Camptocormia, a propósito de un caso / Camptocormia, on the subject of a case

La camptocormia se define como una rara enfermedad que se presenta en pacientes mayores de 50 años y que se caracteriza por la afectación osteomioarticular que imposibilita realizar las actividades de la vida diaria. El propósito de este estudio es dar a conocer los elementos clínicos, diagnósticos y terapéuticos de la camptocormia. Se presenta el caso de un paciente masculino de 62 años de edad, que acude a consulta con manifestaciones clínicas y dolor. Al examen físico se observó un aumento de la cifosis dorsal con un predominio de la flexión lumbar que causa una inclinación hacia delante del tronco. Los exámenes de laboratorio y estudios imagenológicos permitieron llegar al diagnóstico de camptocormia. Se comenzó tratamiento con diclofenaco sódico en dosis de 100 mg diarios por vía oral durante 10 días y analgésicos. Se interconsultó el caso con el servicio de fisioterapia y rehabilitación para aplicar tratamiento rehabilitador. Esta es una enfermedad que genera gran discapacidad; los trastornos osteomusculares limitan considerablemente la calidad de vida relacionada con la salud de los pacientes(AU)

Camptocormia is conceptualized as a rare disease that occurs in patients over 50 years of age and is characterized by the presence of osteomyoarticular involvement that makes it impossible to carry out activities of daily living. To present the clinical, diagnostic and therapeutic elements of camptocormia. 62-year-old male patient, who consults with clinical manifestations that, together with the results of laboratory examinations and imaging studies, lead to the diagnosis of camptocormia. Camptocormia is a disease that generates great disability; musculoskeletal disorders considerably limit the health-related quality of life of patients with this diseasecamptocormia(AU)

Severidade da disfunção temporomandibular e sua relação com a postura corporal / Gravedad de la disfunción temporomandibular y su relación con la postura corporal / Severity of temporomandibular dysfunction and its relationship with body posture

RESUMO O objetivo deste estudo foi identificar se existe correlação entre a severidade da disfunção temporomandibular (DTM) e postura corporal, bem como evidenciar as diferenças existentes na postura corporal nos diferentes graus de severidade. Foram avaliadas 71 mulheres de 18 a 35 anos quanto à severidade da DTM e à postura corporal, sendo divididas em grupo sem DTM e grupo com DTM. Foram utilizados o questionário Mandibular Function Impairment Questionnaire e o software Digital Image-Based Postural Assessment de avaliação postural por fotogrametria. Foi realizada análise estatística com ANOVA de um fator e teste de correlação Tau B de Kendall (α<0,05). Os grupos com e sem DTM apresentaram diferenças estatísticas, com tamanho de efeito grande (ŋ2>0,528), para: lordose cervical, pulsão e inclinação da pelve. Quanto à correlação da postura com a severidade da DTM, índices fracos, mas significativos, foram encontrados: ângulo da lordose cervical (τ=0,250), ângulo da cifose dorsal (τ=0,192), ângulo de inclinação pélvica (τ=−0,222) e medida de pulsão da pelve (τ=0,283). Esses resultados indicam que a lordose cervical e a pulsão da pelve se apresentam em aumento da lordose e da pulsão conforme o acréscimo da severidade da DTM, enquanto o ângulo de inclinação se apresenta em menor grau, tendendo à retroversão. Apesar das correlações fracas, os resultados evidenciam alguma relação da postura corporal com a DTM.

RESUMEN El objetivo de este estudio fue identificar si existe una correlación entre la gravedad de la disfunción temporomandibular (DTM) y la postura corporal, así como mostrar las diferencias en la postura corporal en diferentes grados de gravedad. Se evaluó la la postura corporal de 71 mujeres de 18 a 35 años, divididas en dos grupos: sin DTM y con DTM. Se utilizó el cuestionario Mandibular Function Impairment Questionnaire y el software Digital Image-Based Postural Assessment de evaluación postural por fotogrametría. Se realizó análisis estadístico con Anova de un factor y prueba de correlación Tau B de Kendall (α<0,05). Los grupos con y sin DTM presentaron diferencias estadísticas, con tamaño de efecto grande (ŋ2>0,528) para: lordosis cervical, pulsión e inclinación de la pelvis. En cuanto a la correlación de la postura con la gravedad de la DTM, índices débiles pero significativos fueron encontrados: ángulo de la lordosis cervical (τ=0,250), ángulo de la cifosis dorsal (τ=0,192), ángulo de inclinación pélvica (τ=−0,222) y medida de pulsión de la pelvis (τ=0,283). Estos resultados indican que la lordosis cervical y la pulsión de la pelvis aumentan según la gravedad de la DTM, mientras que el ángulo de inclinación se presenta en menor grado, tendiendo a la retroversión. A pesar de las correlaciones débiles, los resultados evidencian cierta relación de la postura corporal con la DTM.

