Truncal Rotation Research Articles

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

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

Mitral valve anomalies in transposition of the great arteries: Anatomical features, surgical management and outcomes

Mitral valve (MV) anomalies can be associated with transposition of the great arteries (TGA), but their influence on the choice of the surgical technique and the outcomes after anatomical repair, mainly mitral regurgitation (MR) and LVOT obstruction, have rarely been addressed. Our study objectives are to describe the MV anomalies found in patients with TGA, the different surgical procedures performed and the fate of the anomalous MV. From 1990 to 2020, 52 patients out of 1590 (3.3%) were identified. Main MV anomalies were a mitral cleft (88%) and anomalies of the subvalvular apparatus (60%) such as abnormal chordae attachments (16/52, 30.8%), straddling (6/52, 11.5%), accessory tissue (7/52, 13.5%) or an abnormal papillary muscle (4/52, 7.7%). The mitral cleft was described as anterior (ejection/outflow tract) in 40 and as AVSD-type in 6. A ventricular septal defect (VSD) was associated in 88.5% (58% outlet) ( Fig. 1 ). Main surgical procedure performed at repair was the arterial switch operation (ASO) ( n = 47, 90.4%). Two patients (3.8%) underwent a Bex-Nikaidoh procedure, 2 (3.8%) a half turned truncal rotation and 1 (1.9%) a “reparation à l’étage ventriculaire” (REV) procedure. Overall survival was 90% at 1 year and 88% at 10 and 20 years during a mean follow-up period of 9.5 years. Ten patients (19.2%) had a concomitant mitral procedure at repair (cleft closure in 7, procedure on the subvalvular apparatus in 6), of which 4 had a preoperative grade ≥ 2 MR. Five patients required reoperation for MR and/or for left ventricle outflow tract obstruction (LVOTO), none of them had previously undergone a mitral procedure at repair. All five underwent cleft closure, with LVOTO relief in 3. Freedom from MV reoperation was 96% at 1 year, 93% at 5 years, and 84.5% at 20 years. Main MV anomalies in TGA are the presence of an anterior cleft and abnormalities of the subvalvular apparatus, frequently associated with an outlet VSD. Mortality and reoperation rates are higher than in the other subtypes of TGA. Mitral repair at initial surgery should be considered only in cases of MR or LVOTO. Reoperation involves cleft closure and LVOTO relief. No MV replacement was required.

Technological evaluation of strategies to get out of bed by people with Parkinson's disease: Insights from multisite wearable sensors.

BackgroundDifficulty getting out of bed is a common night-time and early morning manifestation of Parkinson's disease (PD), rated by 40% of the patients as their most concerning motor symptoms. However, current assessment methods are based on clinical interviews, video analysis, and clinical scales as objective outcome measures are not yet available.ObjectiveTo study the technical feasibility of multisite wearable sensors in the assessment of the supine-to-stand (STS) task as a determinant of the ability to get out of bed in patients with PD and age-matched control subjects, and develop relevant objective outcome measures.MethodsThe STS task was assessed in 32 patients with PD (mean Hoehn and Yahr; HY = 2.5) in the early morning before their first dopaminergic medication, and in 14 control subjects, using multisite wearable sensors (NIGHT-Recorder®; trunk, both wrists, and both ankles) in a sleep laboratory. Objective getting out of bed parameters included duration, onset, velocity and acceleration of truncal rotation, and angle deviation (a°) from the z-axis when subjects rose from the bed at different angles from the x-axis (10°, 15°, 30°, 45°, and 60°) as measures of truncal lateral flexion. Movement patterns were identified from the first body part or parts that moved. Correlation analysis was performed between these objective outcomes and standard clinical rating scales.ResultsCompared to control subjects, the duration of STS was significantly longer in patients with PD (p = 0.012), which is associated with a significantly slower velocity of truncal rotation (p = 0.003). Moderate and significant correlations were observed between the mean STS duration and age, and the Nocturnal Hypokinesia Questionnaire. The velocity of truncal rotation negatively and significantly correlated with HY staging. Any arm and leg moved together as the first movement significantly correlated with UPDRS-Axial and item #28. Several other correlations were also observed.ConclusionOur study was able to demonstrate the technical feasibility of using multisite wearable sensors to quantitatively assess early objective outcome measures of the ability of patients with PD to get out of bed, which significantly correlated with axial severity scores, suggesting that axial impairment could be a contributing factor in difficulty getting out of bed. Future studies are needed to refine these outcome measures for use in therapeutic trials related to nocturia or early morning akinesia in PD.

