The CAPN3 p.Lys 254del variant is not always associated with dominant CAPN3-related muscular dystrophy

INTRODUCTION/AIMS

Limb-girdle muscular dystrophy R1 (LGMDR1) calpain 3-related usually presents as a recessively transmitted weakness of proximal limb-girdle muscles due to pathogenic variants in the CAPN3 gene. Pathogenic variants in this gene have also been found in patients with an autosomal dominantly inherited transmission pattern (LGMDD4). The mechanism underlying this difference in transmission patterns has not yet been elucidated. Camptocormia, progressive limb weakness, myalgia, back pain, and increased CK levels are common clinical features associated with dominant forms. The p.Lys254del pathogenic variant was associated with camptocormia in two LGMDD4 families. This study aimed to present carriers found in recessively transmitted LGMDR1 families bearing the p.Lys254del variant that do not show muscle weakness.

METHODS

DNA sequencing was performed on exon 5 of CAPN3 in family members to establish the carrier status of the pathogenic variant. They were evaluated clinically and MRI was performed when available.

RESULTS

Two families presented with the p.Lys254del pathogenic variant in a homozygous or compound heterozygous state. Family members carrying only the pathogenic variant in the heterozygous state did not demonstrate the myopathic characteristics described in dominant patients. Camptocormia and other severe clinical symptoms were not observed.

DISCUSSION

We conclude that the p.Lys254del pathogenic variant per se cannot be solely responsible for camptocormia in dominant patients. Other undisclosed factors may regulate the phenotype associated with the dominant inheritance pattern in CAPN3 pathogenic variant carriers.

Magnetic resonance imaging shows spinal curvature in Chinook salmon (Oncorhynchus tshawytscha) is associated with chronic inflammation of peri-vertebral soft tissues

Chinook salmon (Oncorhynchus tshawytscha) farmed in New Zealand are known to develop abnormal spinal curvature late in seawater production. Its cause is presently unknown, but there is evidence to suggest a neuromuscular pathology. Using magnetic resonance imaging (MRI), we evaluated the relationship between soft tissue pathology and spinal curvature in farmed Chinook salmon. Regions of interest (ROIs) presenting as pathologic MRI signal hyper-intensity were identified from scans of 24 harvest-sized individuals: 13 with radiographically-detectable spinal curvature and 11 without. ROIs were excised from individuals using anatomical landmarks as reference points and histologically analysed. Pathologic MRI signal was observed more frequently in individuals with radiographic curvature (92%, n = 12) than those without (18%, n = 2), was localized to the peri-vertebral connective tissues and musculature, and presented as three forms: inflammation, fibrosis, or both. These pathologies are consistent with a chronic inflammatory process, such as that observed during recovery from a soft tissue injury, and suggest spinal curvature in farmed Chinook salmon may be associated with damage to and/or compromised integrity of the peri-vertebral soft tissues. Future research to ascertain the contributing factors is required.

Biomechanical analysis of complications following T10-Pelvis spinal fusion: A population based computational study

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.

Inaugural dropped head syndrome and camptocormia in inflammatory myopathies: a retrospective study

OBJECTIVES

Inaugural axial muscle involvement, defined as dropped head syndrome (DHS) and/or camptocormia (CC), is poorly described in inflammatory myopathies (IM). This study aimed to further characterize IM patients with inaugural DHS/CC, their outcome and care management.

METHODS

This retrospective study included IM patients diagnosed between 2000 and 2021. The main inclusion criterion was IM revealed by axial muscle deficit (DHS/CC).

RESULTS

Twenty-seven patients were included; median (IQR) age at first symptoms was 66.0 years (55.5-75.0); 21 were female (77.8%). There were nine IBM, 33.3%, nine overlap myositis (OM, 33.3%), five DM, 18.5%, two immune checkpoint inhibitor-related myositis (7.4%), one focal myositis (3.7%) and one myositis with anti-Hu antibodies (3.7%). Age at first symptoms was ≤70 years in 16 patients (59.3%), including all DM patients and 8/9 OM patients (88.9%). In this group, partial remission of the disease was obtained in 9/16 (56.3%) and complete remission in 1/16 patients (6.3%); regression of DHS/CC was achieved in 3/16 patients (18.8%). Conversely, in the group of 11 patients aged >70 years at first symptoms, there were eight IBM (72.7%). Partial remission was obtained in 5/11 patients (45.5%), the disease was stable in 6/11 patients (54.5%); no complete remission was obtained nor regression of DHS/CC.

CONCLUSION

The analysis of IM patients with inaugural DHS/CC delineates two groups of patients according to the age at first symptoms in terms of clinical and outcome specificities, and proposes an adapted diagnostic and care management approach to prevent long-term complications.

Sedentary lifestyle of university students is detrimental to the thoracic spine in men and to the lumbar spine in women

BACKGROUND

Sitting for long periods of time and lack of physical activity in young adults can cause postural deterioration leading to rapid onset of fatigue and increase the risk of back pain. We were interested in whether there are gender differences in spinal curvature among university students with a predominantly sedentary lifestyle.

METHODS

20 sedentary female (age 20 ± 0.73 years) and 39 sedentary male university students (age 20 ± 1.08 years) participated in this study. Their thoracic and lumbar curvatures were assessed while standing and sitting using a Spinal Mouse.

RESULTS

In standing, 80.0% of the females and 69.2% of the males had a neutral position of the thoracic spine (33.25° and 35.33°, respectively). However, more males, 30.8%, than females, 10.0%, had hyperkyphosis (54.27° and 47.0°, respectively). Hypokyphosis was found in 10.0% of the females (18.50°) and none in the males. Similarly, 90.0% of the females and 97.4% of the males had neutral position of the lumbar spine (-33.11° and -29.76°, respectively). Increased hyperlordosis was found in 10.0% of the females and 2.6% of the males (-41.0° and -50.0°, respectively). Hypolordosis was not detected in either females or males. In sitting, on the other hand, 70.0% of the females and only 33.3% of the males had a neutral position of the thoracic spine (30.20° and 30.62°, respectively). Increased hyperkyphosis was found in 46.2% of the males (59.76°) and none of the females. 30.0% of the females and 23.1% of the males had light hypokyphosis (47.50° and 46.67°, respectively). Similarly, 70.0% of the females and only 38.5% of the males had a neutral position of the lumbar spine (7.0° and 6.6°, respectively). 35.9% of the males and only 5.0% of the females had a light hypokyphosis (16.14° and 16.0°, respectively). Slightly increased hyperkyphosis was identified in 25.6% of the males and 25.0% of the females (23.9° and 22.5°, respectively).

CONCLUSION

There are significant gender differences in spinal curvature. While in the thoracic spine it was to the detriment of the males when both standing and sitting, in the lumbar spine it is related to the females only when standing. It is therefore necessary to eliminate these spinal deviations in young adults induced by prolonged sitting during university courses by appropriate recovery modalities.

