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1.
Bone ; 166: 116594, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36341948

RESUMO

AIM: Abnormal osteocyte lacunar morphology in adolescent idiopathic scoliosis (AIS) has been reported while the results were limited by the number of osteocyte lacunae being quantified. The present study aimed to validate previous findings through (a) comparing morphological features of osteocyte lacunae between AIS patients and controls in spine and ilium using a large-scale assessment, and (b) investigating whether there is an association between the acquired morphological features of osteocyte lacunae and disease severity in AIS. METHOD: Trabecular bone tissue of the facet joint of human vertebrae on both concave and convex sides at the apex of the scoliotic curve were collected from 4 AIS and 5 congenital scoliosis (CS) patients, and also at the same anatomic site from 3 non-scoliosis (NS) subjects intraoperatively. Trabecular bone tissue from ilium was obtained from 12 AIS vs 9 NS subjects during surgery. Osteocyte lacunae were assessed using ultra-high-resolution micro-computed tomography. Clinical information such as age, body mass index (BMI) and radiological Cobb angle of the major curve were collected. RESULTS: There was no significant difference between density of osteocyte lacuna and bone volume fraction (BV/TV) between groups. A total of 230,076 and 78,758 osteocyte lacunae from facet joints of apical vertebra of scoliotic curve and iliac bone were included in the analysis, respectively. In facet joint bone biopsies, lacunar stretch (Lc.St) was higher, and lacunar equancy (Lc.Eq), lacunar oblateness (Lc.Ob), and lacunar sphericity (Lc.Sr) were lower in AIS and CS groups when compared with NS group. CA side was associated with higher Lc.St when compared with CX side. In iliac bone biopsies, Lc.Ob was higher and lacunar surface area (Lc.S) was lower in AIS group than NS group. Median values of Lc.St, Lc.Eq and Lc.Sr were significantly associated with radiological Cobb angle with adjustment for age and BMI (R-squared: 0.576, 0.558 and 0.543, respectively). CONCLUSIONS: This large-scale assessment of osteocyte lacunae confirms that AIS osteocyte lacunae are more oblate in iliac bone that is less influenced by asymmetric loading of the deformed spine than the vertebrae. Shape of osteocyte lacunae in iliac bone is associated with radiological Cobb angle of the major curve in AIS patients, suggesting the likelihood of systemic abnormal osteocyte morphology in AIS. Osteocyte lacunae from concave side of scoliotic curves were more stretched in both AIS and CS groups, which is likely secondary to asymmetric mechanical loading.


Assuntos
Cifose , Escoliose , Humanos , Adolescente , Microtomografia por Raio-X , Osteócitos/patologia , Escoliose/diagnóstico por imagem , Coluna Vertebral/patologia
2.
Neurosurg Clin N Am ; 34(1): 151-157, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36424055

RESUMO

The management of scoliosis in patients with Chiari I malformation and syringomyelia is a complex decision-making process, which is changing due to evolving evidence. Headache and scoliosis are common presenting symptoms of an underlying Chiari. History, physical examination, and screening with MRI are cornerstones of diagnosis. Posterior fossa decompression provides curve stabilization or regression in about half of patients. In those who require spinal fusion, careful attention must be paid to intraoperative neurological monitoring data to minimize risk of neurologic injury.


Assuntos
Malformação de Arnold-Chiari , Escoliose , Siringomielia , Humanos , Siringomielia/complicações , Siringomielia/diagnóstico por imagem , Siringomielia/cirurgia , Escoliose/complicações , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Descompressão Cirúrgica , Estudos Retrospectivos , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Malformação de Arnold-Chiari/cirurgia
3.
Neurosurg Clin N Am ; 34(1): 159-166, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36424056

RESUMO

CM-I-associated syringomyelia is a risk factor for scoliosis where a larger syrinx size is more likely to be associated with scoliosis. Therefore, the effect of syrinx on scoliosis progression may be alleviated by PFD. There is no difference in the need for fusion surgery between patients undergoing PFD with duraplasty vs. those undergoing extradural decompression; however, PFD with duraplasty is associated with an improvement in curve magnitude compared to extradural decompression alone. Further study on the comparison of PFD techniques for this cohort of patients is needed. PFD is a durable surgical option for patients with CM-I, syrinx, and scoliosis. Early decompression of CM-I in younger patients and those with smaller scoliosis curves at presentation is recommended as there is a higher likelihood of halting curve progression.


