Increase In Thoracic Kyphosis Research Articles

A comparative analysis of sagittal spinopelvic alignment between young and old men without localized disc degeneration

The purpose of this study was to compare the sagittal spinopelvic parameters between young normal asymptomatic adults and older normal asymptomatic adults without localized segmental disc degeneration. Standing sagittal radiographs of the whole spine including the pelvis in 342 adult male volunteers (Group 1: n = 184, average age 21.2 years, range 19-28 vs. Group 2: n = 158, average age 63.8 years, range 53-79) were analyzed prospectively. Volunteers with history of spine operation, spinal disease, chronic pain in their back or legs, scoliosis, spondylolisthesis, 1-3 segmental disc space narrowing, and/or compression fractures in radiographs were excluded. The following parameters were included: thoracic kyphosis between T5 upper endplate (UEP) and T12 lower endplate (LEP), thoracolumbar kyphosis (T10 UEP - L2 LEP), T12 LEP-horizontal (H) angle (minus denotes EP above the H line), lumbar lordosis (T12 LEP - S1 UEP), lower lumbar lordosis (L4 UEP - S1 UEP), sacral slope, pelvic incidence and distances from C7 plumb/T12 plumb to the postero-superior endplate of S1. Group 2 (old men group) demonstrated larger thoracic kyphosis (30.1° ± 8.6° vs. 21.1° ± 7.8° in Group 1, P < 0.001), thoracolumbar kyphosis (10.0° ± 7.5° vs. 2.8° ± 7.1° in Group 1, P < 0.001), total lumbar lordosis at T12-S1 (57.3° ± 8.8° vs. 52.2° ± 9.2° in Group 1, P < 0.001), lower lumbar lordosis at L4-S1 (39.4° ± 6.7° vs. 32.4° ± 6.4° in Group 1, P < 0.001), a higher ratio of lower to total lumbar lordosis (69.5 ± 11.6 vs. 62.7 ± 10.6 % in Group 1, P < 0.001) and T12 LEP-H angle (-20.4° ± 5.7° vs. -15.7° ± 5.1° in Group 1, P < 0.001). There were no significant differences in sacral slope (36.5° ± 7.3° in Group 1 vs. 36.8° ± 6.7° in Group 2, P = 0.67) and pelvic incidence (46.5° ± 7.7° in Group 1 vs. 48.2° ± 8.5° in Group 2, P = 0.06). There was no significant difference in the measurement of distance from C7 plumb to the postero-superior endplate of S1 (-0.7 ± 2.4 cm in Group 1 vs. -0.3 ± 2.7 cm in Group 2, P = 0.197). However, the distance from T12 plumb to the postero-superior endplate of S1 (-0.7 ± 1.7 cm in Group 1 vs. -2.2 ± 1.7 cm in Group 2, P < 0.001) demonstrated a significant difference. The old men group demonstrated a significant increase in thoracic kyphosis, thoracolumbar kyphosis, total and lower lumbar lordosis, a higher ratio of lower to total lumbar lordosis, and a longer distance from T12 plumb to the postero-superior endplate of S1 without changes in sacral slope and global sagittal balance.

Adolescent idiopathic scoliosis: sagital plane and low density pedicle screws

OBJECTIVE: To examine the sagittal curves of patients treated with CD instrumentation using exclusively pedicle screws. METHODS: Image analysis of medical records of 27 patients (26 M and 1 F) with a minimum follow-up of 6 months, who underwent surgical treatment in our service between January 2005 and December 2010. The curves were evaluated on coronal and sagittal planes, taking into account the potential correction of the technique. RESULTS: In the coronal plan the following curves were evaluated: proximal thoracic (TPx), main thoracic (TPp), and thoracolumbar; lumbar (TL, L), and the average flexibility was 52%, 52%, and 92% and the capacity of correction was 51%, 72%, and 64%, respectively. In the sagittal plane there was a mean increase in thoracic kyphosis (CT) of 41% and an average reduction of lumbar lordosis (LL) of 17%. Correlation analysis between variables showed Pearson coefficient of correlation of 0.053 and analysis of dispersion of R2 = &lt;0.001. CONCLUSION: The method has shown satisfactory results with maintenance of kyphosis correction in patients with normal and hyper kyphotic deformities.

