Association between adolescent idiopathic scoliosis and sacroiliac joint dysfunction in young athletes: A case control study

Greater pelvic obliquity in adolescent idiopathic scoliosis combined with hip dysplasia

BACKGROUND

Adolescent idiopathic scoliosis (AIS) is a spinal deformity that affects adolescents and poses a challenging public health problem. Compared to the general population, adolescents with AIS have a higher prevalence of hip dysplasia. However, the mechanisms underlying the impact of hip dysplasia on the coronal balance of the spine remain poorly understood. We hypothesized that the combination of AIS with hip dysplasia would exacerbate coronal imbalance.

METHODS

We retrospectively analyzed the medical records and radiographs of adolescents diagnosed with AIS between 2015 and 2020. Participants were divided into two groups: those with hip dysplasia and those without. We recorded parameters related to the coronal deformity of the spine, sacral and pelvic obliquity, and center edge angle (CEA). We investigated differences in these parameters in those with and without hip dysplasia and analyzed their relationships in those with combined AIS and hip dysplasia.

RESULTS

A total of 103 adolescents were included, 36 with hip dysplasia and 67 without. Those with hip dysplasia had significantly higher sacroiliac discrepancy (SID) compared to those without (t = - 2.438, P = 0.017). In adolescents with hip dysplasia, only iliac obliquity angle (IOA) was significantly correlated with SID (r = - 0.803, P < 0.001), with a linear relationship between them (r2 = 0.645, P < 0.001).

CONCLUSIONS

The incidence of hip dysplasia is higher in the AIS population. In adolescents with combined AIS and hip dysplasia, pelvic obliquity is greater, potentially contributing to the increased prevalence of low back pain.

Non-Invasive Assessment of Back Surface Topography: Technologies, Techniques and Clinical Utility

(1) Background: Frequent exposure to ionising radiation is often used to determine the diagnosis of adolescent idiopathic scoliosis (AIS), a lateral curvature of the spine in those aged between 10 and 18 years, and a treatment plan according to Cobb angle. This narrative review outlines the clinical utility of surface topography (ST), a radiation-free imaging modality. (2) Methods: Publicly available databases were searched to yield literature related to ST. Identified articles were classified based on the equipment used and in order of how it was developed, i.e., historical, recent developments, and state-of-the-art developments. (3) Conclusions: ST is a reliable cost-effective non-invasive technique that provides an alternative to radiation-based imaging to aid with the diagnosis and potential screening of AIS. Several scanning methods are available, which allows ST to be used in several clinical environments. Limitations of inter-reliability and differences of apparatus resulting in variations of data have been noted through this narrative review.

Prevalence and Risk Factors of Musculoskeletal Disorders in Basketball Players: Systematic Review and Meta-Analysis

Musculoskeletal disorders characteristically induce pain and limitations in mobility, ability, and overall functioning. In athletes, including basketball players, disorders such as back pain, postural changes, and spinal injuries are common. This systematic review aimed to evaluate the prevalence of back pain and musculoskeletal disorders in basketball players and ascertain the associated factors. Methods: The Embase, PubMed, and Scopus databases were searched for studies published in English without a time limit. Using STATA, meta-analyses were performed to estimate the prevalence of pain and musculoskeletal disorders of the back and spine. Results: Of the 4135 articles identified, 33 studies were included in this review, with 27 studies included in the meta-analysis. Of these, 21 were used for the meta-analysis of back pain, 6 articles were used for the meta-analysis of spinal injury, and 2 studies were used for the meta-analysis of postural changes. The overall prevalence of back pain was 43% [95% CI, -1% to 88%]; of these, the prevalence of neck pain was 36% [95% CI, 22-50%], the prevalence of back pain was 16% [95% CI, 4-28%], the prevalence of low back pain was 26% [95% CI, 16-37%], the prevalence of thoracic spine pain was 6% [95% CI, 3-9%]. The combined prevalence of spinal injury and spondylolysis was 10% [95% CI, 4-15%], with a prevalence of spondylolysis of 14% [95% CI, 0.1-27%]. The combined prevalence of hyperkyphosis and hyperlordosis was 30% [95% CI, 9-51%]. In conclusion, we found a high prevalence of neck pain, followed by low back pain and back pain, in basketball players. Thus, prevention programs are important to improve health and sports performance.