Assuntos
Malformação de Arnold-Chiari , Escoliose , Siringomielia , Humanos , Siringomielia/complicações , Siringomielia/cirurgia , Escoliose/complicações , Escoliose/cirurgia , Descompressão Cirúrgica/métodos , Resultado do Tratamento , Estudos Retrospectivos , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/cirurgia
4.
Neurosurg Clin N Am ; 34(1): 67-79, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36424066

RESUMO

Chiari I Malformation represents a hindbrain anomaly best demonstrated radiographically with MRI. Brain and spine MRI provide optimal anatomic detail of cerebellar tonsillar descent below the foramen magnum and may reveal additional imaging features including ventriculomegaly (potentially leading to the diagnosis of hydrocephalus), characteristics of intracranial hypertension or hypotension, spinal cord syrinx, scoliosis, and/or tethered spinal cord. Specialized imaging sequences provide enhanced visualization of ventral and dorsal cervicomedullary cisterns and cerebrospinal fluid flow. Although these studies contribute critical information for evaluation, their impact on surgical decision-making remains uncertain. Additional radiographic measures (pBC2 and clival-axial angle) may impact surgical planning and risk assessment.


Assuntos
Malformação de Arnold-Chiari , Hidrocefalia , Escoliose , Humanos , Malformação de Arnold-Chiari/diagnóstico por imagem , Malformação de Arnold-Chiari/cirurgia , Hidrocefalia/diagnóstico , Imageamento por Ressonância Magnética , Medula Espinal/diagnóstico por imagem
5.
Ann Biomed Eng ; 50(4): 401-412, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35201548

RESUMO

A recent innovation in scoliosis monitoring is the use of ultrasonography, which provides true 3D information in one scan and does not emit ionizing radiation. Measuring the severity of scoliosis on ultrasonographs requires identifying lamina pairs on the most tilted vertebrae, which is difficult and time-consuming. To expedite and automate measurement steps, this paper detailed an automatic convolutional neural network-based algorithm for identifying the laminae on 3D ultrasonographs. The predicted laminae were manually paired to measure the lateral spinal curvature on the coronal view, called the Cobb angle. In total, 130 spinal ultrasonographs of adolescents with idiopathic scoliosis recruited from a scoliosis clinic were selected, with 70 for training and 60 for testing. Data augmentation increased the effective training set size to 140 ultrasonographs. Semi-automatic Cobb measurements were compared to manual measurements on the same ultrasonographs. The semi-automatic measurements demonstrated good inter-method reliability (ICC3,1 = 0.87) and performed better on thoracic (ICC3,1 = 0.91) than lumbar curves (ICC3,1 = 0.81). The mean absolute difference and standard deviation between semi-automatic and manual was 3.6° ± 3.0°. In conclusion, the semi-automatic method to measure the Cobb angle on ultrasonographs is feasible and accurate. This is the first algorithm that automates steps of Cobb angle measurement on ultrasonographs.