Changes in sitting posture affect shoulder range of motion

To assess the effect of slouched sitting on shoulder range of motion (ROM). 30 asymptomatic males aged between 18 and 35 years with no history of shoulder problems within the last 6 months. Shoulder ROMs in flexion and abduction as well as external rotation and internal rotation in 90° of shoulder abduction were measured while the subjects sat in 3 different sitting postures. There were statistically significant mean differences among the 3 sitting postures regarding thoracic kyphosis and shoulder ROMs (p<0.001). Post hoc analyzes demonstrated significant differences in all comparisons (p<0.001). Changes in sitting posture affect shoulder ROMs in all directions tested. Greater changes in shoulder ROMs were associated with greater increase in thoracic kyphosis. These findings suggest that even subtle changes in thoracic kyphosis need to be considered during shoulder evaluation.

All-Pedicle Screw Versus Hybrid Instrumentation in Adolescent Idiopathic Scoliosis Surgery

Comparative analysis of 2 groups of patients who underwent surgical treatment of adolescent idiopathic scoliosis (AIS). To compare a segmental pedicle screw only system with a hybrid system for the treatment of Lenke type 1 AIS curves. Although previous AIS studies have tried to compare various constructs with the all-pedicle screw fixation, all have failed to address important confounding variables, such as skeletal maturity, preoperative flexibility of the curve, and factors associated with a multicenter or multisurgeon analysis. The medical records and spinal radiographs of patients with AIS treated surgically by a single surgeon between 2000 and 2009 were retrospectively reviewed. Patients with Lenke type 1 curves and minimum follow-up of 2 years were divided into 2 groups that were meticulously matched: group 1 consisted of patients in whom the all-pedicle screw construct was used, whereas group 2 included patients who were treated with the hybrid hook-screw system. Group 1 included 34 patients and group 2 included 29 patients. At the last follow-up, thoracic curve correction averaged 70.4% for the all-pedicle screw group and 60% for the hybrid group (P = 0.19). The all-pedicle screw group showed a significantly greater increase in thoracic kyphosis than the hybrid group system (P = 0.04). Global sagittal balance showed greater improvement in the all-pedicle screw group during the immediate postoperative that was lost by the last follow-up. The all-pedicle screw system revealed less intraoperative blood loss but greater operating time than the hybrid construct. After controlling for length of follow-up, no statistical difference in any of the radiographical parameters measured was recorded. With the exception of global sagittal balance, the pedicle screw system provided better maintenance of its corrective parameters when followed for greater than two years. 3.

CT and radiographic analysis of sagittal profile changes following thoracoscopic anterior scoliosis surgery

BackgroundPrevious studies report an increase in thoracic kyphosis after anterior approaches and a flattening of sagittal contours following posterior approaches. Difficulties with measuring sagittal parameters on radiographs are avoided with reformatted sagittal CT reconstructions due to the superior endplate clarity afforded by this imaging modality.MethodsA prospective study of 30 Lenke 1 adolescent idiopathic scoliosis (AIS) patients receiving selective thoracoscopic anterior spinal fusion (TASF) was performed. Participants had ethically approved low dose CT scans at minimum 24 months after surgery in addition to their standard care following surgery. The change in sagittal contours on supine CT was compared to standing radiographic measurements of the same patients and with previous studies. Inter-observer variability was assessed as well as whether hypokyphotic and normokyphotic patient groups responded differently to the thoracoscopic anterior approach.ResultsMean T5-12 kyphosis Cobb angle increased by 11.8 degrees and lumbar lordosis increased by 5.9 degrees on standing radiographs two years after surgery. By comparison, CT measurements of kyphosis and lordosis increased by 12.3 degrees and 7.0 degrees respectively. 95% confidence intervals for inter-observer variability of sagittal contour measurements on supine CT ranged between 5-8 degrees. TASF had a slightly greater corrective effect on patients who were hypokyphotic before surgery compared with those who were normokyphotic.ConclusionsRestoration of sagittal profile is an important goal of scoliosis surgery, but reliable measurement with radiographs suffers from poor endplate clarity. TASF significantly improves thoracic kyphosis and lumbar lordosis while preserving proximal and distal junctional alignment in thoracic AIS patients. Supine CT allows greater endplate clarity for sagittal Cobb measurements and linear relationships were found between supine CT and standing radiographic measurements. In this study, improvements in sagittal kyphosis and lordosis following surgery were in agreement with prior anterior surgery studies, and add to the current evidence suggesting that anterior correction is more capable than posterior approaches of addressing the sagittal component of both the instrumented and adjacent non instrumented segments following surgical correction of progressive Lenke 1 idiopathic scoliosis.

