The Italian Spine Youth Quality of Life questionnaire measures health-related quality of life of adolescents with spinal deformities better than the reference standard, the Scoliosis Research Society 22 questionnaire.

OBJECTIVE: To compare the validity of the Italian Spine Youth Quality of Life (ISYQOL) questionnaire with that of the Scoliosis Research Society 22 (SRS22) questionnaire, the criterion standard for health-related quality of life (HRQOL) measurement in adolescents with spinal deformities. DESIGN: Cross-sectional study. SETTING: Outpatient clinic. SUBJECTS: Consecutive adolescents (10-18 years; 541 wearing brace) affected by idiopathic scoliosis (642 females, 100 males) or hyperkyphosis (87 females, 109 males). INTERVENTIONS: NA. MAIN MEASURES: The Spearman's correlation coefficient (rho) between ISYQOL and SRS22 was used to assess ISYQOL concurrent validity. Sex, age, severity, bracing, trunk appearance and deformity type were assessed for known-groups validity. Cohen's d quantified between-groups differences. Multiple linear regression exploring the effect of sex, age, body mass index (BMI), severity, bone age, trunk appearance, physiotherapy, bracing and sport on HRQOL of scoliosis patients was used to assess concurrent validity further. RESULTS: Satisfactory correlations were found between ISYQOL and SRS22 (scoliosis, rho = 0.71; kyphosis, rho = 0.56). Known-groups validity analysis showed that ISYQOL detects all the between-groups differences detected by SRS22 and a males-females difference undetected by SRS22. ISYQOL Cohen's d was larger than SRS22 Cohen's d in three between-groups comparisons and similar in the others. Brace, sport and scoliosis severity were independently related to ISYQOL (linear regression: R2 = 0.23; p < 0.001). Brace, sport and physiotherapy were related to SRS22 (R2 = 0.17). CONCLUSIONS: ISYQOL showed high validity when used to measure HRQOL in adolescents with spinal deformities. Moreover, ISYQOL performs better than SRS22, having better known-groups validity and (contrary to SRS22) detecting the impact of disease severity on HRQOL.

Development of predictive models for all individual questions of SRS-22R after adult spinal deformity surgery: a step toward individualized medicine.

PURPOSE: Health-related quality of life (HRQL) instruments are essential in value-driven health care, but patients often have more specific, personal priorities when seeking surgical care. The Scoliosis Research Society-22R (SRS-22R), an HRQL instrument for spinal deformity, provides summary scores spanning several health domains, but these may be difficult for patients to utilize in planning their specific care goals. Our objective was to create preoperative predictive models for responses to individual SRS-22R questions at 1 and 2 years after adult spinal deformity (ASD) surgery to facilitate precision surgical care. METHODS: Two prospective observational cohorts were queried for ASD patients with SRS-22R data at baseline and 1 and 2 years after surgery. In total, 150 covariates were used in training machine learning models, including demographics, surgical data and perioperative complications. Validation was accomplished via an 80%/20% data split for training and testing, respectively. Goodness of fit was measured using area under receiver operating characteristic (AUROC) curves. RESULTS: In total, 561 patients met inclusion criteria. The AUROC ranged from 56.5 to 86.9%, reflecting successful fits for most questions. SRS-22R questions regarding pain, disability and social and labor function were the most accurately predicted. Models were less sensitive to questions regarding general satisfaction, depression/anxiety and appearance. CONCLUSIONS: To the best of our knowledge, this is the first study to explicitly model the prediction of individual answers to the SRS-22R questionnaire at 1 and 2 years after deformity surgery. The ability to predict individual question responses may prove useful in preoperative counseling in the age of individualized medicine. These slides can be retrieved under Electronic Supplementary Material.

Correlation between body image perception and spinopelvic parameters in ankylosing spondylitis.

