Spinal Curvature Research Articles

Adolescent idiopathic scoliosis: treatment outcomes, quality of life and implications for practice.

Adolescent idiopathic scoliosis (AIS) is the most common spinal disorder among children and adolescents, with most cases being diagnosed around puberty. While the majority of people with AIS do not undergo treatment, a small but significant number are treated, depending on the extent of their spinal curvature. Treatment typically involves bracing, which requires substantial adherence, and/or surgery, which is invasive and permanent. Furthermore, decisions about treatment often need to be made at a critical stage of the person's development. This article examines the evidence on AIS and its treatment, synthesising the current literature and drawing from the authors' empirical work to explore the clinical outcomes of bracing and surgery, as well as the longer-term effects on people's quality of life. Drawing from this evidence, the authors provide guidance for nurses and healthcare professionals who care for people with AIS.

Association between incorrect postures and curve magnitude of adolescent idiopathic scoliosis in china

BackgroundDespite advancements in school scoliosis screening (SSS), there are still no effective indicators to estimate the severity of spinal curvature. We aim to investigate the association between incorrect postures and curve magnitude of adolescent idiopathic scoliosis (AIS) among Chinese adolescents.MethodsIn this SSS program, we examined the incorrect posture, Adam’s forward bending test (FBT) results, and angle of trunk rotation (ATR) in adolescents. Those with suspected scoliosis were referred for a standing anteroposterior whole-spine radiography as outpatients. The radiographic data of 426 students with lateral Cobb angles were collected from 2016 to 2022 and the associations were studied using logistic regression (LR) models and receiver operating characteristic (ROC) curves.ResultsUnivariate LR revealed that female gender [odds ratio (OR) = 2.92, 95% confidence interval (CI) 1.67–5.09, P < 0.001], age 16–19y (OR = 2.83, 95%CI 1.10–7.28, P = 0.031), right shoulder height (OR = 2.15, 95%CI 1.23–3.75, P = 0.007), right scapula tilt (OR = 2.03, 95%CI 1.18–3.50, P = 0.010), right rib hump (OR = 1.88, 95%CI 1.23–2.85, P = 0.003), right thoracic rotation ≥ 5° (OR = 2.14, 95%CI 1.43–3.20, P < 0.001), and left thoracolumbar kyphosis (OR = 3.79, 95%CI 1.06–13.56, P = 0.041) were all significantly associated with the severity of the curve magnitude. Multivariate LR showed that female gender [adjusted OR (AOR) = 3.23, 95%CI 1.81–5.73, P < 0.001], those aged 16–19y (AOR = 5.08, 95%CI 1.86–13.91, P = 0.002), and with a right rib hump (AOR = 1.72, 95%CI 1.11–2.64, P = 0.015) presented with a higher risk of severe curve magnitude than men, those aged 7–12y, and without a rib hump, respectively. ROC curves further proved that sex, age, shoulder-height difference, scapula tilt, flat back, rib hump, angle of thoracic rotation were the risk predictors for curve magnitude.ConclusionIncorrect posture and ATR, especially the right rib hump, were significantly associated with the curve magnitude of AIS. Early screening for incorrect postures and ATR could be an effective and economical strategy to predict the severity of AIS through SSS in Chinese adolescents.

Radiological and Pulmonary Results of Surgical Treatment of Severe Idiopathic Scoliosis Using Preoperative Halo Gravity Traction Compared with Less Invasive Temporary Internal Distraction in Staged Surgery in Adolescents.

Background: Severe and rigid scoliosis represents a type of spinal deformity characterized by a Cobb angle exceeding 90° and a flexibility of less than 30%. Halo spinal traction remains the established standard for managing severe scoliosis, although alternative approaches such as temporary internal distraction rods and staged surgical correction exist. The primary objective of this investigation was to compare two cohorts of patients treated using these distinct methods to ascertain any divergences in terms of surgical and radiological outcomes, pulmonary function (PF), and quality of life (QoL). Methods: This study encompassed a total of 62 pediatric patients meeting the specified criteria, which included severe idiopathic scoliosis (major Cobb curve >90) and flexibility <30%. Group 1 (G1) underwent surgical intervention involving preoperative Halo gravity traction (HGT) succeeded by posterior spinal fusion (PSF). On the other hand, Group 2 (G2) underwent a two-stage procedure starting with a less invasive temporary internal distraction technique (LITID) prior to PSF. The radiological outcomes, PF, and QoL were documented and assessed over a monitoring period ranging from 2 to 5 years. Results: The average preoperative major curves (MCs) measured 124° and 122° in G1 and G2, respectively (p < 0.426). Initial flexibility, as observed in preoperative bending films, ranged from 18% in G1 to 21% in G2 (p < 0.001). Following the ultimate surgical intervention, the MCs were corrected to 45° and 37.4° in G1 and G2, respectively (p < 0.001). The percentage correction of the MCs was higher in G2 (63% vs. 70% in G1 and G2, respectively), with significant between-group disparities (p < 0.001). The mean preoperative thoracic kyphoses (TKs) were 96.5° in G1 and 92° in G2 (p = 0.782), which were rectified to 45.8° in G1 and 36.2° in G2 (p < 0.001), equating to correction rates of 55% and 60% in the respective groups. Initially, G2 exhibited lower values for the percentage of predicted lung volume (FVC) and predicted FEV1 compared with G1 (49% and 58% vs. 54.5% and 60.8%; N.S.). Nonetheless, both groups demonstrated enhancements in their FVC and FEV1 values over the follow-up period. Conclusions: The surgical management of severe and untreated spinal curvatures in the pediatric and adolescent population can be considered safe, with a tolerable incidence of minor complications. LITID emerges as a method offering improved QoL and pulmonary function, achieving notably substantial average corrections in deformity by 70% in the coronal plane and 60% in the sagittal plane, alongside a mean increase in trunk height of 10.8 cm. Furthermore, a typical reduction of 76% in rib humps and enhancements in respiratory function, as indicated by improvements in 1 s predicted forced expiratory volume (by 25-56%) and forced vital capacity (by 35-65%), were achieved, leading to a clinically and statistically significant enhancement in QoL when evaluated using SRS-22r, without resorting to more radical, high-risk procedures.

