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Marie-Hardy L, Slimani L, Messa G, El Bourakkadi Z, Prigent A, Sayetta C, Koëth F, Pascal-Moussellard H, Wyart C, Cantaut-Belarif Y. Loss of CSF-contacting neuron sensory function is associated with a hyper-kyphosis of the spine reminiscent of Scheuermann's disease. Sci Rep 2023; 13:5529. [PMID: 37016154 PMCID: PMC10073078 DOI: 10.1038/s41598-023-32536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/29/2023] [Indexed: 04/06/2023] Open
Abstract
Scheuermann's disease, also referred to as Scheuermann's kyphosis, is the second most frequent spine deformity occurring in humans after adolescent idiopathic scoliosis (AIS), both with an unclear etiology. Recent genetic studies in zebrafish unraveled new mechanisms linked to AIS, highlighting the role of the Reissner fiber, an acellular polymer bathing in the cerebrospinal fluid (CSF) in close proximity with ciliated cells and mechanosensory neurons lining the central canal of the spinal cord (CSF-cNs). However, while the Reissner fiber and ciliary beating have been linked to AIS-like phenotypes in zebrafish, the relevance of the sensory functions of CSF-cNs for human spine disorders remains unknown. Here, we show that the thoracic hyper-kyphosis of the spine previously reported in adult pkd2l1 mutant zebrafish, in which the mechanosensory function of CSF-cNs is likely defective, is restricted to the sagittal plane and is not associated with vertebral malformations. By applying orthopedic criteria to analyze the amplitude of the curvature at the apex of the kyphosis, the curve pattern, the sagittal balance and sex bias, we demonstrate that pkd2l1 knock-outs develop a phenotype reminiscent of Scheuermann's disease. Altogether our work consolidates the benefit of combining genetics and analysis of spine deformities in zebrafish to model idiopathic spine disorders in humans.
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Affiliation(s)
- Laura Marie-Hardy
- Orthopedic Surgery and Trauma Center, Pitié-Salpêtrière Teaching Hospital (AP-HP), 47 Boulevard de L'Hôpital, 75013, Paris, France
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France
| | - Lotfi Slimani
- URP 2496 Laboratory Orofacial Pathologies, Imaging and Biotherapies, Dental School University Paris Cité, and Life Imaging Platform (PIV), Montrouge, France
| | - Giulia Messa
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France
| | - Zaineb El Bourakkadi
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France
| | - Annick Prigent
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France
| | - Celia Sayetta
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France
| | - Fanny Koëth
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France
| | - Hugues Pascal-Moussellard
- Orthopedic Surgery and Trauma Center, Pitié-Salpêtrière Teaching Hospital (AP-HP), 47 Boulevard de L'Hôpital, 75013, Paris, France
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France
| | - Claire Wyart
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France.
| | - Yasmine Cantaut-Belarif
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France.
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Muacevic A, Adler JR. Scheuermann's Disease in Young Adults: A Case Report. Cureus 2022; 14:e31803. [PMID: 36579214 PMCID: PMC9780124 DOI: 10.7759/cureus.31803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/22/2022] [Indexed: 11/24/2022] Open
Abstract
Scheuermann kyphosis, also known as Scheuermann disease, juvenile kyphosis, or juvenile discogenic disease, is a condition involving an abnormal, excessive curvature of the spine. It involves both the vertebral bodies and discs of the spine and is characterized by anterior wedging of greater than or equal to 5 degrees in three or more adjacent vertebral bodies. Type 1 Scheuermann's disease involves the thoracic spine, whereas type 2 involves both the thoracic and lumbar spine. Although no definitive cause for Scheuermann's disease has been found, we have reported a case that may explain further about this disease. This article elucidates a case of a 19-year-old boy experiencing pain in the lower back and showing various signs and symptoms of Scheuermann's disease and the diagnosis and steps taken by doctors toward its treatment.
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Musculoskeletal Problems of Children. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Roberts SB, Calligeros K, Tsirikos AI. Evaluation and management of paediatric and adolescent back pain: Epidemiology, presentation, investigation, and clinical management: A narrative review. J Back Musculoskelet Rehabil 2020; 32:955-988. [PMID: 31524137 DOI: 10.3233/bmr-170987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This narrative review will summarise a clinical approach to the investigation of back pain in children and adolescent patients, including a discussion of the epidemiology, presentation, investigation and clinical management of back pain in children and adolescents. This will assist the prompt and accurate diagnosis of spinal disorders that require significant medical intervention. Existing evidence suggests a relatively high incidence of non-specific back pain among young people; 27-48% of presentations of back pain in children and adolescents are attributed to non-specific back pain. Low back pain among schoolchildren is often linked to psychosocial factors and only occasionally requires medical attention, as pain is benign and self-limiting. Nonetheless, those young patients who seek medical assistance exhibit a higher incidence of organic conditions underlying the major symptom of spinal pain. A cautious and comprehensive strategy - including a detailed history, examination, radiographic imaging and diagnostic laboratory studies - should be employed, which must be accurate, reliable, consistent and reproducible in identifying spinal pathologies. A specific diagnosis can be reached in 52-73% of the cases. For cases in which a specific diagnosis cannot be made, re-evaluation after a period of observation is recommended. At this later stage, minor symptoms unrelated to underlying pathology will resolve spontaneously, whereas serious pathologies will advance and become easily identified.
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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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Bezalel T, Carmeli E, Kalichman L. Introduction of the Novel Radiographic Line (L5-Kyphosis Apex Line) Intended to Evaluate Scheuermann's Disease and Postural Kyphosis Progression on Standard Lateral X-Rays. Asian Spine J 2020; 14:350-356. [PMID: 31940713 PMCID: PMC7280925 DOI: 10.31616/asj.2019.0213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/31/2019] [Indexed: 11/23/2022] Open
Abstract
Study Design Cross-sectional and follow-up nested study. Purpose To assess the reliability of the L5-kyphosis apex line (L5-KAL) evaluation and determine the association between changes in L5-KAL, changes in radiological parameters, and changes in clinical symptoms. Overview of Literature Scheuermann’s disease is the most common cause of hyperkyphosis of the thoracolumbar and thoracic spine during adolescence. Scheuermann’s disease patients usually show compensatory hyperlordosis of the lumbar spine, which is usually flexible, and express an anterior translation of the lumbar section. The L5-KAL was developed on the basis of our clinical experience, displaying the horizontal distance between the thoracic and lumbar curves. Methods In the cross-sectional segment, 150 initial lateral X-rays of patients with Scheuermann’s disease and postural kyphosis were analyzed, and 80 additional X-rays were analyzed in the follow-up segment. The data taken from the X-rays of the whole spinal column included the thoracic kyphosis angle, the C7 plumb line, and the L5-KAL. Clinical data included a numerical rating scale of self-perceived body image, pain, and a Scoliosis Research Society-22 questionnaire (SRS-22). Results Significant positive associations were observed in a cross-sectional study between the L5-KAL and thoracic kyphosis, lumbar lordosis, C7 line, and self-perceived body image. In the follow-up nested study, in a mixed analysis of variance, the main effect of time was significant for the L5-KAL, kyphotic deformity and SRS-22, which indicated a change in these parameters after treatment of Scheuermann’s disease patients. Significant positive associations were observed between the changes in L5-KAL and the changes in thoracic kyphosis. Conclusions Our evidence suggests that the L5-KAL can serve as an indicator of the thoracic curve change in Scheuermann’s disease and postural kyphosis patients and should be considered in clinical practice.
