Relationship of disc degeneration after pubertal growth spurt to future low back pain: a longitudinal cohort study.

PURPOSE: In this longitudinal cohort study, we investigated the relationship of disc degeneration (DD) after pubertal growth spurt to future low back pain (LBP). METHODS: A group of healthy volunteers underwent a semi-structured interview about LBP without trauma and a 1.5T lumbar MRI at ages 18 and 34. A Pfirrmann Summary Score (PSS) was calculated by adding up the Pfirrmann grades of the three lowest lumbar discs of each subject (range 3-15). The relationship of PSS at age 18 to LBP at age 34 was analyzed. RESULTS: Forty-one participants had full data at both time points. Mean PSS at age 18 was 6.8 (SD 1.1) and 5.6 (SD 1.2) for participants with or without LBP at age 34, respectively (p = 0.009). The OR (95% CI) of PSS at age 18 for LBP at age 34 was 5.46 (1.22 to 24.47) when adjusted for sex, BMI, smoking and physical activity. All participants but one with PSS greater than 6 at age 18 reported LBP at age 34. CONCLUSION: This is the first study to suggest that DD may be associated with future LBP and the critical time frame seems to be the pubertal growth spurt. Every 1-point increase in Pfirrmann grade at age 18 increased the risk of LBP 5.5-fold at age 34 when adjusted for sex, BMI, smoking and physical activity at age 34. All participants but one with at least one disc with Pfirrmann grade 3 or higher at age 18 reported LBP at age 34.

Anaesthetic considerations in posterior instrumentation of scoliosis due to spinal muscular atrophy: Case series of 56 operated patients.

BACKGROUND: Spinal muscular atrophy (SMA) is a rare illness that often leads to severe kyphoscoliosis. This case series adds to the heretofore sparse information as regards the anaesthetic management of SMA scoliosis patients. METHODS: This retrospective study reviewed the charts of 79 SMA patients (type II n = 34 and type III n = 45) presenting for possible scoliosis surgery during the time period 2007-2019. Special attention focused on preoperative assessment and clearance requirements, anaesthesia protocol and postoperative handling. RESULTS: Out of 79 patients, 17 did not receive clearance for the procedure mostly due to grave respiratory insufficiency. Out of 62 patients with clearance for both surgery and anaesthesia, 56 patients [44 females, 12 males; age mean ± SD (range) 22 ± 7.3 (10-40) years] underwent the procedure. Their forced vital capacity and forced expiratory volume in 1 s were mean ± SD (range) 1.41 ± 0.53 (0.61-2.65) L and 1.26 ± 0.47 (0.52-2.27) L, respectively. Intubation difficulties and their resolution, e.g. with the help of fibreoptic technique and video laryngoscopy, are described. All 56 patients were extubated in the operating room postoperativley. Patients stayed at the postanaesthesia care unit for one (n = 48) or two (n = 8) nights. A considerable amount of the patients (19/56) developed hypokalaemia postoperatively. CONCLUSION: This analysis is one of the bigger series of its kind and adds insight into the preoperative clearance process, the anaesthetic protocol and some of the postoperative complications, e.g. the tendency for developing postoperative hypokalaemia which has not been reported previously.

ISSLS prize in clinical science 2022: accelerated disc degeneration after pubertal growth spurt differentiates adults with low back pain from their asymptomatic peers.

PURPOSE: In this prospective observational cohort study, the development of lumbar intervertebral discs (LIVD) on magnetic resonance imaging (MRI) was investigated from childhood to adulthood with emphasis on the possible association of disc degeneration (DD) to low back pain (LBP). METHODS: In 2021, 89 subjects who were enrolled in 1994 in a longitudinal study with lumbar spine MRI at ages 8, 11 and 18 were invited to participate in a long-term follow-up comprising a clinical examination, selected patient-reported outcome measures and a lumbar spine MRI. We assessed all MRIs (three lowest LIVDs) with the Pfirrmann summary score, and the ratio of signal intensity of nucleus pulposus to signal intensity of cerebrospinal fluid (SINDL). We further analyzed whether disc changes at any age were associated with self-reported LBP at age 34. RESULTS: Of the 48 subjects in the follow-up, 35 reported LBP at age 34. The Pfirrmann summary score significantly increased with age (p < 0.001). Subjects reporting LBP at age 34 demonstrated statistically significantly higher summary scores at age 18 and 34 compared to asymptomatic subjects (p = 0.004 at age 18, and p = 0.039 at age 34). SINDL significantly decreased with age (p < 0.001 for all levels separately), but no significant differences between subjects with or without LBP at age 34 were noticed. CONCLUSION: Subjects with LBP at age 34 had more widespread or severe DD already at age 18 compared to those without LBP.