Assuntos
Escoliose , Coluna Vertebral , Adolescente , Humanos , Redes Neurais de Computação , Reprodutibilidade dos Testes , Escoliose/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Ultrassonografia/métodos
7.
Acta Chir Orthop Traumatol Cech ; 89(5): 376-379, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36322039

RESUMO

PURPOSE OF THE STUDY To identify risk factors associated with developing Clostridium difficile infection (CDI) in adolescent idiopathic scoliosis patients after surgery and to describe the clinical presentation of CDI in these patients. Clostridium difficile colitis is reportedly increasing in hospitalized patients and can have a negative impact on patient outcomes. No data exist on CDI rates and its consequences on patient undergoing surgery for adolescent idiopathic scoliosis. MATERIAL AND METHODS A retrospective database review of patients who underwent elective idiopathic scoliosis surgery between January 2019 to June 2021 was conducted. The population was divided into patients who developed Clostridium difficile colitis and those who did not. RESULTS A total of 128 patients were included in the study. We did not find notable risk factors for the development of CDI. In 2 patients diagnosis of CDI, was made. Length of hospital stays, and readmissions were significantly higher in patients with CDI. CONCLUSIONS CDI is a rare post-surgical complication in patients who undergo surgery for idiopathic scoliosis. Currently, we cannot identify predisposing factors for the development of CDI in adolescent idiopathic scoliosis patients. A high index of suspicion is necessary for timely diagnosis and treatment in patients presenting with abdominal symptoms around post-operative day 5 after surgical treatment for idiopathic scoliosis. Key words: Clostridium difficile infection, adolescent idiopathic scoliosis, abdominal pain, diarrhea.


Assuntos
Clostridioides difficile , Infecções por Clostridium , Colite , Escoliose , Humanos , Adolescente , Estudos Retrospectivos , Escoliose/cirurgia , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/etiologia , Fatores de Risco
8.
Zhonghua Er Ke Za Zhi ; 60(11): 1134-1139, 2022 Nov 02.
Artigo em Chinês | MEDLINE | ID: mdl-36319146

RESUMO

Objective: To analyze the follow-up and clinical effect of multidisciplinary treatment on the children with spinal muscular atrophy (SMA). Methods: The clinical data including nutritional status, respiratory function, bone health and motor function of 45 children with SMA who received multidisciplinary management 1-year follow-up in the Children's Hospital, Zhejiang University School of Medicine from July 2019 to October 2021 were retrospectively collected. Comparisons before and after management were performed using paired-samples t-test or Wilcoxon rank-sum test, etc. Results: The age of 45 patients (25 boys and 20 girls) was 50.4 (33.6, 84.0) months at the enrollment, with 6 cases of type 1, 22 cases of type 2, and 17 cases of type 3 respectively. After the multidisciplinary management, the cases of SMA patients with malnutrition decreased from 22 to 12 (P=0.030), the level of vitamin D were significantly increased ((45±17) vs. (48±14) nmol/L, t=-4.13, P<0.001). There was no significant difference in the forced vital capacity %pred, the forced expiratory volume at 1 second %pred, and the peak expiratory flow %pred ((76±19)% and (76±21)%, (81±18)% and (79±18)%, (81±21)% and (78±17)%; t=-0.24, 1.36, 1.21; all P>0.05). The Cobbs angle of scoliosis also improved significantly (8.0°(0°, 13.0°) vs. 10.0°(0°, 18.5°), Z=-3.01, P=0.003). The Hammersmith functional motor scale expanded scores of children with SMA type 2 and type 3 both showed significant elevation (11.0 (8.0, 18.0) vs. 11.0 (5.0, 18.5) scores, 44.0 (36.5, 53.0) vs. 44.0 (34.0, 51.5) scores, Z=2.44, 3.11, P=0.015, 0.002). Conclusion: Multidisciplinary management is beneficial for delaying the progression of the multi-system impairments of SMA patients, such as malnutrition, restrictive ventilation dysfunction and scoliosis.