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Affiliation(s)
- Tomer Bezalel
- Maccabi Health Care Services, Posture Clinic, Maccabi Hashalom, Tel Aviv, Israel.,Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences at Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eli Carmeli
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, Haifa University, Mt Carmel, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences at Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Musculoskeletal Problems of Children. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_20-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Correlation between isometric strength in five muscle groups and inclination angles of spine. 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 2019; 29:161-168. [DOI: 10.1007/s00586-019-06182-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/18/2019] [Accepted: 10/05/2019] [Indexed: 11/26/2022]
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Bezalel T, Carmeli E, Levi D, Kalichman L. The Effect of Schroth Therapy on Thoracic Kyphotic Curve and Quality of Life in Scheuermann's Patients: A Randomized Controlled Trial. Asian Spine J 2019; 13:490-499. [PMID: 30669825 PMCID: PMC6547400 DOI: 10.31616/asj.2018.0097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/29/2018] [Indexed: 01/10/2023] Open
Abstract
Study Design Randomized controlled single-blinded clinical trial. Purpose To evaluate the efficacy of Schroth therapy on thoracic curve angle, pain, and self-perceived body image (SPBI) of the back in Scheuermann’s patients in comparison with the efficacy of classic anti-gravitation exercises. Overview of Literature Scheuermann disease is the most common cause of hyperkyphosis of the thoracic and thoracolumbar spine during adolescence. However, very few studies evaluated the effect of exercises on the progression of kyphosis in Scheuermann patients. Schroth three-dimensional exercise therapy was found in several studies to be effective in the treatment of adolescent scoliosis; however, we found no randomized controlled trials that evaluated the efficacy of this method in Scheuermann patients. Methods A total of 50 young adults (males and females) with Scheuermann’s disease were randomly divided into either the experimental group (Schroth therapy treatment, n=25) or the control group (classic anti-gravitation exercises, n=25). Participants in both the groups were provided a course of individual treatment sessions during few weeks, with one appointment per week. They were required to perform the exercises daily throughout the study period (12 months) and fill their performance in a research log. We evaluated the thoracic Cobb angle (main outcome measure), pain, SPBI, flexion of the shoulder (supine), flexion of the shoulder (standing), kyphotic deformity measured using inclinometer, and L5 kyphosis apex line (L5-KAL) as well as administered the Scoliosis Research Society-22 Questionnaire for the participants before the treatment, after 6 months, and 1 year postoperatively. These results were then compared. Results In the mixed analysis of variance, the main effect of time was significant in the thoracic kyphosis (F [1]=5.72, p=0.02), and in the L5-KAL (F [1]=5.76, p=0.02). The main effect of time on the kyphotic deformity, measured using an inclinometer, did not reach the significance level; however, it showed the tendency (F [1]=2.80, p=0.07). In the group-by-time interaction, a significant difference was found in the thoracic kyphosis (F [1]=4.91, p=0.03) and in the kyphotic deformity, measured using an inclinometer (F [1]=4.05, p=0.02). Thus, the Schroth therapy group showed significantly greater improvement than the classic anti-gravitation exercises group. Conclusions The present findings indicate that back exercises in general, and Schroth therapy in particular, is an effective treatment for preventing and significantly improving the thoracic Cobb angle and symptomatic representation in Scheuermann’s patients.
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Affiliation(s)
- Tomer Bezalel
- Maccabi Health Care Services, Maccabi Hashalom Posture Clinic, Tel Aviv, Israe.,Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences at Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eli Carmeli
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, Haifa University, Mt. Carmel, Israel
| | - Dror Levi
- Maccabi Health Care Services, Maccabi Bat-Yam Posture Clinic, Bat-Yam, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences at Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Posterior-only versus combined anterior/posterior fusion in Scheuermann disease: a large retrospective 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 2018; 27:2322-2330. [DOI: 10.1007/s00586-018-5633-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/07/2018] [Accepted: 05/11/2018] [Indexed: 11/26/2022]
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11
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Kleppin T, Cvengros T, Pujalte GGA. Musculoskeletal Problems of Children. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Nahle IS, Hamam MS, Masrouha KZ, Afeiche NE, Abdelnoor J. Back pain: A puzzle in children. J Paediatr Child Health 2016; 52:802-8. [PMID: 27535879 DOI: 10.1111/jpc.13291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2016] [Indexed: 11/27/2022]
Abstract
Back pain in children is underdiagnosed and increases incidence in adolescence. A systematic approach can diagnose the most common causes: trauma, structural deformities, inflammatory diseases, infection and malignancy.
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Affiliation(s)
- Imad S Nahle
- Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamed S Hamam
- Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karim Z Masrouha
- Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadim E Afeiche
- Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Johnny Abdelnoor
- Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Orthopaedic Surgery, University Medical Center - Rizk Hospital, Beirut, Lebanon
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Yun C, Shen CL. Anterior release for Scheuermann’s disease: a systematic literature 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 2016; 26:921-927. [DOI: 10.1007/s00586-016-4632-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
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Khan BI, Yost MT, Badkoobehi H, Ain MC. Prevalence of Scoliosis and Thoracolumbar Kyphosis in Patients With Achondroplasia. Spine Deform 2016; 4:145-148. [PMID: 27927547 DOI: 10.1016/j.jspd.2015.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 08/06/2015] [Accepted: 08/08/2015] [Indexed: 10/22/2022]
Abstract
STUDY DESIGN Retrospective chart review, case series. OBJECTIVES To determine the prevalence of scoliosis and kyphosis in patients with achondroplasia. SUMMARY OF BACKGROUND DATA There is little published research on the prevalence of scoliosis and thoracolumbar kyphosis in patients with achondroplasia. METHODS The authors retrospectively reviewed charts of 459 patients with achondroplasia who were seen by the senior author, an orthopedic surgeon, from 1999 through 2013, at a tertiary referral center. After excluding patients who presented after spinal surgery and those who were referred for specific non-spinal issues, 326 patients were included (71%). Cobb angles were measured on lateral and posteroanterior radiographs. Scoliosis was defined as curvature on posteroanterior radiographs greater than 10°; thoracolumbar kyphosis was defined as any kyphotic curvature with an apex between T11 and L2. These data were then stratified by sex, age group (0-2, 3-12, 13-19, 20-40, and >40 years), and severity: within normal limits (≤10°), mild (>10°-25°), moderate (26°-50°), and severe (>50°). RESULTS The study population consisted of 176 males and 150 females with a mean age of 18 years. Scoliosis was observed in 60%. Thoracolumbar kyphosis was observed in 79%, with 52% exhibiting moderate to severe curvature. CONCLUSIONS In these patients, the rates of scoliosis and kyphosis were 60% and 79%, respectively, which are much higher than the rates reported in the literature for the general population of children. LEVEL OF EVIDENCE Level 3 or 4.
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Affiliation(s)
- Bilal I Khan
- Department of Orthopaedic Surgery, The Johns Hopkins School of Medicine, 4940 Eastern Ave., Baltimore, MD 21224, USA
| | - Mary T Yost
- Department of Orthopaedic Surgery, The Johns Hopkins School of Medicine, 4940 Eastern Ave., Baltimore, MD 21224, USA
| | - Haleh Badkoobehi
- Department of Orthopaedic Surgery, The Johns Hopkins School of Medicine, 4940 Eastern Ave., Baltimore, MD 21224, USA
| | - Michael C Ain
- Department of Orthopaedic Surgery, The Johns Hopkins School of Medicine, 4940 Eastern Ave., Baltimore, MD 21224, USA.
