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Ng PTT, Tucker K, Zahir SF, Izatt MT, Straker L, Claus A. Comparison of physiological and behavioral nutrition-related factors in people with and without adolescent idiopathic scoliosis, from cohort data at 8 to 20 years. JBMR Plus 2024; 8:ziad013. [PMID: 38505221 PMCID: PMC10945716 DOI: 10.1093/jbmrpl/ziad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/16/2023] [Accepted: 11/29/2023] [Indexed: 03/21/2024] Open
Abstract
Nutrition-related variables including lower body mass index (BMI), lower bone mineral density (BMD), altered body composition and hormone levels have been reported in adolescent idiopathic scoliosis (AIS). The aims of this study were to determine if physiological and behavioral nutrition-related factors differ between people with and without AIS, and to quantify their relationship with AIS, in unbiased cohort sample. BMI, presence of an eating disorder, leptin, adiponectin, BMD, vitamin D, lean mass, and fat mass were compared between those with and without AIS at ages 8, 10, 14, 17, and 20 years, and multiple logistic regression was performed between these variables and AIS. Lower total body BMD (median, 1.0 g/cm2 vs 1.1 g/cm2; p = .03) and lean mass (median, 38.8 kg vs 46.0 kg; p = .04) at age 20 years were observed in those with AIS compared to those without scoliosis. At age 20, the odds of AIS were 3.23 times higher for adolescents with an eating disorder compared to those with no eating disorder (95% CI, 1.02-8.63) when adjusted for BMI. Every 1 kg/m2 increase in BMI decreased the odds of AIS by 0.88 times (95% CI, 0.76-0.98), after adjusting for eating disorder diagnosis. In conclusion, lower BMI in mid-adolescence and presence of eating disorder outcomes, lower BMD, and lower lean mass in late adolescence were associated with the presence of AIS. Current data do not explain the mechanisms for these associations but suggest that serum leptin, adiponectin, and vitamin D are unlikely to be contributing factors. Conclusive determination of the prevalence of eating disorders in AIS will require further studies with larger sample sizes.
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Affiliation(s)
- Phoebe T T Ng
- The University of Queensland, Laboratory for Motor Control and Pain Research, School of Biomedical Sciences, St. Lucia, 4072, QLD, Australia
- KK Women’s and Children’s Hospital, Physiotherapy Department, 229899, Singapore
| | - Kylie Tucker
- The University of Queensland, Laboratory for Motor Control and Pain Research, School of Biomedical Sciences, St. Lucia, 4072, QLD, Australia
| | - Syeda Farah Zahir
- The University of Queensland, Centre for Health Services Research, Faculty of Medicine, Woolloongabba, 4102, QLD, Australia
| | - Maree T Izatt
- Queensland University of Technology at the Centre for Children’s Health Research, Biomechanics and Spine Research Group, South Brisbane, 4101, QLD, Australia
| | - Leon Straker
- Curtin University, School of Allied Health, Perth, 6102, WA, Australia
| | - Andrew Claus
- The University of Queensland, School of Health and Rehabilitation Sciences, St. Lucia, 4072, QLD, Australia
- Royal Brisbane and Women’s Hospital, Tess Cramond Pain and Research Centre, Herston, 4029, QLD, Australia
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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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Bimali I, Pudasaini S. Hyperkyphosis among the Elderly in a Community: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:710-713. [PMID: 36705225 PMCID: PMC9446495 DOI: 10.31729/jnma.7351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/27/2022] [Indexed: 01/31/2023] Open
Abstract
Introduction Aging brings progressive changes in the physiology of the musculoskeletal system that leads to postural changes and degenerative diseases in elderly. The most common postural change is hyperkyphosis which decreases physical performance, ability to perform daily activities, overall quality of life, and increases the risk of falls in elderly. The aim of the study was to find out the prevalence of hyperkyphosis among the elderly in a community. Methods A descriptive cross-sectional study was done in a local community from 26 May 2019 to 8 June 2019 after obtaining ethical approval from the Institutional Review Committee (Protocol approval number: 138/19). Participants above 60 years of age were included in the study. Convenience sampling was done. A bubble inclinometer was used to measure the degree of kyphosis. Point estimate and 95% Confidence Interval were calculated. Results Among 144 elderly participants, hyperkyphosis was present in 90 (62.50%) (54.59-70.41, 95% Confidence Interval) with the mean hyperkyphosis being 47.07±4.83˚. The elderly in the age group of 70-75 years had a higher degree of hyperkyphosis with a mean value of 47.77±4.92˚. The mean hyperkyphosis was 48.18±5.30˚ and 45.31±3.36˚ in female and male participants respectively. Conclusions The prevalence of hyperkyphosis was found to be higher in our study compared to other studies conducted in similar settings. Early identification and interventions of hyperkyphosis are thus warranted to prevent the detrimental consequences in the later stages of life. Keywords aging; hyperkyphosis; posture.
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Affiliation(s)
- Inosha Bimali
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Sikha Pudasaini
- Department of Physiotherapy, Norvic International Hospital, Thapathali, Kathmandu, Nepal,Correspondence: Ms Sikha Pudasaini, Department of Physiotherapy, Norvic International Hospital, Thapathali, Kathmandu, Nepal. , Phone: +977-9845034903
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Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE We designed this study to investigate the risk for spinal deformity among individuals whose parents had a spinal deformity. SUMMARY OF BACKGROUND DATA Adolescent idiopathic scoliosis and Scheuermann kyphosis (SK) are common adolescent spinal deformities (ASD) with a significant impact on public health. Timely treatment with bracing is effective in halting or slowing the progression of these deformities. However, screening healthy adolescents for spinal deformities remains debatable. While the leading medical organizations endorse contradictory positions regarding the screening of the general population, there is a consensus that screening of targeted population should be considered. Due to their genetic predisposition, adolescents whose parents suffer from a spinal deformity may be candidates for targeted screening. METHODS We conducted a nationwide, population-based study of 611,689 Israeli adolescents, aged 16 to 19 years old, who were screened for spinal deformities between the years 2000 and 2019. The data for this study were derived from a central database containing medical records of all adolescents who were examined preliminary to mandatory military service. In our study, ASD were strictly defined by plain x-ray. RESULTS Compared with adolescents of whose parents did not have a spinal deformity, the odds ratios (OR) for ASD among adolescents whose father, mother, or both parents had spinal deformity were 1.46, 1.74, and 2.58, respectively. These ratios were consistent in multivariate models. CONCLUSION We have found a considerable increased risk for adolescent spinal deformities among adolescents whose parents suffered from spinal deformities. We believe that our findings should serve the leading medical organizations when considering the screening of targeted populations. LEVEL OF EVIDENCE 4.
