Body Mass Hides the Curve: Thoracic Scoliometer Readings Vary by Body Mass Index Value.

BACKGROUND: Guidelines suggest referral for scoliosis when rib slope (scoliometer measurement, angle of trunk rotation) is ≥7 degrees. We hypothesized that overweight and obese patients would have lower scoliometer measurements compared with normal-weight and underweight patients for a given spinal curvature, causing overweight and obese patients with adolescent idiopathic scoliosis to present for treatment later and with larger curves. Our goal was to determine the association between scoliometer readings and major curve magnitudes in relation to body mass index (BMI). METHODS: This retrospective cohort study at a tertiary referral center included 483 patients (420 girls) aged 10 to 18 years (mean age, 14±1.6 y) with thoracic adolescent idiopathic scoliosis who presented to 1 orthopaedic surgeon for initial evaluation of spinal deformity from 2010 to 2015. Records were reviewed for BMI percentile for age and sex (underweight, ≤fourth percentile; normal weight, fifth to 84th percentile; overweight, 85th to 94th percentile; obese, ≥95th percentile), patient characteristics, thoracic scoliometer measurements, and thoracic major curves. RESULTS: Of the 483 patients, 23 were underweight, 372 were normal weight, 52 were overweight, and 36 were obese. Obese patients had a larger mean major curve (44 degrees) than normal-weight patients (34 degrees) (P=0.004). The odds of presenting with a major curve ≥20 degrees were 4.9 (95% confidence interval, 1.1-22; P=0.037) times higher for obese versus normal-weight patients. Receiver operating characteristic analysis of major curves (≥20 vs. <20 degrees) estimated the scoliometer values with the greatest sensitivity and specificity to be 8 degrees for underweight patients, 7 degrees for normal-weight patients, 6 degrees for overweight patients, and 5 degrees for obese patients. CONCLUSIONS: Obese patients presented with larger thoracic curves versus normal-weight patients. Differences in chest-wall thickness in patients with different BMI values may alter scoliometer measurements for a given rotational deformity. Our data suggest new referral criteria for the scoliometer test based on BMI values. Specifically, obese patients should be referred at an angle of trunk rotation of 5 degrees. LEVEL OF EVIDENCE: Level II.

Language Experience with a Native-Language Phoneme Sequence Modulates the Effects of Attention on Cortical Sensory Processing.

Auditory evoked potentials (AEP) reflect spectro-temporal feature changes within the spoken word and are sufficiently reliable to probe deficits in auditory processing. The current research assessed whether attentional modulation would alter the morphology of these AEPs and whether native-language experience with phoneme sequences would influence the effects of attention. Native-English and native-Polish adults listened to nonsense word pairs that contained the phoneme sequence onsets /st/, /sət/, /pət/ that occur in both the Polish and English languages and the phoneme sequence onset /pt/ that occurs in the Polish language, but not the English language. Participants listened to word pairs within two experimental conditions designed to modulate attention. In one condition, participants listened to word pairs and performed a behavioral task to the second word in the pairs ("with task") and in the alternate condition participants listened to word pairs without performing a task ("without task"). Conditions were counterbalanced so that half the English and Polish subjects performed the "without task" condition as the first testing session and the "with task" condition as the second testing session. The remaining English and Polish subjects performed the tasks in the reverse order. Two or more months separated the testing sessions. Task conditions did not modulate the morphology of the AEP. Attention, however, modulated the AEP by producing a negative shift in the overall waveform. This effect of attention was modulated by experience with a native-language phoneme sequence. Thus, only Polish listeners showed an effect of attention to the native language /pt/ onset when the behavioral task occurred as the second testing session for which attention demands were reduced. This effect began at 400 ms and suggests a mechanism at intermediate stages within auditory cortex that facilitates recognition of the native language for comprehension.