Spinal Scoliosis Research Articles

Skull-femoral traction followed by osteotomy correction is a safe and effective treatment for severe scoliosis with split cord malformation.

This study aimed to evaluate the safety and efficacy of skull-femoral traction followed by osteotomy correction in patients with severe spinal scoliosis and split cord malformation. We retrospectively analyzed ten cases of severe spinal scoliosis with Pang I type split cord malformation treated between August 2012 and August 2023. Patients underwent skull-femoral traction prior to osteotomy correction. We assessed changes in height, weight, coronal and sagittal Cobb's angles, and physiological indicators such as vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and blood gas levels before, during, and after treatment. Traction duration ranged from 9 to 19 days, with height and weight showing significant increases post-treatment. The coronal Cobb's angle improved from pre-treatment to post-corrective surgery and remained stable at the final follow-up. Similar improvements were observed in the sagittal plane. Physiological indicators such as VC, FVC, and FEV1, as well as blood gas levels, normalized after treatment. Nutritional status, indicated by triceps skinfold thickness, albumin, and transferrin concentrations, also improved. No neurological complications or device-related complications occurred during or after treatment. Skull-femoral traction followed by osteotomy correction is a safe and effective treatment for severe spinal scoliosis with split cord malformation, offering an alternative to high-risk procedures.

Improvement of Pulmonary Function and Reconstructed 3-Dimensional Lung Volume After Halo-Pelvic Traction Combined With Posterior Correction for Severe Rigid Spinal Scoliosis: A Multicenter Study.

Severe rigid spinal scoliosis (SRSS) leads to severe restrictive ventilation dysfunction. Currently, the reports about the influence of preoperative halo-pelvic traction (HPT) combined with correction surgery on pulmonary function in patients with SRSS were relatively few. This study aims to investigate (1) the influence of preoperative HPT on lung volume and pulmonary function, (2) the further influence of the following correction surgery on lung volume and pulmonary function, and (3) the relationship among deformity correction, pulmonary function test outcomes, and computed tomography-based lung volume. A total of 135 patients with SRSS who underwent preoperative HPT and followed low-grade osteotomy correction surgery were reviewed. Spinal parameters, including proximal thoracic curve, main thoracic curve (MTC), lumbar curve, coronal balance, thoracic kyphosis, lumbar lordosis, sagittal vertical axis, pulmonary function test outcomes (forced vital capacity [FVC], the percentage of predicted forced vital capacity [FVC%], forced expiratory volume in 1 second [FEV1], total lung capacity [TLC]), and lung volume (Vin), were analyzed before, after HPT and at the final follow-up, respectively. The mean FVC, FVC%, FEV1, and TLC increased from 1.67 L, 51.13%, 1.47 L, and 2.37 L to 1.95 L, 64.35%, 1.75 L, and 2.78 L, respectively, after HPT and further improved to 2.22 L, 72.14%, 1.95 L, and 3.15 L, respectively, at the final follow-up. The mean Vin increased from 1.98 L to 2.42 L after traction and further increased to 2.76 L at the final follow-up. The variation of MTC was correlated with the improvement of FVC (r = 0.429, P = .026), FVC% (r = 0.401, P = .038), FEV1 (r = 0.340, P = .043), and TLC (r = 0.421, P = .029) and the variation of Vin (r = 0.425, P = .015) before HPT and after surgery. Preoperative HPT can improve preoperative pulmonary function and enhance the preoperative lung volume. There were significant correlations among the variations of MTC, pulmonary function indexes, and lung volume before HPT and after surgery in patients with SRSS.

The difficulties of diagnosing and determining the tactics of treating osteoporosis in severe spinal scoliosis case

A female patient with early surgical menopause and severe S-shaped scoliosis was diagnosed with osteoporosis at the place of residence and treated with a bisphosphonate (zoledronic acid). Despite the deformity of the spine and chest, the patient had no complaints until recently and led an active lifestyle. During X-ray densitometry at the National Medical Research Center for Therapy and Preventive Medicine, in particular when examining the lumbar spine, there were difficulties with positioning the patient for correct scanning of the area of interest and, as a result, obtaining information about the true state of trabecular bone tissue. Bone mineral density (BMD) in the proximal femur was consistent with osteopenia. Additional laboratory and instrumental parameters, such as biochemical markers of bone remodelling (osteocalcin and C-terminal type 1 collagen telopeptide) and trabecular bone score (TBS), also did not allow to precise the risk of fractures and make an unambiguous conclusion about the necessity of continuing antiresorptive therapy. Given the low BMD values in lumbar spine (T-score -4.8 SD) and the possibility of developing vertebral compression fractures as a result of minimal trauma with further chest deformity progression and vital organs failure, it was decided to continue treatment with zoledronic acid. Further therapeutic tactics will be determined after the next scheduled examination in 1 year.

