Rib index is a strong surrogate of scoliometric reading in idiopathic scoliosis.

INTRODUCTION AND AIM: Scoliometry is not always included in the examination protocol of IS patients. The aim of this report is to examine the degree of correlation of Segmental Rib Index (SRI) to scoliometry, in order for SRI to be used as a surrogate of scoliometric angle of trunk rotation (ATR). MATERIAL AND METHOD: 66 Idiopathic Scoliosis (IS) subjects were studied, with a mean age 12.2 ± 2.9 years, 18 boys and 48 girls: 20 thoracic, 22 thoracolumbar and 24 lumbar curves. The standing lateral spine radiographs (LSR) were obtained and the Segmental Rib Index (SRI) from T1 to T12 were assessed. The ATR was documented. RESULTS: In all 66 cases with IS the scoliometer readings (ATR) were significantly correlated to the SRI at the T6, T7 and T8 levels. In the thoracic curves SRI and ATR correlations were significant for the levels T6-T12. DISCUSSION: It was suggested that as long as the patients doesn't have scoliometer measurements, the SRI, could be used as a surrogate for scoliometry. It was also found that in thoracic, thoracolumbar and lumbar level, in both genders, changing from the flexed position to the standing position, the mean trunk asymmetry (TA) decreases. Therefore, if these patients had their TA measured using a scoliometer during the Adams test, their body asymmetry would have been greater than that measured using the SRI method on standing LSR. Consequently, it is evident that the significantly correlated SRI used as a surrogate for the scoliometric assessment of TA is reasonably a strong surrogate.

Hip-Spine and Knee-Spine Syndrome: Is Low Back Pain Improved After Total Hip and Knee Arthroplasty?

INTRODUCTION: Hip and knee osteoarthritis (OA) and low back pain (LBP) are prevalent diseases that can negatively impact daily activities. The concurrent existence of lumbar spine disorders with hip or knee issues forms two syndromes: hip-spine syndrome (HSS) and knee-spine syndrome (KSS). The primary objective of this study is to evaluate the relationship between hip and knee OA and LBP, as well as the changes to LBP after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The secondary objective is to identify the cause of LBP among patients with hip and knee OA. MATERIAL AND METHODS: The group of hip OA patients treated with THA consisted of 34 individuals, and the group of knee OA patients treated with TKA consisted of 45 individuals. In these two groups of patients, the LBP was assessed using the visual analog scale score preoperatively and four and 12 months postoperatively. To determine the cause of LBP, we compared preoperative and postoperative (12-month) pelvic obliquity and hip or knee pain in patients with and without preoperative LBP. RESULTS: For hip OA-THA, more than half (55.88%) of patients suffering from hip OA also experienced moderate to severe LBP. Improvement in LBP was noticed in 79% of these patients at both four and 12 months post-THA, with levels dropping from 6.84 to 2.58 and then 2.53, respectively. Moreover, improvements in hip pain and pelvic obliquity were observed in patient groups both with and without preoperative LBP following THA. This suggests that there's no obvious correlation between LBP and these parameters. For knee OA-TKA, most (62.22%) patients with knee OA experienced moderate to very severe LBP. In 50% of these patients, LBP showed improvement at four and 12 months post-TKA (6.39 → 4.79 → 4.04). Additionally, in both groups with and without preoperative LBP, knee pain and pelvic obliquity were improved after TKA, suggesting no clear association between LBP and these parameters. CONCLUSIONS: HSS and KSS were frequently observed in patients. A significant improvement in LBP was seen after THA or TKA, suggesting that total arthroplasty should be prioritized before spinal surgery. Furthermore, there is not a definitive link between LBP, joint pain, and pelvic obliquity.

Are the Spinal Changes in the Course of Scoliogeny Primary but Secondary?

