Magnitude Of Kyphosis Research Articles

Оценка результатов хирургического лечения детей с деформацией позвоночника и грудной клетки с применением навигационной установки

Idiopathic scoliosis (IS) accounts for 2% to 5% of cases in orthopedic pathology. Surgical treatment of severe, rigid IS forms remains an important and pressing problem. The purpose of this research was to evaluate the efficacy and safety of the surgical correction method of severe kyphoscoliotic deformity of the thoracic spine in children with the use of the active optical three-dimensional computer navigation technology. Materials and methods used: a retrospective, single-center cohort study of the surgical treatment results of 30 children aged 14 to 18 y/o with grade 4 IS was conducted with V (C) Level of Evidence. The inclusion criteria were as follows: the scoliotic deformity magnitude of over 80°, simultaneous discopphysectomy, mobilizing dorsal osteotomies and deformity correction with a multi-support metal structure. Results: the scoliosis magnitude in the preoperative period was 100.5° (min 82; max 130; SD=13.21), after surgery 27° (min 4; max 47; SD=12.53). Pairwise comparison demonstrated statistically significant differences (p=0.013). The kyphosis magnitude in the preoperative period was 39.4° (min 3; max 61; SD=16.61), after surgery - 37.7° (min 3; max 49; SD=6.59). The abovementioned data comparison demonstrated the absence of statistically significant differences (p=0.154). The vertebral rotation magnitude in the preoperative period was 35.5° (min 20; max 60; SD=8.73), after surgery - 20° (min 9; max 32; SD=6.54). When comparing the results, statistically significant differences were revealed (p=0.010). Neurological disorders after the surgical interventions were not noted in patients included in the study. Conclusion: the use of the method of surgical correction of severe kyphoscoliotic deformity of the spine from a combined approach using active optical three-dimensional computer navigation technology allows the complete correction of the spinal deformity, indirectly improving both the shape and the size of the chest and restoring the frontal and sagittal profiles of the spine.

Compensation mechanisms for post-traumatic thoracolumbar kyphosis

Objective. To identify the mechanism of deformity compensation in patients with post-traumatic kyphosis of the thoracolumbar junction, based on the analysis of X-ray results of surgical treatment.Material and Methods. The study included data obtained from medical records of 69 patients (47 women, 22 men) operated on for painful post-traumatic kyphosis at the levels of T12, L1 and L2 vertebra. Patients underwent staged surgical interventions in a single surgical session. Demographic data and X-ray results of surgical treatment were evaluated.Results. As a result of surgical interventions, post-traumatic kyphosis (LK) was corrected to an average of 1.9°. After correction of kyphosis, statistically significant changes in the parameters of sagittal spinal curvatures were revealed: an increase in thoracic kyphosis (TK), a decrease in lumbar lordosis (LL), including due to lower lumbar lordosis (LowLL). At the same time, the parameters of the spinopelvic balance (PT, SS) did not change. Statistically significant correlations (p < 0.001) were detected between the magnitude of local kyphosis correction (LK preOP-LKpostOP), which amounted to 33.63° ± 8.77°, and parameters of lumbar lordosis ΔLL, thoracic kyphosis ΔTK and ΔPI-LL. Parameters of global sagittal balance and pelvic balance did not show correlations with the magnitude of kyphosis correction. The X-ray study of patients in Group I (without signs of initial sagittal imbalance) and Group II (with signs of sagittal imbalance) revealed a statistically significant difference in global balance (GT) and spinopelvic balance (PT, SS, LowLL), both before and after correction intervention in the thoracolumbar junction area, despite comparable indicators of sagittal spinal curvatures and the magnitude of post-traumatic kyphosis,.Conclusion. The main compensation mechanism includes changes in the spinal departments adjacent to kyphosis: a decrease in thoracic kyphosis and an increase in lumbar lordosis, rather than changes in the global or spinopelvic balance.

Is Thoracic Kyphosis Relevant to Pain, Autonomic Nervous System Function, Disability, and Cervical Sensorimotor Control in Patients with Chronic Nonspecific Neck Pain?

