Toward the Development of a Comprehensive Clinically Oriented Patient Profile: A Systematic Review of the Purpose, Characteristic, and Methodological Quality of Classification Systems of Adult Spinal Deformity.

BACKGROUND: Existing adult spinal deformity (ASD) classification systems are based on radiological parameters but management of ASD patients requires a holistic approach. A comprehensive clinically oriented patient profile and classification of ASD that can guide decision-making and correlate with patient outcomes is lacking. OBJECTIVE: To perform a systematic review to determine the purpose, characteristic, and methodological quality of classification systems currently used in ASD. METHODS: A systematic literature search was conducted in MEDLINE, EMBASE, CINAHL, and Web of Science for literature published between January 2000 and October 2018. From the included studies, list of classification systems, their methodological measurement properties, and correlation with treatment outcomes were analyzed. RESULTS: Out of 4470 screened references, 163 were included, and 54 different classification systems for ASD were identified. The most commonly used was the Scoliosis Research Society-Schwab classification system. A total of 35 classifications were based on radiological parameters, and no correlation was found between any classification system levels with patient-related outcomes. Limited evidence of limited quality was available on methodological quality of the classification systems. For studies that reported the data, intraobserver and interobserver reliability were good (kappa = 0.8). CONCLUSION: This systematic literature search revealed that current classification systems in clinical use neither include a comprehensive set of dimensions relevant to decision-making nor did they correlate with outcomes. A classification system comprising a core set of patient-related, radiological, and etiological characteristics relevant to the management of ASD is needed.

Reliability of sonography in the assessment of lumbar stabilizer muscles size in healthy subjects and patients with scoliosis.

OBJECTIVE: The purpose of the present study was to compare the reliability of sonography in the evaluation of abdominal and multifidus muscles size between healthy subjects and patients with scoliosis. METHODS: In this study, 20 healthy males and 20 male patients with scoliosis (20-50 years old) were recruited. Multifidus and abdominal muscles (transversus abdominis, internal and external oblique) size were assessed by sonography. Three images were recorded; the first and second images were taken on the same day with an hour interval to evaluate within-day reliability, and the third image was taken one-week later to assess between-day reliability. RESULTS: Intraclass correlation coefficient (ICC = 0.82-0.91) demonstrated high within-day reliability of sonography in the assessment of abdominal muscle thickness in both groups. In addition, high between-day reliability was observed for these muscles in both healthy and patient groups (ICC = 0.80-0.89). Within-day and also between-day reliability of multifidus muscle were shown to be high in the healthy group (ICC = 0.81-0.88) and the patient group (ICC = 0.78-0.85). Overall, within-day reliability was higher than between-day reliability and also the reliability of sonography in healthy subjects was greater than of those suffering from scoliosis. CONCLUSIONS: According to the results, sonography was shown to be a highly reliable imaging technique for assessment of abdominal and multifidus muscle size in healthy males and those suffering from scoliosis.

Características y calidad de la sangre autóloga recuperada del campo quirúrgico durante cirugía de escoliosis en pediatría / Characteristics and quality of intra-operative cell salvage in paediatric scoliosis surgery

Objetivos. Determinar las características hematológicas y microbiológicas de la sangre recuperada mediante el uso de un recuperador celular con campana centrifugadora pediátrica rígida (100 ml) en cirugía de escoliosis en pediatría y comprobar si se ajusta al estándar esperado en el paciente adulto. Material y método. Estudio de cohorte transversal, descriptivo, sobre 24 unidades consecutivas de sangre recuperada del campo quirúrgico procesadas mediante un recuperador de sangre modelo Haemolite® 2+ (Haemonetics Corp., Braintree, MA, EE. UU.). Se recogieron los datos referentes a edad, peso, abordaje (anterior o posterior) de la cirugía de escoliosis, volumen procesado y volumen de concentrado de hematíes (CH) autógeno recuperado, hemograma y hemocultivo del concentrado obtenido y la incidencia de fiebre tras la reinfusión. Resultados. El volumen procesado fue muy escaso (939 ± 569 ml) con gran variabilidad (coeficiente de variación = 0,6), a diferencia del volumen recuperado 129 ± 50 ml (coeficiente de variación = 0,38). Se estableció correlación estadísticamente significativa entre el volumen procesado y el hematocrito del CH recuperado (Pearson, r = 0,659; p = 0,001) que fue menor del esperado. Los parámetros hematológicos más relevantes de los concentrados recuperados fueron: Hb 11 ± 5,3 g dl−1; HTO: 32,1 ± 15,4%; leucocitos 5,34 ± 4,22 × 103 μl−1; plaquetas 37,88 ± 23,5 × 103 μl−1 (media ± DE). El hemocultivo del CH recuperado fue positivo en 13 casos (54,2%) en los que se aisló Staphylococcus coagulasa (−). Conclusiones. Los recuperadores celulares con campana centrifugadora de volumen fijo (incluso pediátrica) no obtienen la concentración esperada si se procesan bajos volúmenes, por lo que no son la mejor opción en el niño (AU)

