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PubMed2006

Spinal deformity in a sandtiger shark, Carcharias taurus Rafinesque: a clinical-pathological study.

The present study investigated spinal deformity in a captive sandtiger shark and describes the clinical and histopathological features of the lesion. Clinically, the shark presented a marked spinal curvature in the region between the pectoral girdle and cranial dorsal fin. Radiographic studies revealed scoliosis and kyphosis of the vertebral column with a modification of the basic structure of five vertebrae. Post-mortem examination confirmed the results of radiographic studies and histological examination showed remodelling and cartilaginous proliferation of the vertebral bodies together with necrosis, haemorrhage and signs of a local chronic inflammatory response extending to the surrounding muscle. Different aetiologies are proposed and discussed but nutritional imbalance (dietary vitamin deficiency) and/or traumatic injury are considered the most likely contributing factors.

Animals↗
PubMed1999

Familial aggregation in Rett syndrome: what is the evidence for clustering of other disorders in families of affected girls?

Rett syndrome is a neurodevelopmental disorder of unknown cause which affects girls almost exclusively. Apparently normal development in the first year of life is usually followed by loss of skills and the development of stereotypic hand movements. This study has used genetic epidemiological methods including a case control design to examine the evidence for aggregation of other disorders in families of girls with Rett syndrome. In one family there were two sisters with a condition consistent with Rett syndrome. Intellectual disability was not reported more commonly in case families (P = 0.46). However, "learning problems" were slightly commoner (P = 0.05) especially in the parental generation (P = 0.02) and these findings warrant further investigation. Mental illness and seizures were not reported at an increased prevalence. However, we would recommend the use of other strategies to collect information about psychiatric illness. Spinal curvature was reported more commonly in case families (P = 0.07) but no mechanism for clinical verification of this was included in the study. There was an apparent increase in bowel problems in the parents (P = 0.04). The major weaknesses of our study were our inability to validate any diagnosis clinically and the lack of power (due to the comparative rarity of the outcomes). The strengths are that we have been able to collect pedigree data on the families of a substantial proportion of a total population of girls with Rett syndrome and to collect comparative data from a control population. Our reported findings warrant further investigation in a larger study.

Case-Control Studies↗
PubMed2002

Congenital abnormalities of the urogenital tract in association with congenital vertebral malformations.

There is a close link between the embryological development of the musculoskeletal system and all other main organ systems. We report a prospective series of 202 patients with congenital vertebral abnormalities and document the associated abnormalities in other systems. There were 100 boys and 102 girls. In 153 there were 460 associated abnormalities, a mean of 2.27 abnormalities for each patient. Intravenous pyelography was carried out on 173 patients (85.6%) and ultrasonography on the remaining 29 (14.4%). Patients with genitourinary anomalies were more likely to have musculoskeletal (p = 0.002), gastrointestinal (p = 0.02) and cardiac abnormalities (p = 0.008) than those without genitourinary involvement. A total of 54 (26.7%) had at least one genitourinary abnormality, the most frequent being unilateral renal agenesis. There was urinary obstruction in six (3%). There was no association between genitourinary abnormality and the place of birth, parental age, birth order, level of spinal curvature, or the number, type and side of spinal anomaly. There was, however, a statistically significant association (p = 0.04) between costal and genitourinary abnormalities. The incidence of genitourinary abnormalities (26.7%) was similar to that of previously reported series. The diagnosis of a congenital vertebral abnormality should alert the clinician to a wide spectrum of possible associated anomalies most of which are of clinical importance.

Abnormalities, Multiple↗
PubMed1993

Optoelectronic evaluation of trunk deformity in scoliosis.

