Kyphotic Curvature Research Articles

Prevalence and Key Radiographic Spinal Malalignment Parameters Associated with the Risk of Pulmonary Function Impairment in Patients Treated Surgically to Correct Adult Spinal Deformity.

Introduction There is a significant relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae, and coronal imbalance in patients with childhood spinal deformity. By contrast, the pathophysiology, epidemiology, and influence of deformity on respiratory dysfunction in patients with adult spinal deformity (ASD) remain largely unknown. We sought to clarify and compare the prevalence of pulmonary function impairment in patients with ASD with that in patients with lumbar spinal stenosis (LSS), to determine radiographically which spinal malalignment parameters are associated with a risk of respiratory dysfunction, and to determine the association of respiratory dysfunction with corrective surgery. Methods We conducted a prospective study of consecutive patients with a diagnosis of ASD or LSS who underwent spinal surgery. We included data from 122 consecutive patients with ASD and 121 consecutive patients with LSS. Parameters were obtained from full-length lateral radiographs taken with the patients standing and in supine and prone positions. We compared respiratory dysfunction between a group of patients with ASD and LSS and determined correlations between respiratory dysfunction and spinopelvic parameters. Results Preoperative % forced vital capacity (FVC) of patients with ASD was significantly lower than that of patients with LSS, and the frequency of restrictive ventilatory impairment was significantly higher in those with ASD (15.7%) than those with LSS (7.4%). Thoracolumbar kyphotic curvature (TK) while the patients were in supine position was significantly greater in the group with restrictive ventilatory impairment, and a significant negative correlation was found between %FVC and TK with the patients in supine position. We found no significant improvement of respiratory dysfunction 1 year after surgery. Conclusions Spinal deformity is a potential risk factor for restrictive ventilatory impairment in the elderly. We propose that radiographs obtained when patients are in supine position are valuable for evaluating the flexibility of the TK. Rigid TK might be an etiology of restrictive ventilatory impairment in patients with ASD.

Differences of Spinal Curvature, Thoracic Mobility, and Respiratory Strength Between Chronic Neck Pain Patients and People Without Cervical Pain.

ObjectiveTo investigate the differences of spinal curvature, thoracic sagittal mobility, and respiratory strength between patients with chronic neck pain (CNP) and people without cervical pain, and to determine the correlation between respiratory strength and thoracic mobility in CNP patients.MethodsA total of 78 participants were finally included in this study, of whom 30 had no cervical pain and 48 had CNP. The Neck Disability Index (NDI), cervical lordotic curvature, thoracic kyphotic curvature, thoracic sagittal range of motion (ROM), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were measured and analyzed.ResultsIn males, thoracic sagittal ROMMEP-MIP and MEP showed a significant difference between the no cervical pain group and the CNP group. In females, thoracic kyphotic curvature, thoracic sagittal ROMMEP-MIP, MIP, and MEP were significantly different between the no cervical pain group and the CNP group. Thoracic kyphotic curvature was significantly correlated with MEP and MIP in all population groups, and significantly correlated with NDI in the female group. Thoracic sagittal ROMMEP-MIP had a significant linear relationship with NDI, MEP, and MIP in all population groups.ConclusionThe thoracic mobility during forced respiration was reduced in patients with CNP and was correlated with respiratory strength. Changes in the biomechanics of the cervicothoracic spine and rib cage due to CNP may contribute to impairment of respiratory strength.

Evaluation of the efficiency of various force configurations on scoliotic, lordotic and kyphotic curves in the subjects with scoliosis.

The efficiency of the braces designed for scoliotic subjects depends on configurations and also magnitudes of the forces used to stabilize and correct scoliotic curve. However, the effects of various force configurations on the spinal curves in sagittal plane should also be considered. The aim of this study was to determine the efficiency of various force configurations on scoliotic, lordotic and kyphotic curves. A 3d model of spine was developed based on CT scan images of spine obtained from a scoliotic girl. The model was exported to Abaqus software to check the effects of various force configurations and magnitudes on spinal curves. The spinal curves in thoracic and lumbar, lordotic and kyphotic curves were evaluated in this study. Transverse forces, vertical forces and combination of transverse and vertical forces were selected in this study. The results of this study showed that use of transverse forces did not influence the scoliotic curve significantly. Vertical directed forces not only decreased scoliotic curves but also decreased lordotic and kyphotic curves. It seems that a combination of both transverse and vertical directed forces decreased scoliotic curves but did not influence spinal curves in sagittal plane. It is recommended to use a combination of transverse and vertical forces to decrease scoliotic curve without significant side effects on the spinal curves in sagittal plane. As this is a case study the outputs of the study should be used with caution.

