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Quantifying Muscle Size Asymmetry in Adolescent Idiopathic Scoliosis Using Three-dimensional Magnetic Resonance Imaging: Erratum. Spine (Phila Pa 1976) 2024; 49:E61. [PMID: 38323692 DOI: 10.1097/BRS.0000000000004919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
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Pizones J, Chang DG, Suk SI, Izquierdo E. Current biomechanical theories on the etiopathogenesis of idiopathic scoliosis. Spine Deform 2024; 12:247-255. [PMID: 37975988 DOI: 10.1007/s43390-023-00787-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE There is great controversy about the etiologic origin of adolescent idiopathic scoliosis. Multiple theories have been suggested, including metabolic aspects, endocrine dysfunction, neurological central abnormalities, genetic predisposition and epigenetic factors involved in the development of scoliosis. However, there has always been speculations based on human biomechanical behavior. METHODS In this article, we performed a literature review on the biomechanical traits of human posture, and the proposed theories that explain the special characteristics present in idiopathic scoliosis. RESULTS The current theory on the etiopathogeneis of AIS suggests that dorsally directed shear loads acting on a preexisting axial plane rotation, in a posteriorly inclined sagittal plane of a growing patient, together with disc maturation, collagen quality at this phase of development and immaturity of proprioception, is the perfect scenario to spark rotational instability and create the three-dimensional deformity that defines idiopathic scoliosis. CONCLUSION The unique spinal alignment of human bipedalism, gravity and muscle forces acting straight above the pelvis to preserve an upright balance, and the instability of the soft tissue in a period of growth development, is an appealing cocktail to try to explain the genesis of this condition in humans.
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Affiliation(s)
- Javier Pizones
- Department of Orthopedic Surgery, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Inje University, Seoul, 50834, Korea
| | - Se-Il Suk
- Department of Orthopedic Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Inje University, Seoul, 50834, Korea
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Duncombe P, Izatt MT, Pivonka P, Claus A, Little JP, Tucker K. Quantifying Muscle Size Asymmetry in Adolescent Idiopathic Scoliosis Using Three-dimensional Magnetic Resonance Imaging. Spine (Phila Pa 1976) 2023; 48:1717-1725. [PMID: 37432908 DOI: 10.1097/brs.0000000000004715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/29/2023] [Indexed: 07/13/2023]
Abstract
STUDY DESIGN This is a case-control study of prospectively collected data. OBJECTIVE To quantify paraspinal muscle size asymmetry in adolescent idiopathic scoliosis (AIS) and determine if this asymmetry is (i) greater than observed in adolescent controls with symmetrical spines; and (ii) positively associated with skeletal maturity using Risser grade, scoliosis severity using the Cobb angle, and chronological age in years. SUMMARY OF BACKGROUND DATA AIS is a three-dimensional deformity of the spine which occurs in 2.5% to 3.7% of the Australian population. There is some evidence of asymmetry in paraspinal muscle activation and morphology in AIS. Asymmetric paraspinal muscle forces may facilitate asymmetric vertebral growth during adolescence. METHODS An asymmetry index [Ln(concave/convex volume)] of deep and superficial paraspinal muscle volumes, at the level of the major curve apex (Thoracic 8-9 th vertebral level) and lower-end vertebrae ( LEV , Thoracic 10-12 th vertebral level), was determined from three-dimensional Magnetic Resonance Imaging of 25 adolescents with AIS (all right thoracic curves), and 22 healthy controls (convex=left); all female, 10 to 16 years. RESULTS Asymmetry index of deep paraspinal muscle volumes was greater in AIS (0.16±0.20) than healthy spine controls (-0.06±0.13) at the level of the apex ( P <0.01, linear mixed-effects analysis) but not LEV ( P >0.05). Asymmetry index was positively correlated with Risser grade ( r =0.50, P <0.05) and scoliosis Cobb angle ( r =0.45, P <0.05), but not age ( r =0.34, P >0.05). There was no difference in the asymmetry index of superficial paraspinal muscle volumes between AIS and controls ( P >0.05). CONCLUSIONS The asymmetry of deep apical paraspinal muscle volume in AIS at the scoliosis apex is greater than that observed at equivalent vertebral levels in controls and may play a role in the pathogenesis of AIS.
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Affiliation(s)
- Phoebe Duncombe
- School of Biomedical Sciences, The University of Queensland, Australia
| | - Maree T Izatt
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Queensland University of Technology, Australia
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Australia
| | - Peter Pivonka
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Australia
| | - Andrew Claus
- School of Health & Rehabilitation Sciences, The University of Queensland, Australia
- Royal Brisbane and Women's Hospital, Tess Cramond Pain and Research Centre, Australia
| | - J Paige Little
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Queensland University of Technology, Australia
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Australia
| | - Kylie Tucker
- School of Biomedical Sciences, The University of Queensland, Australia
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Labrom FR, Izatt MT, Askin GN, Labrom RD, Claus AP, Little JP. Quantifying Typical Progression of Adolescent Idiopathic Scoliosis: Longitudinal Three-Dimensional MRI Measures of Disk and Vertebral Deformities. Spine (Phila Pa 1976) 2023; 48:1642-1651. [PMID: 37702242 DOI: 10.1097/brs.0000000000004829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/06/2023] [Indexed: 09/14/2023]
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVE Detail typical three-dimensional segmental deformities and their rates of change that occur within developing adolescent idiopathic scoliosis (AIS) spines over multiple timepoints. SUMMARY OF BACKGROUND DATA AIS is a potentially progressive deforming condition that occurs in three dimensions of the scoliotic spine during periods of growth. However, there remains a gap for multiple timepoint segmental deformity analysis in AIS cohorts during development. MATERIALS AND METHODS Thirty-six female patients with Lenke 1 AIS curves underwent two to six sequential magnetic resonance images. Scans were reformatted to produce images in orthogonal dimensions. Wedging angles and rotatory values were measured for segmental elements within the major curve. Two-tailed, paired t tests compared morphologic differences between sequential scans. Rates of change were calculated for variables given the actual time between successive scans. Pearson correlation coefficients were determined for multidimensional deformity measurements. RESULTS Vertebral bodies were typically coronally convexly wedged, locally lordotic, convexly axially rotated, and demonstrated evidence of local mechanical torsion. Between the first and final scans, apical measures of coronal wedging and axial rotation were all greater in both vertebral and intervertebral disk morphology than nonapical regions (all reaching differences where P <0.05). No measures of sagittal deformity demonstrated a statistically significant change between scans. Cross-planar correlations were predominantly apparent between coronal and axial planes, with sagittal plane parameters rarely correlating across dimensions. Rates of segmental deformity changes between earlier scans were characterized by coronal plane convex wedging and convexly directed axial rotation. The major locally lordotic deformity changes that did occur in the sagittal plane were static between scans. CONCLUSIONS This novel investigation documented a three-dimensional characterization of segmental elements of the growing AIS spine and reported these changes across multiple timepoints. Segmental elements are typically deformed from initial presentation, and subsequent changes occur in separate orthogonal planes at unique times.
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Affiliation(s)
- Fraser R Labrom
- Biomechanics & Spine Research Group, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
- Queensland Children's Hospital and Mater Health Services, Brisbane, Australia
| | - Maree T Izatt
- Biomechanics & Spine Research Group, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
- Queensland Children's Hospital and Mater Health Services, Brisbane, Australia
| | - Geoffrey N Askin
- Biomechanics & Spine Research Group, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
- Queensland Children's Hospital and Mater Health Services, Brisbane, Australia
| | - Robert D Labrom
- Biomechanics & Spine Research Group, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
- Queensland Children's Hospital and Mater Health Services, Brisbane, Australia
| | - Andrew P Claus
- Tess Cramond Pain and Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, Queensland, Australia
| | - J Paige Little
- Biomechanics & Spine Research Group, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
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de Dios E, Laesser M, Björkman-Burtscher IM, Lindhagen L, MacDowall A. MRI-based measurements of spondylolisthesis and kyphosis in degenerative cervical myelopathy. BMC Med Imaging 2023; 23:180. [PMID: 37946139 PMCID: PMC10634168 DOI: 10.1186/s12880-023-01151-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND To provide normative data and to determine accuracy and reliability of preoperative measurements of spondylolisthesis and kyphosis on supine static magnetic resonance imaging (MRI) of patients with degenerative cervical myelopathy. METHODS T2-weighted midsagittal images of the cervical spine were in 100 cases reviewed twice by one junior observer, with an interval of 3 months, and once by a senior observer. The spondylolisthesis slip (SSlip, mm) and the modified K-line interval (mK-line INT, mm) were assessed for accuracy with the standard error of measurement (SEm) and the minimum detectable change (MDC). Intraobserver and interobserver reliability levels were determined using the intraclass correlation coefficient (ICC). RESULTS The SEm was 0.5 mm (95% CI 0.4-0.6) for spondylolisthesis and 0.6 mm (95% CI 0.5-0.7) for kyphosis. The MDC, i.e., the smallest difference between two examinations that can be detected with statistical certainty, was 1.5 mm (95% CI 1.2-1.8) for spondylolisthesis and 1.6 mm (95% CI 1.3-1.8) for kyphosis. The highest reliability levels were seen between the second observation of the junior examiner and the senior observer (ICC = 0.80 [95% CI 0.70-0.87] and ICC = 0.96 [95% CI 0.94-0.98] for SSlip and mK-line INT, respectively). CONCLUSIONS This study provides normative values of alignment measurements of spondylolisthesis and kyphosis in DCM patients. It further shows the importance of taking measurement errors into account when defining cut-off values for cervical deformity parameters and their potential clinical application in surgical decision-making.
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Affiliation(s)
- Eddie de Dios
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Bruna stråket 11, Gothenburg, 41345, Sweden.
| | - Mats Laesser
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Bruna stråket 11, Gothenburg, 41345, Sweden
| | - Isabella M Björkman-Burtscher
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Bruna stråket 11, Gothenburg, 41345, Sweden
| | - Lars Lindhagen
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Anna MacDowall
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Takahashi I, Watanabe Y, Sonoda H, Tsunoda D, Amano I, Koibuchi N, Iizuka H, Shimokawa N. Calcium sensing and signaling are impaired in the lumbar spine of a rat model of congenital kyphosis. Eur Spine J 2023; 32:3403-3412. [PMID: 37555955 DOI: 10.1007/s00586-023-07877-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 07/07/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE Kyphosis involves spines curving excessively backward beyond their physiological curvature. Although the normal structure of the spinal vertebrae is extremely important for maintaining posture and the normal function of the thoracic and abdominal organs, our knowledge concerning the pathogenesis of the disease is insufficient. We herein report that the downregulation of the calcium signaling pathway is involved in the pathogenesis of congenital kyphosis. METHODS The third to fifth lumbar spine segments, the kyphotic region of Ishibashi (IS) rats, which are used as a model of congenital kyphoscoliosis, were collected. A DNA microarray, quantitative PCR, Western blotting, and immunohistochemistry were used to measure the expression of genes and proteins related to intracellular calcium signaling. RESULTS We found that the expression of calcium-sensing receptor (CaSR) and transient receptor potential vanilloid 1 (Trpv1)-two receptors involved in the calcium signaling-was decreased in the lumbar spine of IS rats. We also observed that the number of CaSR-immunoreactive and Trpv1-immunoreactive cells in the lumbar spine of IS rats was lower than in wild-type rats. Furthermore, the expression of intracellular molecules downstream of these receptors, such as phosphorylated protein kinase C, c-Jun N-terminal kinase, and neural EGFL-like 1, was also reduced. In fact, the calcium content in the lumbar spine of IS rats was significantly lower than that in wild-type rats. CONCLUSION These results indicate that adequate calcium signaling is extremely important for the regulation of normal bone formation and may also be a key factor for understanding the pathogenesis of congenital kyphosis.
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Affiliation(s)
- Itsuki Takahashi
- Department of Nutrition, Takasaki University Graduate Scholl of Health and Welfare, 37-1 Nakaorui-Machi, Takasaki, Gunma, 370-0033, Japan
| | - Yusuke Watanabe
- Department of Nutrition, Takasaki University Graduate Scholl of Health and Welfare, 37-1 Nakaorui-Machi, Takasaki, Gunma, 370-0033, Japan
| | - Hiroyuki Sonoda
- Orthopaedic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Daisuke Tsunoda
- Spine Surgery, Higashi-Maebashi Orthopaedic Hospital, Maebashi, Gunma, Japan
| | - Izuki Amano
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Noriyuki Koibuchi
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Haku Iizuka
- Orthopedic Surgery, Isesaki Municipal Hospital, Isesaki, Gunma, Japan.
| | - Noriaki Shimokawa
- Department of Nutrition, Takasaki University Graduate Scholl of Health and Welfare, 37-1 Nakaorui-Machi, Takasaki, Gunma, 370-0033, Japan.