In this opinion article, there is an analysis and discussion regarding the effects of growth on the spinal and rib cage deformities, the role of the rib cage in scoliogeny, the lateral spinal profile in adolescent idiopathic scoliosis (AIS), the genetics and epigenetics of AIS, and the interesting and novel field investigating the sleep impact at nighttime on AIS in relation to the sequence of the scoliogenetic changes in scoliotics. The expressed opinions are mainly based on the published peer-reviewed research of the author and his team of co-authors. Based on the analysis noted above, it can be postulated that the vertebral growth changes in the spine during initial idiopathic scoliosis (IS) development are not primary-intrinsic but secondary changes. The primary cause starting the deformity is not located within the vertebral bodies. Instead, the deformations seen in the vertebral bodies are the secondary effects of asymmetrical loads exerted upon them, due to muscular loads, growth, and gravity.

Sagittal Balance Parameters and Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis.

Background: To review and evaluate multiple preoperative and postoperative sagittal parameters and their association with the risk of developing proximal junctional kyphosis (PJK) in patients with adolescent idiopathic scoliosis (AIS) who undergo correction surgery. Methods: A systematic search was performed in December 2022 in PubMed, Embase and the Cochrane Library to retrieve all the studies relevant to our research. After the study selection and data extraction following PRISMA guidelines, RevMan 5.3 was used for statistical analysis. All the analyzed factors were evaluated by using odds ratios and weighted mean differences with 95% confidence intervals. Moreover, the meta-analysis of proportions via MedCalc was used for analyzing quantitative data from the studies. Results: A total of 22 studies were included in our meta-analysis. All the available values of sagittal parameters were evaluated. Among all the potential risk factors, higher preoperative thoracic kyphosis (Test for overall effect Z = 11.79, p < 0.00001), higher preoperative sagittal vertical axis (SVA) (test for overall effect Z = 11.19, p < 0.00001), greater thoracic kyphosis change post-op. compared to pre-op. (test for overall effect Z = 6.02, p < 0.00001), increased postoperative lumbar lordosis (test for overall effect Z = 3.65, p = 0.0003), higher post-op. SVA (test for overall effect Z = 24.93, p < 0.00001) and a larger pelvic incidence/lumbar lordosis (PI/LL) mismatch (test for overall effect Z = 20.50, p < 0.00001) were found to be the risk factors for PJK after AIS surgery. Moreover, a decreased rod contour angle (RCA) (test for overall effect Z = 3.79, p < 0.0002) and higher proximal junctional angle-rod contour angle (PJA-RCA) (test for overall effect Z = 39.18, p < 0.00001) play a significant role in the risk of developing PJK after AIS correction. Conclusions: Sagittal balance is of great importance when considering the surgical correction of AIS. Many factors in our meta-analysis were found to increase the incidence for PJK such as higher preoperative thoracic kyphosis and pre-op. SVA. Furthermore, increased thoracic kyphosis change, increased post-operative lumbar lordosis, SVA and PI/LL mismatch are also factors that influence the possibility of post-op. PJK. Lastly, RCA and PJA-RCA are two important factors that need attention during AIS, as over-contouring of the rod could lead to PJK in AIS patients.

A Questionnaire of Physiotherapeutic Specific Exercises of Scoliosis-QPSSE.

STUDY DESIGN: Creating and psychometric testing of a new QoL Questionnaire about Physiotherapeutic Specific Exercises of Scoliosis (Questionnaire of Physiotherapeutic Specific Exercises of Scoliosis-QPSSE). PURPOSE: The purpose of this study is to create a reliable and valid questionnaire for patients suffering from mild and moderate adolescent idiopathic scoliosis (AIS) who have been treated with Physiotherapeutic Specific Exercises of Scoliosis (PSSE) in order to evaluate their quality of life. MATERIALS AND METHODS: The developed questionnaire was based on a thorough literature review as well as on authors' experience. It consists of 53 questions, of which 37 have a positive meaning, 15 have a negative meaning, and 1 is a multiple choice question; additionally, there are 6 "open" questions. Except for the multiple choice question, all other questions are answered on a Likert scale ranging from 1 to 5 points. Five represents a positive meaning or very positive one, whereas one stands for a negative meaning or none at all. Questions were developed by the authors who subsequently categorized the 53 questions into the following eight domains: physical functioning, self-image, Physiotherapeutic Scoliosis-Specific Exercises (PSSEs), psychosocial functioning, cognitive functioning, compliance, motivation, and pain. A pilot study was conducted so that we could calculate Cronbach's Alpha based on the outcome. Due to the COVID-19 pandemic, the authors worked through the Zoom online platform to structure the questionnaire. RESULTS: Pearson's correlation coefficient was used for all correlations evaluated. P values of less than 0.05 were considered to be significant. Internal consistency was evaluated with Cronbach's Alpha. Although there were very few missing values, accounting for 0.78% of the total values of the questionnaire, the expectation maximization likelihood algorithm was used to impute data. IBM® SPSS® Statistics Software v.25 was used for the analysis. Cronbach's Alpha coefficients for the overall score were 0.84. CONCLUSIONS: This original QPSSE was found to be a reliable and valid tool for AIS treated conservatively with PSSE and for the patients' clinicians.

