Adolescent Kyphosis Research Articles

The effect of different tensions/directions of I-shaped taping in combination with corrective exercise on postural kyphosis in adolescents.

Choosing appropriate complementary methods, such as exercise, along with taping methods may be effective in treating patients with kyphosis. The present study aimed to examine the effect of different tape tensions/directions combined with corrective exercises on the degree of postural kyphosis in adolescents. In this randomized controlled trial, 54 adolescents with postural kyphosis were assigned into three groups: No taping (control), I-shaped taping technique with 10% stretching force (Kinesiotape I), and I-shaped taping using facilitation technique with 40% stretching force (Kinesiotape II). Both groups in Kinesiotaping also received a V-shaped tape (10% stretching force). All participants received a similar comprehensive corrective exercise. Patients received the allocated interventions for 6 weeks and visited every two weeks at the clinic. Measurements were done using a flexible ruler, kyphometer, and photogrammetry. Between-group analyses revealed no significant differences between the study groups following the interventions (p> 0.05). However, the within-group analyses according to flexible ruler, Kyphometer, and Photogrammetry measurements indicated that exercise alone (control) [p= 0.011, p= 0.056, and p= 0.005, respectively], Kinesiotape I - exercise [p= 0.001, p= 0.002, p= 0.013, and respectively], as well as Kinesiotape II - exercise [p< 0.001, p< 0.001, and p< 0.001, respectively] significantly decreased the postural kyphosis degree except exercise alone using Kyphometer measurement. No adverse events were observed during the study. The findings of photogrammetry, flexible rulers, and photogrammetry similarly indicated that the corrective exercises with or without tape tension/directions significantly decreased the postural kyphosis degree in adolescents.

The Effectiveness of Exercise Programs in Adolescents with Thoracic Kyphosis: A Narrative Review.

Thoracic kyphosis is a common postural problem affecting over 20% of adolescents. This condition can contribute to various spinal problems, leading to a decreased ability to perform daily activities, reduced quality of life, and impaired pulmonary function. This review aimed to investigate the effectiveness of exercise programs in adolescents with thoracic kyphosis. We systematically searched the PubMed, Embase, Cochrane Library, and Scopus databases for articles relevant to adolescents with thoracic kyphosis that had been published up to 14 May 2024. Our inclusion criteria focused on studies investigating the effects of exercise on improving thoracic kyphosis. A total of 1883 articles was identified using the search terms. After the titles and abstracts had been screened, 1868 articles were found not to meet our inclusion criteria and were excluded. The remaining 15 articles were then assessed for eligibility. Finally, only seven studies were included in this systematic review. Exercises targeting the entire spinal curvature demonstrated efficacy in enhancing the strength and function of the cervical, thoracic, lumbar, and pelvic muscles, resulting in a corrective effect on thoracic kyphosis in adolescents. Consequently, exercise programs have emerged as potentially beneficial treatment approaches to improve poor posture and reduce adolescent thoracic kyphosis.

Scheuermann's Disease.

Scheuermann's disease is a rigid progressive kyphosis occurring in late childhood to adolescence. It is the most common cause of sagittal imbalance and angular progressive kyphosis in adolescents associated with back pain. The exact etiology of the disease is unclear, but it is characterized by defective growth of the end plate that may result from excessive mechanical stress on a weakened end plate during spinal growth. Several other theories have been proposed, and it is thought to be a multifactorial disease occurring as a result of the interplay of multiple factors. The radiographic features consist of anterior vertebral body wedging, irregular end plates, Schmorl's nodes, and intervertebral disk degeneration. The natural history and evolution of this disease is also unknown. Conservative management with physiotherapy, rehabilitation, and bracing is the first line of treatment. Mechanical bracing helps prevent further progression of the kyphotic deformity. Surgery is mostly indicated in patients with failure of conservative management, with neurologic compromise, and for cosmetic reasons.

