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De Marco R, Nasto LA, Strangio A, Piatelli G, Pavanello M. Surgical limits, pitfalls, and potential solutions in kyphectomy in myelomeningocele: three cases and systematic review of the literature. Childs Nerv Syst 2024; 40:1541-1569. [PMID: 38459148 DOI: 10.1007/s00381-024-06341-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES To describe surgical treatment of 3 cases of severe and progressive thoracolumbar kyphosis in myelomeningocele and provide a systematic review of the available literature on the topic. METHODS Medical records and pre- and post-operative imaging of 3 patients with thoracolumbar kyphosis and myelomeningocele were reviewed. A database search was performed for all manuscripts published on kyphectomy and/or surgical treatment of kyphosis in myelomeningocele. Patients' information, preoperative kyphosis angle, type of surgery, levels of surgery degrees of correction after surgery and at follow-up, and complications were reviewed for the included studies. RESULTS Three cases underwent posterior vertebral column resection (pVCR) of 2-4 segments at the apex of the kyphosis (kyphectomy). Long instrumentation was performed with all pedicle screws constructed from the thoracic spine to the pelvis using iliac screws. According to literature review, a total of 586 children were treated for vertebral kyphosis related to myelomeningocele. At least one vertebra was excised to gain some degree of correction of the deformity. Different types of instrumentation were used over time and none of them demonstrated to be superior over the other. CONCLUSION Surgical treatment of progressive kyphosis in myelomeningocele has evolved over the years incorporating all major advances in spinal instrumentation techniques. Certainly, the best results in terms of preservation of correction after surgery and less revision rates were obtained with long construct and screws. However, complication rate remains high with skin problems being the most common complication. The use of low-profile instrumentation remains critical for treatment of these patients.
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Affiliation(s)
- Raffaele De Marco
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10124, Turin, Italy.
| | - Luigi Aurelio Nasto
- Department of Orthopaedics, Azienda Ospedaliera Universitaria "Luigi Vanvitelli", Università degli Studi della Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Antonio Strangio
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10124, Turin, Italy
| | - Gianluca Piatelli
- Department of Neurosurgery, IRCCS Istituto "G. Gaslini", 16148, Genoa, Italy
| | - Marco Pavanello
- Department of Neurosurgery, IRCCS Istituto "G. Gaslini", 16148, Genoa, Italy
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Johari AN, Nemade A, Dhawale A, Wadia F, Shah M. Spinal dysraphism in congenital scoliosis and kyphosis: a retrospective analysis in an Indian population. Int Orthop 2024:10.1007/s00264-024-06156-x. [PMID: 38581468 DOI: 10.1007/s00264-024-06156-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/19/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE Early recognition is crucial for occult spinal dysraphism associated with congenital spinal deformities. There is limited literature available on its occurrence in congenital scoliosis and kyphosis in the Indian population. METHODS Our study involved a retrospective review of 247 children who presented at a single centre. We analyzed their demographics and clinical and radiological findings, which included the type of deformity, its location, vertebral anomaly, Cobb angle, and MRI findings. The deformities were categorized as congenital scoliosis or congenital kyphosis with failure of formation, failure of segmentation, or both. RESULTS A total of 247 cases were examined (congenital scoliosis-229, congenital kyphosis-18). The average age was seven years (range 0.8 to 19 years, SD 4.6). The mean Cobb angle at presentation in the congenital scoliosis group was 49.4° (range 8 to 145°, SD 23.77) for those with abnormal MRI and 42.45° (range 5 to 97°, SD 20.09) for those with normal MRI. For the congenital kyphosis group, the mean K angle at presentation was 47.7° (range 14 to 110°, SD 33.33) for those with abnormal MRI and 47.36° (range 15 to 70°, SD 16.63) for those with normal MRI. Abnormal MRI results were observed in 130 of the patients (congenital scoliosis-53.7%, congenital kyphosis-38.8%). The highest incidence of abnormal MRI findings was observed in the failure of segmentation (66.6%) and mixed (65%) types. Deformities in the dorsal region had the highest incidence (61.9%). The most common dysraphism instances were diastematomyelia and tethered cord. There was a significant correlation between type of deformity and presence of dysraphism. CONCLUSION This is the largest case series of congenital scoliosis and kyphosis reported from India. We found a high incidence of occult spinal dysraphism as compared to other published series. Occult spinal dysraphism is more common in the thoracic region. Diastematomyelia followed by tethered cord was the most common anomaly observed. We recommend MRI screening of whole spine and craniovertebral junction.
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Affiliation(s)
| | - Amit Nemade
- Department of Orthopedics, N K P Salve Institute of Medical Sciences & Research Centre, Nagpur, India
| | - Arjun Dhawale
- Department of Orthopaedics, Sir H N Reliance Foundation Hospital and B.J. Wadia Hospital for Children, Mumbai, India.
| | - Farokh Wadia
- Southampton Children's Hospital, Southampton, UK
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Chokshi SN, Mudiganty S, Clement RC, Accousti W. Vitamin D deficiency in Scheuermann's disease is associated with increased adverse outcomes. SICOT J 2024; 10:13. [PMID: 38568088 PMCID: PMC10989516 DOI: 10.1051/sicotj/2024010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Scheuermann's disease is a diagnosis of hyperkyphosis commonly encountered in pediatric patients. Studies in animal models suggest an association with vitamin D deficiency, however, extensive studies have not been performed in humans. This study analyzes the role of vitamin D deficiency on unfavorable results in patients with Scheuermann's disease. METHODS The TriNetX database was utilized to perform a retrospective analysis. Patients in the United States aged 0-18 years with Scheuermann's disease were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes and categorized into those with and without a diagnosis of vitamin D deficiency. Comparison of patient groups depending on age, sex, ethnic origin, prior diagnosis of fibromyalgia, anxiety disorder, myositis, and major depressive disorder. Statistical analysis was conducted to identify the association between vitamin D levels and unfavorable results including pain, depression, suicide attempt, emergency department (ED) consult, hospitalization, and procedures on the spine or spinal cord. RESULTS In total, 11,277 patients were identified, 39% of whom had a concurrent diagnosis of scoliosis. A total of 1,024 (9.08%) were deficient in vitamin D. Patients with vitamin D deficiency had greater odds of pain (P < 0.0001), depression (P < 0.0001), suicide attempt (P = 0.0021), ED visits (P = 0.0246), and hospital admission (P < 0.0015). Conversely, patients with vitamin D deficiency had decreased odds of surgery on the spine or spinal cord (P = 0.0009). CONCLUSION Vitamin D deficiency is associated with an elevated risk of pain, depression, suicide attempts, ED visits, and hospitalization. Our analysis highlights the need for more research to study the effect of vitamin D on Scheuermann's disease. LEVEL OF EVIDENCE Level III, Prognostic.
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Affiliation(s)
- Shivan N. Chokshi
- John Sealy School of Medicine 301 University Blvd, The University of Texas Medical Branch Galveston TX 77555 USA
| | - Srikanth Mudiganty
- Department of Orthopaedic Surgery, Louisiana State University New Orleans LA 70112 USA
| | | | - William Accousti
- Department of Orthopaedic Surgery, Louisiana State University New Orleans LA 70112 USA
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Lainé G, Mezjan I, Masson D, Civit T, Mansouri N. Risk factors for kyphosis recurrence after implant removal in percutaneous osteosynthesis for post-traumatic thoracolumbar fracture. Eur Spine J 2024; 33:1597-1606. [PMID: 37606724 DOI: 10.1007/s00586-023-07895-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/07/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Short-segment minimally invasive percutaneous spinal osteosynthesis has now become one of the treatments of choice to treat thoracolumbar fractures. The question of implant removal once the fracture has healed is still a matter of debate since this procedure can be associated with loss of sagittal correction. Therefore, we analyzed risk factors for kyphosis recurrence after spinal implants removal in patients treated with short-segment minimally invasive percutaneous spinal instrumentation for a thoracolumbar fracture. METHODS A total of 32 patients who underwent implant removal in percutaneous osteosynthesis for post-traumatic thoracolumbar fracture were enrolled in our study. Patient's medical record, operative report and imaging examinations carried out at the trauma and during the follow-up were analyzed. RESULTS Every patient experienced fracture union. Vertebral kyphotic angle (VKA) and Cobb angle (CA) improved significantly after stabilization surgery. VKA, CA, upper disk kyphotic angle (UDKA) and lower disk kyphotic angle (LDKA) significantly gradually decreased during follow-up. Traumatic disk injury (p: 0.001), younger age (p: 0.01), canal compromise (p: 0.04) and importance of surgical correction (p < 0.001) were significantly associated with kyphosis recurrence after implant removal. Anterior body augmentation did not affect loss of correction (CA and VKA) during the follow-up period (p: 0.57). CONCLUSION Despite correction of the fracture after stabilization, we observed a progressive loss of correction over time appearing even before implant removal. Particular attention should be paid to post-traumatic disk damage or canal invasion, to young patients and to surgical overcorrection of the traumatic kyphosis.
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Affiliation(s)
- G Lainé
- Department of Neurosurgery, Polyclinique Pau Pyrénées, 8 Boulevard Hauterive, 64000, Pau, France.
| | - I Mezjan
- Department of Neurosurgery, Hopital Central, Centre Hospitalier Région Universitaire de Nancy, 29 Avenue Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - D Masson
- Department of Neurosurgery, Hopital Central, Centre Hospitalier Région Universitaire de Nancy, 29 Avenue Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - T Civit
- Department of Neurosurgery, Hopital Central, Centre Hospitalier Région Universitaire de Nancy, 29 Avenue Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - N Mansouri
- Department of Neurosurgery, Hopital Central, Centre Hospitalier Région Universitaire de Nancy, 29 Avenue Maréchal de Lattre de Tassigny, 54000, Nancy, France
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Song KS, Yoon BI, Ham DW. Transpedicular Intravertebral Cage Augmentation Using Expandable Cage in Kummell Disease: Technical Note and Case Series. World Neurosurg 2024; 184:119-124. [PMID: 38266993 DOI: 10.1016/j.wneu.2024.01.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To demonstrate the surgical techniques for transpedicular intravertebral cage augmentation (TPICA) using an expandable cage for Kummell disease, which requires posterior surgical stabilization, and provide the preliminary surgical outcomes. METHODS Six consecutive patients undergoing TPICA surgery using an expandable cage with a minimum 6-month follow-up were evaluated. Radiographic analysis to evaluate the local kyphosis angle, restoration ratio of anterior vertebral height of the index vertebra, and clinical outcomes including the Oswestry Disability Index, EuroQol 5-dimension instrument, and visual analog scale for back and leg pain, were compared between the preoperative and final follow-ups. RESULTS All patients showed improvements in all clinical outcomes and were able to walk independently without support at the last follow-up. In radiographic evaluation, the mean preoperative restoration ratio of anterior vertebral height was 41.2 ± 15.6%, which increased postoperatively to 70.3 ± 20.5% (1.70 times) and 62.4 ± 20.0% at the last follow-up (1.51 times). The mean preoperative local kyphosis angle was 10.5 ± 14.8 and was corrected to 6.0 ± 10.0 at the last follow-up. A slight loss of correction was observed between the postoperative period and the last follow-up; however, there was no clinical significance. CONCLUSIONS Expandable cages in TPICA may allow easier surgical manipulation for cage insertion around the pedicle entrance, minimizing damage to the fractured vertebral body's end plates while achieving satisfactory height restoration compared to static cages, and may also provide wider indications for TPICA surgery.
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Affiliation(s)
- Kwang-Sup Song
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
| | - Byung-Il Yoon
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Dae-Woong Ham
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
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Javadi SAH, Eraghi MM, Iranmehr A, Khan ZH, Rahimizadeh A. Surgical management of idiopathic acute cervical kyphosis; A case-based review of an extremely rare entity. Int J Surg Case Rep 2024; 117:109391. [PMID: 38518468 PMCID: PMC10972822 DOI: 10.1016/j.ijscr.2024.109391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Acute idiopathic cervical kyphosis (AICK) represents a rare entity, and its management remains controversial. Preoperative surgical planning and individual decision-making seem necessary. To date, there is a lack of sufficient evidence and clear guidelines. CASE PRESENTATION A 21-year-old male was referred with a progressive cervical deformity detected 3 months earlier. The patient suffered from severe progressive myelopathy and represented neither neck trauma nor a familial history of similar expected conditions. His cervical imaging revealed 95 degrees of cervical kyphosis. After 3 separate surgical sessions for 360-degree fixation, the cervical kyphosis was reduced by 90 degrees. No facet dislocation was observed, and laminectomy was unnecessary. Post-operative neurological examination detected significant improvement. Six months and 2-year follow-ups were favorable. To the authors' knowledge, the current case had the most extensive degree of cervical kyphosis reported in the literature. CLINICAL DISCUSSION Multistage correction of AICK would result in a favorable outcome and reduce the risk of complications. Particular attention should be paid to the wide inter-spinous spaces in high grades of kyphosis during sub-periosteal dissection to prevent iatrogenic spinal cord injuries. CONCLUSION The present work may provide the first report on the role of cervical postural habits in patients with opiate substance abuse disorder, which could have triggered cervical kyphosis in this particular patient. Multistage correction of AICK would result in a favorable outcome and reduce the risk of complications.
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Affiliation(s)
- Seyed Amir H Javadi
- Department of Neurosurgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Mirahmadi Eraghi
- Department of Neurosurgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Student Research Committee, School of Medicine, Islamic Azad University, Qeshm International Branch, Qeshm, Iran; School of Medicine, Qeshm International Branch, Islamic Azad University, Qeshm, Iran
| | - Arad Iranmehr
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahid Hussain Khan
- Department of Anesthesiology and Critical Care, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Rahimizadeh
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
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Alfawareh MD, Alelaumi AE, Soualmi LA, Wafa MA. Pediatric Cervical Kyphosis: A Retrospective Multicenter Analysis and Literature Review. Spine Surg Relat Res 2024; 8:155-162. [PMID: 38618218 PMCID: PMC11007246 DOI: 10.22603/ssrr.2023-0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/04/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction This study aims to investigate cervical kyphosis in children, which has gained increasing attention in recent years due to its higher incidence and its association with tumor surgeries, and to shed light on the unique anatomical and biomechanical differences between pediatric and adult populations regarding cervical sagittal alignment. Additionally, it explores the diverse causes and management approaches, which often pose significant challenges. Furthermore, this study presents the management outcomes from three spine centers in the Middle East. Methods A retrospective analysis was conducted on patient records from 2009 to 2021 in three centers located in Saudi Arabia, Egypt, and Jordan. Demographic and clinical data were collected, imaging studies were reviewed, and various treatment modalities and their corresponding outcomes were documented and analyzed. Additionally, a literature review on pediatric cervical kyphosis and its management was performed. Results Seventeen patients were included in this study. The average age at presentation was 11.9 years. Among the participants, 14 underwent surgical treatment, 1 was treated with Minerva orthosis, and 2 were observed. The mean follow-up period was 32.4 months. In surgically treated patients, a statistically significant higher degree of correction was achieved when combining anterior and posterior surgeries compared to performing standalone anterior or posterior surgery (P-value = 0.014). Conclusions Although rare, pediatric cervical kyphosis is a significant condition within the spectrum of pediatric deformities and frequently occurs as a component of syndromes or as a result of iatrogenic factors. Neck pain and myelopathy are the most commonly observed symptoms. Thorough evaluation and complex surgical interventions are typically required for most cases.