OBJECTIVE: To identify relationships between spinopelvic parameters and body image perception in ankylosing spondylitis (AS). METHODS: The study and control groups comprised 107 AS patients (18 women and 89 men) and 40 controls. All underwent anteroposterior and lateral radiography of whole spine, including hip joints, and completed clinical questionnaires. The radiographic parameters examined were sagittal vertical axis, sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis, thoracic kyphosis, spinosacral angle (SSA), and spinopelvic angle (SPA). The Trunk appearance scale (TAPS), and the Scoliosis Research Society 22 appearance questionnaire (SRSapp) were administered to evaluate body image perception. RESULTS: The patient and control groups were found to differ significantly in terms of sagittal vertical axis, sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis, SSA, and SPA. However, no significant intergroup difference was observed for thoracic kyphosis (p > .05). Correlation analysis revealed significant relationships between radiographic parameters and body image perception. Multiple regression analysis was performed to identify predictors of body image perception scores, and the results obtained revealed age, SSA, and SPA significantly predicted SRSapp scores and that age and SSA predicted TAPS scores. CONCLUSIONS: AS patients and normal controls were found to differ significantly in terms of sagittal spinopelvic parameters. Correlation analysis revealed significant relationships between radiographic parameters and body image perception. In particular, age, SSA, and SPA were found to be significant predictors of body image perception scores in AS patients.

[Spinal orthoses in the treatment of vertebral fractures with osteoporosis : A systematic review article]. / Rückenorthesen in der Behandlung von Wirbelkörperfrakturen bei Osteoporose : Eine systematische Übersichtsarbeit.

This literature search concerning the potential role of spinal orthoses for rehabilitation and treatment of atraumatic vertebral fractures between Th4 and L5 with osteoporosis and without any evidence for a secondary cause, provided no evidence for the benefits of traditional rigid thoracolumbar corsets, which only had a poor compliance. In addition, there are indications that these rigid corsets may even worsen the disease condition especially in the long-term. Wearing these corsets can result in further loss of muscle mass and strength followed by loss of bone and bone mass. Both together can worsen the functional capabilities of patients. On the other hand the functional capabilities of patients suffering from acute or subacute vertebral fractures due to osteoporosis can be improved by flexible backpack orthoses. These spinal orthoses generate an extension moment about the spine, increase perception of one's own body posture via biofeedback and therefore lead to improved posture. This results in a strengthening of the trunk musculature, a more stable equilibrium and a reduction of pain, which are associated with an increase in functional capabilities and improvement in the parameters of the quality of life. During a long-term phase of rehabilitation individually tailored spinal orthoses guarantee a high level of compliance and adherence. Finally, there is high-quality evidence that spinal orthoses with additional weighting can improve the equilibrium in women with vertebral osteoporosis and hyperkyphosis. Future studies should also be carried out with other groups of patients.

[Treatment of lumbar sagittal split fracture with combined anterior and posterior short segment fixation and fusion].

OBJECTIVE: To evaluate the efficacy and safety of combined anterior and posterior short segment fixation and fusion for lumbar sagittal split fracture.
 Methods: From March, 2005 to May, 2013, 13 patients of lumbar sagittal split fracture underwent short segment posterior fixation and anterior fusion. Preoperative and postoperative kyphotic Cobb's angle, visual analogue scale (VAS) score of back pain, Oswestry disability index (ODI), as well as the incidence of complication were accessed.
 Results: Mean follow-up duration was 42 months (24-60 months). Average operative time was 248 min (185-300 min) and average bleeding was 950 mL (600-1 500 mL). All patients were significantly improved in function and self-image. In the Cobb angle evaluation, there was significant improvement in 2 days or 12 months after the operation (P<0.05). In terms of average VAS pain score and ODI score, the difference was significant (P<0.05) between before and after surgery; the results of 12 months and the final follow-up after operation were significantly better than those before operation (P<0.05), but there was no significant difference at the 12 months and the final follow-up (P>0.05). According to the American Spinal Injury Association (ASIA) standard, in the last follow-up, 6 patients with grade D recovered to grade E, 3 patients had no further recovery. All patients achieved bony fusion in 4.5 months (3-6) months. There were 3 cases with dural tear and it was repaired during operation. There was no neurologic deterioration and vascular injury.
 Conclusion: The short construct with pedicle screws in the fractured vertebrae and disc space fusion may be a better therapeutic option for the highly lumbar unstable fracture of C1.2.1.

Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions.

PURPOSE: Medical and health policy providers should be aware of the impact of adult spinal deformity (ASD) on health-related quality of life (HRQL). The purpose of this study was to compare the relative burden of four chronic conditions with that of ASD. METHODS: The International Quality of Life Assessment project gathered data from 24,936 people and published the SF-36 scores of patients with self-reported arthritis, chronic lung disease, diabetes and congestive heart failure from 8 industrialized countries (3 continents) Alonso et al. (Qual Life Res Int J Qual Life Asp Treat Care Rehabil 13:283-298, 2004). We compared these with the SF-36 baseline data of consecutive patients with ASD enrolled in a prospective multicentre international database with the following inclusion criteria: age >18 years and scoliosis >20°, sagittal vertical axis >5 cm, pelvic tilt >25° or thoracic kyphosis >60°. Four ASD groups were considered: all ASD patients, surgical candidates (preop HRQL scores), and non-surgical candidates with and without previous surgery. Adjusted estimates of the impact of chronic disease were calculated using separate multivariate linear regression models. Individuals without chronic conditions were used as the reference group. Coefficients for each chronic condition and ASD represent the difference compared with this healthy group. RESULTS: 766 patients (mean age 45.8 years) met the inclusion criteria for ASD. The scores on all SF-36 domains were lower in ASD patients than in any other chronic condition. Differences between ASD and the other chronic conditions were always greater than the reported minimal clinically important differences. When compared with individuals reporting no medical conditions, SF-36 scores from the population with self-reported chronic conditions ranged from -2.5 to -14.1. Comparable scores for patients with ASD ranged from -10.9 to -45.0. Physical function, role physical and pain domains showed the worst scores. Surgical candidates with ASD displayed the worst HRQL scores (-17.4 to -45.0) and patients previously operated the best (-10.9 to -33.3); however, even the latter remained worse than any scores for the other self-reported chronic conditions. CONCLUSIONS: The global burden of ASD was huge compared with other self-reported chronic conditions in the general population of eight industrialized countries. The impact of ASD on HRQL warrants the same research and health policy attention as other important chronic diseases.

Health-Related Quality of Life of Patients with Postural Kyphosis Compared to Spinal Deformities in Adolescence: A Cross-Sectional Study.

AIM: To evaluate the quality of life of patients with postural kyphosis (PK) compared with those adolescent idiopathic scoliosis (AIS) and Scheuermann Kyphosis (SK). MATERIAL AND METHODS: Health-related quality of life (HRQoL) of adolescents with PK who were admitted to our clinic between January 2020 and June 2022 was compared with that of patients with AIS and SK who were admitted during the same period by using the Scoliosis Research Society-22 (SRS-22) questionnaire. All patients were asked to complete the SRS-22 questionnaire before the radiological evaluation. In the radiological evaluation, the sagittal and coronal deformities of the patients were measured. RESULTS: In total, 126 patients with PK were compared with age and sex-matched AIS patients and 42 SK patients. The mean SRS-22 function score of the PK group was 4.72 ± 0.3 while it was 4.38 ± 0.6 (p=0.015) in SK patients and it was 4.34 ± 0.6 (p < 0.001) in AIS patients. The mean SRS-22 pain scores of PK patients was 4.18 ± 0.7. The mean pain score was 3.68 ± 0.8 (p=0.033) in the SK group and 3.6 ± 0.8 (p=0.010) in the AIS group. Adolescents with PK perceived less pain than those with AIS or SK. The scores for the other domains of SRS-22 revealed no differences. CONCLUSION: HRQoL of patients with PK is reduced, similar to that of patients with common structural spine deformities. Recognizing the effects of PK on the HRQoL in adolescents can help physicians to treat these patients.