Objective. To determine the haematological and microbiological characteristics of blood recovered by using a cell saver with a rigid centrifuge bowl (100 ml) in paediatric scoliosis surgery and to determine whether it conforms to the standard expected in adult patients. Material and methods. A cross-sectional, descriptive cohort study was performed on 24 consecutive red blood cell (RBC) units recovered from the surgical field and processed by a Haemolite® 2+ (Haemonetics Corp., Braintree, MA, EE. UU.) cell saver. Data were collected regarding age, weight, surgical approach (anterior or posterior), processed shed volume and volume of autologous RBC recovered, full blood count, and blood culture obtained from the RBC concentrate, and incidence of fever after reinfusion. Results. The processed shed volume was very low (939 ± 569 ml) with high variability (coefficient of variation = 0.6), unlike the recovered volume 129 ± 50 ml (coefficient of variation = 0.38). A statistically significant correlation between the processed shed volume and recovered RBC concentrate haematocrit was found (Pearson, r=.659, P=.001). Haematological parameters in the recovered concentrate were: Hb 11 ± 5.3 g dl−1; haematocrit: 32.1 ± 15.4% (lower than expected); white cells 5.34 ± 4.22 × 103 ul−1; platelets 37.88 ± 23.5 × 103 ul−1 (mean ± SD). Blood culture was positive in the RBC concentrate recovered in 13 cases (54.2%) in which Staphylococcus coagulase (−) was isolated. Conclusions. Cell salvage machines with rigid centrifuge bowls (including paediatric small volume) do not obtain the expected haematocrit if low volumes are processed, and therefore they are not the best choice in paediatric surgery (AU)

BIOMECHANICS OF THERAPEUTIC RIDING DURING THE DISEASES OF I-II DEGREE DYSPLASTIC LUMBAR AND STATIC (SHORT LEG) SCOLIOSIS.

The goal of the paper is to substantiate the essence of ridetherapy biomechanics as the pathogenetic therapeutic and prophylactic method at lumbar dysplastic (the I and II degrees) and static (short-legged induced) scoliosis. Uneven lower extremities caused by any reason and asymmetric support induce the change in the arrangement of trochantin to the vertebra and correspondingly the uneven loading of lumbar muscles. The asymmetric strength of lumbar muscles evoked by the change in rotator condition becomes the cause of the formation of scoliosis primary arc which, in its turn, causes a compensatory spinal curvature. In case of dysplastic scoliosis a leading role belongs to the beginning of dystrophic changes in intervertebral discs and its further decentration. At riding position the lower extremities are completely disengaged from the antigravity redistribution, the child is in direct contact with vibrations and jolts coming from the horseback; the antigravity loading is distributed on the muscles of the torso and thus, it creates an opportunity to purposefully affect the correction of the spine. During scoliosis the pathogenic essence of ridetherapy is due to the comprehensiveness of its procedures, expressed in the fact that during one procedure several factors are influenced simultaneously: nucleus pulpous, the torso and iliopsoas muscles, the antigravity system, etc. According to the clinical-functional and radiographic studies carried out in the dynamics on 11-16 years old adolescents it has been established that in those groups where the rehabilitation was conducted in a complex with ridetherapy the authentically higher results were obtained as compared to the groups where the rehabilitation was held using therapeutic exercises and massage.