There is great interest in thoracic kyphosis, as it is thought to be a contributor to neck pain, neck disability, and sensorimotor control measures; however, this has not been completely investigated in treatment or case control studies. This case control design investigated participants with non-specific chronic neck pain. Eighty participants with a defined hyper-kyphosis (>55°) were compared to eighty matched participants with normal thoracic kyphosis (<55°). Participants were matched for age and neck pain duration. Hyper-kyphosis was further categorized into two distinct types: postural kyphosis (PK) and Scheuermann's kyphosis (SK). Posture measures included formetric thoracic kyphosis and the craniovertebral angle (CVA) to assess forward head posture. Sensorimotor control was assessed by the following measures: smooth pursuit neck torsion test (SPNT), overall stability index (OSI), and left and right rotation repositioning accuracy. A measure of autonomic nervous system function included the amplitude and latency of skin sympathetic response (SSR). Differences in variable measures were examined using the Student's t-test to compare the means of continuous variables between the two groups. One-way ANOVA was used to compare mean values in the three groups: postural kyphosis, Scheuermann's kyphosis, and normal kyphosis group. Pearson correlation was used to evaluate the relationship between participant's thoracic kyphosis magnitude (in each group separately and as an entire population) and their CVA, SPNT, OSI, head repositioning accuracy, and SSR latency and amplitude. Hyper-kyphosis participants had a significantly greater neck disability index compared to the normal kyphosis group (p < 0.001) with the SK group having greatest disability (p < 0.001). Statistically significant differences between the two kyphosis groups and the normal kyphosis group for all the sensorimotor measured variables were identified with the SK group having the most decreased efficiency of the measures in the hyper-kyphosis group, including: SPNT, OSI, and left and right rotation repositioning accuracy. In addition, there was a significant difference in neurophysiological findings for SSR amplitude (entire sample of kyphosis vs. normal kyphosis, p < 0.001), but there was no significant difference for SSR latency (p = 0.07). The CVA was significantly greater in the hyper-kyphosis group (p < 0.001). The magnitude of the thoracic kyphosis correlated with worsening CVA (with the SK group having the smallest CVA; p < 0.001) and the magnitude of the decreased efficiency of the sensorimotor control measures and the amplitude and latency of the SSR. The PK group, overall, showed the greatest correlations between thoracic kyphosis and measured variables. Participants with hyper-thoracic kyphosis exhibited abnormal sensorimotor control and autonomic nervous system dysfunction compared to those with normal thoracic kyphosis.

The Association Between Physical Function and Hyperkyphosis in Older Females: Protocol for a Systematic Review.

Identifying factors that impact physical function in older populations is important for the maintenance of good health with aging. Age-related hyperkyphosis, an excessive curvature in the thoracic spine, affects up to 40% of the older adults and is more common in older females than males. An association of age-related hyperkyphosis with impaired physical function has been reported in numerous studies, however, other studies have reported that a greater magnitude of kyphosis did not associate with impaired physical function. Given the inconsistencies regarding the impact of hyperkyphosis on physical function, the purpose of our study is to perform a systematic review of the existing studies in order to better describe the association between hyperkyphosis and physical function. Prospective and retrospective cohort, case-control, and cross-sectional studies which measure physical function by valid functional tests and questionnaires in older females will be included. We will search Scopus, ISI Web of Science, Cochrane Library, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PEDro databases. Studies will be searched and then selected by two independent reviewers based on quality assessment tools from the National Heart, Lung, and Blood Institute (NHLBI). A meta-analysis will be conducted if data reported for individual studies allow. Specifically, if two or more individual studies provide measures of central tendency and variability from any of the categories of physical function measures, data will be gathered for meta-analysis. If a meta-analysis is not possible, data will be synthesized and described in a narrative form by size and variability of effect, direction of effect, and association with hyperkyphosis.

Surgical Site Infection Following Primary Definitive Fusion for Pediatric Spinal Deformity: A Multicenter Study of Rates, Risk Factors, and Pathogens.

A retrospective multicenter study. To determine the surgical site infection (SSI) rate, associated risk factors, and causative pathogens in pediatric patients with spinal deformity. There have been no extensive investigations of the risk factors for SSI in Japan. Demographic data, radiographic findings, and the incidence of SSI were retrospectively analyzed in 1449 pediatric patients who underwent primary definitive fusion surgery for spinal deformity at any of 15 institutions from 2015 to 2017. SSI was defined according to the US Centers for Disease Control and Prevention guideline. The incidence of all SSIs was 1.4% and that of deep SSIs was 0.76%. The most common pathogenic microbes were methicillin-resistant staphylococci (n = 5) followed by gram-negative rods (n = 4), methicillin-sensitive staphylococci (n = 1), and others (n = 10). In univariate analysis, younger age, male sex, a diagnosis of kyphosis, type of scoliosis, American Society of Anesthesiologists (ASA) class ≥3, mental retardation urinary incontinence, combined anterior-posterior fusion, greater magnitude of kyphosis, three-column osteotomy, use of blood transfusion, and number of antibiotic administration were associated with the likelihood of SSI (all P < 0.05). Multivariate logistic regression analysis identified the following independent risk factors for SSI: syndromic scoliosis etiology (vs. idiopathic scoliosis; adjusted odds ratio [OR] 16.106; 95% confidence interval [CI] 2.225-116.602), neuromuscular scoliosis etiology (vs. idiopathic scoliosis; adjusted OR 11.814; 95% CI 1.109-125.805), ASA class 3 (vs. class 2; adjusted OR 15.231; 95% CI 1.201-193.178), and administration of antibiotic therapy twice daily (vs. three times daily; adjusted OR 6.121; 95% CI 1.261-29.718). The overall infection rate was low. The most common causative bacteria were methicillin-resistant followed by gram-negative rods. Independent risk factors for SSI in pediatric patients undergoing spinal deformity surgery were scoliosis etiology, ASA class 3, and administration of antibiotic therapy twice daily.Level of Evidence: 3.

