12th International Conference on Conservative Management of Spinal Deformities – SOSORT 2015 Annual Meeting

O1 The functional properties of paraspinal muscles in adolescents with idiopathic scoliosis (AIS): A systematic review of the literature

Eric Parent, Alan Richter

O2 The importance of the lateral profile in the treatment of idiopathic scoliosis

Angelo Gabriele Aulisa, Vincenzo Guzzanti, Paolo Pizzetti, Andrea Poscia, Lorenzo Aulisa

O3 Radiological outcome in Adolescent idiopathic scoliosis patients 20 years after treatment

Ane Simony, Steen Bach Christensen, Mikkel O Andersen

O4 Junctional Kyphosis, how can we detect and monitor it during growth?

Alessandra Negrini, Sabrina Donzelli, Laura Maserati, Fabio Zaina, Jorge H Villafane, Stefano Negrini

O5 Usefulness of the clinical measure of trunk imbalance in adolescent idiopathic scoliosis

Carole Fortin, Erin Grunstein, Hubert Labelle, Stefan Parent, Debbie Ehrmann Feldman

O6 Can ultrasound imaging be used to determine curve flexibility when designing spinal orthoses?

Edmond Lou, Rui Zheng, Doug Hill, Andreas Donauer, Melissa Tilburn, Jim Raso

O7 Reliability of the Schroth curve type classification in adolescents with idiopathic scoliosis (AIS)

Sanja Schreiber, Eric Parent, Greg Kawchuk, Douglas Hedden

O8 Can Trunk Appearance Perception Scale (TAPS) be used as a descriptive tool of scoliosis severity?

Judith Sánchez-Raya, Antonia Matamalas Adrover, Elisabetta D’Agata, Joan Bagó Granell

O9 Magnitude of the Cobb angle on an X-ray in relation to the angle of trunk rotation in children who come to the “Troniny” Scoliosis Treatment Centre

Marek Kluszczynski, Anna Kluszczyńska, Jacek Wąsik, Marta Motow-Czyż, Adam Kluszczyński

O10 Cobb angel measurement without X-ray, a novel method

Ane Simony, Karen Hojmark Hansen; Hanne Thomsen; Mikkel Meyer Andersen; Morten Vuust

O11 The postural tone magnitude and distribution in patients diagnosed with an adolescent idiopathic scoliosis: a preliminary study

Irmina Blicharska, Jacek Durmała, Bartosz Wnuk, Małgorzata Matyja

O12 From studies on the function of the respiratory system in children with body posture defects

Andrzej Szopa, Małgorzata Domagalska-Szopa, Weronika Gallert-Kopyto, Tomasz Łosień, Ryszard Plintla

O13 Scoliosis as the “first” sign of various diseases

Franz Landauer, Karl Vanas

O14 The effectiveness of core stabilization exercises versus conventional exercises in addition to brace wearing in patients with adolescent idiopathic acoliosis

Gozde Gur, Necdet Sukru Altun, Yavuz Yakut

O15 The effect of physiotherapy techniques on the body balance in patients with scoliosis treated with corrective appliances

Piotr Gawda, Piotr Majcher

O16 New combine method treating AIS – preliminary results

Lior Neuhaus Sulam

O17 Does a 4-week intensive course of ScolioGold therapy reduce angle of trunk rotation in scoliotic patients: a retrospective case series.

Michael Bradley, David Glynn, Alex Hughes, Erika Maude, Christine Pilcher

O18 Schroth physiotherapy method without bracing is an effective treatment for scoliosis in improving curves and avoiding surgery and should be offered as a treatment option for scoliosis in Canada: case series

Andrea Lebel, Victoria Ashley Lebel, Judit Orbán

O19 Rotation of the trunk and pelvis and coupled movements in the sagittal plane in double support stance in adolescent girls with idiopathic scoliosis

Agnieszka Stępień, Krzysztof Graff

O20 Curve progression analysis in Risser 0 patients orthotically managed with compliance monitors

D. Speers

O21 Conservative treatment in Scheuermann’s kyphosis: comparison between lateral curve and variation of the vertebral geometry

Angelo Gabriele Aulisa, Vincenzo Guzzanti, Giuseppe Mastantuoni, Andrea Poscia, Lorenzo Aulisa

O22 The plaster cast in the conservative treatment of idiopathic scoliosis can still play a positive role?

