MedWorm: Back Curves

Extraperitoneal laparoscopy-assisted percutaneous nephrolithotomy in a patient with osteogenesis imperfecta

Urological Research — Sun, 14 Mar 2010 12:26:44 +0100

Abstract Osteogenesis imperfecta (OI) patients represent a challenge to all physicians, as they do for anesthetists and urologists, when they develop symptomatic stones in the urinary tract. We recently treated an OI patient with renal pelvic stone by extraperitoneal laparoscopy-assisted percutaneous nephrolithotomy (PCNL). To our knowledge, this combined treatment modality has not been reported previously in OI. An 18-year-old paraplegic girl with OI presented to our urology department because of right-sided flank pain. She pointed out that she had right kidney stone for the previous 2 years, and because of risks of general anesthesia and surgical procedures, surveillance was recommended. Intravenous pyelography was performed and an 11.9-mm stone at the pelvis of the...

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Abilities of pulse pressure variations and stroke volume variations to predict fluid responsiveness in prone position during scoliosis surgery

British Journal of Anaesthesia — Fri, 12 Mar 2010 16:46:21 +0100

Conclusions PP induces a significant increase in PPV and SVV but does not alter their abilities to predict fluid responsiveness. (Source: British Journal of Anaesthesia)

Risk factor analysis of proximal junctional kyphosis after posterior fusion in patients with idiopathic scoliosis

Injury — Fri, 12 Mar 2010 15:06:27 +0100

Conclusions: There is a high incidence of postoperative proximal junctional kyphosis after posterior fusion to the upper thoracic vertebra within 1.5 years after surgery in adolescents with idiopathic scoliosis. In order to reduce its incidence, the risk factors for PJK should be carefully evaluated before surgery. (Source: Injury)

Cobb Angle Progression in Adolescent Scoliosis Begins at the Intervertebral Disc

Medscape Orthopaedics Headlines — Fri, 12 Mar 2010 13:42:36 +0100

Investigators sought to determine the relative contributions of vertebral and disc wedging to the increase in Cobb angle during 3 phases of adolescent skeletal growth and maturation. Spine (Source: Medscape Orthopaedics Headlines)

Objective compliance of adolescent girls with idiopathic scoliosis in a dynamic SpineCor brace

Journal of Children's Orthopaedics — Fri, 12 Mar 2010 06:49:32 +0100

Conclusion The current study showed that the compliance of patients in a dynamic SpineCor is as limited as in a conventional brace. This is in line with earlier data on patients’ SpineCor and rigid brace acceptance evaluated by a questionnaire and on temperature logging in rigid braces. Content Type Journal ArticleCategory Original Clinical ArticleDOI 10.1007/s11832-010-0249-7Authors Carol C. Hasler, University Children’s Hospital Head Spine Surgery, Orthopaedic Department P.O. Box, Roemergasse 8 4005 Basel SwitzerlandStephanie Wietlisbach, University of Zurich Medical School Pestalozzistrasse 3/5 8091 Zurich SwitzerlandPhilippe Büchler, University of Bern, Medical Faculty Institute for Surgical Technology and Biomechanics Stauffacherstrasse 78 3014 Bern Switze...

Can children with spina bifida and muscular dystrophy participate in their own health status evaluations?

Journal of Children's Orthopaedics — Thu, 11 Mar 2010 02:49:18 +0100

Conclusion Children with spina bifida and muscular dystrophy are capable of understanding and assessing their disability. Content Type Journal ArticleCategory Original Clinical ArticleDOI 10.1007/s11832-010-0248-8Authors Susan C. McLimont, The Hospital for Sick Children Samuel Lunenfeld Research Summer Student Program 555 University Avenue Toronto ON M5G 1X8 CanadaJanice L. Owen, The Hospital for Sick Children Child Health Evaluative Sciences 555 University Avenue Toronto ON M5G 1X8 CanadaJames G. Wright, The Hospital for Sick Children Child Health Evaluative Sciences 555 University Avenue Toronto ON M5G 1X8 Canada Journal Journal of Children's OrthopaedicsOnline ISSN 1863-2548Print ISSN 1863-2521 (Source: Journal of Children's Orthopaedics)

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Co-occurrence of achondroplasia and Down syndrome: Genotype/phenotype association

Birth Defects Research Part A: Clinical and Molecular Teratology — Thu, 11 Mar 2010 00:00:00 +0100

This report describes the sixth case of an unusual association: Down syndrome with achondroplasia. It also analyzes the effects of both of these disorders on patient phenotype.A male infant was evaluated for Down syndrome. His appearance also suggested a diagnosis of achondroplasia. The child was evaluated by physical examination, radiography, cytogenetic study, and mutation analysis.Chromosome analysis showed a karyotype of 47,XY,+21 in all 30 cells analyzed. Radiographic examination showed typical findings of achondroplasia, such as disproportionately large skull, shortening oflimb segments, and lumbar lordosis. FGFR3 screening showed a heterozygous G1138A mutation.The interaction of these two distinct genetic disorders in the same patient produces a phenotype typical of each syndrome wi...

Dural ectasia in adolescent idiopathic scoliosis: quantitative assessment on magnetic resonance imaging

European Spine Journal — Wed, 10 Mar 2010 18:48:32 +0100

Abstract To our knowledge, the assessment of dural sac diameters in patients with adolescent idiopathic scoliosis (AIS) is not reported in the literature. The aim of this study was to find out if, dural ectasia occurs more frequently among patients with AIS, to define cut-off values for dural sac ratio and test the validity of such values. A total of 126 spine MRIs (79 patients with AIS and 47 control subjects) were included in this retrospective analysis (age range 7–25 years, 62% were females). Dural sac diameter (DSD) and vertebral body diameter (VBD) were estimated and dural sac ratio (DSR = DSD/VBD) was calculated at T5 and L3. DSR at T5 and L3 were 0.69 ± 0.12, and 0.52 ± 0.10, respectively, in patients with AIS compared with 0.6...

Can the caudal extent of fusion in the surgical treatment of scoliosis in Duchenne muscular dystrophy be stopped at lumbar 5?

European Spine Journal — Wed, 10 Mar 2010 18:48:31 +0100

Abstract Instrumentation and fusion to the sacrum/pelvis has been a mainstay in the surgical treatment of scoliosis in Duchenne muscular dystrophy (DMD) and is recommended to correct pelvic obliquity. The caudal extent of instrumentation and fusion in the surgical treatment of scoliosis in DMD has remained a matter of considerable debate, and there have been few studies on the use of segmental pedicle screw instrumentation for this pathology. From 2004 to 2007, a total of 28 patients with DMD underwent segmental pedicle screw instrumentation and fusion only to L5. Assessment was performed clinically and with radiologic measurements. All patients had a curve with the apex at L2 or higher preoperatively. Preoperative coronal curve averaged 74°, with a postoperative mean of ...

Clinical application of computer-designed polystyrene models in complex severe spinal deformities: a pilot study

European Spine Journal — Wed, 10 Mar 2010 18:48:30 +0100

This study was conducted to investigate the application of computer-designed polystyrene models in the treatment of complex severe spinal deformity. The study involved 16 cases of complex severe spinal deformity treated in our hospital between 1 May 2004 and 31 December 2007; the mean ± SD preoperative scoliosis Cobb angle was 118° ± 27°. The CT scanning digital imaging and communication in medicine (DICOM) data sets of the affected spinal segments were collected for 3D digital reconstruction and rapid prototyping to prepare computer-designed polystyrene models, which were applied in the treatment of these cases. The computer-designed polystyrene models allowed 3D observation and measurement of the deformities directly, which helped the surgeon to perform morp...

Clasped position for measurement of sagittal spinal alignment

European Spine Journal — Wed, 10 Mar 2010 18:48:25 +0100

Abstract Lateral whole-spine radiography is a useful tool in the management of spinal deformity, but the most appropriate arm position during radiography has yet to be determined. In this prospective study, we evaluated 26 adult volunteers and 22 patients with lumbar spinal canal stenosis. Lateral whole-spine radiographs were acquired in the most stable and relaxed position while the subjects were standing with their arms extended and their hand gently clasped in front of the trunk (clasped position). The following parameters were measured: sagittal vertical axis (SVA), lumbar lordotic angle (LLA), pelvic angle (PA), pelvic lordosis angle (PRS1), pelvic tilt (PT), and pelvic incidence (PI). The reliability of measurements was assessed by interclass correlation coefficients...

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Cervical kyphosis with myelopathy and anomalous vertebral artery entry at C7 treated with pedicle screw and rod fixation

Acta Neurochirurgica — Wed, 10 Mar 2010 16:19:23 +0100

Content Type Journal ArticleCategory Letter to the editorDOI 10.1007/s00701-010-0618-5Authors Masashi Yamazaki, Chiba University Graduate School of Medicine Spine Section, Department of Orthopaedic Surgery 1-8-1 Inohana, Chuo-ku Chiba 260-8677 JapanAkihiko Okawa, Chiba University Graduate School of Medicine Spine Section, Department of Orthopaedic Surgery 1-8-1 Inohana, Chuo-ku Chiba 260-8677 JapanTakeo Furuya, Chiba University Graduate School of Medicine Spine Section, Department of Orthopaedic Surgery 1-8-1 Inohana, Chuo-ku Chiba 260-8677 JapanMasao Koda, Chiba University Graduate School of Medicine Spine Section, Department of Orthopaedic Surgery 1-8-1 Inohana, Chuo-ku Chiba 260-8677 Japan Journal Acta NeurochirurgicaOnline ISSN 0942-0940Print ISSN 0001-6268 (Source: Acta Neu...

Role of 5-Ht(1a) receptors in fluoxetine-induced lordosis inhibition.

Hormones and Behavior — Mon, 08 Mar 2010 00:00:00 +0100

Authors: Guptarak J, Sarkar J, Hiegel C, Uphouse L The selective serotonin reuptake inhibitor (SSRI), fluoxetine (Prozac(R)), is an effective antidepressant that is also prescribed for other disorders (e.g. anorexia, bulimia, and premenstrual dysphoria) that are prevalent in females. However, fluoxetine also produces sexual side effects that may lead patients to discontinue treatment. The current studies were designed to evaluate several predictions arising from the hypothesis that serotonin 1A (5-HT(1A)) receptors contribute to fluoxetine-induced sexual dysfunction. In rodent models, 5-HT(1A) receptors are potent negative modulators of female rat sexual behavior. Three distinct experiments were designed to evaluate the contribution of 5-HT(1A) receptors to the effects of fluoxetine. I...

Children Having Spinal Surgery to Correct Scoliosis: A Qualitative Study of Parents' Experiences

Journal of Health Psychology — Fri, 05 Mar 2010 11:48:38 +0100

In this study, 13 interviews and questionnaires from parents in the UK and USA were carried out and analysed using Interpretative Phenomenological Analysis (IPA). Five themes emerged: ‘Information’; ‘Parenting role’; ‘Confidence in professionals’; ‘Pain’; and ‘Effect on life’. Findings suggested that parents need appropriate information and support from health professionals throughout their experience to help minimize uncertainty and distress and that pain management is a major source of stress to parents. (Source: Journal of Health Psychology)

Kyphosis: Rounded upper back can be mild or painful

MayoClinic.com Full Feed — Thu, 04 Mar 2010 06:00:00 +0100

Kyphosis — Comprehensive overview covers symptoms, causes, treatment of abnormal rounding of the upper spine. (Source: MayoClinic.com Full Feed)

[Deformities following spinal injury at the thoracolumbar junction.]

Der Orthopade — Wed, 03 Mar 2010 00:00:00 +0100

This article gives an overview of pathogenesis, diagnostic steps and therapeutic options for corrective spinal surgery. PMID: 20195572 [PubMed - as supplied by publisher] (Source: Der Orthopade)

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A randomised controlled trial on the effectiveness of bracing patients with idiopathic scoliosis: failure to include patients and lessons to be learnt

European Spine Journal — Tue, 02 Mar 2010 10:01:58 +0100

Abstract Trials often do not succeed in including as many patients as anticipated beforehand. The aim of this paper was to describe why we were not able to include more than a few patients in our randomized controlled treatment trial on the effectiveness of bracing patients with idiopathic scoliosis, and to describe which lessons can be learnt. A pilot study on the willingness to participate in such a trial was conducted amongst 21 patients and their parents. A description of how we prepared and designed this trial, the problems we faced and how we tried to improve the inclusion are given. A total of four patients were included, and 14 refused to participate in an 18-month period. There were a lot less eligible patients than anticipated (40 instead of 100 per year), and th...