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
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Guariento A, Sharma P, Andronikou S. MRI features of spinal chronic recurrent multifocal osteomyelitis/chronic non-bacterial osteomyelitis in children. Pediatr Radiol 2023; 53:2092-2103. [PMID: 37204463 DOI: 10.1007/s00247-023-05688-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Spinal lesions in pediatric chronic recurrent multifocal osteomyelitis/chronic non-bacterial osteomyelitis (CRMO/CNO) can cause permanent sequelae; thus, early recognition of these is vital for management. OBJECTIVE To characterize the MR imaging features and patterns of pediatric spinal CRMO/CNO. MATERIALS AND METHODS This cross-section study received IRB approval. The first available MRI with documented spine involvement in children with CRMO/CNO was reviewed by a pediatric radiologist. Descriptive statistics were used to describe the characteristics of vertebral lesions, disc involvement, and soft tissue abnormality. RESULTS Forty-two patients were included (F:M, 30:12); median age was 10 years (range 4-17). At diagnosis, 34/42 (81%) had spine involvement. Kyphosis in 9/42 (21%) and scoliosis in 4/42 (9.5%) patients were present at the time of spinal disease recognition. Vertebral involvement was multifocal in 25/42 (59.5%). Disc involvement was found in 11/42 (26%) patients, commonly in the thoracic spine and often with adjacent vertebrae height loss. Posterior element abnormalities were present in 18/42 patients (43%) and soft tissue involvement in 7/42 (17%). One hundred nineteen vertebrae were affected, commonly the thoracic vertebrae (69/119; 58%). Vertebral body edema was focal in 77/119 (65%) and frequently superior (42/77; 54%). Sclerosis and endplate abnormality were present in 15/119 (13%) and 31/119 (26%) vertebrae, respectively. Height loss was present in 41/119 (34%). CONCLUSION Chronic non-bacterial osteomyelitis of spine is usually thoracic. Vertebral body edema is often focal at the superior vertebral body. Kyphosis and scoliosis occur in a quarter and vertebral height loss in a third of children at spinal disease recognition.
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Affiliation(s)
- Andressa Guariento
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Parth Sharma
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Savvas Andronikou
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Moser M, Okano I, Albertini Sanchez L, Salzmann SN, Carlson BB, Adl Amini D, Oezel L, Chiapparelli E, Tan ET, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Preoperative Association Between Quantitative Lumbar Muscle Parameters and Spinal Sagittal Alignment in Lumbar Fusion Patients. Spine (Phila Pa 1976) 2022; 47:1675-1686. [PMID: 36255371 DOI: 10.1097/brs.0000000000004410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/04/2022] [Indexed: 11/05/2022]
Abstract
STUDY DESIGN A retrospective cross-sectional study. OBJECTIVE To assess the association between spinal muscle morphology and spinopelvic parameters in lumbar fusion patients, with a special emphasis on lumbar lordosis (LL). SUMMARY OF BACKGROUND DATA Maintenance of sagittal alignment relies on muscle forces, but the basic association between spinal muscles and spinopelvic parameters is poorly understood. MATERIALS AND METHODS Patients operated between 2014 and 2017 who had both lumbar magnetic resonance imaging scan and standing whole-spine radiographs within six months before surgery were included. Muscle measurements were conducted on axial T2-weighted magnetic resonance images at the superior endplate L3-L5 for the psoas and L3-S1 for combined multifidus and erector spinae (paraspinal) muscles. A pixel intensity threshold method was used to calculate the total cross-sectional area (TCSA) and the functional cross-sectional area (FCSA). Spinopelvic parameters were measured on lateral standing whole-spine radiographs and included LL, pelvic incidence (PI), PI-LL mismatch, pelvic tilt, sacral slope, thoracic kyphosis, and sagittal vertical axis. Analyses were stratified by biological sex. Multivariable linear regression analyses with adjustments for age and body mass index (BMI) were performed. RESULTS A total of 104 patients (62.5% female) were included in the analysis. The patient population was 90.4% White with a median age at surgery of 69 years and a median BMI of 27.8 kg/m 2 . All muscle measurements were significantly smaller in women. PI, pelvic tilt, and thoracic kyphosis were significantly greater in women. PI-LL mismatch was 6.1° (10.6°) in men and 10.2° (13.5°) in women ( P =0.106), and sagittal vertical axis was 45.3 (40.8) mm in men and 35.7 (40.8) mm in women ( P =0.251). After adjusting for age and BMI, paraspinal TCSA at L3-L5, and paraspinal FCSA at L4 showed significant positive associations with LL in women. In men, psoas TCSA at L5 and psoas FCSA at L5 showed significant negative associations with LL, but none of the paraspinal muscle measurements. CONCLUSION Our findings indicate that psoas and lumbar spine extensor muscles interact differently on LL among men and women, creating a unique mechanical environment. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
- Department of Spine Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Ichiro Okano
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Leonardo Albertini Sanchez
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Stephan N Salzmann
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
- Department of Orthopedic Surgery and Traumatology, Medical University of Vienna, Vienna, Austria
| | - Brandon B Carlson
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
- Marc A. Asher, MD, Comprehensive Spine Center, University of Kansas Medical Center, Kansas City, KS
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
- Department of Orthopedic Surgery and Traumatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
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Zhao Y, Sun J, Chen Y, Hu Y, Gong X, Ma L. Two novel variants in PLOD1 causing hydrocephalus in female newborn with kyphoscoliotic Ehlers-Danlos syndrome. Eur J Med Genet 2021; 64:104269. [PMID: 34161861 DOI: 10.1016/j.ejmg.2021.104269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 03/14/2021] [Accepted: 06/18/2021] [Indexed: 11/18/2022]
Abstract
The kyphoscoliotic Ehlers-Danlos syndrome (kEDS) is a rare autosomal recessive connective tissue disorder characterized by hyperextensible skin and joints, kyphoscoliosis, and severe muscle hypotonia at birth. Causal variants have been identified in PLOD1 resulting in lysyl hydroxylase deficiency responsible for kEDS. However, the detailed phenotype of kEDS during the perinatal period is still poorly recognized. Here, we describe a case of a female newborn presenting with prenatal hydrocephalus and severe hypotonia after birth with two novel compound heterozygous variants, c.2T > C (p.?) and c.1462del (p. Arg488Glyfs*9) in the PLOD1 gene. Our case suggests that in addition to the reported phenotype during the neonatal period, prenatal hydrocephalus should also be differentially diagnosed to exclude the potential of kEDS.
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Affiliation(s)
- Yingchun Zhao
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jingjing Sun
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yihuan Chen
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Hu
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaohui Gong
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Li Ma
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
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Lai J, Ji G, Zhou Y, Chen J, Zhou M, Mo J, Zheng T. Apoptosis of endplate chondrocytes in cervical kyphosis is associated with chronic forward flexed neck: an in vivo rat bipedal walking model. J Orthop Surg Res 2021; 16:5. [PMID: 33397370 PMCID: PMC7784390 DOI: 10.1186/s13018-020-02124-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study was undertaken to establish a rat bipedal walking model of cervical kyphosis (CK) associated with chronic forward flexed neck and assess the effects of chronic forward flexed neck on endplate chondrocytes. METHODS Forty-eight 1-month-old Sprague-Dawley rats were randomly divided into 3 groups: forward flexed neck group (n = 16), bipedal group (n = 16), and normal group (n = 16). Cervical curves were analyzed on a lateral cervical spine X-ray using Harrison's posterior tangent method before the experiment and at 2-week intervals for a 6-week period. Histologic changes in cartilaginous endplate chondrocytes were observed using hematoxylin and eosin (H&E) staining, transmission electron microscopy (TEM), and terminal deoxyribonucleotidyl transferase (TdT)-mediated dUTP nick-end labeling. RESULTS Radiographic findings suggested a significantly decreased cervical physiological curvature in the forward flexed neck group over the 6-week follow-up; normal cervical curves were maintained in other groups. The average cervical curvature (C2-C7) was - 7.6 ± 0.9° in the forward flexed neck group before the experiment, - 3.9 ± 0.8° at 2 weeks post-experiment, 10.7 ± 1.0° at 4 weeks post-experiment, and 20.5 ± 2.1° at the last follow-up post-experiment. Histologically, results of H&E staining unveiled that cartilaginous endplate chondrocytes were arranged in an irregular fashion, with the decreased number at the observation period; the incidence of apoptotic cells in the forward flexed neck group was noticeably higher at the 6-week follow-up than that in other groups. CONCLUSIONS CK developed as the result of chronic forward flexed neck. Histologic changes suggested that chondrocyte apoptosis may play a critical role in the development of cervical kyphotic deformity associated with chronic forward flexed neck.
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Affiliation(s)
- Jinliang Lai
- Emergency Department, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, China
| | - Guanglin Ji
- Department of Orthopedics, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, China
| | - Yuqiao Zhou
- Gannan Medical University, Ganzhou, 341000, China
| | - Jincai Chen
- Department of Orthopedics, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, China
| | - Min Zhou
- Department of Orthopedics, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, China
| | - Jianwen Mo
- Department of Orthopedics, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, China.
| | - Tiansheng Zheng
- Department of Orthopedics, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, China.
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Jakinapally S, Yamato Y, Hasegawa T, Togawa D, Yoshida G, Banno T, Arima H, Oe S, Yasuda T, Ushirozako H, Yamada T, Ide K, Watanabe Y, Matsuyama Y. Effect of sagittal shape on proximal junctional kyphosis following thoracopelvic corrective fusion for adult spinal deformity: postoperative inflection vertebra cranial to T12 is a significant risk factor. Spine Deform 2020; 8:1313-1323. [PMID: 32578158 DOI: 10.1007/s43390-020-00162-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 06/16/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective analysis of a prospectively collected consecutive case series of patients with adult spinal deformity (ASD). OBJECTIVE This study aimed to investigate the impact of the geometrical sagittal shape of the corrected spine on the development of proximal junctional kyphosis (PJK). Several studies have documented risk factors for PJK in ASD surgery. Geometrical assessment is vital for evaluating sagittal spinal deformity. It is essential to assess the postoperative geometrical shape of the spine and the location of the correction in the spine to decrease postoperative junctional stress and PJK. METHODS Consecutive patients with ASD who underwent corrective fusion with long constructs to the pelvis were included. Patients with neuromuscular disease, congenital and adolescent scoliosis, infection, and spinal tumor were excluded. We investigated the spinopelvic and geometrical parameters of the whole spine. The locations of the thoracic and lumbar apical vertebrae and the inflection vertebrae (IV), where the curvature of the associated adjacent vertebral bodies changes from kyphosis to lordosis, were investigated. The subjects were divided into PJK included patients who underwent revision surgery for junctional failure or with a change in proximal junctional angle ≥ 20°, and non-PJK groups. RESULTS A total of 139 patients (mean age, 69.6 years; range 18-82 years) were included. There were 47 and 92 patients in the PJK and non-PJK groups, respectively. The IV were located significantly cranial and posterior, the lumbar apex were located significantly posterior in the PJK group at the immediate postoperative time points. The significant risk factors for PJK on binary logistic regression were cranial IV and posterior lumbar apical vertebrae. The incidence of PJK in patients with IV at T12 or cranial tends PJK significantly higher (69%) than at L1 or caudal (26%). CONCLUSIONS Geometrical spinal shape should be taken into account to reduce the rate of postoperative mechanical complications. LEVEL OF EVIDENCE Level of evidence III.
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Affiliation(s)
- Sreenath Jakinapally
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, Japan
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, Japan.
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, 1-20-1, Handayama Higashi-ku, Hamamatsu, Shizuoka, Japan.
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, Japan
| | - Daisuke Togawa
- Department of Orthopaedic Surgery, Kindai Nara Hospital, 1248-1, Otodacho, Ikoma, Japan
| | - Go Yoshida
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, Japan
| | - Tomohiro Banno
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, Japan
| | - Hideyuki Arima
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, Japan
| | - Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, 1-20-1, Handayama Higashi-ku, Hamamatsu, Shizuoka, Japan
| | - Tatsuya Yasuda
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, Japan
| | - Hiroki Ushirozako
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, Japan
| | - Tomohiro Yamada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, Japan
| | - Koichirou Ide
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, Japan
| | - Yuh Watanabe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, Japan
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12
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Ishiwata S, Iizuka H, Sonoda H, Tsunoda D, Tajika Y, Chikuda H, Koibuchi N, Shimokawa N. Upregulated miR-224-5p suppresses osteoblast differentiation by increasing the expression of Pai-1 in the lumbar spine of a rat model of congenital kyphoscoliosis. Mol Cell Biochem 2020; 475:53-62. [PMID: 32748313 DOI: 10.1007/s11010-020-03859-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/26/2020] [Indexed: 01/08/2023]
Abstract
Congenital scoliosis is defined by the presence of structural anatomical malformations that arise from failures of vertebral formation or segmentation before and after birth. The understanding of genetic background and key genes for congenital scoliosis is still poor. We herein report that the excess expression of plasminogen activator inhibitor-1 (Pai-1) induced by the upregulation of miR-224-5p is involved in the pathogenesis of congenital kyphoscoliosis through impaired osteoblast differentiation. We first investigated the variety and progression of abnormalities of the lumbar spines in Ishibashi (IS) rats, a rat model of congenital kyphoscoliosis. The rats had already shown fusion and division of the primary ossification center at postnatal day 4. Over time, the rats showed various abnormalities of the lumbar spine, including the fusion of the annular epiphyseal nucleus. At postnatal day 42, spinal curvature was clearly observed due to the fusion of the vertebral bodies. Using a microRNA array, we found that the expression of miR-224-5p was increased in the lumbar spine of the rats at postnatal day 4. The expression of Pai-1, which is involved in osteoblast differentiation regulated by miR-224-5p, was also increased, while the levels of type I collagen, a marker of osteoblast differentiation, were decreased in the lumbar spine. These results indicate that the aberrant expression of miRNA-224-5p and its target genes is involved in the impaired osteoblast differentiation and may provide a partial molecular explanation for the pathogenesis of congenital scoliosis.
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Affiliation(s)
- Sho Ishiwata
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Haku Iizuka
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
- Isesaki Municipal Hospital, Isesaki, Japan
| | - Hiroyuki Sonoda
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
- Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Daisuke Tsunoda
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yuki Tajika
- Department of Anatomy, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Noriyuki Koibuchi
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Noriaki Shimokawa
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
- Department of Nutrition, Takasaki University of Health and Welfare, 31-1 Nakaorui-machi, Takasaki, Gunma, 370-0033, Japan.