Segmental Rib Index and Spinal Deformity: Scoliogenic Implications.

The aim of this report is to evaluate the segmental rib index (RI) from the T1 to T12 spinal levels in mild and moderate idiopathic scoliosis (IS) curves of thoracic, thoracolumbar and lumbar type by gender. The relationship of segmental RI to the frontal plane radiological deformity presented as the Cobb angle and to the posterior truncal surface deformity presented as the scoliometric readings of Angle of Trunk Rotation (ATR) in these patients is also assessed. Any statistically significant relationship between these parameters would be very important for biomechanical relations in rib cage (RC) deformity presented as rib hump deformity (RHD) and deformity in the spine, and would thus provide valuable information about scoliogeny. The segmental rib index (RI) is presented in 83 boys and girls with mild and moderate IS. The measurements include the scoliometric readings for truncal asymmetry (TA), the Cobb angle assessment and the segmental RI from T1-T12. The statistical package SPSS 23 was used for statistical analysis. The TA was documented and the Cobb angle is presented by gender and curve type. The segmental RI of thoracic, thoracolumbar and lumbar curves are presented for the first time. The correlations of the segmental RI to surface deformity presented as rib hump deformity (RHD) in all IS patients, and particularly in thoracic curves, to Cobb angle by gender and age and the comparison of the segmental RI index of asymmetric but not scoliotic children to the scoliotic peers by curve (in thoracic, thoracolumbar, lumbar curves) in boys and girls are presented. The findings emphasize the significant protagonistic role of thoracic asymmetry in relation to the spinal deformity, mainly in girls for the thoracic and in boys for the thoracolumbar curves. The cut-off point of age of the examined scoliotics was 14 years, which is when the RI shows a stronger correlation with spinal deformity, namely when thoracic deformity is decisively effective in the development of thoracic spinal deformity, in terms of Cobb angle. In summary, the results of this study may provide scoliogenic implications for IS, as far as the role of the thorax is concerned.

[Prevalence, risk of progression and quality of life assessment in adolescents undergoing school screening for adolescent idopathic scoliosis]. / Prevalencia, riesgo de progresión y calidad de vida en estudiantes tamizados para escoliosis idiopática adolescente.

OBJECTIVE: To determine the prevalence of adolescent idiopathic scoliosis (AIS), progression risk, and quality of life in students aged from 10 to 18 years. PATIENTS AND METHOD: Cross-sectional descriptive study in students 10 - 18 years old from 5 communes in Santiago, Chile, between 2015-2016. Adam's Test was performed and the angle trunk rotation (ATR) at the thoracic, thoracolumbar, and lumbar levels were measured with a scoliometer. If ATR was ≥ 6°, anteroposterior and lateral radiological images of the spine were taken, and Cobb angle was measured. Scoliosis was confirmed if the Cobb angle was ≥ 10° plus vertebral rotation. Progression factor was calculated with Lonstein and Carlson formula. Quality of life was assessed through spinal deformities questionnaires and the trunk appearance perception scale. RESULTS: 1200 students were evaluated, 54.9% were female, and 8.17% had ATR ≥ 6°. We found mild scoliosis in 2.91%, moderate in 0.75% and severe in 0.17%. Total prevalence was 3.83% (CI 95%: 2.74 - 4.92). 82.61% of the cases had a late diagnosis, after their growth spurt. Of the patients with scoliosis, 21.74% had a progression risk ≥ 50%. Quality of life had a positive correlation with scoliosis severity, not statistically significant. CONCLUSIONS: Prevalence of AIS was 3.83%. Most patients were diagnosed after their growth spurt with high progression risk. Quality of life showed a weak positive correlation with scoliosis severity.

