CT-derived vertebral bone mineral density is a useful biomarker to predict COVID-19 outcome

The low vertebral bone computed tomography (CT) Hounsfield unit values measured on CT scans reflect low bone mineral density (BMD) and are known as diagnostic indicators for osteoporosis. The potential prognostic significance of low BMD defined by vertebral bone CT values for the coronavirus disease 2019 (COVID-19) remains unclear. This study aimed to assess the impact of BMD on the clinical outcome in Japanese patients with COVID-19 and evaluate the association between BMD and critical outcomes, such as high-flow nasal cannula, non-invasive and invasive positive pressure ventilation, extracorporeal membrane oxygenation, or death. We examined the effects of COVID-19 severity on the change of BMD over time. This multicenter retrospective cohort study enrolled 1132 inpatients with COVID-19 from the Japan COVID-19 Task Force database between February 2020 and September 2022. The bone CT values of the 4th, 7th, and 10th thoracic vertebrae were measured from chest CT images. The average of these values was defined as BMD. Furthermore, a comparative analysis was conducted between the BMD on admission and its value 3 months later. The low BMD group had a higher proportion of critical outcomes than did the high BMD group. In a subanalysis stratifying patients by epidemic wave according to onset time, critical outcomes were higher in the low BMD group in the 1st-4th waves. Multivariable logistic analysis of previously reported factors associated with COVID-19 severity revealed that low BMD, chronic kidney disease, and diabetes were independently associated with critical outcomes. At 3 months post-infection, patients with oxygen demand during hospitalization showed markedly decreased BMD than did those on admission. Low BMD in patients with COVID-19 may help predict severe disease after the disease onset. BMD may decrease over time in patients with severe COVID-19, and the impact on sequelae symptoms should be investigated in the future.

Coordination of hip and spine in individuals with acute low back pain during unstable sitting

BACKGROUND CONTEXT

Trunk postural control differs between individuals with and without chronic low back pain (LBP). Whether this corresponds to differences in hip/spine coordination during the early acute phase of LBP (ALBP) is unclear.

PURPOSE

To compare hip/spine coordination in relation to seat movements between individuals with and without ALBP when balancing on an unstable seat and to identify coordination strategies to maintain balance using cluster analysis.

STUDY DESIGN/SETTING

Cross-sectional observational study.

PATIENT SAMPLE

ALBP (n=130) and pain-free (n=72) individuals.

OUTCOME MEASURES

Frequency domain measures to evaluate hip/spine coordination (amplitude spectrum, phase angle, and coherence) and time-series measures to assess overall balance performance (center of pressure [CoP] reflecting the amount of seat movements, upper thorax motion as a surrogate for head motion).

METHODS

Participants maintained balance while sitting on a seat fixed to a hemisphere. Seat, hip, and spine (lower lumbar, lumbar, upper lumbar, and thoracic) angular motion and force plate data were recorded.

RESULTS

Overall, seat/CoP movements (amplitude spectrum and RMSdisplacement) were greater (in both planes) and sagittal coordination (coherence) between the hip or lower spine and seat movements was lower in ALBP than controls. Cluster analysis using coherence data revealed different coordination strategies to maintain balance. Separate clusters used a "lower lumbar strategy" and "hip strategy" in the sagittal plane, and a "lower and upper lumbar strategy" and "lower lumbar strategy" in the frontal plane. A cluster using a "low coherence strategy" in both planes was also identified.

CONCLUSIONS

Hip and lower spine coordination was less in individuals with ALBP in conjunction with a lower quality of overall balance performance. However, interpretation of the relationship between coherence and overall balance performance was not straightforward. Clusters in both the ALBP group and the control group adopted a low coherence strategy, and this was not consistently related to poor overall balance performance. This suggests overall balance performance cannot be inferred from coherence alone and requires consideration of interaction of other different features.

Differences in spinal posture and mobility between adults with obesity and normal weight individuals

The aim of this study was to cross-sectionally investigate the relationships between obesity and spinal posture as well as mobility by comparing the spinal parameters between adults with obesity and normal-weight individuals. The spinal parameters were measured in 71 adults with obesity and 142 normal-weight individuals using a radiation-free back scan, the Idiag M360. Differences in spinal posture and movements between the two groups were determined using a two-way analysis of variance. Adults with obesity had greater thoracic kyphosis [difference between groups (Δ) = 6.1°, 95% CI 3.3°-8.9°, p < 0.0001] and thoracic lateral flexion (Δ = 14.5°, 95% CI 5.1°-23.8°, p = 0.002), as well as smaller thoracic flexion (Δ = 3.5°, 95% CI 0.2°-6.9°, p = 0.03), thoracic extension (Δ = 4.1°, 95% CI 1.1°-7.1°, p = 0.008), lumbar flexion (Δ = 10.4°, 95% CI 7.7°-13.5°, p < 0.0001), lumbar extension (Δ = 4.8°, 95% CI 2.2°-7.4°, p = 0.0003) and lumbar lateral flexion (Δ = 12.8°, 95% CI 9.8°-15.7°, p = < 0.0001) compared to those with normal weight. These findings provide relevant information about the characteristics of the spine in adults with obesity to be taken into careful consideration in the prescription of adapted physical activities within integrated multidisciplinary pathways of metabolic rehabilitation.

The effect of low back pain on spine kinematics: A systematic review and meta-analysis

BACKGROUND

Although impairments in dorso-lumbar spine mobility have been previously reported in patients with low back pain, its exact mechanism is not yet clear. Therefore, the purpose of this systematic review and meta-analysis is to investigate and compare spinal kinematics between subjects with and without low back pain and identify appropriate tools to evaluate it.

METHODS

The PubMed, Scopus and Web of Science databases were searched for relevant literature. The search strategy was mainly focused on studies investigating lumbar kinematics in subjects with and without low back pain during clinical functional tests, gait, sports and daily functional activities. Papers were selected if at least one of these outputs was reported: lumbar range of motion, lumbar velocity, lumbar acceleration and deceleration, lordosis angle or lumbar excursion.

FINDINGS

Among 804 papers, 48 met the review eligibility criteria and 29 were eligible to perform a meta-analysis. Lumbar range of motion was the primary outcome measured. A statistically significant limitation of the lumbar mobility was found in low back pain group in all planes, and in the frontal and transverse planes for thoracic range of motion, but there is no significant limitation for pelvic mobility. The amount of limitation was found to be more important in the lumbar sagittal plane and during challenging functional activities in comparison with simple activities.

INTERPRETATION

The findings of this review provide insight into the impact of low back pain on spinal kinematics during specific movements, contributing to our understanding of this relationship and suggesting potential clinical implications.

Examining relationships between sleep posture, waking spinal symptoms and quality of sleep: A cross sectional study

INTRODUCTION

Research with a focus on sleep posture has been conducted in association with sleep pathologies such as insomnia and positional obstructive sleep apnoea. Research examining the potential role sleep posture may have on waking spinal symptoms and quality of sleep is however limited. The aims of this research were to compare sleep posture and sleep quality in participants with and without waking spinal symptoms.

METHODS

Fifty-three participants (36 female) were, based on symptoms, allocated to one of three groups; Control (n = 20, 16 female), Cervical (n = 13, 10 female) and Lumbar (n = 20, 10 female). Participants completed an online survey to collect general information and patient reported outcomes and were videoed over two consecutive nights to determine sleep posture using a validated classification system including intermediate sleep postures.

RESULTS

Participants in the symptomatic groups also reported a lower sleep quality than the Control group. Compared to Control group participants, those in the Cervical group had more frequent posture changes (mean (SD); 18.3(6.5) versus 23.6(6.6)), spent more time in undesirable/provocative sleep postures (median IQR; 83.8(16.4,105.2) versus 185.1(118.0,251.8)) minutes and had more long periods of immobility in a provocative posture, (median IQR: 0.5(0.0,1.5) versus 2.0 (1.5,4.0)). There were no significant differences between the Control and Lumbar groups in the number of posture changes (18.3(6.5) versus 22.9(9.1)) or the time spent in provocative sleep postures (0.5(0.0,1.5) versus 1.5(1.5,3.4)) minutes.

DISCUSSION

This is the first study using a validated objective measure of sleep posture to compare symptomatic and Control group participants sleeping in their home environment. In general, participants with waking spinal symptoms spent more time in provocative sleep postures, and experienced poorer sleep quality.

Cortactin Contributes to Activity-Dependent Modulation of Spine Actin Dynamics and Spatial Memory Formation

Postsynaptic structures on excitatory neurons, dendritic spines, are actin-rich. It is well known that actin-binding proteins regulate actin dynamics and by this means orchestrate structural plasticity during the development of the brain, as well as synaptic plasticity mediating learning and memory processes. The actin-binding protein cortactin is localized to pre- and postsynaptic structures and translocates in a stimulus-dependent manner between spines and the dendritic compartment, thereby indicating a crucial role for synaptic plasticity and neuronal function. While it is known that cortactin directly binds F-actin, the Arp2/3 complex important for actin nucleation and branching as well as other factors involved in synaptic plasticity processes, its precise role in modulating actin remodeling in neurons needs to be deciphered. In this study, we characterized the general neuronal function of cortactin in knockout mice. Interestingly, we found that the loss of cortactin leads to deficits in hippocampus-dependent spatial memory formation. This impairment is correlated with a prominent dysregulation of functional and structural plasticity. Additional evidence shows impaired long-term potentiation in cortactin knockout mice together with a complete absence of structural spine plasticity. These phenotypes might at least in part be explained by alterations in the activity-dependent modulation of synaptic actin in cortactin-deficient neurons.