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13
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Pasha S, Sankar WN, Castelein RM. The Link Between the 3D Spino-pelvic Alignment and Vertebral Body morphology in Adolescent Idiopathic Scoliosis. Spine Deform 2019; 7:53-59. [PMID: 30587321 DOI: 10.1016/j.jspd.2018.05.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/03/2018] [Accepted: 05/27/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vertebral anterior overgrowth has been suggested as part of the etio-pathogenesis of adolescent idiopathic scoliosis (AIS). However, the link between 3D spinopelvic alignment and the vertebral anteroposterior height asymmetry in different scoliotic curves types and whether it deviates from the non-scoliotic controls, has not been studied. PURPOSE We aimed to retrospectively describe the link between the anteroposterior vertebral height differences (ΔAPVH) measured in the true sagittal plane of each vertebra and the spinopelvic parameters in three anatomical planes. METHODS 30 AIS cases with primary thoracic curves, 28 with thoracolumbar/lumbar curves, and 20 non-scoliotic controls were included. All subjects had 3D reconstruction of the spine, generated from low-dose upright stereoradiography images. Pelvic incidence (PI), thoracic and lumbar coronal and sagittal curve measurements, and vertebral axial rotation were measured. The association between the spinopelvic parameters and ΔAPVH were compared between the two AIS and control groups. RESULTS ΔAPVH at the apex of the curve was significantly different between the two AIS groups, as well as between both AIS groups and the controls and was related to the vertebral apical rotation (p < 0.05). Kyphosis and lordosis measurements were significantly related to the sum of the ΔAPVH in thoracic and lumbar regions respectively in AIS group but not in non-scoliotic controls (p < 0.05). CONCLUSIONS The ΔAPVH depended on the scoliotic curve type and was significantly different from the controls only at the apical levels. Morphological changes in the scoliotic vertebrae, measured as anterior-posterior differences in the vertebral height, are related to the sagittal spinal profile suggesting the morphology of the vertebra contributes to the sagittal curvatures of the spine in AIS; nonetheless, such relationship between the vertebral morphology and the sagittal profile was not evident in non-scoliotic controls.
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Affiliation(s)
- Saba Pasha
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA.
| | - Woudbhav N Sankar
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA
| | - Rene M Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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Abstract
BACKGROUND There is a lack of a classification system providing uniformity in description and guiding management decisions for kyphotic spinal deformities. We developed such a classification based on column deficiency, flexibility of disc spaces, curve magnitude, and correlation with the corrective osteotomy required. METHODS A classification was developed based on analysis of 180 patients with thoracolumbar kyphosis requiring osteotomy. The deformity was classified as Type I if the anterior and posterior columns were intact (IA indicated mobile disc spaces and IB, ankylosed segments). Type II indicated deficiency of only 1 column (IIA = anterior column and IIB = posterior column). Type III indicated deficiency of both columns (IIIA = kyphosis of ≤60°, IIIB = kyphosis of >60°, and IIIC = buckling collapse). A prospective analysis of 76 patients was performed to determine interobserver variability and the ability of the classification to guide selection of osteotomies of increasing complexity, including the Ponte osteotomy, pedicle subtraction osteotomy, disc bone osteotomy, single vertebrectomy, multiple vertebrectomies, and anterior in situ strut fusion procedure. RESULTS The mean age of the 76 patients was 21.2 years, the mean kyphosis was 69.9° (range, 26° to 120°), and the mean follow-up duration was 30 months. Six deformities were classified as IA, 5 as IB, 5 as IIA, 2 as IIB, 13 as IIIA, 35 as IIIB, and 10 as IIIC. Four surgeons classifying the deformities had a high agreement rate (kappa = 0.83), with the highest agreement for Types IA, IB, and IIIB. A correlation between the type of deformity and the osteotomy performed demonstrated that the classification could indicate the type of osteotomy required. All 18 patients with Type-I or II kyphosis were treated with Ponte, pedicle subtraction, or disc bone osteotomy. Forty-three (90%) of the 48 patients with Type IIIA or IIIB underwent vertebrectomy (single in 27 [56%] and multiple in 16 [33%]), and only 5 (10%) underwent disc bone osteotomy. Seven of the 10 patients with Type-IIIC kyphosis were treated with multiple vertebrectomies, with 5 of them needing preoperative halo gravity traction; the other 3 patients underwent an anterior in situ strut fusion procedure. CONCLUSIONS The proposed classification based on the morphology of column deficiency, flexibility, and curve magnitude demonstrated a high interobserver agreement and ability to guide selection of the appropriate osteotomy. CLINICAL RELEVANCE A novel classification system for kyphosis based on spinal column deficiency, flexibility of disc spaces, and curve magnitude would bring uniformity in management and help guide surgeons in the choice of the appropriate corrective osteotomy.
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Affiliation(s)
- S. Rajasekaran
- Department of Spine Surgery, Ganga Hospital, Coimbatore, India
| | | | | | - Rishi Kanna
- Department of Spine Surgery, Ganga Hospital, Coimbatore, India
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15
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Miyakoshi N, Kudo D, Hongo M, Kasukawa Y, Ishikawa Y, Shimada Y. Comparison of spinal alignment, muscular strength, and quality of life between women with postmenopausal osteoporosis and healthy volunteers. Osteoporos Int 2017; 28:3153-3160. [PMID: 28785980 DOI: 10.1007/s00198-017-4184-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/30/2017] [Indexed: 01/14/2023]
Abstract
UNLABELLED This study compared spinal alignment, muscular strength, and quality of life (QOL) between women with postmenopausal osteoporosis and healthy volunteers. The results indicated that lower QOL in osteoporosis patients may be associated with increased thoracic kyphosis, reduced lean muscle mass, and generalized muscle weakness. INTRODUCTION Increased spinal kyphosis is common in patients with osteoporosis and negatively impacts quality of life (QOL). Muscular strength is also important for QOL in patients with osteoporosis. However, spinal kyphosis and muscle weakness also occur in healthy individuals with advancing age. The purposes of this study were thus to compare spinal alignment, muscular strength, and QOL between women with postmenopausal osteoporosis and healthy volunteers. METHODS Participants comprised 236 female patients with postmenopausal osteoporosis (mean age, 68.7 years) and 93 healthy volunteer women (mean age, 71.0 years). Body mass index (BMI), angles of spinal kyphosis, back extensor strength, grip strength, and QOL were compared between groups. RESULTS BMI, back extensor strength, and grip strength were significantly higher in the volunteer group than in the osteoporosis group (p < 0.01). Both thoracic kyphosis and lumbar lordosis were significantly greater in the osteoporosis group than in the volunteer group (p < 0.01). With regard to QOL, the 36-Item Short-Form Health Survey (SF-36) subscale scores of role physical, bodily pain, general health, and role emotional were all significantly lower in the osteoporosis group than in the volunteer group (p < 0.05 each). SF-36 physical component summary (PCS) score was significantly lower in the osteoporosis group than in the volunteer group (p < 0.001). SF-36 PCS score correlated positively with thoracic kyphosis and negatively with BMI only in the osteoporosis group (p < 0.05 each). CONCLUSIONS These results indicated that lower QOL in osteoporosis patients may be associated with increased thoracic kyphosis, reduced lean muscle mass, and generalized muscle weakness.
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Affiliation(s)
- N Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - D Kudo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - M Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Y Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Y Ishikawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Y Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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Katzman WB, Vittinghoff E, Lin F, Schafer A, Long RK, Wong S, Gladin A, Fan B, Allaire B, Kado DM, Lane NE. Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial. Osteoporos Int 2017; 28:2831-2841. [PMID: 28689306 PMCID: PMC5873977 DOI: 10.1007/s00198-017-4109-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/31/2017] [Indexed: 01/01/2023]
Abstract
A 6-month randomized controlled trial of spine-strengthening exercise and posture training reduced both radiographic and clinical measures of kyphosis. Participants receiving the intervention improved self-image and satisfaction with their appearance. Results suggest that spine-strengthening exercise and postural training may be an effective treatment option for older adults with hyperkyphosis. INTRODUCTION The purpose of the present study is to determine in a randomized controlled trial whether spine-strengthening exercises improve Cobb angle of kyphosis in community-dwelling older adults. METHODS We recruited adults ≥60 years with kyphosis ≥40° and enrolled 99 participants (71 women, 28 men), mean age 70.6 ± 0.6 years, range 60-88, with baseline Cobb angle 57.4 ± 12.5°. The intervention included group spine-strengthening exercise and postural training, delivered by a physical therapist, 1-h, three times weekly for 6 months. Controls received four group health education meetings. The primary outcome was change in the gold standard Cobb angle of kyphosis measured from standing lateral spine radiographs. Secondary outcomes included change in kyphometer-measured kyphosis, physical function (modified Physical Performance Test, gait speed, Timed Up and Go, Timed Loaded Standing, 6-Min Walk), and health-related quality of life (HRQoL) (PROMIS global health and physical function indexes, SRS-30 self-image domain). ANCOVA was used to assess treatment effects on change from baseline to 6 months in all outcomes. RESULTS There was a -3.0° (95% CI -5.2, -0.8) between-group difference in change in Cobb angle, p = 0.009, favoring the intervention and approximating the magnitude of change from an incident vertebral fracture. Kyphometer-measured kyphosis (p = 0.03) and SRS-30 self-esteem (p < 0.001) showed favorable between-group differences in change, with no group differences in physical function or additional HRQoL outcomes, p > 0.05. CONCLUSIONS Spine-strengthening exercise and posture training over 6 months reduced kyphosis compared to control. Our randomized controlled trial results suggest that a targeted kyphosis-specific exercise program may be an effective treatment option for older adults with hyperkyphosis. TRIAL REGISTRATION NUMBER AND NAME OF TRIAL REGISTER ClinicalTrials.gov; identifier NCT01751685.
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Affiliation(s)
- W B Katzman
- University of California, 1500 Owens Street, San Francisco, CA, 94158, USA.
| | - E Vittinghoff
- University of California, 550 16th. Street, San Francisco, CA, 94158, USA
| | - F Lin
- University of California, 550 16th. Street, San Francisco, CA, 94158, USA
| | - A Schafer
- University of California, 4150 Clement St, San Francisco, CA, 94121, USA
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA, 94121, USA
| | - R K Long
- University of California, 550 16th. Street, San Francisco, CA, 94143, USA
| | - S Wong
- University of California, 1500 Owens Street, San Francisco, CA, 94158, USA
| | - A Gladin
- Kaiser Permanente Northern CA, San Francisco Medical Center, 1635 Divisadero Street, Suite 300, San Francisco, CA, 94115, USA
| | - B Fan
- University of California, 400 Parnassus Avenue, San Francisco, CA, 94117, USA
| | - B Allaire
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - D M Kado
- University of California, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - N E Lane
- University of California, 4625 Second Avenue, Suite 2000, Sacramento, CA, 95616, USA
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17
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Dolphens M, Vleeming A, Castelein R, Vanderstraeten G, Schlösser T, Plasschaert F, Danneels L. Coronal plane trunk asymmetry is associated with whole-body sagittal alignment in healthy young adolescents before pubertal peak growth. Eur Spine J 2017; 27:448-457. [PMID: 28578458 DOI: 10.1007/s00586-017-5156-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 04/03/2017] [Accepted: 05/25/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate coronal plane trunk asymmetry (TA) and its association with sagittal postural alignment in healthy subjects before pubertal peak growth. METHODS In this cross-sectional baseline study, 1190 healthy pre-peak growth velocity subjects were included. Coronal plane TA was evaluated using back surface topography. Whole-body sagittal alignment (previously validated and objectively classified as neutral, sway-back or leaning-forward) and sagittal spinopelvic profile (trunk lean, lumbar lordosis, thoracic kyphosis, sacral inclination and length of the posteriorly inclined thoracolumbar segment) were determined, as were height, proportion of trunk to body length, body mass index, generalized joint laxity, and handedness. RESULTS Logistic regression analysis yielded overall sagittal posture class to be independently associated with coronal plane TA: having a leaning-forward posture associated with a nearly three times higher odds of coronal TA (p < 0.001) compared to neutrals. A sway-back was 2.2 times more likely to show TA (p = 0.016) than a neutral, yet only in boys. Significant associations with coronal TA were also found for trunk lean, thoracic kyphosis and body mass index. These correlations, however, were gender and posture class specific. The spinal region where asymmetry is seen, varies according to the whole-body sagittal alignment type: primary thoracic curves were the most frequent in leaning-forwards, whereas primary curves in the lumbar or declive thoracolumbar segment were the most common in sway-backs. CONCLUSIONS In immature spines without known scoliosis, coronal plane TA is associated with whole-body sagittal alignment. It is more often seen in non-neutral than neutral sagittal posture types. Whether adolescent idiopathic scoliosis is related with postural characteristics before pubertal growth peak, should be addressed in future prospective studies.