Why Is There Always a Remnant Rib Hump Deformity after Spinal Operations in Idiopathic Scoliosis: Aetiological Implications and Recognition of the Proper Rib Level for Costoplasty.

The aim of this report is to review the literature dealing with the postoperative correction of rib hump (RH) after spinal operations for adolescent idiopathic scoliosis (AIS) and its aetiological implications of hump postoperative fate for IS. Recommendations related to RH deformity for the follow-up of younger asymmetric but not scoliotic children are provided, and the concept that clinical monitoring of the chest deformity is more important than merely an initially negative radiographic examination (curve less than 10°) is underlined. Additionally, guidelines are provided based on the segments T1-T12 rib index (RI) in the existing lateral preoperative radiographs for the optimal selection of the rib level for a successfully costoplasty. This review is based on the collected articles that used either the RI method, derived from the double rib contour sign (DRCS) at the lateral spinal radiographs, or alternative methods for the assessment of the RH deformity and presented the results of the operative treatment of the scoliotic spine on RH. A total of 19 relevant articles published from 1976 to 2022 were found in PubMed. Findings: All the above articles show that not only is the hump incompletely corrected, but it recurs and worsens during the follow-up and even more intensively in skeletally immature operated scoliosis children. Conclusions and Future Directions: Surgery straightens the spine, yet the RH is corrected approximately only as much as the spinal derotation. The only way to correct the RH more is with costoplasty, which, however, is not performed in most cases for many reasons. The key reason for this phenomenon is the fact that the RH deformity (RHD) is mainly due to the asymmetric development of the ribs and much less so due to the rotation of the vertebrae in the thoracic spine. Surgery on the spine cannot limit the asymmetry of the ribs or stop the mechanism that causes their asymmetrical growth. The results presented in all the reviewed articles support the important protagonistic role of RHD on scoliogenesis, which precedes the subsequent formed spinal deformity.

Menarche in Scoliotic and Non-Scoliotic Balkan Girls and the Relationship between Menarche and the Laterality of Scoliotic Curves.

BACKGROUND: Menarche, as an important parameter in the assessment of scoliosis progression in girls, is proven to be dependent on geographical latitude. The aim of this study was to determine whether the age of menarche differs in scoliotic and non-scoliotic Balkan girls and the relationship between menarche and the laterality of scoliotic curves. PARTICIPANTS AND METHODS: This is a retrospective study with three groups: scoliotic, non-scoliotic, and control. Patient data collection and analysis were approved by the Ethical Committee of the Institute. STATISTICAL ANALYSIS: The SPSS 24 program was used, and we employed One-way ANOVA, Fisher's, and Chi-squared tests to compare different groups. Statistical significance was defined as p < 0.05. RESULTS: No statistically significant difference was found in the age of menarche between the three groups (p = 0.168). In the scoliotic postmenarchal group, the primary right curve was dominant in 54.80%, while in the scoliotic premenarchal group, the primary left curve was dominant in 60.09% (p < 0.01). CONCLUSION: In Balkan girls from Bosnia and Herzegovina and Serbia, there was no significant difference in the age of menarche between scoliotic and non-scoliotic girls. A significant difference was found in the laterality of the primary curve in premenarchal and postmenarchal scoliotic girls.

Reply to de Reuver et al. Comment on "Grivas et al. Morphology, Development and Deformation of the Spine in Mild and Moderate Scoliosis: Are Changes in the Spine Primary or Secondary? J. Clin. Med. 2021, 10, 5901".

With great interest we have read the [...].

Nonoperative management of adolescent idiopathic scoliosis (AIS) using braces.