Effect of Perioperative Mental Status on Health-related Quality of Life in Patients With Adult Spinal Deformities.

STUDY DESIGN: A retrospective study. OBJECTIVE: We aimed to evaluate the impact of mental status on the clinical outcomes of patients with adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA: Limited information is currently available on how preoperative mental status affects postoperative health-related quality of life (HRQOL) in patients with ASD. METHODS: We enrolled 165 patients with ASD who underwent corrective surgery at a single university hospital between March 2010 and September 2015. We compared Scoliosis Research Society-22r (SRS-22r) and Oswestry Disability Index (ODI) scores using various x-ray parameters at these time points: preoperative period and postoperative 2 years. Additionally, to determine the associations between perioperative complications and mental health disorders, we examined these x-ray parameters: lumbar lordosis, thoracic kyphosis, sacral slope, pelvic incidence, pelvic tilt, sagittal vertical axis (SVA), and T1 pelvic angle (TPA). RESULTS: We found correlations between the preoperative SRS-22r total score and preoperative ODI (r = -0.692, P < 0.01) and postoperative ODI (r = -0.443, P < 0.01). Preoperative SRS-22r mental domain correlated with preoperative ODI (r = -0.561, P ≤ 0.01) and postoperative ODI (r = -0.315, P ≤ 0.01). Perioperative (preoperative and postoperative) SRS-22r mental domain did not correlate with the postoperative x-ray parameters except for SVA and TPA. Postoperative mental health correlated with early infection (P < 0.05), hematoma (P < 0.05), deep vein thrombosis (P < 0.05), and delirium (P < 0.05). Regression analysis revealed that preoperative SRS-22r mental health score correlated with preoperative ODI (P < 0.001) and postoperative ODI (P < 0.001). The regression coefficient number between preoperative SRS-22r mental health score and perioperative (preoperative and postoperative) ODI improved from -17.3 to -10.2 from preoperative to postoperative periods. CONCLUSION: Diminished preoperative mental health worsened postoperative HRQOL. Perioperative complications influence postoperative mental status and HRQOL; hence, screening preoperative mental health is important. LEVEL OF EVIDENCE: 3.

Concurrent and Overlapping Surgery: Perspectives From Parents of Adolescents Undergoing Spinal Posterior Instrumented Fusion for Idiopathic Scoliosis.

STUDY DESIGN: Prospective cross-sectional survey. OBJECTIVE: To determine the perspectives of parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis (AIS) regarding simultaneous surgery and trainee participation. SUMMARY OF BACKGROUND DATA: Simultaneous ("at the same time") surgery is under scrutiny by the public, government, payers, and the medical community. The objective of this study is to determine the perspectives of parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis. Our goal is to inform the national conversation on this subject with real patient and family voices. METHODS: A survey was prospectively administered to 31 consecutive parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis at a large academic medical center. "Overlapping" was defined as simultaneity during "noncritical" parts of an operation. "Concurrent" was defined as simultaneity that includes "critical" part(s) of an operation. Participants were asked to provide levels of agreement with overlapping and concurrent surgery and anesthesia, as well as with trainee involvement. RESULTS: On average, respondents "strongly agree" with the need to be informed about overlapping or concurrent surgery. They "disagree" with both overlapping and concurrent scheduling, and "disagree" with trainees operating without direct supervision, even for "noncritical" parts. Informing parents about the presence of a back-up surgeon or research demonstrating safety of simultaneous surgery did not make them agreeable to simultaneous scheduling. CONCLUSION: Parents have a strong desire to be informed of simultaneous spinal surgery and anesthesia as part of consent on behalf of their children. Their disagreement with simultaneous surgery, as well as with trainees operating without direct supervision, suggests discordance with current guidelines and practice and should inform the national conversation moving forward. LEVEL OF EVIDENCE: N/A.

Psychological Changes and Employment Outcomes After Kyphosis Correction in Patients With Ankylosing Spondylitis.