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Lam WK, Chen B, Liu RT, Cheung JCW, Wong DWC. Spine Posture, Mobility, and Stability of Top Mobile Esports Athletes: A Case Series. BIOLOGY 2022; 11:biology11050737. [PMID: 35625465 PMCID: PMC9138953 DOI: 10.3390/biology11050737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022]
Abstract
Professional esports athletes spend a long time in the same sitting posture during training and competition. Mobile esports may exacerbate potential postural problems because of the closer and unsupported arms and because athletes spend more time in a forward-/flexed-head posture. Prolonged sitting in these postures carries significant health risks and may lead to musculoskeletal problems and injuries. The objective of this retrospective study is to assess the posture, mobility, and stability of the spine for professional mobile esports athletes. We collected spine-assessment data from 48 athletes participating in a top-tier league on a real-time-strategy battle-arena online game. The spinal assessment was conducted using the SpinalMouse® under upright standing and trunk flexion in addition to the Matthiass test. Measurements were converted into Idiag Scores by the SpinalMouse® software. The Idiag Posture, Idiag Mobility, and Idiag Stability scores were 62.50 (IQR: 21), 63.50 (IQR: 19.5), and 54.50 (IQR: 14.5), respectively, and were significantly lower (p < 0.001) than the reference normative value (100). Age was found to have a weak positive correlation with the posture score (ρ = 0.29, p = 0.048). Although career duration appeared to lower the scores, the association was insignificant (p > 0.05). The scores also had no significant association with body height, body mass, body mass index, and esports team (p > 0.05). It was anticipated that mobile-based esports would attenuate the biomechanics of the spine and increase the likelihood of musculoskeletal problems, such as neck and back pain.
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Affiliation(s)
- Wing-Kai Lam
- Sports Information and External Affairs Centre, Hong Kong Sports Institute, Hong Kong 999077, China;
| | - Bob Chen
- Dr Chen Sport Training and Rehabilitation Research Center, Beijing 101111, China;
- Correspondence: (B.C.); (D.W.-C.W.); Tel.: +86-137-0106-6063 (B.C.); +852-2766-7669 (D.W.-C.W.)
| | - Rui-Tan Liu
- Dr Chen Sport Training and Rehabilitation Research Center, Beijing 101111, China;
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
- Correspondence: (B.C.); (D.W.-C.W.); Tel.: +86-137-0106-6063 (B.C.); +852-2766-7669 (D.W.-C.W.)
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Mishreky A, Parent S, Miyanji F, Smit K, Murphy J, Bowker R, Al Khatib N, El-Hawary R. Body mass index affects outcomes after vertebral body tethering surgery. Spine Deform 2022; 10:563-571. [PMID: 35013996 DOI: 10.1007/s43390-021-00455-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the outcomes of anterior Vertebral Body Tethering (AVBT) surgery between overweight and non-overweight patients. METHODS AIS/JIS patients with AVBT with 2-year follow-up from a multi-center pediatric spine database were evaluated pre-operatively, 1st post-operative erect, and 2 years post-operatively. ANOVA was used to compare 3 categories of BMI with significance as per Tukey-Kramer HSD post hoc test. Risk of scoliosis progression was analysed with Mid-P exact test. RESULTS 121 patients (51 underweight, 58 normal, 12 overweight; mean age 12.5 ± 1.6 yr; BMI 18.8 ± 4.6 kg/m2) were identified. Comparing underweight, normal, and overweight groups: mean pre-operative age (13 yr, 13 yr, 12 yr), scoliosis (52°, 50°, 52°), pre-operative kyphosis (29°, 28°, 33°), peri-operative scoliosis correction (44%, 42%, 46%), and complications by 2-year follow-up (23%, 24%, 17%) were similar between groups. There was one broken tether in each of the underweight and normal weight groups. Change in percent scoliosis correction from 1st erect to 2-year post-operative (i.e., growth modulation phase) was not significantly different between groups; however, the risk ratio for scoliosis progression during this period was 4.74 (1.02-22.02; p = 0.04) for overweight patients. CONCLUSION Our findings demonstrate that, as compared to normal weight and underweight patients, overweight patients did not have a statistically significant difference in intra-operative scoliosis correction or in risk of experiencing complication; however, overweight patients had a risk ratio of 4.74 for progression of scoliosis during the growth modulation phase of treatment from first erect radiographs to minimum 2-year follow-up. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Amir Mishreky
- Division of Orthopaedic Surgery, Department of Surgery, IWK Health Center, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K-6R8, Canada
| | - Stefan Parent
- Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada
| | - Firoz Miyanji
- British Columbia Children's Hospital, 4480 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Kevin Smit
- Children's Hospital of Eastern Ottawa, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Joshua Murphy
- Department of Pediatric Orthopaedic Surgery, Children's Healthcare of Atlanta, 5445 Meridian Mark Road, Suite 250, Halifax, Nova Scotia, Canada
| | - Riley Bowker
- Division of Orthopaedic Surgery, Department of Surgery, IWK Health Center, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K-6R8, Canada
| | - Nedal Al Khatib
- Division of Orthopaedic Surgery, Department of Surgery, IWK Health Center, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K-6R8, Canada
| | - Ron El-Hawary
- Division of Orthopaedic Surgery, Department of Surgery, IWK Health Center, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K-6R8, Canada.
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Bondar K, Nguyen A, Vatani J, Kessler J. The Demographics and Epidemiology of Infantile, Juvenile, and Adolescent Idiopathic Scoliosis in a Southern California Integrated Health Care System. Spine (Phila Pa 1976) 2021; 46:1468-1477. [PMID: 33813584 DOI: 10.1097/brs.0000000000004046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prognostic study, Level III. OBJECTIVES The aim of this study was to determine the incidence and demographics of idiopathic scoliosis (IS) in a large cohort of children in a Southern California integrated healthcare system, and to identify the demographic or clinical factors associated with the greatest risk of IS. SUMMARY OF BACKGROUND DATA Although many authors have reported on the incidence and prevalence of IS in children, there have been few incidence studies in the United States on large, self-contained populations. METHODS A retrospective chart analysis was done on diagnosed cases of IS within our integrated health care system in patients under age 18 years during the entire 2013 calendar year. Patient demographics were recorded and the incidence of IS was determined. Odds ratios (ORs) for having IS and for having more severe initial curve magnitudes based on demographics were determined using logistic regression models. RESULTS IS Incidence was 3.9, 28.6, and 393 per 100,000, respectively, for the infantile, juvenile, and adolescent group. The female incidence was more than twice that of males in all age groups. Multivariate logistic regression analysis showed Asians and non-Hispanic Whites had the highest OR of IS (OR 1.54 and 1.32 with 95% confidence interval [CI] 1.33-1.79 and 1.19-1.47). Whites, Blacks, and mixed-race patients had a significantly higher initial curve magnitude than Hispanics; females also had a significantly greater initial curve magnitude than boys (18.1° vs. 16.7°). Underweight patients had a 50% increased OR of IS versus normal weight (95% CI 1.16-1.94) with a progressively decreased OR of IS as weight increased. CONCLUSION Our study of a large integrated healthcare system sheds light on the incidence of IS and the ORs based on weight, sex, and ethnicity/race. The overall incidence was lower overall than previously thought.Level of Evidence: 3.