Angelo Gabriele Aulisa, Vincenzo Guzzanti, Francesco Falciglia, Andrea Poscia, Lorenzo Aulisa

O23 Bracing for Adolescent Idiopathic Scoliosis (AIS) and Scheuermann Kyphosis : The issue of overtreatment in Greece

Nikos Karavidas

O24 Efficacy of Milwaukee brace for correction of scheurmann kyphosis

Mohammadreza Etemadifar

O25 The three dimensional analysis of the Sforzesco brace correction

Sabrina Donzelli, Fabio Zaina, Monia Lusini, Salvatore Minnella, Luca Balzarini, Stefano Respizzi, Stefano Negrini

O26 Quality of Life in adolescents with idiopathic scoliosis: A comparison measured by the Kidscreen 27 between scoliotic patients and healthy controls

Kathrin Güttinger

O27 The degree of illness acceptance in young women with idiopathic scoliosis treated with orthopedic braces: a preliminary study

Jacek Durmała, Irmina Blicharska, Agnieszka Drosdzol–Cop, Violetta Skrzypulec–Plinta

O28 Which are the personality traits of the patients with Adolescent Idiopathic Scoliosis?

Elisabetta D’Agata, Judith Sánchez-Raya

O29 How many Scolioses do exist in the same person? A zoom vision on the perception of the patient

Judith Sánchez-Raya, Elisabetta D’Agata

P1 The algorithm for the automatic detection of the pelvic obliquity based on analysis of the PA viev of the x-ray image

Sławomir Paśko, Wojciech Glinkowski

P2 Monitoring of spine curvatures and posture during pregnancy using surface topography – case study and method assessment

Jakub Michoński, Katarzyna Walesiak, Anna Pakuła, Robert Sitnik, Wojciech Glinkowski

P3 Spinal rotation under static and dynamic conditions: a prospective study comparing normative data vs. scoliosis

Helmut Diers

P4 The principle of non-surgical treatment of idiopathic scoliosis right-sided breast depending on the volatility of the formation of the intervertebral discs and vertebral bodies

Piotr Majcher, Piotr Gawda

P5 Unexpected late progression of adolescent idiopathic scoliosis treated with short-term, aggressive, full-time bracing and Schroth physiotherapy with excellent preliminary result: case study

Andrea Lebel, Victoria Ashley Lebel

P6 Visible posture in relation to the neuroanatomical and neurodynamical features in spinal deformations

Piet van Loon, Ruud van Erve, Andre Grotenhuis

P7 Immediate effects of scoliosis-specific corrective exercises on the Cobb angle after 1 week and after 1 year of practice

Karina Zapata, Eric Parent, Dan Sucato

P8 Retrospective analysis of idiopathic scoliosis medical records coming from one out-patient clinic for compatibility with Scoliosis Research Society criteria of brace treatment studies

Krzysztof Korbel, Mateusz Kozinoga, Łukasz Stoliński, Tomasz Kotwicki

P9 Adult female with severe progressive scoliosis possibly secondary to benign tumor removal at age 3 treated with scoliosis specific Schroth physiotherapy after refusing surgery: case study

Andrea Lebel, Victoria Ashley Lebel

P10 New aspects of scoliosis therapy planning and monitoring

Helmut Diers

P11 Outcome of intensive outpatient rehabilitation in an adult patient with M. Scheuermann evaluated by radiologic imaging – a case report

Hagit Berdishevsky

P12 The effectiveness of a Scoliosis Specific Home Exercise Program and bracing to reduce an idiopathic scoliosis curve with more than 90 % success in less than a year of exercises. Case report.

Hagit Berdishevsky

The biological basis of degenerative disc disease: proteomic and biomechanical analysis of the canine intervertebral disc

INTRODUCTION

In the present study, we sought to quantify and contrast the secretome and biomechanical properties of the non-chondrodystrophic (NCD) and chondrodystrophic (CD) canine intervertebral disc (IVD) nucleus pulposus (NP).