Idiopathic scoliosis and balance organisation in seated position on a seesaw

European Spine Journal — Tue, 02 Mar 2010 10:01:57 +0100

Abstract The aim was to determine the biomechanical processes involved in postural regulation when self-imposed disturbances occur in the seated position in the antero-posterior direction. Twelve female adolescents with right thoracic scoliosis (SG) (Cobb = 30.4° ± 9.7) and 15 control adolescents (CG) were included in this study. The ground reaction forces (GRF) were studied whilst the subjects maintained their balance in the sitting position on a seesaw. Six conditions were tested: eyes open and closed; with an additional load placed on the subject’s right or left shoulder; and with an additional load on the subject’s right or left pelvis. The SG showed significantly higher force amplitudes and variability and fewer oscillations than the CG in all...

In vivo experimental study of hat type cervical intervertebral fusion cage (HCIFC)

International Orthopaedics — Tue, 02 Mar 2010 10:00:12 +0100

Abstract The purpose of this study was to compare the characteristics of interbody fusion achieved using the hat type cervical intervertebral fusion cage (HCIFC) with those of an autologous tricortical iliac crest graft, Harms cage and the carbon cage in a goat cervical spine model. Thirty-two goats underwent C3-4 discectomy and fusion. They were subdivided into four groups of eight goats each: group 1, autologous tricortical iliac crest bone graft; group 2, Harms cage filled with autologous iliac crest graft; group 3, carbon cage filled with autologous iliac bone; and group 4, HCIFC filled with autologous iliac graft. Radiography was performed pre- and postoperatively and after one, two, four, eight and 12 weeks. At the same time points, disc space height, interverteb...

Response to article: Adolescent idiopathic scoliosis may not be associated with brain abnormalities.

Acta Radiologica — Tue, 02 Mar 2010 00:00:00 +0100

Authors: Shi L, Wang D, Chu WC, Cheng JC PMID: 20192897 [PubMed - as supplied by publisher] (Source: Acta Radiologica)

Multipotential Differentiation of Human Anulus Fibrosus Cells: An in Vitro Study

JBJS [Am] — Mon, 01 Mar 2010 18:30:26 +0100

Conclusions: Anulus fibrosus cells isolated from nondegenerative intervertebral discs can differentiate into adipocytes, osteoblasts, chondrocytes, neurons, and endothelial cells in vitro. Clinical Relevance: Our results, by offering new insights into the biology of anulus fibrosus cells, may assist in future strategies to treat intervertebral disc diseases. (Source: JBJS [Am])

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Perioperative Care in Neuromuscular Scoliosis

Cleveland Clinic Journal of Medicine — Mon, 01 Mar 2010 17:31:57 +0100

(Source: Cleveland Clinic Journal of Medicine)

Clinical measurement of the thoracic kyphosis. A study of the intra-rater reliability in subjects with and without shoulder pain

BMC Musculoskeletal Disorders — Mon, 01 Mar 2010 00:00:00 +0100

Conclusions: The findings of this immediate test-retest reliability study suggest that the clinical measurement of the thoracic kyphosis using gravity dependent inclinometers demonstrates excellent intra-rater reliability. Additional research is required to determine the inter-rater reliability of this method.Trial registration.National Research Register: N0060148286 (Source: BMC Musculoskeletal Disorders)

Infantile developmental thoracolumbar kyphosis with segmental subluxation of the spine.

The Journal of Bone and Joint Surgery. British volume — Mon, 01 Mar 2010 00:00:00 +0100

We report five children who presented at the mean age of 1.5 years (1.1 to 1.9) with a progressive thoracolumbar kyphosis associated with segmental instability and subluxation of the spine at the level above an anteriorly-wedged hypoplastic vertebra at L1 or L2. The spinal deformity appeared to be developmental and not congenital in origin. The anterior wedging of the vertebra may have been secondary to localised segmental instability and subsequent kyphotic deformity. We suggest the term 'infantile developmental thoracolumbar kyphosis with segmental subluxation of the spine' to differentiate this type of deformity from congenital displacement of the spine in which the congenital vertebral anomaly does not resolve. Infantile developmental kyphosis with segmental subluxation of the spine, i...

Multipotential differentiation of human anulus fibrosus cells: an in vitro study.

The Journal of Bone and Joint Surgery. American volume — Mon, 01 Mar 2010 00:00:00 +0100

CONCLUSIONS: Anulus fibrosus cells isolated from nondegenerative intervertebral discs can differentiate into adipocytes, osteoblasts, chondrocytes, neurons, and endothelial cells in vitro. CLINICAL RELEVANCE: Our results, by offering new insights into the biology of anulus fibrosus cells, may assist in future strategies to treat intervertebral disc diseases. PMID: 20194326 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Minimally invasive surgery for thoracolumbar spinal deformity: initial clinical experience with clinical and radiographic outcomes.

Neurosurgical Focus — Mon, 01 Mar 2010 00:00:00 +0100

Conclusions The minimally invasive surgical treatment of adult deformities is a promising method for reducing surgical morbidity. Numerous challenges exist, as the surgical technique does not yet allow for all correction maneuvers used in open surgery. However, as the techniques are advanced, the applicability of minimally invasive surgery for this population will likely be expanded and will afford the opportunity for reduced complications. PMID: 20192721 [PubMed - in process] (Source: Neurosurgical Focus)

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Correction of lumbar coronal plane deformity using unilateral cage placement.

Neurosurgical Focus — Mon, 01 Mar 2010 00:00:00 +0100

Authors: Heary RF, Karimi RJ The authors describe a surgical technique for the correction of symptomatic degenerative lumbar scoliosis. Using a single, unilateral, interbody cage placed on the concave side of the coronal deformity, combined with a dorsal decompression and instrumented posterolateral fusion, this technique has resulted in excellent curve correction, fusion results, and clinical outcomes in a series of 4 patients. Each of these patients presented with intractable, axial low-back pain and symptomatic unilateral nerve root compression on the concave side of a lumbar scoliotic deformity. The management is described in detail. PMID: 20192720 [PubMed - in process] (Source: Neurosurgical Focus)

Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis.

Neurosurgical Focus — Mon, 01 Mar 2010 00:00:00 +0100

Conclusions Degenerative scoliosis of the adult spine is secondary to asymmetrical degeneration of the discs. Surgical decompression and correction of the deformity can be performed from an anterior, posterior, or combined approach. These procedures are often associated with long operative times and a high incidence of complications. The authors' experience with the minimally invasive, lateral retroperitoneal transpsoas approach for placement of a large interbody graft for anterior column support, restoration of disc height, arthrodesis, and realignment is a feasible alternative to these procedures. PMID: 20192668 [PubMed - in process] (Source: Neurosurgical Focus)

Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation.

Neurosurgical Focus — Mon, 01 Mar 2010 00:00:00 +0100

Conclusions Radiographic outcomes such as the Cobb angle and AVT were significantly improved in patients who underwent a combined transpsoas and posterior approach. Lumbar lordosis was maintained in all patients undergoing the combined approach. The combination of XLIF and TLIF/posterior segmental instrumentation techniques may lead to less blood loss and to radiographic outcomes that are comparable to traditional posterior-only approaches. However, the surgical technique carries significant risks that require further evaluation and proper informed consent. PMID: 20192667 [PubMed - in process] (Source: Neurosurgical Focus)

Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis.

Neurosurgical Focus — Mon, 01 Mar 2010 00:00:00 +0100

Conclusions Minimally invasive surgical correction of adult scoliosis results in mid- to long-term outcomes similar to traditional surgical approaches. Whereas operating times are comparable to those achieved with open approaches, blood loss and morbidity appear to be significantly lower in patients undergoing minimally invasive deformity correction. This approach may be particularly useful in the elderly. PMID: 20192666 [PubMed - in process] (Source: Neurosurgical Focus)

Adult scoliosis surgery outcomes: a systematic review.

Neurosurgical Focus — Mon, 01 Mar 2010 00:00:00 +0100

Conclusions Surgery for adult scoliosis is associated with improvement in radiographic and clinical outcomes at a minimum 2-year follow-up. Perioperative morbidity includes an approximately 13% risk of pseudarthrosis and a greater than 40% incidence of perioperative adverse events. Incidence of perioperative complications is substantial and must be considered when deciding optimal disease management. Although the quality of published studies in this area has improved, particularly in the last few years, the current review highlights the lack of routine use of standardized outcomes measures and assessment in the adult scoliosis literature. PMID: 20192664 [PubMed - in process] (Source: Neurosurgical Focus)

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Spondylolisthesis following a pedicle subtraction osteotomy.

Neurosurgical Focus — Mon, 01 Mar 2010 00:00:00 +0100

Authors: Upadhyaya CD, Berven S, Mumaneni PV Pedicle subtraction osteotomy (PSO) is a powerful technique for correcting a fixed sagittal plane deformity. The authors report the case of a 51-year-old man with a history of multiple prior lumbar operations, flat-back syndrome, thoracic kyphosis, and radiculopathy, who underwent deformity correction surgery with T3-S1 pedicle screw fixation and L-3 PSO. Progressive spondylolisthesis of the PSO segment associated with rod fracture then developed. The patient subsequently underwent anterior and posterior revision surgery. This case is a rare instance of spondylolisthesis following PSO. PMID: 20192661 [PubMed - in process] (Source: Neurosurgical Focus)

Comparison between anterior and posterior decompression with instrumentation for cervical spondylotic myelopathy: sagittal alignment and clinical outcome.

Neurosurgical Focus — Mon, 01 Mar 2010 00:00:00 +0100

Conclusions . These results demonstrate that both anterior and posterior decompression (with instrumentation) are effective procedures to improve the neurological outcome of patients with CSM. However, sagittal alignment may be better restored using the anterior approach, but harbors a higher rate of loss of correction. In cases involving a preexisting cervical kyphosis, an anterior or combined approach might be necessary to restore the lordotic cervical alignment. PMID: 20192660 [PubMed - in process] (Source: Neurosurgical Focus)

Outcomes after surgery for cervical spine deformity: review of the literature.

Neurosurgical Focus — Mon, 01 Mar 2010 00:00:00 +0100

Conclusions Although complications are not insignificant, surgery appears to be an effective option when conservative measures fail to provide relief. PMID: 20192659 [PubMed - in process] (Source: Neurosurgical Focus)

Adult degenerative scoliosis: evaluation and management.

Neurosurgical Focus — Mon, 01 Mar 2010 00:00:00 +0100

Authors: Silva FE, Lenke LG Degenerative scoliosis is a prevalent issue among the aging population. Controversy remains over the role of surgical intervention in patients with this disease. The authors discuss a suitable approach to help guide surgical treatment, including decompression, instrumented posterior spinal fusion, anterior spinal fusion, and osteotomy. These treatment options are based on clinical analysis, radiographic analysis of the mechanical stability of the deformity, given pain generators, and necessary sagittal balance. The high potential complication rates appear to be outweighed by the eventual successful clinical outcomes in patients suitable for operative intervention. This approach has had favorable outcomes and could help resolve the controversy. PMID: 2019...

Simultaneous double-rod rotation technique in posterior instrumentation surgery for correction of adolescent idiopathic scoliosis.

Journal of Neurosurgery.Spine — Mon, 01 Mar 2010 00:00:00 +0100

Authors: Ito M, Abumi K, Kotani Y, Takahata M, Sudo H, Hojo Y, Minami A The authors present a new posterior correction technique consisting of simultaneous double-rod rotation using 2 contoured rods and polyaxial pedicle screws with or without Nesplon tapes. The purpose of this study is to introduce the basic principles and surgical procedures of this new posterior surgery for correction of adolescent idiopathic scoliosis. Through gradual rotation of the concave-side rod by 2 rod holders, the convex-side rod simultaneously rotates with the the concave-side rod. This procedure does not involve any force pushing down the spinal column around the apex. Since this procedure consists of upward pushing and lateral translation of the spinal column with simultaneous double-rod rotation maneuve...