Total body bone mineral density and various spinal disorders: a Mendelian randomization study.

Observational studies have yielded inconsistent findings regarding the correlation between bone mineral density (BMD) and various spinal disorders. To explore the relationship between total-body BMD and various spinal disorders further, we conducted a Mendelian randomization analysis to assess this association. Two-sample bidirectional Mendelian randomization (MR) analysis was employed to investigate the association between total-body BMD and various spinal disorders. The inverse-variance weighted (IVW) method was used as the primary effect estimate, and additional methods, including weighted median, MR-Egger, simple mode, and weighted mode, were used to assess the reliability of the results. To examine the robustness of the data further, we conducted a sensitivity analysis using alternative bone-density databases, validating the outcome data. MR revealed a significant positive association between total-body BMD and the prevalence of spondylosis and spinal stenosis. When total-body BMD was considered as the exposure factor, the analysis demonstrated an increased risk of spinal stenosis (IVW odds ratio [OR] 1.23; 95% confidence interval [CI], 1.14-1.32; P < 0.001) and spondylosis (IVW: OR 1.24; 95%CI, 1.16-1.33; P < 0.001). Similarly, when focusing solely on heel BMD as the exposure factor, we found a positive correlation with the development of both spinal stenosis (IVW OR 1.13, 95%CI, 1.05-1.21; P < 0.001) and spondylosis (IVW OR 1.10, 95%CI, 1.03-1.18; P = 0.0048). However, no significant associations were found between total-body BMD and other spinal disorders, including spinal instability, spondylolisthesis/spondylolysis, and scoliosis (P > 0.05). This study verified an association of total-body BMD with spinal stenosis and with spondylosis. Our results imply that when an increasing trend in BMD is detected during patient examinations and if the patient complains of numbness and pain, the potential occurrence of conditions such as spondylosis or spinal stenosis should be investigated and treated appropriately.

Relationship between lumbar spinal stenosis and axial muscle wasting

BACKGROUND CONTEXTAlthough the effect of lumbar spinal stenosis (LSS) on the lower extremities is well documented, limited research exists on the effect of spinal stenosis on the posterior paraspinal musculature (PPM). Similar to neurogenic claudication, moderate to severe spinal canal compression can also interfere with the innervation of the PPM, which may result in atrophy and increased fatty infiltration (FI). PURPOSEThis study aims to assess the association between LSS and atrophy of the PPM. STUDY DESIGNRetrospective cross-sectional study. PATIENT SAMPLEPatients undergoing MRI scans at a tertiary orthopedic center for low back pain or as part of a preoperative evaluation. OUTCOME MEASURESThe functional cross-sectional area (fCSA) and percent fatty infiltration (FI) of the PPM at L4. METHODSLumbar MRIs of patients at a tertiary orthopedic center indicated due to lower back pain (LBP) or as a presurgical workup were analyzed. Patients with previous spinal fusion surgery or scoliosis were excluded. LSS was assessed according to the Schizas classification at all lumbar levels. The cross-sectional area of the PPM was measured on a T2-weighted MRI sequence at the upper endplate of L4. The fCSA and fatty infiltration (FI) were calculated using custom software. Crude differences in FI and fCSA between patients with no stenosis and at least mild stenosis were tested with the Wilcoxon signed-rank test. To account for possible confounders, a multivariable linear regression model was used to adjust for age, sex, body mass index (BMI), and disc degeneration. A subgroup analysis according to MRI indication was performed. RESULTSA total of 522 (55.7% female) patients were included. The median age was 61 years (IQR: 51–71). The greatest degree of moderate and severe stenosis was found at L4/5, 15.7%, and 9.2%, respectively. Stenosis was the least severe at L5/S1 and was found to be 2% for moderate and 0.2% for severe stenosis. The Wilcoxon test showed significantly increased FI of the PPM with stenosis at any lumbar level (p<.001), although no significant decrease in fCSA was observed. The multivariable regression model showed a significant increase in FI with increased LSS at L1/2, L2/3, and L3/4 (p=.013, p<.01 and p=.003). The severity of LSS at L4/5 showed a positive association with the fCSA (p=.019). The subgroup analysis showed, the effect of LSS was more pronounced in nonsurgical patients than in patients undergoing surgery. CONCLUSIONSIn this study, we demonstrated a significant and independent association between LSS and the composition of the PPM, which was dependent on the level of LSS relative to the PPM. In addition to neurogenic claudication, patients with LSS might be especially susceptible to axial muscle wasting, which could worsen LSS due to increased spinal instability, leading to a positive feedback loop.

