Contribution of coronal vertebral and IVD wedging to Cobb angle changes in adolescent idiopathic scoliosis during growth.

STUDY DESIGN: Prospective study BACKGROUND: Vertebral and intervertebral disc (IVD) wedging are often seen in patients with adolescent idiopathic scoliosis (AIS). However, the relationship between wedging and curve progression, and the change of wedging before bracing to final weaning is unknown. The aim of this study was to investigate the pattern and sequence of vertebral and IVD wedging development, and to determine the relationship between the change of wedging and curve progression in AIS during growth. METHODS: This was a prospective study of 32 AIS females with right-sided thoracic curves and/or left-sided lumbar curves who completed brace treatment. They were classified into progression and non-progression groups. Vertebral and IVD wedging were calculated for each spinal segment. The wedging pattern was first identified and then used to determine the sequence of wedging development. Percentage change in the sum of wedging during growth was calculated and compared. RESULTS: The sum of vertebral wedging for both groups was 2.4° to 8.7° more than that of IVD wedging in the thoracic spine but 8.7° to 17.7° less in the lumbar spine. Out of the 20 curves assessed, 5 thoracic curves and 1 lumbar curve developed vertebral wedging before IVD wedging, and 3 thoracic curves and 4 lumbar curves had the opposite pattern. The progression group had larger increases in sum of vertebral (40%) and IVD (28.6%) wedging as compared to the non-progression group (both 16.7%). A significant difference in wedging between the first and the latest visits was found in the progression group only (p < 0.05). CONCLUSION: Pattern and sequence of vertebral and IVD wedging were related to the location of the curve rather than the presence of curve progression. Progressed curves were associated with increased wedging during growth. LEVEL OF EVIDENCE: II.

Role of Ultrasound in Low Back Pain: A Review.

Low back pain is one of most common musculoskeletal disorders around the world. One major problem clinicians face is the lack of objective assessment modalities. Computed tomography and magnetic resonance imaging are commonly utilized but are unable to clearly distinguish patients with low back pain from healthy patients with respect to abnormalities. The reason may be the anisotropic nature of muscles, which is altered in function, and the scans provide only structural assessment. In view of this, ultrasound may be helpful in understanding the disease as it is performed in real-time and comprises different modes that measure thickness, blood flow and stiffness. By the use of ultrasound, patients with low back pain have been found to differ from healthy patients with respect to the thickness and stiffness of the transversus abdominis, thoracolumbar fascia and multifidus. The study results are currently still not conclusive, and further study is necessary to validate. Future work should focus on quantitative assessment of these tissues to provide textural, structural, hemodynamic and mechanical studies of low back pain. This review highlights the current understanding of how medical ultrasound has been used for diagnosis and study of low back pain and discusses potential new applications.

Multichromatic TTF staining characterizes cartilage matrix in osteoarthritis and bone development.

Various histological staining methods have been explored to detect the joint lesions in osteoarthritis (OA), but these histological stains cannot comprehensively present the comparatively complex structures of articular cartilage in knee OA. In addition, no integrated histological staining method can be used to evaluate efficiently both the subzone region and matrix composition in cartilage containing tissues. Therefore, in this study, a novel multichromatic staining method termed TTF staining, using Toluidine Blue (T), Tartrazine (T) and Fast Green (F) sequential combined staining for histological analysis, has been exploited to characterize the changes of matrix components and contents in cartilage during OA and in the bone development. This specific TTF staining profile can be used to differentiate the major compartments of knee joint region, including the synovium, meniscus, multiple subzones of cartilage and subchondral bone. An anterior cruciate ligament transection induced OA model in rat has been established to profoundly present the alterations of glycosaminoglycans in cartilage degeneration by TTF staining profile. The changes of TTF staining profile in the chondrification and ossification centers of the postnatal rat knee joint indicate the developmental features of cartilage matrix during the growth of bone. In summary, we have developed an effective histological staining method that enables us to identify the subzones of cartilage in detail and to define the matrix features of bone development. Therefore, finally using this new TTF staining method may help us to exploit a histopathological grading system to assess cartilage lesions in clinical disease.