Validity of a one-item drawing-based instrument to assess trunk deformity perception in kyphotic deformities.

Body image and trunk appearance perception are two crucial attributes in determiningthequality of lifeofindividuals with spinal deformities.The Trunk Appearance Perception Scale (TAPS) is a drawing-based instrument used to evaluate this feature. TheTAPS does not include a sagittal view of the trunkso it is neverbeenusedto assess trunk deformity perception inhyperkyphoticpatients.Thisstudyaimsto analyze theeffect of introducing a newdrawing on the TAPS scalerepresentingthe trunk view in the sagittal plane. 170 non-surgical patients were included (mean age 16.9years and 77.4% women) distributed in three groups. CONTROL group (no deformity): 22 cases;KYPHOSIS group (sagittal deformity): 49 cases and SCOLIOSIS group (coronal deformity): 99 cases (mean Cobb 42.4º). Cross-sectional study.A new drawing (TAPS4) was designed to represent the deformity in the sagittal plane with five response options. Clinical (SRS-22 and TAPS 4-items) and radiological (kyphosis T4-T12) data were collected in all patients. The statistical analysis consisted in determining for each group theinternal consistencyof the 3-items TAPS vs 4-items TAPS, as well as the discriminant validity (correlation with kyphosis magnitude) and convergent validity (correlation with the SRS-22 image subscale).In addition, test-retest reliability of new item 4 was determined in a subgroup of 30 kyphotic patients.During control visit,thepatients received a complete physical examinationanda full-spine AP and lateralX-ray in standing position using a low-radiation technique and fulfilledinstruments TAPS 4 items and SRS-22r. The three groups were found to have statistically significant differencesinthe magnitude ofkyphosis, quality of life, body image perception,the 3-items TAPS,4-itemsTAPS and new item 4score. The addition of the item 4 to TAPS 3 itemsdid not cause a significant change in the internal consistency of the scales (Cronbach's alpha) (TAPS 3-items 0.8 vs. TAPS 4-items 0.8).Kyphosismagnitudewas not correlated with the 3-items TAPS and 4-items TAPSscores; however, in the KYPHOSIS group, a significant negative correlation was observed between kyphosis anditem 4(Rho = -0.4, p = 0.0001).A significant correlation was found in all groups between TAPS 3-items and TAPS 4-items and SRS-22 imagedomain; the correlation betweenitem4 and SRS-22bodyimagedomainwas 0.3 in the Scoliosis group and 0.7 in the Kyphosisgroup. The 4-items TAPS scale does not provide advantages in the assessment of trunk deformity over the 3-items scale. However, in patients with kyphosis, theitem 4 (Kypho-TAPS) alone isavalidand reliableinstrument to monitor the perception of thetrunkdeformity.

Early corset reclination of uncomplicated type А3 comminuted vertebral fractures in the thoracolumbar spine

Objective. To analyze the results of staged preoperative correction of uncomplicated comminuted fractures in the thoracolumbar spine.Material and Methods. Retrospective study included data from 51 patients (33 men and 18 women) 17–35 years old with type A3 spinal injuries without urgent indications for surgery. In preparation for a possible operation, patients received a corset treatment with reclination pneumopelot for 2–3 days.Results. The results were evaluated based on clinical, radiological and CT data. The result after reclination corset treatment was considered good if a restoration of the vertebral height was achieved with its residual deficit of less than 10 % or local wedge shape not more than 10°; satisfactory – with a residual decrease in vertebral body height from 10 to 30 % or in kyphotic deformity from 10 to 20°; and unsatisfactory – with a decrease in body height of more than 30 %, and in kyphotic deformity of more than 20°. With an average decrease in the height of the fractured vertebral body before surgery by 45 % and the local kyphosis magnitude of 27.0° ± 5.5°, the staged reclination provided complete correction of kyphosis in all cases and restoration of the height of the compressed vertebra to a residual deficit of less than 10 % in 78 % of cases. Neurological disorders were not noted.Conclusion. In case of incomplete burst vertebral fractures not complicated by compression of the spinal cord, the method of early (in the first 7 days after the injury) corset treatment with staged fracture reclination by a pneumatic chamber can be effectively used to eliminate local kyphotic deformity and restore the height of fractured vertebra.