ABSTRACT This study aimed to identify if there is a correlation between temporomandibular dysfunction (TMD) severity and body posture, as well as to show the differences in body posture in different degrees of severity. Seventy-one women aged 18-35 years were assessed for TMD severity and body posture and were divided into: Group without TMD and Group with TMD. We used the Mandibular Function Impairment Questionnaire and the Digital Image-Based Postural Assessment software for postural evaluation by photogrammetry. Statistical analysis was performed with one-way ANOVA and Kendall's Tau B correlation test (α<0.05). The groups with and without TMD presented statistical differences, with large effect size (ŋ2>0.528), for: cervical lordosis, drive and pelvic tilt. Regarding the correlation of posture with TMD severity, weak but significant indexes were found: cervical lordosis angle (τ=0.250), dorsal kyphosis angle (τ=0.192), pelvic tilt angle (τ=−0.222) and pelvic drive measurement (τ=0.283). These results indicate that cervical lordosis and pelvic drive are increased according to the severity of the TMD, while the pelvic tilt angle decreases, tending to a retroversion. Despite the weak correlations, the results show some relationship between body posture and TMD.

Results of Corrective Osteotomy and Treatment Strategy for Ankylosing Spondylitis with Kyphotic Deformity

BACKGROUND: To report the radiological and clinical results after corrective osteotomy in ankylosing spondylitis patients. Furthermore, this study intended to classify the types of deformity and to suggest appropriate surgical treatment options. METHODS: We retrospectively analyzed ankylosing spondylitis patients who underwent corrective osteotomy between 1996 and 2009. The radiographic assessments included the sagittal vertical axis (SVA), spinopelvic alignment parameters, correction angle, correction loss, type of deformity related to the location of the apex, and the craniocervical range of motion (CCROM). The clinical outcomes were assessed by the Oswestry Disability Index (ODI) scores. RESULTS: A total of 292 corrective osteotomies were performed in 248 patients with a mean follow-up of 40.1 months (range, 24 to 78 months). There were 183 cases of single pedicle subtraction osteotomy (PSO), 19 cases of multiple Smith-Petersen osteotomy (SPO), 17 cases of PSO + SPO, 14 cases of single SPO, six cases of posterior vertebral column resection (PVCR), five cases of PSO + partial pedicle subtraction osteotomy (PPSO), and four cases of PPSO. The mean correction angles were 31.9degrees +/- 11.7degrees with PSO, 14.3degrees +/- 8.4degrees with SPO, 38.3degrees +/- 12.7degrees with PVCR, and 19.3degrees +/- 7.1degrees with PPSO. The thoracolumbar type was the most common. The outcome analysis showed a significant improvement in the ODI score (p < 0.05). Statistical analysis revealed that the ODI score improvements correlated significantly with the postoperative SVA and CCROM (p < 0.05). There was no correlation between the clinical outcomes and spinopelvic parameters. There were 38 surgery-related complications in 25 patients (10.1%). CONCLUSIONS: Corrective osteotomy is an effective method for treating a fixed kyphotic deformity occurring in ankylosing spondylitis, resulting in satisfactory outcomes with acceptable complications. The CCROM and postoperative SVA were important factors in determining the outcome.

