Scoliotic Group Research Articles

The back body temperatures of patients with idiopathic scoliosis measured through exercise.

Aerobic exercise is closely associated with the vital functions of patients with scoliosis. Infrared thermography (IRT) has been increasingly applied in physiological measurements in recent years. This observational study aimed to use IRT to examine the back body surface temperatures of patients with idiopathic scoliosis during aerobic exercise. Forty-two participants who completed a pre-test were divided into a scoliotic group and a non-scoliotic group. Both groups completed a 30-minute cycling exercise, during which their back body temperature was measured using IRT, and the root-mean-square of the back electromyography value after 30minutes of aerobic exercise was analyzed. The back body temperature decreased significantly after 30minutes of exercise in the non-scoliotic group. In contrast, the back body temperature (at the trapezius and quadratus lumborum muscles) was asymmetric or increased after exercise in the scoliotic group. These findings suggest that when patients with scoliosis exercise, their back body temperature should be assessed thoroughly to prevent adverse physiological reactions potentially caused by back body temperature imbalances as well as the potential health problems caused by poor heat dissipation. In addition, such observations can be useful in the early screening of scoliosis.

The Influence of the Dominant Leg in Body Asymmetries in Children and Adolescent Male Soccer Players.

The current study aimed to examine (a) whether the dominant leg (DL) was associated with the contralateral side of functional scoliosis and (b) if any of the postural asymmetries' evaluation variables may be a reliable predictor of the functional scoliosis development in young male soccer players. Six hundred-nine (n = 609) male soccer players (age: 10.8 ± 2.7 years; height: 147 ± 17 cm; weight: 43.4 ± 14.6 kg; DL: Right 81.6%, Left 14%, Both 4.4%) participated in this study. The spinal asymmetries evaluation included thoracic kyphosis, lumbar lordosis, truncal rotation, shoulders alignment from posterior view, anterior and posterior pelvic tilt, anterior superior iliac spine (ASIS), hamstring tightness, and lower extremities discrepancy. A significant association was observed between the DL and the truncal rotation side: χ2(4) = 30.84, p = 0.001, V = 0.16. Participants with longer left legs were likelier to present a spinal asymmetry (OR = 1.18). The participants with higher left shoulders were 2.13 times more likely to have spinal asymmetry than the participants with normal shoulders level. Participants with left ASIS higher were 3.08 times more likely to present asymmetry than those with normally aligned ASIS levels. There was also a significant association between the DL and the side of truncal rotation: χ2(2) = 13.30, p = 0.001, V = 0.449. Logistic regression analysis for the functional scoliotic group and truncal rotation side demonstrated that the taller participants and participants with shorter right legs were more likely to have asymmetry on the left side (OR = 1.29, OR = 0.32). Participants with greater right hamstring stiffness were likelier to have a truncal rotation on the right side (OR = 0.93). Participants with higher left shoulders were 0.20 times less likely to have a truncal rotation on the left side than the participants with normal shoulders level. In conclusion, leg dominance in children and in youth soccer players may be a factor causing truncal rotation on the contralateral side. Additional causes, such as leg length discrepancy and pelvic tilt, may progressively lead to functional scoliosis.