Surgical correction of severe forms of idiopathic kyphoscolyosis in children

Background. Significant results have been achieved through the use of hybrid and transpedicular metal structures. However, when spinal systems are implanted during surgery in patients with severe forms and idiopathic scoliosis, a number of limitations arise. Not only the performance of corrective maneuvers during the operation but also the creation of mobility on the top of the main arc accompany the strategies of surgical treatment. Traditionally, mobilizing discectomy at the top of the spark is performed in patients with idiopathic scoliosis. Pedicle subtractional vertebrotomy and Ponte and Smith-Petersen osteotomy are most common in neuromuscular scoliosis and spinal deformity, with a predominance of the kyphotic component. Problems with correction of extremely low and neglected forms and idiopathic scoliosis in children remain.
 Aim. The present study aimed to provide a comparative analysis between using transpedicular spinal systems alone and in combination with a wedge osteotomy of the apical vertebra to correct spinal deformity in children with extremely severe right-sided idiopathic thoracic scoliosis.
 Materials and methods. The surgical treatment results of 20 children 15 to 17 years old with extremely severe forms of right-sided idiopathic thoracic kyphoscoliosis were included in the analysis. All patients underwent standard preoperative examination, including radiology, computed tomography, magnetic resonance imaging, and neurophysiological studies. The patients were divided into two groups according to the method used during the second stage of surgical treatment correction of deformity with the transpedicular system (1) alone or (2) in combination with a wedge osteotomy of the apical vertebra.
 Results. Patients from the first group showed an amount of scoliotic and kyphotic component correction ranging from 25% to 62% and from 21% to 56%, respectively. In patients from the second group, who underwent additional wedge osteotomy of the apical vertebrae during the operation, correction of the scoliotic and kyphotic components ranged from 36% to 74% and from 50% to 70%, respectively.
 Conclusion. In children with idiopathic thoracic kyphoscoliosis, performing a wedge corpectomy of the apical vertebral body is an effective additional mobilizing component, which allows achieving significant correction of both scoliotic and kyphotic curve components, restoring the physiological profile of the spine and body balance during the surgical intervention, and maintaining the achieved result during the long-term observation period.

Scoliosis in patients with Chiari malformation type I.

The literature about the association between Chiari malformations (CMs) and scoliosis has been growing over the last three decades; yet, no consensus on the optimal management approach in this patient population has been reached. Spinal anomalies such as isolated syrinxes, isolated CM, and CM with a syrinx are relatively common among patients with presumed idiopathic scoliosis (IS), a rule that also applies to scoliosis among CM patients as well. In CM patients, scoliosis presents with atypical features such as early onset, left apical or kyphotic curvature, and neurological deficits. While spinal X-rays are essential to confirm the diagnosis of scoliosis among CM patients, a magnetic resonance imaging (MRI) is also recommended in IS patients with atypical presentations. Hypotheses attempting to explain the occurrence of scoliosis in CM patients include cerebellar tonsillar compression of the cervicomedullary junction and uneven expansion of a syrinx in the horizontal plane of the spinal cord. Early detection of scoliosis on routine spinal examination and close follow-up on curve stability and progression are essential initial steps in the management of scoliosis, especially in patients with CM, who may require full spine MRI to screen for associated neuro-axial anomalies; bracing and spinal fusion may be subsequently pursued in high-risk patients.

Indication for anterior spinal cord decompression via a posterolateral approach for the treatment of ossification of the posterior longitudinal ligament in the thoracic spine: a prospective cohort study.

For ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine, anterior decompression is the most effective method for relieving spinal cord compression. The purpose of this study was to prospectively analyze the surgical outcomes based on our strategy in the treatment of thoracic OPLL. This study included 23 patients who underwent surgery for thoracic OPLL based on the following strategy between 2011 and 2017. For patients with a beak-type OPLL in the kyphotic curve with a ≥ 50% canal occupying ratio, circumferential decompression via a posterolateral approach and fusion (CDF) was indicated. For other types of OPLL, posterior decompression and fusion (PDF) was commonly indicated. Posterior fusion without decompression (PF) was applied when the spinal cord was separated from the posterior spinal elements. Clinical and radiological outcomes were compared among the CDF, PDF, and PF groups with a minimum of 20-month follow-up. Ten, eleven, and two patients underwent CDF, PDF, and PF, respectively. The preoperative Japanese Orthopedic Association (JOA) score in the CDF group was significantly lower than that in the PDF group. The average recovery rate, according to JOA score, was 63%, 56%, and 25% in the CDF, PDF, and PF groups, respectively. The result in the CDF group was better than that in the PF group. Anterior decompression was appropriate for patients with localized spinal cord compression by a large OPLL in the kyphotic curve, and CDF via a posterolateral approach appears to be safe and effective. These slides can be retrieved under Electronic Supplementary Material.

Computed tomography method for characterising the zebrafish spine

BackgroundThe zebrafish is widely used in research due in part to its readily manipulable genome. Zebrafish models of spinal deformities including scoliosis were developed recently. However, the methods used to assess the spine in these models vary across studies. The primary objective of this study was to investigate the feasibility and modalities of local and regional spine structure evaluation by micro-CT in the normal zebrafish. The secondary objectives were to assess the feasibility of spinal angle measurements in normal zebrafish subjected to external stresses designed to mimic spinal deformities, to determine normal angle values in the coronal and sagittal planes, and to detail the micro-CT features of the zebrafish spine. HypothesisMicro-CT is an effective and reproducible tool for determining orthopaedic parameters to characterise the zebrafish spine. Material and MethodsTwo observers conducted preliminary analyses on 15 zebrafish including 12 adults (aged 18 months) and 3 juveniles (aged 12 weeks). For the analyses, 6 of the animals were placed in an artificial position to mimic a scoliosis spinal deformity. Micro-CT (Quantum FX Caliper™) was used with 59μm resolution and a 30-mm field of view. Image processing was with RadiAnt DICOM Viewer™ software. ResultsWe defined several assessment planes on the 3D micro-CT reconstructions to measure orthopaedic parameters in the sagittal plane (thoracic and maximal kyphotic curves with their apices, length of the various spinal segments, and sagittal index) and coronal plane (Cobb angles, apices, end-vertebrae, coronal alignment, and side of the convexity). Mean thoracic kyphosis was 20.5°±5.0° in the adults and 8.7° in the juveniles. No curvature was apparent in the coronal plane in the zebrafish left in the neutral position. In the zebrafish with artificially induced curves, micro-CT was effective in determining the Cobb angles and apical vertebrae. DiscussionThis work defines a standardised micro-CT method for assessing the zebrafish spine. In addition, spinal parameter values that can be considered normal were determined, namely, less than 30° of thoracic kyphosis in the sagittal plane and less than 10° in the coronal plane. Our method was effective in assessing induced spinal deformities on micro-CT reconstructions. We hope it will prove of value in future studies of the zebrafish model. Level of evidenceIV.

The Effect of Schroth Therapy on Thoracic Kyphotic Curve and Quality of Life in Scheuermann's Patients: A Randomized Controlled Trial.

