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PubMed1985

Effect of 5 alpha-dihydrotestosterone on sexual receptivity and neural progestin receptors in ovariectomized rats given pulsed estradiol.

Experiments were carried out to examine the mechanism whereby 5 alpha-dihydrotestosterone (DHT) antagonizes the stimulatory effects of estrogen plus progesterone (P) on sexual receptivity (lordosis) in the ovariectomized rat. Estradiol (E2; 1 microgram s.c. in 10% ethanol) was administered in a discontinuous (pulsed) treatment regimen thought to mimic phase requirements of estrogen action; two injections of E2 were given either 6 or 12 h apart (first injection, Hour 0). Progesterone (0.5 mg in oil) was injected at Hour 20, and behavioral testing occurred at Hour 24. Dihydrotestosterone (2.5 mg s.c. in 10% ethanol/propylene glycol) inhibited lordosis when it was given before (-12 or -3 h), between (+3, or -3 and +3 h), or after (+8 h) the two E2 injections, but was not effective when given at +20 h. Significant inhibition of E2 + P-induced lordosis was achieved by 2.5 but not 1.0 or 0.2 mg DHT at -3 h, while uterine weights in the same animals were reduced significantly by 2.5 and 1.0 mg DHT. Serum E2 and DHT concentrations peaked rapidly after injection, declining to near baseline by 3 and 12 h, respectively. Induction of cytosolic progestin receptors (cPR) in the preoptic area and medial basal hypothalamus by estrogen was not prevented by DHT when animals were given the two pulsed E2 injections or daily injections of estradiol benzoate, although P was able to override the inhibitory behavioral effects of DHT in the latter but not the former group.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Prenatal inhibition of aromatase activity affects luteinizing hormone feedback mechanisms and reproductive behaviors of adult guinea pigs.

The necessity of brain aromatization for sexual differentiation was investigated by treating pregnant guinea pigs with an aromatase inhibitor, 1,4,6-androstatriene-3,17-dione (ATD), from Day 30 to Day 55 of gestation. In postnatal Week 16, subjects were gonadectomized, and blood samples were collected after treatment with 10 micrograms estradiol benzoate (EB), used to elicit an LH surge; subjects were subsequently treated with GnRH to test pituitary responsiveness. Plasma samples were assayed for LH by RIA. Prenatal ATD treatment did not affect the organization of the LH surge mechanism in either male or female subjects. All animals, regardless of sex or treatment, released LH after GnRH treatment, but the responsiveness of the gonadotroph to GnRH was attenuated in both males and females treated with ATD in utero. In addition, a significant sex difference in the pattern of LH released in response to a GnRH challenge was found. ATD-treated animals did not respond to the negative feedback actions of EB on LH secretion (p < 0.05), and the percentage of males displaying lordosis behavior was greater in this group than in controls (p < 0.05). Mounting behavior and lordosis behavior of females were not significantly affected by treatment. These data demonstrate a need for estrogen in the organization of brain areas that mediate negative feedback control of LH in both sexes and lordosis behavior in the male guinea pig. The organization of positive feedback mechanisms for controlling LH seems to be under androgenic control. Our data also suggest that the responsiveness of the gonadotroph to GnRH action is developmentally coordinated by prenatal estrogen and is sexually differentiated.

Androstatrienes↗
PubMed2001

Exposure of neonatal female rats to p-tert-octylphenol disrupts afternoon surges of luteinizing hormone, follicle-stimulating hormone and prolactin secretion, and interferes with sexual receptive behavior in adulthood.