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Affiliation(s)
- Mieke Dolphens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans (UZ, 3B3), De Pintelaan 185, 9000, Ghent, Belgium.
| | - Andry Vleeming
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans (UZ, 3B3), De Pintelaan 185, 9000, Ghent, Belgium
- Department of Anatomy, Medical Faculty, Center of Excellence in Neuroscience, University of New England, Biddeford, ME, USA
| | - René Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Guy Vanderstraeten
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans (UZ, 3B3), De Pintelaan 185, 9000, Ghent, Belgium
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Tom Schlösser
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank Plasschaert
- Department of Orthopedics and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans (UZ, 3B3), De Pintelaan 185, 9000, Ghent, Belgium
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Abstract
To date, only a few reports described the potential factors influencing the position of conus medullaris. One previous study revealed no significant change of conus locations in patients with idiopathic scoliosis; however, the effect of ankylosing spondylitis (AS)-related thoracolumbar kyphosis on conus position remains unexplored. Therefore, we aimed to investigate the variation of conus medullaris terminations in patients with thoracolumbar kyphosis secondary to AS when compared with normal subjects, and evaluated the relationship between conus positions and the magnitude of kyphosis. In this study, MR images of 96 AS patients with thoracolumbar kyphosis, including 86 males and 10 females with an average of 34.6 years (range, 17-65 years), and 100 age-matched normal controls were reviewed to determine the conus terminations in relation to spinal levels. Sagittal parameters of the AS group measured on radiograph included: global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), and thoracolumbar junction (TLJ). Finally, conus tips located at the mean level of the lower 3rd of L1 in both groups, there was no significant difference of the conus distributions between AS and control group (P = 0.49). In addition, conus medullaris displayed similar positions in AS patients among various apical region groups (P = 0.88), and no significant difference was found when AS population was stratified into GK ranges of 30° (P = 0.173). Also, no remarkable correlation of the conus positions with GK (r = -0.15, P = 0.15), TK (r = -0.10, P = 0.34), LL (r = -0.10, P = 0.32), and TLJ (r = -0.06, P = 0.54) was identified. This study showed the conus terminations displayed a wide range of distributions in AS patients with thoracolumbar kyphosis, which was similar to normal subjects. Moreover, the conus located at a relatively fixed position and would not be affected by the change of kyphosis magnitude, which is an important knowledge that surgeons should acquire in surgical correction of the deformity in these patients.
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Affiliation(s)
- Zhe Qu
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing
- Orthopedic Surgery, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Bang-ping Qian
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing
| | - Yong Qiu
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing
| | - Yun-peng Zhang
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing
| | - Jun Hu
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing
| | - Ze-zhang Zhu
- Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing
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Tauchi R, Kawakami N, Tsuji T, Ohara T, Suzuki Y, Saito T, Nohara A. Evaluation of thoracic factors after scoliosis surgery in patients with both scoliosis and pectus excavatum. Eur Spine J 2016; 27:381-387. [PMID: 27568387 DOI: 10.1007/s00586-016-4753-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 08/21/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Pectus excavatum can negatively impact cardiac function during scoliosis surgery. Several authors reported severe hypotension associated with the prone position during scoliosis surgery in children that had both scoliosis and pectus excavatum. However, we could find no studies that evaluated the change in the thoracic factors, such as sternal tilt angle and Haller index after scoliosis surgery in patients with both scoliosis and pectus excavatum. The purpose of this study is to evaluate the change in thoracic factors after surgical treatment for scoliosis associated with pectus excavatum. METHODS We performed a retrospective review on 20 patients (10 males and 10 females) who underwent surgical treatment for scoliosis associated with pectus excavatum from August 2004 to April 2014 in our hospital. We investigated the scoliosis diagnosis, preoperative and postoperative Cobb and thoracic kyphosis (TK) angles, the change in TK after surgery and thoracic factors, including the AP and transverse diameters of the chest, the sternal tilt angle, and Haller index. RESULTS Patient mean age was 13.2 years old (4-27 years old) at surgery. Types of scoliosis were idiopathic in 8 patients, syndromic in 10, and neuromuscular in 2. The mean Cobb angles were 72.1° preoperatively and 19.0° postoperatively. Curve locations were thoracic in 13 patients, thoracolumbar in 4, and lumbar in 3. Surgical treatment of pectus excavatum was performed in 9 patients (45 %) before scoliosis treatment. Mean sternal tilt angles were 11.5° preoperatively and 11.1° postoperatively. Mean Haller indices were 4.8 preoperatively and 5.3 postoperatively. This was especially true for syndromic or neuromuscular scoliosis and thoracolumbar/lumbar curve type patients in which scoliosis surgery tended to worsen the Haller index. CONCLUSION The Haller index increased postoperatively in 11 of 20 patients, which means sternal depression deteriorated after scoliosis surgery in about 50 % of patients. We suggest that surgeons fully assess the thoracic factors in patients with scoliosis and pectus excavatum prior to performing scoliosis surgery and carefully monitor their patient's general condition during surgery.
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Affiliation(s)
- Ryoji Tauchi
- Department of Orthopaedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Noriaki Kawakami
- Department of Orthopaedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan.
| | - Taichi Tsuji
- Department of Orthopaedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Tetsuya Ohara
- Department of Orthopaedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Yoshitaka Suzuki
- Department of Orthopaedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Toshiki Saito
- Department of Orthopaedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Ayato Nohara
- Department of Orthopaedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
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Abstract
Conspicuous vertebral column abnormalities in humpback dolphins (genus Sousa) were documented for the first time during 3 photo-identification field studies of small populations in Taiwan, Senegal and Angola. Seven Taiwanese humpback dolphins S. chinensis taiwanensis with vertebral column anomalies (lordosis, kyphosis or scoliosis) were identified, along with 2 possible cases of vertebral osteomyelitis. There was evidence from several individuals photographed over consecutive years that the anomalies became more pronounced with age. Three Atlantic humpback dolphins S. teuszii were observed with axial deviations of the vertebral column (lordosis and kyphosis). Another possible case was identified in a calf, and 2 further animals were photographed with dorsal indents potentially indicative of anomalies. Vertebral column anomalies of humpback dolphins were predominantly evident in the lumbo-caudal region, but one Atlantic humpback dolphin had an anomaly in the cervico-thoracic region. Lordosis and kyphosis occurred simultaneously in several individuals. Apart from the described anomalies, all dolphins appeared in good health and were not obviously underweight or noticeably compromised in swim speed. This study presents the first descriptions of vertebral column anomalies in the genus Sousa. The causative factors for the anomalies were unknown in every case and are potentially diverse. Whether these anomalies result in reduced fitness of individuals or populations merits attention, as both the Taiwanese and Atlantic humpback dolphin are species of high conservation concern.
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Affiliation(s)
- Caroline R Weir
- Ketos Ecology, 4 Compton Road, Kingsbridge, Devon TQ7 2BP, UK
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21
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Protopsaltis T, Bronsard N, Soroceanu A, Henry JK, Lafage R, Smith J, Klineberg E, Mundis G, Kim HJ, Hostin R, Hart R, Shaffrey C, Bess S, Ames C. Cervical sagittal deformity develops after PJK in adult thoracolumbar deformity correction: radiographic analysis utilizing a novel global sagittal angular parameter, the CTPA. Eur Spine J 2016; 26:1111-1120. [PMID: 27437690 DOI: 10.1007/s00586-016-4653-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/05/2016] [Accepted: 06/05/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE To describe reciprocal changes in cervical alignment after adult spinal deformity (ASD) correction and subsequent development of proximal junctional kyphosis (PJK). This study also investigated these changes using two novel global sagittal angular parameters, cervical-thoracic pelvic angle (CTPA) and the T1 pelvic angle (TPA). METHODS Multicenter, retrospective consecutive case series of ASD patients undergoing thoracolumbar three-column osteotomy (3CO) with fusion to the pelvis. Radiographs were analyzed at baseline and 1 year post-operatively. Patients were substratified into upper thoracic (UT; UIV T6 and above) and lower thoracic (LT; UIV below T6). PJK was defined by >10° angle between UIV and UIV + 2 and >10° change in the angle from baseline to post-op. RESULTS PJK developed in 29 % (78 of 267) of patients. CTPA was linearly correlated with cervical plumbline (CPL) as a measure of cervical sagittal alignment (R = 0.826, p < 0.001). PJK patients had significantly greater post-operative CTPA and SVA than patients without PJK (NPJK) (p = 0.042; p = 0.021). For UT (n = 141) but not LT (n = 136), PJK patients at 1 year had larger CTPA (4.9° vs. 3.7°, p = 0.015) and CPL (5.1 vs. 3.8 cm, p = 0.022) than NPJK patients, despite similar corrections in PT and PI-LL. CONCLUSIONS The prevalence of PJK was 29 % at 1 year follow-up. CTPA, which correlates with CPL as a global analog of cervical sagittal balance, and TPA describe relative proportions of cervical and thoracolumbar deformities. Patients who develop PJK in the upper thoracic spine after thoracolumbar 3CO also develop concomitant cervical sagittal deformity, with increases in CPL and CTPA.
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Affiliation(s)
- Themistocles Protopsaltis
- Department of Orthopedic Surgery, New York University School of Medicine, 306 East 15th St., New York, NY, 10003, USA.
| | | | - Alex Soroceanu
- Department of Orthopedic Surgery, New York University School of Medicine, 306 East 15th St., New York, NY, 10003, USA
| | - Jensen K Henry
- Department of Orthopedic Surgery, New York University School of Medicine, 306 East 15th St., New York, NY, 10003, USA
| | - Renaud Lafage
- Department of Orthopedic Surgery, New York University School of Medicine, 306 East 15th St., New York, NY, 10003, USA
| | - Justin Smith
- Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Eric Klineberg
- Department of Orthopedic Surgery, University of California Davis, Sacramento, CA, USA
| | - Gregory Mundis
- San Diego Center for Spinal Disorders, La Jolla, CA, USA
| | - Han Jo Kim
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Robert Hart
- Department of Orthopedic Surgery, University of Oregon Health Sciences Center, Portland, OR, USA
| | - Christopher Shaffrey
- Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Shay Bess
- Department of Orthopedic Surgery, New York University School of Medicine, 306 East 15th St., New York, NY, 10003, USA
| | - Christopher Ames
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
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Tran TH, Wing D, Davis A, Bergstrom J, Schousboe JT, Nichols JF, Kado DM. Correlations among four measures of thoracic kyphosis in older adults. Osteoporos Int 2016; 27:1255-1259. [PMID: 26475287 PMCID: PMC5332161 DOI: 10.1007/s00198-015-3368-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/06/2015] [Indexed: 02/02/2023]
Abstract
SUMMARY There are many ways to measure thoracic kyphosis ranging from simple clinical to more complex assessments. We evaluated the correlation among four commonly used kyphosis measures: Cobb angle, Debrunner kyphometer, kyphotic index, and the blocks method. Each measure was correlated with the others, confirming high clinical and research applicability. INTRODUCTION The purpose of this study was to assess the associations among four commonly used measures of thoracic kyphosis in older adults. METHODS Seventy two men and women aged 65-96 were recruited from the San Diego community. Four kyphosis measures were assessed in the same person during a baseline clinic visit. Two measures were done in the lying (L) and two in the standing (ST) position: (1) Cobb angle calculated from dual X-Ray absorptiometry (DXA) images (L), (2) Debrunner kyphometer (DK) angle measured by a protractor (ST), (3) kyphotic index (KI) calculated using an architect's flexicurve ruler (ST), and (4) the blocks method involving counting the number of 1.7 cm-thick blocks required to achieve a neutral head position while lying flat on the DXA table (L). Spearman rank correlation coefficients were used to determine the strength of the association between each kyphosis measure. RESULTS Using the Cobb angle as the gold standard, the blocks method demonstrated the lowest correlation (r(s) = 0.63, p < 0.0001), the Debrunner method had a moderate correlation (r(s) = 0.65, p < 0.0001), and the kyphotic index had the highest correlation (r(s) = 0.68, p < 0.0001). The correlation was strongest between the kyphotic index and the Debrunner kyphometer (r(s) = 0.76, p < 0.0001). CONCLUSION In older men and women, all four measures of thoracic kyphosis were significantly correlated with each other, whether assessed in the lying or standing position. Thus, any of these measures demonstrate both potential clinical and research utility.
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Affiliation(s)
- T H Tran
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - D Wing
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - A Davis
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - J Bergstrom
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - J T Schousboe
- Park Nicollet Osteoporosis Center and Institute for Research and Education, Minneapolis, MN, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - J F Nichols
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - D M Kado
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA.
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
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Choi MK, Kim SB, Park CK, Kim SM. Comparison of the clinical and radiologic outcomes obtained with single- versus two-level anterior cervical decompression and fusion using stand-alone PEEK cages filled with allograft. Acta Neurochir (Wien) 2016; 158:481-7. [PMID: 26758609 DOI: 10.1007/s00701-015-2692-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/22/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although anterior cervical decompression and fusion with a stand-alone cage (ACDF-SAC) is accepted as a suitable procedure, the outcomes of the multi-level procedure remain controversial. The aim of this study is to compare the clinical and radiologic outcomes achieved with single versus two-level ACDF-SAC along with identification of the factors that contribute to loss in mean disc height (MDH) and change in cervical lordotic angle (CLA). METHODS A total of 109 consecutive patients who underwent ACDF-SAC for degenerative spondylosis were reviewed. Patients were divided into two groups according to surgical level (group A, single; group B, two) and were followed for at least 1 year. Clinical outcomes were evaluated using the visual analog scale (VAS) and Robinson's criteria. The fusion and subsidence rates, MDH, CLA, anterior, and posterior vertebral body height of the fused segments (AVBH, PVBH) were measured retrospectively from plain radiographs. RESULTS Clinical outcomes were similar in both groups, in terms of decreasing VAS score and a grade higher than "good" by Robinson's criteria. The fusion and subsidence rates for each group were found to be 92.2, 91.1, 14.1, and 20.0 %, respectively. The MDH (mm) increased by 1.44 ± 0.96 in group A, 1.57 ± 0.79 and 1.66 ± 0.69 for each surgical level in group B over the 12 postoperative months. The CLA (°) decreased by 1.70 ± 4.04 and 0.75 ± 6.12 over the 12 postoperative months from its presurgery value, the rate of kyphosis >5° was 26.6 and 22.2 % for each group. All compared values were not significantly different between the two groups. Correlation analysis revealed that the AVBH/PVBH ratio exhibited a positive correlation with CLA change in both groups (r = 0.368, 0.397; p = 0.018, 0.040). CONCLUSIONS The overall outcomes achieved with two-level ACDF-SAC were similar to those achieved with single-level ones. In addition, the AVBH/PVBH ratio might be a predictable marker for a postoperative kyphosis.