Assuntos
Desnutrição , Atrofia Muscular Espinal , Escoliose , Criança , Masculino , Feminino , Humanos , Pré-Escolar , Estudos Retrospectivos , Seguimentos
10.
BMC Musculoskelet Disord ; 23(1): 983, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36376952

RESUMO

BACKGROUND: Bracing and exercise methods were used in scoliosis rehabilitation and proven effective. There was little evidence about the efficacy of insoles on scoliosis. OBJECTIVE: This study aimed to investigate the effects of 3D personalized insoles on curve magnitude, postural stability, and quality of life (QOL) in moderate adolescent idiopathic scoliosis (AIS) patients. METHODS: Thirty-six volunteers with adolescent idiopathic scoliosis, who had moderate curves (20°-45°), were randomly divided into the experimental and control groups. The control group received traditional rehabilitation with bracing and exercises, and the experimental group received the insole interventions in addition to traditional rehabilitation. The outcome measures were Cobb angle, angle of trunk rotation (ATR), postural stability, and quality of life (Scoliosis Research Society-22 questionnaire). Measurements were conducted at baseline examination, two months and six months. RESULTS: After two and six months of treatment, the Cobb angle and ATR in both groups were significantly decreased as compared with the baseline (p < 0.05), but no significant group difference in Cobb angle and ATR was found in the study (p > 0.05). There was a significant difference in the sagittal balance index at six months compared to the control group (p < 0.05), and a significant difference in the coronal balance index was observed at six months compared to baseline in the experimental group (p < 0.05). Quality of life did not change in either group (p > 0.05). CONCLUSION: Combining bracing with exercise in patients with moderate AIS is effective. 3D personalized insoles cannot reduce the Cobb angle and angle of trunk rotation of patients with moderate AIS but might have the potential to improve postural stability.


Assuntos
Cifose , Escoliose , Humanos , Adolescente , Escoliose/reabilitação , Qualidade de Vida , Resultado do Tratamento , Braquetes , Terapia por Exercício/métodos
12.
J Med Case Rep ; 16(1): 446, 2022 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-36443749

RESUMO

BACKGROUND: Aneurysmal bone cysts are benign bone tumors that not uncommonly involves the spine. However, this involvement can cause scoliosis, albeit rarely. This report focuses on the importance of proper management for complete tumor resection to prevent recurrence and spinal deformity. CASE PRESENTATION: A 12-year-old Middle Eastern boy, with a history of T11 aneurysmal bone cyst resection and bone grafting carried out at another hospital, presented with spine deformity of 4 months' duration. The deformity was not associated with pain or neurological deficit. A whole-spine magnetic resonance imaging with contrast confirmed the recurrence of the aneurysmal bone cyst. Posterior spinal instrumentation with corpectomy of T11 was then performed, and confirmed with histopathology the recurrence of aneurysmal bone cyst. Two years post-corpectomy, deformity correction was done from T5-L4. CONCLUSION: Management of aneurysmal bone cysts requires meticulous planning and full excision to prevent recurrence, especially in the growing spine. If neglected, it can cause major spinal deformities and cord compression, which places a medical burden on the patient and family. To avoid such complications, treating aneurysmal bone cysts along with scoliosis correction can prevent deformity progression.


Assuntos
Cistos Ósseos Aneurismáticos , Escoliose , Masculino , Humanos , Criança , Escoliose/complicações , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Cistos Ósseos Aneurismáticos/diagnóstico , Cistos Ósseos Aneurismáticos/diagnóstico por imagem , Coluna Vertebral , Procedimentos Neurocirúrgicos , Transplante Ósseo
13.
J Orthop Surg Res ; 17(1): 491, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36384684

