ABSTRACT
STUDY DESIGN: This was a prospective cohort study.PURPOSE: This study aimed to evaluate the potential differences between the objective and subjective bracing compliances of adolescents with Scheuermann’s kyphosis.OVERVIEW OF LITERATURE: Bracing is a well-documented intervention for managing adolescents with progressive thoracic Scheuermann’s kyphosis, and the brace should be worn 23 hours every day. Most research studies that have investigated the efficacy of bracing have assumed that the patients wore the braces as advised or that the bracing time was measured subjectively. This may be one of the reasons for the conflicting reports regarding the efficacy of bracing.METHODS: Nineteen volunteers (11 girls and 7 boys, 12.89±1.77 years) who were prescribed Milwaukee braces for Scheuermann’s kyphosis were enrolled. Each brace was equipped with a miniature temperature logger to record the actual brace wearing time over a period of 3 weeks. The patients and their families were unaware of the mounted sensor. Each participants and/or parent was provided with a questionnaire to record the number of hours for which the brace was worn each day. In addition, the therapist asked each patient and/or his/her parent about the average number of hours that the brace was worn.RESULTS: The compliance rates measured using the temperature logger (16.00±4.90 hours daily) were significantly lower than those reported in the questionnaires (19.52±6.04 hours daily, p<0.001) and the verbal responses (20.21±6.05 hours daily, p<0.001). Moreover, there was no correlation of age, sex, and body mass index with brace compliance.CONCLUSIONS: The braces were worn less often than reported by the patients and/or their parents. Therefore, objective compliance assessments of adolescents with Scheuermann’s kyphosis in a brace are recommended for future studies.
Subject(s)
Adolescent , Female , Humans , Body Mass Index , Braces , Cohort Studies , Compliance , Kyphosis , Parents , Prospective Studies , Scoliosis , VolunteersABSTRACT
Introdução: Os exercícios de Pilates possuem um papel importante na mudança da postura. A cifose em termos anatômicos refere-se à curvatura primária torácica e sacral posterior. Mulheres sedentárias após a menopausa exibem uma mudança nesta curva, aumentando o grau de cifose, e com isso, afetando a estrutura do corpo inteiro. Objetivo: Avaliar a efetividade de um treinamento físico utilizando o método de Pilates para a postura e as funções respiratórias de mulheres com cifose. Metodologia: O estudo foi um ensaio clínico randomizado com 41 mulheres divididas em dois grupos (intervenção e controle). Os exercícios foram conduzidos por 30 semanas. Para analisar a postura, foram vistos exame radiológico e teste de ângulo de Cobb. As funções respiratórias foram medidas por espirômetro e manômetro. Os ângulos da coluna foram avaliados e medidos em graus. Resultados: A análise radiológica apresentou uma diferença significativa entre os grupos, -8,0 ± 7,5 graus para o grupo experimental e -0,6 ± 3,4 graus para o grupo controle com p < 0,001. A porcentagem de gordura corporal e o IMC também apresentaram diferenças significativas (0,001). Conclusão: O grupo que realizou o treinamento de Pilates mostrou uma melhora significativa na pressão expiratória. A comparação entre os grupos antes e após a intervenção mostrou valores significativos de p < 0,05. Os resultados mostraram que o método de Pilates é eficaz para melhorar a postura e a pressão expiratória de mulheres com cifose.(AU)