Friday, September 28, 2018 1:00 PM–2:30 PM abstracts: a new look at imaging: 204. Comparison of supine lateral x-ray, and CT images with standing lateral x-ray in predicting kyphosis flexibility with apex at T10-L2 in adult degenerative spinal deformity

BACKGROUND CONTEXT On sagittal plane, standing lateral x-ray has been taken as the main method to evaluate kyphosis and sagittal balance, which inevitably increase kyphosis magnitude from body weight and gravity. However, surgical sagittal imbalance correction strategy, such as the Smith-Peterson osteotomy (SPO), Pedicle Subtraction Osteotomy (PSO), and posterior vertebral column resection (PVCR), etc, are critically dependent on kyphosis magnitude and kyphosis rigidity. Supine lateral x-ray and CT scan, regularly in supine position, are possibly better ways to evaluate the flexibility and true magnitude of kyphosis. PURPOSE Our goal was to study kyphosis with apex at T10-L2 (TLK) magnitude change among standing lateral x-ray, spine lateral x-ray and supine CT scan. Standing lateral spine radiographs and CT scan may be superior to the standing lateral x-ray to evaluate the true magnitude of kyphosis. STUDY DESIGN/SETTING A retrospective study was conducted using retrospectively collected data at a spine surgery center. PATIENT SAMPLE A total of 45 adult degenerative spinal deformity patients with TLK, with kyphosis apex at T10-L2, were retrospectively studied. OUTCOME MEASURES Data were statistically analyzed using the SPSS software 17.0 version (SPSS, Inc, USA). METHODS A total of 45 adult degenerative spinal deformity patients with TLK, with kyphosis apex at T10-L2, were retrospectively studied with standing lateral x-ray and lateral, full supine x-ray and CT image. All radiographs were analyzed by measuring the TLK angles, lumbar lordosis (LL, T12-S1) and thoracic kyphosis (TK, T5-T12), respectively. The TLK was divided into three groups based on angle magnitude measured on standing radiographs (20°–40°, 40°–60°, and more than 60°) RESULTS Significant differences were found between TLK angles measured on standing radiographs and supine radiograph (P CONCLUSIONS Supine lateral x-ray and supine CT could be taken as reliable alternatives to standing lateral radiographs in the assessment of true kyphosis magnitude in adult spinal deformity patients with thoracolumbar kyphosis.

Does the position of conus medullaris change with increased thoracolumbar kyphosis in ankylosing spondylitis patients?

To date, only a few reports described the potential factors influencing the position of conus medullaris. One previous study revealed no significant change of conus locations in patients with idiopathic scoliosis; however, the effect of ankylosing spondylitis (AS)-related thoracolumbar kyphosis on conus position remains unexplored. Therefore, we aimed to investigate the variation of conus medullaris terminations in patients with thoracolumbar kyphosis secondary to AS when compared with normal subjects, and evaluated the relationship between conus positions and the magnitude of kyphosis. In this study, MR images of 96 AS patients with thoracolumbar kyphosis, including 86 males and 10 females with an average of 34.6 years (range, 17–65 years), and 100 age-matched normal controls were reviewed to determine the conus terminations in relation to spinal levels. Sagittal parameters of the AS group measured on radiograph included: global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), and thoracolumbar junction (TLJ). Finally, conus tips located at the mean level of the lower 3rd of L1 in both groups, there was no significant difference of the conus distributions between AS and control group (P = 0.49). In addition, conus medullaris displayed similar positions in AS patients among various apical region groups (P = 0.88), and no significant difference was found when AS population was stratified into GK ranges of 30° (P = 0.173). Also, no remarkable correlation of the conus positions with GK (r = −0.15, P = 0.15), TK (r = −0.10, P = 0.34), LL (r = −0.10, P = 0.32), and TLJ (r = −0.06, P = 0.54) was identified. This study showed the conus terminations displayed a wide range of distributions in AS patients with thoracolumbar kyphosis, which was similar to normal subjects. Moreover, the conus located at a relatively fixed position and would not be affected by the change of kyphosis magnitude, which is an important knowledge that surgeons should acquire in surgical correction of the deformity in these patients.

Multicenter Comparison of 3D Spinal Measurements Using Surface Topography With Those From Conventional Radiography