[Prevalence and influencing factors of abnormal spinal curvature in primary and secondary school students in Shandong Province in 2020]

In 2020, the prevalence of abnormal spinal curvature among 54 079 students in Shandong Province was 1.54%. The multivariate logistic regression model analysis showed that, compared with those in primary school, economically underdeveloped areas, and non-residential schools, students in middle and high schools, economically average areas, and residential schools had a higher risk of abnormal spinal curvature, with OR (95%CI) values of 2.029 (1.662-2.476), 2.746 (2.208-3.416), 2.237 (1.740-2.875) and 2.057 (1.705-2.483), respectively. Compared with those in economically underdeveloped areas, who were underweight, who had seat adjustments≤1 time per academic year, and who had physical education classes≤1 per week, students in economically developed areas, who were normal weight, overweight, and obese, who had seat adjustments≥2 times per academic year, and who had physical education classes 2-3 or≥4 per week, had a lower risk of abnormal spinal curvature, with OR (95%CI) values of 0.690 (0.521-0.915), 0.722 (0.546-0.955), 0.535 (0.389-0.735), 0.383 (0.274-0.535), 0.835 (0.711-0.980), 0.561 (0.474-0.663) and 0.491 (0.315-0.766), respectively.

Relationship between Physical Activity and Sedentary Behavior, Spinal Curvatures, Endurance and Balance of the Trunk Muscles-Extended Physical Health Analysis in Young Adults

BACKGROUND

Physical inactivity and sedentary behavior are associated with poor well-being in young people with adverse effects extending into adulthood. To date, there are many studies investigating the relationship between physical activity (PA) and posture, but there are no data on the relationship between the type and intensity of PA and sedentary behavior, their association with thoracic and lumbar spine angles, and with endurance and balance of the trunk muscles, especially in healthy young adults aged 18-25 years. Moreover, there are no data on the relationship between PA and sedentary behavior and musculoskeletal and cardiopulmonary health, as well as quality of life (QoL) and sleep that would provide a more comprehensive picture of physical health status.

AIM

Therefore, the aim of this cross-sectional study was to investigate the extent to which PA and sedentary behavior are associated with each other and with changes in spinal curvatures, endurance and balance of trunk muscles in an extended analysis of physical health status in young adults aged 18-25 years by additionally including measures of body composition, cardiorespiratory capacity, and QoL and sleep.

METHODS

A total of 82 students (58% female, 42% male) aged 18-25 years completed all required tests. Primary outcome measures included the following: PA and sedentary behavior calculated from the long form of International PA Questionnaire (IPAQ-LF), spinal curvatures measured by a Spinal Mouse® device, endurance and balance of the trunk muscles measured using trunk endurance tests and their ratio.

RESULTS

Overall, 50% of students were classified as minimally active and 50% as health-enhancing PA (HEPA) active. The angles of thoracic kyphosis and lumbar lordosis showed no correlation with PA or time spent sitting. However, students with the lowest PA had significantly higher scores on the trunk extensor endurance test and trunk extensor/flexor endurance test ratio, indicating imbalanced trunk muscles. Moreover, these students spent the most their time sitting. Only PA of vigorous intensity and PA during recreation, leisure, and sports significantly correlated with QoL related to physical health. QoL related to physical and psychosocial health had significantly higher scores when students spent less time sitting. In addition, we found significantly better respiratory performance and SQ at higher PA values, i.e., PA during recreation, leisure, and sport.

CONCLUSIONS

Our results suggest that students with low PA levels and more time spent sitting have imbalanced trunk muscles, worse respiratory function, and poorer QoL and sleep. Moreover, these findings in college students may reflect their lifestyle and suggest that more PA needs to be promoted to prevent the development of chronic diseases including musculoskeletal disorders.

Automated measurement of size of spinal curve in population-based cohorts: Validation of a method based on total body dual energy X-ray absorptiometry scans

BACKGROUND

Scoliosis is spinal curvature that may progress to require surgical stabilisation. Risk factors for progression are little understood due to lack of population-based research, since radiographs cannot be performed on entire populations due to high levels of radiation. To help address this, we have previously developed and validated a method for quantification of spinal curvature from total body dual energy X-ray absorptiometry (DXA) scans. The purpose of this study was to automate this quantification of spinal curve size from DXA scans using machine learning techniques.

METHODS

To develop the automation of curve size, we utilised manually annotated scans from 7298 participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) at age 9 and 5122 at age 15. To validate the automation we assessed (1) agreement between manual vs automation using the Bland-Altman limits of agreement, (2) reliability by calculating the coefficient of variation, and (3) clinical validity by running the automation on 4969 non-annotated scans at age 18 to assess the associations with physical activity, body composition, adipocyte function and backpain compared to previous literature.

RESULTS

The mean difference between manual vs automated readings was less than one degree, and 90.4 % of manual vs automated readings fell within 10°. The coefficient of variation was 25.4 %. Clinical validation showed the expected relationships between curve size and physical activity, adipocyte function, height and weight.

CONCLUSION

We have developed a reasonably accurate and valid automated method for quantifying spinal curvature from DXA scans for research purposes.

Scoliosis Management through Apps and Software Tools

Background: Scoliosis is curvature of the spine, often found in adolescents, which can impact on quality of life. Generally, scoliosis is diagnosed by measuring the Cobb angle, which represents the gold standard for scoliosis grade quantification. Commonly, scoliosis evaluation is conducted in person by medical professionals using traditional methods (i.e., involving a scoliometer and/or X-ray radiographs). In recent years, as has happened in various medicine disciplines, it is possible also in orthopedics to observe the spread of Information and Communications Technology (ICT) solutions (i.e., software-based approaches). As an example, smartphone applications (apps) and web-based applications may help the doctors in screening and monitoring scoliosis, thereby reducing the number of in-person visits. Objectives: This paper aims to provide an overview of the main features of the most popular scoliosis ICT tools, i.e., apps and web-based applications for scoliosis diagnosis, screening, and monitoring. Several apps are assessed and compared with the aim of providing a valid starting point for doctors and patients in their choice of software-based tools. Benefits for the patients may be: reducing the number of visits to the doctor, self-monitoring of scoliosis. Benefits for the doctors may be: monitoring the scoliosis progression over time, managing several patients in a remote way, mining the data of several patients for evaluating different therapeutic or exercise prescriptions. Materials and Methods: We first propose a methodology for the evaluation of scoliosis apps in which five macro-categories are considered: (i) technological aspects (e.g., available sensors, how angles are measured); (ii) the type of measurements (e.g., Cobb angle, angle of trunk rotation, axial vertebral rotation); (iii) availability (e.g., app store and eventual fee to pay); (iv) the functions offered to the user (e.g., posture monitoring, exercise prescription); (v) overall evaluation (e.g., pros and cons, usability). Then, six apps and one web-based application are described and evaluated using this methodology. Results: The results for assessment of scoliosis apps are shown in a tabular format for ease of understanding and intuitive comparison, which can help the doctors, specialists, and families in their choice of scoliosis apps. Conclusions: The use of ICT solutions for spinal curvature assessment and monitoring brings several advantages to both patients and orthopedics specialists. Six scoliosis apps and one web-based application are evaluated, and a guideline for their selection is provided.

