思春期特発性側弯症の包括的検討

Adolescent Idiopathic Scoliosis (AIS) is a spinal deformity that commonly emerges during the crucial growth years of adolescence. This condition, characterized by an abnormal lateral curvature of the spine, poses unique challenges to affected individuals. Next, we delve into the fundamental aspects of AIS, exploring its definition, the most common deformities associated, its potential progression, and the crucial question of whether it naturally resolves. Additionally, we will explore innovative tools, such as the Forethought Portable Version, designed for efficient large-scale screenings of AIS.

What is Adolescent Idiopathic Scoliosis?

Adolescent Idiopathic Scoliosis is a three-dimensional deformity of the spine that typically surfaces during the growth spurt of adolescence. The term “idiopathic” underscores the enigmatic nature of its origin, as no single cause has been identified. The condition is characterized by a lateral curvature of the spine, often presenting as an ‘S’ or ‘C’ shape when viewed from the front or back.

Onset and Prevalence:

AIS typically becomes noticeable during the growth spurt that occurs just before puberty and into the teenage years, usually between the ages of 10 and 18. It is the most common type of scoliosis, accounting for about 80% of all diagnosed cases.

Diagnostic Criteria:

Diagnosis typically involves a thorough physical examination by a healthcare professional, including an assessment of the spine’s curvature, shoulder alignment, and pelvic tilt. X-rays are often employed to confirm the diagnosis and measure the degree of curvature, known as the Cobb angle.

Unknown Cause (Idiopathic):

Despite extensive research, the precise cause of AIS remains unknown. Genetic factors are believed to contribute, as the condition tends to run in families. Hormonal and environmental factors may also play a role, but the interplay of these elements is not fully understood.

Gender Disparities:

Adolescent Idiopathic Scoliosis is more common in girls than boys, with girls being at a higher risk of developing progressive curves that may require medical intervention.

What is the Most Common Deformity in Adolescent Idiopathic Scoliosis?

The most common deformity associated with Adolescent Idiopathic Scoliosis (AIS) is the lateral curvature of the spine. When viewed from the front or back, the spine may form an ‘S’ or ‘C’ shape, deviating from its normal straight alignment. This lateral curvature is the hallmark of scoliosis and varies in severity among individuals affected by AIS. Key features of the most common deformity in AIS include:

Lateral Curvature:

The primary characteristic of AIS is the abnormal sideways curvature of the spine. This curvature can occur in different regions of the spine, including the thoracic (upper back) or lumbar (lower back) regions, and it may involve one or both of these regions.

Cobb Angle Measurement:

The severity of the lateral curvature is often quantified using the Cobb angle, measured through X-rays. The Cobb angle measures the degree of curvature formed by drawing lines parallel to the most-tilted vertebrae at the top and bottom of the curve.

Variable Presentation:

The deformity can vary widely among individuals. Some may have mild curves that do not significantly impact their daily lives, while others may experience more pronounced and potentially progressive curvature.

Three-Dimensional Nature:

Scoliosis is a three-dimensional deformity, and the lateral curvature is often accompanied by rotational changes in the vertebrae. This three-dimensional aspect contributes to the complexity of the condition and requires a comprehensive approach to diagnosis and treatment.

Severity Grading:

Curves are typically classified based on their severity, with mild scoliosis having a Cobb angle of 10 to 25 degrees, moderate scoliosis ranging from 25 to 40 degrees, and severe scoliosis involving curves exceeding 40 degrees.

Does Adolescent Idiopathic Scoliosis Go Away?

While some cases of AIS may stabilize or improve over time, the condition does not typically resolve entirely on its own. The likelihood of progression is influenced by factors such as the degree of curvature, skeletal maturity, and gender. Regular monitoring and, if necessary, intervention are essential to manage and mitigate potential complications.

What is the Progression of Adolescent Idiopathic Scoliosis?

