Evaluation of Posturometric Parameters in Children and Youth Who Practice Karate: Prospective Cross-Sectional Study.

Reduced physical activity or inappropriate training can cause the development of postural abnormalities. The aim of the present study was to determine the relationship between intensive, controlled physical activity, such as karate, and postural parameters. The study group consisted of 57 young karate competitors aged 9-12 years. The control group included 76 healthy, active children in similar age. The children's posture, activity level, and time in front of electronic devices were evaluated. The following body posture assessments were carried out: Adams' test, evaluation of the plumb line, evaluation of the kyphosis, and lordosis angles using a digital inclinometer and shoulder blade position measurements using a pediscoliometer. In the majority of cases, despite evidence of an increase or decrease in the values of the plumb line and scapulae level, the results were still within the normal ranges. In 71.93% of the examined karate-training children, a decrease in torso rotation was noted. The study revealed a visible difference in postural muscle strength by the Mathiass screening test (P < 0.00001). The children in the control group spent more time in front electronic devices than the karate-training children did (P < 0.007). Postural defects regression was more often observed in the study group than in the controls (P < 10-8). The frequency of postural defects stabilization was also significantly higher in the study group than in the control children (P = 0.001). Conversely, postural defects progression was significantly more frequent in the control group than in young karate competitors (P < 10-8). These differences remained significant in subgroups of girls and boys. Physical activity performed regularly and under the direction of a professional trainer can prevent postural disorders.

Surgical Management of Myelomeningocele-Related Spinal Deformities.

OBJECTIVE: To evaluate the optimal timing and type of surgical treatment of myelomeningocele (MMC)-related spinal deformities and long-term follow-up of surgical treatment. METHODS: We reviewed and presented clinical pictures, treatment strategies and results of 20 patients with MMC-related spinal deformities treated at our center between 2010 and 2017. RESULTS: The average patient age was 6.3 years. The average preoperative neurologic status according to a modified Japan Orthopedic Association (mJOA) scale was 7.3 points (Benzel's modification). Average functional status was 41 points according to a functional independent measure scale (FIM). The average angle of kyphosis was 83.7°, that of scoliosis was 36.7°, and that of lordosis was 67° (Cobb angles). The average duration of surgery was 234 minutes, and the average total blood loss was 175 mL. The average angle of kyphosis correction was 61°, that of scoliosis correction was 25°, and that of lordosis correction was 25° (Cobb angles). The average duration of hospitalization was 16.6 days, and the average follow-up was 34.5 months. The total number of complications was 13. Reoperation was required in 9 cases. Neurologic status according to the mJOA scale improved by 0.6 point on average. Functional status according to the FIM increased by 6.6 points on average. CONCLUSIONS: Early surgical correction of MMC-related spinal deformities improves body balance and quality of life. The dual growing rod technique is safe and effective in cases of moderate neuromuscular spinal deformities at an early age. Kyphectomy is a challenging procedure with high complication rates, especially skin problems, but there are no alternative procedures for cases of heavy rigid kyphosis.

Slow correction of severe spastic hyperlordosis in an adult by means of magnetically expandable rods.

BACKGROUND: We describe a case of severe and progressive lumbar hyperlordosis (160°) in a 28-year-old female university student with cerebral palsy. Her main complaints were abdominal wall pain and increasing inability to sit in her custom wheelchair. METHOD: When deciding on our opinion about the most promising treatment strategy, we contemplated slow continued correction by means of percutaneously expandable magnetic rods (MAGEC) after the index surgery as a key component of a satisfactory correction in this severe and rigid curve. After an initial radical release and partial correction, a release and correction procedure was required for the bilateral hip flexion contracture. A final in situ posterior fusion was performed as a second spinal procedure, once the desired final correction at 66° of lumbar lordosis was achieved. RESULT: Three years after the completion of surgery, the patient has a stable clinical and radiological result as well as a solid posterior fusion on CT. CONCLUSION: This is the first case published in which percutaneous magnetic distraction was successfully used in an adult patient.

Quantitative Postural Analysis of Children With Congenital Visual Impairment.