IntroductionIn pediatric spinal deformity the gold standard for curve surveillance remains standing full-column radiographs, but repeated exposure to ionizing radiation motivates us to look for nonradiographic solutions. This study tests a modern system of surface topography (ST) to determine whether it is reliable and reproducible. MethodsPatients from 6 pediatric spinal deformity clinics were recruited for enrollment. Inclusion criteria were age 8-18; diagnosis of scoliosis measuring ≥10 and <50 degrees or increased kyphosis of ≥45 degrees. Standing radiographs and ST scans (DIERS Formetric, Diers Medical Systems, Chicago, IL) were obtained on all patients and then measured and compared. A single investigator using a validated electronic measurement tool performed all radiographic measurements. Analysis of reproducibility and comparison of ST and radiographs were done. ResultsA total of 193 patients were enrolled (148 F [77%]). The mean age was 13.25 years (range 8–18). The scoliosis magnitude was as follows: thoracic average 22.7 ± 10 degrees; lumbar average 19.6 ± 9 degrees. The kyphosis magnitude was 54.0 ± 11 degrees. The reproducibility for each ST parameter for 3 repeated scans was strong (interclass correlation = 0.855–0.944). Comparison to radiographic measurements was strong in the thoracic (r = 0.7) and moderate in the lumbar curve (r = 0.5). There was an average difference of 5.8 degrees in the thoracic spine and 8.8 degrees in the lumbar spine between ST Cobb angle estimates and radiographs. Thoracic kyphosis also had a strong correlation (r = 0.8) with radiographs. ConclusionsAlthough the results are intended to measure similar aspects of deformity as the traditional Cobb angle, the measurement is not intended to be an exact estimation. The utility of ST is in the reproducible quantification of deformity after the initial radiograph has been taken. This has the potential to make longitudinal assessment of change in deformity without serial radiographs.

Preoperative Pulmonary Function in Patients With Operative Scheuermann Kyphosis

Study DesignA multicenter, prospective study of consecutively enrolled surgical patients with Scheuermann kyphosis (SK). ObjectivesTo evaluate the impact of SK on preoperative pulmonary function and to determine which radiographic criteria may help predict pulmonary impairment. Summary of Background DataPulmonary function in SK is not well studied. Previous studies on adolescent idiopathic scoliosis revealed that certain factors, including the magnitude of the thoracic curve and the number of vertebrae involved, significantly affect pulmonary function. MethodsA total of 64 patients with SK were evaluated. Absolute and percent predicted forced vital capacity (FVC), forced expiratory volume in 1 second, and total lung capacity were collected preoperatively. Subjects were divided according to kyphosis apex (thoracic or thoracolumbar) and kyphosis magnitude groups, and compared. Correlation analysis was performed to evaluate the impact of gender, age, kyphosis magnitude, and apex on pulmonary function. American Thoracic Society guidelines were used to classify patients according to the severity of pulmonary impairment. ResultsMean age was 16 years (range 13–24 years), with 42 males. The percent predicted forced vital capacity was 95.8%, percent forced expiratory volume in 1 second was 92.5%, and percent total lung capacity was 106.2%. The percent predicted FVC differed significantly between the 71°–80° and 81°–90° groups (105% vs. 83%, respectively; p = .016) and the 71°–80° and greater than 90° groups (105% vs. 73%, respectively; p = .009). For percent predicted TLC, patients with greater than 90° had significantly lower average values than those in the 71°–80° range (79% vs. 115%, respectively; p = .016). Greatest kyphosis showed a fairly weak (r = –.24; p < .10) but significant correlation with percent predicted FVC. The percentage of patients with moderate to severe impairment (4%) was lowest in the 71°–80° range, which increased with increasing ranges of kyphosis magnitude: 81°–90° (11%) and greater than 90° (50%).

Analysis of Spinopelvic Sagittal Alignment in Patients With Thoracic and Thoracolumbar Angular Kyphosis

Retrospective and radiological analysis of spinopelvic sagittal alignment in Chinese patients with thoracic and thoracolumbar kyphosis. To determine the impact of thoracic and thoracolumbar kyphosis on pelvic sagittal morphology and the mechanisms of adjusting trunk sagittal balance. Previous studies have reported the normative values of pelvic sagittal parameters and classification of normal patterns of sagittal curvature, but no study has analyzed the impact of thoracic and thoracolumbar kyphosis on pelvic sagittal morphology and the mechanisms of maintaining the sagittal balance. Whole spine and standing lateral radiographs of 49 Chinese patients with thoracic and thoracolumbar kyphosis were obtained before surgery, immediately after surgery, and in the final follow-up. The pelvic and spinal parameters were measured and the correlations of all parameters were analyzed. A descriptive analysis characterizing these parameters and a multivariate analysis were performed. The patients had a mean age of 30.3 years, whereas the mean age at which the patients who developed kyphosis was 7.1 years. Preoperative pelvic incidence was significantly less than that of normal subjects, and there was no difference in the preoperative, in the immediate postoperative, and in the final follow-up radiographs. The magnitude of kyphosis and the levels involved were independent factors of pelvic incidence. Pelvis anteversion and lumbar hyperlordosis were the mechanisms of adjusting the trunk sagittal balance. Although kyphosis and sagittal imbalance was corrected by surgery, pelvic sagittal morphology remained unchanged. Thoracic and thoracolumbar angular kyphosis occurring during the growth period will lead to abnormal pelvic morphology. The greater the kyphotic angle and lower the kyphotic levels, the greater the impact on the pelvic morphology during skeletal maturation. The mechanisms of adjusting the trunk sagittal balance not only include pelvis anteverting, but also lumbar hyperlordosis. The latter serves as the main mechanism once skeletal maturation has been established. After skeletal maturation, surgery can re-establish the spinal sagittal balance but not the pelvis morphology. 3.

