The relationship between the expression of TN and the efficiency of posterior spinal V osteotomy in patients with traumatic kyphosis.

BACKGROUND: This study was conducted with the aim to investigate the relationship between Tetranectin (TN) and efficiency of posterior spinal V osteotomy in patients with traumatic kyphosis. METHODS: Ninety-two patients with traumatic kyphosis admitted in our hospital from February 2014 to June 2016 were included whose serum TN levels were examined by ELISA. Using the mean level of TN as cut-off value, patients were classified into TN high level group (group I) and TN low level group (group II). The observation indexes, including operation time, intra-operational loss of blood, Cobb angle, postoperative complications and recurrence rate of kyphosis within post-operational 6 months were recorded for comparison. RESULTS: TN level was significantly higher in group I [(6.19 ±â€Š0.33) µmol/L] than that in group II [(5.29 ±â€Š0.34) µmol/L] (P < .05). There was no significant difference in average age, sex, lesion site and average time from injury to operation between the two groups (all P > 0.05). Compared to group II, operation time in group I was significantly shortened (5.02 ±â€Š1.15 VS 4.58 ±â€Š0.53, P = .023), the intra-operational loss of blood decreased (2418.56 ±â€Š362.06 VS 2235.84 ±â€Š325.63, P = .013), post-operational Cobb angle decreased (11.10 ±â€Š1.31 VS 6.93 ±â€Š1.04, P = .000), and the incidence of postoperative complications (nail-breaking, rod-breaking and looseness) and recurrence rate decreased (18.8% VS 4.5%, P = .036; 10.4% VS 0.0%, P = .028). CONCLUSION: Serum TN level is proved to be related to the efficiency of posterior spinal V osteotomy in patients with traumatic kyphosis, and may serve as a possible indicator for clinical treatment.

Pentosidine concentration is associated with degenerative lumbar scoliosis in older women: preliminary results.

PURPOSE: Advanced glycation end products (AGEs) have been implicated in the pathogenesis of sarcopenia. The objective of the study was to investigate the prevalence of sarcopenia in degenerative lumbar scoliosis (DLS), and the relationship between biochemical markers including major AGEs, pentosidine, and DLS in older women. METHODS: Our study participants were 20 elderly women with idiopathic DLS (mean age 76.4 years, range 56-88). Nineteen age- and sex-matched volunteers (mean age 74.0 years, range 62-86) served as controls. Spinal and femoral BMD of all participants was measured using dual-energy X-ray absorptiometry. We used a bioelectrical impedance analyzer to analyze body composition, including appendicular skeletal muscle mass index [SMI; appendicular lean mass (kg)/(height (m)]2. SMI < 5.75 was considered diagnostic for sarcopenia. Coronal and sagittal spinal alignments were measured. The following biochemical markers were measured: serum and urinary pentosidine, serum homocysteine, 1,25(OA)2D, and 25(OH)D. The level of each variable was compared between DLS and controls. The relationship between biochemical markers including pentosidine and DLS was examined. RESULTS: Sarcopenia was observed at a high prevalence in participants with DLS: 50% compared with 15.8% of healthy controls. Height, weight, femoral BMI, appendicular lean mass, total lean mass, and SMI all had significantly lower values in the DLS group. Serum pentosidine was significantly higher for the DLS group compared with controls. Correlations with serum pentosidine revealed a significant positive correlation between lumbar scoliosis, pelvic tilt, and pelvic incidence-lumbar lordosis mismatch, and a significantly negative correlation between thoracic kyphosis (P < 0.05). CONCLUSIONS: We found that sarcopenia was involved in DLS, and high serum pentosidine levels are associated with severity of coronal and sagittal malalignment in older women, suggesting that high levels of AGEs are a potential biomarker for the progression of lumbar scoliosis and kyphotic deformity. Further studies are needed to clarify the pathogenesis of DLS.

SHBG, Sex Steroids, and Kyphosis in Older Men: The MrOS Study.

Accentuated kyphosis is associated with adverse health outcomes, including falls and fractures. Low bone density is a risk factor for hyperkyphosis, and each vertebral fracture adds roughly 4° to forward spine curvature. Sex steroids, in particular low bioavailable estradiol and high sex hormone-binding globulin (SHBG), are associated with bone loss and high SHBG is associated with vertebral fractures in older men. We, therefore, hypothesized that low bioavailable estradiol and high SHBG would be associated with worse kyphosis. To test this hypothesis, we examined the cross-sectional associations between individual bioavailable sex hormones and SHBG with radiographically assessed kyphosis. Participants included 1500 men aged 65 and older from the Osteoporotic Fractures in Men (MrOS) Study, in whom baseline measures of kyphosis and sex hormones were available. Modified Cobb angle of kyphosis, calculated from T4 through T12, was assessed from supine lateral spine radiographs. Serum total estradiol and total testosterone were measured by mass spectrometry, and bioavailable sex steroids were calculated from mass action equations. After adjustment for age and other confounding variables, no association was found between bioavailable estradiol or testosterone and Cobb angle, either when kyphosis was analyzed as a continuous variable or dichotomized into highest versus lower three quartiles. In linear regression models adjusted for age and clinic site, there was a significant association between SHBG and kyphosis (parameter estimate = 0.76 per SD increase, p = 0.01). In the fully adjusted model, this association was weakened and of only borderline statistical significance (parameter estimate = 0.61 per SD, p = 0.05). Logistic models demonstrated similar findings. Although associated with bone loss, we did not demonstrate that low bioavailable estradiol translates into worse kyphosis in older men. High SHBG is associated with bone loss and vertebral fractures. Our results suggest that high SHBG may also be a risk factor for hyperkyphosis. © 2016 American Society for Bone and Mineral Research.