Non-intrusive RF sensing for early diagnosis of spinal curvature syndrome disorders

The recent developments in communication and information ease people's lives to sit in one place and access any information from anywhere. However, the longevity of sitting and sitting in different postures raises the issues of spinal curvature. It necessitates a physical examination to identify the spinal illness in its early stages. This article aims to develop an intelligent monitoring framework for detecting and monitoring spinal curvature syndrome problems based on Software Defined Radio Frequency (SDRF) sensing and verify its feasibility for diagnosing actual patients. The proposed SDRF-based system identifies irregular spinal curvature syndrome and offers feedback signals when an incorrect posture is identified. We design the system using wireless university software-defined radio peripheral (USRP) kits to transmit and receive RF signals and record the wireless channel state information (WCSI) for kyphosis, Lordosis, and scoliosis spinal disorders. The statistical measures are extracted from the WCSI and apply machine learning algorithms to identify and classify the type of disorders. We record and test the system using 11 subjects with the spinal disorders kyphosis, Lordosis, and scoliosis. We acquire the WCSI, extract various statistical measures in terms of time and frequency domain features, and evaluate machine learning classifiers to identify and classify the spinal disorder. The performance comparison of the machine learning algorithms showed overall and each spinal curvature disorder recognition accuracy of more than 99%.

The Sizes of Spine Curvatures of Children That Practice Selected Sports

(1) Background: The aim of this study was to evaluate the shape of the spine curves in the cervical, thoracic and lumbar sections of children that practice selected sports. (2) Methods: The body posture of the examined children was assessed using the digital photography method, i.e., the Moiré method. Selected parameters characterizing the curvature of the spine (the Alpha, Beta and Gamma angles, the size of kyphosis in the thoracic spine and the size of lordosis in the lumbar spine) were analyzed. (3) Results: The study of the body posture using the Moiré method allowed for the assessment of the angles that determine the size of the spine's curvature. The analysis of differences among the groups included in the study (football, swimming, biathlon/taekwondo, volleyball) was carried out on the basis of one-dimensional models that take into account the distributions of individual parameters. On the basis of the Alpha, Beta and Gamma angles, it was possible to calculate the size of kyphosis in the thoracic section and the size of lordosis in the lumbar spine. There was a statistically significant difference in the size of the Alpha, Beta and Gamma parameters among the groups. (4) Conclusions: Most of the respondents had the correct body posture in the sagittal plane, regardless of the type of sport they practiced. Our results did not allow us to unequivocally state whether practicing various sports and having different training loads resulting from these sports have a negative or positive effect on the size of the anterior-posterior curvatures of the spine.

Alignment of the Sternum and Sacrum as a Marker of Sitting Body Posture in Children

An analysis of literature on the methods of assuming a sitting position and the results of our own research indicated the need to search for biomechanical parameters and existing relationships that would enable a description of sitting body posture. The purpose of this paper is to analyze the relationship between the alignment of the body of sternum and sacrum and the changes in the thoracic and lumbar spine curvatures in children. The study involved 113 subjects aged 9-13 years. A planned simultaneous measurement of the angle parameters of the alignment of the body of sternum and sacrum relative to the body's sagittal axis and the angle parameters of the thoracic and lumbar spine curvatures was performed during a single examination session. The proposed markers of alignment in the corrected sitting body posture are characterized by homogeneous results. A high measurement repeatability was observed when determining the corrected body posture in the study setting. It was noted that changes in the alignment of the body of sternum and sacrum resulted in changes in the thoracic kyphosis and lumbar lordosis angle values, which may be an important component of clinical observations of sitting body posture in children. Implementing the body of sternum alignment angle of about 64° relative to the body's sagittal axis in clinical practice as one of the objectives of postural education may be the target solution for sitting body posture correction in children.

Adolescents' Experience during Brace Treatment for Scoliosis: A Qualitative Study

This study aimed to explore the subjective experiences of adolescents with scoliosis during brace treatment in order to understand their obstacles and make recommendations to enhance brace compliance. Using purposive sampling, 15 adolescents (2 males and 13 females) with scoliosis aged from 10 to 16 years old during brace treatment were recruited to participate in semi-structured in-depth interviews. The data were recorded, transcribed, and coded using thematic analysis with the qualitative software NVivo 10. Significant statements and phrases were organized into categories and themes to understand adolescents' experiences during brace treatment for scoliosis. In general, the adolescents acknowledged that compliance with brace treatment was essential to reduce or prevent the progression of spinal curvature and tried their best to comply with the treatment. Regarding their subjective experiences during brace treatment, three themes were identified and emerged as obstacles negatively affecting their brace compliance, including physical discomfort due to brace materials and design, reluctance caused by the brace's visual appearance, and passive patient participation during the treatment process. This study reveals insights into the experiences of adolescents with scoliosis during brace treatment and what they perceive as hindrances to compliance. In order to have better brace compliance, adolescents' feelings and difficulties during brace treatment should be recognized and addressed. Therefore, active patient participation throughout the treatment process, involving the co-design of a customized brace, psychosocial interventions, and personalized appearance style management should be considered and promoted to facilitate a more acceptable bracing experience to achieve better brace compliance.

Effects of Postural Interventions on Physical and Psychological Aspects of Children in Terms of Secondary Sexual Characteristics

Children with secondary sexual characteristics who experience considerable physical, psychological, and social development are prone to physical and mental imbalances. The effects of postural intervention on physical and psychological aspects in junior high school students in terms of secondary sexual characteristics were investigated in this study. Of the 30 participants in this study, 21 (10 boys, 11 girls) with complete measurements were included. The postural intervention consisted of 1 month of direct muscle stretching for postural maintenance and breathing as well as activities to orient the spinal curvature. The participants’ body arrangement, spinal curvature, and General Health Questionnaire 30 (GHQ) scores were compared before and after the postural intervention. The intervention improved postural alignment (e.g., head−neck angle t20 = 2.33, p < 0.05, 95%CI [0.30, 5.36]) and GHQ scores (e.g., GHQ total t20 = 3.36, p < 0.01, 95%CI [0.79, 3.40]). The postural intervention improved the posture of the students as well as positively affected their mental health. This study showed that students with secondary sexual characteristics can receive physical and psychological care without the use of special facilities or techniques.