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Affiliation(s)
- Mohammad D Alfawareh
- Department of Orthopedics and Spine Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Ahmad E Alelaumi
- Department of Orthopedics and Spine Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Lahbib A Soualmi
- Neuronavigation & Intraoperative Surgical Imaging Unit, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohamed A Wafa
- Department of Orthopedics and Spine Surgery, Ain Shams University, Cairo, Egypt
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Wang D, Zhang BH, Wen X, Chen KH, Xiao HT, Xu XW, Li QF. Clinical features and surgical treatments of scoliosis in neurofibromatosis type 1: a systemic review and meta-analysis. Eur Spine J 2024:10.1007/s00586-024-08194-w. [PMID: 38526628 DOI: 10.1007/s00586-024-08194-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/29/2023] [Accepted: 02/13/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF 1) is an autosomal-dominant tumor predisposition genetic disease affecting approximately 1 in 3000 live births. The condition could present various manifestations ranging from skin abnormalities to neurological tumors. The musculoskeletal system could also be frequently affected, and scoliosis is the most common orthopedic manifestation. Characterized by the early-onset and rapid progression tendency, NF 1-related dystrophic scoliosis presented discrepancies from idiopathic scoliosis in terms of natural history, clinical features, and management outcomes and thus required special attention. In the current study, the authors conducted a systemic review to outline the body of evidence of the natural history, clinical characteristics, surgical outcomes, and surgical complications of NF 1-induced scoliosis, aiming to provide an elucidative insight into this condition. METHOD Systemic review and meta-analysis were conducted according to the latest Preferred Reporting Items for Systematic Reviews Meta-Analyses (PRISMA) guidelines. The search was performed in Medline, Embase, and Web of Science Core Collection up to December 27, 2022, using related keywords. Clinical features such as frequencies, segmental involvement, and hereditary information were summarized and described qualitatively. Meta-analysis was conducted using R software and the 'meta' package to yield an overall outcome of efficacy and safety of surgical management, precisely, spinal fusion procedure and growing rods procedure. Corrective rate of Cobb angle, sagittal kyphosis angle, and T1-S1 length post-operative and at the last follow-up was used to evaluate the efficacy, and the occurrence of surgery-related complications was used to evaluate the safety. RESULT A total of 37 articles involving 1023 patients were included. Approximately 26.6% of the NF 1 patients would present with scoliosis. Patients tend to develop scoliosis at an earlier age. The thoracic part turned out to be the most affected segment. No obvious correlation between scoliosis and genotype or hereditary type was observed. Both spinal fusion and growing rod surgery have shown acceptable treatment outcomes, with spinal fusion demonstrating better performance in terms of effectiveness and safety. The growing rods technique seemed to allow a better lengthening of the spine. The mainstay post-operative complications were implant-related complications but could be managed with limited revision surgery. Severe neurological deficits were rarely reported. CONCLUSION Scoliosis, especially the subtype characterized by dystrophic bony changes, is a significant orthopedic manifestation of NF1. It has an early onset, a tendency to persistently and rapidly progress, and is challenging to deal with. The current review outlines the available evidence from the perspective of natural history, clinical features, and the treatment efficacy and safety of the mainstay surgical options. Patients with NF1 scoliosis will benefit from a better understanding of the disease and evidence based treatment strategies.
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Affiliation(s)
- Dun Wang
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Sichuan University School of Medicine, No. 37 Wainan Guoxue Road, Chengdu, 610041, China
| | - Bo-Han Zhang
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Sichuan University School of Medicine, No. 37 Wainan Guoxue Road, Chengdu, 610041, China
| | - Xue Wen
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Sichuan University School of Medicine, No. 37 Wainan Guoxue Road, Chengdu, 610041, China
| | - Kun-Hao Chen
- Department of Orthopedic Surgery, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, 610041, China
| | - Hai-Tao Xiao
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Sichuan University School of Medicine, No. 37 Wainan Guoxue Road, Chengdu, 610041, China
| | - Xue-Wen Xu
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Sichuan University School of Medicine, No. 37 Wainan Guoxue Road, Chengdu, 610041, China.
| | - Qing-Feng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
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Eftekhari E, Sheikhhoseini R, Salahzadeh Z, Dadfar M. Effects of telerehabilitation-based respiratory and corrective exercises among the elderly with thoracic hyper- kyphosis: a clinical trial. BMC Geriatr 2024; 24:234. [PMID: 38448857 PMCID: PMC10918978 DOI: 10.1186/s12877-024-04779-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Aging is associated with changes in the musculoskeletal system, including increased susceptibility to spine malalignments. Utilizing corrective exercises with a therapeutic emphasis can be beneficial in the elderly with thoracic spine hyperkyphosis. OBJECTIVE This study aimed to investigate the effects of six weeks of telerehabilitation-based respiratory and corrective exercises on quality of life, disability, thoracic kyphosis, craniovertebral angle, shoulder angle, cranial angle, and chest expansion in the elderly with thoracic spine hyperkyphosis. METHODS In this clinical trial, a total of 40 participants aged 60 and above with thoracic hyperkyphosis were randomly divided into the control (N = 20) and experimental (N = 20) groups. The experimental group performed the corrective exercises for six weeks (3 sessions per week). The control group performed general stretching exercises during the same time period. We measured the outcomes of quality of life, disability, thoracic kyphosis, craniovertebral angle, shoulder angle, cranial angle, and lung expansion before and after the intervention. Analysis of covariance (ANCOVA) was employed to analyze the data. A P-value ≤ 0.05 was considered statistically significant. RESULTS Quality of life (P < 0.001, Effect Size (ES): 0.44), chest expansion (P < 0.001, ES: 0.56), thoracic kyphosis angle (P < 0.001, ES: 0.31), craniovertebral (P < 0.001, ES: 0.33), cranial (P < 0.001, ES: 0.38), and shoulder (P = 0.005, ES: 0.20) angles were significantly improved in the experimental group as compared with controls. However, no statistically significant difference was observed between the two groups in terms of physical ability (P = 0.251, ES: 0.04). CONCLUSION It is therefore recommended that online corrective exercises be used in the rehabilitation protocol to improve the quality of life, posture, chest expansion, and disability in the elderly with thoracic kyphosis.
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Affiliation(s)
- Elham Eftekhari
- Department of Corrective Exercise & Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Rahman Sheikhhoseini
- Department of Corrective Exercise & Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Western Azadi Sport Complex Boulevard, Hakim Highway, Tehran, Iran.
| | - Zahra Salahzadeh
- Department of Physiotherapy, Faculty of Rehabilitation Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdis Dadfar
- Department of Human Health and Performance, Faculty of Kinesiology, University of Houston, Houston, TX, USA
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Domenech P, Mariscal G, Marquina V, Bas P, Bas T. Efficacy and safety of halo-gravity traction in the treatment of spinal deformities: A systematic review of the literature. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:159-167. [PMID: 37230411 DOI: 10.1016/j.recot.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To determine, through a systematic review, the effects of halo gravity traction in spinal deformity. METHODS Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial halo gravity traction (HGT) were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected. RESULTS Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases). CONCLUSIONS Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies.
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Affiliation(s)
- P Domenech
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - G Mariscal
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain.
| | - V Marquina
- Department of Orthopedic Surgery and Traumatology, Valencia General University Hospital, Valencia, Spain
| | - P Bas
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - T Bas
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Wu C, Liu H, Zhong D, Yang X, Liao Z, Chen Y, Zhang S, Su D, Zhang B, Li C, Tian L, Xu C, Su P. Mapk7 deletion in chondrocytes causes vertebral defects by reducing MEF2C/PTEN/AKT signaling. Genes Dis 2024; 11:964-977. [PMID: 37692479 PMCID: PMC10491872 DOI: 10.1016/j.gendis.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/17/2023] [Accepted: 02/07/2023] [Indexed: 03/31/2023] Open
Abstract
Mutation of the MAPK7 gene was related to human scoliosis. Mapk7 regulated the development of limb bones and skulls in mice. However, the role of MAPK7 in vertebral development is still unclear. In this study, we constructed Col2a1-cre; Mapk7f/f transgenic mouse model to delete Mapk7 in cartilage, which displayed kyphosis and osteopenia. Mechanistically, Mapk7 loss decreased MEF2C expression and thus activated PTEN to oppose PI3K/AKT signaling in vertebral growth plate chondrocytes, which impaired chondrocyte hypertrophy and attenuated vertebral ossification. In vivo, systemic pharmacological activation of AKT rescued impaired chondrocyte hypertrophy and alleviated mouse vertebral defects caused by Mapk7 deficiency. Our study firstly clarified the mechanism by which MAPK7 was involved in vertebral development, which might contribute to understanding the pathology of spinal deformity and provide a basis for the treatment of developmental disorders of the spine.
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Affiliation(s)
- Chengzhi Wu
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Hengyu Liu
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Dongmei Zhong
- Precision Medicine Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Xiaoming Yang
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Zhiheng Liao
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Yuyu Chen
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Shun Zhang
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Deying Su
- Guangdong Provincial Key Laboratory of Proteomics and State Key Laboratory of Organ Failure Research, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Baolin Zhang
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Chuan Li
- Research Center for Translational Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Liru Tian
- Research Center for Translational Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Caixia Xu
- Research Center for Translational Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Peiqiang Su
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
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12
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Park D, Lee SH, Lee S, Park J, Yang HG, Kim C, Park JH. The Efficacy of Cervical Pedicle Screw Is Enhanced When Used With 5.5-mm Rods for Metastatic Cervical Spinal Tumor Surgery. Neurospine 2024; 21:352-360. [PMID: 38291748 PMCID: PMC10992656 DOI: 10.14245/ns.2346778.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/12/2023] [Accepted: 11/16/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE The cervical spine presents challenges in treating metastatic cervical spinal tumors (MCSTs). Although the efficacy of cervical pedicle screw placement (CPS) has been well established, its use in combination with 5.5-mm rods for MCST has not been reported. This study aimed to evaluate the efficacy of CPS combined with 5.5-mm rods in treating MCST and compare it with that of CPS combined with traditional 3.5-mm rods. METHODS This retrospective study analyzed 58 patients with MCST who underwent posterior cervical spinal fusion surgery by a single surgeon between March 2012 and December 2022. Data included demographics, surgical details, imaging results, numerical rating scale score for neck pain, Eastern Cooperative Oncology Group performance status, and Spine Oncology Study Group Outcomes Questionnaire responses. RESULTS Preoperative Spinal Instability Neoplastic Scores were significantly higher in the 5.5-mm rod group. Greater kyphotic changes in the index vertebra were observed in the 3.5-mm rod group. Neck pain reduction was significantly better in the 5.5-mm rod group. CONCLUSION CPS with 5.5-mm rods provides superior biomechanical stability and effectively resists forward bending momentum in posterior MCST fusion surgery. These findings support the use of 5.5-mm rods to enhance surgical outcomes.
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Affiliation(s)
- Danbi Park
- Department of Neurological Surgery, Asan Medical Center, Seoul, Korea
- College of Nursing, Korea University, Seoul, Korea
| | - Sang Hyub Lee
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Subum Lee
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jemin Park
- Department of Neurological Surgery, Asan Medical Center, Seoul, Korea
| | - Hyeon Gyu Yang
- Department of Neurological Surgery, Asan Medical Center, Seoul, Korea
| | - Chongman Kim
- Department of Industrial and Management Engineering, Myongji University, Seoul, Korea
| | - Jin Hoon Park
- Department of Neurological Surgery, Asan Medical Center, Seoul, Korea
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13
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Lv X, Nuertai Y, Wang Q, Zhang D, Hu X, Liu J, Zeng Z, Huang R, Huang Z, Zhao Q, Li W, Zhang Z, Gao L. Multilevel Pedicle Subtraction Osteotomy for Correction of Thoracolumbar Kyphosis in Ankylosing Spondylitis: Clinical Effect and Biomechanical Evaluation. Neurospine 2024; 21:231-243. [PMID: 38317554 PMCID: PMC10992630 DOI: 10.14245/ns.2347118.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/08/2023] [Accepted: 12/16/2023] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To compare the clinical outcomes and biomechanical characteristics of 1-, 2-, and 3-level pedicle subtraction osteotomy (PSO), and establish selection criteria based on preoperative radiographic parameters. METHODS Patients undergone PSO to treat ankylosing spondylitis from February 2009 to May 2019 in Sun Yat-sen Memorial Hospital of Sun Yat-sen University were enrolled. According to the quantity of osteotomy performed, the participants were divided into group A (1-level PSO, n = 24), group B (2-level PSO, n = 19), and group C (3-level PSO, n = 11). Clinical outcomes were assessed before surgery and at the final follow-up. Comparisons of the radiographic parameters and quality-of-life indicators were performed among and within these groups, and the selection criteria were established by regression. Finite element analysis was conducted to compare the biomechanical characteristics of the spine treated with different quantity of osteotomies under different working conditions. RESULTS Three-level PSO improved the sagittal parameters more significantly, but resulted in longer operative time and greater blood loss (p < 0.05). Greater stress was found in the proximal screws and proximal junction area of the vertebra in the model simulating 1-level PSO. Larger stress of screws and vertebra was observed at the distal end in the model simulating 3-level PSO. CONCLUSION Multilevel PSO works better for larger deformity correction than single-level PSO by allowing greater sagittal parameter correction and obtaining a better distribution of stress in the hardware construct, although with longer operation time and greater blood loss. Three-level osteotomy is recommended for the patients with preoperative of global kyphosis > 85.95°, T1 pelvic angle > 62.3°, sagittal vertical alignment > 299.55 mm, and pelvic tilt+ chin-brow vertical angle > 109.6°.
