Cifosis patológica en la columna pediátrica / Pathologic kyphosis in the pediatric spine

En este manuscrito se revisan las diferentes causas que producen aumento de la cifosis torácica (dorso curvo), específicamente en niños y adolescentes. Las causas del dorso curvo que se analizan en este artículo son: Dorso curvo postural, idiopático, neuromuscular, congénito y enfermedad de Scheuermann. Se centra en los factores que producen su aparición, características de su evolución y tratamiento.

This manuscript reviews the different causes that lead to increased thoracic kyphosis, specifically in children and adolescents. The causes of increased thoracic kyphosis that will be discussed in this article are: postural, idiopathic, neuromuscular, congenital, and Scheuermann's disease. This paper focuses on the factors that produce its appearance, characteristics of its evolution, and treatment.

Post-implantation Deformation of Titanium Rod and Cobalt Chrome Rod in Adolescent Idiopathic Scoliosis

@#Introduction: Post-implantation rod deformation is anticipated in scoliosis surgery but the difference in rod deformation between titanium and cobalt chrome rod has not been elucidated. This study aims to compare the difference in rod deformation between two groups. Materials and Methods: Twenty-one adolescent idiopathic scoliosis (AIS) patients were recruited from a single center. The over-contoured concave rods were traced prior to insertion. Post-operative sagittal rod shape was determined from lateral radiographs. Rod deformation was determined using maximal rod deflection and angle of the tangents to rod end points. The differences between pre- and post-operative rod contour were analysed statistically. Rod deformation and thoracic kyphosis between two types of implants were analysed. Results:Both rods exhibited significant change of rod angle and deflection post-operatively. Curvature of the titanium rod and cobalt chrome rod decreased from 60.5° to 37°, and 51° to 28° respectively. Deflection of titanium rod and cobalt chrome rod reduced from 28mm to 23.5mm and 30mm to 17mm respectively. There was no significant difference between titanium and cobalt chrome groups with regard to rod angle (p=0.173) and deflection (p=0.654). Thoracic kyphosis was increased from 20° to 26° in titanium group but a reduction from 25° to 23° was noticed in cobalt chrome group, but these findings were not statistically significant. Conclusion: There was no statistical difference in rod deformation between the two groups. Thus, the use of titanium rod in correction of sagittal profile is not inferior in outcome compared with cobalt chrome but with lower cost.

The clinical relevance of abnormal upper trunk posture for predicting shoulder impingement syndrome among stroke survivors / 中华物理医学与康复杂志

Objective To explore the relevance of abnormal posture to the development of shoulder pain among stroke survivors.Methods A total of 102 stroke survivors were studied.Those with shoulder impingement syndrome or shoulder pain formed a shoulder pain group,while those without shoulder pain served as controls.The upper trunk sagittal sitting postures of all of the subjects were quantified using the thoracic and craniovertebral angles measured from photographs.Results The average craniovertebral angle of the shoulder pain group was significantly smaller than that of the control group,while the average thoracic angle of the former was significantly larger.The craniovertebral angles were negatively correlated with shoulder pain,while a large thoracic angle was positively correlated.Conclusion Thoracic and craniovertebral angles can be used as a predictor of shoulder impingement syndrome among stroke survivors.Stroke patients with thoracic kyphosis and forward head posture should undergo active rehabilitation.

Paraplegia in an Ankylosing Spondylitis Patient with a Neglected Spine Fracture after Osteosynthesis for Fracture of the Femur: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To report a case of paraplegia in a patient with thoracic kyphosis after osteosynthesis for a fracture of the femur. SUMMARY OF LITERATURE REVIEW: There are few reports about cases of paraplegia after low extremity fracture surgery in patients with thoracic kyphosis with ankylosing spondylitis. MATERIALS AND METHODS: An 86-year-old female patient presented with right hip pain. She had undergone surgery for an intertrochanteric fracture of the femur in the supine position under general anesthesia. Immediately after surgery, she showed paraplegia. Postoperative thoracolumbar spine images revealed a fracture through the disc at T12 and L1. However, she did not complain of back pain or any neurologic deficits before surgery. RESULTS: Although the patient underwent emergent posterior decompression and fusion surgery, her neurologic compromise did not improve during 1 year of follow-up. CONCLUSIONS: It is necessary to check preoperative spine radiographs before surgery in elderly patients who have a kyphotic deformity and lower extremity fractures. Surgeons should consider changing the position of the patient and the type of anesthesia used during surgery when spine stability is in doubt.

