Costovertebral Joints Research Articles

Randomized trial of lung hyperinflation therapy in children with congenital muscular dystrophy.

Respiratory compromise in congenital muscular dystrophy (CMD) occurs, in part, from chest wall contractures. Passive stretch with hyperinsufflation therapy could reduce related costo-vertebral joint contractures. We sought to examine the impact of hyperinsufflation use on lung function and quality of life in children with CMD. We conducted a randomized controlled trial on hyperinsufflation therapy in children with CMD at two centers. An individualized hyperinsufflation regimen of 15 minutes twice daily using a cough assist device over a 12 months period was prescribed. We measured lung function, quality of life, and adherence. To demonstrate reproducibility, pulmonary function was measured twice on the same day. A mixed-effects regression model adjusting for confounders was used to assess the effects of hyperinsufflation. We enrolled 34 participants in the study; 31 completed the trial (n = 17 treatment group and n = 14 controls). Participants in the treatment group demonstrated a relative gain in lung volume measured at 4 and 8 months, but not at 12 months. The control group required increases in the maximum insufflation pressures to achieve maximum lung volumes while the treatment group did not. Adherence was best early in the study, peaking at the first visit and decreasing at subsequent visits. Caregiver-reported quality of life was higher in the treatment group. Hyperinsufflation therapy is effective in increasing and sustaining lung volume over time. Adherence, however, was inconsistent and difficult to maintain. Further research should determine if improved adherence leads to sustained benefits of hyperinsufflation.

Diffuse Idiopathic Skeletal Hyperostosis: Addressing Confusion with Ankylosing Spondylitis/Spondyloarthropathy

Diffuse idiopathic skeletal hyperostosis (DISH) is an idiopathic florid enthesial reaction, especially recognized in the presence of ossification of the anterior longitudinal ligament of the spine. It is essentially an asymptomatic phenomena, rather than a disease. DISH, however, is not the only phenomenon responsible for florid enthesial reaction and recognition of such reaction, and it is important to assure that hypervitaminosis A (idiopathic or iatrogenic) or spondyloarthropathy is not actually responsible for the ossification. The paravertebral ossification in DISH is separate in space from the vertebral body, allowing it to be distinguished from the syndesmophytes of spondyloarthropathy, which produce anulus fibrosis ossification. The presence of erosion and fusion of zygapophyseal and costovertebral joints in spondyloarthropathy also facilitates distinguishing between the two phenomena. One seeks abnormalities on X-rays in attempting to explain the source of a patient’s back pain. It is critical however to determine whether a given radiologic finding (e.g., DISH) actually could be responsible. In the case of DISH, it is not and its recognition should not deter the healthcare provider from pursuing a complete evaluation.

Predictive value of semi-quantitative index from F-18-fluoride PET/CT for treatment response in patients with ankylosing spondylitis

PurposeWe aimed to investigate whether the lesion-to-background ratio (LBR) of the whole spinal column in ankylosing spondylitis (AS) patients based on baseline F-18-fluoride positron emission tomography/computed tomography (PET/CT) is associated with treatment response. MethodsTwenty-eight male patients with a wide range of disease activity were included in this study. Abnormal bone metabolic lesions on baseline F-18-fluoride PET/CT were visually assessed in three areas: anterior discovertebral units (DVUs) and posterior joints (cervical, thoracic, and lumbar facet joints, costovertebral joints, and costotransverse joints) of vertebrae and sacroiliac joints of the sacrum. The highest maximum standardized uptake value (SUVmax) of lesions within each area was measured. The LBR as a semi-quantitative index was defined as SUVmax of the lesion divided by mean SUV of the L5 vertebral body. Clinical disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and treatment response was evaluated based on follow-up BASDAI score. ResultsThe median follow-up period was 4.5 years (range, 0.9–5.5). The BASDAI score significantly decreased from median 6.6 (range, 1.0–9.5) at baseline to 2.0 (range, 0.6–8.1) at follow-up (P < 0.001), and the median change in BASDAI score was -3.4 (range, -8.2–4.4). The LBR of posterior joints in the spinal column had a significant positive correlation with follow-up BASDAI score (r = 0.394, P = 0.042). ConclusionIn patients with AS, the LBR of posterior joints of the spinal column on baseline PET/CT could be considered one of the potential surrogate markers for predicting treatment response.