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Affiliation(s)
- Xin Lv
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yelidana Nuertai
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiwei Wang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Di Zhang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xumin Hu
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiabao Liu
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ziliang Zeng
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Renyuan Huang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhihao Huang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiancheng Zhao
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenpeng Li
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhilei Zhang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liangbin Gao
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Domenech P, Mariscal G, Marquina V, Bas P, Bas T. Efficacy and safety of halo-gravity traction in the treatment of spinal deformities: A systematic review of the literature. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T159-T167. [PMID: 38000543 DOI: 10.1016/j.recot.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/17/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE To determine, through a systematic review, the effects of halo-gravity traction (HGT) in spinal deformity. METHODS Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial HGT were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected. RESULTS Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases). CONCLUSIONS Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies.
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Affiliation(s)
- P Domenech
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, España
| | - G Mariscal
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, España.
| | - V Marquina
- Department of Orthopedic Surgery and Traumatology, Valencia General University Hospital, Valencia, España
| | - P Bas
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, España
| | - T Bas
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, España
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15
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Taş SA, Çankaya T. Effects of structured training on spinal posture and selective motor control in children with unilateral spastic cerebral palsy. Gait Posture 2024; 109:22-27. [PMID: 38244393 DOI: 10.1016/j.gaitpost.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/09/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Children with Unilateral Spastic Cerebral Palsy (USCP) have an asymmetrical postural pattern. Although functional limitations are less, deteriorations in spinal posture are observed. RESEARCH QUESTION What is the effect of structured training on spinal posture and selective motor control of upper extremity? METHODS Forty five children with USCP were included in the study. Participants were children ages 3-18 with GMFCS levels 1 and 2. Spinal posture and mobility was assessed by Spinal Mouse (SM) and the Spinal Alignment and Range of Motion Measure (SAROMM), and selective motor control of upper extremity was evaluated by the Selective Control of the Upper Extremity Scale (SCUES). Children were divided into two groups: structured training group (STG) (n = 22) and conventional physiotherapy group (CPG) (n = 23). Groups received treatment sessions lasting 45 min, 2 days a week for 8 weeks. Evaluations were made baseline and after treatment. RESULTS In sagittal plane, there was a significant decrease in the degree of thoracic kyphosis after treatment in the STG (p = 0.004). A significant difference was found in total spine angulation (p = 0.015) and mobility from flexion to extension in the STG group. There was a difference in total spine angulation (p = 0.014) in the CPG group, but no difference in spinal mobility. Post-training differences were found in thoracic angulation (p = 0.006) and lateral flexion mobility to the affected side in the STG in thoracic (p = 0.020), lumbar (p = 0.035) and total spine (p = 0.008) in the frontal plane. When SCUES-shoulder, elbow, wrist, total scores changes was significant in CPG (p < 0.001), SCUES-forearm (p = 0.002) and fingers (p = 0.007) changes was significant in STG. SIGNIFICANCE This study showed that although children with USCP are more mildly affected, there are adverse effects on their selective motor control and spinal posture. This study reveals the contribution of structured training in terms of selective movement, spinal smoothness and mobility in children.
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Affiliation(s)
- Seda Ayaz Taş
- Bolu Abant Izzet Baysal University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Bolu, Turkey
| | - Tamer Çankaya
- Bolu Abant Izzet Baysal University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Bolu, Turkey
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16
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Nguyen AQ, Rodriguez C, Kumar R, Gupta S, Anderson DE, Saifi C. Biomechanical analysis of complications following T10-Pelvis spinal fusion: A population based computational study. J Biomech 2024; 165:111969. [PMID: 38394952 DOI: 10.1016/j.jbiomech.2024.111969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 01/22/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024]
Abstract
Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are challenging complications of long fusion constructs for the treatment of adult spinal deformity. The objective of this study is to understand the biomechanical stresses proximal to the upper instrumentation of a T10-pelvis fusion in a large patient cohort. The pre-fusion models were subject-specific thoracolumbar spine models that incorporate the height, weight, spine curvature, and muscle morphology of 250 individuals from the Framingham Heart Study Multidetector CT Study. To create post-fusion models, the subject-specific models were further modified to eliminate motion between the intervertebral joints from T10 to the pelvis. OpenSim analysis tools were used to calculate the medial lateral shear force, anterior posterior shear force, and compressive force on the T9 vertebra during the static postures. Differences between pre-fusion and post-fusion T9 biomechanics were consistent between increased segmental mobility and unchanged segmental mobility conditions. For all static postures, compression decreased (p < 0. 0005). Anterior-posterior shear force significantly increased (p < 0. 0005) during axial twist and significantly increased (p < 0. 0005) during trunk flexion. Medial lateral shear force significantly increased (p < 0. 0005) during axial twist. This computational study provided the first use of subject-specific models to investigate the biomechanics of long spinal fusions. Patients undergoing T10-Pelvis fusion were predicted to have increased shear forces and decreased compressive force at the T9 vertebra, independent of change in segmental mobility. The computational model shows potential for the investigation of spinal fusion biomechanics to reduce the risk of PJK or PJF.
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Affiliation(s)
- Austin Q Nguyen
- Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, TX, United States
| | - Christian Rodriguez
- Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
| | - Rachit Kumar
- Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
| | - Sachin Gupta
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Comron Saifi
- Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, TX, United States.
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He SY, Min JK, Li HD, Zhang QH, Dai JL. [Effect of Kümmell's disease with kyphosis on spinal-pelvic sagittal parameters]. Zhongguo Gu Shang 2024; 37:142-7. [PMID: 38425064 DOI: 10.12200/j.issn.1003-0034.20230201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To explore the effect of Kümmell's disease with kyphosis on the sagittal morphology of the spine-pelvis. METHODS A retrospective analysis of 34 patients of Kümmell's disease with kyphosis (Kümmell group) admitted from August 2015 to September 2022, including 10 males and 24 females with an average age of (71.1±8.5) years old. A control group of 37 asymptomatic population aged (69.3±6.7) years old was matched. Spinal-pelvic sagittal parameters were measured on the anterior-posterior and lateral X-rays of the whole spine in the standing position, including segmental kyphosis(SK) or thoracolumbar kyphosis(TLK), thoracic kyphosis(TK), lumbar lordosis(LL), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), sagittal vertical axis(SVA), T1 pelvic angle(TPA) and PI-LL. Vertebral wedge angle(WA) in Kümmell was measured and differences in parameters among groups were analyzed and the relationship between spino-pelvic parameters and WA, SK were also investigated. RESULTS TK, SK, PT, SVA, TPA and PI-LL in Kümmell group were significantly larger than those in control group (P<0.05), LL and SS in Kümmell group were significantly decreased than those in control group (P<0.05), and there was no significant difference in PI between two groups (P>0.05). In Kümmell group, WA(30.8±5.9)° showed a positive correlation with SK and TK(r=0.366, 0.597, P<0.05), and SK was significantly correlated with LL and SS(r=0.539, -0.591, P<0.05). Strong positive correlation between LL and PI, SS, SVA, TPA, PI-LL were also confirmed in patients with Kümmell with kyphosis(r=0.559, 0.741, -0.273, -0.356, -0.882, P<0.05). CONCLUSION Patients with Kümmell with kyphosis not only have segmental kyphosis, but also changes the overall spinal-pelvic sagittal parameters, including loss of lumbar lordosis, pelvic retrorotation, trunk forward tilt. The surgical treatment of Kümmell disease should not only pay attention to the recovery of the height of the collapsed vertebra, but also focus on the overall balance of the spine-pelvic sagittal plane for patients with kyphosis.
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Affiliation(s)
- Shou-Yu He
- Department of Spine Surgery, the First Affiliated Hospital of Huzhou Teachers College, Huzhou 313000, Zhejiang, China
| | - Ji-Kang Min
- Department of Spine Surgery, the First Affiliated Hospital of Huzhou Teachers College, Huzhou 313000, Zhejiang, China
| | - Hai-Dong Li
- Department of Spine Surgery, the First Affiliated Hospital of Huzhou Teachers College, Huzhou 313000, Zhejiang, China
| | - Qiang-Hua Zhang
- Department of Spine Surgery, the First Affiliated Hospital of Huzhou Teachers College, Huzhou 313000, Zhejiang, China
| | - Ji-Lin Dai
- Department of Spine Surgery, the First Affiliated Hospital of Huzhou Teachers College, Huzhou 313000, Zhejiang, China
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Li F, Omar Dev RD, Soh KG, Wang C, Yuan Y. Effects of Pilates exercises on spine deformities and posture: a systematic review. BMC Sports Sci Med Rehabil 2024; 16:55. [PMID: 38388449 PMCID: PMC10885405 DOI: 10.1186/s13102-024-00843-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Pilates is becoming increasingly popular amongst a wide range of people and is gaining more attention. It is also an effective means of physical rehabilitation. The aim of this systematic review is to explore the effects of Pilates on spinal deformity and posture. METHOD This systematic review was conducted using four recognised academic and scientific databases (Scopus, Web of Science, PubMed and Cochrane) to identify articles that met the inclusion criteria. The secondary search used the Google Scholar and the Science Direct search engines. The search for articles for this review began in July 06, 2023 and was concluded on February 01, 2024. The search process for this study was documented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020). The PEDro scale was used to assess the internal validity and data statistics of the studies included in this systematic review and to evaluate the quality of the studies. RESULTS The systematic review included nine studies that met the inclusion criteria from the 651 studies retrieved, involving a total of 643 participants. The PEDro scale scores of the studies included in this systematic review ranged from 3 to 8. The intervention was in the form of Pilates or Pilates combined exercises. The studies included in this review used outcome measures of Cobb angle, angle of trunk rotation (ATR), range of motion (ROM), chest expansion, Scoliosis Research Society Questionnaire (SRS-22r) and postural assessment. Research has shown that Pilates is effective in correcting spinal deformities and posture, as well as improving quality of life, pain relief, function and fitness. CONCLUSIONS This systematic review provide substantial evidence that Pilates has a positive impact on improving spinal deformity and posture. However, more research is needed to validate whether Pilates can be used effectively as a physical therapy for spinal deformity rehabilitation. Pilates has considerable potential for public health interventions.
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Affiliation(s)
- Fangyi Li
- Department of Sports Studies Faculty of Educational Studies, Universiti Putra Malaysia, Serdang, Malaysia.
| | - Roxana Dev Omar Dev
- Department of Sports Studies Faculty of Educational Studies, Universiti Putra Malaysia, Serdang, Malaysia.
| | - Kim Geok Soh
- Department of Sports Studies Faculty of Educational Studies, Universiti Putra Malaysia, Serdang, Malaysia
| | - Chen Wang
- Department of Sports Studies Faculty of Educational Studies, Universiti Putra Malaysia, Serdang, Malaysia
| | - Yubin Yuan
- Department of Sports Studies Faculty of Educational Studies, Universiti Putra Malaysia, Serdang, Malaysia
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Karataş ME, Bayram Y, Şafak H, Kar İ, Sağlam N, Uçar BY. Kyphectomy and sliding growing rod technique in patients with congenital lumbar kyphosis deformity with myelomeningocele. J Orthop Surg Res 2024; 19:114. [PMID: 38308272 PMCID: PMC10837965 DOI: 10.1186/s13018-024-04577-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/23/2024] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVE Neural tube defects are the most common congenital disorders after cardiac anomalies. Lumbar kyphosis deformity is observed in 8-15% of these patients. This deformity severely limits the daily lives of these patients. In our study, we aimed to correct the kyphosis angle of the patients with lumbar kyphosis associated with myelomeningocele (MMC) and allow them to continue their growth without limiting their lung capacity by applying kyphectomy and sliding growing rod technique. PATIENTS AND METHODS In this study, we retrospectively evaluated 24 patients with congenital lumbar kyphosis deformity associated with MMC, aged between 4 and 9 years, and who applied to Umraniye Training and Research Hospital between the dates of 2018 and 2021. We evaluated preoperative and postoperative kyphosis angles, correction rates, bleeding during operations, operation time, level of instrumentation, number of the resected vertebrae, initial levels of the posterior defects, duration of hospital stays, annual lengthening, and weight of the patients. RESULTS Mean age was 5.04 (between 4 and 9). Mean preoperative and early postoperative kyphosis angles were 129.8° (87-175°) and 0.79° (- 20-24°), respectively. The kyphotic deformity correction rate was 99.1%. A difference was found regarding kyphosis measurements between preoperative and early period values (p < 0.05). The annual height lengthening of patients was calculated as 0.74 cm/year and 0.77 cm/year between T1-T12 and T1-S1, respectively. Mean preoperative level of hemoglobin (Hgb) was 11.95, postoperative Hgb value was 10.02, and the decrease was significant (p < 0.05). In terms of complications, 50% (12) had broken/loosen screws, 50% (12) had undergone debridement surgery, 37.5% (9) had vacuum-assisted closure therapy, and 33.3% (8) had to get all of their implants removed. CONCLUSION We believe that our sliding growing rod technique is a new and updated surgical method that can be applied in these patient groups, facilitating the life, rehabilitation process, and daily care of MMC patients with lumbar kyphosis. This technique seems to be a safe and reliable method which preserves lung capacity and allows lengthening.
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Affiliation(s)
- Muhammed Enes Karataş
- Department of Orthopaedics and Traumatology, Kartal Dr.Lütfi Kırdar City Hospital, Istanbul, Turkey.
| | - Yusuf Bayram
- Department of Orthopaedics and Traumatology, Hisar İntercontinental Hospital, Istanbul, Turkey
| | - Halid Şafak
- Department of Orthopaedics and Traumatology, Gumushane State Hospital, Istanbul, Turkey
| | - İlyas Kar
- Department of Orthopaedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Necdet Sağlam
- Department of Orthopaedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Bekir Yavuz Uçar
- Department of Orthopaedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey
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20
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Yoon SH, Park HG, Lee DH, Lee DU. Comparison of Clinical and Radiological Outcomes after Vertebroplasty and Balloon Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures. J Bone Metab 2024; 31:56-62. [PMID: 38485242 PMCID: PMC10940103 DOI: 10.11005/jbm.2024.31.1.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Vertebroplasty (VP) and balloon kyphoplasty (KP) are effective means with which to improve pain and function in osteoporotic vertebral compression fractures. However, the risk of complications after these procedures is poorly understood, with concerns regarding adjacent vertebral fractures. This study retrospectively investigated the clinical and radiological outcomes of these procedures. METHODS A total of 115 patients who experienced their first vertebral fracture were treated with VP (N=63) or KP (N=52) at the Dankook University Hospital between January 2013 and December 2022. The clinical outcomes were evaluated using the visual analog scale (VAS) preoperative and at 1-year follow-up. Radiological comparisons were performed for kyphosis correction, vertebral height restoration, and postoperative cement leakage. RESULTS KP was more effective than VP, especially for vertebral body height restoration and kyphotic angle reduction (P<0.05). However, the incidence of cement leakage, new adjacent vertebral fractures, and improvement in pain assessed by VAS did not differ statistically between the 2 groups (P>0.05). CONCLUSIONS Considering that KP was performed on fractures with severe deformity, no differences were observed in the clinical outcomes and incidence of adjacent vertebral fractures compared Considering that KP was performed for fractures with severe deformity, there was no difference in clinical outcomes and incidence of adjacent vertebral fractures compared to VP. Improvements in radiological measurements were demonstrated. Therefore, KP may be a good treatment option for pain relief and long-term prognosis in patients with high-compressive-rate vertebral fractures.