Obesity Is Associated With Increased Thoracic Kyphosis in Adolescent Idiopathic Scoliosis Patients and Nonscoliotic Adolescents

Study DesignRetrospective comparative cohort study. ObjectiveTo compare radiographic parameters between adolescents with a greater body mass index (BMI) percentile to underweight individuals. Summary of Background DataIncreased BMI percentile has been associated with increased complications after surgical correction of adolescent idiopathic scoliosis (AIS). However, association between BMI percentile and preoperative sagittal plane alignment has not been evaluated. The purpose of this study was to evaluate the effect of BMI percentile on sagittal alignment in AIS patients compared with nonscoliotic adolescents. MethodsPosterior-anterior and lateral spinal radiographs of 1,551 AIS patients with a thoracic major curve (Lenke 1–4) and 70 nonscoliotic adolescent patients were compared. BMI percentile was determined based on age and sex, and patients were divided into four categories: underweight (<5th percentile), normal-weight (5th–85th percentile), overweight (85th–95th percentile), and obese (≥95th percentile). ResultsCoronal plane deformity magnitude was not significantly different between the 4 categories of AIS patients (p = .51). Increased BMI percentile was associated with increased thoracic kyphosis globally (T2–T12: p < .005) as well as segmentally (T2–T5: p < .001; T5–T12: p < .001) in patients with AIS. This was also true in obese adolescents without spinal deformity (p < .04). Lumbar lordosis, pelvic incidence, and pelvic tilt were not significantly different between AIS patients in the four BMI percentile categories (p > .07). Pelvic incidence was significantly greater in AIS patients compared with nonscoliotic adolescents (54 ± 13 vs. 46 ± 11; p = .01). ConclusionIncreased BMI percentile is associated with increased thoracic kyphosis in AIS patients and nonscoliotic adolescents. Excess weight may reduce anterior vertebral growth. AIS patients have an increased pelvic incidence compared with nonscoliotic adolescents; however, this variable is not influenced by body mass. These relationships should be taken into account when planning sagittal plane deformity correction or considering neuro axis disorders (also associated with increased kyphosis) in patients with scoliosis. Level of EvidenceLevel II.

Utilization of ring-shaped bone allograft for surgical treatment of adolescent post-tubercular kyphosis: A retrospective study.

This study aimed to investigate the mid-term outcome of ring-shaped bone allografts in the surgical treatment of adolescent post-tubercular kyphosis secondary to spinal tuberculosis.The records of adolescent patients diagnosed with spinal tuberculosis who received treatment in our department between 2009 and 2013 were retrospectively reviewed. The anterior approach was used in cases of cervical kyphosis and the posterior approach was used in cases of thoracic and lumbar kyphosis. During the surgery, the ring-shaped bone was used as a structural bone graft associated with the cancellous bone filing in the center portion of the ring shape. Cobb's angle, signs of spinal infusion on computed tomography, and complications were followed up.A total of 25 patients were included in our study. Among them, 3 involved the cervical region, 5 involved the thoracic region, 8 involved the thoracolumbar region, and 9 involved the lumbar region. The preoperative kyphosis deformity was a mean 65° Cobb's angle (40°–97°) compared to the postoperative 14° Cobb's angle (10°–21°) for an average correction of 51°. All wounds healed well without graft rejection. All patients achieved bone fusion 3 months postoperative for a 100% fusion rate.Our results show that the ring-shaped allograft bone is an effective option for the treatment of adolescent kyphosis. The ring-shaped allograft bone demonstrated satisfactory mechanical strength and vertebral fusion without mid-term metallic toxicity.

Scheuermann's disease: current diagnosis and treatment approach.