Concomitant low-grade isthmic L5-spondylolisthesis does not affect the course of adolescent idiopathic scoliosis.

BACKGROUND: Scoliosis with spondylolisthesis was described in 4.4-48%. No information on clinical impact or outcome is available. PURPOSE: To determine the prevalence of this pathology and to investigate its affect on the course of adolescent idiopathic scoliosis (AIS). METHODS: A retrospective comparative study using patients' records, radiographs, the national inpatient registry, and Patient-rated outcome measures (PROM): Oswestry disability index (ODI), modif.SRS-24 questionnaire, WHO-Quality of life index (WHOQoL), Numerical rating scale (NRS) for pain. Clinical follow-up time was 4.4 (4.3) years, and follow-up rate was 95%. PROM follow-up time 26.4 (2.8) years χ2 statistics and t-tests were applied. Significance threshold was set at P < 0.05. RESULTS: Out of 1531 consecutive Caucasian AIS patients, aged 13.9 (1.8) years, primary curve 29.2 (11.5) drs., 120 (7.8%) had low-grade isthmic L5-slip of mean 15.0 (8.3)% (Study group = S). The distribution of the curve types in the study group was comparable to the remaining 1411 patients with AIS only. In comparison with a pair-matched control group (C) at admission, back pain interfering with activities of daily living had 4.2% of the study group and 1.7% of the control group, at clinical follow-up 2.6/4.2% resp. (n.s.). Between groups S/C, there was no significant difference concerning scoliosis treatment: observation 38.3/45.8%, bracing 48.3/46.6%, surgery 10.8/10.2%. Results of treatment were equal in both groups. Long-term outcomes (ODI, SRS-24, WHOQoL, NRS-back/leg pain) were comparable. CONCLUSIONS: The prevalence of low-grade isthmic L5-spondylolisthesis in AIS patients was 7.8%. The presence of low-grade isthmic spondylolisthesis did not influence the curve type of AIS nor did it affect the course or long-term outcome. These slides can be retrieved under Electronic Supplementary Material.

Progression of untreated mild thoracic Scheuermann's kyphosis - Radiographic and functional assessment after mean follow-up of 46 years.

BACKGROUND: There is no data available on the radiographic development of the Scheuermann's deformity. Our purpose was to investigate radiographic deformity progression and the relation between kyphosis progression and clinical outcome in patients with untreated Scheuermann's kyphosis. METHODS: Thoracic kyphosis (Th4-Th12) was measured from standing lateral radiographs in 19 patients at baseline and after mean 46-year follow-up. Mean age at baseline was 19.2 and at follow-up 64.7 years. At follow-up, height, weight, hand grip strength, and hamstring tightness were measured, and sit-to-stand and walking tests were performed. Additionally general health and quality of life questionnaires were administered. RESULTS: The mean thoracic kyphosis increased from 46° (range 25°-78°) at baseline to 60° (34°-82°) (p < 0.001) at follow-up. Mean of the vertebrae wedge increased from 8.8° to 9.9° (p = 0.046). There was no correlation between extent of kyphosis progression and function at follow-up. CONCLUSIONS: Among patients with Scheuermann's disease the degree of radiographic deformity progressed slightly during long-term follow-up. Progression did not predict symptoms.

Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: 5-year follow-up.

OBJECTIVE: To study the long-term outcome of arthroscopy in patients with chronic patellofemoral pain syndrome (PFPS), the authors conducted a randomised controlled trial. The authors also investigated factors predicting the outcome in patients with PFPS. METHODS: Fifty-six patients with PFPS were randomised into two groups: an arthroscopy group (N=28), treated with knee arthroscopy and an 8-week home exercise programme, and a control group (N=28), treated with a similar 8-week home exercise programme only. The primary outcome was the Kujala score on pain and function at 5-year. Secondary outcomes were visual analogue scales (VASs) to assess activity-related symptoms. RESULTS: According to the Kujala score, both groups showed a marked improvement during the 5-year follow-up: a mean improvement of 14.7 (95% CI 9.9 to 19.4) in the arthroscopy group and 13.5 (95% CI 8.1 to 18.8) in the controls. No differences between the groups in mean improvement in the Kujala score (group difference 1.2 (95% CI -8.4 to 6.1)) or in the VAS scores were found. None of the investigated factors predicted the long-term outcome, but in most of the cases the treatment result immediately after the exercise programme remained similar also after the 5-year follow-up. CONCLUSION: Our RCT, being the first of its kind, indicates that the 5-year outcome in most of the patients with chronic PFPS treated with knee arthroscopy and home exercise programme or with the home exercise programme only is equally good in both groups. Some of the patients in both groups do have long-term symptoms.