Anteroposterior displacement behavior of the center of pressure, without visual reference, in postmenopausal women with and without lumbar osteoporosis

OBJECTIVE: The aims of this study were to evaluate the anteroposterior displacement behavior of the center of pressure without any visual reference and determine its relationship with knee muscle strength and reports of falls in postmenopausal women. Among those with osteoporosis, the specific objective was to evaluate the correlation of thoracic kyphosis and vitamin D with center of pressure displacement. METHODS: This was a cross-sectional observational study without intervention. The assessments were performed on 126 postmenopausal women (aged 55-65 years) who were grouped according to their lumbar bone density into osteoporosis and control groups. Center of pressure was evaluated on a force platform (100 Hz frequency and 10 Hz filter), with the subjects standing on both feet with eyes closed for 60 seconds. Knee muscle strength was evaluated using an isokinetic dynamometer in concentric/concentric mode at a velocity of 60°/s. In the osteoporosis group, vitamin D was assayed, and the thoracic spine was radiographed. RESULTS: In the control group, there was a correlation between the center of pressure and knee strength (r = 0.37; p<0.003). Reports of falls were not associated with center of pressure displacement (p = 0.056). In the osteoporosis group, thoracic kyphosis and vitamin D levels were not correlated with the center of pressure. CONCLUSION: Anteroposterior center of pressure displacement without visual influence was not associated with falls, thoracic kyphosis or vitamin D in the osteoporosis group. Only knee muscle strength was associated with center of pressure displacement in the control group. .

O impacto da cifose congênita nas habilidades de autocuidado na mielomeningocele de nível torácico / The impact of congenital kyphosis on self-care skills in patients with thoracic myelomeningocele

Este estudo teve por objetivos: comparar o desempenho no autocuidado de crianças com mielomeningocele em relação ao de crianças típicas, identificar o impacto da cifose congênita nesta área e investigar possíveis correlações entre as tarefas de autocuidado pesquisadas. Métodos e resultados: A amostra foi composta de 30 crianças com mielomeningocele divididas em 2 grupos (com e sem cifose congênita) com média de idade 54,73 meses. Os dados foram coletados através da versão brasileira do Inventário de Avaliação Pediátrica de Incapacidade. Os resultados indicaram déficit funcional em todas as crianças (escore<30) e diferenças significativas entre os grupos (p<0,01) com pontuações inferiores na presençade cifose nas tarefas de higiene oral, banho, fechos, entre outras. A análise inter-itens indicou que, para esta amostra, há associação entre algumas das tarefas de autocuidado com baixa pontuação. Conclusão: Amielomeningocele repercute em atraso funcional, e este é maior quando acompanhado de cifose congênita. Este tipo de informação é essencial para o planejamento de programas de reabilitação com enfoque para a independência dessas crianças nas atividades da vida diária.

This study aimed to: compare self-care skills of children with myelomeningoceleto those of healthy children, identify the impact of congenital kyphosis on such skills, and verify possible correlations between the selfcare tasks analyzed. Methods and results: The sample was comprised of 30 children with myelomeningocele, divided into two groups (with and without congenital kyphosis), with a mean age of 54.73 months. Data were collected using the Brazilian version of the Pediatric Evaluation of Disability Inventory. Results showed functional deficits in every child assessed (score <30) and significant differences between the groups, (p <0.01) with lower scores for those with kyphosis during the performance of oral hygiene, bathing, and locking tasks, among others. The inter-item analysis indicated that for this sample, there is an association between some self-care tasks and low scores. Conclusion: Myelomeningocele results in functional delay, which becomes more severe when accompanied by congenital kyphosis. Such information is essential for the creation of rehabilitation programs with a focus on the independence of these children in their activities of daily living.

Hiperlordosis y tacones altos / Hyperlordosis and high heels

Se hace una descripción anatómica y fisiológica de la columna vertebral y de la etiología y fisiopatología de la hiperlordosis. También se hacen consideraciones sobre el uso de zapatos inadecuados y sus consecuencias en los pies.

Synergistic convergence and split pons in horizontal gaze palsy and progressive scoliosis in two sisters.

Synergistic convergence is an ocular motor anomaly where on attempted abduction or on attempted horizontal gaze, both the eyes converge. It has been related to peripheral causes such as congenital fibrosis of extraocular muscles (CFEOM), congenital cranial dysinnervation syndrome, ocular misinnervation or rarely central causes like horizontal gaze palsy with progressive scoliosis, brain stem dysplasia. We hereby report the occurrence of synergistic convergence in two sisters. Both of them also had kyphoscoliosis. Magnetic resonance imaging (MRI) brain and spine in both the patients showed signs of brain stem dysplasia (split pons sign) differing in degree (younger sister had more marked changes).

