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Sebaaly A, Farjallah S, Kharrat K, Kreichati G, Daher M. Scheuermann's kyphosis: update on pathophysiology and surgical treatment. EFORT Open Rev 2022; 7:782-791. [PMID: 36475554 PMCID: PMC9780615 DOI: 10.1530/eor-22-0063] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Scheuermann's Kyphosis (SK) is a rigid spinal kyphosis. Several theories have been proposed concerning its pathogenesis, but it is, to this day, still unknown. It has a prevalence of 0.4-8.3% in the population with a higher incidence in females. Clinical examination with x-rays is needed to differentiate and confirm this diagnosis. Non-surgical management is reserved for smaller deformities and in skeletally immature patients, whereas surgery is recommended for higher deformities. Combined anterior and posterior approach was considered the gold standard for the surgical treatment of this disease, but there is an increasing trend toward posterior-only approaches especially with use of segmental fixation. This study reviews the pathophysiology of SK while proposing a treatment algorithm for its management.
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Affiliation(s)
- Amer Sebaaly
- School of Medicine, Saint Joseph University, Beirut, Lebanon,Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon,Correspondence should be addressed to A Sebaaly;
| | - Sarah Farjallah
- Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Khalil Kharrat
- Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Gaby Kreichati
- School of Medicine, Saint Joseph University, Beirut, Lebanon,Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Mohammad Daher
- School of Medicine, Saint Joseph University, Beirut, Lebanon
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2
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Lentle BC, Prior JC. Osteoporotic vertebral fracture (OVF): diagnosis requires an informed observer. Osteoporos Int 2022; 33:1409-1410. [PMID: 35352143 DOI: 10.1007/s00198-021-06287-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 10/18/2022]
Affiliation(s)
- B C Lentle
- BC Centre of the Canadian Multicentre Osteoporosis Study (CaMos), Vancouver, Canada.
- Department of Radiology, The University of British Columbia, 205 Kimta Rd., 740, Victoria, British Columbia, V9A 6T5, Canada.
| | - J C Prior
- BC Centre of the Canadian Multicentre Osteoporosis Study (CaMos), Vancouver, Canada
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology and Metabolism, Department of Medicine, The University of British Columbia, Room 4111-2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- BC Women's Health Research Institute, Vancouver, Canada
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3
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Amundson LA, Crenshaw TD. Lessons learned from the hypovitaminosis D kyphotic pig model. J Anim Sci 2020; 98:S52-S57. [PMID: 32810238 DOI: 10.1093/jas/skaa146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 05/04/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Laura A Amundson
- Department of Animal Sciences, University of Wisconsin Madison, Madison, WI.,Research and Nutritional Services, Zinpro Corporation, Eden Prairie, MN
| | - Thomas D Crenshaw
- Department of Animal Sciences, University of Wisconsin Madison, Madison, WI
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4
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Comparison of the accuracy of the cannulated pedicle screw and the classical pedicle screw in the treatment of Scheuermann's kyphosis: A retrospective study. Jt Dis Relat Surg 2020; 31:201-208. [PMID: 32584715 PMCID: PMC7489173 DOI: 10.5606/ehc.2020.73017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/30/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives
This study aims to investigate if use of cannulated pedicle screw (CPS) in the dysplastic pedicles in Scheuermann’s kyphosis (SK) increases the accuracy rate of the screw and reduces screw-related complications. Patients and methods
This retrospective study included 21 patients (11 males, 10 females; mean age 19.1 years; range, 13 to 22 years) (550 screws) who received correction with pedicle screws due to SK deformity between May 2015 and January 2019. Between 2017 and 2018, classical pedicle screws were used in addition to CPSs in the upper thoracic region (T2, T3, T4) and thin pedicles (group 1). However, during the years 2015 to 2016, only classical pedicle screws were used for the patients who underwent posterior instrumentation for SK (group 2). Computed tomography scanning was used to investigate the accuracy of the screws. Results
There were 12 patients (316 screws) in group 1 and nine patients (234 screws) in group 2. Seventy-four (13.4%) of all screws were inserted incorrectly. Incorrect screw rate in group 1 was significantly lower than group 2; 21 (6.6%) and 53 (22.6%), respectively (p<0.001). There were no complications related to the use of CPSs after a mean follow-up of two-and-a-half years. Conclusion The use of CPS in the surgical treatment of SK does not increase the complication rate; instead it increases the accuracy of the screw. For this reason, we believe that CPS may be an effective and reliable option in the treatment of SK.
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Huq S, Ehresman J, Cottrill E, Ahmed AK, Pennington Z, Westbroek EM, Sciubba DM. Treatment approaches for Scheuermann kyphosis: a systematic review of historic and current management. J Neurosurg Spine 2020; 32:235-247. [DOI: 10.3171/2019.8.spine19500] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEScheuermann kyphosis (SK) is an idiopathic kyphosis characterized by anterior wedging of ≥ 5° at 3 contiguous vertebrae managed with either nonoperative or operative treatment. Nonoperative treatment typically employs bracing, while operative treatment is performed with either a combined anterior-posterior fusion or posterior-only approach. Current evidence for these approaches has largely been derived from retrospective case series or focused reviews. Consequently, no consensus exists regarding optimal management strategies for patients afflicted with this condition. In this study, the authors systematically review the literature on SK with respect to indications for treatment, complications of treatment, differences in correction and loss of correction, and changes in treatment over time.METHODSUsing PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library, all full-text publications on the operative and nonoperative treatment for SK in the peer-reviewed English-language literature between 1950 and 2017 were screened. Inclusion criteria involved fully published, peer-reviewed, retrospective or prospective studies of the primary medical literature. Studies were excluded if they did not provide clinical outcomes and statistics specific to SK, described fewer than 2 patients, or discussed results in nonhuman models. Variables extracted included treatment indications and methodology, maximum pretreatment kyphosis, immediate posttreatment kyphosis, kyphosis at last follow-up, year of treatment, and complications of treatment.RESULTSOf 659 unique studies, 45 met our inclusion criteria, covering 1829 unique patients. Indications for intervention were pain, deformity, failure of nonoperative treatment, and neural impairment. Among operatively treated patients, the most common complications were hardware failure and proximal or distal junctional kyphosis. Combined anterior-posterior procedures were additionally associated with neural, pulmonary, and cardiovascular complications. Posterior-only approaches offered superior correction compared to combined anterior-posterior fusion; both groups provided greater correction than bracing. Loss of correction was similar across operative approaches, and all were superior to bracing. Cross-sectional analysis suggested that surgeons have shifted from anterior-posterior to posterior-only approaches over the past two decades.CONCLUSIONSThe data indicate that for patients with SK, surgery affords superior correction and maintenance of correction relative to bracing. Posterior-only fusion may provide greater correction and similar loss of correction compared to anterior-posterior approaches along with a smaller complication profile. This posterior-only approach has concomitantly gained popularity over the combined anterior-posterior approach in recent years.