Effect of Spinal Deformity on Adolescent Quality of Life

A prospective multicenter study and retrospective chart review. To compare health-related quality of life (HRQOL) measures and sagittal deformity in operative Scheuermann kyphosis (SK), operative adolescent idiopathic scoliosis (AIS), and normal populations. No study to date has evaluated patient reported HRQOL measures before surgery in operative patients with SK. HRQOL data were prospectively collected pretreatment for operative patients with SK using the SRS-22 outcomes instrument and visual analogue scale (VAS). Comparison was made with the SRS-22 from operative AIS and normal populations. Eighty-six patients with SK enrolled in the prospective study were compared with 184 patients with AIS from a prospective database and 31 normal controls. To study the correlation between T5-T12 kyphosis magnitude and SRS-22 score, patients with AIS and SK were pooled together to create a larger continuum of kyphosis. Analysis of covariance, Pearson correlation analysis, and Bonferroni pairwise comparisons were used to determine statistical differences between group demographics, HRQOL indicators, and radiographical variables. Patients with SK had significantly lower scores in all domains of the SRS-22 than patients with AIS. Patients with SK with a thoracolumbar apex reported significantly lower mean scores in the pain domain than those with a thoracic apex. Significant negative correlations were found between all domains of the SRS-22 and T5-T12 kyphosis-the self-image domain demonstrated the highest correlation (r = 0.37). VAS score in the SK population correlated negatively to the pain, self-image, and mental health domains. Increasing sagittal plane deformity as a result of SK has a significant impact on HRQOL as determined by the SRS-22 outcome instrument. In this study, patients with SK reported significantly decreased (worse) scores in all subdomains of the SRS-22 compared with patients with AIS. 1.

Kyphosis and Decline in Physical Function Over 15 Years in Older Community-Dwelling Women: The Study of Osteoporotic Fractures

Maintaining physical function is an important prerequisite for preserving independence in later life. Greater degrees of kyphosis in the thoracic spine are prevalent in older persons and accompanied by reduced physical function in multiple cross-sectional studies. It is unknown whether kyphosis predicts worse physical function over time. We retrospectively assessed whether greater magnitude of kyphosis is associated with decline in self-reported and objectively measured physical function over 15 years. Digitized Cobb angle kyphosis (T4-T12) was derived from supine lateral thoracic spine radiographs in a cohort of 1,196 women aged 65 and older (mean = 69.3 years [SD = 4.0]). Using regression models, we evaluated associations of baseline kyphosis with both self-reported functional status and objectively measured gait speed, grip strength, and timed chair stands cross-sectionally and as change assessed over 15 years. In cross-sectional multivariate analyses, with each 10-degree increment of kyphosis, grip strength was 0.24 kg lower (p = .02), but there were no significant associations between kyphosis and functional status, gait speed, or timed chair stand, likely reflecting the high functioning study participants. In multivariate longitudinal analysis, with each 10-degree increment in baseline kyphosis, there was 0.07 point additional decline in functional status (p = .09), 0.01 m/s more decline in gait speed (p = .07), and 0.32 s greater decline in time to complete five chair stands (p = .004), but no association with decline in grip strength. Greater magnitude of kyphosis may predict worsening lower extremity function over time in older women. Early recognition and preventative measures against kyphosis progression may help preserve physical function over the long term.

How Does Thoracic Kyphosis Affect Patient Outcomes in Growing Rod Surgery?