[Postural effect of vestibular galvanic stimulation in patients with Parkinson's disease and camptocormia: Case series]

The objective of this paper is to explore the postural effect of galvanic vestibular stimulation (GVS) in camptocormia. It is a retrospective case series of 7 Parkinson disease and camptocormia patients. Binaural monopolar GVS was administered. Main outcome variable was trunk forward flexion (TFF), assessed pre and immediately post GVS, and one month after. The TFF was assessed in the standing position, with open and closed eyes. The Berg balance scale was assessed before and 1 month after GVS. The TFF immediately after the GVS showed a reduction of 2.3 cm (p = 0.091) in the first reading, and after a 1-min stance (p = 0.025). Four of 5 patients maintained or even improved this effect a month after (p = 0.082). No changes in Berg balance scale were observed. Our results suggest an acute improvement in posture after one session of GVS, which significantly decreased TFF. Most of the results had a marginal significance due to small sample size.

Cross-cultural adaptation and validation of the Italian Spine Youth Quality of Life (ISYQOL) questionnaire's Arabic version

Health-related quality of life (HRQOL) assessment is considered among the most relevant outcome measures following conservative and surgical interventions for various spinal conditions. Several questions are available to evaluate HRQOL in these conditions. A more recent Italian Spine Youth Quality of Life (ISYQOL) questionnaire was developed for this purpose and showed high validity in measuring HRQOL.To translate and adapt the ISYQOL questionnaire into Arabic language (ISYQOL-Ar) and evaluate its validity and reliability, and to correlate it with the validated revised Scoliosis Research Society (SRS-22r)'s Arabic questionnaire in a cross-sectional multicenter study.The ISYQOL was translated, back-translated, and reviewed by an expert committee. Reliability assessment for the questionnaire domains was performed using Cronbach's alpha. For construct validation, the Pearson's correlation coefficient was used.A total of 115 patients were enrolled in the study and completed the ISYQOL-Ar and Arabic SRS-22r questionnaires. A total of 72 patients (63%) completed the first set of questionnaires, and 2 weeks later, 63 patients (55%) completed both sets of questionnaires, with 15.8 a mean age, 39.5° mean Cobb angle of 88.9% females. ISYQOL-Ar showed excellent validity, good reliability, and internal consistency for spine health and brace wear, with Cronbach's alpha > 0.6, similar to SRS-22r in the same cohort. The correlation was significant between ISYQOL-Ar and Arabic SRS-22r (Pearson's coefficient = 0.708, P < .001).The ISYQOL-Ar questionnaire is a reliable and valid outcome measure for the assessment of young patients with spinal deformity among the Arabic-speaking population.

Effect of Different Exercise Types on the Cross-Sectional Area and Lumbar Lordosis Angle in Patients with Flat Back Syndrome

Flat back syndrome (FBS) is a sagittal imbalance wherein the normal spinal curvature is reduced. This study aimed to compare the effects of different exercise programs on the cross-sectional area (CSA) of the lumbar muscles, lumbar lordosis angle (LLA), lumbar disability, and flexibility in patients with FBS. Thirty-six females with flexible FBS were randomly allocated to the corrective exercise group (CEG, n = 12), resistance exercise group (REG, n = 12), and physical therapy group (PTG, n = 12). CEG and REG patients participated in a 12-week exercise intervention for 60 min three times per week. The CSA, LLA, Oswestry disability index (ODI), and sit-and-reach test were measured before and after intervention. CSA showed a significant difference between groups (p < 0.01), with CEG and REG demonstrating a significant increase (p < 0.05 and p < 0.05, respectively). LLA showed a significant difference between groups (p < 0.001); CEG showed a higher increase than did REG (p < 0.01) and PTG (p < 0.001). ODI also showed a significant difference between groups (p < 0.001), being lower in CEG than in REG (p < 0.001) and PTG (p < 0.001). Lumbar flexibility significantly improved in all groups, albeit with a significant difference (p < 0.001). Although corrective and resistance exercise programs effectively improve these parameters, corrective exercise is superior to other interventions for patients with FBS.

Estimation and assessment of sagittal spinal curvature and thoracic muscle morphometry in different postures

Spine models are typically developed from supine clinical imaging data, and hence clearly do not fully reflect postures that replicate subjects' clinical symptoms. Our objectives were to develop a method to: (i) estimate the subject-specific sagittal curvature of the whole spine in different postures from limited imaging data, (ii) obtain muscle lines-of-action in different postures and analyze the effect of posture on muscle fascicle length, and (iii) correct for cosine between the magnetic resonance imaging (MRI) scan plane and dominant fiber line-of-action for muscle parameters (cross-sectional area (CSA) and position). The thoracic spines of six healthy volunteers were scanned in four postures (supine, standing, flexion, and sitting) in an upright MRI. Geometry of the sagittal spine was approximated with a circular spline. A pipeline was developed to estimate spine geometry in different postures and was validated. The lines-of-action for two muscles, erector spinae (ES) and transversospinalis (TS) were obtained for every posture and hence muscle fascicle lengths were computed. A correction factor based on published literature was then computed and applied to the muscle parameters. The maximum registration error between the estimated spine geometry and MRI data was small (average RMSE∼1.2%). The muscle fascicle length increased (up to 20%) in flexion when compared to erect postures. The correction factor reduced muscle parameters (∼5% for ES and ∼25% for TS) when compared to raw MRI data. The proposed pipeline is a preliminary step in subject-specific modeling. Direction cosines of muscles could be used while improving the inputs of spine models.

[Non-surgical orthopaedic therapies of the spine in the elderly]

"Non-surgical orthopaedic therapies of the spine in the elderly. Non-surgical orthopaedic therapies of the spine in the elderly Aging is responsible for several spine pathologies characterized by static disorders. These are degenerative scoliosis (SD), degenerative lumbar kyphosis (CDL), narrow lumbar canal, fracturing osteoporosis with vertebral settlements, complications of spine surgery, degenerative spondylolisthesis, Camptocormia and drooping head. SD is an onset (de novo) or late worsening scoliosis, the critical period being most often menopause. CLD is a non-reducible lumbar kyphosis caused by degenerative disc and posterior joint lesions. Camptocormia is a very disabling thoracolombary kyphosis of at least 30° degrees worthening with walking which is largely reductible. There are different causes: neuromuscular disease or central neurologic disease (extrapyramidal), metabolic, medicamentous but also at a late age the possible evolution of an SD and CLD. The consequences of these pathologies are pain, walking difficulties, aesthetic damage and sometimes in case of camptocormia of digestive and respiratory disorders. Treatments are physiotherapy with postural, muscular and proprioceptive work, radio- guided infiltrations by radiologists experienced in deviations of the spine after an accurate analysis of the cause of pain allowing targeted infiltration and plastic or fabric corsets custom-made in close collaboration between doctor and orthoprosthetist. The purpose of corsets is to improve pain, the static of the spine and to slow down the evolution."