On growth and scoliosis

PurposeTo describe the physiology of spinal growth in patients with adolescent idiopathic scoliosis (AIS).MethodsNarrative review of the literature with a focus on mechanisms of growth.ResultsIn his landmark publication On Growth and Form, D’Arcy Thompson wrote that the anatomy of an organism reflects the forces it is subjected to. This means that mechanical forces underlie the shape of tissues, organs and organisms, whether healthy or diseased. AIS is called idiopathic because the underlying cause of the deformation is unknown, although many factors are associated. Eventually, however, any deformity is due to mechanical forces. It has long been shown that the typical curvature and rotation of the scoliotic spine could result from vertebrae and intervertebral discs growing faster than the ligaments attached to them. This raises the question why in AIS the ligaments do not keep up with the speed of spinal growth. The spine of an AIS patient deviates from healthy spines in various ways. Growth is later but faster, resulting in higher vertebrae and intervertebral discs. Vertebral bone density is lower, which suggests less spinal compression. This also preserves the notochordal cells and the swelling pressure in the nucleus pulposus. Less spinal compression is due to limited muscular activity, and low muscle mass indeed underlies the lower body mass index (BMI) in AIS patients. Thus, AIS spines grow faster because there is less spinal compression that counteracts the force of growth (Hueter–Volkmann Law). Ligaments consist of collagen fibres that grow by tension, fibrillar sliding and the remodelling of cross-links. Growth and remodelling are enhanced by dynamic loading and by hormones like estrogen. However, they are opposed by static loading.ConclusionIncreased spinal elongation and reduced ligamental growth result in differential strain and a vicious circle of scoliotic deformation. Recognising the physical and biological cues that contribute to differential growth allows earlier diagnosis of AIS and prevention in children at risk.

Quantifying rider posture variability in powered two- and three-wheelers for safety assessment

Objective Injury outcomes for powered two- and three-wheeler (PTW) riders are influenced by the rider posture. To enable analysis of PTW rider accidents and development of protection systems, detailed whole-body posture data is needed. Therefore, the aim of this study is to fill this gap by providing collections of average male whole-body postures, including subpopulation variability, for different PTW types. This will enable future studies to explore the influence of PTW rider posture variation and to support safety system development. Methods 3D photometric measurements of 51 anatomical landmarks were recorded on 20 (50th percentile male) volunteers in their preferred riding postures across three PTW types (naked, scooter, and touring). Following an outlier removal process, a principal component analysis (PCA) was performed to calculate average postures and principal components (PCs), to describe the observed posture variation, for each PTW. The visualization of the PCs was facilitated through kinematic linkage representations, connecting anatomical landmarks and estimated joint centers to form segments and characteristic joint angles. Results The first seven PCs explained 80% of the variance in posture for each of the three PTWs. Across PTWs, these PCs frequently described combinations of postural features including variation in fore-aft seat positions, pelvic tilt, spinal curvature, head position, and extremity flexion-extension. Analysis revealed distinct differences in average postures across the three PTWs, on average, 10 ± 9° for the characteristic joint angles within a min-to-max range between the three PTWs. However, for all three PTWs, the variability between volunteers in characteristic joint angles on the same PTW were on average more than twice as large within a ± 2 SD range (26 ± 11°). Conclusions The results suggest that PTW rider posture variation must be addressed by involving simultaneous adjustments of multiple body parts, as described by each of the first seven PCs, as a direct consequence of the human body interconnectedness. Furthermore, the study’s findings challenge conventional assumptions that the relative distance between PTWs’ handlebar, seat, and foot support predominantly influences rider postures. Instead, the research demonstrates that individual variability has a substantial influence on rider posture and should be considered in PTW safety development.