Aporte del estudio por imágenes en el estudio de alteraciones respiratorias en niños con limitaciones neurológicas / Contribution of imaging in the study of the respiratory complications in the neurologically impaired child

Neurologically impaired children have a high incidence of coexistent respiratory problems, of multifactorial etiology. Among the main related factors are: ineffective cough, hypersalivation, dysphagia, gastroesophageal reflux and lung restriction secondary to chest wall deformity. Because of this, patients with cerebral palsy and neuromuscular diseases present a high prevalence of pulmonary aspiration, which has very varied and sometimes complex clinical manifestations. a variety of imaging exams are available to clarify the etiological diagnosis of the neurological affectation (Computed Tomography -CT- and magnetic Resonance –mR), and evaluate the gastrointestinal compromise of this patients, including the diagnosis of anterograde and retrograde aspiration (upper gi Barium Radiography and Videofluoroscopic swallowing study). An early and accurate imaging diagnosis allows an appropriate clinical management, which anticipates the possible complications and allows us to choose the therapies that improve the quality of life of these children.

Los niños con severos déficits neurológicos tienen una alta incidencia de problemas respiratorios, de etiología multifactorial. Entre los factores asociados destacan la tos inefectiva, sialorrea, disfagia, reflujo gastroesofágico y restricción pulmonar secundaria a deformidades de la caja torácica. Por lo anterior, los pacientes con parálisis cerebral y enfermedades neuromusculares presentan una alta incidencia de aspiración pulmonar cuyas manifestaciones clínicas son variadas y a veces complejas. La imaginología cuenta con exámenes que resultan de utilidad en precisar el diagnóstico etiológico del compromiso neurológico (tomografía computarizada, TC, y resonancia magnética), diagnosticar y evaluar el compromiso pulmonar (radiografías simples y TC) y valorar el compromiso gastrointestinal, incluyendo el diagnóstico de aspiración anterógrada y retrógrada (radiografía de esófago-estómago-duodeno y videofluoroscopía de deglución). Un adecuado diagnóstico por imágenes permite un manejo clínico adecuado que se anticipe a las posibles complicaciones y permita elegir terapias que mejoren la calidad de vida de estos niños.

Influence of spinal deformity on pulmonary function, arterial blood gas values, and exercise capacity in thoracic kyphoscoliosis

To evaluate the influence of thoracic spine curvature on lung parameters in kyphoscoliosis. Twenty-one patients with kyphoscoliosis were evaluated at the Vallabhbhai Patel Chest Institute, Delhi, India from January to June 2006 using spirometry, arterial blood gas [ABG], and 6-minute walk test. The degree of spinal deformity was measured by Cobb's method for angle of scoliosis and angle of kyphosis. There were 13 males and 8 females [mean age 47.38 +/- 20.10 years]. Decreased lung volumes, hypoxemia, arterial oxygen desaturation, and decreased exercise capacity was observed in patients with kyphoscoliosis. The angle of scoliosis ranged from 60-126° [78.1 +/- 18.3] and angle of kyphosis ranged from 5-48° [18.05 +/- 10.5]. The forced vital capacity [FVC] was 1.92 +/- 0.8 L [0.66-3.44], and the forced expiratory volume in one second [FEV1] was 1.51 +/- 0.5 L [0.6-2.6]. The FEV1/FVC was 60.9 +/- 12.9 [42-86%]. The partial arterial oxygen tension was 51.7 +/- 6.9 Hg. The partial pressure of carbon dioxide in arterial blood was 49.85 +/- 7.9 mm Hg. The functional oxygen saturation was 84 +/- 3.7%. No correlation was found between pulmonary function test [PFT] or ABG values with the degree of spinal deformity. Mean oxygen desaturation [87.48-84.43%] and rise in systolic blood pressure [118.48-126.67 mm Hg] during walk test correlated well with degree of spinal deformity. The severity of pulmonary impairment could not be inferred from the angle of scoliosis alone. The 6-minute walk test gives an early indication of limitations and correlates well with structural deformity. The PFT and ABG parameters do not correlate well with the severity of deformity. Thus, the 6-minute walk test must be included in the thorough evaluation of all patients with kyphoscoliosis