School Scoliosis Screening: The Influence of Dominant Limbs and Gender

This study aimed to examine whether (a) there is an association of the dominant hand (DH) and leg (DL) with the side of the primary angle of trunk rotation (ATR A) and (b) there are any differences between boys and girls in the degree of the angle of trunk rotation (ATR) and the dominant hand and leg. One thousand sixty-five (age: 14 ± 3 years; height: 162 ± 13 cm; weight: 56 ± 18.7 kg; BMI: 21.18 ± 5.07) secondary school children participated in this study. Of the participants, 52.5% (n = 559) were male students (age: 14 ± 2 years; height: 166 ± 16 cm; weight: 58.7 ± 22.6 kg; BMI: 21.41 ± 5.61), and 47.5% (n = 506) were female students (age: 14 ± 3 years; height: 159.5 ± 8.5 cm; weight: 53.9 ± 14.8 kg; BMI: 21.03 ± 4.38). The ATR was measured with a scoliometer. Boys were taller and heavier (p = 0.001) and had more left DLs (p = 0.039) than girls. Girls were biologically more mature (p = 0.002), also having higher measurements for the ATR A (p = 0.004) and secondary angle of trunk rotation (ATR B) (p = 0.023) degrees compared to boys. In the general sample, only in boys, there was a significant association between the DH (p = 0.012) and DL (p = 0.001) with the ATR A side. Also, within the scoliotic group, only in boys, there was a significant association between the DH (p = 0.048) and DL (p = 0.024) with the ATR A. In conclusion, girls had higher measurements for the ATR than boys, but cross laterality was found only in boys. The results suggest different progression patterns of ATR between genders during their growth. Future research should focus on examining other possible progression mechanisms.

Scoliosis and BMI in patients with Prader-Willi syndrome.

Although scoliosis is commonly seen in patients with Prader-Willi syndrome, the patterns and extent of the deformity may change along their growth. Increased body weight is another issue in these patients, and its relationship with scoliosis is still controversial. The aim of this study was to evaluate scoliosis in patients with PWS, and its relationship with BMI. This was a retrospective cohort study in which a series of radiographic images and BMI from each patient were collected, and the data were rearranged following the age at which they were recorded. These patients were subsequently labeled as non-Scoliotic (<10°), Moderate (10° - 39°), and Severe (≥40°) according to their final Cobb angle, also as Normal (≤85%), Overweight (86%-95%), and Obese (≥95%) according to final BMI percentage. Thirty-four patients with age from 1 to 20 years old were recruited for this study, and the mean length of follow-up was 6.6 years. The prevalence of scoliosis was 71% (24 patients in Moderate, and 9 patients in Severe), and 65.6% were either overweight (11 patients) or obese (10 patients). The mean BMI percentage in non-scoliotic patients was 93.10 ± 13.84, which was significantly higher than that of the scoliotic groups ( P = 0.0180). When looking at the longitudinal change, the non-Scoliotic group had high BMI since childhood, and obese patients had less spine deformity also from early childhood. In this study, we found that the prevalence of scoliosis in Taiwanese population with PWS was 71% without gender preference. Not every patient had a high BMI, and obese patients seemed to have significantly less chance to develop scoliosis. Level III.

Evaluation of the Dynamic Trunk Motion of Scoliotic Patients Using Ultrasound-based Motion Analysis System

This study was investigated the effects of the adolescent idiopathic scoliosis on dynamic trunk motion using ultrasound-based motion analysis system. 15 subjects were participated in this study and divided into three groups according to the curve direction. Experimental procedure was divided into two sections: initial position, and left/right lateral bending position. To analyze the alteration of the trunk motion, ultrasound markers was represented the segments. There were significant differences in angle variation between left and right side during lateral bending for the scoliotic groups. In addition, angle differences between left and right side were decreased gradually according to the regions of scoliotic curvature. From these results, it was concluded that the direction and region of the abnormal lateral curvature can influence on dynamic trunk movement and postural balance. Furthermore, ultrasound-based motion analysis system can be utilized to detect asymmetrical balance and dynamic postural change of idiopathic scoliosis patients in adolescence.

Hip And Knee Abductor Moments In Normal Subjects And Subjects With Idiopathic Scoliosis During Level Walking: Comparative Study

Background: Kinetic analysis appears to be useful in providing objective information regarding the gait abilities of scoliotic patients, which is difficult to be observed in a clinical setting. Objective: the aim of the study was to analyze and compare the hip and knee peak abductor moments in subjects with idiopathic scoliosis and normal subjects during level walking. Methodology: Forty-four male subjects was aged 14-17 years participated in the study. They were assigned into two groups, scoliosis, and control groups. The scoliosis group included 22 subjects with idiopathic moderate right dorso-lumbar curve. The control group contained normal 22 subjects. 3D motion analysis system and force plates were used for data collection for hip and knee abductor moment. MANOVA was used to study the difference between normal and scoliotic groups’ hip and knee abductor moments in both lower limbs at an alpha level of significance of 0.05. Results: During free walking, there was a significant increase in the hip abductor moment contralateral to the scoliotic side, while the ipsilateral side showed non-significant increase when compared with normal subjects. There was a significant increase in the knee abductor moment ipsilateral and contralateral to the scoliotic side when compared with normal. Conclusion: Idiopathic scoliosis could affect the hip and knee gait kinetics in the frontal plane.