Tuina Inhibits Chondrocyte Apoptosis by Regulating the FAK/PI3K/Akt Pathway in Rabbits with IVDD.

Intervertebral disc degeneration (IVDD), a key contributor to degenerative spinal diseases such as cervical spondylosis, significantly influences the quality of life of patients. Tuina, historically employed in the clinical management of cervical spondylosis, has demonstrated positive therapeutic outcomes; however, the mechanism of Tuina remains unclear. This study examined the efficacy of Tuina in correcting the imbalanced structure of the cervical spine and its impact on apoptotic chondrocytes within the cervical disc. The underlying mechanisms were explored using a rabbit model of IVDD induced by dynamic and static imbalances. The IVDD rabbit model was established by restraining the head in a downward position for 12 weeks (Model group). In the Tuina1 group, treatment was performed on the posterior cervical trapezius muscle daily for 2 weeks, whereas in the Tuina2 group, treatment was performed on both the posterior cervical trapezius and anterior sternocleidomastoid muscles daily for 2 weeks. After treatment, X-ray, micro-computed tomography (CT), histological staining, qRT-PCR, and western blotting were used to evaluate the mechanism by which Tuina inhibits chondrocyte apoptosis. The results demonstrated that Tuina treatment inhibited chondrocyte apoptosis in cervical discs by adjusting the neck structure balance, and a more significant therapeutic effect was observed in the Tuina2 group. Lateral cervical spine X-ray and CT scans in rabbits revealed notable improvements in cervical spine curvature and vertebral structure in the treatment groups compared with those in the Model group. Hematoxylin and eosin staining and TUNEL staining further confirmed the positive impact of Tuina treatment on intervertebral disc tissue morphology and chondrocyte apoptosis. Additionally, western blotting and immunohistochemical analysis showed that Tuina treatment suppressed chondrocyte apoptosis by downregulating Bax and caspase-3 while upregulating Bcl-2. Western blotting results further indicated that Tuina could activate the FAK/PI3K/Akt signaling pathway by mediating integrin-β1. Tuina treatment inhibited chondrocyte apoptosis in cervical discs by activating the FAK/PI3K/Akt signaling pathway, providing convincing evidence to support Tuina treatment as a promising method for IVDD.

Simulative investigation of the required level of geometrical individualization of the lumbar spines to predict fractures.

Injury mechanisms of the lumbar spine under dynamic loading are dependent on spine curvature and anatomical variation. Impact simulation with finite element (FE) models can assist the reconstruction and prediction of injuries. The objective of this study was to determine which level of individualization of a baseline FE lumbar spine model is necessary to replicate experimental responses and fracture locations in a dynamic experiment.Experimental X-rays from 26 dynamic drop tower tests were used to create three configurations of a lumbar spine model (T12 to L5): baseline, with aligned vertebrae (positioned), and with aligned and morphed vertebrae (morphed). Each model was simulated with the corresponding loading and boundary conditions from dynamic lumbar spine experiments. Force, moment, and kinematic responses were compared to the experimental data. Cosine similarity was computed to assess how well simulation responses match the experimental data. The pressure distribution within the vertebrae was used to compare fracture risk and fracture location between the different models.The positioned models replicated the injured spinal level and the fracture patterns quite well, though the morphed models provided slightly more accuracy. However, for impact reconstruction or injury prediction, the authors recommend pure positioning for whole-body models, as the gain in accuracy was relatively small, while the morphing modifications of the model require considerably higher efforts. These results improve the understanding of the application of human body models to investigate lumbar injury mechanisms with FE models.

Harmonizing musculoskeletal health: transformative effects of 8-week intervention program on posture in music students

Background and Study Aim. Musculoskeletal complaints are common among music students, irrespective of gender. They develop due to intense practice over an instrument; spending long hours of practice may cause muscular imbalance, tension, and awkward posture. The repetitive nature of practice in music students may cause overuse and fatigue. This increases the risk of acute pain and can affect both quality of life and performance. Therefore, the present study aimed at evaluating the transformative effects of an 8-week intervention program on posture in music students. Material and Methods. The 8-week intervention program with transformative effects was conducted over 8 weeks (from September 18 to November 12) on Mondays and Thursdays, for 45 minutes each session. The program aimed to benefit 25 music students, of whom (i) 15 were in the experimental group (with an average age of 24.20 years, average weight of 82.40 kg, and average height of 178.60 cm), and (ii) 10 were in the control group (with an average age of 24.60 years, average weight of 78.40 kg, and average height of 182.20 cm). All participants were enrolled in the second year of a master's degree program in Performing Arts. Standardized measures for evaluating posture (utilizing Klein and Thomas's method, as refined by Mayer) were conducted both before (Week 1, September 18) and after (Week 8, November 12) the intervention. The impact of the 8-week intervention program was assessed using the Wilcoxon Rank-Sum Test, Wilcoxon Signed-Rank Test, and Pearson's r. Results. Significant differences (p ˂ 0.05, ˂ 0.01) between 25 music students (M); in particular experimental group (n = 15) and control group (n = 10), were in 4 (80%) segments of body in post-test: (i) Head and neck; (ii) Abdomen and pelvis; (iii) Curvature of spine; (iiii) Shoulders and scapulas. Insignificant differences (p ˃ 0.05) between 25 music students (M) were in pre-test. Conclusions. Significant differences (p ˂ 0.05, ˂ 0.01) indicated the transformative effects in the experimental group's (n = 15) posture. This emphasizes the potential of the 8-week intervention program in promoting musculoskeletal health of music students. Therefore, additional research is necessary to investigate the lasting resilience (sustainability) of advantages and enhance the intervention plan in music education.

