Effects of telerehabilitation-based respiratory and corrective exercises among the elderly with thoracic hyper-kyphosis: a clinical trial.

BACKGROUND: Aging is associated with changes in the musculoskeletal system, including increased susceptibility to spine malalignments. Utilizing corrective exercises with a therapeutic emphasis can be beneficial in the elderly with thoracic spine hyperkyphosis. OBJECTIVE: This study aimed to investigate the effects of six weeks of telerehabilitation-based respiratory and corrective exercises on quality of life, disability, thoracic kyphosis, craniovertebral angle, shoulder angle, cranial angle, and chest expansion in the elderly with thoracic spine hyperkyphosis. METHODS: In this clinical trial, a total of 40 participants aged 60 and above with thoracic hyperkyphosis were randomly divided into the control (N = 20) and experimental (N = 20) groups. The experimental group performed the corrective exercises for six weeks (3 sessions per week). The control group performed general stretching exercises during the same time period. We measured the outcomes of quality of life, disability, thoracic kyphosis, craniovertebral angle, shoulder angle, cranial angle, and lung expansion before and after the intervention. Analysis of covariance (ANCOVA) was employed to analyze the data. A P-value ≤ 0.05 was considered statistically significant. RESULTS: Quality of life (P < 0.001, Effect Size (ES): 0.44), chest expansion (P < 0.001, ES: 0.56), thoracic kyphosis angle (P < 0.001, ES: 0.31), craniovertebral (P < 0.001, ES: 0.33), cranial (P < 0.001, ES: 0.38), and shoulder (P = 0.005, ES: 0.20) angles were significantly improved in the experimental group as compared with controls. However, no statistically significant difference was observed between the two groups in terms of physical ability (P = 0.251, ES: 0.04). CONCLUSION: It is therefore recommended that online corrective exercises be used in the rehabilitation protocol to improve the quality of life, posture, chest expansion, and disability in the elderly with thoracic kyphosis.

The effect of various therapeutic exercises on forward head posture, rounded shoulder, and hyperkyphosis among people with upper crossed syndrome: a systematic review and meta-analysis.

OBJECTIVES: This review study aimed to evaluate the impact of therapeutic exercises on Upper-Crossed Syndrome (UCS). The study utilized a systematic review and meta-analysis approach to investigate the effects of various therapeutic exercises on forward head posture, rounded shoulders, and hyperkyphosis associated with upper crossed syndrome. METHODS: The study identified relevant keywords for each independent and dependent variable and conducted a search in scientific databases, including PubMed, Web of Science, Scopus, and Google Scholar, without any time limitations until 12 August 2023. Overall, 4625 articles were found in the selected databases, which were reduced to 1085 after being entered into the EndNote software and removing duplicate data. The full texts of 30 remaining studies were reviewed; ten articles meeting the criteria were included. Additionally, 12 studies from the Google Scholar database were included, resulting in 22 studies. Using Comprehensive meta-analysis software (CMA ver 3), data heterogeneity was measured with I2 and the Q tests. The Funnel Plot and Egger test methods were utilized to determine the possibility of publication bias. The JBI checklist was used to assess the quality of the studies. RESULTS: The results of the meta-analysis showed that therapeutic exercises were effective in improving forward head, rounded shoulders, and thoracic kyphosis angles (CI 95% = -1.85-1.161, P = 0.001, P = 0.001, CI95%=-1.822-1.15, and P = 0.001, CI 95%= -1.83-1.09, respectively). CONCLUSION: Based on the results, it appears that performing therapeutic exercises in the form of strength exercises, stretching, shoulder-based exercises, and incredibly comprehensive exercises that target all muscles may be effective in reducing forward head, rounded shoulders, thoracic kyphosis, and overall UCS.

Conservative treatment for dropped head syndrome.