To summarize the current knowledge relating to diagnosing and treating Scheuermann's disease. Scheuermann's disease is the most common cause of structural kyphosis in adolescence. A literature-based narrative review of English language medical literature. Recent studies have revealed a major genetic contribution (a dominant autosomal inheritance pattern with high penetrance and variable expressivity) to the etiology of Scheuermann kyphosis with a smaller environmental component (most probably mechanical factors). The natural history of Scheuermann kyphosis remains controversial, with conflicting reports as to the severity of pain and physical disability. Since we cannot predict which kyphotic curves will progress, we are unable to determine effectiveness of brace treatment. Physical therapy is scarcely mentioned in the literature as an effective treatment for Scheuermann kyphosis. Although there is little evidence that physical therapy alone can alter the natural history of Scheuermann's disease, it is often used as the first choice of treatment. Brace treatment appears to be more effective if an early diagnosis is made, prior to the curvature angle exceeding 50° in patients continuing to grow. Surgical treatment is rarely indicated for severe kyphosis (>75°) with curve progression, refractory pain, or a neurologic deficit. Rigorous methodology clinical trials are essential to evaluate the efficacy of conservative interventions, especially different exercises and manual therapies and their combinations with braces.

Radiographic Outcome of Surgical Treatment of Scheuermann’s Kyphosis: a Comparative Study Between Old and New Spinal Instruments

Dear Editor, Scheuermann’s kyphosis (SK) is the most common cause of structural kyphosis in adolescents (1). Surgery appears to be the only way to significantly improve the kyphotic deformity associated with SK. The need for the anterior procedure can be questioned when adequate correction and fusion can be achieved by a posterior procedure alone using pedicular screws with or without Smith-Petersen osteotomies (2, 3). The aim of this retrospective study was to evaluate and compare the radiographic outcomes of surgery in patients with Scheuermann’s kyphosis operated by old (Harrington Instrumentation; HI) and new segmental spinal implants (Diapason instrumentation; Stryker; DI). Our inclusion criteria were unsightly appearance, painful or progressive curves refractory to brace treatment, or curve magnitude greater than 65°. The patients with other causes of kyphosis or follow-up period less than 2 years were excluded. From October 1971 to November 1998, 37 cases with HI (group A) and from then to August 2008 33 cases with DI fulfilled these criteria. We routinely performed two stage surgeries except in the cases that kyphosis decreased to 40° in supine lateral hyperextension view. Fusion levels are determined from the standing anteroposterior and lateral radiographs (3). The operative technique was according to the standard surgical manner (4). The Cobb method was used to measure the curve magnitude (5). Data were analyzed using SPSS software (version 18, Chicago, IL, USA). The paired t test was used to compare pre- and postoperative kyphosis while independent t test was used to compare mean loss of correction. P value equal to or below 0.05 was considered statistically significant. Our patients’ characteristics are depicted in Table 1. All the patients except one (in Group A) treated with combined anterior and posterior approaches. Table 1. Two Groups Treated With Harrington and Diapason Instrumentation Recently, most studies concerning the surgical treatment of SK showed better results, especially in adults, when a combined anterior and posterior approach was used (3, 6-8). The modern instrumentation systems provide a more rigid fixation, and postoperative bracing is no longer necessary (9, 10). This study shows that although immediate kyphosis correction was higher in Harrington group (P = 0.0019), throughout the time loss of correction was also higher in this group (P < 0.0001). A lesser amount of correction that was obtained in Group B could be due to the fact that with increasing concept of the normal spinal alignment, more vigorous correction was not necessary because this could be potentially harmful. Therefore less correction should not be judged as incapability. Furthermore with modern spinal instrumentation, the amount of correction is much more durable and associated with less radiologic complications.

Enfermedad de Scheuermann lumbar atípica: a propósito de 6 casos

Scheuermann's disease is the most common cause of kyphosis in adolescence, and one of the most common causes of back pain in this age group. It is most commonly located in thoracic spine and is generally painless. Scheuermann's disease in the lumbar spine is less known and may go undetected in daily clinical practice. Blumenthal described this entity as atypical lumbar Scheuermann's disease. This form presents with Schmorl's hernias in one or two vertebral bodies, with narrowing of disc space and changes in the vertebral plates. It is more often painful and it can be confused with traumatic, infectious or tumor diseases. In most patients, a radiographic study is enough to establish the diagnosis and to differentiate both forms. Our series consists of six patients affected with the atypical form of lumbar Scheuermann's disease and diagnosed by us. All patients had a repeated history of back pain with associated Schmorl's hernias, and a very high increase in lateral diameter in radiographic views of the lumbar spine. Involvement of a single vertebral body was the most prevalent (50% of cases), and the 4th lumbar vertebra was the most commonly affected. All patients returned to normal activities after conservative treatment with temporary immobilization and NSAIDs during pain episodes.