COMPARISON OF SPINAL CURVATURES OF WOMEN HAD GIVEN MULTIPLE TIMES AND NEVER GIVEN BIRTH

Background: It is known that the amount of load loaded on the body affects the spine and spinal curvature. It was thought that the spine could be affected during each pregnancy experienced by the women. The spine measurements of women who gave birth and those who did not were compared . Material and methots: In this study, the spines of women who came to X X.X. Medical Center Gynecology and Obstetrics Poliyclinic in 2020 were examined using the Spinal Mouse device. In posture analysis, it was aimed to evaluate the results of the measurements obtained with the Spinal Mouse. A total of 100 women between the ages of 30-35, 50 from women who have never given birth and 50 from women who have had multiple births [women who have given birth at least three times ], were included in the study. T-Test was used to compare group means in terms of continuous variables. Results: As a result of the findings obtained, the average weight of women who gave birth and never gave birth was p=0.001 as a result of statistical analysis and it was found significant. There was a difference in angular values between the two groups, with LL [p=0.001 ] and SK [p=0.003 ] measurements taken in the extension position in the measurements taken in the upright position, a significant result was obtained in the TK [p=0.040 ] and LL [p=0.001 ] values. Conclusions: It is seen that every birth process experienced negatively affects the posture of women. Therefore, women who have given birth should be made aware of the necessary exercise and physical activity in order to control and protect the spine health.

The effect of rehabilitative exercises in correcting spinal curvature and head fall forward for high school students aged 16 years

يعتبر القوام السليم أحد المطالب الهامة بل والضرورية التي أصبحت ملحة في ظل حياتنا اليومية والتي طرأ عليها العديد من أشكال الرفاهية حتى أصبحت هي سمة العصر الحديث ،حيث أصبح الإنسان مسرفا في استخدام التقنيات الحديثة وذلك بهدف الراحة ،فكان نتاج ذلك عدم ممارسة الأنشطة الرياضية ولو في أبسط صورها فأصبح الفرد عرضة للإصابة وكذا العديد من الإنحرافات القوامية وتكمن أهميه البحث في اعداد تمرينات تاهيلية في تقويم انحناء العمود الفقري وسقوط الرأس لطالبات المرحلة الإعدادية بعمر 16 سنة وبالتالي ظهرت الحاجة لإعداد التمرينات التاهيلية لإصلاح ما أفسدته الحياة الحديثة في عصر الكومبيوتر والإتصالات حيث أطلقت العنان لعمل العقل وقيدت حركة الجسد داخل أسوار العقل فالتمرينات التاهيلية تعتبر أكثر الوسائل فعالية في تحسين القوام ،وهي في نفس الوقت تضمن أمن وسلامة الفرد أثناء ممارستها وتتمثل مشكلة البحث من خلال خبرة الباحثين ومشاهدتهم للطالبات في التطبيق الميداني في الاصابات الرياضية وتاهيلها واعدوا السؤال الاتي ؟. هل أن استخدام التمرينات التاهيلية تساهم في استعادة تقويم انحناء العمود الفقري وسقوط الرأس اماماً لدى لطالبات المرحلة الإعدادية بعمر 16 سنة ؟. وهدف البحث الى اعداد تمرينات تاهيلية في تقويم انحناء العمود الفقري وسقوط الرأس اماماً لدى طالبات المرحلة الإعدادية بعمر 16 سنة. وأيضا التعرف على تاثير التمرينات التاهيلية في تقويم انحناء العمود الفقري وسقوط الرأس اماماً لدى طالبات المرحلة الإعدادية بعمر 16 سنة. و استخدام الباحثون المنهج التجريبي لملائمته طبيعة البحث بتصميم المجموعة الواجدة ذات الاختبارين القبلي - البعدي تكون مجتمع البحث من طالبات المرحلة الإعدادية بعمر 16 سنة ، حيث قام الباحثون باختيار عمدي لأفراد مجتمع البحث من اعدادية واسط والبالغ عددهم (20) طالبة وبعد اخذ موافقة أولياء أمور الطالبات وإدارة المدرسة المعنية تم إجراء الفحص الطبي من خلال النظر ومن خلال الوقوف والظهر ملاصق للحائط وكانت حصيلة هذه لفحوصات وجود مجموعة مكونة من (5) طالبات مصابات بالتحدب وتضمن البحث مجموعة من الإختبارات ومنها إ قياس درجة التحدب للعمود الفقري او زاوية فركسون عن طريق الاشعة السينية Xray لتقويم تحدب العمود الفقري وسقوط الراس اماما وأخيراً ولغرض إستخراج النتائج تم إستخدام الوسائل الإحصائية المناسبة (الحقيبة الإحصائية SPSS ولقد توصل الباحثون الى عدة استنتاجات منها هناك تاثيرات إيجابية للتمرينات التاهيلية وهذة التمرينات تقلل من درجة تحدب العمود الفقري لافراد عينة البحث بعمر 16 سنة في اختبار الأشعة السينية XRay أو عن طريق زاوية فركسون من خلال النتائج التي خرجت بها هذه الدراسة يوصي الباحثون بضرورة الاعتماد على التمرينات التاهيلية وهذة التمرينات تقلل من درجة تحدب العمود الفقري لافراد عينة البحث بعمر 16 سنة للجميع مدارس المحافظة وذلك للحد من نسبة انتشارحدوث تحدب العمود الفقري وسقوط الراس اماما وهذا ما يحقق احد اهداف التنمية المستدامة للامم المتحدة في العراق (التعليم الجيد)

