Scoliotic Deformity Research Articles

Двусторонняя хондромезенхимальная гамартома грудной стенки у детей

Chondromesenchymal hamartoma (CMH) of the chest wall is a rare benign tumor arising from the ribs and affecting mainly infants and young children. Intrathoracic tension syndrome and scoliotic deformities are the leading clinical manifestations in such patients. At the same time, tumor removal, which always includes rib resection, leads to chest wall deformities. The issue of the optimal method of thoracoplasty for such lesions remains unresolved. Our study presents the 15th case of bilateral chondromesenchymal hamartoma of the chest wall among those described in the world literature. Surgical intervention to remove tumor consisted of three stages due to the bilateral lesion and ongoing tumor growth in the postoperative period. Xenopericardial plates and an artificial rib were used as materials for thoracoplasty. Key words: chest wall, children, artificial rib, xenopericardium, thoracoplasty, chondromesenchymal hamartoma

Recognition and evaluation of specific physiotherapeutic techniques in the conservative treatment of adolescents with idiopathic scoliosis. A literature review

Scoliosis is a lateral deformation of the spine in the shape of the letter “S” or “C”, which can be located in different segments of it. Idiopathic scoliosis is the most common form encountered in 80% of scoliosis cases. Its nature or cause is not exactly known, so the classification is related to the age at which the deformity is detected. Purpose: Recognition and application of some specific physiotherapeutic methods as part of the international treatment of scoliosis which physiotherapists should include in their practices to improve the conservative management of adolescents with idiopathic scoliosis in Albania. Methodology: The study presents a theoretical-scientific overview, based on evidence. The search in the database PubMed, Google Scholar, Scopus, and guidelines of physiotherapy evidence included the period 2016-2022, using the keywords: ‘scoliosis’, ‘physiotherapy’, ‘Schroth technique’, and ‘Lion method’. Articles that were not in the English language were excluded. The basis for data processing for this study was 8 articles, which met all the criteria. Results: Specific physiotherapeutic methods proved to be very efficient in the latest studies by reducing the scoliotic deformity angle (Kob) by 5-10°, improving the posture with symmetry of the scapular and pelvic circumference, increasing the articular amplitudes of the back and improving the functions respiratory. Conclusion: All physiotherapists in Albania should know these methods from a theoretical-practical point of view and include them in their professional practices to improve the conservative management of adolescents with idiopathic scoliosis.

Аналіз математичного моделювання біомеханічної моделі гало-гравітаційної тракції при деформаціях хребта в дітей

Halo-gravity traction (HGT) systems are widely used in leading clinics around the world as a staged method for correcting complex (>100°) scoliotic deformities of the spine in children. Today there is no single approach to the use of this technique, and each doctor makes a decision regarding the treatment regimen empirically, based on his clinical experience. Purpose – to investigate with the help of finite element method the stress-strain state of the spine of various degrees of deformation using HGT. Materials and methods. When constructing the computational model, geometric models of various parts of the spine, developed in the laboratory of biomechanics of the State Institution «IPPS named after I.P. Sitenko of the National Academy of Medical Sciences of Ukraine». The following changes were made to the model, in accordance with the purpose of the study: spinal deformity 70° and 100°; added skull model; added model of HGT and its fixation to the skull. Results. When using the HGT system with fixation, the most loaded part of the spine is the T2-T5 vertebrae. It should be noted that with an increase in the degree of deformity, the T4 and T5 vertebrae become loaded. The HGT system with fixation and load equal to half the body weight does not lead to critical values of bone tissue stress in terms of strength. Results. In the treatment of rigid spinal deformities in children with a deformity angle (>100°) using a HGT system, the first stage mathematically proved the effectiveness of this technique, but the maximum recommended load should not exceed 50% of the patient’s body weight. Modeling the correction of spinal deformities using mathematical models makes it possible to analyze the effect of various treatment methods in several versions without surgery. The maximum von Mises stress value of 40.1 MPa is not critical for bone tissue in terms of strength (ultimate strength for cortical bone is 70 MPa). However, when the load is doubled, i.e. with HGT to a load equal to the body weight, the level of stress will also double and exceed the ultimate strength of the bone tissue. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: final element method, spinal deformity, halo-gravity traction.