Study DesignRandomized controlled single-blinded clinical trial.PurposeTo evaluate the efficacy of Schroth therapy on thoracic curve angle, pain, and self-perceived body image (SPBI) of the back in Scheuermann’s patients in comparison with the efficacy of classic anti-gravitation exercises.Overview of LiteratureScheuermann disease is the most common cause of hyperkyphosis of the thoracic and thoracolumbar spine during adolescence. However, very few studies evaluated the effect of exercises on the progression of kyphosis in Scheuermann patients. Schroth three-dimensional exercise therapy was found in several studies to be effective in the treatment of adolescent scoliosis; however, we found no randomized controlled trials that evaluated the efficacy of this method in Scheuermann patients.MethodsA total of 50 young adults (males and females) with Scheuermann’s disease were randomly divided into either the experimental group (Schroth therapy treatment, n=25) or the control group (classic anti-gravitation exercises, n=25). Participants in both the groups were provided a course of individual treatment sessions during few weeks, with one appointment per week. They were required to perform the exercises daily throughout the study period (12 months) and fill their performance in a research log. We evaluated the thoracic Cobb angle (main outcome measure), pain, SPBI, flexion of the shoulder (supine), flexion of the shoulder (standing), kyphotic deformity measured using inclinometer, and L5 kyphosis apex line (L5-KAL) as well as administered the Scoliosis Research Society-22 Questionnaire for the participants before the treatment, after 6 months, and 1 year postoperatively. These results were then compared.ResultsIn the mixed analysis of variance, the main effect of time was significant in the thoracic kyphosis (F [1]=5.72, p=0.02), and in the L5-KAL (F [1]=5.76, p=0.02). The main effect of time on the kyphotic deformity, measured using an inclinometer, did not reach the significance level; however, it showed the tendency (F [1]=2.80, p=0.07). In the group-by-time interaction, a significant difference was found in the thoracic kyphosis (F [1]=4.91, p=0.03) and in the kyphotic deformity, measured using an inclinometer (F [1]=4.05, p=0.02). Thus, the Schroth therapy group showed significantly greater improvement than the classic anti-gravitation exercises group.ConclusionsThe present findings indicate that back exercises in general, and Schroth therapy in particular, is an effective treatment for preventing and significantly improving the thoracic Cobb angle and symptomatic representation in Scheuermann’s patients.

Transpedicular Wedge Resection Osteotomy of the Apical Vertebrae for the Treatment of Severe and Rigid Thoracic Kyphoscoliosis: A Retrospective Study of 26 Cases

Study DesignRetrospective analysis of clinical records. ObjectiveTo determine the efficacy of transpedicular wedge resection osteotomy (TWRO) of the apical vertebrae to treat severe and rigid thoracic kyphoscoliosis in 26 adults. Summary of Background DataAlthough posterior vertebral column resection has traditionally been used to correct severe and rigid kyphoscoliosis, TWRO may achieve the same correction with a shorter operative time and lower rate of complications. MethodsBetween May 2011 and December 2014, 29 adults underwent a TWRO of the apical vertebrae for severe and rigid thoracic kyphoscoliosis, and 26 adults completed the 24-month follow-up. Radiologic measurements, including coronal plane major curve, kyphotic curve, coronal offset, and sagittal offset, were measured and compared. The following patient-reported health-related quality of life outcomes, including Oswestry Disability Index score, visual analog scale score for back pain, and SRS-22 questionnaire, were used to evaluate the clinical outcomes. ResultsFor the 26 patients followed over 24 months, the mean coronal plane major curve improved from 107.6° to 37.5° immediately after surgery and to 40.0° at 24 months postoperatively. The mean kyphotic curve improved from 90.6° to 30.5° immediately after surgery and to 33.3° at 24 months postoperatively. The mean coronal offset and sagittal offset were also improved. Improved self-reported quality of life scores were achieved postoperatively and at 24 months postoperatively, including all domains of the SRS-22 questionnaire. Bony fusion was achieved at 6 or 12 months in all patients. Unilateral leg paresis occurred in one case and recovered after three months, with a neurologic complication rate of 3.8%. ConclusionsTWRO of the apical vertebrae as a treatment for severe and rigid thoracic kyphoscoliosis in adult patients provided excellent clinical outcomes. However, the procedure remains technically demanding and exhausting, with a potential risk for complications. Level of EvidenceLevel IV.

Functional Outcomes of Thoracolumbar Junction Spine Fractures

Few studies have evaluated the functional outcomes of traumatic thoracic and lumbar vertebral body fractures. This study evaluated the functional and clinical outcomes of patients, who sustained a fracture to the thoracolumbar area of the spine (T10 to L2 region), with ≥ 25° kyphosis versus those with less kyphotic curvature. The trauma registry records of two level 1 trauma centers using ICD-9 codes for fracture to the thoracolumbar juncture (T10 to L2 region) were reviewed. Kyphosis angle was measured on the standing lateral thoracolumbar (T1 - L5) radiograph at initial trauma and at clinical follow-up. Functional outcome questionnaires, including the Oswestry Disability Questionnaire (ODQ), the Roland Morris Disability Questionnaire (RMDQ), and the Nottingham Health Profile (NHP), were evaluated at clinical follow-up. Work status and medication used after trauma also were recorded. A total of 38 patients met the inclusive criteria. Seventeen patients (45%) had ≥ 25° kyphosis and 21 patients (55%) had < 25° kyphosis at follow-up. These two groups were similar based on sex and age. Based on the ODQ Score, the RMDQ Score, and the NHP, no statistically significant differences were detected between the two groups in regards to energy, pain, mobility, emotional reaction, social isolation, and sleep. Patients who sustained a fracture to the thoracolumbar area of the spine with ≥ 25° kyphosis do not report worse clinical outcomes. When using the kyphosis angle as an indication for surgery, it should be used with caution and not exclusively.