The present study investigated the effects of exposure of neonatal female rats to p-tert-octylphenol (OP) on estrogen-induced afternoon surges of LH, FSH, and prolactin (PRL) secretion, and on sexual behavior in adulthood. After birth, one group of female Wistar rat pups received s.c. injections of OP (100 mg/kg body weight [BW]; OP group) dissolved in DMSO, while the control group received DMSO only (DMSO group). In order to make a qualitative comparison, a third group was injected with estradiol-17beta (500 microg/kg BW; estradiol group) dissolved in DMSO. Injections were given on Days 1, 3, 5, 7, 9, 11, 13, and 15 of age. The rats from the OP and estradiol groups that were used for subsequent experiments were in persistent vaginal estrus. Spontaneous LH surge measured at Postnatal Days (PND) 78-81 was observed only in the DMSO group on the afternoon of the day of proestrus. At PND 115, randomly selected rats from each of three treatment groups were bilaterally ovariectomized (ovx), and 8 days later, Silastic capsules containing estradiol-17beta were implanted under the skin. Estrogen implants stimulated afternoon surges of LH, FSH, and PRL for two consecutive days in the DMSO group, but not in the OP and estradiol groups. Rats from the OP and DMSO groups underwent ovx at PND 186, and 6 days later they were treated with a combination of estradiol benzoate s.c. (15 microg/kg BW) and progesterone s.c. (2 mg/kg BW) to test the lordosis reflex. In response to this hormone treatment and mounting stimulus delivered by the stud male rats, the OP-treated rats were less receptive compared with control DMSO-treated rats, and thus the lordosis quotient and lordosis rating were significantly (P < 0.05) reduced in the OP group compared with the DMSO group. Analysis of the area of the sexually dimorphic nucleus of the preoptic area of the brain revealed that the area of this nucleus was larger in the OP group than it was in control DMSO rats. We conclude that the exposure of neonatal female rats to higher doses of OP disrupts the cyclic release of LH, FSH, and PRL, and interferes with the display of sexual receptive behavior in adulthood.

Aging↗
PubMedDate not supplied

Spinal fusions to the sacrum in adults with scoliosis.

Forty-five skeletally mature patients averaging 44.3 years of age had spinal fusions which extended to the sacrum for pain and/or progression of their scoliosis. The primary diagnosis was idiopathic scoliosis in 35 patients, congenital scoliosis in two patients, and paralytic scoliosis in eight patients. A single curve pattern was present in 41 patients and the remainder had double primary curves. Thirty-eight patients had single stage procedures and 35 of these were done posteriorly. There was an evolution in the type of posterior instrumentation used over the 12 years. Thirty-five patients (78%) had at least one significant postsurgical complication. Thirteen of 22 patients with loss of lordosis required corrective osteotomies. Other complications included pseudoarthrosis in ten patients and neurologic complications in five patients, four of which had complete recovery. Twenty-five patients required a total of 51 subsequent surgical procedures. Despite a 51% initially poor result and a high complication rate, the final results were good or fair in 93% of the patients. This change was primarily the result of successful subsequent surgical procedures for correction of loss of lordosis and pseudoarthrosis. The adult scoliosis patient should be fused to the sacrum only if the lumbosacral disc is clearly a source of pain or the degree of pelvic obliquity makes it necessary in the paralytic curve. Every effort must be made to carefully preserve the patient's lumbar lordosis. Better results were obtained by using segmental spinal fixation in the form of sublaminar wiring of double Luque rods.

Adult↗
PubMed1985

Spinal deformities in patients with muscular dystrophy other than Duchenne. A review of 11 patients having surgical treatment.

Eleven patients diagnosed as having muscular dystrophy and who underwent posterior spinal fusion were reviewed: Becker dystrophy in one, limb girdle in two, facioscapulohumeral in one, myopathia unspecified in one, myotonia dystrophica in two, myotonia congenita in one, and hypotonia congenita in three. There were eight females and three males. The curve pattern was thoracic in four, thoracolumbar in three, double thoracic and thoracolumbar in three, and thoracolumbar lordosis in one. Scoliosis was associated with kyphosis in two, with lumbar lordosis in one, and thoracic lordosis in four patients associated with poor vital capacity and shortness of breath. Seven patients had nonoperative treatment, five showing increase of the curve, and two having control of the curve. All patients had posterior spinal fusion with instrumentation with a follow-up of 9-89 months (average, 41 months). Postoperative support was used in all but one. Major complications occurred in four patients: a symptom of vascular obstruction of the duodenum in two, extubation delayed until the 7th day postoperatively in one and pseudarthrosis in one resulting in an increasing curve and refusion. One patient (limb girdle), 6 years after surgery at 21 years died from cardiomyopathy. The second (limb girdle) lost ambulation at age 22 years, 6.6 years after spinal surgery. In conclusion, patients with muscular dystrophies other than Duchenne generally have slowly evolving curves, and the use of an orthosis in the juvenile years controlled the curve until the pubertal growth spurt, when progression occurred. Surgical treatment was successful in stabilizing the deformities.