Spinal osteotomy for children with congenital scoliosis with unilateral unsegmented bar: Preliminary results

Introduction. Segmentation disorder of the lateral surfaces of the vertebral bodies leads to the development of progressive deformity of the spine. Surgical interventions in different variants are the only effective way of treatment. This study examines the use of corrective vertebrectomy in patients with congenital scoliosis with impaired segmentation of the lateral surfaces of the vertebral bodies.
 Objective of the study. To evaluate the results of surgical treatment of children with congenital scoliosis with impaired segmentation of the lateral surfaces of vertebral bodies.
 Materials and Methods. A single-center retrospective study on the basis of the Department of Spinal Pathology and Neurosurgery at the Turner Scientific and Research Center for Pediatric Traumatology and Orthopedics. G.I. Turner for the period from 2014 to 2020. Twenty-six patients were included in the study: 14 girls and 12 boys. The age range was 84 to 144 months. All patients underwent surgical intervention in the volume of a one-stage corrective wedge vertebrectomy. Statistical processing was performed by comparing the reliability of differences in distributions using Wilcoxon t-criterion.
 Results and discussion. The median Cobb preoperative scoliotic deformity was 31, interquartile interval (IQR) = 30.5. The median preoperative lordotic deformity was 29 Cobb, IQR = 29.5. The magnitude of correction of the scoliotic component of the deformity was 84%, (median value after intervention: 5 according to Cobb, IQR = 14.5). The magnitude of correction of pathological lordosis of the thoracic spine was 41%, (median value after intervention: 17 according to Cobb, IQR = 14.5). The obtained results were statistically significant (p 0.05).
 Conclusion. Corrective wedge vertebrectomy is an effective method for surgical treatment of children with congenital spinal deformity with impaired segmentation of the lateral surfaces of vertebral bodies. This method of treatment achieves an average of 84% correction of scoliotic deformity and 41% correction of pathological lordosis.

Evaluation of the idiopathic scoliosis of varying severity treatment effectiveness with transpedicular systems

Introduction Significant success has been achieved in the development of new methods of treatment and rehabilitation of patients with idiopathic scoliosis, however, in many aspects of this problem there is no unambiguous approach to the choice of a correction method, assessment of treatment results.Objective To study the results of treatment of patients with idiopathic scoliosis according to X-ray and MSCT data, as well as according to the questionnaire – the SRS-30, depending on the degrees of the deformity, the type of scoliosis.Material and methods The study is retrospective, single center. Evidence level – IV. In 300 patients with idiopathic scoliosis of varying severity at the age from 10 to 50 years, the immediate and long-term results of elimination of spinal deformity by the method of internal transpedicular fixation were studied. In the study we used polypositional radiography, multislice computed tomography (MSCT) and questionnaire SRS-30.Results In patients with spinal deformity up to 60 ° a year after surgery, no loss of correction was found. After elimination of the deformity at 60–90 °, loss of correction up to 2 ° was observed in 3.6% of patients. In patients with deformity greater than 90 °, the average postoperative progression of scoliotic deformity was 3.5 ± 0.7 °. When examining patients after 2–5 years, there was no loss of correction in the group with initial spinal deformity up to 60 ° and in the group from 60–90 °. In patients with deformity greater than 90 °, the postoperative progression of scoliotic deformity in persons over 25 years old was 4.5 ± 0.6 °, which is associated with degenerative changes in the spine.Conclusion The study of immediate and long-term results showed that 1 year after treatment, 94% of patients rated the treatment result as excellent and good, in 6% – as satisfactory. All patients noted a positive effect of the cosmetic and functional results of treatment, while 56% believed that they looked “better” than before surgery (4 points), 44% rated the effect at 5 points and noted that they looked “much better”. Long-term results were studied in 50 patients 10 years after surgery.

Sclerostin and Its Involvement in the Pathogenesis of Idiopathic Scoliosis.

Idiopathic scoliosis is a disorder of unknown etiology. Bone biopsies from idiopathic scoliosis patients revealed changes at cellular and molecular level. Osteocytic sclerostin is downregulated, and serum level of sclerostin is decreased. Osteocytes in idiopathic scoliosis appear to be less active with abnormal canaliculi network. Differentiation of osteoblasts to osteocytes is decelerated, while Wnt/β-catenin signaling pathway is overactivated and affects normal bone mineralization that leads to inferior mechanical properties of the bone, which becomes susceptible to asymmetrical forces and causes deformity of the spinal column. Targeting bone metabolism during growth by stimulating sclerostin secretion from osteocytes and restoring normal function of Wnt/β-catenin signaling pathway could, in theory, increase bone strength and prevent deterioration of the scoliotic deformity.