The Influence of Nordic Walking on Isokinetic Trunk Muscle Endurance and Sagittal Spinal Curvatures in Women after Breast Cancer Treatment: Age-Specific Indicators

Nordic walking (NW) is a popular form of rehabilitation. NW improves psychophysical condition in breast cancer (BC) survivors. This study aimed to analyze the effects of NW on functional and postural changes of the trunk in women of different ages after BC. We hypothesized that an age relationship would be found. BC survivors (n = 39) were stratified by age as “middle- aged” (45–59 years) or “older” (60–75 years), then randomly allocated to the training intervention. A study group (SG, n = 19) participated in NW and a control group (CG, n = 20) performed general gymnastics. The sagittal spinal curvatures and isokinetic trunk muscle endurance were recorded at two time points, pre- and post-training intervention. Significant within NW group changes (p < 0.05) were found for the total work (TW) and average power (AP) of trunk flexors and extensors and the upper thoracic angle in middle-aged women. In older Nordic walkers, significant increases in TW and AP of the trunk flexor muscles were observed, with a negative increase in the trunk inclination angle. In CG, no significant functional or postural changes were observed in response to general gymnastics. NW improved both functional and postural changes in middle-aged women. This study identified the limitations of NW training in older women.

Automatic Measurement of Spinous Process Angles on Ultrasound Spine Images

Ultrasound (US) imaging technique has been applied to measure the proxy Cobb angle and spinous process angle (SPA) for spinal curvatures of scoliosis. However manual measurement of ultrasound images is time consuming and greatly relying on the experience of raters. The objectives of this work are to develop an automatic measurement method to assess SPA of spine curves and to evaluate the accuracy and reliability of the method. The spinous process curves were identified and fitted on US images, and the automatically measured SPA were compared with the results from US manual and radiographic measurements. It illustrates that the US-auto measurement of SPA presents higher correlation and smaller difference with clinical standard radiographic results than the US-manual measurement.

Sling-based infant carrying affects lumbar and thoracic spine neuromechanics during standing and walking

BACKGROUND

Regular infant carrying might be a contributing factor for the development and progression of low back and pelvic girdle pain in mothers after childbirth. However, the neuromechanical adaptations of the spine due to different sling-based carrying techniques are not sufficiently well understood in order to provide evidence-based carrying recommendations.

RESEARCH QUESTION

What are the immediate effects of different sling-based infant carrying techniques on trunk neuromechanics?

METHODS

Using a Vicon motion capture and a wireless surface electromyography system, three-dimensional pelvis and spinal kinematics as well as activation patterns of eight trunk muscles were derived from fifteen healthy young women during upright standing and level walking without carrying a load and while carrying a 6 kg-dummy with a sling in front and on either side. Data were analyzed using Statistical Parametric Mapping, allowing group comparisons of discrete parameters (standing) as well as continuous data (walking). To distinguish between clinically relevant and clinically not relevant kinematic findings, statistically significant differences were only considered in case of ≥5°.

RESULTS

Compared to unloaded walking, carrying the dummy in front was mainly associated with increased lumbar lordosis (standing: (Δ8.8°, p = 0.006; walking: (Δ ≥ 8.2°, 1-100% of gait cycle [%GC], p < 0.001). When carrying the dummy on the preferred side, increased thoracic kyphosis (standing: ≥6.4°, p ≤ 0.003; walking: Δ ≥ 5.6°, 1-100%GC, p < 0.001) and axial rotation towards the ipsilateral side (standing: Δ5.3°, p = 0.003; walking: Δ ≥ 5.0°, 46-58%GC, p = 0.002) were observed. All three conditions entailed increased paraspinal muscle activity during walking, although only unilaterally in side carrying (lumbar, preferred condition: Δ ≥ 13.2%maxMVIC, 49-57%GC, p < 0.001; thoracic, non-preferred condition: Δ ≥ 5.3%maxMVIC, 47-58%GC, p < 0.001).

SIGNIFICANCE

Carrying an infant alternating on both sides using a sling could be advantageous for preventing musculoskeletal pain resulting from excessive lumbar hyperextension and paraspinal muscle hyperactivation in women after childbirth.

Multi-objective analysis for assessing simultaneous changes in regional spinal curvatures under backpack carriage in young adults

Change in sagittal spinal curvature from the neutral upright stance is an important measure of the heaviness and correctness of backpack use. As current recommendations, with respect to spinal profile, of backpack load thresholds were based on the significant curvature change in individual spinal region only, this study investigated the most critical backpack load by assessing simultaneously the spinal curvature changes along the whole spine. A motion analysis system was used to measure the curvature changes in cervical, upper thoracic, lower thoracic and lumbar regions with backpack load at 0, 5, 10, 15 and 20% of body weight. A multi-objective goal programming model was adopted to determine the global critical load of maximum curvature change of the whole spine in accordance with the maximum curvature changes of the four spinal regions. Results suggested that the most critical backpack load was 13% of body weight for healthy male college students. Practitioner Summary: As current recommendations of backpack load thresholds were based on the significant curvature change in individual spinal region only, this study investigated the backpack load by considering simultaneously the spinal curvature changes along the whole spine. The recommendation, in terms of the global critical load, was 13% of body weight for healthy male college students.

3D ultrasound imaging method to assess the true spinal deformity

Spinal deformity is a three-dimensional (3D) spinal disorder with a lateral deviation and coupled with axial vertebral rotation (AVR). The current clinical practice only measures its severity on postero-anterior (PA) radiographs, which may underestimate the deformity. The actual severity should be obtained on the plane of maximal curvature (PMC), which requires a 3D spinal image. There are many approaches to reconstruct 3D spinal images; however, ultrasound is one of the promising techniques with its non-ionizing characteristic. This study proposed an image processing method using the voxel-based bilinear interpolation to reconstruct a 3D spinal image from ultrasound data, from which the AVR was measured and the spinal curvature on the PMC was determined. In-vitro and in-vivo experiments were performed to determine the accuracy of the measurements from the ultrasound method. The results showed that the 3D ultrasound spinal image could be reconstructed. The curvature angle on the PA and the PMC planes could also be determined. The tilt angle of each individual vertebra in in-vitro study showed high accuracy and correlation (MAD <; 0.9° ± 0.2° and r(2) > 0.87) when comparing the measurements from CT with ultrasound. In in-vivo study, the curvature angles measured on the PA radiographs and ultrasound images yielded a small difference (MAD 3.4° ± 1.0°) and a strong correlation (r(2) = 0.63) within a clinical accepted error of 5°.