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Cytokine evaluation in individuals with low back pain using discographic lavage

The Spine Journal — Mon, 01 Mar 2010 00:00:00 +0100

Conclusions: Among the potential inflammatory markers tested in this Phase 1 study, IFN-γ immunoreactivity was most commonly elevated in discogram “positive” discs but absent in asymptomatic controls. However, this marker was also frequently elevated in degenerative but “negative” discography discs. From these findings, Phase 2 and Phase 3 validity studies are reasonable to pursue. Phase 4 utility studies may be performed concurrently to assess this method's predictive value in outcome studies. (Source: The Spine Journal)

Spinal flexibility in scoliosis: roots “bending” to antiquity

The Spine Journal — Mon, 01 Mar 2010 00:00:00 +0100

Scoliosis is a common spinal deformity affecting individuals worldwide. In recent times, much attention has been devoted to the “flexibility” of the scoliotic curve to assist in determining management options for curve correction and their outcomes. In individuals with scoliosis, various methods using radiographic imaging have been proposed to assess the flexibility of the spine, such as the supine bending, traction, push-prone, and fulcrum-bending radiographs . Many of these methods use traction techniques or active/static forces to assess the curve's flexibility. However, such principles in evaluating spinal flexibility are not that novel but have roots stemming to antiquity. (Source: The Spine Journal)

Letter 6

Neuromuscular Disorders — Mon, 01 Mar 2010 00:00:00 +0100

I personally find the prednisone dosage recommended in the Lancet Neurology article extremely high. Consider this scene: a DMD boy, 5years old. How can one give him 0.75mg/kg/day of prednisone continuously for say 10–15years? I have noted that the paper mentions reducing by 25–33% if necessary, but still in the long run it may turn out to be a health hazard. Some clinicians advocate lower dosages, and our group has been one of them. We were able to prolong ambulation and prevent scoliosis in a group of children with DMD with a 0.75mg/kg alternate day regimen . (Source: Neuromuscular Disorders)

Posterior surgery in Scheuermann’s kyphosis

European Spine Journal — Fri, 26 Feb 2010 16:43:35 +0100

Content Type Journal ArticleCategory Open Operating Theatre (OOT)DOI 10.1007/s00586-010-1351-8Authors Claudio Lamartina Journal European Spine JournalOnline ISSN 1432-0932Print ISSN 0940-6719 (Source: European Spine Journal)

Coronal plane segmental flexibility in thoracic adolescent idiopathic scoliosis assessed by fulcrum-bending radiographs

European Spine Journal — Fri, 26 Feb 2010 06:45:15 +0100

The objective of this study was, therefore, to compute segmental flexibility indices (standing angle minus corrected angle/standing angle). We compared segmental disc angles in 76 preoperative sets of standing and fulcrum-bending radiographs of thoracic curves (paired, two-tailed t tests, p < 0.05). The mean standing Cobb angle was 59.7° (range 41.3°–95°) and the flexibility index of the curve was 48.6% (range 16.6–78.8%). The disc angles showed symmetric periapical distribution with significant decrease (all p values <0.0001) for every cephalad (+) and caudad (−) level change. The periapical levels +1 and −1 wedged at 8.3° and 8.7° (range 3.5°–14.8°), respectively. All angles were significantly smaller on the-bending views (p values <0.0001). We not...

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Anaesthetic considerations of adults with Morquio's syndrome - a case report

BMC Anesthesiology — Fri, 26 Feb 2010 00:00:00 +0100

Conclusion: This report details an awake fiberoptic intubation in an adult with Morquio syndrome. We recommend that this approach be considered in patients with Morquio syndrome undergoing general anaesthesia. (Source: BMC Anesthesiology)

Spinal Stenosis Cases Can Be Managed Nonoperatively

Modern Medicine — Fri, 26 Feb 2010 00:00:00 +0100

In patients with spinal stenosis, those without concomitant degenerative spondylolisthesis or scoliosis can be managed nonoperatively regardless of the number of levels; and, if surgery is performed, the number of levels treated does not predict outcome. However, among patients with concomitant degenerative spondylolisthesis, those with only single level stenosis tend to improve more than those with multilevel stenosis, especially after surgery, according to a research published in the Feb. 15 issue of Spine. (Source: Modern Medicine)

Correction and stabilization of a double major adult idiopathic scoliosis from T5/L5

European Spine Journal — Thu, 25 Feb 2010 20:32:19 +0100

Content Type Journal ArticleCategory Open Operating Theatre (OOT)DOI 10.1007/s00586-010-1349-2Authors Max Aebi Journal European Spine JournalOnline ISSN 1432-0932Print ISSN 0940-6719 (Source: European Spine Journal)

Posterior surgery congenital scoliosis

European Spine Journal — Thu, 25 Feb 2010 17:55:35 +0100

Content Type Journal ArticleCategory Open Operating Theatre (OOT)DOI 10.1007/s00586-010-1348-3Authors Claudio Lamartina Journal European Spine JournalOnline ISSN 1432-0932Print ISSN 0940-6719 (Source: European Spine Journal)

Radiographs Help Predict Curve Flexibility in Scoliosis

Modern Medicine — Thu, 25 Feb 2010 00:00:00 +0100

In the prediction of curve flexibility and postoperative correction in adolescent idiopathic scoliosis, traction under general anesthesia radiographs perform equivalently to supine bending radiographs, according to a study in the Feb. 15 issue of Spine. (Source: Modern Medicine)

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Accuracy of Thoracic Pedicle Screw Using Ideal Pedicle Entry Point in Severe Scoliosis.

Clinical Orthopaedics and Related Research — Thu, 25 Feb 2010 00:00:00 +0100

CONCLUSIONS: Use of the ideal pedicle entry point is safe and accurate for thoracic pedicle screw placement in rigid curves of 90 degrees or greater. LEVEL OF EVIDENCE: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID: 20182830 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

Epidemiology of Surgical Admissions to a Children’s Disability Hospital in Nepal

World Journal of Surgery — Tue, 23 Feb 2010 07:18:48 +0100

Conclusions The majority of surgical pathology involved injuries and congenital problems (mainly clubfoot). The presentation was delayed in most patients, and in such cases, the treatment is more complex and costly, and the desired functional outcome is difficult to achieve. In addition to preventive measures, morbidity cases could have been reduced by the timely provision of services at the primary referral level. Strengthening the delivery of basic orthopedic services at primary health care facilities may eliminate or reduce the need for complex reconstructive procedures and diminish the likelihood of permanent disability in our population. Content Type Journal ArticleDOI 10.1007/s00268-010-0487-3Authors David A. Spiegel, Children’s Hospital of Philadelphia a...

Clinical and physiological effects of transcranial electrical stimulation position on motor evoked potentials in scoliosis surgery

Scoliosis — Tue, 23 Feb 2010 00:00:00 +0100

Conclusions: Our findings suggest that cross scalp stimulation resulted in MEPs obtained ipsilaterally and contralaterally which may be contributed to by summation of ipsilateral and simultaneous transcallosally or deep white matter conducted stimulation of the opposite motor cortex. Use of this stimulating position is advocated to elicit MEPs under operative circumstances where anesthetic agents may cause suppression of cortical and spinal excitability. Although less focal in nature, cross scalp stimulation would be most suitable for infratentorial or spinal surgery, in contrast to supratentorial neurosurgical procedures. (Source: Scoliosis)

Measurement of vertebral rotation in adolescent idiopathic scoliosis with low-dose CT in prone position - method description and reliability analysis

Scoliosis — Tue, 23 Feb 2010 00:00:00 +0100

Conclusions: This study has shown that measurements of vertebral rotation in prone position were more reliable on axial CT images than on CT scanogram. The measurement of vertebral rotation on CT (corrected to the pelvic tilt) in prone position imposes lower impact of the recumbent position on the vertebral rotation than did MRI in supine position. However, the magnitude of differences is of doubtful clinical significance. (Source: Scoliosis)

Plate augmentation in anterior cervical discectomy and fusion with cage for degenerative cervical spinal disorders

European Spine Journal — Sun, 21 Feb 2010 06:54:42 +0100

Abstract Anterior cervical discectomy and fusion (ACDF) with cage alone (ACDF-C) is associated with a significant incidence of subsidence, local kyphosis, and migration. The use of concurrent plate augmentation may decrease the incidence of these complications while improving the fusion rate. The purpose of the study is to present our results with ACDF with cage and plate augmentation (ACDF-CPA) and to compare these results to previous reports of outcomes following ACDF-C. We evaluated the radiologic and clinical parameters of 83 patients (266 fusion sites) who had an ACDF-CPA between March 2002 and May 2006. Radiologic parameters included fusion rate, fusion time, fusion type, site of pseudoarthrosis and rate and degree of subsidence. Clinical parameters included complica...

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Post-traumatic thoracic scoliosis with rib head dislocation and intrusion into the spinal canal: a case report and review of literature

European Spine Journal — Sun, 21 Feb 2010 06:54:41 +0100

The objective of the study was to report a rare occurrence of dislocation and intrusion of two rib heads into the spinal canal at the convex apex of a post-traumatic thoracic scoliosis in an adult in the absence of any neurological impairment. A 47-year-old male presented with a slowly progressive, post-traumatic thoracic scoliosis and a mild aching sensation over the posterior chest wall. The lower limb neurology and bowel and bladder function were normal. There was no clinical evidence of neurofibromatosis. CT scans showed that the 8th and 9th ribs on the convex apex of the scoliotic curve had intruded into the spinal canal and were lying adjacent to the dura and spinal cord. The MRI scan did not show any cord signal intensity changes. Although rib dislocation and intrusion into th...

Noncontiguous anterior decompression and fusion for multilevel cervical spondylotic myelopathy: a prospective randomized control clinical study

European Spine Journal — Sat, 20 Feb 2010 06:51:32 +0100

In conclusion, in the patients with MCSM, without developmental stenosis and continuous or combined ossification of posterior longitudinal ligaments, NADF and CCF showed an identical effect of decompression. In terms of surgical time, blood loss, VAS, fusion rate and cervical alignment, NADF was superior compared with CCF. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00586-010-1319-8Authors Xiao-Feng Lian, Sixth People’s Hospital, Shanghai Jiaotong University Department of Orthopedics Shanghai ChinaJian-Guang Xu, Sixth People’s Hospital, Shanghai Jiaotong University Department of Orthopedics Shanghai ChinaBing-Fang Zeng, Sixth People’s Hospital, Shanghai Jiaotong University Department of Orthopedics Shanghai ChinaWei Zhou, Sixth People’s Hospital, Shan...

Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain.

Cochrane Database of Systematic Reviews — Sat, 20 Feb 2010 04:58:05 +0100

CONCLUSIONS: When used in isolation, current evidence indicates poor diagnostic performance of most physical tests used to identify lumbar disc herniation. However, most findings arise from surgical populations and may not apply to primary care or non-selected populations. Better performance may be obtained when tests are combined. PMID: 20166095 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Rere controls retinoic acid signalling and somite bilateral symmetry

Nature — Thu, 18 Feb 2010 15:27:01 +0100

Authors: Gonçalo C. Vilhais-Neto, Mitsuji Maruhashi, Karen T. Smith, Mireille Vasseur-Cognet, Andrew S. Peterson, Jerry L. Workman & Olivier Pourquié One of the most notable features of the vertebrate body plan organization is its bilateral symmetry, evident at the level of vertebrae and skeletal muscles. Here we show that a mutation in Rere (also known as atrophin2) leads to the formation of asymmetrical somites in mouse embryos, similar to embryos deprived of retinoic acid. Furthermore, we also demonstrate that Rere controls retinoic acid signalling, which is required to maintain somite symmetry by interacting with Fgf8 in the left–right signalling pathway. Rere forms a complex with Nr2f2, p300 (also known as Ep300) and a retinoic acid receptor, which is recruited to ...

