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Li P, Zhou Y, Yan J. Letter to the Editor: Effectiveness of Physiotherapeutic Scoliosis-Specific Exercises on 3-Dimensional Spinal Deformities in Patients With Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024; 105:1807. [PMID: 38838801 DOI: 10.1016/j.apmr.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Peng Li
- Department of Tuina, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ya Zhou
- Department of Tuina, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Juntao Yan
- Department of Tuina, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Aksu H, Manduz B, Armagan M, Satoglu İS, Hanci V. Early complications in scoliosis surgery and relation to preoperative factors: A single-center retrospective study. Medicine (Baltimore) 2024; 103:e37529. [PMID: 38552046 PMCID: PMC10977596 DOI: 10.1097/md.0000000000037529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/15/2024] [Indexed: 04/02/2024] Open
Abstract
In this study, we aimed to investigate the perioperative complications of the patients who underwent scoliosis surgery in our hospital and the factors that may affect the outcome. Between 2014 and 2018, scoliosis patients recorded data was examined retrospectively. Age, gender, height, body weight, comorbidity, Cobb index, scoliosis etiology, operation time, preoperative and postoperative hemoglobin, hematocrit, leukocyte, blood urea nitrogen, creatinine, coagulation value, operation time, level of instrumentation, intraoperative and postoperative blood loss, blood transfusion, intraoperative fluid administration, preoperative pulmonary function test values, blood gas values, urine outputs, hospital (LOS) and post anesthesia care unit stays, complications and mortality rates were examined. The files of 77 patients (48 female, 29 male) were retrospectively analyzed. The average age was 19.54 ± 16.32 years and 98.7% were elective surgery. The mean of LOS was 13.55 ± 9.13 days. As the preoperative hematocrit value decreases, LOS increases significantly. In patients with chronic obstructive pulmonary disease, smokers and high ASA scores, LOS is prolonged in patients with previous operations. As intraoperative colloid administration increased, crystalloid and blood products increased, it was also observed that the amount of crystalloid increased LOS. As the amount of intraoperative colloid or red blood cell administration increases, the duration of surgery and anesthesia increases, also increases the duration of post anesthesia care unit. Compared to patients with complications (n = 29) to the patients without complications (n = 47), it was found that they had longer anesthesia, and surgery times, also longer LOS times (P < .05). Our study showed that chronic obstructive pulmonary disease in the preoperative period, smoking, high ASA score, excessive use of colloid, prolonged duration of surgery and anesthesia, and long intubation durations increase the length of hospital stay. Preoperative comorbidity is directly related to postoperative complications and causes longer hospitalization after reconstructive scoliosis surgery.
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Affiliation(s)
- Hale Aksu
- Department of Anesthesiology and Reanimation, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Busra Manduz
- Department of Anesthesiology and Reanimation, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Mustafa Armagan
- Orthopedics and traumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - İsmail Safa Satoglu
- Department of Anesthesiology and Reanimation, School of Medicine, Dokuz Eylul University, Izmir, Turkey
- Orthopedics and traumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Volkan Hanci
- Department of Anesthesiology and Reanimation, School of Medicine, Dokuz Eylul University, Izmir, Turkey
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Sağlam Y, Bingöl I, Yaşar NE, Dumlupınar E, Ata N, Ülgü MM, Birinci Ş, Özdemir G, Aslantürk O, Görgün B. The burden of scoliosis: a nationwide database study on demographics, incidence, and surgical rates. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:655-662. [PMID: 37803157 DOI: 10.1007/s00586-023-07967-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Scoliosis is characterized as a three-dimensional deformity of the spine, affected by variety of factors, including biological, mechanical, hormonal, and genetics. METHODS Our study's primary objective was to delineate the demographics, incidence, and prevalence of scoliosis from a nationwide perspective, analyze the surgical intervention rates, with the aim of offering more insightful guidance to orthopedic physicians. This nationwide cohort study was conducted from digital database for healthcare information management. Relevant population data, for children under 18 years old, was extracted from the official government census within the period of January 2015 to December 2022. Utilizing diagnostic code of M41 [Scoliosis] was used to define the patient pool from ICD-10. Demographic variables, type of operations (posterior only, anterior only, or combined), and complications were documented. Incidence and prevalence values were calculated using population figures and case numbers. RESULT There were 276,521 patients with an average incidence of 129 per 100,000. Frequency of females was 1.45 times greater than that of males (p < 0.001). A total of 10,417 surgeries were performed in 10,311 patients during the inspection period (3.8% of all cases). Posterior fusion was by far the most common surgical approach (n = 10.111; 97%) followed by anterior fusion (n = 200; 1,9%). CONCLUSIONS Our findings reveal a significant increase in the average incidence of scoliosis diagnosis, rising from 107 per 100,000 individuals in 2015 to 161 per 100,000 in 2022. Scoliosis now impacts an estimated 1.2% of children and adolescents in Turkey. The risk is 1.45 times higher in females than in males.
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Affiliation(s)
- Yavuz Sağlam
- Istanbul Faculty of Medicine, Orthopedics and Traumatology Department, Istanbul University, Istanbul, Turkey.
| | - Izzet Bingöl
- Faculty of Medicine, Ankara Onchology Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Niyazi Erdem Yaşar
- Ankara Bilkent City Hospital, Department of Orthopaedics and Traumatology, Health Sciences University, Ankara, Turkey
| | - Ebru Dumlupınar
- Faculty of Medicine, Department of Biostatistics, Ankara University, Ankara, Turkey
| | - Naim Ata
- Ministry of Health, General Directorate of Health Information Systems, Ankara, Turkey
| | - M Mahir Ülgü
- General Directorate of Health Information Systems, Ankara, Turkey
| | | | - Güzelali Özdemir
- Faculty of Medicine, Ankara Bilkent City Hospital, Department of Orthopaedics and Traumatology, Health Sciences University, Ankara, Turkey
| | - Okan Aslantürk
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Inonü University, Malatya, Turkey
| | - Barış Görgün
- Ortopediatri Istanbul, Academy of Children Orthopaedics, Istanbul, Turkey
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Zhao M, Meng N, Cheung JPY, Yu C, Lu P, Zhang T. SpineHRformer: A Transformer-Based Deep Learning Model for Automatic Spine Deformity Assessment with Prospective Validation. Bioengineering (Basel) 2023; 10:1333. [PMID: 38002457 PMCID: PMC10669780 DOI: 10.3390/bioengineering10111333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
The Cobb angle (CA) serves as the principal method for assessing spinal deformity, but manual measurements of the CA are time-consuming and susceptible to inter- and intra-observer variability. While learning-based methods, such as SpineHRNet+, have demonstrated potential in automating CA measurement, their accuracy can be influenced by the severity of spinal deformity, image quality, relative position of rib and vertebrae, etc. Our aim is to create a reliable learning-based approach that provides consistent and highly accurate measurements of the CA from posteroanterior (PA) X-rays, surpassing the state-of-the-art method. To accomplish this, we introduce SpineHRformer, which identifies anatomical landmarks, including the vertices of endplates from the 7th cervical vertebra (C7) to the 5th lumbar vertebra (L5) and the end vertebrae with different output heads, enabling the calculation of CAs. Within our SpineHRformer, a backbone HRNet first extracts multi-scale features from the input X-ray, while transformer blocks extract local and global features from the HRNet outputs. Subsequently, an output head to generate heatmaps of the endplate landmarks or end vertebra landmarks facilitates the computation of CAs. We used a dataset of 1934 PA X-rays with diverse degrees of spinal deformity and image quality, following an 8:2 ratio to train and test the model. The experimental results indicate that SpineHRformer outperforms SpineHRNet+ in landmark detection (Mean Euclidean Distance: 2.47 pixels vs. 2.74 pixels), CA prediction (Pearson correlation coefficient: 0.86 vs. 0.83), and severity grading (sensitivity: normal-mild; 0.93 vs. 0.74, moderate; 0.74 vs. 0.77, severe; 0.74 vs. 0.7). Our approach demonstrates greater robustness and accuracy compared to SpineHRNet+, offering substantial potential for improving the efficiency and reliability of CA measurements in clinical settings.
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Affiliation(s)
| | | | | | | | | | - Teng Zhang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong; (M.Z.); (N.M.); (J.P.Y.C.); (C.Y.); (P.L.)
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Zhang T, Zhu C, Zhao Y, Zhao M, Wang Z, Song R, Meng N, Sial A, Diwan A, Liu J, Cheung JPY. Deep Learning Model to Classify and Monitor Idiopathic Scoliosis in Adolescents Using a Single Smartphone Photograph. JAMA Netw Open 2023; 6:e2330617. [PMID: 37610748 PMCID: PMC10448299 DOI: 10.1001/jamanetworkopen.2023.30617] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/07/2023] [Indexed: 08/24/2023] Open
Abstract
Importance Adolescent idiopathic scoliosis (AIS) is the most common pediatric spinal disorder. Routine physical examinations by trained personnel are critical to diagnose severity and monitor curve progression in AIS. In the presence of concerning malformation, radiographs are necessary for diagnosis or follow-up, guiding further management, such as bracing correction for moderate malformation and spine surgery for severe malformation. If left unattended, progressive deterioration occurs in two-thirds of patients, leading to significant health concerns for growing children. Objective To assess the ability of an open platform application (app) using a validated deep learning model to classify AIS severity and curve type, as well as identify progression. Design, Setting, and Participants This diagnostic study was performed with data from radiographs and smartphone photographs of the backs of adolescent patients at spine clinics. The ScolioNets deep learning model was developed and validated in a prospective training cohort, then incorporated and tested in the AlignProCARE open platform app in 2022. Ground truths (GTs) included severity, curve type, and progression as manually annotated by 2 experienced spine specialists based on the radiographic examinations of the participants' spines. The GTs and app results were blindly compared with another 2 spine surgeons' assessments of unclothed back appearance. Data were analyzed from October 2022 to February 2023. Exposure Acquisitions of unclothed back photographs using a mobile app. Main Outcomes and Measures Outcomes of interest were classification of AIS severity and progression. Quantitative statistical analyses were performed to assess the performance of the deep learning model in classifying the deformity as well as in distinguishing progression during 6-month follow-up. Results The training data set consisted of 1780 patients (1295 [72.8%] female; mean [SD] age, 14.3 [3.3] years), and the prospective testing data sets consisted of 378 patients (279 [73.8%] female; mean [SD] age, 14.3 [3.8] years) and 376 follow-ups (294 [78.2%] female; mean [SD] age, 15.6 [2.9] years). The model recommended follow-up with an area under receiver operating characteristic curve (AUC) of 0.839 (95% CI, 0.789-0.882) and considering surgery with an AUC of 0.902 (95% CI, 0.859-0.936), while showing good ability to distinguish among thoracic (AUC, 0.777 [95% CI, 0.745-0.808]), thoracolumbar or lumbar (AUC, 0.760 [95% CI, 0.727-0.791]), or mixed (AUC, 0.860 [95% CI, 0.834-0.887]) curve types. For follow-ups, the model distinguished participants with or without curve progression with an AUC of 0.757 (95% CI, 0.630-0.858). Compared with both surgeons, the model could recognize severities and curve types with a higher sensitivity (eg, sensitivity for recommending follow-up: model, 84.88% [95% CI, 75.54%-91.70%]; senior surgeon, 44.19%; junior surgeon, 62.79%) and negative predictive values (NPVs; eg, NPV for recommending follow-up: model, 89.22% [95% CI, 84.25%-93.70%]; senior surgeon, 71.76%; junior surgeon, 79.35%). For distinguishing curve progression, the sensitivity and NPV were comparable with the senior surgeons (sensitivity, 63.33% [95% CI, 43.86%-80.87%] vs 77.42%; NPV, 68.57% [95% CI, 56.78%-78.37%] vs 72.00%). The junior surgeon reported an inability to identify curve types and progression by observing the unclothed back alone. Conclusions This diagnostic study of adolescent patients screened for AIS found that the deep learning app had the potential for out-of-hospital accessible and radiation-free management of children with scoliosis, with comparable performance as spine surgeons experienced in AIS management.