Retrospective review of a multicenter series. This study was conducted to specifically identify the complication rate of growing rod surgery in patients with normal (10°-40°) versus abnormal thoracic kyphosis. Surgical treatment options for progressive early onset scoliosis include spinal fusion versus growth-sparing techniques. The current most commonly employed growing rod technique involves short fusions at the foundation sites using either hooks or screws as anchors and placement of dual growing rods spanning the deformity. Although the coronal deformity in these patients has been studied extensively, the sagittal profile has received less attention as a possible factor in complication rates and patient outcomes. Out of 387 patients who underwent surgical placement of growing rods, 90 patients had complete clinical and radiographical data, with 2-year follow-up after initial surgery. Patients were categorized into 3 groups on the basis of preoperative thoracic kyphosis magnitude: less than 10° (K- group), 10°-40° (N group), and more than 40° (K+ group). Patient diagnosis, demographics, surgical information, radiographical measurements, and complication types were tabulated and analyzed. A P value of <0.05 was considered significant for all statistical tests. The K- group experienced 27 total complications including 15 general medical complications, the N group had 20 total and 4 general complications, and the K+ group had 55 total and 22 general complications. Patients in the K+ group were 3.1 times more likely to experience a complication than those in the N group, which was statistically significant (P < 0.05). When considering all types of complications, length of follow-up, T2-T5 proximal kyphosis, postoperative Cobb angle, and rod diameter were identified as confounding variables. When the confounding variables were taken into consideration in the analysis, the odds ratios were no longer significant between the N and K+ groups. Patients in the K+ group and K- group were 2.95 and 2.89 times more likely to experience a general medical complication than those in the N group, respectively (P > 0.05). The rate of implant-related complications between the groups did not reach statistical significance, although the K+ group had the most implant complications (n = 34), including 25 rod breakages in 16 patients. Syndromic patients had 2.9 times the risk of having an overall complication when compared with the entire patient series (P < 0.05). The number of patients who experienced multiple complications was higher in the K- and K+ groups than in the N group. Patients with thoracic hyperkyphosis present even more of a challenge with respect to complications, specifically implant-related complications. Our study shows that growing rod surgery in patients with kyphosis more than 40° has significantly more general and implant complications than that in patients with normal thoracic kyphosis. Implant complications were more common in hyperkyphotic (>40°) patients and increased linearly with increasing kyphosis. The most common implant complication was rod breakage. Patients with hyperkyphotic thoracic spines, particularly syndromic patients, must be monitored closely and parents should be counseled regarding the likelihood of future adverse events.

Operative Management of Scheuermannʼs Kyphosis in 78 Patients

A retrospective multicenter review of 78 patients with Scheuermann's kyphosis treated operatively was conducted. The purpose of this study was to evaluate correction of sagittal alignment, maintenance of correction, and occurrence of, and etiologic factors associated with, junctional kyphosis in patients managed operatively for Scheuermann's kyphosis. There is a paucity of literature regarding the surgical treatment of Scheuermann's kyphosis using current implant systems and operative techniques. Junctional kyphosis has been shown to occur in up to one third of patients. Factors causing junctional kyphosis have not been clearly elucidated. Loss of correction has been variable based on the technique used. No clear-cut advantages or disadvantages have been shown for the use of anterior release. Kyphosis, lordosis, C7 sagittal plumbline, apical translation, junctional sagittal alignment, and pelvic incidence were assessed among other radiographic parameters from a centralized database. The incidence of junctional kyphosis and its association to the above parameters and to fusion levels were assessed. Complication rates and differences between patients undergoing combined anteroposterior surgery and those having posterior surgery alone were evaluated. Of the 78 patients, 42 underwent combined anteroposterior procedures (Group 1) and 36 had posterior surgery only (Group 2). Mean age was 16.7 years. Overall, the greatest Cobb kyphosis of 78.8 degrees was corrected to 51.4 degrees at follow-up. Preoperative kyphosis was 82.6 degrees and 74.4 degrees for Groups 1 and 2, respectively (P < 0.001) and 55.8 degrees and 46.2 degrees at follow-up (P = 0.000). Loss of correction was 3.2 degrees (not significant) and 6.4 degrees (P = 0.000), respectively. Lordosis corrected from -65.5 degrees to -51.7 degrees . Proximal and distal junctional kyphosis of >or=10 degrees occurred in 25 (32.1%) and 4 (5.1%), respectively. The development of a proximal junctional kyphosis correlated directly with kyphosis at follow-up and indirectly with percent correction. Among patients with proximal junctional kyphosis, the magnitude of junctional kyphosis correlated directly with the degree of pelvic incidence. Pelvic incidence correlated directly with lumbar lordosis but not kyphosis. Twelve complications occurred in 12 patients, including posterior wound infection (1), distal (2), and proximal (1) junctional kyphosis, and pseudarthrosis (1), those requiring reoperation. This is one of the largest reported series of Scheuermann's kyphosis treated operatively to our knowledge. A high rate of junctional kyphosis, especially at the proximal end, is associated with surgery for Scheuermann's kyphosis using current techniques. Proximal junctional kyphosis is associated with higher magnitude of kyphosis at follow-up, less percent correction; its magnitude correlated directly with pelvic incidence. Loss of correction is less in patients undergoing combined anteroposterior surgery. Pelvic incidence correlates directly with lordosis but not kyphosis, suggesting that these parameters are not causative of Scheuermann's kyphosis.