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Affiliation(s)
- Sung-Hyun Yoon
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Hee-Gon Park
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Dong-Uk Lee
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
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21
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Jouve JL, Choufani E, Peltier E, Khal A, Pesenti S. Neuromonitoring for spine surgery in children. Orthop Traumatol Surg Res 2024; 110:103780. [PMID: 38043606 DOI: 10.1016/j.otsr.2023.103780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/04/2023] [Accepted: 05/15/2023] [Indexed: 12/05/2023]
Abstract
Neuromonitoring or electrophysiologic monitoring is now an essential component of pediatric spine surgery due to the high number of spinal deformity indications in asymptomatic patients, for whom any neurological complication would be disastrous. Technological advances have led to the development of compact monitors that allow surgeons themselves to monitor the motor evoked potentials (MEP) perioperatively. This shift happened because it was difficult to always have a neurophysiologist in the operating room. Unfortunately, this also means that multimodal monitoring (sensory, mixed, D-wave, electromyography, pedicle screws) is much more difficult to implement. There are absolute indications, such as any spinal deformity without neurological deficit and relative indications, which are more difficult to interpret. Technical incidents frequently occur before the start of the surgery. If no replacement device is available, the procedure must be cancelled unless the patient's life or function are at risk. At least two monitoring systems should be available at every facility to avoid having to cancel surgery for purely technological reasons. Once the surgical procedure has started, the absence of MEP recruitment curves in the upper and lower limbs is likely due to the anesthesia depth; the surgery should be stopped until this problem is corrected. When there is a true intraoperative alert (MEPs disappear in the lower limbs only), we propose taking the following steps, depending on whether the spine is stable or unstable: remove the causal implant, remove all hardware, preserve any stabilization devices, initiate an intraoperative wake-up test, verify conditions under which the intervention should continue. Level of evidence: V.
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Affiliation(s)
| | | | | | - Adyb Khal
- Hôpital de la Timone, Marseille, France
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22
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Heyde CE, von der Höh N, Völker A. [Surgical treatment of kyphosis in children and adolescents]. Oper Orthop Traumatol 2024; 36:33-42. [PMID: 37704775 DOI: 10.1007/s00064-023-00828-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Correction of a pathological kyphosis to restore a balanced, low-pain or pain-free and load-bearing spine. INDICATIONS Pronounced sagittal imbalance, progressive kyphosis despite conservative therapy, and neurological deficits are indications for surgery. Further surgical indications are severe therapy-resistant complaints and/or psychologically burdening cosmetic impairment. The guidelines for surgical indications are kyphosis angles of 75-80° thoracic and 30-50° lumbar. CONTRAINDICATIONS No specific, but general contraindications for surgical treatment. SURGICAL TECHNIQUE Depending on the characteristics of the kyphosis, different surgical techniques are used. Rod-screw systems are mainly used, and surgery is primarily performed by shortening the spinal column from posterior using a wide variety of techniques. In individual cases, this can be combined with ventrally mobilizing, resecting, or straightening techniques. POSTOPERATIVE MANAGEMENT The aim of surgical treatment is to achieve a primarily stable and weight-bearing spine. Regular wound control as well as stabilizing physiotherapy during follow-up are essential. Postoperatively, initially abstaining from sports; later physical activity is encouraged under professional guidance. RESULTS The literature shows very good corrective results in children and adolescents. The technical procedures are associated with a low and acceptable complication rate. Over the course of time, these patients must be monitored in order to detect possible long-term complications such as junctional kyphosis or pseudarthrosis.
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Affiliation(s)
- C E Heyde
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universität Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - N von der Höh
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universität Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - A Völker
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universität Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
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Sepehri S, Sheikhhoseini R, Piri H, Sayyadi P. The effect of various therapeutic exercises on forward head posture, rounded shoulder, and hyper kyphosis among people with upper crossed syndrome: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:105. [PMID: 38302926 PMCID: PMC10832142 DOI: 10.1186/s12891-024-07224-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES This review study aimed to evaluate the impact of therapeutic exercises on Upper-Crossed Syndrome (UCS). The study utilized a systematic review and meta-analysis approach to investigate the effects of various therapeutic exercises on forward head posture, rounded shoulders, and hyperkyphosis associated with upper crossed syndrome. METHODS The study identified relevant keywords for each independent and dependent variable and conducted a search in scientific databases, including PubMed, Web of Science, Scopus, and Google Scholar, without any time limitations until 12 August 2023. Overall, 4625 articles were found in the selected databases, which were reduced to 1085 after being entered into the EndNote software and removing duplicate data. The full texts of 30 remaining studies were reviewed; ten articles meeting the criteria were included. Additionally, 12 studies from the Google Scholar database were included, resulting in 22 studies. Using Comprehensive meta-analysis software (CMA ver 3), data heterogeneity was measured with I2 and the Q tests. The Funnel Plot and Egger test methods were utilized to determine the possibility of publication bias. The JBI checklist was used to assess the quality of the studies. RESULTS The results of the meta-analysis showed that therapeutic exercises were effective in improving forward head, rounded shoulders, and thoracic kyphosis angles (CI 95% = -1.85-1.161, P = 0.001, P = 0.001, CI95%=-1.822-1.15, and P = 0.001, CI 95%= -1.83-1.09, respectively). CONCLUSION Based on the results, it appears that performing therapeutic exercises in the form of strength exercises, stretching, shoulder-based exercises, and incredibly comprehensive exercises that target all muscles may be effective in reducing forward head, rounded shoulders, thoracic kyphosis, and overall UCS. LEVEL OF EVIDENCE: 1
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Affiliation(s)
- Simin Sepehri
- Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Rahman Sheikhhoseini
- Department of Corrective Exercise & Sport injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Western Azadi Sport Complex Boulevard, Hakim Highway, Tehran, Iran.
| | - Hashem Piri
- Department of Corrective Exercise & Sport injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Western Azadi Sport Complex Boulevard, Hakim Highway, Tehran, Iran
| | - Parisa Sayyadi
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
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Alcala C, Mehbod AA, Ramos O, Dawson JM, Denis F, Garvey TA, Perra JH, Beauchamp E, Transfeldt EE. Moderate scoliosis continues to progress at 30-year follow-up: a call for concern? Spine Deform 2024; 12:89-98. [PMID: 37755682 DOI: 10.1007/s43390-023-00765-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 09/02/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE This natural history study reports long-term radiographic and clinical outcomes of patients with diagnosis of AIS with curves between 30° and 50°. Our purpose was to determine if any intervention in the natural history is warranted. METHODS This was a longitudinal descriptive study at a single institution. We reviewed patient factors, radiographic parameters, and patient-reported outcomes at 20- and 30-year follow-up. RESULTS A total of 31 patients were included. At skeletal maturity (which was the initial point of measurement), the median age was 17 years (range 12-21), the thoracic Cobb angle was 35° ± 5° (maximum-minimum 27°-47°), and the lumbar Cobb angle was 33° ± 7° (maximum-minimum 18°-45°). The median final follow-up was 35 years (median age 52, range 32-61) when the thoracic Cobb angle was 47° ± 12° (maximum-minimum 31°-74°) and the lumbar Cobb angle was 40° ± 17° (maximum-minimum 19°-69°). At final follow-up, 9 (29%) patients had a structural curve > 50°. Ten (32%) patients had a curve from 40° to 49° and 11 (35%) patients had a curve < 40°. The thoracic Cobb angle had progressed from < 40° to > 50° in 5 patients. Thoracolumbar and lumbar Cobb angles progressed from < 40° to greater than > 50° in 1 and 3 patients, respectively. Few patients had functional limitations according to Roland-Morris, Oswestry, and SF36 scores. Pain scores were minimal at final follow-up. CONCLUSION All AIS curves between 30° and 50° at skeletal maturity tend to progress. Thoracic curves progress more than lumbar curves during the first 20 years and then progression slows down. The opposite happens with lumbar curves. Therefore, the rate of progression decreases with thoracic curves and increases with lumbar curves. Nevertheless, few patients have functional limitations. Further follow-up is necessary to define the true long-term outcome of moderate curves at maturity.
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Affiliation(s)
- Christopher Alcala
- Twin Cities Spine Center, 913 E. 26th Street, #600, Minneapolis, MN, 55404, USA.
| | - Amir A Mehbod
- Twin Cities Spine Center, 913 E. 26th Street, #600, Minneapolis, MN, 55404, USA
| | - Omar Ramos
- Twin Cities Spine Center, 913 E. 26th Street, #600, Minneapolis, MN, 55404, USA
| | - John M Dawson
- Twin Cities Spine Center, 913 E. 26th Street, #600, Minneapolis, MN, 55404, USA
| | - Francis Denis
- Twin Cities Spine Center, 913 E. 26th Street, #600, Minneapolis, MN, 55404, USA
| | - Timothy A Garvey
- Twin Cities Spine Center, 913 E. 26th Street, #600, Minneapolis, MN, 55404, USA
| | - Joseph H Perra
- Twin Cities Spine Center, 913 E. 26th Street, #600, Minneapolis, MN, 55404, USA
| | - Eduardo Beauchamp
- Twin Cities Spine Center, 913 E. 26th Street, #600, Minneapolis, MN, 55404, USA
| | - Ensor E Transfeldt
- Twin Cities Spine Center, 913 E. 26th Street, #600, Minneapolis, MN, 55404, USA
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Park S, Yoo HJ, Jang JS, Lee SH. Automated non-contact measurement of the spine curvature at the sagittal plane using a deep neural network. Clin Biomech (Bristol, Avon) 2024; 111:106146. [PMID: 37976690 DOI: 10.1016/j.clinbiomech.2023.106146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/28/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Non-radiographical techniques have been suggested to measure the spine curvature at the sagittal plane. However, a neural network has not been used to measure the curvature. METHODS A single video camera captured images of a standing posture at the sagittal plane from twenty healthy males. Six marker positions along the spine's contour in each image were identified for measuring inclination, thoracic kyphosis, and lumbar lordosis angles. We estimated three inflection points around the neck, hip, and between the neck and hip, followed by identifying two adjacent marker positions per inflection point to compute its tangent. The angular deviation of each tangent line from the horizontal was computed to measure inclination angles. Thoracic kyphosis and lumbar lordosis angles were computed by the angular difference between the two adjacent tangents. A deep neural network was trained with 500,000 iterations using the labeled images from 18 participants (388 and 44 images for training and test set) and then evaluated using the unseen images (2 participants, 48 images; evaluation set). FINDINGS The mean total training and test errors were <2 pixels (∼ 0.6 cm). The total error in the evaluation set was qualitatively comparable (∼ 3 pixels = ∼ 0.9 cm), suggesting the model performance was maintained in the unseen data. The angle values between labeled and network-predicted marker positions were similar in the evaluation set. INTERPRETATION The network training with a relatively small number of images was successful based on the small error values observed in the evaluation set. The model may be an affordable, automated, and non-contact measurement tool for the human spine curvature.
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Affiliation(s)
- Sangsoo Park
- School of Global Sport Studies, Korea University Sejong Campus, Sejong City 30019, South Korea.
| | - Hyun-Joon Yoo
- Korea University Research Institute for Medical Bigdata Science, Korea University, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, South Korea
| | - Jin Su Jang
- Human Behavior & Genetic Institute, Associate Research Center, Korea University, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, South Korea
| | - Sang-Heon Lee
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, South Korea
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Liang D, Pei J, Pei R, Zhou X, Zhang X. Clinical efficacy of percutaneous vertebroplasty versus percutaneous kyphoplasty treating osteoporotic vertebral compression fractures with kyphosis. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02416-4. [PMID: 38112829 DOI: 10.1007/s00068-023-02416-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/25/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE This study aimed to investigate the clinical efficacy of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in treating osteoporotic vertebral compression fractures (OVCFs) with kyphosis. METHODS The clinical data included 63 patients in the PVP group and 70 in the PKP group. The study assessed the pain visual analog scale (VAS), Oswestry Disability Index (ODI), wedge angle (WA), local kyphotic angle (LKA), and vertebral height. RESULTS The operative time was significantly less in the PVP group (p < 0.05). Meanwhile, more bone cement was injected into the PKP group (p < 0.05), with significantly higher surgical costs (p > 0.05). Post-operative VAS, ODI, WA, LKA, and vertebral height were significantly improved in PVP and PKP groups compared with pre-operative measurements (p < 0.05). The results revealed insignificant VAS and ODI improvement differences between the two groups at each follow-up time (p > 0.05). Vertebral height, WA, and LKA improved more significantly in the PKP group at day 1 and 3 months post-operatively (p < 0.05), with insignificant group differences at subsequent time points (p > 0.05). The improvements in VAS were unrelated to those in WA, LKA, or vertebral height in either group (p > 0.05). The improvement in VAS was unrelated to the amount of bone cement injected (p > 0.05); the PKP group demonstrated a lower incidence of cement leakage (12.9%; p < 0.05). CONCLUSION PVP and PKP can restore partial vertebral height and improve kyphosis with similar clinical outcomes. PVP has a shorter operating time, is more economical, and can represent a therapeutic choice.
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Affiliation(s)
- Dawei Liang
- Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), 100 Yongping Road, Zhengzhou, 450000, Henan, China
| | - Jia Pei
- Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), 100 Yongping Road, Zhengzhou, 450000, Henan, China
| | - Ruoyan Pei
- Shenyang Pharmaceutical University, Shenyang, 110000, Liaoning, China
| | - Xianwei Zhou
- Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), 100 Yongping Road, Zhengzhou, 450000, Henan, China
| | - Xiaohui Zhang
- Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), 100 Yongping Road, Zhengzhou, 450000, Henan, China.