Locomotor rib kinematics in two species of lizards and a new hypothesis for the evolution of aspiration breathing in amniotes

Most lizards walk and run with a sprawling gait in which the limbs are partly advanced by lateral undulation of the axial skeleton. Ribs and vertebrae are integral to this locomotor mode, but 3D motion of the axial skeleton has not been reported for lizard locomotion. Here, we use XROMM to quantify the relative motions of the vertebrae and ribs during slow treadmill locomotion in three savannah monitor lizards (Varanus exanthematicus) and three Argentine black and white tegus (Salvator merianae). To isolate locomotion, we selected strides with no concurrent lung ventilation. Rib rotations can be decomposed into bucket-handle rotation around a dorsoventral axis, pump-handle rotation around a mediolateral axis, and caliper rotations around a craniocaudal axis. During locomotion, every rib measured in both species rotated substantially around its costovertebral joint (8–17 degrees, summed across bucket, pump and caliper rotations). In all individuals from both species, the middle ribs rotated cranially through bucket and pump-handle motion during the propulsive phase of the ipsilateral forelimb. Axial kinematics during swing phase of the ipsilateral forelimb were mirror images of the propulsive phase. Although further work is needed to establish what causes these rib motions, active contraction of the hypaxial musculature may be at least partly responsible. Unilateral locomotor rib movements are remarkably similar to the bilateral pattern used for lung ventilation, suggesting a new hypothesis that rib motion during locomotion may have been an exaptation for the evolution of costal aspiration breathing in stem amniotes.

Reaction Forces and Rib Function During Locomotion in Snakes.

Locomotion in most tetrapods involves coordinated efforts between appendicular and axial musculoskeletal systems, where interactions between the limbs and the ground generate vertical (GV), horizontal (GH), and mediolateral (GML) ground-reaction forces that are transmitted to the axial system. Snakes have a complete absence of external limbs and represent a fundamental shift from this perspective. The axial musculoskeletal system of snakes is their primary structure to exert, transmit, and resist all motive and reaction forces for propulsion. Their lack of limbs makes them particularly dependent on the mechanical interactions between their bodies and the environment to generate the net GH they need for forward locomotion. As organisms that locomote on their bellies, the forces that enable the various modes of snake locomotion involve two important structures: the integument and the ribs. Snakes use the integument to contact the substrate and produce a friction-reservoir that exceeds their muscle-induced propulsive forces through modulation of scale stiffness and orientation, enabling propulsion through variable environments. XROMM work and previous studies suggest that the serially repeated ribs of snakes change their cross-sectional body shape, deform to environmental irregularities, provide synergistic stabilization for other muscles, and differentially exert and transmit forces to control propulsion. The costovertebral joints of snakes have a biarticular morphology, relative to the unicapitate costovertebral joints of other squamates, that appears derived and not homologous with the ancestral bicapitate ribs of Amniota. Evidence suggests that the biarticular joints of snakes may function to buttress locomotor forces, similar to other amniotes, and provide a passive mechanism for resisting reaction forces during snake locomotion. Future comparisons with other limbless lizard taxa are necessary to tease apart the mechanics and mechanisms that produced the locomotor versatility observed within Serpentes.

Electric Resistance Changes in Costovertebra Joints with and without Spurs: A Cadaveric Study