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Urrutia J, Narvaez F, Besa P, Meissner-Haecker A, Rios C, Piza C. Scheuermann's disease in patients 15-40 years old: A study to determine its prevalence and its relationship with age and sex using chest radiographs as screening tool. J Orthop Sci 2019; 24:776-779. [PMID: 30685093 DOI: 10.1016/j.jos.2018.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 12/25/2018] [Accepted: 12/27/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND There is insufficient knowledge of the epidemiology of Scheuermann's disease. The data available comes from estimations from young adults with obvious deformity, from studies evaluating children who may not have developed the deformity yet, or from older populations who can develop vertebral wedging secondary to other causes. We aimed to determine the prevalence of Scheuermann's disease in patients 15-40 years old using plain chest radiographs as a screening tool. METHODS We evaluated 454 patients aged 15-40 years old studied using standing plain chest radiographs. We measured thoracic kyphosis from T5 to T12; using the intraclass correlation coefficient (ICC), we determined inter- and intra-observer agreement. To determine the prevalence of Scheuermann's disease we used the Sorensen criteria. We performed a correlation analysis of thoracic kyphosis and age, and a linear regression to determine the impact of age and sex on the kyphosis angle. RESULTS The prevalence of Scheuermann's disease was 2.2% (0.9-3.5%). The prevalence was not different in females (1.4%) and males (2.8%), p = 0.36. Inter-and intra-observer agreements were excellent: ICC = 0.93 (0.84-0.97) and 0.97 (0.95-0.98). There was a small positive correlation of kyphosis angle with age (r = 0.110; p = 0.019). Linear regression revealed that age (ß = 0.138; p = 0.019) was an independent predictor of kyphosis angle, but sex was not (ß-coefficient = 0.007; p = 0.994). CONCLUSION We found a prevalence of Scheuermann's disease of 2.2%, without significant differences between males and females. Age independently influenced the kyphosis angle; sex did not. This study allows a better understanding of the epidemiology of Scheuermann's disease.
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Affiliation(s)
- Julio Urrutia
- Department of Orthopaedic Surgery, School of Medicine, Pontificia, Universidad Catolica de Chile, Chile.
| | - Felipe Narvaez
- Department of Orthopaedic Surgery, School of Medicine, Pontificia, Universidad Catolica de Chile, Chile
| | - Pablo Besa
- Department of Orthopaedic Surgery, School of Medicine, Pontificia, Universidad Catolica de Chile, Chile
| | - Arturo Meissner-Haecker
- Department of Orthopaedic Surgery, School of Medicine, Pontificia, Universidad Catolica de Chile, Chile
| | - Clemente Rios
- Department of Orthopaedic Surgery, School of Medicine, Pontificia, Universidad Catolica de Chile, Chile
| | - Cristobal Piza
- Department of Orthopaedic Surgery, School of Medicine, Pontificia, Universidad Catolica de Chile, Chile
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Kordi Yoosefinejad A, Ghaffarinejad F, Hemati M, Jamshidi N. Comparison of grip and pinch strength in young women with and without hyperkyphosis: A cross-sectional study. J Back Musculoskelet Rehabil 2019; 32:21-26. [PMID: 29865029 DOI: 10.3233/bmr-170932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hyperkyphosis is a common postural defect with high prevalence in the 20 to 50 year old population. It appears to compromise proximal scapular stability. Grip and pinch strength are used to evaluate general upper extremity function. OBJECTIVE The aim of this study was to compare pinch and grip strength between young women with and without hyperkyphosis. METHODS Thirty young women (18-40 years old) with hyperkyphosis and 30 healthy women matched for age and body mass index participated in the study. Hyperkyphosis was confirmed by measuring the kyphosis angle with a flexible ruler. Grip strength was measured with the Waisa method and a dynamometer. Pinch strength was assessed with a pinch meter. RESULTS Grip (P= 0.03) and pinch strength (P= 0.04) were significantly lower in women with hyperkyphosis compared to the control group. Kyphosis angle correlated weakly with grip (r= 0.26) and pinch strength (r= 0.23). CONCLUSIONS Hyperkyphotic posture has led to decreased grip and pinch strength compared to people without hyperkyphosis.
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Affiliation(s)
- Amin Kordi Yoosefinejad
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farahnaz Ghaffarinejad
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahbubeh Hemati
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Narges Jamshidi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Bezalel T, Carmeli E, Kalichman L. Scheuermann's Disease: Radiographic Pathomorphology and Association with Clinical Features. Asian Spine J 2019; 13:86-95. [PMID: 30326689 PMCID: PMC6365786 DOI: 10.31616/asj.2018.0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 06/06/2018] [Accepted: 07/01/2018] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Cross-sectional analytical study. PURPOSE To evaluate the spinal radiological features in patients with Scheuermann's disease and the association between the thoracic kyphosis angle and clinical presentation. Overview of the Literature: Scheuermann's disease is the most common cause of hyperkyphosis of the thoracic and thoracolumbar spine in adolescents; however, literature is limited in this area. METHODS Data regarding 150 successive X-ray images of 95 males and 55 females diagnosed with Scheuermann's disease were retrieved from the digital archives of the Maccabi Healthcare Services in Tel Aviv. Data included thoracic kyphosis angle (T3-T12), cervical lordosis (C2-C7), lumbar lordosis (L1-S1), sacral slope (SS), number and location of the anterior wedged vertebrae (AWV, minimum 5°), and C7 plumb line. Other data included age, sex, height, family history, Risser sign, self-perceived body image (rated by the Numeric Rating Scale [NRS]), and back pain during the previous week (rated by the Numeric Pain Rating Scale [NPRS]). RESULTS Significant positive associations were observed between the Cobb angle of thoracic kyphosis and age (r =0.186, p =0.023), cervical lordosis (r =0.263, p <0.001), lumbar lordosis (r =0.576, p <0.001), SS (r =0.236, p <0.004), T10-T12 Cobb angle (r =0.319, p <0.001), and number of AWV (r =0.519, p <0.001). The highest frequency of vertebral wedging was noted in T7 (68%), followed by T8 (65%) and T9 (44%). The NPRS showed a significant association only with SS (r =0.219, p =0.014). Significant positive associations were observed between the NRS for self-perceived body image, the thoracic kyphosis (r =0.494, p <0.001), and the number of AWV (r =0.361, p <0.001). CONCLUSIONS Thoracic kyphosis was significantly associated with cervical and lumbar lordosis, SS, T10-T12 Cobb angle, and AWV number. Pain was not substantial; however, self-perceived body image, the most common complaint of patients with Scheuermann's disease, was high and significantly associated with thoracic kyphosis and the number of AWV.