METHODS

We used iTRAQ proteomic methods to quantify the secretome of both CD and NCD NP. Differential levels of proteins detected were further verified using immunohistochemistry, Western blotting, and proteoglycan extraction in order to evaluate the integrity of the small leucine-rich proteoglycans (SLRPs) decorin and biglycan. Additionally, we used robotic biomechanical testing to evaluate the biomechanical properties of spinal motion segments from both CD and NCD canines.

RESULTS

We detected differential levels of decorin, biglycan, and fibronectin, as well as of other important extracellular matrix (ECM)-related proteins, such as fibromodulin and HAPLN1 in the IVD NP obtained from CD canines compared with NCD canines. The core proteins of the vital SLRPs decorin and biglycan were fragmented in CD NP but were intact in the NP of the NCD animals. CD and NCD vertebral motion segments demonstrated significant differences, with the CD segments having less stiffness and a more varied range of motion.

CONCLUSIONS

The CD NP recapitulates key elements of human degenerative disc disease. Our data suggest that at least some of the compromised biomechanical properties of the degenerative disc arise from fibrocartilaginous metaplasia of the NP secondary to fragmentation of SLRP core proteins and associated degenerative changes affecting the ECM. This study demonstrates that the degenerative changes that naturally occur within the CD NP make this animal a valuable animal model with which to study IVD degeneration and potential biological therapeutics.

The quality of reports on cervical arterial dissection following cervical spinal manipulation

BACKGROUND

Cervical artery dissection (CAD) and stroke are serious harms that are sometimes associated with cervical spinal manipulation therapy (cSMT). Because of the relative rarity of these adverse events, studying them prospectively is challenging. As a result, systematic review of reports describing these events offers an important opportunity to better understand the relation between adverse events and cSMT. Of note, the quality of the case report literature in this area has not yet been assessed.

PURPOSE

1) To systematically collect and synthesize available reports of CAD that have been associated with cSMT in the literature and 2) assess the quality of these reports.

METHODS

A systematic review of the literature was conducted using several databases. All clinical study designs involving CADs associated with cSMT were eligible for inclusion. Included studies were screened by two independent reviewers for the presence/absence of 11 factors considered to be important in understanding the relation between CAD and cSMT.

RESULTS

Overall, 43 articles reported 901 cases of CAD and 707 incidents of stroke reported to be associated with cSMT. The most common type of stroke reported was ischemic stroke (92%). Time-to-onset of symptoms was reported most frequently (95%). No single case included all 11 factors.

CONCLUSIONS

This study has demonstrated that the literature infrequently reports useful data toward understanding the association between cSMT, CADs and stroke. Improving the quality, completeness, and consistency of reporting adverse events may improve our understanding of this important relation.

Within- and between-day reliability of spinal stiffness measurements obtained using a computer controlled mechanical indenter in individuals with and without low back pain

Instrumented spinal stiffness measurements have shown high test-retest reliability. However, factors that may affect reliability have yet to be investigated. The objective of this study was to compare the: 1) within- and between-day reliability of a mechanical indentation device (MID) in measuring spinal stiffness, 2) measurement precision of averaging multiple measurements, and 3) reliability of stiffness measurements between individuals with and without low back pain (LBP). The spinal stiffness of 26 volunteers with and without LBP was measured 3 times by MID in each of two visits 1-4 days apart. Two stiffness measures were calculated from the resulting force-displacement data: global stiffness and terminal stiffness. Intraclass correlation coefficients (ICCs) were used to estimate reliability. Measurement precision was measured by minimal detectable changes, bias and 95% limits of agreement. Using the mean of three spinal stiffness measurements, the measurement precision was improved by 33.7% over a single measurement. Averaging three measurements, the within- and between-day reliability point estimates of both global and terminal stiffness were 0.99 and 0.98, respectively. The reliability estimates of spinal stiffness measurement using MID were not significantly altered by the participants' LBP status across all circumstances (95% confidence intervals overlapped). With our experimental protocol, averaging three spinal stiffness measurements using MID produces reliable stiffness measurements regardless of individuals' LBP status.

Evidence-informed management of chronic low back pain with spinal manipulation and mobilization

The management of chronic low back pain (CLBP) has proven very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing among available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.