Ponte osteotomies in a matched series of large AIS curves increase surgical risk without improving outcomes.

The routine use of Ponte osteotomies in adolescent idiopathic scoliosis (AIS) surgery is controversial with conflicting data for coronal plane correction and little analysis in the sagittal plane. The objective of this study was to analyze the efficacy of Ponte osteotomies in large curve AIS. A single institution, prospectively-collected series of consecutive AIS patients who had Ponte osteotomies (P cohort) was directly matched to patients with no Pontes (NP cohort) by age, gender, Lenke classification, surgeon, coronal, and sagittal Cobb angles. The radiographic review included adjusted values using a 3D-derived published formula for preoperative T5-T12 kyphosis. Patient-reported outcomes (PROs) were assessed with the SRS-30 and Spinal Appearance Questionnaire (SAQ). There were 68 patients (34/cohort) with minimum 2-year follow-up with no differences between P and NP cohorts in age, preoperative coronal Cobb (74.5° vs 70.8°), flexibility index, measured or 3D-adjusted T5-T12 kyphosis. Rod material/diameter, fusion levels, blood loss, and operative time did not differ, but implant density was higher in the P group (1.53 vs 1.31, p < 0.001). The P group had 7.9% greater coronal Cobb correction (66.6% vs 58.7%, p < 0.003) without difference in final Cobb angles (24.7° vs. 29.1°, p = 0.052). There were no differences in measured or adjusted T5-T12 kyphosis in the sagittal plane. The P group had a 15% rate of critical intraoperative neuromonitoring changes versus 0% in the NP group (p = 0.053). At follow-up, there were no differences in scoliometer measurements or any domain of SRS-30 or SAQ scores. In this first reported matched series of AIS patients, Ponte osteotomies provide small radiographic gains in the coronal plane with no improvement in the sagittal plane and no change in truncal rotation. There was a higher risk of critical intraoperative neuromonitoring changes, and no benefits in patient-reported outcomes. This calls into question the routine use of Ponte osteotomies in AIS, even for curves averaging 70 degrees. II.

Impact of wearing a service vest on three-dimensional truncal motion in dogs.

To develop a 3-D kinematic model to measure truncal motion in dogs and assess changes in truncal motion in dogs when wearing each of 2 service vests. 5 adult mixed-breed dogs. 27 reflective markers were placed on the pelvis, trunk, and scapula of each dog. Six infrared cameras were placed around a treadmill to track the location of the markers within a calibrated space. Dogs were recorded during walking and trotting on the treadmill. Local and global coordinate systems were established, and a segmental rigid-body model of the trunk was created. Dogs were then recorded while wearing a custom vest and an adjustable vest during walking and trotting on the treadmill. Range of motion of the trunk when dogs were and were not wearing vests was compared by repeated-measures ANOVA. An anatomic coordinate system was established by use of markers located at T1, T13, and the xiphoid process. Range of motion of the trunk during a gait cycle did not differ significantly regardless of the day of the test for both walking and trotting gaits. Trunk motion of dogs when walking and trotting was significantly reduced when dogs were wearing a vest, compared with trunk motion when not wearing a vest. A 3-D kinematic model for measuring truncal rotation was developed. Results indicated measurable differences in the gait of dogs when wearing each of the 2 service vests, compared with the gait when not wearing a vest.

