Spinal Scoliosis Research Articles

Real-time measurement of radiation exposure in interventional radiologists during CT-guided intrathecal injections of nusinersen.

Some patients with spinal muscular atrophy and scoliosis require CT guidance during injections of nusinersen. The radiation applied to the operator in such procedures becomes an important issue in terms of staff health and safety. The aim of the study was to assess the operator's radiation exposure during CT-guided nusinersen injections in patients with spinal muscular atrophy and scoliosis. Consecutive 40 CT-guided nusinersen injections were analyzed in terms of operator's radiation exposure measured in real time. The median radiation dose measured under the physician's lead apron and patient dose in terms of DLP was 0.20 µSv and 31.90 mGy*cm respectively. The radiation doses were significantly higher (p = 0.047) in patients with spinal instrumentation. The results show that CT-guided nusinersen injection is a relatively safe procedure in terms of operator's radiation exposure. This can allow for interventional radiologists to perform more procedures without exceeding their annual dose limit.

The spine-brain axis: is spinal anatomy associated with brain volume?

First small sample studies indicate that disturbances of spinal morphology may impair craniospinal flow of cerebrospinal fluid and result in neurodegeneration. The aim of this study was to evaluate the association of cervical spinal canal width and scoliosis with grey matter, white matter, ventricular and white matter hyperintensity volumes of the brain in a large study sample. Four hundred participants underwent whole-body 3 T magnetic resonance imaging. Grey matter, white matter and ventricular volumes were quantified using a warp-based automated brain volumetric approach. Spinal canal diameters were measured manually at the cervical vertebrae 2/3 level. Scoliosis was evaluated using manual measurements of the Cobb angle. Linear binomial regression analyses of measures of brain volumes and spine anatomy were performed while adjusting for age, sex, hypertension, cholesterol levels, body mass index, smoking and alcohol consumption. Three hundred eighty-three participants were included [57% male; age: 56.3 (±9.2) years]. After adjustment, smaller spinal canal width at the cervical vertebrae 2/3 level was associated with lower grey matter (P = 0.034), lower white matter (P = 0.012) and higher ventricular (P = 0.006, inverse association) volume. Participants with scoliosis had lower grey matter (P = 0.005), lower white matter (P = 0.011) and larger brain ventricular (P = 0.003) volumes than participants without scoliosis. However, these associations were attenuated after adjustment. Spinal canal width at the cervical vertebrae 2/3 level and scoliosis were not associated with white matter hyperintensity volume before and after adjustment (P > 0.864). In our study, cohort smaller spinal canal width at the cervical vertebrae 2/3 level and scoliosis were associated with lower grey and white matter volumes and larger ventricle size. These characteristics of the spine might constitute independent risk factors for neurodegeneration.

Pregnancy outcomes in patients with undifferentiated connective tissue disease: An observational cohort prospective study