Clobetasol promotes neuromuscular plasticity in mice after motoneuronal loss via sonic hedgehog signaling, immunomodulation and metabolic rebalancing

Motoneuronal loss is the main feature of amyotrophic lateral sclerosis, although pathogenesis is extremely complex involving both neural and muscle cells. In order to translationally engage the sonic hedgehog pathway, which is a promising target for neural regeneration, recent studies have reported on the neuroprotective effects of clobetasol, an FDA-approved glucocorticoid, able to activate this pathway via smoothened. Herein we sought to examine functional, cellular, and metabolic effects of clobetasol in a neurotoxic mouse model of spinal motoneuronal loss. We found that clobetasol reduces muscle denervation and motor impairments in part by restoring sonic hedgehog signaling and supporting spinal plasticity. These effects were coupled with reduced pro-inflammatory microglia and reactive astrogliosis, reduced muscle atrophy, and support of mitochondrial integrity and metabolism. Our results suggest that clobetasol stimulates a series of compensatory processes and therefore represents a translational approach for intractable denervating and neurodegenerative disorders.

Validity and reliability of a sensor-based electronic spinal mobility index for axial spondyloarthritis

OBJECTIVE

To evaluate the validity and reliability of inertial measurement unit (IMU) sensors in the assessment of spinal mobility in axial spondyloarthritis (axSpA).

METHODS

A repeated measures study design involving 40 participants with axSpA was used. Pairs of IMU sensors were used to measure the maximum range of movement at the cervical (Cx) and lumbar (Lu) spine. A composite IMU score was defined by combining the IMU measures. Conventional metrology and physical function assessment were performed. Validation was assessed considering the agreement of IMU measures with conventional metrology and correlation with physical function. Reliability was assessed using intra-class correlation coefficients (ICCs).

RESULTS

The composite IMU score correlated closely (r = 0.88) with the BASMI. Conventional Cx rotation and lateral flexion tests correlated closely with IMU equivalents (r = 0.85, 0.84). All IMU movement tests correlated strongly with BASFI, while this was true for only some of the BASMI tests. The reliability of both conventional and IMU tests (except for chest expansion) ranged from good to excellent. Test-retest ICCs for individual conventional tests varied between 0.57 and 0.91, in comparison to a range from 0.74 to 0.98 for each of the IMU tests. Each of the composite regional IMU scores had excellent test-retest reliability (ICCs=0.94-0.97), comparable to the reliability of the BASMI (ICC=0.96).

CONCLUSION

Cx and Lu spinal mobility measured using wearable IMU sensors is a valid and reliable assessment in multiple planes (including rotation), in patients with a wide range of axSpA severity.

Natural changes of traumatic vertebral compression fractures during the first 6 months in patients visiting for disability certificates: A retrospective observational study

To identify the natural changes of traumatic vertebral compression fractures during the first six months in patients visiting for disability certificates after conservative treatment.Data of patients who visited the rehabilitation medicine department of a university hospital for disability certificates concerning traumatic vertebral compression fractures from 2015 to 2018 were reviewed. Those who visited 180 to 210 days after injuries were included, and those who received invasive procedures for compression fractures were excluded. The anterior and posterior heights, local kyphotic angle of compression fractures, and upper and lower vertebrae on initial and follow-up images were measured and compared. Compression ratio was calculated by vertebral body compression ratio and anterior vertebral body compression percentage. Thoracic and lumbar traumatic fractures were also compared.Among 110 patients, 61 patients met the criteria. After six months, the anterior height of compression fractures decreased more than 4 mm, which implies the development of new compression fractures. The compression ratio and local kyphotic angle increased significantly without affecting the upper and lower vertebrae. Thoracic and lumbar compression fractures showed similar changes.Traumatic vertebral compression fractures change significantly during the first six months. This study could warrant 6 months of waiting for issuance of disability certificates for patients with traumatic vertebral compression fractures.

Protective effect of gastrodin on peripheral neuropathy induced by anti-tumor treatment with vincristine in rat models

Cancer is a common disease threatening human health, chemotherapy is widely used in clinical treatment of cancer, but chemotherapy-induced peripheral neuropathy (CIPN) has a relevant impact on life quality of cancer patients. Administration of gastrodin can relieve chronic pain to cancer patients with CIPN and attenuated the inflammatory response by reducing the expression of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). However, its exact molecular mechanisms remain unclear. In this study, we established an animal model of CIPN using Walker-256 breast cancer cell and vincristine. We found that the mechanical and thermal pain threshold of rats was decreased with treatment of vincristine. Using gastrodin could restore the mechanical and thermal threshold without interfering anti-tumor effect of vincristine. Gastrodin relieved CIPN by inhibiting activation of spinal microglia through Fractalkine (CX3CL1) and its receptor CX3CR1, then inhibited P38/mitogen-activated protein kinase (MAPK) signaling pathway and reduced the expression of inflammatory factor TNF-α and interleukin-1β (IL-1β). Taking together, our study demonstrated that gastrodin is a potential drug for the treatment of CIPN and likely to improve cancer patient's life quality.

Bone strain index as a predictor of further vertebral fracture in osteoporotic women: An artificial intelligence-based analysis

BACKGROUND

Osteoporosis is an asymptomatic disease of high prevalence and incidence, leading to bone fractures burdened by high mortality and disability, mainly when several subsequent fractures occur. A fragility fracture predictive model, Artificial Intelligence-based, to identify dual X-ray absorptiometry (DXA) variables able to characterise those patients who are prone to further fractures called Bone Strain Index, was evaluated in this study.

METHODS

In a prospective, longitudinal, multicentric study 172 female outpatients with at least one vertebral fracture at the first observation were enrolled. They performed a spine X-ray to calculate spine deformity index (SDI) and a lumbar and femoral DXA scan to assess bone mineral density (BMD) and bone strain index (BSI) at baseline and after a follow-up period of 3 years in average. At the end of the follow-up, 93 women developed a further vertebral fracture. The further vertebral fracture was considered as one unit increase of SDI. We assessed the predictive capacity of supervised Artificial Neural Networks (ANNs) to distinguish women who developed a further fracture from those without it, and to detect those variables providing the maximal amount of relevant information to discriminate the two groups. ANNs choose appropriate input data automatically (TWIST-system, Training With Input Selection and Testing). Moreover, we built a semantic connectivity map usingthe Auto Contractive Map to provide further insights about the convoluted connections between the osteoporotic variables under consideration and the two scenarios (further fracture vs no further fracture).

RESULTS

TWIST system selected 5 out of 13 available variables: age, menopause age, BMI, FTot BMC, FTot BSI. With training testing procedure, ANNs reached predictive accuracy of 79.36%, with a sensitivity of 75% and a specificity of 83.72%. The semantic connectivity map highlighted the role of BSI in predicting the risk of a further fracture.

CONCLUSIONS

Artificial Intelligence is a useful method to analyse a complex system like that regarding osteoporosis, able to identify patients prone to a further fragility fracture. BSI appears to be a useful DXA index in identifying those patients who are at risk of further vertebral fractures.

EEG individual power profiles correlate with tension along spine in horses

Assessing chronic pain is a challenge given its subjective dimension. In humans, resting state electroencephalography (EEG) is a promising tool although the results of various studies are contradictory. Spontaneous chronic pain is understudied in animals but could be of the highest interest for a comparative study. Riding horses show a very high prevalence of back disorders thought to be associated with chronic pain. Moreover, horses with known back problems show cognitive alterations, such as a lower attentional engagement. Therefore, we hypothesized that the individual EEG power profiles resting state (i.e. quiet standing) of different horses could reflect the state of their back, that we measured using static sEMG, a tool first promoted to assess lower back pain in human patients. Results show that 1) EEG profiles are highly stable at the intra-individual level, 2) horses with elevated back tension showed resting state EEG profiles characterized by more fast (beta and gamma) and less slow (theta and alpha) waves. The proportion of theta waves was particularly negatively correlated with muscular tension along the spine. Moreover, elevated back tension was positively correlated with the frequency of stereotypic behaviours (an "addictive- like" repetitive behavior) performed by the horses in their stall. Resting state quantitative EEG appears therefore as a very promising tool that may allow to assess individual subjective chronic pain experience, beyond more objective measures of tension. These results open new lines of research for a multi-species comparative approach and might reveal very important in the context of animal welfare.