Interobserver agreement using Schlapbach graded scale for diffuse idiopathic skeletal hyperostosis (DISH): can we reduce the cut-off point of vertebral affection?

Resnick-Niwayama criteria for diagnosing DISH depict an advanced stage, and a new reduced cut-off point with three contiguous vertebrae affected (two bone bridges) has been proposed. The aim has been to know the interobserver agreement by using a graded scale of DISH in which grade II matches with the new proposed cut-off point and grade III matches with the first criterion of Resnick-Niwayama. Males ≥ 50years and postmenopausal women included in a population-based prospective study (the Camargo Cohort) were analyzed. Sample size was obtained according to an expected kappa of 0.95 and an accuracy of ± 8%. Three physicians applied independently Schlapbach graded scale (ranged from grade 0, no ossification, to grade III, ≥ 3 consecutive bone bridges) on the lateral radiographs of thoracic and lumbar spine of participants. We calculated inter- and intra-observer agreement and correlation. One hundred and fifty eight radiographs (79 patients, 68 ± 9years) were assessed. Kappa values (95% confidence interval) for grades 0, I, II, and III were 0.63 (0.50-0.77), 0.49 (0.37-0.62), 0.32 (0.17-0.47), and 0.69 (0.60-0.77), respectively. Weighted kappa for the three pairs of raters were 0.87 (0.82-0.93), 0.84 (0.77-0.91), and 0.81 (0.72-0.90). Grade III was the image that generated greater agreement, while a significant decrease was noted in grade II, the new proposed criterion. The simultaneous presence of an incomplete DISH and osteoarthritis, in a thoracic spinal segment with peculiar anatomical characteristics (reduced disk spaces, kyphotic curve), is thought to be a major cause of variability in the results.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P82. Surgical strategy for congenital scoliosis associated with asymptomatic tethered cord

BACKGROUND CONTEXT A few studies in surgical treatment of congenital scoliosis have been associated with asymptomatic tethered cord. PURPOSE To evaluate the safety and effectiveness of correction of congenital scoliosis associated with asymptomatic tethered cord without untethering it. STUDY DESIGN/SETTING A case series. PATIENT SAMPLE Twenty-six patients. OUTCOME MEASURES Cobb angle of major coronal and kyphotic curve. METHODS Twenty-six patients with asymptomatic tethered cord who underwent congenital scoliosis correction were presented. There were 17 male and 9 female with an average 15.2years (range 13–22). RESULTS The preoperative Cobb angle of major coronal curve averaged 55° (range 38°–74°), and it measured 21° (range 13°–35°) at the last follow-up, for a 62% correction. Maximal kyphosis averaged 43° (range 32°–54°) preoperatively, and improved to 23° (range 16°–38°) at ultimate follow-up, for a 46% correction. The average follow-up was 6.5years (4–8 years). None of the patients experienced deterioration in their neurologic status. CONCLUSIONS The study results suggested that prophylactic neurosurgery may be unnecessary in patients with asymptomatic tethered cord who underwent congenital scoliosis correction. One-stage posterior correction of scoliosis in this patient population does not involve significant complications and seems to be an alternative and safe treatment option.

Combined Effects of Postural Education, Therapeutic Massage, Segmental Stretching, and Motor Control Exercise in a 19-Year-Old Male with Chronic Back Pain and Kypholordotic Posture: A Case Report