In this study, truncal deformity in patients with scoliosis was evaluated by circumferential scanning using an optoelectronic device (Optronic Torsograph, Anima Corp., Tokyo, Japan). This device generates cross-sectional skin surface topography at 10 axial levels to provide a three-dimensional representation of truncal shape. Ninety-three patients with suspected idiopathic scoliosis were evaluated with conventional Cobb measurements, and their parameters were computed using the device's measurements. The geometric cross-sectional indexes correlated poorly with the Cobb angle and were highly variable during repeated measurements. The optoelectronic device's angle, a measure of centroid curvature, correlated highly with the Cobb angle for primary spinal curves. The highest correlation was observed in thoracolumbar curves. This optoelectronic device has clinical relevance as a method for further scoliosis screening and monitoring the progression of spinal curvature in a patient.

Adolescent↗
PubMed1997

Spinal abnormalities in classic bladder exstrophy.

OBJECTIVE: To determine the frequency and clinical sequelae of significant spinal malformations in children born with classic bladder exstrophy. PATIENTS AND METHODS: All patients evaluated or treated for classic bladder exstrophy at this institution were reviewed retrospectively. Radiographs or reports pertinent to the spine were retrieved and reviewed with a paediatric radiologist and all vertebral abnormalities categorized. Clinical charts of those with spinal anomalies were reviewed to determine any clinical neurological disorders associated with the radiographic findings. RESULTS: Of 423 patients with classic bladder exstrophy who were identified, 299 had radiographs or reports available for adequate review. Of these, 34 (11%) normal variants, e.g. spina bifida occulta and lumbarization or sacralization of vertebrae, were identified. Abnormalities of spinal curvature were identified in eight patients (2.7%), all with uncomplicated scoliosis. Spinal dysraphism was diagnosed in 12 patients (4%) and included myelomeningocele, lipomeningocele, scimitar sacrum, posterior laminal defects in two or more vertebrae, vertebral fusion and hemivertebrae. The one patient with myelomeningocele had clinical neurological dysfunction, giving an overall incidence of 0.3%. CONCLUSIONS: Spinal anomalies, excluding normal variants, occur in children born with classic bladder exstrophy at a rate of about 6.7%. The incidence of this association is much less than that for cloacal exstrophy. Although rare, neurological dysfunction can occur in the case of spinal dysraphism. Paediatric urologists and neurologists should be aware of this significant difference between patients with classic bladder and cloacal exstrophy to properly diagnose, evaluate and treat the attendant neurological problems.

Adolescent↗
PubMed1984

Orthotic management of scoliosis in Duchenne muscular dystrophy.

This study investigates the effectiveness of spinal supports and seating systems in retarding the progress of spinal curvature in Duchenne muscular dystrophy. The approach was to take six monthly radiographs of children with this disease attending the Regency Park Centre sitting in their wheelchairs with their usual spinal supports. Scoliosis progressed from a mean value of approximately 10 degrees for children under 12 years to a value of the order of 75 degrees by the age of 16 to 18 years. The rate of progression peaked at an average of more than 1 degree per month between 14 and 18 years. The curvatures observed using modular seats, spinal jackets and custom-molded seats were not significantly different from those observed using unmodified wheelchair seats.

Adolescent↗
PubMed2006

Adolescent idiopathic scoliosis: modern management guidelines.

Adolescent idiopathic scoliosis (AIS), a structural lateral curvature of the spine of uncertain etiology, is the most common cause of spinal deformity in adolescents. In its most severe form, AIS is characterized by progressive spinal curvature that may lead to a permanent deformity. Thus, the goal of treatment is early detection and prevention of progression. This article provides a review of general spinal anatomy relevant to AIS and its etiology, describes several proposed methods of classifying curves in AIS, delineates the natural history of AIS, and discusses the nonoperative and operative treatment options.

Adolescent↗
PubMed1997

The biomechanics of gravity-dependent traction of the lumbar spine.