Results of surgical treatment of tuberculosis of the dorsolumbar spine

The aim of this work is to study the results of surgical debridement JL ML and posterior instrumentation in treating cases of Pott's disease of the dorso lumbar spine complicated by cold abscess, kyphosis and / or paraplegia . This study included 18 cases of Pott's disease. The age of the patients ranged 29-70 years [mean = 52.1], 12 were males and 6 were females [ratio =2:1]. Twelve patients were immuno-compromised; 8 due to diabetes mellitus and 4 due to chronic renal failure. Patients presented with pain, kyphosis and constitutional manifestations [night fever, sweating, anorexia, loss of weight]. Motor paralysis of the lower limbs was present in 10 patients [2 patients with type B, 3 with type C and 5 with type D according to Frankel grading]. In 17 cases, 2 contiguous vertebrae were affected; 2 in the mid dorsal spine, 11 in the lower dorsal and 4 in the lower lumbar. In only one case, 4 adjacent vertebrae were affected [DV. 7, 8, 9, 10]. MRI examination showed cold abscess formation in all cases. The kyphotic angle ranged 11-38° [mean = 26.9°]. CT guided needle biopsy was done to confirm the diagnosis. It was successful in 14 patients [77.8%] and failed in 4 patients where open biopsy was taken at the time of surgery. All cases were treated surgically through a posterior approach.Costotransversectomy, debridement, grafting and posterior pedicular screw rod fixation using ISO LA system was carried out. Patients were followed up for 20-44 months [mean= 32.6]. The infection was controlled in all cases. The kyphotic angle was partially corrected as it ranged 5-18° [mean = 12.1°] post operatively. Motor paralysis improved completely in 9 patients [90%] and partially in one patient [10%].surgical treatment is effective in controlling infection, kyphosis and improving paralysis

A case of sternal insufficiency fracture

We report a case of insufficiency fracture of the sternum in a 70-year-old female patient with a review of the literature. She complained of sudden onset chest pain and aggravating dyspnea. She has been managed with corticosteroid due to chronic obstructive pulmonary disease for 15 years. Diagnosis of sternal insufficiency fracture presented with thoracic kyphosis was made on the basis of absence of trauma history, radiologic findings of lateral chest radiograph, bone scintigraphy and chest computed tomography. Thoracic kyphosis and osteoporosis secondary to menopause, corticosteroid therapy and limited mobility due to chronic obstructive pulmonary disease were considered as predisposing factors of the sternal insufficiency fracture in this patient.

Avaliaçäo da funçäo pulmonar em adolescentes com aumento da cifose torácica / A assessment of lung function in adolescents with increased thoracic kyphosis

Foi realizado um estudo da funçäo pulmonar em pacientes portadores de doença de Scheuermann ou dorso curvo postural juvenil, que apresentavam cifose torácica maior que 45 Graus Celsius e inferior a 80 Graus Celsius, sem sinais clínicos de outras patologias associadas. O estudo da funçäo pulmonar foi realizado por meio de espirometria, tendo sido avaliados a capacidade vital, capacidade pulmonar total, volume residual e volume expiratório forçado no primeiro segundo. Comparando-se os valores previstos com os observados das variáveis espirométricas estudadas, verificou-se que 28 por cento dos pacientes apresentavam disfunçäo ventilatória restritiva leve. Os resultados representam novo achado, ainda que sujeito a controvérsias, devendo ser melhor estudado, pois sua confirmaçäo introduzirá novo e importante tópico no tratamento e orientaçäo dos pacientes com aumento da cifose torácica.

Dorso curvo / Curve dorse

El dorso curvo es una patología frecuente en la infancia y adolescencia, por lo tanto, el pediatra puede verse enfrentado en numerosas oportunidades con el problema. Tanto los padres como los médicos pueden notar la anormalidad y asumir que se trata sólo de un problema postural, restándole la importancia que se merece. La experiencia demuestra que frecuentemente lo que se encuentra bajo este aparente problema postural es una alteración estructural de la columna vertebral, cuyo reconocimiento y tratamientoprecoz permite llegar a resultados satisfactorios sobre la deformidad y sobre las consecuencias uque esta anomalía podría provocar de ser abandonada a su suerte