The progression of AIS is variable and depends on several factors. Skeletal maturity plays a crucial role; the risk of progression is higher in individuals who have not yet reached skeletal maturity. Additionally, the magnitude of the initial curvature and the pattern of the curve influence the likelihood of progression. The initial degree of curvature, as measured by the Cobb angle on X-rays, is a significant predictor of progression. Smaller curves are less likely to progress than more pronounced ones. Mild scoliosis is often defined by a Cobb angle of 10 to 25 degrees, moderate scoliosis ranges from 25 to 40 degrees, and severe scoliosis involves curves exceeding 40 degrees. The pattern of the curve, whether it is a single curve (C-shaped) or a double curve (S-shaped), can influence the likelihood of progression. Single curves, particularly in the thoracic region, are less likely to progress compared to double curves. Regular monitoring through clinical examinations and imaging helps track any changes and guides appropriate intervention.

How to Quickly Find Adolescent Idiopathic Scoliosis at a Provincial or City-wide Level?

Efficient screening at a provincial or city-wide level is crucial for early detection and timely intervention. The Forethought Portable Version emerges as a cutting-edge tool for large-scale screenings. This tool boasts innovative Smart Light Sensing Technology, enabling dynamic capture of small angular velocity changes using MEMS sensors. This feature allows for the detection of subtle changes in spinal alignment that might be indicative of scoliosis.

Furthermore, the Accurate Terrain Scanning Technology in the Forethought Portable Version proves invaluable. It adapts to the speed of the operator, ensuring optimal terrain data collection. The multi-level, multi-space information provided by this technology allows for a comprehensive and complementary analysis, enhancing the accuracy of scoliosis detection.

Adolescent Idiopathic Scoliosis is a multifaceted condition that demands thorough understanding and proactive management. Early detection and appropriate intervention are essential in managing scoliosis, particularly during the critical growth years of adolescence when the spine is still developing. Timely and targeted interventions can help prevent further progression, reduce the impact on an individual’s quality of life, and promote better long-term outcomes for those affected by Adolescent Idiopathic Scoliosis. Innovative tools like the Forethought Portable Version can revolutionize the screening process, offering a more efficient and accurate means of identifying AIS at a broader scale. Continued research and technological advancements promise a brighter future for those affected by this spinal deformity, with the potential for improved diagnostic tools and treatment strategies.