STUDY DESIGN: This study evaluated the biomechanical responses evoked by the use of a gravity-dependent, self-operated traction device. These responses were determined by radiographs and were correlated with the body weight of the patient who was supported by a seat strap. OBJECTIVES: To examine the biomechanical effectiveness of the LTX 3000 Lumbar Rehabilitation System. SUMMARY OF BACKGROUND DATA: The LTX 3000 Lumbar Rehabilitation System (Spinal Designs International, Minneapolis, MN) was used to administer the lumbar fraction. No previous study has been conducted on this device. METHODS: For each of the 14 healthy male patients (age range, 19-69 years), lumbar lengthening, alterations in spinal curvature, and thoracic spine movement were assessed using radiographs taken: 1) before traction; 2) at 2, 10, and 15 minutes after the onset of traction; and 3) 2 minutes after traction was completed. Strain on the buttocks-supporting seat strap was recorded continuously during study sessions. RESULTS: The entire patient pool displayed an average maximal lumbar lengthening of 6.39 +/- 4.21 mm. The amount of lumbar lengthening was influenced by the degree of thoracic immobilization and by the amount of prior LTX 3000 (Spinal Designs International) use. Significant curvature reduction was observed during and after traction for the entire patient pool. Strain measurements correlated well with the measured response in the radiographs. CONCLUSIONS: Proper use of the LTX 3000 (Spinal Designs International) induces significant lumbar lengthening and curvature reduction in healthy patients. Measurements of body weight supported by the seat strap could help determine if thoracic immobilization has been achieved and if the patient is responding to the lumbar unloading.

Adult↗
PubMed1994

Three-dimensional simulations of the scoliosis derotation maneuver with Cotrel-Dubousset instrumentation.

The derotation maneuver using Cotrel-Dubousset instrumentation (CDI) is intended to correct the counterdirectional transverse plane rotations of the spine and of the vertebrae in thoracic scoliosis. This was simulated in a finite element model of an idealized thoracic scoliosis with an initial 65 degrees scoliosis angle and 0 degree kyphosis angle. After 90 degrees of rod rotation the apical vertebra derotated 50 degrees towards the sagittal plane but the apical vertebra axial rotation worsened by 8 degrees. The scoliosis angle corrected to 29 degrees and a 54 degrees kyphosis was created. If the initial rod curvature was reduced by 9 degrees, the model predicted only small changes in spinal curvature resulting from the forces required to connect the vertebrae to the hooks. Decreased kyphosis and scoliosis curvatures but increased vertebra axial rotation were produced by the derotation maneuver. The increase in apical vertebra axial rotation was reversed by modifying the representation of the motion segments by repositioning their effective axes 30 mm posteriorly.

Biomechanical Phenomena↗
PubMed2006

Sublethal effects of lead on northern leopard frog (Rana pipiens) tadpoles.

Northern leopard frogs (Rana pipiens) were exposed to environmentally relevant concentrations of lead in water (3, 10, and 100 microg/L as lead nitrate) from the embryonic stage to metamorphosis. Survival, growth, deformity, swimming ability, metamorphosis, and lead tissue concentrations were evaluated. Tadpole growth was significantly slower in the early stages (Gosner stages 25-30) in 100 microg/L treatment. More than 90% of tadpoles in the 100 microg/L treatment developed lateral spinal curvature, whereas almost all the tadpoles in the other groups were morphologically normal. Spinal deformity was associated with abnormal swimming behavior. Maximum swimming speed of tadpoles in the 100 microg/L treatment was significantly lower than that in the other groups. No significant effect of lead exposure was found on percentage metamorphosis, snout-vent length, mortality, and sex ratio of metamorphs. Time to metamorphosis was delayed in 100 microg/L treatment. Lead tissue concentrations in the tadpoles ranged from 0.1 to 224.5 mg/kg dry mass, were positively related to lead concentrations in the water, and fell within the range of tissue concentrations of wild tadpoles found in previous studies. According to our results, the current U.S. Environmental Protection Agency freshwater-quality chronic criterion for lead (2.5 microg/L) is appropriate to protect northern leopard frog larvae.

Aging↗
PubMed1988

[Neurologic evaluation of the fitness for vocational training of students of the school of fashion. The qualifying criteria].