Background. Undifferentiated connective tissue disease is the subject of research in a large number of medical specialties, as it leads to an aggravated course of various diseases. In the presence of this pathology during pregnancy, the incidence of such complications as preeclampsia, gestational diabetes, and placental abruption increases. Failure to carry a pregnancy to term can be associated with various causes, including the activity of myocytes, while the pathology in question involves the connective tissue of the uterus. In this connection, it seems necessary to study the impact of undifferentiated connective tissue disease on pregnancy outcomes in order to administer timely treatment.Objectives. To assess how undifferentiated connective tissue disease affects the risk of failure to carry a pregnancy to term.Methods. An observational cohort prospective study was conducted among pregnant women who were under antenatal care in 2021–2022. The study was performed at the premises of the Clinical Maternity Hospital of Minsk Region (Republic of Belarus). The patients were divided into two groups: an exposed group comprising 59 patients with diagnosed undifferentiated connective tissue disease and a nonexposed group comprising 59 patients without this pathology. Both groups were divided into subgroups according to the obstetric outcome. The exposed group included a subgroup of 17 undifferentiated connective tissue disease patients who had failed to carry pregnancy to term (miscarriage and preterm labor) and a subgroup of 42 undifferentiated connective tissue disease patients with delivery at term. The nonexposed group included a subgroup of five women without undifferentiated connective tissue disease who had failed to carry pregnancy to term (miscarriage and preterm labor) and a subgroup of 54 women without undifferentiated connective tissue disease and with delivery at term. According to ICD-10, abortive outcomes occurred before 21 weeks and six days gestation; labor that occurred at 22–36 weeks and six days gestation was considered preterm, whereas in the case of delivery at term, the baby was born at 37–41 weeks and six days gestation. The obstetric, gynecological, and somatic history, as well as pregnancy outcomes, were analyzed. Statistical processing of data was performed using the following software: Statistica 12.0 (StatSoft, USA), Microsoft Excel 2016, Epi InfoTM 7.2.6.0 (USA), and MedCalc 15.8 (MedCalc Software, Belgium). In hypothesis testing, differences were considered statistically significant at p < 0.05.Results. In the group of undifferentiated connective tissue disease patients, metrorrhagia was statistically significantly more common than in the patients without undifferentiated connective tissue disease: 18 out of 59 (30.5 %) and six out of 59 (10.2 %), respectively, p = 0.012. The obstetric history revealed no statistically significant intergroup differences, p > 0.05. In the undifferentiated connective tissue disease patients, the following diseases were statistically significantly more common: myopia, spinal scoliosis, lower limb varicose veins, chronic tonsillitis, mitral valve prolapse, and iron deficiency anemia (p < 0.05). The incidence of new cases of failure to carry a pregnancy to term in the cohort during the observation period amounted to 18.6 % for the patients in both groups. The pregnancy ended prematurely in 17 out of the 59 undifferentiated connective tissue disease patients (28.8 %) and in five out of the 59 patients without undifferentiated connective tissue disease (8.5 %), relative risk of 3.4 (95 % CI:1.3–8.6), p = 0.005.Conclusion. Undifferentiated connective tissue disease increases the risk of failure to carry a pregnancy to term by 3.4 times. Timely diagnosis and treatment of undifferentiated connective tissue disease at the stage of preconception preparation can reduce the incidence of failure to carry a pregnancy to term.

Spinal scoliosis: insights into developmental mechanisms and animal models.

Spinal scoliosis, a prevalent spinal deformity impacting both physical and mental well-being, has a significant genetic component, though the exact pathogenic mechanisms remain elusive. This review offers a comprehensive exploration of current research on embryonic spinal development, focusing on the genetic and biological intricacies governing axial elongation and straightening. Zebrafish, a vital model in developmental biology, takes a prominent role in understanding spinal scoliosis. Insights from zebrafish studies illustrate genetic and physiological aspects, including notochord development and cerebrospinal fluid dynamics, revealing the anomalies contributing to scoliosis. In this review, we acknowledge existing challenges, such as deciphering the unique dynamics of human spinal development, variations in physiological curvature, and disparities in cerebrospinal fluid circulation. Further, we emphasize the need for caution when extrapolating findings to humans and for future research to bridge current knowledge gaps. We hope that this review will be a beneficial frame of reference for the guidance of future studies on animal models and genetic research for spinal scoliosis.

Reliability and validity of the pediatric adaptation of the mJOA scale for evaluating cervical spine disorders.

The study aimed to evaluate the validity and reliability of the pediatric adaptation of the Japanese Orthopedic Association (mJOA) scale in pediatric patients with various cervical spine pathologies. Initial assessments were performed by a neurosurgeon, followed by an independent evaluation by a neurologist within 1-2days to test inter-rater reliability. The same clinician assessed the same group of children using the adapted mJOA scale at different point in time (between 1month and 1year after the initial assessment) to test intra-rater reliability. For known-groups validity, the pediatric mJOA scale assessments were compared between two groups of pathologies with different prognosis. Concurrent validity was assessed against the McCormick scale, and convergent validity was tested by reassessing patients using the adult mJOA scale two or more years after the initial assessment by pediatric one. A cohort of 169 pediatric patients aged 6months to 18years (mean age: 10 ± 4.6years) with various cervical spine pathologies was recruited. Pathologies included atlanto-axial rotatory fixation (AARF), Chiari type I anomaly, congenital cervical spine scoliosis, atlanto-axial dislocation (AAD) and instability (AAI), cervical spine stenosis and trauma, and congenital cervicothoracic dislocations. The majority of patients underwent cervical spine surgery and were followed up for an average of 6.9 ± 2.97years. The pediatric mJOA scale demonstrated high inter-rater reliability (r = 0.99, p < 0.0001) and strong intra-rater reliability (r = 0.82, p < 0.0001). Significant differences in pediatric mJOA scores were observed between patients with expected-intact neurological status and those with expected-pathological neurological status (p < 0.0001). The pediatric mJOA scale showed a strong correlation with the McCormick grading system (r = 0.97, p < 0.001) and good correlation with the adult mJOA scale during long-term follow-up (r = 0.82, p < 0.0001). The pediatric version of the mJOA scale is a reliable and valid tool for assessing pediatric patients with cervical spine disorders. Its high reliability and validity support its use in both clinical practice and research.