RESUMO

STUDY DESIGN: A retrospective case-control study. OBJECTIVE: To evaluate whether Ponte osteotomy improves thoracic kyphosis and to determine its clinical efficacy in hypokyphotic adolescent idiopathic scoliosis (AIS). METHODS: Eighty consecutive Lenke type 1 AIS patients with hypokyphotic curves who underwent posterior spinal fusion by one spine surgeon at a single institution were recruited. According to whether Ponte osteotomy was performed, the patients were divided into two groups. The preoperative, immediate, one-year postoperative, and two-year postoperative radiographs were analyzed. The demographic characteristics, surgical information, radiographic parameters, Scoliosis Research Societye-22 (SRS-22) questionnaire, and complications were compared. RESULTS: The sagittal alignment and coronal alignment were both improved in the Ponte group and the control group postoperatively. There was no significant difference in the preoperative parameters between the two groups, except the TL/L, CB, and LL. Significant differences were found in the MT (15.18° ± 2.84° vs. 20.33° ± 3.75°, P < 0.001) and TK (24.23° ± 2.71° vs. 19.93° ± 2.38°, P < 0.001) at the two-year follow-up. The Ponte group had a longer operation time and more intraoperative blood loss. No significant difference was observed between the groups in the SRS-22 scores at the final follow-up. CONCLUSIONS: Ponte osteotomy could obtain better coronal correction and sagittal contour restoration in AIS patients with hypokyphosis. However, Ponte osteotomies might lead to more intraoperative blood loss and longer operation time. Moreover, no discrepancy was found in the postoperative health-related quality of life of the included patients. Therefore, we considered that the Ponte osteotomy may be an alternative method to restore the desired thoracic kyphosis, which needs further study.


Assuntos
Cifose , Escoliose , Humanos , Adolescente , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Estudos Retrospectivos , Perda Sanguínea Cirúrgica , Estudos de Casos e Controles , Qualidade de Vida , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Cifose/diagnóstico por imagem , Cifose/cirurgia , Osteotomia/métodos , Resultado do Tratamento , Ponte
14.
Artigo em Inglês | MEDLINE | ID: mdl-36429727

RESUMO

The aim of the study was to determine the relationship between idiopathic asymmetry in infants and body posture in children at an early school age. The study included 45 girls aged nine. The Diers Formetric III 4D device was used to assess body posture, which allows photogrammetric registration of the back surface using the raster stereography process. For the purposes of the re-search project, the examination was performed via DiCAM using the "Average measurement" mode. Despite physiotherapy, these children had more postural defects later on compared to the control group due to asymmetry. They mainly concerned pelvic skewness, scoliosis angle, deviation from the vertical line and lateral deviation, as well as surface rotation. Positive correlations were observed between direction of asymmetry and pelvic skewness (r = 0.40), and between the location of asymmetry and the location of curvature (r = 0.39). Significant negative correlations were also found between the age of treatment initiation and trunk length (r = -0.42). There was also a negative correlation between the number of physiotherapeutic appointments and deviation from the vertical line, which means that along with an increase in the number of physiotherapeutic visits, the value of deviation from the vertical line decreased (p = -0.40). For scoliosis angle, the most important predictor was the direction of asymmetry (p = 0.05). For the location of the curvature, the most important predictor was the direction of asymmetry (p = 0.04), as well as the number of physiotherapeutic appointments (p = 0.04). Additionally, regression analysis allowed us to show that the number of physiotherapeutic visits (p = 0.03) was the most important predictor of curvature direction. The applied physiotherapy probably contributed to the occurrence of a smaller number of postural defects in these children at a later age. Physiotherapy as a specific and targeted form of physical activity among infants with idiopathic asymmetry should play a very important role in the prevention of body posture defects.


Assuntos
Escoliose , Criança , Feminino , Humanos , Escoliose/diagnóstico , Modalidades de Fisioterapia , Fotogrametria , Postura , Exercício Físico
15.
BMC Musculoskelet Disord ; 23(1): 948, 2022 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-36324093