S1 vertebral bone quality score independently predicts pedicle screw loosening following surgery in patients with adult degenerative scoliosis

BACKGROUND CONTEXTMRI-based vertebral bone quality (VBQ) score is an effective predictor of pedicle screw loosening after lumbar fusion surgery and has been recognized as a valuable tool for assessing preoperative bone quality. Due to the lateral curvature of lumbar spine of degenerative scoliosis, accurate measurement of VBQ score by conventional measurement methods that capture MRI signal intensity at L1–4 may be limited under certain conditions. To this end, a new simplified S1 VBQ score method has been proposed, which is comparable to the previous L1–4 VBQ score or S1 Hounsfield unit (HU) value, and has high accuracy and reliability. PURPOSETo evaluate the predictive value of MRI-based S1 VBQ score for pedicle screw loosening following surgery for adult degenerative scoliosis (ADS). STUDY DESIGN/SETTINGRetrospective single-center cohort. PATIENT SAMPLEWe reviewed 92 patients who underwent posterior lumbar interbody fusion (PLIF) with pedicle screw fixation for ADS between January 2017 and January 2020. OUTCOME MEASURESAssociation between S1 VBQ score and pedicle screw loosening following surgery for ADS. METHODSWe retrospectively reviewed the records of all patients who performed PLIF between January 2017 and January 2020. The clear zone around pedicle screws≥1 mm can be identified as screw loosening. The S1 VBQ score is calculated from the S1 central-based noncontrast T1-weighted magnetic resonance imaging (MRI). The signal intensity (SI) of the cerebrospinal fluid (CSF) was then measured using ROI placed at the L3 level to normalize the results. Multivariate logistic regression analysis was performed to identify independent risk factors for screw loosening. Then, constructed a receiver operating characteristic (ROC) curve and determined the threshold (cut-off) of VBQ score with high sensitivity and specificity based on Youden Index. RESULTSA total of 92 patients were included, including 34 males and 58 females. The mean age of the patients was 61.23±1.23 years old. At 1-year follow-up, the screw loosening rate was 56.5% (52/92). The age and levels of fixation were higher in the loosening group than in the nonloosening group (p=.036, p=.025). Patients in the loosening group had a greater VBQ score compared to patients in the nonloosening group (3.31±0.41 vs 3.01±0.28, p=.001). Multivariate logistic regression analysis showed that advanced age (OR, 1.090; 95% CI 1.005–1.183; p=.039) and higher VBQ score (OR, 5.778; 95% CI 2.889–16.177; p=.001) were independent risk factors for screw loosening. In addition, the ROC curve were created to assess the role of VBQ score as predictors of screw loosening with a diagnostic accuracy of 74.6% (95% CI 64.2%–85.1%).The most suitable threshold for the VBQ score as determined by the Youden Index was 3.175 (sensitivity: 76.0%, specificity: 83.3%). CONCLUSIONSHigher S1 VBQ score was significantly associated with pedicle screw loosening following surgery for ADS. The S1 VBQ score can be used as an effective preoperative predictor, which has the potential clinical application.

Capturing the cervical spine shape: Angular measurements versus geometric morphometric methods.