Untreated adolescent idiopathic scoliotic girls display altered balance modalities during self-paced voluntary body sways compared to able-bodied girls

IntroductionThis study investigated self-paced voluntary oscillations of scoliotic and non-scoliotic girls. Temporal variables and frequency coherence were calculated for the overall, low and high frequency bandwidths of the center of pressure excursions and free-moment to identify which variables best describe sway balance modalities in both groups. MethodsTwenty-three girls with adolescent idiopathic moderate scoliosis (spinal curves to the right) formed the scoliotic group and 19 matched able-bodied girls formed the non-scoliotic group. Each girl performed self-paced voluntary medio-lateral and antero-posterior sways while standing on a force platform. Center of pressure displacements, out of plane deviation and free-moment were measured and their frequency content calculated. The magnitude of the coherence was calculated for each signal pairs for three frequency ranges. ResultsIn both sway conditions, the center of pressure excursion parameters were on average 28% higher for the scoliotic group. Factor analysis revealed that balance modalities were essentially based on frequency coherence pair interactions whereas temporal parameters play a secondary role. However, these balance modalities were altered in the scoliotic group. They relied essentially on 2 additional principal components and 3 additional variables reflecting a fine tuning of the control mechanism to maintain dynamic balance. InterpretationScoliotic girls appear to be performing a wide ellipsoidal trajectory when performing whole body oscillations. Superfluous variables could be related to the difficulty in preserving balance during body sway tasks and could parasitize the scoliotic dynamic control balance modalities. Self-paced voluntary sways could be an appropriate complementary balance test for untreated scoliotic girls.

Thoracic vertebral morphology in normal and scoliosis deformity in skeletally immature rabbits: A Longitudinal study.

ObjectiveTo measure age‐related changes in thoracic vertebral body heights (VBH) in skeletally immature normative and scoliotic rabbits to assess how VBH change during growth. To examine the potential link between the moment‐arm of the rib tether and vertebral wedging as well as the sum of the curvature angles at the apical level (T7). To assess the correlation between the magnitude of initial spine curve and final spine curve in the scoliotic group.MethodsEight healthy, skeletally immature normative New Zealand rabbits and ten skeletally immature scoliotic rabbits which underwent unilateral rib tethering were included retrospectively. Each rabbit was scanned at two to four time points (at 7, 11, 14 and 28 weeks). Three dimensional bone models of thoracic vertebrae (T1‐T12) were digitally segmented and reconstructed. VBH were calculated using surface landmark points from each thoracic vertebra. Apical level (T7) ± 2 levels in scoliotic rabbits were compared to their corresponding levels and time points in the normative group. The moment‐arms between the centroids of 2D projections of T3‐T9 vertebral bodies and the line which connects the centroids of the end levels were calculated.ResultsBilateral left‐right (L‐R) symmetry and anterior‐posterior (A‐P) asymmetry were observed in normative VBH. Bilateral concave‐convex (CC‐CX) asymmetry and (A‐P) asymmetry were observed in scoliotic VBH. No significant differences in growth rates were found between the normative and scoliotic groups. Vertebral wedging as well as curvature magnitude were positively correlated with the moment‐arms.ConclusionUnilateral rib tether applies compressive forces on both concave and convex sides, whereas compressive forces are lower on the latter. Knowing the amount of vertebral wedging or curve magnitude would enable us to predict the applied force (moment‐arms), which is important for planning a corrective surgery.