What You Need to Know About Sacroiliac Dysfunction

Low back pain is the leading cause of disability worldwide, and sacroiliac dysfunction is estimated to occur in 15%-30% of those with nonspecific low back pain. Nurses are in the unique position to support and provide education to patients who may be experiencing sacroiliac dysfunction or possibly apply this knowledge to themselves, as low back pain is a significant problem experienced by nurses. A patient's clinical presentation, including pain patterns and characteristics, functional limitations, common etiologies and musculoskeletal system involvement, current diagnostic tools, and realm of treatments, are discussed along with their respective efficacy. Distinction is made between specific diagnosis and treatment of joint involvement and that of sacroiliac regional pain, as well as other factors that play a role in diagnosis and treatment for the reader's consideration.

The importance of extrinsic and intrinsic compensatory mechanisms to body posture of competitive athletes a systematic review and meta-analysis

The aim of this systematic review (qualitative analysis) was to identify the variables of changes induced by extrinsic (sport specific training) and intrinsic (individual anatomical predispositions) compensatory mechanisms that impact on the physiological magnitude of spinal curvatures in the sagittal plane and their deviations in the frontal plane. Furthermore, the aim of the quantitative analysis was to verify and objectivize the impact of these variables on athlete’s body posture. A search of electronic database (PubMed, EBSCO, MEDLINE) was conducted to identify all studies on sports training and athlete’s spine and body posture from 2011 to 2021. In the sagittal plane, the pooled proportion accounted for 44.97% (95% CI 31.22–58.72%) for thoracic hyperkyphosis (TH), 4.98% (95% CI 1.60–8.36%) for lumbar hyperlordosis (hyperLL), and 12.35% (95% CI 1.60–8.36%) for lumbar hypolordosis (hypoLL). Furthermore, in the sagittal plane, the pooled mean of thoracic kyphosis angle was 37.59° (95% CI 34.45–40.73%), whereas lumbar lordosis angle was 29.79° (95% CI 26.46–33.12%). Professional athletes tend to have postural disturbances and/or spinal curvature disorders in the sagittal and frontal planes. The meta-analysis indicated which intrinsic and extrinsic components might induce spinal abnormalities.

The Prevalence of Hip Pathologies in Adolescent Idiopathic Scoliosis

Background

Adolescent idiopathic scoliosis (AIS) is the most common form of abnormal spine curvature observed in patients age 10 to 18. Typically characterized by shoulder height and waistline asymmetry, AIS may drive uneven distribution of force in the hips, leading to increased rates of concurrent hip diagnoses. The relationship between AIS and concurrent hip diagnoses is underexplored in the literature, and to date, there has been little research comparing rates of hip diagnoses between patients with AIS and those unaffected.

Purpose

Assess differences in rates and clusters of hip diagnoses between patients with AIS and those unaffected.

Study design

Retrospective review of Healthcare Cost and Utilization Project's (HCUP) Nationwide Inpatient Sample (NIS).

Patient sample

224,504 weighted inpatient discharges.

Outcome measures

Rates of hip diagnoses.

Methods

Patients in the NIS database (2005-2013) ages 10-18 years were isolated. Patients were grouped by those diagnosed with AIS (ICD-9: 737.30) and those unaffected. Patient groups were propensity score matched (PSM) for age. Means comparison tests assessed differences in demographic, comorbidity, and diagnosis profiles between patient groups for corresponding age categories. ICD-9 codes were used to identify specific hip diagnoses.

