Three-dimensional reconstruction of intervertebral disc based on magnetic resonance imaging in patients with acute low back pain.

The aim of the study is to evaluate the morphology of the intervertebral discs visible in the magnetic resonance image in patients with sudden severe low back pain (with or without radiation of pain to the lower limb). The second goal of the study is to perform a digital three-plane reconstruction of the intervertebral disc and to compare this technique with a standard magnetic resonance imaging test. Twenty-five patients, mean age 35.5 years, all with acute low back pain, were examined. We compared the 3D MR models with standard MRI scans by measuring seven MRI parameters. In patients with sudden, severe low back pain, with clinical symptoms suggesting an etiology within the intervertebral disc, changes in a standard MRI are found consisting of the presence of a hernia / protrusion of the intervertebral disc and lowering the height of the intervertebral disc - with lowering the disc height occurs to a greater extent in the rear section. The 3D reconstruction is a reliable 3D representation of the intervertebral disc and adjacent vertebral bodies.

Back muscle function in adolescent girls treated with a rigid brace for idiopathic scoliosis: no impact of 6-month brace wear on muscle strength or endurance.

The study aimed to determine the impact of 6-month rigid brace on back muscle strength and endurance in adolescents with idiopathic scoliosis. Sixty-one girls, aged 7.0-16.0, were analyzed in two groups: the study group (6-month rigid brace wear) vs. the control group (no brace treatment), recruited consecutively and matched for age, body height, weight, BMI, primary curve location and Cobb angle. All patients underwent clinical and radiological examination, modified Biering-Sorensen test, prone and standing maximum strength and endurance tests. No significant difference between groups in back muscles strength or endurance, both gobal and reported to body weight was found. No relation between the daily brace time and the back muscle strength or endurance was observed. The 6-month use of a rigid brace did not affect the strength or endurance of the back muscles in adolescent girls treated for idiopathic scoliosis.

Is there any difference in pulmonary testing parameters due to spirometry reference values? A study in adolescents with idiopathic scoliosis.

The Global Lung Function Initiative (GLI 2012) presented multi-ethnic spirometry reference values that are recommended to be used instead previous Zapletals' reference values. The study aimed to compare the values of the pulmonary parameters calculated according to the Zapletals' versus the GLI 2012 reference values in adolescents with idiopathic scoliosis. Preoperative pulmonary testing and radiographic evaluation were performed in 39 adolescents (29 females, 10 males) aged 12-17 years. The thoracic Cobb angle ranged 50°-104°. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were measured. The percentages of predicted values of FVC (%FVC) and the FEV1 (%FEV1) were calculated according to the Zapletals' reference values and to the GLI 2012 reference values. The subgroup analysis was performed for the subjects with Cobb curve 50°-74° (N=26) versus the subjects with Cobb curve 75°-104° (N=13). Mean %FVC was significantly higher using the Zapletals' reference values 86.1%±16.4 versus 84.6%±15.6 using the GLI 2012 reference values, p=0.0116. Mean %FEV1 was significantly higher using the Zapletals' reference values 84.5%±18.2 versus 80.0%±16.3 using GLI 2012 reference values, p=0.000001. The subgroup analysis revealed significant difference of %FVC in moderate (p=0.033974) and no difference in severe curves (p=0.1993). The %FEV1 differences were significant in both moderate (p=0.000011) and severe curves (p=0.0334). The study demonstrated that a significant difference might be observed in the spirometry parameters due to the applied reference values. These differences might be taken into account during the spirometry examination interpretation.

Loss of body height due to severe thoracic curvature does impact pulmonary testing results in adolescents with idiopathic scoliosis.

A standing body height is a variable used to calculate pulmonary parameters during spirometry examination. In adolescents with idiopathic scoliosis, the loss of the body height is observed, and it may potentially influence the results of pulmonary testing. The study aimed to analyze pulmonary parameters in adolescents with idiopathic scoliosis in relation to the measured versus the corrected body height. Preoperative pulmonary testing and radiographic evaluation were performed in 39 children (29 females, 10 males) aged 12-17 years. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were measured. The single best effort was analyzed. Thoracic Cobb angle ranged 50°-104°. Corrected body height was calculated according to the Stokes' formula. The subgroup analysis was performed for the subjects with curves 50°-74° (N=26) versus 75°-104° curves (N=13). Mean measured body height was 166.1±9.0 cm versus 168.9±8.9 cm mean corrected body height. The %FVC obtained for the measured height was significantly higher than obtained for the corrected height: 84.6% ±15.6 vs. 81.6% ±15.6, p<0.001. The %FEV1 obtained for the measured height was significantly higher than obtained for the corrected height: 79.8% ±16.3 vs. 77.35% ±15.9, p<0.001. The subgroup analysis revealed significant differences in %FVC and %FEV1 calculated for the measured versus the corrected body height, p<0.001. Corrected body height significantly influences the results of pulmonary parameters measurement. In consequence, it may influence the analysis of the pulmonary status of children with idiopathic scoliosis.