Continuous Hypodynamic Change of Cerebrospinal Fluid Flow as A Potential Factor Working for Experimental Scoliotic Formation

Scoliosis is often associated with syringomyelia (SM). As an important role in SM formation, the influence from abnormal cerebrospinal fluid (CSF) flow is still unclear to scoliosis. The aim of this experimental work is to explore the connection between CSF flow and scoliosis through imaging and histological analysis on the basis of a kaolin-induced scoliotic rabbit model. For imaging observation, in 40 kaolin-induced rabbits by C7 spinal cord injection, through pre- and postoperative MRI and radiography, CSF flow and scoliosis formation were detected at consecutive phases. According to the final formation of scoliosis until postoperative week 12, the kaolin-induced rabbits were divided into 2 groups. Through comparing the 2 groups, the relationship between the changes of CSF flow velocity and scoliosis formation were reviewed and analyzed. For histological observation, another 20 kaolin-induced rabbits were used for consecutive histological observations of spinal cord at postoperative 3-day, 2-week, 4-week and 6-week. After kaolin-induction, abnormal spinal coronal curve was observed from postoperative week 6 in the 37 survived rabbits. At postoperative week 12, scoliosis formation was detected in 73.0% kaolin-induced rabbits and the mean Cobb angle was 27.4°. From the comparison between scoliotic and non-scoliotic groups, the difference of the velocities of CSF flow was more obviously from postoperative week 4 to 12, especially after week 6. In the scoliotic group, the peak velocity of CSF flow was diseased gradually following scoliosis formation after induction. Moreover, the decrease of the peak velocities of CSF flow from preoperation to postoperative 12 weeks (ΔVmax), including up-flow (ΔVUmax) and down-flow (ΔVDmax), were positively correlated to the final scoliotic Cobb angle (P < 0.01). Through histological observation at different phases, the distinctive pathological changes of the spinal cord included early inflammatory reaction, adhesion and blockage in the subarachnoid space and the central canal, perivascular space enlargement, central canal expansion, which suggested the CSF flow being blocked by multiple ways after kaolin-induction. In conclusion, experimental scoliosis can be successfully induced by intraspinal kaolin injection. In this model, continuous hypodynamic change of CSF flow was correlated to the formation of scoliosis, which could be an important factor of scoliotic pathogenesis being explored furtherly.

Postural Stability in Adolescent Girls with Progressive Idiopathic Scoliosis.

The aim of this work was to analyze postural stability of girls having progressive form of idiopathic scoliosis and undergoing specific period of the adolescent growth spurt. Twenty-seven girls, aged 13.4 ± 1.2 years, presenting structural idiopathic scoliosis, thoracic or thoracolumbar pattern, radiological Cobb angle 41.7 ± 17.4° (study group) and 37 healthy girls (control group) were included. The groups were sex, age, height, weight, and BMI matched. Postural stability examination was performed using two stabilometric platforms with visual control (eyes open) at three stages: (1) both legs' stance, (2) left leg stance, and (3) right leg stance. The Center of Pressure (COP) sway path length, the area and the displacement amplitude were compared. For the double stance, no difference in postural stability parameters between the groups was found. However, for the right leg stance, the total sway path length was longer (p = 0.04) and the mean amplitude of the lateral COP displacement was increased (p = 0.03) in the scoliotic group. In conclusion, for double stance, the adolescent girls with progressive form of idiopathic scoliosis revealed fair postural stability compared to control group. An impaired postural control was observed during right leg stance.