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Affiliation(s)
- Teng Zhang
- Digital Health Laboratory, School of Clinical Medicine, Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Chuang Zhu
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | - Yongkang Zhao
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | - Moxin Zhao
- Digital Health Laboratory, School of Clinical Medicine, Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Zhihao Wang
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | - Ruoning Song
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | - Nan Meng
- Digital Health Laboratory, School of Clinical Medicine, Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Alisha Sial
- SpineLabs, St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia
- Spine Service, Department of Orthopaedic Surgery, St George Hospital Campus, Sydney, Australia
| | - Ashish Diwan
- SpineLabs, St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia
- Spine Service, Department of Orthopaedic Surgery, St George Hospital Campus, Sydney, Australia
| | - Jun Liu
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | - Jason P. Y. Cheung
- Digital Health Laboratory, School of Clinical Medicine, Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
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Akyurek E, Zengin Alpozgen A, Akgul T. The preliminary results of physiotherapy scoliosis-specific exercises on spine joint position sense in adolescent idiopathic scoliosis: A randomized controlled trial. Prosthet Orthot Int 2022; 46:510-517. [PMID: 36215059 DOI: 10.1097/pxr.0000000000000136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 03/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND It has been observed that there are difficulties in maintaining spinal harmony in the absence of proprioceptive information, which has an important role in achieving postural control in scoliosis. One of the tests used to evaluate proprioceptive mechanisms is joint position reproduction. OBJECTIVES The main aim of our study was to investigate the effect of physiotherapy scoliosis-specific exercise (PSSE) on spine joint reposition (JR) sense. The second aim was to determine the effects of PSSE on the angle of trunk rotation (ATR), posture, and deformity perception in adolescent idiopathic scoliosis. METHODS Twenty-nine patients with adolescent idiopathic scoliosis (mean age 13.79 ± 1.82 years) were randomly allocated to two groups. "Schroth" exercises were applied to the PSSE group for 8 weeks (16 sessions). The control group was placed on the waiting list. Patients' JR error (dual inclinometer), ATR (scoliometer), posture parameters (PostureScreen Mobile, Posterior Trunk Asymmetry Index, and Anterior Trunk Asymmetry Index), and deformity perception (Walter Reed Visual Assessment Scale [WRVAS]) were assessed at the first session and at the end of 8 weeks. RESULTS The initial demographic characteristics, Cobb (thoracal: 19.41 ± 7.03 degrees; lumbar: 20.76 ± 7.24 degrees) and ATR (thoracal: 5.86 ± 3.98 degrees; lumbar: 5.66 ± 3.33 degrees) and clinical test parameters of the groups (JR, posture parameters, and WRVAS) were similar (P > .05). According to the findings, thoracal and lumbar JR error values (P < .05), ATR (P ≤ .001), posture parameters (P ≤ .001), and WRVAS (P = .048) were significantly improved in the PSSE group. Besides, when the groups were compared, a significant difference was found in favor of PSSE except for the deformity perception (P < .05). CONCLUSIONS Schroth exercises have a positive contribution for improving JR sense of the spine, vertebral rotation, and posture.
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Affiliation(s)
- Elcin Akyurek
- Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, Institute of Graduate Studies, Istanbul, Turkey
| | - Ayse Zengin Alpozgen
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Turgut Akgul
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, Istanbul, Turkey
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Wang X, Liu H, Wang W, Sun Y, Zhang F, Guo L, Li J, Zhang W. Comparison of multifidus degeneration between scoliosis and lumbar disc herniation. BMC Musculoskelet Disord 2022; 23:891. [PMID: 36180878 PMCID: PMC9526284 DOI: 10.1186/s12891-022-05841-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
Objective To assess and compare the pathological and radiological outcomes of multifidus degeneration in scoliosis and lumbar disc herniation patients. Methods We performed a retrospective review on 24 patients with scoliosis and 26 patients with lumbar disc herniation (LDH) in the Third Hospital of Hebei Medical University from January 2017 to March2021. The patients were divided into scoliosis group and LDH group according to the treatment. The MRI fatty infiltration rate (FIR) of multifidus and strength of back muscle were calculated to evaluate muscle condition. Multifidus biopsy samples were obtained during surgery in the affected side at L4 or L5 segment in LDH group and on the concavity side of apical vertebrae in scoliosis group. The biopsy fatty infiltration degree (FID) and FIR in two groups, the FIR of affected and unaffected side in LDH group, and the FIR of concavity and convexity side in scoliosis group were compared. The correlation between concavity-convexity FIR difference and cobb angle in scoliosis group, back muscle strength and FIR in LDH group, FID and FIR in both groups was calculated respectively. Results The FIR was higher in scoliosis group than in LDH group, higher in concavity side than convexity side in scoliosis group (both P < 0.05). The FID was higher in scoliosis group than in LDH group (P < 0.05). No significant difference was found between affected and unaffected side in LDH group (P > 0.05). There was a positive correlation between concavity-convexity FIR difference and cobb angle, FIR and FID (both P < 0.01). There was a negative correlation between back muscle strength and FIR (P < 0.01). The biopsy staining results showed that both two groups were found the existence of rimmed vacuoles, nuclear aggregation, and abnormal enzyme activity, indicating that the scoliosis and LDH may be associated with myogenic diseases. Conclusion The scoliosis patients showed more serious fatty infiltration than LDH patients and rare pathological findings were found in both diseases.
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Affiliation(s)
- Xianzheng Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 050000, Shijiazhuang, China
| | - Huanan Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 050000, Shijiazhuang, China
| | - Weijian Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 050000, Shijiazhuang, China
| | - Yapeng Sun
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 050000, Shijiazhuang, China
| | - Fei Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 050000, Shijiazhuang, China
| | - Lei Guo
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 050000, Shijiazhuang, China
| | - Jiaqi Li
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 050000, Shijiazhuang, China.
| | - Wei Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 050000, Shijiazhuang, China.
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Scaturro D, Balbo A, Vitagliani F, Stramazzo L, Camarda L, Letizia Mauro G. Is There a Relationship between Idiopathic Scoliosis and Body Mass? A Scoping Review. Nutrients 2022; 14:nu14194011. [PMID: 36235665 PMCID: PMC9572444 DOI: 10.3390/nu14194011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
The etiopathogenesis of idiopathic scoliosis remains unknown, although genetic or hereditary factors, neurological disorders, hormonal and metabolic dysfunctions, biomechanical factors, and environmental factors seem to be involved. Several studies have found that patients with scoliosis have common characteristics of taller stature, lower body mass index (BMI), and low systemic bone mass. We conducted a scoping review to analyze the association between idiopathic scoliosis and BMI. The search for articles was performed on PubMed and Cochrane, including the English language, full-text and free-full-text articles published from 31 December 2011 to 31 December 2021. Most of the results analyzed are in favor of a relationship between low BMI and scoliosis. Having a low BMI could be associated with the presence of scoliosis, although the reason for which is still doubtful. However, further large-scale epidemiological studies on different ethnicities and a comparison of BMI with the healthy population will be needed to better define the correlation between BMI and scoliosis.
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Affiliation(s)
- Dalila Scaturro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy
| | - Agnese Balbo
- Faculty of Medicine and Surgery, University of Catania, Via Santa Sofia 87, 95100 Catania, Italy
| | - Fabio Vitagliani
- Faculty of Medicine and Surgery, University of Catania, Via Santa Sofia 87, 95100 Catania, Italy
- Correspondence: ; Tel.: +39-3920677899
| | - Leonardo Stramazzo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy
| | - Lawrence Camarda
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy
| | - Giulia Letizia Mauro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy
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Sklensky J, Urbasek K, Svehlik M, Svozilova V, Kocanda J, Prymek M, Vyskocil R, Repko M. The relationship of hip loading asymmetry and radiological parameters of the spine in Lenke type 1 idiopathic scoliosis. Gait Posture 2022; 94:160-165. [PMID: 35338978 DOI: 10.1016/j.gaitpost.2022.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/20/2022] [Accepted: 03/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Idiopathic scoliosis does not only cause structural changes in the spine, but also functional changes of the musculoskeletal system. RESEARCH QUESTION Does idiopathic scoliosis lead to asymmetric hip loading in severe Lenke type 1 deformity? METHODS 23 patients (18 girls, 5 boys) aged 15 ± 2.8 years with an adolescent idiopathic main thoracic curve (Cobb angle 48.8°+/- 9.2°) were included. Measured X-ray parameters were: Cobb angle of primary thoracic and secondary lumbar curve, translation of the C7- plumb line, apical thoracic vertebra and apical lumbar vertebra from the central sacral vertical line. Subjects were examined by means of kinematic and kinetic gait analysis. The symmetry index (SI) was calculated as a ratio of hip frontal moments during a single stance for both sides when the symmetrical load was considered SI = 0 + /- 29.36 (0 +/- 1 SD of the mean SI of the healthy population). The Pearson correlation coefficient was used to show the relation between hip loading and radiologic measures of spinal deformity. RESULTS Only 34.8% of subjects with Lenke type 1 deformity showed symmetrical hip loading. Significant negative correlation was proved between SI and apical thoracic vertebra translation (R = - 0541; p < 0,05) as well as between SI and coronal imbalance (R = -0,5197; p < 0,05). There was no correlation between SI and the magnitude of the primary thoracic curve (R = -0.19; p = 0.385). Coronal imbalance correlates positively with translation of apical thoracic vertebra (R = 0,7255; p < 0,05). SIGNIFICANCE Two-thirds of subjects with Lenke type 1 deformity showed asymmetrical hip loading. This asymmetry is related to the translation of the apical thoracic vertebra and coronal imbalance and is not related to the magnitude of the main thoracic curve. On the contrary, the secondary lumbar curve plays role in the compensatory mechanism of the trunk.
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Affiliation(s)
- Jan Sklensky
- Department of Orthopaedic Surgery, University Hospital Brno, Brno, Czech Republic; Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Karel Urbasek
- Department of Paediatric Surgery, Orthopaedics, and Traumatology, University Hospital Brno, Brno, Czech Republic; Department of Paediatric Surgery, Orthopaedics and Traumatology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Martin Svehlik
- Department of Orthopaedics and Trauma - Section of Pediatric Orthopaedics, Medical University of Graz, Graz, Austria.
| | - Veronika Svozilova
- Department of Biomedical Engineering, Faculty of Electrical Engineering And Communication, Brno University of Technology, Brno, Czech Republic.
| | - Jan Kocanda
- Department of Orthopaedic Surgery, University Hospital Brno, Brno, Czech Republic; Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Martin Prymek
- Department of Orthopaedic Surgery, University Hospital Brno, Brno, Czech Republic; Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Robert Vyskocil
- Department of Orthopaedic Surgery, University Hospital Brno, Brno, Czech Republic; Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Martin Repko
- Department of Orthopaedic Surgery, University Hospital Brno, Brno, Czech Republic; Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Active Soft Brace for Scoliotic Spine: A Finite Element Study to Evaluate in-Brace Correction. ROBOTICS 2022. [DOI: 10.3390/robotics11020037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Scoliosis is a spinal disorder that is conventionally treated using rigid or soft braces. Computational methods such as finite element-based models are used to investigate the mechanics of the spine and the effect of braces. Most spinal braces are either passive, static, or rigid and do not allow mobility to the spine, resulting in muscle atrophy, skin deterioration and other spine complexities. Lack of control over the amount of force being exerted by braces on the human spine could have adverse effects. Therefore, developing an active soft brace which allows mobility to the spine while applying controlled corrective forces could be a promising solution. This study presents finite element analysis (FEA) of an active soft brace that applies corrective forces using elastic bands. The pressure exerted by the brace on the spine can be controlled by varying the tensions in the elastic bands. The elastic band tensions are controlled using low-power, lightweight, and twisted string actuators (TSAs). This study aims to demonstrate the immediate corrections induced by the soft active brace using a scoliotic spine finite element (FE) model. A FE model of the patient’s trunk was created and validated with in vitro study. The brace model was installed on the simulated trunk to evaluate in-brace correction in both sagittal and coronal planes. The brace was evaluated under various load cases by simulating the actuator action.
