Spinal Curvature In Patients Research Articles

The Relationship Between Body Mass Index and the Magnitude of Curve at Diagnosis of Adolescent Idiopathic Scoliosis: A Retrospective Chart Review.

PurposeTo evaluate the relationship between body mass index (BMI) and spinal curvature in patients presenting with idiopathic scoliosis at a major pediatric tertiary care centre.Patients and MethodsRetrospective chart review (2015–2019). Data extracted from patient’s first visit included age, sex, height, weight, spinal curvature (magnitude, location), referral source, physical activity participation (yes/no), pain (yes/no). Demographics were analyzed descriptively. The relationship between BMI and spinal curve magnitude was analyzed using Spearman correlation coefficient. Linear regression was applied to determine the relationship between BMI, curve magnitude, and curve location. Exploratory univariate analyses were conducted for BMI and referral source, pain, and skeletal maturity, and physical activity and pain.ResultsA total of 206 patient charts were included (177 females, 29 males). Patients presented with double major (41.3%), thoracic (26.7%), thoracolumbar (22.8%), and lumbar (9.2%) curves. Mean (SD) BMI percentile was 48.3 (30.5). No relationship existed between BMI percentile and curve magnitude with curve locations combined. However, a test for interaction revealed a positive relationship between BMI percentile and curve magnitude for adolescents with double major curves, and a negative relationship for adolescents with thoracic curves. Exploratory analyses suggested a relationship between BMI percentile and presence of pain, and between referral source and curve magnitude. No relationship was observed between BMI and skeletal maturity, or physical activity and pain.ConclusionThe relationship between BMI varied by curve location within this cohort, in which most patients presented with a BMI <85th percentile. Findings highlight the importance of sensitive history taking and careful physical examination for early detection of scoliosis.

The effect of minimally invasive pectus excavatum repair on thoracic scoliosis.

The Nuss technique comprises the placement of an intrathoracic bar behind the sternum. However, besides improving the body posture through the correction of the pectus excavatum (PE), this procedure may cause or worsen thoracic scoliosis as a result of the considerable stress loaded on the chest wall and the thorax. Our goal was to investigate the impact of the Nuss procedure on the thoracic spinal curvature in patients with PE. A total of 100 patients with PE who underwent the Nuss procedure were included in the study and evaluated retrospectively. The Haller index (HI), asymmetry index and sternal torsion angle were calculated from thoracic computed tomography images before the operation. To evaluate the scoliosis in the T2-T8 thoracic vertebrae, Cobb angles were calculated on a plain chest X-ray before the Nuss operation and after the removal of the bar. Cobb angles were classified as normal (5°), scoliotic posture (5°-10°) and scoliosis (>10°). All angles before and after the Nuss operation were compared. The patients were followed up for a mean of 41 months. Substernal bars were removed after a mean of 33 months. The mean age of the patients was 19.6 ± 6.7 years. The Cobb angle was statistically significantly increased in all patients (P = 0.01), male patients (P = 0.01) and children (P = 0.046) but not in adults (P = 0.11) and female patients (P = 0.54). The Cobb angle was increased in patients with severe (HI ≥ 3.5) but not in patients with moderate (3.2 < HI < 3.5) or mild (2.0 < HI < 3.2) PE deformity. The present study shows that the Cobb angle indicates that the severity of thoracic scoliosis increases following the Nuss procedure, particularly in male patients, in patients with mild and moderate sternal torsion angle and in those with a high preoperative HI. This alteration might be due to correctional forces and torque applied by the bar. Patients undergoing the Nuss procedure for the correction of PE should be followed up strictly for timely diagnosis and management of the scoliosis.

Effect of muscle energy techniques and facet joint mobilization on spinal curvature in patients with mechanical neck pain: A pilot study.

Neck is one of the most common site of musculoskeletal symptom manifestations. An impaired spinal curvature is a common finding in patients with mechanical neck pain. A pre-post quasi experimental pilot study was conducted at Fauji Foundation Hospital from January- March 2017,in which 12 patients with mechanical neck pain and straightening of the cervical spine were included and treated for 7 consecutive sessions consisting of muscle energy techniques (MET) in combination with facet joint mobilization. The objective of this study was to determine the effects of MET and facet joint mobilization on spinal curvature and functional outcomes in patients with neck pain. Outcome measurement tools that were included comprised of pain severity, neck disability index (NDI), cervical lordosis which was measured via x-ray based posterior tangential method, goniometry for cervical range of motion (ROM) and modified sphygmomanometer dynamometry (MSD) for isometric muscle strength. A significant difference was observed in pre and post treatment scores for all outcomes (p<0.05); demonstrating an effective combination therapy in terms of improved spinal curvature, pain, disability, ROM and isometric muscle strength.

Effects of Nuss procedure on thoracic scoliosis in patients with pectus excavatum.