This review presents the state of the art according to the current evidence on nonoperative treatment for adolescent idiopathic scoliosis, focusing on bracing. The definition of braces for the treatment of adolescent idiopathic scoliosis and a short history are provided. The analysis includes biomechanics, types, existing classifications, indications for treatment, time of brace wear and weaning, adherence, three-dimensional modeling, use of ultrasound imaging for bracing, management of treatment, issue of immediate in-brace correction, and documentation of the outcomes usually assessed for brace treatment, including the quality-of-life issues. According to the current evidence, there are two randomized control trials in favor of bracing. There are insufficient data on the superiority of one brace over another, although it is possible to classify and grade braces for efficacy from nonrigid to rigid and very rigid. Nevertheless, there is consensus on patients' management on the need for teamwork focusing on adherence to treatment, acceptability, and family and patient involvement.

Investigation of the Relationship Between Hip and Knee Osteoarthritis and Disordered Spinal and Pelvic Morphology.

Introduction A critical question is the causal relationship between hip or knee osteoarthritis (OA) and disordered spinal and pelvic morphology. The aim of this study is to examine this correlation. Therefore, we studied the effect of total hip or knee arthroplasty (THA/TKA) on truncal parameters to determine the causal relationship between these two situations. Materials and methods This is a prospective study of the effect of THA or TKA in patients with hip or knee OA on truncal morphological parameters. Patients with one-sided hip or knee OA who chose to undergo THA or TKA were enrolled and surveyed. A control group (CG) was also surveyed for comparison with the patients. The patients were preoperatively examined for truncal parameters using the Diers Formetric four-D analysis system (surface topography technique) to calculate several truncal parameters in all planes at four months and 12 months postoperatively. Measurable examinations were performed using the Statistical Package for the Social Sciences (SPSS) version 17.00 (SPSS Inc., Chicago), and statistical significance was set at a p-value of <0.05. Results The study examined 34 patients who underwent THA, including 19 women and 15 men with a mean age of 67.62 ± 8.28 years. The study also examined 45 patients who underwent TKA, including 34 women and 11 men, with a mean age of 72.42 ± 7.0 years. These patients were also compared with a CG that consisted of 25 normal individuals, including 12 women and 13 men, with a mean age of 69.28 ± 10.11 years. The results of this study from four months after THA revealed that the lordotic angle, trunk torsion, pelvic inclination, pelvic obliquity, and pelvis rotation were improved to normal levels. At 12 months after THA, only the pelvic obliquity was improved to normal levels. At four months after TKA the lordotic angle, pelvic inclination, and pelvic obliquity were improved to normal levels. However, the fleche cervicale and vertebral rotation were worse. At 12 months after TKA, only the pelvic obliquity was improved to normal levels. Conclusions THA and TKA to correct hip and knee OA do not correct the disordered morphology of the trunk in the long term. Thus, hip or knee OA does not seem to be responsible for disordered trunk morphology. However, it cannot be ruled out whether the disturbed morphology is responsible for the appearance of the hip and knee OA.

The classification of scoliosis braces developed by SOSORT with SRS, ISPO, and POSNA and approved by ESPRM.

PURPOSE: Studies have shown that bracing is an effective treatment for patients with idiopathic scoliosis. According to the current classification, almost all braces fall in the thoracolumbosacral orthosis (TLSO) category. Consequently, the generalization of scientific results is either impossible or misleading. This study aims to produce a classification of the brace types. METHODS: Four scientific societies (SOSORT, SRS, ISPO, and POSNA) invited all their members to be part of the study. Six level 1 experts developed the initial classifications. At a consensus meeting with 26 other experts and societies' officials, thematic analysis and general discussion allowed to define the classification (minimum 80% agreement). The classification was applied to the braces published in the literature and officially approved by the 4 scientific societies and by ESPRM. RESULTS: The classification is based on the following classificatory items: anatomy (CTLSO, TLSO, LSO), rigidity (very rigid, rigid, elastic), primary corrective plane (frontal, sagittal, transverse, frontal & sagittal, frontal & transverse, sagittal & transverse, three-dimensional), construction-valves (monocot, bivalve, multisegmented), construction-closure (dorsal, lateral, ventral), and primary action (bending, detorsion, elongation, movement, push-up, three points). The experts developed a definition for each item and were able to classify the 15 published braces into nine groups. CONCLUSION: The classification is based on the best current expertise (the lowest level of evidence). Experts recognize that this is the first edition and will change with future understanding and research. The broad application of this classification could have value for brace research, education, clinical practice, and growth in this field.