Atypical lumbar Scheuermann's disease: A presentation of 6 cases

Scheuermann's disease is the most common cause of kyphosis in adolescence, and one of the most common causes of back pain in this age group. It is most commonly located in thoracic spine and is generally painless. Scheuermann's disease in the lumbar spine is less known and may go undetected in daily clinical practice. Blumenthal described this entity as atypical lumbar Scheuermann's disease. This form presents with Schmorl's hernias in one or two vertebral bodies, with narrowing of disc space and changes in the vertebral plates. It is more often painful and it can be confused with traumatic, infectious or tumour diseases. In most patients, a radiographic study is enough to establish the diagnosis and to differentiate both forms. Our series consists of six patients affected with the atypical form of lumbar Scheuermann's disease and diagnosed by us. All patients had a repeated history of back pain with associated Schmorl's hernias, and a very high increase in lateral diameter in radiographic views of the lumbar spine. Involvement of a single vertebral body was the most prevalent (50% of cases), and the 4th lumbar vertebra was the most commonly affected. All patients returned to normal activities after conservative treatment with temporary immobilization and NSAIDs during pain episodes.

Special issue: Wearable computing and communication for e-Health

Wearable computers and communication devices are computing and communication systems that are body-worn. This technology is used in behavioral modeling, health-monitoring systems, information technologies and media development. Wearable devices are especially useful for applications that require computational and communicational support while the user’s physical and mental capabilities are actively engaged with the physical environment. Wearable technology is a broad topic of research, with areas of study that include user interface design, augmented reality, pattern recognition, targeting specific applications or disabilities. This special issue aimed at collecting contributions on wearable systems with e-health applications. Seven original papers have been selected to cover a wide variety of applications. The use of smart, wearable technologies can offer ways to reduce the number of nursing staff and costs for care of senior citizens. The paper “User Interaction in Smart Ambient Environment Targeted for Senior Citizen” presents a projection-based display system for elderly people with memory impairments. Thanks to this wearable system, elderly people can interact with the projected user interface by tapping physical surfaces, using them as natural, haptic feedback input interfaces. Ambient intelligence and wearable computing need innovative hardware and software technologies, including a highly capable, flexible and efficient middleware, allowing for the reuse of existing pervasive applications when developing new ones. In the paper “Towards a Flexible Middleware for Context-aware Pervasive and Wearable Systems”, the authors illustrate how these concepts can be described into a theoretical tool, called Networked Autonomic Machine (NAM), and how they can be implemented into an NAM-based middleware, and evaluated against practical problems of pervasive computing. A relevant application of wearable computing and communication systems is the long-term monitoring of physiological parameters. In these applications, a key issue is the reduction of the average power consumption of the small wearable device. It is known that a way to reduce the power consumption is by including in the wearable device a low power and real-time compression of the raw physiological data. The paper “Compressive sensing scalp EEG signals: implementations and practical performance” focuses on the use of compressive sensing, which is a new paradigm in the data compression field. In particular, the paper investigates the practical performance of different implementation of compressive sensing systems when applied to scalp EEG signals. Within the area of physiological data monitoring and its exploitation, another application of wearable e-health is to provide a feedback on physiological parameters to the users. This may be helpful, for example, to reduce the long-term effects of bad posture or body misalignment, which generates pain and potential disabilities. Postural kyphosis in adolescence, which is an excessive rounding of the upper spine, may be one of the effects of poor standing and sitting habits. In the paper “Development of a Smart Garment to Reduce Kyphosis during Daily Living”, a smart garment, consisting of a harness and two data-sensor loggers, was developed to monitor and provide vibration feedback to wearers to improve their posture during daily activities. Further, the authors of “Measuring Skin Conductance over Clothes” propose a new method that measures skin conductance over clothes to non-intrusively monitor the changes in physiological conditions affecting skin conductance during daily activities. The performance of the proposed method was compared with the traditional Galvanic Skin Response (GSR) measured directly from the fingers. The results proved the effectiveness of the proposed method. Emotion identification and recognition through wearable devices has become recently a noteworthy research area and it is the topic of the paper “A novel EDA glove based on textile integrated electrodes for affective computing”. The paper describes an experiment aiming at discriminating different affective states using the Electro Dermal Response (EDR). Using non-linear methods, a novel set of features for pattern classification was extracted and used to obtain remarkably successful recognition rates. Finally, the paper “Kinematic description of soft tissue artifacts: quantifying rigid vs deformation components and their relation with bone motion”, focuses on the use of wearable devices to monitor and analyze human movements. Soft tissue artifacts (STA) are a major source of error in this type of movement analysis. The paper provides the quantitative relation between rigid movements and deformation of marker cluster components of the STA and the results are useful to assess the potential effectiveness of the usual strategies to compensate STA. The above papers provide a set of representative applications of wearable technology for e-Health. From these contributions it is possible to appreciate the richness in potential applications of such technology but also the many challenges that need to be faced for translating basic research results into practical, daily life applications.