Influence of thoracic spine postural disorders on cardiorespiratory parameters in children and adolescents with cystic fibrosis

To assess the impact of increased thoracic kyphosis on pulmonary function and functional capacity in children and adolescents with cystic fibrosis (CF) and to verify the influence of disease severity, age and nutritional status on this deformity. This was a cross-sectional, analytical study conducted at a university hospital. It included CF patients with confirmed diagnosis and without pulmonary exacerbation. The sample was submitted to postural assessment, spirometry (FEV1, FVC and FEV1/FVC) and 6-minute walk test distance (6-MWT distance). Data were analyzed using the Mann Whitney test, Spearman correlation and logistic regression. Forty-two patients were enrolled, 61.9% presented increase of thoracic kyphosis. There was no difference in values of FEV1, FVC, FEV1/FVC and 6-MWT distance between the groups with or without thoracic kyphosis (p = 0.407; p = 0.756; p = 0.415; p = 0.294). In the group without alteration, patients with more disease severity had a mean FEV1 of 74.1±21.9% and FVC of 79.8±18.7% while in those of lesser severity higher values were found (95.6±12.2% and 97.6±13.2%, respectively) (p = 0.027 and p = 0.027). The presence of kyphosis was correlated with age (p = 0.048) but not with severity (p = 0.151) and body mass index (p = 0.088). There was a high prevalence of increased thoracic kyphosis in children and adolescents with CF. The deformity did not affect pulmonary function and functional capacity and there was no relationship with disease severity. Regardless of posture, worsening of disease severity determined worsening of pulmonary function.

The effect of thoracic kyphosis and sagittal plane alignment on vertebral compressive loading.

To better understand the biomechanical mechanisms underlying the association between hyperkyphosis of the thoracic spine and risk of vertebral fracture and other degenerative spinal pathology, we used a previously validated musculoskeletal model of the spine to determine how thoracic kyphosis angle and spinal posture affect vertebral compressive loading. We simulated an age-related increase in thoracic kyphosis (T(1) -T(12) Cobb angle 50-75 degrees) during two different activities (relaxed standing and standing with 5-kg weights in the hands) and three different posture conditions: (1) an increase in thoracic kyphosis with no postural adjustment (uncompensated posture); (2) an increase in thoracic kyphosis with a concomitant increase in pelvic tilt that maintains a stable center of mass and horizontal eye gaze (compensated posture); and (3) an increase in thoracic kyphosis with a concomitant increase in lumbar lordosis that also maintains a stable center of mass and horizontal eye gaze (congruent posture). For all posture conditions, compressive loading increased with increasing thoracic kyphosis, with loading increasing more in the thoracolumbar and lumbar regions than in the mid-thoracic region. Loading increased the most for the uncompensated posture, followed by the compensated posture, with the congruent posture almost completely mitigating any increases in loading with increased thoracic kyphosis. These findings indicate that both thoracic kyphosis and spinal posture influence vertebral loading during daily activities, implying that thoracic kyphosis measurements alone are not sufficient to characterize the impact of spinal curvature on vertebral loading.

Relação entre cifose dorsal, densidade mineral óssea e controle postural em idosas

To verify the relationship between the angle of thoracic kyphosis, bone mineral density, and postural control in elderly women. Through a cross-sectional study, 95 elderly participants were subdivided into four groups according to the thoracic kyphosis angle (obtained by the flexicurve method) and to bone densitometry results. On the force platform and through the dynamic test, stabilometric data were obtained. For statistical analysis, we assessed the performance of each group on the force platform by non-parametric tests: between group comparison (Mann-Whitney) and within group comparison according to the condition of the eyes - open or closed (Signed Rank). On the force platform, the only statistically significant difference was found between groups 1 (loss of bone mass and increased thoracic kyphosis) and 3 (no loss of bone mass or increase in thoracic kyphosis) in the anteroposterior direction (p=0.0124). All groups presented different performances with the eyes open and closed in the mediolateral direction, except for group 3 (p=0.4263), whereas in the anteroposterior direction, we did not observe differences. The results suggest an influence of the angle of thoracic kyphosis and bone mineral density on the postural control of our sample in the anteroposterior direction and in the standing position.