Frequency coherence analysis of postural balance in able-bodied and in non-treated adolescent idiopathic scoliotic girls

BackgroundThis study test if the frequency coherence calculated for the overall, low and high frequency bandwidths of the center of pressure excursions and free-moment calculated during standing balance are similar between scoliotic and non-scoliotic girls and if the coherence values within each frequency band are comparable for a given group of girls. MethodsTwenty-nine girls with adolescent idiopathic scoliosis formed the scoliotic group and 22 able-bodied girls formed the non-scoliotic group. Each girl maintained a quiet upright stance on a force plate. Three trials were performed at a sampling frequency of 64 Hz for 64 s. Mean anterio-posterior, medio-lateral center of pressure positions and free-moment were measured and their frequency content calculated. The magnitude of the coherence was calculated for each signal pairs for three frequency ranges. ResultsThe magnitude of the medio-lateral center of pressure/free-moment coherence in the low and high frequency bands was significantly different between the groups. Within each group, the magnitude of the medio-lateral center of pressure/free-moment coherence was significantly higher than the other two coherence pairs at low frequencies (P < 0.001). Factor analysis revealed that able-bodied girls exhibited a mixed standing balance modality consisting of posture (center of pressure) and proprioceptive information (free-moment). Scoliotic girls adopted an adaptive modality mostly based on proprioception information to maintain their standing balance. InterpretationScoliotic girls systematically depend on the free-moment to modulate their antero-posterior center of pressure displacements. These results suggest a postural reeducation program aimed at improving proprioception while repositioning the mean center of pressure by postural corrections.

Kyphosis – A risk factor for positioning brachial plexopathy during spinal surgeries

ObjectiveThe aim of this study was to evaluate the differences in transcranial electric motor-evoked potentials – TceMEP on upper limbs and the incidences of postoperative brachial plexopathy between patients with kyphotic and scoliotic trunk shapes. MethodsIn the period of January 2011–January 2017, 61 consecutive patients (mean age: 18.4 years ± 4.4 years (range: 10–32)) with pediatric spinal deformity underwent surgery in our Department. Eight of them had a kyphotic trunk deformity (Scheuermann kyphosis, neurofibromatosis, posterior thoracic hemivertebra), and the rest of the 53 patients had a scoliotic trunk deformity (mostly adolescent idiopathic scoliosis – AIS, lateral hemivertebra). The TceMEP recordings in all four limbs were analyzed every 30 min, or upon the surgeon's command. Upper limb TceMEP recordings were used as a control of systemic and anesthetic related changes, and as the indicator of positioning brachial plexopathy. ResultsFour out of 8 patients (50.0%) from the kyphotic group experienced noteworthy decreases in TceMEP amplitude (≥65%) in one or both arms, and only 2 out of 53 patients (3.8%) from the scoliotic group, confirming significant statistical difference (Chi-square 16.75, p < 0.05). Two out of 8 patients with decreases in TceMEP amplitude suffered from transitory postoperative brachial plexopathy, and both of them were from the kyphotic group. ConclusionIt seems that kyphotic trunks have a higher risk for positioning-related brachial plexopathy, probably due to distribution of trunk's weight onto only four points (two iliac bones and two shoulders), compared to the scoliotic trunks that have wider weight-bearing areas. We emphasize the importance of proper patient positioning and close intraoperative neuro-monitoring of all four limbs in more than one channel per limb. Level of EvidenceLevel IV Therapeutic Study.

Sagittal plane assessment of spino-pelvic complex in a Central European population with adolescent idiopathic scoliosis: a case control study

BackgroundScoliosis is a complex three-dimensional deformity. While the frontal profile is well understood, increasing attention has turned to balance in the sagittal plane. The present study evaluated changes in sagittal spino-pelvic parameters in a large Hungarian population with adolescent idiopathic scoliosis.MethodsEOS 2D/3D images of 458 scoliotic and 69 control cases were analyzed. After performing 3D reconstructions, the sagittal parameters were assessed as a whole and by curve type using independent sample t test and linear regression analysis.ResultsPatients with scoliosis had significantly decreased thoracic kyphosis (p < 0.001) with values T1–T12, 34.1 ± 17.1o vs. 43.4 ± 12.7o in control; T4–T12, 27.1 ± 18.8o vs. 37.7 ± 15.1o in control; and T5–T12, 24.9 ± 15.8o vs. 32.9 ± 15.0o in control. Changes in thoracic kyphosis correlated with magnitude of the Cobb angle (p < 0.001). No significant change was found in lumbar lordosis and the pelvic parameters. After substratification according to the Lenke classification and individually evaluating subgroups, results were similar with a significant decrease in only the thoracic kyphosis. A strong correlation was seen between sacral slope, pelvic incidence, and lumbar lordosis, and between pelvic version and thoracic kyphosis in control and scoliotic groups, whereas pelvic incidence was also seen to be correlated with thoracic kyphosis in scoliosis patients.ConclusionAdolescent idiopathic scoliosis patients showed a significant decrease in thoracic kyphosis, and the magnitude of the decrease was directly related to the Cobb angle. Changes in pelvic incidence were minimal but were also significantly correlated with thoracic changes. Changes were similar though not identical to those seen in other Caucasian studies and differed from those in other ethnicities. Scoliotic curves and their effect on pelvic balance must still be regarded as individual to each patient, necessitating individual assessment, although changes perhaps can be predicted by patient ethnicity.