A horizontal and perpendicular interlaminar approach for intrathecal nusinersen injection in patients with spinal muscular atrophy and scoliosis: an observational study

BackgroundLumbar puncture is challenging for patients with scoliosis. Previous ultrasound-assisted techniques for lumbar puncture used the angle of the probe as the needle trajectory; however, reproducing the angle is difficult and increases the number of needle manipulations. In response, we developed a technique that eliminated both the craniocaudal and lateromedial angulation of the needle trajectory to overall improve this technique. We assessed the feasibility and safety of this method in patients with scoliosis and identify factors related to difficult lumbar puncture.MethodsPatients with spinal muscular atrophy and scoliosis who were referred to the anesthesia department for intrathecal nusinersen administrations were included. With a novel approach that utilized patient position and geometry, lumbar puncture was performed under ultrasound guidance. Success rates, performance times and adverse events were recorded. Clinical-demographic and spinal radiographic data pertaining to difficult procedures were analyzed.ResultsSuccess was achieved in all 260 (100%) lumbar punctures for 44 patients, with first pass and first attempt success rates of 70% (183/260) and 87% (226/260), respectively. Adverse events were infrequent and benign. Higher BMI, greater skin dural sac depth and smaller interlaminar size might be associated with greater difficulty in lumbar puncture.ConclusionsThe novel ultrasound-assisted horizontal and perpendicular interlaminar needle trajectory approach is an effective and safe method for lumbar puncture in patients with spinal deformities. This method can be reliably performed at the bedside and avoids other more typical and complex imaging such as computed tomography guided procedure.

Analysis of clinical characteristics of different types of lung function impaiement in TDL patients

AimThe clinical characteristics associated with pulmonary function decline in patients with Tuberculosis-destroyed lung (TDL) remain uncertain. We categorize them based on the pattern of pulmonary function impairment, distinguishing between restrictive spirometric pattern (RSP) and obstructive spirometric pattern (OSP). We aim to compare the severity of these patterns with the clinical characteristics of TDL patients and analyze their correlation.MethodWe conducted a retrospective analysis on the clinical data of TDL patients who underwent consecutive pulmonary function tests (PFT) from November 2002 to February 2023. We used the lower limit formula for normal values based on the 2012 Global Lung Function Initiative. We compared the clinical characteristics of RSP patients with those of OSP patients. The characteristics of RSP patients were analyzed using the tertiles of forced vital capacity percentage predicted (FVC% pred) decline based on PFT measurements, and the characteristics of OSP patients were analyzed using the tertiles of forced expiratory volume in 1 s percentage predicted (FEV1% pred) decline.ResultAmong the RSP patients, those in the Tertile1 group (with lower FVC% pred) were more likely to have a higher of body mass index (BMI), spinal deformities, and C-reactive protein (CRP) compared to the other two groups (P for trend < 0.001, 0.027, and 0.013, respectively). Among OSP patients, those in the Tertile1 group (with lower FEV1% pred) showed an increasing trend in cough symptoms and contralateral lung infection compared to the Tertile 2–3 group (P for trend 0.036 and 0.009, respectively).ConclusionFor TDL patients, we observed that Patients with high BMI, a higher proportion of spinal scoliosis, and abnormal elevation of CRP levels were more likely to have reduced FVC. Patients with decreased FEV1% pred have more frequent cough symptoms and a higher proportion of lung infections on the affected side.

Spinal Muscular Atrophy Scoliosis in the Era of Background Therapies-A Review of the Literature.