Spinal epidural lipomatosis: a common imaging feature in Scheuermann disease.

STUDY DESIGN: Retrospective study. OBJECTIVES: To find out if spinal epidural lipomatosis (SEL) occurs more commonly among patients with Scheuermann disease than in the general population. SUMMARY AND BACKGROUND: On the basis of our own radiologic and operative observation, SEL seems to occur frequently in patients with Scheuermann disease. METHODS: Magnetic resonance imaging of 87 individuals (72% male, average age 19±6 y) from 2 centers (29 consecutive patients with Scheuermann disease and 58 controls) were retrospectively evaluated by 2 neuroradiologists. Spinal epidural fat (EF) at seventh thoracic vertebra (EF7), maximum EF (EFmax), dural sac diameter at T7 and at the level of maximum EF (DS7 and DSmax) were measured. EF ratios at T7 (EFR7) and at maximum EF (EFRmax) were calculated as EF/DS. Body mass index (BMI) for study population and kyphosis severity for the patients were recorded. Mann-Whitney, Spearman correlation, and χ tests were performed dependent on the variable in question. RESULTS: EF7, DS7, EFmax, EFR7, and EFRmax was significantly higher among patients with Scheuermann disease (EFmax 5.7±2.4 mm) than among controls (EFmax 3.8±1.1 mm), P<0.001. Twelve patients with Scheuermann disease (41%) fulfilled our proposed criteria for the diagnosis of SEL (EFmax>6 mm+EFRmax>0.51) compared with 2 (3%) among controls (P<0.001). Patients with Scheuermann disease exhibited higher BMI than controls (24.9±5 kg/m vs. 22.9±4 kg/m, P=0.138). Logistic regression showed that the occurrence of SEL among patients with Scheuermann disease was independent of BMI (P=0.880). The degree of kyphosis in patients with Scheuermann's disease (62±20°) was correlated to the amount of the EF. CONCLUSIONS: As SEL occurs more frequently among patients with Scheuermann disease, spine magnetic resonance imaging should be routinely performed to screen each of these patients to avoid impending neurological injury during surgery, especially in those exhibiting SEL.

The intervertebral disc during growth: Signal intensity changes on magnetic resonance imaging and their relevance to low back pain.

Life-time prevalence of low back pain (LBP) in children and adolescents varies from 7% to 72%. Disc changes on magnetic resonance imaging (MRI) have been reported in up to 44% of children with earliest observations around pre-puberty. In this longitudinal cohort study, our objective was to determine the natural history of disc changes from childhood to early adulthood, and the possible association of these changes to LBP. Healthy 8-year-old schoolchildren were recruited for this longitudinal study consisting of a semi-structured interview, a clinical examination, and an MRI investigation at the age of 8-9 (Y8), 11-12 (Y12) and 18-19 (Y19) years. The interview inquired about LBP without trauma. T2-weighted sagittal MRI of the lumbar spine was acquired. Life-long prevalence of LBP was determined, and the disc signal intensity (SI) at the three lowest lumbar levels was assessed both visually using the Schneiderman classification (Bright-Speckled-Dark), and digitally using the disc to cerebrospinal fluid -SI ratio. Possible associations between SI changes and LBP were analyzed. Ninety-four of 208 eligible children were included at Y8 in 1994, 13 and 23 participants were lost to follow-up at Y12 and Y19, respectively. Prevalence of LBP increased after the pubertal growth spurt reaching 54% at Y19. On MRI, 18%, 10% and 38% of participants had disc SI changes at Y8, Y12 and Y19, respectively. No significant associations between self-reported LBP and either qualitative or quantitative disc SI changes were observed at any age. Life-time prevalence of LBP reached 54% by early adulthood. Disc SI changes on MRI traditionally labeled as degenerative were seen earlier than previously reported. Changes in disc SI were not associated with the presence of LBP in childhood, adolescence or early adulthood.