STUDY DESIGN: A retrospective study. OBJECTIVE: To evaluate the psychological changes and employment outcomes following corrective osteotomy in patients with ankylosing spondylitis (AS). SUMMARY OF BACKGROUND DATA: To date, no study has investigated the changes in psychological status and subsequent improvement in employment outcome after correction of kyphotic deformities in patients with AS. METHODS: This study included 48 patients with AS who underwent corrective osteotomy for severe kyphotic deformity. Sagittal alignment was assessed radiographically. Clinical status was evaluated using the Short Form-36 Health Survey, psychological status was evaluated using the Hospital Anxiety and Depression Scale (HADS), and employment outcomes were assessed using the Lam Employment Absence and Productivity Scale (LEAPS). The degree of postoperative sagittal alignment correction was measured, and changes in clinical and employment outcomes and psychological status were evaluated. The relationship between the degree of sagittal alignment correction and each evaluation item was analyzed. RESULTS: Following postoperative sagittal alignment correction, all patients could stand erect and look straight. Significant improvements were observed in the clinical and employment outcomes, as well as in patients' psychological status. The degree of sagittal vertical axis correction was significantly correlated with the HADS depression and the LEAPS total scores. The degree of correction of the chin-brow vertical angle was significantly correlated with the Short Form-36 mental health score, the HADS depression and anxiety scores, and the LEAPS total and productivity subscores. Notably, the improvement in the HADS depression score was significantly correlated with the LEAPS total score. CONCLUSION: This study demonstrated the psychological changes and subsequent improvement in employment outcomes after corrective osteotomy in patients with AS. The degree of sagittal alignment correction was correlated with improvements in psychological status and employment outcomes. LEVEL OF EVIDENCE: 4.

Minimum Detectable Measurement Difference for Health-Related Quality of Life Measures Varies With Age and Disability in Adult Spinal Deformity: Implications for Calculating Minimal Clinically Important Difference.

STUDY DESIGN: Retrospective cohort. OBJECTIVE: To investigate the minimum detectable measurement difference (MDMD) in the Scoliosis Research Society-22r (SRS-22r) outcomes instrument in adult spinal deformity (ASD) and to evaluate the effect of baseline data on measurable difference. SUMMARY OF BACKGROUND DATA: The minimum clinically important difference (MCID) is the smallest, clinically relevant change observed and has been proposed for the SRS-22r instrument in ASD as 0.4. The MCID must be greater than the MDMD to be useful. The MDMD for the SRS-22r has not been calculated, nor have the effect of patient baseline values on MDMD. METHODS: A prospective observation cohort was queried for patients treated both operatively and nonoperatively for ASD. Patients with baseline and 1-year, 2-year follow-up SRS-22r data were included in the analysis. The MDMD was calculated using classical test theory and item-response theory methods. Effect size and standardized response means were calculated. The effect of baseline data values was evaluated for MDMD. RESULTS: A total 839 Patients were eligible for cohort inclusion with 428 (51%) eligible for analysis with complete data. MDMD for Pain (0.6) and Self-Image (0.5) were greater than 0.4. MDMD varied with age (highest for the youngest patients) and with disability (highest for SF-36 Physical Component Summary <28.6). MDMD was less than 0.4 for Activity (0.3), Mental Health (0.3), and Total Score (0.2). Gender and mental health did not affect MDMD for the SRS-22r instrument. CONCLUSION: An MCID of 0.4 for the SRS-22r total score and domain scores may not be an appropriate value as the calculated MDMD is greater than 0.4 for both the Pain and Self-Image subscores. The MDMD for the SRS-22r instrument varied with age and baseline disability, making the assessment of clinically significant change more difficult using this tool. The MCID must be considered in the setting of the MDMD for instruments used to assess outcomes in ASD. LEVEL OF EVIDENCE: 3.

Psychosocial Difficulties in Adolescent Idiopathic Scoliosis: Body Image, Eating Behaviors, and Mood Disorders.

