Very short-term effect of brace wearing on gait in adolescent idiopathic scoliosis girls

Purpose

Adolescent idiopathic scoliotic (AIS) deformity induces excessive oxygen consumption correlated to a bilateral increase of lumbo-pelvic muscles timing activity (EMG) during gait. Wearing a brace, the usual treatment for AIS, by supporting the spine and the pelvis, would generate lumbo-pelvic muscular relaxation and consequently reduce excessive oxygen consumption. The purpose of this study was to evaluate the short-term effect of bracing on gait biomechanics in scoliotic spine when compared with normal braced spine.

Methods

Thirteen healthy volunteers were compared to 13 AIS girls. In both samples, gait analysis was assessed using a three-dimensional motion analysis, including synchronous kinematic, electromyographic, mechanical and energy measurements, first without brace, then wearing a brace.

Results

For scoliotic patients, comparison of in-brace and out-brace situations revealed a significant decrease of frontal pelvis (p < 0.001), hip (p < 0.001) and shoulder (p = 0.004) motion in brace associated with a significant reduction of pelvis rotation (p = 0.003). However, the brace did not change significantly the lumbo-pelvic muscle activity duration (EMG) or the mechanical and energetic parameters. Transversal pelvis motion was reduced by 39 % (p = 0.04), frontal hip and shoulder motions by 23 % (p = 0.004) and 30 % (p = 0.01) respectively, and energy cost of walking remained increased by 37 % in braced AIS girls relatively to braced healthy subjects. Mechanical and electromyographic variables were not significantly different between the two braced populations during gait except for the gluteus medius muscle that showed bilaterally an increase of duration of electrical activity in healthy subjects and contrarily a decrease in AIS patients (healthy: −3.5 ± 9.6 % of gait cycle vs. scoliotic: 3.7 ± 7.7 % of gait cycle; p = 0.04).

Conclusions

Bracing changed neither the oxygen consumption nor the timing of the lumbo-pelvic muscles activity in both groups during gait. However, in brace the timing activity of bilateral gluteus medius muscles tended to decrease in AIS patients and increase in healthy subjects. Moreover, braced AIS patients had more restricted frontal hips and shoulder motion as well as pelvis rotation than braced healthy subjects.     

Family history and its association to curve size and treatment in 1,463 patients with idiopathic scoliosis

Purpose

To study family history in relation to curve severity, gender, age at diagnosis and treatment in idiopathic scoliosis.

Methods

A self-assessment questionnaire on family history of scoliosis was administered to 1,463 untreated, brace or surgically treated idiopathic scoliosis patients.

Results

Out of the 1,463 patients, 51 % had one or more relatives with scoliosis. There was no significant difference between females and males, nor between juvenile and adolescent study participants in this respect (p = 0.939 and 0.110, respectively). There was a significant difference in maximum curve size between patients with one or more relatives with scoliosis (median 35°, interquartile range 25) and patients without any relative with scoliosis (median 32°, interquartile range 23) (p = 0.022). When stratifying patients according to treatment (observation, brace treatment or surgery), we found that it was more common to have a relative with scoliosis among the treated patients (p = 0.011). The OR for being treated was 1.32 (95 % CI 1.06–1.64) when the patient had a relative with scoliosis, compared to not having.

Conclusions

Larger curve sizes were found in patients with a family history of scoliosis than in the ones without. No relation between family history and gender or between family history and age at onset of idiopathic scoliosis was found. Although the presence of a family history of scoliosis may not be a strong prognostic risk factor, it indicates that these patients are at higher risk of developing a more severe curve.     

Can decompression surgery relieve low back pain in patients with lumbar spinal stenosis combined with degenerative lumbar scoliosis?

Introduction

Decompression with fusion is usually recommended in patients with lumbar spinal stenosis (LSS) combined with degenerative lumbar scoliosis (DLS). However, elderly patients with LSS and DLS often have other comorbidities, and surgical treatment must be both safe and effective. The aim of this study was to investigate whether decompression surgery alone alleviates low back pain (LBP) in patients with LSS and DLS, and to identify the predictors of postoperative residual LBP.

Materials and methods

A total of 75 patients (33 males and 42 females) with a mean age of 71.8 years (range 53–86 years) who underwent decompression surgery for LSS with DLS (Cobb angle ≥ 10°) and had a minimum follow-up period of 1 year, were retrospectively reviewed using the Japanese Orthopaedic Association scoring system for the assessment of lumbar spinal diseases (JOA score). Radiographic measurements included coronal and sagittal Cobb angles, apical vertebral rotation (Nash-Moe method), and anteroposterior and lateral spondylolisthesis. Logistic regression analysis was performed to investigate the predictors of residual LBP after surgery.