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Affiliation(s)
- Tomer Bezalel
- Maccabi Health Care Services, Posture Clinic, Maccabi Hashalom, Tel Aviv, Israel
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences at Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eli Carmeli
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, Haifa University, Haifa, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences at Ben-Gurion University of the Negev, Beer-Sheva, Israel
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9
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Ehsani NN, Oakley PA, Harrison DE. Scheuermann’s disease: non-surgical improvement in whole spine sagittal alignment in the treatment of a symptomatic patient using Chiropractic BioPhysics<sup>®</sup> technique. J Phys Ther Sci 2019; 31:965-970. [PMID: 31871386 PMCID: PMC6879408 DOI: 10.1589/jpts.31.965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/14/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To present the dramatic improvement of sagittal posture in a young male with
Scheuermann’s disease suffering from pain ailments as treated by Chiropractic
BioPhysics® technique. [Participant and Methods] An 18 year old reported low
back pain and headaches for several years. Full spine radiographic assessment revealed
pronounced thoracic hyperkyphosis, anterior head translation, posterior thoracolumbar
sagittal balance, and a reduced sacral base orientation. The patient was treated by
Chiropractic BioPhysics methods incorporating mirror image® exercises,
traction, as well as spinal manipulation. [Results] Assessment after 35 treatment sessions
over 14-weeks revealed a dramatic improvement in postural parameters. The thoracic
kyphosis reduced by 13°, and was accompanied by a reduction in forward head posture,
reduction in posterior sagittal balance, and an increase in sacral base angle to normal.
The low back pain and headaches were alleviated. [Conclusion] This case adds to the
accumulating evidence demonstrating CBP methods offers an effective approach to reduce the
burden of postural disorders including those with Scheuermann’s disease. Since thoracic
hyperkyphosis is a serious disorder, the routine comprehensive assessment via full-spine
radiography is essential for the quantification of relevant postural parameters.
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Trends in Treatment of Scheuermann Kyphosis: A Study of 1,070 Cases From 2003 to 2012. Spine Deform 2019; 7:100-106. [PMID: 30587300 PMCID: PMC7102192 DOI: 10.1016/j.jspd.2018.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 05/24/2018] [Accepted: 06/02/2018] [Indexed: 01/09/2023]
Abstract
STUDY DESIGN Retrospective review of KID Inpatient Database (KID) from 2003, 2006, 2009, and 2012. OBJECTIVES The aim of this study was to evaluate the impact of advances in spinal surgery on patient outcomes in the treatment of Scheuermann kyphosis (SK). SUMMARY OF BACKGROUND DATA SK is one of the most common causes of back pain in adolescents. Trends in diagnoses and surgical treatment and approach to SK have not been well described. METHODS SK patients aged 0-20 years in KID were identified by ICD-9 code 732.0. KID-supplied year- and hospital-trend weights were used to establish prevalence. Patient demographics, surgical details, and outcomes were analyzed with analysis of variance. RESULTS A total of 1,070 SK patients were identified (33.2% female), with increasing incidence of SK diagnosed from 2003 to 2012 (3.6-7.5 per 100,000, p < .001). The average age of operative patients was 16.1±2.0 years and did not change (16.27-16.06 years, p = .905). The surgical rate has not changed over time (72.8%-72.8%, p = .909). Overall, 96.3% of operative patients underwent fusion, with 82.2% of cases spanning ≥4 levels; in addition, 8.6% underwent an anterior-only surgery, 74.6% posterior-only, and 13.6% combined approach. From 2003 to 2012, rates of posterior-only surgeries increased (62.4%-84.4%, p < .001) whereas the rate of combined-approach surgeries decreased (37.6%-8.8%, p < .001). Overall complication rates for SK surgeries have decreased (2003: 20.9%; 2012: 11.9%, p = .029). Concurrently, the rate of ≥4-level fusions has increased (43.5%-89.6%, p < .001), as well as the use of Smith-Peterson (7.8%-23.6%, p < .001) and three-column osteotomies (0.0%-2.7%, p = .011). In subanalysis comparing posterior to combined approaches, complication rates were significantly different (posterior: 9.88%, combined: 19.46%, p = .005). Patients undergoing a combined approach have a longer length of stay (LOS) than patients undergoing a posterior-only approach (7.8 vs. 5.6 days, p < .001). CONCLUSIONS Despite unchanged demographics and operative rates in SK, there has been a shift from combined to isolated posterior approaches, with a concurrent increase in levels treated. A combined approach was associated with increased complication rates, LOS, and total charges compared to isolated approaches. Awareness of these inherent differences is important for surgical decision making and patient education. LEVELS OF EVIDENCE Level III.