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Affiliation(s)
- Man Kyu Choi
- Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea, 130-872
| | - Sung Bum Kim
- Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea, 130-872.
| | - Chang Kyu Park
- Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea, 130-872
| | - Sung Min Kim
- Department of Neurosurgery, Kyung Hee University Hospital, Gangdong, Seoul, South Korea
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Katzman WB, Vittinghoff E, Kado DM, Lane NE, Ensrud KE, Shipp K. Thoracic kyphosis and rate of incident vertebral fractures: the Fracture Intervention Trial. Osteoporos Int 2016; 27:899-903. [PMID: 26782685 PMCID: PMC4939887 DOI: 10.1007/s00198-015-3478-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/29/2015] [Indexed: 01/08/2023]
Abstract
SUMMARY Biomechanical analyses support the theory that thoracic spine hyperkyphosis may increase risk of new vertebral fractures. While greater kyphosis was associated with an increased rate of incident vertebral fractures, our analysis does not show an independent association of kyphosis on incident fracture, after adjustment for prevalent vertebral fracture. Excessive kyphosis may still be a clinical marker for prevalent vertebral fracture. INTRODUCTION Biomechanical analyses suggest hyperkyphosis may increase risk of incident vertebral fracture by increasing the load on vertebral bodies during daily activities. We propose to assess the association of kyphosis with incident radiographic vertebral fracture. METHODS We used data from the Fracture Intervention Trial among 3038 women 55-81 years of age with low bone mineral density (BMD). Baseline kyphosis angle was measured using a Debrunner kyphometer. Vertebral fractures were assessed at baseline and follow-up from lateral radiographs of the thoracic and lumbar spine. We used Poisson models to estimate the independent association of kyphosis with incident fracture, controlling for age and femoral neck BMD. RESULTS Mean baseline kyphosis was 48° (SD = 12) (range 7-83). At baseline, 962 (32%) participants had a prevalent fracture. There were 221 incident fractures over a median of 4 years. At baseline, prevalent fracture was associated with 3.7° greater average kyphosis (95% CI 2.8-4.6, p < 0.0005), adjusting for age and femoral neck BMD. Before adjusting for prevalent fracture, each 10° greater kyphosis was associated with 22% increase (95% CI 8-38%, p = 0.001) in annualized rate of new radiographic vertebral fracture, adjusting for age and femoral neck BMD. After additional adjustment for prevalent fracture, estimated increased annualized rate was attenuated and no longer significant, 8% per 10° kyphosis (95% CI -4 to 22%, p = 0.18). CONCLUSIONS While greater kyphosis increased the rate of incident vertebral fractures, our analysis does not show an independent association of kyphosis on incident fracture, after adjustment for prevalent vertebral fracture. Excessive kyphosis may still be a clinical marker for prevalent vertebral fracture.
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Affiliation(s)
- W B Katzman
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of California, 1500 Owens Suite 400, San Francisco, CA, 94158, USA.
| | - E Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - D M Kado
- Departments of Family and Preventive Medicine and Internal Medicine, University of California, San Diego, USA
- Department of Internal Medicine, University of California, Davis, USA
| | - N E Lane
- Department of Internal Medicine, University of California, Davis, USA
| | - K E Ensrud
- Minneapolis VA Health Care System, University of Minnesota, Minneapolis, USA
| | - K Shipp
- Division of Physical Therapy, Department of Community and Family Medicine, Duke University, Durham, USA
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25
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Zhou C, Wang H, Zou Y, Fang H. [RESEARCH PROGRESS OF ROLE OF ESTROGEN AND ESTROGEN RECEPTOR ON ONSET AND PROGRESSION OF ADOLESCENT IDIOPATHIC SCOLIOSIS]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2015; 29:1441-1445. [PMID: 26875282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To review the recent progress in research on the role of estrogen and estrogen receptor on the onset and progression of adolescent idiopathic scoliosis (AIS). METHODS The recently published clinical and experimental literature at home and abroad on abnormality of estrogen and its receptor in AIS was reviewed and summarized. RESULTS There are many abnormal changes of estrogen and estrogen receptor in most AIS patients, including higher serum estrogen concentration, unusual cellular response to estrogen, late age at menarche, and gene polymorphisms of estrogen receptor, which are closely associated with AIS predisposition, curve severity, and scoliosis progression. CONCLUSION Estrogen and its receptor participate in the onset and progression of AIS by certain mechanisms, but exact mechanism remains indefinite, which needs further research to better define the role of estrogen and its receptor in AIS.
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Bertulli CG, Galatius A, Kinze CC, Rasmussen MH, Deaville R, Jepson P, Vedder EJ, Sánchez Contreras GJ, Sabin RC, Watson A. Vertebral column deformities in white-beaked dolphins from the eastern North Atlantic. Dis Aquat Organ 2015; 116:59-67. [PMID: 26378408 DOI: 10.3354/dao02904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Five white-beaked dolphins Lagenorhynchus albirostris with outwardly vertebral kyphosis, kyphoscoliosis or lordosis were identified during a photo-identification survey of over 400 individuals (2002-2013) in Faxaflói and Skjálfandi Bays, Iceland. In addition, 3 stranding reports from Denmark, The Netherlands and the UK were analysed, providing both external observation and post mortem details of axial deviations of the vertebral column in this species. Two of the free-ranging cases and 2 of the stranded specimens appeared to have an acquired disease, either as a direct result of trauma, or indirectly from trauma/wound and subsequent infection and bony proliferation, although we were unable to specifically identify the causes. Our data represent a starting point to understand vertebral column deformations and their implications in white-beaked dolphins from the eastern North Atlantic. We recommend for future necropsy cases to conduct macro- and microscopic evaluation of muscle from both sides of the deformed region, in order to assess chronic or acute conditions related to the vertebral deformations and cause of death.
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Affiliation(s)
- Chiara G Bertulli
- Department of Life and Environmental Sciences, University of Iceland, Sturlugata 7, 101 Reykjavik, Iceland
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27
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Sheng-yun L, Letu S, Jian C, Mamuti M, Jun-hui L, Zhi S, Chong-yan W, Shunwu F, Zhao F. Comparison of modic changes in the lumbar and cervical spine, in 3167 patients with and without spinal pain. PLoS One 2014; 9:e114993. [PMID: 25506944 PMCID: PMC4266639 DOI: 10.1371/journal.pone.0114993] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 11/17/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND CONTEXT There are few comparisons of Modic changes (MCs) in the lumbar and cervical spine. PURPOSE Compare the prevalence of MCs in the lumbar and cervical spine, and determine how MC prevalence depends on spinal pain, age, disc degeneration, spinal level, and the presence or absence of kyphosis. STUDY DESIGN Retrospective clinical survey. MATERIALS AND METHODS Magnetic resonance images (MRIs) were compared from five patient groups: 1. 1223 patients with low-back pain/radiculopathy only; 2. 1023 patients with neck pain/radiculopathy only; 3. 497 patients with concurrent low-back and neck symptoms; 4. 304 asymptomatic subjects with lumbar MRIs; and 5. 120 asymptomatic subjects with cervical MRIs. RESULTS The prevalence of MCs was higher in those with spinal pain than in those without, both in the lumbar spine (21.0% vs 10.5%) and cervical spine (8.8% vs 3.3%). Type II MCs were most common and Type III were least common in all groups. The prevalence of lumbar MCs in people with back pain was little affected by the presence of concurrent neck pain, and the same was true for the prevalence of cervical MCs in people with neck pain with or without concurrent back pain. When symptomatic patients were reclassified into two groups (back pain, neck pain), the prevalence of lumbar MCs in people with back pain was greater than that of cervical MCs in people with neck pain. The prevalence of lumbar and cervical MCs increased with age, disc degeneration, (descending) spinal level, and increased kyphosis. CONCLUSIONS There is a significantly higher prevalence of MCs in patients with back and neck pain. The reported association with increased kyphosis (flat back) is novel.
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Affiliation(s)
- Li Sheng-yun
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, P.R. China
| | - Suyou Letu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, P.R. China
| | - Chen Jian
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, P.R. China
| | - Maiwulanjiang Mamuti
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, P.R. China
| | - Liu Jun-hui
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, P.R. China
| | - Shan Zhi
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, P.R. China
| | - Wang Chong-yan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, P.R. China
| | - Fan Shunwu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, P.R. China
| | - Fengdong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, P.R. China
- * E-mail:
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Morita D. Answer to the letter to the editor of J. Padulo et al. concerning "range of motion of thoracic spine in sagittal plane" by D. Morita et al. Eur Spine J (2014) 23:673-678. Eur Spine J 2014; 23:1578. [PMID: 24828959 DOI: 10.1007/s00586-014-3361-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 04/26/2014] [Accepted: 04/26/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Daigo Morita
- Department of Orthopaedic Surgery, Hamamatsu Medical Center, 328 Tomitsuka-cho, Naka-ku, Hamamatsu, Shizuoka, 432-8580, Japan,
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29
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Juneja SC, Vonica A, Zeiss C, Lezon-Geyda K, Yatsula B, Sell DR, Monnier VM, Lin S, Ardito T, Eyre D, Reynolds D, Yao Z, Awad HA, Yu H, Wilson M, Honnons S, Boyce BF, Xing L, Zhang Y, Perkins AS. Deletion of Mecom in mouse results in early-onset spinal deformity and osteopenia. Bone 2014; 60:148-61. [PMID: 24316420 PMCID: PMC4440591 DOI: 10.1016/j.bone.2013.11.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 11/13/2013] [Accepted: 11/20/2013] [Indexed: 02/04/2023]
Abstract
Recent studies have indicated a role for a MECOM allele in susceptibility to osteoporotic fractures in humans. We have generated a mutation in Mecom in mouse (termed ME(m1)) via lacZ knock-in into the upstream transcription start site for the gene, resulting in disruption of Mds1 and Mds1-Evi1 transcripts, but not of Evi1 transcripts. We demonstrate that ME(m1/m1) mice have severe kyphoscoliosis that is reminiscent of human congenital or primary kyphoscoliosis. ME(m1/m1) mice appear normal at birth, but by 2weeks, they exhibit a slight lumbar lordosis and narrowed intervertebral space. This progresses to severe lordosis with disc collapse and synostosis, together with kyphoscoliosis. Bone formation and strength testing show that ME(m1/m1) mice have normal bone formation and composition but are osteopenic. While endochondral bone development is normal, it is markedly dysplastic in its organization. Electron micrographs of the 1week postnatal intervertebral discs reveals marked disarray of collagen fibers, consistent with an inherent weakness in the non-osseous connective tissue associated with the spine. These findings indicate that lack of ME leads to a complex defect in both osseous and non-osseous musculoskeletal tissues, including a marked vertebral osteopenia, degeneration of the IVD, and disarray of connective tissues, which is likely due to an inherent inability to establish and/or maintain components of these tissues.
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Affiliation(s)
- Subhash C Juneja
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, USA; Department of Orthopedics, University of Rochester Medical Center, USA; Department of Biomedical Engineering, University of Rochester Medical Center, USA.
| | - Alin Vonica
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, USA.
| | | | | | | | | | | | - Sharon Lin
- Department of Pathology, Yale University, USA.
| | | | | | - David Reynolds
- Department of Orthopedics, University of Rochester Medical Center, USA.
| | - Zhenqiang Yao
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, USA.
| | - Hani A Awad
- Department of Orthopedics, University of Rochester Medical Center, USA; Department of Biomedical Engineering, University of Rochester Medical Center, USA.
| | - Hongbo Yu
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, USA.
| | - Michael Wilson
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, USA.
| | - Sylvie Honnons
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, USA.
| | - Brendan F Boyce
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, USA.
| | - Lianping Xing
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, USA.
| | - Yi Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, USA.
| | - Archibald S Perkins
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, USA.
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Park JH, Kang KC, Shin DE, Koh YG, Son JS, Kim BH. Preventive effects of conservative treatment with short-term teriparatide on the progression of vertebral body collapse after osteoporotic vertebral compression fracture. Osteoporos Int 2014; 25:613-8. [PMID: 23943161 DOI: 10.1007/s00198-013-2458-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 07/02/2013] [Indexed: 12/26/2022]
Abstract
UNLABELLED The progression of fractured vertebral collapse is not rare after a conservative treatment of vertebral compression fracture (VCF). Teriparatide has been shown to directly stimulate bone formation and improve bone density, but there is a lack of evidence regarding its use in fracture management. Conservative treatment with short-term teriparatide is effective for decreasing the progression of fractured vertebral body collapse. INTRODUCTION Few studies have reported on the prevention of collapsed vertebral body progression after osteoporotic VCF. Teriparatide rapidly enhances bone formation and increases bone strength. This study evaluated preventive effects of short-term teriparatide on the progression of vertebral body collapse after osteoporotic VCF. METHODS Radiographs of 68 women with single-level osteoporotic VCF at thoracolumbar junction (T11-L2) were reviewed. Among them, 32 patients were treated conservatively with teriparatide (minimum 3 months) (group I), and 36 were treated with antiresorptive (group II). We measured kyphosis and wedge angle of the fractured vertebral body, and ratios of anterior, middle, and posterior heights of the collapsed body to posterior height of a normal upper vertebra were determined. The degree of collapse progression was compared between two groups. RESULTS The progression of fractured vertebral body collapse was shown in both groups, but the degree of progression was significantly lower in group I than in group II. At the last follow-up, mean increments of kyphosis and wedge angle were significantly lower in group I (4.0° ± 4.2° and 3.6° ± 3.6°) than in group II (6.8° ± 4.1° and 5.8° ± 3.5°) (p = 0.032 and p = 0.037). Decrement percentages of anterior and middle border height were significantly lower in group I (9.6 ± 10.3 and 7.4 ± 7.5 %) than in group II (18.1 ± 9.7 and 13.8 ± 12.2 %) (p = 0.001 and p = 0.025), but not in posterior height (p = 0.086). CONCLUSIONS In female patients with single-level osteoporotic VCF at the thoracolumbar junction, short-term teriparatide treatment did not prevent but did decrease the progression of fractured vertebral body collapse.