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Affiliation(s)
- Kevin Bondar
- Department of Education, The University of Miami Leonard M. Miller School of Medicine, Miami, FL
| | - Annie Nguyen
- University of California, Irvine, School of Medicine, Irvine, CA
| | - Jasmine Vatani
- University of Virginia School of Medicine, Charlottesville, VA
| | - Jeffrey Kessler
- Kaiser Los Angeles Medical Center Department of Orthopedics, Los Angeles, CA
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Molina-Garcia P, Miranda-Aparicio D, Ubago-Guisado E, Alvarez-Bueno C, Vanrenterghem J, Ortega FB. The Impact of Childhood Obesity on Joint Alignment: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6134724. [PMID: 33580953 DOI: 10.1093/ptj/pzab066] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/08/2020] [Accepted: 12/31/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE It has been suggested that overweight/obesity (OW/OB) impairs the normal alignment of children and adolescents' musculoskeletal system. However, to date, no study has systematically reviewed or quantified the effect of OW/OB on the development of joint malalignments in children and adolescents. The purpose of this study was to systematically review the association between OW/OB and joint alignment in children and adolescents and to quantify the evidence on whether children and adolescents with OW/OB have a higher risk of developing joint malalignments than their peers of normal weight. METHODS PubMed and Web of Science databases were systematically searched from inception to March 9, 2020. Studies investigating the association between OW/OB and joint alignment in children and adolescents were selected. Nonoriginal articles, participants with movement pattern diseases, and adolescents studied while pregnant were excluded. Two independent reviewers conducted the study selection and data extraction. Qualitative synthesis of evidence and random effect meta-analyses (risk ratio [RR]) were performed. RESULTS Seventy-three studies (5 longitudinal and 68 cross-sectional) met the inclusion criteria involving 1,757,107 children and adolescents. There was consistent evidence supporting associations of OW/OB with rounded shoulder, lumbar hyperlordosis, genu valgum, and flatfoot. Our meta-analysis showed that children and adolescents with OW/OB had a significantly higher risk of lumbar hyperlordosis (RR = 1.41), genu valgum (RR = 5.92), flatfoot (RR = 1.49), and any joint malalignment (RR = 1.68) when compared with their peers of normal weight. The presence of genu valgum and flatfoot were the most robust results. CONCLUSION Based on these findings, OW/OB is associated with the presence of joint malalignments in children and adolescents. IMPACT This is the first study that has systematically reviewed the effect of OW/OB on the development of joint malalignments in children and adolescents.
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Affiliation(s)
- Pablo Molina-Garcia
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Belgium
| | - Damian Miranda-Aparicio
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Esther Ubago-Guisado
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Celia Alvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Jos Vanrenterghem
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Belgium
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Department of Biosciences and Nutrition, Karolinska Institute, Sweden
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Comparison of a dual-surgeon versus single-surgeon approach for scoliosis surgery: a systematic review and meta-analysis. 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 2021; 30:740-748. [PMID: 33439334 DOI: 10.1007/s00586-021-06717-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 12/09/2020] [Accepted: 01/01/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Corrective surgery for scoliosis is a complex and challenging prospect for experienced spine surgeons due to the prolonged duration of surgery and the significant level of technical skill and expertise required. Traditionally, shorter operative time and lower blood loss have correlated well with improved outcomes and as such, efforts have been made to affect these metrics including the use of two attending surgeons for major cases in preference to one. This systematic review and meta-analysis assessed the available literature to further clarify the potential benefit that adopting a dual-surgeon approach offers over single-surgeon operations. METHODS A systematic review and meta-analysis assessed the effect of dual-surgeon operating compared to single-surgeon with respect to a number of indicators including blood loss, operative duration and length of hospital stay. In addition, we evaluated whether blood transfusion or complication rates differed between the two groups. RESULT Seven studies met our inclusion criteria. Mean difference indicated shorter duration of surgery (- 90.5 min, 95% CI [- 103.3, - 77.6]) and a lower blood loss (- 379.1, 95% CI [- 572.2, - 230.9]) in the dual-surgeon group compared to the single-surgeon group. Six studies reported mean length of stay and also favoured the dual-surgeon group. CONCLUSION This review observed that there are no randomised control trials evaluating dual-surgeon versus single-surgeon operating for scoliosis. We provide aggregated data and analysis of available literature, suggesting that outcomes in complex scoliosis surgery may be improved by adopting a dual-surgeon approach. LEVEL OF EVIDENCE III.
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Yan NG S, NG YL, Cheng KP, Chan WY, Ho TK. Intervention versus Observation in Mild Idiopathic Scoliosis in Skeletally Immature Patients. Open Orthop J 2020. [DOI: 10.2174/1874325002014010186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Introduction:
Observation is the treatment of choice for idiopathic scoliosis with Cobb angles between 15 degrees - 20 degrees in growing children. This passive approach does not address the anxiety of the patient and the stress of the parents. In this paper, we attempt to identify skeletally immature patients with mild scoliosis curvatures that are more at risk of progression and propose possible intervention for this group of subjects.
Methods:
The literature was searched in Pubmed, and additional references were searched manually in the literature.
Results:
Many studies have shown that low serum 25[OH]D level, bone mineral density (BMD), and body mass index (BMI) are related to the curve severity or progression of the curve.
We suggest that skeletally immature patients (< Risser 2) with mild curves be divided into two groups, viz. Group O (observation) with a lower risk of progression, and Group I (intervention) with a higher risk of curvature progression. We propose early intervention for the latter group.
It is suggested that pre-menarcheal, skeletally immature patients with mild idiopathic scoliosis, and low vitamin D, BMD, and BMI should be treated. Also, asymmetric foot biomechanics should be addressed, although nutrition and foot orthoses are regarded to have no role in the management of idiopathic scoliosis. The outcome of early intervention may be utterly different from late treatment when the curvature becomes more structural, and the patient more skeletally mature.
Conclusion:
Research is required to prove if the intervention is clinically indicated.
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Abstract
Etiology of adolescent idiopathic scoliosis (AIS), a complicated three-dimensional spinal deformity with early-onset, receives continuous attention but remains unclear. To gain an insight into AIS pathogenesis, this review searched PubMed database up to June 2019, using key words or medical subject headings terms including "adolescent idiopathic scoliosis," "scoliosis," "pathogenesis," "etiology," "genetics," "mesenchymal stem cells," and their combinations, summarized existing literatures and categorized the theories or hypothesis into nine aspects. These aspects include bone marrow mesenchymal stem cell studies, genetic studies, tissue analysis, spine biomechanics measurements, neurologic analysis, hormone studies, biochemical analysis, environmental factor analysis, and lifestyle explorations. These categories could be a guidance for further etiology or treatment researches to gain inspiration.
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Normand E, Franco A, Marcil V. Nutrition and physical activity level of adolescents with idiopathic scoliosis: a narrative review. Spine J 2020; 20:785-799. [PMID: 31783126 DOI: 10.1016/j.spinee.2019.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 02/03/2023]
Abstract
Some studies have shown that patients with adolescent idiopathic scoliosis (AIS) have different anthropometric features compared with their peers such as taller stature, lower body mass index, and bone mineral density. Yet the causes explaining these differences remain uncertain. Nutritional intake and status, combined with physical activity, could explain these discrepancies. We aimed to review the current literature on energy and nutrient intake, on nutritional status and physical activity in relation to AIS and to discuss study methodologies and propose avenues for future studies. Studies describing energy or nutrient intake in AIS mostly focused on total energy and calcium and found no difference between AIS and control cohorts. Regarding nutritional status, it was found that AIS patients have lower vitamin D levels than controls and that most patients have insufficient or deficient vitamin D serum levels. Lower concentration of parathyroid hormones and calcitonin were also found in AIS compared to controls as well as anomalies in trace elements. In the studies that have assessed physical activity, three found that AIS girls were less active than controls, but four did not observe differences between groups. In this review, we highlight that nutrition and physical activity are important topics in AIS that require further research as they could help understand anthropometric discrepancies and disease etiology.