Body Image Disturbance Improvement After Operative Correction of Adolescent Idiopathic Scoliosis

HypothesisBody Image Disturbance Questionnaire–Scoliosis version (BIDQ-S) is a sensitive outcomes instrument to evaluate improvements in body image–related psychosocial effects with surgical correction. DesignProspective observational study. IntroductionThe BIDQ-S was previously validated (convergent validity, internal consistency) as a tool to assess body image–related distress and psychosocial impairment in adolescent idiopathic scoliosis (AIS). This study was conducted to evaluate responsiveness to change in the BIDQ-S associated with surgical treatment of AIS two years postoperatively to complete the validation of this questionnaire. MethodsSeventy-five consecutive operative AIS patients were enrolled and completed BIDQ-S and Scoliosis Research Society–22 (SRS-22) at preoperative and two-year postoperative visits. Demographic and radiographic data were collected. Preoperative and two-year postoperative BIDQ-S (1 = best, 5 = worst) and SRS-22 scores (1 = worst, 5 = best) were compared using paired t test. Correlations between BIDQ-S and SRS-22 scores were evaluated by linear regression. ResultsEighty-four percent of the subjects were females, with average age at surgery of 14.4 ± 1.6 years. The mean follow-up was 2.26 years (range 2.0-4.5). The major Cobb was corrected from 50.0° ± 7.2° to 14.2° ± 5.8° (Δ = 71.3% ± 12.1%; p < .0001). There was a significant improvement in BIDQ-S scores after surgery (1.64 ± 0.51 to 1.21 ± 0.38, p < .0001). BIDQ-S improvements were correlated with change in SRS self-image (p = .0055), activity (p = .0057), mental (p = .0018), and overall mean (p = .0007) domains. Preoperative, two-year postoperative, and Δ BIDQ-S score were not associated with major Cobb magnitude, truncal rotation, or Lenke curve type. Patients who reached SRS-22r minimal clinically important difference (MCID) in activity and self-image domains had worse preoperative BIDQ scores than those who did not reach MCID (activity 1.91 vs. 1.54 [1 = best, 5 = worst], p = .0099; self-image 2.08 vs. 1.51, p < .0001). Greater improvement in BIDQ-S was noted in patients who reached MCID in SRS-22 self-image than those who did not (Δ = 0.77 vs. 0.38, p = .0052). ConclusionBIDQ-S is responsive to surgical correction of AIS. The BIDQ-S is a valuable clinical outcome tool to assess the psychosocial effects of scoliosis in adolescents augmenting existing outcome instruments.

Performance-Based Outcomes Following Symptomatic Pars Injuries in American Professional Baseball Players

Objectives:Previous studies in the evidence-based literature suggest that lumbar spine injuries can lead to a significant decrease in athletic performance. This phenomenon is particularly evident in sports that require repetitive truncal rotation, such as baseball. Although we have previously characterized the natural history of symptomatic spondylolysis and spondylolisthesis in professional baseball players, no prior study has investigated the impact of pars injuries on player performance in this patient population. The purpose of this study was to report performance-based outcomes following symptomatic pars injuries in elite-level baseball athletes.Methods:A retrospective cohort study was conducted among all professional baseball players who presented with a symptomatic pars defect between 2011 and 2016. Both Major League and Minor League players were enrolled using a de-identified injury surveillance database maintained by the MLB. Lumbar spine imaging reports were reviewed to confirm the radiologic diagnosis of spondylolysis or spondylolisthesis. Players were stratified according to baseball position (pitcher vs. position player). Primary outcome measures for pitchers were earned run average (ERA) and walks plus hits per inning pitched (WHIP), while primary outcomes for position players were batting average (AVG) and on-base plus slugging (OPS). Paired t tests were used to compare pre-injury statistical performance to post-injury performance, with p < 0.05 treated as statistically significant.Results:During the defined study period, 75 players presented with low-back pain in the setting of a pars defect. 47 players were diagnosed with spondylolysis (62.7%), while 28 were diagnosed with spondylolisthesis (37.3%). Of those individuals, 19 players were excluded due to incomplete statistical data in the MLB injury surveillance system. Pre-injury vs. post-injury statistical comparisons are presented in Table 1. Pitching performance after the pars injury did not significantly differ with regard to the primary outcome measures, ERA (3.45 vs. 4.73; p = 0.25) and WHIP (1.28 vs. 1.47; p = 0.26). There was also no significant difference in any of the secondary outcomes - runs per 9 innings (R/9), hits per 9 innings (H/9), walks per 9 innings (BB/9), strikeouts per 9 innings (K/9), home runs per 9 innings (HR/9), and strikeout-to-walk ratio (K/BB). Similarly, batting performance among position players did not significantly differ from pre-injury to post-injury with regard to the primary outcomes, AVG (.261 vs. .256; p = 0.59) and OPS (.672 vs. .667; p = 0.87), or any of the secondary outcomes - on-base percentage (OBP), slugging percentage (SLG), runs per plate appearance (R/PA), hits per plate appearance (H/PA), runs batted in per plate appearance (RBI/PA), extra-base hits per plate appearance (XBH/PA), home runs per plate appearance (HR/PA), and walk-to-strikeout ratio (BB/K).Conclusion:This study represents the most comprehensive analysis of the impact of symptomatic pars injuries on MLB player performance. While previous studies suggest that lumbar injuries lead to shorter careers in both pitchers and position players, our current data demonstrate that pars defects do not cause a significant decrease in performance when MLB athletes return to play following these injury episodes. Given the limitations of our study design, larger prospective investigations are needed to validate these conclusions.Table 1.Pre-Injury and Post-Injury StatisticsPre-Injury (mean)Post-Injury (mean)P ValuePitchers ERA3.454.730.25 WHIP1.271.470.26 R/93.985.500.22 H/98.698.550.86 BB/92.794.680.26 K/97.288.570.07 HR/91.150.840.57 K/BB2.883.000.69Position Players AVG.261.2560.59 OPS.672.6670.87 OBP.266.2590.27 SLG.406.4090.90 R/PA0.120.120.86 H/PA0.240.230.31 RBI/PA0.110.110.56 XBH/PA0.080.080.93 HR/PA0.020.020.74 BB/K0.450.430.70