Scoliosis Secondary to Lumbar Spine Herniated Nucleus Pulposus in Adolescents: A Case Report

Introduction: Herniated nucleus pulposus (HNP) is infrequent among children and adolescents. The first case of surgical intervention for disc herniation was reported in a 12-year-old child. Since then, very few cases or series of cases have been published. The reactive scoliosis is frequently associated with lumbar HNPs, a compensatory effort to relieve nerve compression. Moreover, reactive scoliosis secondary to lumbar HNP is typically associated with children and usually resolves with effective management of lumbar HNP. Although the surgical intervention is frequently employed among adults, only 0.5% of discectomies are carried out in children <16 years old. The current case report is of a 15-year-old girl, with no history of spinal ailment, who presented with a large disc herniation at L4–L5 region, associated with a reactive secondary scoliosis, which was resolved following a successful surgical intervention.
 Case Report: A 15-year-old female with known case of scoliosis and a history of lower back pain for nine months following a fall while playing football presented at outpatient clinic. She sought medical opinion after two months of persistent pain with radiculopathy to the right side toward big toe. Similarly, there was normal plantar reflex and no clonus or Hoffman sign. There was positive straight leg raise test as well as positive contralateral straight leg raise test. Scoliosis is idiopathic in majority of young patients. However, it might also arise as a part or complication of a triggering health state. Although scoliosis has been frequently associated with lumbar HNP among adolescents, most patients with lumbar disc ailment in this age group might be underdiagnosed initially. Similarly, in our case study the patient was not diagnosed when medical opinion was sought after two months of persistent pain with radiculopathy to the right side toward big toe. The clinical characteristics of pediatric lumbar HNP are usually comparable to those seen in adults; however, one distinguishing feature is that up to 90% have a positive straight-leg raising test. The most common symptom is lumbar pain; limitation of lumbar motility and lassegue are the most common signs. The etiology, pathophysiology, and patterns of the scoliotic posture in cases secondary to HNP remain debated. It is highly recommended to do CT scan in cases of adolescent lumbar HNP to rule out apophyseal ring fracture; accurate diagnosis helps surgeon in planning the appropriate surgical intervention needed. Scoliosis secondary to lumbar disc herniation is observed occasionally, therefore, its clinical significance and pathophysiology are not well-established. However, it is well-recognized that children’s spines have superior adaptive capacity, which shields nervous tissue. An example of this could be scoliosis in patients with root compression, when they bend to the side contrary to the compression, causing an enlargement of the affected foramen and root release. It has been reported that 80% of the patients with disc herniation and scoliosis had the convexity on the side of the root compression. The MRI findings revealed that the scoliosis widened the foramen. Similarly, in our case report the X-ray depicted scoliotic deformity with convexity toward the right side. MRI is the best imaging technique to indicate disc herniation and eliminate other likelihoods in both children and adolescents. Surgical interventions, such as micro-endoscopy discectomy and percutaneous endoscopic lumbar discectomy, could achieve considerable pain relief and function improvement. Our case finding revealed that microscopic discectomy relieved the pain and improved the scoliosis.
 Conclusion: Lumbar disc herniation is a rare entity among both children and adolescent and may also result in scoliosis and lumbar pain with or without sciatica. Therefore, lumbar disc herniation in association with scoliosis need vigilant evaluation of signs and symptoms in addition to appropriate diagnostic imaging. Imaging has a vital role in the diagnosis of underlying disease state and helps in clinical management along with surgical planning. The appropriate treatment is discectomy.

Результаты тотальной артропластики по поводу прогрессирующей дисплазии тазобедренного сустава