PURPOSE: Previous reports on the outcome of conservative treatment for dropped head syndrome (DHS) are scarce. The purpose of this study was to elucidate the efficacy of conservative treatment for DHS and to identify possible predictive factors relating to the outcome. METHODS: Among 76 DHS patients, conservative treatment (2-3 months collar application, active neck range of motion exercise, and occasional prescription of analgesics) succeeded in 17 patients (22.4%, group S, 4 male, 13 female, mean age 75.9 years). The treatment failed in the remaining 59 patients (group F). Clinical and radiological parameters were compared between the groups. Radiological findings of group S were compared between before treatment and at follow-up. RESULTS: Duration of disease was 6.6 ± 9.3 months in group S and 20.0 ± 27.6 months in group F. C2-7 angle (degree), the incidence of anterior slippage of the vertebra (%), reducibility (%), and upper thoracic kyphosis angle (degree) in group S/F were - 19.2 ± 17.5/- 34.6 ± 26.6, 23.5/62.7, 100/52, and 6.7 ± 8.6/17.9 ± 13.7, respectively. C2-7 angles were - 19.2 ± 17.5 degrees at pre-treatment and 10.2 ± 20.7 degrees at follow-up. These differences were statistically significant. CONCLUSIONS: The present study indicated that conservative treatment was successful in 22% of DHS patients, with improvement in their cervical kyphotic alignment. Shorter duration of disease, relatively smaller cervical kyphosis without anterior slippage of the vertebra, reducibility, and abundant compensation at the upper thoracic region were good indications for the success of conservative treatment.

Effects of a Pilates programme in spinal curvatures and hamstring extensibility in adolescents with thoracic hyperkyphosis: a randomised controlled trial.

AIM: To evaluate the effects of a 9-month Pilates exercise programme on the sagittal spinal posture and hamstring extensibility of adolescents with thoracic hyperkyphosis. DESIGN: Randomised controlled trial with blinded examiner. PATIENTS: One-hundred and three adolescents with thoracic hyperkyphosis. INTERVENTIONS: Participants were randomly placed into an experimental group which participated in a Pilates exercise programme implemented for a total of 38 weeks (two sessions/week, 15 min/session) (Pilates group (PG), sample = 49, or control group (CG), sample = 48). MAIN OUTCOME MEASURES: The outcome measures were the thoracic curve in sagittal spinal curvature in relaxed standing, sagittal spinal curvatures and pelvic tilt in relaxed standing and sit-and-reach positions, and hamstring extensibility. RESULTS: There was a significant adjusted mean difference between groups in favour of the PG in the thoracic curve in relaxed standing position (-5.6°, p = 0.003), pelvic tilt (-2.9°, p = 0.03) and all straight leg tests (p<0.001). The PG showed a significant change in thoracic curve (-5.9, p<0.001) and in lumbar angle (4.0, p = 0.001) in relaxed standing position and in all straight leg raise tests (+6.4 to +15°, p<0.0001). CONCLUSIONS: The adolescents with thoracic hyperkyphosis from the PG had a decreased thoracic kyphosis in relaxed standing position, and improved hamstring extensibility as compared with the CG. More than 50% of the participants obtained kyphosis values inside normality, showing an adjusted mean difference between groups in the thoracic curve of about 73% of the baseline mean, resulting in a large improvement and high clinical importance. TRIAL REGISTRATION NUMBER: NCT03831867.

The Effects of Exercise in Older Adults with Hyperkyphotic Posture.

The objective of this review was to investigate the effects of exercise in older adults with hyperkyphosis. Medline and Google Scholar databases were searched from June to August 2022 for studies related to exercise interventions in older adults above 60 years of age. All types of exercise interventions (such as strengthening, stretching, Yoga, and/or any other exercise with a focus on treatment or prevention of postural malalignment) were included. The keywords used were "hyperkyphosis," "exercise," and "older adults." Ten studies were included involving 625 older adults with hyperkyphotic posture. The exercise interventions included spine strengthening (strengthening of back and abdominal muscles), poses of Yoga and postural alignment, and flexibility and respiratory muscle exercises. Duration of exercise programs varied from 6 weeks (1 study) to 8 weeks (3 studies), 12 weeks (4 studies), and 6 months (3 studies). Exercise adherence was generally good in studies. In summary, low to moderate evidence suggest that exercises in age-related hyperkyphosis have a role in the management of this group of patients. It can be beneficial in order to improve postural control, spinal stability, and kyphosis outcomes. The adherence reported across studies suggests that exercise is an acceptable treatment option for people with age-related hyperkyphosis. Types of exercise and dose-response parameters of exercise eliciting improvement warrant further investigation. Due to heterogeneity in clinical trials, future research is needed with the goal of improving the health of our growing geriatric population.