The effects of scoliosis and subsequent surgery on the shape of the torso

BackgroundAdolescent idiopathic scoliosis (AIS) causes asymmetry of the torso, and this is often the primary concern of patients. Surgery aims to minimise the visual asymmetry. It is not clear how scoliosis makes the torso asymmetric or how scoliosis surgery changes that asymmetry when compared to the distribution of asymmetries seen in a non-scoliotic group of normal controls.MethodsSurface topography images were captured for a group with AIS both pre-operatively and post-operatively. Identifiable points were compared between the images to identify the effects of AIS on the shape of the torso by looking at the relative heights and distances from the midline of the shoulders, axillae and waist in a two-dimensional coronal view. This was then compared to a previously reported group of normal non-scoliotic children to analyse whether surgery recreated normality.ResultsThere were 172 pairs of images with 164 females and 8 males, mean age at pre-operative scan of 13.7 years. The normal group was 642 images (237 females and 405 males) from 116 males and 79 females, mean age of 12.5 years.The curve patterns seen in the scoliotic group matched the patterns of a main thoracic curve (n = 146) and main thoracolumbar curve (n = 26). The asymmetries seen in both shoulders, axillae and waist were different between the two different types of curve. Across both groups, the shoulder asymmetry was less than that of the corresponding axillae.There was a statistically significant reduction in all asymmetries following surgery in the main thoracic group (p < 0.001). This was not seen in the main thoracolumbar group, thought to be due to the small sample size. In the main thoracic group, there were statistically significant differences in the asymmetries between the post-operative and normal groups in the shoulders and axillae (p < 0.001) but not the waist.ConclusionsThis paper demonstrates quantitatively the range of asymmetries seen in the AIS torso and the degree to which surgery alters them. Surgery does not recreate normality but does cause a statistically significant change in torso shape towards that seen in a non-scoliotic group.

Effect of natural sagittal trunk lean on standing balance in untreated scoliotic girls

BackgroundGenerally, scoliotic girls have a tendency to lean further back than a comparable group of non-scoliotic girls. To date, no study has addressed how standing balance in untreated scoliotic girls is affected by a natural backwardly or forwardly inclined trunk. Methods27 able-bodied young girls and 27 young girls with a right thoracic curve were classified as leaning forward or backward according to the median of their trunk sagittal inclination. Participants stood upright barefoot. Trunk and pelvis orientations were calculated from 8 bony landmarks. Upright standing balance was assessed by 9 parameters calculated from the excursion of the center of pressure and the free moment. FindingsIn the anterior-posterior direction, backward scoliotic girls had a greater center of pressure range (P=0.036) and speed (P=0.015) by 10.4mm and 2.8mm/s respectively than the forward scoliotic group. Compared to their matching non-scoliotic group, the backward scoliotic girls stood more on their heels by 14.6mm (P=0.017) and display greater center of pressure speed by 2.5mm/s (P=0.028). Medio-lateral center of pressure range (P=0.018) and speed (P=0.008) were statistically higher by 8.7mm and 3.6mm/s for the backward group. Only the free moment RMS was significantly larger (P=0.045) for the backward scoliotic group when compared to the forwardly inclined scoliotic group. InterpretationOnly those with a backward lean displayed statistically significant differences from both forward scoliotic girls and non-scoliotic girls. Untreated scoliotic girls with an exaggerated back extension could profit more from postural rehabilitation to improve their standing balance.