Biplanar Measurement of Thoracolumbar Curvature in Older Adults Using an Electromagnetic Tracking Device

Singh DK, Bailey M, Lee R. Biplanar measurement of thoracolumbar curvature in older adults using an electromagnetic tracking device. Objectives To develop a new biplanar method of thoracolumbar curvature measurement by using an electromagnetic tracking device and to study the effects of aging on the thoracolumbar curvature. Design Cross-sectional study. Setting Human movement laboratory. Participants Healthy (N=52, 26 younger and 26 older) volunteers. Interventions Not applicable. Main Outcome Measures An electromagnetic tracking device was used to trace the thoracolumbar curvature by recording the positions of the spinous processes of the spine. The coordinates of the curvature were fitted with polynomial equations, and the magnitudes of thoracic kyphosis, lumbar lordosis, and lateral thoracic and lumbar curves were determined. Results The present technique was shown to be highly reliable in measuring thoracolumbar curvature with an intraclass correlation coefficient of more than .90. The mean thoracic kyphosis (−46.95°±11.41°) in the older adults was significantly larger than that in the younger adults (−38.82°±9.86°) ( P<.01). However, there were no significant differences in lumbar lordosis and lateral curvatures between the 2 subject groups. Conclusions The present study provided evidence of an increase in thoracic kyphosis in older adults. The method of measurement presented in this study was found to provide reliable biplanar data that will be useful in a clinical setting.

Restoration of Thoracic Kyphosis After Operative Treatment of Adolescent Idiopathic Scoliosis

Multicenter analysis of 3 groups of patients who underwent surgical treatment for adolescent idiopathic scoliosis (AIS). OBJECTIVE.: To evaluate 3 surgical approaches to determine the modality that has the greatest influence on improving thoracic kyphosis. AIS is characterized by thoracic hypokyphosis which may be restored to normal to varying degrees with surgery. A multicenter retrospective AIS surgical database was reviewed. Patients with only a structural main thoracic curve (Lenke 1, 2, or 3), and instrumentation of only the main thoracic curve were included. Lateral radiographs were analyzed to determine sagittal plane measurements before surgery, after surgery at 6 to 8 weeks, 1 year, and 2 years. The 3 groups were compared and statistical significance was defined as P < 0.05. Three groups were analyzed: (1) ASF group (n = 135), Anterior spinal fusion and instrumentation, (2) PSF-Hybrid group (n = 86), PSF with proximal hooks, +/- apical wires and distal pedicle screws, and 3) PSF-Hooks group (n = 132), PSF with only hooks. All groups had similar preoperative coronal main thoracic curve magnitudes (ASF: 50.6 degrees , PSF-Hybrid: 49.1 degrees , PSF-Hooks: 52.0 degrees ) and thoracic kyphosis (ASF: 23.7 degrees , PSF-Hybrid: 19.3 degrees , PSF-Hooks: 21.9 degrees ). After surgery, the T5-T12 kyphosis was greater in the ASF group (25.1 degrees ) compared with PSF-Hooks (19.0 degrees ) and PSF-Hybrid (18.5 degrees (P < 0.05). At 1 year, thoracic kyphosis (T5-T12) remained greater in the ASF group (28.8 degrees ) compared with PSF-Hooks (22.6 degrees ) and PSF-Hybrid (20.2 degrees ) (P < 0.05), and was also greater at 2 years (29.9 degrees vs. 23.8.8 degrees and 19.7 degrees ) (P < 0.05). Kyphosis at the thoracolumbar junction was not seen in the PSF-Hybrid group. Lumbar lordosis increased only in the ASF group in response to the increase in thoracic kyphosis. ASFI is the best method to restore thoracic kyphosis when compared with posterior approaches using only hooks or a hybrid construct in the treatment of thoracic adolescent idiopathic scoliosis.