Operative treatment of isthmic spondylolisthesis in children: a long-term, retrospective comparative study with matched cohorts.

The purpose of the present study was to compare the long-term clinical, functional and radiographic outcomes of young patients operated on before or at the onset of puberty (Children) and those operated on after that (Adolescents). The study group consisted of 298 patients operated on under the age of 20 years; 55 of them were operated on before or at the onset of growth spurt (29 females<12.5 years, 26 males<14.5 years). Preoperative data were retrieved from patients' records. After mean follow-up of 17 years (10.7-26.3), physical examination, radiographic measurements and functional testing were performed by independent observers. SRS-24, Oswestry Disability Index (ODI), and Visual Analogue Scale (VAS) were utilised to evaluate health-related quality of life. The data were compared between the two age groups in the whole study population and in 41 pairs of patients matched by gender, operative method, severity of preoperative slip, and age at follow-up. Preoperatively, one-third of children did not have significant pain symptoms. They were operated upon for resistant postural anomalies in combination with high risk of slip progression. All of the adolescents had low-back pain as the main clinical symptom. The outcomes were satisfactory in both groups in the whole population (children vs. adolescents; low-grade slip: SRS-24: 95.9 vs. 92.0, ODI: 5.2 vs. 7.5, VAS low-back pain: 18.9 vs. 21.2; high-grade slip: SRS-24: 95.6 vs. 90.6, ODI: 3.4 vs. 6.9, VAS low-back pain: 10.5 vs. 22.1). The differences were statistically significant for ODI and VAS in high-grade patients in favor of the children. The clinical relevance of these differences seems to be minimal. The results of the comparison of the matched cohorts were comparably good. One-fifth of the whole study group had a non-union which did not affect the final outcome. In the children with high-grade slips, there was a mean slip improvement of 14 percentage points due to remodelling. The overall complication rate in the whole population was 7.7%. In conclusion, spinal fusion can be carried out at an early age for low- and high-grade spondylolisthesis with good long-term clinical, functional, radiographic and health-related quality-of-life outcomes when the indications are met.

[Lengthening of lower limbs--implantable therapeutic devices in distraction osteogenesis]. / Alaraajojen pidennys--implantoitavat hoitolaitteet venytysluudutuksessa.

Severe anisomelia and stunting of the lower limbs are treated with distraction osteogenesis, which involves osteotomy of the femur and tibia and distraction of bone ends by using a device designed for this purpose. Sufficiently slow distraction induces bone growth into the generated gap, whereby the limb can be lengthened by up to 15 cm at a time. Attempts have been made to diminish the disadvantages associated with commonly utilized external distraction devices by using completely implantable lengthening devices, which have been shown to result in an at least equal treatment outcome.

Multi-Axis Fatigue Experimentation System of Intramedullary Implants for Femur and Tibia.

Current designs of leg-lengthening implants have faced serious failures due to inadequacies in the mechanical design. The failure typically is the result of fatigue induced by a combined loading condition with axial and shear components acting in the tubular body of the implant. One of the reasons leading to the failure is improper verification testing for the design of the fatigue limit. The current test standards for pre-clinical design phases of nail implants are relatively straightforward and widely accepted yet cannot produce the three-dimensional stress state representative of the anticipated operation in a patient during the consolidation phase. This work introduces a major improvement toward a method for verifying fatigue life of tubular as well as solid implants under combined torque, axial load, and bending. The report describes a new loading fixture, a calibration method, and compares the qualification results of finite element simulation analyses and experimental measurements during cyclic loading tests. The findings state that the fixture produces controlled multi-axial loadings to study varied osteotomy locations, quasi-static strength and fatigue of intramedullary implants at an intermediate, 2 Hz, cycle rate. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 38:984-995, 2020.

Magnetic resonance imaging findings of the lumbar spine, back symptoms and physical function among male adult patients with Scheuermann's disease.

