Coronal plane trunk asymmetry is associated with whole-body sagittal alignment in healthy young adolescents before pubertal peak growth

Musculoskeletal System and Gait Characteristics in Patients with Osteogenesis imperfecta

OBJECTIVES

The aim of the study was to assess the muscoloskeletal system and spatiotemporal gait parameters of patients in three types of osteogenesis imperfecta.

DESIGN STUDY

Retrospective observational study.

SETTINGS

The Department of Rehabilitation, Children's Memorial Health Institute in Warsaw, Poland.

PARTICIPANTS

This study investigated individuals with various types of osteogenesis imperfecta: 33 with osteogenesis imperfecta I (aged 13.9), 16 with osteogenesis imperfecta III (aged 10.4), and 14 with osteogenesis imperfecta IV (aged, 15.8), as well as a reference group of 400 healthy individuals.

MAIN MEASURES

The musculoskeletal assessment included: medical record review, clinical evaluation, functional tests, long bone deformity assessment via clinical and X-ray examination, and objective gait analysis with the Vicon Motion Systems (Ltd, Oxford, UK).

RESULTS

The study revealed notable differences in clinical presentation, deformities within the musculoskeletal system, gait parameters across the various types of osteogenesis imperfecta (p < 0.001). The most affected gait parameters were: cadence, gait speed and step length. The greatest deformities of lower limbs and spine were presented in patients with osteogenesis imperfecta type III.

CONCLUSIONS

These findings are significant for understanding gait abnormalities in osteogenesis imperfecta patients and designing customized physiotherapy programs to help them participate fully in daily life. Improvement of muscle strength is one of the key for easier engagement in activities like walking or stair-climbing.

Analysis of sagittal spinal alignment at the adolescent age: for furniture design

Knowledge of the parameters of the human spine is essential in designing ergonomic furniture. The purpose of this study was to evaluate spinal alignment in adolescents of various ages. The lengths, curvatures, and concave-convex spacings of the spine were investigated in 268 participants aged 9-18 years. Ten ages were classified, and the rate of increase of parameters was calculated for each age and age group. The results showed that spinal parameters, except for cervical lordosis, increased with age. Adolescents were classified as 9-10, 11-12, 13-15, and 16-18 years old. A rapid increment of lengths and concave-convex spacings occurred at ages 13-15, while that of curvatures occurred at ages 16-18. Spinal parameters differed significantly among the age groups (p < 0.05). Concave-convex spacings reflected differences in the spine more clearly than the other parameters. This study suggests the necessity of designing spine-related furniture based on spinal parameters, thus providing adaptive support for the adolescent spine, particularly the lumbar spine. Practitioner summary: This study examined spinal lengths, curvatures, and concave-convex spacings in adolescents aged 9-8 years and then divided them into four age groups. Concave-convex spacings effectively reflected spinal differences between age groups, particularly the lumbar spine. These results can inform the ergonomic design of spine-related furniture.HIGHLIGHTSSpinal parameters increased progressively between 9 and 18 years. Regression analysis showed good linear correlations between TK, LL, SK, TS, and LS with age.Age classification of adolescents was Group I (9-10 years), Group II (11-12 years), Group III (13-15 years), and Group IV (16-18 years). The rapid increment of lengths and concave-convex spacings were in Group III while that of curvatures were in Group IV.Concave-convex spacings were vital parameters to evaluate the global balance of the spine.The lumbar spine is an essential segment for characterizing spinal alignment.

Are Craniofacial Asymmetries Related to Trunk Asymmetries?

OBJECTIVE

The aim of this study was to investigate whether craniofacial asymmetries could be a predictor of spine asymmetries or not.

METHODS

Female individuals aged between 18 and 25 years participated in this cross-sectional descriptive-analytic study. The angle of trunk rotation was measured by a scoliometer in conjunction with the Adams forward-bending test. Individuals in the control group (n = 57) had spinal curvature of 0 to 3 degrees, and individuals in the study group (n = 53) had spinal curvature of between 4 and 6 degrees. Facial anthropometric measurements of individuals were evaluated by referencing anatomical landmarks determined on the face with 2-dimensional photogrammetry using ImageJ (Version 1.53q) program.

RESULTS

Both groups were similar in terms of facial measurements (P > 0.05). Axial trunk rotation values of the mid-thoracic and thoraco-lumbar regions were significantly higher on both sides of the asymmetry group (P < 0.05). The distances between facial landmarks are not associated with asymmetries of spine regions (P > 0.05).