The cervical spine manifests a wide shape variation. However, the traditional methods to evaluate the cervical spine curve were never tested against its actual shape. The study's main aim was to determine whether the shape classification of the cervical spine, based on traditional angular measurements, coincides with each other and with the shape captured by the 2D landmark-based geometric morphometric method. The study's second aim was to reveal the associations between the cervical spine shape and the demographic parameters, the head's position, and the spine's sagittal balance. CT scans of the cervical spine of 163 individuals were evaluated to achieve these goals. The shape was assessed by measuring the C2-C7 Cobb angle (CA), the C2-C7 posterior tangent angle (PTA), the curvedness of the arch, and by a 2D landmark-based geometric morphometric method. The position of the head and the sagittal balance of the spine were evaluated by measuring the foramen magnum-C2 Cobb angle (FMCA) and the T1 slope angle (T1SA), respectively. Based on the size of the angle measured, each individual was classified into one of the three cervical 'shape groups' (lordotic, straight, and kyphotic). We found that cervical lordosis was the dominant shape regardless of the measuring methods utilized (46.6%-54.6%), followed by straight neck (28.2%-30.1%), and kyphosis (15.3%-25.2%); however, about a third of the 163 individuals were classified into a different shape group using the CA and PTA methods. The cervical spine angle was sex-independent and age-dependent. The T1SA was significantly correlated with CA and PTA (r = 0.640 and r = 0.585, respectively; p < 0.001). In conclusion, the cervical spine shape evaluation is method-dependent and varies with age.

Twisted Surfaces in Semi-Euclidean $4$-Space with Index $2$

In this paper, we consider the twisted surfaces in semi-Euclidean 4-space with index 2.We classify the twisted surface with respect to their spine curve which are non-null or null curves. So, we study the geometric properties of these surfaces. Also we obtain the family of some special surfaces such as flat surfaces, marginally trapped surfaces.

Comparison of the effects of core stability and whole-body electromyostimulation exercises on lumbar lordosis angle and dynamic balance of sedentary people with hyperlordosis: a randomized controlled trial

BackgroundHyperlordosis is an excessive inward curvature of the lumbar spine that affects spinal function. The aim of this study was to compare the effects of core stability exercises (CSE), Whole-Body Electromyostimulation (WB-EMS), and CSE Plus on the Lumbar lordosis angle and dynamic balance in sedentary people with hyperlordosis.MethodsIn a parallel randomized controlled trial study, seventy five untrained male adults with hyperlordosis, recruited from clinics of sports medicine and corrective exercise centers in Tehran, were randomly assigned to four groups: CSE (n = 19), WB-EMS (n = 18), CSE Plus (n = 18), and control Group (CG) (n = 20). The CSE group performed Core stability exercises, the WB-EMS group followed a Whole-body electromyostimulation combined training protocol, and the CSE Plus group engaged in a combined program protocol (CSE with the WB-EMS vest), and the control group only participated in activities of daily living. Anthropometric parameters and outcomes, including the lordosis angle and dynamic balance, were assessed before and after a six-week training program. A flexible ruler was used to measure the angle of lordosis, and the Y balance test was employed to evaluate the dynamic balance.ResultsThe results indicated that the lordosis angle improved in both the CSE and CSE Plus groups compared to the CG in the post-test (P = 0.017, P = 0.024). However, there were no significant differences observed between the other group pairs. Additionally, a significant difference in dynamic balance was found between the CSE Plus group and the CG in the post-test (P = 0.001), while no significant differences were observed between the other group pairs. Furthermore, within-group test results demonstrated that lumbar lordosis angle and dynamic balance variables significantly improved in the post-test compared to the pre-test stage (P < 0.05).ConclusionsThe two CSE and CSE Plus training protocols are effective as training methods for correcting certain parameters and physical deformities, including lumbar lordosis. Furthermore, the CSE Plus group demonstrated a positive impact on improving dynamic balance. Consequently, it is highly recommended that individuals with hyperlordosis can benefit from the exercises of the present study, especially CSE Plus exercises along with other rehabilitation exercises.Trial registrationThe trial was registered at Thai Clinical Trials Registry (TCTR20221004011, registration date: 04/10/2022).

Synergistic developmental effects of zebrafish exposed to combined perfluorooctanoic acid and atrazine

Perfluorooctanoic acid (PFOA) and atrazine are two endocrine disruptors that are widely found in waters. Negative effects of PFOA and atrazine have been studied individually, but few data have focused on their combined effects. Here, zebrafish embryos were used as model to investigate the combined toxicity of PFOA and atrazine. The acute toxicity of atrazine (11.9 mg/L) to zebrafish embryos was much higher than that of perfluorooctanoic acid (224.6 mg/L) as shown by the 120h-LC50 value. Developmental effects, including delayed yolk sac absorption, spinal curvature, and liver abnormalities, were observed in both one- and two-component exposures. Notably, the rate of embryonic malformations in the co-exposure group was more than twice as high as that of single component exposure in the concentration range of 1/8-1/2 EC50, which indicated a synergistic effect of the binary mixture. The synergistic effect of PFOA-atrazine was further validated by combinatorial index (CI) modeling. In addition, changes of amino acid metabolites, reactive oxygen species and superoxide dismutase indicated that oxidative stress might be the main pathway for enhanced toxicity under co-exposure condition. Overall, co-exposure of PFOA and atrazine resulted in stronger developmental effects and more complicated amino acid metabolic response toward zebrafish, compared with single component exposure.