Clinical and Radiographic Results After Implant Removal in Idiopathic Scoliosis

Prospective radiographic and clinical analysis of patients with idiopathic scoliosis who had complete implant removal following posterior spinal fusion (PSF) at least 2 years previously. To evaluate the clinical and radiographic effect of implant removal after PSF for idiopathic scoliosis. Occasionally, implants must be removed following instrumented PSF. Indications for removal include infection and late operative site pain. Previously, it has been thought that there was little morbidity associated with implant removal in the presence of a solid fusion. However, recent studies have reported loss of coronal correction after implant removal in patients who had a PSF for adolescent idiopathic scoliosis. Few long-term studies have assessed the clinical or radiographic results of complete implant removal after PSF. We identified 56 patients who had undergone PSF for idiopathic scoliosis and subsequently had complete removal of all instrumentation. None of these patients had a pseudarthrosis at the time of implant removal. After IRB approval, 43 of 56 (77%) patients returned for new standing posteroanterior and lateral spine radiographs and completion of an SRS-22 questionnaire. For the 43 patients who had new radiographs and completed an SRS-22, the time from the original PSF to complete implant removal averaged 2.9 years (range, 7 months to 7.25 years). Twenty-two patients had implants removed because of infection, and 21 patients had implants removed secondary to pain. The average time from implant removal to completion of the most recent radiographs and SRS-22 questionnaire was 9.5 years (range, 3.2-17.9 years). Patients were considered to have had progression of deformity after implant removal if their Cobb angle measurements increased by more than 10 degrees . Two patients had 11 degrees to 20 degrees of coronal plane progression of their main thoracic curve. No patient had more than 10 degrees of coronal plane progression of a lumbar curve. Sagittal curve progression was identified more frequently. Nineteen patients had between an 11 degrees and 20 degrees increase in thoracic kyphosis, and 5 patients had >20 degrees of thoracic kyphosis progression. Patients with >20 degrees of thoracic kyphosis progression after implant removal had greater thoracic kyphosis before surgery and larger main thoracic and lumbar coronal curves at the time of implant removal. Progressive kyphosis did not correlate with: reason for implant removal, length of follow-up, or time from fusion to implant removal. Although total SRS-22 scores correlated inversely with increased thoracic kyphosis, this trend did not reach statistical significance. Implant removal after PSF for idiopathic scoliosis may be complicated by progression of deformity. Patients requiring implant removal should be appropriately counseled and monitored.

Gravity Line Analysis in Adult Volunteers

Prospective radiographic and forceplate analysis in adult volunteers. Assess gravity line (GL) location and foot position regarding anatomic spinal structures to evaluate key correlations and age-related changes in balance. Global spinal balance is commonly assessed by the C7 plumbline. This radiographic parameter does not offer information on foot position or forces transmitted, and poor correlation with the true GL has been demonstrated. A total of 75 asymptomatic adult volunteers were equally distributed into three age groups. Full length, free-standing spine radiographs were obtained with simultaneous acquisition of GL and feet location (forceplate). GL and heels were projected on each radiograph to compute their distance from anatomic entities and to investigate correlations with radiologic parameters and age-related changes. In this study group, advancing age led to a significant increase in thoracic kyphosis. The plumbline from C7 shifted anteriorly with age. In the sagittal plane, the GL was anterior to the vertebral column for all groups. With age, the GL location regarding the heels remained constant, while the pelvis moved posteriorly toward the heels and underwent a small retroversion (increasing pelvic tilt). The acetabulum was the most reliable radiographic marker of the GL location. This quantitative study in volunteers reveals clear age-related changes in the spino-pelvic association and offers quantitative support to the "cone of economy" concept proposed by Dubousset. The pelvis can be seen as a regulator to help maintain a rather fixed GL-heel association with age-related changes in the spinal column. Further study in patients suffering from deformity can confirm the importance of radiographic-gravity line correlations and enhance our understanding of optimal balance.