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Affiliation(s)
- J-H Park
- Department of Neurological Surgery, Yonsei Sarang Hospital, 478-3, Bangbae-dong, Seocho-gu, Seoul, Republic of Korea
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MacIntyre NJ, Lorbergs AL, Adachi JD. Inclinometer-based measures of standing posture in older adults with low bone mass are reliable and associated with self-reported, but not performance-based, physical function. Osteoporos Int 2014; 25:721-8. [PMID: 23974857 DOI: 10.1007/s00198-013-2484-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 07/24/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED The association between posture and physical function during daily activities in people at risk for osteoporotic fracture is not clear. We report the reliability of measuring posture using the digital inclinometer and how these measures relate to performance-based and self-reported physical function. INTRODUCTION This study aims to determine the reliability of a simple clinical method for assessing spine curvatures in people with low bone mass and the association between spine curvature measures and pain, physical function (mobility/activities of daily living (ADL)) and quality of life. METHODS One rater assessed 36 high-functioning adults, aged 52-82 years, attending an outpatient osteoporosis clinic. A digital inclinometer was used to measure lumbosacral angle (S), lumbar standing posture (L), and thoracic standing posture (T) and ADL performance was assessed using the short form of the Safe Functional Motion test (SFM-6), on two occasions approximately 8.7 days apart. Participants reported average pain intensity over the past week and completed the Timed Up and Go test (TUGT) and the mini-Osteoporosis Quality of Life questionnaire (mini-OQLQ). Acceptable reliability was determined using the intraclass correlation coefficient (ICC). Associations were determined using Pearson's correlation coefficients (r) (and Spearman's rho (r s), for non-normal data). RESULTS ICC (95 % CI) for S, L, and T = 0.91 (0.82, 0.95), 0.90 (0.82, 0.95), and 0.91 (0.84, 0.95), respectively, for test-retest reliability. Thoracic standing posture was associated with the ADL domain of the mini-OQLQ (r s = -0.39) and the TUGT (r = 0.42). Standing posture was not related to pain or total SFM-6 score. CONCLUSIONS Digital inclinometer measures provide a quick highly reliable, valid, direct assessment of kyphosis. Use of these measures in the clinical setting is expected to facilitate identification and effective management of postural impairments (e.g., trunk extensor muscle weakness, vertebral fracture) associated with osteoporosis.
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Affiliation(s)
- N J MacIntyre
- School of Rehabilitation Science, McMaster University, IAHS-403 1400 Main St. West, Hamilton, ON, Canada, L8S 1C7,
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Hui H, Zhang ZX, Yang TM, He BR, Hao DJ. Vertebral column resection for complex congenital kyphoscoliosis and type I split spinal cord malformation. Eur Spine J 2013; 23:1158-63. [PMID: 24232596 DOI: 10.1007/s00586-013-3044-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 09/12/2013] [Accepted: 09/24/2013] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Congenital progressive kyphoscoliosis associated with split spinal cord malformation (SSCM) is a very rare disease. METHODS AND RESULTS Here, we present the case of a 23-year-old woman who was found kyphoscoliosis when she was 10 years old and developed rapidly. Thereafter, no management was proposed before her consultation at our center. On examination, numbness was found in the right low limbs, kyphoscoliosis was detected in thoracolumbar, the trunk deviated to the right on standing view and curvature of the thoracolumbar spine was left-sided, the left rib hump was severe and there was little muscle tissue felt under the right side paravertebral area, the pelvis was oblique with the right side higher than the left side, the right arcus costarum was 5 cm below the right iliac crest. One-stage corrective surgery was determined, at first, halo-wheelchair traction gradually with increased traction weights out of hospital for a month; then, after a reasonable correction achieved without any neurological deficits. The one-stage operation was taken through single posterior segmental pedicle screw instrumented fusion with VCR between T12 and L1. Post-operative recovery was uneventful and there were no complications, she was discharged 10 days post operation. At 2 years follow-up, the patient's outcome is excellent with balance and correction of the deformity. CONCLUSION Based on the Grand Round case and relevant literature, we discuss the different options for the treatment of congenital kyphoscoliosis associated with type I SSCM. In the patient whose kyphoscoliosis is severe and rigid, we recommend an initial release followed by halo-wheelchair traction gradually to correct the deformity, once optimal correction acquires during the traction, the posterior instrumented fusion with VCR upper the bony spur could be done safely without the resection of bony spur.
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Yang X, Kong Q, Song Y, Liu L, Zeng J, Xing R. The characteristics of spinopelvic sagittal alignment in patients with lumbar disc degenerative diseases. Eur Spine J 2013; 23:569-75. [PMID: 24142044 DOI: 10.1007/s00586-013-3067-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 09/24/2013] [Accepted: 10/09/2013] [Indexed: 02/05/2023]
Abstract
PURPOSE A comparative study of the spinopelvic sagittal alignment in patients with lumbar disc degeneration or herniation (LDD/LDH) in normal population was designed to analyse the role of sagittal anatomical parameter (pelvic incidence, PI) and positional parameters in the pathogenesis and development of the disease. Several comparative studies of these patients with asymptomatic controls have been done. However, in previous studies without lumbar MRI, a certain number of asymptomatic LDD patients should have been included in the control group and then impacted on the results. METHODS Based on MRI findings, we divided 60 LDD or LDH patients and 110 asymptomatic volunteers into the normal group (NG) and the degeneration group (DG), which was further subdivided into the symptomatic (SDG) and asymptomatic (ADG) subgroups according to patients' symptoms. Standing full spine radiographs were used to measure sagittal parameters, including PI, sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), sagittal vertical axis (SVA), and sacrum-bicoxofemoral distance (SFD). RESULTS The PI, SS and LL in DG were significantly lower than NG, while the SVA and SFD were significantly greater (P < 0.05). PI correlated well with the SS and LL in all subjects. However, the trend lines of SS or LL over PI were downward in DG. PI was similar in SDG and ADG (P = 0.716) but SS and LL were significantly lower and SVA was significantly greater (P < 0.05). CONCLUSIONS PI may play a predisposing role in the pathogenesis of lumbar disc degenerative diseases. The secondary structural and compensatory factors would lead to a straighter spine after disc degenerative change.
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Affiliation(s)
- Xi Yang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China,
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La Rosa G, Giglio G, Oggiano L. The Universal Clamp hybrid system: a safe technique to correct deformity and restore kyphosis in adolescent idiopathic scoliosis. Eur Spine J 2013; 22 Suppl 6:S823-8. [PMID: 24052403 DOI: 10.1007/s00586-013-3014-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 09/08/2013] [Accepted: 09/08/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Adolescent idiopathic scoliosis (AIS) is a tridimensional deformity characterized by coronal and sagittal profiles changes. We present a series of 62 patients affected by AIS and treated by thoracic Universal Clamps and transpedicular lumbar screws hybrid system. METHODS Mean age was 13 years. Average pre-operative Cobb angle was 63° ± 12°. Patients were divided into two groups depending on the kyphosis angle: lower than 45° (51 patients, 82.3 %, mean 21° ± 3°) and higher than 45° (11 patients, 17.7 %, mean 62° ± 6°). RESULTS The average percentage of coronal correction was 70 ± 3 % (mean post-operative Cobb angle 19° ± 4°, P < 0.001). In patients with pre-operative physiological thoracic kyphosis-hypokyphosis, we observed an increase in the average value (32° ± 4°, P < 0.001), while in patients with pre-operative hyperkyphosis, mean decrease of thoracic kyphosis was 19° ± 3° (43° ± 4°, P < 0.001). CONCLUSIONS This case-series study showed the efficacy and safety of Universal Clamp hybrid system in correcting coronal deformity and restoring physiological thoracic kyphosis in patients affected by AIS.
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Affiliation(s)
- Guido La Rosa
- Orthopedic Unit, Department of Surgery and Transplant Center, Bambino Gesù Children's Hospital, IRCCS, Palidoro (Rome), Via Torre di Palidoro snc, 00050, Fiumicino (Rome), Italy,
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Pavlovic A, Nichols DL, Sanborn CF, Dimarco NM. Relationship of thoracic kyphosis and lumbar lordosis to bone mineral density in women. Osteoporos Int 2013; 24:2269-73. [PMID: 23400251 DOI: 10.1007/s00198-013-2296-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 01/03/2013] [Indexed: 10/27/2022]
Abstract
UNLABELLED The relationship between spinal curvature and bone mineral density (BMD) in women was examined. Significant relationships were observed between spinal curvature and BMD in both pre- and postmenopausal women. Excessive spinal curvature may be associated with low bone mass in premenopausal women. INTRODUCTION The purpose of this study was to examine the associations between spinal measurements of thoracic and lumbar curvatures and bone mineral density in pre- and postmenopausal women. METHODS The data for this study were obtained from the Texas Woman's University Pioneer Project. Female participants (n = 242; premenopausal n = 104, postmenopausal n = 138) between the ages of 18 and 60 years were evaluated on multiple health measures. Thoracic and lumbar curvatures were measured with a 24-in. (60 cm) flexicurve. Bone mineral density was assessed via dual-energy X-ray absorptiometry (Lunar DPX IQ, version 4.6e). Pearson correlations and logistic regression analysis were used to examine the associations between the obtained spinal curvature measurements and bone mineral density. Significance was set at p < .05. RESULTS Significant correlations were observed for the femoral neck and lumbar spine bone mineral density with thoracic and lumbar curve in premenopausal women (r = -.344 to - .525; p < .001). Slightly weaker, but significant, correlations were observed for femoral neck and lumbar spine in relation to thoracic and lumbar curve in postmenopausal women (r = -.288 to -.397; p < .01). Premenopausal women with thoracic curvature greater than 4 cm had a greater risk of having low bone mass compared to premenopausal women with less than 4 cm of curvature (odds ratio = 3.982, 95 % CI = 1.206, 13.144). CONCLUSIONS The observed negative relationship suggests that as either thoracic or lumbar curvature increases, the regional bone mineral density decreases in both pre- and postmenopausal women.
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Affiliation(s)
- A Pavlovic
- Department of Kinesiology and Institute for Women's Health, Texas Woman's University, Denton, TX, USA.
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Xue XH, Shen JX, Liu JM, Zhang JG, Zhao H, Li SG, Zhao Y, Zhao LJ, Wang YP, Qiu GX. [Analysis of ribs and intraspinal anomalies in congenital scoliosis]. Zhonghua Wai Ke Za Zhi 2013; 51:732-736. [PMID: 24252682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate the incidences and characteristics of the ribs and intraspinal abnormalities in surgical patients with congenital scoliosis. METHODS We conducted a retrospective study of the medical records and spine radiographs of 118 patients underwent surgical treatment between January 2010 and March 2011 with congenital scoliosis. The average age was 14 years (3-50 years).Fifty-two were male and 66 were female patients. The rib and intraspinal abnormalities were compared in different vertebral anomalies. Pearson's χ(2) test were used to analyze the incidence of anomalies of the ribs and vertebrae, as well as intraspinal anomalies. RESULTS A total of 57 (48.3%) patients were found to have intraspinal abnormalities.Split cord deformities were identified to be the most common intraspinal anomaly (32.2%), followed by syringomyelia (21.2%).Sixty-nine patients (58.5%) had rib anomalies, which occurring on the concavity of the scoliosis was most frequent. The patients with mixed deformity and failure of segment were found to have a higher incidence of rib anomaly than those with failure formation (χ(2) = 14.05, P < 0.01). The patients with multiple level malformations were found to have significantly higher incidence of rib anomaly than those with single level malformation (χ(2) = 27.50, P < 0.01).Intraspinal anomalies occurred in 42 of 69 patients (60.9%) with rib anomalies and 15 of 49 patients (30.6%) without rib anomalies in congenital scoliosis. The occurrence of intraspinal malformation has significant difference with or without rib anomalies in congenital scoliosis (χ(2) = 10.5, P < 0.01). CONCLUSIONS The intraspinal malformation is common in patients with mixed defects and failures of segmentation. The rib anomalies occurring on the concavity of the scoliosis is most frequent. The incidence of intraspinal anomaly is significant higher in the patients with rib anomalies than those without rib anomalies. Both the occurrence and type of rib anomaly, combined with vertebral deformity are helpful in forecasting the occurrence of intraspinal abnormalis.