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Zhang M, Hu X, Lei S, Jia J, Kang X. Trends and prospects in spinal tuberculosis research: a future-oriented approach. Eur Spine J 2023; 32:4246-4258. [PMID: 37115281 DOI: 10.1007/s00586-023-07728-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/09/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE Tuberculosis is one of the oldest diseases in human history, and spinal tuberculosis (STB) is the most common form of extrapulmonary tuberculosis. A large number of research has been conducted in this field. However, there has been no bibliometric analysis performed in recent years in STB. The aim of this study was to analyze trends and hotspots in research on STB. METHODS Publications regarding STB between 1980 and 2022 were extracted from the Web of Science database. CiteSpace (V5.7.R2) and VOSviewer (1.6.10) were used to perform global analyses of the number of publications, countries, institutions, authors, journals, keywords, and cited references. RESULTS A total of 1262 articles were published between 1980 and 2022. We observed rapid growth in the number of publications since 2010. Spine had the highest number of publications (47, 3.7%). Zhang HQ and Wang XY were key researchers. The Central South University published the most papers (90, 7.1%). China was the leading contributor in this field with 459 publications and 29 H-index. National partnerships are dominated by the USA, and there is a lack of active cooperation between other countries and authors. CONCLUSION research on STB has achieved great progress, with an increasing number of publications since 2010. Surgical treatment and debridement are current research hots pots, and diagnosis, drug resistance, and kyphosis are likely research frontiers. Cooperation between countries and authors needs to be further strengthened.
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Affiliation(s)
- Mingtao Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, 730000, Gansu, China
| | - Xuchang Hu
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, 730000, Gansu, China
| | - Shuanhu Lei
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, 730000, Gansu, China
| | - Jingwen Jia
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, 730000, Gansu, China
| | - Xuewen Kang
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, China.
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, 730000, Gansu, China.
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Tanishima S, Hagino H, Matsumoto H, Tanimura C, Nagashima H. Relationship among Osteoporosis, Sarcopenia, Locomotive Syndrome, and Spinal Kyphosis in Older Individuals Living in a Local Mountain Area. Asian Spine J 2023; 17:1074-1081. [PMID: 38050363 PMCID: PMC10764126 DOI: 10.31616/asj.2023.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/01/2023] [Accepted: 07/12/2023] [Indexed: 12/06/2023] Open
Abstract
STUDY DESIGN Cross-sectional cohort study. PURPOSE This study investigated the relationship among osteoporosis, sarcopenia, locomotive syndrome, and spinal kyphosis in older individuals living in a mountain area. OVERVIEW OF LITERATURE Kyphosis greatly reduces the quality of life of older individuals. Osteoporosis and sarcopenia are kyphosiscausing factors. METHODS This cross-sectional study included 361 individuals aged ≥65 years (mean age, 75.0 years) living in a local mountain area and underwent medical check-ups from 2014 to 2018. The survey items included kyphosis index, body mass index, back pain prevalence, back pain Visual Analog Scale score, Oswestry Disability Index, walking speed, grip strength, skeletal mass index, osteoporosis (% young adult mean [YAM]), LOCOMO 5 score, and presence of sarcopenia (Asian Working Group for Sarcopenia). The participants were divided into the N (kyphosis index: <12; n=229, 63.4%), M (kyphosis index: 12-15; n=99, 27.4%), and K (kyphosis index: ≥15; n=33, 9.2%) groups. p -values of <0.05 were considered statistically significant. An association factor of kyphosis (kyphosis index: ≥15) was investigated with logistic regression analysis. RESULTS Age and LOCOMO 5 scores were significantly higher (p <0.05) and %YAM and walking speed were significantly lower (p <0.05) in the K group than in the M and N groups. Other survey items showed significant differences. Only %YAM (odds ratio, 0.20; 95% confidence interval, 0.04-0.96) was an independent factor associated with a kyphosis index of ≥15. CONCLUSIONS Decreased muscle mass and muscle strength would be related to kyphosis; however, no such relations were noted. Bone loss was significantly related to kyphosis. Osteoporosis-induced decrease in vertebral body height is present in the background. Sarcopenia and locomotive syndrome were not related to kyphosis, whereas decreased bone density was independently associated with kyphosis in older individuals living in a mountain area.
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Affiliation(s)
- Shinji Tanishima
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, Yonago,
Japan
| | - Hiroshi Hagino
- Department of Health Science, Tottori University, Yonago,
Japan
| | - Hiromi Matsumoto
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki,
Japan
| | - Chika Tanimura
- School of Health Science, Faculty of Medicine, Tottori University, Yonago,
Japan
| | - Hideki Nagashima
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, Yonago,
Japan
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Börekci A, Ekşi MŞ, Osama M, Tunçkale T, Yılmaz M, Koban O, Öğrenci A, Dalbayrak S. Circumferential Approach to Congenital Kyphoscoliosis with Hemivertebra: Adding on Rather than Resecting Could Be a Better Option in Older Adolescents. World Neurosurg 2023; 180:22-28. [PMID: 37683923 DOI: 10.1016/j.wneu.2023.08.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To present a new technique combining anterior release with allograft insertion and lateral fixation at the concave side of the curve, preserving the hemivertebra and posterior bilateral transpedicular fixation in patients with congenital kyphoscoliosis (CKS) who were not operated on until late adolescence, including long-term follow-up of patients, and a discussion of the literature on CKS with hemivertebra. METHODS Two patients with CKS concomitant with hemivertebra underwent circumferential (anterior-posterior) instrumentation and fusion using a new technique. RESULTS Patient 1 underwent a 2-stage operation, first anterior then posterior. Patient 2 was operated on circumferentially in 1 session. Both patients had >10 years of follow-up showing solid fusion of their operated spine segments. The patients were pain-free, and their body heights were comparable to healthy peers. CONCLUSIONS In our circumferential approach, we successfully integrated the hemivertebrae in anterior fusions rather than resecting them in older adolescents with CKS. This technique decreased bleeding, shortened operative time, and promised potential benefits compared with the available techniques in the literature.
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Affiliation(s)
- Ali Börekci
- Neurosurgery Clinic, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
| | - Murat Şakir Ekşi
- Department of Neurosurgery, Health Sciences University, Istanbul, Türkiye.
| | - Mahmoud Osama
- Department of Neurosurgery, Nasser Institute for Research and Treatment, Cairo, Egypt
| | - Tamer Tunçkale
- Department of Neurosurgery, Tekirdağ Namık Kemal University, Tekirdağ, Türkiye
| | - Mesut Yılmaz
- Private Practice of Neurosurgery, Istanbul, Türkiye
| | - Orkun Koban
- Neurosurgery Clinic, Lokman Hekim İstanbul Hospital, Istanbul, Türkiye
| | - Ahmet Öğrenci
- Neurosurgery Clinic, Medicana Ataşehir Hospital, Istanbul, Türkiye
| | - Sedat Dalbayrak
- Neurosurgery Clinic, Medicana Ataşehir Hospital, Istanbul, Türkiye
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Ogden M, Karagedik MI, Ozdemir A, Bulut IU, Erdogan AM, Bakar B. Investigation of the Efficacy of Bilateral Osteoligamentous Decompression via Hemilaminectomy in Cervical Spondylotic Myelopathy: A Clinical Study. World Neurosurg 2023; 180:e560-e578. [PMID: 37778625 DOI: 10.1016/j.wneu.2023.09.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Cervical stability may deteriorate and kyphotic spinal deformities may develop in cervical spondylotic myelopathy (CSM) after laminectomy or laminoplasty. This study aimed to investigate the therapeutic efficacy of the "bilateral osteoligamentous decompression via unilateral hemilaminectomy approach (UHBOLD)" technique in CSM patients. METHODS The study included 34 adult patients who underwent UHBOLD surgery for CSM between 2016 and 2022. A record was made for all patients of age, gender, number of operated levels, preoperative and postoperative long-term follow-up VAS scores, Nurick grade values and mJOA scores, kyphosis angles measured on X-ray, and spinal canal areas measured on T2-weighted MR axial images. RESULTS Preoperative VAS scores of the patients were 6 (4-9), Nurick grade values were 3 (2-5), mJOA scores were 10.50 ± 3.42, kyphosis angles were -13.34 ± 13.69° and spinal canal areas were 87.11 ± 28.30 mm2. In postoperative long-term follow-up of these patients, VAS scores were 2 (1-5), Nurick grade values were 1 (0-5), mJOA scores were 13.94 ± 3.09, kyphosis angles were -15.07 ± 12.78° and spinal canal areas were 149.65 ± 42.57 mm2. A statistically significant difference was determined between the preoperative and the postoperative long-term follow-up VAS scores, Nurick grade values, mJOA scores, and spinal canal areas (P < 0.001). Kyphosis angles were not different (P = 0.198), and no instability was observed in any patient in long-term follow-up. CONCLUSIONS The UHBOLD technique performed in multilevel CSM patients did not cause any change in cervical lordosis angle in long-term follow-up, did not cause cervical kyphotic deformity or cervical instability, and significantly improved Nurick grade values, and VAS and mJOA scores.
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Affiliation(s)
- Mustafa Ogden
- Department of Neurosurgery, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey.
| | | | - Alemiddin Ozdemir
- Department of Neurosurgery, Iskenderun State Hospital, Hatay, Turkey
| | - Ibrahim Umud Bulut
- Department of Neurosurgery, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Ahmet Melih Erdogan
- Department of Neurosurgery, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Bulent Bakar
- Department of Neurosurgery, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
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Gupta T, Ali Y, Sudan S, Bowles PFD. Injection medialisation laryngoplasty: an alternative approach for challenging cases. J Laryngol Otol 2023; 137:1406-1408. [PMID: 36683388 DOI: 10.1017/s0022215123000038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Conventional injection medialisation laryngoplasty techniques may be compromised by patient-specific factors such as marked kyphosis, an anteriorly positioned larynx or intolerance to nasendoscopy. This paper describes a technique for successful injection medialisation laryngoplasty where conventional methods are precluded, in an 88-year-old man with presbyphonia on a background of Parkinson's disease. METHODS After induction of general anaesthesia, a transoral introducing needle, shaped by tactile manipulation to match the curvature of a 'C-MAC' intubating video-laryngoscope 'D-blade' attachment, was introduced until visible above the glottis. The implant material was then injected into the paraglottic space as normal until satisfactory medialisation of the vocal fold was achieved. RESULTS When reviewed in the out-patient clinic four weeks later, the patient's post-operative Voice Handicap Index score fell to 6, from a pre-operative score of 21. CONCLUSION By utilising commonly available equipment and anaesthetic support to recreate the views and access conventional nasendoscopy and laryngoscopy facilitate, this novel procedure provides a viable and proven alternative in uncommon but challenging cases.
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Affiliation(s)
- T Gupta
- ENT, Royal Sussex County Hospital, Brighton, UK
| | - Y Ali
- Anaesthetics, Royal Sussex County Hospital, Brighton, UK
| | - S Sudan
- Anaesthetics, Royal Sussex County Hospital, Brighton, UK
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Deng Y, Wang B, Liu H, Meng Y, Rong X, Wu T, Chen H, Hong Y. A Novel Intraoperative Posture-Adjustment Apparatus for Correction of Cervical Lordosis in Anterior Cervical Surgery. Orthop Surg 2023; 15:3162-3173. [PMID: 37866365 PMCID: PMC10694009 DOI: 10.1111/os.13917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVE Cervical alignment is a crucial factor related to the success of anterior cervical surgical procedures. In patients with severe spinal cord compression, a traditional neck pillow (TNP) may not adequately correct cervical position during surgery. Therefore, the aim of this study was to introduce this innovative intraoperative posture-adjustment apparatus (IPAA), and explored its clinical and radiological results in cervical angle correction against TNP in patients who had undergone anterior cervical surgery. METHODS The clinical and radiological data of 86 patients who underwent anterior cervical surgery with a minimum follow-up period of 1 year were retrospectively reviewed. Of these, 58 patients underwent IPAA, whereas 28 underwent TNP. Radiological parameters such as the degree of C2-C7 lordosis (CL), functional spinal unit angle (FSUA), C7 slope (C7S), fusion rate, and adjacent segment disease (ASD) were recorded and compared between the groups. Clinical outcomes including the Japanese Orthopaedic Association (JOA), neck disability index (NDI), visual analogue scale (VAS) for neck and arm were recorded. Complications such as kyphosis, dysphagia, Braden Scale score, revision surgery, hematoma, cerebrospinal fluid leakage, wound infection, and deep venous thrombosis were also recorded. The independent t-test or Mann-Whitney U test was used to compare continuous data, and categorical variables were assessed using the Pearson's chi-square test or Fisher's exact test. RESULTS Compared with the pre-operative data, the post-operative CL, FSUA, and C7S were significantly increased in both groups. CL, FSUA, and C7S in the IPAA group (14.44 ± 4.94°, 7.36 ± 2.91°, 16.54 ± 4.63°) were significantly higher than those in the TNP group (7.17 ± 8.19°, 4.99 ± 5.36°, 14.19 ± 4.48°; P < 0.05). Although there were no significant differences between the groups in terms of VAS arm and JOA scores, the post-operative and final follow-up NDI and VAS neck scores in the IPAA group were significantly lower than those in the TNP group (p < 0.05). At the last follow-up, the TNP group had significantly more kyphotic patients than the IPAA group (2 vs. 0, p = 0,041). There was no significant difference between the groups in terms of fusion rate, ASD, or complications such as dysphagia, Braden's Scale score, revision surgery, hematoma, cerebrospinal fluid leakage, wound infection, or deep venous thrombosis. CONCLUSION IPAA was shown to be more effective than TNP in adjusting cervical alignment (CL, FSUA, and C7S). These findings suggest that IPAA could be used as an alternative way to TNP in neck setting and cervical alignment adjustment and IPAA could potentially improve clinical outcomes after anterior cervical surgery.