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Peleg S, Dar G, Steinberg N, Masharawi Y, Hershkovitz I. Sacral orientation and Scheuermann's kyphosis. SPRINGERPLUS 2016; 5:141. [PMID: 26933639 PMCID: PMC4761356 DOI: 10.1186/s40064-016-1772-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 02/12/2016] [Indexed: 11/10/2022]
Abstract
To examine whether the association between spinal alignment and sacral anatomical orientation (SAO) can be detected in skeletal populations, by comparing SAO values in individuals with a typical SD to individuals with normal spinal alignment. 2025 skeletons were screened for Scheuermann's disease. Scheuermann's kyphosis was established by the presence of apophyseal abnormalities associated with more than 5° of anterior wedging in each of three adjacent vertebrae. SAO was measured as the angle created between the intersection of a line running parallel to the superior surface of the sacrum and a line running between the anterior superior iliac spine and the anterior-superior edge of the symphysis pubis (PUBIS). SAO was measured on 185 individuals with normal spines and 183 individuals with Scheuermann's kyphosis. Out of 2025 skeletons, 183 (9 %) were diagnosed with Scheuermann's kyphosis. The sacrum was significantly more horizontally oriented in individuals with Scheuermann's kyphosis compared with the control (SAO: 44.44 ± 9.7° vs. 50 ± 9.9°, p < 0.001). Alteration in spinal biomechanics due to a horizontally orientated sacrum may be an important contributing factor for the development of Scheuermann's kyphosis.
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Affiliation(s)
- Smadar Peleg
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, 69978 Ramat Aviv, Tel Aviv, Israel ; Department of Physical Therapy, Zefat Academic College, Jerusalem Street 11, P.O. Box 160, 13206 Zefat, Israel
| | - Gali Dar
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, 69978 Ramat Aviv, Tel Aviv, Israel ; Department of Physical Therapy, Faculty of Social Welfare and Health Studies, University of Haifa, Mount Carmel, 31905 Haifa, Israel
| | - Nili Steinberg
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, 69978 Ramat Aviv, Tel Aviv, Israel ; The Zinman College of Physical Education and Sports Sciences at the Wingate Institute, 42902 Netanya, Israel
| | - Youssef Masharawi
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, 69978 Ramat Aviv, Tel Aviv, Israel ; Department of Physiotherapy, School of Health Professions, Tel Aviv University, 69978 Ramat Aviv, Tel Aviv, Israel
| | - Israel Hershkovitz
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, 69978 Ramat Aviv, Tel Aviv, Israel ; Physical Anthropology Laboratory, Cleveland Museum of Natural History, 1 Wade Oval Drive, University Circle, Cleveland, OH 44106-1767 USA
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Lonner BS, Toombs CS, Husain QM, Sponseller P, Shufflebarger H, Shah SA, Samdani AF, Betz RR, Cahill PJ, Yaszay B, Newton PO. Body Mass Index in Adolescent Spinal Deformity: Comparison of Scheuermann's Kyphosis, Adolescent Idiopathic Scoliosis, and Normal Controls. Spine Deform 2015; 3:318-326. [PMID: 27927476 DOI: 10.1016/j.jspd.2015.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 02/13/2015] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
Abstract
STUDY DESIGN Prospective, multicenter study of Scheuermann's kyphosis (SK) and adolescent idiopathic scoliosis (AIS) compared to a control group. OBJECTIVES Compare body mass index (BMI) and Scoliosis Research Society Questionnaire-22 (SRS-22) scores among two diagnosis and one control group. SUMMARY OF BACKGROUND DATA BMI has been reported as increased in SK patients; however, there are few recent data on this subject or comparing SK to AIS. METHODS Ninety-two SK patients (37 female, 55 male, average age 16 years), 1,051 AIS patients (814 female, 237 male, average age 15 years), and 380 adolescents without scoliosis (controls) were compared based on age, gender, race, height (m), weight (kg), BMI, and SRS-22 scores. An analysis of variance was used to test differences in BMI and SRS-22 scores between the groups and between males and females. Pearson correlations determined the relationship between AIS T5-T12 kyphosis and BMI, SK max kyphosis and BMI, and to determine the relationship between BMI and SRS-22 scores in each group. RESULTS More SK patients were "obese" and "overweight" (28% and 22%) compared to the AIS (6% and 9%) and Control groups (5.8% and 17.9%) (p < .001). More AIS patients were "underweight" (27%, SK: 13%, Control: 12.1%; p < .03). T5-T12 kyphosis was weakly correlated with BMI (r = 0.17), whereas max kyphosis correlated well with BMI (r = 0.39, p < .00). The SK group had significantly lower (worse) SRS-22 scores than AIS patients in the Pain (3.97 vs. 4.10), Self-Image (2.86 vs. 3.35), Mental Health (3.72 vs. 4.02), and Total Score domains (3.62 vs. 3.92, p < .001). Increased pain scores were weakly correlated with decreasing BMI in all three groups. CONCLUSIONS SK patients are at increased risk for elevated BMI and worse SRS-22 scores, indicating that they may suffer from delayed diagnosis and increased surgical complications. AIS patients are at increased risk for issues related to low BMI and should also be monitored.
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Affiliation(s)
- Baron S Lonner
- Department of Orthopaedic Surgery, Beth Israel Medical Center, New York, NY 10003, USA.
| | - Courtney S Toombs
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY 10003, USA
| | - Qasim M Husain
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY 10003, USA
| | - Paul Sponseller
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Harry Shufflebarger
- Department of Orthopaedic Surgery, Miami Children's Hospital, Miami, FL 33155, USA
| | - Suken A Shah
- Department of Orthopaedic Surgery, Nemours Children's Clinic, Wilmington, DE 19803, USA
| | - Amer F Samdani
- Department of Orthopaedic Surgery, Shriners Hospitals for Children, Philadelphia, PA 19140, USA
| | - Randal R Betz
- Department of Orthopaedic Surgery, Shriners Hospitals for Children, Philadelphia, PA 19140, USA
| | - Patrick J Cahill
- Department of Orthopaedic Surgery, Shriners Hospitals for Children, Philadelphia, PA 19140, USA
| | - Burt Yaszay
- Department of Orthopaedic Surgery, Rady Children's Hospital San Diego, San Diego, CA 92123, USA
| | - Peter O Newton
- Department of Orthopaedic Surgery, Rady Children's Hospital San Diego, San Diego, CA 92123, USA
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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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Kleppin T, Cvengros T, Pujalte GGA. Musculoskeletal Problems of Children. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_20-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schlösser TPC, Vincken KL, Rogers K, Castelein RM, Shah SA. Natural sagittal spino-pelvic alignment in boys and girls before, at and after the adolescent growth spurt. 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 2014; 24:1158-67. [DOI: 10.1007/s00586-014-3536-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
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Hershkovich O, Friedlander A, Gordon B, Arzi H, Derazne E, Tzur D, Shamiss A, Afek A. Association between body mass index, body height, and the prevalence of spinal deformities. Spine J 2014; 14:1581-7. [PMID: 24332597 DOI: 10.1016/j.spinee.2013.09.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 08/05/2013] [Accepted: 09/19/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The most common spinal deformities among adolescents are adolescent idiopathic scoliosis (AIS; 2%-3% prevalence) and Scheuermann kyphosis (SK; 1%-8% prevalence). Both are believed to have a genetic influence in their etiology. The association between body mass index (BMI) and body stature and their possible association to spinal deformities is uncertain. STUDY DESIGN A cross-sectional prevalence study. PURPOSE To examine the prevalence of all adolescent spinal deformities according to the extent of their severity as well as their possible association to BMI and body height. OUTCOME MEASURES Subjects diagnosed as having spinal deformities were classified into one of three severity groups; "Mild," "Intermediate," or "Severe," according to their curve scoliosis or kyphosis measurement with a standing X-ray. METHODS The data for this study were derived from a medical database containing records of 17-year-old male and female patients before their recruitment into mandatory military service. Information on the disability codes associated with spinal deformities according to the Regulations of Medical Fitness Determination was retrieved. Logistic regression models were used to assess the association between the BMI and body height to various degrees of spinal deformities by severity. RESULTS The study cohort included 829,791 consecutive subjects, of whom 103,249 were diagnosed with spinal deformities (76% were mild in degree). The prevalence of spinal deformities was significantly greater among the underweight male and female patients (p<.001). Increased BMI had a protective effect for developing spinal deformities. The odds ratios for severe spinal deformities were greater compared with mild spinal deformities in the underweight groups. The risk for developing spinal deformities increased significantly with height for both genders (p<.001). CONCLUSIONS An association between height and the risk for spinal deformities by severity was found for all height groups. Below normal BMI is associated with severity of spinal deformities, whereas above-normal BMI apparently has a protective effect. Body height is also positively associated with the severity of spinal deformities.