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11
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Meng N, Cheung JP, Wong KYK, Dokos S, Li S, Choy RW, To S, Li RJ, Zhang T. An artificial intelligence powered platform for auto-analyses of spine alignment irrespective of image quality with prospective validation. EClinicalMedicine 2022; 43:101252. [PMID: 35028544 PMCID: PMC8741432 DOI: 10.1016/j.eclinm.2021.101252] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Assessment of spine alignment is crucial in the management of scoliosis, but current auto-analysis of spine alignment suffers from low accuracy. We aim to develop and validate a hybrid model named SpineHRNet+, which integrates artificial intelligence (AI) and rule-based methods to improve auto-alignment reliability and interpretability. METHODS From December 2019 to November 2020, 1,542 consecutive patients with scoliosis attending two local scoliosis clinics (The Duchess of Kent Children's Hospital at Sandy Bay in Hong Kong; Queen Mary Hospital in Pok Fu Lam on Hong Kong Island) were recruited. The biplanar radiographs of each patient were collected with our medical machine EOS™. The collected radiographs were recaptured using smartphones or screenshots, with deidentified images securely stored. Manually labelled landmarks and alignment parameters by a spine surgeon were considered as ground truth (GT). The data were split 8:2 to train and internally test SpineHRNet+, respectively. This was followed by a prospective validation on another 337 patients. Quantitative analyses of landmark predictions were conducted, and reliabilities of auto-alignment were assessed using linear regression and Bland-Altman plots. Deformity severity and sagittal abnormality classifications were evaluated by confusion matrices. FINDINGS SpineHRNet+ achieved accurate landmark detection with mean Euclidean distance errors of 2·78 and 5·52 pixels on posteroanterior and lateral radiographs, respectively. The mean angle errors between predictions and GT were 3·18° and 6·32° coronally and sagittally. All predicted alignments were strongly correlated with GT (p < 0·001, R2 > 0·97), with minimal overall difference visualised via Bland-Altman plots. For curve detections, 95·7% sensitivity and 88·1% specificity was achieved, and for severity classification, 88·6-90·8% sensitivity was obtained. For sagittal abnormalities, greater than 85·2-88·9% specificity and sensitivity were achieved. INTERPRETATION The auto-analysis provided by SpineHRNet+ was reliable and continuous and it might offer the potential to assist clinical work and facilitate large-scale clinical studies. FUNDING RGC Research Impact Fund (R5017-18F), Innovation and Technology Fund (ITS/404/18), and the AOSpine East Asia Fund (AOSEA(R)2019-06).
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Affiliation(s)
- Nan Meng
- Digital Health Laboratory, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, Professorial Block, Pokfulam, Hong Kong, China
| | - Jason P.Y. Cheung
- Digital Health Laboratory, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, Professorial Block, Pokfulam, Hong Kong, China
| | - Kwan-Yee K. Wong
- Department of Computer Science, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Socrates Dokos
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Sofia Li
- Digital Health Laboratory, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, Professorial Block, Pokfulam, Hong Kong, China
| | - Richard W. Choy
- Digital Health Laboratory, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, Professorial Block, Pokfulam, Hong Kong, China
| | - Samuel To
- Digital Health Laboratory, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, Professorial Block, Pokfulam, Hong Kong, China
| | - Ricardo J. Li
- Digital Health Laboratory, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, Professorial Block, Pokfulam, Hong Kong, China
| | - Teng Zhang
- Digital Health Laboratory, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, Professorial Block, Pokfulam, Hong Kong, China
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Catanzariti JF, Darchicourt D, Chevutschi A, Le Berre M, Tanche L, Guyot MA. Is self-image, in reference to the gravitational vertical, altered in adolescent idiopathic scoliosis? A multicenter, single-blind, case-control study. J Pediatr Rehabil Med 2022; 15:477-486. [PMID: 36031914 DOI: 10.3233/prm-200689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Adolescent idiopathic scoliosis (AIS) is associated with perturbation of orthostatic postural control. In humans, orthostatic postural control is organized around the gravitational vertical (GV). Perception of the GV involves a bottom-up process (central integration of multisensorial information) and a top-down process that uses cognitive mechanisms relying on body image. This study hypothesized that AIS would be associated with an erroneous central representation of verticality. The objective was to demonstrate an altered top-down process of sense of verticality in AIS. METHODS This multicenter, single-blind, case-control study evaluated 63 adolescent girls with AIS divided into two groups (major AIS (n = 31) and minor AIS (n = 32)) and 30 matched non-scoliotic adolescents. Participants scored their perception of trunk appearance in an upright position using a pictographic scale. The outcome measure was the difference between perception score and real trunk deformity. RESULTS Participants with major AIS presented with misperception of their trunk appearance in an upright position when compared with those with minor AIS or controls. CONCLUSION Adolescents with major AIS underestimate their trunk deformity in an upright position. This suggests an altered representation of body image, affecting top-down control of sense of verticality.
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Affiliation(s)
- Jean-François Catanzariti
- Pediatric Rehabilitation Center Marc Sautelet, Villeneuve-d'Ascq, France.,Physical Therapy School, Loos, France.,La Maison de la Scoliose, Villeneuve-d'Ascq, France
| | | | - Alain Chevutschi
- Physical Therapy School, Loos, France.,COMUE Lille Nord de France, University Nord de France, Villeneuve d'Ascq, France
| | - Morgane Le Berre
- Department of Physical Medicine and Rehabilitation, Hospital Swynghedauw - Lille University Hospital, Lille, France
| | - Laetitia Tanche
- Pediatric Rehabilitation Center Marc Sautelet, Villeneuve-d'Ascq, France.,La Maison de la Scoliose, Villeneuve-d'Ascq, France
| | - Marc-Alexandre Guyot
- COMUE Lille Nord de France, University Nord de France, Villeneuve d'Ascq, France.,Department of Physical Medicine and Rehabilitation, Hospital Saint Philibert, Lille Catholic University Hospital, Lomme, France
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Incidence and Surgery Rate of Idiopathic Scoliosis: A Nationwide Database Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158152. [PMID: 34360445 PMCID: PMC8346015 DOI: 10.3390/ijerph18158152] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022]
Abstract
Idiopathic scoliosis is the most common cause of three-dimensional deformities of the spine. Most of the previous studies have been cross-sectional studies to estimate the prevalence in the general population. An age-matched, population-based study is performed using nationwide databases between 2011 and 2015. The incidence rates of idiopathic scoliosis by age group, sex, and region are identified. We also investigate the pattern of medical institution use and the surgery rate of patients with idiopathic scoliosis. Our results show that a total of 268,372 patients were diagnosed with idiopathic scoliosis. The overall incidence was 0.497%, and the incidence for females was 1.44 times higher than for males. By age group, the incidence of adolescent idiopathic scoliosis in patients aged 10–14 years was 0.821% compared to 0.029%, 0.192%, and 0.709% for those patients aged 0–2, 3–9, and 15–19 years, respectively. Both male and female urban populations had higher incidences than rural populations with no age differences at diagnosis. Survival analysis confirmed that 0.7% of diagnosed patients underwent surgical treatment within five years. Understanding the epidemiology of idiopathic scoliosis is helpful in diagnosing high risk patients and monitoring surgical interventions.
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Analysis of the Degree of Involvement of the Lower Limb Muscles in the Pathological Process in Adolescents with Idiopathic Scoliosis. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.2.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. The problem of the effect of adolescent idiopathic scoliosis on the functional condition of the lower limb muscles is still highlighted insufficiently.Aim. Analysis of the degree of involvement of the lower limb muscles in the pathological process in adolescents with idiopathic scoliosis.Methods. A comparative analysis has been made on the results of examination of 209 adolescents: 25 adolescents with idiopathic scoliosis; 170 normal adolescents; 14 adolescents with congenital scoliosis. The moments of force ofthe lower limb muscles were evaluated using dynamometric stands. Electrophysiological characteristics of the lower limb muscles were registered by the method of global and stimulation electroneuromyography.Results. The decrease in the amplitude of voluntary EMG of the femoral muscles in adolescents with idiopathic and congenital scoliosis is accompanied by dropping the moments of force relative to the values of the control group. The leg muscles are characterized by the preservation of the values of force at the level of normal test subjects under the conditions of the reduced voluntary EMG of high frequency. The amplitude of the M-responses of the indicator muscles and the values of the excitation propagation velocity along the motor fibers were also preserved. There are no statistically significant correlations between the amount of the spine deformity, on the one hand, and the values of asymmetry of the characteristics of the muscles in adolescents with idiopathic scoliosis.Conclusion. In adolescents with idiopathic scoliosis the function of femoral muscles is decreased, and there is no relationship between the amount of the spine deformity and the values of asymmetry of the characteristics of the lower limb muscles. The similar character of muscle function changes in adolescents with idiopathic and congenital scoliosis can testify that the cause of the observed changes is not the disease etiology, but the insufficient level of motor activity.
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Grünwald ATD, Roy S, Alves-Pinto A, Lampe R. Assessment of adolescent idiopathic scoliosis from body scanner image by finite element simulations. PLoS One 2021; 16:e0243736. [PMID: 33566808 PMCID: PMC7875351 DOI: 10.1371/journal.pone.0243736] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/26/2020] [Indexed: 11/28/2022] Open
Abstract
Adolescent idiopathic scoliosis, is a three-dimensional spinal deformity characterized by lateral curvature and axial rotation around the vertical body axis of the spine, the cause of which is yet unknown. The fast progression entails regular clinical monitoring, including X-rays. Here we present an approach to evaluate scoliosis from the three-dimensional image of a patient’s torso, captured by an ionizing radiation free body scanner, in combination with a model of the ribcage and spine. A skeletal structure of the ribcage and vertebral column was modelled with computer aided designed software and was used as an initial structure for macroscopic finite element method simulations. The basic vertebral column model was created for an adult female in an upright position. The model was then used to simulate the patient specific scoliotic spine configurations. The simulations showed that a lateral translation of a vertebral body results in an effective axial rotation and could reproduce the spinal curvatures. The combined method of three-dimensional body scan and finite element model simulations thus provide quantitative anatomical information about the position, rotation and inclination of the thoracic and lumbar vertebrae within a three-dimensional torso. Furthermore, the simulations showed unequal distributions of stress and strain profiles across the intervertebral discs, due to their distortions, which might help to further understand the pathogenesis of scoliosis.
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Affiliation(s)
- Alexander T. D. Grünwald
- Orthopaedic Department, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Susmita Roy
- Orthopaedic Department, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Ana Alves-Pinto
- Orthopaedic Department, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Renée Lampe
- Orthopaedic Department, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Markus Würth Professorship, Technical University of Munich, Munich, Germany
- * E-mail:
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Barba N, Ignasiak D, Villa TMT, Galbusera F, Bassani T. Assessment of trunk muscle activation and intervertebral load in adolescent idiopathic scoliosis by musculoskeletal modelling approach. J Biomech 2020; 114:110154. [PMID: 33279818 DOI: 10.1016/j.jbiomech.2020.110154] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine, the aetiology and pathogenesis of which are poorly understood. Unfortunately, biomechanical data describing trunk muscle activation and intervertebral load, which can contribute to understanding the pathomechanics of the AIS spine, cannot be measured in vivo due to the invasiveness of the procedures. The present study provides the biomechanical characterization of the spinal loads in scoliotic subjects by exploiting musculoskeletal modelling approach, allowing for calculating biomechanical measures in an assigned posture. A spine model with articulated ribcage previously developed in AnyBody software was applied. The predicted outcomes were evaluated in the upright posture, depending on scoliosis severity and curve type, in a population of 132 scoliotic subjects with mild, moderate, and severe scoliosis. Radiographic-based three dimensional reconstruction of vertebral orientations and scaling of body segments and trunk muscle cross-section area guaranteed geometrical subject-specificity. Validation analysis supporting the application of the model was performed. Trunk muscles were found more activated in the convex side of the scoliotic curve, in agreement with reference in vivo measurements, with progressive increase with scoliosis severity. The intervertebral lateral shear was found positively correlated with the severity of the scoliosis, demonstrating that the transferred load is not a priori orthogonal to vertebral endplate in the frontal plane, and thus questioning the assumption of the 'follower load' approach in case of experimental or computational study on the scoliotic spine. The study opens the way for the subject-specific characterization of scoliosis in assigned loading and motion conditions.