Introduction: Sagittal spine malalignment has been linked with a number of health consequences including pain, disability, and suboptimal quality of life. Case Presentation: We present a 19-year-old male with 3 years history of chronic back pain associated with kypholordotic posture. Upon examination, lumbar hyperlordosis and thoracic hyperkyphosis were mainly associated with muscular imbalance around the chest, upper back, and lumbopelvic-hip region. The patient received treatment comprising postural education (PE), therapeutic massage (TM), segmental stretching exercise (SSE), and motor control exercise (MCE) twice a week for 8 weeks. The patient demonstrated a significant improvement in lumbar lordotic (83.80 to 76.30) and thoracic kyphotic (65.20 to 60.60) curves as measured by flexible ruler, back pain (7.0 cm to 1.0 cm) as measured by visual analogue scale, spine ranges of motion (flexion: 5.2cm to 7.5cm; extension: 3.5cm to 4.7cm) as measured by modified Schober’s test, and functional disability (46.7% to 20.0%) as measured by modified Oswestry disability index. Conclusions: The results showed that the combination of PE, TM, SSE, and MCE was effective in improving sagittal spine alignment, back pain, spine range of movement, and function.

SURGICAL TREATMENT OF CHILDREN WITH CONGENITAL LUMBAR SCOLIOSIS: COMPLETE OR PARTIAL RESECTION OF MALFORMED VERTEBRAE?

The purpose of the study – to compare the effectiveness of surgical correction of spine lumbar congenital deformity by complete or partial resection of the abnormal vertebra in children.Material and methods. 68 children with isolated congenital malformation of the lumbar area of the spine were evaluated both clinically and instrumentally. Age of the patients was 6 months — 16 years 2 months (mean — 4 years 5 months). There were 41 female and 27 male patients. Patients were divided in two groups depending on the volume of the surgery. First group (n = 52) consisted of patients treated with complete hemivertebrae resection. Second group (n = 16) consisted of patients treated with partial resection of the malformed vertebrae.Results. After the surgery in the 1st group scoliotic curve was 0 to 21° and kyphotic curve was from -33 to 9°. 9 years post-op scoliotic and kyphotic curves were 0 to 22° and -31 to 10° respectively. In the 2nd group scoliotic curve was 3 to 27° and kyphotic curve was from -30 to 12°. 9 years post-op scoliotic and kyphotic curves were 7 to 41° and -26 to 8° respectively. Significant differences in the amount of scoliotic curve correction were revealed between the groups: in the 1st group mean Cobb angle for the scoliotic curve after surgery was 3,3° (correction — 94%), in the 2nd group — 13,6° (correction — 80%) (p0,05). Mean Cobb angle for the scoliotic curve in the long-term period was 5° (correction — 92%) for the 1st group wich was significantly lower (p0,05) comparing to the 2nd group (mean Cobb angle 18,3° correction — 62%).Conclusion. Our data showed higher efficacy of the complete resection of the hemivertebrae comparing to its partial resection in pediatric patients with isolated malformation in the lumbar spine. Complete removal of the vertebrae body, its growth plates and disks allowed to achieve radical correction of the deformity and to perform short fusion of the adjacent segments which was crucial for further normal growth and development of the child’s spine with saving the results in the long-term period. Thus complete resection of the malformed vertebrae with radical correction and short segment fusion is the most appropriate option in surgical treatment of pediatric patient of any age with isolated vertebrae malformation in the lumbar spine.

Scheuermann’s disease in a juvenile male from the late Roman necropolis of Torrenueva (3rd–4th century CE, Granada, Spain)

This study details a severe case of Scheuermann’s disease (SD) in a well-preserved skeleton of a juvenile male (designated TOR302), dated to 3rd–4th century CE, from the late Roman necropolis of Torrenueva (Granada, Spain). Individual TOR302 shows an evident kyphotic curve in the thoraco-lumbar spine, which is characterised by: (i) vertebral bodies of thoracic vertebra T2, thoracic segment T4–T9, and thoraco-lumbar segment T12–L2 wedged at >5°; (ii) slight anterior extensions of the epiphyseal ring; (iii) Schmorl’s nodes on the superior and/or inferior plates; and (iv) a Cobb angle of 75°, derived from thoracic segments T4–T9. In addition, TOR302 shows other skeletal malformations as the secondary results of abnormal growth, due to altered biomechanical forces imposed by the spinal deformity, including: (i) lateral distortion of the spine that causes a slight secondary scoliotic curve; (ii) pelvic obliquity; and (iii) discrepancy in the length of the limbs. We argue that the secondary skeletal abnormalities allowed the individual to adapt to his spinal deformity meaning he was able to walk without the aid of a stick. Despite SD being a common modern clinical finding, few cases have been reported in ancient skeletal remains. This case therefore represents an important contribution to the palaeopathological literature.