Do the three-dimensional parameters of brace-wearing patients with AIS change when transitioning from standing to sitting position? A preliminary study on Lenke I.

BACKGROUND: Bracing is the most common conservative treatment for preventing the progression of adolescent idiopathic scoliosis (AIS) in patients with a curve of 25°-40°. X-ray examinations are traditionally performed in the standing position. However, school-age teenagers may take more time to sit. Thus far, little is known about three-dimensional (3D) correction in the sitting position. Hence, this study aimed to determine the effects of standing and sitting positions on 3D parameters during brace correction. METHODS: We evaluated a single-center cohort of patients receiving conservative treatment for thoracic curvature (32 patients with AIS with a Lenke I curve). The 3D parameters of their standing and sitting positions were analyzed using the EOS imaging system during their first visit and after bracing. RESULTS: At the patients' first visit, sagittal plane parameters such as thoracic kyphosis (TK), lumbar lordosis (LL), and sacral slope decreased when transitioning from the standing position to the sitting position (standing 29° ± 6°, 42° ± 8°, and 42° ± 8° vs. sitting 22° ± 5°, 27° ± 6°, and 24° ± 4°; p < 0.001), whereas pelvic tilt (PT) increased and sagittal vertical axis shifted forward (standing 9° ± 6° and 1.6 ± 2.7 cm vs. sitting 24° ± 4° and 3.8 ± 2.3 cm; p < 0.001). After bracing, TK and LL decreased slightly (from 29° ± 6° and 42° ± 8° to 23° ± 3° and 38° ± 6°; p < 0.001), whereas the thoracolumbar junction (TLJ) value increased (from 3° ± 3° to 11° ± 3°; p < 0.001). When transitioning to the sitting position, similar characteristics were observed during the first visit, except for a subtle increase in the TLJ and PT values (standing 11° ± 3° and 9° ± 4° vs. sitting 14° ± 3° and 28° ± 4°; p < 0.001). Moreover, the coronal and axial parameters at different positions measured at the same time showed no significant change. CONCLUSIONS: In brace-wearing patients with thoracic scoliosis, compensatory sagittal plane straightening may be observed with a slight increase in thoracolumbar kyphosis, particularly when transitioning from the standing position to the sitting position, due to posterior rotation of the pelvis. Our results highlight that sagittal alignment in AIS with brace treatment is not completely analyzed with only standing X-Ray. TRIAL REGISTRATION: The study protocol was registered with the Chinese Clinical Trial Registry (ChiCTR1800018310).

Secondary analysis of change in physical function after exercise intervention in older adults with hyperkyphosis and low physical function.

BACKGROUND: Hyperkyphosis is common in older adults and associated with low physical function and reduced health related quality of life (HrQol). Improved kyphosis has been previously established in kyphosis-targeted interventions in randomized controlled trials in older adults with hyperkyphosis; however, evidence for improved physical function is conflicting. Few studies have investigated change in physical function after a targeted kyphosis intervention in older adults with low physical function. The primary aim in this descriptive study was to explore change in physical function after a progressive high-intensity 3-month targeted kyphosis exercise and posture training intervention in older adults with low physical function and hyperkyphosis. Secondary aims were to explore change in HrQol, spinal strength and spinal curvature, and adherence and safety of the intervention. METHODS: In this secondary analysis of the Specialized Center of Research (SCOR) Kyphosis randomized trial, 101 community dwelling older men and women with hyperkyphosis who completed the intervention were divided into a low function group (LFG) and high function group (HFG). Baseline characteristics were compared between LFG and HFG. Physical function, HrQol, spinal strength and spinal curvature (kyphosis and lordosis) pre/post intervention change scores were explored within and between groups. Adherence and adverse events were examined in the LFG and HFG. RESULTS: Twenty-six (26%) older adults were LFG, mean Short Phyiscal Performance Battery (SPPB) 9.62 (SD = 1.17) points. At baseline, the LFG was older than HFG (p = 0.005), experienced more pain, (p = 0.060), had worse physical function and HrQol (p ≤ 0.001), and comparable kyphosis (p = 0.640). SPPB changed 0.62 (95% CI: - 0.20 to 1.44) points in the LFG and - 0.04 (95%CI: - 0.28 to 0.19) points in the HFG, p = 0.020. Gait speed changed 0.04 (95% CI: - 0.02 to 0.10) m/s in the LFG. Kyphosis improved equally in both groups. Adherence to the intervention was 83% in the LFG and 79% in the HFG. There were no adverse events in either group. CONCLUSIONS: Older adults with low physical function and hyperkyphosis may improve physical function after a kyphosis targeted intervention. Older adults with low physical function may safely participate in targeted high-intensity kyphosis exercise and posture training. This observation needs to be confirmed in larger adequately powered studies. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01766674 .