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Affiliation(s)
- Noemi Barba
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | | | - Tomaso Maria Tobia Villa
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Fabio Galbusera
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. LABS - Laboratory of Biological Structures Mechanics
| | - Tito Bassani
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. LABS - Laboratory of Biological Structures Mechanics..
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Veis Karami M, Aboutorabi A, Ebrahimzadeh K, Arazpour M, Asare E. The effect of orthotic interventions on balance performance in adolescent idiopathic scoliosis: A systematic literature review. Assist Technol 2020; 32:260-267. [PMID: 30601092 DOI: 10.1080/10400435.2018.1539419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Spinal bracing is one form of conservative treatment used in the treatment of adolescent idiopathic scoliosis (AIS). AIM The aim of this review was therefore to evaluate the effect of brace treatment on balance in subjects with AIS. METHOD The search strategy was based on the Population Intervention Comparison Outcome (PICO). PubMed, Scopus, ISI web of knowledge, Ovid, the Cochrane library (CENTRAL) and Google scholar databases and also the reference lists of relevant articles were searched for articles of clinical trials with level of evidence of three or more of AIS that underwent spinal bracing treatment. RESULTS Ten studies, investigating a total of 282 subjects with AIS, met the inclusion criteria. AIS subjects were characterized by a significant increase in the excursion of their center of pressure position compared with healthy subjects. AIS subjects are able to control their quiet standing balance via muscle co-contraction and proprioceptive stimulation, but following a short period of brace wear, no further improvement in balance parameters has been observed. CONCLUSION There is a requirement to follow up the use and wear of orthoses and also studies with high quality in subjects with AIS.
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Affiliation(s)
- Masomeh Veis Karami
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences , Tehran, Iran
| | - Atefeh Aboutorabi
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences , Tehran, Iran
| | - Kaveh Ebrahimzadeh
- Skull Base Research Center, Loghman Hakim Hospital , Tehran, Iran.,Department of Neurosurgery, Loghman Hakim Hospital,Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Mokhtar Arazpour
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences , Tehran, Iran.,Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences , Tehran, Iran
| | - Ehsan Asare
- Department of Neurosurgery, Lorestan University of Medical Sciences , Khoramabad, Iran
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18
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Lee CS, Hwang CJ, Jung HS, Lee DH, Park JW, Cho JH, Yang JJ, Park S. Association Between Vertebral Rotation Pattern and Curve Morphology in Adolescent Idiopathic Scoliosis. World Neurosurg 2020; 143:e243-e252. [PMID: 32712411 DOI: 10.1016/j.wneu.2020.07.111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Although rotation is an important aspect of pathogenesis of adolescent idiopathic scoliosis (AIS), there are no studies demonstrating rotation pattern by directly measuring rotation angle in computed tomography (CT) images. The present retrospective comparative radiographic study was conducted to evaluate the rotation pattern in AIS and its relation to curve morphology and Lenke classification. METHODS The study included 245 patients diagnosed with AIS and evaluated with a preoperative CT scan. Rotation angle of each vertebrae was measured using reconstructed axial CT images. Lenke classification of scoliosis curvature, Cobb angle, location of apical vertebra and end vertebra, level of most rotated vertebra (MRV), and rotational shift vertebra were recorded. Student's t-test, analysis of variance test, and correlation analysis were performed to identify the characteristics of rotation patterns in each Lenke type. RESULTS The rotation angle of MRV was significantly correlated with the Cobb angle. The level of MRV and rotation angle of MRV demonstrated significant correlation in both the main thoracic curve and lumbar curve, which signified that MRV located near the thoracolumbar junction is related to more severe rotational deformity. The level of MRV was also significantly correlated to the Cobb angle in both the main thoracic curve and lumbar curve. The types of structural curves proximal to major structural curves, such as type 2, 4, and 6, demonstrated more severe rotational and coronal plane deformities as compared with types 1, 3, and 5. CONCLUSIONS Curves with different Lenke types demonstrated different levels of MRV and severity of rotation. The results suggest that different center levels of rotation, signified by MRV, are a factor determining curve morphology. The findings would be a basis of connection between 2-dimensional classification and transverse plane deformity.
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Affiliation(s)
- Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyung Seo Jung
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Woo Park
- Department of Orthopedic Surgery, Gangneung Asan Hospital, Gangneung-si, Gangwon-do, Republic of Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea.
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Schmid S, Burkhart KA, Allaire BT, Grindle D, Bassani T, Galbusera F, Anderson DE. Spinal Compressive Forces in Adolescent Idiopathic Scoliosis With and Without Carrying Loads: A Musculoskeletal Modeling Study. Front Bioeng Biotechnol 2020; 8:159. [PMID: 32195239 PMCID: PMC7062648 DOI: 10.3389/fbioe.2020.00159] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/17/2020] [Indexed: 12/14/2022] Open
Abstract
The pathomechanisms of curve progression in adolescent idiopathic scoliosis (AIS) remain poorly understood and biomechanical data are limited. A deeper insight into spinal loading could provide valuable information toward the improvement of current treatment strategies. This work therefore aimed at using subject-specific musculoskeletal full-body models of patients with AIS to predict segmental compressive forces around the curve apex and to investigate how these forces are affected by simulated load carrying. Models were created based on spatially calibrated biplanar radiographic images from 24 patients with mild to moderate AIS and validated by comparing predictions of paravertebral muscle activity with reported values from in vivo studies. Spinal compressive forces were predicted during unloaded upright standing as well as standing with external loads of 10, 15, and 20% of body weight (BW) applied to the scapulae to simulate carrying a backpack in the regular way on the back as well as in front of the body and over the shoulder on the concave and convex sides of the scoliotic curve. The predicted muscle activities around the curve apex were higher on the convex side for the erector spinae (ES) and multifidi (MF) muscles, which was comparable to the EMG-based in vivo measurements from the literature. In terms of spinal loading, the implementation of spinal deformity resulted in a 10% increase of compressive force at the curve apex during unloaded upright standing. Apical compressive forces further increased by 50–62% for a simulated 10% BW load and by 77–94% and 103–128% for 15% and 20% BW loads, respectively. Moreover, load-dependent compressive force increases were the lowest in the regular backpack and the highest in the frontpack and convex conditions, with concave side-carrying forces in between. The predictions indicated increased segmental compressive forces during unloaded upright standing, which could be ascribed to the scoliotic deformation. When carrying loads, compressive forces further increased depending on the carrying mode and the weight of the load. These results can be used as a basis for further studies investigating segmental loading in AIS patients during functional activities. Models can thereby be created using the same approach as proposed in this study.
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Affiliation(s)
- Stefan Schmid
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States.,Spinal Movement Biomechanics Group, Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Katelyn A Burkhart
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Brett T Allaire
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Daniel Grindle
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Division of Engineering Mechanics, Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Tito Bassani
- Laboratory of Biological Structures Mechanics (LABS), IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Fabio Galbusera
- Laboratory of Biological Structures Mechanics (LABS), IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
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Abstract
STUDY DESIGN A case-control study. OBJECTIVE This study aimed to investigate the potential role of PIEZO2 gene in the development of AIS. SUMMARY OF BACKGROUND DATA Mutations of PIEZO2 gene have been reported to be associated with progressive scoliosis and impaired proprioception. Previous studies showed that patients with AIS may have impaired proprioception. However, there is lack of knowledge concerning the mechanism underlying the proprioception of AIS patients and the role of PIEZO2 gene in the etiology of AIS. METHODS Proprioception tests were performed in both AIS patients and age-matched healthy controls. Based on the falling risk scores, AIS patients were divided into impaired proprioception group and unimpaired proprioception group. Paraspinal muscle was collected from 34 AIS patients during surgery. The tissue expression of PIEZO2 was compared between the impaired group and the unimpaired group. In addition, the average number of muscle fibers in the muscle spindle was compared between the two groups. RESULTS Proprioception test showed that patients had significantly higher falling index (41.7 ± 16.5 vs. 11.3 ± 8.3, P = 0.004). In addition, the expression of PIEZO2 gene was remarkably decreased in the impaired group (0.51 ± 0.24 vs. 1.00 ± 0.33, P = 0.04). The average number of muscle fibers in the muscle spindle was significantly decreased in AIS patients of the impaired group than those of the unimpaired group (2.2 ± 1.3 vs. 3.5 ± 2.1, P = 0.04). PIEZO2 expression level was remarkably correlated with the average number of muscle fibers in the muscle spindle (r = 0.352, P = 0.04). CONCLUSION Proprioception is remarkably impaired in patients with AIS. Abnormal expression of PIEZO2 may play a role in AIS via altered proprioception and number of muscle fibers in the muscle spindles. Further investigation is warranted to illustrate the mechanism regulating PIEZO2 expression in AIS. LEVEL OF EVIDENCE 4.
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Meng Z, Wang C, Guo X, Chen W, Ding W. Analysis of the disc pressure of the upper thoracic spine using pressure-sensitive film: an experimental study in porcine model-implications for scoliosis progression. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:1069-1079. [PMID: 31617153 DOI: 10.1007/s13246-019-00804-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 09/30/2019] [Indexed: 11/28/2022]
Abstract
There has been few studies focusing on the disc pressure of the upper thoracic spine and it still lacks the quantitative pressure measurement of each spinal disc segment. The aim of this study was to study the pressure changes of intervertebral disc in porcine upper thoracic spine using pressure-sensitive film. Twelve porcine thoracic motion segments were harvested and successively loaded with vertical loads of 100 N, 150 N, and 200 N during 5° of anterior flexion, 5° of posterior extension and 5° of lateral bending. The resulting pressure values were measured. During anterior flexion, the anterior annulus of all segments at all loads showed higher mean pressure values than those during vertical compression, whereas the posterior annulus did not show higher mean values. During posterior extension, the anterior annulus of all segments showed lower mean pressure values than those during vertical compression, whereas the posterior annulus did not show lower mean pressure values. During lateral bending, the annulus of all segments showed higher mean pressure values than those during vertical compression. The posterior thoracic vertebra plays an important role in the motion of the upper thoracic vertebral segment and pressure distribution. During lateral bending, the concave side pressure of the annulus increases obviously, suggesting that asymmetrical force is a contributory factor for scoliosis progression.