Adolescent↗
PubMed1988

The sagittal configuration and mobility of the spine in idiopathic scoliosis.

The aim of this study is to see how the spinal sagittal configuration and mobility in 127 patients with idiopathic scoliosis are influenced by increasing scoliotic deformity and to determine when this deformity gets clinically significant compared to controls (n = 92). In patients with thoracic curves the degrees of thoracic kyphosis and lumbar lordosis were significantly less than those of the controls. Neither the kyphosis nor the lordosis were correlated to the Cobb angles. Even patients with small curves have straight spines in the sagittal plane; there is no tendency for the kyphosis and lordosis to decrease when the scoliotic deformity increases. This indicates that it is especially individuals with straight spines in the sagittal plane who are prone to develop scoliosis. It is also suggested that the limitation in spinal function for curves with Cobb angles below 50 degrees may be neglected.

Adolescent↗
PubMed1989

Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction.

Recent advances in spinal instrumentation have brought about a new emphasis on the three-dimensional spinal deformity of scoliosis and especially on the restoration of normal sagittal plane contours. Normal alignment in the coronal and transverse planes is easily defined; however, normal sagittal plane alignment is not so simple. This retrospective study was undertaken to increase the understanding of the normal alignment of the spine in the sagittal plane, with a special emphasis on the thoracolumbar junction. Measurements were made from the lateral radiographs of 102 subjects with clinically and radiographically normal spines. Cobb measurements of the thoracic kyphosis (T3-T12), the thoracolumbar junction (T10-T12 and T12-L2), and the lumbar lordosis (L1-L5) were determined. The spices of the thoracic kyphosis and lumbar lordosis also were determined. Using a computerized digitalizing table, the segmental angulation was determined at each level from T1-2 to L5-S1. In conclusion, there is a wide range of normal sagittal alignment of the thoracic and lumbar spines. When using composite measurements of the combined frontal and sagittal plane deformity of scoliosis, this wide range of sagittal variance should be taken into consideration. Using norms established here for segmental alignment, areas of hypokyphosis and hypolordosis commonly seen in scoliosis can be more objectively evaluated. The thoracolumbar junction is for all practical purposes straight; lumbar lordosis usually starts at L1-2 and gradually increases at each level caudally to the sacrum.

Adolescent↗
PubMed1992

Chiba Spinal System in the operative management of scoliosis.

The Chiba Spinal System was developed for three-dimensional correction of scoliosis. The system consists of a 7-mm diameter smooth solid rod, closed and open hooks, and specially designed conical sleeves. The rod does not have ratchets or threads, thus minimizing stress concentrations. The closed and open hooks are attached to the rod using the conical sleeves. The sleeves have longitudinal slits permitting compression during insertion. The outrigger system with a torque wrench is used to correct the deformity in the frontal plane. When correcting lordosis with vertebral rotation, a sagittal correction device may be used. Fifty-two patients with idiopathic scoliosis were operated on with this system from 1986 through 1989. The average correction of the scoliosis was 58%. For the 21 patients with thoracic lordosis less than 0 degrees, the mean preoperative lordosis was -8 degrees, which was corrected to +7 degrees. The mean correction of the vertebral rotation was 24%. Two patients complained of paresthesia of the thoracic region after operation, but this disappeared within 2 weeks. In 32 patients with more than 2 years' follow-up, the mean loss of correction was 3 degrees. One case with instrumentation failure was noted.

Adolescent↗
PubMed1994

An analysis of sagittal curves and balance after Cotrel-Dubousset instrumentation for kyphosis secondary to Scheuermann's disease. A review of 32 patients.