Wearable monitoring of lumbar spine curvature by inertial and e-textile sensory fusion

This paper describes the design, the development and the preliminary testing of a wearable system able perform a real time estimation of the local curvature and the length of the spine lumbar arch. The system integrate and fuse information gathered from textile based piezoresistive sensor arrays and tri-axial accelerometers. E-textile strain sensing garments suffer from non-linearities, hysteresis and long transient, while accelerometers, used as inclinometers, present biased values and are affected by the system acceleration due to subject movements. In this work, focused on the wearability and comfort of the user, we propose a fusion of the information deriving from the two class of sensors to reduce their intrinsic errors affecting measurements. Comparative evaluation of system performances with stereophotogrammetric techniques shows a 2% error in lumbar arch length reconstruction.

Long-term investigation of nonsurgical treatment for thoracolumbar and lumbar burst fractures: an outcome analysis in sight of spinopelvic balance

The nonsurgical treatment of thoracolumbar (TLB) and lumbar burst (LB) fractures remains to be of interest, though it is not costly and avoids surgical risks. However, a subset of distinct burst fracture patterns tend to go with a suboptimal radiographic and clinical long-term outcome. Detailed fracture pattern and treatment-related results in terms of validated outcome measures are still lacking. In addition, there are controversial data on the impact of local posttraumatic kyphosis that is associated, in particular, with nonsurgical treatment. The assessment of global spinal balance following burst fractures has not been assesed, yet. Therefore, the current study intended to investigate the radiographical and clinical long-term outcome in neurologically intact patients with special focus on the impact of regional posttraumatic kyphosis, adjacent-level compensatoric mechanisms, and global spine balance on the clinical outcome. For the purpose of a homogenous sample, strong in- and exclusion criteria were applied that resulted in a final study sample of 21 patients with a mean follow-up of 9.5 years. Overall, clinical outcome evaluated by validated measures was diminished, with 62% showing a good or excellent outcome and 38% a moderate or poor outcome in terms of the Greenough Low Back Outcome Scale. Notably, vertebral comminution in terms of the load-sharing classification, posttraumatic kyphosis, and an overall decreased lumbopelvic lordosis showed a significant effect on clinical outcome. A global and segmental curve analysis of the spine T9 to S1 revealed significant alterations as compared to normals. But, the interdependence of spinopelvic parameters was not disrupted. The patients' spinal adaptability to compensate for the posttraumatic kyphotic deformity varied in the ranges dictated by pelvic geometry, in particular the pelvic incidence. The study substantiates the concept that surgical reconstruction and maintenance of a physiologically shaped spinal curve might be the appropriate treatment in the more severely crushed TLB and LB fractures.

Can future back pain in AIS subjects be predicted during adolescence from the severity of the deformity?

Back pain is frequently reported as a symptom of adolescent idiopathic scoliosis (AIS). Prediction of pain in adulthood would be useful to identify subjects requiring follow-up. The aim is to determine adolescent predictors of adult back pain. This study is a retrospective review of 27 females with AIS who attended our pediatric scoliosis clinic and later completed the SRS-22 questionnaire as young adults (range 18-25 years). Subjects with surgery at baseline (age 14-16 years) were excluded. The relationships between largest curve size, decompensation and trunk twist at baseline and pain as measured by the SRS-22 pain domain as young adults were studied. At baseline, subjects had a largest curve of 47+/-15 degrees , decompensation of 18+/-14 mm and trunk twist of 14+/-6 degrees . At follow-up, 5.3+/-1.9 years later, the total SRS-22 score was 3.9+/-0.3 and the pain domain score was 3.9+/-0.7. Pearson correlations between the SRS-22 pain domain and largest curve, decompensation and trunk twist were 0.17, -0.11 and -0.25, respectively (p>0.05). Individual questions within the pain domain had similar correlations. Even though the sample represented a wide range of scoliosis severity at baseline and a wide range of pain scores (2.4 to 5) at follow-up, baseline scoliosis deformity parameters of largest curve size, decompensation and trunk twist did not predict scoliosis-related pain in young adulthood.

Development of an apparatus to evaluate Adolescent Idiopathic Scoliosis by dynamic surface topography

For cases of Adolescent Idiopathic Scoliosis (AIS), commonly the first indicator is a change in the surface shape of the back over time. A proportion of patients so diagnosed require surgical intervention to prevent further progression and to improve cosmesis. The results of a preliminary literature survey have revealed that significant work has already been published on the static acquisition and analysis of back surface shape. There is new interest in establishing correlations between breathing, posture, the underlying spinal deformity and changes in the surface topography of the back during clinical sessions together with an increased focus on the impact of the cosmetic defect on the patient and in the measurement of pre and post-operative dynamic capability.The continuing development of an apparatus based on established optical motion capture technologies, that generates a sequence of tri-dimensional images and provides measurements derived from changes in the position of anatomical reference landmarks and of the surface topography of the back will be presented. If, using the same landmarks, the trunk range of motion could be captured concurrently, it is hoped that the resulting data would form the basis of a useful clinical study.

Suggestions for improvement of school screening for idiopathic scoliosis

There is skepticism and the worth of school screening for the purposes of health care has been challenged. Numerous reasons are raised by the negativists to abandon these programs, even though the value of school screening is well documented in the literature. The aim of the present study is to update the evidence based recommendations for the improvement of school screening effectiveness, in order to support its continuation. All the relative research papers which originated from our scoliosis school screening program were analyzed. Specific suggestions for a) the organization, b) the optimal age of screening according to the geographical latitude, c) the best examined position, d) the standardization of referrals, e) the follow up of younger referrals with trunk asymmetry and f) the reduction of the financial cost are made. Today there is evidence that the incidence of surgery can significantly be reduced in areas where idiopathic scoliosis can be detected at an early stage through these programs. The introduction of these recommendations to all the existing school screening programs is strongly suggested, to reduce the negative impact they may have on families and on the health system and to improve their effectiveness.

