Curve evolution during bracing in children with scoliosis secondary to early-onset neurofibromatosis type 1: indicators of rapid curve progression / 中华医学杂志(英文版)

BACKGROUND@#Scoliosis secondary to neurofibromatosis type 1 (NF1) in children aged 10°/year) were identified. The age at modulation and the AV before and after modulation were obtained. Patients with (n = 18) and without rapid curve progression (n = 10) were statistically compared.@*RESULTS@#Twenty-eight patients with a mean age of 6.5 ± 1.9 years at the initial visit were reviewed. The mean Cobb angle of the main curve was 41.7° ± 2.4° at the initial visit and increased to 67.1° ± 8.6° during a mean follow-up of 44.1 ± 8.5 months. The overall AV was 6.6° ± 2.4°/year for all patients. At the last follow-up, all patients presented curve progression of >5°, and 20 (71%) patients had progressed by >20°. Rapid curve progression was observed in 18 (64%) patients and was associated with younger age at the initial visit and a higher incidence of modulation change during follow-up (t = 2.868, P = 0.008 and 10°/year is associated with younger age at the initial visit, and modulation change indicated the occurrence of the rapid curve progression phase.

Three-dimensional spine morphology measuring technology for daily surface monitoring / 生物医学工程学杂志

In order to conduct surface monitoring of the three-dimensional spine morphology of the human body in daily life, a spine morphology measuring method using "single camera, multi-view" to construct stereo vision is proposed. The images of the back of the human body with landmarks of spinous process are captured from multiple angles by moving a single camera, and based on the "Zhang Zhengyou calibration method" and the triangulation principle of binocular stereo vision, the spatial conversion matrices corresponding to each other between all images and the 3D coordinates of the landmarks are calculated. Then the spine evaluation angle used to evaluate the spine morphology is further calculated. The tests' results showed that the spine evaluation angle error of this method is within ±3°, and the correlation between the results and the X-ray film Cobb angles is 0.871. The visual detection algorithm used in this paper is non-radioactive, and because only one camera is used in the measurement process and there is no need to pre-set the camera's shooting pose, the operation is simple. The research results of this article can be used in a mobile phone-based intelligent detection system, which will be suitable for the group survey of scoliosis in communities, schools, families and other occasions, as well as for the long-term follow-up of confirmed patients. This will provide a reference for doctors to diagnose the condition, predict the development trend of the condition, and formulate treatment plans.

Importância da experiência clínica para a mensuração da curva escoliótica de crianças pela técnica de Cobb / La importancia de la experiencia clínica en la medición de la curva escoliótica de niños mediante la técnica de Cobb / The importance of clinical experience for the measurement of scoliosis curve in children by Cobb technique

RESUMO A escoliose é definida como uma deformidade com desvio lateral da coluna no plano coronal, torsão da coluna e do tronco e distúrbio no perfil sagital. Essa alteração postural é avaliada por meio de radiografia de incidência anteroposterior, utilizando-se o método de Cobb. O objetivo do estudo é verificar a influência da experiência do avaliador sobre a confiabilidade intraexaminador e interexaminador do ângulo Cobb em curvaturas escolióticas de crianças. Foram incluídas na pesquisa 39 crianças portadoras de escoliose idiopática, com idade entre 7 e 18 anos. Os exames foram avaliados por dois fisioterapeutas, um quiropraxista e um estudante de fisioterapia - cada um avaliando duas vezes cada exame. A segunda avaliação ocorreu após sete dias, para confiabilidade intraexaminador. Ademais, as primeiras avaliações forneceram dados para confiabilidade interexaminador. A análise estatística foi realizada com coeficiente de correlação intraclasse (CCI), análise de Bland e Altman e análise descritiva do desvio absoluto médio, erro-padrão de medição e mínima mudança detectável. Observou-se boa confiabilidade (CCI>0,5) para as análises intraexaminadores entre os profissionais, e confiabilidade fraca (CCI=0,4) para o avaliador inexperiente. A confiabilidade interexaminador dos profissionais foi boa (CCI=0,6), e com a presença do avaliador inexperiente foi fraca (CCI=0,3). As avaliações entre os profissionais apresentaram menor variabilidade das medidas e valores de desvio-padrão quando comparadas com as do avaliador inexperiente. A mensuração dos ângulos da escoliose por meio do método de Cobb realizada por profissionais experientes apresentou melhores índices de concordância e de confiabilidade intra e interexaminadores e menor desvio-padrão e variabilidade entre as medidas.