Development of a smart garment to reduce kyphosis during daily living

Many of the aches and pains of adults are the result of the long-term effects of bad posture or body misalignment. Postural kyphosis in adolescence, which is an excessive rounding of the upper spine, may be one of the effects of poor standing and sitting habits. A smart garment, consisting of a harness and two data-sensor loggers, was developed to monitor and provide vibration feedback to wearers to improve their posture during daily activities. Laboratory tests verified that the garment could provide an accuracy of 2±2° during static measurement and 3±2° during stable or slowly changing posture activities and 4±4° during rapidly changing posture activities. Four volunteers wore the system for 3h per day and for 4 consecutive days. The feedback was provided on the last 2days and the kyphotic angle reduced by 8±1° and 8±2° on the last 2days, respectively. Although the long-term effects of reminding the subjects' posture is still not clear, a short-term result shows promise that the smart garment may be able to improve the kyphosis.

Values of thoracic kyphosis in adolescents from the city of Czestochowa (simple method of measurement during clinical examination) – pilot study

4th International Conference on Conservative Management of Spinal Deformities Publication of these abstracts has been funded by the National Scoliosis Foundation ( http://www.scoliosis.org ) and the Asklepios Katharina Schroth, Spinal Deformities Rehabilitation Centre ( http://www.skoliose.com ) Meeting abstracts – A single PDF containing all abstracts in this Supplement is available here . http:// www.biomedcentral.com/conte /pdf/1748-7161-2-S1-info.pdf