Seventy two pupils of the vocational clothing school underwent neurological examinations. The examinations were aimed at finding out which diseases or deviations of the nervous system might contraindicate professional education at the clothing school. In the authors' opinion, limitations in professional education capability would apply to young people affected by: epilepsy, advanced neurosis, migraine with frequent headache attacks, certain forms of vasomotor headaches, and, in pupils with spinal curvature--those cases which were periodically affected by radiculalgia or myalgia resulting from spinal overload.

Adolescent↗
PubMed2003

Chiropractic management of Ehlers-Danlos syndrome: a report of two cases.

OBJECTIVE: To discuss 2 patients with Ehlers-Danlos syndrome seeking chiropractic evaluation and management of their disabling musculoskeletal pain and associated disorders. CLINICAL FEATURES: Two disabled patients diagnosed with Ehlers-Danlos syndrome had spinal pain, including neck and back pain, headache, and extremity pain. Commonalities among these 2 cases included abnormal spinal curvatures (kyphosis and scoliosis), joint hypermobility, and tissue fragility. One patient had postsurgical thoracolumbar spinal fusion (T11-sacrum) for scoliosis and osteoporosis. The other patient had moderate anterior head translation. INTERVENTION AND OUTCOME: Both patients were treated with mechanical force and manually assisted spinal adjustments delivered to various spinal segments and extremities utilizing an Activator II Adjusting Instrument and Activator Methods Chiropractic Technique. Patients were also given postural advice, stabilization exercises, and postural corrective exercises, as indicated in Chiropractic BioPhysics Technique protocols. Both patients were able to reduce pain and anti-inflammatory medication usage in association with chiropractic care. Significant improvement in self-reported pain and disability as measured by visual analog score, Oswestry Low-Back Disability Index, and Neck Pain Disability Index were reported, and objective improvements in physical examination and spinal alignment were also observed following chiropractic care. Despite these improvements, work disability status remained unchanged in both patients. CONCLUSION: Chiropractic care may be of benefit to some patients with connective tissue disorders, including Ehlers-Danlos syndrome. Low-force chiropractic adjusting techniques may be a preferred technique of choice in patients with tissue fragility, offering clinicians a viable alternative to traditional chiropractic care in attempting to minimize risks and/or side effects associated with spinal manipulation. Psychosocial issues, including patient desire to return to work, were important factors in work disability status and perceived outcome.

Adult↗
PubMed1999

Ten-year follow-up evaluation of a school screening program for scoliosis. Is the forward-bending test an accurate diagnostic criterion for the screening of scoliosis?