The Impact of the Derotational Mobilization of Manual Therapy According to Kaltenborn-Evjenth on the Angle of Trunk Rotation in Patients with Adolescent Idiopathic Scoliosis--Pilot Study, Direct Observation.

BACKGROUND: The use of manual therapy in the treatment of scoliosis has been controversial. Scientific reports do not clearly indicate its effectiveness or harmfulness. The aim of this study was to determine the effectiveness of passive and active derotation techniques of manual therapy according to Kaltenborn-Evjent on the reduction of the angle of trunk rotation in patients with idiopathic scoliosis. MATERIAL AND METHODS: The study enrolled 33 female patients from the Department of Rehabilitation who were diagnosed with adolescent idiopathic scoliosis. The patients were divided into two groups according to the curve location (SRS classification). Group A consisted of 17 women, aged 14.±2.4 years, with single-curve scoliosis in the thoracolumbar segment and group B was composed of 16 women, aged 15±2.24 years, with double-curve scoliosis in the thoracic and lumbar segments. In both groups, the angle of trunk rotation, the magnitude of thoracic kyphosis and lumbar lordosis were measured twice, before and after each session of derotation techniques. RESULTS: Both groups demonstrated a positive impact of active and passive derotation techniques on the angle of trunk inclination. The greatest difference was observed after a session of active derotation in the patients with lumbar scoliosis. The angle of trunk rotation decreased on average by 4.5°±1.14°. No correlations were found between the curve angle values and the degree of thoracic derotation after the application of these techniques. CONCLUSION: Derotational mobilization techniques may be a valuable complement to scoliosis treatment methods as they increase their effectiveness.

Lateral Semicircular Canal Asymmetry in Idiopathic Scoliosis: An Early Link between Biomechanical, Hormonal and Neurosensory Theories?

INTRODUCTION: Despite its high incidence and severe morbidity, the physiopathogenesis of adolescent idiopathic scoliosis (AIS) is still unknown. Here, we looked for early anomalies in AIS which are likely to be the cause of spinal deformity and could also be targeted by early treatments. We focused on the vestibular system, which is suspected of acting in AIS pathogenesis and which exhibits an end organ with size and shape fixed before birth. We hypothesize that, in adolescents with idiopathic scoliosis, vestibular morphological anomalies were already present at birth and could possibly have caused other abnormalities. MATERIALS AND METHODS: The vestibular organ of 18 adolescents with AIS and 9 controls were evaluated with MRI in a prospective case controlled study. We studied lateral semicircular canal orientation and the three semicircular canal positions relative to the midline. Lateral semicircular canal function was also evaluated by vestibulonystagmography after bithermal caloric stimulation. RESULTS: The left lateral semicircular canal was more vertical and further from the midline in AIS (p = 0.01) and these two parameters were highly correlated (r = -0.6; p = 0.02). These morphological anomalies were associated with functional anomalies in AIS (lower excitability, higher canal paresis), but were not significantly different from controls (p>0.05). CONCLUSION: Adolescents with idiopathic scoliosis exhibit morphological vestibular asymmetry, probably determined well before birth. Since the vestibular system influences the vestibulospinal pathway, the hypothalamus, and the cerebellum, this indicates that the vestibular system is a possible cause of later morphological, hormonal and neurosensory anomalies observed in AIS. Moreover, the simple lateral SCC MRI measurement demonstrated here could be used for early detection of AIS, selection of children for close follow-up, and initiation of preventive treatment before spinal deformity occurs.

A Functional SNP in BNC2 Is Associated with Adolescent Idiopathic Scoliosis.

Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity. We previously conducted a genome-wide association study (GWAS) and detected two loci associated with AIS. To identify additional loci, we extended our GWAS by increasing the number of cohorts (2,109 affected subjects and 11,140 control subjects in total) and conducting a whole-genome imputation. Through the extended GWAS and replication studies using independent Japanese and Chinese populations, we identified a susceptibility locus on chromosome 9p22.2 (p = 2.46 × 10(-13); odds ratio = 1.21). The most significantly associated SNPs were in intron 3 of BNC2, which encodes a zinc finger transcription factor, basonuclin-2. Expression quantitative trait loci data suggested that the associated SNPs have the potential to regulate the BNC2 transcriptional activity and that the susceptibility alleles increase BNC2 expression. We identified a functional SNP, rs10738445 in BNC2, whose susceptibility allele showed both higher binding to a transcription factor, YY1 (yin and yang 1), and higher BNC2 enhancer activity than the non-susceptibility allele. BNC2 overexpression produced body curvature in developing zebrafish in a gene-dosage-dependent manner. Our results suggest that increased BNC2 expression is implicated in the etiology of AIS.

Richard's back: death, scoliosis and myth making.

The body of a mediaeval monarch was always under scrutiny, and Richard III's was no exception. In death, however, his body became subject to new forms of examination and interpretation: stripped naked after the battle of Bosworth, his corpse was carried to Leicester and exhibited before being buried. In 2012, it was rediscovered. The revelation that Richard suffered from scoliosis prompts this article to re-evaluate the historical sources about Richard's physique and his posthumous reputation. This article argues that Richard's death and his myth as 'crookback' are inextricably linked and traces attitudes to spinal curvature in the early modern period. It also considers how Shakespeare represented Richard as deformed, and aspects of performance history which suggest physical vulnerability. It then considers Richard's scoliosis from the perspective of medical history, reviewing classical accounts of scoliosis and arguing that Richard was probably treated with a mixture of axial traction and pressure. It demonstrates from the evidence of Richard's medical household that he was well placed to receive hands-on therapies and considers in particular the role of his physician and surgeon, William Hobbes. Finally, it shows how the case of Richard III demonstrates the close relationship between politics and medicine in the period and the contorted process of historical myth making.

Prediction of health status based on postoperative radiographic variables in adult scoliosis.

OBJECTIVE: To evaluate the effect of surgical treatment on health related quality of life (HRQOL) and radiographic variables in patients with adult scoliosis. METHODS: Sixty-eight patients with adult spinal deformities underwent radiographic analysis. The enrollment criteria were as follows: age older than 18 years, adult degenerative or progressive idiopathic scoliosis (Cobb angle >10°), and surgical treatment within one year before this study was undertaken. The following variables were measured: curve type, apical level, curve magnitude, coronal and sagittal balance using a C7 plumb line (C7 PL) and gravity line, lateral intervertebral olisthesis, lumbar lordosis, sacral slope and pelvic tilt. HRQOL was assessed by the Oswestry Disability Index (ODI). Both preoperative and postoperative data were collected and changes in radiographically assessed variables and ODI scores attributable to surgery calculated; correlations between these changes were then assessed. The radiographically assessed variables and ODI scores were analyzed with SigmaStat (SPSS, Chicago, IL, USA). The level of statistical significance was set at P < 0.05. RESULTS: Surgical treatment resulted in improvements in ODI scores and several radiographically assessed variables, including sagittal balance, lumbar lordosis, lateral olisthesis and coronal Cobb angle. Only sagittal balance expressed as C7 PL was correlated to both preoperative and postoperative ODI. Gravity line, an alternative measurement of spinal balance, did not provide better correlations with HRQOL than C7 PL. CONCLUSIONS: Spinal balance assessed by gravity line did not provide a better correlation with HRQOL than C7 PL. Loss of sacral slope and retroverted pelvis are commonly seen in adult scoliosis and are not significantly changed by surgical treatment, including restoration of lumbar lordosis and sagittal balance.

Bone densitometry in children and adolescents.