CONCLUSION

Although the sensitivity and predictive value of facial asymmetries in determining trunk asymmetries and sagittal spinal posture were low, it was concluded that comparative studies are needed, especially in individuals with asymmetry at the level of scoliosis, as the asymmetries of the individuals in our study were not at the level of scoliosis.

The relationship between minor coronal asymmetry of the spine and measures of spinal sagittal shape in adolescents without visible scoliosis

The purpose of this work is to identify what features of overall spinal sagittal shape are associated with coronal asymmetry in those without scoliosis. Using a longitudinal analysis of Integrated Shape Imaging System 2 (ISIS2) surface topography images of those without scoliosis, measures of coronal asymmetry, along with measures of spinal sagittal shape (kyphosis, lordosis and sagittal imbalance, which is a measure of the position of the top of the thoracic spine relative to the sacrum) were analysed using linear mixed effect models (LMEM), which is a method of analysing the components of a complex model (such as that describing overall spinal shape), to ascertain the relative relationships between the parameters. Data was also analysed when subdivided for the anatomical level of coronal asymmetry (thoracic or thoracolumbar/lumbar pattern). There were 784 measures from 196 children. Kyphosis had little effect on coronal asymmetry for males and females, lordosis increased with coronal asymmetry in females only and sagittal imbalance increased with coronal asymmetry in males only. The results of the LMEM modelling were that the parameters related to coronal asymmetry were lordosis and sagittal imbalance. In thoracic coronal asymmetry, whilst lordosis was predominant, kyphosis played more of a role. In thoracolumbar/lumbar coronal asymmetry, lordosis and sagittal imbalance were the larger coefficients. Coronal asymmetry of the spine in those without scoliosis is related to features of spinal sagittal shape, particularly lordosis and sagittal imbalance. This knowledge adds to the understanding of the aetiology of adolescent idiopathic scoliosis.

Comparison of Spinopelvic Configuration and Roussouly Alignment Types Between Pediatric and Adult Populations

STUDY DESIGN

Retrospective cross-sectional study.

OBJECTIVE

The aim was to describe spinopelvic alignment types by pelvic incidence (PI) and age to compare the Roussouly classification between pediatric and adult populations.

SUMMARY OF BACKGROUND DATA

The Roussouly classification was validated for adults. Alignment types may vary during growth.

MATERIALS AND METHODS

Radiographs of 1706 non pathologic individuals (5-49 yr) were analyzed. Individuals ≤19 years were stratified by chronological age and skeletal maturity (triradiate cartilage, Risser), and compared with adults. Global and spinopelvic alignment parameters were assessed. Roussouly Types 1, 2, 3, 3A (anteverted pelvis), and 4 were determined. The distribution of parameters was analyzed by Bayesian inference. The relationship between PI and age by Roussouly type was modeled by linear regression.

RESULTS

The Sagittal Vertical Axis C7 decreased during growth and was significantly smaller in adults (20-34 yr) (Pr>0.99). Thoracic kyphosis and lumbar lordosis increased during growth and were larger in adults (Pr<0.025). Lordosis increased mainly in the cranial arch (Pr<0.025). PI and pelvic tilt increased during growth and were larger in adults (Pr<0.025). In children and adolescents, PI<45° represented the largest proportion, significantly larger compared with adults (Pr>0.99). Proportions of Roussouly Types 1 and 2 were similar throughout ages. Types 3 and 4 were rarer during the prepubertal period (Pr<0.025). The proportion of Type 3A was significantly higher in children and adolescents (Pr>0.99). Linear regression showed that Type 4 had the largest PI increase with age, with significantly higher curve slope compared with other types (Pr>0.9999). Types 3, 3A and 2 had similar slopes and lowest PI increase with age.

CONCLUSION

Global and spinopelvic alignment changed during childhood and adolescence, leading to different kyphosis and lordosis distribution compared with adults. Growth-related PI increase influenced Roussouly types with typical predominance of Type 3A in the pediatric population and larger PI increase in Type 4.

LEVEL OF EVIDENCE

Level III.

Systematic review of the association between isolated musculoskeletal hypermobility and adolescent idiopathic scoliosis

INTRODUCTION

Adolescent idiopathic scoliosis (AIS) affects 1-3% of the population, but its pathogenesis remains unclear. The coexistence of musculoskeletal hypermobility and scoliosis in many inherited syndromes raises the possibility that isolated musculoskeletal hypermobility may contribute to AIS development or progression.

METHODS

We performed a systematic review of the evidence for a relationship between isolated musculoskeletal hypermobility and AIS. A meta-analysis was planned, but if not possible, a narrative evidence synthesis was planned.