Predicting who responds to spinal manipulative therapy using a short-time frame methodology: Results from a 238-participant study

Background

Spinal manipulative therapy (SMT) is among the nonpharmacologic interventions that has been recommended in clinical guidelines for patients with low back pain, however, some patients appear to benefit substantially more from SMT than others. Several investigations have examined potential factors to modify patients’ responses prior to SMT application. The objective of this study was to determine if the baseline prediction of SMT responders can be improved through the use of a restricted, non-pragmatic methodology, established variables of responder status, and newly developed physical measures observed to change with SMT.

Materials and methods

We conducted a secondary analysis of a prior study that provided two applications of standardized SMT over a period of 1 week. After initial exploratory analysis, principal component analysis and optimal scaling analysis were used to reduce multicollinearity among predictors. A multiple logistic regression model was built using a forward Wald procedure to explore those baseline variables that could predict response status at 1-week reassessment.

Results

Two hundred and thirty-eight participants completed the 1-week reassessment (age 40.0± 11.8 years; 59.7% female). Response to treatment was predicted by a model containing the following 8 variables: height, gender, neck or upper back pain, pain frequency in the past 6 months, the STarT Back Tool, patients’ expectations about medication and strengthening exercises, and extension status. Our model had a sensitivity of 72.2% (95% CI, 58.1–83.1), specificity of 84.2% (95% CI, 78.0–89.0), a positive likelihood ratio of 4.6 (CI, 3.2–6.7), a negative likelihood ratio of 0.3 (CI, 0.2–0.5), and area under ROC curve, 0.79.

Conclusion

It is possible to predict response to treatment before application of SMT in low back pain patients. Our model may benefit both patients and clinicians by reducing the time needed to re-evaluate an initial trial of care.

Evaluation of the association between postural control and sagittal curvature of the spine

Introduction

Balance is key to controlling body posture. Balance is typically assessed by measures of the body’s vertical orientation, obtained by balancing out the forces acting on different body segments. The ability to maintain balance is assessed by evaluating centre of pressure (CoP) displacement; such assessments are typically used to evaluate responses to a treatment process.

Purpose of study

This study evaluated the efficiency of compensatory reactions in children according to the extent of thoracic kyphosis and lumbar lordosis.

Materials and method

The study enrolled 312 children aged 8‒12 years, including 211 patients with postural disorders: thoracic kyphosis outside the 47‒50-degree range and lordosis outside the 38‒42-degree range (study group). A control group was also recruited and comprised 101 children without postural disorders. The DIERS formetric 4D system was used to assess posture and CoP displacement.

Results

Children in the study group showed a significantly greater range of CoP displacement than children in the control group. The kyphosis angle correlated with the maximum CoP displacement in the coronal plane and the maximum CoP displacement in the sagittal plane during gait. The kyphosis angle also correlated with the maximum CoP displacement back in the static test. The size of the lordosis angle correlated with the maximum displacement of CoP in the coronary plane during gait, and with the maximum displacement of CoP toward the left, forward, and backward in the static test. The correlation coefficient of the lordosis angle with displacement of the CoP in the sagittal plane was 0.999.

Conclusions

Influence of low back pain and its remission on motor abundance in a low-load lifting task

Having an abundance of motor solutions during movement may be advantageous for the health of musculoskeletal tissues, given greater load distribution between tissues. The aim of the present study was to understand whether motor abundance differs between people with and without low back pain (LBP) during a low-load lifting task. Motion capture with electromyography (EMG) assessment of 15 muscles was performed on 48 participants [healthy control (con) = 16, remission LBP (rLBP) = 16, current LBP (cLBP) = 16], during lifting. Non-negative matrix factorization and uncontrolled manifold analysis were performed to decompose inter-repetition variability in the temporal activity of muscle modes into goal equivalent (GEV) and non-goal equivalent (NGEV) variabilities in the control of the pelvis and trunk linear displacements. Motor abundance occurs when the ratio of GEV to NGEV exceeds zero. There were significant group differences in the temporal activity of muscle modes, such that both cLBP and rLBP individuals demonstrated greater activity of muscle modes that reflected lumbopelvic coactivation during the lifting phase compared to controls. For motor abundance, there were no significant differences between groups. Individuals with LBP, including those in remission, had similar overall motor abundance, but use different activation profiles of muscle modes than asymptomatic people during lifting.

A preliminary study of spinal cord blood flow during PVCR with spinal column shortening: A prospective clinic study in severe rigid scoliokyphosis patients

Posterior vertebral column resection (PVCR) was the most powerful technique for treating severe rigid spinal deformity, but it has been plagued with high neurologic deficits risk. The fluctuations of spinal cord blood flow (SCBF) play an important role in secondary spinal cord injury during deformity correction surgery.The objective of this study was to first provide the characteristic of SCBF during PVCR with spinal column shortening in severe rigid spinal deformity.Severe rigid scoliokyphosis patients received PVCR above L1 level were included in this prospective study. Patients with simple kyphosis, intraspinal pathology and any degree of neurologic deficits were excluded. The deformity correction was based on spinal column shortening over the resected gap during PVCR. Laser Doppler flowmetry was used to monitor the SCBF at different surgical stages.There were 12 severe rigid scoliokyphosis patients in the study. The baseline SCBF was 316 ± 86 perfusion unite (PU), and the SCBF decreased to 228 ± 68 PU after VCR (P = .008). The SCBF increased to 296 ± 102 PU after the middle shortening and correction which has a 121% increased comparison to the SCBF after VCR (P = .02). The SCBF will slightly decrease to 271 ± 65 PU at final fixation. The postoperative neural physical examination of all patients was negative, and the MEP and SSEP of all patients did not reach the alarm value during surgery.These results indicate that PVCR is accompanied by a change in SCBF, a proper spinal cord shortening can protect the SCBF and can prevent a secondary spinal cord injury during the surgery.

Kyphosis and 3-year fall risk in community-dwelling older men

Hyperkyhosis is thought to be a fall risk factor in older adults. This large study of older men found that fall risk increased with greater kyphosis measured with the blocks method, but did not find an association between kyphosis and falls when measured by the commonly used the Cobb angle method.

INTRODUCTION

Research suggests an association between hyperkyphosis and falls in community-dwelling older adults, though this has not been investigated within large, population-based studies. This study sought to determine whether two measures of kyphosis prospectively predict fall risk over 3 years among older men.

METHODS

Within the Osteoporotic Fractures in Men Study (MrOS), we conducted two 3-year prospective studies of 2346 and 2928 men. The first group had kyphosis measured by the Cobb angle at visit 1, while the second group had kyphosis assessed with the blocks method at visit 3; both groups then self-reported falls tri-annually for 3 years. Poisson regression with GEE was used to obtain relative risks (RR) of falls.

RESULTS

The fall rates over 3 years were 651/1000 person-years among the visit 1 sample (mean age 74 ± 6 years) and 839/1000 person-years among the visit 3 sample (mean age 79 ± 5 years). In adjusted models of the visit 3 sample, the risk of falls was increased by 12% for each standard deviation increase (1.4 blocks) in the number of blocks required to achieve a neutral head and neck position (RR = 1.12, 95% CI = 1.06, 1.18). The Cobb angle was not associated with falls in the visit 1 sample.

CONCLUSIONS

Although the Cobb angle did not predict falls in community-dwelling older men over 3 years, the blocks method of measuring kyphosis was predictive of falls in this population. This difference could be due to the Cobb angle's focus on thoracic kyphosis, whereas the blocks method may additionally capture abnormal cervical spine curvature.

Spinal mobility in the cervical and lumbar spine correlates with magnetic resonance imaging findings for inflammatory and structural changes in patients with active ankylosing spondylitis

OBJECTIVES

We aimed to assess relationships between single Bath Ankylosing Spondylitis Metrology Index (BASMI) components and corresponding spinal segment magnetic resonance images (MRI) in anti-tumour-necrosis-factor-treated AS patients.

METHODS

Using available MRI and BASMI data from the GO-RAISE trial (n=91 patients), MRI scores for active inflammatory (ASspiMRI-a) and chronic structural (ASspiMRI-c) changes in cervical and lumbar spine segments were compared with BASMI cervical (cervical-rotation [CR] angle, tragus-to-wall [TTW] distance) and lumbar (lumbar flexion [LF], lateral-lumbar-flexion [LLF]) spine component scores (linear definition). Generalised linear models were employed to assess relationships between BASMI components and ASspiMRI-a/ASspiMRI-c measurements at baseline and for week-14 (golimumab/placebo groups) and week-104 (all golimumab-treated) change scores.

RESULTS

Baseline lumbar ASspiMRI-a scores correlated with LF and LLF (β=0.231 and 0.238, respectively; both p<0.01), while this was less prominent for ASspiMRI-c scores and LLF (β=0.142, p=0.04). A significant but weak correlation was found between changes from baseline to week 104 in cervical spine ASspiMRI-c score and TTW distance among all treated patients (β=0.161, p=0.003).

CONCLUSIONS

Detailed assessments indicated baseline spinal mobility impairment in patients with active AS correlated weakly with MRI-detected lumbar spinal inflammation; correlations with chronic, structural damage/changes were very weak. Improved, less variable MRI and spinal metrology assessments are needed for future clinical research.