King Tutankhamun 'died from a broken leg and malaria'

Guardian Unlimited Science — Wed, 17 Feb 2010 08:57:38 +0100

DNA testing and CT scans on 16 mummies reveal that the Egyptian king's parents were probably brother and sisterEgypt's most famous pharaoh, King Tutankhamun, was a frail boy who suffered from a cleft palate and club foot, according to a study published today that shows he died of complications from a broken leg exacerbated by malaria and his parents were most likely brother and sister.Two years of DNA testing and CT scans on Tutankhamun's 3,300-year-old mummy and 15 others are helping end many of the myths surrounding the boy king. While a comparatively minor ruler, he has captivated the public since the 1922 discovery of his tomb, which was filled with a stunning array of jewels and artefacts, including a golden funeral mask.The study, which will be published today in the Journal of the A...

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Tutankhamun died from broken leg and malaria

Guardian Unlimited Science — Wed, 17 Feb 2010 08:57:38 +0100

King Tut's Tough Life

Scientific American - Official RSS Feed — Wed, 17 Feb 2010 05:05:08 +0100

The Journal of the American Medical Association doesn’t usually report autopsy results. But they make an exception this week: for King Tut. The study of the boy king involved DNA analysis and CAT scans.Researchers [led by Zahi Hawass of the Supreme Council of Antiquities in Cairo, Egypt] used genetic fingerprints from Tut and 10 presumed relatives to map out his most accurate five-generation family tree to date. It reveals a family history of clubfoot and scoliosis. And CAT scans of Tut turned up foot deformities, like a missing toe bone, and bone necrosis, which means some of his foot bones were dying due to poor blood circulation. Previous scans had identified a femur fracture. [More] (Source: Scientific American - Official RSS Feed)

Effects of an exercise and manual therapy program on physical impairments, function and quality-of-life in people with osteoporotic vertebral fracture: a randomised, single-blind controlled pilot trial

BMC Musculoskeletal Disorders — Wed, 17 Feb 2010 00:00:00 +0100

Conclusion: Despite the modest sample size, these results support the benefits of exercise and manual therapy in the clinical management of patients with osteoporotic vertebral fractures, but need to be confirmed in a larger sample.Trail registration: NCT00638768 (Source: BMC Musculoskeletal Disorders)

Abnormalities of cell packing density and dendritic complexity in the MeCP2 A140V mouse model of Rett syndrome/X-linked mental retardation

BMC Neuroscience - Latest articles — Wed, 17 Feb 2010 00:00:00 +0100

Conclusion: We have identified various neurological abnormalities in this mouse model of Rett syndrome/X-linked mental retardation which may help to elucidate the manner in which MECP2 mutations cause neuronal changes resulting in mental retardation without the confounding effects of seizures, chronic hypoventilation, or other Rett syndrome associated symptoms. (Source: BMC Neuroscience - Latest articles)

Diagnosis and Management of Low Lumbar Burst Fractures

Seminars in Spine Surgery — Tue, 16 Feb 2010 15:05:04 +0100

Fractures of the low lumbar spine are relatively uncommon and have various injury patterns. Treatment must be individualized and should take into account the fracture type, ligamentous injury pattern, neurological injury, the limitations of surgical implants, and the anatomical approaches available. Nonoperative management of burst fractures for patients without neurological deficits has generally been reported to have acceptable outcomes. For low lumbar burst fractures or fracture dislocations of the lumbosacral segment where neurological injury has occurred, surgery is indicated. This surgery should include decompression (posterior or anterior), spinal realignment with maintenance of lumbar lordosis, and instrumentation over minimal segments. Conservatively managed patients require conti...

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One-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits

European Spine Journal — Tue, 16 Feb 2010 06:41:30 +0100

Abstract The number of reports describing osteoporotic vertebral fracture has increased as the number of elderly people has grown. Anterior decompression and fusion alone for the treatment of vertebral collapse is not easy for patients with comorbid medical problems and severe bone fragility. The purpose of the present study was to evaluate the efficacy of one-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits. A consecutive series of 21 patients who sustained osteoporotic vertebral collapse with neurological deficits were managed with posterior decompression and short-segmental pedicle screw instrumentation augmented with ultra-high molecular weight polyethylene (UHMWP) cables with or without vertebroplas...

Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction

International Orthopaedics — Mon, 15 Feb 2010 06:42:40 +0100

Abstract In a previous study, the authors reported the clinical and radiological results of Duchenne muscular dystrophy (DMD) scoliosis surgery in 14 patients with a low FVC of <30%. The purpose of this study was to determine if surgery improved function and QOL in these patients. Furthermore, the authors assessed the patients’ and parents’ satisfaction. %FVC increased in all patients after preoperative inspiratory muscle training. Scoliosis surgery in this group of patients presented no increased risk of major complications. All-screw constructions and fusion offered the ability to correct spinal deformity in the coronal and pelvic obliquity initially, intermediate and long-term. All patients were encouraged to continue inspiratory muscle training after surgery. Th...

Kinematic aspects of trunk motion and gender effect in normal adults

Journal of NeuroEngineering and Rehabilitation — Mon, 15 Feb 2010 00:00:00 +0100

Conclusions: Men and women showed different lumbar lordosis during normal gait, which might be partly responsible for the different prevalence of lumbar diseases between genders. However, this needs further investigation. (Source: Journal of NeuroEngineering and Rehabilitation)

Segmental pedicle screws instrumentation and fusion to L5 for spinal deformity secondary to Duchenne muscular dystrophy: results with a minimum of 2 years follow-up

European Journal of Orthopaedic Surgery & Traumatology — Sun, 14 Feb 2010 06:50:31 +0100

Conclusion Segmental pedicle screw instrumentation and fusion to L5 is effective and safe in patients with scoliosis secondary to DMD without significant pelvic obliquity initially and long term, obviating the need for fixation to the sacrum/pelvis. There was no major complication. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00590-010-0589-5Authors Masashi Takaso, Kitasato University, School of Medicine Department of Orthopaedic Surgery Kitasato1-15-1 Sagamihara city Kanagawa JapanToshiyuki Nakazawa, Kitasato University, School of Medicine Department of Orthopaedic Surgery Kitasato1-15-1 Sagamihara city Kanagawa JapanTakayuki Imura, Kitasato University, School of Medicine Department of Orthopaedic Surgery Kitasato1-15-1 Sagamihara city Kanagawa J...

Anterior decompression and fusion versus laminoplasty for cervical myelopathy caused by soft disc herniation: a prospective multicenter study

Journal of Orthopaedic Science — Fri, 12 Feb 2010 07:24:06 +0100

Conclusions There was no critical difference between the ADF and laminoplasty groups with regard to neurological recovery and other surgery-related factors 1 year after surgery. Laminoplasty can be employed for cervical myelopathy caused by soft disc herniation in particular combined with multilevel spinal canal stenosis to avoid secondary myelopathy. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-009-1429-4Authors Tomoaki Koakutsu, Nishitaga National Hospital Department of Orthopaedic Surgery Sendai JapanNaoki Morozumi, Nishitaga National Hospital Department of Orthopaedic Surgery Sendai JapanYushin Ishii, Nishitaga National Hospital Department of Orthopaedic Surgery Sendai JapanFumio Kasama, Tohoku Rosai Hospital Department of Orthopaedic Su...

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Gait in thoracolumbar/lumbar adolescent idiopathic scoliosis: effect of surgery on gait mechanisms

European Spine Journal — Thu, 11 Feb 2010 11:48:30 +0100

Abstract For patients whose scoliosis progresses, surgery remains the ultimate way to correct and stabilise the deformity while maintaining as many mobile spinal segments as possible. In thoracolumbar/lumbar adolescent idiopathic scoliosis (AIS), the spinal fusion has to be extended to the lumbar spine. The use of anterior spinal fusion (ASF) instead of the classic posterior fusion (PSF) may preserve more distal spinal levels in attempt to limit the consequences of surgery on trunk mobility. The effects of surgery on body shape, pain and the decompensation phenomenon have all been well evaluated. Very few studies have addressed the effect of ASF or PSF on basic activities, such as walking. Before any treatment, AIS patients already have reduced pelvis, hip and shoulder mot...

In Utero and Lactational Exposure to Bisphenol A, In Contrast to Ethinyl Estradiol, Does Not Alter Sexually Dimorphic Behavior, Puberty, Fertility, and Anatomy of Female LE Rats

Toxicological Sciences — Wed, 10 Feb 2010 19:40:40 +0100

Many chemicals released into the environment display estrogenic activity including the oral contraceptive ethinyl estradiol (EE2) and the plastic monomer bisphenol A (BPA). EE2 is present in some aquatic systems at concentrations sufficient to alter reproductive function of fishes. Many concerns have been raised about the potential effects of BPA. The National Toxicology Program rated the potential effects of low doses of BPA on behavior and central nervous system (CNS) as an area of "some concern," whereas most effects were rated as of "negligible" or "minimal" concern. However, the number of robust studies in this area was limited. The current study was designed to determine if maternal exposure to relatively low oral doses of EE2 or BPA in utero and during lactation would alter the expr...

Dual growth rods for infantile scoliosis

European Spine Journal — Tue, 09 Feb 2010 17:36:24 +0100

Content Type Journal ArticleCategory Ganga Operative Spine CourseDOI 10.1007/s00586-010-1310-4Authors Arvind JayaswalBidre N. UpendraAshwin AvadhaniS. Rajasekaran Journal European Spine JournalOnline ISSN 1432-0932Print ISSN 0940-6719 (Source: European Spine Journal)

Scoliosis Surgery in Children With Neuromuscular Disease: Findings From the US National Inpatient Sample, 1997 to 2003 [Original Contribution]

Archives of Neurology — Mon, 08 Feb 2010 20:51:02 +0100

Conclusion Children with NMD have increased hospital length of stay and higher in-hospital mortality associated with scoliosis surgery, highlighting the need for further study of measures that could reduce complications and improve outcomes in this population. (Source: Archives of Neurology)

Selective lumbar neuroforaminal decompression in lateral spinal stenosis

Orthopedics and Traumatology — Mon, 08 Feb 2010 17:39:45 +0100

Summary Objectives To eliminate radicular symptoms by decompression of a lumbar nerve root (usually L5) from its dural exit to the intervertebral foramen up to the lateral compartment without damaging the facet joint. Indications Bony compression of a lumbar nerve root at the lateral recess. in the intervertebral foramen. and in the intervertebral compartment. The mediolateral and lateral decompression is indicated in deformation of the spinal canal caused by wear. It is usually found at the concave side of a degenerative scoliosis. Contraindications There exists no contraindication on the condition that the diagnosis is correct. An extraforaminal decompression of the fifth lumbar nerve root can be more difficult, particularly in inst...

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Percutaneous vertebroplasty for intravertebral cleft: analysis of therapeutic effects and outcome predictors

Skeletal Radiology — Mon, 08 Feb 2010 17:28:12 +0100

Conclusions Percutaneous vertebroplasty on osteoporotic vertebral compression fractures (VCF) with IVC was effective in only about 69.6% of patients after the first week and month and in 65.2% of patients after 2 months. Post-procedural kyphosis correction ≥5˚ was associated with poor outcomes after the first week. Two months after PVP, the functional status was more important because of the development of subsequent fractures. Content Type Journal ArticleCategory Scientific ArticleDOI 10.1007/s00256-009-0866-8Authors Yeo Ju Kim, Inha University Hospital Department of Radiology Incheon 400-711 KoreaJoon Woo Lee, Seoul National University Bundang Hospital Department of Radiology 300 Gumi-dong, Bundang-gu Seongnam-si Gyeongi-do 463-707 KoreaKi-Jeong Kim, S...

Posterior instrumentation and fusion for progressive idiopathic scoliosis

Orthopedics and Traumatology — Mon, 08 Feb 2010 17:13:19 +0100

Summary Objectives Prevention of progression of an idiopathic scoliosis. Structural improvement of the spinal column and correction of the trunk deformity. Indications Progressive idiopathic scoliosis with a Cobb angle > 45° in adolescents and adults. Contraindications Poor general health, high anesthetic risk, severe osteoporosis. Surgical Technique The lateral deviation is straightened through distraction and correction and stabilized with 1 rod. Two pedicle screws implanted at the caudal end of the rod assure its rotational stability. The amount of distraction corresponds to the lengthening of the spinal column as visualized on extension films according to Cotrel. Sublaminar wires inserted at the apex of the scol...