Актуальность. При прогрессирующей дисплазии тазобедренного сустава у взрослых тотальная артропластика признается безальтернативным хирургическим вмешательством. В научном и практическом аспектах главной задачей артропластики является максимальное восстановление опорно-двигательной функции или компенсация биомеханических нарушений, а также обеспечение условий для продолжительного сохранения стабильности импланта. Цель работы — исследовать факторы, которые определяют результаты тотального эндопротезирования по поводу прогрессирующей дисплазии тазобедренного сустава в средние сроки наблюдения. Материалы и методы. Обследованы 84 пациента, которые перенесли тотальное эндопротезирование по поводу прогрессирующей дисплазии тазобедренного сустава в течение 2014–2019 годов. Сроки оценивания результатов выбрали на основании наблюдений того, что определенный стабильный уровень достигнутого результата формируется в период от 1 до 3 лет в зависимости от тяжести анатомических нарушений. Результаты. Всего выполнено 116 операций тотальной артропластики. Из них по поводу дисплазии I степени по Crowе — 52 (44,8 %), II — 34 (29,4 %), III — 26 (22,4 %), IV — 4 (3,4 %). Концепция исследования заключалась в изучении факторов, которые влияют на выбор хирургической тактики, особенности послеоперационного восстановительного лечения и функциональные результаты в средние сроки наблюдения. Обобщенные результаты по шкале W. Harris: отличные (средний балл — 92,3) — у 39 (46,4 %), хорошие (средний балл — 86,6) — у 26 (30,9 %), удовлетворительные (средний балл — 78,3) — у 15 (17,9 %), неудовлетворительные (средний балл — 67,4) — у 4 (4,8 %). Состояние костных и мягких тканей в области тазобедренных суставов, а также степень анатомических нарушений являются критическим для успешного выполнения артропластики. После артропластики по поводу дисплазии II и III степени наблюдаются хромота, несоответствие длины нижних конечностей, ощущение слабости мышц. Причинные факторы — асимметричность расположения центра ротации тазобедренных суставов, нарушение бедренного офсета, сколиотическая деформация поясничного отдела позвоночника. Выводы. После артопластики по поводу дисплазии тазобедренного сустава пациенты нуждаются в более продолжительном восстановительном лечении, а результаты артропластики определяются степенью достигнутой компенсации анатомических и функциональных нарушений.

ORTHOPEDIC MANIFESTATIONS OF CONGENITAL VASCULAR MALFORMATIONS OF THE LOWER EXTREMITIES

The spectrum of orthopedic manifestations of congenital vascular malformations of lower limbs remains insufficiently studied. Objective. To analyze the results of examination of patients with orthopedic manifestations of congenital vascular malformations. Methods. 24 patients with various forms of congenital vascular malformations of the lower extremities were examined. Distribution of patients according to the Hamburg classification of vascular malformations: arteriovenous type — 14 patients; venous — 6; capillary — 2; capillaryvenous — 1; lymphatic — 1 patient. The diagnosis of orthopedicpathology was performed on the basis of clinical examination, X-ray, ultrasound, X-ray densitometry. Results. All patients with congenital vascular malformations were diagnosed with orthopedic pathology: leg length discrepancy (75 %), secondary scoliotic deformity (16 %), knee flexion contracture 40° (8 %), flatfoot (12 %), equinus deformity of the foot (8 %), osteoporosis of the affected limb (16 %), areas of pathological reconstruction of the affected bone (lytic areas) (4 %), hip osteoarthritis of the affected limb (grade 2) (4 %). Leg length discrepancy was observed due to the elongation of the affectedlimb — in 16 patients (67 %), shortening — in 2 (8 %). Leg length discrepancy was in the range of 0.5–6 cm. Elongation of the affected limb < 2 cm was noted in 5 patients (21 %), > 2 cm — in 11 patients (46 %); shortening of the affected limb < 2 cm was observed in one patient (4 %), > 2 cm — in one patient (4 %). Among the patients with leg length discrepancy, 61 % had combinations of several orthopedic manifestations of the disease. Conclusions. Patients with congenital vascular malformations have a wide range of orthopedic pathology, among them the leading is leg length discrepancy (75 %) due to elongation(67 %) or shortening of the affected limb (8 %). Leg length discrepancy is most often observed in patients with arteriovenous type of vascular malformation (67 %), elongation of the lower limb > 2 cm (75 %) significantly predominating in this category. Among patients with a difference in the length of the lower limbs in 61 % of cases, there is a combination with other orthopedic manifestations of the disease. Systematization of orthopedic pathology and development lesions’ classification of the musculoskeletal system taking into account the forms of vascular malformation will improve the diagnosisof the disease and improve the tactics of its orthopedic treatment.

Application of the ‘Surgical GPS’ to posterior spinal fusion procedures for scoliosis correction

ABSTRACT Scoliotic deformity correction is usually addressed with a posterior spinal fusion (PSF) approach. PSF operations are significantly invasive but can become safer and more efficient by reducing the number of ligament releases performed. However, PSF pre-operative planning to lessen ligament releases is constrained by current diagnostic imaging, which struggles with soft tissue localization, causing ligament release minimisation to be indeterminable. Patient-specific meshes that encompass vertebrae, intervertebral disks, ligaments, and other soft tissue may more accurately guide these pre-operative planning studies as well as intra-operative, computer-assisted surgery (CAS) systems supporting deformity correction. Further, merging physician-designated anatomical landmarks and pre-existing surgical ontologies into a resource description framework (RDF) format permits real-time, CAS guidance accommodating countless surgical workflows. By combining RDF-driven CAS guidance and patient-specific meshes, preoperative and intraoperative support of PSF procedures can be achieved at an individualised level. This study presents an early implementation of this combination, as the ‘Surgical GPS’.