Spinal deformities are considered an important complication of neuromuscular disorders such as spinal muscular atrophy (SMA). SMA patients typically develop progressive early-onset scoliosis, which is associated with increased functional decline, discomfort, and respiratory dysfunction. Over the second decade of the twenty-first century, a lot has changed in terms of the therapeutic options available to people with SMA. Specifically, the use of pharmaceutical agents such as nusinersen (Spinraza), onasemnogene abeparvovec (Zolgensma), and risdiplam (Evrysdi) has dramatically changed the landscape for SMA patients. These medications significantly alter motor- and respiratory functioning, as well as the natural progression of spinal deformities. When evaluating these agents and their impact on the development of scoliosis and motor functioning, it is important to consider the timing of treatment initiation. In patients treated after they had already developed symptoms, a shift of phenotype to a less severe subtype has been observed. This results in a delay in the onset of scoliosis for the less severe SMA types and an increase in early-onset scoliosis for the severe types in patients who would typically not live to develop scoliosis. Patients who receive treatment before they develop symptoms achieve almost normal motor functioning and will likely have a significant decrease in scoliosis prevalence or at least delay its onset.

A survey of practice in the anesthetic management of adolescent idiopathic scoliosis spine fusion by the North American Pediatric Spine Anesthesiologists Collaborative.

Adolescent Idiopathic Scoliosis (AIS) affects 2%-4% of the general pediatric population. While surgical correction remains one of the most common orthopedic procedures performed in pediatrics, limited consensus exists on the perioperative anesthetic management. To examine the current state of anesthetic management of typical AIS spine fusions at institutions which have a dedicated pediatric orthopedic spine surgeon. A web-based survey was sent to all members of the North American Pediatric Spine Anesthesiologists (NAPSA) Collaborative. This group included 34 anesthesiologists at 19 different institutions, each of whom has a Harms Study Group surgeon performing spine fusions at their hospital. Thirty-one of 34 (91.2%) anesthesiologists completed the survey, with a missing response rate from 0% to 16.1% depending on the question. Most anesthesia practices (77.4%; 95% confidence interval [CI], 67.7-93.4) do not have patients come for a preoperative visit prior to the day of surgery. Intravenous induction was the preferred method (74.2%; 95% CI 61.3-89.9), with the majority utilizing two peripheral IVs (93.5%; 95% CI 90.3-100) and an arterial line (100%; 95% CI 88.8-100). Paralytic administration for intubation and/or exposure was divided (51.6% rocuronium/vecuronium, 45.2% no paralytic, and 3.2% succinylcholine) amongst respondents. While tranexamic acid was consistently utilized for reducing blood loss, dosing regimens varied. When faced with neuromonitoring signal issues, 67.7% employ a formal protocol. Most anesthesiologists (93.5%; 95% CI 78.6-99.2) extubate immediately postoperatively with patients admitted to an inpatient floor bed (77.4%; 95% CI 67.7-93.3). Most anesthesiologists (87.1%; 95% CI 80.6-99.9) report the use of some form of an anesthesia-based protocol for AIS fusions, but our survey results show there is considerable variation in all aspects of perioperative care. Areas of agreement on management comprise the typical vascular access required, utilization of tranexamic acid, immediate extubation, and disposition to a floor bed. By recognizing the diversity of anesthetic care, we can develop areas of research and improve the perioperative management of AIS.

Evaluating the Readability of Patient Education Materials for Anterior Vertebral Body Tethering, Distraction-Based Methods, and Posterior Spinal Fusion for the Treatment of Pediatric Spinal Deformity.