Introduction: The Pilates exercises have an important role in changing the posture. The kyphosis in anatomical terms refers to the posterior thoracic and sacral primary curvature. Sedentary women after menopause exhibit a change in this curve, increasing the degree of kyphosis, affecting the entire body structure. Objective: To evaluate the effectiveness of a physical training using the Pilates method for laying and respiratory functions of women with kyphosis. Methods: This study was randomized clinical trial with 41 women divided into two groups (intervention and control). The exercises were conducted for 30 weeks. To analyze posture, we use radiological examination and Cobb angle test. Respiratory functions were measured by spirometer and manometer. The angles of the cervical spine, hip and trunk were evaluated and measured in degrees. Results: The radiological analysis shows a significant difference between groups, -8.0 ± 7.5 degrees to the experimental group and -0.6 ± 3.4 degrees to the control group with p < 0.001. The percentage of body fat and BMI also showed significant differences (0.001). Conclusion: The group that performed the Pilates training showed a significant improvement in expiratory pressure. The comparison between the groups before and after the intervention showed significant values of p < 0.05. The results showed that Pilates method is effective for improving posture and expiratory pressure women with kyphosis.(AU)
Subject(s)
Humans , Female , Middle Aged , Aged , Aged, 80 and over , Exercise Movement Techniques , PostureABSTRACT
Background: Thoracic hyper-kyphosis is a postural deviation that is associated with morbidity and mortality. There is limited evidence for the non-surgical reduction treatment for this condition. Objective: To describe the successful case of conservative reduction in thoracic hyper-kyphosis utilizing thoracic extension traction methods as performed in Chiropractic BioPhysics (CBP®) Technique. Clinical Features: On May 8, 2009 a 24-year old female music teacher reported to a spine clinic in Las Vegas seeking treatment while suffering from neck, mid, and low back pain as well as headaches. The major postural condition was determined to be a hyper-kyphotic thoracic spine with concomitant posterior thoracic translation. Intervention and Outcome: This patient was treated with full CBP® protocol with the unique application of thoracic extension traction. Although the treatment was interrupted by her involvement in a motor vehicle collision, a clinically significant reduction in her kyphosis occurred bringing her spine to within normal limits. She had simultaneous improvements in her clinical symptoms, neurologic and orthopedic tests. Discussion: Traditional conservative treatment options for thoracic hyper-kyphosis have included exercise, manual therapy, spinal orthosis, ‘practiced normal posture,’ and more recently, taping. All of these procedures, however, have been criticized because despite these methods as showing promise for improving health outcomes in patients with hyper-kyphosis, the trials used to evaluate them have been “small in scale, and most short in duration.” Since this deformity is associated with osteoporosis and worsening of kyphosis it is well advised to treat this condition earlier rather than later. Conclusion: Although traditional approaches to non-surgical treatment for thoracic hyper-kyphosis has weak supportive evidence, we propose extension traction for this condition will prove to be an effective treatment option.
ABSTRACT
Se describe el caso de una paciente de 47 años de edad, atendida en la Consulta de Medicina Interna del Policlínico "Esteban Caballero", perteneciente al área de salud Matías del municipio de Tercer Frente de Santiago de Cuba, quien presentó dolores de moderada intensidad en la región dorsolumbar, que no se aliviaban con analgésicos. Los estudios ecográfico y radiográfico de la columna vertebral confirmaron el diagnóstico de mal de Pott. Se indicó tratamiento específico y la afectada evolucionó satisfactoriamente.
The case of a 47 years patient assisted in the Internal Medicine Service of "Esteban Caballero" Polyclinic is described, belonging to Matías health area of Tercer Frente municipality in Santiago de Cuba who presented pains of moderate intensity in the dorsolumbar region that were not relieved with analgesics. The echographic and radiographic studies of the spine confirmed the diagnosis of Pott´s disease. Specific treatment was indicated and the patient had a satisfactory clinical course.