Risser sign: the value of the lateral spinal radiograph to assess the excursion of the iliac apophysis.

The course of the ossification of the iliac apophysis is considered in adolescent patients with idiopathic scoliosis, under the name of the Risser sign, to determine the remaining spinal growth. Although the iliac crest develops in the three-dimensional space as a complex structure, the iliac apophysis ossification has been assessed only on a one plane frontal spinal radiograph. This study points out the usefulness of the lateral radiograph for the visualization of the whole iliac crest, especially the posterior region which otherwise cannot be observed. Two young female pelvis specimen were examined with anatomical measurements and radiography. Lateral spinal radiographs of 201 girls were analyzed for the iliac apophysis excursion. The measures of the width of the iliac bone beneath the iliac crest revealed one anterior and one posterior thick regions, coupled with an intermediate thin region. The regions of the maximal thickness corresponded to the earliest appearance of the apophysis ossification (Risser 1), while the thin part of the iliac bone corresponded to late appearance of the apophysis ossification (Risser 3-4). The ossification of the posterior part of the crest was best visualized with the lateral radiograph, which was exclusive in showing the posterior superior iliac spine region. On the frontal spinal radiograph the end of the course of the apophysis (Risser 3-4) is usually searched at the level of the sacroiliac joint, while in reality this point was found to be situated more caudal, and accessible for observation on the lateral radiograph.

Two-dimensional digital photography for child body posture evaluation: standardized technique, reliable parameters and normative data for age 7-10 years.

BACKGROUND: Digital photogrammetry provides measurements of body angles or distances which allow for quantitative posture assessment with or without the use of external markers. It is becoming an increasingly popular tool for the assessment of the musculoskeletal system. The aim of this paper is to present a structured method for the analysis of posture and its changes using a standardized digital photography technique. MATERIAL AND METHODS: The purpose of the study was twofold. The first one comprised 91 children (44 girls and 47 boys) aged 7-10 (8.2 ± 1.0), i.e., students of primary school, and its aim was to develop the photographic method, choose the quantitative parameters, and determine the intraobserver reliability (repeatability) along with the interobserver reliability (reproducibility) measurements in sagittal plane using digital photography, as well as to compare the Rippstein plurimeter and digital photography measurements. The second one involved 7782 children (3804 girls, 3978 boys) aged 7-10 (8.4 ± 0.5), who underwent digital photography postural screening. The methods consisted in measuring and calculating selected parameters, establishing the normal ranges of photographic parameters, presenting percentile charts, as well as noticing common pitfalls and possible sources of errors in digital photography. RESULTS: A standardized procedure for the photographic evaluation of child body posture was presented. The photographic measurements revealed very good intra- and inter-rater reliability regarding the five sagittal parameters and good reliability performed against Rippstein plurimeter measurements. The parameters displayed insignificant variability over time. Normative data were calculated based on photographic assessment, while the percentile charts were provided to serve as reference values. The technical errors observed during photogrammetry are carefully discussed in this article. CONCLUSIONS: Technical developments are allowed for the regular use of digital photogrammetry in body posture assessment. Specific child positioning (described above) enables us to avoid incidentally modified posture. Image registration is simple, quick, harmless, and cost-effective. The semi-automatic image analysis, together with the normal values and percentile charts, makes the technique reliable in terms of child's posture documentation and corrective therapy effects' monitoring.

Actual evidence in the medical approach to adolescents with idiopathic scoliosis.

Idiopathic scoliosis (IS) is a three-dimensional deformity of the spine and trunk. The most common form involve adolescents. The prevalence is 2-3% of the population, with 1 out of 6 patients requiring treatment of which 25% progress to surgery. Physical and rehabilitation medicine (PRM) plays a primary role in the so-called conservative treatment of adolescents with IS, since all the therapeutic tools used (exercises and braces) fall into the PRM domain. According to a Cochrane systematic review there is evidence in favor of bracing, even if it is of low quality. Recently, a controlled prospective trial including a randomised arm gave more strength to this conclusion. Another Cochrane review shows that there is evidence in favor of exercises as an adjunctive treatment, but of low quality. Three meta-analysis have been published on bracing: one shows that bracing does not reduce surgery rates, but studies with bracing plus exercises were not included and had the highest effectiveness; another shows that full time is better than part-time bracing; the last focuses on observational studies following the Scoliosis Research Society (SRS) criteria and shows that not all full time rigid bracing are the same: some have the highest effectiveness, others have less than elastic and nighttime bracing. Two very important RCTs failed in recruitment, showing that in the field of bracing for scoliosis RCTs are not accepted by the patients. Consensuses by the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) show that there is no agreement among experts either on the best braces or on their biomechanical action, and that compliance is a matter of clinical more than patients' behavior (there is strong agreement on the management criteria to achieve best results with bracing). A systematic review of all the existing studies shows effectiveness of exercises, and that auto-correction is their main goal. A systematic review shows that there are no studies on manual treatment. The SOSORT Guidelines offer the actual standard of conservative care.