How helpful is the halo-gravity traction in severe spinal deformity patients?: A systematic review and meta-analysis.

PURPOSE: This study sought to evaluate the complications and clinic outcome in radiographic parameters, pulmonary function, and nutritional status of halo-gravity traction (HGT) in treating severe spinal deformity. METHODS: Embase, PubMed, Cochrane, Web of Science databases were searched comprehensively for relevant studies from inception to February 2021, by using combined text and MeSH terms and English language restriction was used. The data, including radiographic parameters, pulmonary function (FVC %), and nutritional status (BMI) was extracted from included studies. All meta-analyses were conducted using random or fixed-effects models according the between-study heterogeneity, estimated with I2. RESULTS: Four hundred and forty-six studies were identified and twelve studies with a total of 372 patients were included in this review. Compared with pre-traction values, there were reduction in cobb angle of 28.12° [95% CI (22.18, 34.18)], decrease in thoracic kyphosis of 26.76°[95% CI (20.73, 32.78)], improvements in spine height[SMD = -0.89, 95% CI (- 1.56, - 0.21)] and in coronal balance[WMD = - 0.03, 95% CI (- 1.56, - 0.21), P = 0.84] with preoperative halo-gravity traction for severe spinal deformity patients. Besides, our pooled analysis showed the improvement in pulmonary function (FVC %) [WMD = - 9.56, 95% CI (- 1.56, - 0.21)] and increase in nutritional status (BMI) [WMD = - 0.50, 95% CI (- 1.56, - 0.21)]. CONCLUSION: Partial correction can be achieved by preoperative HGT, thereby reducing the difficulty of the operation and the risk of neurologic injury caused by excessive correction. Moreover, preoperative HGT can improve pulmonary function and nutritional status and, thus, increase patients' tolerance to surgery.

Transition to adult care for young people with cerebral palsy.

Cerebral palsy (CP) is associated with a high burden of comorbid respiratory disease subsequent to multiple risk factors associated with increasing levels of disability. Correspondingly, respiratory disease is the leading cause of death in CP, including amongst young people who are transitioning or who have just transitioned between paediatric and adult healthcare services. Therefore, consideration of both preventive and therapeutic respiratory management is integral to transition in patients with CP, as summarised in this review.

Effects of a Virtual Reality Dance Training Program on Kyphosis Angle and Respiratory Parameters in Young Women With Postural Hyperkyphosis: A Randomized Controlled Clinical Trial.

CONTEXT: Thoracic hyperkyphosis, one of the most common spinal deformities, may lead to undesirable pulmonary outcomes. OBJECTIVE: To study, the efficacy of virtual reality exercise training on thoracic hyperkyphosis and respiratory parameters in young women. DESIGN: Randomized clinical trial. SETTING: Laboratory setting. PARTICIPANTS AND INTERVENTION: Participants were randomly assigned to one of two 4-week exercise training groups: regular training (RT), which involved stretch and strength training, or virtual reality with RT (VRRT), which involved dance training with the Xbox 360 Kinect® game in addition to the exercises, which the RT group received. MAIN OUTCOME MEASURES: The authors measured kyphosis angle with a Flexicurve ruler and recorded respiratory parameters (forced vital capacity [FVC] and forced expiratory volume in 1 s [FEV1]) with a spirometer in each participant at baseline and postintervention. Separate 2 × 2 repeated-measure analysis of variances were used to analyze differences between means for kyphosis angle, FEV1, and FVC. Based on the significant interactions between time and group, the paired t test was used to compare the results at baseline and postintervention, and the independent sample t test was used to compare the differences in changes between groups. Level of significance was considered at P < .05 except for paired t test that was adjusted to P < .025 for each variable in 2 groups. RESULTS: The results showed statistically significant interactions between time and group for kyphosis angle, FEV1, and FVC. Postintervention thoracic kyphosis angle decreased and FVC increased significantly in both groups and FEV1 improved significantly in virtual reality with RT group. The improvements in thoracic kyphosis, FVC, and FEV1 in the virtual reality with RT group were significantly greater (P < .001) than in the RT group. CONCLUSION: Dance training with the Xbox 360 Kinect game was an effective therapy in improving thoracic kyphosis angle, FVC, and FEV1 in young women with thoracic hyperkyphosis.