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Affiliation(s)
- Oded Hershkovich
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel; Medical Corps, Israeli Defense Forces, Israel.
| | - Alon Friedlander
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel
| | - Barak Gordon
- Medical Corps, Israeli Defense Forces, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - Harel Arzi
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel
| | - Estela Derazne
- Medical Corps, Israeli Defense Forces, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - Dorit Tzur
- Medical Corps, Israeli Defense Forces, Israel
| | - Ari Shamiss
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel; Central Management, Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
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Bezalel T, Kalichman L. Improvement of clinical and radiographical presentation of Scheuermann disease after Schroth therapy treatment. J Bodyw Mov Ther 2014; 19:232-7. [PMID: 25892377 DOI: 10.1016/j.jbmt.2014.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/28/2014] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Scheuermann's disease is the most common cause of hyperkyphosis of the thoracolumbar spine. Few case reports have demonstrated the effectiveness of Schroth therapy in improving the thoracic angle curve in Scheuermann's patients; however, additional verification is needed. CASE DESCRIPTION A 14-year-old female patient presented with Scheuermann's disease. On X-ray, thoracic kyphosis was 55° and lumbar lordosis 55°. The self-rated cosmetic disturbance was graded 10/10 on a verbal numeric scale. The patient received a course of seven weekly Schroth therapy sessions, in addition to daily home exercises tailored specifically for the patient's posture. Five months later, follow-up X-rays revealed thoracic kyphosis of 27° and lumbar lordosis 35°. The patient graded the degree of her cosmetic disturbance as 3/10. CONCLUSIONS Schroth therapy seems to be able to decrease the thoracic curve angle of Scheuermann's patients; however, efficacy and effectiveness of this method should be investigated in future prospective controlled clinical trials.
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Affiliation(s)
- Tomer Bezalel
- Maccabi Health Care Services, Posture Clinic, Maccabi Hashalom, Tel Aviv, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences at Ben-Gurion University of the Negev, POB 653, Beer-Sheva 84105, Israel.
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Assessing kyphosis with SpineScan: another attempt to reduce our dependence on radiography. Spine J 2013; 13:926-31. [PMID: 23669125 DOI: 10.1016/j.spinee.2013.03.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 07/04/2012] [Accepted: 03/20/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Kyphosis management is mainly conservative, with annual examinations to assess angular progression. This includes physical examination and usually long spine X-rays, notorious for ionizing radiation. Several nonradiological instruments have been devised for this, but none have become popular. SpineScan, a programmed digital inclinometer, has been proved effective for screening kyphoscoliosis. PURPOSE The aim of this study was to assess the accuracy of SpineScan in monitoring kyphosis. STUDY DESIGN/SETTING Prospective, observational, diagnostic accuracy study. PATIENT SAMPLE Twenty-eight subjects examined for kyphosis, with recent full-length lateral spine X-rays. METHODS Each subject was examined by two examiners. The technique involved the subject standing with arms flexed to 90° and then sliding the SpineScan from just below C7 to L2. Maximum X-ray kyphotic Cobb angle was compared with the SpineScan result. The study was institutional review board approved, and all patients signed an informed consent. RESULTS The mean Cobb angle of the 28 subjects on radiography was 51° ± 15°. The mean SpineScan angle of all trials of all examiners was 54° ± 12°. The difference between the two measurements was significantly different from zero (3.2° ± 9.4°, p<.0001) and not normally distributed. The difference was significantly affected by the Cobb angle, examiner, and interaction between Cobb and examiner (statistical significance for all p<.0001). Ninety-five percent confidence intervals for all examiners ranged between -16° and 22° and for separate examiners between -25° and 32°, far above the 5° preplanned error level. CONCLUSIONS The results demonstrated that there is significant error in monitoring kyphosis with SpineScan. Even for a more modest indication including replacing radiography with SpineScan on alternate visits, the measurement was not accurate enough. Future research is necessary to find a nonradiographic method of kyphosis follow-up, possibly using a digitalized modification of one of the described instruments.
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Surgical treatment of Scheuermann's kyphosis using a combined antero-posterior strategy and pedicle screw constructs: efficacy, radiographic and clinical outcomes in 111 cases. 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 2013; 23:180-91. [PMID: 23893052 DOI: 10.1007/s00586-013-2894-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 05/23/2013] [Accepted: 07/05/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION There is sparse literature on how best to correct Scheuermann's kyphosis (SK). The efficacy of a combined strategy with anterior release and posterior fusion (AR/PSF) with regard to correction rate and outcome is yet to be determined. MATERIALS AND METHODS A review of a consecutive series of SK patients treated with AR/PSF using pedicle screw-rod systems was performed. Assessment of demographics, complications, surgical parameters and radiographs including flexibility and correction measures, proximal junctional kyphosis angle (JKA + 1) and spino-pelvic parameters was performed, focusing on the impact of curve flexibility on correction and clinical outcomes. RESULTS 111 patients were eligible with a mean age of 23 years, follow-up of 24 months and an average of eight levels fused. Cobb angle at fusion level was 68° preoperatively and 37° postoperatively. Flexibility on traction films was 34 % and correction rate 47 %. Postoperative and follow-up Cobb angles were highly correlated with preoperative bending films (r = 0.7, p < 0.05). Screw density rate was 87 %, with increased correction with higher screw density (p < 0.001, r = 0.4). Patients with an increased junctional kyphosis angle (JKA + 1) were at higher risk of revision surgery (p = 0.049). 22 patients sustained complication, and 21 patients had revision surgery. 42 patients with ≥24 months follow-up were assessed for clinical outcomes (follow-up rate for clinical measures was 38 %). This subgroup showed no significant differences regarding baseline parameters as compared to the whole group. Median approach-related morbidity (ArM) was 8.0 %, SRS-sum score was 4.0, and ODI was 4 %. There was a significant negative correlation between the SRS-24 self-image scores and the number of segments fused (r = -0.5, p < 0.05). Patients with additional surgery had decreased clinical outcomes (SRS-24 scores, p = 0.004, ArM, p = 0.0008, and ODI, p = 0.0004). CONCLUSION The study highlighted that AR/PSF is an efficient strategy providing reliable results in a large single-center series. Results confirmed that flexibility was the decisive measure when comparing surgical outcomes with different treatment strategies. Findings indicated that changes at the proximal junctional level were impacted by individual spino-pelvic morphology and determined by the individually predetermined thoracolumbar curvature and sagittal balance. Results stressed that in SK correction, reconstruction of a physiologic alignment is decisive to achieving good clinical outcomes and avoiding complications.
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Neves NSM, Ribeiro da Silva M, Cacho Rodrigues P, Silva ML, Matos R, Pinto R. Symptomatic giant Schmorl's node treated by a decompression procedure. Orthop Traumatol Surg Res 2013; 99:371-4. [PMID: 23507456 DOI: 10.1016/j.otsr.2013.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 12/29/2012] [Accepted: 01/17/2013] [Indexed: 02/02/2023]
Abstract
Schmorl's nodes (SN) are common lesions that represent disc material prolapse through the vertebral endplate, into the vertebral body with generally limited clinical significance. Rarely they have been related to the onset of back pain, usually self-limited. Recently giant variants of SN have been described, with very discrete clinical and imaging expression. Knowledge of the typical imaging appearance in both CT-scan and MRI may preclude the use of unnecessary diagnostic and treatment procedures. The authors present a case of symptomatic giant SN resembling these rare variants by its size and persistent pain, but also featuring distinct classic SN characteristics. Although not usually needed when the image is typical, a percutaneous biopsy was performed which allowed both the definitive diagnosis and, surprisingly, the almost immediate and complete resolution of the symptoms. Five years later the patient is pain free and a new MRI showed a significant decrease of the lesion size and no edema of the vertebral body.