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Affiliation(s)
- Emilie Normand
- Research Center of the Sainte-Justine University Hospital, Montreal, Quebec, Canada H3T 1C5; Department of Nutrition, Faculty of Medicine, Université de Montreal, Montreal, Quebec, Canada H3T 1J4
| | - Anita Franco
- Research Center of the Sainte-Justine University Hospital, Montreal, Quebec, Canada H3T 1C5; Viscogliosi Laboratory in Molecular Genetics of Musculoskeletal Diseases, Research Center of the Sainte-Justine University Hospital, 3175 Côte Ste-Catherine room 4.17.006, Montreal, Quebec, Canada H3T 1C5
| | - Valérie Marcil
- Research Center of the Sainte-Justine University Hospital, Montreal, Quebec, Canada H3T 1C5; Department of Nutrition, Faculty of Medicine, Université de Montreal, Montreal, Quebec, Canada H3T 1J4.
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The Influence of Body Habitus on Documented Brace Wear and Progression in Adolescents With Idiopathic Scoliosis. J Pediatr Orthop 2020; 40:e171-e175. [PMID: 31259783 DOI: 10.1097/bpo.0000000000001420] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although studies have been published stating obese patients are less compliant with brace use, no objective studies measuring hours of daily brace wear have been performed to correlate brace wear and success with body mass index (BMI). The purpose of this study was to establish the relationship between BMI and brace compliance, and between BMI and progression to surgical magnitude of 50 degrees or more. METHODS A total of 175 adolescents were prescribed thoracolumbarsacral orthosis for the treatment of an adolescent idiopathic scoliosis and followed to completion of treatment. BMI was measured at brace prescription, and divided into: (1) underweight (< 5th percentile), (2) normal (>5th, <85%), (3) overweight (>85%, <95%), and (4) Obese (>95%). Thermochron sensors were used to measure compliance. Radiographs were measured at brace prescription, and at time of brace discontinuation or surgery. Outcome was classified as successful if curve magnitude was <50 degrees and no surgery was performed. RESULTS The underweight group wore their braces more hours than the other groups (15.7 h low, 12.5 h normal, 11.7 h high, and 9.0 h obese BMI (low vs. normal P=0.031, low vs. high P=0.01, low vs. obese P=0.01). The underweight group had the highest rate of surgical progression (60%), compared with 27.7% of normal BMI teens, 28.6% of overweight patients, and 55.6% of obese patients. The low BMI had a significantly higher rate of surgery than the normal BMI group (P=0.01). CONCLUSIONS Although overweight and obese patients wear orthoses the least hours daily, the highest surgical risk is in underweight adolescents despite good compliance. LEVEL OF EVIDENCE Level 2.
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Low Body Mass Index for Early Screening of Adolescent Idiopathic Scoliosis: A Comparison Based on Standardized Body Mass Index Classifications. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:24-29. [DOI: 10.1016/j.anr.2019.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/25/2019] [Accepted: 12/26/2019] [Indexed: 01/25/2023] Open
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15
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Faulty posture: Prevalence and its relationship with Body Mass Index and Physical Activity among female adolescents. BIOMEDICAL HUMAN KINETICS 2020. [DOI: 10.2478/bhk-2020-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Summary
Study aim: The aim of this study was to determine the prevalence of postural disorders and their associated risk factors among high school girls in the city of Tabriz, Iran.
Material and methods: A cross-sectional study was conducted on 400 female students aged 14 to 18 years. Students were examined using a scoliometer, a Debrunner kyphometer, and a flexible ruler, and were directly studied for genu varum/valgum. The information about possible risk factors such as age, BMI, school bag, study time, use of social networks, and physical activity was collected through demographic survey and the International Physical Activity Questionnaire. Data were analyzed by SPSS ver. 22 through independent t-test, chi-square, and logistic regression.
Results: 181 participants (45%) had one or more abnormalities such as scoliosis (4%), kyphosis (5%), genu varum (5.7%), genu valgum (9.7%), hyperlordosis (11.2%), and asymmetrical shoulder (24.5%). The risk of hyperlordosis increased with increase in weight (OR: 1.08, 95%CI: 1.02 to 1.15; p = 0.014) and BMI (OR: 1.37, 95%CI: 1.13 to 1.67; p = 0.002). Moreover, the odds for genu valgum increased with increase in weight (OR: 1.07, 95%CI: 1.01 to 1.13; p = 0.045) and BMI (OR: 1.84, 95%CI: 1.29 to 2.62; p < 0.001); but it decreased with increase in age (OR: 0.62, 95%CI: 0.39 to 0.98; p = 0.039) and not using a study table (OR: 0.31, 95%CI: 0.12 to 0.78; p = 0.013).
Conclusions: Forty-five percent of female students had one or more postural abnormalities. Asymmetrical shoulder was the most common disorder. Weight and BMI were associated with genu valgum and hyperlordosis.
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Bao H, Liu Z, Bao M, Zhu Z, Yan P, Liu S, Feng Z, Qian B, Qiu Y. Predicted final spinal height in patients with adolescent idiopathic scoliosis can be achieved by surgery regardless of maturity status. Bone Joint J 2018; 100-B:1372-1376. [PMID: 30295519 DOI: 10.1302/0301-620x.100b10.bjj-2017-1540.r2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to investigate the impact of maturity status at the time of surgery on final spinal height in patients with an adolescent idiopathic scoliosis (AIS) using the spine-pelvic index (SPI). The SPI is a self-control ratio that is independent of age and maturity status. PATIENTS AND METHODS The study recruited 152 female patients with a Lenke 1 AIS. The additional inclusion criteria were a thoracic Cobb angle between 45° and 70°, Risser 0 to 1 or 3 to 4 at the time of surgery, and follow-up until 18 years of age or Risser stage 5. The patients were stratified into four groups: Risser 0 to 1 and selective fusion surgery (Group 1), Risser 0 to 1 and non-selective fusion (Group 2), Risser 3 to 4 and selective fusion surgery (Group 3), and Risser 3 to 4 and non-selective fusion (Group 4). The height of spine at follow-up (HOSf) and height of pelvis at follow-up (HOPf) were measured and the predicted HOS (pHOS) was calculated as 2.22 (SPI) × HOPf. One-way analysis of variance (ANOVA) was performed for statistical analysis. RESULTS Of the 152 patients, there were 32 patients in Group 1, 27 patients in Group 2, 48 patients in Group 3, and 45 patients in Group 4. Significantly greater HOSf was observed in Group 3 compared with Group 1 (p = 0.03) and in Group 4 compared with Group 2 (p = 0.02), with similar HOPf (p = 0.75 and p = 0.83, respectively), suggesting that patients who undergo surgery at Risser grade of 0 to 1 have a shorter spinal height at follow-up than those who have surgery at Risser 4 to 5. HOSf was similar to pHOS in both Group 1 and Group 2 (p = 0.62 and p = 0.45, respectively), indicating that undergoing surgery at Risser 0 to 1 does not necessarily affect final spinal height. CONCLUSION This study shows that fusion surgery at Risser 0 may result in growth restriction unlike fusion surgery at Risser 3 to 4. Despite such growth restriction, AIS patients could reach their predicted or 'normal' spinal height after surgery regardless of baseline maturity status due to the longer baseline spinal length in AIS patients and the remaining growth potential at the non-fusion levels. Cite this article: Bone Joint J 2018;100-B:1372-6.