Morphology, Development and Deformation of the Spine in Mild and Moderate Scoliosis: Are Changes in the Spine Primary or Secondary?

INTRODUCTION AND AIM OF THE STUDY: We aim to determine whether the changes in the spine in scoliogenesis of idiopathic scoliosis (IS), are primary/inherent or secondary. There is limited information on this issue in the literature. We studied the sagittal profile of the spine in IS using surface topography. MATERIAL AND METHODS: After approval of the ethics committee of the hospital, we studied 45 children, 4 boys and 41 girls, with an average age of 12.5 years (range 7.5-16.4 years), referred to the scoliosis clinic by our school screening program. These children were divided in two groups: A and B. Group A included 17 children with IS, 15 girls and 2 boys. All of them had a trunk asymmetry, measured with a scoliometer, greater than or equal to 5 degrees. Group B, (control group) included 26 children, 15 girls and 11 boys, with no trunk asymmetry and scoliometer measurement less than 2 degrees. The height and weight of children were measured. The Prujis scoliometer was used in standing Adam test in the thoracic (T), thoraco-lumbar (TL) and lumbar (L) regions. All IS children had an ATR greater than or equal to 5 degrees. The Cobb angle was assessed in the postero-anterior radiographs in Group A. A posterior truncal surface topogram, using the "Formetric 4" apparatus, was also performed and the distance from the vertebra prominence (VP) to the apex of the kyphosis (KA), and similarly to the apex of the lumbar lordosis (LA) was calculated. The ratio of the distances (VP-KA) for (PV-LA) was calculated. The averages of the parameters were studied, and the correlation of the ratio of distances (VP-KA) to (VP-KA) with the scoliometer and Cobb angle measurements were assessed, respectively (Pearson corr. Coeff. r), in both groups and between them. RESULTS: Regarding group A (IS), the average height was 1.55 m (range 1.37, 1.71), weight 47.76 kg (range 33, 65). The IS children had right (Rt) T or TL curves. The mean T Cobb angle was 24 degrees and 26 in L. In the same group, the kyphotic apex (KA (VPDM)) distance was -125.82 mm (range -26, -184) and the lordotic apex (LA (VPDM)) distance was -321.65 mm (range -237, -417). The correlations of the ratio of distances (KA (VPDM))/(LA (VPDM)) with the Major Curve Cobb angle measurement and scoliometer findings were non-statistically significant (Pearson r = 0.077, -0.211, p: 0.768, 0.416, respectively. Similarly, in the control group, KA (VPDM))/(LA (VPDM) was not significantly correlated with scoliometer findings (Pearson r = -0.016, -p: 0.939). DISCUSSION AND CONCLUSIONS: The lateral profile of the spine was commonly considered to be a primary aetiological factor of IS due to the fact that the kyphotic thoracic apex in IS is located in a higher thoracic vertebra (more vertebrae are posteriorly inclined), thus creating conditions of greater rotational instability and therefore greater vulnerability for IS development. Our findings do not confirm this hypothesis, since the correlation of the (VP-KA) to (VP-KA) ratio with the truncal asymmetry, assessed with the scoliometer and Cobb angle measurements, is non-statistically significant, in both groups A and B. In addition, the aforementioned ratio did not differ significantly between the two groups in our sample (0.39 ± 0.11 vs. 0.44 ± 0.08, p: 0.134). It is clear that hypokyphosis is not a primary causal factor for the commencing, mild or moderate scoliotic curve, as published elsewhere. We consider that the small thoracic hypokyphosis in developing scoliosis adds to the view that the reduced kyphosis, facilitating the axial rotation, could be considered as a permissive factor rather than a causal one, in the pathogenesis of IS. This view is consistent with previously published views and it is obviously the result of gravity, growth and muscle tone.