BACKGROUND: There are only a few studies on untreated Scheuermann's disease and magnetic resonance imaging (MRI) findings in the lumbar spine. The primary aim of this study was to clarify lumbar MRI findings in patients with Scheuermann's disease and to compare with subjects without diagnosed spine disease. METHODS: Twenty-two male adult Scheuermann's patients (mean age 64.7 years (Standard Deviation [SD] 6.4) and 26 males (mean age 59.7 years [SD 7.4]) from a national health survey were included in this study. From MR images, the dimensions of the vertebral bodies, intervertebral discs and the dural sac were measured. Spondylolisthesis, Modic changes (MC), high intensity zone values (HIZ), and Schmorl's nodes were registered from both groups as well as self-reported data concerning general health, quality of life, and back pain symptoms. RESULTS: Significantly more patients with Scheuermann's disease had at least one MC compared to the controls at the level L1/L2 (Odds Ratio [OR] 21.11, 95% Confidence Interval [95% CI] 2.31-192.96), at the level L3/L4 (OR 13.62, 95% CI 1.41-131.26), and at the level L5/S1 (OR 6.11, 95% CI 1.50-24.83). Patients had significantly more Schmorl's nodes compared to the controls (64% vs. 8%, p < 0.001). The area of the dura sac (L3/L4) was larger (mean 201 mm2 vs. 152 mm2, p = 0.017) in the patients compared to controls. At level L1/L2 patients had higher disc than controls (mean 7.9 mm vs. 6.8 mm, p = 0.038). After adjusting for age patients had more commonly constant back pain (OR 9.4, 95% CI 1.56-56.97), and difficulties in walking up one floor without resting (OR 9.8, 95% CI 1.01-95.34) than controls. CONCLUSIONS: Schmorl's nodes and Modic changes on lumbar MRI, back pain and physical function restrictions seem to be more prevalent among patients with Scheuermann's disease than in the general population.

Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: a randomized controlled trial.

BACKGROUND: Arthroscopy is often used to treat patients with chronic patellofemoral pain syndrome (PFPS). As there is a lack of evidence, we conducted a randomized controlled trial to study the efficacy of arthroscopy in patients with chronic PFPS. METHODS: A total of 56 patients with chronic PFPS were randomized into two treatment groups: an arthroscopy group (N = 28), treated with knee arthroscopy and an 8-week home exercise program, and a control group (N = 28), treated with the 8-week home exercise program only. The arthroscopy included finding-specific surgical procedures according to current recommendations. The primary outcome was the Kujala score on patellofemoral pain and function at 9 months following randomization. Secondary outcomes were visual analog scales (VASs) to assess activity-related symptoms. We also estimated the direct healthcare costs. RESULTS: Both groups showed marked improvement during the follow-up. The mean improvement in the Kujala score was 12.9 (95% confidence interval (CI) 8.2-17.6) in the arthroscopy group and 11.4 (95% CI 6.9-15.8) in the control group. However, there was no difference between the groups in mean improvement in the Kujala score (group difference 1.1 (95% CI -7.4 - 5.2)) or in any of the VAS scores. Total direct healthcare costs in the arthroscopy group were estimated to exceed on average those of the control group by euro901 per patient (p < 0.001). CONCLUSION: In this controlled trial involving patients with chronic PFPS, the outcome when arthroscopy was used in addition to a home exercise program was no better than when the home exercise program was used alone. TRIAL REGISTRATION: Current Controlled Trials ISRCTN 41800323.

Uninstrumented in situ fusion for high-grade childhood and adolescent isthmic spondylolisthesis: long-term outcome.

BACKGROUND: Intermediate-term radiographic studies have shown that anterior and circumferential techniques result in high fusion rates in patients with high-grade spondylolisthesis, whereas posterolateral fusion is less successful. We are not aware of any long-term comparative studies in which these three methods have been evaluated with regard to functional outcome, including systematic spinal mobility and trunk strength measurements. METHODS: Sixty-nine of eighty-three consecutive patients with high-grade isthmic spondylolisthesis who underwent posterolateral (twenty-one), anterior (twenty-three), or circumferential (twenty-five) uninstrumented spondylodesis between 1977 and 1991 participated in the study. The average duration of follow-up was 17.2 years. Radiographs that were made preoperatively and at the time of the most recent follow-up were assessed with regard to fusion quality and degenerative changes. Outcome was assessed at the time of the most recent follow-up by independent observers on the basis of a physical examination, spinal mobility and nondynamometric trunk strength measurements, and Oswestry Disability Index scores. RESULTS: The mean preoperative vertebral slip was 61% in the posterolateral fusion group, 63% in the anterior fusion group, and 71% in the circumferential fusion group. The final fusion rate was 86% (eighteen of twenty-one) in the posterolateral fusion group, 100% (twenty-three of twenty-three) in the anterior fusion group, and 96% (twenty-four of twenty-five) in the circumferential fusion group. A decrease in lumbar intervertebral disc height at the first mobile level superior to the fusion was noted in five patients in the posterolateral fusion group, seven patients in the anterior fusion group, and one patient in the circumferential fusion group (p = 0.037). The mean Oswestry Disability Index score was 9.7 for the posterolateral fusion group, 8.9 for the anterior fusion group, and 3.0 for the circumferential fusion group (p = 0.035). Nondynamometric trunk strength measurements corresponded with referential values. Abnormally low lumbar flexion affected the posterolateral and circumferential fusion groups more often than the anterior fusion group (p = 0.0015). The percentage of slip showed inverse correlations with lumbar flexion, lumbar extension, and trunk side-bending. CONCLUSIONS: As assessed on the basis of patient-based outcomes, circumferential in situ fusion provided slightly better long-term results than did posterolateral or anterior in situ fusion. When the radiographic and functional results were combined with the patient-based outcomes, the overall differences between the three groups were small.