OBJECTIVES: The aim of this study was to compare the postural alignment of children with visual impairment with that of children without visual impairment. METHODS: The sample studied was 74 children of both sexes ages 5 to 12 years. Of these, 34 had visual impairment and 40 were control children. Digital photos from the standing position were used to analyze posture. Postural variables, such as tilt of the head, shoulder position, scapula position, lateral deviation of the spine, ankle position in the frontal plane and head posture, angle of thoracic kyphosis, angle of lumbar lordosis, pelvis position, and knee position in the frontal and sagittal planes, were measured with the Postural Assessment Software 0.63, version 36 (SAPO, São Paulo, Brazil), with markers placed in predetermined bony landmarks. RESULTS: The main results of this study showed that children with visual impairment have increased head tilt (P < .001), shoulder deviation in frontal plane (P = .004), lateral deviation of the spine (P < .001), changes in scapula position (P = .012), higher thoracic kyphosis (P = .004), and lower lumbar lordosis (P < .001). CONCLUSIONS: Visual impairment influences postural alignment. Children with visual impairment had increased head tilt, uneven shoulders, greater lateral deviation of the spine, thoracic kyphosis, lower lumbar lordosis, and more severe valgus deformities on knees.

Preliminary results of anterior lumbar interbody fusion, anterior column realignment for the treatment of sagittal malalignment.

OBJECTIVE Sagittal malalignment decreases patients' quality of life and may require surgical correction to achieve realignment goals. High-risk posterior-based osteotomy techniques are the current standard treatment for addressing sagittal malalignment. More recently, anterior lumbar interbody fusion, anterior column realignment (ALIF ACR) has been introduced as an alternative for correction of sagittal deformity. The objective of this paper was to report clinical and radiographic results for patients treated using the ALIF-ACR technique. METHODS A retrospective study of 39 patients treated with ALIF ACR was performed. Patient demographics, operative details, radiographic parameters, neurological assessments, outcome measures, and preoperative, postoperative, and mean 1-year follow-up complications were studied. RESULTS The patient population comprised 39 patients (27 females and 12 males) with a mean follow-up of 13.3 ± 4.7 months, mean age of 66.1 ± 11.6 years, and mean body mass index of 27.3 ± 6.2 kg/m2. The mean number of ALIF levels treated was 1.5 ± 0.5. Thirty-three (84.6%) of 39 patients underwent posterior spinal fixation and 33 (84.6%) of 39 underwent posterior column osteotomy, of which 20 (60.6%) of 33 procedures were performed at the level of the ALIF ACR. Pelvic tilt, sacral slope, and pelvic incidence were not statistically significantly different between the preoperative and postoperative periods and between the preoperative and 1-year follow-up periods (except for PT between the preoperative and 1-year follow-up, p = 0.018). Sagittal vertical axis, T-1 spinopelvic inclination, lumbar lordosis, pelvic incidence-lumbar lordosis mismatch, intradiscal angle, and motion segment angle all improved from the preoperative to postoperative period and the preoperative to 1-year follow-up (p < 0.05). The changes in motion segment angle and intradiscal angle achieved in the ALIF-ACR group without osteotomy compared with the ALIF-ACR group with osteotomy at the level of ACR were not statistically significant. Total visual analog score, Oswestry Disability Index, and Scoliosis Research Society-22 scores all improved from preoperative to postoperative and preoperative to 1-year follow-up. Fourteen patients (35.9%) experienced 26 complications (15 major and 11 minor). Eleven patients required reoperation. The most common complication was proximal junctional kyphosis (6/26 complications, 23%) followed by vertebral body/endplate fracture (3/26, 12%). CONCLUSIONS This study showed satisfactory radiographic and clinical outcomes at the 1-year follow-up. Proximal junctional kyphosis was the most common complication followed by fracture, complications that are commonly associated with sagittal realignment surgery and may not be mitigated by the anterior approach.

Effects of dietary DHA and α-tocopherol on bone development, early mineralisation and oxidative stress in Sparus aurata (Linnaeus, 1758) larvae.

DHA deficiency has been related to skeletal malformations in fish, but high DHA levels have produced controversial results that could relate to the oxidative status of fish tissues in the different reports. In the present study, gilthead seabream (Sparus aurata) larvae were fed deficient, adequate or high DHA levels, or high DHA levels supplemented with the antioxidant α-tocopherol. Larvae fed deficient DHA levels tended to be smaller, and showed the highest incidence of urinary bladder calculi, lordosis and kyphosis and the lowest number of mineralised vertebrae for any given size class. Elevation of dietary DHA increased larval growth and significantly enhanced the expression of the insulin-like growth factor 1 (IGF-1) gene. However, a DHA level increase up to 5 % raised the degree of lipid oxidation in larval tissues and deformities in cranial endochondral bones and in axial skeletal haemal and neural arches. The increase in dietary α-tocopherol supplementation in high-DHA feeds reduced again the occurrence of skeletal deformities. Moreover, the expression of genes coding for specific antioxidants such as catalase, superoxide dismutase or glutathione peroxidase, which neutralised reactive oxygen substances formed by increased dietary DHA, was significantly decreased in larvae fed high α-tocopherol levels. These results denoted the importance of DHA for early bone formation and mineralisation. Low dietary DHA levels delay early mineralisation and increase the risk of cranial and axial skeletal deformities. Excessive DHA levels, without an adequate balance of antioxidant nutrients, increase the production of free radicals damaging cartilaginous structures before bone formation.