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Affiliation(s)
- Zhao Meng
- Department of Orthopaedics, Children's Hospital of Hebei Province, No. 133, South Jianhua Street, Shijiazhuang, 050031, People's Republic of China.
| | - Chen Wang
- Department of Orthopaedics, Children's Hospital of Hebei Province, No. 133, South Jianhua Street, Shijiazhuang, 050031, People's Republic of China
| | - Xuzhao Guo
- Department of Orthopaedics, Children's Hospital of Hebei Province, No. 133, South Jianhua Street, Shijiazhuang, 050031, People's Republic of China
| | - Wei Chen
- Department of Traumatology Orthopaedics, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Wenyuan Ding
- Department of Spinal Surgery, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
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22
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Šarčević Z, Tepavčević A. Association between adolescent idiopathic scoliosis and sacroiliac joint dysfunction in young athletes: A case control study. Medicine (Baltimore) 2019; 98:e15161. [PMID: 30985695 PMCID: PMC6485790 DOI: 10.1097/md.0000000000015161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis, a 3-dimensional deviation in the axis of the spine. Etiology of AIS is unclear and the general belief is that AIS is multifactorial disorder possibly caused by different factors. It would be worthwhile to reveal new factors associated with AIS. The present study aimed to investigate association between sacroiliac joint (SIJ) dysfunction and AIS in young athletes.This case-control study included 196 children athletes (basketball, football, volleyball, handball, ballet, and others), 82 males and 114 females aged 8 to 17, 98 of them with the diagnosis of AIS. The case group consisted of young athletes examined at a regular checkup by a sport physician and diagnosed with AIS. The control group consisted of athletes matched to the case group according to sex, age, sports, number of training years and number of training hours per week, but without AIS.The scoliosis was diagnosed with Adams' forward bend test and the scoliometer measurement. The SIJ dysfunction was determined using the palpation meter (PALM) measuring the sagittal pelvic position in standing position and in standing position with the hip flexion angle of 90°. The data were analyzed using Student t test, Mann-Whitney U test, contingency coefficients, and logistic regression.The average difference in pelvic position in the sagittal plane (in standing position), with and without hip flexion 90° was found to be statistically different in the case and the control groups (t = 13.88, P = .00). There was a strong positive association between variables representing presence of AIS and SIJ dysfunction (determined by contingency coefficient C = 0.62, coefficient Phi = 0.79 and tetrachoric correlation coefficient 0.95).The logistic regression indicated that the average difference in pelvic position in the sagittal plane (in standing position), with and without hip flexion 90° was significantly associated with the probability of scoliosis in young athletes (P = .00, Wald test).There was a strong positive association between SIJ dysfunction and AIS in young athletes.
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Affiliation(s)
- Zoran Šarčević
- Novi Sad Health Care Centre, Sports Medicine Centre
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
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Le Berre M, Pradeau C, Brouillard A, Coget M, Massot C, Catanzariti JF. Do Adolescents With Idiopathic Scoliosis Have an Erroneous Perception of the Gravitational Vertical? Spine Deform 2019; 7:71-79. [PMID: 30587324 DOI: 10.1016/j.jspd.2018.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/28/2018] [Accepted: 05/05/2018] [Indexed: 10/27/2022]
Abstract
STUDY DESIGN Multicenter, case-control study. OBJECTIVES Demonstrate altered perception of verticality in AIS compared with matched controls. SUMMARY OF BACKGROUND DATA The cause of adolescent idiopathic scoliosis (AIS) remains to be found. AIS is associated with neurosensorial anomalies, in particular, altered control of orthostatic posture. During kinetic activity, the upright posture, in humans, is determined in reference to the gravitational vertical (GV). We hypothesized that in AIS, there is a discordance in the perception of the GV and the true GV. In AIS, the longitudinal axis of the body would thus be misoriented because of an erroneous perception of the GV. METHODS Thirty adolescents with right thoracic AIS (age 14.23 ± 1.75 years; Cobb angle 31.97°± 12.83°) and 30 controls matched for age (13.93 ± 1.85 years), body mass index, Tanner stage, and handedness were compared for subjective visual vertical (SVV) measured in static and dynamic (optokinetic stimulation) conditions, and subjective postural vertical (SPV). RESULTS There was no difference in the two groups, AIS and controls, for SVV. The SPV was significantly different between the two groups (p = .00023). The SPV was shifted to the right for most of the AIS patients (2.13°± 2.22°) compared with controls (-0.08°±1.40°). There was a significant correlation between SPV and clinical frontal tilt in the AIS patients. CONCLUSION Our findings demonstrate that patients with right thoracic AIS have an erroneous perception of the GV. In most AIS patients, SPV was shifted to the right, with no alteration of the SVV. AIS might be the consequence of a reoriented longitudinal body axis aligned with an erroneous vertical reference. The underlying mechanism might involve dysfunction of trunk graviceptors. The primary or secondary nature of this dysfunction remains an open question.
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Affiliation(s)
- Morgane Le Berre
- Physical Medicine and Rehabilitation Department, Swynghedauw University Hospital Center, Lille, France
| | - Charles Pradeau
- Physical Medicine and Rehabilitation Department, Swynghedauw University Hospital Center, Lille, France
| | | | - Monique Coget
- Spine department, SSR pediatric center Marc Sautelet, Villeneuve-d'Ascq, France
| | - Caroline Massot
- Physical Medicine and Rehabilitation Department, Saint Philibert University Hospital Center, Lomme 59462, France
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Lee Y, Kim YJ, Ryu HY, Ku GW, Sung TY, Yoon YS, Kim TK. Thoracic Scoliosis in Patients with Primary Spontaneous Pneumothorax. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:254-259. [PMID: 30109203 PMCID: PMC6089628 DOI: 10.5090/kjtcs.2018.51.4.254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 10/26/2017] [Accepted: 11/06/2017] [Indexed: 11/23/2022]
Abstract
Background Primary spontaneous pneumothorax (PSP) affects patients without clinically apparent lung disorder found in tall and thin young male. Scoliosis refers to curves exceeding 10° Cobb angle observed through chest X-ray and affects 2% to 4% of adolescents. Both conditions are commonly encountered in primary health care setting. The aim of this study is to access the correlation of thoracic scoliosis and PSP in adolescent. Methods A retrospective analysis was conducted for patients diagnosed for PSP in Konyang University Hospital between January 2010 and March 2017. Chest X-rays of 222 patients and 155 normal control (NC) cases were reviewed to measure the Cobb angle. Greater than 10° of Cobb angle is diagnosed as scoliosis. Results Scoliosis in patient with PSP has higher incidence than that of NC group (p<0.001). Median value of Cobb angle is 12.9° in PSP group and 14.7° in NC group. Directional relationship between scoliosis and pneumothorax in PSP group is also observed; 40.5% cases are ipsilateral and 59.5% are contralateral. Conclusion PSP patients tend to have thoracic scoliosis more commonly compared with normal healthy adolescent. Scoliosis may contribute to heterogeneity of alveolar pressure which exacerbates subpleural bleb formation that can cause pneumothorax. The causal relationship is unclear and further studies are needed in the future.
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Affiliation(s)
- Yeiwon Lee
- Department of Thoracic and Cardiovascular Surgery, Konyang University College of Medicine
| | - Young Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Konyang University College of Medicine
| | - Han Young Ryu
- Department of Thoracic and Cardiovascular Surgery, Konyang University College of Medicine
| | - Gwan Woo Ku
- Department of Thoracic and Cardiovascular Surgery, Konyang University College of Medicine
| | - Tae Yun Sung
- Department of Anesthesiology and Pain Medicine, Konyang University College of Medicine
| | - Yoo Sang Yoon
- Department of Thoracic Surgery, Dongnam Institute of Radiological and Medical Science
| | - Tae-Kyun Kim
- Department of Orthopaedic Surgery, Konyang University College of Medicine
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Gilsanz V, Wren TAL, Ponrartana S, Mora S, Rosen CJ. Sexual Dimorphism and the Origins of Human Spinal Health. Endocr Rev 2018; 39:221-239. [PMID: 29385433 PMCID: PMC5888211 DOI: 10.1210/er.2017-00147] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/24/2018] [Indexed: 12/26/2022]
Abstract
Recent observations indicate that the cross-sectional area (CSA) of vertebral bodies is on average 10% smaller in healthy newborn girls than in newborn boys, a striking difference that increases during infancy and puberty and is greatest by the time of sexual and skeletal maturity. The smaller CSA of female vertebrae is associated with greater spinal flexibility and could represent the human adaptation to fetal load in bipedal posture. Unfortunately, it also imparts a mechanical disadvantage that increases stress within the vertebrae for all physical activities. This review summarizes the potential endocrine, genetic, and environmental determinants of vertebral cross-sectional growth and current knowledge of the association between the small female vertebrae and greater risk for a broad array of spinal conditions across the lifespan.
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Affiliation(s)
- Vicente Gilsanz
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027.,Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027.,Department of Orthopaedic Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027
| | - Tishya A L Wren
- Department of Orthopaedic Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027
| | - Skorn Ponrartana
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027
| | - Stefano Mora
- Laboratory of Pediatric Endocrinology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Clifford J Rosen
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, Maine 04074
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Comparing Uniplanar and Multiaxial Pedicle Screws in the Derotation of Apical Vertebrae for Lenke V Adolescent Idiopathic Scoliosis: A Case-Controlled Study. World Neurosurg 2018; 111:e608-e615. [DOI: 10.1016/j.wneu.2017.12.135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 11/18/2022]
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Yin X, Wang H, Guo J, Zhang L, Zhang Y, Li L, Hou S. Association of vitamin D receptor BsmI rs1544410 and ApaI rs7975232 polymorphisms with susceptibility to adolescent idiopathic scoliosis: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e9627. [PMID: 29480871 PMCID: PMC5943872 DOI: 10.1097/md.0000000000009627] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AIS is the most common spinal deformity disease, yet its etiology remains uncertain. Significant associations have been found between AIS risk and vitamin D receptor (VDR) gene polymorphisms; however, some of these results are controversial. The aim of this study was to determine whether VDR BsmI rs1544410 and ApaI rs7975232 polymorphisms are correlated with AIS. METHODS Databases, including PubMed, EMBASE, Web of Science, the Cochrane Library, the Chinese Biomedical Literature Database, and the Wanfang Database, were systematically searched, and eligible case-control studies that explored the association of VDR (BsmI and ApaI) and the susceptibility to AIS were selected. The pooled odds ratio (OR) with 95% confidence interval (95% CI) was calculated to assess the associations, and subgroup meta-analyses were performed according to the ethnicity of the study population. RESULTS A total of 5 studies with 717 cases and 554 controls fulfilled the inclusion criteria after assessment by 2 reviewers. Generally, significant correlations were found between the BsmI polymorphism and AIS risk in overall populations and in Asian populations (overall population: B vs b: OR = 2.12, 95% CI = 1.21-3.75, P = .009; BB vs bb: OR = 3.38, 95% CI = 1.08-10.57, P = .036; Bb vs bb: OR = 2.50, 95% CI = 1.29-4.82, P = .006; BB/Bb vs bb: OR = 2.71, 95% CI = 1.31-5.63, P = .007; Asian population: B vs b: OR = 2.42, 95% CI = 1.27-4.61, P = .007; BB vs bb: OR = 4.09, 95% CI = 1.03-16.22, P = .045; Bb vs bb: OR = 2.94, 95% CI = 1.42-6.10, P = .004; BB/Bb vs bb: OR = 3.23, 95% CI = 1.42-7.35, P = .005). There was no significant association observed in Caucasian populations (all P > .05). With regard to the ApaI polymorphism, we found that it significantly decreased the risk of AIS (Aa vs AA: OR = 0.43, 95% CI = 0.24-0.77, P = .004; Aa/aa vs AA: OR = 0.52, 95% CI = 0.30-0.91, P = .023); however, we could not draw a definitive conclusion for Caucasian populations, as no studies have been conducted in this group to determine the role of the VDR ApaI polymorphism in AIS etiology and development. CONCLUSION VDR BsmI was significantly associated with AIS susceptibility in the overall and Asian populations, while the VDR ApaI polymorphism only played a key role in AIS etiology and development in Asian populations.