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Affiliation(s)
- N S M Neves
- Spine Group, Orthopedic Department, São João Hospital, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
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Tomé-Bermejo F, Tsirikos A. Current concepts on Scheuermann kyphosis: Clinical presentation, diagnosis and controversies around treatment. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.recote.2012.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tomé-Bermejo F, Tsirikos AI. [Current concepts on Scheuermann kyphosis: clinical presentation, diagnosis and controversies around treatment]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012; 56:491-505. [PMID: 23594948 DOI: 10.1016/j.recot.2012.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 06/21/2012] [Accepted: 07/06/2012] [Indexed: 12/15/2022] Open
Abstract
Scheuermann kyphosis is a structural deformity of the thoracic or thoracolumbar spine that develops prior to puberty and deteriorates during adolescence. There is limited information on its natural history but many patients are expected to have a benign course. Severe kyphosis can progress into adult life and cause significant deformity and debilitating back pain. Conservative treatment includes bracing and physical therapy, but although widely prescribed they have not been scientifically validated. Surgical treatment may be considered in the presence of a progressive kyphosis producing severe pain resistant to conservative measures, neurological compromise, or unacceptable deformity. This is associated with significant risks of major complications that should be discussed with the patients and their families. Modern techniques allow better correction of the deformity through posterior-only surgery with lower complication rates. Simultaneous shortening of the posterior vertebral column across the apical levels, along with spinal cord monitoring, reduces the risk of neurological deficits.
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Affiliation(s)
- F Tomé-Bermejo
- Spinal Fellow, Scottish National Spine Deformity Centre, Royal Hospital for Sick Children & Royal Infirmary of Edinburgh, Edinburgh, Escocia, Reino Unido.
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Untreated Scheuermann's disease: a 37-year follow-up 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 2011; 21:819-24. [PMID: 22101868 DOI: 10.1007/s00586-011-2075-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 11/06/2011] [Indexed: 12/16/2022]
Abstract
INTRODUCTION There are only a few follow-up studies of untreated Scheuermann's disease. The aim of this study was to investigate the relationship between vertebral changes, back pain, and disability in patients with untreated Scheuermann's disease after a 37-year follow-up. MATERIALS AND METHODS Eighty patients responded to a postal questionnaire concerning back pain and disability and 49 of them had classic Scheuermann's disease. Degree of kyphosis, lordosis, scoliosis, the number of affected vertebrae, and mean and maximum wedge angles were measured from radiographs. Back pain and disability scores were compared to a sample of the general Finnish population (n = 3,835). RESULTS At follow-up, the patients were on average 59 (SD 8) years old (range 44-79 years), and the mean follow-up time was 37 (SD 7) years (26-54 years). The patients comprised more males than females (3.1:1). At follow-up, male patients were on average 3 cm taller than controls (p = 0.007). At age 20, female patients compared to controls were on average 6 kg heavier (p = 0.016) and had higher body mass index (BMI) (mean 23.9 kg/m(2) vs. 20.8 kg/m(2), p = 0.001). Scheuermann's patients had 2.5-fold [odds ratio (OR); 95% confidence interval (CI); 1.4-4.5, p = 0.003] increased risk for constant back pain compared to controls. The risk for disability because of back pain during the past 5 years (OR 2.6; 95% CI 1.4-4.7, p = 0.002), risk for back pain during the past 30 days (OR 3.7; 95% CI 1.9-7.0, p < 0.001) and risk for sciatic pain (OR 2.3; 95% CI 1.3-4.3, p = 0.005) were higher compared to controls. Scheuermann's patients had higher risk for difficulties in mounting stairs (OR 5.4; 95% CI 2.8-10.3, p < 0.001) and in carrying a 5 kg load for at least 100 m (OR 7.2; 95% CI 3.9-13.3, p < 0.001). CONCLUSION Scheuermann's patients had a higher risk for back pain and disabilities during activities of daily living than controls. However, the degree of thoracic kyphosis among Scheuermann's patients was not related to back pain, quality of life, or general health.
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Abstract
Thoracic and thoracolumbar kyphosis is a common deformity in pediatric and adolescent populations. Kyphotic deformation of the spine is defined as a curve which shows an increase in the dorsal convex angulation. The most common causes of kyphosis in pediatric and adolescent populations are Scheuermann's disease, postural and congenital kyphosis. The fundamental principles of treatment are analysis of the kyphotic deformity and restoration or maintenance of sagittal balance. Clinically significant sagittal deformities can lead to severe pain, substantial cosmetic alterations, spinal cord dysfunction, problems with swallowing, gastrointestinal and cardiopulmonary complications. When the kyphotic deformity exceeds a certain point and conservative therapy options are no longer sufficient surgical intervention is indicated. The available operative options for treatment of the various types of pediatric and adolescent thoracolumbar kyphosis include dorsal instrumentation and fusion combined with ventral fusion and purely ventral instrumentation and fusion.
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Haidar R, Saad S, Khoury NJ, Musharrafieh U. Practical approach to the child presenting with back pain. Eur J Pediatr 2011; 170:149-56. [PMID: 20495823 DOI: 10.1007/s00431-010-1220-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 05/05/2010] [Indexed: 03/03/2023]
Abstract
Back pain may be the presenting symptom of many children attending to pediatric health care settings. As such, awareness to the common etiologies of back pain in this subgroup of patients remains essential as it guides appropriate diagnosis. Although several clues may be derived from the child's history and physical examination, imaging techniques may be required to confirm the underlying diagnosis. This review summarizes the most commonly encountered causes of back pain in children and highlights diagnostic approaches that will ensure early diagnosis and intervention for a more favorable outcome.
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Affiliation(s)
- Rachid Haidar
- Department of Surgery, American University of Beirut Medical Center, Riad El Solh 1107 2020, PO Box 11-0236, Beirut, Lebanon.
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Garcia EB, Souza SVD, Gonçalves RG, Silveira RT, Garcia EB, Garcia LF, Garcia JF. Correção da cifose de Scheuermann: estudo comparativo da fixação híbrida com ganchos e parafusos versus fixação apenas com parafusos. COLUNA/COLUMNA 2009. [DOI: 10.1590/s1808-18512009000400002] [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
OBJETIVOS: avaliar o grau de correção da cifose de Scheuermann, em 6 pacientes que se submeteram à instrumentação híbrida composta por ganchos e parafusos (H) e 17 fixados apenas com parafusos (P). MÉTODOS: 23 pacientes, com cifose de Scheuermann, submetidos a tratamento cirúrgico por dupla via com início pela via anterior, seguido pela via posterior. Do conjunto de pacientes, 6 foram operados com fixação híbrida e 17 com uso exclusivo de parafusos pediculares. O tratamento cirúrgico foi indicado para cifose rígida, variando de 60º e 105º e portadores do sinal de Risser acima de 4. RESULTADOS: observou-se, no Grupo H, cifose pré-operatória média de 84,17º e no pós-operatório de 47,5º. No Grupo P, a média de cifose no pré-operatório era de 80,35º e, no pós-operatório, de 33,53º. CONCLUSÃO: concluiu-se que os dois tipos de fixação apresentaram resultados muito satisfatórios, contudo, sendo ainda superior quando fixados só com parafusos.