STUDY DESIGN: This study compared preoperative and postoperative saggittal curves and spinal balance in patients undergoing spinal fusion with Cotrel-Dubousset instrumentation for severe kyphosis secondary to Scheuermann's disease. Also determined was patient satisfaction regarding relief of pain and correction of the deformity. Thirty two patients with kyphosis > 75 degrees underwent spinal fusion with Cotrel-Dubousset instrumentation. OBJECTIVES: To evaluate the initial and long-term correction of the primary kyphosis and changes in lumbar lordosis and sagittal balance, and to determine the incidence and etiology of junctional sagittal deformities. SUMMARY OF BACKGROUND DATA: The average preoperative kyphosis was 85 degrees (range, 75 degrees to 105 degrees) with an average correction at final follow-up of 43 degrees (range, 26 degrees to 65 degrees). Preoperative lumbar lordosis averaged 75 degrees (range, 58 degrees to 100 degrees) and at final follow-up averaged 55 degrees (range, 23 degrees to 74 degrees). Most of the patients demonstrated negative sagittal balance and became slightly more negatively balanced postoperatively. RESULTS: Maintenance of correction postoperatively was excellent, with only a 4 degree average loss of correction. There was spontaneous reduction in lumbar lordosis of varying degrees. Proximal junctional kyphosis was associated with over-correction (> 50%) of the kyphotic deformity or a fusion starting short of the proximal vertebra in the measured kyphosis. Distal junctional kyphosis developed in patients whose fusion ended short of the first lordotic segment. CONCLUSIONS: This procedure appeared to yield good results when proper levels of fusion were selected and correction > 50% was not attempted.

Adult↗
PubMed1996

New anterior instrumentation for the management of thoracolumbar and lumbar scoliosis. Application of the Kaneda two-rod system.

STUDY DESIGN: The Kaneda multisegmental instrumentation is a new anterior two-rod system for the correction of thoracolumbar and lumbar spine deformities. This system consists of a vertebral plate and two vertebral screws for individual vertebral bodies and two semirigid rods to interconnect the vertebral screws. Clinical results of 25 thoracolumbar and lumbar scoliosis patients treated with this new instrumentation were analyzed. OBJECTIVES: To evaluate the efficacy of the new anterior instrumentation in correction and stabilization of thoracolumbar and lumbar scoliosis. SUMMARY OF BACKGROUND DATA: Since Dwyer first introduced the concept of anterior spinal instrumentation and fusion for scoliosis, anterior surgery has gradually gained acceptance. In 1976, a useful modification for the anterior spinal instrumentation, which reportedly provided means of lordosation and vertebral body derotation, was described. However, some authors reported a high tendency of the implant breakage, loss of correction, progression of the kyphosis, and pseudoarthrosis as the major complications. To overcome the disadvantages of Zielke instrumentation, the authors have developed a new anterior spinal instrumentation (two-rod system) for the management of thoracolumbar and lumbar scoliosis. METHODS: Anterior correction and fusion using Kaneda multisegmental instrumentation was performed in 25 patients with thoracolumbar or lumbar scoliosis. The average follow-up period was 3 years, 1 month (range, 2 years to 4 years, 7 months). There were 20 patients with idiopathic scoliosis (13 adolescents and seven adults) and five patients with other types of scoliosis, including congenital and other etiologies. All patients had correction of scoliosis by fusion within the major curve, and for 16 of the 25 patients, the most distal end vertebra was not included in the fusion (short fusion). Radiographic evaluations were performed to analyze frontal and sagittal alignments of the spine. RESULTS: The average correction rate of scoliosis was 83%. Over the instrumented levels, the correction rate was 90%. Preoperative kyphosis of the instrumented levels of 7 degrees was corrected to 9 degrees of lordosis. Sagittal lordosis of the lumbosacral area beneath the fused segments averaged 51 degrees before surgery and was reduced to 34 degrees after surgery. The trunk shift was improved from 25 mm before surgery to 4 mm at final follow-up evaluation. The average improvement in the lower end vertebra tilt-angle was 97% in those patients whose lower end vertebra was included in the fusion and 83% in patients whose lower end vertebra was not included in the fusion. Apical vertebral rotation showed an average correction rate of 86%. At final follow-up evaluation, all patients demonstrated solid fusion without implant-related complications. There was 1.5 degrees of frontal plane and 1.5 degrees of sagittal plane correction loss within the instrumented area at final follow-up evaluation. CONCLUSIONS: New anterior two-rod system showed excellent correction of the frontal curvature and sagittal alignment with extremely high correction capability of rotational deformities. Furthermore, correction of thoracolumbar kyphosis to physiologic lordosis was achieved. This system provides flexibility of the implant for smooth application to the deformed spine and overall rigidity to correct the deformity and maintain the fixation without a significant loss of correction or implant failure compared with conventional one-rod instrumentation systems in anterior scoliosis correction.