IntroductionElectricity is inherent in signal propagation in nerve cells for every reaction in the body. Moreover, every cell in the human body generates an electrical current traversing back and forth from inside to the outside of the cell. As such, electrons rapidly move around the whole body and generates some form of an electric field (EF) depending on the circumstances. EF stimulation has been used in wound healing and neural regeneration. Direct current EF plays a role in influencing the biological behavior and functions of the cells. Even if the cadavers were not living organisms, electricity from an external source could travel depending on the cadaver’s structural condition. The sympathetic chain ganglion is a nerve cell body outside of the spinal cord cavity. It is located anterior to the costovertebral joints. In the cadaver model, it is easy to see bony spurs in the thoracic vertebra near the sympathetic chain ganglion. The unique characteristics of the spurs may influence the electric field or currency in and around the sympathetic chain ganglion.AimThis study will explain the relationship between spinal degeneration or joint lesion and nerve signal changes. Eventually, it can explain the disease process by the nerve signal.MethodCadavers in the dissection lab for classes were being used. An ohmmeter (Rigol DM3058e) was used for measuring the electric resistance. Measurements were taken between the costovertebral joints in the sympathetic chain. The segment was recorded with and without bony spurs. Three cadavers were measured in 5 different segments from T2‐T7 along the segment of the costovertebral joints.ResultsBony spurs varied in size within the segment. There was greater resistance associated with bigger spurs. Case 1 had bony spurs located in T3, T4, T5, and T6. Especially T4 and T5 had larger bony spurs near the costovertebral joint. T2–3 had 1.35 mΩ, T3–4 had 1.32mΩ, T4–5 had 1.38mΩ, T5–6 had 1.29mΩ, and T6–7 had 1.09mΩ (Figure 1.). Case 2 had bony spurs in T2,3 and 4. T3 had a larger bony spur. T2–3 had 1.42mΩ, T3–4 had 1.20mΩ, T4–5 had 1.10mΩ, T5–6 had 1.06mΩ, and T6–7 had 0.98mΩ (Figure 2.). Case 3 had a large bony spur in T6. T2–3 had 0.48mΩ, T3–4 had 0.56mΩ, T4–5 had 0.43mΩ, T5–6 had 0.89mΩ, and T6–7 had 0.63mΩ. Based on these data, the electrical resistance was increased with the larger bony spurs.ConclusionElectricity is everywhere in the human body. Normally, body electricity is alternating current (AC). Ohm's law is mostly for direct current (DC), but is still applicable to AC. The results of this study revealed that bony spurs increase the electric resistance in the area along the sympathetic chain ganglion and that increased size of the bony spur increased the resistance. Based on ohm’s law, if the amperage is held constant, an increase of resistance requires an increase of voltage. The sympathetic chain ganglion is a multipolar neuron. It is possible that a site with increased electric resistance may increase the resting potential voltage of the nerve cell. In this case, the nerve cell may demonstrate limited stimulation compared to the nerve cell with no spurs in it, or it may generate higher than normal voltage to reach depolarization. If the latter is true, vertebra degeneration may induce unwanted sympathetic stimulation and increase the sensitivity of the smooth muscle in the body.Support or Funding InformationIndiana Wesleyan UniversityCase 1. Posterior thoracic wall. The arrows were the bony spurs. The dots were the point of electrodes for the measurement.Figure 1Case 2. Posterior thoracic wall. The arrows were the bony spurs. The dots were the point of electrodes for the measurement.Figure 2

Rib Hyperostosis as a Risk Factor for Poor Prognosis in Cervical Spine Injury Patients With Diffuse Idiopathic Skeletal Hyperostosis.

Retrospective multi-center study. To identify the morphological features of costovertebral joints and ribs in surgically managed cervical injury patients with diffuse idiopathic skeletal hyperostosis (DISH) and to examine its impact on their vital prognosis. Several reports have indicated that DISH is an independent risk factor for mortality after spinal fracture. The reason for the high mortality in cervical injury patients with DISH is unclear, although some reports have suggested a possible association between pulmonary complications and mortality. From 1999 to 2017, a total of 50 DISH patients (44 males) with cervical spine injuries who underwent spinal surgery were enrolled (average age 74 yrs). Prognosis and clinical risk factor data were collected; the morphological features of the patients' costovertebral joints and ribs were evaluated with computed tomography. The influence of each proposed risk factor and thoracic morphological feature on mortality was tested with univariate and multivariate analyses. The survival rate at 5 years after surgery was 52.3%. Nineteen (38%) patients died, and the most common cause of death was pneumonia (68%). Costovertebral bone excrescences and rib hyperostosis were found to be thoracic pathognomonic signs; their frequencies were 94% and 82%, respectively, and these conditions occurred in an average of 7.0 joints and 4.7 bones, respectively. The results of the log-rank test showed a significant difference in age, injury severity score (ISS), costovertebral bone excrescences, and rib hyperostosis. The results of age-adjusted multivariate analysis indicated that age (hazard ratio [HR] = 8.65, 95% confidence interval [CI] = 1.10-68.28, P = 0.041) and rib hyperostosis (HR = 3.82, 95% CI = 1.38-10.57, P = 0.010) were associated with mortality. Reduced chest wall mobility associated with rib hyperostosis in cervical spine injury patients with DISH leads to a poor prognosis. 3.