Impact of Sarcopenia on Spinal Spondylosis: A Literature Review.

Sarcopenia and spinal spondylosis (SS) are important health challenges among older individuals; however, data regarding the effect of sarcopenia on SS are lacking. Hence, we aimed to organize the existing knowledge on the impact of sarcopenia on SS and explore potential issues in the available literature. We examined the trends and interventions regarding sarcopenia and SS, searching five databases (PubMed, Embase, CINHAL, Web of Science, and Cochrane Library) from inception to January 2023. Sarcopenia-related events were screened, selected, and reviewed, ultimately identifying 19 relevant studies. The identified reports were predominantly retrospective observational studies addressing lumbar degenerative spine disease (LDSD). Sarcopenia could negatively impact the quality of life and postoperative outcomes in several diseases, including cervical spondylotic myelopathy (CSM) and LDSD. However, there was no consensus among the studies regarding the relationship between sarcopenia and pain. These discrepancies were attributed to gaps in the assessment of sarcopenia, which the current study identifies as important challenges. This review identified several problems in the literature, including the limited number of studies examining CSM, adult spinal deformity (ASD) and scoliosis, and the retrospective study design of most reports. The further accumulation of quality research is needed to clarify the relationship between SS and sarcopenia.

Artificial Intelligence in Neuroradiology: A Review of Current Topics and Competition Challenges.

There is an expanding body of literature that describes the application of deep learning and other machine learning and artificial intelligence methods with potential relevance to neuroradiology practice. In this article, we performed a literature review to identify recent developments on the topics of artificial intelligence in neuroradiology, with particular emphasis on large datasets and large-scale algorithm assessments, such as those used in imaging AI competition challenges. Numerous applications relevant to ischemic stroke, intracranial hemorrhage, brain tumors, demyelinating disease, and neurodegenerative/neurocognitive disorders were discussed. The potential applications of these methods to spinal fractures, scoliosis grading, head and neck oncology, and vascular imaging were also reviewed. The AI applications examined perform a variety of tasks, including localization, segmentation, longitudinal monitoring, diagnostic classification, and prognostication. While research on this topic is ongoing, several applications have been cleared for clinical use and have the potential to augment the accuracy or efficiency of neuroradiologists.

Nusinersen Treatment of Children with Later-Onset Spinal Muscular Atrophy and Scoliosis Is Associated with Improvements or Stabilization of Motor Function.

Nusinersen has been shown to improve or stabilize motor function in individuals with spinal muscular atrophy (SMA). We evaluated baseline scoliosis severity and motor function in nusinersen-treated non-ambulatory children with later-onset SMA. Post hoc analyses were conducted on 95 children initiating nusinersen treatment in the CHERISH study or SHINE long-term extension trial. Participants were categorized by baseline Cobb angle (first nusinersen dose): ≤10°, >10° to ≤20°, and >20° to <40° (no/mild/moderate scoliosis, respectively). Outcome measures included the Hammersmith Functional Motor Score-Expanded (HFMSE) and the Revised Upper Limb Module (RULM). Regression analysis determined the relationships between baseline scoliosis severity and later motor function. For children with no, mild, and moderate scoliosis, the mean increase in HFMSE from baseline to Day 930 was 6.0, 3.9, and 0.7 points, and in RULM was 6.1, 4.6, and 2.3 points. In the linear model, a 10° increase in baseline Cobb angle was significantly associated with a -1.4 (95% CI -2.6, -0.2) point decrease in HFMSE (p = 0.02) and a -1.2 (95% CI -2.1, -0.4) point decrease in RULM (p = 0.006) at Day 930. Treatment with nusinersen was associated with improvements/stabilization in motor function in all groups, with greater response in those with no/mild scoliosis at baseline.

18F-FDG PET/CT and Whole-Body Bone Scan Findings in Gorlin-Goltz Syndrome.