The Duration of the correction loss after removing cheneau brace in patients with adolescent idiopathic scoliosis

ObjectiveThe aim of the study was to evaluate the loss of truncal rotation over 54 hours after removing Chêneau brace. MethodsThe studied groups consisted of 39 girls aged 10–18 years old, diagnosed with adolescent idiopathic scoliosis (AIS) and treated with Chêneau brace (CAST) and 20 AIS girls aged 10–18 years old, not treated with bracing. Posterior-anterior radiographs were obtained from the clinical assessment of all subjects and were subsequently used to determine Cobb angles. The measurements of the angle of trunk rotation (ATR) were taken with the Scoliometer® and back-contour device during Adams forward bending test by the two evaluators. The changes in ATRs during 54 hours of observation were performed after the brace had been taken off (0, 2, 24, 30, 48 and 54 hours after debracing). This was described using VATR variable, defined as the change in the absolute Scoliometer® readings in the time intervals against the time interval Δt between the measurements. During back-contour assessment the differential factor (kra) has been used for the digital analysis. The changes in kra over 54 hours of observation were expressed as Vkra factor, defined as the difference in the absolute value of the amplitude differential factor (kra) in the time intervals against the time interval Δt between the measurements. ResultsThe highest changes were observed in the thoracic as well as in lumbar spine in patients with Cobb angle ≥30°, axial rotation of the apical vertebrae within 5–15°, Risser sign 0–2. The biggest change in the trunk rotation after Chêneau brace had been taken off was noted within the first two hours of observation. ConclusionThe patients should be advised to take the brace off for a minimum of two hours before the scheduled x-ray, to allow full relaxation of the trunk in order to obtain reliable radiological images of the deformation. Level of EvidenceLevel III Therapeutic study.

Outcomes of the anatomical repair in patients with congenitally corrected transposition of the great arteries: lessons learned in a high-volume centre.

The physiological repair of the congenitally corrected transposition of the great arteries (ccTGA) has been associated with a long-term risk of the right ventricular dysfunction and tricuspid valve regurgitation. On the other side, the anatomical repair with the restoration of the left ventricle in a systemic position has been hypothesized to improve long-term outcomes. The aim of this study was to determine the results of the anatomical repair. Between 1990 and 2015, 39 patients underwent an anatomical repair of a ccTGA. The median age was 7 years (range from 8 days to 42.8 years). Eighteen (46%) patients had a double switch. Of these, 21 (54%) patients had an atrial switch with a Rastelli technique (n = 16, 41%), with a réparation à l'étage ventriculaire (REV) procedure (n = 4, 10%) or a truncal rotation (n = 1, 3%). The follow-up was 100% complete at 2 years with a median follow-up of 3.17 years (range 0-26 years). The early mortality was 10% (n = 4) and the late mortality was 20% (n = 8). The long-term survival was 77 ± 10% at 10 years for the double switch group and 62 ± 11% at 10 years for the Rastelli group (P = 0.25). Eight (20%) patients required reintervention. Freedom from reoperation at 10 years was 82 ± 11% in the double switch group and 88 ± 11% in the Rastelli group. At the last follow-up, 23 (82%) patients were in New York Heart Association (NYHA) functional class I and 2 (7%) patients in NYHA class II. The anatomical repair of the ccTGA is associated with significant early mortality and morbidity. However, the long-term functional status is satisfactory. The anatomical repair of the ccTGA should be reserved for a carefully selected group of patients.