Range of international surgical strategies for adolescent idiopathic scoliosis: Evaluation of a multi-center survey.

Surgical treatment of adolescent idiopathic scoliosis (AIS) is very complex and modern instrumentation techniques offer multiple possibilities. Despite numerous publications, there is no clear consensus on the optimal strategy for the correction of scoliotic deformities. The goal of this study was to summarize the current surgical strategies for specific AIS cases within various countries. Thirty-two experienced scoliosis surgeons from 15 countries were asked to plan surgeries on 12 representative AIS cases. All AIS cases had an indication for surgery. A questionnaire was provided to document surgical planning. The surgeons were provided with the patients' age and sex, together with radiographs in the lateral and sagittal planes during upright standing and in lateral bending to the left and right, as well as with clinical images. The angles of the main spinal curvatures were specified in the questionnaire. The surgeons were asked to specify their preferred classification system, their surgical approach, the planned fusion length, the type of implants, the rod type, and the resection steps. The data were analyzed with respect to the inter-rater variability, which was quantified using the Fleiss-Kappa Method. There was a good agreement (k = 0.61) between the surgeons in choosing the Lenke curve type, and a moderate agreement for the lumbar (0.41) and sagittal (0.56) modifiers. The most frequently planned resection procedure was complete facetectomy (67%). The posterior approach was the most commonly (91%) selected strategy to treat AIS. Anterior approaches were chosen most for Lenke 5 type with a rate of 20%. The upper instrumented vertebra (UIV) varied most for Lenke 1, 5, and 6 cases, with a vertebral level discrepancy of up to 10 levels at Lenke 6. The lowest instrumented vertebra varied most for Lenke 1 and 4 by up to five levels. Polyaxial screws were chosen most (56%), followed by monoaxial (20%) and uniplanar (19%) screws and hooks (5%). The results highlight the commonalities and discrepancy in the surgical treatment of AIS in between surgeons. The selected LIV and UIV can vary depending on the curve type and surgeon. Hook constructs appear to be generally replaced by transpedicular screws. The survey indicates open questions in the AIS treatment and in the understanding of scoliosis biomechanics.

A Novel “De-tension”-guided Anterior Decompression Strategy—Thoracic Anterior Controllable Antedisplacement Fusion (TACAF) for Multilevel Ossification of Posterior Longitudinal Ligament in Thoracic Spine: A Retrospective Study with at Least 2-Year Follow-Up

To propose a novel surgical strategy-thoracic anterior controllable antedisplacement fusion (TACAF) to treat multilevel thoracic ossification of the posterior longitudinal ligament (mT-OPLL), and investigate its safety and efficacy. Between January 2019 and December 2021, a total of 49 patients with thoracic myelopathy due to mT-OPLL surgically treated with TACAF were retrospectively reviewed. Patients' demographic data, radiologic parameters, and surgery-related complications, modified Japanese Orthopedic Association (mJOA) and visual analog scale (VAS) scores, thoracic kyphosis (TK), kyphosis angle in fusion area (FSK), thoracic curvature, spinal cord curvature, and curvature of curved rod in surgical region, diameter, and area of the spinal cord at the most compressed level were included. All patients acquired satisfactory recovery of neurologic function and overall complication rate was low at the final follow up. The mean mJOA of the laminectomy+TACAF and Full Lamina Preservation+TACAF groups, respectively, was 3.74 ± 2.05, 3.67 ± 1.95 before surgery, and 9.97 ± 0.83, 9.80 ± 0.68 at the final followed up, with the recovery rate of 84.26% ± 14.20%, 82.79% ± 10.35%, as to VAS Scores. The mean FSK was 34.50 ± 4.46,35.33 ± 3.44 before surgery, and was restored to 20.97 ± 5.70, 22.93 ± 6.34 at the final followed up respectively, as to mean TK (P < 0.05). Spinal cord curvature was improved from 34.12 ± 3.59, 33.93 ± 3.45 before surgery to 19.47 ± 3.53, 18.80 ± 3.17 at the final follow-up respectively, as to thoracic curvature (P < 0.05). In addition, the area and diameter of the spinal cord was also significantly improved at the final follow up (all P < 0.05). The curvature of the thoracic pulp and thoracic vertebra is closely related to the curvature of the rod. There was no statistically significant difference in the incidence of the pelvis and the slope value of the sacrum. This strategy provides a novel solution for the treatment of mT-OPLL with favorable recovery of neurological function, the tension of spinal cord, and fewer complications.