Гало-гравітаційна тракція при лікуванні складних (>100°) деформацій хребта в дітей із респіраторними дисфункціями

HGT is a safe technique as the world literature describes complications in the form of loosening of the pins or superficial infections of the skin around the pins, which are not significant and do not pose a threat to the patient’s life. Purpose – to improve the results of the ventilation function of the lungs in patients with complex spinal deformities through the preliminary use of halo gravity traction and to introduce an effective and safe method for the treatment of complex spinal deformities in children with respiratory dysfunctions. Materials and methods. 64 children with complex spinal deformities (>100°) were treated in the orthopedic and traumatology department of the Okhmatdet NSPU using halo gravity traction during the period from 2003 until 2018. Of these, 38 are boys and 26 are girls. The average age of the patients was 11.6 years. The average Risser score was 3.8 (P>0.01). Results. According to the data of spirography performed, 46% of patients had moderate ventilation disorders and 54% – severe ventilation disorders (FVC<60% – grade 3 and 4 of ventilation failure). Mixed type disorders were recorded in 83% of patients, and restrictive type disorders in 17% (8/48) of children. After HGT, there was an improvement in pulmonary function indicators: an increase in FVC from 63.19% to 71.77% and FEV1 from 54.71% to 65.46%, Tiffeneau-Pinelli index – from 74.59% to 85.33%. Compared with the initial level of indicators, the improvement in FVC was 13.6% after HGT and 14.6% in dynamics during the year, and FEV1 – 19.6% and 21.6%, respectively. The results obtained indicate a significant improvement in the ventilation function of the lungs, especially due to the degree of FEV1 increase, which correlates with the degree of improvement in performance, mortality and life prognosis. Conclusions. The use of HGT makes it possible to improve the results of the final correction of spinal deformity, which in turn significantly improves the ventilation function of the lungs, which in turn helps to reduce the risks of mortality due to pulmonary insufficiency in adulthood. The choice of the appropriate methods of surgical correction for complex deformity of the spine is a prerequisite for successful treatment and the achievement of three-dimensional correction of the spine to maximally approximate its parameters to the physiological norm. The indication for halo gravity traction is a rigid scoliotic deformity of the spine with a deformity angle (>100°). This study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethics Committee of the institutions mentioned in the work. Informed parental agreement was obtained for the research. No conflict of interests was declared by the authors. Key words: spinal deformity, respiratory dysfunctions, halo-gravity traction.

Complications of surgical treatment of idiopathic scoliosis in adolescents

Introduction. In modern literature, there are still debates on causes of the most common complications after surgeries for idiopathic scoliosis in adolescents and their risk factors. Currently, there are growing potentials to reduce the length of patients’ postoperative stay in hospitals, but it arises the need for attending physicians to know better the main types of complications of juvenile idiopathic scoliosis after surgery, their risk factors so as to predict and avoid them, to develop an individual program for patient’s management in the postoperative period, especially for patients from the risk group.Material and methods. Literature search was done in databases Pubmed, Medline, Google Scholar, using key words, on complications of surgical correction of juvenile idiopathic scoliosis.Results. On analyzing the obtained literature data, two large groups of postoperative complications were described in details: somatic and neurological. In addition to most common complications, some rare ones are described too which include superior mesenteric artery syndrome and distant deep infections.Conclusion. Over the past twenty years, the incidence of postoperative complications after surgical correction of scoliotic deformities has significantly decreased. When analyzing findings of various trials, it can be concluded that the overall complication rate decreased in 2004-2007 from 5.7% (2000-2003) to 4.95% and then to 0.98% (2013-2016). Despite the general decrease in the incidence of complications, the latter still remain a problem for clinicians. The basic risk factors for such complications are: concomitant renal pathology, large volume of surgical blood loss, significant increase of exposure to anesthesia and surgical intervention, application of stainless steel constructions, anterior or combined surgical access, refusal of intraoperative neuromonitoring.