3D spinal and rib cage predictors of brace effectiveness in adolescent idiopathic scoliosis.

BACKGROUND: Scoliotic braces are the standard of curve for management of moderate spinal deformities in pediatric patients. The effectiveness of this treatment method has been shown; however, the spinal and rib cage parameters, in the three anatomical planes, that are associated with bracing outcome in adolescent idiopathic scoliosis (AIS) are not fully identified. METHODS: A total number of 45 right thoracic AIS patients who had received a thoraco-lumbo-scaral brace for the first time were included retrospectively. For each patient, radiographic images at three visits, pre-brace, in-brace, and at least 1 year after the first brace fit were included. Age, sex, Risser sign, and curve type at pre-brace, and thoracic and lumbar frontal and sagittal Cobb angles, thoracic and lumbar apical rotations, sagittal and frontal balances at pre-brace and in-brace were determined. Two sagittal curve types (hypothoracolumbar and normal/hyperthoracolumbar kyphosis), two rib cage types based on the costovertebral joints (drooping and horizontal), and two axial shapes of the spine (S shaped and V shaped) were used to stratify the patients. Feature selection and linear regression with regularization determined the parameters and the interaction terms that predicted the brace effectiveness significantly. RESULTS: Smaller in-brace thoracic Cobb and larger in-brace lordosis predicted brace effectiveness, p < 0.05. Impact of the out of brace lordosis on the brace success increased as the in brace kyphosis angle decreased, p = 0.046. A larger out of brace lordosis in hypothoracolumbar sagittal profile type patients improved the outcomes, p = 0.031. A smaller out of brace thoracic rotation improved the bracing outcomes in patients with horizontal ribs, p = 0.040. CONCLUSION: Both 3D patient specific parameters (lordosis, thoracic rotation, shape of the rib cage, and sagittal profile) and brace design (which allows larger in brace lordosis, better in brace Cobb correction) are important predictors of the brace effectiveness in AIS.

Growth Friendly Surgery and Serial Cast Correction in the Treatment of Early-onset Scoliosis for Patients With Prader-Willi Syndrome.

BACKGROUND: Prader-Willi syndrome (PWS) patients can present with scoliosis which can be treated with serial cast correction (SCC) or with growth friendly surgery (GFS). This study's purpose was to describe the results of SCC as well as GFS for PWS patients with early-onset scoliosis (EOS). METHODS: PWS patients were identified from 2 international multicenter EOS databases. Scoliosis, kyphosis, spine height (T1-S1), right/left hemithoracic heights/widths (RHTH, LHTH, RHTW, LHTW) were measured pretreatment, postoperation, and at 2-year follow-up. Complications were recorded. RESULTS: Overall, 23 patients with 2-year follow-up were identified. Pretreatment; patients treated with SCC (n=10) had mean age of 1.8±0.6 years; body mass index (BMI), 16±1.5 kg/m; scoliosis, 45±18 degrees; kyphosis, 56±9 degrees; T1-S1, 22.4±2.4 cm; RHTH, 8.0±2.0 cm; LHTH, 8.5±1.7 cm; RHTW, 6.6±1.3 cm; and LHTW, 8.0±1.0 cm. Patients treated with GFS (n=13) had mean age of 5.8±2.6 years; BMI, 21±5.4 kg/m; scoliosis, 76±14 degrees; kyphosis, 59±25 degrees; T1-S1, 24.1±3.6 cm; RHTH, 10.0±1.6 cm; LHTH, 10.6±1.6 cm; RHTW, 9.4±2.5 cm; and LHTW, 8.1±2.8 cm. At 2-year follow-up, patients treated with SCC had mean scoliosis 37±11 degrees (18% correction, P=0.06); kyphosis, 42±6 degrees (NS); T1-S1, 26.4±2.1 cm (P<0.01); RHTH, 9.0±1.1 cm (13%; P=0.30); LHTH, 10.0±1.5 cm (18%, P<0.01); RHTW, 7.4±1.1 cm (12%, P<0.01); and LHTW, 8.0±1.0 cm (0%, P=0.34). At 2-year follow-up, patients treated with GFS had mean scoliosis 42±13 degrees (45% correction, P<0.000001); kyphosis, 53±13 degrees (10%, P=0.19); T1-S1, 31.5±5.4 cm (P<0.00001); RHTH, 12.0±2.4 cm (20%; P<0.01); LHTH, 12.0±1.7 cm (13%; P<0.01); RHTW, 9.8±1.3 cm (4%; P=0.27); and LHTW, 7.9±2.3 cm (3%;P=0.11). As an entire group, patients with a BMI>17 kg/m² had more device-related than disease-related complications (P=0.09). Patients treated with SCC had 0.9 complications per patient. Patients treated with GFS had 2.2 complications per patient [≤5 y more often had ≥2 complications (P=0.05)]. CONCLUSIONS: At 2-year follow-up, SCC and GFS were both effective in treating EOS in PWS patients. Patients treated with SCC had significant improvements in spine height and LHTH. Patients treated with GFS had significant improvements in scoliosis magnitude, spine height, RHTH, and LHTH. LEVEL OF EVIDENCE: Level IV-therapeutic study.