Rib Hump Deformity Correction in Patients with Adolescent Idiopathic Scoliosis: A Comparison of Three Spinal Fusion Systems.

The aim of the present study is to control the hypothesis that the rib hump deformity can be adequately corrected when applying vertebral derotation. We retrospectively studied patients treated with full pedicle screw systems (group A), hybrid constructs (group B), and Harrington rod instrumentation (group C). No costoplasties were performed in the patients included in our study. Derotation was applied in groups A and B. The rib hump deformity was assessed on lateral radiographic studies by rib index (RI). Of the 72 patients that were finally included in our study, 30 patients (24 females and 6 males; mean age, 14.5 ± 2.2 years) were treated with a full pedicle screw system, 23 patients (19 females and 4 males; mean age, 13.8 ± 1.9 years) were treated with a hybrid construct, and 19 patients (16 females and 3 males; mean age, 14.3 ± 2 years) received the Harrington rod instrumentation. In all groups RI was significantly corrected after surgery. Before surgery no difference in RI was found among groups; however, after surgery RI was found significantly higher in group C as compared to groups A and B. The between-group analysis revealed that the correction of RI, and thereby the rib hump deformity correction, did not significantly differ among the three patient groups. In conclusion, it cannot be suggested based on the present study that vertebral derotation alone can offer an adequate correction of the rib hump deformity. Further, the development of rib cage deformity and its degree of interdependence with the scoliotic spinal deformity has to be further investigated and assessed, as it seems that it may not necessarily result directly from the primary vertebral deformity.

Truncal Changes in Patients Suffering Severe Hip or Knee Osteoarthritis: A Surface Topography Study.

BACKGROUD: Osteoarthritis (OA) of the hip and knee is a degenerative disease with complications, including reduced range of motion and pain. Although OA of the hip and knee is common, there are few studies that investigated if patients with this condition had affected morphological truncal parameters. The objectives of this study were to compare the morphology of the spine and the pelvis of patients with hip or knee OA to that of a control group (CG) and to comment on the proposed mechanisms of these changes and the clinical effects on patients. METHODS: This study included three groups of individuals. The first group consisted of 34 patients (15 men and 19 women with a mean age of 67.62 ± 8.28 years) suffering from hip OA. The second group consisted of 45 patients (11 men and 34 women with a mean age of 72.47 ± 7.0 years) suffering from knee OA. These patients were compared with a CG, which consisted of 25 individuals (13 men and 12 women with a mean age of 69.28 ± 10.11 years). The DIERS formetric 4D analysis system was used to calculate several truncal parameters in all planes. All analyses were accomplished using the SPSS ver. 17.0, and p < 0.05 was used to determine statistical significance. RESULTS: Patients with hip OA presented with significantly increased values than those in the CG for sagittal imbalance, scoliosis angle, vertebral rotation, trunk torsion, and pelvic obliquity, and decreased values than those in the CG for fleche lombaire. Patients with knee OA presented with significantly increased values than those in the CG for sagittal imbalance, apical deviation, scoliosis angle, vertebral rotation, trunk torsion, and pelvic obliquity. Patients with hip or knee OA, compared to the CG, had greater forward inclination of the spine, greater scoliosis, greater vertebral rotation and trunk torsion, and greater obliquity of the pelvis at the frontal plane. CONCLUSIONS: Patients with severe hip or knee OA could have truncal morphology alterations, in addition to reduced hip or knee range of motion and pain. These alterations could cause significant negative effects, which may then seriously affect the patients' quality of life.

Establishing consensus on the best practice guidelines for the use of bracing in adolescent idiopathic scoliosis.