The clinical relevance of abnormal upper trunk posture for predicting shoulder impingement syndrome among stroke survivors / 中华物理医学与康复杂志

Objective To explore the relevance of abnormal posture to the development of shoulder pain among stroke survivors.Methods A total of 102 stroke survivors were studied.Those with shoulder impingement syndrome or shoulder pain formed a shoulder pain group,while those without shoulder pain served as controls.The upper trunk sagittal sitting postures of all of the subjects were quantified using the thoracic and craniovertebral angles measured from photographs.Results The average craniovertebral angle of the shoulder pain group was significantly smaller than that of the control group,while the average thoracic angle of the former was significantly larger.The craniovertebral angles were negatively correlated with shoulder pain,while a large thoracic angle was positively correlated.Conclusion Thoracic and craniovertebral angles can be used as a predictor of shoulder impingement syndrome among stroke survivors.Stroke patients with thoracic kyphosis and forward head posture should undergo active rehabilitation.

Analysis of 150 cases from measuring sternal angle corresponded to thoracic plane by three-dimensional recon-struction of spiral CT / 局解手术学杂志

Objective To measure the sternal angle corresponded to thoracic plane by three-dimensional reconstruction of spiral CT , and to explore the accurate positioning methods and the preoperative assessment of cervicothoracic junction lesions .Methods Selected 42 cases of normal bone mass , 48 cases with bone loss , and 60 cases of osteoporosis who were diagnosed by dual-energy X-ray absorptiometry , and measured the location of thoracic sternal angle corresponded to the thoracic spine and thoracic kyphosis angle through the volume recon -struction data of the 16-slice spiral CT chest examinations .Results The range of sternal angle corresponded to thoracic plane was measure-ment units ⅢtoⅥ.The measure unit Ⅳwas the most, accounting for about 55%.There was no statistical significance between the position of sternal angle corresponded to thoracic plane and the relationship of bone mass , which required further study .The position of sternal angle corresponded to thoracic plane was associated with the thoracic kyphosis angle .The larger the thoracic kyphosis angle , the lower the corre-sponding position was .Conclusion The thoracic segment corresponded to the sternal angle is not a constant or accurate plane , which is not properly concerned as an accurate positioning mark to the thoracic segment .The measurement of the thoracic sternal angle was corresponded to the thoracic spine location , and its co-relationship evaluation between the thoracic kyphosis angle was vital for the accurately positioning of cervico-thoracic junction area lesions , the pre-assessment methods of surgical treatment , approach selection , and different methods for ster-num and other such contents .This research was of important clinical significance .

Cervical and Thoracic Sagittal Curves in Thoracic Adolescent Idiopathic Scoliosis / 대한척추외과학회지

STUDY DESIGN: Prospective study OBJECTIVES: To analyze and compare the cervical and thoracic sagittal curves between normal adolescents and patients with thoracic adolescent idiopathic scoliosis (AIS). SUMMARY OF THE LITERATURE REVIEW: There are no reports on cervical sagittal curves and its correlation with thoracic sagittal curves in AIS. MATERIALS AND METHODS: The sagittal curves were analyzed in normal adolescents (N-adol group, n=23) and patients with thoracic AIS (AIS group, n=26) who had thoracic curves > or = 45degrees. Lateral standing radiographs of the cervical spine with a elbow straight and the whole spine with the hands on the clavicles were taken. The sagittal curves and balance were measured in the following segments; C2-C7, T2-T5, T5-12, T2-12, T12-S1. Cervical lordosis (C2-C7) was measured in both cervical spine radiographs and whole spine radiographs. RESULTS: In the N-adol group, the cervical lordosis was 9.2+/-14.6degrees in the cervical spine radiographs and -0.6+/-12.9degrees ('-' means kyphosis) in whole spine radiographs. In the AIS group, cervical lordosis was -5.0+/-12.9degrees in the cervical radiographs and -8.1+/-12.7degrees in the whole radiographs. The AIS group had significantly less cervical lordosis than the N-adol group. Thoracic kyphosis of T5-12 and T2-12 was 24.1+/-10.6degrees and 38.9+/-13.1degrees in the N-adol group, respectively, and 17.8+/-9.4degrees and 30.1+/-11.8degrees in the AIS group, respectively. There was a significant difference between the two groups (Ps0.05). In the AIS group, the cervical lordosis measured in the cervical spine radiograph showed a positive correlation with thoracic kyphosis of T2-5 (r=0.50, P=0.009) and T2-12 (r=0.57, P=0.003). CONCLUSIONS: AIS patients had significantly less cervical lordosis and thoracic kyphosis than normal adolescents. Decreased cervical lordosis in AIS had a significant correlation with their relative thoracic hypokyphosis.