PURPOSE OF REVIEW: Abnormalities in bone health are increasingly recognized in the pediatric population. Although the methodologies for assessing bone mineral density were originally developed for adults, great strides have been made in recent years, improving their applicability to children. Understanding these technologies, their interpretation, utility, and limitations is critical when assessing a child or adolescent with a suspected abnormality in bone mineral density. RECENT FINDINGS: Improved normative databases that address some of the confounding variables in the growing and maturing child have solidified dual-energy X-ray absorptiometry as the preferred method for the assessment of bone mineral density in children. Consensus statements by expert panels now provide specific guidance to clinicians seeking to evaluate children with fractures or at risk for fractures. Although still primarily a research tool, continued development of quantitative computed tomography applications in pediatrics suggests there may be a complementary role for clinical use in the future. SUMMARY: In the child or adolescent with a significant fracture history or a potential for fractures because of an underlying cause, clinicians now have guidelines and normative data to better focus their evaluation. Likewise, researchers can use this information to improve clinical trial design and interpretation of results.

Idiopathic scoliosis, growth zones, magnetic therapy.

BACKGROUND: The study has been performed to investigate the influence of pulsed magnetic field on the bone growth plates to get new grounds of magneto therapy in AIS treatment. MATERIALS AND METHODS: Were used methods of "strong" and "weak" pulsed magnetic fields influence. RESULTS: Application of pulsed magnetic field causes an authentic inhibition of chondrocytes' active proliferation processes, decreases the index of labeled nuclei, indicating the suppression of DNA synthesis, takes place an increase in the unit weight of the more "mature" differentiated chondrocytes. The final result of these effects is the accelerated synostosis of bones' growth plates. CONCLUSION: Regardless of the reasons that cause growth infringements, the operating organ in the chain is the body's growth plate. Therefore, the appliance of magnetic fields in AIS treatment can be considered as a perspective one concerning growth plates' functional activity local management. To our point of view, the potential of magneto therapy methods in child's orthopedic treatment is significantly higher compared with modern practice.

[Peculiarities of clinical manifestations and physiotherapy of discogenic scoliosis in young subjects].

The present study has demonstrated that pulsed magnetotherapy in combination with the traction of the vertebral column in young subjects with discogenic scoliosis makes it possible to reduce the flow of vertebral painful pulsation, has beneficial effect on the spinal muscular corset (reduced asymmetry of the muscular tone on the intact and affected sides), decreases the degree of vertebral deformation, broadens the scope of spinal movements due to the enhanced activity of vertebral muscles, and helps to sustain and maintain the results thus obtained for a longer period.

The effect of robo-horseback riding therapy on spinal alignment and associated muscle size in MRI for a child with neuromuscular scoliosis: an experimenter-blind study.

PURPOSE: This case study was conducted to highlight the clinical and radiological features of a patient with progressive neuromuscular scoliosis before and after robo-horseback riding therapy (HBRT). DESIGN: A clinical, laboratory, and radiological analysis of a single case. SUBJECT: An 11-year-old child, dignosed right thoracolumbar neuromuscular scoliosis secondary to cerebral palsy. METHOD: The child received a 5-week course of robo-HBRT, comprising of 60-minute periods a day, five times a week. Postural alignment was determined by Cobb's method. A real-time magnetic resonance imaging (MRI) was performed to determine the robo-HBRT-induced changes in cross-sectional area (CSA) of bilateral thoracic (T2) and lumbar (L2) paraspinalis. Clinical tests including the standard Gross Motor Function Measure (GMFM) and manual muscle testing (MMT) with the Lafayette Manual Muscle Tester were used to compare the intervention-related changes in motor performance and power. The surface EMG was also used to examine therapy-induced changes in muscle activity amplitude for bilateral T2 and L2 paraspinalis and rectus abdominis muscles. RESULTS: Clinical motor and strength scores increased after the intervention. Radiographic Cobb's angle, MRI, and electromyographic amplitude data demonstrated notably enhanced spinal alignment and muscle fiber CSA and symmetry, respectively. CONCLUSIONS: This is the first study to provide evidence of the therapeutic efficacy of a novel form of robo-HBRT on motor function and associated structural and motor control improvements, thus suggesting a method of augmenting therapy in neuromuscular scoliosis.

Calcification in human intervertebral disc degeneration and scoliosis.