Results

Forty-nine patients had preoperative LBP, of which 29 (59.1 %) experienced postoperative relief of LBP. Logistic regression analysis demonstrated that the degree of apical vertebral rotation on preoperative radiography was significantly associated with postoperative residual LBP (odds ratio, 8.16, 95 % confidence interval, 1.55–83.81, p = 0.011).

Conclusion

A higher degree of apical vertebral rotation may therefore be an indicator of mechanical LBP in patients with LSS and DLS. Decompression with fusion should be recommended in these patients.     

Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years

Purpose

Our objectives were primarily to review the published literature on complications in neuromuscular scoliosis (NMS) surgery and secondarily, by means of a meta-analysis, to determine the overall pooled rates (PR) of various complications associated with NMS surgery.

Methods

PubMed and Embase databases were searched for studies reporting the outcomes and complications of NMS surgery, published from 1997 to May 2011. We focused on NMS as defined by the Scoliosis Research Society’s classification. We measured the pooled estimate of the overall complication rates (PR) using a random effects meta-analytic model. This model considers both intra- and inter-study variation in calculating PR.

Results

Systematic review and meta-analysis were performed for 68 cohort and case–control studies with a total of 15,218 NMS patients. Pulmonary complications were the most reported (PR = 22.71 %) followed by implant complications (PR = 12.51 %), infections (PR = 10.91 %), neurological complications (PR = 3.01 %) and pseudoarthrosis (PR = 1.88 %). Revision, removal and extension of implant had highest PR (7.87 %) followed by malplacement of the pedicle screws (4.81 %). Rates of individual studies have moderate to high variability. The studies were heterogeneous in methodology and outcome types, which are plausible explanations for the variability; sensitivity analysis with respect to age at surgery, sample size, publication year and diagnosis could also partly explain this variability. In regard to surgical complications affiliated with various surgical techniques in NMS, the level of evidence of published literature ranges between 2+ to 2−; the subsequent recommendations are level C.

Conclusion

NMS patients have diverse and high complication rates after scoliosis surgery. High PRs of complications warrant more attention from the surgical community. Although the PR of all complications are affected by heterogeneity, they nevertheless provide valuable insights into the impact of methodological settings (sample size), patient characteristics (age at surgery), and continual advances in patient care on complication rates.

Electronic supplementary material

The online version of this article (doi:10.1007/s00586-012-2542-2) contains supplementary material, which is available to authorized users.     

Are intraspinal anomalies in early onset idiopathic scoliosis as common as once thought? A two centre United Kingdom study

Purpose

Rates of neural axis abnormalities in infantile and juvenile idiopathic scoliosis may be as high as 50 %. We aimed to determine the rates of neural axis abnormalities in early onset idiopathic scoliosis patients in a British population.

Methods

This retrospective study at two British spinal deformity clinics identified 72 patients satisfying the inclusion criteria of: (1) age at diagnosis of 7 years and younger, (2) idiopathic scoliosis and (3) magnetic resonance imaging of the neuraxis.

Results

The mean age at diagnosis was 3.6 years and the mean Cobb angle was 47° with a near equal distribution of left (32) and right (36) sided curves. Eight (11.1 %) neural axis abnormalities consisting of two syrinxes, one Arnold–chiari Type I malformation and five combined (Arnold–chiari malformation Type I and syrinx) anomalies were identified.

Conclusions

This multi-centre study on the largest number of British subjects to date helps to establish the rates of neural axis abnormalities.     

条件性敲除Osterix基因获得先天性脊柱侧凸小鼠动物模型及表型分析

目的 通过Osterix基因敲除获得先天性脊柱侧凸动物模型及表型分析.方法 应用Cre-LoxP系统繁育成骨细胞特异性敲除Osterix基因小鼠.取4、12周龄的敲除小鼠各10只,以同龄同系野生型小鼠各10只为对照,行全身及脊柱X线摄像观察;收集脊柱标本行苏木素-伊红(HE)染色及抗酒石酸酸性磷酸酶(TRAP)染色观察并检测.结果 成功获得成骨细胞特异性敲除Osterix基因小鼠,X线显示敲除小鼠中75％出现严重的脊柱侧凸,Cobb角平均值为35..HE染色显示敲除小鼠椎体生长板增宽,椎体骨量增加,TRAP染色显示腰椎中破骨细胞数量显著减少(P＜0.05).结论 小鼠成骨细胞中条件性敲除Osterix基因后成功获得先天性脊柱侧凸模型,提示Osterix在先天性脊柱侧凸的发病中有重要作用.     