Rotational hypermobility of disc wedging using kinematic CT: preliminary study to investigate the instability of discs in degenerated scoliosis in the lumbar spine

European Spine Journal — Sat, 06 Feb 2010 08:18:44 +0100

Abstract The number of patients showing lumbar degenerative scoliosis, including disc wedging, has increased, and examination of the mechanism of spinal nerve compression due to lateral and rotational mobility of the lumbar spine is necessary. Thirty-two patients with L4–L5 disc wedging but without antero- or retrospondylolisthesis and ten age-matched controls were examined. The angle of disc wedging and change in the angle between left and right bending were evaluated by anterior–posterior X-ray images of patients while they were in a standing position. The degree of disc degeneration and existence of vacuum phenomena were evaluated at the L4–L5 discs. Rotational mobility between maximal right and left rotation was examined by computed tomography (CT). Rotational mo...

Anterior fusion for thoracic scoliosis

European Spine Journal — Fri, 05 Feb 2010 08:43:37 +0100

Content Type Journal ArticleCategory Ganga Operative Spine CourseDOI 10.1007/s00586-010-1313-1Authors Sajan HedgeAppaji KrishnanMeenakshi SubbiahAshwin AvadhaniS. Rajasekaran Journal European Spine JournalOnline ISSN 1432-0932Print ISSN 0940-6719 (Source: European Spine Journal)

An overview of a cohort of South African patients with mitochondrial disorders

Journal of Inherited Metabolic Disease — Fri, 05 Feb 2010 07:57:38 +0100

The objective of this paper is to describe the profile of patients with mitochondrial disorders in South Africa. Patients with possible mitochondrial disorders were accessed over 10 years. Analyses for respiratory chain and pyruvate dehydrogenase complex enzymes were performed on muscle. A diagnosis of a mitochondrial disorder was accepted only if an enzyme activity was deficient. Sixty-three patients were diagnosed with a mitochondrial disorder, including 40 African, 20 Caucasian, one mixed ancestry, and two Indian patients. The most important findings were the difference between African patients and other ethnicities: respiratory chain enzyme complexes CI+III or CII+III deficiencies were found in 52.5% of African patients, being of statistical significance (p value = 0.0061). T...

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Correction of thoracic kyphosis with Ponte osteotomy

European Spine Journal — Fri, 05 Feb 2010 06:46:24 +0100

Content Type Journal ArticleCategory Ganga Operative Spine CourseDOI 10.1007/s00586-010-1311-3Authors Michael GrevittVijay KamathAshwin AvadhaniS. Rajasekaran Journal European Spine JournalOnline ISSN 1432-0932Print ISSN 0940-6719 (Source: European Spine Journal)

Postural stability in patients with ankylosing spondylitis.

Disability and Rehabilitation — Thu, 04 Feb 2010 00:00:00 +0100

Conclusions. We have found that postural stability decreases in patients with AS in both the early and the late stages of the disease, but especially in the latter ones. This result may be thought to be related with increased kyphosis which is seen during the course of the disease. PMID: 20131954 [PubMed - as supplied by publisher] (Source: Disability and Rehabilitation)

The Genetics and Development of Scoliosis

Springer Biomedical Sciences titles — Mon, 01 Feb 2010 15:49:57 +0100

edited by Kenro Kusumi, Ph.D.Table of Contents: Genetic Regulation of Somite and Early Spinal Patterning Kenro Kusumi, Ph.D., Walter Eckalbar, Olivier Pourquie, Ph.D. Development and Functional Anatomy of the Spine J. Alan Rawls, PhD and Rebecca E. Fisher, PhD Environmental Factors and Axial Skeletal Dysmorphogenesis Peter G. Alexander, Ph.D. and Rocky ... (Source: Springer Biomedical Sciences titles)

An interspecific analysis of relative jaw-joint height in primates

American Journal of Physical Anthropology — Mon, 01 Feb 2010 00:00:00 +0100

Jaw-joint height (JJH) above the occlusal plane is thought to be influenced by cranial base angle (CBA) and facial angulation during growth. To better understand how JJH relates to midline craniofacial form, we test the hypothesis that relative increases in JJH are correlated with increasing CBA flexion and facial kyphosis (i.e., ventral bending) across primates. We compared JJH above the occlusal plane to CBA and the angle of facial kyphosis (AFK) across adults from 82 species. JJH scales with positive allometry relative to a skull geometric mean in anthropoids and most likely strepsirrhines. Anthropoid regressions for JJH are elevated above strepsirrhines, whereas catarrhines exhibit a higher slope than platyrrhines. Semipartial correlations between relative JJH and both CBA and AFK show...

Which lumbar interbody fusion technique is better in terms of level for the treatment of unstable isthmic spondylolisthesis?

Journal of Neurosurgery.Spine — Mon, 01 Feb 2010 00:00:00 +0100

Conclusions Considering the clinical and radiological outcomes in both groups, the authors recommend that instrumented mini-TLIF is preferable at the L4-5 level, whereas instrumented mini-ALIF might be preferable at the L5-S1 level for the treatment of unstable isthmic spondylolisthesis. PMID: 20121352 [PubMed - in process] (Source: Journal of Neurosurgery.Spine)

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Positioning patients with severe kyphosis during cataract surgery

Journal of Cataract and Refractive Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Muthialu et al. are to be commended for their innovative technique of using a parachute-like harness to securely strap the patient postured in the Trendelenburg position. However, they acknowledge that because of the limited leg room under the stacked up head and neck supports, the surgeon has to be seated superiorly rather than temporally, which is the preferred approach. (Source: Journal of Cataract and Refractive Surgery)

Reply

Journal of Cataract and Refractive Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Chee's strategy for patient positioning seems simple and elegant using this table. With severe kyphosis, we have found that the curve of the spine is so low under the head (when the head is horizontal) that we cannot get our feet under the bed for a temporal approach. It sounds as though this bed and position allow a temporal approach, which I think would be preferred. (Source: Journal of Cataract and Refractive Surgery)

Colonic interposition for esophageal replacement in children remains a good choice: 33-year median follow-up of 65 patients

Journal of Pediatric Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Conclusions: Colon conduits restored gastrointestinal continuity with limited mortality and considerable morbidity but good functional outcome and health perception in the long-term. Our study suggests that colon grafts are no worse than gastric pull-ups in the long-term. (Source: Journal of Pediatric Surgery)

Herpes Zoster–Induced Trunk Muscle Paresis Presenting With Abdominal Wall Pseudohernia, Scoliosis, and Gait Disturbance and Its Rehabilitation: A Case Report

Archives of Physical Medicine and Rehabilitation — Mon, 01 Feb 2010 00:00:00 +0100

We describe a 73-year-old man with T12 and L1 segmental paresis caused by HZ presenting with abdominal wall pseudohernia, scoliosis, and standing and gait disturbance who responded well to a systematic rehabilitation approach. He first noticed a right abdominal bulge in the 6th postherpetic week, which was gradually accompanied by right convex thoracolumbar scoliosis, pain, and standing and gait disturbance in the 12th week. Needle electromyography revealed abnormal spontaneous activities at rest in the right T12 myotomal muscles, and motor unit recruitment was markedly decreased. We arranged an outpatient rehabilitation program consisting of using a soft thoracolumbosacral orthosis for pain relief and trunk stability, muscle reeducation of the paretic abdominal muscles, strengthening of t...

The use of expandable cages in patients undergoing multilevel corpectomies for metastatic tumors in the cervical spine.

Orthopedics — Mon, 01 Feb 2010 00:00:00 +0100

We report our experience with the use of expandable cages in this subgroup of patients.From August 2006 to May 2008, 5 patients presenting with myelopathy, pain, and/or radiculopathy secondary to metastatic disease of the cervical spine underwent multilevel cervical corpectomies and placement of expandable cages in our institution. All procedures were supplemented with an anterior cervical plate and with posterior instrumentation to achieve a 360 degrees fusion. A visual analog scale (VAS), Nurick grade, Frankel grade, American Spinal Injuries Association (ASIA) grade, and Ranawat grade were used to evaluate patients pre- and postoperatively. The mean follow-up period was 13.2 months. Three patients underwent a 2-level corpectomy, 1 a 3-level corpectomy, and 1 a 4-level corpectomy. Postope...

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3-D MRI/CT fusion imaging of the lumbar spine

Skeletal Radiology — Fri, 29 Jan 2010 17:57:36 +0100

Conclusion Use of 3-D MRI/CT fusion imaging for the lumbar vertebral region successfully revealed the relationship between bone construction (bones, intervertebral joints, and intervertebral disks) and neural architecture (cauda equina and nerve roots) on a single film, three-dimensionally and in color. Such images may be useful in elucidating complex neurological conditions such as degenerative lumbar scoliosis(DLS), as well as in diagnosis and the planning of minimally invasive surgery. Content Type Journal ArticleCategory Technical ReportDOI 10.1007/s00256-009-0788-5Authors Yuki Yamanaka, Ehime University Department of Bone and Joint Surgery Shitsukawa Toon-shi, Ehime 791-0295 JapanJunji Kamogawa, Ehime University Department of Bone and Joint Surgery Shitsukawa To...

Shoulder arthrodesis: Description of a modified technique

Orthopedics and Traumatology — Fri, 29 Jan 2010 12:05:12 +0100

Summary Objectives Stabilization of the glenohumeral joint to relieve pain and to improve function in instances of muscle paralysis secondary to plexus palsy, destruction of the joint with massive bone loss and large irreparable cuff tears. Indications Paralysis of the rotator cuff or deltoid muscles secondary to brachial plexus lesions or polio. Severe joint degeneration following infection. Massive irreparable cuff tears. Failed arthroplasty. Severe rheumatoid disease. Contraindications Advanced arthritis of the ipsilateral elbow. Arthroplasty of the ipsilateral elbow. Extensive loss of scapulothoracic muscles. Severe thoracic scoliosis and advanced arthritis of the sternoclavicular and acromioclavicular ...

Introduction to the "Scoliosis" Journal Brace Technology Thematic Series: increasing existing knowledge and promoting future developments

Scoliosis — Thu, 28 Jan 2010 00:00:00 +0100

Bracing is the main non-surgical intervention in the treatment of idiopathic scoliosis during growth, in hyperkyphosis (and Scheuermann disease) and occasionally for spondylolisthesis; it can be used in adult scoliosis, in the elderly when pathological curves lead to a forward leaning posture or in adults after traumatic injuries. Bracing can be defined as the application of external corrective forces to the trunk; rigid supports or elastic bands can be used and braces can be custom-made or prefabricated.The state of research in the field of conservative treatment is insufficient and while it can be stated that there is some evidence to support bracing, we must also acknowledge that today we do not have a common and generally accepted knowledge base, and that instead, individual expertise ...

A specific scoliosis classification correlating with brace treatment: description and reliability

Scoliosis — Wed, 27 Jan 2010 00:00:00 +0100

Conclusions: A specific scoliosis classification which correlates with brace treatment has been proposed with an acceptable intra-and inter-observer reliability. (Source: Scoliosis)

Exceptions to the Valsalva doctrine

Neurology — Mon, 25 Jan 2010 21:04:05 +0100

In 1707, Valsalva reported a patient with unilateral cerebral hemorrhage associated with weakness on the contralateral side of the body, and Morgagni in De Sedibus subsequently referred to this crossed relationship of brain to body as the Valsalva doctrine. Since then, decussation of corticospinal tracts and many other neural pathways within the CNS has become so deeply embedded in neurologic thinking that exceptions may not be considered and therefore may be overlooked. Several uncommon clinical events that result in paralysis ipsilateral to brain injury highlight nuances of normal human neuroanatomy and neuropathology. More recently, exceptions to the Valsalva doctrine have been documented in 2 autosomal recessive genetic conditions: horizontal gaze palsy and progressive scoliosis and Jo...