7th SOSORT consensus paper: conservative treatment of idiopathic & Scheuermann's kyphosis.

UNLABELLED: : Thoracic hyperkyphosis is a frequent problem and can impact greatly on patient's quality of life during adolescence. This condition can be idiopathic or secondary to Scheuermann disease, a disease disturbing vertebral growth. To date, there is no sound scientific data available on the management of this condition. Some studies discuss the effects of bracing, however no guidelines, protocols or indication's of treatment for this condition were found. The aim of this paper was to develop and verify the consensus on managing thoracic hyperkyphosis patients treated with braces and/or physiotherapy. METHODS: The Delphi process was utilised in four steps gradually modified according to the results of a set of recommendations: we involved the SOSORT Board twice, then all SOSORT members twice, with a Pre-Meeting Questionnaire (PMQ), and during a Consensus Session at the SOSORT Lyon Meeting with a Meeting Questionnaire (MQ). RESULTS: There was an unanimous agreement on the general efficacy of bracing and physiotherapy for this condition. Most experts suggested the use of 4-5 point bracing systems, however there was some controversy with regards to physiotherapeutic aims and modalities. CONCLUSION: The SOSORT panel of experts suggest the use of rigid braces and physiotherapy to correct thoracic hyperkyphosis during adolescence. The evaluation of specific braces and physiotherapy techniques has been recommended.

'SOSORT consensus paper on brace action: TLSO biomechanics of correction (investigating the rationale for force vector selection)'.

BACKGROUND: The effectiveness of orthotic treatment continues to be controversial in international medical literature due to differences in the reported results and conclusions of various studies. Heterogeneity of the samples has been suggested as a reason for conflicting results. Besides the obvious theoretical differences between the brace concepts, the variability in the technical factors can also explain the contradictory results between same brace types. This paper will investigate the degree of variability among responses of scoliosis specialists from the Brace Study Ground of the International Society on Scoliosis Orthopedic and Rehabilitation Treatment SOSORT. Ultimately, this information could be a foundation for establishing a consensus and framework for future prospective controlled studies. METHODS: A preliminary questionnaire on the topic of 'brace action' relative to the theory of three-dimensional scoliosis correction and brace treatment was developed and circulated to specialists interested in the conservative treatment of adolescent idiopathic scoliosis. A particular case was presented (main thoracic curve with minor lumbar). Several key points emerged and were used to develop a second questionnaire which was discussed and full filed after the SOSORT consensus meeting (Milano, Italy, January 2005). RESULTS: Twenty-one questionnaires were completed. The Chêneau brace was the most frequently recommended. The importance of the three point system mechanism was stressed. Options about proper pad placement on the thoracic convexity were divided 50% for the pad reaching or involving the apical vertebra and 50% for the pad acting caudal to the apical vertebra. There was agreement about the direction of the vector force, 85% selecting a 'dorso lateral to ventro medial' direction but about the shape of the pad to produce such a force. Principles related to three-dimensional correction achieved high consensus (80%-85%), but suggested methods of correction were quite diverse. CONCLUSION: This study reveals that among participating SOSORT specialists there continues to be a strongly held and conflicting if not a contentious opinion regarding brace design and treatment. If the goal of a 'treatment consensus' is realistic and achievable, significantly more effort will be required to reconcile these differences.

[Osteotomy of the medial cuneiform in the treatment of the adducted forefoot]. / Osteotomia kosci klinowatej przysrodkowej w leczeniu przywiedzenia przodostopia.

A series of 20 feet in 17 children (12 females, 5 males) treated surgically with medial cuneiform osteotomy and bony bloc insertion to correct forefoot adduction has been assessed. Primary diagnosis were: congenital clubfoot (17 feet), skewfoot (2 feet) and congenital fibular aplasia (1 foot). The average age at the operation was 4.5 years (range from 23 months to 8 years 2 months). Five children (7 feet) were operated before 4 years of age. Medial cuneiform osteotomy has been combined with complete subtalar release from Cincinnati approach, wedge resection of the cuboid and Dwyer procedure. The follow-up was 18 months on an average (6-30 months). Correction of the deformity has been assessed clinically and radiologically (angles: tarsal-metatarsal I, tarsal-metatarsal V and first ray angle ray angle according to Barriolhet. In all cases accurate position of the forefoot has been achieved.