Calcification is a pathological process that may lead to impairment of nutrient supply and disc metabolism in degenerative and scoliotic intervertebral discs (IVDs). The purpose of this study was to assess the calcification potential of IVDs in degenerative disc disease (DDD) and adolescent idiopathic scoliosis (AIS). For this purpose, 34 IVDs from 16 adult patients with DDD and 25 IVDs from 9 adolescent patients with AIS were obtained at surgery. The concave and convex parts of the scoliotic discs were analyzed separately. Von Kossa staining was performed to visualize calcium deposits, while type X collagen (COL X) expression associated with endochondral ossification was measured by immunohistochemistry. Alkaline phosphatase activity and calcium and inorganic phosphate concentrations were used as indicators of calcification potential. Results showed the presence of calcium deposits and COL X in degenerative and scoliotic IVDs, but not in control discs, and the level of the indicators of calcification potential was consistently higher in degenerative and scoliotic discs than in control discs. The results suggest that disc degeneration in adults is associated with ongoing mineral deposition and that mineralization in AIS discs might reflect a premature degenerative process.

Serum melatonin levels in adolescent idiopathic scoliosis prediction and prevention for curve progression--a prospective study.

The correlation of serum melatonin levels and curve progression in adolescent idiopathic scoliosis, and the effects of melatonin therapy in scoliotic patients with reduced levels of endogenous melatonin were studied in 40 adolescent patients with moderate to severe idiopathic scoliosis. Of the scoliotic subjects, 28 had stable scoliosis and 12 had progressive scoliosis. Normal melatonin levels were derived from 25 age-matched control patients. Serum melatonin levels were monitored yearly in scoloiotic patients for a period ranging from 3 to 6 yr, revealing a diurnal pattern with low values during the day and high at night. Scoliotic patients with normal levels were not treated or were treated with a brace, and all but two patients with low endogenous melatonin were treated with oral supplements of the indole. Of the 22 patients with a normal melatonin level, 16 had stable scoliosis and six had progressive scoliosis. Of the 16 patients treated for a low melatonin level, 12 had stable scoliosis and four had a progressive course. The two untreated cases had a progressive course. Of the 12 patients who had progressive scoliosis, nine had >35 degrees of curve at initial examination. These findings suggest that melatonin deficiency plays a role in the prognosis of idiopathic scoliosis. Therefore, melatonin supplements may prevent the progression of scoliosis, especially in mild cases with less than a 35 degrees curve.

Idiopathic scoliosis and concentrations of zinc, copper, and selenium in blood plasma.

The concentration of zinc, copper, selenium, albumin, and ceruloplasmin in blood plasma and the activity of superoxide dismutase and glutathione peroxidase in erythrocytes were determined in a set of patients with idiopathic scoliosis (n=51). A significant decrease of selenium concentration (0.50 +/- 0.16 micromol/L) was found when compared with a control group (0.69 +/- 0.07 micromol/L) (p<0.01). The same levels of significance were found out for selenium levels corrected for albumin content. In a group of patients with a curvature over 45 degrees indicated for a surgical correction, the average plasma concentrations of selenium were significantly lower (p < 0.05) in comparison with a group of patients with a curvature below 45 degrees treated conservatively. The GSH-Px activity in erythrocytes was the same in both sets. In comparison with the controls, no significant differences were revealed in all of the other parameters. The detection of the decreased blood plasma concentration of selenium has suggested possible disturbance of well-proportioned distribution and of general optimal availability of selenium in the organism of patients with idiopathic scoliosis with likely effects on the process of synthesis and maturation of collagen affecting the axial skeleton stability.

The effect of spinal electrostimulation on the testicular structure in rabbit.