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Affiliation(s)
- Yifei Deng
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Beiyu Wang
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Hao Liu
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Yang Meng
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Xin Rong
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Tingkui Wu
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Hao Chen
- Department of Orthopedic Surgery, West China HospitalSichuan UniversityChengduChina
| | - Ying Hong
- Department of Anesthesiology, West China HospitalSichuan UniversityChengduChina
- Department of Operation Room, West China HospitalSichuan UniversityChengduChina
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Perisetla N, Doyle WN, Ladehoff L, Natarelli N, Nemov V, Pittala K, Sujka J, Saad AR, DuCoin C, Velanovich V. Effects of Spinal Deformities on Hiatal Hernia Occurrence and Recurrence. J Gastrointest Surg 2023; 27:2718-2723. [PMID: 37932593 DOI: 10.1007/s11605-023-05877-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Spinal deformities such as kyphosis, lordosis, and scoliosis have demonstrated a possible association between these deformities. Our hypothesis is that the presence of spinal deformities will increase the risk of hiatal hernia recurrence after repair. METHODS The following data was retrospectively gleaned for patients undergoing hiatal hernia repair (1997-2022): age, sex, date of hiatal hernia repair, presence and type of spinal deformity, Cobb angle, type of hiatal hernia and size, type of hiatal hernia repair, recurrence and size, time to recurrence, reoperation, type of reoperation, and time to reoperation. RESULTS Spinal deformities were present in 15.8% of 546 patients undergoing hiatal hernia repair, with a distribution of 21.8% kyphosis, 2.3% lordosis, 58.6% scoliosis, and 17.2% multiple. There was no difference in sex or age between groups. Spinal deformity patients were more likely to have types III and IV hiatal hernias (52.3% vs. 38.9%, p = 0.02) and larger hernias (median 5 [3-8] vs. 4 [2-6], p = 0.01). There was no difference in access, fundoplication use, or mesh use between groups. However, these patients had a higher recurrence rate (47.7% vs 30.0%, p = 0.001) and a shorter time to recurrence (months) (10.3 [5.6-25.1] vs 19.2 [9.8-51.0], p = 0.02). Cobb angle did not affect recurrence. CONCLUSIONS Spinal deformity patients were more likely to have more complex and larger hiatal hernias. They were at higher risk of hiatal hernia recurrence after repair with shorter times to recurrence. This is a group that requires special attention with additional preoperative counseling and possibly use of surgical adjuncts in repair.
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Affiliation(s)
- Naveen Perisetla
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - William N Doyle
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Lauren Ladehoff
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Nicole Natarelli
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Valerie Nemov
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Karthik Pittala
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Joseph Sujka
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Adham R Saad
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Chistopher DuCoin
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Vic Velanovich
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA.
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Ghanem I, Saliba I, Ghanem D, Assi A, Dubousset J, Bernstein S, Tolo V, Bassett G, Miladi L. Kyphectomy in myelomeningocele revisited: risk factors for failure. Eur Spine J 2023; 32:4128-4144. [PMID: 37698696 DOI: 10.1007/s00586-023-07924-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 08/09/2023] [Accepted: 08/27/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Lumbar kyphosis occurs in approximately 8-20% of patients with myelomeningocele (MMC). The purpose of this article is to analyze the risks and benefits of vertebrectomy and spinal stabilization in MMC children with severe lumbar kyphosis and to establish treatment guidelines. METHODS This is an IRB-approved retrospective analysis of 59 patients with MMC who underwent kyphectomy and posterior instrumentation in three centers. Average age at surgery was 7.9 years (2 weeks-17 years). Sitting trunk position, skin status, kyphosis angle, and thoracic lordosis were analyzed preoperatively, postoperatively, and at an average follow-up of 8.2 years (range 2.5-16). The correction was maintained by applying a short posterior instrumentation in 6 patients, and extending to the pelvis in 53 cases. Pelvic fixation was achieved using the Warner and Fackler technique in 24 patients, the Dunn-McCarthy in 8, Luque-Galveston in 8, sacral screws in 2, and ilio-sacral screws in 11. RESULTS Sitting position improved postoperatively in 47 of the 53 patients who underwent pelvic fixation and only in one patient with short instrumentation. All 6 patients with long instrumentation and poor postoperative sitting balance were in the Dunn-McCarthy fixation group. Skin sores at the apex of the deformity disappeared postoperatively in all patients but recurred in two patients with short instrumentations. Kyphosis angle improved from 109° (45°-170°) preoperatively to 10° (0°-45°) postoperatively and 21° (0°-55°) at last follow-up. The best results were seen in cases where a cross-k-wire fixation of the kyphectomy site was used, augmented with a long thoraco-pelvic instrumentation consisting of Luque sublaminar wires in the thoracic region and a Warner-Fackler type of pelvic fixation. Good results were also found with the bipolar technique and ilio-sacral screw fixation. Six over 24 patients with the Warner and Fackler technique showed gradual dislodgment or hardware failure, with subsequent nonunion of the kyphectomy site in four. Infection, with or without wound dehiscence and/or hardware exposure, occurred in 17 cases, necessitating hardware removal in 9 patients. CONCLUSION Lumbar kyphosis in MMC children is best managed by resection of enough vertebrae from the apex to produce a flat lumbar spine, with perfect bone-to-bone contact and long thoraco-pelvic instrumentation using the Warner and Fackler technique through the S1 foramina or the bipolar technique with ilio-sacral screw fixation. Additional local fixation of the osteotomy site using cross-wires with or without cerclage increases the stability of the construct. The majority of complications occurred in patients with short instrumentations or where residual kyphosis persisted postoperatively regardless of the type of pelvic fixation or hardware density. The Dunn-McCarthy technique for pelvic fixation following kyphectomy in MMC was less successful in producing stable pelvic fixation and should not be considered in this patient category.
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Affiliation(s)
- Ismat Ghanem
- Division of Orthopedics, Hotel-Dieu de France Hospital, St Joseph University, Beirut, Lebanon
| | - Ibrahim Saliba
- Division of Orthopedics, Hotel-Dieu de France Hospital, St Joseph University, Beirut, Lebanon.
| | - Diane Ghanem
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ayman Assi
- Division of Orthopedics, Hotel-Dieu de France Hospital, St Joseph University, Beirut, Lebanon
| | - Jean Dubousset
- Saint Vincent de Paul Hospital, Université Paris Descartes, Paris, France
| | - Saul Bernstein
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Vernon Tolo
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - George Bassett
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Lotfi Miladi
- Saint Vincent de Paul Hospital, Université Paris Descartes, Paris, France
- Hopital d'Enfants Malades Necker, Paris, France
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de Dios E, Laesser M, Björkman-Burtscher IM, Lindhagen L, MacDowall A. MRI-based measurements of spondylolisthesis and kyphosis in degenerative cervical myelopathy. BMC Med Imaging 2023; 23:180. [PMID: 37946139 PMCID: PMC10634168 DOI: 10.1186/s12880-023-01151-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND To provide normative data and to determine accuracy and reliability of preoperative measurements of spondylolisthesis and kyphosis on supine static magnetic resonance imaging (MRI) of patients with degenerative cervical myelopathy. METHODS T2-weighted midsagittal images of the cervical spine were in 100 cases reviewed twice by one junior observer, with an interval of 3 months, and once by a senior observer. The spondylolisthesis slip (SSlip, mm) and the modified K-line interval (mK-line INT, mm) were assessed for accuracy with the standard error of measurement (SEm) and the minimum detectable change (MDC). Intraobserver and interobserver reliability levels were determined using the intraclass correlation coefficient (ICC). RESULTS The SEm was 0.5 mm (95% CI 0.4-0.6) for spondylolisthesis and 0.6 mm (95% CI 0.5-0.7) for kyphosis. The MDC, i.e., the smallest difference between two examinations that can be detected with statistical certainty, was 1.5 mm (95% CI 1.2-1.8) for spondylolisthesis and 1.6 mm (95% CI 1.3-1.8) for kyphosis. The highest reliability levels were seen between the second observation of the junior examiner and the senior observer (ICC = 0.80 [95% CI 0.70-0.87] and ICC = 0.96 [95% CI 0.94-0.98] for SSlip and mK-line INT, respectively). CONCLUSIONS This study provides normative values of alignment measurements of spondylolisthesis and kyphosis in DCM patients. It further shows the importance of taking measurement errors into account when defining cut-off values for cervical deformity parameters and their potential clinical application in surgical decision-making.
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Affiliation(s)
- Eddie de Dios
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Bruna stråket 11, Gothenburg, 41345, Sweden.
| | - Mats Laesser
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Bruna stråket 11, Gothenburg, 41345, Sweden
| | - Isabella M Björkman-Burtscher
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Bruna stråket 11, Gothenburg, 41345, Sweden
| | - Lars Lindhagen
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Anna MacDowall
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Fehr BJ, Visser A, Parent EC. Systematic review of imaging comparisons of spinal alignment among standing positions in healthy adolescents or adolescents with idiopathic scoliosis: SOSORT 2023 award winner. Eur Spine J 2023; 32:3941-3960. [PMID: 37393596 DOI: 10.1007/s00586-023-07815-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Clinicians detect scoliosis worsening over time using frequent radiographs during growth. Arms must be elevated when capturing sagittal radiographs to visualize the vertebrae, and this may affect the sagittal angles. The aim was to systematically review the published evidence of the effect of arm positions used during radiography on spinal alignment parameters in healthy participants and those with AIS. METHODS Design was registered in PROSPERO (CRD42022347494). A search strategy was run in Medline, Embase, CINAHL, and Web of Science. Healthy participants ≥ 10 years old and participants with AIS between 10 and 18 years old, with Cobb angles > 10° were included. Study quality was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS). Meta-analysis was performed where possible. RESULTS Overall, 1332 abstracts and 33 full texts were screened. Data was extracted from 7 included studies. The most common positions were habitual standing, fists on clavicle, and active (arms raised unsupported). Kyphosis, lordosis, and sagittal vertical axis (SVA) were most measured. Meta-analysis showed significantly decreased kyphosis (SMD = 0.78, 95%CI 0.48, 1.09) and increased lordosis (SMD = - 1.21, 95%CI - 1.58, - 0.85) when clavicle was compared to standing. Significant posterior shifts in SVA were shown in clavicle compared to standing (MD = 30.59 mm, 95%CI 23.91, 37.27) and active compared to clavicle (MD = - 2.01 mm, 95%CI - 3.38, - 0.64). Cobb angles and rotation were rarely studied (1 study). CONCLUSION Meta-analysis evidence showed elevated arm positions modify sagittal measurements compared to standing. Most studies did not report on all relevant parameters. It is unclear which position best represent habitual standing.
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Affiliation(s)
- Brianna J Fehr
- Department of Physical Therapy, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Annika Visser
- Department of Physical Therapy, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Eric C Parent
- Department of Physical Therapy, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
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Homer CJ, Haselhuhn JJ, Ellingson AM, Bechtold JE, Polly DW. Development of a sacral fracture model to demonstrate effects on sagittal alignment. Spine Deform 2023; 11:1325-1333. [PMID: 37382877 DOI: 10.1007/s43390-023-00721-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/10/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE To develop a modeling framework to predict the secondary consequences on spinal alignment following correction and to demonstrate the impact of pedicle subtraction osteotomy (PSO) location on sagittal alignment. METHODS Six patients were included, and pelvic incidence (PI) was measured. Full-length standing radiographs were uploaded into PowerPoint and manipulated to model S1-S2 joint line sacral fractures at 15°, 20°, 25°, and 30°. PSO corrections with hinge points at the anterior superior corner and vertical midpoint of the L3-5 vertebral bodies were modeled. Anterior translation (AT) and vertical shortening (VS) were calculated for the six PSO locations in the four fracture angle (FA) models. RESULTS PI had a strong effect in the mixed AT and VS models (P < 0.001). Both AT and VS were significantly different from zero at all FA (p < 0.001), and pairwise comparisons revealed all FA were different from each other with respect to both AT and VS after adjusting for PSO location (p < 0.001), increasing as FA increased. Varying PSO location resulted in significant differences in AT when comparing all locations (p < 0.001). AT was greatest for all FA in all patients when the PSO correction was performed at the L3-AS (p < 0.001). There were significant differences in VS when comparing the L5-Mid PSO location to the L3-AS, L3-Mid, L4-AS, and L4-Mid PSO locations (p < 0.034). CONCLUSION PSO correction superior to a sacral fracture resulted in AT and VS of the spine. It is crucial that these changes in spinal measures be predicted and accounted for to optimize patient sagittal alignment and outcomes.
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Affiliation(s)
- Cole J Homer
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
| | - Jason J Haselhuhn
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
| | - Arin M Ellingson
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
- The Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Joan E Bechtold
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
- The Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - David W Polly
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
- The Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
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Wang R, Wang F, Liu Q, Zhang F, Chen J, Wu B, Ru N. Reconstruction of complicated spinal tuberculosis with long-segment fibula transplantation: a case report. BMC Musculoskelet Disord 2023; 24:821. [PMID: 37848853 PMCID: PMC10580617 DOI: 10.1186/s12891-023-06935-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Treating complex cases of spinal tuberculosis (STB) that involve multiple vertebral bodies and cause destruction of the spinal structure, kyphotic deformity, and acute nerve injury can be challenging. This report describes the course of treatment and 5-year follow-up of a complex case of multisegmental STB. CASE PRESENTATION This report describes a case of tuberculosis affecting the vertebrae extending from thoracic 12 to lumbar 5 in a 60-year-old woman who suffered sudden paralysis in both lower extremities. The patient underwent emergency posterior paraspinal abscess clearance, laminectomy with spinal decompression. Partial correction of the kyphotic deformity via long-segment fixation from the T9 vertebral body to the ilium in a one-stage posterior procedure. The patient's neurological status was diagnosed as grade E on the American Spinal Injury Association (ASIA) scale after the one-stage operation. Following standardized 4-combination anti-tuberculosis drug therapy for three months in postoperative patients, the patient underwent two-stage transabdominal anterior abscess removal, partial debridement of the lesion and bilateral fibula graft support. One year after the two-stage operation, the patient's visual analog scale (VAS) score of back pain was 1 point, and the patient's erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels returned to normal. Five years after the second-stage operation, the Oswestry disability index (ODI) of patient quality of life was 14 points. There was a 4-degree change in the Cobb angle over five years. During the five-year follow-up period, the grafted fibula did not experience any subsidence. CONCLUSION For patients with spinal tuberculosis and acute paralysis, it is essential to relieve spinal cord compression as soon as possible to recover spinal cord function. For lesions that cannot be debrided entirely, although limited debridement combined with anti-tuberculosis drug therapy has the risk of sinus formation and tuberculosis recurrence, it is much safer than the risk of thorough debridement surgery. In this case, an unconventional long-segment fibula graft, pelvis-vertebral support, was an effective reconstruction method.
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Affiliation(s)
- RuiYang Wang
- Orthopedics Department, the First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - FeiFan Wang
- Orthopedics Department, the First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Qing Liu
- Orthopedics Department, the First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Fan Zhang
- Orthopedics Department, the First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - JianFeng Chen
- Orthopedics Department, the First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Bin Wu
- Orthopedics Department, the First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Neng Ru
- Orthopedics Department, the First College of Clinical Medical Science, China Three Gorges University, Yichang, China.