The objectives of this study are to investigate the association between pectus excavatum (PE) and thoracic scoliosis (TS) and to analyze the effects of the Nuss procedure on the thoracic spinal curvature in patients with PE. A total of 468 patients who underwent the Nuss procedure and pectus bar removal for PE from March 2011 to January 2015 were assessed and included into the present study. TS prevalence was 9.4% pre-correctively and 9.8% post-correctively. There was a positive correlation between age and Cobb angle (CA), pre-correctively and post-correctively (both, P<0.001). The late correction group (LG, age ≥10 years) had a higher CA and more frequent TS than the early correction group (EG, age <10 years) (pre-correction: CA 6.3±4.9° vs. 4.5±3.8°, P<0.001, TS P<0.001; post-correction: 7.6±7.2° vs. 4.1±3.3°, P<0.001, TS P<0.001). The post-corrective changes in CA were different according to the time of correction (decreased in EG: 4.5±3.8° vs. 4.1±3.3°, P=0.078; increased in LG: 6.3±4.9° vs. 7.6±7.2°, P=0.002). In patients with pre-corrective TS, CA after correction was decreased (post-correctively 11.9±10.0° vs. pre-correctively 13.9±6.0°, P=0.090). In addition, post-corrective CA was significantly decreased in EG (pre-correction 13.9±7.4° vs. post-correction 6.6±8.1°, P<0.001). However, post-corrective CA was increased in LG (pre-correction 13.8±4.5° vs. post-correction 16.7±9.2°, P=0.053). The number of patients with TS after correction was decreased in EG (P=0.194) and significantly increased in LG (P=0.028). There were both pre-corrective and post-corrective predictive factors for TS (Pre-corrective: age P<0.001, severity P=0.016, and BMI P=0.046; post-corrective: age at the time of correction P<0.001, weight P=0.046, and pre-corrective CA P<0.001). The Nuss procedure had some significant effects on the thoracic spinal curvature, with early correction able to reduce TS in patients with PE.

Influence of proprioceptive insoles on spinal curvature in patients with slight idiopathic scoliosis.

Proprioceptive insoles are known to influence the functions of posture and gait by modulations of the sensory structures at the sole of the foot. Literature has shown that they could improve the position of the upper-body in patients with postural complaints of the musculoskeletal system. The aim of this study was to evaluate the influence of proprioceptive insoles on the spinal curvature in patients with slight idiopathic scoliosis. Eighteen patients were included in this prospective, single-centre, randomized study. All patients needed to have a relevant growth potential and suffered from a slight idiopathic scoliosis. Two groups were used, where group 1 performed physiotherapy twice a week, whereas group 2 was additionally supplied with proprioceptive insoles. Patients underwent three-dimensional rasterstereography for back-shape analysis. Furthermore, a conventional x-ray imaging of the spine was performed at the beginning and 1 year later to document the curvatures. There was no statistical difference in the Cobb angles, and in almost all parameters of the rasterstereography, there was no statistically significant change between and within both groups. According to the results of this study, there was no evidence of any statistical significant effect of proprioceptive insoles on spinal curvature in patients with slight idiopathic scoliosis.

Adolescent idiopathic scoliosis and spinal fusion do not substantially impact on postural balance.

BackgroundThe spinal curvature in patients with Adolescent Idiopathic Scoliosis (AIS) causes an asymmetry of upper body postural alignment, which might affect postural balance. However, the currently available studies on balance in AIS patients are not consistent. Furthermore, it is not known whether potential deficits are similar between patients with single and double curves. Finally, the effects of a corrective posterior spinal fusion on postural balance have not yet been well established.MethodsPostural balance was tested on a force plate, in 26 female subjects with AIS (12–18 years old; preoperative Cobb-angle: 42-71°; single curve n = 18, double curve n = 6) preoperatively, at 3 months and 1 year postoperatively. We also conducted a balance assessment in 18 healthy age-matched female subjects. Subjects were tested during quiet double-leg standing in four conditions (eyes open/closed; foam/solid surface), while standing on one leg, while performing a dynamic balance (weight shifting) task and while performing a reaching task in four directions.ResultsAIS subjects did not demonstrate greater COP velocities than controls during the double-leg standing tasks. In the reaching task, however, they achieved smaller COP displacements than healthy controls, except in the anterior direction. AIS patients with double curves had significantly greater COP velocities in all test conditions compared to those with a single curve (p < 0.05). For the AIS group, a slight increase in COP velocities was observed in the foam eyes closed and right leg standing condition at 3 months post surgery. At 1-year post surgery, however, there were no significant differences in any of the outcome measures compared to the pre-surgery assessment, irrespective of the curve type.ConclusionsPostural balance in AIS patients scheduled for surgery was similar to healthy age matched controls, except for a poorer reaching capacity. The latter finding may be related to their reduced range of motion of the spine. Patients with double curves demonstrated poorer balance than those with a single curve, despite the fact that they have a more symmetrical trunk posture. Postural balance one year after surgery did not improve as a result of the better spinal alignment, neither did the reduced range of trunk motion inherent to fusion negatively affect postural balance.