Gorlin-Goltz syndrome (basal cell nevus syndromes) is an uncommon, autosomal dominant inherited disorder characterized by developing basal cell carcinomas from a young age. Other distinct clinical features include keratocystic odontogenic tumors, dyskeratotic palmar and plantar pitting, and skeletal abnormalities. Clinicopathological findings of the syndrome are very diverse, and many symptoms manifest during a certain period of life. We present the compelling whole-body bone scan and 18F-FDG PET/CT findings in a 32-year-old man with odontogenic keratocyst, early-onset basal cell carcinoma, multiple ectopic calcifications in extremities, calcified falx cerebri, spinal scoliosis, macrocephaly, and ocular hypertelorism.

Influence of Paraspinal Growth-Friendly Spinal Implants in Children with Spinal Muscular Atrophy on Parasol Deformity, Rib-Vertebral Angles, Thoracic, and Lung Volumes

Introduction: Children with spinal muscular atrophy (SMA) and progressive neuromuscular scoliosis often require early growth-friendly spinal implant (GFSI) treatment for deformity correction with implant fixation either through pedicle screws or bilateral to the spine using ribto pelvis fixation. It has been proposed that the latter fixation may change the collapsing parasol deformity via changes in the rib-vertebral angle (RVA) with a positive effect on thoracic and lung volume. The purpose of this study was to analyze the effect of paraspinal GFSI with bilateral rib-to-pelvis fixation on the parasol deformity, RVA, thoracic, and lung volumes. Methods: SMA children with (n = 19) and without (n = 18) GFSI treatment were included. Last follow-up was before definite spinal fusion at puberty. Scoliosis and kyphosis angles, parasol deformity, and index, as well as convex and concave RVA, were measured on radiographs, whereas computed tomography images were used to reconstruct thoracic and lung volumes. Results: In all SMA children (n = 37; with or without GFSI), convex RVA was smaller than concave values at all times. GFSI did not crucially influence the RVA over the 4.6-year follow-up period. Comparing age- and disease-matched adolescents with and without prior GFSI, no effect of GFSI treatment could be detected on either RVA, thoracic, or lung volumes. Parasol deformity progressed over time despite GFSI. Conclusion: Despite different expectations, implantation of GFSI with bilateral rib-to-pelvis fixation did not positively influence parasol deformity, RVA and/or thoracic, and lung volumes in SMA children with spinal deformity directly and over time.

Characteristics of Sagittal Alignment in Patients with Severe and Rigid Scoliosis.

There has been increasing concern about the importance of sagittal alignment in the evaluation and treatment of spinal scoliosis. However, recent studies have only focused on patients with mild to moderate scoliosis. To date, little is known about the sagittal alignment in patients with severe and rigid scoliosis (SRS). This study was performed to evaluate the sagittal alignment in patients with SRS, and to analyze how it was altered after corrective surgery. In this retrospective cohort study, we included 58 patients with SRS who underwent surgery from January 2015 to April 2020. Preoperative and postoperative radiographs were reviewed, and the sagittal parameters mainly included thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacrum slope (SS), and sagittal vertical axis (SVA). The sagittal balance state was evaluated according to whether the PI minus the LL (PI-LL) was less than 9°, and the patients were divided into thoracic hyperkyphosis and normal groups based on whether the TK exceeded 40°. The Student's t test, Pearson's test, and Receiver operating characteristic (ROC) curve analysis were used to compare related parameters between the different groups. The mean follow-up duration was 2.8 years. Preoperatively, the mean PI was 43.6 ± 9.4°, and the mean LL was 65.2 ± 13.9°. Sixty-nine percent of patients showed sagittal imbalance, and they showed larger TK and LL values and smaller PI and SVA values than those with sagittal balance. Additionally, most patients (44/58) presented with thoracic hyperkyphosis; this group had smaller PI and SVA values than the normal patients. Patients with syringomyelia-associated scoliosis were more likely to present with thoracic hyperkyphosis. The TK and LL values were significantly decreased, and 45% of patients with preoperative sagittal imbalance recovered after surgery. These patients had a larger PI (46.4 ± 9.0° vs 38.3 ± 8.8°, P = 0.003) and a smaller TK (25.5 ± 5.2° vs 36.3 ± 8.0°, P = 0.000) at the final follow-up. Preoperative sagittal imbalance appears in the majority of SRS patients, accounting for approximately 69% of our cohort. Patients with small PI values or syringomyelia-associated scoliosis were more likely to present with thoracic hyperkyphosis. Sagittal imbalance can generally be corrected by surgery, except in patients with a PI less than 39°. To achieve good postoperative sagittal alignment, we recommend controlling the TK to within 31°.