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Si G, Qiu W, Shen Q, Wang Y, Li W, Yu M, Wang Y. Mini-open Pedicle Subtraction Osteotomy versus Standard Posterior Approach for Ankylosing Spondylitis-related Spinal Kyphosis: A Comparative Study. Orthop Surg 2023; 15:2656-2664. [PMID: 37681279 PMCID: PMC10549849 DOI: 10.1111/os.13873] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 07/19/2023] [Accepted: 07/29/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE Surgical strategy for spinal kyphosis in patients with ankylosing spondylitis (AS) has been challenging. Pedicle subtraction osteotomy (PSO) through a minimally invasive (MI) approach has been developed with promising clinical outcomes. We aimed to compare the effectiveness and safety of PSO via an MI approach and a standard posterior approach (SPA) for treating AS-related spinal kyphosis. METHODS A total of 41 patients with AS-related spinal kyphosis who underwent PSO through an MI approach (MI surgery [MIS] group: n = 25) or SPA (SPA group: n = 16) between January 2015 and July 2020 were retrospectively included. Spinopelvic parameters were evaluated before the surgery, immediately after the surgery, and at the 2-year follow-up. Clinical data including operative time, estimated blood loss, blood transfusion, level of fusion, incision length, bed rest period, length of hospitalization, and surgical complications were compared between the two groups. The Scoliosis Research Society outcomes instrument-22 (SRS-22) was administered to assess patients' quality of life at the latest follow-up. Comparisons between the two groups were performed using independent sample t-test or Chi-square test. RESULTS Characteristics and baseline kyphosis of the two groups were matched. At the 2-year follow-up, in the MIS group, the average correction values of the sagittal vertical axis and global kyphosis (GK) were 9.5 cm and 44.3°, respectively. Compared with the SPA group, the MIS group had similar correction values and correction losses after surgery. No obvious differences were observed in any radiographic parameters, except for GK, immediately after surgery and at the 2-year follow-up between the two groups (p > 0.05). The MIS group had a significantly shorter operative time, lesser blood loss, lesser transfusion volume, shorter fusion level, and lesser time to mobilization than did the SPA group. Higher average functional activity scores of SRS-22 were obtained in the MIS group than in the SPA group. CONCLUSION Mini-open PSO may be an effective alternative to the SPA for treating AS-related spinal kyphosis, with comparable correction effect, lesser surgical trauma and faster recovery. This comparative study may provide valuable guidance for surgical decision-making and patient counseling.
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Affiliation(s)
- Gao Si
- Peking University Third Hospital, Department of OrthopaedicsBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Weipeng Qiu
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
- Peking University Health Science CenterBeijingChina
| | - Qixian Shen
- Peking University Health Science CenterBeijingChina
| | - Yongqiang Wang
- Peking University Third Hospital, Department of OrthopaedicsBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Weishi Li
- Peking University Third Hospital, Department of OrthopaedicsBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Miao Yu
- Peking University Third Hospital, Department of OrthopaedicsBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yu Wang
- Peking University First Hospital, Department of OrthopaedicsBeijingChina
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Jimbayashi H, Iida K, Kazu K, Saiwai H, Kawaguchi K, Matsumoto Y, Nakashima Y. Cases requiring reoperation for recurrence of myelopathy by lamina closure after a double-door laminoplasty using a modified Kirita-Miyazaki suture method. J Orthop 2023; 44:12-16. [PMID: 37649794 PMCID: PMC10462786 DOI: 10.1016/j.jor.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/30/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023] Open
Abstract
Background Progression of kyphosis after laminoplasty sometimes results in the recurrence of myelopathy with lamina closure. However, only a few case reports have been published on the reoperation of double-door laminoplasty using the suture method. This study investigated the incidence and clinical features of reoperation cases caused by the recurrence of myelopathy with lamina closure after double-door laminoplasty using a modified Kirita-Miyazaki suture method. Methods A total of 169 patients who underwent double-door laminoplasty were included in this study, with a mean follow-up duration of 6.6 years (range: 2-16). All surgeries were double-door laminoplasties in which the open lamina was sutured to the paravertebral muscle. The reoperation rate for myelopathy recurrence due to lamina closure and the associated risk factors were investigated. The risk factors included age, history, cervical alignment, C2-7 lordosis, the cervical sagittal vertical axis, and C7 slope. Results The reoperation rate for recurrence of myelopathy by lamina closure was 3.0% (5/169). All patients showed kyphosis progression after surgery; the spinal cord was more compressed by closed lamina than before the initial surgery. The reoperation group had more patients with neuromuscular or psychiatric disorders (60% [3/5] vs. 2% [4/164]; p < 0.001), kyphotic alignments (60% [3/5] vs. 10% [16/164]; p < 0.001), and cases with less than -10° of C2-7 lordosis (60% [3/5] vs. 7% [11/164]; p < 0.001). Conclusions Double-door laminoplasty with the suture method may not be suitable for patients with a neuromuscular or psychiatric disease or those with preoperative C2-7 lordosis less than -10°.
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Affiliation(s)
- Hideki Jimbayashi
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Keiichiro Iida
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kobayakawa Kazu
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hirokazu Saiwai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kenichi Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Long Z, Gong F, Xiong L, Wen J, Chen G. Modified posterior osteotomy for osteoporotic vertebral collapse with neurological dysfunction in thoracolumbar spine: a preliminary study. J Orthop Surg Res 2023; 18:688. [PMID: 37715231 PMCID: PMC10502986 DOI: 10.1186/s13018-023-04189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE The risk of osteoporotic vertebral collapse (OVC) associated with delayed neurological dysfunction (DND) is substantial, and performing surgery for this condition in elderly patients presents challenges. The focus of the current research is on simplifying surgical procedures while maintaining their effectiveness. This study was designed to contribute clinical data supporting the use of modified posterior osteotomy for treating thoracolumbar OVC with DND. The study compares perioperative clinical parameters, imaging data characteristics, and changes in efficacy outcome indicators to provide evidence for the advancement of this technique. METHODS A total of 12 patients diagnosed with osteoporotic vertebral collapse and neurological dysfunction were included in the study. All patients underwent modified posterior osteotomy. Data regarding perioperative and radiological parameters as well as complications such as surgery duration, blood loss, ASIA grade, VAS, ODI, regional kyphosis angle (RKA), anterior vertebral height ratio (AVHr), and spinal canal clearance ratio (SCCr), were collected retrospectively. These parameters were then analysed to evaluate the clinical efficacy and safety of the modified posterior osteotomy technique. RESULTS A total of 12 patients were included in the study, with a mean age of 65.5 ± 9.7 years. The average follow-up period was 29.4 ± 5.0 months. The mean operative blood loss was 483.3 ± 142.0 ml, and the average operative time was 3.7 ± 0.7 h. The visual analogue scale (VAS) score decreased from a preoperative value of 5.8 ± 0.7 to a final follow-up value of 1.3 ± 0.8 (P < 0.05), indicating a significant improvement in pain. The ODI decreased from 65.2 ± 6.0 before surgery to 20.5 ± 7.0, indicating a decrease in disability, and the postoperative neurological function showed a significant improvement. Correction of the RKA was observed, with the angle changing from 35.8 ± 10.8° before surgery to 20.0 ± 3.5° after surgery and to 22.5 ± 3.1° at the final follow-up. Similarly, correction of the AVHr was observed, with the height changing from 39.3 ± 18.0 to 63.0 ± 14.3 after surgery and to 53.9 ± 8.9 at the final follow-up. Correction of the SCCr was also observed, with the ratio changing from 54.9 ± 5.4 to 68.1 ± 5.3 after surgery and to 68.68 ± 6.76 at the final follow-up. CONCLUSIONS Posterior modified osteotomy is an effective treatment for thoracolumbar osteoporotic fractures with OVC combined with DND. It can significantly preserve vertebral height, increase vertebral canal volume, correct kyphotic angle, and improve postoperative neurological function. The simplified osteotomy also offers advantages in terms of operating time, blood loss, postoperative VAS score, and improvement in lumbar function.
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Affiliation(s)
- Zhisheng Long
- Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Feipeng Gong
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Long Xiong
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Jiabin Wen
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China.
| | - Gang Chen
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
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Zhang W, Yin W, Cui X, Chai Z, Zheng G, Ding Y, Wang H, Zhai Y, Yu H. Operative strategies for ankylosing spondylitis-related thoracolumbar kyphosis: focus on the cervical stiffness, coronal imbalance and hip involvement. BMC Musculoskelet Disord 2023; 24:723. [PMID: 37697276 PMCID: PMC10494390 DOI: 10.1186/s12891-023-06810-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 08/18/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Cervical stiffness, coronal imbalance and limited hip movement all play crucial roles in designing the corrective surgery for ankylosing spondylitis-related thoracolumbar kyphosis (AS-TLK). However, a comprehensive classification and tailored strategies for directing clinical work are lacking. This study aims to investigate the types and surgical strategies for AS-TLK that consider cervical stiffness, coronal imbalance and hip involvement as the key factors. METHODS 25 consecutive AS-TLK patients were divided into three types according to their accompanying features: Type I: with a flexible cervical spine; Type IIA: with a stiff cervical spine; Type IIB: with coronal imbalance; Type IIC: with limited hip movement. Type III is the mixed type with at least two conditions of Type II. Individual strategies were given correspondingly. Spinal-pelvic-femoral parameters were measured, Scoliosis Research Society outcome instrument-22 (SRS-22) was used and complications were recorded and analysed. RESULTS All patients (Type I 10, Type II 8 and Type III 7) underwent surgery successfully. 13 cases with 16 complications were recorded and cured. The patients were followed up for 24-65 months with an average of 33.0 ± 9.6 months. Both the sagittal and coronal parameters were corrected and decreased significantly (all, p < 0.05). SRS-22 scores showed a satisfactory outcome. CONCLUSION Thoracolumbar kyphosis secondary to ankylosing spondylitis are complex and variable. Considering the factors of cervical stiffness, coronal imbalance and hip involvement assists in making decisions individually and achieving a desired surgical result.
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Affiliation(s)
- Wei Zhang
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Wen Yin
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Xilong Cui
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Zihao Chai
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Guohui Zheng
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Ya Ding
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Hongliang Wang
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Yunlei Zhai
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Haiyang Yu
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China.
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China.
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Park PJ, Hassan FM, Ferrer XE, Morrissette C, Lee NJ, Cerpa M, Sardar ZM, Kelly MP, Bourret S, Hasegawa K, Wong HK, Liu G, Hey HWD, Riahi H, Huec JCL, Lenke LG. The Posterior Cranial Vertical Line: A Novel Radiographic Marker for Classifying Global Sagittal Alignment. Neurospine 2023; 20:790-797. [PMID: 37798971 PMCID: PMC10562219 DOI: 10.14245/ns.2346408.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE To define a novel radiographic measurement, the posterior cranial vertical line (PCVL), in an asymptomatic adult population to better understand global sagittal alignment. METHODS We performed a multicenter retrospective review of prospectively collected radiographic data on asymptomatic volunteers aged 20-79. The PCVL is a vertical plumb line drawn from the posterior-most aspect of the occiput. The horizontal distances of the PCVL to the thoracic apex (TA), posterior sagittal vertical line (PSVL, posterosuperior endplate of S1), femoral head center, and tibial plafond were measured. Classification was either grade 1 (PCVL posterior to TA and PSVL), grade 2 (PCVL anterior to TA and posterior to PSVL), or grade 3 (PCVL anterior to TA and PSVL). RESULTS Three hundred thirty-four asymptomatic patients were evaluated with a mean age of 41 years. Eighty-three percent of subjects were PCVL grade 1, 15% were grade 2, and 3% were grade 3. Increasing PCVL grade was associated with increased age (p < 0.001), C7-S1 sagittal vertical axis (SVA) (p < 0.001), C2-7 SVA (p < 0.001). Additionally, it was associated with decreased SS (p = 0.045), increased PT (p < 0.001), and increased knee flexion (p < 0.001). CONCLUSION The PCVL is a radiographic marker of global sagittal alignment that is simple to implement and interpret. Increasing PCVL grade was significantly associated with expected changes and compensatory mechanisms in the aging population. Most importantly, it incorporates cervical alignment parameters such as C2-7 SVA. The PCVL defines global sagittal alignment in adult volunteers and naturally distributes into 3 grades, with only 3% being grade 3 where the PCVL lies anterior to the TA and PSVL.
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Affiliation(s)
- Paul J. Park
- Department of Orthopedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
- Deparment of Neurological Surgery, Weil Cornell Brain and Spine Center, New York, NY, USA
| | - Fthimnir M. Hassan
- Department of Orthopedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Xavier E. Ferrer
- Department of Orthopedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Cole Morrissette
- Department of Orthopedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Nathan J. Lee
- Department of Orthopedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Meghan Cerpa
- Department of Orthopedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Zeeshan M. Sardar
- Department of Orthopedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Michael P. Kelly
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Stephane Bourret
- Spine Unit 2, Surgical Research Lab, Bordeaux University Hospital, Bordeaux, France
| | | | - Hee-Kit Wong
- Department of Orthopedic Surgery, National University Hospital (Singapore), Singapore
| | - Gabriel Liu
- Department of Orthopedic Surgery, National University Hospital (Singapore), Singapore
| | - Hwee Weng Dennis Hey
- Department of Orthopedic Surgery, National University Hospital (Singapore), Singapore
| | - Hend Riahi
- Institut Kassab D'orthopédie, Ksar Said La Manouba, Tunis, Tunisia
| | - Jean-Charles Le Huec
- Spine Unit 2, Surgical Research Lab, Bordeaux University Hospital, Bordeaux, France
| | - Lawrence G. Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
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Ali S, Louie AV, Tsao MN. Severe kyphosis and stereotactic lung radiation therapy set-up: A case report and lessons learned. J Med Imaging Radiat Sci 2023; 54:566-571. [PMID: 37422412 DOI: 10.1016/j.jmir.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION Stereotactic body radiation therapy (SBRT) for lung cancers allows for safe ablative radiation doses to be delivered precisely to treat localized stage 1 lung cancers and for the treatment of lung oligometastasis/es. The successful delivery of lung SBRT requires multidisciplinary technical expertise, from radiation oncologists, medical physicists, radiation therapists, and a clinical specialist radiation therapist in SBRT. While the majority of SBRT lung set-ups are routine, we present a challenging situation in the lung SBRT set-up for a patient with severe kyphosis. CASE AND OUTCOMES An 80-year-old woman was diagnosed with a right upper lobe non-small cell lung cancer. She declined surgery and was referred for lung SBRT. Her severe kyphosis did present challenges in terms of reproducible lung SBRT set-up. We were successful in immobilizing this patient in a vacuum customized rigid support which was shaped to accommodate this patient's extreme kyphosis and elevated head. The patient tolerated the treatment position and successfully completed her lung SBRT treatments comfortably, without any reproducibility issues. Four months after SBRT, the patient was doing well without any new chest symptoms. DISCUSSION This report is the first, in the published medical literature, to describe a lung SBRT set-up for a patient with extreme kyphosis. Her successful set-up and ability to complete her lung SBRT was dependent on creative problem-solving from the multi-disciplinary team and a patient-centred approach to care CONCLUSION: Multidisciplinary collaboration was essential in the successful SBRT treatment for a severely kyphotic patient. The use of a vacuum customized thoracic rigid support was effectively used in a patient with severe kyphosis for lung SBRT. Results from this case report could be useful and guide other clinicians if presented with similarly challenging cases.