A new method of creating intervertebral disc disruption of various grades

BACKGROUND

The purpose of this study was to develop a model of intervertebral disc disruption capable of (1) internal disruption without excessive disruption to the disc surface, (2) user-defined disruption magnitude and location and (3) interrogation by magnetic resonance imaging. Present models of disc disruption may have some, but not all, of these features.

METHODS

Intravenous tubes were inserted into the intervertebral discs of a cadaveric porcine lumbar spine. Tube placement in the inner annulus was confirmed by magnetic resonance imaging. Each disc was then injected through the intravenous tube with nitrogen gas at pressures of 69 kPa, 172 kPa, 345 kPa and 690 kPa. Before and after injection, edge detection analysis of magnetic resonance imaging images was used to quantify tissue disruption. These values were then multiplied by the thickness of the slices and summed to determine disruption volume for individual discs. Four additional discs were injected with the addition of ink, sectioned and then inspected visually.

RESULTS

As the injection pressure increased, the gas volume within the annulus increased significantly as did visualized annular disruption. No significant difference in gas volume was observed between different discs injected with equal pressure.

INTERPRETATION

As confirmed by magnetic resonance imaging and dissection, gas volume and tissue disruption within the annulus fibrosus were proportional to the pressure of injected nitrogen. This model of disc disruption promises to provide several advantages in the investigation of disc pathology including (1) user-controlled magnitude of inner annulus disruption, (2) user-controlled tissue disruption localization, (3) minimal disruption of the exterior annulus, (4) independence between the magnitude of external and internal disruption and (5) the ability to visualize resulting disruptions with magnetic resonance imaging.

Human lumbar facet joint capsule strains: I. During physiological motions

BACKGROUND CONTEXT

The lumbar facet joint capsule is innervated with nociceptors and mechanoreceptors, and is thought to play a role in low back pain as well as to function proprioceptively.

PURPOSE

In order to examine the facet capsule's potential proprioceptive role, relationships between intracapsular strain and relative spine position were examined.

STUDY DESIGN/SETTING

Lumbar facet joint capsule strains were measured in human cadaveric specimens during displacement-controlled motions.

METHODS

Ligamentous lumbar spine specimens (n=7) were potted and actuated without inducing a moment at the point of application. Spines were tested during physiological motions of extension, flexion, left and right lateral bending. Intervertebral angulations (IVA) were measured using biaxial inclinometers mounted on adjacent vertebrae. Joint moments were determined from the applied load at T12 and the respective moment arms. Capsule plane strains were measured by optically tracking the displacements of infrared reflective markers glued to capsule surfaces. Statistical differences (p<.05) in moment, IVA and strain were assessed across facet joint levels using analysis of variance and comparison of linear regressions.

RESULTS

The developed moments and IVAs increased monotonically with increasing displacements; the relationships were highly correlated for all four motion types. Although highly variable among specimens, principal strains also increased monotonically in magnitude with increasing displacements during extension and flexion, but were more complex during lateral bending. At a given joint level, the absolute magnitudes of principal strains and IVA were largest during the same motion type.

CONCLUSIONS

Distinct patterns in principal strains and IVA were identified during physiological motions, lending biomechanical support to the theory that lumbar facet joint capsules could function proprioceptively.

Measurements of vertebral translations using bone pins, surface markers and accelerometers

OBJECTIVE: To compare invasive and non-invasive techniques for measuring the posterior-to-anterior translations of vertebrae during spinal manipulative therapy. DESIGN: This study represents a small part of a larger experiment. BACKGROUND: Despite the mechanical nature of spinal manipulative therapy, the mechanism by which it alleviates back pain is still unknown. An understanding of the deformation behaviour of the spine during spinal manipulative therapy would aid in the formulation of a hypothesis underlying its efficacy. METHODS: A clinician delivered posterior-to-anterior manipulative thrusts to the right transverse process of either T(10), T(11) or T(12) in two cadavers. Posterior-to-anterior translations of the bone pins and surface markers (embedded in and taped over T(10), T(11) and T(12), respectively) were recorded by cine cameras. Posterior-to-anterior accelerations, recorded by the accelerometers, were used to calculate posterior-to-anterior translations. Translation measurements made by using the surface markers and the accelerometers were compared to those made by using the bone pins. RESULTS: There were no significant differences between the posterior-to-anterior translations of vertebrae obtained from the surface markers, as compared to the bone pins. The accelerometers underestimated the absolute, and overestimated the relative, vertebral translations, respectively, compared to the bone pins. CONCLUSIONS: The translations measured by the surface markers were more similar to the translations derived from the bone pins than those calculated from the accelerometers. Three-dimensional surface marker arrays would therefore be more useful to determine all relative movements non-invasively.