Effect of elastic scapular taping on shoulder and spine kinematics in adolescents with idiopathic scoliosis

OBJECTIVE

The aim of this study was to investigate the short-term effects of scapular repositioning using an elastic taping technique on the three-dimensional (3-D) shoulder and thoracic kinematics during various activities of daily living (ADLs) in adolescents with idiopathic scoliosis (IS).

METHODS

Shoulder and spine kinematics during five ADL movement tasks were assessed in 24 adolescents with IS (3 males and 21 females; mean age: 15.8 years; age range: 14-17 years) before and 15 min after elastic scapular taping. All the participants had a moderate curve magnitude (Cobb angle: 20°-45°), with a primary thoracic curve. A 3-D electromagnetic tracking system (Ascension Technology Corporation, Shelburne, VT, USA) was used to record 3-D shoulder and thoracic kinematics. ADL movement tasks included touching the mouth/drinking, touching the back, touching the contralateral shoulder, reaching upward, and bilateral 4-kg weight lifting. Two separate strips of elastic tape were applied using the same correction technique for each shoulder and scapular region to control scapular alterations in the resting position.

RESULTS

Elastic scapular taping significantly improved scapular external rotation and scapular upward rotation. Similarly, humeral horizontal adduction, external rotation, thoracic flexion, and lateral bending significantly increased in the taped condition depending on the specific task (p<0.05).

CONCLUSION

Elastic scapular taping can change scapular orientations on the convex and concave sides, thereby affecting upper extremity and trunk kinematics. Thus, the dynamic stability of the scapula increases to produce larger movements during functional activities.

LEVEL OF EVIDENCE

Level IV, Therapeutic study.

The prevention of musculoskeletal complaints: long-term effect of a work-related psychosocial coaching intervention compared to physiotherapy alone-a randomized controlled trial

PURPOSE

Research shows that psychosocial factors play a significant role in the emergence of musculoskeletal complaints (MSC). The aim of this study was to determine the long-term effects on unspecific MSC by a combined physiotherapy and coaching intervention compared to physiotherapy alone. The coaching intervention focussed on enabling better strategies for coping with work stressors.

METHODS

The participants of a previous randomized controlled intervention were invited to participate again in a third follow-up survey 22 months after the end of the intervention. In 2014, 65 nurses completed a 10-week personalised physiotherapy. Additionally, the intervention group (n = 33) passed five individual coaching sessions, plus an opening and closing session. 44 nurses (IG: n = 24; CG: n = 20) passed again a physical examination as well as another questionnaire assessment in 2016. The primary outcome was MSC, secondary outcomes were work ability and work-related well-being. Due to missing data, multiple imputations were conducted using the mice package in R. Data were analysed by ANOVA with two-way repeated measures, t tests for independent samples and Chi-squared tests.

RESULTS

In respect of MSC, stronger improvement of movement in the vertebral column was observed in the IG compared to the CG. No differences between the IG and CG regarding other long-term effects were observed.

CONCLUSIONS

The results suggest that the combined intervention of work-related coaching and physiotherapy had only a marginally stronger long-term effect with respect to MSC than physiotherapy alone.

Effect of Extra Virgin Olive Oil and Traditional Brazilian Diet on the Bone Health Parameters of Severely Obese Adults: A Randomized Controlled Trial

Dietary interventions can stabilize and/or reverse bone mass loss. However, there are no reports on its effects on bone mineral density (BMD) in severely obese people, despite the vulnerability of this group to bone loss. We examine the effect of extra virgin olive oil supplementation and the traditional Brazilian diet (DieTBra) on BMD and levels of calcium, vitamin D, and parathyroid hormone (PTH) in severely obese adults. A randomized controlled trial followed-up with severely obese adults (n = 111, with mean body mass index 43.6 kg/m2 ± 4.5 kg/m2) for 12 weeks. Study participants received either olive oil (52 mL/day), DieTBra, or olive oil + DieTBra (52 mL/day + DieTBra). BMD was assessed by total spine and hip dual-energy X-ray absorptiometry. After interventions, BMD means for total spine (p = 0.016) and total hip (p = 0.029) were higher in the DieTBra group than in the olive oil + DieTBra group. Final mean calcium levels were higher in the olive oil group compared to the olive oil + DieTBra group (p = 0.026). Findings suggest that DieTBra and extra virgin olive oil have positive effects on bone health in severely obese adults. The major study was registered at ClinicalTrials.gov (NCT02463435).

Analysis of spinal stress analysis application in determining method for the pedicle screw placement under the guidance of X-Ray

OBJECTIVE

To evaluate the accuracy of a novel guidance method of pedicle screw implantation determined by spinal stress.

METHODS

We retrospectively analyzed patients underwent pedicle screw internal fixation between January 2015 and August 2018 in our hospital. Patients were divided into two groups according to the methods of pedicle screw implantation namely, the conventional nail placement and novel guidance method of pedicle screw implantation determined by spinal stress. Accuracy of spinal pedicle screw placements was evaluated using intraoperative and postoperative X-ray computed tomography (CT) examination and intraoperative touch of nerve root dissection pedicle bone. The success rate of intraoperative one-time screw placement was calculated according to Heary classification I.

RESULTS

A total of 785 patients underwent pedicle screw internal fixation were retrospectively analyzed. Among them 384 patients were treated using conventional nail placement (Group A) and 401 patients were treated using the technique according to analysis of spinal stress (Group B). There was no significant difference in terms of the characteristics between two groups. There were significant differences in terms of the success rate of total of screw placement (88.7% vs. 96.2%, P < 0.001) including thoracic screw placement (87.8% vs. 94.5%, P = 0.003) and lumbar screw placement (88.8% vs. 96.5%, P = 0.001) for Group A and Group B, respectively.

CONCLUSIONS

Using the novel guidance method of pedicle screw implantation determined by spinal stress might improve the accuracy of pedicle screw implantation.

Inter-segmental coordination of the spine is altered during lifting in patients with ankylosing spondylitis: A cross-sectional study

The abnormal inter-segmental coordination of the spine during lifting could be used to monitor disease progression and rehabilitation efficacy in patients with ankylosing spondylitis (AS). This study aimed to compare the inter-segmental coordination patterns and variability of the spine during lifting between patients with AS (n = 9) and control (n = 15) groups.Continuous relative (CRP) and deviation (DP) phases between each segment of the spine (two lumbar and three thorax segments) and lumbosacral joint were calculated. The CRP and DP curves among participants were decomposed into few functional principal components (FPC) via functional principal component analysis (FPCA). The FPC score of CRP or DP of the two groups were compared, and its relationship with the indexes of spinal mobility was investigated.Compared with the control group, the AS patients showed more anti-phase coordination patterns in each relative upper spine segment and lumbosacral joint. In addition, either less or more variation was found in the coordination of each relative lower spine segment and lumbosacral joint during different time periods of lifting for these patients. Some cases were considerably related to spinal mobility.the inter-segmental coordination of the spine was altered during lifting in AS patients to enable movement, albeit inefficient and might cause spinal mobility impairment.

The Hip-Spine Relationship Simplified

Much attention has recently been focused on the relationship between the hip and spine and its contribution to postoperative instability following total hip arthroplasty. However, the terminology can be confusing. Through an understanding of spinopelvic parameters, spinopelvic motion, and the interplay between the spine and pelvis, the surgeon can plan for and decrease the risk of instability after total hip arthroplasty. This review details spinopelvic parameters that predispose to instability and guides readers in understanding spinopelvic motion as it relates to THA instability.

Implications of Spinopelvic Mobility on Total Hip Arthroplasty: Review of Current Literature

Understanding the impact of pathologic spinopelvic mobility on total hip arthroplasty instability requires an appreciation of the dynamic interplay between and the spine, hip and pelvis. This complex interdependent relationship changes with position, pathology and surgical intervention. Spinal pathology may prevent normal dynamic motion leading to spinopelvic stiffness and abnormal pelvic position. Patients at high risk for pathologic spinopelvic motion and subsequent total hip arthroplasty (THA) dislocation should be assessed with a functional imaging series with lateral standing, sitting and AP standing radiographs. Common patterns of stiffness and imbalance as well as proposed surgical treatment algorithms are presented and discussed in this review.

The ergonomic impact of a mattress lift tool and bottom sheet type on hotel room cleaners while making beds

The purpose of this study was to quantify biomechanical and cardiovascular exposure while making beds with and without interventions (mattress lift tool and fitted sheet). Sixteen female hotel room cleaners participated in this multifactorial (tool and sheet) laboratory study of crossover design. Exertion in the upper extremity (<2) and back (<3) was consistently lower when using the tool and fitted sheet (p < 0.05). The average number of lifts per bed was reduced by 48% with an 18 s increase in cycle time per bed. Peak forearm flexor activity was significantly lower when using a tool(p < 0.05). Spinal lateral plane range of motion (p < 0.02) and maximum twisting velocity (p < 0.03) were lowest using the tool and fitted sheet together. Interventions such as a mattress lift tool used with a fitted sheet reduced the number of mattress lifts and lowered perceived exertion among hotel room cleaners while making beds.