Screw Versus Hybrid Constructs for Flexible Thoracic Curves in Adolescent Idiopathic Scoliosis: A Prospective, Randomized Study

Study DesignProspective, computer-randomized design. ObjectiveCompare screw and hybrid constructs in flexible, thoracic curves for adolescent idiopathic scoliosis (AIS) in a prospective randomized fashion. Summary of BackgroundThe consensus in scientific literature is that all-screw constructs correct AIS better than hooks in the lumbar and in large, stiff thoracic curves. However, debate continues whether all-screw constructs outperform hybrid constructs in small, flexible thoracic AIS. To our knowledge, this is the first prospective, randomized scoliosis study that examines measures of correction and patient satisfaction with the Scoliosis Research Society–30 (SRS-30) questionnaire. MethodsA total of 45 enrolled AIS patients with flexible, thoracic curves were given an identification number with an associated computer-generated randomization to the hybrid (n = 22) or screw group (n = 23). The treating surgeon received the randomization 2–3 days before surgery. Data including major Cobb (MC), truncal rotation (TR), rib index (RI), secondary curve (SC), and SRS-30 questionnaire were collected preoperatively and postoperatively at 4 weeks and 3, 6, 12, and 24 months. ResultsThirty-seven patients in the hybrid (n = 18) and screw (n = 19) groups completed the study with a mean follow-up of 26 months (range, 24–49 months). Hybrid versus screw group means for preoperative, postoperative, and final follow-up were: MC 58° ± 8° versus 55° ± 6°, 18° ± 8° versus 15° ± 7°, and 23°± 8° versus 14° ± 6°; TR 14° ± 6° versus 16° ± 4°, 10° ± 5° versus 7° ± 3°, and 11° ± 5° versus 7° ± 4°; RI 3.0° ± 1.2° versus 3.4° ± 1.4°, 2.5° ± 0.7° versus 1.8° ± 0.6°, and 2.5° ± 0.8° versus 2.0° ± 0.5°; SC 35° ± 13° versus 31° ± 8°, 13° ± 11° versus 7° ± 9°, and 13° ± 12° versus 7° ± 7°; and SRS-30 3.9 ± 0.2 versus 3.9 ± 0.2, 4.1 ± 0.4 versus 4.0 ± 0.3, and 4.1 ± 0.3 versus 4.0 ± 0.2. ConclusionsIntergroup preoperative and early postoperative values were comparable (p > .05). At final follow-up, owing to loss of correction in the hybrid group, differences in MC (9°; p = .000), RI (0.54; p = .016), and TR (4°; p = .039) correction were statistically significant as SC trended toward significance (6°; p = .052). All-screw constructs outperformed hybrid constructs, especially over time. No differences in SRS-30 scores occurred between groups.