The first experience of anterior dynamic correction of scoliosis in adolescents with complete growth and adults: surgical technique and immediate results

Objective. To describe the technique of anterior scoliosis correction in patients with completed growth and to analyze immediate results of its application.Material and Methods. Study design: retrospective clinical series. Level of evidence IV (D). A retrospective analysis of clinical and radiological data of 19 patients aged 13–44 years, who underwent anterior dynamic correction of typical idiopathic scoliosis, was performed. Patients were divided into groups as follows: Group 1 (Lenke type 1 scoliosis) – 8 patients; Group 2 (Lenke 3) – 4 patients; and Group 3 (Lenke 5) – 7 patients. When analyzing clinical and radiological data, the age was taken into account; the deformity magnitude before and after surgery, and correction angle, were studied; and intraoperative blood loss, the number of fixed levels, duration of surgery and hospital stay length were evaluated. The functional status was assessed using the VAS and the SRS-22 questionnaire. Control examinations were carried out before and after surgery as well as at 4–6 weeks and 3, 6, and 12 months after surgery. The search for statistically significant differences was carried out between all groups in pairs: between groups 1 and 2, 2 and 3, and 1 and 3. Statistical analysis was conducted using Mann – Whitney U-test. The SRS-22 and VAS data were processed using the Wilcoxon W-test.Results. The number of dynamically fixed levels varied from 6 to 12. The most proximal level of fixation was T5, the most distal – L4. The average time of surgery was 181 ± 28 minutes for transthoracic access and 198 ± 34 minutes for thoracophrenolumbotomy. The average length of hospital stay was 7.2 ± 1.5 days. In the intergroup comparison of indicators of age, mean angle of deformity before and after surgery, mean angle of correction and blood loss between groups with Lenke 1 and 3 scoliosis, no statistically significant differences were found. Comparison of the same indicators for groups with Lenke 1 and 5 scoliosis showed significant differences in the angles of deformity after surgery and in the number of fixed levels (p = 0.024 and p = 0.006, respectively). There were also no statistical differences between types 1 and 5. At 3 months after surgery the average SRS-22 score for all patients was 4.0 ± 0.42 (from 3.00 to 4.95). The VAS score changed from 6.9 ± 1.5 (4.0–9.0) before surgery to 4.4 ± 1.6 (1.0–7.0) which indicates the effectiveness of the treatment in the short term.Conclusion. Analysis of the immediate results of anterior dynamic correction of Lenke type 1, 3 and 5 scoliotic deformities in physically active young adults showed positive primary effectiveness in terms of VAS and SRS-22, which makes it possible to recommend this technique for use in the presented cohort of patients. The method is effective for all studied types of scoliosis, with a greater efficiency in Lenke types 1 and 5. Further evaluation of long-term results on a larger clinical material will allow developing more precise indications and an algorithm for application of the method.

Changes in Coxo-Vertebral Parameters in Scoliotic Deformity of the Spine

Considering the pathology of the spine and hip joint, it is necessary to take into account their biomechanical relationships under axial loading. Scoliotic deformity leads to the development of compensatory misalignment and inclination of the pelvis, resulting in a functional shortening of one of the lower extremities, which, in turn, leads to the formation of degenerative changes in the hip joint. The development of degenerative changes in the hip joint depends on the degree of scoliotic deformity, taking into account changes in the sagittal and frontal balance. However, research studies state that scoliotic spinal deformity 40 did not cause a pronounced degenerative process in the hip joint area. In our review we studied and analyzed clinical and radiological data of patients operated on for 4 years at the spine surgery department of the National Medical Research Center of Traumatology and Orthopedics named after R.R. Vreden for scoliotic deformity 3-4 degrees. All patients underwent a teleroentgenogram of the spine with the capture of the upper third of the thigh in two projections. According to X-ray data, the angles of the lumbar lordosis, the inclination of the sacrum, the inclination of the pelvis, the deviation of the pelvis from the vertical, the angles of misalignment of the pelvis, the determination of the angle of inclination of the acetabulum in the vertical plane (Sharpe's angle)), sagittal and frontal balance were assessed. The presence of concomitant diseases of the hip joints was separately registered. To assess the correlation, Kendall's coefficients and Student's t-test were used. The study involved 60 patients (47 women and 13 men), aged on average 29.7. When evaluating the correlation, it was found that the Sharpe angle on the left (S) correlates with the Sharpe angle on the right (R), the Sharpe angle (R) correlates with hip dysplasia, where Lumbar lordosis (GLL) correlates with Sacral slope (SS), Sacral slope (SS) correlates with the pelvic incidence (PI). Pelvic deviation from the vertical (PT) correlates with PI, PI before surgery most strongly correlates with PI after surgery (for all values p 0.01). In addition, PI in patients with unilateral lesions of the hip joint is higher than in patients with bilateral lesions, which proves that there is no relationship between PI and GLL in this category of patients. According to the results of our study, changes in coxo-vertebral parameters did not change significantly in the pre and postoperative period, with the exception of lumbar lordosis and sagittal balance.

Management of thoracic spinal cord injury in a professional American football athlete: illustrative case.