Spine challenges in mucopolysaccharidosis.

PURPOSE: Mucopolysaccharidosis (MPS) are rare inherited metabolic diseases, causing lysosomal storage of mucopolysaccharides; clinical presentation involves skeletal system and particularly the spine. Anomalies include developing kyphosis at thoracolumbar junction, that can causes nervous symptoms, and dens hypoplasia with associated atlantoaxial subluxation that can cause myelopathy. We present our experience in the treatment of spine pathology in MPS. METHODS: Medical treatments of MPS seem to have little impact on spine disease: treatment of cervical instability often includes surgical decompression and stabilization, as in patient MPS1 that we present, while thoracic lumbar kyphosis is treated by bracing and, in severe cases, with surgery. Bracing is more effective in kyphosis under 40° Cobb. Our surgical cases with thoracic lumbar kyphosis over 40° Cobb, treatment include the first one ever described by only posterior approach with vertebrectomy in MPS and a case of lateral costo-transverse approach instrumented correction. RESULTS: Surgical patients had no major complications after surgery and CT scan at follow-up showed complete fusion without loss of correction, even if in a cervical case we used an adult rigid instrumentation in a four year-and-six month-old girl (11 years follow-up) and in thoracic lumbar kyphosis case treated by vertebrectomy due to diminutive anatomy we positioned interbody cage in suboptimal position. CONCLUSIONS: Bracing is a viable treatment strategy in thoracic lumbar kyphosis and can obtain good clinical results at medium terms follow-up even if kyphosis deformity remains in radiographs. Surgical treatment is effective in severe evolving cases both at cervical and thoracic lumbar level, main difficulties arose from unavailability of dedicated instrumentation in very young patient, as even smallest devices available are often too big.

Systemic AAV-Mediated ß-Sarcoglycan Delivery Targeting Cardiac and Skeletal Muscle Ameliorates Histological and Functional Deficits in LGMD2E Mice.

Limb-girdle muscular dystrophy type 2E (LGMD2E), resulting from mutations in ß-sarcoglycan (SGCB), is a progressive dystrophy with deteriorating muscle function, respiratory failure, and cardiomyopathy in 50% or more of LGMD2E patients. SGCB knockout mice share many of the phenotypic deficiencies of LGMD2E patients. To investigate systemic SGCB gene transfer to treat skeletal and cardiac muscle deficits, we designed a self-complementary AAVrh74 vector containing a codon-optimized human SGCB transgene driven by a muscle-specific promoter. We delivered scAAV.MHCK7.hSGCB through the tail vein of SGCB-/- mice to provide a rationale for a clinical trial that would lead to clinically meaningful results. This led to 98.1% transgene expression across all muscles that was accompanied by improvements in histopathology. Serum creatine kinase (CK) levels were reduced following treatment by 85.5%. Diaphragm force production increased by 94.4%, kyphoscoliosis of the spine was significantly reduced by 48.1%, overall ambulation increased by 57%, and vertical rearing increased dramatically by 132% following treatment. Importantly, no adverse effects were seen in muscle of wild-type mice injected systemically with scAAV.hSGCB. In this well-defined model of LGMD2E, we have demonstrated the efficacy and safety of systemic scAAV.hSGCB delivery, and these findings have established a path for clinically beneficial AAV-mediated gene therapy for LGMD2E.