SpineCor vs. natural history - explanation of the results obtained using a simple biomechanical model

In the recent peer reviewed literature the SpineCor is described as an effective method of treatment for patients with scoliosis. However until recently no prospective controlled end-result study is presented comparing the results obtained with this soft brace to natural history. The objective was to determine whether the results obtained by the use of the SpineCor are better than natural history during pubertal growth spurt. The method employed prospective comparison of the survival rates of SpineCor treatment vs. natural history with respect to curve progression during pubertal growth spurt. 12 Patients with Cobb angles between 16 and 32 degrees (at average 21 degrees) during pubertal growth spurt are presented as a case series treated with the SpineCor. Survival rate of this sample is described and compared to natural history (SRS brace study 1995). All girls treated in both studies were at risk for being progressive with the first clinical signs of maturation (Tanner 2-3). During the pubertal growth spurt most of the patients (11/12) with SpineCor progressed clinically and radiologically as well (at least 5 degrees). Progression could be stopped changing SpineCor to the Chêneau brace in most of the sample described (7/10). The avarage Cobb angle at the start of treatment with the SpineCor was 21.3 degrees, after an average observation time of 21.5 months 31 degrees. At 24 months of treatment time 33% of the patients with the SpineCor where still under treatment with their original bracing concept, at 72 months follow-up time 8 % of the patients with the SpineCor survived with respect to curvature progression. Survival proportion in the SpineCor sample, though was 0.08, while in the natural history cohort it was 0.34. The SpineCor treatment during pubertal growth spurt seems to lead to a worse outcome than observation only. The use of a simple biomechanical model explains that in the brace the compression forces exceed the lateral forces used for the corrective movement. Therefore SpineCor does not seem to be indicated as a treatment during pubertal growth spurt.

Ergonomically designed kneeling chairs are they worth it? : Comparison of sagittal lumbar curvature in two different seating postures

General agreement among researchers suggests that poor seating posture may predispose individuals to developing low back pain. A variety of methods such as ergonomically designed chairs have been developed to assist people to maintain good posture and preserve the 'natural' lumbar curve. The aim of this study was to compare lumbar curvature on an ergonomically designed kneeling chair (EKC) with that on a standard computer chair (SCC), with reference to the standing lumbar curvature. The study used a repeated measures, within-subjects design. A convenience sample of twenty participants was recruited aged 18-35 (9 male and 11 female). Lumbar curvature was measured using the 'Middlesbrough Integrated Assessment System' (MIDAS) postural assessment tool in three different postures; sitting on a SCC, sitting on an EKC set at +20 degrees inclination and standing as the reference measurement. Results were analysed by a repeated measures oneway ANOVA (1 factor) with 3 levels followed by the Bonferroni post hoc test. The results showed a statistically significant difference between standing lumbar curvature and lumbar curvature produced by both of the chairs (p<0.05). There was also a statistically significant difference between the two seated positions (p<0.05). This study suggests that ergonomically designed kneeling chairs set at +20 degrees inclination do maintain standing lumbar curvature to a greater extent than sitting on a standard computer chair with an overall mean difference of 7.633 degrees . Further research with a greater number of subjects and on different chair designs is warranted.

Effects of back posture education on elementary schoolchildren's back function

The possible effects of back education on children's back function were never evaluated. Therefore, main aim of the present study was to evaluate the effects of back education in elementary schoolchildren on back function parameters. Since the reliability of back function measurement in children is poorly defined, another objective was to test the selected instruments for reliability in 8-11-year olds. The multi-factorial intervention lasting two school-years consisted of a back education program and the stimulation of postural dynamism in the class. Trunk muscle endurance, leg muscle capacity and spinal curvature were evaluated in a pre-post design including 41 children who received the back education program (mean age at post-test: 11.2 +/- 0.9 years) and 28 controls (mean age at post-test: 11.4 +/- 0.6 years). Besides, test-retest reliability with a 1-week interval was investigated in a separate sample. Therefore, 47 children (mean age: 10.1 +/- 0.5 years) were tested for reliability of trunk muscle endurance and 40 children (mean age: 10.2 +/- 0.7 years) for the assessment of spinal curvatures. Reliability of endurance testing was very good to good for the trunk flexors (ICC = 0.82) and trunk extensors (ICC = 0.63). The assessment of the thoracic (ICC = 0.69) and the lumbar curvature (ICC = 0.52) in seating position showed good to acceptable reliability. Low ICCs were found for the assessment of the thoracic (ICC = 0.39) and the lumbar curvature (ICC = 0.37) in stance. The effects of 2 year back education showed an increase in trunk flexor endurance in the intervention group compared to a decrease in the controls and a trend towards significance for a higher increase in trunk extensor endurance in the intervention group. For leg muscle capacity and spinal curvature no intervention effects were found. The small samples recommend cautious interpretation of intervention effects. However, the present study's findings favor the implementation of back education with focus on postural dynamism in the class as an integral part of the elementary school curriculum in the scope of optimizing spinal loading through the school environment.

Finite element model of the human neck during omni-directional impacts. Part II: relation between cervical curvature and risk of injury

A detailed 3D FE model of the human neck was used to assess a possible relationship between risk of injury and cervical spine curvature for various impacts. A FE model was previously developed, representing the head and neck of a 50th percentile human with a normal lordotic curvature. The model behaviour was omni-directionally validated for various impacts using published results. For the present study, the model was deformed in order to obtain a straight and a kyphotic curvature, and for each geometry, rear-end, frontal, lateral and oblique impact were simulated. Although results showed similar kinematic patterns, significant differences were found in the distribution and peak values of ligament elongations, forces and moments along the cervical spine for the three configurations. It was concluded that the variability observed on the curvature of the human cervical spine may have a significant influence both on the behaviour and on the risk of injury of the neck during impact.

[Use of a cytogenetic method for buccal epithelium study, and a method of laser correlation spectrometry for health disturbances monitoring in children]

Buccal epithelium cytogenetic disturbances were studied in schoolchildren from Moscow schools, a country school (Novgorod region) and a Moscow boarding school for chindren with musculoskeletal diseases (scoliosis and kyphosis). The minimal mean frequency of cells with karyorrhexis were revealed in children from an ecologically pure Novgorod region. Moscow schoolchildren demonstrated more than 13-fold higher level of this parameter. Children with spinal deformities had an intermediate frequency. Cells with karyolysis minimal mean frequency were observed in Moscow pupils. Children from Novgorod demonstrated a statistically valid higher level of this parameter, and the maximum was reached in Moscow boarding school. No difference between these groups was revealed in a study of the mean frequency of binucleated cells, cells with pyknosis, cells with micronuclei, or "broken eggs" incidence. Laser correlation spectrometry (LCS) method was used for parallel studies. It was shown that the distribution of spectra in Moscow pupils and in children with spinal deformities differs from that in children living in ecologically pure region. Normal spectra prevailed in pupils of country school, who demonstrated, in addition, high levels of anabolic and low levels of catabolic type metabolism. The examined Moscow schoolchildren demonstrated almost the same incidence of normal spectra. They differed from the country children by statistically valid reduction of anabolic type spectra, and by increased levels of catabolic type spectra. Young patients with spinal deformities demonstrated the maximum incidence of catabolic type spectra. The authors suggest the availability of a qualitative correlation between both the monitoring methods used in this study. It was shown that children living in unfavorable conditions and patients with musculoskeletal diseases manifested an enhanced incidence of buccal epithelium cells with karyorrhexis and karyolysis, as well as higher levels of catabolic type spectra accompanied by reduction of normal and anabolic type spectra.