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Affiliation(s)
- S Ali
- Odette Cancer Centre, Sunnybrook Health Sciences, Toronto, ON, CANADA
| | - A V Louie
- Odette Cancer Centre, Sunnybrook Health Sciences, Toronto, ON, CANADA; Department of Radiation Oncology, University of Toronto, Toronto, ON, CANADA
| | - M N Tsao
- Odette Cancer Centre, Sunnybrook Health Sciences, Toronto, ON, CANADA; Department of Radiation Oncology, University of Toronto, Toronto, ON, CANADA.
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Ghazi J, Sparagana S, Rampy P, Sucato D, Johnson M. Upper extremity neuromonitoring changes are more common than lower extremity during spinal fusion for Scheuermann's kyphosis. Spine Deform 2023; 11:1253-1259. [PMID: 37074516 DOI: 10.1007/s43390-023-00688-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/04/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION The purpose of this study is to determine the incidence of intraoperative neuromonitoring (IONM) changes and postoperative neurologic deficit in patients with Scheuermann's Kyphosis (SK) undergoing posterior spinal fusion (PSF). METHODS Single-center, retrospective chart review of the clinical, surgical and IONM data (somatosensory evoked potential (SSEP) and neurogenic motor evoked potential (NMEP) or transcranial motor evoked potential (TcMEP)) from patients with SK undergoing PSF at our center from 1993 to 2021. RESULTS One hundred and four SK patients (mean 16.4 ± 1.9 years) underwent PSF with correction of kyphosis from mean 79.4 ± 10.8° to 35.4 ± 13.9°. MEP data were obtained using either NMEP in 34.6% of patients) or TcMEP in 65.4% of patients. Only 3.8% of cases had lower extremity (LE) IONM changes during surgery, with no postoperative neurologic deficits in those patients. IONM changes occurred more frequently in the upper extremities (UE) with 14 (13.4%) patients having changes in UE SSEPs. Patients with UE IONM changes had significantly longer surgical times (p = 0.0096) and higher number of levels fused (p = 0.003) compared to patients without changes. Their weight, but not BMI, was also significantly higher (p = 0.036). These UE IONM changes resolved with arm repositioning in all but one patient who had a postoperative UE neurapraxia that resolved by 6 weeks. There was 1 postoperative transient femoral nerve palsy without IONM changes thought to be due to patient positioning. CONCLUSION The incidence of critical LE IONM changes during PSF for SK is 3.4%, which is similar to that reported in AIS. UE IONM changes are significantly more common at 13.4%, revealing that these patients are vulnerable to malpositioning of the arms during surgery.
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Affiliation(s)
- John Ghazi
- Department of Orthopedic Surgery, Texas Scottish Rite Hospital for Chidren, University of Texas Southwestern Medical Center, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Steven Sparagana
- Department of Neurology and Rehabilitation Medicine, Texas Scottish Rite Hospital for Children, University of Texas Southwestern Medical Center, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Patricia Rampy
- Department of Neurology and Rehabilitation Medicine, Texas Scottish Rite Hospital for Children, University of Texas Southwestern Medical Center, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Daniel Sucato
- Department of Orthopedic Surgery, Texas Scottish Rite Hospital for Chidren, University of Texas Southwestern Medical Center, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Megan Johnson
- Department of Orthopedic Surgery, Texas Scottish Rite Hospital for Chidren, University of Texas Southwestern Medical Center, 2222 Welborn Street, Dallas, TX, 75219, USA.
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Lim J, Lee D, Kim S, Lee S, Ryu JS. Analysis of abnormal muscle activities in patients with loss of cervical lordosis: a cross-sectional study. BMC Musculoskelet Disord 2023; 24:666. [PMID: 37608321 PMCID: PMC10464463 DOI: 10.1186/s12891-023-06782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/04/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND This study aimed to detect the differences in cervical muscle activation patterns in people with versus without cervical lordosis and explore the possible mechanism of cervical pain originating therein. METHODS This cross-sectional design included 39 participants without and 18 with normal cervical lordosis. Muscular activation was measured for 5 s in both groups using surface electromyography. Subsequently, the root mean square (RMS) of muscle amplitude was obtained at the bilateral splenius capitis, upper and lower parts of the splenius cervicis, upper and lower parts of the semispinalis cervicis, sternocleidomastoid, upper trapezius, and rhomboid muscles in five cervical positions: 0° (resting), 30° of flexion, 30° of extension, 60° of extension, and upon a 1-kg load on the head in a resting posture. RESULTS The RMS values of the upper trapezius muscle at all postures and the rhomboid muscles at 60° of extension were significantly lower in the loss of lordosis than control group. Comparing the RMS ratio of each posture to the resting position, the ratio of the upper trapezius at flexion was significantly higher and that of the rhomboids at 60° of extension and upon loading was significantly lower in the loss of lordosis than control group. Moreover, the pattern changes in the RMS values according to posture showed a similar shape in these two muscles, and lower in the loss of lordosis than the normal group. CONCLUSIONS The loss of normal cervical alignment may correlate with predisposed conditions such as reduced muscle activation of the trapezius and rhomboid muscle, and may also provoke over-firing of the upper trapezius muscle, possibly increasing neck musculoskeletal pain. TRIAL REGISTRATION CLINICALTRIALS gov, registration number: NCT03710785.
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Affiliation(s)
- Jiwoon Lim
- Department of Rehabilitation Medicine, Korea University Ansan Hospital, Ansan-si, South Korea
| | - Dajeong Lee
- Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Sangyoung Kim
- Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seungeun Lee
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea.
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea.
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Uchida M, Yamaguchi K, Tamai T, Kobayashi K, Tohara H. Effects of simulated kyphosis posture on swallowing and respiratory functions. J Phys Ther Sci 2023; 35:593-597. [PMID: 37529064 PMCID: PMC10390037 DOI: 10.1589/jpts.35.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/18/2023] [Indexed: 08/03/2023] Open
Abstract
[Purpose] To evaluate the effects of kyphosis on swallowing and respiratory functions. [Participants and Methods] In 94 healthy adult volunteers, the respiratory (vital capacity, percentage of vital capacity, and cough peak flow and swallowing (hyoid amplitude and tongue pressure) functions, were evaluated under the following conditions: vertical, moderate kyphosis, and severe kyphosis postures defined by the round-back index. [Results] The mean vital capacity and percentage of vital capacity were significantly lower in severe kyphosis than in the vertical posture. The suprahyoid muscle amplitudes, tongue pressure, and cough peak flow was significantly lower in severe kyphosis than in moderate kyphosis or the vertical positions. [Conclusion] The swallowing and breathing functions were significantly lower in volunteers with severe kyphosis than in those with moderate kyphosis or the vertical positions. Although strengthening of the suprahyoid muscles is a typical example of rehabilitation for dysphagia, but it may also be necessary to consider postural adjustment for patients with kyphosis. A comprehensive evaluation of swallowing function that takes both posture and respiratory function into consideration is necessary.
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Affiliation(s)
- Manabu Uchida
- Division of Physical Therapy, Department of Rehabilitation,
Faculty of Health Sciences, University of Tokyo Health Sciences: 4-11 Ochiai, Tama City,
Tokyo 206-0033, Japan
| | - Kohei Yamaguchi
- Dysphagia Rehabilitation, Department of Gerontology and
Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental
University, Japan
| | - Tomoe Tamai
- Dysphagia Rehabilitation, Department of Gerontology and
Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental
University, Japan
| | - Kensuke Kobayashi
- Social Welfare Service Corporation Sawarabi-kai Special
Nursing Home for the Elderly, Syugetsu, Japan
| | - Haruka Tohara
- Dysphagia Rehabilitation, Department of Gerontology and
Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental
University, Japan
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Mousavi SR, Farrokhi MR, Liaghat A, Hassani A, Kazeminezhad A, Ghaffarpasand F. Atypical Scheuermann's disease with severe kyphosis and negative sagittal balance in the thoracolumbar region: A case report and literature review. Int J Surg Case Rep 2023; 109:108618. [PMID: 37557040 PMCID: PMC10424201 DOI: 10.1016/j.ijscr.2023.108618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Scheuermann's kyphosis is a structural deformity of the thoracolumbar spine that is classified in typical (thoracic) and atypical (lumbar and thoracolumbar) Scheuermann's disease. Surgical intervention is reserved for those with progressive kyphosis, intractable pain and neurological impairment. Although, previous literature focuses on the correction of the thoracic kyphosis (TK), recent lines of evidence recommend considering all the sagittal balance parameters when performing a surgery. We herein, report a posterior-only approach in a patient with Scheuermann's kyphosis, considering all the sagittal balance parameters. CASE PRESENTATION The patient was a 17-year-old boy with a kyphotic deformity in the lumbar region, with urinary retention and upper back intractable pain. The preoperative physical examination was normal except for a kyphotic gait. The patient was first treated with thoracic lumbosacral orthoses (TLSO) brace that was not effective; consequently, the patient underwent posterior only approach (pedicular screw fixation along with Smith-Peterson osteotomy) with correction of the sagittal balance and kyphosis. The patient's sign and symptoms improved significantly. The surgery was uneventful and no complication was recorded. The 1-year follow-up revealed normal neurological examination and normal sagittal balance parameters. CLINICAL DISCUSSION Atypical Scheuermann's kyphosis with neurological impairment and progressive kyphosis should be treated with surgical intervention. CONCLUSION Considering the sagittal parameters of the spine, the surgical intervention should be designed to correct the kyphosis and the other indices of the sagittal balance. Posterior-only approach is safe and effective method for correction of the TK and improving the signs and symptoms of the patients.
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Affiliation(s)
- Seyed Reza Mousavi
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Reza Farrokhi
- Shiraz Neurosciences Research Center, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Alireza Liaghat
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirhossein Hassani
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Kazeminezhad
- Department of Neurosurgery, Peymanieh Hospital, Trauma Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Fariborz Ghaffarpasand
- Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran.
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Safaei S, Azimi P, Yazdanian T. Clinical outcomes of surgical treatment for Copenhagen syndrome: a case series. J Med Case Rep 2023; 17:282. [PMID: 37408023 DOI: 10.1186/s13256-023-04004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/22/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Copenhagen syndrome (CS) is a rare disorder mostly observed in adolescent. The onset of the disease, with a progressive anterior vertebral ankylosis in the thoracic and/or lumbar areas often clinically revealed by thoracolumbar kyphosis. We report a series of three patients of CS with good outcome. CASE PRESENTATION The mean age of patients were 14.0 (SD = 3.6) years at admission time. Patients underwent clinical and radiological examination (MRI, CT scan, and bone scan) before surgery and revealed Copenhagen syndrome. Case 2 received conservative treatment braces and regular follow-up. Finally, all patients were treated according to their clinical conditions through a combined surgical approach such as pedicle subtraction osteotomy (PSO), ponte osteotomy, hook, pedicular screw insertion, and fusion. In postoperative follow-up, the deformity correction was achieved with proper alignment in all the cases. CONCLUSION The treatment of CS with PSO plus ponte osteotomy seems to result in an excellent surgical procedure and outcome for our patients based on deformity severity. Bone scan imaging could be considered as an aid to differential diagnosis, which is an effective method.
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Affiliation(s)
- Saeid Safaei
- Knee and Sport Medicine Research Center, Milad Hospital, Tehran, Iran
| | - Parisa Azimi
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Illingworth KD, Siddiqui AA, Skaggs DL, Andras LM. Deformity angular ratio is associated with neuromonitoring changes without a vertebral column resection: spinal deformity is more influential than type of surgery. Spine Deform 2023; 11:951-956. [PMID: 36930440 PMCID: PMC10261247 DOI: 10.1007/s43390-023-00669-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/18/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE The purpose of this study is to investigate the effect of the deformity angular ratio (DAR) on intra-operative neuromonitoring (IONM) signal changes during posterior spinal fusion (PSF) without vertebral column resection (VCR). METHODS Retrospective review of severe pediatric spinal deformity patients treated with PSF without VCR or three-column osteotomy from 2008 to 2018. Exclusion criteria were prior instrumentation, lack of IONM, and incomplete radiographic data. Coronal DAR (C-DAR), sagittal DAR (S-DAR), and total DAR (T-DAR) were calculated and compared between patients with IONM signal loss and those without. RESULTS Two hundred and fifty-three patients met inclusion criteria. Forty-seven of two hundred and fifty-three (19%) patients had IONM signal loss. Intra-operative wake-up test was performed in seven cases; three of seven (43%) had a neurological deficit on wake-up test. All neurological deficits resolved at a mean of 41 days postop. IONM loss was associated with increased kyphosis (p = 0.003) and was not associated with Cobb angle (p = 0.16). S-DAR (p = 0.03) and T-DAR (p = 0.005) were associated with IONM signal loss but C-DAR was not (p = 0.06). Increased incidence of IONM signal loss was seen with S-DAR > 7 (p = 0.02) or T-DAR > 27 (p = 0.02). Twenty-four of ninety-two (26%) patients with S-DAR > 7 had IONM signal loss compared to twenty-three of one hundred and sixty-one (14%) with S-DAR ≤ 7 (OR, 2.1; 95% CI, 1.1-4.0). Seven of sixteen (44%) patients with T-DAR > 27 had signal loss compared to forty of two hundred and thirty-seven (17%) patients with T-DAR ≤ 27 (OR, 3.8; 95% CI, 1.3-10.9). CONCLUSION Patients with S-DAR > 7 or T-DAR > 27 have a higher risk of IONM loss during pediatric PSF even in the absence of a VCR or three-column osteotomies. LEVEL OF EVIDENCE II
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Affiliation(s)
| | - Ali A Siddiqui
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- University of FL College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - David L Skaggs
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lindsay M Andras
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA.
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
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