Morphology and deformity of the shoulder and pelvis in the entire spine radiographs of adolescent idiopathic scoliosis.

To investigate the deformity and asymmetry of the shoulder and pelvis in adolescent idiopathic scoliosis (AIS) patients. This retrospective cross-sectional study enrolled 223 AIS patients with a right thoracic curve or left thoracolumbar/lumbar curve who underwent spine radiographs at the Third Hospital of Hebei Medical University between November 2020 and December 2021. The following parameters were measured: Cobb angle, clavicular angle, glenoid obliquity angle, acromioclavicular joint deviation, femoral neck-shaft projection angle, iliac obliquity angle, acetabular obliquity angle, coronal trunk deviation distance, and spinal deformity deviation distance. The Mann-Whitney U test, Kruskal-Wallis H test were used for inter-group comparisons, and Wilcoxon signed-rank test were used for intra-group left and right sides comparisons. Shoulder and pelvic imbalances were found in 134 and 120 patients, respectively, and there were 87, 109, and 27 cases of mild, moderate, and severe scoliosis, respectively. Compared with mild scoliosis patients, the difference in the acromioclavicular joint offset on bilateral sides was significantly increased in moderate and severe scoliosis [11.04, 95% confidence interval (CI): 0.09-0.14 for mild, 0.13-0.17 for moderate, and 0.15-0.27 for severe scoliosis, P=0.004], and the difference in the femoral neck-shaft projection angle on bilateral sides was significantly enhanced with scoliosis aggravation (14.14, 95% CI: 2.34-3.41 for mild, 3.00-3.94 for moderate, and 3.57-6.43 for severe scoliosis, P=0.001). The acromioclavicular joint offset was significantly larger on the left than that on the right in patients with a thoracic curve or double curves (thoracic curve -2.75, 95% CI: 0.57-0.69 for the left and 0.50-0.63 for the right, P=0.006; double curve -3.27, 95% CI: 0.60-0.77 for the left and 0.48-0.65 for the right, P=0.001). The femoral neck-shaft projection angle was significantly larger on the left than right in patients with a thoracic curve (-4.46, 95% CI: 133.78-136.20 for the left and 131.62-134.01 for the right, P<0.001), but larger on the right than left in patients with thoracolumbar/lumbar curve (thoracolumbar -2.98, 95% CI: 133.75-136.70 for the left and 135.13-137.82 for the right, P=0.003; lumbar -3.24, 131.97-134.56 for the left and 133.76-136.26 for the right, P=0.001). In AIS patients, shoulder imbalance has a greater impact on coronal balance and spinal scoliosis above the lumbar segment, whereas pelvic imbalance has a greater impact on sagittal balance and spinal scoliosis below the thoracic segment.

Abstract #1406558: Severe Renal Compromise Associated with Hypercalcemic Crisis Due to Giant Parathyroid Adenoma in a Woman with Bilateral Adrenal Incidentalomas