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Affiliation(s)
- Xu-hong Xue
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing 100730, China
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Krause M, Breer S, Mohrmann B, Vettorazzi E, Marshall RP, Amling M, Barvencik F. Influence of non-traumatic thoracic and lumbar vertebral fractures on sagittal spine alignment assessed by radiation-free spinometry. Osteoporos Int 2013; 24:1859-68. [PMID: 23064371 DOI: 10.1007/s00198-012-2156-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 09/20/2012] [Indexed: 12/01/2022]
Abstract
UNLABELLED Due to missing indications for specific diagnostics, the majority of non-symptomatic vertebral fractures are not diagnosed. This study shows the ability of radiation-free spinometry to assess sagittal spine parameters to raise suspicion for new non-traumatic thoracic and lumbar vertebral fractures and indicate specific diagnostics. INTRODUCTION The primary aim of this study was to investigate the accuracy of radiation-free spinometry to predict new non-traumatic vertebral fractures (VF) by the assessment of thoracic kyphosis (TK), lumbar lordosis (LL), and trunk inclination. METHODS Three hundred sixty-one patients (278 females and 83 males; age, 67.0 ± 8.6 years) were enrolled. In 86 women and 24 men, at least one non-traumatic VF was confirmed by radiography, MRI, and/or CT. Spinometry (video rasterstereography) was used to assess TK, LL, and trunk inclination. Receiver operating characteristic (ROC) and multivariate logistic regression analyses were performed to test the influence of age, sex, number, location, and grade of fractures on sagittal spine alignment. RESULTS TK, LL, and trunk inclination were associated with advancing age (p < 0.05). Patients with prevalent thoracic and lumbar VFs showed increased TK (p < 0.001), decreased LL (p < 0.001), and increased trunk inclination (p < 0.001) in comparison to patients without VFs. ROC analysis revealed that the combination of TK and LL presented with the best predictive accuracy to raise suspicion for new grade 2 or grade 3 VFs in the thoracic and the lumbar spine (AUC, 0.752-0.771). Odds ratio (OR) showed an increased risk for VFs with increased TK (OR, 1.05-1.11; p < 0.001) and LL (1.05-1.07; p < 0.001) in specified regions of interest. A TK <50° (sensitivity, 88-100 %; specificity, 23-25 %) and LL (78-92 %; 24-27 %) were considered as appropriate cutoffs for future screening. CONCLUSION Spinometry showed better predictive accuracy than historical height loss. Severe changes of TK and LL may help to raise suspicion of new VFs radiation-free and indicate proper diagnostics, such as radiographs, MRI, or CT.
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Affiliation(s)
- M Krause
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529 Hamburg, Germany
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Kong D, Zheng T, Fang J, Li X. Apoptosis of endplate chondrocytes in post-laminectomy cervical kyphotic deformity. An in vivo animal model in sheep. Eur Spine J 2013; 22:1576-82. [PMID: 23645228 DOI: 10.1007/s00586-013-2811-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 04/21/2013] [Accepted: 04/28/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE The present study was performed to establish an animal model of cervical kyphosis after laminectomy (C2-C5), and to determine the role of endplate chondrocytes apoptosis in cervical kyphosis after laminectomy. METHODS Twenty-four 3-month-old sheep were randomly divided into two groups: the laminectomy group (n = 12), and the control group (n = 12). The cervical spine alignment was evaluated on a lateral cervical spine X-ray using Harrison's posterior tangent method before surgery and at follow-up. Cartilaginous endplate chondrocyte apoptosis was confirmed using transmission electron microscopy and terminal deoxyribonucleotidyl transferase (TdT)-mediated dUTP nick-end labelling. RESULTS The mean preoperative cervical curvature (C2-5) in the surgery group was -15.8°. The cervical curvature was 19.1° at 3 months post-operation and decreased to 20.2° at the final follow-up postoperatively. The cervical curvature was significantly decreased in the laminectomy group compared with the control group at the last follow-up (P < 0.001), which was a direct indication of kyphotic change. The incidence of apoptotic cells in the surgery group was significantly higher at the 3- and 6-month follow-up than the incidence in the control group. CONCLUSIONS The frequency of endplate chondrocyte apoptosis in the laminectomy group was significantly higher than in the control group, indicating that chondrocyte apoptosis may play a pivotal role in the progress of post-laminectomy cervical kyphosis.
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Affiliation(s)
- Dechao Kong
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
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Abstract
UNLABELLED We prospectively investigated related clinical and radiological risk factors for progression following acute osteoporotic spinal fractures. Fracture location, morphological feature (mid-portion), and involvement of vertebral posterior wall were statistical significant risk factors considering increase of height loss and kyphotic angle, and occurrence of intravertebral cleft sign as a progressive collapse. INTRODUCTION This study was designed to investigate the clinical and radiological risk factors related to progressive collapse of acute osteoporotic spinal fractures (OSF). METHODS In total, 100 patients with acute OSF were prospectively enrolled at a single institute. Five pathological fractures were excluded. Twelve patients dropped out of the study because of conversion to surgical treatment during follow-up. Eight patients were excluded as follow-up losses. Thus, 75 patients were analyzed. Clinical data and radiological data were recorded and analyzed. As a definition of progressive OSF, height loss≥15%, kyphotic angle≥10°, and the occurrence of an intravertebral cleft sign at the 6-month follow-up compared to the initial values were adopted. Correlation analysis and multiple logistic regression analyses were performed to elucidate the related clinical or radiological factors for progressive OSF. RESULTS The occurrence of intravertebral cleft was not related to any significant differences in the clinical results and was only related to the fracture level in the regression analysis. A ≥15% increase in height loss and a ≥10° increase in kyphotic angle were related to worse clinical results. Mid-portion type fractures and involvement of the posterior wall were significant risk factors with relatively high odds ratios for progressive OSF under these criteria. CONCLUSION A thoracolumbar fracture, a mid-portion type fracture, and involvement of the vertebral posterior wall are relative risk factors for progressive collapse following acute OSF. More attention should be paid to patients with OSF and these risk factors during conservative management.
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Affiliation(s)
- K Y Ha
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 137-701, South Korea
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Kim HJ, Lenke LG, Shaffrey CI, Van Alstyne EM, Skelly AC. Proximal junctional kyphosis as a distinct form of adjacent segment pathology after spinal deformity surgery: a systematic review. Spine (Phila Pa 1976) 2012; 37:S144-64. [PMID: 22885829 DOI: 10.1097/brs.0b013e31826d611b] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To review the literature on proximal junctional kyphosis (PJK) as a specific form for proximal adjacent segment pathology and report on the incidence, timing, risk factors, and effect on health-related quality of life (HRQOL) outcomes reported for PJK. SUMMARY OF BACKGROUND DATA PJK is a complication of spinal deformity surgery that can compromise outcomes and necessitate revision surgery. Multiple risk factors have been associated with PJK, making the etiology multifactorial. Knowledge of the risk factors is important for minimizing the occurrence of PJK and to allow surgeons to take measures for its prevention when possible. METHODS A systematic search of PubMed, CINAHL, EMBASE, the Cochrane Library, and Google Scholar through February 15, 2012, was performed. The focus was on studies designed to evaluate PJK in patients who had surgery for scoliosis and/or kyphosis. Adjusted effect sizes and significance based on adjusting for confounders were reported if available, otherwise, crude risk ratios and 95% confidence intervals were calculated. RESULTS The search yielded 85 citations and 8 met the criteria for inclusion. The incidence of PJK ranged from 17% to 39% and the majority seemed to occur within 2 years of surgery. The most common patient demographic associated with a higher PJK risk was increased age. Surgery-related risk factors were fusions to the sacrum, combined anterior/posterior surgery, thoracoplasty, and upper instrumented vertebra at T1-T3. Postoperative hypokyphosis or hyperkyphosis was associated with an increased risk of PJK. Despite the presence of PJK, health-related quality of life outcomes were not affected. CONCLUSION Patients at higher risk for PJK are those who are of older age, who had fusions to the sacrum, combined anterior/posterior surgery, thoracoplasty, and an upper instrumented vertebra at T1-T3. Despite the presence of PJK, no differences were noted in health-related quality of life outcomes. CONSENSUS STATEMENT 1. The risk of developing PJK above a spinal deformity fusion is 17% to 39%, with most noted by 2 years postoperative. LEVEL OF EVIDENCE Moderate. Strength of Statement: Strong. 2. The risk factors of PJK development include increased age, fusion to sacrum, combined ASF/PSF, thoracoplasty, UIV at T1–T3, and nonanatomic restoration of thoracic kyphosis. LEVEL OF EVIDENCE Low. Strength of Statement: Weak. 3. The development of PJK does not seem to have a detrimental effect on HRQOL outcomes, at least in milder/nonrevision forms. LEVEL OF EVIDENCE Moderate. Strength of Statement: Weak.
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Affiliation(s)
- Han Jo Kim
- Hospital for Special Surgery, New York, NY, USA
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Hansen MA, Kim HJ, Van Alstyne EM, Skelly AC, Fehlings MG. Does postsurgical cervical deformity affect the risk of cervical adjacent segment pathology? A systematic review. Spine (Phila Pa 1976) 2012; 37:S75-84. [PMID: 22885832 DOI: 10.1097/brs.0b013e31826d62a6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To assess whether the presence or magnitude of postsurgical malalignment in the coronal (scoliosis) or sagittal plane (kyphosis/spondylolisthesis) affects the risk of cervical adjacent segment pathology (ASP). SUMMARY OF BACKGROUND DATA ASP occurs in selected patients who have undergone surgical treatment for cervical spondylosis. The reasons are multifactorial; however, postsurgical alignment may play a key role. To elucidate this issue, a systematic review of the literature was undertaken. METHODS A systematic search in PubMed was conducted for literature published in English language through February 15, 2012. Studies in adults, designed to evaluate postsurgical sagittal or coronal malalignment as risk factors for radiographical or clinical ASP, were sought. Studies of pediatric or oncological patients were excluded. Case reports, case series, and patient populations of less than 10 patients were also excluded. Unadjusted risk ratios (RRs) and 95% confidence intervals were calculated to evaluate the association between alignment and the risk for developing ASP. RESULTS The search yielded 338 citations. Of that, 311 were excluded at the title and abstract level. Of the 27 selected for full-text review, 5 poor-quality retrospective studies met the inclusion criteria and described sagittal imbalance measures as risk factors for radiological ASP after anterior surgery. No studies examined ASP after posterior cervical surgery. Three studies provided data from which unadjusted RRs and 95% confidence intervals could be calculated. These studies showed an increased risk of ASP associated with malalignment (RR, 2.24 [95% confidence interval, 1.40-3.56]; RR, 2.40 [1.33, 4.33]; RR, 1.32 [0.96, 1.81]). No study evaluating coronal imbalance as a risk factor for cervical ASP was found and none reported on clinical ASP. CONCLUSION There is low-grade evidence from 3 published studies that postsurgical sagittal imbalance may increase the risk for cervical radiological ASP. CONSENSUS STATEMENT An attempt should be made to maintain or restore cervical lordosis in surgical intervention for cervical disorders. Strength of Statement: Weak.
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Affiliation(s)
- Mitchell A Hansen
- Krembil Neuroscience Center, Spinal Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Robledo RF, Seburn KL, Nicholson A, Peters LL. Strain-specific hyperkyphosis and megaesophagus in Add1 null mice. Genesis 2012; 50:882-91. [PMID: 22926980 DOI: 10.1002/dvg.22342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 08/02/2012] [Accepted: 08/16/2012] [Indexed: 11/08/2022]
Abstract
The three adducin proteins (α, β, and γ) share extensive sequence, structural, and functional homology. Heterodimers of α- and β-adducin are vital components of the red cell membrane skeleton, which is required to maintain red cell elasticity and structural integrity. In addition to anemia, targeted deletion of the α-adducin gene (Add1) reveals unexpected, strain-dependent non-erythroid phenotypes. On an inbred 129 genetic background, Add1 null mice show abnormal inward curvature of the cervicothoracic spine with complete penetrance. More surprisingly, a subset of 129-Add1 null mice develop severe megaesophagus, while examination of peripheral nerves reveals a reduced number of axons in 129-Add1 null mice at four months of age. These unforeseen phenotypes, described here, reveal new functions for adducin and provide new models of mammalian disease.
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Alfieri A, Gazzeri R, Prell J, Scheller C, Rachinger J, Strauss C, Schwarz A. Role of lumbar interspinous distraction on the neural elements. Neurosurg Rev 2012; 35:477-84; discussion 484. [PMID: 22549123 DOI: 10.1007/s10143-012-0394-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 09/03/2011] [Accepted: 03/01/2012] [Indexed: 12/19/2022]
Abstract
The interspinous distraction devices are used to treat variable pathologies ranging from facet syndrome, diskogenic low back pain, degenerative spinal stenosis, diskopathy, spondylolisthesis, and instability. The insertion of a posterior element with an interspinous device (ISD) is commonly judged responsive to a relative kyphosis of a lumbar segment with a moderate but persistent increase of the spinal canal and of the foraminal width and area, and without influence on low-grade spondylolisthesis. The consequence is the need of shared specific biomechanical concepts to give for each degenerative problem the right indication through a critical analysis of all available experimental and clinical biomechanical data. We reviewed systematically the available clinical and experimental data about kyphosis, enlargement of the spinal canal, distraction of the interspinous distance, increase of the neural foramina, ligamentous structures, load of the posterior annulus, intradiskal pressure, strength of the spinous processes, degeneration of the adjacent segment, complications, and cost-effectiveness of the ISD. The existing literature does not provide actual scientific evidence over the superiority of the ISD strategy, but most of the experimental and clinical data show a challenging potential. These considerations are applicable with different types of ISD with only few differences between the different categories. Despite--or because of--the low invasiveness of the surgical implantation of the ISD, this technique promises to play a major role in the future degenerative lumbar microsurgery. The main indications for ISD remain lumbar spinal stenoses and painful facet arthroses. A clear documented contraindication is the presence of an anterolisthesis. Nevertheless, the existing literature does not provide evidence of superiority of outcome and cost-effectiveness of the ISD strategy over laminectomy or other surgical procedures. At this time, the devices should be used in clinical randomized independent trials in order to obtain more information concerning the most advantageous optimal indication or, in selected cases, to treat tailored indications.