Subject(s)
Spondylitis , Tuberculosis, Spinal , Primary Health CareABSTRACT
STUDY DESIGN: A retrospective study for clinical, radiographic assessment. OBJECTIVES: To determine the appropriate level of distal fusion for the posterior instrumentation and fusion for thoracic hyperkyphosis by investigating the relationship between the sagittal stable (the most proximal vertebra touched by the vertical line from the posterior-superior corner of the sacrum), first lordotic (just caudal to the first lordotic disc) and lowest instrumented vertebrae. LITERATURE REVIEW SUMMARY: It has been recommended that the distal level of fusion for thoracic hyperkyphosis should include not only the distal end vertebra of kyphosis, but also the first lordotic disc beyond the transitional zone, distally. However, distal junctional breakdown was noted, even when these rules have been followed. MATERIALS AND METHODS: Thirty-one patients, with a mean age of 18, ranging from 13 to 38 years, who underwent long posterior instrumentation and fusion for thoracic hyperkyphosis, with a minimum of 2 years of follow up, were reviewed. The preoperative diagnosis included: Scheuermann`s disease (n=29), posttraumatic kyphosis (n=1) and postlaminectomy kyphosis (n=1). According to the level of distal fusion, the patients were divided into two groups. Group I (n=24): lowest instrumented vertebra (LIV), including the sagittal stable vertebra (SSV), Group II (n=7): lowest instrumented vertebra proximal to the sagittal stable vertebra. Patients were evaluated utilizing both standing radiographs and chart reviews. RESULTS: The mean thoracic kyphosis was 86.6+/-8.5 before surgery, which had been corrected to 53.0+/-10.4 by the final follow-up, with a correction rate of 39%. The average sagittal balance was slightly negative (0.24+/-3.8 cm) before surgery, and became more negative (1.33+/-2.8 cm) by the final follow-up. There were no statistical differences in the thoracic kyphosis between the two groups. However, there was a statistically significant difference, with Group II having a more posterior translation of the center of the LIV from the posterior sacral vertical line, preoperatively, than at the final follow-up in Group I (p=0.003). In Group I, distal junctional problems developed in only 2 of the 24 (8%) patients, whereas in Group II, they occurred in 5 of the 7 (71%) patients (p<0.05). Despite extending the fusion to the first lordotic vertebra, distal junctional problems developed in 3 of the 8 (38%) patients. CONCLUSIONS: The distal end of the fusion for thoracic hyperkyphosis should include the sagittal stable vertebra. The levels of distal fusion that include the first lordotic vertebra, but not the sagittal stable vertebra, are not always appropriate for the prevention of postoperative distal junctional kyphosis.
Subject(s)
Humans , Diagnosis , Follow-Up Studies , Kyphosis , Retrospective Studies , SpineABSTRACT
STUDY DESIGN: A retrospective study for clinical, radiographic assessment. OBJECTIVES: To determine the appropriate level of distal fusion for the posterior instrumentation and fusion for thoracic hyperkyphosis by investigating the relationship between the sagittal stable (the most proximal vertebra touched by the vertical line from the posterior-superior corner of the sacrum), first lordotic (just caudal to the first lordotic disc) and lowest instrumented vertebrae. LITERATURE REVIEW SUMMARY: It has been recommended that the distal level of fusion for thoracic hyperkyphosis should include not only the distal end vertebra of kyphosis, but also the first lordotic disc beyond the transitional zone, distally. However, distal junctional breakdown was noted, even when these rules have been followed. MATERIALS AND METHODS: Thirty-one patients, with a mean age of 18, ranging from 13 to 38 years, who underwent long posterior instrumentation and fusion for thoracic hyperkyphosis, with a minimum of 2 years of follow up, were reviewed. The preoperative diagnosis included: Scheuermann`s disease (n=29), posttraumatic kyphosis (n=1) and postlaminectomy kyphosis (n=1). According to the level of distal fusion, the patients were divided into two groups. Group I (n=24): lowest instrumented vertebra (LIV), including the sagittal stable vertebra (SSV), Group II (n=7): lowest instrumented vertebra proximal to the sagittal stable vertebra. Patients were evaluated utilizing both standing radiographs and chart reviews. RESULTS: The mean thoracic kyphosis was 86.6+/-8.5 before surgery, which had been corrected to 53.0+/-10.4 by the final follow-up, with a correction rate of 39%. The average sagittal balance was slightly negative (0.24+/-3.8 cm) before surgery, and became more negative (1.33+/-2.8 cm) by the final follow-up. There were no statistical differences in the thoracic kyphosis between the two groups. However, there was a statistically significant difference, with Group II having a more posterior translation of the center of the LIV from the posterior sacral vertical line, preoperatively, than at the final follow-up in Group I (p=0.003). In Group I, distal junctional problems developed in only 2 of the 24 (8%) patients, whereas in Group II, they occurred in 5 of the 7 (71%) patients (p<0.05). Despite extending the fusion to the first lordotic vertebra, distal junctional problems developed in 3 of the 8 (38%) patients. CONCLUSIONS: The distal end of the fusion for thoracic hyperkyphosis should include the sagittal stable vertebra. The levels of distal fusion that include the first lordotic vertebra, but not the sagittal stable vertebra, are not always appropriate for the prevention of postoperative distal junctional kyphosis.