Parathyroid or hypercalcaemic crisis is a rare presenting manifestation of primary hyperparathyroidism (PHPT). We present a woman with severe hypercalcaemia due to giant parathyroid adenoma presenting as exacerbated chronic kidney disease, who was also found to have non-functioning bilateral adrenal adenomas. A 74-year-old woman, a history of arterial hypertension 10 years ago and lumbar spine scoliosis, usual medication irbersartan 150 mg/day, was admitted by emergency with a 1-week illness time characterized by lower limb weakness, severe low back pain, nausea and vomiting, which intensified the day of admission. Examination revealed BP 120/60 mmHg, heart rate 89 beats/min, weight 75kg, height 1.72cm, dry oral mucosa, no lymphadenopathy or nodules palpable at neck level. Laboratory tests: Arterial gases pH: 7.3, HCO3: 17mmol/L, Calcium: 3.8meq/L; hemoglobin: 10.1g/dl, creatinine: 7.32mg/dl, urea: 181mg/dl, sodium: 140mmol/L, potassium: 5mmol/L, calcium: 14.1mg/dl, phosphorus: 5.6mg/dl, magnesium: 2.18mg/dl. Renal ultrasound showed: signs of bilateral chronic kidney disease. Given the suspicion of malignancy and awaiting the result of parathormone (PTH), the body CT in the emergency room showed a solid lesion at the neck level, located posteriorly and in contact with the left thyroid lobe, measuring 39 x 14 x 30 mm, contacted the trachea and partially displaced the esophagus to the right without infiltrating them, it maintained interface with the left carotid and jugular, suggesting parathyroid dependence; and incidentally, both adrenal glands were diffusely thickened, the left showed a nodular formation of 20 x 15 mm, with an attenuation of -10 HU. She was hospitalized, received hydration, furosemide and pamidronate, did not require renal replacement therapy. Intact PTH was 1114 pg/mL; it was possible to normalize the levels of calcium, phosphorus, magnesium, creatinine decreased to 2.53mg/dl. Sestamibi scintigraphy showed an image compatible with lower left parathyroid adenoma and bone densitometry showed osteoporosis with a high risk of fracture (left forearm (1/3): bdm= 0.475g/cm2, Tscore= -5.3, hip: bdm= 0.435g /cm2, tscore= -4.5). The patient underwent a lower left parathyroidectomy, where a 5x3.5cm parathyroid tumor was reported with an increased consistency of brown coloration; the pathology reported giant adenoma of the parathyroid gland with apoplexy. In the postoperative period, the intact PTH was 57 pg/ml, at the same time the functionality of the adrenal adenoma was ruled out. She developed hungry bone syndrome for which she receives calcium and calcitriol to this day. Some studies provided an unclear definition of hypercalcemic crisis as a serum calcium concentration >3.5 mmol/L, accompanied by signs and symptoms. A hypercalcemic crisis was first described in 1939 by Hanes, and is considered as an endocrine emergency and fatal in the absence of optimal treatment. The acute effects of PHPT on renal function are not well understood. Furthermore, non-oliguric acute kidney injury caused by refractory hypercalcemia requires emergent hemodialysis, which was not necessary in our patient.

Long-term sustained swimming improves swimming performance in Chinook salmon, Oncorhynchus tshawytscha, with and without spinal scoliosis

Exercise training during pre-and post-smolt production is becoming a key component in salmon hatcheries as it is known to enhance several production-related traits in salmonids. Exercise conditions for rearing salmonids are continually being optimised and now that the salmonid industry is developing offshore, training is being considered as a tool to prepare domestic stocks for high energy environments. It is unknown if exercise can enhance traits in other understudied salmonid species and in individuals with spinal curvature (scoliosis), which is a common health concern within some salmon farms. Here we exposed Chinook salmon (initial weight: 82.9 ± 0.30 g) to low (0.3 bl s−1) and moderate (0.8 bl s−1) flow regimes for ten to eleven months and quantified respiratory and swimming performance in individuals with and without mild scoliosis. Further, we investigated compositional changes and morphological responses at cellular and whole-body levels. Raising Chinook salmon under moderate flow regimes improved critical swimming speed, maximum metabolic rate, and aerobic scope in individuals with and without spinal curvature, but recovery processes (exhaustive exercise post oxygen consumption and time) in individuals with spinal curvature required higher energetic costs (measured immediately after reaching critical swimming speed). Fat content was reduced in fish raised under moderate flow regimes, while protein content was higher in individuals with spinal curvature. Exercise regimes caused morphological changes in muscle fibres, gill, and skin. Together, the results of this study shows benefits for integrating exercise training into hatchery settings (i.e., pre- and post-smolts) to prepare stocks for offshore farming and provides evidence that some exercise-enhanced traits can be translated into individuals with spinal curvature, but concerns remain for individuals with more severe spinal curvature. Additionally, this study reveals that exercise regimes influence nutrient utilisation and deposition in Chinook salmon, therefore optimising nutrient profiles for offshore feeds should be considered as nutrient demands in fish farmed in high energy sites may differ to nutrient demands of fish in lower energy nearshore farms.