STUDY DESIGN: Survey. OBJECTIVES: Bracing is the mainstay of conservative treatment in Adolescent Idiopathic Scoliosis (AIS). The purpose of this study was to establish best practice guidelines (BPG) among a multidisciplinary group of international bracing experts including surgeons, physiatrists, physical therapists, and orthotists utilizing formal consensus building techniques. Currently, there is significant variability in the practice of brace treatment for AIS and, therefore, there is a strong need to develop BPG for bracing in AIS. METHODS: We utilized the Delphi process and the nominal group technique to establish consensus among a multidisciplinary group of bracing experts. Our previous work identified areas of variability in brace treatment that we targeted for consensus. Following a review of the literature, three iterative surveys were administered. Topics included bracing goals, indications for starting and discontinuing bracing, brace types, brace prescription, radiographs, physical activities, and physiotherapeutic scoliosis-specific exercises. A face-to-face meeting was then conducted that allowed participants to vote for or against inclusion of each item. Agreement of 80% throughout the surveys and face-to-face meeting was considered consensus. Items that did not reach consensus were discussed and revised and repeat voting for consensus was performed. RESULTS: Of the 38 experts invited to participate, we received responses from 32, 35, and 34 for each survey, respectively. 11 surgeons, 4 physiatrists, 8 physical therapists, 3 orthotists, and 1 research scientist participated in the final face-to-face meeting. Experts reached consensus on 67 items across 10 domains of bracing which were consolidated into the final best practice recommendations. CONCLUSIONS: We believe that adherence to these BPG will lead to fewer sub-optimal outcomes in patients with AIS by reducing the variability in AIS bracing practices, and provide a framework future research. LEVEL OF EVIDENCE: Level IV.

Atlas Fracture with Concomitant Vertebral Artery Hypoplasia, a Rare but Potentially Hazardous Combination: A Case Report.

The fractures of the first cervical spine vertebrae (atlas) represent 7% of all the overall cervical spine fractures. Hypoplasia of the vertebral artery is also rare (10% of the general population), but even rarer is the combination of those both conditions. This combination should always be identified and treated because sometimes it can be extremely dangerous for the patient. We present a case of a 24-year-old patient who suffered an atlas fracture with concomitant vertebral artery hypoplasia (VAH). We also present the diagnostic algorithm and the treatment management that we have followed. In case of cervical spine trauma the neurovascular symptoms should not be underestimated. Any neurological symptom (sensory, motor, reflex deficits) should be evaluated in detail. In some cases, with uncommon neurological symptoms such as, in our case, unilateral headache, dizziness and vertigo (or generally, involuntary eye movements and salivation, impaired speech and hearing, diplopia, blur vision, incoordination, imbalance, limb weakness) head injury or vertebral artery (VA) injuries have to be suspected. Further evaluation with brain computed tomography (CT) scan and computed tomography angiography (CTA) should be provided. In case of cervical spine trauma over a pre-existing VAH the complications rate is even higher and the early diagnosis and treatment are crucial.

Translation and validation of the Greek version of the "ASEPSIS" scoring method for orthopaedic wound infections.

INTRODUCTION: The ASEPSIS scoring method represents an important instrument for assessing surgical wounds for infections. The purpose of this study was to translate and validate the ASEPSIS in Greek. METHODS: The ASEPSIS was translated from English to Greek, back-translated to English, and reviewed by an expert committee. Reliability and validity analyses were performed in a sample of 111 consecutive orthopaedic patients. Patients were assessed during hospitalisation (using the ASEPSIS) and at three months after discharge (by phone, through questions about wound healing). RESULTS: Face validity was considered to be very good. The surgical wound infection rate was 6.3% with the Centers for Disease Control and Prevention criteria and 3.6% with the ASEPSIS (i.e. score ≥21) (p < 0.001). At three months, 7.4% of the participants reported they were given antibiotics for wound infection and 5.4% needed a rehospitalisation. The ASEPSIS score was correlated to the therapeutic administration of antibiotics (p = 0.001) and the need for rehospitalisation (p < 0.001) during the follow-up. The inter-rater agreement was 90%. CONCLUSIONS: The Greek version of the ASEPSIS can be used by both surgeons and nurses. However, it should be used with caution until more studies are conducted with larger samples and in patients with different surgical procedures.