Comparison of thoracic kyphosis and postural stiffness in younger and older women

Background context An increase in thoracic kyphosis and postural stiffness is commonly associated with aging and many pathological conditions. Simple clinical measurements are needed to estimate the relative degree of postural stiffness to determine whether clinical interventions, such as exercise, are beneficial. Purpose To compare the amount of kyphosis and postural stiffness in the thoracic spine of younger and older women. Study design/setting Experimental design conducted at a large health science center in southeastern Texas. Patient sample Fifty-one healthy adult women, 25 between the ages of 21 and 51 years and 26 aged 66 to 88 years. Outcome measures Index of kyphosis (IK) measured with a surveyor's flexicurve. Differences, percent change and ratios between IK measures taken in the relaxed and maximally erect positions were used to estimate postural stiffness. Methods Subjects were measured while standing in their usual relaxed posture and again in their maximally erect posture by three different raters. IK measures were calculated by each rater and averaged for further data analysis. Independent t tests were used to compare the two age groups at the .05 alpha level. Results Significant differences were found in both the relaxed (p = .018) and erect (p<.001) IK measures of younger and older women. The differences, percent change and ratio between the two IK measures were also significantly different in that the younger women demonstrated a greater degree of active reduction of their kyphosis (in the erect posture) than older women. Conclusions Age-related differences in thoracic kyphosis and postural stiffness were documented between younger and older women by means of repeated flexicurve measurements performed in both a relaxed and a maximally erect position.

Posterior cervicothoracic instrumentation in spine tumors.

We retrospectively review 32 patients who underwent posterior fixation for cervicothoracic junctional tumors. All patients possessed unstable or potential after surgery unstable spines as a result of either their tumors or the surgery performed. We examined cervicothoracic spine stability, maintenance of alignment, and associated complications. To review our experience with 3 different posterior osteosynthesis systems applied to the cervico-thoracic junction for spinal tumors. Our review includes surgical outcomes and complications. The evolution through 3 different systems between 1994 and 1997 reflects our attempts to improve accuracy in light of variable facet and pedicle interspaces. Our goal is not to compare the efficacy of the systems but to assess the efficiency of cervicothoracic facet and transpedicular screw and plate or rod fixation. However, we will comment on why the evolution occurred. The 3 different systems share a similar characteristic. Each system employs posterior cervical facet screw fixation and thoracic trans-pedicular screw fixation. Spinal disorders involving the cervicothoracic junction and specific instrumentation to this region have been sparsely described in the literature. Between June 1994 and June 2000, 32 patients underwent surgery for spinal tumors involving the cervicothoracic junction at our institution. There were 27 males and 5 females. The ages ranged from 17 to 72 years with a mean age of 52 years. A total of 32 cervicothoracic instrumentations were performed. We used the R. Roy-Camille thoracolumbar plate in 20 patients, the cervico-thoracic plate in 8, and the Agora rod system in 4. In all, 96 lateral mass screws were implanted from C4 to C6, 54 into C7, and 180 pedicle screws from T1 to T8. Nineteen patients had lung cancer with vertebral body invasion (Pancoast tumors), 11 had metastasis to the cervicothoracic junction, 1 had a chondrosarcoma, and 1 had myeloma. In a first group consisting of 19 patients, a combination of anterior and extended posterior surgical approaches allowed complete en bloc resection of the tumors, including all invaded vertebrae. Four total vertebrectomies and 15 partial vertebrectomies were performed. A second group of 13 patients had only posterior palliative stabilizing procedures with laminectomy and cervicothoracic fixation. The follow-up period varied from 3 to 54 months, average 15 months. The average duration of survival for patients who underwent partial or total vertebrectomy was 16 months (range 3-54 months). The average duration of survival for patients who underwent palliative decompression and stabilization was 11 months (range 5-19 months). No changes in the sagittal alignment occurred during the immediate postoperative period for 30 patients. However, 2 mechanical failures occurred. Two patients experienced a clinically significant early increase in thoracic kyphosis and required revision of the posterior instrumentation. A 21-month minimum follow-up was available for 6 patients, in whom all implants were stable. We noted no screw, plate, or rod breakage in this series. No neurologic complications, including root impingement or spinal cord injury, or vertebral artery injury occurred related to screw insertion into either the thoracic pedicles (180 screws) or the cervical lateral masses (96 screws in C4-C5-C6 and 54 screws in C7). Posterior plate or rod and screw fixation is a good method of treatment for cervicothoracic instability in spine tumors. Facet screw fixation in the cervical spine with Roy-Camille drilling technique and transpedicular screw fixation in the thoracic spine provides an efficacious means by which to stabilize the cervicothoracic junction. This stabilization technique was effective even in cases of high postoperative instability, such as with partial or total vertebrectomy. This screw-type stabilization is clinically effective and well documented. The evolution through 3 different systems reflects our attempts to improve accuracy in light of variable facet and pedicle interspaces. Importantly, posterior instrumentation will not interfere with subsequent laminectomy or more extreme surgical procedures.