Serum prolidase activity in benign joint hypermobility syndrome.

BACKGROUND: Moderate joint laxity is widespread in many joints of the body, and this condition is considered to be caused by an abnormality in the collagen structure. This study was carried out to determine the serum prolidase activity in female patients with benign joint hypermobility syndrome (BJHS), and to evaluate its correlation with their clinical features. METHODS: A total of 45 patients with BJHS and 40 healthy controls were included in the study. All of the patients with BJHS met the Beighton diagnostic criteria. All the patients and the control group underwent a comprehensive examination of the locomotor system and took the New York Posture Rating Test. The examination and test results were recorded. Serum prolidase activity was measured in both the groups. RESULTS: Prolidase activity was significantly lower in patients with BJHS (479.52 ± 126.50) compared to the healthy controls (555.97 ± 128.77) (p = 0.007). We found no correlation between serum prolidase activity and Beighton scores or New York rating test scores. On the other hand, mean prolidase activity was significantly lower in patients with pes planus or hyperlordosis compared to those without (p = 0.05, p = 0.03, respectively). We did not find such a correlation with the other clinical features. CONCLUSIONS: Significantly lower prolidase activity in patients with BJHS suggests that prolidase may affect the collagen metabolism and cause hyperlaxity.

Serum titanium, niobium, and aluminum levels after instrumented spinal arthrodesis in children.

STUDY DESIGN: A prospective cohort study. OBJECTIVE: To determine serum titanium, niobium, and aluminum levels in pediatric patients within the first postoperative year after instrumented spinal arthrodesis. SUMMARY OF BACKGROUND DATA: Instrumented spinal arthrodesis is a common procedure to correct scoliosis and kyphosis. Titanium-based instrumentation is increasingly favored due to enhanced biomechanical properties, but concerns have arisen regarding metal debris release and the potential for local and systemic complications. METHODS: The pattern of systemic metal release over time was evaluated by measuring serum titanium, niobium, and aluminum levels preoperatively and 1 week, 1 month, 6 months, and 12 months after instrumented spinal arthrodesis using a titanium alloy. Serum metal levels were measured using high-resolution inductively coupled plasma mass spectrometry. RESULTS: Thirty-two patients were included in the study group. Mean age at surgery was 14.7 years. Preoperative and postoperative concentrations of serum titanium and niobium were significantly different (P = 0.0001). Median postoperative serum concentrations of titanium and niobium were elevated 2.4- and 5.9-fold above the normal range respectively with 95% and 99% of samples elevated postoperatively. A significant and rapid rise in serum titanium and niobium levels was observed within the first postoperative week, after which elevated serum levels persisted up to 12 months. CONCLUSION: We report abnormally elevated serum titanium and niobium levels in patients with titanium-based spinal instrumentation up to 12 months. The long-term systemic consequences of debris generated by wear and corrosion of spinal instrumentation is unclear but concerning, particularly as these implants inserted into the pediatric population may remain in situ for beyond 6 decades.

Juvenile kyphosis in pigs. A spontaneous model of Scheuermann's kyphosis.

The development of kyphotic lesions in pigs with different weights from herds with a high frequency of the lesion was analysed pathologically, radiologically, and for alkaline phosphatase, calcium, magnesium, and phosphate in blood samples. The development of kyphosis was caused by the formation of ventral hemivertebrae due to the absence of ventral vertebral epiphyseal centres of ossification. Within the ventral parts of affected vertebral epiphyses, the retained chondroid tissue was dysplastic and the contents of cartilage canals with vessels often clotted with fibrin were reduced. As lesions such as fractures and inflammation that may be a secondary cause of kyphosis in pigs were absent and all blood parameters were within normal range, secondary causes of the condition, including metabolic disturbances, were excluded. It can be seen that the present type of porcine kyphosis does not develop until later in life as the ossification centres within the epiphyses of vertebrae have a retarded appearance. As the present porcine type of kyphosis pathomorphologically is comparable with Scheuermann's kyphosis in man, it constitutes a spontaneous model for this common cause of structural kyphosis of the thoracic or thoracolumbar spine.

Effects of bracing on lung function in idiopathic juvenile kyphosis.