Harrington and Cotrel-Dubousset instrumentation in adolescent idiopathic scoliosis. Long-term functional and radiographic outcomes.

BACKGROUND: Previous studies have shown that the long-term clinical outcome does not correlate with the radiographic outcome in patients treated with Harrington instrumentation for adolescent idiopathic scoliosis. Cotrel-Dubousset instrumentation has been reported to provide better correction radiographically, but it is unclear whether it provides better long-term clinical or functional outcomes. We are not aware of any long-term studies comparing Harrington and Cotrel-Dubousset instrumentation. METHODS: Seventy-eight patients in whom adolescent idiopathic scoliosis was treated with Harrington instrumentation and fifty-seven in whom it was treated with Cotrel-Dubousset instrumentation participated in this study. The mean duration of follow-up was 20.8 years for the Harrington instrumentation group and 13.0 years for the Cotrel-Dubousset instrumentation group. The mean age at the time of follow-up was thirty-six years and twenty-eight years, respectively. Radiographs were made preoperatively and at the two-year and final follow-up examinations. The Scoliosis Research Society questionnaire was completed, a physical examination was performed, and spinal mobility and non-dynamometric trunk strength were measured at the final follow-up visit. RESULTS: The mean preoperative Cobb angle of the thoracic curves was 53 degrees in the Harrington instrumentation group and 55 degrees in the Cotrel-Dubousset instrumentation group. The mean numbers of vertebrae included in the instrumentation were 10.7 and 9.9, respectively. At the two-year follow-up evaluation, the mean postoperative Cobb angles were 38 degrees and 25 degrees, respectively (p < 0.0001). At the final follow-up evaluation, the mean angles were 45 degrees and 32 degrees (p < 0.0001). No significant difference in thoracic kyphosis or lumbar lordosis was observed between the study groups at the final follow-up evaluation. The average score on the Scoliosis Research Society questionnaire was 97 points in both groups. Measurements of non-dynamometric trunk strength corresponded with age and sex-adjusted reference values, on the average, but patients with Cotrel-Dubousset instrumentation performed significantly better in the squatting test (p = 0.010). Abnormal lumbar extension and trunk side-bending were significantly more common in the Harrington instrumentation group (p = 0.050 and p = 0.0061, respectively). Complications were recorded for nine (12%) of the patients treated with Harrington instrumentation and fifteen (26%) of those treated with Cotrel-Dubousset instrumentation (p = 0.027). CONCLUSIONS: Cotrel-Dubousset instrumentation yielded better long-term functional and radiographic outcomes in patients with adolescent idiopathic scoliosis than did Harrington instrumentation. However, complications were more common in the Cotrel-Dubousset instrumentation group.

Body mass index and slipped capital femoral epiphysis.

Body mass index (BMI) as a predictor of slipped capital femoral epiphysis (SCFE) was studied. A total of 26 adolescent patients had complete annual height and weight measurements taken from birth to onset of slippage. These values were compared with those of the normal adolescent population. Patients with SCFE showed statistically higher BMI during growth than normal developing children. BMI gives more accurate data on body build than height and weight alone and may be a useful tool for evaluating risk factors in SCFE.

Bracing in adolescent idiopathic scoliosis.

The article reviews the present knowledge about brace treatment for adolescent idiopathic scoliosis (AIS). Indications, technique, problems, and results, are presented based on the literature. It is stressed by the authors that more scientific evidence is needed to reach a final conclusion whether brace treatment in AIS is effective or not.