1～6岁正常小儿胸椎椎弓根形态学研究

【摘要】 目的：测量1～6岁小儿胸椎椎弓根的形态学参数,为小儿胸椎椎弓根螺钉固定提供解剖学依据。方法：收集2009年7月~2010年1月在北京儿童医院行胸部CT检查的1～6岁非脊柱疾患小儿胸椎螺旋CT影像资料。根据年龄将入组儿童分为1～岁组（1组）,2～岁组（2组）,4～6岁组（3组）,每组20例。每例均测量T1～T12左右两侧椎弓根参数共24组数值。将64排螺旋CT平扫胸椎的三维重建数据传至工作站,在多平面重建技术下获得每个椎弓根的矢状面及横断面成像,测量胸椎椎弓根横径（内外径）、纵径（内外径）、骨-螺钉通道长度、椎弓根横断面夹角、椎弓根矢状面夹角,并将上述各参数与年龄进行相关性分析,椎弓根横断面夹角和椎弓根矢状面夹角年龄组间采用多重T检验。结果：（1）椎弓根的横径（内外径）T1～T4逐渐减小,T5～T12逐渐增大;横内径值（除T1、T6、T11、T12外）与年龄无显著相关性（rs：0.011～0.363,除T1、T6、T11、T12外,P>0.05）,其随年龄增长变化不明显;横外径值（除T4外）与年龄均存在显著正相关性（rs：0.151～0.539,除T4外,P<0.05）,其随年龄增长而增长。（2）椎弓根纵径（内外径）T1～T12逐渐增大,除T1外纵径均大于横径;各节段参数与年龄均存在显著正相关性（纵内径rs：0.526～0.786,纵外径rs：0.692～0.864,P<0.05）。（3）骨-螺钉通道长度各年龄组中最短为T1或T2,最长为T9或T10,T1～T9有逐渐增加的趋势,T10～T12有逐渐减小的趋势;各节段参数与年龄均存在显著正相关性（rs：0.299～0.676,P<0.05）。（4）椎弓根横断面夹角最大为T1,T1～T12逐渐减小,部分小儿T11及T12的椎弓根横断面夹角可达0°甚至负角,除T1外,其余各节段参数与年龄均存在显著负相关性（rs：-0.432～-0.107,除T1 P>0.05外,余P<0.05）,1组与2、3组间存在显著性差异（P<0.05）,2组与3组间无显著性差异（P>0.05）。（5）椎弓根矢状面夹角T1~T12呈下降趋势,各节段参数与年龄无显著相关性（rs：-0.125～0.127,P>0.05）,1、2、3三组间无显著性差异（P>0.05）。结论：1～6岁小儿胸椎椎弓根横外径、纵经、骨-螺钉通道长度与年龄的相关性较大,而椎弓根横内径的生长速度较慢,与年龄的相关性较小;横断面及矢状面夹角与年龄的相关性较小,除1~岁年龄组外,其余年龄段的参数值随年龄增长无明显变化。因此行1～6岁小儿胸椎椎弓根螺钉内固定手术时,应根据患儿年龄及术中情况妥善选择螺钉型号及进钉方式,以避免手术风险。     

后路矫形手术对青少年特发性脊柱侧凸患者脊柱高度的影响

要】 目的：评估后路矫形手术对青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）患者脊柱高度的矫正程度及其影响因素。方法：2010年1月~2011年6月接受后路矫形内固定术的AIS患者277例,单弯（single curve,SC）173例,双弯（double curve,DC）104例,站立位主弯Cobb角平均53.63°±15.38°（40°~140°）,仰卧位主弯Cobb角43.87°±15.01°（20°~124°）。脊柱高度（spinal height,SH）定义为仰卧位全脊柱正位X线片上T1椎体上终板中点至S1椎体上终板中点之间的垂直距离。测量术前、术后SH,ΔSH为手术矫正SH值。评估不同Cobb角侧凸患者的ΔSH,并采用偏相关分析评估脊柱侧凸术前Cobb角、Cobb角矫正值、Cobb角矫正率、术前SH及术后SH与ΔSH的相关性。结果：SC组仰卧位Cobb角术后矫正至15.69°±9.21°（4°~79°）,DC组仰卧位主弯Cobb角术后矫正至19.50°±13.07°（3°~95°）,矫正率分别为69.7%和65.5%。SC组和DC组术前SH分别为41.29±2.96cm和39.97±3.26cm,术后SH分别为43.77±2.71cm和42.86±3.04cm。SC组术前仰卧位Cobb角分别为≤30°、31°~40°、41°~50°、51°~60°、61°~70°、71°~80°、>80°时,ΔSH分别为1.97±0.79cm、2.14±0.63cm、2.52±0.65cm、2.77±0.51cm、3.92±0.61cm、4.33±0.22cm、4.85±0.22cm;而在DC组中,ΔSH分别为2.37±0.60cm、2.35±0.69cm、2.56±0.53cm、3.27±0.40cm、3.79±0.94cm、3.89±1.11cm、5.46±0.91cm。ΔSH与术前Cobb角[SC：r=0.702,P<0.001;DC（主弯+次发弯）：r=0.718,P<0.001]、Cobb角矫正值[SC：r=0.659,P<0.001;DC（主弯+次发弯）：r=0.698,P<0.001]和术后SH[SC：r=0.182,P=0.017;DC（主弯+次发弯）：r=0.213,P=0.033]呈显著相关性,但与Cobb角矫正率[SC：r=0.083,P>0.05;DC（主弯+次发弯）：r=0.039,P>0.05]和术前SH[SC：r=-0.082,P>0.05;DC（主弯+次发弯）：r=-0.047,P>0.05]无明显相关性。结论：后路矫形手术可显著改善AIS患者的SH,术前Cobb角和Cobb角矫正值是影响SH矫正程度的主要因素,术后SH是次要影响因素,而Cobb角矫正率则影响不大。     