RESULTS

Nineteen studies met eligibility criteria for inclusion. One study was excluded due to insufficient quality. Substantial heterogeneity in study design and methodology negated meta-analysis, so a narrative review was performed. Of the 18 studies included, seven suggested a positive association and eight found no association. Three reported the prevalence of musculoskeletal hypermobility in individuals with AIS. Overall, there was no convincing population-based evidence for an association between musculoskeletal hypermobility and AIS, with only two case-control studies by the same authors presenting compelling evidence for an association. Although populations at extremes of hypermobility had a high prevalence of spinal curvature, these studies were at high risk of confounding. Wide variation in methods of measuring musculoskeletal hypermobility and the challenge of assessing AIS in population-based studies hinder study comparison.

CONCLUSIONS

There is a paucity of high-quality evidence examining the association between isolated musculoskeletal hypermobility and AIS. Large-scale prospective studies with adequate adjustment for potential confounding factors could clarify the relationship between musculoskeletal hypermobility and AIS to elucidate its role in the pathogenesis of AIS.

The Impact of Childhood Obesity on Joint Alignment: A Systematic Review and Meta-Analysis

OBJECTIVE

It has been suggested that overweight/obesity (OW/OB) impairs the normal alignment of children and adolescents' musculoskeletal system. However, to date, no study has systematically reviewed or quantified the effect of OW/OB on the development of joint malalignments in children and adolescents. The purpose of this study was to systematically review the association between OW/OB and joint alignment in children and adolescents and to quantify the evidence on whether children and adolescents with OW/OB have a higher risk of developing joint malalignments than their peers of normal weight.

METHODS

PubMed and Web of Science databases were systematically searched from inception to March 9, 2020. Studies investigating the association between OW/OB and joint alignment in children and adolescents were selected. Nonoriginal articles, participants with movement pattern diseases, and adolescents studied while pregnant were excluded. Two independent reviewers conducted the study selection and data extraction. Qualitative synthesis of evidence and random effect meta-analyses (risk ratio [RR]) were performed.

RESULTS

Seventy-three studies (5 longitudinal and 68 cross-sectional) met the inclusion criteria involving 1,757,107 children and adolescents. There was consistent evidence supporting associations of OW/OB with rounded shoulder, lumbar hyperlordosis, genu valgum, and flatfoot. Our meta-analysis showed that children and adolescents with OW/OB had a significantly higher risk of lumbar hyperlordosis (RR = 1.41), genu valgum (RR = 5.92), flatfoot (RR = 1.49), and any joint malalignment (RR = 1.68) when compared with their peers of normal weight. The presence of genu valgum and flatfoot were the most robust results.

CONCLUSION

Based on these findings, OW/OB is associated with the presence of joint malalignments in children and adolescents.

IMPACT

This is the first study that has systematically reviewed the effect of OW/OB on the development of joint malalignments in children and adolescents.

The odontoid-CSVL distance in a global population of asymptomatic volunteers: normative values and implications for spinal coronal alignment

PURPOSE

In a population of asymptomatic volunteers across 5 countries, we sought to: (a) establish normative values of the Odontoid-Central Sacral Vertical Line (OD-CSVL) across patient factors, and (b) assess correlations of OD-CSVL with other radiographic parameters.

METHODS

A prospective, cross-sectional study of asymptomatic adult volunteers, ages 18-80 years, were enrolled across 5 countries (France, Japan, Singapore, Tunisia, United States) forming the Multi-Ethnic Alignment Normative Study (MEANS) cohort. Included volunteers had no known spinal disorder(s), no significant neck/back pain (VAS ≤ 2; ODI ≤ 20), and no significant scoliosis (Cobb ≤ 20°). Radiographic measurements included commonly used coronal alignment parameters (mm) and angles (°). OD-CSVL was defined as the difference between the odontoid plumb line (line from the tip of the odontoid vertically down) and the CSVL (vertical line from the center of the sacrum). Chi-square, student's t tests, Kruskal-Wallis, Wilcoxon rank-sum, linear regression, and Pearson's correlation were used with significance at p < 0.05.

RESULTS

467 volunteers were included with normative OD-CSVL values by age decade, gender, BMI, and country. Mean ± SD OD-CSVL was 8.3 mm ± 6.5 mm and 31 (6.6%) volunteers were almost perfectly aligned (OD-CSVL < 1 mm). A linear relationship was seen between OD-CSVL with both age (p < 0.001) and BMI (p = 0.015). Significant variation was seen between OD-CSVL and 5 different ethnicities (p = 0.004). OD-CSVL correlated best with other coronal radiographic parameters, C7-CSVL (r = 0.743, p < 0.001), OD-knee (r = 0.230, p < 0.001), CAM-knee (r = 0.612, p < 0.001), and regional TL cobb angle (r = 0.4214, p = 0.005).