RESUMO

INTRODUCTION: The three dimensional deformation of the spine in scoliosis is specific for a given child with regard to the number and length of curvatures, their degree of rotation and the size of the curvature angle. Early diagnosis of scoliosis in a clinical examination according to the Adams test depends on the correlation between the angle of trunk inclination (ATI) and the Cobb angle and the adopted diagnosis criterion. The aim of the study was to demonstrate the need to adopt different diagnostic criteria for ATI depending on the age and location of scoliosis. Moreover, the observed differences in the ATI/Cobb correlation became the basis for the proposal to introduce the concept of low, medium and high-rotated of curvature to the clinical description of scoliosis. MATERIALS AND METHODS: The group consisted of 229 children who were first examined, aged 6 to 17 years, with an average age of -11.57 years (SD ± 3.26), with symptoms of idiopathic scoliosis. The correlation of the criteria for the diagnosis of scoliosis in the ATI 7° clinical trial with a Cobb angle of 10° three dimensional in the X-ray image was used to distinguish three types of curvature/scoliosis, i.e., low, medium and high rotation. The frequencies of each type were compiled for three age groups and three scoliosis locations. Moreover, the degree of vertebral rotation according to the Perdriolli (AVR) of curvature was correlated with the Cobb angle and ATI. A one-way logistic regression model was used to assess the effectiveness of scoliosis detection in children based on the measurement of the ATI angle alone and the measurement of both ATI and Cobb angles. RESULTS: Low-rotated curves were most often found in the age groups of 6-9 and 10-12 years in 65.6% and 71.4% of patients, respectively (p < 0.05). Medium-rotated curvatures were most common in the age group of 13-17 years - 51.6%. With regard to the localization of scoliosis, the low-rotated curvatures were significantly more frequently (p < 0.05) found in the lumbar and thoracolumbar spine. Moreover, the univariate regression model for ATI showed that we could detect scoliosis best by taking the cut-off point of 5° and the mathematically determined Cobb angle was 9.5°. Patients with ATI ≥ 7° had significantly higher AVR values ​​than those with ATI < 7°, and the ATI/AVR correlation was of average strength. CONCLUSION: The specific morphology of the scoliotic curvature of the child's spine may be manifested by the difference in the ATI/Cobb correlation depending on the location of the scoliosis and change with age. The curvatures of the scoliosis that form can be low, medium and high-rotated, and the low-rotated curvatures were most often found in the 6-9- and 10-12-year-old groups and in the lumbar and thoracolumbar section. To increase the rate of early diagnosis of scoliosis, the results suggest the need to adopt two ATI criteria for the diagnosis of scoliosis at screening, 5° for age of 6-12 years, and when asymmetry affects the lumbar and thoracolumbar section, and 7° for the remaining children.


Assuntos
Escoliose , Adolescente , Criança , Humanos , Diagnóstico Precoce , Exame Físico , Rotação , Escoliose/complicações , Escoliose/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Ensaios Clínicos como Assunto
16.
BMC Musculoskelet Disord ; 23(1): 947, 2022 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-36324134

RESUMO

BACKGROUND: In clinical practice, there are a significant percentage of Lenke 2 AIS patients suffered from medial shoulder imbalance (MSI) despite achieving good lateral shoulder balance (LSB) following surgery. However, there are few studies evaluating the features of the medial shoulder. The objective of this study was to determine the incidence and independent risk factors of MSI with LSB after Lenke 2 AIS corrective surgery. METHODS: One hundred and twenty Lenke 2 AIS patients with LSB at the last follow-up were reviewed from 2009 to 2018. Preoperative, and 3-month and the last postoperative follow-up radiographs were measured using a number of specific measurements. At the last follow-up, patients were divided into medial shoulder balance (MSB) group and the MSI group according to whether the T1 tilt was greater than 3°. A stepwise multiple linear regression analysis was used to examine the independent risk factors for MSI. Scoliosis Research Society (SRS)-30 questionnaire was used to assess clinical outcomes. RESULTS: Up to 69.2% of patients suffered from MSI with LSB after Lenke Type 2 AIS corrective surgery. Multiple regression showed that postoperative upper instrumented vertebra tilt (UIVt), proximal thoracic curve (PTC), the ratio of PTC and main thoracic curves (PTC/MTC) and T2 vertebra rotation ratio (T2-VR) were significant predictors for MSI (UIVt: b = 0.398, p < 0.001; PTC/MTC: b = 2.085, p < 0.001; PTC: b = 0.155, p < 0.001; T2-VR: b = 3.536, p = 0.008; adjusted R2 = 0.711). 72 patients completed the SRS-30 questionnaire survey, and the MSB group were scored the higher (p ≤ 0.001) in self-image domain (4.18 ± 0.43 vs. 3.70 ± 0.35), satisfaction domain (4.39 ± 0.54 vs. 3.95 ± 0.46) and total average (4.31 ± 0.23 vs. 4.11 ± 0.19). CONCLUSION: Although the patients with Lenke 2 AIS achieve LSB after corrective surgery, up to 69.2% of them suffered from MSI. Postoperative UIVt, PTC, PTC/MTC and T2-VR were significant predictors for MSI. Sufficient correction of these variables may facilitate the achievement of MSB.