Evans Blue Reduces Neuropathic Pain Behavior by Inhibiting Spinal ATP Release

Upon peripheral nerve injury, vesicular ATP is released from damaged primary afferent neurons. This extracellular ATP subsequently activates purinergic receptors of the spinal cord, which play a critical role in neuropathic pain. As an inhibitor of the vesicular nucleotide transporter (VNUT), Evans blue (EB) inhibits the vesicular storage and release of ATP in neurons. Thus, we tested whether EB could attenuate neuropathic pain behavior induced by spinal nerve ligation (SNL) in rats by targeting VNUT. An intrathecal injection of EB efficiently attenuated mechanical allodynia for five days in a dose-dependent manner and enhanced locomotive activity in an SNL rat model. Immunohistochemical analysis showed that EB was found in VNUT immunoreactivity on neurons in the dorsal root ganglion and the spinal dorsal horn. The level of ATP in cerebrospinal fluid in rats with SNL-induced neuropathic pain decreased upon administration of EB. Interestingly, EB blocked ATP release from neurons, but not glial cells in vitro. Eventually, the loss of ATP decreased microglial activity in the ipsilateral dorsal horn of the spinal cord, followed by a reduction in reactive oxygen species and proinflammatory mediators, such as interleukin (IL)-1β and IL-6. Finally, a similar analgesic effect of EB was demonstrated in rats with monoiodoacetate-induced osteoarthritis (OA) pain. Taken together, these data demonstrate that EB prevents ATP release in the spinal dorsal horn and reduces the ATP/purinergic receptor-induced activation of spinal microglia followed by a decline in algogenic substances, thereby relieving neuropathic pain in rats with SNL.

Injectable Catalyst-Free Poly(Propylene Fumarate) System Cross-Linked by Strain Promoted Alkyne-Azide Cycloaddition Click Chemistry for Spine Defect Filling

A new PPF-BCN/hyPCL32-N3 injectable system that can be cross-linked by catalyst-free, strain promoted alkyne-azide cycloaddition (SPAAC) click chemistry was developed for tissue engineering applications. The system consisted of two components: PPF-BCN, poly(propylene fumarate) (PPF) functionalized with (1R,8S,9s)-bicyclo[6.1.0]non-4-yn-9-ylmethanol (BCN-OH), and hyPCL32-N3, a hyper-branched 32-arm poly(ε-caprolactone) (PCL) dendrimer functionalized with azide as the cross-linker core. Fast SPAAC click reaction allowed the desired gelation of the system without using any toxic initiator or catalyst. Compared to the conventional injectable formulation, e.g., poly(methyl methacrylate) (PMMA), our PPF-BCN/hyPCL32-N3 (abbreviated as PFCL-Click) injectable system showed enhanced biocompatibility and low heat generation during cross-linking. After reaction, the cross-linked PFCL-Click scaffolds supported excellent proliferation and differentiation of preosteoblast cells on the surface. The PFCL-Click system can be successfully injected into vertebral bodies of rabbit spine and can be monitored by X-ray imaging after incorporating zirconium dioxide (ZrO2) powder. With these unique advantages, this injectable system has promising potential for bone defect repair and other tissue engineering and regenerative medicine applications.

Reliability of the balance evaluation systems test and trunk control measurement scale in adult spinal deformity

OBJECTIVE

To test the reliability of the Balance Evaluation Systems Test (BESTest) and Trunk Control Measurement Scale (TCMS) between sessions and raters in the adult spinal deformity (ASD) population.

SUMMARY OF BACKGROUND DATA

Up to now evaluation in ASD was mainly based on static radiographic parameters. Recently literature showed that dynamic balance was a better predictor of health-related quality of life than radiographic parameters, stressing the importance of balance assessment. However, to the best of our knowledge, reliability of balance assessment tools has not yet been investigated in the ASD population.

METHODS

Twenty ASD patients participated in this study. Ten patients were included in the test-retest study, including repeated measurements. Ten patients were measured once, simultaneously but independently by three raters. Each participant performed two balance scales, namely the BESTest and the TCMS. Statistical analysis consisted of intra class correlations (ICC) on scale- and subscale level, and kappa scores on item-level. Cronbach's alpha on total scores, standard errors of measurement (SEM), smallest detectable differences and percentages of agreement were also calculated. Bland-altman plots were created to investigate systematic bias.

RESULTS

ICC scores between sessions and raters for TCMS (0.76 and 0.88) and BESTest (0.90 and 0.94) total scores were good to excellent. SEM's between sessions and raters were also low for total scores on TCMS (1.66 and 2.35) and BESTest (2.99 and 2.32). However, on subscale- and item-level reliability decreased and ceiling effects were observed. No systematic bias was observed between sessions and raters.

CONCLUSION

BESTest and TCMS showed to be reliable tools to measure balance in ASD on scale-level. However, on subscale- and item-level reliability decreased and ceiling effects were observed. Therefore, the question arises if there is need for an ASD-specific balance scale.

Effects of facet joint degeneration on stress alterations in cervical spine C5-C6: A finite element analysis

It has been demonstrated that articular facet degeneration can cause local strain alterations and induce neck pain. This study aims to quantify the biomechanical effects of normal and degenerated C5-C6 articular facets, and evaluate the correlation of mechanical strain between healthy and degenerated spine. A 3-dimensional finite element (FE) model of the C5-C6 cervical spine was developed [Model 0 (M0)]. The asymmetric models of C5-C6 bilateral articular facet joint were established separately to mimic articular facet joint degeneration. The capsule ligament stiffness of C5-C6 unilateral facet joint was altered with minimum and maximum threshold to simulate capsule ligaments' lesion and calcification [Model 1 (M1) and Model 2 (M2), respectively]. Besides, the cervical C5-C6 unilateral articular facet joint direction was changed by 5° and 10° forward to imitate the moderate joint hyperplasia and severe osteophyte (Model 3 and Model 4 respectively). M1 increased the rotation range of ipsilateral side (left), while M2 reduced, and both had limited effect on the contralateral side (right). The angle increased in Model 3 (M3) (61°) and Model 4 (M4) (55°) comparing to M0 during the axial rotation, and the angle of M4 was larger. M3 and M4 increased the nucleus pulposus pressure with and without controlled angular displacement during axial rotation. The pressure of nucleus pulpous increased during M1 rotating to the abnormal side but decreased when rotating to the other side, but the results of M2 were opposite. The capsule ligament stiffness made an impact on segmental mobility and vertebral spatial position, and the sagittal angle of articular facet joint exerted an influence on disc pressure distribution.

The effect of age on in-vivo spine stiffness, postures and discomfort responses during prolonged sitting exposures

Many industrialised working populations are ageing and prolonged sitting exposures are prevalent across occupational sectors. The purpose of this work was to determine the effect of age and sex on passive spine stiffness, postures and discomfort in response to seated work. A total of 34 participants were recruited, with 17 older adults with an average age of (standard deviation) 63.7 (±3.9) years and 17 younger adults aged 23.8 (±5.0) years. Participants were asked to sit continuously for 90 min while typing. Baseline passive spine stiffness was higher in older adults at 40% flexion compared to younger adults (p = .0233). Older adults sat in less normalised flexion, at 33.4% (±16.4) compared to 60.9% (±20.2) in the younger group (p = .0003). Discomfort was higher among older adults in the neck, right shoulder and middle back regions (p < .0086). An understanding of age-specific responses to workplace exposures is essential to determine whether age-specific interventions are warranted.   Practitioner summary: Older adults had higher passive spine stiffness and sat with less flexion during prolonged sitting. Discomfort was higher among older adults and occurred earlier in the simulation compared to younger participants, indicating that interventions, such as walking breaks may need to be implemented earlier during sitting for aged workers.

Abaloparatide improves cortical geometry and trabecular microarchitecture and increases vertebral and femoral neck strength in a rat model of male osteoporosis

Androgen deficiency is a leading cause of male osteoporosis, with bone loss driven by an inadequate level of bone formation relative to the extent of bone resorption. Abaloparatide, an osteoanabolic PTH receptor agonist used to treat women with postmenopausal osteoporosis at high risk for fracture, increases bone formation and bone strength in estrogen-deficient animals without increasing bone resorption. This study examined the effects of abaloparatide on bone formation, bone mass, and bone strength in androgen-deficient orchiectomized (ORX) rats, a male osteoporosis model. Four-month-old Sprague-Dawley rats underwent ORX or sham surgery. Eight weeks later, sham-operated rats received vehicle (saline; n = 10) while ORX rats (n = 10/group) received vehicle (Veh) or abaloparatide at 5 or 25 μg/kg (ABL5 or ABL25) by daily s.c. injection for 8 weeks, followed by sacrifice. Dynamic bone histomorphometry indicated that the tibial diaphysis of one or both abaloparatide groups had higher periosteal mineralizing surface, intracortical bone formation rate (BFR), endocortical BFR, and cortical thickness vs Veh controls. Vertebral trabecular BFR was also higher in both abaloparatide groups vs Veh, and the ABL25 group had higher trabecular osteoblast surface without increased osteoclast surface. By micro-CT, the vertebra and distal femur of both abaloparatide-groups had improved trabecular bone volume and micro-architecture, and the femur diaphysis of the ABL25 group had greater cortical thickness with no increase in porosity vs Veh. Biomechanical testing indicated that both abaloparatide-groups had stronger vertebrae and femoral necks vs Veh controls. These findings provide preclinical support for evaluating abaloparatide as an investigational treatment for male osteoporosis.