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Affiliation(s)
- H Bao
- Chief of Orthopedic Department Spine Surgery, Nanjing Drum Town Hospital, Nanjing University Medical School, Nanjing, China
| | - Z Liu
- Chief of Orthopedic Department Spine Surgery, Nanjing Drum Town Hospital, Nanjing University Medical School, Nanjing, China
| | - M Bao
- Geisel School of Medicine, Dartmouth College, New Hampshire, USA
| | - Z Zhu
- Chief of Orthopedic Department Spine Surgery, Nanjing Drum Town Hospital, Nanjing University Medical School, Nanjing, China
| | - P Yan
- Chief of Orthopedic Department Spine Surgery, Nanjing Drum Town Hospital, Nanjing University Medical School, Nanjing, China
| | - S Liu
- Chief of Orthopedic Department Spine Surgery, Nanjing Drum Town Hospital, Nanjing University Medical School, Nanjing, China
| | - Z Feng
- Chief of Orthopedic Department Spine Surgery, Nanjing Drum Town Hospital, Nanjing University Medical School, Nanjing, China
| | - B Qian
- Chief of Orthopedic Department Spine Surgery, Nanjing Drum Town Hospital, Nanjing University Medical School, Nanjing, China
| | - Y Qiu
- Chief of Orthopedic Department Spine Surgery, Nanjing Drum Town Hospital, Nanjing University Medical School, Nanjing, China
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Kou I, Watanabe K, Takahashi Y, Momozawa Y, Khanshour A, Grauers A, Zhou H, Liu G, Fan YH, Takeda K, Ogura Y, Zhou T, Iwasaki Y, Kubo M, Wu Z, Matsumoto M, Einarsdottir E, Kere J, Huang D, Qiu G, Qiu Y, Wise CA, Song YQ, Wu N, Su P, Gerdhem P, Ikegawa S. A multi-ethnic meta-analysis confirms the association of rs6570507 with adolescent idiopathic scoliosis. Sci Rep 2018; 8:11575. [PMID: 30069010 PMCID: PMC6070519 DOI: 10.1038/s41598-018-29011-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 06/29/2018] [Indexed: 01/04/2023] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is the most common type of spinal deformity and has a significant genetic background. Genome-wide association studies (GWASs) identified several susceptibility loci associated with AIS. Among them is a locus on chromosome 6q24.1 that we identified by a GWAS in a Japanese cohort. The locus is represented by rs6570507 located within GPR126. To ensure the association of rs6570507 with AIS, we conducted a meta-analysis using eight cohorts from East Asia, Northern Europe and USA. The analysis included a total of 6,873 cases and 38,916 controls and yielded significant association (combined P = 2.95 × 10-20; odds ratio = 1.22), providing convincing evidence of the worldwide association between rs6570507 and AIS susceptibility. In silico analyses strongly suggested that GPR126 is a susceptibility gene at this locus.
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Affiliation(s)
- Ikuyo Kou
- Laboratory of Bone and Joint Diseases, RIKEN Center for Integrative Medical Sciences, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Yohei Takahashi
- Laboratory of Bone and Joint Diseases, RIKEN Center for Integrative Medical Sciences, Tokyo, Japan.,Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yukihide Momozawa
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Anas Khanshour
- Sarah M. and Charles E. Seay Center for Musculoskeletal Research, Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Anna Grauers
- Department of Orthopaedics, Sundsvall and Härnösand County Hospital, Sundsvall, Sweden.,Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet, Stockholm, Sweden
| | - Hang Zhou
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Gang Liu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yan-Hui Fan
- Department of Biochemistry, University of Hong Kong, Hong Kong, China
| | - Kazuki Takeda
- Laboratory of Bone and Joint Diseases, RIKEN Center for Integrative Medical Sciences, Tokyo, Japan.,Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoji Ogura
- Laboratory of Bone and Joint Diseases, RIKEN Center for Integrative Medical Sciences, Tokyo, Japan.,Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taifeng Zhou
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yusuke Iwasaki
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Michiaki Kubo
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Zhihong Wu
- Department of Central Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China.,Medical Research Center of Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | | | - Elisabet Einarsdottir
- Folkhälsan Institute of Genetics, and Molecular Neurology Research Program, University of Helsinki, Helsinki, Finland.,Department of Biosciences and Nutrition, , Karolinska Institutet, Huddinge, Sweden
| | - Juha Kere
- Folkhälsan Institute of Genetics, and Molecular Neurology Research Program, University of Helsinki, Helsinki, Finland.,Department of Biosciences and Nutrition, , Karolinska Institutet, Huddinge, Sweden.,Department of Medical and Molecular Genetics, King's College London, Guy's Hospital, London, UK
| | - Dongsheng Huang
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Guixing Qiu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China.,Medical Research Center of Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Yong Qiu
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Carol A Wise
- Sarah M. and Charles E. Seay Center for Musculoskeletal Research, Texas Scottish Rite Hospital for Children, Dallas, Texas, USA.,McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.,Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.,Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - You-Qiang Song
- Department of Biochemistry, University of Hong Kong, Hong Kong, China
| | - Nan Wu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China.,Medical Research Center of Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Peiqiang Su
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Paul Gerdhem
- Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet, Stockholm, Sweden.,Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Shiro Ikegawa
- Laboratory of Bone and Joint Diseases, RIKEN Center for Integrative Medical Sciences, Tokyo, Japan.
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Stokes IA. Spinal Deformity in Vitamin D-Deprived Pigs: Why and What Next?: Commentary on an article by Matthew A. Halanski, MD, et al.: "Maternal Diets Deficient in Vitamin D Increase the Risk of Kyphosis in Offspring. A Novel Kyphotic Porcine Model". J Bone Joint Surg Am 2018; 100:e33. [PMID: 29509629 DOI: 10.2106/jbjs.17.01345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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19
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Tarrant RC, Queally JM, Moore DP, Kiely PJ. Prevalence and impact of low body mass index on outcomes in patients with adolescent idiopathic scoliosis: a systematic review. Eur J Clin Nutr 2018; 72:1463-1484. [DOI: 10.1038/s41430-018-0095-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 10/25/2017] [Accepted: 01/05/2018] [Indexed: 01/20/2023]
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20
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Fadzan M, Bettany-Saltikov J. Etiological Theories of Adolescent Idiopathic Scoliosis: Past and Present. Open Orthop J 2017; 11:1466-1489. [PMID: 29399224 PMCID: PMC5759107 DOI: 10.2174/1874325001711011466] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/01/2017] [Accepted: 09/11/2017] [Indexed: 12/11/2022] Open
Abstract
Adolescent idiopathic scoliosis is one of the most common spinal deformities, yet its cause is unknown. Various theories look to biomechanical, neuromuscular, genetic, and environmental origins, yet our understanding of scoliosis etiology is still limited. Determining the cause of a disease is crucial to developing the most effective treatment. Associations made with scoliosis do not necessarily point to causality, and it is difficult to determine whether said associations are primary (playing a role in development) or secondary (develop as a result of scoliosis). Scoliosis is a complex condition with highly variable expression, even among family members, and likely has many causes. These causes could be similar among homogenous groups of AIS patients, or they could be individual. Here, we review the most prevalent theories of scoliosis etiology and recent trends in research.