Adolescent↗
PubMed1998

Comparison of standing sagittal spinal alignment in asymptomatic adolescents and adults.

STUDY DESIGN: A retrospective examination of the spine radiographs of 88 asymptomatic adolescents was performed to analyze the indices of regional and segmental sagittal spinal alignment in relation to the sagittal vertical axis as determined by the C7 plumb line. OBJECTIVES: To determine the sagittal spinal alignment in asymptomatic adolescents and to correlate the sagittal vertical axis with the overall sagittal spinal balance and other indices of sagittal spinal alignment. In addition, to compare these results with previously established data for asymptomatic adults. SUMMARY OF BACKGROUND DATA: Previous studies of sagittal spinal alignment have included subjects encompassing a wide range of ages. A previous study at the authors' institution established normative data for sagittal spinal alignment in asymptomatic adults. No previous study has reported on the correlation between the sagittal vertical axis and other measurements of sagittal spinal alignment in asymptomatic adolescents. METHODS: Measurements obtained from the standing lateral spine radiographs of 88 asymptomatic adolescents (age range, 10-18 years) were collected and analyzed using statistical methods. These data were compared with previously established data for asymptomatic adults. RESULTS: There was a striking similarity in regional thoracic kyphosis and lumbar lordosis between adolescents and adults. Despite having similar regional and segmental sagittal alignments, adolescents had a significantly more negative sagittal vertical axis (mean, -5.6 cm) than adults (mean, -3.2 cm; P = 0.0001). Also, unlike that in adults, the sagittal vertical axis in adolescents was not significantly correlated with the distal segmental lumbar lordosis. The sagittal vertical axis in adolescents was significantly correlated with the level of thoracic kyphosis and the distances from the thoracic apex, lumbar apex, and T12 to the C7 plumb line. Sacral inclination, which is a determinant of hip extension and standing pelvic rotation, was correlated with the lumbar apex and the total and segmental lordosis, except at L5-S1. CONCLUSIONS: Asymptomatic adolescents tend to stand in greater negative sagittal spinal balance than asymptomatic adults, despite similar regional and segmental alignments in the thoracic and lumbar spine. The role of hip extension, spinopelvic axis rotation, and other sagittal alignment parameters in determining the sagittal vertical axis in adolescents warrants further study.

Adolescent↗
PubMed2004

Correlation between backpack weight and way of carrying, sagittal and frontal spinal curvatures, athletic activity, and dorsal and low back pain in schoolchildren and adolescents.

This cross-sectional study was carried out to investigate any correlation between backpack carrying, spinal curvatures, and athletic activities on schoolchildren's dorsal (DP) and low back pain (LBP). Three thousand four hundred forty-one students aged from 9 to 15 years who carried backpacks to school were included in this study and asked for DP and LBP experiences in the school period while carrying the backpack. Nonradiating methods (surface back contour analysis) were used to indirectly measure frontal spinal curve (scoliosis) with the scoliometer and lateral curves (thoracic kyphosis and lumbar lordosis) with the kyphometer. All data analyses were undertaken regarding school year level, age, gender, sports participation, backpack weight, and way of carrying (one versus both shoulder) in relation to magnitude of scoliosis, thoracic kyphosis, lumbar lordosis, and DP and LBP while carrying the backpack. DP increased with increasing backpack weight (P < 0.05). The way (one versus both shoulder) of backpack carrying did not correlate either with DP or with LBP. Girls experienced much more LBP and DP than boys (P < 0.001). There was no difference in the prevalence of LBP and DP between adolescents and children. Students' age, height, and body weight as well as magnitude of kyphosis, lordosis, and scoliosis did not correlate with either LBP or DP. At the age of 11 years, girls and boys showed the highest prevalence for DP (72% and 38.5%, respectively), while at the age of 14 years, girls reported significantly (P < 0.05) more DP than boys. Girls showed the highest prevalence of LBP (71%) at the age of 11 years, while for the boys, it was at the age of 15 years (21%). Girls showed at the age of 11 years significantly more LBP (P < 0.05) than boys. Sports exposure seemed to increase LBP in girls (P < 0.001). The results of this study suggest a differential DP and LBP prevalence in schoolchildren and adolescents carrying backpacks with regard to gender and age. The peak in pain prevalence was immediately before puberty as well as immediately after its onset. Girls who participated in sports activities seem to experience more often DP and LBP than boys. Short children who carry backpacks as heavy as do tall children at the same age are more prone to LBP.