Face-to-face intubation using a lightwand in a patient with severe thoracolumbar kyphosis: a case report.

BACKGROUND: Severe deformity of the thoracolumbar spine may cause difficulty in airway management during induction of anesthesia. Therefore, special attention must be devoted to patient safety. CASE PRESENTATION: A 65-year-old male with severe thoracolumbar kyphosis was scheduled to undergo posterior spinal fusion under general anesthesia. Due to his inability to lie supine, conventional tracheal intubation under direct laryngoscopy was difficult. Alternatively, face-to-face tracheal intubation using a lightwand in the semi-recumbent position was performed. Intubation was successful on the first attempt without any complications. CONCLUSIONS: The face-to-face intubation technique using a lightwand is one of several alternative techniques for tracheal intubation in patients who cannot lie supine.

Walking Out of the Curve: Thoracolumbar Kyphosis in Achondroplasia.

BACKGROUND: Thoracolumbar kyphosis (TLK) is common in infants with achondroplasia. Our goals were to examine the natural history of TLK and identify factors associated with persistent TLK. METHODS: We reviewed records of patients with achondroplasia seen by a board-certified orthopaedic surgeon at a tertiary care medical center between 1997 and 2013. Inclusion criteria were minimum 2-year follow-up and radiographs taken at time of presentation, within 6 months of walking age, and within 6 months of the first anniversary of walking age. We defined TLK as kyphosis of ≥20 degrees centered at T12 and L1. We assessed patient demographic characteristics, radiographic parameters (Cobb angle, apical vertebral translation, and apical vertebral wedging for vertebral height and width), and clinical parameters (developmental motor delay, hydrocephalus, presence of a ventriculoperitoneal shunt, and foramen magnum decompression). Developmental motor delay was defined as the inability to sit or ambulate independently by age 14 or 30 months, respectively. Associations between these factors and persistent TLK (ie, unresolved at final follow-up) were evaluated using logistic regression and χ, Fisher exact, and independent t tests. Significance was set at P<0.05. RESULTS: A total of 60 patients were included. Mean values were as follows: age at presentation, 10.9±7.0 months; length of follow-up, 5.7±3.6 years; initial curve, 43.8±11.0 degrees; independent sitting age, 12.6±5.5 months; and independent walking age, 21.1±7.8 months. At walking age and 1 year after walking age, 15% and 58% of patients, respectively, had spontaneous TLK resolution. In total, 30% of patients had persistent TLK at final follow-up. Apical vertebral translation (P=0.001), percentage of apical vertebral wedging for vertebral height (P=0.031), and developmental motor delay (P=0.043) were associated with unresolved TLK. CONCLUSIONS: In patients with achondroplasia, TLK resolved at walking age in 15% of patients and after a year of walking in 58% of patients. Earlier bracing may slow TLK progression in patients with achondroplasia and developmental motor delay. Patients with kyphotic curves between 20 and 40 degrees should be examined intermittently for progressive deformity or worsening symptoms of spinal cord compression. LEVEL OF EVIDENCE: Level II.

An evaluation of two types of exercise classes, containing shoulder exercises or a combination of shoulder and thoracic exercises, for the treatment of nonspecific shoulder pain: A case series.