CONCLUSION

Among asymptomatic volunteers, increased OD-CSVL was significantly associated with increased age, increased BMI, and ethnicity, but not gender. OD-CSVL correlated strongest with C7-CSVL, TL cobb angle, OD-knee, and CAM-knee. OD-CSVL. These results support further study of OD-CSVL in symptomatic adult spine deformity patients.

The Development of Kyphosis and Lordosis in the Growing Spine

STUDY DESIGN

A longitudinal cohort study.

OBJECTIVE

The aim of this study was to do the analysis of the development of kyphosis and lordosis in the growing spine.

SUMMARY OF BACKGROUND DATA

Previous studies have measured kyphosis and lordosis in different ways with differing techniques. None of the previous literature has a truly longitudinal design and there is disagreement as to whether there exists a difference between the development of kyphosis and lordosis between males and females.

METHODS

Repeated measures using Integrated Shape Imaging System Integrated Shape Imaging System 2 surface topography over 5 years of a group of children aged 5 to 16 years without spinal deformity. Longitudinal analysis was performed using linear mixed effects modeling.

RESULTS

There were 638 measures in 194 children. Both kyphosis and lordosis increased with age in both males and females (P < 0.001 for kyphosis and P = 0.002 for lordosis). There was no statistical difference in the development of kyphosis between males and females (P = 0.149). However, there was a significant difference in lordosis between males and females (P < 0.001) with female lordosis larger than that seen in males. Kyphosis and lordosis increased in a nonlinear fashion with age.

CONCLUSION

Kyphosis and lordosis increase as children age. Between males and females there is no difference in the increase in the size of kyphosis, but there is difference in the size of lordosis with females having greater lordosis versus males at the same age.

LEVEL OF EVIDENCE

2.

Comparison of Spinal Curvatures in the Sagittal Plane, as Well as Body Height and Mass in Polish Children and Adolescents Examined in the Late 1950s and in the Early 2000s

BACKGROUND Humans are exposed to various stimuli which lead to somatic modifications and changes in body posture, negatively affecting many of its characteristics. The purpose of this study was to assess significant alterations which occurred in selected morphological features and spinal curvatures in children and adolescents over a period of 40 years. MATERIAL AND METHODS The total of 7041 subjects, aged 4-18 years (mean age 11.3 years) were included in the study, which was designed to compare measurements performed in year 1959 (Group 1, n=3235 individuals) and in year 2003 (Group 2, n=3806 individuals). The children were examined for body height, body mass, as well as thoracic and lumbar curvatures. In 1959, the measurements were carried out using a spherodorsimeter, while in 2003, the CQ System photogrammetry was used, producing corresponding results. The Mann-Whitney U test and the Student's t-test were used for statistical analysis. RESULTS The findings showed a significant decrease in the angle of lumbar lordosis and in sacral inclination as well as an increase in body height and mass, particularly in prepubertal children. On the other hand, the angle of thoracic kyphosis and the partial angles of physiological spinal curvatures changed only to a small degree over the 40-year period. CONCLUSIONS This study provides evidence related to changes which occurred during the relevant period of over 40 years, namely a decrease in both the angle of lumbar lordosis and the sacral inclination angle, as well as an increase in body height and mass. These changes should be taken into consideration in selecting norms and standards applied in healthcare services, and the findings suggest it is necessary to regularly update such standards.

Trunk and craniofacial asymmetry are not associated in the general population: a cross-sectional study of 1029 adolescents

Background

The literature did not show clearly if a correlation between trunk and facial asymmetry exists. The aim of this study was to verify the association between trunk and facial asymmetries, and trunk and facial sagittal configuration in adolescents.

Methods

This is a cross-sectional screening study. It was carried out in a small town in Northern Italy, from February to April 2014. Healthy children met the inclusion criteria. Exclusion criteria were subjects with physical and cognitive disability, genetic disease, and polymorphism. All subjects underwent a three phases for postural screening program.

Results

1029 healthy children were 491 females and 538 males with mean age: 12 (range 11–16) years. The association of facial and trunk asymmetry had a point prevalence rate around 1% for the various regions of the spine, the association on the sagittal plane of almost 1.3% for hyperkyphosis and hyperlordosis. Overall, results showed a very low sensitivity, specificity, and predictive values of facial anomalies for trunk asymmetry and sagittal spinal posture.

Conclusion

While correlations between jaw position and body posture for cervical spine can exist, our study denied association with trunk and back in a general population: postural compensatory mechanism may have minimized the effects of one area on the other, if any existed.