STUDY DESIGN: A 10-year follow-up evaluation of the effectiveness of school screening for scoliosis performed in a closed island population. OBJECTIVES: To evaluate the diagnostic accuracy of methods used for screening scoliosis and to re-examine the long-term effectiveness of the school scoliosis screening program. SUMMARY OF BACKGROUND DATA: The diagnostic accuracy of the forward-bending test and the long-term efficacy of the screening programs have not been clearly established. METHODS: In 1987, 2700 pupils aged 8 to 16 years from the island of Samos were screened for scoliosis. The Adams forward-bending test, Moire topography, the scoliometer, and the humpometer were used. Radiologic evaluation of the spine was available for each pupil and the number of false-negative and false-positive results of the screening methods was calculated. Subsequently, sensitivity, specificity, and positive and negative predictive values were estimated for each screening technique. Pupils found positive for spinal deformity were then followed up regularly at yearly intervals. In 1997, all positive subjects attended a 10-year clinical and radiologic follow-up, and the remaining subjects were re-evaluated by a postal questionnaire and were clinically examined if necessary. RESULTS: Spinal deformity was found in 153 (5.66%) pupils. Scoliosis (defined as a spinal curvature > or = 10 degrees) was found in 32 pupils, for a prevalence of 1.18%. For scoliosis, the Adams forward-bending test showed a number of false-negative results (in five cases), for a sensitivity of 84.37% and specificity of 93.44%. The sensitivities of Moire topography, the humpometer, and the scoliometer were 100%, 93.75%, and 90.62%, respectively, and specificity was 85.38%, 78.11%, and 79.76% respectively. The negative predictive value of the forward-bending test was inferior to those of the other methods. During this scoliosis screening program, if cutoff limits for referral had been used, such as the asymmetry of two Moire fringes, a humpogram deformity of (D + H) = 10 mm, and 8 degrees of scoliometer angle, it would have been possible to reduce radiologic examination by 89.4%. Three (0.11%) pupils aged between 12 and 14 years with scoliotic deformities greater than 20 degrees underwent satisfactory nonoperative treatment with Boston braces. One pupil with a 40 degrees thoracic curvature, underwent satisfactory surgical treatment because of progression 1 year later. Of the 121 spinal deformities with an initial Cobb angle less than 10 degrees, 44 (35.8%), and of the 29 scoliotic deformities with an initial Cobb angle between 10 degrees and 20 degrees, 14 (48.3%) progressed (a Cobb angle difference of at least 5 degrees in more than one examination). Observation and physiotherapy were the only treatments applied to all except one of the pupils in these groups. CONCLUSIONS: The Adams forward-bending test cannot be considered a safe diagnostic criterion for the early detection of scoliosis (especially when it is used as the only screening tool) because it results in an unacceptable number of false-negative findings. For the early detection of scoliosis, a combination of back-shape analysis methods can be safely used with the introduction of cutoff limits for referral being a useful procedure. The incidence of significant scoliosis is low, and its natural history seems to be independent of early detection. The wide-spread use of school scoliosis screening with the use of the forward-bending test must be questioned.

Adolescent↗
PubMed2004

Spinal fusion in children with spina bifida: influence on ambulation level and functional abilities.

The aim of this study was to determine the influence of spinal fusion on ambulation and functional abilities in children with spina bifida for whom early mobilization was stimulated. Ten children (three males and seven females) with myelomeningocele were prospectively followed. Their mean age at operation was 9.3 years (standard deviation (SD): 2.4). Spinal curvature was measured according to Cobb. Pelvic obliquity and trunk decompensation were measured as well. The ambulation level was scored according to Hoffer, and functional abilities, as well as the amount of caregiver assistance, were documented using the Pediatric Evaluation of Disability Inventory. All patients were assessed before surgery and three times after surgery, with a total follow-up duration of 18 months after surgery. After spinal fusion, magnitude of primary curvature decreased significantly (p=0.002). Pelvic obliquity and trunk decompensation did not change. In spite of less immobilization as compared with other reported experiences, ambulation became difficult in three out of four patients who had been able to ambulate prior to surgery. Functional abilities and amount of caregiver assistance concerning self-care (especially regarding dressing upper and lower body, and self-catheterization) and mobility (especially regarding transfers) showed a nonsignificant trend to deterioration within the first 6 months after surgery, but recovered afterwards. From pre-surgery to 18 months after surgery, functional skills on self-care showed borderline improvement (p=0.07), whereas mobility did not (p=0.2). Mean scores on caregiver assistance improved significantly on self-care (p=0.03), and borderline on mobility (p=0.06), meaning that less caregiver assistance was needed compared with pre-surgery. The complication rate was high (80%). In conclusion, within the first 6 months after spinal fusion, more caregiver assistance is needed in self-care and mobility. It takes about 12 months to recover to pre-surgery level, while small improvement is seen afterwards. After spinal fusion, ambulation often becomes difficult, especially in exercise walkers. These findings are important for health-care professionals, in order to inform and prepare the patients and their parents properly for a planned spinal fusion.

Activities of Daily Living↗
PubMed1999

Neuroimaging of scoliosis in childhood.