The frequency of degenerative-dystrophic lesions of the joints of the spine in young and middle-aged patients with dorsopathy

Introduction. Degenerative-dystrophic lesion of the spinal joints or spondylarthrosis is one of the most common diseases of the spine. The signs of non-infl ammatory changes in the joints can be detected even in children. The reason for this is the repetitive biomechanical microtrauma. The goal of research — to study the frequency of degenerative-dystrophic lesions of the spinal joints at all the levels in young and middle-aged patients suffering from dorsopathy.Materials and methods. Radiography of all the regions of the spine was performed with the description of system models of 507 patients: 211 men and 296 women, suffering from dorsopathy. The method of integral study of the spine roentgenograms was used. Systemic models of patients with determined diagnosis of ankylosing spondylitis (Bekhterev disease) were excluded from the general population. The reason for this was a signifi cant morphological change in the joints and in the spinal column as a whole, due to chronic infl ammation, which is the main manifestation of this disease. Statistical processing was carried out using Microsoft Offi ce Excel 2007.Results. It was established that with age the frequency of appearance of radiological signs of spondylarthrosis increases. Signs of arthrosis of the zygapophyseal joints appear in the fi rst turn and are the most frequent ones. Arthrosis of the zygapophyseal joints is diagnosed in 70–90 % of patients. Spondylarthrosis of the semilunar joints is diagnosed in almost 80 % of patients. Most often arthrosis of the semilunar joints was observed in the vertebrae CV and CVI. Athrosis of costovertebral joints was registered in 32,7 % of patients. In most cases the joints TVII–TX were affected by this disease. Arthrosis of the sacroiliac joints was diagnosed in an average of 63,8 % of patients, equally often on the left and on the right sides. The interspinal neoarthrosis (Baastrup symptom) was diagnosed at the level of LIII–LV(VI) in 22,6 % of patients and at the level of CI–CII in 2 % of patients.Conclusion. Radiological manifestations of spondylarthrosis are markers of static and dynamic biomechanical overload of the spinal joints.

Rib Presence, Anterior Rib Cage Integrity, and Segmental Length Affect the Stability of the Human Thoracic Spine: An in vitro Study.

The effects of segmental length as well as anterior rib cage and costovertebral joint integrity on thoracic spinal stability have not been extensively investigated, but are essential for the calibration and validation of numerical models of the thoracic spine and rib cage. The aim of the study was to quantify these effects by in vitro experiments. Eight human thoracic spine specimens (C7-L1) including the rib cage were loaded with pure moments of 5 Nm in flexion/extension, lateral bending, and axial rotation while tracking the motions of all functional spinal units. Specimens were tested stepwise in four different conditions: (1) In the intact condition, (2) after cutting all anterior rib-to-rib connections, (3) after partitioning the polysegmental specimens into monosegmental specimens, and (4) after removing the ribs in the monosegmental condition. Significant increases of the range of motion (p < 0.05) were especially found at the segmental levels of the upper half of the thoracic spine in all motion planes and for all resection steps, particularly in axial rotation, while the stabilizing effects of the structures decreased in inferior direction. Partitioning of polysegmental specimens into monosegmental specimens primarily affected the stability in lateral bending, while the effects of resection were generally lowest in flexion/extension. Presence of the ribs, anterior rib cage integrity, and segmental length all affect the thoracic spinal stability and have therefore to be considered in the calibration process of numerical models of the thoracic spine and rib cage.

MRI inflammation of facet and costovertebral joints is associated with restricted spinal mobility and worsened functional status.

To investigate the association of spinal inflammation on MRI in patients with various clinical, functional and radiological outcomes in patients with axial spondyloarthritis (SpA). Three hundred and ninety-seven participants with axial SpA and back pain were recruited from 10 rheumatology centres. Clinical, biochemical and radiological parameters were collected and participants underwent MRI of the spine. MRI features including inflammatory lesions of facet joints and costovertebral joints, corner inflammatory lesions, and spondylitis were assessed. BASFI, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Global Index, BASMI and modified Stoke Ankylosing Spondylitis Spinal Score were measured. Multivariate linear regression models were used to determine the associations between MRI parameters and various clinical, functional and radiological outcomes. BASMI and BASFI correlated well with inflammatory features in spinal MRI. Multivariate analysis showed that lumbar facet joint inflammation was independently associated with BASMI (regression coefficient (β) = 0.12, P < 0.001), lumbar spinal flexion (β = 0.13, P = 0.00), lateral spinal flexion (β = 0.09, P = 0.04), tragus-to-wall distance (β = 0.16, P < 0.001) and BASFI (β = 0.14, P = 0.01). Costovertebral joint inflammation was also associated with BASMI (β = 0.08, P = 0.05). Inflammatory lesions of facet and costovertebral joints in MRI are associated with restriction in spinal mobility and functional impairment. These important yet commonly overlooked lesions should be reviewed in clinical practice in patients with SpA.