RESUMEN La escoliosis se define como una alteración con curvatura lateral de la columna vertebral en el plano coronal, torsión de la columna vertebral y del tronco y trastorno en el perfil sagital. Esta alteración postural se evalúa mediante radiografía anteroposterior, utilizando el método de Cobb. El presente estudio tiene como objetivo verificar la influencia de la experiencia del evaluador para la fiabilidad intraexaminador e interexaminador del ángulo de Cobb en las curvaturas escolióticas de los niños. El estudio incluyó a 39 niños con escoliosis idiopática entre 7 y 18 años de edad. Los exámenes fueron evaluados por dos fisioterapeutas, un quiropráctico y un estudiante de fisioterapia, siendo que cada uno evaluó cada examen dos veces. Tras siete días, ocurrió una segunda evaluación para la fiabilidad intraexaminador. Además, las primeras evaluaciones proporcionaron datos para la fiabilidad interexaminador. El análisis estadístico se realizó con el coeficiente de correlación intraclase (ICC), con el análisis de Bland y Altman y con el análisis descriptivo de la desviación media absoluta, del error estándar de medición y del cambio mínimo detectable. Se observó una alta fiabilidad (ICC>0,5) en los análisis intraexaminadores entre los profesionales, y una baja fiabilidad (ICC=0,4) en los de evaluadores inexpertos. La fiabilidad interexaminador de los profesionales fue buena (ICC=0,6), y la presencia del evaluador inexperto fue baja (ICC=0,3). Las evaluaciones entre los profesionales mostraron una menor variabilidad de las medidas y valores de desviación estándar en comparación con los del evaluador inexperto. La medición de los ángulos de escoliosis utilizando el método de Cobb que había sido realizada por profesionales con experiencia mostró mejores índices de concordancia y fiabilidad intra e interexaminadores y una menor desviación estándar y variabilidad entre las mediciones.

ABSTRACT Scoliosis is defined as a deformity with lateral deviation of the spine in the coronal plane, torsion of the spine and trunk, and disturbances in the sagittal profile. This postural alteration is evaluated by anteroposterior incidence radiography using the Cobb method. The objective of this study was to verify the influence of evaluator experience on inter- and intra-rater reliability of the Cobb angle of scoliosis curvatures in children. In total, 39 patients aged 7 to 18 years with idiopathic scoliosis were included in this study. The exams were evaluated by two physical therapists, a chiropractor and a physical therapy student. Each evaluator rated each exam twice and the second evaluation occurred after seven days, characterizing the intra-rater reliability. Furthermore, the first evaluations provided the inter-rater reliability. Statistical analysis was performed with intraclass correlation coefficient (ICC), Bland-Altman analysis, descriptive analysis of mean absolute deviation, standard error of measurement, and minimum detectable chance. Correlations ranged from good (ICC>0.5) for intra-rater reliability among professionals to weak (ICC=0.4) for the inexperienced evaluator. The inter-rater reliability of the professional's evaluations was good (ICC=0.6) and the same analysis with the presence of an inexperienced evaluator was weak (ICC=0.3). Evaluations among professionals showed less variability of measurements and standard deviation values compared to the inexperienced evaluator. The measurement of the angles of the scoliosis through the Cobb method carried out by experienced professionals showed better agreement as well as intra- and inter-rater reliability, lower standard deviation, and variability among the measurements.

Síndrome lumbocostovertebral: primer reporte de caso en Argentina / Lumbocostovertebral syndrome: first case report in Argentina

El síndrome lumbocostovertebral se define por la presencia de hernia lumbar, hemivértebras y anomalías costales. El objetivo de este trabajo es describir el primer caso reportado en Argentina. El paciente fue comunicado a la Red Nacional de Anomalías Congénitas de Argentina. Se describe el cuadro clínico, los diagnósticos diferenciales y los posibles mecanismos patogénicos involucrados. Se sugiere que esta entidad sea considerada como una asociación. La hernia lumbar en un recién nacido es un hallazgo infrecuente y debe pesquisarse la presencia de otras anomalías asociadas.

Lumbocostovertebral syndrome is defined by the presence of lumbar hernia, hemivertebrae and costal anomalies. Our aim was to describe the first case reported in Argentina. The patient was reported to the National Registry of Congenital Anomalies of Argentina. The clinical picture, differential diagnoses and possible pathogenic mechanisms involved are described. We suggest considering this as a lumbocostovertebral association. Lumbar hernia in a newborn is an infrequent finding and other associated anomalies should be evaluated.