OBJECTIVE: To examine the recent literature on psychologic comorbidities prevalent in youth living with adolescent idiopathic scoliosis (AIS)-including body image, eating behaviors, and mood disorders-to improve patient outcomes. METHODS: A comprehensive literature review was performed using the PubMed database. Eligible studies were extracted based on defined inclusion criteria, and the effects of AIS on psychologic comorbidities were evaluated. Studies were categorized and analyzed based on 3 recurrent themes: body image, eating behaviors, and mood. RESULTS: Body image presents the most important link between psychosocial difficulties and AIS. Self-reported body image is a significant factor for successful treatment outcomes in AIS. As such, specific patient-reported outcome measures have recently been developed and validated to aid in the treatment of AIS. Although patients with AIS consistently demonstrate altered anthropometry compared with their healthy counterparts, links between these factors and pathologic behaviors, such as abnormal fear of gaining weight or disordered eating, are not clear. Equally unclear is the association between AIS and altered moods, notably depression and anxiety, because of the wide variety of disparate instruments used to measure mood disorders in patients with AIS. CONCLUSIONS: Patients with AIS undergoing treatment often face psychosocial difficulties. Together, the current literature points to a growing understanding and appreciation of the psychosocial aspects of AIS, but a clear need for more study is needed to optimize treatment of these patients.

Health-related Quality of Life of Adolescents With Severe Untreated Congenital Kyphosis and Kyphoscoliosis in a Developing Country.

STUDY DESIGN: A cross-sectional study OBJECTIVE.: The aim of this study was to study the health-related quality of life (HRQOL) of adolescents with severe untreated congenital kyphosis (CK) and congenital kyphoscoliosis (CKS) in a developing country. SUMMARY OF BACKGROUND DATA: Surgical intervention is generally indicated early in patients with progressive CK or CKS to prevent the progression of deformity and to improve the quality of life of the patients. HRQOL of adolescents with untreated CK and CKS in developing countries has never been investigated. METHODS: Arabic version of the Scoliosis Research Society 22 revision (SRS-22r) questionnaire used to study HRQOL of adolescents with severe untreated CK or CKS in a dev eloping country. RESULTS: A total of 134 adolescent (mean age 17.1 years) completed SRS-22r questionnaire: 38 patients with CK from 80° to 110° (group 1), 24 patients with CK > 110° (group 2), 27 patients with CKS (group 3), and 45 healthy controls (group 4). Group 1 had significant lower scores than group 4 in all SRS 22r domains (P < 0.001). Scores of all domains except pain showed significant (P < 0.001) decrease with increase of the severity of CK. Group 3 had significant lower scores than group 2 in all SRS-22r domains except mental health. Satisfaction domain had significant lower scores than all other SRS-22r domains for group 1, 2, and 3. All patients of groups 2 and 3 gave the minimum answers for satisfaction domain questions. A total of 69%, 84% and 94% of group 1, 2, and 3, respectively, gave the minimum answer when asked whether their back condition affects their personal relationships. Female patients of group 1, 2, and 3 had significant lower scores for self-image domain. CONCLUSION: HRQOL is severely affected in adolescents with untreated severe CK and CKS in a developing country. LEVEL OF EVIDENCE: 3.

Psychosocial Factors and Surgical Outcomes in Adult Spinal Deformity: Do Dementia Patients Have More Complications?