Age-related changes in thoracic skeletal geometry of elderly females

ABSTRACTObjective: Both females and the elderly have been identified as vulnerable populations with increased injury and mortality risk in multiple crash scenarios. Particularly in frontal impacts, older females show higher risk to the chest and thorax than their younger or male counterparts. Thoracic geometry plays a role in this increase, and this study aims to quantify key parts of that geometry in a way that can directly inform human body models that incorporate the concept of person age.Methods: Computed tomography scans from 2 female subject groups aged 20–35 and 65–99 were selected from the International Center for Automotive Medicine scan database representing young and old female populations. A model of thoracic skeletal anatomy was built for each subject from independent parametric models of the spine, ribs, and sternum, along with further parametric models of those components’ spatial relationships. Parameter values between the 2 groups are directly compared, and average parameter values within each group are used to generate statistically average skeletal geometry for young and old females. In addition to the anatomic measures explicitly used in the parameterization scheme, key measures of rib cage depth and spine curvature are taken from both the underlying subject pool and from the resultant representative geometries.Results: Statistically significant differences were seen between the young and old groups’ spine and rib anatomic components, with no significant differences in local sternal geometry found. Vertebral segments in older females had higher angles relative to their inferior neighbors, providing a quantification of the kyphotic curvature known to be associated with age. Ribs in older females had greater end-to-end span, greater aspect ratio, and reduced out-of-plane deviation, producing an elongated and overall flatter curvature that leads to distal rib ends extending further anteriorly in older individuals. Combined differences in spine curvature and rib geometry led to an 18-mm difference in anterior placement of the sternum between young and old subjects.Conclusions: This study provides new geometric data regarding the variability in anthropometry of adult females with age and has utility in advancing the veracity of current human body models. A simplified scaffold representation of underlying 3-dimensional bones within the thorax is presented, and the reported young and old female parameter sets can be used to characterize the anatomic differences expected with age and to both validate and drive morphing algorithms for aged human body models. The modular approach taken allows model parameters to hold inherent and intuitive meaning, offering advantages over more generalized methods such as principal component analysis. Geometry can be assessed on a component level or a whole thorax level, and the parametric representation of thorax shape allows direct comparisons between the current study and other individuals or human body models.

Development of spinal deformities in the tight-skin mouse

Tight-skin (TSK) mice are commonly used as an animal model to study the pathogenesis of Marfan syndrome (MFS), but little is known of their skeletal phenotype and in particular of the development of the spinal deformities, common in MFS. Here we examined growth of the axial skeletons of TSK and wild-type(B6) mice during their period of rapid growth. The whole bodies of mice, 4–12 weeks of age, were scanned after sacrifice, by micro-computed tomography (microCT). We reconstructed three-dimensional models of the spine and ribs, and measured vertebral body heights and rib lengths using the Mac-based image-processing software “OsiriX”. Although the TSK mice were smaller than the B6 mice at 4 weeks, they experienced an early growth spurt and by 8 weeks the height, but not the width, of the vertebral body was significantly greater in the TSK mice than the B6 mice. Measurement of the angles of scoliotic and kyphotic curves post-mortem in the mice was problematic, hence we measured changes that develop in skeletal elements in these disorders. As a marker of kyphosis, we measured anterior wedging of the vertebral bodies; as a marker for scoliosis we measured asymmetries in rib length. We found, unlike in the B6 mice where the pattern was diffuse, wedging in TSK mice was directly related to spinal level and peaked steeply at the thoracolumbar junction. There was also significant asymmetry in length of the ribs in the TSK mice, but not in the B6 mice. The TSK mice thus appear to exhibit spinal deformities seen in MFS and could be a useful model for gaining understanding of the mechanisms of development of scoliosis and kyphosis in this disorder.

Posterior-only surgical correction of adolescent idiopathic scoliosis: an Egyptian experience.