Rib kinematics analysis in oblique and lateral impact tests

Understanding thorax kinematics and rib breaking mechanisms in conditions of oblique and lateral impact is crucial in safety systems development. To increase knowledge level on this subject, simulation and experimental tests are necessary. The purpose of this study was to obtain single rib kinematics in the case of oblique and lateral impact conditions using numerical simulation approach. Two impact tests using human body model of a 50th percentile man (THUMS v4.0.1 AM50) were performed in LS-Dyna R7.1.1. Impactor was a rigid cylinder with a diameter of 152 mm, and velocity equal to 6.7 m/s. Impact angle measured to sagittal plane was 30 and 90°, respectively in oblique and lateral impact case. Kinematics of ribs from 3rd to 6th were analyzed. Results shown significant similarities between oblique impact and kinematics of ribs tested in frontal impact conditions in the literature, with maximal costochondral joint displacement relatively to costovertebral joint varying from 65.4 mm (3rd rib) to 82.0 mm (5th rib). Deformation of rib in lateral impact conditions was different than during oblique impact test, with distinctive "flattening" approximately in the middle of the rib. Maximal relative displacement varies from 16.4 mm (6th rib) to 26.6 mm (5th rib) and its location depends on the analyzed rib. Oblique impact scenario may be simulated for the single rib on an experimental way using set-up of the frontal impact. Experimental simulation of the lateral impact for the single rib should not use the same set-up, as the kinematics analysis showed significant differences between simulated cases.

Skeletal malformations and developmental arthropathy in individuals who have fibrodysplasia ossificans progressiva.

Fibrodysplasia ossificans progressiva (FOP) is primarily a disease of progressive heterotopic ossification (HO) leading to impaired mobility throughout life. An additional diagnostic feature is a characteristic malformation of the great toes. The culpable gene for FOP,ACVR1 (activin A receptor type 1) has a clear effect on the induction of extra-skeletal bone formation. However, this bone morphogenetic protein (BMP) pathway receptor is expressed widely throughout skeletal development and has a seminal role in axial and appendicular chondrogenesis, prompting suspicion of widespread bone and joint defects in those with ACVR1 mutations. We analyzed baseline whole body (minus skull) computed tomographic (CT) scans of 113 individuals with classic clinical features of FOP and the ACVR1 (R206H) mutation who were enrolled in a non-interventional natural history study ((NCT02322255)) for skeletal malformations, atypical morphology, intra-articular synovial osteochondromatosis, developmental arthropathy, and associated degenerative joint phenotypes. Individuals were evaluated in three age groups: 4-13; 14-25; and 25-56 years old, based on historical models of FOP disease progression. We found widespread evidence of developmental arthropathy throughout the axial and appendicular skeleton in all age groups (61M, 52F; ages: 4-56 years). Asymmetric narrowing and subchondral sclerosis were present throughout the joints of the normotopic skeleton and osteophytes were common in the hips and knees of individuals who have FOP in all age groups. The costovertebral joints, intervertebral facet joints, and proximal tibio-fibular joints frequently showed partial or total intra-articular ankylosis, particularly after age 13. The hips of FOP subjects are frequently malformed and dysplastic. We also found evidence of degenerative joint phenotypes after age 13, particularly in the spine, sacro-iliac joints, and lower limbs. The effects of ACVR1 mutation on the normotopic skeletons of individuals who have FOP extend beyond malformation of the great toes and include both morphological defects and developmental arthropathy. Associated degenerative joint disease occurring at multiple sites starts in adolescence and progresses throughout life. These phenotypes appear to be uncoupled from heterotopic bone formation, indicating a potential role for ACVR1 in the development and progression of degenerative joint disease. FOP is a disease of not only progressive heterotopic ossification, but also widespread and extensive developmental arthropathy and associated degenerative joint disease. These findings have relevance for understanding the natural history of FOP and for designing and evaluating clinical trials with emerging therapeutics.