Adolescent↗
PubMed2003

Anterior single rod instrumentation for thoracolumbar adolescent idiopathic scoliosis with and without the use of structural interbody support.

STUDY DESIGN: A radiographic and clinical outcomes analysis of 41 patients treated for thoracolumbar adolescent idiopathic scoliosis utilizing a single anterior rigid rod construct. OBJECTIVES: To evaluate the necessity of structural interbody support to improve primary curve correction and preserve or augment lordosis when used in conjunction with a single anterior rigid rod construct, to identify parameters that predict horizontalization of the lowest instrumented vertebra, adjacent disc angulation, and distal uninstrumented vertebrae, and to assess patient satisfaction following surgery. BACKGROUND DATA: Instrumentation-induced kyphosis has been a concern with nonrigid anterior systems used in the past for the treatment of scoliosis. Interbody structural support has been recommended to maintain appropriate sagittal profile when anterior systems are utilized. It has also been suggested that the use of structural interbody support creates a fulcrum to increase curve correction when compression is applied to the convexity of the deformity. However, the necessity of interbody structural support when used in conjunction with a rigid anterior system has not been previously evaluated in patients with adolescent idiopathic scoliosis. MATERIALS AND METHODS: Forty-one patients mean age 15.9 years (range 12.1-18.6 years) with thoracolumbar adolescent idiopathic scoliosis underwent anterior spinal fusion using a single 6.0 to 6.5 mm solid rod construct between June 1995 and August 1999 performed by the senior author (T.G.L.). Four additional patients with thoracolumbar curves with similar anterior instrumentation over the same time period were lost to follow-up or had incomplete records and were not included in the study. Structural interbody support was used in 21 patients and packed morselized autograft alone was used in 20 patients. The patients in the group with packed morselized bone alone generally underwent surgery earlier in the series before the author began using structural interbody support on a regular basis. Each patient had a minimum follow-up of 3 years. Preoperative, initial, and most recent (>3 years) follow-up radiographs were reviewed to determine in each group Cobb angle measurements, flexibility of primary, secondary, and fractional curves, apical and end vertebral translation, lowest instrumented vertebral and caudal disc angulation, global coronal and sagittal balance, and sagittal Cobb measurements in both instrumented levels as well as lumbar lordosis (T12-S1). In addition, the SRS outcomes instrument was completed by 38 of 41 patients. RESULTS: The mean preoperative primary curve in patients with structural support was 47 degrees (Group II) and 45 degrees in patients without structural support (Group I). Mean curve correction was to 13 degrees in Groups I and II. One patient in Group II became slightly more unbalanced at final follow-up; otherwise all were improved after surgery. Sagittal measurements over instrumented segments as well as total lumbar lordosis (T12-S1) was maintained between preoperative and final postoperative values in both groups. Similarly, in both groups, when horizontalization of the distal end instrumented vertebra was achieved on the preoperative reverse side-bending radiograph, more normal relationships were achieved between instrumented and distal noninstrumented segments (adjacent disc angulation and fractional lumbar curve) at final follow-up (P <or= 0.01). Patients in both groups were equally pleased with their clinical outcomes based on the SRS outcomes instrument. CONCLUSIONS: The use of interbody structural support does not appear to be necessary to maintain an appropriate sagittal profile or to maximize coronal curve correction when a rigid rod construct with packed morselized bone is used for the treatment of thoracolumbar adolescent idiopathic scoliosis. Parameters predicting horizontalization of the lower instrumented vertebra and uninstrumented segments below the construct were identified, which, if achieved, should predict an optimal long-term outcome. Clinical outcomes were very good in both groups.