Although considerable information is available on the effects of bracing on lung function in kyphoscoliosis, there is a paucity of data on idiopathic juvenile kyphosis (IJK). The present study was designed to investigate the immediate effect of bracing on lung function in children and adolescents with mild-to-moderate IJK. Spirometry, measurement of lung volumes, and arterial oxyhemoglobin saturation (SaO(2)) were performed in 24 patients, 9-17 years of age, who were treated with a corrective brace for mild-to-moderate IJK (Cobb angle, 46-75 degrees ). Children were studied when braced and unbraced. When children were unbraced, mean percent predicted values (+/-standard deviation) for total lung capacity (TLC), vital capacity (VC), functional residual capacity (FRC), and forced expiratory volume in 1 sec (FEV(1)) were 100.0% (+/-13.0%), 92.7% (+/-14.2%), 108.2% (+/-20.4%), and 95.0% (+/-16.3%), respectively. With the brace on, significant reductions occurred in all lung function measurements: TLC decreased by 9.5% (P < 0.001), VC by 9.3% (P = 0.001), FRC by 14.2% (P = 0.005), and FEV(1) by 8.9% (P = 0.009). SaO(2) decreased from 96.2% (+/-1.6%) to 95.2% (+/-1.4%) (P = 0.027). An inverse relationship was observed between pre- and postbracing change in TLC and Cobb angle children (P = 0.021). Our findings indicate that corrective bracing in mild-to-moderate IJK results in mild lung restriction and a clinically insignificant drop in SaO(2). The effect of bracing on TLC decreases as the severity of kyphosis increases in these patients.

[The Harrington scoliosis operation: the anesthesiological problems in the perioperative phase]. / Die Skolioseoperation nach Harrington: anästhesiologische Probleme in der perioperativen Phase.

85 histories of scoliosis patients who had the operation with Harrington rod instrumentation were analysed retrospectively in order to reveal perioperative anaesthesiological problems. The cardiovascular and pulmonary alterations represented in addition to the length and the area involved eo ipso was a risk during narcosis. The neurolept analgesia in combination with inhalation anaesthetics after introduction with a barbiturate proved to be a safe procedure. The tachycardia turned out to be the main cardiovascular postoperative complication, which also characterised the situation after one week. In contrast, the blood pressure remained relatively stable. The average blood loss of 1.75 l was responsible for a postoperative anaemia, whilst serious depletions of hemoglobin below 8 mg% could be corrected immediately. Temperatures above 40 degrees C were not noticed. There was no indication for renal damage. The electrolytes did not show serious imbalances in comparison with the extreme fluid fluctuations. The blood gas analysis spoke for a bias to partially compensated respiratory alkalosis during the operation and acidosis postoperatively. The vital capacity was improved significantly by preoperative training. Depressed values of the vital capacity were still measured one week after spondylodesis. In conclusion, the results showed that moderate tachycardia was the most frequent complication of the Harrington operation. The Harrington procedure was a safe therapeutical option.

Treatment of respiratory failure due to kyphoscoliosis with nasal intermittent positive pressure ventilation (NIPPV).

Nasal intermittent positive pressure ventilation (NIPPV) represents a major advance in the management of respiratory failure. While its role in chronic respiratory failure is well documented, its use in acute respiratory failure is less well defined. We studied four patients with respiratory failure due to kyphoscoliosis, two of whom presented with acute respiratory acidosis. All four patients were on conventional maximum medical therapy prior to treatment with NIPPV. All patients survived to be discharged from hospital on home ventilation and significant improvements were noted in pO2, pCO2 and pulmonary function. We conclude that NIPPV is useful in the management of both acute and chronic ventilatory failure due to kyphoscoliosis.

[Effect of guided ventilation on gas exchange in kypho-scoliotic patients in post-intensive care]. / Effet de la ventilation dirigée sur les échanges gazeux du cyphoscoliotique en post-réanimation.

Post-intensive care stabilized kyphoscoliotic patients are characterized by a limited circulation which reduces VCO in relation to VCO2 (specific VCO, Sp VCO) by diminution of the "contact time". This might help in explaining the hypoxaemia observed in these patients concurrently with alveolar hypoventilation and altered ventilation/perfusion ratio. Bradypnoea (Bp) may reduce the last two factors but not the vascular field amputation. In 10 kyphoscoliotic patients examined in spontaneous ventilation (SV), then in Bp, gas exchanges were evaluated under their 2 aspects: gas flow rates and ventilatory efficiency (ERCO2, VA/V). The results obtained in 16 examinations concerning 10 patients were analysed. There were great differences in the amplitude of ventilatory response, a significant increase of VA improving PaCO2 more constantly than PaO2, a slight increase of Sp VCO and a decrease of VCO/VA. In the discussion, ERCO2 and VA/V are compared, the high VA/V and VD/VT values are justified, the uncertain effect of Bp on PaO2 is confirmed, and the relationship of Sp VCO with DuCO and PaO2 is determined. The evaluation of exchanges in SV and Bp provides information on the degree of deterioration of blood perfusion, the physiopathology of each individual subject and the advisability of kinesitherapy with Bp.