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Segatto E, Lippold C, Végh A. Craniofacial features of children with spinal deformities. BMC Musculoskelet Disord 2008; 9:169. [PMID: 19102760 PMCID: PMC2637865 DOI: 10.1186/1471-2474-9-169] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 12/22/2008] [Indexed: 11/30/2022] Open
Abstract
Background The objective of this epidemiological study is to map the dentofacial anomalies that can be correlated to the two most frequent spinal diseases responsible for postural abnormalities and that can be clinically identified by the orthodontic examination. Methods Twenty-three children with Scheuermann's disease participated in the study (mean age: 14Y8M; SD: 1Y8M), 28 with Scoliosis (mean age: 14Y7M; SD: 2Y3M) and a control group of 68 orthopedically healthy children (mean age: 14Y8M; SD: 0Y11M). Standardized orthodontic screening protocols were used to map the occlusal relations in the sagittal, vertical, and transversal dimensions, space relations of the maxillary and mandibular frontal segment, and the TMJ status and function. The examinations for the children with orthopedic disorders were supplemented by the evaluation of routine orthodontic radiograms – lateral cephalograms and panoramic X-rays. Results The majority of the dentofacial features examined revealed more and greater abnormalities among patients in the Scheuermann's disease group than in the scoliosis group. In the latter group the proportion of the TMJ symptoms and the consecutive functional deviations were greater. When comparing the values of the two spinal-disorder groups and the control group, statistically significant differences (p < .05) occurred for the following measurements: frequency of unilateral Cl.II. molar occlusion, overjet and extreme overjet mean value (Scheuermann's disease group), as well as the frequency of TMJ pathological symptoms (scoliosis group). The evaluation of the panoramic X-rays showed significant differences among the mandibular measurements of the two spinal-disorder groups. Within the framework of the evaluation of the cephalograms significant differences (p < .05) were found only in the case of dental relations. However, several values differed significantly from the Ricketts' norms, none of the indices strictly characterized any of the groups with spinal disorders. Conclusion The more extended treatment of the malocclusions closely correlated to postural disorders draws attention to the indicators of a higher frequency and severity occurring in the case of the dentofacial deviations in the patients of the MSCH group who had previously been less examined.
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Affiliation(s)
- Emil Segatto
- Department of Orofacial Orthopedics and Orthodontics, Heim Pál Children's Hospital, Zoltán u 18, 1054 Budapest, Hungary.
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Fotiadis E, Kenanidis E, Samoladas E, Christodoulou A, Akritopoulos P, Akritopoulou K. Scheuermann's disease: focus on weight and height role. 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 2008; 17:673-8. [PMID: 18301929 DOI: 10.1007/s00586-008-0641-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Revised: 01/16/2008] [Accepted: 01/31/2008] [Indexed: 12/16/2022]
Abstract
The aim of this cross-sectional case-control study is the comparison of the weight and height between a group of children with Scheuermann's disease (SD) and a comparable group of healthy ones and also the correlation of them with the degree and the morphology of the kyphotic curve. Following a school-screening program of 10,057 school students, aged between 11 and 17 years old, 175 adolescents with Scheuermann's disease were diagnosed. The mean height and weight of 175 adolescents diagnosed to have SD compared with this of a group of normal children taken randomly from the group of 9,882 healthy children screened. The control group was comparable with the study group concerning age (p = 0.605) and sex. The weight, height and body mass index (BMI) were significantly lower in the healthy (control) group (p < 0.001). However, there was no correlation between weight (r = -0.019, p = 0.804), height (r = 0.053, p = 0.484) and BMI (r = -0.177, p = 0.019) with the magnitude of kyphotic curve. There was also no correlation between weight (r = -0.27, p = 0.722), height (r = -0.025, p = 0.744) and BMI (r = -0.038, p = 0.619) with Voutsinas index as well. Scheuermann's disease is probably a multifactorial skeletal deformity. Weight and height do not seem to affect the magnitude and morphology of the main kyphotic curve in SD. It seems probably that this observation is not part of the pathogenetic mechanism of SD but a result of its cascade. The increased weight and height of these patients may be the secondary result of other disturbances (i.e. hormonal), which may play more crucial role in Scheuermann's disease pathogenesis.
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Affiliation(s)
- E Fotiadis
- Orthopaedic Department, General Hospital of Veria, Veria, Greece.
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Papagelopoulos PJ, Mavrogenis AF, Savvidou OD, Mitsiokapa EA, Themistocleous GS, Soucacos PN. Current concepts in Scheuermann's kyphosis. Orthopedics 2008; 31:52-8; quiz 59-60. [PMID: 18269168 DOI: 10.3928/01477447-20080101-33] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
Pediatric spinal deformity is a common manifestation of multiple disorders. The clinical picture varies depending on the age at presentation, the severity of the curve at the time of diagnosis, and the underlying cause. Knowledge of the natural history of these varied conditions, the dynamics of growth in the developing spine, and normal axial skeletal biomechanics are fundamental in planning an appropriate treatment. Furthermore, in many instances the spinal anomaly is just part of the problem in a globally affected patient. Treatment alternatives must be judged based on their capacity to positively alter the natural course of the disease and provide a long-standing solution into a patient's adulthood.
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Affiliation(s)
- Mauricio A Campos
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
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Williams FMK, Manek NJ, Sambrook PN, Spector TD, Macgregor AJ. Schmorl's nodes: Common, highly heritable, and related to lumbar disc disease. ACTA ACUST UNITED AC 2007; 57:855-60. [PMID: 17530687 DOI: 10.1002/art.22789] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Schmorl's nodes (SN) are common, but little is known of their relationship with degenerative change and back pain or genetic and environmental factors influencing their expression. We studied healthy female twin volunteers to determine the prevalence and clinical features associated with SN. METHODS Serial sagittal T1- and T2-weighted magnetic resonance images of the lower thoracic and lumbar spine were analyzed in 516 healthy female twins (150 monozygotic and 366 dizygotic). The images were scored for lumbar degenerative change. Presence of SN was noted at cranial and caudal vertebral levels T9 to L5. Data on physical activity and back pain were collected by questionnaire. Heritability of SN was calculated using variance components modeling. RESULTS SN were found in 30% of subjects. Of the 374 SN, 153 (41%) were in the lumbar spine and 221 (59%) were in the thoracic spine. SN heritability was >70%. There was a positive association between SN and lumbar disc disease (LDD). SN were more frequent in subjects with back pain (for >/=2 SN: odds ratio [OR] 2.68, 95% confidence interval [95% CI] 1.11-6.47, P = 0.03), but this was largely accounted for by the association of SN with LDD (OR 1.97, 95% CI 0.78-5.0, P = 0.15 adjusted for LDD). No independent association of SN with back pain was identified. CONCLUSION SN are common in middle-aged women and are strongly genetically determined. They are associated with lumbar degenerative change, which is a risk factor for back pain, but are not themselves an independent risk factor for back pain.
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Affiliation(s)
- F M K Williams
- Twin Research and Genetic Epidemiology Unit, King's College London, St. Thomas' Campus, London, UK.