Introduction: The aim of this prospective case series study is to document safety and effectiveness of high density pedicle screws through posterior only approach with intraoperative wake-up test in correction of adolescent idiopathic scoliosis (AIS).Methods: Between 2011 and 2015, all surgically treated patients for AIS were followed up for a minimum of 2 years. Clinical outcomes were evaluated using scoliosis research society-22 (SRS) questionnaire. All patients were classified according to Lenke classification. Major and minor curves Cobb angle as well as sagittal parameters were measured on whole spine X-rays. All patients underwent an intra-operative wake-up test after deformity correction and a minimum of 80% metal density of implants was used.Results: This study included 50 patients. The mean age at time of surgery was 16.8 years. The mean follow-up period was 38.1 months. The mean correction rate for the coronal Cobb angle of the major curve was 79.12%, while that of the minor curve was 68.9%. The mean thoracic kyphosis angle was 38.4° preoperatively, 29.76° postoperatively and 30.36° at the last follow-up. The mean SRS-22 questionnaire scores improved significantly at the last follow-up (P > 0.001). There were no neurological deficits at the wake-up test. No cases of pseudarthrosis or metal failure were encountered.Conclusion: This is a prospective study of at least 80% metal density pedicle screws technique and intra-operative wake-up test in Egyptian patients with AIS. It proved to be an effective and safe technique in correction of radiological parameters, with no neurological or implant related complications. It allowed excellent scoliotic and kyphotic curves correction with minimal loss of correction. On the whole it led to better quality of life.

Walking Out of the Curve: Thoracolumbar Kyphosis in Achondroplasia.

Thoracolumbar kyphosis (TLK) is common in infants with achondroplasia. Our goals were to examine the natural history of TLK and identify factors associated with persistent TLK. We reviewed records of patients with achondroplasia seen by a board-certified orthopaedic surgeon at a tertiary care medical center between 1997 and 2013. Inclusion criteria were minimum 2-year follow-up and radiographs taken at time of presentation, within 6 months of walking age, and within 6 months of the first anniversary of walking age. We defined TLK as kyphosis of ≥20 degrees centered at T12 and L1. We assessed patient demographic characteristics, radiographic parameters (Cobb angle, apical vertebral translation, and apical vertebral wedging for vertebral height and width), and clinical parameters (developmental motor delay, hydrocephalus, presence of a ventriculoperitoneal shunt, and foramen magnum decompression). Developmental motor delay was defined as the inability to sit or ambulate independently by age 14 or 30 months, respectively. Associations between these factors and persistent TLK (ie, unresolved at final follow-up) were evaluated using logistic regression and χ, Fisher exact, and independent t tests. Significance was set at P<0.05. A total of 60 patients were included. Mean values were as follows: age at presentation, 10.9±7.0 months; length of follow-up, 5.7±3.6 years; initial curve, 43.8±11.0 degrees; independent sitting age, 12.6±5.5 months; and independent walking age, 21.1±7.8 months. At walking age and 1 year after walking age, 15% and 58% of patients, respectively, had spontaneous TLK resolution. In total, 30% of patients had persistent TLK at final follow-up. Apical vertebral translation (P=0.001), percentage of apical vertebral wedging for vertebral height (P=0.031), and developmental motor delay (P=0.043) were associated with unresolved TLK. In patients with achondroplasia, TLK resolved at walking age in 15% of patients and after a year of walking in 58% of patients. Earlier bracing may slow TLK progression in patients with achondroplasia and developmental motor delay. Patients with kyphotic curves between 20 and 40 degrees should be examined intermittently for progressive deformity or worsening symptoms of spinal cord compression. Level II.

Orthotic treatment of idiopathic hyperkyphosis with Milwaukee brace.

Hyperkyphosis with unknown reason is common in teenagers and can be corrected by orthotic management. Investigation of orthotic outcomes by Milwaukee brace. Sixty-one patients with idiopathic hyperkyphosis (> 45 degrees) were given Milwaukee brace before skeletal maturity. Hyperkyphosis was measured during the first visit without brace, in-brace, at the end of full-time and part time duration of treatment. After treatment completion, participants were categorized in two groups: with hyperkyphosis of 45 degrees and less (Group I) and more than 45 degrees (Group II). These groups were compared to interpret the treatment outcomes. The mean kyphotic curve was 60.1 (SD ± 7.7) and 71 (SD = 10.1) degrees in Group I and II, respectively. The mean kyphotic curve at the time of full time and part time duration of treatment showed no significant difference in patients successfully completed the treatment (P = 0.10) while there was a significant difference between mean kyphotic curve in full time and part time treatment duration for patients with hyperkyphosis of more than 45 degrees (P < 0.05). Hyperkyphosis of less than 70 degrees can be treated if the in-brace correction is saved in part-time duration.