A comparison of the torsional stiffness of the lumbar spine in flexion and extension.

OBJECTIVE: The main mechanism of injury to the spine is torsion especially when coupled with compression. In this study, the in vitro torsional stiffness of the lumbar spine segments is compared in flexion and extension positions by cyclic and failure testing. METHODS: Fifteen lumbar spines were sectioned from fresh cadavers into 15 L2/3 and 15 L45 motion segments. Each vertebral segment was then potted superiorly and inferiorly in polymethylmethacrylate, effectively creating a bone-disk-bone construct. The potted spinal segments were mounted in a mechanical testing system, preloaded in compression to 300 N, and axially rotated to 3 degrees in both directions at a load rate of 1 degrees /s. This was done over 3 cycles for each motion segment in the flexion and extension positions. Each specimen was then tested to torsional failure in either flexion or extension. Stiffness, torque, and energy were determined from cyclic and failure testing. RESULTS: The results showed that in all cases of cyclic testing, the higher segment extension resulted in higher torsional stiffness. In relative extension, the lumbar specimens were stiffer, generated higher torque values, and generally absorbed more energy than the relative flexion condition. There were no differences found in loading direction or failure testing. CONCLUSIONS: Increasing the effective torsional stiffness of the lumbar spine in extension could provide a protective mechanism against interverbral disk injury. Restoration of segmental extension through increasing the lumbar lordosis may decrease the strain and reinjury of the joints, which can help reduce the extent of pain in the lumbar spine.

Conservative treatment of a patient with syringomyelia using chiropractic biophysics protocols.

OBJECTIVE: To present a case of a 41-year-old man with syringomyelia and intractable pain and the subsequent reduction of symptoms. CLINICAL FEATURES: This patient acquired a traumatically induced syrinx in his upper cervical spinal cord after he fell approximately 9 feet and landed on his head, upper back, and neck 9 years before presenting for care. He was diagnosed with a spinal cord cyst (syrinx), located at approximately C2 through C4 after magnetic resonance imaging. In 1995, the patient underwent occipitoatlantal decompression surgery, which improved his symptoms for a short time. INTERVENTION AND OUTCOMES: The patient was treated using Clinical Biomechanics of Posture protocol. The patient was seen 26 times over the course of 3 weeks. His scale for pain severity decreased 50% and other subjective complaints decreased. His posture improved based upon pretreatment and posttreatment lateral cervical radiographs, showing a change from a 10 degrees lordosis with midcervical kyphosis to a 30 degrees lordosis. One-year follow-up examination showed stable improvement in the cervical lordosis and pain intensity. CONCLUSION: This case represents a change in subjective and objective measurements after conservative chiropractic care. This case provides an example that structural rehabilitation may have a positive effect on symptoms of a patient with syringomyelia.

Historical perspective milestones in the evolution of lumbar spinal postural health in seating.

The best knowledge on seated posture before the Enlightenment was not scientific, but influenced by sociocultural, economic, and manufacturing factors. Although the pursuit of knowledge related to spinal postural health was advanced with the advent of empirico-analytic research, academic opinion continued to be influenced by unsubstantiated information, often resulting in incorrect advice to the public. Only in the past decade has advice on "correct" seated posture, spanning the time from the Hippocratic texts to the present, been brought into question by evidence-based research. By exploring seating from 3100 B.C to the present, this article discusses key influences that have an impact on seating functional to spinal postural health. Emphasis is placed on the role of medical opinion.

The curve of the cervical spine: variations and significance.