Results

Following PSM, 24,656 AIS and 24,656 unaffected patients were included. The AIS patient group was comprised of more females (66% vs 59%) and had lower rates of obesity (2.4% vs 3.5%, both p < 0.001). Overall, 1.1% of patients had at least one hip diagnosis: congenital deformity (0.31%), developmental dysplasia (0.24%), recurrent dislocation (0.18%), isolated dislocation (0.09%), osteonecrosis (0.08%), osteochondrosis (0.07%), acquired deformity (0.03%), and osteoarthritis (0.02%). AIS patients had lower rates of osteonecrosis (0.04% vs 0.12%, p = 0.003), but higher rates of all other hip diagnoses, including dysplasia (0.41% vs 0.07%, p < 0.001), recurrent dislocation (0.32% vs 0.03%, p < 0.001), isolated dislocation (0.13% vs 0.06%, p < 0.001), and osteoarthritis (0.04% vs 0.01%, p = 0.084. Co-occurrences of hip diagnoses were relatively rare, with 0.03% patients having more than one hip diagnosis. Rates of co-occurring hip diagnoses did not differ between AIS and unaffected groups (0.04% vs 0.02%, p = 0.225).

Conclusions

Compared to unaffected patients of similar ages, patients with AIS had higher overall rates of hip diagnoses, including dysplasia and recurrent dislocation. A higher trend of precocious osteoarthritis was also observed at a higher rate in AIS patients, although this difference was not statistically significant. Our results present an argument for surgical realignment in the coronal and sagittal planes to neutralize asymmetrical forces in the hips, and suggest the need for increased awareness and clinical screening for hip-related disorders in AIS patients.

Level of Evidence

III.

Effect of Compensatory Mechanisms on Postural Disturbances and Musculoskeletal Pain in Elite Sitting Volleyball Players: Preparation of a Compensatory Intervention

The aim of the study was to identify the effect of compensatory mechanisms on the prevalence of sagittal spinal curvature deformity and musculoskeletal pain and to assess the interrelationships between those components in sitting volleyball players. Twenty-one elite Polish sitting volleyball players (age = 34.1 ± 7.5, BM = 77.9 ± 16.0) participated in the study in which direct participatory systematic observation and a non-invasive method were used. Both objective (anthropometric, spinal curvature-Idiag M360) and subjective (musculoskeletal ailments-NMQ = 7) measurements were performed. The Statistica 13.3 software package was used for statistical analyses. The neck, lower back (43%), and upper back (38%) were the most frequently reported painful areas. Of all participants, 76% reported sagittal spinal deformities. In the habitual position, the results indicated moderate correlations (r = 0.5, p < 0.05) between the lumbar concavity of the back and low back pain (LBP) and between thoracic convexity and LBP (r = 0.4, p < 0.05). Internal and external compensation have an effect on the prevalence of spinal curvature deformities in the sagittal plane, with thoracic hyperkyphosis (38%) and lumbar hyperlordosis (33%) being the most common. More severe lower and upper back pain were correlated with greater angles of thoracic kyphosis and lumbar lordosis in the habitual position.

Etiopathogenesis of sacroiliitis: implications for assessment and management

The sacroiliac joints connect the base of the sacrum to the ilium. When inflamed, they are suspected to cause low back pain. Inflammation of the sacroiliac joints is called sacroiliitis. The severity of the pain varies and depends on the degree of inflammation. Sacroiliitis is a hallmark of seronegative spondyloarthropathies. The presence or absence of chronic sacroiliitis is an important clue in the diagnosis of low back pain. This article aims to provide a concise overview of the anatomy, physiology, and molecular biology of sacroiliitis to aid clinicians in the assessment and management of sacroiliitis. For this narrative review, we evaluated articles in English published before August 2019 in PubMed. Then, we selected articles related to the painful manifestations of the sacroiliac joint. From the retrieved articles, we found that chronic sacroiliitis may be caused by various forms of spondyloarthritis, such as ankylosing spondyloarthritis. Sacroiliitis can also be associated with inflammatory bowel disease, Crohn’s disease, gout, tuberculosis, brucellosis, and osteoarthritis, indicating common underlying etiological factors. The pathophysiology of sacroiliitis is complex and may involve internal, environmental, immunological, and genetic factors. Finally, genetic factors may also play a central role in progression of the disease. Knowing the genetic pre-disposition for sacroiliitis can be useful for diagnosis and for formulating treatment regimens, and may lead to a substantial reduction in disease severity and duration and to improved patient performance.