STUDY DESIGN: Retrospective analysis of a prospectively collected, national inpatient hospital database. OBJECTIVE: We aimed to investigate comorbid psychiatric disorders in the adult spinal deformity (ASD) population. We hypothesized that a high incidence of comorbid psychiatric disorders in ASD would negatively impact perioperative outcomes. SUMMARY OF BACKGROUND DATA: Patients with adult spinal fusion (ASF) suffer from severe back pain and often depression. Psychiatric comorbidities in the ASD population are not well understood, despite the apparent psychological effects of spinal deformity-related self-image. METHODS: The Nationwide Inpatient Sample databases from 2001 to 2009 were queried for patients ages 18 years or older with in-hospital stays including a spine arthrodesis. Patients were divided into two groups: ASD (diagnosis of scoliosis, excluding neuromuscular and congenital) and all other ASF. Subjects were further stratified by presence of a comorbid psychiatric diagnosis. Differences between each surgical group in psychiatric frequency and complications were calculated using analysis of variance, adjusted for operative complexity. A binary logistic regression analyzed the association between psychiatric diagnoses and likelihood of complications. RESULTS: A total of 3,366,352 ASF and 219,975 ASD patients were identified. The rate of comorbid psychiatric diagnoses in ASD was significantly higher (23.5%) compared to ASF patients (19.4%, P < 0.001). Complication rates were higher for ASD compared to ASF; patients without a psychiatric diagnosis had lower (or comparable) complication rates than psychiatric patients, across all disorder categories. Patients with psychotic disorders and dementia showed more complications than controls; patients with mood, anxiety and alcohol disorders showed fewer. CONCLUSION: Psychiatric comorbidities are more common in the ASD population than in adult fusion patients. ASD and ASF patients with the most common psychiatric disorders (mood, anxiety, and alcohol abuse) are not at increased risk for complications compared to controls. Those patients with psychotic disorders and dementia are at a significant risk for increased complications and surgeons should be aware of these specific risks. LEVEL OF EVIDENCE: 2.

Inclinometric measurement of kyphotic curvature: Description and clinimetric properties.

BACKGROUND: Hyperkyphosis is associated with physical impairments, activity limitations, and reduced quality of life. Therefore, a simple, reliable, responsive, and valid clinical measure of dorsal kyphosis would be valuable to clinicians. OBJECTIVE: To describe a novel procedure for measuring kyphotic curvature-the inclinometric kyphosis measure (IKM)-and provide an estimation of reliability, responsiveness, and validity. METHODS: During 2 sessions spaced days apart, we used a bubble inclinometer to measure dorsal kyphosis in 68 patients receiving outpatient physical therapy. We also documented occiput-to-wall status and tragus-to-wall distance. RESULTS: Intra-rater reliability of the IKM was supported by intra-class correlation coefficients (ICC3,1) of 0.94 and 0.91 for relaxed and cued conditions, respectively. Responsiveness, as indicated by minimal detectable change, was 8.0 and 10.0 degrees under relaxed and cued conditions, respectively. Validity was supported by significant correlations between the IKM and tragus-to-wall and by differences in the IKM between: 1) relaxed and cued conditions; 2) patients who could and could not touch occiput to the wall; and 3) patients who were older versus younger than 50 years of age. CONCLUSIONS: The IKM is a simple, reliable, responsive, and valid method for assessing posture in patients with musculoskeletal conditions.

Preoperative and Postoperative Photographs and Surgical Outcomes of Patients With Kyphosis.

STUDY DESIGN: A retrospective clinical study was performed. OBJECTIVE: The aim of the study was to show patients their pre- and postoperative body photographs, and determine the effect on postoperative patient satisfaction for thoracic and thoracolumbar sharp and round angular kyphosis. SUMMARY OF BACKGROUND DATA: Previous studies have reported the normative values of pelvic sagittal parameters and the classification of normal patterns of sagittal curvature, but no study has investigated and compared the clinical photographs of sharp and round kyphosis. METHODS: In patients who underwent surgery for thoracic and thoracolumbar sharp and round angular kyphosis, whole spine anteroposterior and lateral radiographs, and clinical photographs were obtained preoperatively and at the final follow-up. Pelvic and spinal parameters were measured, and the pre- and postoperative photographs were shown to patients. The Scoliosis Research Society 22r (SRS22r) and Short Form 36 surveys were administered to all patients, and the scores were analyzed. RESULTS: Thirty-eight patients diagnosed with kyphosis (mean age 19.6 yr, mean follow-up duration 26.4 mo) were divided into two groups: sharp (18 patients, mean age 20.1 yr) and round (20 patients, mean age 19.6 yr) kyphosis. There was no difference between values in the sharp and round groups in terms of age, follow-up duration, and Risser score (P > 0.05). In both groups, the subscores for pain, self-image, mental health, and satisfaction, except for the function/activity score, and the total score of the SRS22r survey were, however, significantly different between pre- and postoperative photographs. In addition, there was no significant difference between the two groups in any SRS22r domain and Short Form 36 scores. CONCLUSION: The surgical treatment of kyphosis was uniformly associated with improved quality of life, regardless of the kyphosis type. Thus, showing patients their pre- and postoperative photographs may enhance patient satisfaction, as measured by SRS22r scores. LEVEL OF EVIDENCE: 4.