The adult scoliosis

Adult scoliosis is defined as a spinal deformity in a skeletally mature patient with a Cobb angle of more than 10 degrees in the coronal plain. Adult scoliosis can be separated into four major groups: Type 1: Primary degenerative scoliosis, mostly on the basis of a disc and/or facet joint arthritis, affecting those structures asymmetrically with predominantly back pain symptoms, often accompanied either by signs of spinal stenosis (central as well as lateral stenosis) or without. These curves are often classified as "de novo" scoliosis. Type 2: Idiopathic adolescent scoliosis of the thoracic and/or lumbar spine which progresses in adult life and is usually combined with secondary degeneration and/or imbalance. Some patients had either no surgical treatment or a surgical correction and fusion in adolescence in either the thoracic or thoracolumbar spine. Those patients may develop secondary degeneration and progression of the adjacent curve; in this case those curves belong to the type 3a. Type 3: Secondary adult curves: (a) In the context of an oblique pelvis, for instance, due to a leg length discrepancy or hip pathology or as a secondary curve in idiopathic, neuromuscular and congenital scoliosis, or asymmetrical anomalies at the lumbosacral junction; (b) In the context of a metabolic bone disease (mostly osteoporosis) combined with asymmetric arthritic disease and/or vertebral fractures. Sometimes it is difficult to decide, what exactly the primary cause of the curve was, once it has significantly progressed. However, once an asymmetric load or degeneration occurs, the pathomorphology and pathomechanism in adult scoliosis predominantly located in the lumbar or thoracolumbar spine is quite predictable. Asymmetric degeneration leads to increased asymmetric load and therefore to a progression of the degeneration and deformity, as either scoliosis and/or kyphosis. The progression of a curve is further supported by osteoporosis, particularly in post-menopausal female patients. The destruction of facet joints, joint capsules, discs and ligaments may create mono- or multisegmental instability and finally spinal stenosis. These patients present themselves predominantly with back pain, then leg pain and claudication symptoms, rarely with neurological deficit, and almost never with questions related to cosmetics. The diagnostic evaluation includes static and dynamic imaging, myelo-CT, as well as invasive diagnostic procedures like discograms, facet blocks, epidural and root blocks and immobilization tests. These tests may correlate with the clinical and the pathomorphological findings and may also offer the least invasive and most rational treatment for the patient. The treatment is then tailored to the specific symptomatology of the patient. Surgical management consists of either decompression, correction, stabilization and fusion procedures or a combination of all of these. Surgical procedure is usually complex and has to deal with a whole array of specific problems like the age and the general medical condition of the patient, the length of the fusion, the condition of the adjacent segments, the condition of the lumbosacral junction, osteoporosis and possibly previous scoliosis surgery, and last but not least, usually with a long history of chronified back pain and muscle imbalance which may be very difficult to be influenced. Although this surgery is demanding, the morbidity cannot be considered significantly higher than in other established orthopaedic procedures, like hip replacement, in the same age group of patients. Overall, a satisfactory outcome can be expected in well-differentiated indications and properly tailored surgical procedures, although until today prospective, controlled studies with outcome measures and pre- and post-operative patient's health status are lacking. As patients, who present themselves with significant clinical problems in the context of adult scoliosis, get older, minimal invasive procedures to address exactly the most relevant clinical problem may become more and more important, basically ignoring the overall deformity and degeneration of the spine.

Anterior thoracic posture increases thoracolumbar disc loading

In the absence of external forces, the largest contributor to intervertebral disc (IVD) loads and stresses is trunk muscular activity. The relationship between trunk posture, spine geometry, extensor muscle activity, and the loads and stresses acting on the IVD is not well understood. The objective of this study was to characterize changes in thoracolumbar disc loads and extensor muscle forces following anterior translation of the thoracic spine in the upright posture. Vertebral body geometries (C2 to S1) and the location of the femoral head and acetabulum centroids were obtained by digitizing lateral, full-spine radiographs of 13 men and five women volunteers without previous history of back pain. Two standing, lateral, full-spine radiographic views were obtained for each subject: a neutral-posture lateral radiograph and a radiograph during anterior translation of the thorax relative to the pelvis (while keeping T1 aligned over T12). Extensor muscle loads, and compression and shear stresses acting on the IVDs, were calculated for each posture using a previously validated biomechanical model. Comparing vertebral centroids for the neutral posture to the anterior posture, subjects were able to anterior translate +101.5 mm+/-33.0 mm (C7-hip axis), +81.5 mm+/-39.2 mm (C7-S1) (vertebral centroid of C7 compared with a vertical line through the vertebral centroid of S1), and +58.9 mm+/-19.1 mm (T12-S1). In the anterior translated posture, disc loads and stresses were significantly increased for all levels below T9. Increases in IVD compressive loads and shear loads, and the corresponding stresses, were most marked at the L5-S1 level and L3-L4 level, respectively. The extensor muscle loads required to maintain static equilibrium in the upright posture increased from 147.2 N (mean, neutral posture) to 667.1 N (mean, translated posture) at L5-S1. Compressive loads on the anterior and posterior L5-S1 disc nearly doubled in the anterior translated posture. Anterior translation of the thorax resulted in significantly increased loads and stresses acting on the thoracolumbar spine. This posture is common in lumbar spinal disorders and could contribute to lumbar disc pathologies, progression of L5-S1 spondylolisthesis deformities, and poor outcomes after lumbar spine surgery. In conclusion, anterior trunk translation in the standing subject increases extensor muscle activity and loads and stresses acting on the intervertebral disc in the lower thoracic and lumbar regions.

[Cervical curvature. A cephalometric study in position of clinical rest]

BACKGROUND

Alterations in the head position and in cervical curvature are associated with mandibular dysfunction, an increased vertical occlusal dimension, upper airways obstruction and bad postural behaviors at work among other conditions.

AIM

To perform a cephalometric analysis in young adults.

SUBJECTS AND METHODS

Lateral cervical X-ray examinations were performed in 46 university students (26 female) aged 19 years old as a mean, Cephalometric landmarks and planes reported by Sollow & Tallgren, determined by investigators, were used for radiographic analysis.

RESULTS

The combined error of the method did not exceed 0.9 degree for any studied variable. Mean craniocervical angulations were 102 degrees for OPT-SNL, 109 degrees for CVT-SNL, 94.8 degrees for cranium-C2 and 105 for SN-vertical. There were significant sex differences in craniocervical angulations and these were abnormal in two thirds of subjects studies. The Forward Head Position is characterized by a cervical compensation with head inclination. This abnormal postural position showed a dolichofacial growth and an alteration of hyoid angle.

CONCLUSIONS

The craniocervical position appeared to be related to a vertical craniofacial growth pattern.