Analysing Anthropometric Measurement and Body Shape Data to Incorporate Body Asymmetry, due to Scoliosis, into Improved Clothing Sizing Systems

The purpose of this research was to improve current clothing sizing systems of female adolescents with adolescent idiopathic scoliosis (AIS). AIS is a complex, three-dimensional spinal deformity, appearing particularly among children aged 8–14 years, especially in girls (nine girls for one boy), resulting in body asymmetry that could affect a female adolescent’s appearance, compromising her health and ability to function. The study took place in Greece where today scoliosis affects at least 2.9% of the population. Measuring procedures were used that were specifically adapted for body asymmetry and that complied with the appropriate code of ethics. Using front/back and left/right arc measurements, both right and left body halves of 75 females aged 16–22 years diagnosed with AIS were measured in order to register their different body shapes and classify them into different scoliotic groups. Analysis of the measurements related to the trunk documented the asymmetry arising from the different types and degrees of spinal curvature that provided a three-dimensional classification of scoliotic deformities, according to the magnitude and type of scoliosis. As a result of this classification, different size charts were created and mathematically evaluated to correspond to different scoliotic groups.

Impact of Scoliosis on Laparoscopic Nissen Fundoplication.

Scoliosis, which is often associated with neurological impairment in children, sometimes makes it difficult to perform laparoscopic procedures. This study assessed the impact of scoliosis on performing laparoscopic Nissen fundoplication. Medical records and radiographic examinations of patients who underwent laparoscopic Nissen fundoplication at a single institution from 2006 to 2015 were reviewed retrospectively. Patients' data on age at surgery, height, weight, duration of pneumoperitoneum, and amount of bleeding were collected. The Cobb angle was measured using X-rays, and the direction (right or left) of the scoliotic curve was recorded. The chest compression ratio was calculated using computed tomography axial images. Eighty-five patients were included and analyzed in this study, of which 89% were neurologically impaired. Median age, height, and weight were 120 months, 110 cm, and 17 kg, respectively. A positive correlation between age and the Cobb angle (ρ = 0.64) and a negative correlation between age and the chest compression ratio (ρ = -0.56) were observed. The right-curved scoliotic group showed significantly more bleeding than the nonscoliotic (<10°) group (P = .01; nonscoliotic, 0 mL; right curved, 7.5 mL; left curved, 0 mL). The severe scoliotic group (≥45°) showed more bleeding than the nonscoliotic group (P = .02). Neither the direction of the scoliotic curve nor scoliotic severity showed a significant difference in the duration of pneumoperitoneum. The older the patient, the more severe their scoliosis and chest compression were. Right-curved or severe scoliosis could be risk factors for intraoperative bleeding in laparoscopic Nissen fundoplication.

Genetic ACE I/D and ACTN3 R577X polymorphisms and adolescent idiopathic scoliosis.

The etiology of adolescent idiopathic scoliosis remains unknown. Angiotensin-converting enzyme and α-actinin-3 polymorphisms influence the characteristics of muscle fibers. The aim of this study was to examine the association between idiopathic scoliosis and genetic polymorphism of angiotensin-converting enzyme and α-actinin-3. Ninety-seven females with scoliosis, and 137 healthy, age-matched control females were studied. The presence of polymorphisms was determined by PCR. A χ2 test was used to analyze differences, and odds ratios were estimated. The frequencies of ACE genotypes in the scoliotic group were 46.4% DD, 45.4% ID, and 8.2% II, while in the control group they were 40.1% DD, 43.8% ID, and 16.1% II (P = 0.197). The D allele had a frequency of 69.1% in patients with idiopathic scoliosis and 62% in the control group (P = 0.116). The frequencies of ACTN3 genotypes in females with scoliosis were 31.8% RR, 49.4% RX, and 18.8% XX, while in the control group they were 35% RR, 49% RX, and 16% XX (P = 0.810). The frequency of the R allele was 56.4% in the scoliotic group and 59.6% in the control group (P = 0.518). There was no statistically significant association between angiotensin-converting enzyme or α-actinin-3 polymorphisms and the presence of adolescent idiopathic scoliosis in females.