Spinal manual therapy in infants, children and adolescents: A systematic review and meta-analysis on treatment indication, technique and outcomes

BACKGROUND

Studies on effectiveness and safety of specific spinal manual therapy (SMT) techniques in children, which distinguish between age groups, are lacking.

OBJECTIVE

To conduct a systematic review of the evidence for effectiveness and harms of specific SMT techniques for infants, children and adolescents.

METHODS

PubMed, Index to Chiropractic Literature, Embase, CINAHL and Cochrane Library were searched up to December 2017. Controlled studies, describing primary SMT treatment in infants (<1 year) and children/adolescents (1-18 years), were included to determine effectiveness. Controlled and observational studies and case reports were included to examine harms. One author screened titles and abstracts and two authors independently screened the full text of potentially eligible studies for inclusion. Two authors assessed risk of bias of included studies and quality of the body of evidence using the GRADE methodology. Data were described according to PRISMA guidelines and CONSORT and TIDieR checklists. If appropriate, random-effects meta-analysis was performed.

RESULTS

Of the 1,236 identified studies, 26 studies were eligible. Infants and children/adolescents were treated for various (non-)musculoskeletal indications, hypothesized to be related to spinal joint dysfunction. Studies examining the same population, indication and treatment comparison were scarce. Due to very low quality evidence, it is uncertain whether gentle, low-velocity mobilizations reduce complaints in infants with colic or torticollis, and whether high-velocity, low-amplitude manipulations reduce complaints in children/adolescents with autism, asthma, nocturnal enuresis, headache or idiopathic scoliosis. Five case reports described severe harms after HVLA manipulations in four infants and one child. Mild, transient harms were reported after gentle spinal mobilizations in infants and children, and could be interpreted as side effect of treatment.

CONCLUSIONS

Based on GRADE methodology, we found the evidence was of very low quality; this prevented us from drawing conclusions about the effectiveness of specific SMT techniques in infants, children and adolescents. Outcomes in the included studies were mostly parent or patient-reported; studies did not report on intermediate outcomes to assess the effectiveness of SMT techniques in relation to the hypothesized spinal dysfunction. Severe harms were relatively scarce, poorly described and likely to be associated with underlying missed pathology. Gentle, low-velocity spinal mobilizations seem to be a safe treatment technique in infants, children and adolescents. We encourage future research to describe effectiveness and safety of specific SMT techniques instead of SMT as a general treatment approach.

Scoliosis in Duchenne muscular dystrophy children is fully reducible in the initial stage, and becomes structural over time

BACKGROUND

Patients with Duchenne muscular dystrophy (DMD) often develop scoliosis that progresses rapidly after loss of ambulation. Management of scoliosis is crucial because it affects both life expectancy and quality of life of patients with DMD. Spinal orthosis attempts to prevent or delay scoliosis using spinal support at three points of the controlling mechanism; the curve should be flattened by the pressure. Therefore, it is assumed that spine flexibility could be a significant influencing factor for the effectiveness of braces. Hence, we attempted to investigate the flexibility of scoliosis in non-ambulant patients with DMD.

METHODS

We reviewed the medical records of 273 boys who were genetically identified as having DMD, and finally, 50 boys with serial records of radiographs after loss of ambulation were finally enrolled. And among them, only 31 patients developed scoliosis. Spine radiographs in sitting and supine positions were also reviewed to obtain Cobb angle, curve flexibility, and pelvic obliquity. Flexibilities (%) were calculated by the difference in angles between the sitting and supine positions divided by the angle at the sitting position, multiplied by 100.

RESULTS

Among 31 boys who had scoliosis, all but 2 boys with curves went through a sequential course of 1) no scoliosis, 2) nonstructural scoliosis, when scoliosis was only measurable in the sitting position, and 3) structural scoliosis, when scoliosis was also detectable in the supine position. Flexibility decreased each year after detection of scoliosis in those who developed scoliosis the first year, from 75.5 ± 5.0% to 57.1 ± 10.5% and to 49.1 ± 10.0% (mean ± standard deviation). Spinal flexibility was significantly correlated with curve magnitude of scoliosis in both sitting and supine position (p < 0.05, respectively).

CONCLUSIONS

There is a period of fully reducible curve in DMD patients at the initial stage of scoliosis. Afterward, as spinal curve progresses, flexibility decreases over time. To detect the scoliosis when the curve is fully reducible, scoliosis curve in DMD patients should be evaluated dynamically, including radiographs of at least in two different positions.

Does stopping at C7 in long posterior cervical fusion accelerate the symptomatic breakdown of cervicothoracic junction?

OBJECT

To compare the clinical and radiological outcomes between patients with long posterior cervical fusion (PCF) in which fusion stopped at C7 versus patients in which fusion crossed the cervicothoracic junction (CTJ).

METHODS

The patients were divided into 2 groups on the basis of the lower-most instrumented vertebra (LIV); C7 group patients (n = 25) and upper thoracic (UT) group (n = 21). We analyzed the visual analogue scale of arm/neck pain, Japanese Orthopedic Association (JOA) score, and neck disability index (NDI). And we also measured the following parameters: (1) pseudomotion of fused segments; (2) C2-C7 sagittal vertical axis; (3) T1 slope; and (4) C2-C7 lordosis.

RESULTS

Arm and neck pain were similar in both groups pre- and postoperatively. Interestingly, mean postoperative NDI score in the UT group was significant worse when compared with the C7 group (9.7±4.6 vs. 14.2±3.7, p = 0.006). Although UT patients had longer fusion levels, the fusion rates were not significantly different between the C7 and UT groups (96.0% vs. 90.5%; p = 0.577). The radiographic parameters did not show any significant differences between the groups at final follow-up.

CONCLUSIONS

Our study demonstrates that multi-level PCF stopping at C7 does not negatively affect C7-T1 segment failure, fusion rate, neck pain, neurologic outcomes, and global sagittal alignment of the cervical spine. Hence, it is unnecessary to extend the long PCF levels caudally across the healthy CTJ for fear of development of adjacent segmental disease (ASD) at the C7-T1 segment.

Features of trunk muscle weakness in patients with ankylosing spondylitis: A cross-sectional study

BACKGROUND

Ankylosing spondylitis (AS) is an inflammatory autoimmune disorder that manifested with sacroiliitis at its early stage and developed extensive inflammation with syndesmophytes of the lumbar, thoracic and cervical spines at its later stage. In the present study, we characterized the trunk isometric strength in patients with AS with different disease severity, defined by the radiological images.

METHODS

In a cross-sectional study conducted in a university-affiliated hospital, thirty-eight male AS patients (23 in the early AS group whose radiological findings showed no syndesmophyte, Modified Stoke Ankylosing Spinal Score (m-SASSS <3); and 15 in the syndesmophyte group, m-SASSS ≥24), and 22 healthy controls were recruited. All subjects received assessments of maximum isometric strength of trunk flexor and extensor muscles at a variety of trunk postures measured by an isokinetic device.

RESULTS

Under all examined trunk postures, the syndesmophyte AS patient group had the lowest isometric trunk muscle strength among the three groups. The flexion/extension ratio, defined by the ratio between isometric trunk flexor and extensor strengths, was highest among the three groups.

CONCLUSIONS

Trunk muscle strength significantly decreases in patients with syndesmophyte AS. The decrease of trunk muscle is inhomogeneous, which is more profound in extensor than in flexor muscles.

Center of pressure progression patterns during level walking in adolescents with idiopathic scoliosis

The purpose of this study was to determine whether functional walking performance measured with Timed Up-and-Go (TUG) and center of pressure (CoP) progression pattern is different across adolescents with various curve severity of idiopathic scoliosis (IS). The CoP coordinates during a stance phase for self-paced level walking between adolescent with three different severities of IS (mild IS, moderate IS, and severe IS) and age-matched normal subjects were measured with foot pressure measurement. The average data of three trials were compared among groups with repeated measure analysis of variance. Results showed that the TUG was different between normal and AIS subjects, indicating use of TUG as a marker of functional walking performance in AIS is plausible but studies with larger sample size is needed before using TUG to identify AIS with different scoliosis severity. The results also showed that the CoP displacement, velocity and acceleration during a stance phase was different across groups, and with the most prominent deviations found in the moderate IS group. The medial-lateral shifting of the CoP trajectory at mid-foot regions in all IS groups deviated the most. A tendency of asymmetry in CoP progression pattern between feet in IS groups was also found. The deviation of the spine alignment in frontal plane could change the CoP progression patterns during level walking, suggesting the risk of the locomotors subjecting to abnormal loading during daily walking. Education and conservative interventions might be needed for preservation of medical outcome and prevention of back pain and/or musculoskeletal consequences later in the lives of AIS with and without surgical correction.