Pain Management Strategies for Thoracic Surgery

Improper management of postoperative pain following thoracic surgery can be quite debilitating and lead to a number of complications due to the multitude of comorbid conditions manifested by the population of patients undergoing these types of procedures. These can include advanced lung disease, advanced age, heart disease, renal insufficiency and obesity.¹ The source of this acute postsurgical pain is multifactorial and can include skin incisions, deep tissue injuries, thoracostomy tubes, costovertebral joint separation and rib or sternal fractures.² Benefits of effective analgesia include decreased risk of perioperative morbidity, decreased hospital stay, decreased cost and increased patient satisfaction.³ There have been numerous studies conducted to determine the best pain management regimen for control of postthoracotomy pain, however, no single technique has thus far proven to be superior. Instead, most clinicians would advocate for a multimodal approach combining regional techniques, such as thoracic epidural analgesia or paravertebral blocks, with systemic analgesic medications including a combination of cyclooxygenase (COX)-2 inhibitors, nonsteroidal anti-inflammatory drugs, opioids and other analgesic adjuncts. This chapter will examine the different analgesic options currently available and being utilized for various types of thoracic surgical procedures. This will include a review of the systemic analgesic and non-analgesic optiondis as well as regional anesthetic techniques. The chapter will conclude with a discussion of chronic post-thoracotomy pain syndrome and currently available treatments. This review contains 4 tables, and 87 references. Keywords: systemic analgesic therapy, opioid analgesic medications, regional anesthetic techniques, thoracic epidural analgesia, paravertebral analgesia, chronic post-thoracotomy pain management, Enhanced Recovery After Surgery (ERAS), intrathecal opioid analgesia, intercostal analgesia, intrapleural analgesia

CASE REPORT: BI-APICAL PULMONARY FIBROSIS WITH BRONCHIECTASIS IN A PATIENT WITH ANKYLOSING SPONDYLITIS

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting joints of the axial skeleton. In addition to disabling joint changes, pulmonary manifestations beyond the mechanical restrictive syndrome imposed by costovertebral joint ankylosis have been described [1]. These changes are seen on chest X-ray (CXR), pulmonary function tests (PFTs), bronchoalveolar lavage (BAL), and high-resolution chest tomography (HRCT) in varying degrees. They do not correlate with severity and duration of the primary disease [2]. Of the pulmonary findings, apical fibrosis is among the most distinctive. CASE PRESENTATION: We report a case of a 56-year-old male with long-standing AS (on indomethacin) who developed a dry cough with intermittent dyspnea and lung changes that were followed radiographically for several years. An initial CXR obtained for unrelated pre-operative purposes was unremarkable 21 years into his AS disease course. Two years after the first CXR, a right apical mass-like density with associated pleural thickening was detected. A QuantiFERON test was negative. Further evaluation by a computed tomography (CT) scan of the chest demonstrated volume loss of the right upper lobe with associated ground-glass opacities and pleural thickening. PFTs were consistent with a restrictive pattern, though the results were technically confounded by cough. Three years later, a follow-up CT scan of the chest showed significant progression to severe bi-apical fibrosis of the lungs with bronchiectasis and pleural thickening. Throughout this time, his joint disease remained stable, but his chronic cough worsened to the point of post-tussive emesis. DISCUSSION: The literature reports that a patient with AS with a normal CXR, normal PFTs, and lack of respiratory symptoms can still have pulmonary manifestations detectable by HRCT [3]. This patient’s cough first started 12 years before his first abnormal CXR. Despite his initial normal CXR, it is likely that radiographic evidence of the pulmonary changes predates this if evaluated by advanced chest imaging modalities. The pathogenesis of these pulmonary complications remains unknown; however, studies of BAL fluid have shown that subclinical inflammation of the alveoli is not a contributor [2-3]. CONCLUSIONS: The clinical significance of these early pulmonary changes is not known. There is a lack of studies evaluating benefit in obtaining advanced chest imaging on asymptomatic patients with AS. These changes were thought to be rare; however, newer studies suggest a higher prevalence. For patients presenting with respiratory symptoms with inflammatory arthritis, it is important to consider pleuropulmonary changes (ranging from airway disease to parenchymal scarring) in setting of AS. Reference #1: Kiris A, Ozgocmen S, Kocakoc E, Ardicoglu O, Ogur E. Lung findings on high resolution CT in early ankylosing spondylitis. Eur J Radiol. 2003;47(1):71-76. Reference #2: Kchir MM, Mtimet S, Kochbati S, et al. Bronchoalveolar lavage and transbronchial biopsy in spondyloarthropathies. J Rheumatol. 1992;19(6):913-916. Reference #3: Quismorio FP. Pulmonary involvement in ankylosing spondylitis. Curr Opin Pulm Med. 2006;12(5):342-345. https://doi.org/10.1097/01.mcp.0000239551.47702.f4 DISCLOSURES: No relevant relationships by Sudhir Rajan, source=Web Response No relevant relationships by Eduardo Solbes, source=Web Response No relevant relationships by Paulina Sun, source=Web Response