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Affiliation(s)
- Maja Fadzan
- Scoliosis 3DC, 3 Baldwin Green Common, Suite 204, Woburn, MA 01801, USA
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21
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Zheng Y, Dang Y, Yang Y, Sun N, Wang T, Li H, Zhang L, He C, Wong MS. A Case-Control Study of Body Composition, Prevalence, and Curve Severity of the Patients With Adolescent Idiopathic Scoliosis in the East Part of China. Spine Deform 2017; 5:374-380. [PMID: 29050712 DOI: 10.1016/j.jspd.2017.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 02/09/2017] [Accepted: 04/03/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of the study is to investigate the characteristics of prevalence and curve severity in patients with adolescent idiopathic scoliosis (AIS) and the body composition alterations between the patients with AIS and healthy controls. METHODS Information on the study sample was obtained from a screening database. The AIS cohort was paired with an age- and gender-matched healthy cohort. The stratification of BMI and curve severity was conducted according to the criteria developed by the US Centers for Disease Control and Prevention and the Scoliosis Research Society. The prevalence and curve severity of the patients with AIS were investigated. Multigroup comparison of body composition parameters was conducted according to BMI between the patients with AIS and healthy controls. RESULTS A total of 1,202 patients with AIS and an age- and gender-matched cohort were recruited from local schools. The underweight cases had the highest prevalence of AIS and significantly higher Cobb angle compared with the other three BMI subgroups. Although the patients with AIS had lower body weight, body fat mass, percentage of body fat, and fat-free mass compared with healthy controls, converse results were observed in the underweight cases after stratification according to BMI. CONCLUSION Based on the sporadic body composition of the patients with AIS observed in the current study, it is predictable that the pathophysiological alterations may be different before and after the onset of scoliosis. Well-designed human or animal studies for underweight patients would be helpful to reveal the mechanisms of pathophysiological alterations and better predict the development of AIS.
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Affiliation(s)
- Yu Zheng
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, 999077, China; Center of Rehabilitation Medicine, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China; Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Huanghe Middle Road, Chengdu, 610041, China; Department of Rehabilitation Medicine, Wuxi Rehabilitation Hospital, 100 Beitang Street, Wuxi, 214000, China
| | - Yini Dang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Yang
- Department of Rehabilitation Medicine, Wuxi Rehabilitation Hospital, 100 Beitang Street, Wuxi, 214000, China
| | - Ning Sun
- Department of Rehabilitation Medicine, Wuxi Rehabilitation Hospital, 100 Beitang Street, Wuxi, 214000, China
| | - Tao Wang
- Department of Rehabilitation Medicine, Wuxi Rehabilitation Hospital, 100 Beitang Street, Wuxi, 214000, China
| | - Huabo Li
- Department of Rehabilitation Medicine, Wuxi Rehabilitation Hospital, 100 Beitang Street, Wuxi, 214000, China
| | - Lijie Zhang
- Department of Rehabilitation Medicine, Wuxi Rehabilitation Hospital, 100 Beitang Street, Wuxi, 214000, China
| | - Chengqi He
- Center of Rehabilitation Medicine, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China; Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Huanghe Middle Road, Chengdu, 610041, China
| | - M S Wong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, 999077, China.
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Machluf Y, Tal O, Navon A, Chaiter Y. From Population Databases to Research and Informed Health Decisions and Policy. Front Public Health 2017; 5:230. [PMID: 28983476 PMCID: PMC5613084 DOI: 10.3389/fpubh.2017.00230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/15/2017] [Indexed: 12/21/2022] Open
Abstract
Background In the era of big data, the medical community is inspired to maximize the utilization and processing of the rapidly expanding medical datasets for clinical-related and policy-driven research. This requires a medical database that can be aggregated, interpreted, and integrated at both the individual and population levels. Policymakers seek data as a lever for wise, evidence-based decision-making and information-driven policy. Yet, bridging the gap between data collection, research, and policymaking, is a major challenge. The model To bridge this gap, we propose a four-step model: (A) creating a conjoined task force of all relevant parties to declare a national program to promote collaborations; (B) promoting a national digital records project, or at least a network of synchronized and integrated databases, in an accessible transparent manner; (C) creating an interoperative national research environment to enable the analysis of the organized and integrated data and to generate evidence; and (D) utilizing the evidence to improve decision-making, to support a wisely chosen national policy. For the latter purpose, we also developed a novel multidimensional set of criteria to illuminate insights and estimate the risk for future morbidity based on current medical conditions. Conclusion Used by policymakers, providers of health plans, caregivers, and health organizations, we presume this model will assist transforming evidence generation to support the design of health policy and programs, as well as improved decision-making about health and health care, at all levels: individual, communal, organizational, and national.
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Affiliation(s)
| | - Orna Tal
- The Israeli Center for Emerging Technologies (ICET) in Hospitals and Hospital-Based Health Technology Assessment (HB-HTA), Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Israeli Center for Technology Assessment in Health Care (ICTAHC), The Gertner Institute for Epidemiology and Health Policy, Tel Aviv, Israel
| | - Amir Navon
- The School of Social Sciences and Humanities, Kinneret College, Sea of Galilee, Jordan Valley, Israel
| | - Yoram Chaiter
- The Israeli Center for Emerging Technologies (ICET) in Hospitals and Hospital-Based Health Technology Assessment (HB-HTA), Assaf Harofeh Medical Center, Zerifin, Israel
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23
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The Height-Width-Depth Ratios of the Intervertebral Discs and Vertebral Bodies in Adolescent Idiopathic Scoliosis vs Controls in a Chinese Population. Sci Rep 2017; 7:46448. [PMID: 28418040 PMCID: PMC5394479 DOI: 10.1038/srep46448] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 03/20/2017] [Indexed: 11/10/2022] Open
Abstract
Adolescent idiopathic scoliosis (AIS) patients have been reported to be taller and more slender than normal controls, suggesting less mechanical stiffness of their trunk and spine. For assessment of mechanical stiffness, to our best knowledge this is the first to study height-width-depth relations at the level of the individual vertebra and disc in 3-D and to evaluate its relation with the Cobb angle severity. A unique series of high-resolution pre-operative computed tomographic (CT) scans of a total of 105 Chinese patients with moderate to severe AIS and 11 age-matched non-scoliotic controls were used for this study. It was found that some geometric relations differed between primary thoracic curves, secondary curves and normal controls at the individual affected vertebra and disc level. The scoliotic discs in the primary curves were relatively more slender (taller and thinner) than in secondary curves and as compared to controls. In the lumbar spinal area, the vertebral bodies were more slender in the primary as well as secondary AIS curves as compared to the controls. Therefore, if all material properties remain the same, our finding indicates that scoliotic spines may be mechanically less stiff than normal spines. No significant correlation between any of the measures and Cobb angle severity was found.