Joint hypermobility is not positively associated with prevalent multiple joint osteoarthritis: a cross-sectional study of older adults

BACKGROUND

This cross-sectional study evaluated associations of joint hypermobility and multiple joint osteoarthritis (MJOA) in a community-based cohort of adults 45+ years of age.

METHODS

MJOA and joint hypermobility data were from 1677 participants (mean age 69 years, 68% women) who completed research clinic visits during 2003-2010. Prevalent MJOA was defined in four ways. Radiographic OA (rOA) was defined as Kellgren-Lawrence (KL) > 2 at any included study joint; symptomatic OA (sxOA) required both symptoms and rOA in a joint. Joint hypermobility was defined as a Beighton score of > 4. Separate logistic regression models were used to estimate odds ratios (OR) between joint hypermobility and each MJOA definition, adjusting for age, sex, race, body mass index, and baseline visit.

RESULTS

In this cohort, 4% had Beighton score > 4 and 63% met any definition of MJOA. Joint hypermobility was associated with significantly lower odds of radiographic and symptomatic MJOA-1 (multiple joint OA-definition 1: involvement of > 1 IP (interphalangeal) nodes and > 2 sites of hip, knee, and spine; 74 and 58% lower, respectively). However, for the other MJOA definitions (i.e., MJOA-2:involvement of > 2 IP joints, > 1 carpometacarpal [CMC] joints, and knee or hip sites; MJOA-3: involvement of > 5 joint sites from among distal interphalangeal, proximal interphalangeal, CMC, hip, knee, or spine sites; and MJOA-4:involvement of > 2 lower body sites (hip, knee, or spine), there were no statistically significant associations. For associations between site-specific hypermobility and any MJOA definition, most adjusted ORs were less than one, but few were statistically significant.

CONCLUSIONS

Overall, joint hypermobility was not positively associated with any definition of prevalent MJOA in this cohort, and an inverse association existed with one definition of MJOA. Longitudinal studies are needed to determine the contribution of hypermobility to the incidence and progression of MJOA outcomes.

Bone accrual in oligo-amenorrheic athletes, eumenorrheic athletes and non-athletes

BACKGROUND

Mechanical loading improves bone mineral density (BMD) and strength while decreasing fracture risk. Cross-sectional studies show that exercise advantage is lost in oligo-amenorrheic athletes (OA). Longitudinal studies examining the opposing effects of exercise and hypogonadism on bone are lacking in adolescents/young adults.

OBJECTIVE

Evaluate differences in bone accrual over 12 months in OA, eumenorrheic athletes (EA) and non-athletes (NA). We hypothesized that bone accrual would be lower in OA than EA and NA, with differences most pronounced at non-weight bearing trabecular sites.

METHODS

27 OA, 29 EA, and 22 NA, 14-25 years old, completed 12-months of the prospective study. Athletes were weight-bearing endurance athletes. Subjects were assessed for areal BMD and bone mineral content (BMC) using DXA at the femoral neck, total hip, lumbar spine and whole body (WB). Failure load (a strength estimate) at the distal radius and tibia was assessed using microfinite element analysis of data obtained via high resolution peripheral quantitative computed tomography (HRpQCT). The primary analysis was a comparison of changes in areal BMD, BMC, and failure load across groups over 12-months at the respective sites.

RESULTS

Groups did not differ for baseline age, height or BMI. Percent body fat was lower in both OA and EA compared to NA. OA attained menarche later than EA and NA. Over the follow-up period, OA gained 1.9 ± 2.7 kg of weight compared to 0.5 ± 2.4 kg and 0.8 ± 2.3 kg in EA and NA respectively (p = 0.09); 39% of OA resumed menses. Changes in BMD, BMD Z-scores, and tibial failure load over 12-months did not differ among groups. At follow up, EA had higher femoral neck, hip and WB BMD Z-scores than NA, and higher hip BMD Z-scores than OA (p < 0.05) after adjusting for covariates. At follow-up, radial failure load was lower in OA vs. NA, and tibial failure load lower in OA and NA vs. EA (p ≤ 0.04 for all). Change in weight and fat mass were associated with changes in BMD measures at multiple sites.

CONCLUSION

Despite weight gain and menses recovery in many OA during follow-up, residual deficits persist without catch-up raising concerns for suboptimal peak bone mass acquisition.

Unilateral versus bilateral lower extremity motor deficit following complex adult spinal deformity surgery: is there a difference in recovery up to 2-year follow-up?

BACKGROUND CONTEXT

Scoli-RISK-1 is a multicenter prospective cohort designed to study neurologic outcomes following complex adult spinal deformity (ASD). The effect of unilateral versus bilateral postoperative motor deficits on the likelihood of long-term recovery has not been previously studied in this population.

PURPOSE

To evaluate whether bilateral postoperative neurologic deficits have a worse recovery than unilateral deficits.

STUDY DESIGN

Secondary analysis of a prospective, multicenter, international cohort study.

METHODS

In a cohort of 272 patients, neurologic decline was defined as deterioration of the American Spinal Injury Association Lower Extremity Motor Scores (LEMS) following surgery. Patients with lower extremity neurologic decline were grouped into unilateral and bilateral cohorts. Differences in demographics, surgical variables, and patient outcome measures between the two cohorts were analyzed.

RESULTS

A total of 265 patients had LEMS completed at discharge. Unilateral decline was seen in 32 patients (12%), while 29 (11%) had bilateral symptoms. At 2 years, there was no significant difference in either median LEMS (unilateral 50.0, interquartile range [IQR] 47.5-50.0; bilateral 50.0, IQR 48.0-50.0, p=.939) or change in LEMS from baseline (unilateral 0.0, IQR -1.0 to 0.0; bilateral 0.0, IQR -1.0 to 0.0, p=.920). In both groups, approximately two-thirds of patients saw recovery to at least their preoperative baseline by 2 years postoperatively (unilateral n=15, 63%; bilateral n=14, 67%). The mean Scoliosis Research Society-22R (SRS-22R) score at 2 years was 3.7±0.6 versus 3.2±0.6 (p=.009) for unilateral and bilateral groups, respectively.

CONCLUSIONS

The prognosis for neurologic recovery of new motor deficits following complex adult spinal deformity is similar with both unilateral and bilateral weaknesses. Despite similar rates of neurologic recovery, patient reported outcomes for those with bilateral motor decline measured by SRS-22R are worse at 2 years after surgery.

VACTERL Association with Situs Inversus Totalis: A Unique Combination

BACKGROUND

VACTERL association is a sporadic, nonrandom series of congenital malformations diagnosed by the presence of three or more of the following: vertebral malformations, anal atresia, cardiac defects, tracheoesophageal fistula, renal malformations, and limb malformations. Situs inversus totalis (SIT) and esophageal malformations are rarely associated. This is the first reported case in North America of VACTERL association with SIT.

IMPLICATIONS FOR PRACTICE

Respiratory distress in the term infant requires full exploration of all possible causes because the etiology may be far more complex than routinely diagnosed respiratory distress syndrome. This particular case demonstrates physical exam findings and supportive imaging that would be observed in infants with VACTERL association and with SIT, highlighting considerations when, rarely, both occur simultaneously.

Examining relationships of the anterior pelvic tilt angle with the anterior-posterior curvatures and elongation of the spine

PURPOSE

A pelvic tilt may lead to body posture disturbances. The aim of the study was to determine relationships between the anterior pelvic tilt angle and the curvature and mobility of lumbar lordosis and thoracic kyphosis.

METHODS

The angles of anterior pelvic tilt, lumbar lordosis, thoracic kyphosis and spinal elongation were measured with the use of Posturometr-S device. The posturometric measurements were carried out with the pointing stick of the device moving along spinous processes (from C7 to L5) and marking the selected anthropometric points.

RESULTS

In the studied group of boys, the angles in a free-standing position and the thoracic kyphosis angle during elongation were significantly greater than the corresponding lordosis angles. In all measured variables the range of measured angles was characteristically wide. The greatest individual differences were found in the lumbar lordosis angles. All the boys featured a significant increase in body height during linear elongation. The measurements of angles at baseline and during elongations of lumbar lordosis and thoracic kyphosis in a standing position in the entire study group revealed that the anterior pelvic tilt had no significant impact on lumbar lordosis in a free-standing posture and its elongation. In the case of thoracic kyphosis, the correlation was statistically significant, although it was not strong.

CONCLUSIONS

The anterior pelvic tilt angle is correlated with the subject's age, body mass, body height and the size of thoracic kyphosis.

Immediate effects of real-time postural biofeedback on spinal posture, muscle activity, and perceived pain severity in adults with neck pain

BACKGROUND

Previous studies have investigated various types of postural biofeedback devices on different body regions to improve posture; however, they focused only on healthy adults without a history of chronic musculoskeletal disorders. In addition, those postural biofeedback devices used in previous studies are often designed for experimental research. The designs are usually bulky with many wires, which is not practical for everyday use.