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Halanski MA, Hildahl B, Amundson LA, Leiferman E, Gendron-Fitzpatrick A, Chaudhary R, Hartwig-Stokes HM, McCabe R, Lenhart R, Chin M, Birstler J, Crenshaw TD. Maternal Diets Deficient in Vitamin D Increase the Risk of Kyphosis in Offspring: A Novel Kyphotic Porcine Model. J Bone Joint Surg Am 2018; 100:406-415. [PMID: 29509618 PMCID: PMC6818982 DOI: 10.2106/jbjs.17.00182] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to explore the role of perinatal vitamin-D intake on the development and characterization of hyperkyphosis in a porcine model. METHODS The spines of 16 pigs were assessed at 9, 13, and 17 weeks of age with radiography and at 17 weeks with computed tomography (CT), magnetic resonance imaging (MRI), histology, and bone-density testing. An additional 169 pigs exposed to 1 of 3 maternal dietary vitamin-D levels from conception through the entire lactation period were fed 1 of 4 nursery diets supplying different levels of vitamin D, calcium, and phosphorus. When the animals were 13 weeks of age, upright lateral spinal radiography was performed with use of a custom porcine lift and sagittal Cobb angles were measured in triplicate to determine the degree of kyphosis in each pig. RESULTS The experimental animals had significantly greater kyphotic sagittal Cobb angles at all time points when compared with the control animals. These hyperkyphotic deformities demonstrated no significant differences in Hounsfield units, contained a slightly lower ash content (46.7% ± 1.1% compared with 50.9% ± 1.6%; p < 0.001), and demonstrated more physeal irregularities. Linear mixed model analysis of the measured kyphosis demonstrated that maternal diet had a greater effect on sagittal Cobb angle than did nursery diet and that postnatal supplementation did not completely eliminate the risk of hyperkyphosis. CONCLUSIONS Maternal diets deficient in vitamin D increased the development of hyperkyphosis in offspring in this model. CLINICAL RELEVANCE This study demonstrates that decreased maternal dietary vitamin-D intake during pregnancy increases the risk of spinal deformity in offspring. In addition, these data show the feasibility of generating a large-animal spinal-deformity model through dietary manipulation alone.
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Affiliation(s)
- Matthew A. Halanski
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin,E-mail address for M.A. Halanski:
| | - Blake Hildahl
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Laura A. Amundson
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Ellen Leiferman
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Annette Gendron-Fitzpatrick
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Rajeev Chaudhary
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Heather M. Hartwig-Stokes
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Ronald McCabe
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Rachel Lenhart
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Matthew Chin
- Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania
| | - Jennifer Birstler
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin
| | - Thomas D. Crenshaw
- Departments of Orthopedics and Rehabilitation (M.A.H., B.H., E.L., R.C., H.M.H.-S., R.M., and R.L.) and Animal Sciences (L.A.A. and T.D.C.), Comparative Pathology Laboratory (A.G.-F.), and Department of Biostatistics and Medical Informatics (J.B.), University of Wisconsin-Madison, Madison, Wisconsin,Swine Research and Teaching Center, Arlington, Wisconsin,E-mail address for T.D. Crenshaw:
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Al Kaissi A, Marrakchi Z, Nassib NM, Hofstaetter J, Grill F, Ganger R, Kircher SG. Craniosynostosis, Scheuermann's disease, and intellectual disability resembling Shprintzen-Goldberg syndrome: a report on a family over 4 generations: Case report. Medicine (Baltimore) 2017; 96:e6199. [PMID: 28328806 PMCID: PMC5371443 DOI: 10.1097/md.0000000000006199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Craniosynostosis is a disorder characterized by premature fusion of cranial sutures with subsequent development of abnormal craniofacial contour associated with variable skeletal and extra-skeletal abnormalities. In this family syndromic type of craniosynostosis was recognized and the etiology behind diverse forms of deformities have been diagnosed. PATIENT CONCERNS The negative impact of the disorder on the child and his family is enormous. Particularly when the diagnosis is late and little can be done. Though counselling the family through discussing the whole picture of the disorder might lessens their concern. DIAGNOSES Diagnosis is the corner stone of management. In this paper we aimed to sensitize pediatricians, physicians, and orthopedic surgeons concerning the necessity to recognize syndromic associations early on. INTERVENTIONS Patients with syndromic craniosynostosis are usually associated with a complexity of malformation complex. Craniofacial surgery can be of remarkable help if the diagnosis is made early. It requires a series of corrections to avoid intellectual disability and other neurological deficits.The timing of interventions is strongly correlated on the timing of diagnosis. OUTCOMES The earliest the diagnoses, the much better the outcomes are. And consequently avert the psychological and the financial cost on the patient and his family. LESSONS The golden principle of medicine should prevail in all medical disciplines, which states: The more you see, the more you know and conversely the more you know is the more you see.
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Affiliation(s)
- Ali Al Kaissi
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, First Medical Department, Hanusch Hospital
- Orthopedic Hospital of Speising, Pediatric Department, Vienna, Austria
| | - Zahra Marrakchi
- Department of Neonatology, Charles Nicolle Hospital, Tunisia
| | - Nabil M. Nassib
- Department of Pediatric Orthopedic Surgery, Children Hospital of Tunis, Tunisia
| | | | - Franz Grill
- Orthopedic Hospital of Speising, Pediatric Department, Vienna, Austria
| | - Rudolf Ganger
- Orthopedic Hospital of Speising, Pediatric Department, Vienna, Austria
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Oei L, Koromani F, Rivadeneira F, Zillikens MC, Oei EHG. Quantitative imaging methods in osteoporosis. Quant Imaging Med Surg 2016; 6:680-698. [PMID: 28090446 DOI: 10.21037/qims.2016.12.13] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Osteoporosis is characterized by a decreased bone mass and quality resulting in an increased fracture risk. Quantitative imaging methods are critical in the diagnosis and follow-up of treatment effects in osteoporosis. Prior radiographic vertebral fractures and bone mineral density (BMD) as a quantitative parameter derived from dual-energy X-ray absorptiometry (DXA) are among the strongest known predictors of future osteoporotic fractures. Therefore, current clinical decision making relies heavily on accurate assessment of these imaging features. Further, novel quantitative techniques are being developed to appraise additional characteristics of osteoporosis including three-dimensional bone architecture with quantitative computed tomography (QCT). Dedicated high-resolution (HR) CT equipment is available to enhance image quality. At the other end of the spectrum, by utilizing post-processing techniques such as the trabecular bone score (TBS) information on three-dimensional architecture can be derived from DXA images. Further developments in magnetic resonance imaging (MRI) seem promising to not only capture bone micro-architecture but also characterize processes at the molecular level. This review provides an overview of various quantitative imaging techniques based on different radiological modalities utilized in clinical osteoporosis care and research.