STUDY OF FUNCTIONAL OUTCOME OF DORSOLUMBAR SPINE FRACTURES TREATED WITH MINIMAL INVASIVE SPINE SURGERY

Introduction – Spine disorders including spinal instability, bone spurs, ruptured discs, scoliosis, or spinal malignancies, minimally invasive spine surgery (MIS) aims to stabilize the vertebral bones and spinal joints as well as relieve pressure on the spinal nerves. Aims &amp; Objectives - To study the functional outcome of dorsolumbar spine fractures treated with minimal invasive surgery, to study complications of post minimal invasive spine surgery and the course of recovery and physical activity in the study patients, also to evaluate the neurological status post minimal invasive spine surgery. Materials And Methods – 35 patients were included in the study. Inclusion and exclusion criteria was followed. Routine investigations were carried out. Along with it radiographic examination , CTscan &amp; MRI of cervical / thoracic / lumbar spine were also taken based on history. Results - The mean VAS In the present study group was 8.40 at presentation which came down to 1.65 at 6 month follow up which was statistically signicant (p value= &lt;0.001). The mean ODI score in the present study was 61.00% preoperatively which gradually decreased to 24.3% at the end of 6 months which was statistically signicant (p &lt;0.001). According to the modied Mcnab criteria at the nal follow up at 6 months,9 (25.71%) patients were excellent, 15 (42.85%) were good,6 (17.14%) were fair , 5 (14.28%) patients were poor. Conclusion - Minimal invasive spine surgery is safe and efcient technique when compared to traditional open spine surgery

Clinical characteristics and offspring developmental malformation of 126 patients with septate uterus.

Clinical characteristics and offspring developmental malformation of 126 patients with septate uterus.

The phenotypic spectrum of terminal 6q deletions based on a large cohort derived from social media and literature: a prominent role for DLL1

BackgroundTerminal 6q deletions are rare, and the number of well-defined published cases is limited. Since parents of children with these aberrations often search the internet and unite via international social media platforms, these dedicated platforms may hold valuable knowledge about additional cases. The Chromosome 6 Project is a collaboration between researchers and clinicians at the University Medical Center Groningen and members of a Chromosome 6 support group on Facebook. The aim of the project is to improve the surveillance of patients with chromosome 6 aberrations and the support for their families by increasing the available information about these rare aberrations. This parent-driven research project makes use of information collected directly from parents via a multilingual online questionnaire. Here, we report our findings on 93 individuals with terminal 6q deletions and 11 individuals with interstitial 6q26q27 deletions, a cohort that includes 38 newly identified individuals.ResultsUsing this cohort, we can identify a common terminal 6q deletion phenotype that includes microcephaly, dysplastic outer ears, hypertelorism, vision problems, abnormal eye movements, dental abnormalities, feeding problems, recurrent infections, respiratory problems, spinal cord abnormalities, abnormal vertebrae, scoliosis, joint hypermobility, brain abnormalities (ventriculomegaly/hydrocephaly, corpus callosum abnormality and cortical dysplasia), seizures, hypotonia, ataxia, torticollis, balance problems, developmental delay, sleeping problems and hyperactivity. Other frequently reported clinical characteristics are congenital heart defects, kidney problems, abnormalities of the female genitalia, spina bifida, anal abnormalities, positional foot deformities, hypertonia and self-harming behaviour. The phenotypes were comparable up to a deletion size of 7.1 Mb, and most features could be attributed to the terminally located gene DLL1. Larger deletions that include QKI (> 7.1 Mb) lead to a more severe phenotype that includes additional clinical characteristics.ConclusionsTerminal 6q deletions cause a common but highly variable phenotype. Most clinical characteristics can be linked to the smallest terminal 6q deletions that include the gene DLL1 (> 500 kb). Based on our findings, we provide recommendations for clinical follow-up and surveillance of individuals with terminal 6q deletions.

Non-intrusive RF sensing for early diagnosis of spinal curvature syndrome disorders

The recent developments in communication and information ease people’s lives to sit in one place and access any information from anywhere. However, the longevity of sitting and sitting in different postures raises the issues of spinal curvature. It necessitates a physical examination to identify the spinal illness in its early stages. This article aims to develop an intelligent monitoring framework for detecting and monitoring spinal curvature syndrome problems based on Software Defined Radio Frequency (SDRF) sensing and verify its feasibility for diagnosing actual patients. The proposed SDRF-based system identifies irregular spinal curvature syndrome and offers feedback signals when an incorrect posture is identified. We design the system using wireless university software-defined radio peripheral (USRP) kits to transmit and receive RF signals and record the wireless channel state information (WCSI) for kyphosis, Lordosis, and scoliosis spinal disorders. The statistical measures are extracted from the WCSI and apply machine learning algorithms to identify and classify the type of disorders. We record and test the system using 11 subjects with the spinal disorders kyphosis, Lordosis, and scoliosis. We acquire the WCSI, extract various statistical measures in terms of time and frequency domain features, and evaluate machine learning classifiers to identify and classify the spinal disorder. The performance comparison of the machine learning algorithms showed overall and each spinal curvature disorder recognition accuracy of more than 99%.