The Relationship Between Thoracic Hyperkyphosis and the Scoliosis Research Society Outcomes Instrument

A retrospective chart review and radiographic analysis. To evaluate the association between thoracic hyperkyphosis and patient quality of life measures as determined by the Scoliosis Research Society (SRS) outcomes instrument. Although validated outcomes questionnaires (e.g., Pediatric Outcomes Data Collection Instrument and SRS) have been used to evaluate patients with scoliosis, there has been little written about the effects of sagittal plane alignment on these functional outcome measurements. Data from the SRS outcomes instrument were collected from patients with thoracic hyperkyphosis as well as those with normal spinal alignment. A total of 50 patients with thoracic kyphosis >or=45 degrees were compared with 50 normal patients with thoracic kyphosis <45 degrees . Correlation analysis was performed to identify significant relationships between the magnitude of the major kyphotic curve and the 4 SRS outcome questionnaire domains (Total Pain, General Self-Image, General Function, and Activity). Lower SRS scores indicate an increase in symptoms. The average age of the subjects was 14 +/- 4 years (range, 8-18 years). The thoracic kyphosis varied between 11 degrees and 95 degrees for all subjects. Significant negative correlations were found between kyphosis magnitude and the total pain, general self-image, general function, overall level of activity, and total SRS scores (P < 0.0001). Of the 4 domains, self-image had the highest correlation with kyphosis magnitude while activity had the lowest. These findings indicate that higher kyphosis magnitudes were associated with increased pain, lower self-image, and decreased function and activity. Patients with thoracic hyperkyphosis were significantly more symptomatic than normal subjects in all domains. The r values for this analysis of kyphosis (0.40-0.66), in fact were substantially greater than those previously reported for scoliosis magnitude versus SRS Questionnaire scores (0.16-0.26), suggesting this instrument may be even better suited for the evaluation of hyperkyphosis patients.

Correlation between backpack weight and way of carrying, sagittal and frontal spinal curvatures, athletic activity, and dorsal and low back pain in schoolchildren and adolescents.

This cross-sectional study was carried out to investigate any correlation between backpack carrying, spinal curvatures, and athletic activities on schoolchildren's dorsal (DP) and low back pain (LBP). Three thousand four hundred forty-one students aged from 9 to 15 years who carried backpacks to school were included in this study and asked for DP and LBP experiences in the school period while carrying the backpack. Nonradiating methods (surface back contour analysis) were used to indirectly measure frontal spinal curve (scoliosis) with the scoliometer and lateral curves (thoracic kyphosis and lumbar lordosis) with the kyphometer. All data analyses were undertaken regarding school year level, age, gender, sports participation, backpack weight, and way of carrying (one versus both shoulder) in relation to magnitude of scoliosis, thoracic kyphosis, lumbar lordosis, and DP and LBP while carrying the backpack. DP increased with increasing backpack weight (P < 0.05). The way (one versus both shoulder) of backpack carrying did not correlate either with DP or with LBP. Girls experienced much more LBP and DP than boys (P < 0.001). There was no difference in the prevalence of LBP and DP between adolescents and children. Students' age, height, and body weight as well as magnitude of kyphosis, lordosis, and scoliosis did not correlate with either LBP or DP. At the age of 11 years, girls and boys showed the highest prevalence for DP (72% and 38.5%, respectively), while at the age of 14 years, girls reported significantly (P < 0.05) more DP than boys. Girls showed the highest prevalence of LBP (71%) at the age of 11 years, while for the boys, it was at the age of 15 years (21%). Girls showed at the age of 11 years significantly more LBP (P < 0.05) than boys. Sports exposure seemed to increase LBP in girls (P < 0.001). The results of this study suggest a differential DP and LBP prevalence in schoolchildren and adolescents carrying backpacks with regard to gender and age. The peak in pain prevalence was immediately before puberty as well as immediately after its onset. Girls who participated in sports activities seem to experience more often DP and LBP than boys. Short children who carry backpacks as heavy as do tall children at the same age are more prone to LBP.

Change in Spinal Curvature following Release of Tethered Spinal Cord Associated with Spina bif ida

Changes in spinal curvature, scoliosis, kyphosis and lordosis are associated with the growth of patients with myelomeningocele. Previous investigators have stated that progressive developmental scoliosis is related to tethered spinal cord. In order to investigate the relationship of tethered spinal cord release to progression of spinal curvature, we surveyed the medical records of 262 patients with a history of one or more tethered spinal cord release. For 216 of these patients, a total of 2,369 serial spine x-rays, obtained over a 20-year period, were reviewed by the standard Cobb method for progression of scoliosis, thoracic kyphosis and lordosis. In addition, the serial spine x-rays of 74 patients without clinical findings of tethered spinal cord were collected and reviewed for comparison of progressive scoliosis and kyphosis. One hundred and sixty normal lumbar x-rays were evaluated to compare the progression of the lordotic curve in patients with tethered cord release with a normal population. Progression of scoliosis plateaued or declined following release of tethered cord in patients with lumbar and sacral level lesions, however, tether release did not halt the progression of scoliosis in the thoracic level group. Tethered cord release altered the course of lordosis in L1 through L3 level lesions, but had little affect on the normal progression of lordosis in patients with L4, L5 or sacral level lesions. Finally, tethered spinal cord release appears to be associated with a decrease in the incidence and magnitude of kyphosis.