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Scoliosis in Teenagers: To Brace or Not to Brace Is Still a Question,

Health Behavior News Service — Mon, 25 Jan 2010 14:50:58 +0100

01/19/2010, Cochrane Library, The use of braces to correct excessive curvature of the spine, or scoliosis, in adolescents is still an area of controversy — and is likely to remain that way until there is better evidence, concludes a new review of published research. Although some evidence points toward a benefit from using braces, research has failed to prove definitively that they work. (Source: Health Behavior News Service)

Weak evidence of benefit for scoliosis bracing

Reuters: Health — Fri, 22 Jan 2010 19:44:09 +0100

NEW YORK (Reuters Health) - The use of braces to correct excessive curvature of the spine (scoliosis) in adolescents is a subject of ongoing debate and a new review of the medical literature does little to resolve the matter. (Source: Reuters: Health)

Weak Evidence of Benefit for Scoliosis Bracing

MedlinePlus Health News — Fri, 22 Jan 2010 19:44:09 +0100

The use of braces to correct excessive curvature of the spine (scoliosis) in adolescents is a subject of ongoing debate and a new review of the medical literature does little to resolve the matter. Source: Reuters Health Related MedlinePlus Topic: Scoliosis (Source: MedlinePlus Health News)

Efficacy of postoperative epidural analgesia in adolescent scoliosis surgery: a meta-analysis.

Paediatric Anaesthesia — Fri, 22 Jan 2010 18:30:05 +0100

CONCLUSION: Epidural analgesia is beneficial to patients in terms of improving pain control and reducing side effects. The influence on respiratory depression, length of stay in the intensive care unit, or mortality is not available in the literature at this time. PMID: 20091934 [PubMed - in process] (Source: Paediatric Anaesthesia)

Comparison of the biomechanical 3D efficiency of different brace designs for the treatment of scoliosis using a finite element model

European Spine Journal — Fri, 22 Jan 2010 10:09:20 +0100

This study could help to better understand the brace biomechanics and to rationalize and optimize their design. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00586-009-1268-2Authors Julien Clin, École Polytechnique de Montréal Department of Mechanical Engineering P.O. Box 6079 Downtown Station Montreal QC H3C 3A7 CanadaCarl-Eric Aubin, École Polytechnique de Montréal Department of Mechanical Engineering P.O. Box 6079 Downtown Station Montreal QC H3C 3A7 CanadaStefan Parent, Sainte-Justine University Hospital Center 3175 Côte-Ste-Catherine Rd Montreal QC H3T 1C5 CanadaArchana Sangole, École Polytechnique de Montréal Department of Mechanical Engineering P.O. Box 6079 Downtown Station Montreal QC H3C 3A7 CanadaHubert Labelle, Sainte-Justine University Hospital ...

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A wireless sensor network system to determine biomechanics of spinal braces during daily living

Medical and Biological Engineering and Computing — Fri, 22 Jan 2010 09:54:47 +0100

This study developed a battery-powered wireless sensor network to continuously monitor forces exerted by the braces to scoliotic patients. This network consisted of one master, up to 15 slave loggers, and one base station. The time of the loggers were synchronized every 6 h to ensure that force measurements were taken at the same time. Each logger could continuously log data for at least 4 months with a sample rate of 1 sample/min. The wireless system was fully tested in the laboratory and individual logger units were tested in 6 patients. The power consumption of each logger for 4 months at 1.2 V was 454 mAh. This system will allow us to investigate the force distribution inside the brace during daily activities. Content Type Journal ArticleCategory O...

[Intramedullary tumors. Results of a national investigation in private neurosurgery.]

Neuro-Chirurgie — Fri, 22 Jan 2010 00:00:00 +0100

CONCLUSION: Total removal of the intramedullary tumors is a challenge. In cases of removal, the risk of worsening status is 18-19.5%. Subtotal or incomplete removal 27-40% risk of recurrence. PMID: 20097390 [PubMed - as supplied by publisher] (Source: Neuro-Chirurgie)

Untreated Scoliosis Patients Show High Quality of Life

Modern Medicine — Thu, 21 Jan 2010 00:00:00 +0100

In their 30s, patients with moderate idiopathic scoliosis report a good quality of life regardless of whether or not they were braced during adolescence, according to a study in the Jan. 15 issue of Spine. (Source: Modern Medicine)

Screening for deep venous thrombosis after idiopathic scoliosis surgery in children: a pilot study.

Paediatric Anaesthesia — Wed, 20 Jan 2010 21:50:33 +0100

Conclusion: Thromboembolic event seems to be rare after scoliosis surgery. Prophylaxis for venous thrombosis should not be recommended in such patient. But, larger series are required to confirm such results. PMID: 20078811 [PubMed - in process] (Source: Paediatric Anaesthesia)

Scoliosis In Teenagers: To Brace Or Not To Brace Is Still A Question

Health News from Medical News Today — Wed, 20 Jan 2010 10:00:00 +0100

The use of braces to correct excessive curvature of the spine, or scoliosis, in adolescents is still an area of controversy and is likely to remain that way until there is better evidence, concludes a new review of published research. Although some evidence points toward a benefit from using braces, research has failed to prove definitively that they work. Adolescent idiopathic scoliosis curvature of the spine in which the cause is unknown affects about 1 percent to 12 percent of the general population. Scoliosis is much more common in girls and is more likely to be severe in girls... (Source: Health News from Medical News Today)

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Scoliosis In Teenagers: To Brace Or Not To Brace Is Still A Question

Bones / Orthopaedics News From Medical News Today — Wed, 20 Jan 2010 10:00:00 +0100

[Spread of hyperbaric local anesthetics in a spinal canal model : The influence of Trendelenburg position and spinal configuration.]

Der Anaesthesist — Wed, 20 Jan 2010 00:00:00 +0100

CONCLUSIONS: Diffusion processes represent the decisive factor for distribution patterns of hyperbaric anesthetics in the supine position. Only the 5 degrees head-down tilt demonstrated an influence of specific gravity. When tilted 10 degrees head-down gravitation prevailed over differences in density. A 15 degrees head-down tilt is a precondition for the mobilization of sacrally pooled local anesthetic. Data comparison of both model investigations showed that the extent of spread depends more on initial bidirectional distribution of the local anesthetic than on increasing flow rate due to the slope of lumbar lordosis. PMID: 20084350 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)

Compromise in mRNA processing machinery in senescent human fibroblasts: implications for a novel potential role of Phospho-ATR (ser428).

Biogerontology — Tue, 19 Jan 2010 00:00:00 +0100

This study implicates the spatiotemporal presence of the phosphorylated kinase in the regulation of mRNA splicing and polyadenylation. This function appears perturbed in senescent cells, accompanied by a distinct pattern of phospho-ATR in the senescent nucleus. PMID: 20084458 [PubMed - as supplied by publisher] (Source: Biogerontology)

Familial 1.1 Mb deletion in chromosome Xq22.1 associated with mental retardation and behavioural disorders in female patients.

European Journal of Medical Genetics — Tue, 19 Jan 2010 00:00:00 +0100

We report on a 7-year-old girl with severe mental retardation (MR), autism, micro-brachycephaly, generalized muscle hypotonia with distal hypotrophy of lower limbs, scoliosis and facial dysmorphisms. Array-CGH analysis identified a 1.1 Mb deletion of chromosome Xq22.1. Further analysis demonstrated that the deletion was inherited from her mother who showed mild MR, short stature, brachycephaly, epilepsy and a Borderline Personality Disorder. Microsatellite segregation analysis revealed that the rearrangement arose de novo in the mother on the paternal X chromosome. The deleted Xq22.1 region contains part of the NXF gene cluster which is involved in mRNA nuclear export and metabolism. Among them, the NXF5 gene has already been linked to mental retardation whereas NXF2 protein has been recen...

Methamphetamine facilitates female sexual behavior and enhances neuronal activation in the medial amygdala and ventromedial nucleus of the hypothalamus

Psychoneuroendocrinology — Mon, 18 Jan 2010 16:35:38 +0100

Summary: Methamphetamine (MA) abuse has reached epidemic proportions in the United States. Users of MA report dramatic increases in sexual drive that have been associated with increased engagement in risky sexual behavior leading to higher rates of sexually transmitted diseases and unplanned pregnancies. The ability of MA to enhance sexual drive in females is enigmatic since related psychostimulants like amphetamine and cocaine appear not to affect sexual drive in women, and in rodents models, amphetamine has been reported to be inhibitory to female sexual behavior. Examination of MA's effects on female sexual behavior in an animal model is lacking. Here, using a rodent model, we have demonstrated that MA enhanced female sexual behavior. MA (5mg/kg) or saline vehicle was administered once ...

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Effect of obesity and low back pain on spinal mobility: a cross sectional study in women

Journal of NeuroEngineering and Rehabilitation — Mon, 18 Jan 2010 00:00:00 +0100

Conclusions: obese individuals with cLBP showed higher degree of spinal impairment when compared to those without cLBP. The observed obesity-related thoracic stiffness may characterize this sub-group of patients, even if prospective studies should be carried out to verify this hypothesis. (Source: Journal of NeuroEngineering and Rehabilitation)

Does Multilevel Lumbar Stenosis Lead to Poorer Outcomes?: A Subanalysis of the Spine Patient Outcomes Research Trial (SPORT) Lumbar Stenosis Study.

Pain Physician — Thu, 14 Jan 2010 00:00:00 +0100

CONCLUSION.: Patients with spinal stenosis without associated degenerative spondylolisthesis or scoliosis can be managed nonoperatively irrespective of the number of levels involved. If surgery is performed, the number of levels treated does not predict outcome. In contrast, patients with concomitant degenerative spondylolisthesis and single level stenosis do better surgically than those with additional levels of stenosis. This study emphasizes the importance of shared decision-making between the physician and patient when considering treatment for spinal stenosis. PMID: 20081560 [PubMed - as supplied by publisher] (Source: Pain Physician)

Diffusion tensor imaging in horizontal gaze palsywith progressive scoliosis

Magnetic Resonance Imaging — Thu, 14 Jan 2010 00:00:00 +0100

Abstract: Horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare disorder characterized by absence of conjugate horizontal eye movements, preservation of vertical gaze and convergence, progressive scoliosis developing in childhood and adolescence. It is caused by mutations in the ROBO3 gene which are critical for the crossing of long ascending medial lemniscal and descending corticospinal tracts in the medulla. Diffusion tensor imaging on a 14-year-old boy with HGPPS revealed ipsilateral ascending and descending connectivity in the brainstem without any crossing over of the major tracts although normal interhemispheric connections in the corpus callosum was demonstrable. Absent decussation of smaller sized superior cerebellar peduncles but with normal crossing over of the middl...

Schmid-Fraccaro Syndrome: Severe Neurologic Features

Pediatric Neurology — Tue, 12 Jan 2010 15:55:40 +0100

We report on a 17-year-old girl with Schmid-Fraccaro syndrome and severe cognitive deficits and motor deficits, who presented at our healthcare unit for a medical consultation. Her physical examination was remarkable for bilateral coloboma of the iris, hypertelorism, bilateral preauricular tags, scoliosis, and cardiac systolic murmur. After her birth, she was evaluated for anal atresia and congenital cardiac disease, which led to a genetic investigation and a diagnosis of Schmid-Fraccaro syndrome. Life expectancy in Schmid-Fraccaro syndrome depends on the number and variety of malformations, but in most cases the prognosis is favorable. (Source: Pediatric Neurology)

Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk

European Spine Journal — Tue, 12 Jan 2010 06:44:41 +0100

Abstract Surgical site infection (SSI) following spinal surgery is a frequent complication and results in higher morbidity, mortality and healthcare costs. Patients undergoing surgery for spinal deformity (scoliosis/kyphosis) have longer surgeries, involving more spinal levels and larger blood losses than typical spinal procedures. Previous research has identified risk factors for SSI in spinal surgery, but few studies have looked at adult deformity surgeries. We retrospectively performed a large case cohort analysis of all adult patients who underwent surgery for kyphosis or scoliosis, between June 1996 and December 2005, by our adult spine division in an academic institution to asses the incidence and identify risk factors for SSI. We reviewed the electronic patient reco...