BACKGROUND: The main objective of this study was to create an experimental model of idiopathic scoliosis (i.s.), and to assess the effect of Lateral Electrical Surface Stimulation (LESS) on the organism both intra vitam and post mortem. The experiment made it possible to determine the extent to which LESS affects overall development of the organism, apart from its positive clinical effect in correcting i.s. in children and youth. An attempt is also made to explain the basis of systemic complications accompanying this method. MATERIAL AND METHODS: Studies were carried out on 10 white New Zealand male rabbits aged 3.5 months. They were divided into two groups, 5 animals in each group. The LESS group was stimulated using an SCOL-2 apparatus, 9 hours a day. The second group served as controls. After three months, the animals were sacrificed. Detailed macroscopic and microscopic examinations were performed on the rabbits' testicles. Scraps were collected immediately after the animal's death, from the free brim of the testis. The ultrastructure was examined with a TESLA BS-500 electron microscope. RESULTS: In the LESS group, histopathological examination of the testicles revealed considerable necrosis of the seminiferous epithelium, frequently coupled with peritubular fibrosis, atrophy of seminal tubules, and proliferation of Leydig cells. Ultrastructural examination revealed a multi-layered basal lamina, collagen appearing in the proper membrane of the seminiferous epithelium and blood vessels, lysis of supporting and sex cells of the tubular epithelium, mitochondrial damage, and the formation of myelin-like bodies in the round spermatids and the middle segment of the elongated spermatid tails. Lysis of the cytoplasm of Leydig cells was observed in the testes. CONCLUSION: Traditional electrostimulation induced regressive changes in the testes, in the form of necrosis of the seminiferous epithelium, atrophy of seminal tubules, and destruction of Leydig cells.

Experimental scoliosis in the course of unilateral surface electrostimulation of the paravertebral muscles in rabbits: effects according to stimulation period.

Scoliosis among children and adolescents is a persistent problem. Worldwide, it afflicts between 0.3 to 15.3% of the population. One of the treatment methods of this disorder is to administer lateral electrical surface stimulation (LESS) for 9 h/day; unfortunately, however, this results in side-effects. Improvements are therefore sought. The main aim of the study was to investigate the effects of the duration of LESS on scoliosis progression and to evaluate, qualitatively, any associated macroscopic effect on other internal organs. The length of the LESS period was based on the results of previous clinical trials in children. The experiment was performed on 13 developing rabbits (aged 3.5 months), divided into three groups: group 1, rabbits subsequently treated for 9 h/day (n=5); group 2, animals treated for 2 h/day (n=5); group 3, control rabbits without electrostimulation (n=3). Stimulation was carried out using an electric stimulator SCOL-2 according to the method modified by Kowalski. The animals were killed after 3 months and examined macroscopically, and their adrenal glands were dissected and weighed. The X-rays of the spine of the animals were taken to analyse spinal deformity. Macroscopic lesions in rabbits from groups 2 and 3 (control) were mostly absent. While there was considerable deviation in group 1, all the stress features were apparent. The enlargement of the adrenal glands observed in group 2 was significantly less marked than in group 1. The degree of scoliotic deformity (according to the Cobb method) ranged from 21 degrees to 410 degrees (mean, 31.2 degrees) and from 23 degrees to 330 degrees (mean, 30 degrees) in groups 1 and 2, respectively. LESS resulted in spinal deformity to a similar degree in the rabbits treated for either 9 or 2 h/day over a 3-month period. Short LESS therapy (2 h/day) significantly reduced detrimental effects associated with the treatment on internal organs of laboratory animals.

[Decreased bone mineral density as a risk factor in the development of spinal deformities in neurofibromatosis]. / Csökkent csontdenzitás, mint lehetséges tényezó a neurofibromatosist kíséró gerincdeformitások kialakulásában.

Neurofibromatosis-1 is a here-do-familiar disorder that is associated with a variety of skeletal anomalies, mostly with spinal deformities in 10-50% of the patients. Intraoperatively, a poor vertebral bone quality has been observed. Efforts have been made to identify factors preventing curve progression, to optimize operational planning and to explain the pathomechanism. As part of the preoperative evaluation, the authors used a dual X-ray absorptiometry to assess the bone mineral density of the lumbar spine in 12 non operated patients with neurofibromatosis-1, supplemented by laboratory blood/urine investigations. A significant decrease in bone mineral density of lumbar spine was measured. An inverse relation was suggested between the severity of scoliosis and the lumbar spine Z-scores. No pivotal alterations were identified in the laboratory measurements. The bony tissue abnormality observed intraoperatively in neurofibromatosis-1 patients may be described as a diminution of the axial bone mineral density. The evaluation of bone mineral density in the course of the preoperative planning is proposed in neurofibromatosis-1.