The diagnosis of art: Lowry's Cripples

Lawrence Stephen Lowry (1887-1976) is best known for his naive-style ‘matchstick’ people in the industrial north of England. In the later stages of his career, he became increasingly fascinated by misfits, down and outs, and cripples. Perhaps the attraction stemmed from his depression after the death in 1939 of his mother, to whom he was very close, or it may have arisen in the aftermath of World War II. His job as a rent collector with the Pall Mall Property Company in Manchester, until his retirement in 1952, allowed him to wander through the streets and record ‘his people’.1 Lowry was also interested in crowds. ‘Accidents interest me—I have a very queer mind you know. What fascinates me is the people they attract. The patterns those people form, and the atmosphere of tension when something has happened... Where there's a quarrel there's always a crowd... It's a great draw. A quarrel or a body.’ In The Fever Van (1935) he shows a large crowd drawn by the sight of an ambulance arriving to collect a patient, probably a child with diphtheria or scarlet fever, from a small terraced house.2 However, despite his interest in the scene, Lowry avoided excessive sentimentality and detached himself both emotionally and physically. This is also true of The Cripples (1949), a social commentary on the able-bodied beholding the disabled, painted in a distinctive mono-chrome, with tinges of red, ochre, and pale blue (Figure 1). Figure 1 The Cripples (1949); oil on canvas, 76.3 cm×101.8 cm; The Lowry, Salford Quays. In colour online Attracted to the painting as voyeurs, we are tempted to essay fanciful diagnoses of the problems that afflict some of the ‘cripples’ that Lowry assembled in this composite painting, derived from sketches made at different times. At the bottom right of the picture we see a man with no legs (an above-knee amputation on the right and a likely hindquarter amputation on the left) riding on a home-made cart. He is probably a war amputee and was well known in Manchester, where he used to sell small items on the corner of Deansgate and St Mary's Gate. Immediately above him in the middle background is a man in a grey coat and red scarf whose gait suggests that he may have a disorder such as cerebellar ataxia or Huntingdon's chorea. To his right is a very tall man with retrognathia, perhaps due to Marfan's syndrome. In the middle foreground we see a man with crutches, who may have had a stroke—he has an extended, perhaps spastic, left leg with a possible equinus deformity and may have a contralateral facial palsy. Just behind him is a woman with hunched shoulders or a short neck; she looks as if she is wearing a permanent coat-hanger and has facial asymmetry, characteristics of Klippel-Feil syndrome, in which torticollis is also common. At the bottom left is another man with crutches, this time because of a left above-knee amputation, also probably a war victim. Above him is a man with a left-sided hook prosthesis, presumably another war amputee. Talking to him is a man with a well-rounded gibbus, for which many possible causes can be suggested—tuberculosis, severe osteoarthritis, Forestier's disease (diffuse idiopathic skeletal hyperostosis), Scheuermann's disease (adolescent kyphosis) or ankylosing spondylitis. In the middle ground a man in a bowler hat with varus knees walks away from the viewer, complemented by a lady to his right, facing the viewer, with valgus knees. The underlying pathology is likely to be osteoarthritis. Of course, the point of Lowry's painting is not what the cripples are suffering from, but their very existence and the way in which the healthy on-lookers, mostly children, gaze at them with curiosity. Lowry once said, ‘I feel more strongly about these people than I ever did about the industrial scene. They are real people, sad people. I'm attracted to sadness and there are some very sad things. I feel like them.’ And look at the man in the focal centre of the painting, walking his dog. It has been suggested that this is Lowry himself, who may have suffered from Asperger's syndrome.3,4 Here he is depicted lost in thought, an emotional cripple, studiously not looking at all the physical cripples around him.

Segregation analysis of Scheuermann disease in ninety families from Siberia.

Scheuermann disease [OMIM number 181440] is the most common cause of structural kyphosis in adolescence. Segregation analysis using a model with gender effects was applied to 90 pedigrees from Barnaul (West Siberia, Russia) ascertained through a proband with Scheuermann disease. The transmission probability model was used to detect major gene effect. A significant contribution of a major gene to the control of the pathology was established. Inheritance of the disease can be described within the framework of a dominant major gene diallele model. According to this model, Scheuermann disease should never occur in the absence of the mutant allele. All male carriers of the mutant allele develop the disease, while only a half of female carriers manifest it. We found a high frequency of idiopathic scoliosis in the families with Scheuermann disease (0.08 vs. 0.01-0.02 in general population). We also observed a succession of idiopathic scoliosis and Scheuermann disease in consecutive generations. The familial aggregation of these two spinal pathologies in the present sample may indicate a genetic unity of Scheuermann disease and idiopathic scoliosis.

SCHEUERMANN'S DISEASE

Scheuermann's disease is the most common cause of structural kyphosis in adolescence. The mode of inheritance is likely autosomal dominant and the etiology remains largely unknown. Indications for treatment remain controversial because the true natural history of the disease has not been clearly defined. Brace treatment appears to be very effective if the diagnosis is made early. Surgical treatment is rarely indicated for severe kyphosis (> 75 degrees ) with curve progression, refractory pain, or neurologic deficit.

Scheuermann's kyphosis in adolescents and adults: diagnosis and management.