The Internet is an important source of information for patients, but its effectiveness relies on the readability of its content. Patient education materials (PEMs) should be written at or below a sixth-grade reading level as outlined by agencies such as the American Medical Association. This study assessed PEMs' readability for the novel anterior vertebral body tethering (AVBT), distraction-based methods, and posterior spinal fusion (PSF) in treating pediatric spinal deformity. An online search identified PEMs using the terms "anterior vertebral body tethering," "growing rods scoliosis," and "posterior spinal fusion pediatric scoliosis." We selected the first 20 general medical websites (GMWs) and 10 academic health institution websites (AHIWs) discussing each treatment (90 websites total). Readability tests for each webpage were conducted using Readability Studio software. Reading grade levels (RGLs), which correspond to the US grade at which one is expected to comprehend the text, were calculated for sources and independent t tests compared with RGLs between treatment types. The mean RGL was 12.1 ± 2.0. No articles were below a sixth-grade reading level, with only 2.2% at the sixth-grade reading level. AVBT articles had a higher RGL than distraction-based methods (12.7 ± 1.6 vs 11.9 ± 1.9, P = 0.082) and PSF (12.7 ± 1.6 vs 11.6 ± 2.3, P = 0.032). Materials for distraction-based methods and PSF were comparable (11.9 ± 1.9 vs 11.6 ± 2.3, P = 0.566). Among GMWs, AVBT materials had a higher RGL than distraction-based methods (12.9 ± 1.4 vs 12.1 ± 1.8, P = 0.133) and PSF (12.9 ± 1.4 vs 11.4 ± 2.4, P = 0.016). Patients' health literacy is important for shared decision-making. Assessing the readability of scoliosis treatment PEMs guides physicians when sharing resources and discussing treatment with patients. Both GMWs and AHIWs exceed recommended RGLs, which may limit patient and parent understanding. Within GMWs, AVBT materials are written at a higher RGL than other treatments, which may hinder informed decision-making and patient outcomes. Efforts should be made to create online resources at the appropriate RGL. At the very least, patients and parents may be directed toward AHIWs; RGLs are more consistent.

Clinical characteristics analysis of pediatric spinal cord injury without radiological abnormality in China: a retrospective study

PurposeThis study aims to analyze the clinical characteristics of Chinese children with spinal cord injury (SCI) without radiographic abnormality (SCIWORA) and explore their contributing factors and mechanisms of occurrence.MethodsA retrospective analysis was conducted on the clinical data of pediatric patients diagnosed with SCIWORA from January 2005 to May 2020. Epidemiological, etiological, mechanistic, therapeutic, and outcome aspects were analyzed.ResultsA total of 47 patients with SCIWORA were included in this study, comprising 16 males and 31 females. The age range was 4 to 12 years, with an average age of 7.49 ± 2.04 years, and 70% of the patients were below eight. Sports-related injuries constituted 66%, with 70% attributed to dance backbend practice. Thoracic segment injuries accounted for 77%. In the American Spinal Injury Association (ASIA) classification, the combined proportion of A and B grades accounted for 88%. Conservative treatment was chosen by 98% of the patients, with muscle atrophy, spinal scoliosis, hip joint abnormalities, and urinary system infections being the most common complications.ConclusionSCIWORA in Chinese children is more prevalent in those under eight years old, with a higher incidence in females than males. Thoracic spinal cord injuries are predominant, dance backbend as a primary contributing factor, and the social environment of “neijuan” is a critical potential inducing factor. Furthermore, the initial severity of the injury plays a decisive role in determining the prognosis of SCIWORA.

Application of System Nursing in the Prevention of Postoperative Nonstructural Scoliosis in Patients With Ear Reconstruction.

To evaluate whether early systematic nursing can reduce the occurrence of postoperative nonstructural scoliosis in patients undergoing ear reconstruction. A total of 136 patients with congenital microtia who underwent ear reconstruction surgery at the Department of Plastic Surgery, Chinese Academy of Medical Sciences from, January 2022 to July 2022 were included as study subjects. They were randomly divided into a routine nursing group and a systematic nursing group. After preoperative and postoperative education, as well as continuous follow-up intervention after surgery, spinal CT three-dimensional imaging examination was performed 6 months later to measure the Cobb angle and observe the occurrence of spinal scoliosis. Compared with the routine nursing group, the incidence and severity of postoperative nonstructural scoliosis were significantly reduced in patients who received systematic nursing. Systematic nursing intervention for patients undergoing ear reconstruction can help prevent the occurrence of postoperative nonstructural scoliosis and has a positive effect on improving patient prognosis. It is worth promoting in clinical treatment.

Reconstructing the life histories of a noble couple from the Joseon period, Korea, based on skeletal evidence and historical records

AbstractThis study is an osteobiography of a noble couple who were members of the “ruling elite” in the 18th‐century Joseon period, Korea. The archaeological context and historical records indicate that the couple lived and died during a period marked by strict observance of social hierarchy. The husband's skeleton exhibits clear evidence of craniosynostosis and spinal scoliosis. In particular, congenital craniosynostosis of the skull likely caused deformities in his craniofacial morphology during his lifetime. The physical deformities and discomforts revealed by his craniofacial and vertebral skeleton shed light on the documented passivity and frequent disruptions to his government positions. Meanwhile, his wife's age at death, 93 years, is exceptionally long. The osteological investigation suggests that she seems to have lived without severe stressors. Her skeletal remains show no evidence of occupational stress or chronic disease. Until now, our understanding of the Joseon period nobility has predominantly relied on artifacts and summaries of the deceased's life discovered in tombs, as well as written documents such as diaries, evaluation records, and letters. This study reconstructs the lives of this couple through osteological evidence, historical records, and social context. This holistic approach will provide a novel perspective for a more comprehensive understanding of the lives of nobility and intellectuals of the period.