Monitoring for idiopathic scoliosis curve progression using surface topography asymmetry analysis of the torso in adolescents

Background contextAt first visit and each clinical follow-up session, patients with adolescent idiopathic scoliosis (AIS) undergo radiographic examination, from which the Cobb angle is measured. The cumulative exposure to X-ray radiation justifies efforts in developing noninvasive methods for scoliosis monitoring. PurposeTo determine the capability of the three-dimensional markerless surface topography (ST) asymmetry analysis to detect ≥5° progression in the spinal curvature in patients with AIS over 1-year follow-up interval. Study design/settingCross-sectional study in a specialized scoliosis clinic. Patient sampleIn this study, baseline and 1-year follow-up full torso ST scans of 100 patients with AIS were analyzed using three-dimensional markerless asymmetry analysis. Outcome measuresPatients with ΔCobb≥5° and ΔCobb<5° were categorized into progression and nonprogression groups, respectively. MethodsThe ST scan of each full torso was analyzed to calculate the best plane of symmetry by minimizing the distances between the torso and its reflection about the plane of symmetry. Distance between the torso and its reflection was measured and displayed as deviation color maps. The difference of ST measurements between two successive acquisitions was used to determine if the scoliosis has progressed at least 5° or not. The classification tree technique was implemented using the local deformity of the torso in the thoracic–thoracolumbar (T–TL) and lumbar (L) regions to categorize curves into progression and nonprogression groups. The change in maximum deviation and root mean square of the deviations in the torso were the parameters effective in capturing the curve progression. Funding for this research is provided by the Scoliosis Research Society, and Women and Children's Health Research Institute. ResultsThe classification model detected 85.7% of the progression and 71.6% of the nonprogression cases. The resulting false-negative rate of 4% for T–TL curves, representing the proportion of undetected progressions, confirmed that the technique shows promise to monitor the progression of T–TL scoliosis curves. Although 100% L curves with progression were detected using the deviation color maps of the torsos, because of the small number of analyzed L curves, further research is needed before the efficiency of the method in capturing the L curves with progression is confirmed. ConclusionsUsing the developed classification tree for the patients analyzed in this study, 43% of nonprogression cases between two visits would not have to undergo an X-ray examination.

Three-Dimensional Volume-Rendered Series Complements 2D Orthogonal Multidetector Computed Tomography in the Evaluation of Abnormal Spinal Curvature in Patients at a Major Cancer Center: A Retrospective Review.

Background. Abnormal spinal curvature is routinely assessed with plain radiographs, MDCT, and MRI. MDCT can provide two-dimensional (2-D) orthogonal as well as reconstructed three-dimensional volume-rendered (3-D VR) images of the spine, including the translucent display: a computer-generated image set that enables the visualization of surgical instrumentation through bony structures. We hypothesized that the 3-D VR series provides additional information beyond that of 2-D orthogonal MDCT in the evaluation of abnormal spinal curvature in patients evaluated at a major cancer center. Methods. The 3-D VR series, including the translucent display, was compared to 2-D orthogonal MDCT studies in patients with an abnormal spinal curvature greater than 25 degrees and scored as being not helpful (0) or helpful (1) in 3 categories: spinal curvature; bony definition; additional findings (mass lesions, fractures, and instrumentation). Results. In 38 of 48 (79.2%) patients assessed, the 3-D VR series were scored as helpful in 63 of 144 (43.8%) total possible categories (32 spinal curvature; 14 bony definition; 17 additional findings). Conclusion. Three-dimensional MDCT images, including the translucent display, are complementary to multiplanar 2-D orthogonal MCDT in the evaluation of abnormal spinal curvature in patients treated at a major cancer center.

Accuracy and Repeatability of a New Method for Measuring Scoliosis Curvature

A prospective diagnostic clinical trial. To evaluate the accuracy, repeatability of a new method for measuring spinal curvature in patients with scoliosis, the axis-line-distance technique (ALDT), in comparison with the Cobb method. Timely and accurate determination of the degree of lateral curvature of the spine is essential for deciding the appropriate treatment method for scoliosis. Although the Cobb method has been accepted as the clinical standard for 60 years, many investigators have reported a high degree of variance in the measurements of spinal curvature obtained using this method. Therefore, the development of an alternative method that incorporates the advances in imaging technology and assessment is needed. Sixty-five scoliosis patients were evaluated by 6 physician observers. The spinal curves were measured on 2 separate occasions using the Cobb method and the ALDT on a picture archiving and communication system workstation. The time interval between the 2 measurements was 3 weeks, and the data were analyzed by a paired-sample Student t test and Pearson correlation method using SPSS 12.0 software package. Intraobserver variance of the 2 measurements, the minimum variance, the maximum variance, and the mean and standard deviation values were 0 degrees, 26 degrees, and 5.14 degrees +/- 0.69 degrees for the Cobb method, and 0 mm, 20 mm, and 2.55 +/- 0.38 mm for the ALDT, respectively. There was a significant intraobserver difference in the Cobb angle measurements among 3 of the 6 observers (P < 0.05). No significant intraobserver variance in ALDT measurements was detected. The mean interobserver measurement variance for the Cobb method was 6.54 degrees +/- 1.35 degrees, significantly greater than that for the ALDT (3.58 +/- 0.93 mm; P < 0.05). There were significant positive correlation between the ALDT and the Cobb measurements (r = 0.73, P < 0.05). The ALDT is more reliable, reproducible, and straightforward, and less error-prone than the Cobb method for measurements of spinal curvature.