BACKGROUNDA case of catastrophic thoracic spinal cord injury (SCI) sustained by a professional American football player with severe scoliosis is presented.OBSERVATIONSA 25-year-old professional football player sustained an axial loading injury while tackling. Examination revealed a T8 American Spinal Injury Association Impairment Scale grade A complete SCI. Methylprednisolone and hypothermia protocols were initiated. Computed tomography scan of the thoracic spine demonstrated T8 and T9 facet fractures on the left at the apex of a 42° idiopathic scoliotic deformity. Magnetic resonance imaging (MRI) demonstrated T2 spinal cord hyperintensity at T9. He regained trace movement of his right lower extremity over 12 hours, which was absent on posttrauma day 2. Repeat MRI revealed interval cord compression and worsening of T2 signal change at T7-T8 secondary to hematoma. Urgent decompression and fusion from T8 to T10 were performed. Additional treatment included high-dose omega-3 fatty acids and hyperbaric oxygen therapy. A 2-month inpatient spinal cord rehabilitation program was followed by prolonged outpatient physical therapy. He currently can run and jump with minimal residual distal left lower limb spasticity.LESSONSThis is the first known football-related thoracic SCI with idiopathic scoliosis. Aggressive medical and surgical intervention with intensive rehabilitation formed the treatment protocol, with a favorable outcome achieved.

Orthopädische Technik und neuromuskuläre Skoliosen

Children and adolescents with neuromuscular scoliosis usually undergo severe challenges with their respiratory and locomotor systems during growth. Early onset scoliotic deformities take awhole team of specialists to ease the problematic side effects associated with poor posture and seating abilities. Wheelchairs and seating shells need to be adjusted as does suitable bracing for the collapsing spine. Key issues are the maintenance of proper lung function and upright sitting in the wheelchair or seating shell. Although spine bracing can be helpful and has its place in seating, the natural history of progression in neuromuscular curvatures is rarely sustainably stopped. While bracing is sometimes not tolerated by patients with severe hypotonic thoracic collapse and breathing issues, it can otherwise buy time for some patients to gain height and weight before surgical intervention inevitably takes place.

«Conscious correction of scoliosis and posture disorders» in the complex rehabilitation treatment of degrees 1–3 thoracic spine idiopathic scoliosis

BACKGROUND: Severe functional disorders in the internal organs and systems of the body, increased fatiguability, and cosmetic body shape defects that lead to social and psychological problems, as well as the potential adverse effect of the progression of scoliotic deformity, necessitate the constant monitoring and timely treatment of sick children until their bone growth is completed. Thus, early diagnostics of scoliosis and timely combination therapy at the early stages of the disease are required.
 AIM: This study aimed to compare the efficiency of spinal deformity correction and apical vertebrae derotation in pediatric patients with thoracic spine idiopathic scoliosis and justification of the use of physiotherapy exercise method, Conscious correction of scoliosis and postural disorders (DCS) in children and adolescents with degrees 13 thoracic spine idiopathic scoliosis (IS).
 MATERIALS AND METHODS: This study included 98 patients with IS under supervision (78 (79.6%) females and 20 (20.4%) males). The average age of subjects was 12.5 years (916 years), namely 25 patients aged 911 years, 42 patients aged 1214 years old, and 31 patients aged 1416 years old. The anatomical type of deformity and its parameters were determined according to radiographs and clinical examination data (81 cases of right-sided thoracic scoliosis and 17 left-sided thoracic scolioses). The angular deformity was assessed according to J.R. Cobb, and the angle of curvature was 736. At baseline, all patients had active growth bone plasticity of the spine. Depending on the degree of deformity, they were distributed into groups of 37 patients with 716, 33 patients with 1722, and 28 patients with 2336. The radiograph analyses of the spine were performed in frontal and lateral projections in an upright position (frontal and sagittal plane curvature in degree measurements). Radiography was performed before the complex therapy and 2 years thereafter, which included individual isometric, derotation, respiratory, and other complexes of physiotherapy exercises according to the methods of DCS, K. Schroth, and Chneau corsetting.
 RESULTS: The changes over time of scoliotic deformity angle correction are closely related to the time of diagnosis, which was noted in all patient groups under study.
 CONCLUSIONS: Early diagnostics of thoracic spine IS and the use of DCS remedial gymnastics within the program of timely conservative treatment eliminated the disease progression in patients with deformity up to 17. In the case of IS of 20 and more, the combined use of the Chneau corset and exercise therapy using the DCS method achieved significant stabilization and correction.