RESEARCH QUESTION

The aim of this study was to determine the immediate effect of a commercially available real-time postural biofeedback device on spinal posture, muscle activity, and perceived pain severity in adults with neck pain.

METHODS

21 adults who had chronic or recurrent nonspecific neck pain for more than 3 months and whose pain was induced or aggravated by prolonged computer work were enrolled in this study. Spinal posture (head tilt, neck flexion, cervical and thoracic angles), muscle activity (cervical erector spinae, upper trapezius, and thoracic erector spinae), and self-reported neck and shoulder pain were measured during computer typing tasks, with and without biofeedback.

RESULTS

Compared with the non-biofeedback condition, the biofeedback condition significantly decreased neck flexion, upper cervical, and lower thoracic angles and lowered the activity of the cervical erector spinae. Self-reported neck pain was not influenced by the application of biofeedback, but significantly increased over the 1-hour typing task.

SIGNIFICANCE

The application of a commercially available wearable real-time biofeedback device improves sitting posture and reduces muscular activity in adults with nonspecific neck pain during computer work. Future studies should examine the long-term effects of wearable real-time postural biofeedback devices for prevention and management of neck pain.

An evaluation of the efficiency of endpoint control on the correction of scoliotic curve with brace. A case study

PURPOSE

The use of braces is one of the conservative treatment approaches recommended for scoliotic subjects. However, the main question posted here is how to improve the efficiency of braces to control the scoliotic curve or to decrease its progression. The aim of this study was to evaluate the efficiency of various boundary conditions (endpoint control) of brace on the correction of scoliotic curves.

METHOD

CT scan images of a scoliotic subject, with double lumbar and thoracic curves, was used to produce 3d model of spine. The correction of spine (decrease in scoliotic curves) was determined following the use of transverse (lateral-to-medial direction) and the combination of transverse and vertical (upward directed force, traction) forces on spine in Abaqus software. The effects of pelvic fixation (pelvic basket of a brace) on both sides (basket enclosed pelvic in both sides), on one side (basket enclosed the pelvic in only one side), and fixation of lumbar (part of the brace encircled the lumbar area) were evaluated in this study.

RESULTS

The results of this study showed that the effect of vertical forces (traction) was more than that of transverse force. Moreover, the combination of vertical and transverse forces on lumbar and thoracic curves correction was more than that of other conditions (only transverse forces). The best correction was achieved with lumbar fixation and with combination of vertical and transverse forces.

CONCLUSIONS

The use the combination of vertical and transverse forces may be suggested to correct the scoliotic curve. Moreover, the efficiency of lumbar fixation in frontal plane seems to be more than pelvic fixation to correct scoliotic curve. The outputs of this study can be used to design new braces for scoliotic subjects.

Effect of subgroup-specific multimodal therapy on chronic spinal back pain and function-a prospective inpatient multicentre clinical trial in Germany

Treatment modalities of spinal pain patients are discussed diversely, and different multimodal therapy programs have been developed. Purpose of the present study was to evaluate therapy outcome and effectiveness of an inpatient interdisciplinary and multimodal treatment program.This prospective multicentre clinical trial has been performed with patients from orthopedic hospitals receiving a functional musculoskeletal therapy pathway. Outcome measures were pain intensity and back-specific function (Oswestry Disability Index) before (T1) and after the intervention (T2) as well as after 6 and 12 months (T3, T4). Statistical approach included parametric (t test) and nonparametric (Wilcoxon-test) tests and the calculation of effect sizes. Additionally, a statistical subgroup analysis based on selected parameters (degree of pain chronicity, gender, and age) was performed using linear mixed models.In total, 249 patients (42.6% men, 57.4% women) with spinal pain were included, 133 patients were accessible for follow-up at T3 and 106 patients at T4.Average pain (AP) reduced significantly (P <.001) from T1 to T4 with an effect size of 0.99. Back-specific function also improved (P <.001) over all measuring time points (TP) (effect size: 0.63). Furthermore, the statistical subgroup analysis demonstrated the efficacy of the treatment concept within the subgroup parameters chronicity degree and age.A functional musculoskeletal therapy pathway including treatment of musculoskeletal dysfunctions appears to be beneficial in terms of treating pain and function. Pain chronicity and age seems to be factors influencing therapy outcome. Further studies are needed to examine the superiority of these inpatient programs for back pain including control groups.

Clinical Decision-Making in Chronic Spine Pain: Dilemma of Image-Based Diagnosis of Degenerative Spine and Generation Mechanisms for Nociceptive, Radicular, and Referred Pain

BACKGROUND

Spine-related pain is a complex heterogeneous condition. Excessive reliance on radiological imaging might lead to overdiagnosis of incidental asymptomatic spinal changes and unnecessary surgery. Approaches to the clinical management of spine pain should (1) identify pain generators, types, patterns, and mechanisms; (2) confirm clinical suspension with a diagnostic injection; and (3) ensure that treatment is aimed at controlling pain and improving patient function rather than image-based surgical success.

METHOD

This case series (7 cases) discusses commonly seen clinical presentation of spine pain analytically, with illustrations of possible pain generators, mechanisms, pathways, and pain types. Each case discusses pain types and location (axial nociceptive, referred, and radicular neuropathic), generators (degenerated disc, herniated disc, facet joint, and sacroiliac joint), pathways (sinuvertebral ventral ramus and medial and lateral branches dorsal ramus), and radiculopathy versus radicular pain, elaborating on coccydynia and cervicogenic headaches, epimere versus hypomere muscle embryology, function, innervation, and role in spine-related pain.

RESULTS

Multiple pain generators might coexist in the same patient causing mixed pain types and referral patterns with multiple mechanisms and pathways. History review, physical examination, and diagnostic injections are the mainstays of diagnosis.

CONCLUSIONS

Image-detected spondylosis might be an asymptomatic process. Clinical presentation is related to stenosis or pain. The mechanism of pain is related to compression, inflammation, or microinstability. Spine pain can be nociceptive axial, neuropathic radicular, and/or referred pain. Although image findings are helpful in radicular neuropathic pain from disc herniation, they are unreliable in nociceptive pain, and correlation with clinical and diagnostic injections is mandatory.

Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline

INTRODUCTION

In adult spinal deformity (ASD), sagittal imbalance and sagittal malalignment have been extensively described in the literature during the past decade, whereas coronal imbalance and coronal malalignment (CM) have been given little attention. CM can cause severe impairment in adult scoliosis and ASD patients, as compensatory mechanisms are limited. The aim of this paper is to develop a comprehensive classification of coronal spinopelvic malalignment and to suggest a treatment algorithm for this condition.

METHODS

This is an expert's opinion consensus based on a retrospective review of CM cases where different patterns of CM were identified, in addition to treatment modifiers. After the identification of the subgroups for each category, surgical planning for each subgroup could be specified.

RESULTS

Two main CM patterns were defined: concave CM (type 1) and convex CM (type 2), and the following modifiers were identified as potentially influencing the choice of surgical strategy: stiffness of the main coronal curve, coronal mobility of the lumbosacral junction and degeneration of the lumbosacral junction. A surgical algorithm was proposed to deal with each situation combining the different patterns and their modifiers.

CONCLUSION

Coronal malalignment is a frequent condition, usually associated to sagittal malalignment, but it is often misunderstood. Its classification should help the spine surgeon to better understand the full spinal alignment of ASD patients. In concave CM, the correction should be obtained at the apex of the main curve. In convex CM, the correction should be obtained at the lumbosacral junction. These slides can be retrieved under Electronic Supplementary Material.

Osteopathic care for spinal complaints: A systematic literature review

The aim of the current study was to evaluate the literature examining the impact of osteopathic care for spinal complaints. The bibliographic databases Medline (Pubmed), Web of Science, Embase, and PEDro were searched. In addition, a number of grey literature sources were searched. Only randomized controlled trials conducted in high-income Western countries were considered. Two authors independently screened the titles and abstracts. Primary outcomes included ‘pain’ and ‘functional status’, while secondary outcomes included ‘medication use’ and ‘health status’. It was examined if differences existed related to the treatment protocol and geography (European vs. US studies). Study quality was assessed using the risk of bias tool of the Cochrane Back Review Group. Nineteen studies were included and qualitatively synthesized. Nine studies were from the US, followed by Germany with seven studies. The majority of studies (n = 13) focused on low back pain. In general, mixed findings related to the impact of osteopathic care on primary and secondary outcomes were observed. For the primary outcomes, a clear distinction between US and European studies was found, in favor of the latter ones. Studies were characterized by substantial methodological differences in sample sizes, number of treatments, control groups, and follow-up. In conclusion, there is some evidence suggesting that osteopathic care may be effective for people suffering from spinal complaints. Further studies with larger study samples and assessment of long-term impact are required to further increase the evidence-based knowledge of the potential of osteopathic care for individuals suffering from spinal complaints.