, postoperatively, and at latest follow-up through paired-t tests.

RESULTSAll patients had a mean follow-up of (32 ± 11) months. Totally 41 surgeries were performed, averagely 3.7 surgeries per patient; and 30 expansion surgeries were carried out, averagely 2.7 surgeries per patient. The average interval for each expansion surgery was 8 months. From preoperatively to latest follow-up, the Cobb angle of primary curves was averagely corrected from 78° ± 18° to 55° ± 11° (t = 4.931, P < 0.05), and apical vertebral translation and thoracic kyphosis displayed slight improvement. Average thoracic height increased from (13.3 ± 2.0) cm to (17.2 ± 2.4) cm (t = 8.365, P < 0.001), and average T(1)-S(1) height from (24.4 ± 3.8) cm to (32.5 ± 5.3) cm (t = 9.080, P < 0.001). After initial surgery with VEPTR instrumented, gains in thoracic height and T(1)-S(1) height per expansion surgery averaged (0.8 ± 0.3) cm and (1.8 ± 0.4) cm, respectively. Eight complications occurred in 6 patients, including rib cradle dislodgements, displayed infection, intraoperative pleura rupture and loosening of lumbar pedicle screws.

CONCLUSIONSVEPTR technique proves to be an effective way of preventing curve progression in early-onset scoliosis patients while allowing growth of spine and chest. Yet, indications for such a technique need to be strictly selected because of the relatively high complication rate.

Age of Onset ; Bone Substitutes ; therapeutic use ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Male ; Postoperative Complications ; epidemiology ; Ribs ; Scoliosis ; surgery ; Spine ; anatomy & histology ; surgery ; Titanium ; Treatment Outcome

BACKGROUND: Idiopathic scoliosis (IS) affects patients' quality of life, yet there have been few reports of its morphology and epidemiological study in the southeast region of China. The aim of this study is to access the curve characteristics, prevalence, and factors associated with IS in Chaozhou city. METHODS: A cross-sectional study was performed in 2018, in which scoliosis screening was conducted among 5497 primary school students in Chaozhou city. Then, a case-control study based on the screening involving 2547 children was followed for the exploration of the associated factors. The questionnaires covering demographic characteristics, postural habits, cognition and self-sensation of scoliosis, and physical conditions were addressed for the investigation. ORs with 95%CIs were calculated based on logistic regression analysis to evaluate the factors associated with scoliosis. RESULTS: The prevalence of IS among primary school students was 6.15% in Chaozhou city, with 4.04% for males and 8.71% for females. The average Cobb angle was 15° (range 8 to 37°). Multiple logistic regression analysis suggested that female (OR=2.45), BMI (OR=0.67), having myopia (OR=1.49), self-sensation of scoliosis with symptoms (OR=5.52), insufficient sleep time (OR=2.65, 3.33), and less exercise time (OR=7.09, 7.29) were significantly associated with IS. CONCLUSIONS The prevalence of IS among primary school students in Chaozhou was at an average level, and it was significantly higher in females than in males. Lower body mass, having myopia, insufficient sleep time, and lower physical activity were associated with IS.
Case-Control Studies ; Child ; China/epidemiology* ; Cross-Sectional Studies ; Epidemiologic Studies ; Female ; Humans ; Male ; Myopia/complications* ; Risk Factors ; Schools ; Scoliosis/physiopathology* ; Students

OBJECTIVE: To analyze the etiology and prevention of complications related to the pedicle screw technique in the treatment of thoracic scoliosis. METHODS: There were 183 thoracic deformity patients 110 idiopathic scoliosis, 32 adult scoliosis, 28 congenital kyphoscoliosis, 8 Marfan syndrome with scoliosis, and 6 others. All patients' Cobb angles were evaluated preoperatively, intraoperatively, and postoperatively by roentgenograms. The deformity correction rate was calculated. All radiographic evaluations were carried out in a double-blind fashion. The complication rate was analyzed perioperatively and postoperatively. RESULTS: The deformity correction rate was 72%, better than others treated with hook-rod system. The perioperation complication rate was 8.4% (pedicle fracture 1.5%, infection 3.8%, pneumothorax and plural effusion 1.6%, transitory neurological damage 0.5%, and over-bleeding shock 1%). The complication rate at follow-up was 3.6% (infection 0.5%, fatigue fracture 1%, loss of deformity correction 1.6%, and transitory neurological damage 0.5%). Compared with those treated with hook-rod system, the perioperation complication rate, loss of deformity correction, permanent damage, and complications related to the internal fixation were all low. CONCLUSION The complication rate of pedicle screw fixation system was low in the treatment of thoracic deformity. When surgeons are thoroughly familiar with the technique and related pathoanatomy, and with the spinal cord function wardship by SEP, complications related to the pedicle screw technique in the treatment of thoracic scoliosis will be well controlled.
Adolescent ; Adult ; Bone Screws ; adverse effects ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Humans ; Internal Fixators ; adverse effects ; Male ; Middle Aged ; Orthopedic Procedures ; methods ; Postoperative Complications ; epidemiology ; prevention & control ; Scoliosis ; surgery ; Spinal Fusion ; instrumentation ; Thoracic Vertebrae ; surgery ; Young Adult