OBJECTIVE: To review the literature regarding the curve of the cervical spine in normal and injured persons, emphasizing common variations in cervical curvature and their possible clinical significance. DATA SOURCE: A MEDLINE literature search of the English-language, human literature was performed using multiple search strategies relevant to radiography, posture, lordosis, injury, diagnosis and prognosis of the cervical spine (MESH: cervical vertebrae). Additionally, article bibliographies were searched for further relevant articles. No publication time limit was imposed. STUDY SELECTION: Articles were identified by the author as being directly relevant to the objective and scope of this review. DATA EXTRACTION: Data was extracted as presented in each original article. DATA SYNTHESIS: The articles reviewed indicate that a wide range of normal exists in the posture and configuration of the cervical spine. Although kyphotic angulation and straightening or reversal of cervical lordosis are commonly seen following trauma, they may be normal variants. Muscle spasm is a widely used explanation for these variations when seen in patients with pain or trauma. Kyphotic angulation is often associated with posterior ligamentous injury of a motion segment. Prognostic significance of these variations is claimed by some authors. CONCLUSION: There is little evidence to support the contention that altered cervical curvatures are of prognostic significance. Although kyphotic angulation is associated with anterior subluxation (hyperflexion sprain), it is not a reliable diagnostic criterion for that condition. It is reasonable to assume that straightening or reversal of a previously lordotic cervical curve is the result of muscular spasm, but more specific interpretation is not supported by the literature. More study is needed to characterize the specific dynamics and etiologies involved in the determination of cervical spine configuration.

Anatomical leg length inequality, scoliosis and lordotic curve in unselected clinic patients.

Anatomic leg length inequality (LLI) and various mechanical measures of the lumbar spine, particularly scoliosis, lordosis and Ferguson's angle, were analyzed retrospectively from the X-rays of 106 consecutive patients in a private chiropractic practice. Results showed that 40% of the subjects had LLI greater than 6 mm while 70% had LLI greater than 3 mm. These data compared closely with studies done by other investigators, indicating that our routine diagnostic X-ray procedure is sufficient for accurately determining LLI. Our most noteworthy finding was that patients with LLI greater than 6 mm often (53% of the cases) had scoliosis and/or abnormal lordotic curves. Altered lordotic curves comprised both hypo- and hyperlordosis with about equal frequency. The correlation coefficients between the amount of LLI and any of the parameters taken singly, however, were not significant. The results of this study indicate that while there is no strong correlation between any one of the particular postural adaptations to anatomic leg length deficiency, nevertheless at least one abnormal spinal adaptation (scoliosis or hypo-hyperlordosis) occurs in over half of subjects who have LLI greater than 6 mm.

[Experience with lateral electric surface stimulation in the treatment of progressive idiopathic scoliosis]. / Erfahrungen mit der lateralen elektrischen Oberflächenstimulation bei der Behandlung der progredienten idiopathischen Skoliose.

Due to incorrect use of nomenclature, scolioses are incorrectly classified in the paper by Altekruse and Heine. The angle measurement is inaccurate and does not correspond to Cobb's measuring method. The accuracy of the scientific statement and its value can be derived from this. The results of treatment obtained by Altekruse and Heine were improvement in or standstill of the scoliosis in 80% of the cases and progression in over 17%. This corresponds to the "Natural History of Scoliosis:" 5 to 25% of juvenile scolioses (age 3 to 10 years according to Drummont) are progressive, the figure for adolescent scolioses being lower. Therefore, electrostimulation is used to 70-80% in cases requiring no treatment, where there is no progression, in which there are no structural changes or which should be classified as malposture, in which spontaneous remission usually occurs or which remain stationary. In scolioses of over 25 degrees, with proven progression and structural changes, and possibly also with positive family history, electrostimulation fails. As in almost all papers published to date, Altekruse and Heine's paper disregards the behavior of the sagittal curvature of the spine under electrostimulation. We demonstrate in two cases that electrostimulation can have a considerable pathologic effect, causing lordosis. Since, on the basis of recently adopted opinions, there is reason to believe that there is a causal connection between lordosis and the pathogenesis of scoliosis, it must be assumed that in such cases electrostimulation incites or aggravates the development of scoliosis or is at least potentially capable of doing so. At any rate, in the two cases in which it was demonstrated that electrostimulation caused lordosis, the scoliosis was significantly aggravated, so that in these cases at least it must be assumed that the method has a health-damaging effect. Electrostimulation is a cost factor which does not seem justifiable today, with economy an obligation. The cost of using it in a mere 100 cases would be sufficient to pay for proper screening of all the children in one school year in the Federal Republic. Children who are really at risk could be given effective treatment. In Sweden, this has resulted in 60% of the scoliosis operations previously required in populations of the same size no longer being necessary.