Impact of obesity on complications and surgical outcomes after adult degenerative scoliosis spine surgery

ObjectiveTo compare perioperative outcomes of obese versus non-obese adult patients who underwent degenerative scoliosis spine surgery. Methods235 patients who underwent thoracolumbar adult spinal deformity (ASD) surgery (≥4 levels) were identified and categorized into two cohorts based on their body mass indices (BMI): obese (BMI ≥30 kg/m2; n = 81) and non-obese (BMI <30 kg/m2; n = 154). Preoperative (demographics, co-morbidities, American Society of Anesthesiologists (ASA) score and modified frailty indices (mFI-5 and mFI-11)), intraoperative (estimated blood loss (EBL) and anesthesia duration), and postoperative (complication rates, Oswestry Disability Index (ODI) scores, discharge destination, readmission rates, and survival) characteristics were analyzed by student’s t, chi-squared, and Mann-Whitney U tests. ResultsObese patients were more likely to be Black/African-American (p < 0.05, OR:4.11, 95% CI:1.20–14.10), diabetic (p < 0.05, OR:10.18, 95% CI:4.38–23.68) and had higher ASA (p < .01) and psoas muscle indices (p < 0.0001). Furthermore, they had greater pre- and post-operative ODI scores (p < 0.05) with elevated mFI-5 (p < 0.0001) and mFI-11 (p < 0.01). Intraoperatively, obese patients were under anesthesia for longer time periods (p < 0.05) with higher EBL (p < 0.05). Postoperatively, while they were more likely to have complications (OR:1.77, 95% CI:1.01 – 3.08), had increased postop days to initiate walking (p < .05) and were less likely to be discharged home (OR:0.55, 95% CI:0.31–0.99), no differences were found in change in ODI scores or readmission rates between the two cohorts. ConclusionsObesity increases pre-operative risk factors including ASA, frailty and co-morbidities leading to longer operations, increased EBL, higher complications and decreased discharge to home. Pre-operative assessment and systematic measures should be taken to improve peri-operative outcomes.

Role of Posterior Longitudinal Ligament Complex in Spinal Deformity Secondary to Surgical Resection of the Intradural Tumor.

In most cases, complete resection of the intradural tumor is accompanied by long-term neurological complications. Postoperative spinal deformity is the most common complication after surgical resection of intradural tumors, and posterior longitudinal ligament complex (PLC) plays an important role in postoperative spinal deformity. In this study, we investigated the role of PLC in spinal deformity after the surgical treatment of intradural tumors. We analyzed the data of 218 consecutive patients who underwent intradural tumor resection from 2000 to 2018 in this retrospective study. Before 2010, patients underwent laminoplasty without maintaining the integrity of PLC (laminoplasty group, n=155). After 2010, patients performed single-port laminoplasty to maintain the integrity of PLC (laminoplasty retain posterior ligament complex group, n=63). The score of quality of life, painful cortex, spinal cord movement, progressive kyphosis or scoliosis, perioperative morbidity, and neurological results were analyzed in the laminoplasty group and laminoplasty retain posterior ligament complex group. The distributed variable was shown as mean ± standard deviation and an independent t-test or one-way analysis of variance was calculated. There are 155 patients (71.1%) included in the laminoplasty group, and 63 patients (28.9%) in the laminoplasty retain posterior ligament complex group. The average age of patients was 42 ± 2.3 years, and the average modified McCormick score was 2. There were 158 (72.4%) patients with intramedullary tumors and 115 (52.7%) patients with extramedullary tumors. The length of hospital stays (8 days vs. 6 days; p=0.023) and discharge to inpatient rehabilitation (48.4% vs. 26.9%; p=0.012) were significantly lower in the laminoplasty retain posterior ligament complex group than the laminoplasty group. There was no significant difference in the risk of progressive deformity between the two groups at 18months after surgery (relative risk 0.12; 95% confidence interval [CI] 0.43-1.25; p=0.258) and at 20months after surgery (relative risk 0.24; 95% CI 0.21-2.1). Laminoplasty retains posterior ligament complex showed no impact on the spinal deformities compared with laminoplasty, but significantly improved the postoperative spinal activity, alleviated pain symptoms, and reduced hospital recovery time.