Assuntos
Cifose , Escoliose , Fusão Vertebral , Humanos , Adolescente , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Ombro/diagnóstico por imagem , Ombro/cirurgia , Fusão Vertebral/efeitos adversos , Incidência , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Fatores de Risco , Seguimentos
17.
Sci Rep ; 12(1): 18675, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36333417

RESUMO

The asymmetry of paravertebral muscle (PVM) degeneration in degenerative lumbar scoliosis (DLS) patients has been extensively studied by imaging and histological examination and has not yet been verified by surface electromyography (sEMG) techniques. To study the relationship between the surface electromyography (sEMG) and degenerative characteristics of paravertebral muscles (PVMs) in patients with degenerative lumbar scoliosis (DLS). In twenty DLS patients and fifteen healthy subjects, sEMG activity of the PVMs at the level of the upper end vertebra (UEV), apical vertebra (AV) and lower end vertebra (LEV) was measured during static standing and dynamic standing forward flexion and backward extension tasks. Action segmentation was achieved according to inertial measurement unit (IMU) data. The sEMG characteristics of the PVMs on the convex and concave sides were compared, and the relationship of these data with the Cobb angle and lumbar lordotic angle (LL) was analyzed. In the DLS group, there was no difference in sEMG activity between the convex and concave sides at the UEV or AV level, but in the motion and return phases of the standing forward flexion task (P = 0.000, P = 0.015) and the maintenance and return phases of the standing backward extension task (P = 0.001, P = 0.01), there was a significant difference in sEMG activity between the convex and concave sides at the LEV level. Asymmetrical sEMG activity at the LEV level was negatively correlated with the Cobb angle (F = 93.791, P < 0.001) and LL angle (F = 65.564, P < 0.001). In the DLS group, asymmetrical sEMG activity of the PVMs appeared at the LEV level, with the concave side being more active than the convex side. This sEMG characteristics were consistent with their imaging and histological degenerative features and correlated with bone structural parameters.


Assuntos
Lordose , Escoliose , Humanos , Escoliose/patologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Eletromiografia , Atrofia Muscular/patologia , Lordose/patologia , Músculos/patologia , Estudos Retrospectivos
18.
BMC Surg ; 22(1): 379, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36333715

RESUMO

BACKGROUND: Although thoracic pedicle (TP) screw has gained increasingly popularity in the surgical treatment of adolescent idiopathic scoliosis (AIS) patients, questions remain about the accurate selection of entry point for TP screw placement in these patient. The main objective of the present study was to evaluate the accuracy of TP screw placement in AIS patients using the entry point identified by new landmarks. METHODS: Thirty-four thoracic AIS patients treated with posterior TP screw instrumentation were included. All these TP screws were inserted through the entry point identified by new landmarks with free-hand technique. Postoperative CT scans were obtained to evaluate the screw position. The perforations of the pedicle were classified as grade 0 (no perforation), grade 1 (≤ 2 mm), grade 2 (2.1-4 mm), grade 3 (4.1-6 mm) and grade 4 (6.1-8.0 mm). Screws in grade 0, displaced either medially or anteriorly in grade 1 and displaced laterally in grades 1 to 2 were considered acceptable. RESULTS: Of the 495 TP screws inserted, 34 (6.9%) screws were displaced with 7 screws (1.4%) displaced medially, 20 screws (4.1%) displaced laterally and 7 screws (1.4%) displaced anteriorly (P < 0.05). Among the 34 displaced screws, 11 screws (32.4%) were considered as grade 1, 14 screws (38.2%) as grade 2 and 9 screws (29.4%) as grade 3 (P < 0.05). The overall rate of acceptable screws was 97.8%. No screw-related complication was noted. CONCLUSION: Our new method for selecting the entry point of TP screw in AIS patients is convenient and can achieve high accuracy of screw placement, which is worthy of being widely popularized.