Método não ionizante de rastreamento da escoliose idiopática do adolescente em escolares / Non-ionizing method of screening adolescent idiopathic scoliosis in schoolchildren

Resumo Escoliose idiopática do adolescente (EIA) atinge de 2% a 4% de jovens no Brasil. Repetidas exposições aos exames radiológicos, no acompanhamento desta deformidade, podem ser danosos à saúde. O objetivo deste estudo é apresentar um protocolo de fotogrametria, como método não ionizante para quantificação da escoliose, e relacioná-lo ao método radiológico de Cobb. Dezesseis indivíduos portadores de escoliose idiopática (21,4 ± 6,1 anos de idade e 19,8±0,2 de índice de massa corporal) foram submetidos à radiografia posteroanterior do tronco, de pé e, posteriormente, fotografia do tronco posterior, após receberem marcadores anatômicos nos processos espinhosos das vértebras C7 até L5. As imagens foram encaminhadas para análise independente de dois examinadores treinados na quantificação da escoliose para o tipo de imagem recebida. A média angular torácica de Cobb e de fotogrametria foram 36,14° e 36,43°, respectivamente. A diferença média entre os métodos foi de 4,1°. Não houve diferença estatisticamente significante (p-valor < 5%) entre eles. A fotogrametria, por ser não ionizante, ter baixo custo e ser portátil, poderá representar uma alternativa ao método radiológico. Novos estudos são necessários no aprimoramento das técnicas não ionizantes no rastreamento da EIA.

Abstract Adolescent idiopathic scoliosis (AIS) affects 2% to 4% of young people in Brazil. Repeated exposures to radiation used in the monitoring of the deformity can be harmful to the health. This study aimed to present a photogrammetry protocol as a non-ionizing method to quantify scoliosis and relate it to the Cobb radiological method. Sixteen individuals with idiopathic scoliosis (age: 21.4 ± 6.1 years, body mass index: 19.8 ± 0.2 kg/m2) underwent standing posteroanterior X-ray examination of the trunk. Additionally, markers were placed on the spinal processes of the C7 to L5 vertebrae, and posterior trunk photographs were taken. All images were sent for independent analysis by two examiners who were trained in the quantification of scoliosis. The average of the thoracic curvature evaluated through the photogrammetry and Cobb methods were 36.43° and 36.14°, respectively. With an average difference of 4.1°, the methods were not statistically different (p < 0.05). As a non-ionizing method that is low cost and portable, photogrammetry may represent a suitable alternative to the radiological method. Further studies are needed for the improvement of non-ionizing techniques in AIS screening.

Tratamiento quirúrgico de escoliosis en personas menores de 25 años / Surgical treatment of scoliosis in people under 25 years of age

Generar recomendaciones basadas en la mejor evidencia disponible acerca del manejo de personas menores de 25 años con Escoliosis. Personas menores de 25 años con Escoliosis que reciben atención en el nivel primario, secundario y terciario de salud en el sector público y privado de salud. Todos los profesionales de salud con responsabilidades en personas con Escoliosis: ortopedistas Infantiles, enfermeras/os, neumólogos/as, neurólogos/as, pediatras, médicos/as generales y enfermeras/os de Atención Primaria que realizan el seguimiento de salud Infantil. Fisiatras y kinesiólogos/as. Las recomendaciones de esta Guía fueron elaboradas de acuerdo al sistema "Grading of Recommendations Assessment, Development, and Evaluation" (GRADE). Luego de priorizadas las preguntas a responder, se realizó la búsqueda y la síntesis de evidencia, para finalmente generar las recomendaciones a través del juicio del Panel de Expertos.

Cobalt chromium-Titanium rods versus Titanium-Titanium rods for treatment of adolescent idiopathic scoliosis; which type of rod has better postoperative outcomes?