成人特发性脊柱侧凸患者SRS-22简体中文版问卷评分的影响因素分析

目的:探讨临床及影像学参数对成人特发性脊柱侧凸患者脊柱侧凸研究协会22项(SRS-22)量表简体中文版问卷评分的影响.方法:2008年1月～2012年12月109例无支具及手术治疗史的成人特发性脊柱侧凸患者接受SRS-22简体中文版的问卷调查.男17例,女92例;年龄19～40岁,平均24.8岁.冠状面主弯Cobb角16°～102°,平均37.3°.分析SRS-22各维度得分及亚总分与年龄、体重指数、主弯Cobb角及矢状面平衡间的相关性,并分别比较年轻(＜30岁)与年长(≥30岁)、小角度(Cobb角＜40°)与大角度(Cobb角≥40°)、胸弯与胸腰/腰弯以及男性与女性患者间SRS-22评分差异.结果:年龄与SRS-22亚总分、疼痛、心理状况及功能维度得分负相关(r分别为-0.35、-0.50、-0.31、-0.21,P＜0.05);体重指数与疼痛得分负相关(r=-0.23,P＜0.05);主弯Cobb角与SRS-22亚总分、自我形象及功能维度得分负相关(r分别为-0.31、-0.49、-0.30,P＜0.05);矢状面平衡与功能维度得分负相关(r=-0.26,P＜0.05).年长患者SRS-22亚总分、疼痛及心理得分低于年轻患者(P＜0.05).大角度患者SRS-22亚总分、自我形象及功能维度得分低于小角度患者(P＜0.05).胸弯患者自我形象及心理维度得分低于胸腰/腰弯患者(P＜0.05).女性患者的疼痛维度得分明显低于男性(P＜0.05),其余参数及得分无统计学差异.结论:年龄、侧凸Cobb角、体重指数、躯干矢状面平衡可影响成人特发性脊柱侧凸患者SRS-22简体中文版问卷不同维度得分.胸弯患者自我形象及心理受侧凸的影响较腰弯患者更大,女性患者对疼痛的耐受性低于男性.     

Lenke 1A型青少年特发性脊柱侧凸患者胸弯融合术后附加现象的原因分析

目的:分析Lenke 1A型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者胸弯融合术后发生远端附加现象的原[因,探讨远端固定椎(lowest instrumented vertebra,LIV)的选择方法.方法:2007年1月～2010年12月,对54例Lenke 1A型AIS患者采用后路椎弓根螺钉系统矫形固定,女43例,男11例,平均年龄14.4岁.平均随访3.2年,在末次随访时的站立位全脊柱正位X线片上观察融合远端附加现象,主胸弯下端椎(lowest end vertebra,LEV)向远端移动且Cobb角增加5°以上或LIV远端椎间隙成角5°以上为发生远端附加现象.将发生远端附加现象可能的相关因素进行统计学分析.结果:54例患者中有12例(22.2％)发生远端附加现象,纳入病例组;未发生附加现象的42例患者纳入对照组.单因素变量分析发现两组间存在统计学差异的因素包括:术前LIV偏离骶骨中线(center sacral vertical line,CSVL)距离、LIV与LEV相距节段数、LIV与中立椎(neutral vertebra,NV)相距节段数、LIV与稳定椎(stable vertebra,SV)相距节段数以及Risser征;多变量Logistic回归分析显示术前LIV偏距超过10mm、未固定到NV (NV-LIV＞0)、Risser 征 2级以下是发生远端附加现象的独立危险因素.结论:远端固定椎选择不当和骨骼发育程度低是术后发生附加现象的重要原因;固定到NV是最佳选择,当选择NV-1作为LIV时,术前LIV偏离CSVL的距离超过10mm容易发生附加现象.