Scheuermann's thoracic kyphosis is a structural deformity classically characterized by anterior wedging of 5 degrees or more of three adjacent thoracic vertebral bodies. Secondary radiographic findings of Schmorl's nodes, endplate narrowing, and irregular endplates confirm the diagnosis. The etiology remains unclear. Adolescents typically present to medical attention because of cosmetic deformity; adults more commonly present because of increased pain. The indications for treatment are similar to those for other spinal deformities, namely, progression of the deformity, pain, neurologic compromise, and cosmesis. The adolescent with pain associated with Scheuermann's kyphosis usually responds to physical therapy and a short course of anti-inflammatory medications. Bracing has been shown to be effective in controlling a progressive curve in the adolescent patient. For the adult who presents with pain, the early mainstays of treatment are physical therapy, anti-inflammatory medications, and behavioral modification. In patients, either adolescent or adult, with a progressive deformity, refractory pain, or neurologic deficit, surgical correction of the deformity may be indicated. Surgical correction should not exceed 50% of the initial deformity. Distally, instrumentation should be extended beyond the end vertebral body to the first lordotic disk to prevent the development of distal junctional kyphosis.

Orthotic results in adolescent kyphosis.

Seventy-five patients with adolescent kyphosis, treated with Boston lumbar or the modified Milwaukee orthosis, were reviewed. For compliant patients, the average improvement in kyphosis was 27% in the Boston orthosis group and 35% in the Milwaukee orthosis group, despite the fact that the former group were younger and had smaller, more flexible curves. Compliance with orthosis wearing and, therefore, effective treatment was twice as likely with the Boston orthosis (61% compliance vs. 29% with the Milwaukee). Results in patients who wore their orthoses at least 16 hours per day were equal to results in patients with 23 hours of daily wear. In a small group of compliant patients with kyphotic deformities greater than 75 degrees, the Milwaukee orthosis was surprisingly effective. The Boston lumbar kyphosis orthosis offers a satisfactory alternative to the modified Milwaukee brace in adolescent kyphosis patients whose curves measure less than 70 degrees, especially if satisfactory compliance with brace wear is suspect.

Wedging of Lower Thoracic and Upper Lumbar Vertebral Bodies in Early Recent Japanese

An examination of the vertebrae of the early recent Japanese (in the 17th century) from Hitotsubashi Metropolitan High School Site, Tokyo, revealed that wedge-shaped vertebral bodies were sometimes found at the lower thoracic and upper lumbar, especially at the lowermost thoracic and uppermost lumbar, in males. The wedging of the vertebral bodies was, however, rarely present at those in females. The wedge-shaped vertebrae in question would commonly accompany a fixed thoraco-lumbar kyphosis in the living body, and possibly were caused by it. Such a thoraco-lumbar kyphosis might be a very common, localized form of adolescent kyphosis or SCHEUERMANN's disease. It was suggested that the wedging of the vertebrae in males were probably caused by resting and working in the cross-legged sitting or sartorial posture, which was commonly assumed only by males in the recent Japan. A few occurrence of the wedging in females would be due to some postural defects, such as sway back and round back.

Surgical management of thoracic kyphosis in adolescents: T. C. Taylor, D. R. Wenger, J. Stephen, et al. J Bone Joint Surg 61A:496–503, (June), 1979

Surgical management of thoracic kyphosis in adolescents: T. C. Taylor, D. R. Wenger, J. Stephen, et al. J Bone Joint Surg 61A:496–503, (June), 1979

Surgical management of thoracic kyphosis in adolescents.

Twenty-seven patients of a group of twenty-nine who underwent posterior spine fusion using Harrington compression instrumentation for Scheuermann's disease or postural roundback deformity were reviewed with a mean follow-up of 27.6 months. The mean curve before operation was 72 degrees and at review, 46.1 degrees. The mean loss of correction in the fusion from initial examination to final follow-up was 5.7 degrees. This procedure can achieve satisfactory correction of deformity as well as pain relief. We think that Harrington compression instrumentation and spine fusion is indicated in selected cases of roundback deformity.