STUDY DESIGN: A case series was carried out. INTRODUCTION: There is a lack of evidence exploring the effectiveness of group exercise classes for people with nonspecific shoulder pain (NSSP). Also, there is a lack of research that measures potential reductions in thoracic kyphosis after exercise interventions in people with NSSP. PURPOSE OF THE STUDY: To observe changes in shoulder pain, disability, and thoracic kyphosis in 2 groups of people with NSSP, after 2 different types of group exercise classes. METHODS: People with NSSP received a 6-week block of exercises classes containing either shoulder exercises alone (shoulder group, n = 20) or a mixture of shoulder and thoracic extension exercises (thoracic group, n = 19). The Disabilities of the Arm, Shoulder and Hand questionnaire for disability and the Numeric Rating Scale for pain were measured at baseline, 6 weeks, and 6 months. Thoracic kyphosis was measured at baseline and 6 weeks using the manual inclinometer. RESULTS: Significant and clinically meaningful improvements in Numeric Rating Scale and Disabilities of the Arm, Shoulder and Hand were demonstrated in both groups at 6-week and 6-month follow-up (P < .001). Effect sizes ranged from 0.78-1.16 in the shoulder group and 0.85-1.88 in the thoracic group. Thoracic kyphosis did not change beyond measurement error in either group. DISCUSSION/CONCLUSION: Group exercise classes can improve shoulder pain and disability in people with NSSP. Resting thoracic kyphosis did not change after either exercise intervention, which suggests that the treatment effect was not due to a change in static thoracic spine posture.

Implications of Subarchnoid Block in Senile Kyphosis.

Since the literature related to safety or efficacy of placing spinal blocks in patients with kyphosis is lacking, we aim to discuss about the anaesthesia implications of spinal anaesthesia in senile kyphosis. We successfully administered spinal anesthesia in three elderly patients with predominant kyphotic deformity with absent or mild scoliosis. The needle insertion attempts did not exceed two and a smaller dose of anesthetic was sufficient. While choosing spinal anaesthesia in patients with kyphosis, a risk benefit analysis needs to be performed based on the co-presence of scoliosis and its severity, desired level of anesthesia, and associated or coexisting systemic illness.

Current Care and Investigational Therapies in Achondroplasia.

PURPOSE OF REVIEW: The goal of this review is to evaluate the management options for achondroplasia, the most common non-lethal skeletal dysplasia. This disease is characterized by short stature and a variety of complications, some of which can be quite severe. RECENT FINDINGS: Despite several attempts to standardize care, there is still no widely accepted consensus. This is in part due to absence of concrete data on the incidence of sudden unexplained death in infants with achondroplasia and the best investigation for ascertaining which individuals could benefit from foramen magnum decompression surgery. In this review, we identify the different options of care and management for the various orthopedic, neurologic, and respiratory complications. In parallel, several innovative or drug repositioning therapies are being investigated that would restore bone growth but may also prevent complications. Achondroplasia is the most common non-lethal skeletal dysplasia. It is characterized by short stature and a variety of complications, some of which can be quite severe. Despite several attempts to standardize care, there is still no widely accepted consensus. This is in part due to absence of concrete data on the incidence of sudden unexplained death in infants with achondroplasia and the best investigation for ascertaining which individuals could benefit from foramen magnum decompression surgery. In this review, we identify the different options of care and management for the various orthopedic, neurologic, and respiratory complications. In parallel, several innovative or drug repositioning therapies are being investigated that would restore bone growth but may also prevent complications.

Preoperative Halo-Gravity Traction for Severe Thoracic Kyphoscoliosis Patients from Tibet: Radiographic Correction, Pulmonary Function Improvement, Nursing, and Complications.

BACKGROUND This study investigated the outcomes of preoperative HGT as an adjunct treatment for severe thoracic kyphoscoliosis, its role in radiographic correction, and pulmonary function improvement, together with nursing strategy and incidence of complications. MATERIAL AND METHODS Eleven patients with a mean age of 18.8 years were retrospectively reviewed. Inclusion criteria were: patients with severe kyphoscoliosis (coronal Cobb angle and kyphosis angle ≥80°); duration of HGT ≥8 weeks; patients undergoing HGT for at least 12 h per day; traction weight no less than 40% of body weight; and patients not receiving physical therapies. All patients underwent respiratory training. RESULTS The major coronal curve scoliosis averaged 114.00±24.43° and was reduced to 80.55±17.98° after HGT. The major kyphosis was 103.91±18.95° and was reduced to 80.55±17.98°. Significantly improved percent-predicted values for FVC was found after HGT (p=0.014), and significantly increased forced expiratory volume in 1 s (FEV1%) was also observed (p<0.001), with significantly improved percent-predicted values for PEF (p=0.003) after HGT. CONCLUSIONS Our data reveal that preoperative HGT can be performed safely, and can help achieve excellent curve correction in both the coronal and sagittal planes, together with improved respiratory function and no severe complications in patients with severe thoracic kyphoscoliosis.