Head and trunk moments of inertia of able-bodied and unbraced scoliotic girls.

The purposes of this study were to estimate head and trunk's (HT) radii of gyration (K) and moments of inertia (I) in able-bodied and unbraced scoliotic girls using an angular momentum method, to test if the use of mean ratios calculated in this study and given by de Leva present similar values compared to the experimental data, and to determine how these methods behave in estimation of scoliotic HT's K and I with variable Cobb angles. Scoliotic HT's I estimated from anthropometric tables can lead to error in joint muscle moment calculations. Twenty-one unbraced scoliotic and 20 able-bodied girls participated. HT's I values were calculated using an angular momentum method. Angular momentum method provided greater HT's I for the scoliotic group compared with the able-bodied girls. HT's I obtained by the mean ratios calculated from this study were close to the measured values. Compared with the experimental I, de Leva method provided significantly lower I in the scoliotic group. Scoliotic HT's K and I obtained from angular momentum method showed greater correlations with the Cobb angles. The use of mean ratios obtained in this study to estimate HT's K values in unbraced scoliotic girls could overcome the drawbacks of current anthropometric methods. These results can be used to calculate more precise moments of force during daily activities in scoliotic girls with mild scoliosis and to improve the design of corrective flexible body braces prescribed in cases of rapid interventions in young patients of moderate spinal deformities.

Gait deviations in patients operated on bladder extrophy

Based on these vectors the forward – backward bending and rotation from the upper trunk with respect to lower trunk and pelvis, and from the lower trunk with respect to the pelvis were analyzed. Furthermore, the torsional offset (TO) [2] of upper trunkwith respect to lower trunkandpelvis andTOof lower trunkwith respect to pelvis were calculated in the different phases of the gait cycle. Results: In the scoliosis group, mean Cobb angle was 26.03◦ ±7.14 and mean spinal rotation was 22.77%±6.79. Sagital plane kinematics werewithin normal ranges at the ankle, knee and hip. High AI was found for frontal and transverse plane kinematics. In loading respons, AI for peak pelvis obliquity and peak hip exorotation in the scoliotic group was 13.39% and 49.83% respectively, compared to −16.58% and −7.6% in the control group. In pre-swing, AI for peak pelvis exorotation was −67.39% in the scoliotic group compared to 7.26% in the control group. In swing AI for peak hip abduction was −10.90% in the scoliotic group compared to -1.68% in the control group. Upper to lower trunk rotation was continuously clockwise in the scoliosis group while in the control group the rotation was symmetric. Upper trunk to pelvis motion showed a bending of 4.5◦ in the scoliosis group and 32.3◦ in the control group. Rotation was similar in both groups. Lower trunk to pelvis motion was similar in both groups with 3–4◦ of bending and 11.5–12◦ of rotation switching clockwise to anti-clockwise during the gait cycle, but the switch occurred later in the gait cycle in the scoliotic group. Discussion and conclusions: AI up to 14% are reported in normal subjects [2]. We found high AI for frontal and transverse plane motion compared to normal data,which canbe related to the spinal deformation in these planes. An excessive pelvic clockwise rotation coincides with an excessive anticlockwise torsion of the upper trunk. Compensatory hip rotation was found to align the legs into the walking direction. The lack of bending of the upper trunk and the delay in switch in rotation of the lower trunkwith respect to the pelvis might be due to the rotational deformity and rigidity of the scoliotic spine. Insight in how different parts of the trunk act during gait in subjects with scoliosis will enhance the understanding of the pathology and will provide information for optimized treatment. Therefore, further research on a larger population including kinetic analysis will be performed.