A curvature abnormality may be the initial or major presenting feature in a child with disease of the spinal column or spinal neuraxis. A simplified classification of common spinal curvature abnormalities of childhood include idiopathic, congenital/dysraphic, skeletal dysplasia, neurofibromatosis, and painful. The great majority of childhood scoliosis falls into the idiopathic category. Atypical clinical or radiographic features in a presumed idiopathic scoliosis may indicate an otherwise occult tumor or hydrosyringomyelia, or may be a consequence of increasing curvature with disk protrusion, nerve impingement, or cord attenuation. Neuroimaging beyond plain films is commonly necessary for atypical idiopathic scoliosis and for the other categories of scoliosis listed.

Adolescent↗
PubMed2002

Minimally invasive spine instrumentation.

OBJECTIVE: We discuss the instrumentation used with minimally invasive spine surgery. METHODS: Minimally invasive surgery has revolutionized all areas of surgery. The use of endoscopes permits surgical maneuvers to be performed through small incisions. RESULTS: Video-assisted thoracoscopic surgery can be used for a variety of spinal indications. The nerve roots and the spinal cord can be decompressed, bone grafts can be placed for interbody fusion and vertebral body reconstruction, and internal fixation devices can be applied to stabilize the spine. Thoracoscopy can be used to perform thoracic sympathectomies, to resect thoracic disk herniations, to biopsy thoracic vertebral body lesions, to release complex spinal curvatures for the reduction of scoliosis, to perform vertebrectomies, to resect tumors, to debride infections, and to treat spinal fractures. Laparoscopic techniques have been applied to the lumbar spine. Laparoscopic procedures have been used for anterior and posterior approaches to the lumbar spine. Anterior arthrodesis has been performed by laparoscopic insertion of the Bagby and Kuslich cages into the L4-5 and the L5-S1 intervertebral disc spaces. Laparoscopic retroperitoneal techniques have been used for anterior plating to fixate the anterior column rigidly to restore stability. In addition, the posterolateral approach has been used for pedicle screw fixation of the lumbar spine using endoscopic techniques. CONCLUSION: Minimally invasive techniques have been used successfully for treating spinal disorders. With the use of endoscopic techniques, a spine surgeon can perform complex spinal instrumentation through small portals, thus reducing morbidity for the patient.

Humans↗
PubMedDate not supplied

Soft Boston orthosis in management of neuromuscular scoliosis: a preliminary report.

Collapsing neuromuscular spinal curvature is extremely difficult to manage with standard rigid orthoses owing to skin breakdown and patient intolerance. Experience with a new, more malleable type of spinal brace (the "soft Boston orthosis") has been very rewarding in 55 children with neuromuscular scoliosis with an average curvature of 42 degrees. Patient tolerance was improved in 38%, patient handling was facilitated in 68%, and postural positioning was enhanced in 79%. Although improvement in the scoliosis averaged only 15 degrees, the major advantage of this orthosis was a marked improvement in sitting stability in 80% of patients.

Activities of Daily Living↗
PubMed1994

Spinal cord injury rehabilitation in a pediatric achondroplastic patient: case report.

Achondroplasia is an autosomal dominant condition that occurs in approximately 1 of 25,000 births. It has long been associated with neurologic morbidity and mortality in adults, but more recently it has been increasingly identified in children. Neurological sequelae of achondroplasia includes spinal stenosis, spinal cord compression at the foramen magnum (which can result in fatal acute craniocervical junction compression), hydrocephalus, radiculopathy, paresis, and abnormal spinal curvature. We report the case of a 12-year-old achondroplastic patient who incurred an apparently nontraumatic cervical spinal cord infarction, with resultant quadriplegia, with no apparent cause, which was complicated by impaired tolerance of temperature changes and hypercalcemia of immobilization. Whereas persons with achondroplasia have many of the same physical and functional impairments from spinal cord injury as other SCI patients, they are more likely to experience certain types of neurologic deficits and are more subject to other problems because of their altered body habitus.

Achondroplasia↗