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Affiliation(s)
- Xin Yin
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of PLA, Beijing
| | - Huadong Wang
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of PLA, Beijing
| | - Jidong Guo
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of PLA, Beijing
| | - Liang Zhang
- Department of Orthopaedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, People's Republic of China
| | - Yupeng Zhang
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of PLA, Beijing
| | - Li Li
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of PLA, Beijing
| | - Shuxun Hou
- Department of Orthopaedics, The First Affiliated Hospital of General Hospital of PLA, Beijing
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Poorghasamians E, Aggabao PC, Wren TAL, Ponrartana S, Gilsanz V. Vertebral cross-sectional growth: A predictor of vertebral wedging in the immature skeleton. PLoS One 2017; 12:e0190225. [PMID: 29281728 PMCID: PMC5745000 DOI: 10.1371/journal.pone.0190225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/11/2017] [Indexed: 11/26/2022] Open
Abstract
The degree of vertebral wedging, a key structural characteristic of spinal curvatures, has recently been found to be negatively related to vertebral cross-sectional area (CSA). The purpose of this longitudinal study was to examine the relation between vertebral cross-sectional growth and vertebral wedging progression within the immature lumbar spine. Using magnetic resonance imaging (MRI), we analyzed the potential association between increases in lumbar vertebral CSA and changes in L5 vertebral wedging in 27 healthy adolescent girls (ages 9–13 years) twice within a two-year period. Vertebral CSA growth was negatively associated with changes in posteroanterior vertebral wedging (r = -0.61; p = 0.001). Multiple regression analysis showed that this relation was independent of gains in age, height, and weight. When compared to the 14 girls whose vertebral wedging progressed, the 13 subjects whose vertebral wedging decreased had significantly greater vertebral cross-sectional growth (0.39 ± 0.25 vs. 0.75 ± 0.23 cm2; p = 0.001); in contrast, there were no significant differences in increases in age, height, or weight between the two groups. Changes in posteroanterior vertebral wedging and the degree of lumbar lordosis (LL) positively correlated (r = 0.56, p = 0.002)—an association that persisted even after adjusting for gains in age, height, and weight. We concluded that in the immature skeleton, vertebral cross-sectional growth is an important determinant of the plasticity of the vertebral body; regression of L5 vertebral wedging is associated with greater lumbar vertebral cross-sectional growth, while progression is the consequence of lesser cross-sectional growth.
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Affiliation(s)
- Ervin Poorghasamians
- Department of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Patricia C. Aggabao
- Department of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Tishya A. L. Wren
- Division of Orthopaedic Surgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Skorn Ponrartana
- Department of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Vicente Gilsanz
- Department of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Division of Orthopaedic Surgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- * E-mail:
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29
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Wren TA, Ponrartana S, Aggabao PC, Poorghasamians E, Gilsanz V. Association Between Vertebral Cross-sectional Area and Vertebral Wedging in Children and Adolescents: A Cross-sectional Analysis. J Bone Miner Res 2017; 32:2257-2262. [PMID: 28667786 DOI: 10.1002/jbmr.3210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/16/2017] [Accepted: 06/24/2017] [Indexed: 11/11/2022]
Abstract
A small vertebral cross-sectional area (CSA) imparts a mechanical disadvantage that escalates the risk for vertebral fractures in elderly populations. We examined whether a small vertebral CSA is also associated with a greater degree of vertebral wedging in children. Measurements of vertebral CSA, lumbar lordosis (LL) or thoracic scoliosis angle, and vertebral wedging were obtained in 100 healthy adolescents (50 boys and 50 girls) and 25 girls with adolescent idiopathic scoliosis (AIS) using magnetic resonance imaging. Vertebral CSA of the lumbar vertebrae negatively correlated to the degree of posteroanterior vertebral wedging at L5 (r = -0.49; p < 0.0001); this was true whether all subjects were analyzed together or boys and girls independently. In contrast, we found a positive correlation between the degree of LL and vertebral wedging (r = 0.57; p < 0.0001). Multiple regression analysis showed that the association between vertebral CSA and wedging was independent of age and body mass index. In girls with AIS, vertebral CSA negatively correlated to the degree of lateral thoracic vertebral wedging (r = -0.66; p = 0.0004), an association that persisted even after accounting for age and body mass index. Additionally, Cobb angle positively correlated to lateral thoracic vertebral wedging (r = 0.46; p = 0.021). Our cross-sectional results support the hypothesis that smaller vertebral CSA is associated with greater vertebral deformity during growth, as in adulthood. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Tishya Al Wren
- Division of Orthopaedic Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Skorn Ponrartana
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Patricia C Aggabao
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ervin Poorghasamians
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Vicente Gilsanz
- Division of Orthopaedic Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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30
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Abstract
STUDY DESIGN Cross-sectional. OBJECTIVE To examine the relationships between spine morphology, spine flexibility, and idiopathic scoliosis. BACKGROUND Girls have a higher incidence of clinically significant scoliosis than boys, along with smaller vertebrae and greater flexibility. Based on biomechanical modeling, we hypothesized that smaller vertebral width relative to intervertebral disc (IVD) height would be associated with both greater lateral flexibility of the spine and with idiopathic scoliosis. METHODS Magnetic resonance imaging was used to measure IVD height, vertebral width, and paraspinous musculature in 22 girls with mild and moderate idiopathic scoliosis and 29 girls without scoliosis ages 9-13 years. Clinical measurement of maximum lateral bending was also performed in the girls without scoliosis. A simple biomechanical model was used to estimate bending angle from the ratio of IVD height to vertebral half-width for L1-L4. The average ratio (Ravg) and calculated total bending angle (αtot) for L1-L4 were compared to the clinical measurements of lateral bending flexibility in the control group. These measures were also compared between the scoliosis and control groups. RESULTS There was a significant positive relationship between clinical flexibility and both Ravg (p = .041) and αtot (p = .042) adjusting for skeletal age, height, body mass index, and paraspinous muscle area as covariates. The ratio was significantly higher (Ravg = 0.45 vs. 0.38, p < .0001) and the bending angle was significantly greater (αtot = 107° vs. 89°, p < .0001) for girls with scoliosis compared with controls. CONCLUSION These results suggest that differences in spine morphology and corresponding changes in spine flexibility may be related to idiopathic scoliosis. If these relationships can be corroborated in larger prospective studies, these easily measured morphologic traits may contribute to a better understanding of the etiology of idiopathic scoliosis and an improved ability to predict scoliosis progression. LEVEL OF EVIDENCE Level III.
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31
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Yalaki Z, Ozdemir HM, Zengin T, Işik M. Investigation of Serum Levels of Selenium, Zinc, and Copper in Adolescents with Idiopathic Scoliosis. DICLE MEDICAL JOURNAL 2017. [DOI: 10.5798/dicletip.298579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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Understanding Idiopathic Scoliosis: A New Zebrafish School of Thought. Trends Genet 2017; 33:183-196. [DOI: 10.1016/j.tig.2017.01.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/03/2017] [Accepted: 01/06/2017] [Indexed: 12/28/2022]
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SILVA RICARDOTEIXEIRAE, FERNANDES RENANJOSERODRIGUES, ONO ALLANHIROSHIDEARAÚJO, MARCON RAPHAELMARTUS, CRISTANTE ALEXANDREFOGAÇA, BARROS FILHO TARCISIOELOYPESSOADE. ROLE OF DIFFERENT HORMONES IN THE PATHOGENESIS AND SEVERITY OF ADOLESCENT IDIOPATHIC SCOLIOSIS. ACTA ORTOPEDICA BRASILEIRA 2017. [PMID: 28642644 PMCID: PMC5474396 DOI: 10.1590/1413-785220172501168600] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the hormonal profile of patients with adolescent idiopathic scoliosis (AIS) and its relationship to the severity of the curvature and quality of life . METHOD Patients with scoliosis (Cobb angle above 10°), of both genders, diagnosed after 10 years of age were included, excluding those who presented other condition that could lead to scoliosis. Serum levels of 25-hydroxyvitamin D (25-OHD), cortisol and gastrin were correlated with Cobb angle and quality of life, measured by the SRS-30 questionnaire . RESULTS The levels of 25-OHD decreased in 97% of patients. There was an inverse relationship between gastrin levels and quality of life (p = 0.016). Moreover, there was an inverse correlation between the value of Cobb angle and quality of life (p = 0.036). There were no changes in cortisol levels. There was no correlation between Cobb angle and any of the hormones measured . CONCLUSION The patients had levels of 25-OHD diminished, strengthening the hypothesis of its involvement in the development of AIS. This study also suggests that increased gastrin levels may be associated with a worse quality of life in patients with AIS. Level of Evidence II, Diagnostic Study.
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Le Berre M, Guyot MA, Agnani O, Bourdeauducq I, Versyp MC, Donze C, Thévenon A, Catanzariti JF. Clinical balance tests, proprioceptive system and adolescent idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:1638-1644. [PMID: 27844226 DOI: 10.1007/s00586-016-4802-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 08/09/2016] [Accepted: 09/30/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spinal column of unknown etiology. Multiple factors could be involved, including neurosensory pathways and, potentially, an elective disorder of dynamic proprioception. The purpose of this study was to determine whether routine balance tests could be used to demonstrate an elective alteration of dynamic proprioception in AIS. METHODS This was a multicentre case-control study based on prospectively collected clinical data, in three hospitals pediatric, with spine consultation, from January 2013 through April 2015. From an original population of 547 adolescents, inclusion and non-inclusion criteria indentified 114 adolescents with right thoracic AIS (mean age 14.5 ± 1.9 years, Cobb angle 35.7 ± 15.3°) and 81 matched adolescents without scoliosis (mean age 14.1 ± 1.9 years). Participants performed three routine clinical balance tests to assess the static and dynamic proprioception: the Fukuda-Utenberger stepping test (angle of rotation in degrees and distance of displacement in cm) to assess dynamic balance; the sharpened Romberg test and the unipedal stance test (eyes closed) to assess static balance. RESULTS There was no significant difference between AIS subjects and controls for the static tests, but there was a significant difference for the dynamic test for both measures: distance of displacement (p < 0.01) and angle of rotation (p < 0.0001). This result confirms our initial these: the dynamic proprioception is altered electively in AIS. CONCLUSION These findings confirm recent AIS studies. Our results might be related to immature central integration of dynamic proprioceptive input leading to a poorly adapted motor response, particularly for postural control of the, in AIS. These balance tests can be performed in routine practice. Their validity as a biomarker for screening and monitoring purposes should be assessed.
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Affiliation(s)
- Morgane Le Berre
- Soins de Suite et de Réadaptation Pédiatrique Marc Sautelet de Villeneuve d'Ascq, 59650, Villeneuve d'Ascq, France.,Service de Médecine Physique et de Réadaptation-Hôpital Swynghedauw, Centre Hospitalier Universitaire de Lille, 59000, Lille, France
| | - Marc-Alexandre Guyot
- Université Nord de France, 59000, Lille, France.,Service de Médecine Physique et de Réadaptation-Centre Hospitalier Saint Philibert de Lomme, Groupe Hospitalier de l'Institut Catholique de Lille (GHICL), Lomme, France
| | - Olivier Agnani
- Université Nord de France, 59000, Lille, France.,Service de Médecine Physique et de Réadaptation-Centre Hospitalier Saint Philibert de Lomme, Groupe Hospitalier de l'Institut Catholique de Lille (GHICL), Lomme, France
| | - Isabelle Bourdeauducq
- Soins de Suite et de Réadaptation Pédiatrique Marc Sautelet de Villeneuve d'Ascq, 59650, Villeneuve d'Ascq, France.,Institut de Formation en Masso-Kinésithérapie du Nord de la France, Lille, France
| | - Marie-Christine Versyp
- Soins de Suite et de Réadaptation Pédiatrique Marc Sautelet de Villeneuve d'Ascq, 59650, Villeneuve d'Ascq, France
| | - Cécile Donze
- Université Nord de France, 59000, Lille, France.,Service de Médecine Physique et de Réadaptation-Centre Hospitalier Saint Philibert de Lomme, Groupe Hospitalier de l'Institut Catholique de Lille (GHICL), Lomme, France
| | - André Thévenon
- Université Nord de France, 59000, Lille, France.,Service de Médecine Physique et de Réadaptation-Hôpital Swynghedauw, Centre Hospitalier Universitaire de Lille, 59000, Lille, France
| | - Jean-Francois Catanzariti
- Soins de Suite et de Réadaptation Pédiatrique Marc Sautelet de Villeneuve d'Ascq, 59650, Villeneuve d'Ascq, France. .,Université Nord de France, 59000, Lille, France. .,Service de Médecine Physique et de Réadaptation-Centre Hospitalier Saint Philibert de Lomme, Groupe Hospitalier de l'Institut Catholique de Lille (GHICL), Lomme, France. .,Institut de Formation en Masso-Kinésithérapie du Nord de la France, Lille, France. .,Service de Rhumatologie-Hôpital Roger Salengro, Centre Hospitalier Universitaire de Lille, Lille, France.