Adult Spinal Deformity: Contemporary Treatment and Patient Outcomes.

The incidence of symptomatic adult spinal deformity (ASD) is increasing due to aging of the population, iatrogenic factors, and an increasingly active elderly population. Spinal deformity in the adult population can produce major functional disability. Patients with less severe forms of ASD can generally be managed without operative intervention. For those individuals with disabling pain, functional impairment, or progressive spinal malalignment, surgical treatment is available and effective. However, the surgery is complex and associated with a significant risk of perioperative complications. Efficacy and safety is optimal when operative intervention is performed by a surgical team (and hospital system) experienced in the management of complex spinal pathology. Quality of life for the ASD patient can be greatly improved with proper patient selection, technical execution, and perioperative care.

The natural history and long-term follow-up of Scheuermann kyphosis.

Sixty-seven patients who had a diagnosis of Scheuermann kyphosis and a mean angle of kyphosis of 71 degrees were evaluated after an average follow-up of thirty-two years (range, ten to forty-eight years) after the diagnosis. All sixty-seven patients completed a questionnaire; fifty-four had a physical examination and radiographs; fifty-two, pulmonary function testing; and forty-five, strength-testing of the trunk muscles. The results were compared with those in a control group of thirty-four subjects who were matched for age and sex. The patients who had Scheuermann kyphosis had more intense back pain, jobs that tended to have lower requirements for activity, less range of motion of extension of the trunk and less-strong extension of the trunk, and different localization of the pain. No significant differences between the patients and the control subjects were demonstrated for level of education, number of days absent from work because of low-back pain, extent that the pain interfered with activities of daily living, presence of numbness in the lower extremities, self-consciousness, self-esteem, social limitations, use of medication for back pain, or level of recreational activities. Also, the patients reported little preoccupation with their physical appearance. Normal or above-normal averages for pulmonary function were found in patients in whom the kyphosis was less than 100 degrees. Patients in whom the kyphosis was more than 100 degrees and the apex of the curve was in the first to eighth thoracic segments had restrictive lung disease. Five patients had an unexplained, mildly abnormal neurological examination. Mild scoliosis was common; spondylolisthesis was not observed.

Behavioral treatment of scoliosis and kyphosis.

A behavioral treatment of scoliosis and kyphosis was tested with 27 adolescent patients (19 scoliosis, eight kyphosis patients) to determine in which cases the conspicuous and restraining brace treatment could be replaced. In 22 compliant patients, posture biofeedback (PB) was highly effective compared to five non-compliant patients. Biologically more mature scoliosis patients (menarche at the beginning of treatment) seemed to profit more from PB. With kyphosis patients the PB treatment resulted in rapid straightening of the spine and removal of structural deformities of Scheuermann's disease. PB may serve as an unobtrusive yet effective treatment alternative for both juvenile scoliosis and kyphosis.

A review of camptocormia and an unusual case in the female.

Camptocormia is a rare low-back disorder involving an abnormal posture of extreme forward flexion. Most reports of camptocormia were of male military recruits during World Wars I and II. The differential diagnosis of the postural deformity, the psychologic formulation of camptocormia as a conversion disorder, and the treatments that have been used are reviewed. An unusual case of camptocormia in a female is presented to illustrate one psychologic basis and one form of effective treatment of this disorder.