Clinical Efficacy of Unilateral Dual-channel Endoscopic Lumbar Interbody Fusion for Lumbar Spondylolisthesis with Spinal Scoliosis.

Scoliosis associated with spondylolisthesis is a common phenomenon. Recent research has reported that scoliosis can spontaneously disappear after lumbar spinal fusion surgery. Researchers have advocated that, for scoliosis associated with vertebral slippage, surgery for the latter may be the only necessary intervention, while unnecessary surgery for scoliosis should be avoided. So we propose that minimally invasive techniques can achieve treatment effects similar to those of open surgery. Therefore, in this study, we aimed to investigate the clinical efficacy of unilateral dual-channel endoscopic lumbar interbody fusion (ULIF) for treating lumbar spondylolisthesis with spinal scoliosis. This study retrospectively analyzed patients with lumbar spondylolisthesis and spinal scoliosis who underwent ULIF between September 2021 and September 2023. Measurements of the Cobb angle, lumbar lordosis (LL) angle, sacral slope (SS), slip percentage (SP), slip angle (SA), L1 plumb line-S1 distance (LASD), and average intervertebral height (AIH) were taken preoperatively, immediately following surgery, 3 months after surgery, and at the final follow-up. The visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) scoring systems were used to assess clinical results. The surgical efficacy was evaluated by comparing these parameters before and after surgery. Comparison of indicators within the same group was conducted using one-way repeated-measures analysis of variance or paired sample t-tests, whereas between-group differences were compared using an independent t-test. This study included 31 individuals who underwent surgery and completed follow-up. The follow-up period did not show a significant loss of corrective angles. Furthermore, the Cobb angle, SP, SA, and LASD significantly decreased after surgery, whereas the LL angle, SS, and AIH significantly increased (all p < 0.05). SP did not differ between the immediate postoperative period and the 3-month and final follow-up periods (p > 0.05). However, other parameters significantly improved during the follow-up period at all time points, except from 3 months to the final follow-up period (p > 0.05). Throughout the follow-up period, the lower back and leg pain VAS, ODI, and JOA scores considerably improved compared with the preoperative levels (p < 0.05). ULIF effectively treated lumbar spondylolisthesis with scoliosis, thereby reducing the degree of slip and scoliosis. By performing surgical reduction, fusion, and fixation only on the slipped segment, ULIF also had a corrective effect on the spinal lateral curvature, thereby avoiding the need for unnecessary scoliosis surgery. Moreover, the short-term efficacy was satisfactory, but the long-term efficacy requires further study.

Finite element method-based study for spinal vibration characteristics of the scoliosis and kyphosis lumbar spine to whole-body vibration under a compressive follower preload

Purpose To analyze the dynamic response of the lumbosacral vertebrae structure of a scoliosis spine and a kyphosis spine under whole-body vibration. Methods Typical Lenke4 (kyphosis) and Lenke3 (scoliosis) spinal columns were used as research objects. A finite element model of the lumbosacral vertebrae segment was established and validated based on CT scanning images. Modal, harmonic response, and transient dynamic analyses were performed on the lumbar-sacral scoliosis model using the finite element software abaqus. Results The first four resonance frequencies of kyphosis spine extracted from modal analysis were 0.86, 1.45, 8.51, and 55.71 Hz. The first four resonance frequencies of scoliosis spine extracted from modal analysis were 0.76, 1.45, 10.51, and 63.82 Hz. The scoliosis spine had the maximum resonance amplitude in the transverse direction, while the kyphosis spine had the maximum resonance amplitude in the anteroposterior direction. The dynamic response in transient analysis exhibited periodic response over time at all levels. Conclusion The scoliosis and kyphosis deformity of the spine significantly complicates the vibration response in the scoliosis and kyphosis areas at the top of the spine. Scoliosis and kyphosis patients are more likely to experience vibrational spinal diseases than healthy people. Besides, applying vertical cyclic loads on a malformed spine may cause further rotation of scoliosis and kyphosis deformities.