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Zamecnik J, Krskova L, Hacek J, Stetkarova I, Krbec M. Etiopathogenesis of adolescent idiopathic scoliosis: Expression of melatonin receptors 1A/1B, calmodulin and estrogen receptor 2 in deep paravertebral muscles revisited. Mol Med Rep 2016; 14:5719-5724. [DOI: 10.3892/mmr.2016.5927] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 10/11/2016] [Indexed: 11/05/2022] Open
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Small vertebral cross-sectional area and tall intervertebral disc in adolescent idiopathic scoliosis. Pediatr Radiol 2016; 46:1424-9. [PMID: 27183842 DOI: 10.1007/s00247-016-3633-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/24/2016] [Accepted: 04/27/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND When compared to boys, girls have smaller vertebral cross-sectional area, which conveys a greater spinal flexibility, and a higher prevalence of adolescent idiopathic scoliosis. OBJECTIVE To test the hypothesis that small vertebral cross-sectional area and tall intervertebral disc height are structural characteristics of patients with adolescent idiopathic scoliosis. MATERIALS AND METHODS Using multiplanar imaging techniques, measures of vertebral cross-sectional area, vertebral height and intervertebral disc height in the lumbar spine were obtained in 35 pairs of girls and 11 pairs of boys with and without adolescent idiopathic scoliosis of the thoracic spine matched for age, height and weight. RESULTS Compared to adolescents without spinal deformity, girls and boys with adolescent idiopathic scoliosis had, on average, 9.8% (6.68 ± 0.81 vs. 7.40 ± 0.99 cm(2); P = 0.0007) and 13.9% (8.22 ± 0.84 vs. 9.55 ± 1.61 cm(2); P = 0.009) smaller vertebral cross-sectional dimensions, respectively. Additionally, patients with adolescent idiopathic scoliosis had significantly greater values for intervertebral disc heights (9.06 ± 0.85 vs. 7.31 ± 0.62 mm and 9.09 ± 0.87 vs. 7.61 ± 1.00 mm for girls and boys respectively; both P ≤ 0.011). Multiple regression analysis indicated that the presence of scoliosis was negatively associated with vertebral cross-sectional area and positively with intervertebral disc height, independent of sex, age and body mass index. CONCLUSION We provide new evidence that girls and boys with adolescent idiopathic scoliosis have significantly smaller vertebral cross-sectional area and taller intervertebral disc heights - two major structural determinants that influence trunk flexibility. With appropriate validation, these findings may have implications for the identification of children at the highest risk for developing scoliosis.
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Cervicocephalic relocation test to evaluate cervical proprioception in adolescent idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:3130-3136. [PMID: 27072549 DOI: 10.1007/s00586-016-4551-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine associated with disturbed postural control. Cervical proprioception participates in controlling orthostatic posture via its influence on head stabilization. We hypothesized that patients with AIS exhibit altered cervical proprioception. METHODS We conducted a case-control study to evaluate cervical proprioception using the cervicocephalic relocation test (CRT) in 30 adolescents with AIS (15.5 ± 1.5 years; Cobb 24.8° ± 9.5°) versus 14 non-scoliotic controls (14.6 ± 2.0 years). CRT evaluates cervical proprioception by measuring the capacity to relocate the head on the trunk after active rotation of the head in the transversal plane without visual control. Each subject performed ten right and then ten left head rotations. RESULTS The CRT results were pathological in 12 AIS patients (40 %). The CRT mean was significantly different between AIS patients with a pathological CRT (5° ± 1.4° for right rotation; 4.2° ± 0.9° for left rotation) compared with AIS patients with a normal CRT (2.7° ± 0.6° for right rotation; 2.9° ± 0.8° for left rotation) or with the control group (3.5° ± 2.1° for right rotation; 3.1° ± 1.2° for left rotation). CONCLUSION Cervical proprioception is impaired in certain AIS patients. This anomaly may worsen the prognosis of AIS (headache; balance disorders; worsened spinal deformity; complication after spinal fusion). We recommend systematic screening for altered cervical proprioception in AIS patients.
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Abstract
ABSTRACT Scoliosis is characterized by three-dimensional changes of the spine and is estimated to be present in 4% of the population worldwide. The most common form is the adolescent idiopathic. The purpose of this study is to identify the major muscle abnormalities found in patients with adolescent idiopathic scoliosis through a literature review. We conducted an electronic search of the national databases PubMed, Lilacs, PEDro, and EMBASE using the keywords "scoliosis", "biomechanics", "exercise", "physical therapy specialty", "idiopathic", and "muscles", from January 2003 to April 2015. The most relevant articles in English, Portuguese and Spanish were selected by title and abstract. It was also performed a manual search of the references of the selected articles. From a total of 4,319 articles, 11 were selected. We conclude that individuals with AIS have changes in the paraspinal muscles, with a difference in activation between the concave and convex sides, suggesting an increase in EMG activity on the convex side, although there is still no consensus among the authors.
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Schmid S, Studer D, Hasler CC, Romkes J, Taylor WR, Lorenzetti S, Brunner R. Quantifying spinal gait kinematics using an enhanced optical motion capture approach in adolescent idiopathic scoliosis. Gait Posture 2016; 44:231-7. [PMID: 27004664 DOI: 10.1016/j.gaitpost.2015.12.036] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 12/14/2015] [Accepted: 12/17/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE The pathogenesis of adolescent idiopathic scoliosis (AIS) remains poorly understood. Previous research has indicated possible relationships between kinematics of the spine, pelvis and lower extremities during gait and the progression of AIS, but adequate evidence on spinal kinematics is lacking. The aim of this study was to provide a detailed assessment of spinal gait kinematics in AIS patients compared to asymptomatic controls. METHODS Fourteen AIS patients and 15 asymptomatic controls were included. Through introducing a previously validated enhanced trunk marker set, sagittal and frontal spinal curvature angles as well as general trunk kinematics were measured during gait using a 12-camera Vicon motion capture system. Group comparisons were conducted using T-tests and relationships between kinematic parameters and severity of scoliosis (Cobb angle) were investigated using regression analyses. RESULTS The sagittal thoracic curvature angle in AIS patients showed on average 10.7° (4.2°, 17.3°) less kyphosis but 4.9° (2.3°, 7.6°) more range of motion (Cobb angle-dependent (R(2)=0.503)). In the frontal plane, thoracic and thoracolumbar/lumbar curvature angles indicated average lateral deviations in AIS patients. General trunk kinematics and spatio-temporal gait parameters, however, did not show any clinically relevant differences between the groups. CONCLUSIONS This demonstrates that the dynamic functionality of the scoliotic spine can be assessed using advanced non-invasive optical approaches and that these should become standard in clinical gait analysis. Furthermore, curvature angle data might be used to drive sophisticated computer simulation models in order to gain an insight into the dynamic loading behavior of the scoliotic spine during gait.
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Affiliation(s)
- Stefan Schmid
- ETH Zurich, Institute for Biomechanics, Zurich, Switzerland; Bern University of Applied Sciences, Health Division, Bern, Switzerland.
| | - Daniel Studer
- University of Basel Children's Hospital, Orthopaedic Department, Basel, Switzerland
| | | | - Jacqueline Romkes
- University of Basel Children's Hospital, Laboratory for Movement Analysis, Basel, Switzerland
| | | | | | - Reinald Brunner
- University of Basel Children's Hospital, Orthopaedic Department, Basel, Switzerland; University of Basel Children's Hospital, Laboratory for Movement Analysis, Basel, Switzerland
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Evaluation of motion sickness susceptibility by motion sickness susceptibility questionnaire in adolescents with idiopathic scoliosis: a case-control study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:438-43. [PMID: 26077100 DOI: 10.1007/s00586-015-4060-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 05/16/2015] [Accepted: 06/07/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine, with unknown origin. Some studies have noted impaired postural balance in AIS, in particular, difficulty to manage situations with sensory conflict. The motion sickness susceptibility can be secondary to a sensory conflict, for example, between visual and vestibular information. Our hypothesis is: patients with AIS have difficulty in managing situations with sensory conflict and therefore have increased motion sickness susceptibility. The purpose of this study was to evaluate in AIS subjects by evaluating their susceptibility to motion sickness, as compared to a control group. METHODS We conducted an analysis of data on motion sickness susceptibility collected prospectively from 2012, with the B score of motion sickness susceptibility questionnaire. This evaluation was completed for 65 adolescents (age 14.5 ± 1.6 year) with major right thoracic AIS (Cobb = 40.7° ± 13.1°) and 71 matched controls (14.6 ± 1.6 year). RESULTS Adolescents with major right thoracic AIS were more susceptible to motion sickness (B score = 5.3 ± 5.8) than controls (B score = 3.4 ± 3.7) with significant difference (p = 0.025). CONCLUSIONS We interpret our results suggesting there is difficulty for patients with AIS to manage situations with sensory conflict. Previous studies focusing on situations with sensory conflict in AIS have required sophisticated technology. They are not accessible for routine patient management. Our research shows the same result with simple, non invasive, low-cost and quick method: B score of motion sickness susceptibility questionnaire.
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Hurtado-Avilés J, Roca-González J, Santonja-Medina F. Hypothesis about an existent biomechanical cause-effect relationship between Schëuermann's kyphosis and scoliosis. Med Hypotheses 2015; 85:94-8. [PMID: 25913541 DOI: 10.1016/j.mehy.2015.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 03/19/2015] [Accepted: 04/09/2015] [Indexed: 11/17/2022]
Abstract
Schëuermanńs kyphosis is usually observed with a mild idiopathic scoliosis, and there is parity between these two diseases. The aim of this work is to establish a hypothesis about the existence of a biomechanical causal relationship between Schëuermann's kyphosis and scoliosis. To achieve this, a literature review was conducted. A simple mechanical model of the passive thoracolumbar subsystem was created to support part of the discussion. This mechanical model describes the passive thoracolumbar subsystem under ideal conditions of equilibrium. After giving consideration to the system under these conditions, some of the geometrical changes that may be found in Schëuermanńs kyphosis are considered. Next, this work discusses the evolution of the spine, taking into account its relationship with stable equilibrium, which the passive subsystem tends toward. We hypothesized about the postural response of the body to compensate for possible situations of imbalance. In conclusion, it can be found that a change in the alignment of the spine may occur due to the postural adaptation of the body to an inadequate mechanical situation that may lead to scoliotic deformity of the spine.
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Affiliation(s)
- J Hurtado-Avilés
- Industrial & Medical Electronics Research Group (EIMED), Technical University of Cartagena (UPCT), Cartagena, Spain.
| | - J Roca-González
- Industrial & Medical Electronics Research Group (EIMED), Technical University of Cartagena (UPCT), Cartagena, Spain.
| | - F Santonja-Medina
- Faculty of Medicine, University of Murcia, Department of Traumatology, V. de la Arrixaca University Hospital, Murcia, Spain.