参考文献

  1. Konieczny MR, Senyurt H, Krauspe R. “Epidemiology of Adolescent Idiopathic Scoliosis.” Journal of Children’s Orthopaedics. 2013;7(1):3-9. doi: 10.1007/s11832-012-0457-4.
  2. Hresko MT. “Clinical Practice: Idiopathic Scoliosis in Adolescents.” ニューイングランド・ジャーナル・オブ・メディシン.2013;368(9):834-841: 10.1056/NEJMcp1209063.
  3. Weinstein SL, Dolan LA, Wright JG, Dobbs MB. “Effects of Bracing in Adolescents with Idiopathic Scoliosis.” ニューイングランド・ジャーナル・オブ・メディシン. 2013;369(16):1512-1521. doi: 10.1056/NEJMoa1307337.
  4. Schlosser TP, van der Heijden GJ, Versteeg AL, Castelein RM, et al. “The Role of High-Quality Screening Programs for the Early Detection of Adolescent Idiopathic Scoliosis.” 脊椎変形. 2017;5(5):380-387. doi: 10.1016/j.jspd.2017.03.010.
  5. Lonstein JE, Carlson JM. “The Prediction of Curve Progression in Untreated Idiopathic Scoliosis During Growth.” Journal of Bone and Joint Surgery American Volume.1984;66(7):1061-1071: 10.2106/00004623-198466070-00016.
  6. Negrini S, Aulisa AG, Aulisa L, et al. “2016 SOSORT Guidelines: Orthopaedic and Rehabilitation Treatment of Idiopathic Scoliosis During Growth.” 脊柱側湾症と脊椎疾患.2018;13:3: 10.1186/s13013-017-0145-8.
  7. Bunnell WP. “Selective Screening for Scoliosis.” 臨床整形外科学および関連研究. 2005;434:40-45. doi: 10.1097/01.blo.0000161249.07309.bf.
  8. Tsirikos AI, Sud A. “Current Concepts and Controversies in the Surgical Management of Adolescent Idiopathic Scoliosis.” Bone & Joint Journal. 2012;94(12):1541-1552. doi: 10.1302/0301-620X.94B12.30270.
  9. Dimeglio A, Canavese F. “The Growing Spine: How Scoliosis Evolves During Growth.” ヨーロピアン・スパイン・ジャーナル. 2012;21(1):64-70. doi: 10.1007/s00586-011-1926-1.
  10. Forethought Medical. “Innovative Scoliosis Screening and Management Solutions.” Forethought Medical Technology, 2023.
  11. Sanders JO, Newton PO, Browne RH, et al. “Bracing for Idiopathic Scoliosis: How Many Patients Require Treatment to Prevent One Surgery?” Journal of Bone and Joint Surgery American Volume. 2014;96(8):649-653. doi: 10.2106/JBJS.M.00329.
  12. Parent S, Newton PO, Wenger DR. “Adolescent Idiopathic Scoliosis: Etiology, Anatomy, Natural History, and Bracing.” Instructional Course Lectures. 2005;54:529-536. doi: 10.2106/00004623-200511000-00007.
  13. Nash CL Jr., Moe JH. “A Study of Vertebral Rotation.” Journal of Bone and Joint Surgery American Volume. 1969;51(2):223-229. doi: 10.2106/00004623-196951020-00004.
  14. Glassman SD, Carreon LY, Shaffrey CI, et al. “The Impact of Positive Sagittal Balance in Adult Spinal Deformity.” 背骨. 2005;30(18):2024-2029. doi: 10.1097/01.brs.0000179081.30449.d5.
  15. Cobb JR. “Outline for the Study of Scoliosis.” Instructional Course Lectures. 1948;5:261-275.
  16. Zaborowska-Sapeta K, Kowalski IM, Protasiewicz-Fałdowska H, et al. “Risk Factors for the Progression of Idiopathic Scoliosis in Children and Adolescents.” BioMed Research International. 2019;2019:1-7. doi: 10.1155/2019/1951972.
  17. Ovadia D, Eylon S. “Conservative Treatment of Adolescent Idiopathic Scoliosis.” Journal of Children’s Orthopaedics. 2013;7(1):51-57. doi: 10.1007/s11832-012-0458-3.
  18. Altaf F, Gibson A, Dannawi Z, et al. “Adolescent Idiopathic Scoliosis: A Review of Aetiology, Diagnosis, and Management.” Journal of Bone and Joint Surgery British Volume. 2013;95(10):1308-1314. doi: 10.1302/0301-620X.95B10.31233.
  19. Kotwicki T, Negrini S, Grivas TB, et al. “Methodology of Evaluation of Posture and Trunk Asymmetry in Idiopathic Scoliosis and Other Spinal Deformities—6th SOSORT Consensus Paper.” 脊柱側湾症と脊椎疾患.2009;4:26: 10.1186/1748-7161-4-26.
  20. Weinstein SL, Dolan LA, Spratt KF, et al. “Health and Function of Patients with Untreated Idiopathic Scoliosis: A 50-Year Natural History Study.” JAMA. 2003;289(5):559-567. doi: 10.1001/jama.289.5.559.
  21. Lebel DE, Brooks JT, Lenke LG, et al. “Surgical Outcomes for Severe Adolescent Idiopathic Scoliosis: The Impact of Early Versus Late Intervention.” 小児整形外科ジャーナル. 2020;40(8). doi: 10.1097/BPO.0000000000001678.
  22. Asher MA, Burton DC. “Adolescent Idiopathic Scoliosis: Natural History and Long-Term Treatment Effects.” 脊柱側湾症. 2006;1:2. doi: 10.1186/1748-7161-1-2.
  23. Goldberg CJ, Dowling FE, Fogarty EE, et al. “Adolescent Idiopathic Scoliosis: The Effect of Brace Treatment on the Incidence of Surgery.” 背骨. 2001;26(1):42-47. doi: 10.1097/00007632-200101010-00009.
  24. Schmitz A, Asselen M, Staudenmann D. “Idiopathic Scoliosis: A Review on the Current Understanding and Treatment Options.” リハビリテーション研究開発ジャーナル. 2016;53(3):231-242. doi: 10.1682/JRRD.2015.03.0047.
  25. Nachemson AL, Peterson LE. “Effectiveness of Treatment with a Brace in Girls Who Have Adolescent Idiopathic Scoliosis.” ニューイングランド・ジャーナル・オブ・メディシン. 1995;333(11):727-733. doi: 10.1056/NEJM199509143331101.

コメントを残す

メールアドレスが公開されることはありません。 が付いている欄は必須項目です