Paravertebral abscess

A 42-year-old Ethiopian man, resident in the United Kingdom for a year, presented with a history of fevers, weight loss and back pain. He had congenital scoliosis and a large, tender, fluctuant mass on the lower back. Neurological examination was normal but truncal rotation was limited. On questioning, he admitted to a past history of pulmonary tuberculosis and had received non-conventional treatment for the swelling prior to arrival in this country. Chest radiography revealed apical fibrotic changes with asymmetrical volume loss and pulmonary function testing confirmed a restrictive ventilatory pattern. Computed tomography of the chest demonstrated the presence of a semi-cystic paravertebral abscess with L1/L2 vertebral erosion. Fine needle aspiration yielded numerous acid-fast bacilli later confirmed as mycobacterium tuberculosis. The atropic scars on his back are the result of moxibustion treatment which he received from the village medicine man in Ethiopia, in an attempt to alleviate symptoms arising from the mass. A 42-year-old Ethiopian man, resident in the United Kingdom for a year, presented with a history of fevers, weight loss and back pain. He had congenital scoliosis and a large, tender, fluctuant mass on the lower back. Neurological examination was normal but truncal rotation was limited. On questioning, he admitted to a past history of pulmonary tuberculosis and had received non-conventional treatment for the swelling prior to arrival in this country. Chest radiography revealed apical fibrotic changes with asymmetrical volume loss and pulmonary function testing confirmed a restrictive ventilatory pattern. Computed tomography of the chest demonstrated the presence of a semi-cystic paravertebral abscess with L1/L2 vertebral erosion. Fine needle aspiration yielded numerous acid-fast bacilli later confirmed as mycobacterium tuberculosis. The atropic scars on his back are the result of moxibustion treatment which he received from the village medicine man in Ethiopia, in an attempt to alleviate symptoms arising from the mass.

Truncal flexibility exercise effects on musculoskeletal capability for manual handling operations

The main purpose of this study was to investigate the effects of a truncal flexibility programme on manual material handling strength and endurance, low-back flexibility and truncal rotation. Two training groups (males and females) and one control group participated in the study. Multivariate analysis of variance and discriminant analysis suggested that it is possible to improve significantly dynamic muscular strength, low-back flexibility and truncal rotation during the course of the exercises described in this investigation. However, the effects of the programme on muscular endurance were mixed; females significantly improved and males did not. The response variables collected for the control group did not show any significant change over the study period. The implications of the results with respect to the industrial environment are discussed.

PREVENTION OF THE COMPLICATIONS OF SCOLIOSIS BY EARLY DETECTION

The focus of medicine has increasingly turned toward prevention rather than treatment of disease. In the absence of the ability to prevent the occurrence of scoliosis, the focus of attention should be on early identification in order to prevent complications brought on by the disease. Scoliosis detection through screening of school children is a technique that has been popularized over the last three decades. The screening technique can be performed by trained personnel. Though the initial result of these screenings was over-diagnosis, the program has been shown to be cost-effective when the screeners are well-trained and appropriate referrals are made to minimize the lack of specificity. The use of the scoliometer to make a quantitative determination of the degree of truncal rotation has reduced the number of inappropriate referrals. The complications of scoliosis itself include pulmonary compromise, pain, and deformity; these are best prevented by early detection and early treatment. When scoliosis is treated late and larger curves are present, more involved and complication-ridden procedures are required. School children screening programs promote a better understanding and heightened awareness of this disease and acceptance of the treatment methods by the public.

Prevention of the Complications of Scoliosis by Early Detection

The focus of medicine has increasingly turned toward prevention rather than treatment of disease. In the absence of the ability to prevent the occurrence of scoliosis, the focus of attention should be on early identification in order to prevent complications brought on by the disease. Scoliosis detection through screening of school children is a technique that has been popularized over the last three decades. The screening technique can be performed by trained personnel. Though the initial result of these screenings was over-diagnosis, the program has been shown to be cost-effective when the screeners are well-trained and appropriate referrals are made to minimize the lack of specificity. The use of the scoliometer to make a quantitative determination of the degree of truncal rotation has reduced the number of inappropriate referrals. The complications of scoliosis itself include pulmonary compromise, pain, and deformity; these are best prevented by early detection and early treatment. When scoliosis is treated late and larger curves are present, more involved and complication-ridden procedures are required. School children screening programs promote a better understanding and heightened awareness of this disease and acceptance of the treatment methods by the public.

The conotruncus. I. Its normal inversion and conus absorption.

The processes which are involved in the development of the normal outflow tracts of the ventricles are the following: The ostium bulbar torsion accounts for the concordant flow between the ventricles and the proximal conuses. The leftward shift of the ostium bulbi accounts for the partial overriding of the aorta over the left ventricle. The truncal rotation accounts for the twisted relationships of the great vessels and for the definitive interrelationships of the semilunar valves. The aortic conus absorption accounts for the aorticomitral fibrous continuity. These processes are not necessarily linked to each other. In the normal, mature heart the conus is represented by the subpulmonary portion of the right ventricular outflow tract.