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Romano M, Negrini A, Parzini S, Tavernaro M, Zaina F, Donzelli S, Negrini S. SEAS (Scientific Exercises Approach to Scoliosis): a modern and effective evidence based approach to physiotherapic specific scoliosis exercises. SCOLIOSIS 2015; 10:3. [PMID: 25729406 PMCID: PMC4344739 DOI: 10.1186/s13013-014-0027-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 12/24/2014] [Indexed: 11/10/2022]
Abstract
Background SEAS is the acronym for “Scientific Exercise Approach to Scoliosis”, a name related to the continuous changes of the approach based on results published in the literature. Rehabilitation program SEAS is an individualized exercise program adapted to all situations of conservative treatment of scoliosis: stand-alone in low-medium degree curves during growth to reduce the risk of bracing; complimentary to bracing in medium-high degree curves during growth, with the aim to increase correction, prepare weaning, and avoid/reduce side-effects; for adults either progressing or fused, to help stabilising the curve and reduce disability. SEAS is based on a specific active self-correction technique performed without external aid, and incorporated in functional exercises. Evaluation tests guide the choice of the exercises most appropriate to the individual patient. Improvement of the stability of the spine in active self-correction is the primary objective of SEAS. SEAS exercises train neuromotor function so to stimulate by reflex a self-corrected posture during the activities of daily life. SEAS can be performed as an outpatient (two/three times a week 45 for minutes) or as a home program to be performed 20 minutes daily. In the last case, expert physiotherapy sessions of 1.5 hours every three months are proposed. Results Different papers, including a randomized controlled trial (2014), published over the past several years, documented the efficacy of the SEAS approach applied in the various phases of scoliosis treatment in reducing Cobb angle progression and the need to wear a brace. Conclusions SEAS is an approach to scoliosis exercise treatment with a strong modern neurophysiological basis, to reduce requirements for patients and possibly the costs for families linked to the frequency and intensity of treatment and evaluations. Therefore, SEAS allows treating a large number of patients coming from far away. Even if SEAS appears simple by requiring less physiotherapist supervision and by using fewer home exercises prescribed at a lower dose than some of the other scoliosis-specific exercise approaches, real expertise in scoliosis, exercises, and patient and family management is required. The program has no copyrights, and teachers are being trained all over the world.
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Affiliation(s)
- Michele Romano
- ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino 13, 20141 Milan, Italy
| | - Alessandra Negrini
- ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino 13, 20141 Milan, Italy
| | - Silvana Parzini
- ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino 13, 20141 Milan, Italy
| | - Marta Tavernaro
- ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino 13, 20141 Milan, Italy
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino 13, 20141 Milan, Italy
| | - Sabrina Donzelli
- ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino 13, 20141 Milan, Italy
| | - Stefano Negrini
- University of Brescia, Brescia, Italy ; IRCCS Don Gnocchi, Milan, Italy
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De Korvin G, Randriaminahisoa T, Cugy E, Cheze L, de Sèze M. Detection of progressive idiopathic scoliosis during growth using back surface topography: A prospective study of 100 patients. Ann Phys Rehabil Med 2014; 57:629-39. [DOI: 10.1016/j.rehab.2014.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/03/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
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Catanzariti JF, Agnani O, Guyot MA, Wlodyka-Demaille S, Khenioui H, Donze C. Does adolescent idiopathic scoliosis relate to vestibular disorders? A systematic review. Ann Phys Rehabil Med 2014; 57:465-79. [DOI: 10.1016/j.rehab.2014.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/18/2014] [Accepted: 04/19/2014] [Indexed: 10/25/2022]
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Inter-observer reproducibility of back surface topography parameters allowing assessment of scoliotic thoracic gibbosity and comparison with two standard postures. Ann Phys Rehabil Med 2013; 56:599-612. [DOI: 10.1016/j.rehab.2013.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 10/11/2013] [Accepted: 10/14/2013] [Indexed: 11/17/2022]
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Identification of the relationships between sagittal plane and coronal plane curvature in guppy models. Int J Surg 2013; 12:41-4. [PMID: 24215817 DOI: 10.1016/j.ijsu.2013.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 10/11/2013] [Accepted: 10/31/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To explore the relationship between sagittal plane and coronal plane curvatures in guppies by investigating the curvature angles of sagittal and sagittal-coronal guppies. METHODS After mating between 1000 spinal curvature guppies, 124 guppies (3-month old) were screened from progenies for the present study. Photos of all fishes were taken and the sagittal and coronal angles were calculated via angle measure tool of Photoshop 12.0 software. All data were analyzed by SPSS 11.0. RESULTS In sagittal and sagittal-coronal curvature guppies, there was a significant linear correlation between sagittal angles and coronal angles. In 48 sagittal-coronal curvatures, their sagittal angles were above 40°, meanwhile, in 76 sagittal guppies, their sagittal angles were mostly below 40°. CONCLUSIONS These findings indicated that the occurrence of coronal curvature might be later than sagittal curvature and could be influenced by other factors. Sagittal angles 40° might be involved in the onset of coronal curvature.
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Clutton RE, Vettoratto E, Schoeffman G, Docherty J, Burke J, Gibson AJN. The perioperative care of lambs and ewes when the former undergo major experimental (scoliotic) surgery. Lab Anim 2013; 48:27-35. [PMID: 23940124 DOI: 10.1177/0023677213498718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of the study was to optimize postoperative comfort in lambs anaesthetized for the surgical creation of scoliosis while maintaining the ewe-lamb relationship to miminize rejection rates. The first management plan produced six scoliotic lambs but intraoperative hypoventilation and hypovolaemia followed by postoperative dyspnoea, pain, monitoring and nursing difficulties, hypothermia, hypoglycaemia and tympany were encountered. Three of eight lambs (38%) were rejected by their ewes. Perioperative management was amended which, combined with improved surgical technique, produced 16 scoliotic lambs. The lambs recovered more rapidly (mean time to standing after discontinuation of anaesthesia was reduced from 12 h to 70 min) and appeared to be more comfortable. No rejections occurred after the refinements were implemented.
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Affiliation(s)
- R Eddie Clutton
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush Veterinary Centre, Midlothian, UK
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Destieux C, Gaudreault N, Isner-Horobeti ME, Vautravers P. Use of Postural Reconstruction® physiotherapy to treat an adolescent with asymmetric bilateral genu varum and idiopathic scoliosis. Ann Phys Rehabil Med 2013; 56:312-26. [PMID: 23541175 DOI: 10.1016/j.rehab.2013.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 02/21/2013] [Accepted: 02/26/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To document the effect of Postural Reconstruction® physiotherapy on two postural disorders commonly observed in adolescents: genu varum and idiopathic scoliosis. PATIENT AND METHODS A case report on a 16-year-old boy suffering from knee pain and presenting with bilateral genu varum and mild scoliosis. At the initial evaluation (T0), the intercondylar space was 7 cm and the Cobb angles for the right lumbar curve and left thoracic curve were 18° and 13°, respectively. The boy was treated with Postural Reconstruction(®), a neuromuscular physiotherapy intervention using facilitation/inhibition techniques. The outcomes used to quantify the effect of 6 months (T1), 12 months (T2) and 26 months (T3) of treatment were pain levels, the intercondylar space, the lumbar gibbosity and the lumbar and thoracic Cobb angles. RESULTS The knee pain disappeared rapidly. At T3, the intercondylar space had decreased by 4 cm, the lumbar gibbosity angle had decreased by 2° and the lumbar and thoracic Cobb angles had decreased by 8° and 7°, respectively. CONCLUSION This non-invasive physiotherapy intervention appears to have considerable promise for the long-term correction of postural disorders.
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Affiliation(s)
- C Destieux
- École de réadaptation, faculté de médecine et des sciences de la santé, université de Sherbrooke, 3001, 12e, avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada
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Burwell RG, Dangerfield PH, Moulton A, Grivas TB, Cheng JC. Whither the etiopathogenesis (and scoliogeny) of adolescent idiopathic scoliosis? Incorporating presentations on scoliogeny at the 2012 IRSSD and SRS meetings. SCOLIOSIS 2013; 8:4. [PMID: 23448588 PMCID: PMC3608974 DOI: 10.1186/1748-7161-8-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/09/2013] [Indexed: 01/01/2023]
Abstract
This paper aims to integrate into current understanding of AIS causation, etiopathogenetic information presented at two Meetings during 2012 namely, the International Research Society of Spinal Deformities (IRSSD) and the Scoliosis Research Society (SRS). The ultimate hope is to prevent the occurrence or progression of the spinal deformity of AIS with non-invasive treatment, possibly medical. This might be attained by personalised polymechanistic preventive therapy targeting the appropriate etiology and/or etiopathogenetic pathways, to avoid fusion and maintain spinal mobility. Although considerable progress had been made in the past two decades in understanding the etiopathogenesis of adolescent idiopathic scoliosis (AIS), it still lacks an agreed theory of etiopathogenesis. One problem may be that AIS results not from one cause, but several that interact with various genetic predisposing factors. There is a view there are two other pathogenic processes for idiopathic scoliosis namely, initiating (or inducing), and those that cause curve progression. Twin studies and observations of family aggregation have revealed significant genetic contributions to idiopathic scoliosis, that place AIS among other common disease or complex traits with a high heritability interpreted by the genetic variant hypothesis of disease. We summarize etiopathogenetic knowledge of AIS as theories of pathogenesis including recent multiple concepts, and blood tests for AIS based on predictive biomarkers and genetic variants that signify disease risk. There is increasing evidence for the possibility of an underlying neurological disorder for AIS, research which holds promise. Like brain research, most AIS workers focus on their own corner and there is a need for greater integration of research effort. Epigenetics, a relatively recent field, evaluates factors concerned with gene expression in relation to environment, disease, normal development and aging, with a complex regulation across the genome during the first decade of life. Research on the role of environmental factors, epigenetics and chronic non-communicable diseases (NCDs) including adiposity, after a slow start, has exploded in the last decade. Not so for AIS research and the environment where, except for monozygotic twin studies, there are only sporadic reports to suggest that environmental factors are at work in etiology. Here, we examine epigenetic concepts as they may relate to human development, normal life history phases and AIS pathogenesis. Although AIS is not regarded as an NCD, like them, it is associated with whole organism metabolic phenomena, including lower body mass index, lower circulating leptin levels and other systemic disorders. Some epigenetic research applied to Silver-Russell syndrome and adiposity is examined, from which suggestions are made for consideration of AIS epigenetic research, cross-sectional and longitudinal. The word scoliogeny is suggested to include etiology, pathogenesis and pathomechanism.
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Affiliation(s)
- R Geoffrey Burwell
- Centre for Spinal Studies and Surgery, Nottingham University Hospitals Trust, Queen's Medical Centre Campus, Derby Road, Nottingham, NG7 2UH, UK.
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Desbiens-Blais F, Clin J, Parent S, Labelle H, Aubin CE. New brace design combining CAD/CAM and biomechanical simulation for the treatment of adolescent idiopathic scoliosis. Clin Biomech (Bristol, Avon) 2012; 27:999-1005. [PMID: 22989479 DOI: 10.1016/j.clinbiomech.2012.08.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 08/15/2012] [Accepted: 08/16/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND A numerical based brace design platform, including biomechanical simulation, Computer Aided Design and Computer Aided Manufacturing (CAD/CAM) was developed to rationalize braces for the treatment of adolescent idiopathic scoliosis. The objective of this study was to test the feasibility of the approach and assess the effectiveness of braces issued from this platform as compared to standard brace design. METHODS The biomechanical finite element model was built using the 3D reconstruction of the trunk skeleton from bi-planar radiographs and of the torso surface from surface topography. The finite element model is linked to a CAD/CAM software (Rodin4D), allowing the iterative design and simulation of the correction provided by the brace, as well as predicting pressures exerted on the torso. The resulting brace design was then fabricated using a numerical controlled carver. A brace designed using this platform (New Brace) as well as a standard thoraco-lumbo-sacral orthosis (Standard Brace) were built for six scoliotic patients. Both brace effectiveness was assessed using radiographs and compared to the simulations. FINDINGS The New Brace corrected on average the spine deformities within 5° of Cobb angle of the simulated correction and with a similar correction as compared to the Standard Brace (average correction of 16° vs. 11° (MT); P=0.1 and 13° vs. 16° (TL/L); P=0.5 for the Standard Brace and the New Brace respectively). The two braces had a similar 10° lordosing effect of the thoracic curve. The coronal balance was quite similar (7.3 vs. 6.8mm balance improvement respectively for New Brace vs. Standard Brace). INTERPRETATION These first clinical results showed the feasibility of building computer-assisted braces, equivalent to standard orthosis. An extended study on more cases is under way to fully assess this new design paradigm, which in the long term would allow improving brace design and rationalize the conservative treatments of scoliosis.
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Affiliation(s)
- Frederique Desbiens-Blais
- Ecole Polytechnique de Montréal, Department of Mechanical Engineering, PO Box 6079, Station Centre-ville, Montreal (Quebec), Canada H3C 3A7
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