Movements of vertebrae during manipulative thrusts to unembalmed human cadavers

OBJECTIVE

The purpose of this study was to measure the relative movements of vertebrae during manipulative thrusts to unembalmed post-rigor mortis human cadavers.

SETTING

The investigation was conducted in the gross anatomy laboratory at the University of Calgary.

SUBJECTS

Two 77-yr-old, unembalmed, post-rigor mortis, male cadavers were used.

INTERVENTIONS

The movements of vertebrae were investigated by using high-speed cinematography to record the movements of bone pins threaded into T10, T11 and T12 during spinal manipulative therapy to unembalmed post-rigor human cadavers. A single clinician delivered a series of posterior-to-anterior (p-to-a) thrusts to the right transverse process of either T10, T11 or T12, using a reinforced hypothenar contact. Relative p-to-a and lateral translations, as well as axial and sagittal rotations, in T10-T11 and T11-T12 were calculated. Corresponding p-to-a forces exerted by the clinician onto the cadaver were recorded using a pressure pad.

MAIN RESULTS

Significant relative movements were measured primarily between the targeted and immediately adjacent vertebrae during the thrusts. Vertebral pairs remained slightly 'hyper-extended' after the rapid thrusts to T11, when the p-to-a forces returned to preload levels.

CONCLUSIONS

These findings may be useful for the understanding of the deformation behavior of the vertebral column during therapeutic manipulation. A fully three-dimensional analysis of all six degrees of freedom, using a larger number of unembalmed cadavers, would be useful in clarifying the relationship between the externally applied forces and the observed relative movement patterns of the vertebrae.

A new technique of tissue stiffness (compliance) assessment: its reliability, accuracy and comparison with an existing method

OBJECTIVE

To assess the reliability and accuracy of a new method of tissue stiffness (TS) assessment, automated stiffness assessment (ASA), and compare these findings with previously published results of manual stiffness assessment (MSA).

DESIGN

Descriptive study.

SETTING

Human Performance Laboratory, University of Calgary.

INTERVENTION

ASA was used to collect stiffness measurements from three foam surfaces of different stiffness characteristics and two control surfaces. Control surface one (CS1) was rigid and could not be displaced; control surface two (CS2) was rigid but could be displaced. The three foam surfaces and CS1 had been previously tested using MSA.

MAIN OUTCOME MEASURE

Reliability and accuracy were assessed for each separate electronic component by root mean square analysis (RMS) and linear regression/calibration curves, respectively. The reliability of ASA (all electronic components working in concert) was determined by computing intraclass correlation coefficients (ICC); the accuracy of ASA was assessed by studying relative deformations of the control surfaces.

RESULTS

Each electronic component used in ASA was found to have a calculated RMS of less than 0.03% of the mean, whereas the R2-value for any of these separate components was never lower than 0.99. For ASA, the median ICC for all surfaces tested was 0.99. The mean relative deformation collected from CS1 was 0.34 +/- mm at 44.0 N of input force whereas the mean relative deformation collected from CS2 was 0.008 +/- 0.013 mm. The median ICC for MSA found in a previous investigation was 0.005 and the mean displacement recorded from the control surface with MSA was 1.28 +/- 0.57 mm at 49.10 N.

CONCLUSION

ASA seems to be extremely reliable and accurate. When ASA and MSA were used to assess identical test surfaces, the results of MSA were poor when compared with those obtained by ASA; we therefore suggest that conclusions reached in prior research employing MSA should be considered with caution. It is our recommendation that remotely controlled, electronic signal gathering procedures such as ASA be the method of choice when assessing TS.