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Affiliation(s)
- Ling Oei
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Fjorda Koromani
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Khanna V, Vaishya R. Lumbar Scheuermann disease – Disease without the deformity! APOLLO MEDICINE 2016. [DOI: 10.1016/j.apme.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Oei L, Zillikens MC, Rivadeneira F, Oei EHG. Osteoporotic Vertebral Fractures as Part of Systemic Disease. J Clin Densitom 2016; 19:70-80. [PMID: 26376171 DOI: 10.1016/j.jocd.2015.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 08/13/2015] [Indexed: 12/31/2022]
Abstract
Our understanding of the genetic control of skeletogenesis and bone remodeling is expanding, and normally, bone resorption and bone formation are well balanced through regulation by hormones, growth factors, and cytokines. Osteoporosis is considered a systemic disease characterized by low bone mass and microarchitectural deterioration of bone tissue. Consequent increased bone fragility results in higher fracture risk. The most common osteoporotic fractures are located in the spine, and they form a significant health issue. A large variety of systemic diseases are associated with risk of osteoporotic vertebral fractures, illustrating its multifactorial etiology. Prevalences of these conditions vary from common to extremely rare, and incidence peaks differ according to etiology. This review appreciates different aspects of osteoporotic vertebral fractures as part of systemic disease, including genetic, immunologic, inflammatory, metabolic, and endocrine pathways. It seems impossible to be all-comprehensive on this topic; nevertheless, we hope to provide a reasonably thorough overview. Plenty remains to be elucidated in this field, identifying even more associated diseases and further exposing pathophysiological mechanisms underlying osteoporotic vertebral fractures.
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Affiliation(s)
- Ling Oei
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, The Netherlands; Department of Internal Medicine, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, The Netherlands
| | - Edwin H G Oei
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Oei L, Zillikens MC, Rivadeneira F, Oei EHG. Genetics of Osteoporotic Vertebral Fractures. J Clin Densitom 2016; 19:23-8. [PMID: 26376172 DOI: 10.1016/j.jocd.2015.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022]
Abstract
Our understanding of the genetic control of skeletogenesis and bone remodeling is increasing, and in addition to various nongenetic risk factors, a positive family history confers an increased risk of fracture. Vertebral fractures are the most common osteoporotic fractures and they are often a first manifestation of osteoporosis. This review presents the current state of knowledge on the genetic basis of osteoporotic vertebral fractures and, additionally, of structural vertebral deformities resembling osteoporotic vertebral fractures but which may have their own genetic basis. We conclude that, apart from tentative screening for rare monogenic forms of osteoporosis in very unusual case presentations, not enough is currently known to encourage routine genetic screening in regular osteoporotic vertebral fracture cases.
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Affiliation(s)
- Ling Oei
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, The Netherlands; Department of Internal Medicine, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, The Netherlands
| | - Edwin H G Oei
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Axelrod T, Zhu F, Lomasney L, Wojewnik B. Scheuermann's disease (dysostosis) of the spine. Orthopedics 2015; 38:4, 66-71. [PMID: 25611402 DOI: 10.3928/01477447-20150105-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 17-year-old adolescent boy presented with progressive lower back pain and fatigue.
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PostureMonitor: Real-Time IMU Wearable Technology to Foster Poise and Health. DESIGN, USER EXPERIENCE, AND USABILITY: INTERACTIVE EXPERIENCE DESIGN 2015. [DOI: 10.1007/978-3-319-20889-3_50] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Jain A, Sponseller PD, Kebaish KM, Mesfin A. National Trends in Spinal Fusion Surgery For Scheuermann Kyphosis. Spine Deform 2015; 3:52-56. [PMID: 27927452 DOI: 10.1016/j.jspd.2014.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/12/2014] [Accepted: 06/18/2014] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Analysis of a national database. OBJECTIVE To analyze national trends in spinal fusion surgery for Scheuermann kyphosis (SK) and to compare surgical approaches used in treatment. SUMMARY OF BACKGROUND DATA The preferred surgical approach for treating SK is not well established. Recent studies support the use of posterior spinal fusion (PSF) instead of anterior-posterior spinal fusion (APSF). METHODS Using the Nationwide Inpatient Sample database, we identified 2,796 patients (mean age, 24.9 years; 66% men) from 2000 to 2008 who had spinal fusion surgery for SK. We compared the two approaches with respect to patient demographics, institutional characteristics, in-hospital complications, and hospitalization lengths and costs. Significance was set at a value of p less than .05. RESULTS The number of spinal fusion surgeries performed in patients with SK increased significantly (p = .03). The proportion of patients undergoing surgery as adults also increased significantly (p < .05). The number of PSF surgeries performed in patients with SK increased 2.9-fold (34% to 78%) (p < .01); APSF use declined by 7% per year. There was no significant association among surgical approach and patient age, sex, hospital capacity, or teaching status. Compared with patients undergoing PSF, patients undergoing APSF had 2.1-fold more in-hospital complications (p < .01), 3.8-fold more pulmonary complications (p < .01), 2.7-fold more renal complications (p < .01), and significantly longer hospitalizations (mean, 8.5 days vs. 5.9 days, respectively; p < .01). There was no significant difference in mean total hospital charges: $117,921 for APSF and $119,322 for PSF. CONCLUSION There have been significant increases in the number of spinal fusion surgeries for SK, and in the proportion of patients with SK who are choosing surgery as adults. Surgical treatment has shifted predominantly toward an all-posterior approach. PSF is associated with lower complication rates (especially pulmonary complications) and shorter hospitalizations.
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Affiliation(s)
- Amit Jain
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA.
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Al Kaissi A, Laccone F, Karner C, Ganger R, Klaushofer K, Grill F. [Hip dysplasia and spinal osteochondritis (Scheuermann's disease) in a girl with type II manifesting collagenopathy]. DER ORTHOPADE 2014; 42:963-8. [PMID: 24013370 DOI: 10.1007/s00132-013-2182-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This paper describes the natural course of irritable hip pain associated with spinal rigidity and pain in the thoracic region with subsequent development of mild kyphosis in a girl with a mutation in the collagen 2 alpha 1 gene (type II collagenopathy). METHODS Phenotypic and genotypic characterization was carried out in a 14-year-old girl to identify the underlying pathology of severe irritable hip pain associated with thoracic spinal rigidity and pain. Detailed clinical examination, skeletal survey and genetic testing were performed accordingly. Bernese periacetabular osteotomy was used to alleviate pain and to improve the anatomical correlation of the acetabular and femoral heads. RESULTS Short stature associated with acetabulo-femoral dysplasia, spinal osteochondritis (Scheuermann's disease) and mild thoracic kyphosis were the most prominent abnormalities. Genetic analysis showed a heterozygous mutation in the collagen type II gene (COL2A1-c.1636G>A, p. G546S). A Bernese periacetabular osteotomy was performed to improve the clinical status of the patient. There was significant improvement in the extrusion index, the acetabular index and the lateral center-edge angle. CONCLUSIONS Hip dysplasia and Scheuermann's osteochondritis have never been reported in connection with a mutation in COL2A1 (collagenopathy type II). Awareness is needed for careful phenotypic and genotypic characterization in patients with irritable hip pain and spinal stiffness.