From 2D to 3D: automatic measurement of the Cobb angle in adolescent idiopathic scoliosis with the weight-bearing 3D imaging

Background contextAdolescent idiopathic scoliosis (AIS) necessitates accurate spinal curvature assessment for effective clinical management. Traditional two-dimensional (2D) Cobb angle measurements have been the standard, but the emergence of three-dimensional (3D) automatic measurement techniques, such as those using weight-bearing 3D imaging (WR3D), presents an opportunity to enhance the accuracy and comprehensiveness of AIS evaluation. PurposeThis study aimed to compare traditional 2D Cobb angle measurements with 3D automatic measurements utilizing the WR3D imaging technique in patients with AIS. Study design/settingA cohort of 53 AIS patients was recruited, encompassing 88 spinal curves, for comparative analysis. Patient sampleThe patient sample consisted of 53 individuals diagnosed with AIS. Outcome measuresCobb angles were calculated using the conventional 2D method and three different 3D methods: the Analytical Method (AM), the Plane Intersecting Method (PIM), and the Plane Projection Method (PPM). MethodsThe 2D cobb angle was manually measured by 3 experienced clinicians with 2D frontal whole-spine radiographs. For 3D cobb angle measurements, the spine and femoral heads were segmented from the WR3D images using a 3D-UNet deep-learning model, and the automatic calculations of the angles were performed with the 3D slicer software. ResultsAM and PIM estimates were found to be significantly larger than 2D measurements. Conversely, PPM results showed no statistical difference compared to the 2D method. These findings were consistent in a subgroup analysis based on 2D Cobb angles. ConclusionEach 3D measurement method provides a unique assessment of spinal curvature, with PPM offering values closely resembling 2D measurements, while AM and PIM yield larger estimations. The utilization of WR3D technology alongside deep learning segmentation ensures accuracy and efficiency in comparative analyses. However, additional studies, particularly involving patients with severe curves, are required to validate and expand on these results. This study emphasizes the importance of selecting an appropriate measurement method considering the imaging modality and clinical context when assessing AIS, and it also underlines the need for continuous refinement of these techniques for optimal use in clinical decision-making and patient management.

Artificial Intelligence in Medical Imaging: Analyzing the Performance of ChatGPT and Microsoft Bing in Scoliosis Detection and Cobb Angle Assessment.

Open-source artificial intelligence models (OSAIM) find free applications in various industries, including information technology and medicine. Their clinical potential, especially in supporting diagnosis and therapy, is the subject of increasingly intensive research. Due to the growing interest in artificial intelligence (AI) for diagnostic purposes, we conducted a study evaluating the capabilities of AI models, including ChatGPT and Microsoft Bing, in the diagnosis of single-curve scoliosis based on posturographic radiological images. Two independent neurosurgeons assessed the degree of spinal deformation, selecting 23 cases of severe single-curve scoliosis. Each posturographic image was separately implemented onto each of the mentioned platforms using a set of formulated questions, starting from 'What do you see in the image?' and ending with a request to determine the Cobb angle. In the responses, we focused on how these AI models identify and interpret spinal deformations and how accurately they recognize the direction and type of scoliosis as well as vertebral rotation. The Intraclass Correlation Coefficient (ICC) with a 'two-way' model was used to assess the consistency of Cobb angle measurements, and its confidence intervals were determined using the F test. Differences in Cobb angle measurements between human assessments and the AI ChatGPT model were analyzed using metrics such as RMSEA, MSE, MPE, MAE, RMSLE, and MAPE, allowing for a comprehensive assessment of AI model performance from various statistical perspectives. The ChatGPT model achieved 100% effectiveness in detecting scoliosis in X-ray images, while the Bing model did not detect any scoliosis. However, ChatGPT had limited effectiveness (43.5%) in assessing Cobb angles, showing significant inaccuracy and discrepancy compared to human assessments. This model also had limited accuracy in determining the direction of spinal curvature, classifying the type of scoliosis, and detecting vertebral rotation. Overall, although ChatGPT demonstrated potential in detecting scoliosis, its abilities in assessing Cobb angles and other parameters were limited and inconsistent with expert assessments. These results underscore the need for comprehensive improvement of AI algorithms, including broader training with diverse X-ray images and advanced image processing techniques, before they can be considered as auxiliary in diagnosing scoliosis by specialists.

Comparison of Neck Pain and Posture with Spine Angle Tracking System between Static and Dynamic Computer Monitor Use

This study investigates the effect of dynamic changes in monitor height and tilt on neck pain and posture of computer users. Using a wearable device, we aim to compare neck pain and spine angle between static and dynamic monitors. A spine angle tracking system using the Inertial Measurement Unit (IMU) was proposed, and the accuracy was validated. Eight office workers participated for five hours over two days, and each day used either a static monitor or a dynamic monitor that changed height and tilt every 30 min. The angles of C0, C7, L1, and S1 endplates were estimated using the proposed system. Changes in neck pain and spine angle with time were compared in static and dynamic monitors. The intraclass correlation coefficient confirmed a high concordance between the estimated and actual angles (p &lt; 0.001). Rehabilitation Bioengineering Group (RBG) score increased less in the dynamic monitor compared to the static monitor (p = 0.003). Spinal curvatures are bent in the static monitor compared to the dynamic monitor. The estimated angles aligned well with X-ray measurements. A dynamic monitor that changes height and tilt at regular intervals may reduce neck pain increase and reduce bend forward posture compared to a static monitor.