Butterfly Vertebra: A Retrospective Study of 30 Patients

BackgroundButterfly vertebra (BV) is a rare congenital spinal anomaly for which there is a paucity of large-scale retrospective studies and established guidelines for treatment. The objective of this study was to elucidate the clinical characteristics, imaging findings, and therapeutic approaches for BV. Materials and methodsWe conducted a retrospective analysis of 30 patients diagnosed with BV at our hospital from 2009 to 2023, examining clinical data, imaging findings, and clinical interventions. ResultsThe analysis comprised a cohort of 30 patients, consisting of 15 males and 15 females, with a mean age of 27.63±19.84 years. Imaging studies indicated that the majority of vertebral bodies affected by BV were single-segmented (63.3%, 19/30) and less commonly multi-segmented (36.7%, 11/30). These findings frequently coexisted with other medical conditions, most notably spinal scoliosis (76.7%, 23/30). Furthermore, the study identified a range of spinal abnormalities among patients, including hemivertebral deformity (30.0%, 9/30), spinal cleft (10.0%, 3/30), lumbar disc protrusion or herniation (10.0%, 3/30), vertebral slippage (10.0%, 3/30), thoracic kyphosis deformity (6.67%, 2/30), vertebral fusion deformity (6.67%, 2/30), compressive fractures (3.3%, 1/30), and vertebral developmental anomalies (3.3%, 1/30). Clinical intervention resulted in symptom relief for 23 non-surgical patients through lifestyle modifications, analgesic use, and physical therapy. Seven surgical patients underwent appropriate surgical procedures, leading to satisfaction and adherence to regular postoperative follow-up appointments. ConclusionBV is a rare vertebral anomaly that can be easily misdiagnosed due to its similarity to other diseases. Consequently, it is imperative to enhance vigilance in the differential diagnosis process in order to promptly recognize BV. Furthermore, in cases where patients present with additional associated radiographic findings, a thorough evaluation is typically warranted, and timely measures should be taken for treatment.

Аналіз частоти маніфестації деяких ізольованих та поєднаних вад розвитку опорно-рухового апарату в дітей молодшого шкільного віку

Over the past few decades, there has been a significant decrease in the number of healthy children, while the number of children with chronic illnesses, developmental disorders, various forms of postural issues, and scoliosis has significantly increased. Purpose - to determine the frequency of manifestation of developmental abnormalities in the spine, chest, foot, and lower jaw, as well as detection of variations and characteristics of their combinations in younger school children to develop new and improve existing criteria for early diagnosis of musculoskeletal development disorders and the correct selection of methods for their correction. Materials and methods. In order to conduct the study as part of preventive check-ups with parental informed consent, 200 children (100 boys and 100 girls) aged 6-9 years were examined. The working group was formed using the randomization method. The groups of boys and girls were further divided into 4 age groups, (6 years, 7 years, 8 years and 9 years) each consisting of 25 children. We determined the shape of the chest , the symmetry of processus mastoideus, claviculae and fossa supraclaviculare, scapulae, cristae illiacae, maleolus medialis, the condition of the foot arch and the lower jaw development. Results. Among the total number of examined children, isolated or combined variations of the following developmental abnormalities of the musculoskeletal system were found in 21.5% of cases. Isolated developmental abnormalities of the musculoskeletal system were found in 10% of examined boys and 8% of examined girls. Various combinations of detected abnormalities were found to manifest in 13% of boys and 12% of girls. Thoracic scoliosis is present in 16% of boys and 14% of girls; developmental issues of the lower jaw affect 9% of boys and 8% of girls, scoliosis of the cervical spine affects 4% of boys and 3% of girls; 6% of boys and 5% of girls have chest deformities and lumbar spine scoliosis. Conclusions. Developmental musculoskeletal abnormalities were found in 21.5% of children of. The frequency of combined developmental abnormalities increases with age. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Correlation analysis and clinical significance of changes in upper thoracic vertebra tilt and clavicle angle pre- and post-operation.