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Affiliation(s)
- A Al Kaissi
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital, Heinrich-Collin-Str. A-30, 1140, Wien, Österreich,
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Abstract
Scheuermann's disease is a juvenile osteochondrosis of the spine. It is a disease of the growth cartilage endplate, probably due to repetitive strain on the growth cartilage weakened by a genetic background. The radiographic aspects are related to the vertebral endplate lesions and include vertebral wedging, irregularity of the vertebral endplate, and Schmorl's node (intraossous disk herniation). Disc alterations are frequent and may be secondary to dysfunction of the disc-vertebra complex. The definitions of Scheuermann's disease are varied; it can refer to the classical form of juvenile kyphosis, described by Scheuermann as well as asymptomatic radiographic abnormalities. Lumbar involvement is probably as frequent as the thoracic form and might be more painful. The first-line treatment is medical and includes rehabilitation and bracing. The earlier the start of treatment, the better the outcome, which highlights the importance of early diagnosis. Surgery is uncommon and must be limited to severe involvement after failure of conservative treatment. The natural history of Scheuermann's disease is unknown, but it might be associated with increased risk of back pain. The evolution of thoracolumbar and lumbar disease is unknown.
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Tomé-Bermejo F, Tsirikos A. Current concepts on Scheuermann kyphosis: Clinical presentation, diagnosis and controversies around treatment. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.recote.2012.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tomé-Bermejo F, Tsirikos AI. [Current concepts on Scheuermann kyphosis: clinical presentation, diagnosis and controversies around treatment]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012; 56:491-505. [PMID: 23594948 DOI: 10.1016/j.recot.2012.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 06/21/2012] [Accepted: 07/06/2012] [Indexed: 12/15/2022] Open
Abstract
Scheuermann kyphosis is a structural deformity of the thoracic or thoracolumbar spine that develops prior to puberty and deteriorates during adolescence. There is limited information on its natural history but many patients are expected to have a benign course. Severe kyphosis can progress into adult life and cause significant deformity and debilitating back pain. Conservative treatment includes bracing and physical therapy, but although widely prescribed they have not been scientifically validated. Surgical treatment may be considered in the presence of a progressive kyphosis producing severe pain resistant to conservative measures, neurological compromise, or unacceptable deformity. This is associated with significant risks of major complications that should be discussed with the patients and their families. Modern techniques allow better correction of the deformity through posterior-only surgery with lower complication rates. Simultaneous shortening of the posterior vertebral column across the apical levels, along with spinal cord monitoring, reduces the risk of neurological deficits.
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Affiliation(s)
- F Tomé-Bermejo
- Spinal Fellow, Scottish National Spine Deformity Centre, Royal Hospital for Sick Children & Royal Infirmary of Edinburgh, Edinburgh, Escocia, Reino Unido.
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Temponi EF, de Macedo RD, Pedrosa LOG, Fontes BPC. SCHEUERMANN'S KYPHOSIS: COMPARISON BETWEEN THE POSTERIOR APPROACH ASSOCIATED WITH SMITH-PETERSEN OSTEOTOMY AND COMBINED ANTERIOR-POSTERIOR FUSION. Rev Bras Ortop 2011; 46:709-17. [PMID: 27047831 PMCID: PMC4799343 DOI: 10.1016/s2255-4971(15)30329-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 07/01/2011] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Surgical treatment of Scheuermann's kyphosis (SK) remains a subject under discussion. In view of the controversy over the best form of surgical tr otomy. METHODS This was a descriptive case-control study with cross-sectional analysis. Twenty-eight patients, split into two groups conducted at different times, were evaluated. RESULTS The first group comprised patients treated using the double approach, with an average age of 19 years, preoperative kyphosis of 77.6°, postoperative kyphosis of 35.8° and average correction of 53.2%. The second group comprised patients treated using the posterior route associated with Smith-Petersen osteotomy, with a mean age of 27.3 years, preoperative kyphosis of 72.9°, postoperative kyphosis of 44.3° and average correction of 39.3%. Analysis between the two groups showed statistically significant differences in the following variables: age (p = 0.02), postoperative kyphosis (p = 0.04) and degree and percentage of kyphosis correction (p = 0.001). There was no difference concerning preoperative kyphosis (p = 0.33). In the assessment of postoperative pain (VAS), the first group presented an average of 0.6, versus 0.5 in the second group. There were only minor complications: seven in the first group and two in the second. CONCLUSION The two surgical techniques studied proved to be adequate for treating SK. In the present study, the deformity correction was greater in the first group, while the pain VAS results were better in the second group, with lower incidence of complications.
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Affiliation(s)
- Eduardo Frois Temponi
- Third-year Orthopedics and Traumatology Resident at the Professor Matta Machado Clinic of Hospital Baleia/Fundação Benjamin Guimarães – Belo Horizonte, MG, Brazil
| | - Rodrigo D'Alessandro de Macedo
- Coordinator of the Spine Group of Instituto de Previdência dos Servidores de Minas Gerais – IPSEMG. Preceptor of the Spine Group of the Professor Matta Machado Clinic of Hospital da Baleia/Fundação Benjamin Guimarães; Master's Degree in Nuclear Sciences and Techniques from the Department of Nuclear Engineering of Universidade Federal de Minas Gerais – UFMG – Belo Horizonte, MG, Brazil
| | - Luiz Olímpio Garcia Pedrosa
- Coordinator of the Spine Group of Professor Matta Machado's Service at Hospital da Baleia/Benjamin Guimarães Foundation, Belo Horizonte, MG, Brazil
| | - Bruno Pinto Coelho Fontes
- Preceptor of the Spine Group of the Professor Matta Machado Clinic of Hospital da Baleia/Fundação Benjamin Guimarães – Belo Horizonte, MG, Brazil
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Segatto E, Lippold C, Végh A. Craniofacial features of children with spinal deformities. BMC Musculoskelet Disord 2008; 9:169. [PMID: 19102760 PMCID: PMC2637865 DOI: 10.1186/1471-2474-9-169] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 12/22/2008] [Indexed: 11/30/2022] Open
Abstract
Background The objective of this epidemiological study is to map the dentofacial anomalies that can be correlated to the two most frequent spinal diseases responsible for postural abnormalities and that can be clinically identified by the orthodontic examination. Methods Twenty-three children with Scheuermann's disease participated in the study (mean age: 14Y8M; SD: 1Y8M), 28 with Scoliosis (mean age: 14Y7M; SD: 2Y3M) and a control group of 68 orthopedically healthy children (mean age: 14Y8M; SD: 0Y11M). Standardized orthodontic screening protocols were used to map the occlusal relations in the sagittal, vertical, and transversal dimensions, space relations of the maxillary and mandibular frontal segment, and the TMJ status and function. The examinations for the children with orthopedic disorders were supplemented by the evaluation of routine orthodontic radiograms – lateral cephalograms and panoramic X-rays. Results The majority of the dentofacial features examined revealed more and greater abnormalities among patients in the Scheuermann's disease group than in the scoliosis group. In the latter group the proportion of the TMJ symptoms and the consecutive functional deviations were greater. When comparing the values of the two spinal-disorder groups and the control group, statistically significant differences (p < .05) occurred for the following measurements: frequency of unilateral Cl.II. molar occlusion, overjet and extreme overjet mean value (Scheuermann's disease group), as well as the frequency of TMJ pathological symptoms (scoliosis group). The evaluation of the panoramic X-rays showed significant differences among the mandibular measurements of the two spinal-disorder groups. Within the framework of the evaluation of the cephalograms significant differences (p < .05) were found only in the case of dental relations. However, several values differed significantly from the Ricketts' norms, none of the indices strictly characterized any of the groups with spinal disorders. Conclusion The more extended treatment of the malocclusions closely correlated to postural disorders draws attention to the indicators of a higher frequency and severity occurring in the case of the dentofacial deviations in the patients of the MSCH group who had previously been less examined.