Prediction of Scoliosis Curve Correction Using Apical Fulcrum Bending Radiographs in Adolescent Idiopathic Scoliosis (AIS)

Background: Scoliosis is defined as a three-dimensional deformity of spine. Surgical treatment is indicated for curves equal to/or more than 40 degrees in magnitude. Curve flexibility is determined preoperatively through bending films, which help in the selection of fusion levels. Surgical treatment for fully-grown spine is a spinal fusion use to inhibit the progress of deformity which further helps in balancing of both sagittal and coronal planes. Therefore, this study aimed to find out the association between predicted via bending films after correction and final surgical correction of skeletally mature patients with Adolescent Idiopathic Scoliosis (AIS). Methods: Thirty-three patients with Adolescent Idiopathic Scoliosis (AIS) were recruited for the study. Those patients were operated at Dr. Ziauddin University Hospital, Karachi from June 2016 to June 2020. Using Pre- and post-operative radiographs of the spine, Cobb values were used to calculate the percentage of correction achieved. Percentage correction (surgical) was then compared to correction possible (predicted) to find association via an independent t-test with p<0.05 considered as statistically significant. Results: Out of total 33 patients, 24 (72.7%) were females and 9 (27.2%) were males. The mean age of the patients was 17.2±3.0 years. Using bending films, correction of the scoliotic deformity was predicted through measured angles with 78±18°. The corrections’ difference was 84.5±11°. This difference was found to be statistically insignificant (p=0.0769) which showed no difference in predicted and actual correction achieved. Conclusion: In skeletally mature patients with AIS, bending films have been shown to accurately predict the amount of postoperative correction of Cobb’s angle which is possible. Keywords: Age Determination by Skeleton; Scoliosis; X-Ray Film; Spinal Curvatures.

Rastersterographic measurement of scoliotic deformity: reducing X-ray exposure in adolescent idiopathic scoliosis patient

article: Rastersterographic measurement of scoliotic deformity: reducing X-ray exposure in adolescent idiopathic scoliosis patient - Minerva Orthopedics 2021 June;72(3):250-7 - Minerva Medica - Journals

The mechanobiology of differential growth in Adolescent Idiopathic Scoliosis.

Introduction: Adolescent Idiopathic Scoliosis (AIS) is a multifactorial disorder that has been linked to genetic, hormonal, neurological, microbial and environmental cues. Eventually, however, AIS is a mechanical deformation of the spine, so an adequate theory of etiopathogenesis must provide an explanation for this and address the forces involved. Objective: In previous research with a physical model of the spine we showed that restrained differential growth, a mismatch of growth in mutually attached tissues, can result in the typical sequence of three-dimensional deformations seen in AIS.[1] Here we aim to identify the mechanobiological principles that may underlie this phenomenon and explain the deformities observed. Methods: We performed a literature study in Pubmed using the keywords growth, spine, tensegrity, muscle strength, vertebral body, growth plate, Hueter-Volkmann Law, intervertebral disc height, ligament, notochordal cells, and osmosis. Relevant information was gathered and combined for a comprehensive theory of etiopathogenesis for AIS. Results and Discussion: The human body is a tensegrity-like structure, in which muscles, ligaments and fasciae stabilize the skeleton. As the child grows, bone and cartilage elongate the muscles, ligaments and fasciae and induce their remodeling and growth. Considering the literature, we suggest the following scenario for the etiopathogenesis of AIS. During the growth spurt, there is a delay in muscular maturation, resulting in lowered prestress and decreased stability of the skeleton. According to Hueter-Volkmann, reduced axial compression enhances the growth of bones, which is indeed observed in AIS patients. Decreased spinal compression further results in lower vertebral bone density and increased disc height. Reduced dynamic loading also preserves the notochordal cells in the nucleus pulposus, which stimulates the production of proteoglycans and the assembly of the osmotic extracellular matrix. This intradiscal pressure increases intervertebral disc height to its limits, rendering the longitudinal ligaments and the annulus fibrosus under excessive tension (Figure 1). Under these conditions, spinal ligaments cannot remodel and therefore not grow with the intervertebral discs. The enhanced intradiscal pressure and locked ligamental remodeling embody the differential growth of the spine that results in scoliotic bending and rotation. Conclusion and Significance: AIS has been related to many physiological cues, yet the deformations observed remain essentially unexplained. The suggested differential growth mechanism fits well with the timing and speed of scoliotic deformations during the adolescent growth spurt. The identification of increased intradiscal pressure as the driving force of scoliotic deformities may be helpful to design prevention and treatment strategies for AIS.