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Novel FOXG1 mutations associated with the congenital variant of Rett syndrome

Journal of Medical Genetics — Mon, 11 Jan 2010 23:58:27 +0100

Background Rett syndrome is a severe neurodevelopmental disorder representing one of the most common genetic causes of mental retardation in girls. The classic form is caused by MECP2 mutations. In two patients affected by the congenital variant of Rett we have recently identified mutations in the FOXG1 gene encoding a brain specific transcriptional repressor, essential for early development of the telencephalon. Methods 60 MECP2/CDKL5 mutation negative European Rett patients (classic and variants), 43 patients with encephalopathy with early onset seizures, and four atypical Rett patients were analysed for mutations in FOXG1. Results and conclusions Mutations have been identified in four patients, independently classified as congenital Rett variants from France, Spain and Latvia. Clinica...

Estrogen regulates the expression of N-methyl-d-aspartate (NMDA) receptor subunit epsilon 4 (Grin2d), that is essential for the normal sexual behavior in female mice

FEBS Letters — Mon, 11 Jan 2010 00:00:00 +0100

Abstract: Estrogen plays important roles in the reproductive behavior of animals. In the present study, we found that the Grin2d gene of mouse possessed half-sites of the estrogen-responsive element (ERE) in the 3′-untranslated region (UTR). Quantitative PCR analysis showed that the reduced Grin2d mRNA expression in the hypothalamus of the ovariectomized mice was restored by estrogen administration. Downregulation of Grin2d mRNA expression was also detected in the hypothalamus of estrogen receptor alpha-knockout female mice. Moreover, estrogen-induced lordosis response was decreased in Grin2d-knockout mice. These results suggest that estrogen regulates lordosis behavior through the regulation of Grin2d expression in the hypothalamus of female mice. (Source: FEBS Letters)

Risk Factors for Spinal Cord Injury During Surgery for Spinal Deformity

JBJS [Am] — Mon, 04 Jan 2010 18:02:21 +0100

Conclusions: Combined somatosensory and motor evoked potential monitoring effectively prevents neurologic injury in most children undergoing surgery for spinal deformity. Despite the potential for false-positive results, we recommend setting a low threshold for defining relevant electrophysical changes. Rapid intervention can reverse these changes and avoid potentially serious neurologic complications. Patients with cardiopulmonary comorbidities may be at a higher risk for having relevant electrophysical events. Level of Evidence: Diagnostic Level III. See Instructions to Authors for a complete description of levels of evidence. (Source: JBJS [Am])

Predictability of the Fulcrum Bending Radiograph in Scoliosis Correction with Alternate-Level Pedicle Screw Fixation

JBJS [Am] — Mon, 04 Jan 2010 18:02:21 +0100

Conclusions: To our knowledge, this is the first study to demonstrate the predictive value of the fulcrum bending radiograph in the context of alternate-level pedicle screw fixation in patients with adolescent idiopathic scoliosis. Curve flexibility may dictate the degree of the fulcrum bending correction index, whereby a curve that is less flexible may achieve a greater fulcrum bending correction index. The fulcrum bending radiograph has potential predictive utility. In addition, pedicle screw constructs appear to have a better ability to correct scoliosis in comparison with hooks and hybrid constructs. Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence. (Source: JBJS [Am])

Growth Modulation by Means of Anterior Tethering Resulting in Progressive Correction of Juvenile Idiopathic Scoliosis: A Case Report

JBJS [Am] — Mon, 04 Jan 2010 18:02:21 +0100

(Source: JBJS [Am])

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Operative versus Nonoperative Treatment of Thoracolumbar Burst Fractures

Seminars in Spine Surgery — Mon, 04 Jan 2010 00:00:00 +0100

High energy injuries to the thoracolumbar (TL) region are commonly encountered and have been described since the time of Hippocrates. Despite this long history and mountains of manuscripts generated on the topic, the optimal care of TL burst fractures remains controversial. There is such great heterogeneity in study designs, inclusion criteria, and interventions used that traditional treatment guidelines require a critical re-evaluation. Many outcome studies have failed to correlate radiographic indicators such a kyphosis, loss of vertebral body height, and canal compromise to long-term clinical outcomes. Furthermore, 3 large prospective, randomized trials have demonstrated outcome equivalency of operative and nonoperative treatment for TL burst fractures without neurological compromise. S...

The association of disproportionate skeletal growth and abnormal radius dimension ratio with curve severity in adolescent idiopathic scoliosis

European Spine Journal — Sat, 02 Jan 2010 16:53:59 +0100

Abstract Abnormal anthropometric measurements during the peripubertal growth spurt have been documented in adolescent idiopathic scoliosis (AIS). Magnetic resonance (MR) imaging studies of the spine have suggested a disproportionate endochondral and membranous ossification in AIS. The present study aimed at investigating whether disproportional ossification and skeletal growth occurred in the peripheral bone of AIS patients using the radius as the target bone. Skeletally mature AIS girls with different severity (n = 290) and age-matched control healthy girls (n = 80) were recruited. The anthropometric parameters were recorded. The midshaft of non-dominant radius was scanned with peripheral quantitative computed tomography (pQCT) and the radius diameter w...

The association of spinal osteoarthritis with lumbar lordosis

BioMed Central — Sat, 02 Jan 2010 00:00:00 +0100

Conclusions: There is no difference in lordosis between those affected with lumbar spine osteoarthritis and those who are disease free. It appears that osteoarthritis is nomicront associated with the degree of lumbar lordosis. (Source: BioMed Central)

Functional Consequences of Homocysteinylation of the Elastic Fiber Proteins Fibrillin-1 and Tropoelastin [Glycobiology and Extracellular Matrices]

Journal of Biological Chemistry — Fri, 01 Jan 2010 17:05:56 +0100

We report here that homocysteinylation affects functional properties of fibrillin-1 and tropoelastin. We used recombinant fragments spanning the entire fibrillin-1 molecule to demonstrate that homocysteinylation, but not cysteinylation leads to abnormal self-interaction, which was attributed to a reduced amount of multimerization of the fibrillin-1 C terminus. The deposition of the fibrillin-1 network by human dermal fibroblasts was greatly reduced by homocysteine, but not by cysteine. Furthermore, homocysteinylation, but not cysteinylation of elastin-like polypeptides resulted in modified coacervation properties. In summary, the results provide new insights into pathogenetic mechanisms potentially involved in cystathionine-β-synthase-deficient homocystinuria. (Source: Journal of Biol...

Scoliosis - The current concepts

Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1) — Fri, 01 Jan 2010 14:44:14 +0100

Sengupta Dilip Kumar, Webb John KIndian Journal of Orthopaedics 2010 44(1):5-8 (Source: Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1))

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The natural history of adolescent idiopathic scoliosis

Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1) — Fri, 01 Jan 2010 14:44:14 +0100

Wong Hee-Kit, Tan Ken-JinIndian Journal of Orthopaedics 2010 44(1):9-13There have been great advances in the conservative and surgical treatment for adolescent idiopathic scoliosis in the last few decades. The challenge for the physician is the decision for the optimal time to institute therapy for the individual child. This makes an understanding of the natural history and risk factors for curve progression of significant importance. Reported rates of curve progression vary from 1.6% for skeletally mature children with a small curve magnitude to 68% for skeletally immature children with larger curve magnitudes. Although the patient's age at presentation, the Risser sign, the patient's menarchal status and the magnitude of the curve have been described as risk f...

Results of the spine-to-rib-cage distraction in the treatment of early onset scoliosis

Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1) — Fri, 01 Jan 2010 14:44:14 +0100

Conclusion: Treatment of EOS with spine-to-rib growing rod in the present form provides similar correction and complication rates to those published in the series considering traditional single or dual growing rod systems. Based on this, the authors recommend revision of the GSP design and a new clinical trial to test safety and efficacy. (Source: Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1))

The evaluation of short fusion in idiopathic scoliosis

Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1) — Fri, 01 Jan 2010 14:44:14 +0100

Conclusions: With modern instrumentations, the EVB of the major curve can be used at the end of the instrumentation in most cases of idiopathic scoliosis. In those cases with either severe trunk shift, younger than 11 years old, or extreme rigid curve, an extension of one or more levels might be safer. In particular situations, the concept of centering the lowest vertebra over the sacrum should be adopted. (Source: Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1))

Adolescent idiopathic scoliosis: Retrospective analysis of 235 surgically treated cases

Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1) — Fri, 01 Jan 2010 14:44:14 +0100

Conclusion : The coronal plane correction was better when all screw constructs were employed. Use of all pedicle screw systems obviated the need for costoplasty in most cases. The increased incidence of intraspinal anomaly may warrant a routine pre operative MR imaging of all adolescent scoliosis needing surgical treatment. (Source: Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1))

Posterior scoliosis correction for adolescent idiopathic scoliosis using side-opening pedicle screw-rod system utilizing the axial translation technique

Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1) — Fri, 01 Jan 2010 14:44:14 +0100

Conclusion : Side-opening spinal instrumentation systems, using the axial translation technique, achieved good clinical and radiological outcome for patients of AIS. (Source: Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1))

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Spinal loop rectangle and sub laminar wiring as a technique for scoliosis correction

Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1) — Fri, 01 Jan 2010 14:44:14 +0100

Conclusion: Segmental spinal fixation with locally made spinal loop rectangle and sublaminar wires is comparable as a modality to correct scoliotic spinal deformities. (Source: Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1))

Intraspinal anomalies in scoliosis: An MRI analysis of 177 consecutive scoliosis patients

Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1) — Fri, 01 Jan 2010 14:44:14 +0100

Conclusion : The high incidence of intraspinal anomalies in presumed idiopathic scoliosis in our study group emphasizes the need for detailed examination for subtle neurological signs that accompany neuro-axial anomalies. Preoperative MRI screening is recommended in patients with presumed 'idiopathic' scoliosis who present at young age, with neurological findings and in curves with apical thoracic kyphosis. (Source: Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1))

Multimodal intraoperative neuromonitoring in corrective surgery for adolescent idiopathic scoliosis: Evaluation of 354 consecutive cases

Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1) — Fri, 01 Jan 2010 14:44:14 +0100

Conclusion : Neurogenic motor-evoked potential (NMEP) monitoring appears to be superior to conventional SSEP monitoring for identifying evolving spinal cord injury. Used in conjunction, the sensitivity and specificity of combined neuromonitoring may reach up to 100%. Multimodality monitoring with SSEP + NMEP should be the standard of care. (Source: Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1))

Cervical neurofibromatosis with quadriparesis: Management by fibular strut graft

Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1) — Fri, 01 Jan 2010 14:44:14 +0100

Laohacharoensombat Wichien, Wajanavisit Wiwat, Woratanarat PatarawanIndian Journal of Orthopaedics 2010 44(1):95-97This is a case report of an eight-year old boy with neurofibromatosis and a 120&#186; dystrophic kyphosis of the cervical spine. He presented with progressive quadriparesis caused by spondyloptosis of the C2/C3, and was successfully treated by skull traction and one-stage anterior fibular strut graft lying between the tubercle of the atlas through the C2 body slot and lower vertebrae. At seven years follow-up there was, loosening of lower vertebral screws which allowed growth and residual mobility of lower vertebral joints while the fusion of upper cervical spines was still solid. (Source: Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1))

Posterior decompression surgery for extraforaminal entrapment of the fifth lumbar spinal nerve at the lumbosacral junction.

Journal of Neurosurgery.Spine — Fri, 01 Jan 2010 00:00:00 +0100

Conclusions Extraforaminal stenosis at the lumbosacral junction is a rare but distinct pathological condition causing L-5 radiculopathy. Decompression surgery without fusion using a microendoscope or a surgical microscope/ loupe is a feasible and less invasive surgical option for elderly patients with extraforaminal stenosis at the lumbosacral junction. PMID: 20043768 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery.Spine)

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Long-term surgical outcome and risk factors in patients with cervical myelopathy and a change in signal intensity of intramedullary spinal cord on magnetic resonance imaging.