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Affiliation(s)
- Emil Segatto
- Department of Orofacial Orthopedics and Orthodontics, Heim Pál Children's Hospital, Zoltán u 18, 1054 Budapest, Hungary.
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Wong WY, Wong MS. Smart garment for trunk posture monitoring: A preliminary study. SCOLIOSIS 2008; 3:7. [PMID: 18489789 PMCID: PMC2423362 DOI: 10.1186/1748-7161-3-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 05/20/2008] [Indexed: 11/18/2022]
Abstract
Background Poor postures of the spine have been considered in association with a number of spinal musculoskeletal disorders, including structural deformity of the spine and back pain. Improper posturing for the patients with spinal disorders may further deteriorate their pain and deformities. Therefore, posture training has been proposed and its rationale is to use the patient's own back muscles to keep the spine within the natural curvature. A posture training device may help to facilitate this therapeutic approach by providing continuous posture monitoring and feedback signals to the patient when "poor" posture is detected. In addition, the users of the device may learn good postural habits that could carry over into their whole life. Methods A smart garment with integrated accelerometers and gyroscopes, which can detect postural changes in terms of curvature variation of the spine in the sagittal and coronal planes, has been developed with intention to facilitate posture training. The smart garment was evaluated in laboratory tests and with 5 normal subjects during their daily activities. Results Laboratory tests verified that the accuracy of the system is < 1° and < 1.5° in static and dynamic tilting measurements respectively. The results showed that the smart garment could facilitate subjects to prevent prolonged poor postures of the spine, especially the posture of the lumbar spine in which at least 40% of the time in poor posture were reduced. Conclusion The smart garment has been developed to be a portable and user-friendly trunk posture monitoring system and it could be used for collection of the trunk posture information and provision of instant feedback to the user if necessary for posture training purpose. The current pilot study demonstrated that the posture of normal subjects could be monitored and trained via this smart garment. With further clinical investigations, this system could be considered in some flexible spinal deformities such as scoliosis and kyphosis.
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Affiliation(s)
- Wai Yin Wong
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, ProC.
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Fotiadis E, Kenanidis E, Samoladas E, Christodoulou A, Akritopoulos P, Akritopoulou K. Scheuermann's disease: focus on weight and height role. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2008; 17:673-8. [PMID: 18301929 DOI: 10.1007/s00586-008-0641-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Revised: 01/16/2008] [Accepted: 01/31/2008] [Indexed: 12/16/2022]
Abstract
The aim of this cross-sectional case-control study is the comparison of the weight and height between a group of children with Scheuermann's disease (SD) and a comparable group of healthy ones and also the correlation of them with the degree and the morphology of the kyphotic curve. Following a school-screening program of 10,057 school students, aged between 11 and 17 years old, 175 adolescents with Scheuermann's disease were diagnosed. The mean height and weight of 175 adolescents diagnosed to have SD compared with this of a group of normal children taken randomly from the group of 9,882 healthy children screened. The control group was comparable with the study group concerning age (p = 0.605) and sex. The weight, height and body mass index (BMI) were significantly lower in the healthy (control) group (p < 0.001). However, there was no correlation between weight (r = -0.019, p = 0.804), height (r = 0.053, p = 0.484) and BMI (r = -0.177, p = 0.019) with the magnitude of kyphotic curve. There was also no correlation between weight (r = -0.27, p = 0.722), height (r = -0.025, p = 0.744) and BMI (r = -0.038, p = 0.619) with Voutsinas index as well. Scheuermann's disease is probably a multifactorial skeletal deformity. Weight and height do not seem to affect the magnitude and morphology of the main kyphotic curve in SD. It seems probably that this observation is not part of the pathogenetic mechanism of SD but a result of its cascade. The increased weight and height of these patients may be the secondary result of other disturbances (i.e. hormonal), which may play more crucial role in Scheuermann's disease pathogenesis.
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Affiliation(s)
- E Fotiadis
- Orthopaedic Department, General Hospital of Veria, Veria, Greece.