3D spinal and rib\xa0cage predictors of brace effectiveness in adolescent idiopathic scoliosis

BackgroundScoliotic braces are the standard of curve for management of moderate spinal deformities in pediatric patients. The effectiveness of this treatment method has been shown; however, the spinal and rib cage parameters, in the three anatomical planes, that are associated with bracing outcome in adolescent idiopathic scoliosis (AIS) are not fully identified.MethodsA total number of 45 right thoracic AIS patients who had received a thoraco-lumbo-scaral brace for the first time were included retrospectively. For each patient, radiographic images at three visits, pre-brace, in-brace, and at least 1 year after the first brace fit were included. Age, sex, Risser sign, and curve type at pre-brace, and thoracic and lumbar frontal and sagittal Cobb angles, thoracic and lumbar apical rotations, sagittal and frontal balances at pre-brace and in-brace were determined. Two sagittal curve types (hypothoracolumbar and normal/hyperthoracolumbar kyphosis), two rib cage types based on the costovertebral joints (drooping and horizontal), and two axial shapes of the spine (S shaped and V shaped) were used to stratify the patients. Feature selection and linear regression with regularization determined the parameters and the interaction terms that predicted the brace effectiveness significantly.ResultsSmaller in-brace thoracic Cobb and larger in-brace lordosis predicted brace effectiveness, p < 0.05. Impact of the out of brace lordosis on the brace success increased as the in brace kyphosis angle decreased, p = 0.046. A larger out of brace lordosis in hypothoracolumbar sagittal profile type patients improved the outcomes, p = 0.031. A smaller out of brace thoracic rotation improved the bracing outcomes in patients with horizontal ribs, p = 0.040.ConclusionBoth 3D patient specific parameters (lordosis, thoracic rotation, shape of the rib cage, and sagittal profile) and brace design (which allows larger in brace lordosis, better in brace Cobb correction) are important predictors of the brace effectiveness in AIS.

Classifications in Brief: The Spinal Instability Neoplastic Score.

Classifications in Brief: The Spinal Instability Neoplastic Score.

Validated thoracic vertebrae and costovertebral joints increase biofidelity of a human body model in hub impacts

Objective: A recent emphasis on nontraditional seating and omnidirectional impact directions has motivated the need for deformable representation of the thoracic spine (T-spine) in human body models. The goal of this study was to develop and validate a deformable T-spine for the Global Human Body Models Consortium (GHBMC) M50-O (average male occupant) human model and to demonstrate improved biofidelity.Methods: Eleven functional spinal units (FSUs) were developed with deformable vertebrae (cortical and trabecular), spinal and costovertebral ligaments, and intervertebral discs. Material properties for all parts were obtained from the literature.FSUs were subjected to quasistatic loads per Panjabi et al. (1976) in 6 degrees of freedom. Stiffness values were calculated for each moment (Nm/°) and translational force (N/µm). Updated costovertebral (CV) joints of ribs 2, 6, and 10 were subjected to moments along 3 axes per Duprey et al. (2010). The response was optimized by maximum force and laxity in the ligaments. In both cases, updated models were compared to the baseline approach, which employed rigid bodies and joint-like behavior. The deformable T-spine and CV joints were integrated into the full M50-O model Ver. 5.0β and 2 full-body cases were run: (1) a rear pendulum impact per Forman et al. (2015) at speeds up to 5.5 m/s. and (2) a lateral shoulder impact per Koh (2005) at 4.5 m/s. Quantitative evaluation protocols were used to evaluate the time history response vs. experimental data, with an average correlation and analysis (CORA) score of 0.76.Results: All FSU responses showed reduced stiffness vs. baseline. Tension, extension, torsion, and lateral bending became more compliant than experimental data. Like the experimental results, no trend was observed for joint response by level. CV joints showed good biofidelity. The response at ribs 2, 6, and 10 generally followed the experimental data.Conclusions: Deformable T-spine and CV joint validation has not been previously published and yielded high biofidelity in rear impact and notable improvement in lateral impact at the full body level. Future work will focus on localized T-spine injury criteria made possible by the introduction of this fully deformable representation of the anatomy.