Effects of Thoracic Spinal Exercise Program in VDT Workers: Pain Relief and Increased Flexibility / 대한산업의학회지

OBJECTIVES: The purpose of this study of the Thoracic Spinal Exercise Program was to evaluate its effects on VDT workers. These effects were found to include a decrease thoracic kyphosis, increase thoracic spine mobility and decrease in the VAS (visual analog scale). These measures provide a means of assessing the muscle endurance and muscle strength of the subjects. METHODS: This study was conducted during the period from July 1 to August 31, 2003, and involved 58 VDT workers belonging to a company located in Seoul who were working seated in front of a computer for most of the day. After applying the thoracic exercise program, we examined the changes in the of thoracic kyphosis angle, spinal length (C7-S3), TFED (thoracic flexibility in the extension direction), MEBH (maximal elevation with both hands in the overhead direction) and CE (chest expansion). RESULTS: Obtained f om this study are as follows. 1. A significant reduction in the VAS was observed in the exercise group (pre-exercise 5.90 +/- 0.88 points, post-exercise 4.23+/- 0.82 points), as compared with the control group (pre-exercise 6.00+/-0.90 points, post-exercise 5.93+/-0.81 points). 2. A significant reduction in thoracic kyphosis (pre-exercise 36.97+/-7.49, post-exercise 31.83 +/-5.90) and a significant increase in thoracic flexibility in the extension direction (pre-exercise 7 . 4 7+/-2.30, post-exercise 11.77+/-3.65) were observed in the exercise group. The thoracic kyphosis angle showed a significant reduction in the exercise group, as compared to the control group. The thoracic flexibility in the extension direction showed a significant increase in the exercise group, as compared to the control group. 3. There was a significant increase in the spinal length in the exercise group (pre-exercise 494 +/-27.66 mm, post-exercise 518.60+/-27.95 mm). CONCLUSIONS: The Thoracic Spinal Exercise Program results in an increase in thoracic spine mobility and a decrease in pain. In practical terms, the effects of the exercise program are good health and posture.

Tardy Paraplegia due to Myelomalacia in a Patient with Tuberculous Thoracic Kyphosis: A Case Report / 대한정형외과학회잡지

Many cases of tardy paraplegia after bony fusion have been reported among well-treated tuberculous spondylitis patients. In most cases, the cause of the paraplegia is known to be spinal cord compression caused by kyphosis, and in these patients cord decompression and kyphotic deformity correction have been commonly performed. A 44 year-old-male patient presenting with thoracic kyphosis and tardy paraplegia was admitted to our department. The cause of his paraplegia was considered to be a compression of the spinal cord by progressive kyphosis. The initial therapeutic plan involved decompression of the spinal cord and surgical correction of kyphotic deformity. However an MRI of the thoracic spine revealed a myelomalacia of the whole thoracic cord associated with severe cord atrophy. Myelomalacia is known to be an irreversible condition with no surgical remedy. Although this condition is very rare, an unnecessary decompressive surgical procedure may be performed if this possiblity is not considered. Because of its rarity and the importance of planning a therapeutic treatment modality, the authors report this case and include a review of the literature.

Thoracic Kyphosis and Myofascial Pain Syndrome in Male Adolescents

OBJECTIVE: To assess the prevalence and contributing factors for myofascial pain syndrome in male adolescents and to evaluate the association of thoracic kyphosis and myofascial pain syndrome. METHOD: Four hundred thirteen male students of three high schools and one middle school were randomly selected. With the diagnostic criteria of palpable taut band, spot tenderness and pain recognition, myofascial pain syndrome in trapezius and infraspinatus were diagnosed. Thoracic kyphosis and pressure pain threshold were measured and contributing factors were collected with questionnaire. The relation between thoracic kyphosis and pressure pain threshold was evaluated and contributing factors for myofascial pain syndrome were compared. RESULTS: The prevalence of myofascial pain syndrome was 31.5% in trapezius and 1.0% in infraspinatus. Mean pressure pain thresholds were low in latent trigger point and myofascial pain syndrome group in comparison with normal group (p<0.05). There was no statistically significant correlation between thoracic kyphosis and pressure pain threshold. Aging and uncomfortable desk and chair were associated with high risk of myofascial pain syndrome. CONCLUSION: Myofacial pain syndrome is common in male adolescents and inadequate posture due to uncomfortable desk and chair rather than physical attributes like thoracic kyphosis is a contributing factor. Proper education and prevention are needed.