Adolescent↗
PubMed2006

Surgical treatment of scoliosis in larsen syndrome with bilateral hip dislocation.

STUDY DESIGN: This is a report of a 12-year-old girl treated surgically for scoliosis associated with bilateral hip dislocation in Larsen syndrome. OBJECTIVE: To describe a rare case of scoliosis associated with Larsen syndrome and bilateral hip dislocation that was treated surgically with follow-up for 15 years. SUMMARY OF BACKGROUND DATA: There are few reports of the long-term follow-up of cases involving surgically treated scoliosis associated with bilaterally dislocated hips. METHODS: The patient's spine showed a right thoracic curve (T5-T12) with a Cobb angle of 77 degrees and did not show pelvic obliquity on an anterior-posterior radiograph film. On the sagittal alignment of her spine, the thoracic spine showed an abnormal lordosis (T5-T12: 19 degrees), and the lumbar spine had a hyperlordosis (L1-S1: 57 degrees) with a large lumbosacral angle (72 degrees ). We performed a posterior spinal fusion between T4 and L2 using Cotrel-Dubousset Instrumentation, anticipating the restoration of normal lumbar and cervical lordosis, as well as thoracic kyphosis. RESULTS: The Cobb angle of thoracic scoliosis improved from 77 degrees to 28 degrees, and a thoracic kyphosis of 12 degrees (T5-T12) was obtained. Subsequently, on the sagittal plane, the lumbosacral angle (sacral anteflexion) decreased from 72 degrees to 52 degrees, comparable to that of patients with hip dislocation, and the lumbar lordotic angle increased from 57 degrees to 66 degrees. The restoration of thoracic kyphosis resulted in an increase of lumbar lordosis and decrease of sacral anteflexion. At the 15-year follow-up,although the thoracic scoliosis (T5-T12) had increased to 36 degrees, good coronal and sagittal balance had been maintained. The patient is asymptomatic in her spine and hip. CONCLUSIONS: A case of scoliosis associated with dislocated hips in a patient with Larsen syndrome was successfully treated with posterior correction surgery. Fusion surgery between T4 and L2 provided an ideal sagittal balance of the total spine, while preserving 4 lumbar mobile segments.

Child↗
PubMed1998

Effect of wide posterior release on correction in adolescent idiopathic scoliosis.

Wide lumbar posterior release, consisting of partial excision of spinous process, excision of interspinous ligament and ligamentum flavum, and excision of facet in plane of facet from both outside and within the spinal canal has been employed to increase coronal correction and improve the production of lumbar lordosis (10). Adolescent idiopathic patients with fusion into the lumbar spine were studied. Pre- and postsurgical coronal and sagittal Cobb measurements as well bending measurements were done. Intraoperative biplanar radiographs were done after positioning, after lumbar rod placement, and finally after wide release and placement of the same rod. Statistical analysis was by paired Student's t-test. Significantly (p < 0.005), improved correction was attained in the coronal plane with release (76% vs. 64%). Total lordosis and instrumented segment lordosis was also significantly (p < 0.025) improved with release (12 degrees vs. 3 degrees). Coronal and sagittal plane correction in the lumbar spine is improved significantly with a wide posterior lumbar release.

Adolescent↗
PubMed1984

A long-term retrospective study of proximal hamstring release for hamstring contracture in cerebral palsy.

Proximal hamstring release was used exclusively for hamstring contracture in patients with spastic cerebral palsy. Average follow-up was 9 years 5 months. Thirty-two of 78 patients were examined retrospectively. Straight leg raising increased from 30 to 68 degrees. Knee flexion contracture decreased from 16 to 9 degrees. Knee flexion contractures of greater than 10 degrees were not permanently corrected. Only four of 64 knees were in mild (5-10 degrees) recurvatum at follow-up. Lumbar lordosis averaged 53 degrees at follow-up, and hip flexion contracture release apparently had little effect on lumbar lordosis. Proximal hamstring release can be used by this described technique without severe lumbar lordosis or devastating genu recurvatum.