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Arun R, Mehdian SMH, Freeman BJC, Sithole J, Divjina SC. Do anterior interbody cages have a potential value in comparison to autogenous rib graft in the surgical management of Scheuermann's kyphosis? Spine J 2006; 6:413-20. [PMID: 16825049 DOI: 10.1016/j.spinee.2005.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Revised: 09/06/2005] [Accepted: 10/27/2005] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies have analyzed the outcome following posterior correction and combined anterior-posterior correction for Scheuermann's kyphosis. Traditionally interbody fusion has been obtained using morselized rib graft. Recently the use of titanium anterior cages has been suggested for interbody use. There are no long-term studies comparing these two techniques. PURPOSE To investigate the potential value of titanium anterior interbody cages compared with morselized rib graft for anterior interbody fusion in combination with posterior instrumentation, correction, and fusion for Scheuermann's kyphosis. STUDY DESIGN Nonrandomized comparison of two surgical techniques in matched subjects. PATIENT SAMPLE Fifteen patients with identical preoperative radiographic and physical variables (age, gender, height, weight, body mass index) were managed with combined anterior release, interbody fusion, posterior instrumentation, correction, and fusion. Group A (n=8) had morselized rib graft inserted into each intervertebral disc space. Group B (n=7) had titanium interbody cages packed with bone graft inserted at each level. The posterior instrumentation extended from T2 to L2 in both groups. OUTCOME MEASURES Preoperative and postoperative curve morphometry was studied on plain radiographs by two independent observers. The indices studied included Cobb angle, Ferguson's angle, Voutsinas index, sagittal vertical axis (SVA), sacral inclination (SI), and lumbar lordosis (LL). Interbody fusion was assessed at final follow-up. Each patient was reviewed at 3, 6, 12, 24, 48, and 60 months after surgery with standing radiographs. METHODS Both surgical groups were compared in terms of radiological parameters and complications. Wilcoxon-matched pairs test and Mann-Whitney test were used. RESULTS The average follow-up for Group A was 70 months and for Group B 66 months. For the whole group, the preoperative median Cobb angle for thoracic kyphosis was 86 degrees , the median Ferguson angle was 50 degrees , Voutsinas index was 28.7, SVA -3.5 centimeters, lumbar lordosis was 66 degrees , and the median sacral inclination angle was 40 degrees . The median postoperative Cobb angle was 42 degrees , Ferguson angle 28.4 degrees , Voutsinas index 13, SVA -4.0 centimeters, and the median sacral inclination angle was 34 degrees . There were significant differences between preoperative and postoperative measurements for all variables (p<.01), indicating that good correction was achieved. At 4-year follow-up, fusion criteria were satisfied in 12 of 15 cases (80%). Three patients had distal junctional kyphosis. There was no significant difference obtained in the final Cobb angle, Ferguson angle, and Voutsinas index when Group A (rib graft) was compared with Group B (titanium cage) Both Group A and B patients retained the postoperative correction achieved with respect to all the radiographic parameters studied. CONCLUSION We were unable to demonstrate any significant advantage for the use of anterior titanium interbody cages over the use of morselized rib graft in the surgical management of Scheuermann's kyphosis. Given the not inconsiderable cost and the need for posterior chevron osteotomies when interbody cages are used, we have now reverted to our previous practice of using morselized rib graft at each intervertebral level.
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Affiliation(s)
- R Arun
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospital, Nottingham NG7 2UH, United Kingdom.
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Jansen RC, van Rhijn LW, van Ooij A. Predictable correction of the unfused lumbar lordosis after thoracic correction and fusion in Scheuermann kyphosis. Spine (Phila Pa 1976) 2006; 31:1227-31. [PMID: 16688036 DOI: 10.1097/01.brs.0000217682.53629.ad] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective examination of preoperative and postoperative radiographs of the sagittal spine of 30 patients with Scheuermann kyphosis. OBJECTIVES To determine significant correlations between kyphosis and lordosis in Scheuermann kyphosis, determine predictability of spontaneous sagittal lordosis correction after thoracic correction and fusion, and understand better the biomechanics of the spine. SUMMARY OF BACKGROUND DATA Previous studies described relations between kyphosis and lordosis in healthy people. To our knowledge, no relationships, have been described between kyphosis and lordosis in Scheuermann kyphosis. METHODS On radiographs, maximum kyphosis, maximum lordosis, sacral slope and L5-S1 angle were measured in the preoperative and postoperative standing lateral radiographs of the spine, and correlations were calculated. RESULTS Preoperative significant correlations were present between kyphosis and lordosis (R = 0.421; P = 0.021), and between lordosis and sacral slope (R = 0.824; P < 0001). Postoperative correlations were stronger (R = 0.591; P = 0.001 and R = 0.844; P < 0.001). The percentage of correction of kyphosis was correlated with the percentage of spontaneous decrease of lordosis (R = 0.593; P < 0.001). A negative correlation between L5-S1 angle and upper lumbar segment of lordosis was found before and after surgery. CONCLUSIONS This study shows a significant correlation between kyphosis and lordosis before and after surgery. Surgical correction of thoracic hyperkyphosis gives a predictable spontaneous decrease of lumbar lordosis. Correction of lordosis occurs mainly in the upper segment of lumbar lordosis.
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Affiliation(s)
- Rob C Jansen
- Department of Orthopedic Surgery, University Hospital Maastricht, Maastricht, The Netherlands
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van Loon PJM, Raissadat K, van Loon CJM, van Susante JLC. Transient kyphotic deformity of the thoracolumbar junction resulting from a large abdominal cyst: a case report. Spine J 2005; 5:329-31. [PMID: 15863088 DOI: 10.1016/j.spinee.2004.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2004] [Accepted: 09/08/2004] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Pronounced kyphosis of the thoracolumbar junction is a common orthopedic problem in adolescents and may require prolonged bracing therapy or correction spondylodesis. PURPOSE To describe a case where a kyphotic deformity was related to gynecological instead of spine pathology. STUDY DESIGN Case report. METHODS A 17-year-old girl presented with a structural hyperkyphosis of the thoracolumbar spine and radiographic changes of the involved vertebral end plates. RESULTS The thoracolumbar hyperkyphosis appeared to have evolved from a massive intra-abdominal ovarian cyst. Endoscopic paracentesis of the cyst resulted in a complete regression of the hyperkyphosis. CONCLUSIONS A hyperkyphosis is not always related to spine pathology, and other potential causes must be excluded before bracing therapy is initiated.
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Affiliation(s)
- Piet J M van Loon
- Department of Orthopedics, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, The Netherlands
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Arlet V, Schlenzka D. Scheuermann’s kyphosis: surgical management. 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 2005; 14:817-27. [PMID: 15830215 DOI: 10.1007/s00586-004-0750-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2004] [Accepted: 05/08/2004] [Indexed: 10/25/2022]
Abstract
Indications for surgery in Scheuermann disease are not well codified and remain rare, as the natural history of the disease is in most cases benign. In the immature adolescent, conservative treatment, such as bracing or casting, can be tried for moderate curves. For larger curves, or in the adult, conservative treatment is usually not effective, and surgery can be considered. Such indications are mostly cosmetic for large curves above 75 degrees. Pain over the deformity or in the low back may represent another surgical indication, especially in the adult group. The question of anterior release or straight posterior fusion has become more of an actuality with the advent of powerful, third-generation stiff segmental instrumentation. However, the long-term results of a modern, posterior-only instrumentation fusion are not known. Concern about loss of correction, late pseudarthrosis or the need to remove instrumentation for infected hardware or due to late pain at the operative site must make us careful about choosing this method. Very rigid and large curves still require an anterior release, either done in a conventional or mini-open fashion, or through video-assisted thoracoscopic surgery. The extent of the posterior instrumentation has now been better defined. One must fuse the whole Cobb angle without hypercorrection and stop distally, above the first lordotic disc, to avoid sagittal decompensation. New approaches such as short anterior fusion with bone-on-bone techniques and pedicle substraction osteotomies have not yet been reported in the literature as having been used for treating Scheuermann's kyphosis. These should be considered experimental.
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Affiliation(s)
- Vincent Arlet
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908, USA.
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Abstract
Athletes younger than 12 years of age commonly have pathology related to the lower back pain. Spondylolysis is the most common condition in these athletes. Other conditions, including lumbar Scheuermann's disease,scoliosis, disc herniation, fractures, and muscular stains, can occur. Most of the mature general population experiences low back at some time in life. Athletes may be at increased risk, but outcomes are good. The majority of low back pain in mature athletes is mechanical in nature. Herniated discs,spinal stenosis, sacoilitis, and sacral stress fractures can also cause low back pain in these athletes. Low back conditions mentioned above may be treated with rest, specific exercise programs, and medication. Surgery is indicated for severe spinal stenosis, pain with evidence of neurological compromise,and some painful deformities. Newer treatments for back pain are emerging,but few controlled clinical trials are available.