Spinal mobility and posture: changes during growth with postural defects, structural scoliosis and spinal osteochondrosis.

A number of case studies were followed for 10 years. Children suffering from postural defects, structural scoliosis and spinal osteochondrosis were separated from a normal group. Spinal mobility and posture were compared with the mobility of normal, healthy boys and girls aged 5-14 years. In postural defects curves similar to the physiologic one were observed. The range of motion was not physiologic in scoliosis. In this disease, rotation-flexion thoracic hypermobility with decreased lumbar flexion ability was found. A physiologic trend was found in spinal osteochondrosis, although sometimes the rotational mobility of the spine was reduced. An extremely high increase of thoracic kyphosis was found only in children aged 14 years.

Effect of Back-Strengthening Exercise on Posture in Healthy Women 49 to 65 Years of Age

To evaluate the effect of back-strengthening exercise on posture in 60 healthy estrogen-deficient women. The 60 study subjects were randomly assigned to either an exercise or a control group, and various factors were assessed at time of enrollment in the study and at 2-year follow-up. The 32 women in the exercise group were instructed in progressive back-strengthening exercises, whereas the 28 women in the control group had no exercise prescription and were asked to continue their usual physical and dietary activities. At baseline and 2-year follow-up examinations, back extensor strength was measured with a strain-gauge dynamometer, and lateral roentgenograms of the thoracic and lumbar areas of the spine were obtained to measure the angles of thoracic kyphosis, lumbar lordosis, and sacral inclination. The changes in radiographic measurements and back extensor strength were analyzed statistically. Back extensor strength increased significantly in both the exercise and the control groups, but no radiographic measurements were significantly different between these groups. The significant increase in back extensor strength in both groups of healthy women suggested that the original grouping did not accurately reflect the amount of exercise. Thus, the 60 subjects were reclassified for comparison on the basis of increase in back extensor strength--27 with more than or equal to the mean increase of 21.1 kg and 33 with less than 21.1 kg. Furthermore, each of these groups of subjects was subdivided on the basis of degree of thoracic kyphosis. Among the subjects with substantial thoracic kyphosis, those with a significant increase in back extensor strength had a significant decrease in thoracic kyphosis (-2.8 +/- 4.2 degrees; P = 0.041), whereas those with a small increase in strength had a nonsignificant increase in thoracic kyphosis (1.8 +/- 5.3 degrees). The increase in back extensor strength did not seem to affect mild degrees of kyphosis. Increasing the back extensor strength in healthy estrogen-deficient women helps decrease thoracic kyphosis.

Cervical and lumbar lordosis and thoracic kyphosis in 8, 11 and 15-year-old children.

In a sample of 125 boys and girls registered at 8, 11 and 15 years of age the curvature of the cervical, thoracic and lumbar spine was studied. Cervical lordosis was calculated from the second, fourth and sixth vertebra on lateral skull radiographs. Thoracic kyphosis and lumbar lordosis were measured using a kyphometer. The results showed a decrease in the cervical lordosis and an increase in thoracic kyphosis and lumbar lordosis with increasing age in both sexes. In order to eliminate the systematic effects of sex and age a multiple stepwise regression analysis providing residuals corrected for the above mentioned variables was employed. When the entire sample was analysed again a highly significant correlation between thoracic and lumbar curvature was obtained. An almost significant, negative correlation was found between the inclination of the lower part of the cervical spine to a true vertical and the thoracic curvature. An almost significant correlation was also obtained between the inclination of the upper and lower part of the cervical spine to a true vertical, however no correlation was found between thoracic kyphosis and cervical lordosis. An almost significant, negative correlation was furthermore found between the upper part of the cervical spine and the lumbar spine.