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Abstract
BACKGROUND It is our clinical suspicion that children with higher body mass index (BMIs) who are diagnosed with scoliosis tend to have larger curves on presentation. The purpose of this study was to determine the effect of BMI on severity of curve at initial presentation of adolescent idiopathic scoliosis. METHODS This is a retrospective, descriptive cohort study of consecutive patients age 10 or greater referred to a single large tertiary care center with concern for spinal asymmetry. Patients were separated into 3 BMI categories as measured on the presenting visit: normal weight-≥5th and <85th percentile, overweight-≥85th and <95th percentile, and obese-≥95th percentile. In addition to demographic information, data collected included BMI, curve magnitude, curve location, Risser stage, and where or by whom spinal asymmetry was noted. RESULTS A total of 150 patients, 50 in each the normal weight, overweight, and obese categories, were included in this study. Average curve at presentation for normal weight patients was 18.1 degrees, for overweight patients 23.9 degrees (P=0.02), and for obese patients 24.5 degrees (P=0.02). As compared with the normal weight group, odds ratio of presenting with a curve of 40 degrees or above was 10.8 for the overweight group (95% confidence interval, 1.3-88.5, P=0.03) and 12.2 for the obese group (95% confidence interval, 1.5-99.8, P=0.02). Assuming a cut-off of 45 degrees as surgical range, no normal weight patients presented in surgical range (0%), but 7/50 (14%, P=0.01) overweight and 8/50 (16%, P<0.01) obese patients did. Moreover, higher BMI patients were significantly more likely to present at a higher degree of skeletally maturity, with an average Risser of 1.8 for normal weight patients, 2.7 (P=0.01) for overweight patients, and 2.9 (P=0.01) for obese patients. CONCLUSIONS Overweight and obese patients with adolescent idiopathic scoliosis present at significantly larger curve magnitudes and significantly higher degrees of skeletal maturity. Moreover, these patients were significantly more likely to present with very large curves and, in our study, all patients presenting with a surgical range curve were either overweight or obese. LEVEL OF EVIDENCE Level III-Retrospective case-control.
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25
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Prevalence of incorrect body posture in children and adolescents with overweight and obesity. Eur J Pediatr 2017; 176:563-572. [PMID: 28229267 PMCID: PMC5415578 DOI: 10.1007/s00431-017-2873-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 02/05/2017] [Accepted: 02/07/2017] [Indexed: 01/19/2023]
Abstract
UNLABELLED The ever increasing epidemics of overweight and obesity in school children may be one of the reasons of the growing numbers of children with incorrect body posture. The purpose of the study was the assessment of the prevalence of incorrect body posture in children and adolescents with overweight and obesity in Poznań, Poland. The population subject to study consisted of 2732 boys and girls aged 3-18 with obesity, overweight, and standard body mass. The assessment of body mass was performed based on BMI, adopting Cole's cutoff values. The evaluation of body posture was performed according to the postural error chart based on criteria complied by professor Dega. The prevalence rates of postural errors were significantly higher among children and adolescents with overweight and obesity than among the group with standard body mass. In the overweight group, it amounted to 69.2% and in the obese group to 78.6%. CONCLUSION The most common postural deviations in obese children and adolescents were valgus knees and flat feet. Overweight and obesity in children and adolescents, predisposing to higher incidence of some types of postural errors, call for prevention programs addressing both health problems. What is Known: • The increase in the prevalence of overweight and obesity among children and adolescents has drawn attention to additional health complications which may occur in this population such as occurrence of incorrect body posture. What is New: • The modified chart of postural errors proved to be an effective tool in the assessment of incorrect body posture. • This chart may be used in the assessment of posture during screening tests and prevention actions at school.
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Correlations of VDR and VDBP genetic polymorphisms with susceptibility to adolescent idiopathic scoliosis and efficacy of brace treatment. Genomics 2016; 108:194-200. [DOI: 10.1016/j.ygeno.2016.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/21/2016] [Accepted: 11/12/2016] [Indexed: 02/01/2023]
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Abstract
STUDY DESIGN This is a population-based, cross-sectional study of school scoliosis screening program in mainland China. OBJECTIVE The aim of this study was to assess current prevalence and distribution of idiopathic scoliosis (IS) in schoolchildren and to compare with the results of previous studies. SUMMARY OF BACKGROUND DATA The feasibility and predictive values of scoliosis screening programs for school-age children remains controversial and many of these programs have recently been discontinued in different countries. Due to different race and medical model in China, it is not feasible to introduce these data without further study. Therefore, a reliable retrospective cohort study with a large sample size to ensure proper evaluation of school scoliosis screening is needed. METHODS Schoolchildren were initially screened by visual inspection of clinical signs, the forward-bending test, and the measurement of the angle of trunk rotation (ATR). Students suspected were rescreened, and then were referred for radiography or dismissed. The diagnosis and treatment were based on the Cobb angle. The personal information, demographic information, and results of tests performed were recorded and analyzed. RESULTS A total of 99,695 children were screened, with a female-to-male ratio of 1:1.03. Around 6.56% of children screened were referred for radiography, and 5125 of them had confirmed diagnosis. The overall scoliosis prevalence rate was 5.14%. According to age and gender, 14- to 15-year-old girls had the highest prevalence rates (13.81%). And, the prevalence of IS in need of treatment was 0.64%. A prevalence rate of 13.1% was observed in girls with BMI less than 18 kg/m². CONCLUSION The prevalence rate of IS was 5.14% in our study. Screening of 13- to 14- and 14- to 15-year-old girls identified a significant number who could benefit from preventive treatment. Low BMI may be a risk factor for IS. We present this study as a guide for studying the prevalence of IS and modifying our further research. LEVEL OF EVIDENCE 3.
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Grauers A, Wang J, Einarsdottir E, Simony A, Danielsson A, Åkesson K, Ohlin A, Halldin K, Grabowski P, Tenne M, Laivuori H, Dahlman I, Andersen M, Christensen SB, Karlsson MK, Jiao H, Kere J, Gerdhem P. Candidate gene analysis and exome sequencing confirm LBX1 as a susceptibility gene for idiopathic scoliosis. Spine J 2015; 15:2239-46. [PMID: 25987191 DOI: 10.1016/j.spinee.2015.05.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 04/09/2015] [Accepted: 05/07/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Idiopathic scoliosis is a spinal deformity affecting approximately 3% of otherwise healthy children or adolescents. The etiology is still largely unknown but has an important genetic component. Genome-wide association studies have identified a number of common genetic variants that are significantly associated with idiopathic scoliosis in Asian and Caucasian populations, rs11190870 close to the LBX1 gene being the most replicated finding. PURPOSE The aim of the present study was to investigate the genetics of idiopathic scoliosis in a Scandinavian cohort by performing a candidate gene study of four variants previously shown to be associated with idiopathic scoliosis and exome sequencing of idiopathic scoliosis patients with a severe phenotype to identify possible novel scoliosis risk variants. STUDY DESIGN This was a case control study. PATIENT SAMPLE A total of 1,739 patients with idiopathic scoliosis and 1,812 controls were included. OUTCOME MEASURE The outcome measure was idiopathic scoliosis. METHODS The variants rs10510181, rs11190870, rs12946942, and rs6570507 were genotyped in 1,739 patients with idiopathic scoliosis and 1,812 controls. Exome sequencing was performed on pooled samples from 100 surgically treated idiopathic scoliosis patients. Novel or rare missense, nonsense, or splice site variants were selected for individual genotyping in the 1,739 cases and 1,812 controls. In addition, the 5'UTR, noncoding exon and promoter regions of LBX1, not covered by exome sequencing, were Sanger sequenced in the 100 pooled samples. RESULTS Of the four candidate genes, an intergenic variant, rs11190870, downstream of the LBX1 gene, showed a highly significant association to idiopathic scoliosis in 1,739 cases and 1,812 controls (p=7.0×10(-18)). We identified 20 novel variants by exome sequencing after filtration and an initial genotyping validation. However, we could not verify any association to idiopathic scoliosis in the large cohort of 1,739 cases and 1,812 controls. We did not find any variants in the 5'UTR, noncoding exon and promoter regions of LBX1. CONCLUSIONS Here, we confirm LBX1 as a susceptibility gene for idiopathic scoliosis in a Scandinavian population and report that we are unable to find evidence of other genes of similar or stronger effect.