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Affiliation(s)
- Alex Alfieri
- Department of Neurosurgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
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Zhou J, Peng J, Yang B, Niu J, Chen Z, Wang X, Li J, Ma H. [Effectiveness comparison between pedicle subtraction osteotomy and non-osteotomy techniques in treatment of medium-to-severe kyphoscoliosis]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2012; 26:406-410. [PMID: 22568317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of pedicle subtraction osteotomy (PSO) and non-osteotomy techniques in treatment of medium-to-severe kyphoscoliosis by retrospective studies. METHODS Between January 2005 and January 2009, 99 patients with medium-to-severe kyphoscoliosis were treated by PSO (PSO group, n = 46) and non-osteotomy technique (non-osteotomy group, n = 53) separately. There was no significant difference in sex, age, Cobb angle of scoliosis on coronal plane, and Cobb angle of kyphosis on saggital plane between 2 groups (P > 0.05). The operation time and blood loss were recorded; the Cobb angle of scoliosis on coronal plane and kyphosis on sagittal plane were measured at pre- and postoperation to caculate the rates of correction on both planes. RESULTS The operation was successfully completed in all the patients. The operation time and blood loss of the patients in PSO group were significantly greater than those of the patients in non-osteotomy group (P < 0.05). All patients were followed up 12-56 months (mean, 22.4 months); no spinal cord injury occurred, and bone fusion was achieved at last follow-up. The Cobb angles of scoliosis and kyphosis at 2 weeks and last follow-up were significantly improved when compared with the preoperative angles in the patients of 2 groups (P < 0.05). There was no significant difference in Cobb angle of scoliosis and the rate of correction between 2 groups (P > 0.05), but the correction loss of PSO group was significantly smaller than that of non-osteotomy group (P < 0.05) at last follow-up. At 2 weeks and last follow-up, the Cobb angle of kyphosis, the rate of correction, and correction loss were significantly better in PSO group than in non-osteotomy group (P < 0.05). CONCLUSION There is no signifcant difference in scoliosis correction between PSO and non-osteotomy techniques. PSO can get better corrective effect in kyphosis correction than non-osteotomy technique, but the operation time and blood loss would increase greatly.
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Affiliation(s)
- Jianwei Zhou
- Spine Centre of Chinese PLA, the 306th Hospital of Chinese PLA, Beijing, 100101, P.R. China
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Celan D, Palfy M, Bracun D, Turk Z, Mozina J, Komadina R. Measurement of spinal sagittal curvatures using the laser triangulation method. Coll Antropol 2012; 36:179-186. [PMID: 22816218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The purpose of the first part of the study was to establish the variability of repeated measurements in different measuring conditions. In the second part, we performed in a large number of patients, a measurement of thoracic kyphosis and lumbar lordosis and compared them to age, gender, and level of nourishment. In the first part, measurements were performed on a plastic model of the back of a patient with a rigid and a normal spine. In the second part, 250 patients participated in the study (126 men and 124 women). For measuring spinal curvatures we used an apparatus for laser triangulation constructed at the Faculty of Mechanical Engineering, University of Ljubljana. A comparison of 30 repeated measurements was shown as the average value +/- 2 SD which included 95% of the results. Thirty repeated readings of one 3D measurement: thoracic kyphosis 41.2 degrees +/- 0.6 degrees, lumbar lordosis 4.4 degrees +/- 1.2 degrees; 30 measurements on a plastic model: thoracic kyphosis 36.8 degrees +/- 1.2 degrees, lumbar lordosis 30.9 degrees +/- 2.0 degrees; 30 measurements on a patient with a rigid spine: thoracic kyphosis 41.5 degrees +/- 2.4 degrees, lumbar lordosis 4.0 degrees +/- 1.8 degrees; 30 measurements on a patient with a normal spine: thoracic kyphosis 48.8 degrees +/- 7.4 degrees, lumbar lordosis 21.1 degrees +/- 4.4 degrees. The average size of thoracic kyphosis in 250 patients was 46.8 degrees (SD 10.1 degrees) and lumbar lordosis 31.7 degrees (SD 12.5 degrees). The angle size was statistically significantly correlated to gender (increased thoracic kyphosis and lumbar lordosis in women) and body mass index (increased thoracic kyphosis and lumbar lordosis in more nourished patients). Age was not significantly correlated to the observed angles. During measurements of the spinal angles it was important to pay attention to relaxation and the patient's position as well as to perform more measurements providing the average value. The age and the level of nourishment influence the size of the sagittal spinal angles. In the observed sample the effect of age was not confirmed.
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Affiliation(s)
- Dusan Celan
- Institute of Physical and Rehabilitation Medicine, University Medical Centre Maribor, Maribor, Slovenia.
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Czaprowski D, Pawłowska P, Gębicka A, Sitarski D, Kotwicki T. Intra- and interobserver repeatability of the assessment of anteroposterior curvatures of the spine using Saunders digital inclinometer. Ortop Traumatol Rehabil 2012; 14:145-153. [PMID: 22619099 DOI: 10.5604/15093492.992283] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION According to the requirements of Evidence Based Medicine, every research tool and method should be subjected to reliability evaluation. A variety of inclinometers are used for the assessment of sagittal plane spinal curvatures in clinical practice. The aim of the study was to evaluate the intra- and interobserver repeatability of measurements of the anterior-posterior spinal curvatures taken with Saunders digital inclinometer. MATERIAL AND METHODS The study involved 30 healthy subjects (5 males, 25 females) aged 20 to 35 years. The anteroposterior curvatures of the spine were measured in all subjects using a Saunders digital inclinometer. In order to evaluate the intraobserver repeatability of measurements, the results obtained by one investigator were compared. To evaluate interobserver repeatability, the results obtained by three investigators were compared. Additionally, the levels of reliability and measurement error were determined. RESULTS The measurements conducted by one investigator showed good repeatability for sacral slope, lumbar lordosis, and thoracic kyphosis, including the angle of proximal (Th1-Th6) and distal (Th6-Th12) thoracic kyphosis (p>0.05). For measurements taken by three investigators, interobserver repeatability was achieved for thoracic kyphosis (p>0.05). The reliability of the measurements was good (Cronbach's alpha was 0.9> α ≥0.8), and the measurement error was between 2.8°-3.8°. CONCLUSIONS The assessment of anteroposterior curvatures of the spine by one investigator provided good repeatability and reliability of measurements. Measurements performed by more than one investigator displayed partial repeatability. The value of the observational error should be taken into account in the interpretation of results of measurements performed with the Saunders inclinometer. The assessment of anteroposterior curvatures of the spine should be preceded by a verification of measurement reliability.
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Keshavarzi S, Newman CB, Ciacci JD, Aryan HE. Expandable titanium cages for thoracolumbar vertebral body replacement: initial clinical experience and review of the literature. Am J Orthop (Belle Mead NJ) 2011; 40:E35-E39. [PMID: 21720606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Reconstruction of the anterior and middle column after vertebrectomy is essential for restoring stability. Use of expandable implants is supported by an emerging body of literature. Newer expandable cages have some advantages over traditional mesh implants, structural allograft, and polyetheretherketone or carbon fiber cages. To determine the utility of an expandable titanium cage in spine reconstruction, we conducted a retrospective cohort study of patients who had undergone this reconstruction after single or multilevel thoracic and/or lumbar vertebrectomy. Here we report on our experience using expandable cages at 2 large academic medical centers. Outcome was based on both clinical and radiographic measures with cross-sectional analysis. Thirty-five patients were identified. Of these, 20 had undergone surgery for neoplasm, 8 for trauma, and 7 for infection. Mean follow-up was 31 months (range, 12 to 50 months). Early postoperative kyphosis correction, restoration of sagittal alignment at 12 months, and reduction in visual analog scale pain score were significant. There was no difference in Oswestry Disability Index or height restoration. Expandable intervertebral body strut grafts appear to be a safe and effective option in spine reconstruction after a vertebrectomy and should be considered a treatment option.
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Affiliation(s)
- Sassan Keshavarzi
- Division of Neurosurgery, University of California, San Diego, California, USA.
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Chanplakorn P, Chanplakorn N, Pongtippan A, Jaovisidha S, Laohacharoensombat W. Recurrent epithelioid sarcoma in the thoracic spine successfully treated with multilevel total en bloc spondylectomy. Eur Spine J 2011; 20 Suppl 2:S302-8. [PMID: 21331752 DOI: 10.1007/s00586-011-1723-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 11/30/2010] [Accepted: 02/06/2011] [Indexed: 11/27/2022]
Abstract
Epithelioid sarcoma (ES) is a rare type of soft tissue tumor. The common location of ES is at the extremities and rarely occurs in axial skeleton. Only two cases have been reported so far. Initial wide resection is recommended for the treatment of ES. However, the local recurrent rate is high and repeat surgical resection is still an option for the treatment of the recurrent. In the spine, however, the proper treatment of recurrent ES has not yet been published. Therefore, the objective of this case report is to illustrate the management strategies for the local recurrent ES after initial surgical resection in the thoracic spine. A 14-year-old boy was diagnosed for ES in the thoracic spine for 2 years. He was first treated by surgical resection followed by the chemotherapy and radiotherapy but the disease had progressed and the spine was gradually deformed. He was admitted to our facility with a large soft tissue mass, severe kyphotic deformity and neurological deficit. We removed the tumor en bloc by one-stage posterior only approach. The posterior transpedicular spinal instrumentation and fibular strut graft were used for the reconstruction. On the last follow-up, 2 year after the surgery, the patient remained in good condition. In conclusion, the recurrent ES of the spine can still archive a good oncological outcome with repeat radical resection, but the initial radical resection remains the best treatment option in order to retard the relentless course of this kind of malignancy.
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Affiliation(s)
- Pongsthorn Chanplakorn
- Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Payathai, Ratchathewi, Bangkok 10400, Thailand.
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Katzman WB, Vittinghoff E, Kado DM. Age-related hyperkyphosis, independent of spinal osteoporosis, is associated with impaired mobility in older community-dwelling women. Osteoporos Int 2011; 22:85-90. [PMID: 20480146 PMCID: PMC2958231 DOI: 10.1007/s00198-010-1265-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2009] [Accepted: 03/09/2010] [Indexed: 10/25/2022]
Abstract
UNLABELLED While many assume hyperkyphosis reflects underlying spinal osteoporosis and vertebral fractures, our results suggest hyperkyphosis is independently associated with decreased mobility. Hyperyphosis is associated with slower Timed Up and Go performance times and may be a useful clinical marker signaling the need for evaluation of vertebral fracture and falling risk. INTRODUCTION While multiple studies have demonstrated negative effects of hyperkyphosis on physical function, none have disentangled the relationship between hyperkyphosis, impaired function, and underlying spinal osteoporosis. The purpose of this study is to determine whether kyphosis, independent of spinal osteoporosis, is associated with mobility on the Timed Up and Go, and to quantify effects of other factors contributing to impaired mobility. METHODS We used data for 3,108 community-dwelling women aged 55-80 years in the Fracture Intervention Trial. All participants had measurements of kyphosis, mobility time on the Timed Up and Go test, height, weight, total hip bone mineral density (BMD), grip strength, and vertebral fractures at baseline visits in 1993. Demographic characteristics included age and smoking status. We calculated mean Timed Up and Go time by quartile of kyphosis. Using multivariate linear regression, we estimated the independent association of kyphosis with mobility time, and quantified effects of other covariates on mobility. RESULTS Mean mobility time increased from 9.3 s in the lowest to 10.1 s in the highest quartile of kyphosis. In a multivariate-adjusted model, mobility time increased 0.11 s (p = 0.02) for each standard deviation (11.9°) increase in kyphosis. Longer performance times were significantly associated with increasing age, decreasing grip strength, vertebral fractures, body mass index ≥25, and total hip BMD in the osteoporotic range. CONCLUSIONS Kyphosis angle is independently associated with decreased mobility on the Timed Up and Go, which is in turn correlated with increased fall risk. Hyperkyphosis may be a useful clinical marker signaling the need for evaluation of vertebral fracture and falling risk.
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Affiliation(s)
- W B Katzman
- University of California, San Francisco, UCSF Box 0625, San Francisco, CA 94143-0625,
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Abstract
BACKGROUND Kyphosis is a risk factor for the presence of hiatal hernia, which is a strong predictor of Barrett's esophagus. However, the association between kyphosis and Barrett's esophagus has not yet been clarified. To investigate this relationship, the Cobb angle, a marker of kyphosis, was measured in patients with and without Barrett's esophagus. METHODS From January 2006 to December 2010, 26 patients with long-segment Barrett's esophagus (LSBE) were retrospectively enrolled. As the comparative groups, 100 consecutive patients with short-segment Barrett's esophagus (SSBE) and 100 consecutive control patients without Barrett's esophagus were also enrolled in this study. Cobb angles were measured on lateral chest radiographs, and kyphosis was defined as a Cobb angle of greater than 50°. Kyphosis, along with other patient characteristics, were evaluated as possible predictors for SSBE and LSBE. RESULTS The mean Cobb angles in the non-BE, SSBE, and LSBE groups were 31.6° (95% CIs, 29.3°-33.9°), 34.8° (32.1°-37.4°) and 49.4° (44.9°-53.9°), respectively. Statistically significant differences were found between the LSBE and the other 2 groups (p<0.001). The mean Cobb angles were 33.3°±12.4° and 37.0°±14.1°, respectively in patients without and with hiatal hernia (p=0.039). Predictors for Barrett's esophagus of any length were erosive esophagitis and hiatal hernia. Kyphosis had the highest odds ratio for the presence of LSBE (OR, 1.50; 95% CI, 1.05-1.94; p=0.033). Other predictors were hiatal hernia and the absence of Helicobacter pylori infection. CONCLUSION Kyphosis is a risk factor for the presence of LSBE in Japanese patients.
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Affiliation(s)
- Goichi Uno
- Division of Endoscopy, Shimane University Hospital, Japan
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