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Abstract
STUDY DESIGN A clinical cohort study of sternum clinical measurements was performed in 10,057 students, during a school screening program for Scheuermann disease. OBJECTIVE To determine whether the length of sternum is correlated with Scheuermann disease pathogenesis. SUMMARY OF BACKGROUND DATA Many theories have been proposed for the etiology of Scheuermann disease, but the true cause remains unclear. Probably mechanical factors play a role in the development of the deformity. The reported success of brace treatment leads to the support to this theory. METHODS There were 5048 boys and 5009 girls. The mean age of children was 13,07 years (SD = +/-0.82). Scheuermann disease was detected clinically and was documented with lateral radiograph of spinal column. All children were measured for their sternum's length from the jugular notch until the top of xiphoid process. This measure was repeated 3 times for each child. The height of all students and the arm span were measured, as well. RESULTS In total 10,057 students screened, children with Scheuermann disease (study group) were 175 (147 men and 28 women). The length of sternum was greater in the healthy (control) group. There was a statistically significant difference between the 2 groups with regard to the sternum's length (Mann-Whitney U test, P = 0000). This is of particular importance, because in 2 groups that were comparable according to age (Mann-Whitney U test, P = 0605), the children with Scheuermann disease were taller in relation with the control group (Mann-Whitney U test, P = 0000). CONCLUSION The smaller length of sternum than the normal has a possible correlation with the appearance of Scheuermann disease. Probably the smaller length of sternum increases the compressive forces on the vertebral endplates anteriorly, allowing uneven growth of the vertebral bodies with wedging. More studies are required for the documentation of this theory of pathogenesis.
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Arun R, Mehdian SMH, Freeman BJC, Sithole J, Divjina SC. Do anterior interbody cages have a potential value in comparison to autogenous rib graft in the surgical management of Scheuermann's kyphosis? Spine J 2006; 6:413-20. [PMID: 16825049 DOI: 10.1016/j.spinee.2005.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Revised: 09/06/2005] [Accepted: 10/27/2005] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies have analyzed the outcome following posterior correction and combined anterior-posterior correction for Scheuermann's kyphosis. Traditionally interbody fusion has been obtained using morselized rib graft. Recently the use of titanium anterior cages has been suggested for interbody use. There are no long-term studies comparing these two techniques. PURPOSE To investigate the potential value of titanium anterior interbody cages compared with morselized rib graft for anterior interbody fusion in combination with posterior instrumentation, correction, and fusion for Scheuermann's kyphosis. STUDY DESIGN Nonrandomized comparison of two surgical techniques in matched subjects. PATIENT SAMPLE Fifteen patients with identical preoperative radiographic and physical variables (age, gender, height, weight, body mass index) were managed with combined anterior release, interbody fusion, posterior instrumentation, correction, and fusion. Group A (n=8) had morselized rib graft inserted into each intervertebral disc space. Group B (n=7) had titanium interbody cages packed with bone graft inserted at each level. The posterior instrumentation extended from T2 to L2 in both groups. OUTCOME MEASURES Preoperative and postoperative curve morphometry was studied on plain radiographs by two independent observers. The indices studied included Cobb angle, Ferguson's angle, Voutsinas index, sagittal vertical axis (SVA), sacral inclination (SI), and lumbar lordosis (LL). Interbody fusion was assessed at final follow-up. Each patient was reviewed at 3, 6, 12, 24, 48, and 60 months after surgery with standing radiographs. METHODS Both surgical groups were compared in terms of radiological parameters and complications. Wilcoxon-matched pairs test and Mann-Whitney test were used. RESULTS The average follow-up for Group A was 70 months and for Group B 66 months. For the whole group, the preoperative median Cobb angle for thoracic kyphosis was 86 degrees , the median Ferguson angle was 50 degrees , Voutsinas index was 28.7, SVA -3.5 centimeters, lumbar lordosis was 66 degrees , and the median sacral inclination angle was 40 degrees . The median postoperative Cobb angle was 42 degrees , Ferguson angle 28.4 degrees , Voutsinas index 13, SVA -4.0 centimeters, and the median sacral inclination angle was 34 degrees . There were significant differences between preoperative and postoperative measurements for all variables (p<.01), indicating that good correction was achieved. At 4-year follow-up, fusion criteria were satisfied in 12 of 15 cases (80%). Three patients had distal junctional kyphosis. There was no significant difference obtained in the final Cobb angle, Ferguson angle, and Voutsinas index when Group A (rib graft) was compared with Group B (titanium cage) Both Group A and B patients retained the postoperative correction achieved with respect to all the radiographic parameters studied. CONCLUSION We were unable to demonstrate any significant advantage for the use of anterior titanium interbody cages over the use of morselized rib graft in the surgical management of Scheuermann's kyphosis. Given the not inconsiderable cost and the need for posterior chevron osteotomies when interbody cages are used, we have now reverted to our previous practice of using morselized rib graft at each intervertebral level.
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Affiliation(s)
- R Arun
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospital, Nottingham NG7 2UH, United Kingdom.
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Moquin RR, Rosner MK, Cooper PB. Combined anterior–posterior fusion with laterally placed threaded interbody cages and pedicle screws for Scheuermann kyphosis. Neurosurg Focus 2003; 14:e10. [PMID: 15766217 DOI: 10.3171/foc.2003.14.1.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report their preferred method for correcting Scheuermann disease via a combined anterior–posterior approach; their procedure is associated with a lower morbidity rate than the standard approach. Twenty-month follow-up examination demonstrated excellent maintenance of correction. The results satisfied the requirements to function without restriction in a vigorous military environment.
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Affiliation(s)
- Ross R Moquin
- National Capital Consortium, Neurosurgery Program, Walter Reed, Army Medical Center, Washington, DC, USA.
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Axenovich TI, Zaidman AM, Zorkoltseva IV, Kalashnikova EV, Borodin PM. Segregation analysis of Scheuermann disease in ninety families from Siberia. AMERICAN JOURNAL OF MEDICAL GENETICS 2001; 100:275-9. [PMID: 11343318 DOI: 10.1002/ajmg.1290] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Scheuermann disease [OMIM number 181440] is the most common cause of structural kyphosis in adolescence. Segregation analysis using a model with gender effects was applied to 90 pedigrees from Barnaul (West Siberia, Russia) ascertained through a proband with Scheuermann disease. The transmission probability model was used to detect major gene effect. A significant contribution of a major gene to the control of the pathology was established. Inheritance of the disease can be described within the framework of a dominant major gene diallele model. According to this model, Scheuermann disease should never occur in the absence of the mutant allele. All male carriers of the mutant allele develop the disease, while only a half of female carriers manifest it. We found a high frequency of idiopathic scoliosis in the families with Scheuermann disease (0.08 vs. 0.01-0.02 in general population). We also observed a succession of idiopathic scoliosis and Scheuermann disease in consecutive generations. The familial aggregation of these two spinal pathologies in the present sample may indicate a genetic unity of Scheuermann disease and idiopathic scoliosis.
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Affiliation(s)
- T I Axenovich
- Department of Recombination and Segregation Analysis, Institute of Cytology and Genetics, Russian Academy of Science, Novosibirsk, Russia.
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