SUMMARY OBJECTIVE; Compare the outcome of spinal deformity correction between Ti-Ti and CrCo-Ti rods for the treatment of spinal Adolescent Idiopathic Scoliosis (AIS) using rods mentioned with all pedicle screws and translation technique. METHOD; 59 patients operated for spinal deformity (Lenke 1 or 2) AIS. The patients were divided into two groups by random allocation using Ti-Ti rods (n = 29) and CrCo-Ti rods (n = 30) and the alone difference among them in the surgical procedure was rod material (Ti-Ti or CrCo-Ti rods) and finally, radiological outcomes were compared preoperatively, postoperatively and at last follow-up for 12 months. RESULTS; Patients' main curve correction after surgical procedure regardless type of rod was 48.95±11.04 (13-75) degree. Success rate of spinal deformity correction following surgical procedure regardless of type of administered rod was 86.76 ± 11.30 percent (62.5-100%). Mean of deformity correction rate was 91.49±10.67% using CrCo-Ti rods versus 81.86±9.88% using Ti-Ti rods (P-value=0.01). Angle change was 3.29±6.60 for kyphosis angle and 0.59±7.76 for lordosis angle. Rate of main curve correction was not significantly different considering patients' gender (P-value0.657). Main curve correction success rate was in association with patients' age and type of rod (P-value=0.054, r=-1.863 and P-value=0.001, r=8.865 respectively). CONCLUSION; CrCo-Ti rods have the ability to produce higher correction rates in AIS compared to Ti-Ti rod of the same diameter. CrCo-Ti rods provide significant and stable spinal correction, especially in correction of main curve. This rate was associated with patients' age and type of rod administered but not gender.

RESUMO OBJETIVO: Comparar o resultado da correção da deformidade da coluna vertebral com ligas de Ti-Ti e CrCo-Ti para o tratamento da Escoliose Idiopática do Adolescente (EIA) na coluna usando as ligas mencionadas com todos os parafusos pediculares e técnica de tradução. MÉTODO: 59 pacientes operados por EIA com deformidade da coluna vertebral (Lenke 1 ou 2). Os pacientes foram divididos em dois grupos por alocação aleatória usando ligas de Ti-Ti (n = 29) e ligas de CrCo-Ti (n = 30) e a única diferença entre eles no procedimento cirúrgico foi o material da liga (ligas de Ti-Ti ou CrCo-Ti) e, finalmente, resultados radiológicos foram comparados no pré-operatório, pós-operatório e no último retorno por 12 meses. RESULTADOS: A correção da curva principal do paciente após o procedimento cirúrgico, independentemente do tipo de liga, foi de 48,95±11,04 (13-75) graus. A taxa de sucesso da correção da deformidade da coluna vertebral após o procedimento cirúrgico, independentemente do tipo de liga administrada, foi de 86,76 ± 11,30% (62,5-100%). A média da taxa de correção da deformidade foi de 91,49±10,67% usando ligas de CrCo-Ti e 81,86±9,88% usando ligas de Ti-Ti (valor de P = 0,01). A mudança de ângulo foi de 3,29±6,60 para o ângulo de cifose e de 0,59±7,76 para o ângulo de lordose. A taxa de correção da curva principal não foi significativamente diferente considerando o sexo dos pacientes (Valor de P 0,657). A taxa de sucesso da correção da curva principal foi associada à idade do paciente e ao tipo de liga (valor de P=0,054, r=-1,863 e valor de P=0,001, r=8,865, respectivamente). CONCLUSÃO: As ligas de CrCo-Ti têm a capacidade de produzir taxas de correção mais altas em EIA em comparação com a liga de Ti-Ti do mesmo diâmetro. As ligas de CrCo-Ti fornecem uma correção espinhal significativa e estável, especialmente na correção da curva principal. Essa taxa foi associada à idade e ao tipo de liga administrada, mas não ao sexo.

Síndrome de Klippel-Feil: a propósito de un caso en Ecuador / Klippel-Feil syndrome: about a case in Ecuador

El síndrome de Klippel-Feil (KFS) es un grupo heterogéneo de malformaciones a nivel vertebral que presentan un componente genético monogénico; se caracteriza por presentar un defecto en la formación o segmentación de las vértebras cervicales, que da como resultado una apariencia fusionada. La tríada clínica consiste en un cuello corto, una línea de implantación baja del cabello y un movimiento limitado del cuello. Presentamos el caso de un paciente masculino de 17 años que manifiesta los hallazgos clínicos y radiológicos de esta anomalía. (AU)

Klippel-Feil syndrome (KFS) is a heterogeneous group of vertebral malformations that presents a monogenic genetic component, characterized by a defect in the formation or segmentation of the cervical vertebrae, which results in a fused appearance. The clinical triad consists of a short neck, a low hairline and a limited movement of the neck. We present the case of a 17 year-old male patient who presented the clinical and radiological findings of this anomaly. (AU)