Assuntos
Cifose , Parafusos Pediculares , Escoliose , Fusão Vertebral , Humanos , Adolescente , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Estudos Retrospectivos , Cifose/etiologia , Tomografia Computadorizada por Raios X/métodos
19.
Arch Osteoporos ; 17(1): 148, 2022 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-36418608

RESUMO

BACKGROUND: Severe presentation of primary hyperparathyroidism (PHPT) which, although, common in the Asian population, is albeit rarely encountered in the present era. CASE PRESENTATION: We present a 23-year-old lady whose symptoms began in 2016 with generalized body aches. Subsequently, her husband noticed a reduction in her height and she developed gradual protrusion of chest. Meanwhile, she conceived in November 2019 and delivered a full-term healthy baby girl. She breastfed her baby for 18 months during which her symptoms worsened. On examination, she measured only 123 cm, having lost nearly 23 cm in height. She had a short neck, pectus carinatum-like deformity of chest, protruded abdomen, kyphosis, and scoliosis. Investigations revealed PTH-dependent hypercalcemia, diffuse cortical thinning, brown tumors, codfish vertebrae, and bilateral nephrolithiasis. A diagnosis of primary hyperparathyroidism (PHPT) was made with the grave clinical picture bearing a striking resemblance to that of Captain Charles Martell, the first ever recorded case of PHPT in the world. CONCLUSION: The index case highlights the fact that PHPT, if left undiagnosed and untreated, can have debilitating consequences. A high index of suspicion should be exercised while evaluating all suspected cases of metabolic bone disorders and being the third most common endocrine disorder, the possibility of PHPT should be entertained wherever appropriate.


Assuntos
Hiperparatireoidismo Primário , Cifose , Escoliose , Lactente , Feminino , Humanos , Adulto Jovem , Adulto , Hiperparatireoidismo Primário/diagnóstico , Asiáticos , Estatura
20.
BMC Surg ; 22(1): 405, 2022 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-36419148

RESUMO

PURPOSE: This retrospective study was performed to analyze the clinical effects and complications of LSFCF in the surgical treatment of DLS combined with lumbar spinal stenosis (LSS). METHODS: A total of 26 eligible patients (mean age, 64.73 y; 17 men, 9 women) with DLS combined with LSS were included and LSFCF surgery was performed. An independent spine surgeon retrospectively reviewed the medical records and radiographs of all patients to evaluate surgical data and surgery-related complications. Preoperative, postoperative, and follow-up questionnaires were obtained to assess clinical outcomes. RESULTS: The average follow-up period of this study was 20.14 ± 5.21 months. The operation time and blood loss of patients underwent LSFCF were 129.33 ± 15.74 min and 356.13 ± 21.28 ml. The clinical effects of all patients in terms of visual analogue scale (VAS) and Oswestry disability index (ODI) have been significantly improved at the final follow-up postoperatively (P < 0.05). Complications such as infection, cerebrospinal fluid leakage, nerve injury, and internal fixation failure, etc. were not observed during the follow-up period. CONCLUSION: The LSFCF surgery is a safe and effective treatment for DLS patients combined with LSS.


Assuntos
Escoliose , Estenose Espinal , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Estenose Espinal/complicações , Estenose Espinal/cirurgia , Escoliose/cirurgia , Estudos Retrospectivos , Região Lombossacral , Resultado do Tratamento
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