THE EFFECTS OF POSTURAL AND ANATOMICAL ALIGNMENT ON SPEED, POWER, AND ATHLETIC PERFORMANCE IN MALE COLLEGIATE ATHLETES: A RANDOMIZED CONTROLLED TRIAL

Many human beings are strongly influenced by right-sided dominance. This may cause potentially pathologic or dysfunctional asymmetries within the innominates of the pelvis, which in turn influences movement throughout the body including the glenohumeral (GH), vertebral, femoral acetabular (FA), sacroiliac, and costovertebral joints. Techniques based upon the science of Postural Restoration® may help correct these asymmetries and improve multiple physiological and mechanical aspects of sports performance. To examine difference between non-manual, Postural Restoration® exercises and traditional postural interventions on anatomical alignment, available range of motion and symmetry, and speed and power in active college-aged males. Randomized control trial, pretest-posttest control group design. 25 male collegiate students (age = 21 ± 3 years) who met the ACSM guidelines to be considered physically active were chosen to participate. Participants completed a vertical jump test using a power analyzer (Tendo Sport, Lexington, SC, USA) and the pro agility test. Anatomical alignment was assessed through an adduction drop test, extension drop test, and standard goniometric measurements including femoral acetabular external rotation (ER), internal rotation (IR), flexion, and abduction, and glenohumeral internal rotation. Participants were randomly assigned to either non-manual, Postural Restoration® techniques or traditional posture improvement exercises. Following a four-week intervention period, participants were reassessed using the same aforementioned outcomes completed pre-intervention. Participants who completed the non-manual, Postural Restoration® techniques demonstrated significant improvements in pro-agility scores (-0.03 ± 0.10 seconds; p=0.0005). Neither set of interventions improved vertical jump scores (Treatment: + 35.7 ± 288.02 W, p=0.1000; Control: -10.08 ± 301.04 W, p=0.381). Areas of anatomical alignment that demonstrated significant change included the treatment group for FA IR (p=0.010) and FA abduction (p=0.035) symmetry and the left adduction drop test (p=0.039). Non-manual exercise techniques based upon the science of Postural Restoration® may equalize asymmetries present in FA internal rotation and hip abduction. Improvements in symmetry of joint motion may indicate a restoration of neutrality of the pelvis and femoroacetabular joints. By improving anatomical alignment, through establishing a neutral pelvis, athletes may demonstrate improved neuromechanical efficiency, and kinesthetic control of multi-directional motions required for enhanced sports performance markers. 1b.

Rib Motions Don't Completely Hinge on Joint Design: Costal Joint Anatomy and Ventilatory Kinematics in a Teiid Lizard, Salvator merianae.

Rib rotations contribute to lung ventilation in most extant amniotes. These rotations are typically described as bucket-handle rotation about a dorsoventral axis, caliper rotation about a craniocaudal axis, and pump-handle rotation about a mediolateral axis. A synapomorphy for Lepidosauria is single-headed costovertebral articulations derived from the ancestral double-headed articulations of most amniotes. With a single articular surface, the costovertebral joints of squamates have the potential to rotate with three degrees-of-freedom (DOFs), but considerable variation exists in joint shape. We compared the costovertebral morphology of the Argentine black and white tegu, Salvator merianae, with the green iguana, Iguana iguana, and found that the costovertebral articulations of I. iguana were hemispherical, while those of S. merianae were dorsoventrally elongated and hemiellipsoidal. We predicted that the elongate joints in S. merianae would permit bucket-handle rotations while restricting caliper and pump-handle rotations, relative to the rounded joints of I. iguana. We used X-ray reconstruction of moving morphology to quantify rib rotations during breathing in S. merianae for comparison with prior work in I. iguana. Consistent with our hypothesis, we found less caliper motion in S. merianae than in I. iguana, but unexpectedly found similar pump-handle magnitudes in each species. The dorsoventrally elongate costovertebral morphology of S. merianae may provide passive rib support to reduce the conflict between locomotion and ventilation. Moreover, the observation of multiple DOFs during rib rotations in both species suggests that permissive costovertebral morphology may be more related to the biological roles of ribs outside of ventilation and help explain the evolution of this trait.

Luxation of the First Costovertebral Joint after Trauma of the Thorax

Thoracic trauma is common and may vary from simple contusions to lethal injuries. Uncommon thoracic injury is a costovertebral luxation of the first rib. Up till now only one other case report has been written in 1980. Therefore a case with this injury is presented.