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Affiliation(s)
- Robert J Baker
- WMU Bronco Athletics, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI 49008, USA.
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Affiliation(s)
- Amy O Bowles
- Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900, USA
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Karppinen J, Pääkkö E, Paassilta P, Lohiniva J, Kurunlahti M, Tervonen O, Nieminen P, Göring HHH, Malmivaara A, Vanharanta H, Ala-Kokko L. Radiologic phenotypes in lumbar MR imaging for a gene defect in the COL9A3 gene of type IX collagen. Radiology 2003; 227:143-8. [PMID: 12601188 DOI: 10.1148/radiol.2271011821] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate whether the COL9A3 tryptophan allele (Trp3 allele) is associated with a specific radiologic phenotype among patients with sciatica. MATERIALS AND METHODS One hundred fifty-three patients with sciatica were evaluated for the presence of Trp3 allele, Scheuermann disease, intervertebral disk degeneration, Schmorl nodules, dorsal anular tears, hyperintense lesions, and endplate degeneration on sagittal T2-weighted lumbar magnetic resonance images. The Trp3 genotype was determined by means of sequencing the COL9A3 gene. Radiologic phenotypes were evaluated while blinded to the genotype. Scheuermann disease was diagnosed if either endplate irregularities or Schmorl nodules and two of the other three criteria (disk space narrowing, disk dehydration, and wedging of anterior vertebral body margins) were present at three or more adjacent disk levels from T10-11 to L3-4. Disk degeneration was evaluated separately for each disk (T11-12 to L5-S1) and for all disks combined. Frequencies of radiologic phenotypes between individuals with or without Trp3 allele were compared. RESULTS Thirty-four patients had at least one Trp3 allele. When compared with the matched control subjects, they had an increased likelihood of Scheuermann disease (P =.035) and an increased number of degenerated disks from T11 to S1 (P =.021). Comparisons at individual disks showed a statistically significant increase in disk degeneration at T11-12 (analysis of all grades of degeneration [graded], P =.018; analysis of any degeneration vs none [dichotomous], P =.039) and L4-5 (graded, P =.011; dichotomous, P =.016). Prevalences of anular tears, endplate degeneration, Schmorl nodules, and hyperintense lesions were comparable. CONCLUSION The results of this study indicate that the presence of Trp3 allele is associated with Scheuermann disease and intervertebral disk degeneration. No associations were found for other radiologic phenotypes.
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Affiliation(s)
- Jaro Karppinen
- Department of Physical Medicine and Rehabilitation, University Hospital of Oulu, PL 25, FIN-90029 Oulu, Finland.
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Priftis KN, Hager J, Vlachou M, Anthracopoulos MB. Effects of bracing on lung function in idiopathic juvenile kyphosis. Pediatr Pulmonol 2003; 35:83-6. [PMID: 12526067 DOI: 10.1002/ppul.10220] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although considerable information is available on the effects of bracing on lung function in kyphoscoliosis, there is a paucity of data on idiopathic juvenile kyphosis (IJK). The present study was designed to investigate the immediate effect of bracing on lung function in children and adolescents with mild-to-moderate IJK. Spirometry, measurement of lung volumes, and arterial oxyhemoglobin saturation (SaO(2)) were performed in 24 patients, 9-17 years of age, who were treated with a corrective brace for mild-to-moderate IJK (Cobb angle, 46-75 degrees ). Children were studied when braced and unbraced. When children were unbraced, mean percent predicted values (+/-standard deviation) for total lung capacity (TLC), vital capacity (VC), functional residual capacity (FRC), and forced expiratory volume in 1 sec (FEV(1)) were 100.0% (+/-13.0%), 92.7% (+/-14.2%), 108.2% (+/-20.4%), and 95.0% (+/-16.3%), respectively. With the brace on, significant reductions occurred in all lung function measurements: TLC decreased by 9.5% (P < 0.001), VC by 9.3% (P = 0.001), FRC by 14.2% (P = 0.005), and FEV(1) by 8.9% (P = 0.009). SaO(2) decreased from 96.2% (+/-1.6%) to 95.2% (+/-1.4%) (P = 0.027). An inverse relationship was observed between pre- and postbracing change in TLC and Cobb angle children (P = 0.021). Our findings indicate that corrective bracing in mild-to-moderate IJK results in mild lung restriction and a clinically insignificant drop in SaO(2). The effect of bracing on TLC decreases as the severity of kyphosis increases in these patients.
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Affiliation(s)
- Kostas N Priftis
- Department of Allergy-Pulmonology, Penteli Children's Hospital, Athens, Greece.
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Stotts AK, Smith JT, Santora SD, Roach JW, D'Astous JL. Measurement of spinal kyphosis: implications for the management of Scheuermann's kyphosis. Spine (Phila Pa 1976) 2002; 27:2143-6. [PMID: 12394929 DOI: 10.1097/00007632-200210010-00013] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Repeat clinical radiograph measurement of kyphosis was performed. OBJECTIVES To evaluate precision in kyphosis measurement, the presence of intra- and interobserver error, and the effect of endplate selection and curve magnitude on error. SUMMARY OF BACKGROUND DATA One study thus far has shown no interobserver difference in readings and an error interval of +/-11 degrees. METHODS Four experienced examiners measured 30 radiographs of varying angles of kyphosis without preselected end vertebrae twice using the Cobb method. RESULTS The mean intraobserver variance was 4.3 degrees (95% confidence interval, +/-9.6 degrees). One examiner had significantly better precision (P= 0.02) than the other examiners, who had no significant difference among them (P = 0.41). This examiner's mean intraobserver difference was 2.3 degrees (95% confidence limit, +/-6.2 degrees ). The 95% confidence limit for the interobserver difference was +/-8.7 degrees. The vertebral error index did not have a rank correlation with precision between readings. Magnitude of curve did not correlate with variance in measurement. CONCLUSIONS The broad range in intra- and interobserver differences in the measurement of kyphosis should be taken into account in making management decisions or evaluating the success or failure of a treatment program. Careful technique in measurement may allow for improvement in individual precision.
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Affiliation(s)
- Alan K Stotts
- University of Utah School of Medicine, Salt Lake City, Utah, USA.
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Axenovich TI, Zaidman AM, Zorkoltseva IV, Kalashnikova EV, Borodin PM. Segregation analysis of Scheuermann disease in ninety families from Siberia. AMERICAN JOURNAL OF MEDICAL GENETICS 2001; 100:275-9. [PMID: 11343318 DOI: 10.1002/ajmg.1290] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Scheuermann disease [OMIM number 181440] is the most common cause of structural kyphosis in adolescence. Segregation analysis using a model with gender effects was applied to 90 pedigrees from Barnaul (West Siberia, Russia) ascertained through a proband with Scheuermann disease. The transmission probability model was used to detect major gene effect. A significant contribution of a major gene to the control of the pathology was established. Inheritance of the disease can be described within the framework of a dominant major gene diallele model. According to this model, Scheuermann disease should never occur in the absence of the mutant allele. All male carriers of the mutant allele develop the disease, while only a half of female carriers manifest it. We found a high frequency of idiopathic scoliosis in the families with Scheuermann disease (0.08 vs. 0.01-0.02 in general population). We also observed a succession of idiopathic scoliosis and Scheuermann disease in consecutive generations. The familial aggregation of these two spinal pathologies in the present sample may indicate a genetic unity of Scheuermann disease and idiopathic scoliosis.
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Affiliation(s)
- T I Axenovich
- Department of Recombination and Segregation Analysis, Institute of Cytology and Genetics, Russian Academy of Science, Novosibirsk, Russia.
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