Adolescent↗
PubMed2006

Infusions of 5alpha-pregnan-3alpha-ol-20-one (3alpha,5alpha-THP) to the ventral tegmental area, but not the substantia nigra, enhance exploratory, anti-anxiety, social and sexual behaviours and concomitantly increase 3alpha,5alpha-THP concentrations in the hippocampus, diencephalon and cortex of ovariectomised oestrogen-primed rats.

Sequential actions of 17beta-oestradiol (E2) and progesterone (P4) in the ventromedial hypothalamus (VMH) and ventral tegmental area (VTA) mediate sexual behaviour of female rodents. In the presence of appropriate environmental stimuli, E2 and P4 can facilitate initiation of sex behaviour (i.e. lordosis), in part through classic actions at intracellular progestin receptors in the VMH. However, the effects of P4 in the VTA to modulate lordosis involve its metabolite, 5alpha-pregnan-3alpha-ol-20-one (3alpha,5alpha-THP), which can have paracrine effects in the brain to reduce anxiety and stress. We investigated the effects of 3alpha,5alpha-THP infusions to the VTA, and a control site, the substantia nigra (SN), on exploratory, anti-anxiety, social and sexual behaviours (socio-sexual behaviours) and hormone levels in the midbrain and other regions (hippocampus, diencephalon and cortex) that may mediate these functions. Ovariectomised, rats were E2-primed (10 microg, s.c.) at 0 h and were infused with beta-cyclodextrin vehicle or 3alpha,5alpha-THP to the VTA or SN 44-48 h later. Ten minutes after infusions, rats were tested in the open field, plus maze, partner preference, social interaction and paced mating tasks, or served as nontested controls. Infusions of 3alpha,5alpha-THP to the VTA, but not the SN, increased central entries in the open field, open arm time in the plus maze, time spent in proximity to a male, duration of social interaction, incidence and intensity of lordosis, pacing, proceptivity, and anti-conflict behaviour. 3Alpha,5alpha-THP, but not vehicle, infusions to the VTA (but not the SN) also increased 3alpha,5alpha-THP levels in the midbrain, as well as the hippocampus, diencephalon and cortex. Behavioural testing increased levels of the precursor of 3alpha,5alpha-THP precursor, dihydroprogesterone (DHP). Thus, infusions of 3alpha,5alpha-THP to the VTA enhance socio-sexual behaviours and increase 3alpha,5alpha-THP levels in the hippocampus, diencephalon and cortex, and behavioural testing increases DHP levels in brain areas involved in modulating socio-sexual behaviours.

Animals↗
PubMed1986

Environment and hamster reproduction: responses to phase-specific starvation during estrous cycle.

Reproductive capacity of female hamsters, as estimated by the ovulatory response, is particularly susceptible to interference by food deprivation. Previous studies showed that hamsters generally fail to ovulate if deprived of food for one or two estrous cycles. The present work demonstrates that starvation which is specific to the 2 days immediately after ovulation will block the next expected ovulation in approximately 80% of the animals. Such phasic starvation also resulted in significantly smaller ovarian follicle sizes. When placed with vigorous males, anovulatory animals failed to show lordosis behavior unless exogenous estradiol benzoate (EB) was supplied. With EB provided, all animals showed short-latency lordosis. These bioassay data suggested that poorly developed follicles were secreting insufficient estradiol for the facilitation of lordosis. Exogenous luteinizing hormone (LH) given 6 h before lights off on cycle day 4 failed to elicit ovulation, further suggesting that the follicles were not mature. Radioimmunoassay of LH and follicle-stimulating hormone (FSH) levels during the ovulatory gonadotropin surge showed that LH was vastly reduced, whereas FSH was in the low-to-normal range. Estradiol levels, assayed immediately before the gonadotropin surge, were low compared with controls, whereas progesterone levels were higher than normal. The results suggest that ovulatory failure in response to phasic food deprivation is a joint function of absence of an ovulatory LH surge and a set of immature follicles.

Animals↗