Journal of Neurosurgery.Spine — Fri, 01 Jan 2010 00:00:00 +0100

Conclusions Long-term clinical outcome was significantly worse in patients with intramedullary signal intensity changes on MR images. The risk factors were instability of the cervical spine and severe ventral spinal compression. The long-term clinical outcome was also significantly worse in patients with postoperative expansion of the high signal intensity area. The fact that cervical instability was a risk factor for the postoperative expansion of the high signal intensity indicates that this high signal intensity area occurred, not only from necrosis secondary to ischemia of the anterior spinal artery, but also from the repeated minor traumas inflicted on the spinal cord from an unstable cervical spine. The long-term neurological outcome found in the preliminary study of patients with CC...

"Skip" corpectomy in the treatment of multilevel cervical spondylotic myelopathy and ossified posterior longitudinal ligament.

Journal of Neurosurgery.Spine — Fri, 01 Jan 2010 00:00:00 +0100

Conclusions The authors conclude that the preservation of the C-5 vertebral body provided an additional screw purchase and strengthened the construct. The results of the current study demonstrated effectiveness and safety of the skip corpectomy in patients with multilevel CSM and OPLL. PMID: 20043761 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery.Spine)

Biplanar Measurement of Thoracolumbar Curvature in Older Adults Using an Electromagnetic Tracking Device

Archives of Physical Medicine and Rehabilitation — Fri, 01 Jan 2010 00:00:00 +0100

Abstract: Singh DK, Bailey M, Lee R. Biplanar measurement of thoracolumbar curvature in older adults using an electromagnetic tracking device.Objectives: To develop a new biplanar method of thoracolumbar curvature measurement by using an electromagnetic tracking device and to study the effects of aging on the thoracolumbar curvature.Design: Cross-sectional study.Setting: Human movement laboratory.Participants: Healthy (N=52, 26 younger and 26 older) volunteers.Interventions: Not applicable.Main Outcome Measures: An electromagnetic tracking device was used to trace the thoracolumbar curvature by recording the positions of the spinous processes of the spine. The coordinates of the curvature were fitted with polynomial equations, and the magnitudes of thoracic kyphosis, lumbar lordosis, and l...

Growth modulation by means of anterior tethering resulting in progressive correction of juvenile idiopathic scoliosis: a case report.

The Journal of Bone and Joint Surgery. American volume — Fri, 01 Jan 2010 00:00:00 +0100

Authors: Crawford CH, Lenke LG PMID: 20048114 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Predictability of the fulcrum bending radiograph in scoliosis correction with alternate-level pedicle screw fixation.

The Journal of Bone and Joint Surgery. American volume — Fri, 01 Jan 2010 00:00:00 +0100

CONCLUSIONS: To our knowledge, this is the first study to demonstrate the predictive value of the fulcrum bending radiograph in the context of alternate-level pedicle screw fixation in patients with adolescent idiopathic scoliosis. Curve flexibility may dictate the degree of the fulcrum bending correction index, whereby a curve that is less flexible may achieve a greater fulcrum bending correction index. The fulcrum bending radiograph has potential predictive utility. In addition, pedicle screw constructs appear to have a better ability to correct scoliosis in comparison with hooks and hybrid constructs. PMID: 20048109 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

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Risk factors for spinal cord injury during surgery for spinal deformity.

The Journal of Bone and Joint Surgery. American volume — Fri, 01 Jan 2010 00:00:00 +0100

CONCLUSIONS: Combined somatosensory and motor evoked potential monitoring effectively prevents neurologic injury in most children undergoing surgery for spinal deformity. Despite the potential for false-positive results, we recommend setting a low threshold for defining relevant electrophysical changes. Rapid intervention can reverse these changes and avoid potentially serious neurologic complications. Patients with cardiopulmonary comorbidities may be at a higher risk for having relevant electrophysical events. PMID: 20048097 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Pathologic correlation of posterior ligamentous injury with MRI.

Orthopedics — Fri, 01 Jan 2010 00:00:00 +0100

This article describes 2 cases of spinal trauma in which diagnostic magnetic resonance imaging (MRI) was correlated with histopathology for diagnosis of a posterior ligamentous complex injury. Spine fractures are common and represent up to 16% of traumatic fractures. Diagnostic imaging currently involves plain films and computerized tomography, but MRI is being used with increasing frequency. The definition of neurologic tissue injury has had substantial documentation in the spinal literature. Clinically, posterior ligamentous complex injury has been associated with facet disruption, gapping of the spinous processes, and significant kyphosis. Assessment of spinal stability in the spine trauma population is based significantly on the assumed disruption or integrity of the posterior ligament...

Balloon kyphoplasty in the treatment of osteoporotic vertebral compression fracture nonunion.

Orthopedics — Fri, 01 Jan 2010 00:00:00 +0100

This study evaluated the therapeutic potential of balloon kyphoplasty in the treatment of nonunion of osteoporotic vertebral compression fractures. Twenty-one patients with nonunion of osteoporotic vertebral compression fractures were treated with balloon kyphoplasty. The criteria for diagnosis of nonunion osteoporotic vertebral compression fractures included the following: (1) history of pain for at least 6 months at the fracture site; (2) low T1- and high T2-signal on magnetic resonance images; (3) widening of fracture line on routine radiographs; and (4) movement of the endplate and changes of anterior vertebral heights on hyperextension radiographs. All patients were followed for 9 to 33 months postoperatively (mean 25 months). Statistically significant improvements in the mean postope...

Laminoplasty with miniplates for posterior approach in thoracic and lumbar intraspinal surgery.

Turkish Neurosurgery — Fri, 01 Jan 2010 00:00:00 +0100

CONCLUSIONS: No patient required additional surgery because of progressive spinal instability. This technique is safe and well-suited to serve as a standard posterior approach to intraspinal pathologies and offers distinct advantages over laminectomy and repeat surgery. PMID: 20066618 [PubMed - in process] (Source: Turkish Neurosurgery)

Lumbar Spine and Pelvic Posture Between Standing and Sitting: A Radiologic Investigation Including Reliability and Repeatability of the Lumbar Lordosis Measure

Journal of Manipulative and Physiological Therapeutics — Fri, 01 Jan 2010 00:00:00 +0100

Conclusion: The significant differences in lumbar and pelvic measures from standing to sitting further emphasize the range of motion experienced at vertebral levels in sitting. Based on the results of this study, interventions to return motion segments to a less flexed posture should be investigated because they may play a role in preventing injury and low back pain. (Source: Journal of Manipulative and Physiological Therapeutics)

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Update on scoliosis in children and adolescents

Modern Medicine Contemporary Pediatrics — Fri, 01 Jan 2010 00:00:00 +0100

Scoliosis is a relatively common childhood disorder that can affect infants, children, and adolescents. (Source: Modern Medicine Contemporary Pediatrics)

Primary effect of dual growing rod technique for the treatment of severe scoliosis in young children.

Chinese Medical Journal — Fri, 01 Jan 2010 00:00:00 +0100

CONCLUSIONS: The dual growing rod technique was useful in the management of rapidly progressing scoliosis in young children. This technique could control severe scoliosis, allow for spinal growth, and maintain the coronal and sagittal balance. But the technique has high complications requiring strict and regular follow-up. PMID: 20137362 [PubMed - in process] (Source: Chinese Medical Journal)

Various attitudes to the use of corrective exercises in conservative treatment of scoliosis.

Ortopedia, Traumatologia, Rehabilitacja — Fri, 01 Jan 2010 00:00:00 +0100

Authors: Nowotny J, Nowotny-Czupryna O, Czupryna K In acquired scoliosis, the degree of the curve is initially low and its type becomes apparent only after it has progressed. The characteristics of scoliosis include an abnormal spatial arrangement of individual body segments, which the central nervous system (CNS) interprets as a defect and automatically launches compensatory mechanisms. Neglecting low-degree scoliosis poses a two-fold danger. It usually leads to the development of structural changes, while the child gets used to the abnormal body arrangement, thus reinforcing the poor postural habits. The basic aim of early rehabilitation is to manage the compensatory mechanisms and prevent the development of adverse secondary changes, rehabilitation in scoliosis being no exception.So...

Long-term surgical outcomes in congenital diaphragmatic hernia: observations from a single institution

Journal of Pediatric Surgery — Thu, 31 Dec 2009 15:18:29 +0100

Conclusions: For long-term survivors of CDH, specific perinatal and operative variables, particularly patch repair, are associated with subsequent adverse surgical outcomes. (Source: Journal of Pediatric Surgery)

Efficacy and safety of VEPTR instrumentation for progressive spine deformities in young children without rib fusions

European Spine Journal — Wed, 30 Dec 2009 06:46:00 +0100

Abstract This retrospective study analyses 23 children treated with vertical expandable prosthetic titanium rib (VEPTR) for correction of non-congenital early onset spine deformities. After the index procedure (IP), the device was lengthened at 6-month intervals. The average (av) age at the time of IP was 6.5 years (1.11–10.5). The av follow-up time was 3.6 years (2–5.8). Diagnosis included 1 early onset idiopathic scoliosis, 11 neuromuscular, 2 post-thoracotomy scoliosis, 1 Sprengel deformity, 2 hyperkyphosis, 1 myopathy and 5 syndromic. Surgeries (187) included 23 IPs, av 6.5 (4–10) device expansions per patient (149) and 15 unplanned surgeries. 23 complications (0.13 per surgery) included 10 skin sloughs, 5 implant dislocations, 2 rod breakages and 6 infe...

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Cartilage oligomeric matrix protein promotes cell attachment via two independent mechanisms involving CD47 and alphaVbeta3 integrin.

Molecular and Cellular Biochemistry — Thu, 24 Dec 2009 00:00:00 +0100

In this study, the role of COMP in ligament was investigated with a series of cell attachment assays using ligament cells binding to COMP. A dose-dependent cell attachment activity was found, which was inhibited by a peptide containing the SFYVVMWK amino acid sequence derived from the globular C-terminal domain of COMP. This activity was independent of the recently described RGD-dependent attachment activity. Function-blocking antibodies to CD47 and alphaVbeta3 integrin reduced cell attachment to COMP, implicating the participation of these cell surface molecules in COMP cell binding. Immunofluorescence studies showed that cell attachment to COMP induced the formation of lamellae containing F-actin microspikes associated with fascin. We propose that COMP promotes cell attachment via two in...

Congenital Cervical Kyphosis in a Child Associated with Tetraparesis: Case Report

Pediatric Neurosurgery — Wed, 23 Dec 2009 23:00:00 +0100

Pediatr Neurosurg 2009;45:422-424 (DOI:10.1159/000270158) (Source: Pediatric Neurosurgery)

Motor cortical hyperexcitability in idiopathic scoliosis: could focal dystonia be a subclinical etiological factor?

European Spine Journal — Wed, 23 Dec 2009 22:29:41 +0100

Abstract The aetiology of idiopathic scoliosis (IS) remains unknown; however, there is a growing body of evidence suggesting that the spine deformity could be the expression of a subclinical nervous system disorder. A defective sensory input or an anomalous sensorimotor integration may lead to an abnormal postural tone and therefore the development of a spine deformity. Inhibition of the motor cortico-cortical excitability is abnormal in dystonia. Therefore, the study of cortico-cortical inhibition may shed some insight into the dystonia hypothesis regarding the pathophysiology of IS. Paired pulse transcranial magnetic stimulation was used to study cortico-cortical inhibition and facilitation in nine adolescents with IS, five teenagers with congenital scoliosis (CS) and ei...

[Current strategies of conservative and operative treatment of the most frequent muscular disorders.]

Der Orthopade — Wed, 23 Dec 2009 00:00:00 +0100

Authors: Fujak A, Forst R, Forst J Though up to now no causal treatment for the majority of neuromuscular disorders is available, their disease progress and above all the quality of life of these patients can be decisively improved by established medical procedures. The main symptom is variably rapid, progressive muscle weakness, which leads to muscular imbalance and differently manifested impairment of motor functions. This results in the essential orthopaedic problems in these patients, e.g. contractures and deformities of the lower and upper extremities, foot deformities and sitting instability due to progressive scoliosis. Since the affected muscles have no physiological adaptability, they cannot be trained like healthy muscles. The orthopaedic treatment includes conservative metho...