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Affiliation(s)
- Anna Grauers
- Department of Orthopedics, Sundsvall and Härnösand County Hospital, SE-85186, Sundsvall, Sweden; Department of Orthopedics, Karolinska University Hospital, K54, SE-14186, Stockholm, Sweden; Department of Clinical Sciences, Intervention and Technology (CLINTEC) Karolinska Institutet, SE-14186, Stockholm, Sweden
| | - Jingwen Wang
- Department of Biosciences and Nutrition, Karolinska Institutet, Novum, Hälsovägen 7-9, SE-14183, Huddinge, Sweden; Center for Innovative Medicine, Karolinska Institutet, Novum, Hälsovägen 7-9, SE-14183, Huddinge, Sweden
| | - Elisabet Einarsdottir
- Department of Biosciences and Nutrition, Karolinska Institutet, Novum, Hälsovägen 7-9, SE-14183, Huddinge, Sweden; Center for Innovative Medicine, Karolinska Institutet, Novum, Hälsovägen 7-9, SE-14183, Huddinge, Sweden
| | - Ane Simony
- Sector for Spine Surgery and Research, Middelfart Hospital, Middelfart, Denmark
| | - Aina Danielsson
- Department of Orthopedics, Sahlgren University Hospital, Gothenburg, Sweden
| | - Kristina Åkesson
- Department of Orthopedics and Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden
| | - Acke Ohlin
- Department of Orthopedics and Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden
| | - Klas Halldin
- Department of Orthopedics, Sahlgren University Hospital, Gothenburg, Sweden
| | - Pawel Grabowski
- Department of Orthopedics, University Hospital of Umeå, Umeå, Sweden
| | - Max Tenne
- Department of Orthopedics and Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden
| | - Hannele Laivuori
- Department of Medical Genetics and Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Institute for Molecular Medicine Finland, University of Helsinki, Tukholmankatu 8, Helsinki, Finland
| | - Ingrid Dahlman
- Department of Medicine, Lipid Laboratory, Karolinska Institutet, SE-14186, Stockholm, Sweden
| | - Mikkel Andersen
- Sector for Spine Surgery and Research, Middelfart Hospital, Middelfart, Denmark
| | | | - Magnus K Karlsson
- Department of Orthopedics and Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden
| | - Hong Jiao
- Department of Biosciences and Nutrition, Karolinska Institutet, Novum, Hälsovägen 7-9, SE-14183, Huddinge, Sweden; Center for Innovative Medicine, Karolinska Institutet, Novum, Hälsovägen 7-9, SE-14183, Huddinge, Sweden
| | - Juha Kere
- Department of Biosciences and Nutrition, Karolinska Institutet, Novum, Hälsovägen 7-9, SE-14183, Huddinge, Sweden; Center for Innovative Medicine, Karolinska Institutet, Novum, Hälsovägen 7-9, SE-14183, Huddinge, Sweden; Molecular Neurology Research Program, University of Helsinki and Folkhälsan Institute of Genetics, Helsinki, Finland.
| | - Paul Gerdhem
- Department of Orthopedics, Karolinska University Hospital, K54, SE-14186, Stockholm, Sweden; Department of Clinical Sciences, Intervention and Technology (CLINTEC) Karolinska Institutet, SE-14186, Stockholm, Sweden.
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Xie N, Li M, Wu T, Liu J, Wang B, Tang F. Does elevated osteopontin level play an important role in the development of scoliosis in bipedal mice? Spine J 2015; 15:1660-4. [PMID: 25801389 DOI: 10.1016/j.spinee.2015.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/11/2015] [Accepted: 03/16/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies implied indirectly that an elevated osteopontin (OPN) level might play a key role in the pathomechanism of adolescent idiopathic scoliosis. Nonetheless, up to now, no direct evidence was proposed to determine this issue. PURPOSE The aim was to determine the role of OPN in the pathomechanism of scoliosis. STUDY DESIGN This was an experimental study to investigate the role of OPN in a bipedal mouse scoliosis model. METHODS All procedures were performed under the approval and supervision of the Institutional Animal Care and Use Committee of our university. A new bipedal mouse model with elevated OPN level was established in this study. Amputation of forelimbs and tail was performed on 80 male C3H/HeJ mice at the age of 3 weeks. Then, these mice were randomly divided into two groups: Group A consisted of 40 mice treated with OPN 40 mg/kg daily and Group B consisted of the remaining 40 mice treated with saline. Then, 40 quadruped mice with saline were included in Group C. Body length, X-rays, and computed tomographic scans were obtained at the twentieth week. Then, scoliosis incidence, curve magnitude, and circulating OPN level were compared among groups. RESULTS Osteopontin level was significantly higher in Group A compared with that in Groups B and C. Spine deformity was identified in 37 mice in Group A, 21 mice in Group B, and 5 mice in Group C. The average Cobb angle was 29.8° in Group A, 20.9° in Group B, and 17.5° in Group C. Although no significant difference of body length was found, significant statistical difference was noted in terms of scoliosis incidence and curve magnitude, among the three groups. CONCLUSIONS The results of the present study indicated that the elevated OPN level might play an important role in the etiopathogenesis of scoliosis, that is, it not only raises the risk for scoliosis in bipedal mice but also contributes to curve progression.
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Affiliation(s)
- Ning Xie
- Department of Spine Surgery, Affiliated Changzheng Hospital of Second Military Medical University, No. 800 Xiangyin Rd, Shanghai, 200433 China
| | - Mo Li
- Department of Orthopaedic Surgery, Xijing Hospital, The Fourth Military Medical University, No.169 Changle West Rd, Xi'an, Shaanxi 710032 China
| | - Tao Wu
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Rd No. 121, Nanjing, Jiangsu, China
| | - Jun Liu
- Department of Spine Surgery, Affiliated Changzheng Hospital of Second Military Medical University, No. 800 Xiangyin Rd, Shanghai, 200433 China; Department of Orthopaedics, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Rd No. 121, Nanjing, Jiangsu, China.
| | - Binbin Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Rd No. 121, Nanjing, Jiangsu, China
| | - Feng Tang
- Department of Spine Surgery, Affiliated Changzheng Hospital of Second Military Medical University, No. 800 Xiangyin Rd, Shanghai, 200433 China
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