The imbalance of the lateral shoulder is reflected by the clavicle angle (CA) in radiology. It remains unclear how to achieve postoperative lateral shoulder balance (LSB) after spinal deformity correction surgery. A retrospective analysis was conducted on AIS patients who underwent surgery by the same spine surgeon at our hospital from 2016 to 2020. A total of 110 patients with spinal deformity were included in the study to verify the correlation between the T1-T5 tilt angle and CA before and after surgery, as well as the relation-ship between the change in T1-T5 tilt angle before and after surgery and the change in CA before and after surgery. By comparing the correlation coefficients, it was found that there may not be a direct relationship between the pre- and postoperative tilt angles of T1-5 and CA, but their changes were closely related to the changes in CA. The change in T1 tilt angle after orthopaedic surgery was significantly correlated with the change in CA, with a correlation coefficient of 0.976, indicating a close relationship between T1 and the clavicle. As the vertebrae moved down, the correlation gradually decreased. In summary, this study suggests that there is a close relationship between T1-T5 and the clavicle and that the change in T1 tilt angle after spinal scoliosis correction surgery is significantly correlated with CA, which decreases as the vertebra moves down.

Features of arrhythmic syndrome in children with nonspecific connective tissue disorder

Introduction. In case of nonspecific connective tissue disorder (NCTD), the most significant in terms of prognosis for life is arrhythmic syndrome. Therefore, it remains important to introduce modern diagnostic methods into practice to prevent fatal events in childhood and young people.Aim. To study the features of arrhythmic syndrome in children with NCTD in relation to the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and structural changes in the heart.Materials and methods. A total of 45 children aged 10–17 years with arrhythmic syndrome due to NCTD and 20 children with normal heart rhythm and isolated presentations of NCTD (control group) were enrolled in the study. NSDT phenotypic markers, NT-proBNP levels, electrocardiogram (ECG) monitoring findings and speckle-tracking echocardiography data were studied.Results and discussion. Children with arrhythmic syndrome and NCTD had more frequently dolichostenomelia, arachnodactyly, keeled chest deformity of II–III-degree, spinal scoliosis of II–III-degree, joint hypermobility, blue sclera. The structure of the arrhythmic syndrome in children with NCTD is – ventricular and supraventricular extrasystoles, paroxysmal supraventricular tachycardia. Speckle-tracking echocardiography showed a left ventricular strain in anterior basal segment and global longitudinal strain. There was association between a local longitudinal strain in the anterior basal segment and keeled chest deformity of II–III-degree, mitral valve prolapse, longitudinal flatfoot, asthenic shape of the chest, pectus excavatum deformity of II–III degree. There was association between the NT-proBNP level and the diagnostic threshold for NCTD. Patients with arrhythmic syndrome and NCTD had a direct, medium-degree significant correlation between the NT-proBNP level and heart rate, mitral valve prolapse and cardiac arrhythmia such as ventricular extrasystoles.Conclusion. The results of the study will be implemented in the future in the individual programs for the management of patients with NCTD.

Clinical characteristics and assessment of structural and functional myocardium changes in patients with nonspecific connective tissue disorder

Early non-invasive diagnosis of structural changes in the heart plays an important role in optimizing approaches to preventing dangerous rhythm disorders at a young age.Aim: To study the phenotypic features of nonspecifi c connective tissue disorder (NCTD) in relation to the myocardial strain and the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with cardiac arrhythmias and NCTD.Results. There was an association between a local longitudinal left ventricular (LV) strain and pectus excavatum (r1 = 0.234, p = 0.008), joint hypermobility syndrome (r1 = 0.406, p = 0.026), spinal scoliosis (r1 = 0.266, p = 0.003), mitral valve prolapse (MVP) (r1 = 0.519, p = 0.003), diagnostic threshold of NCTD (r1 = 0.395, p = 0.031) in patients with arrhythmias and NCTD;there was an inverse weak to moderate association of body mass index (BMI) and myocardial strain in a number of LV segments. There was a signifi cant relationship between NT-proBNP and diagnostic threshold of NCTD (r1 = 0.496, p = 0.001), mitral valve prolapse (r1 = 0.469, p = 0.002).Conclusion. Chest deformity, spinal scoliosis, joint hypermobility, mitral valve prolapse and BMI decrease in patients with arrhythmic syndrome and NCTD are associated with the myocardial strain and NT-proBNP level that can be used for the early identifi cation of myocardial remodeling in this patient cohort.