Clinical and radiographic outcomes of upper thoracic versus lower thoracic upper instrumented vertebrae for adult scoliosis: a meta-analysis

The aim of this study was to evaluate the clinical and radiographic outcomes of upper thoracic (UT) versus lower thoracic (LT) upper instrumented vertebrae (UIV) for adult scoliosis by meta-analysis. We conducted a literature search in three databases to retrieve related studies up to March 15, 2017. The preliminary screened studies were assessed by two reviewers according to the selection criteria. All analyses were carried out using the statistical software package R version 2.31. Odds ratios (OR) with 95% confidence intervals (CI) were used to describe the results. The I2 statistic and Q statistic test were used for heterogeneity assessment. Egger's test was performed to detect publication bias. To assess the effect of each study on the overall pooled OR or standardized mean difference (SMD), sensitive analysis was conducted. Ten trials published between 2007 and 2015 were eligible and included in our study. Meta-analysis revealed that the UT group was associated with more blood loss (SMD=0.4779, 95%CI=0.3349-0.6209, Z=6.55, P<0.0001) and longer operating time (SMD=0.5780, 95%CI=0.1971-0.958, Z=2.97, P=0.0029) than the LT group. However, there was no significant difference in Oswestry Disability Index, Scoliosis Research Society (SRS) function subscores, radiographic outcomes including sagittal vertical axis, lumbar lordosis, and thoracic kyphosis, length of hospital stay, and revision rates between the two groups. No evidence of publication bias was found between the two groups. Fusion from the lower thoracic spine (below T10) has as advantages a shorter operation time and less blood loss than upper thoracic spine (above T10) in posterior long-segment fixation for degenerative lumbar scoliosis.

Anatomical and radiological characteristics in adolescent idiopathic scoliosis with surgical indication / Características anatomorradiológicas na escoliose idiopática do adolescente com indicação cirúrgica

ABSTRACT OBJECTIVE: This study aims to analyze the anatomical and radiological characteristics of adolescent idiopathic scoliosis patients with surgical indication. METHODS: Retrospective, descriptive study of 100 medical records pertaining to patients included in the group of scoliosis with surgical indication from the years 2008 to 2015. Descriptive statistics were used for statistical analysis. RESULTS: 28 patients met the inclusion and exclusion criteria, and were selected for the study. The average age was 15.4 (SD ± 1.2 years); in the selected sample, the female/male ratio was 6:1; the kyphosis measured in degrees by Cobb angle between T5-T12 had an average 32.10 (SD ± 13.37); according to the Lenke classification, the most prevalent type was type 2, representing 28.6% of cases. CONCLUSION: The mean patient age in the present study was 15.4 (SD ± 1.2 years); the most prevalent type was type 2 in the Lenke classification. There is a need for new anatomical and radiological studies to elucidate the morphological characteristics common in adolescent idiopathic scoliosis patients.

RESUMO OBJETIVO: Avaliar as características anatomorradiológicas em pacientes com escoliose idiopática do adolescente com indicação cirúrgica. MÉTODOS: Estudo descritivo retrospectivo de 100 prontuários de pacientes do grupo de escoliose com indicação cirúrgica de 2008 a 2015. A análise usada foi a estatística descritiva. RESULTADOS: Preencheram os critérios de inclusão e exclusão 28 pacientes e foram selecionados para o estudo. A média foi de 15,4 ± 1,2 anos DP; na amostra selecionada, a proporção menina:menino foi de 6:1; a cifose foi medida em graus pelo ângulo de Cobb entre T5-T12 e teve como média 32,10° ± 13,37° DP; segundo a classificação de Lenke, o mais prevalente foi o tipo 2, observado em 28,6% dos casos. CONCLUSÃO: A idade média dos pacientes no presente estudo foi de 15,4 anos; o mais prevalente foi o tipo 2 da classificação de Lenke. Novos trabalhos anatomorradiológicos são necessários para elucidar características morfológicas comuns nos pacientes com escoliose idiopática do adolescente.

Correlation between the degree of correction of neuromuscular scoliosis and patient quality of life

OBJECTIVE: There are few data on patient satisfaction with surgery for the correction of neuromuscular scoliosis or on the correlation between patient satisfaction and the degree of curve correction achieved by surgery. Our aim was to determine the correlations between both patient satisfaction and perception of quality of life and the degree of curve correction. METHODS: We interviewed 18 patients and administered a questionnaire that collected social and economic data and information about functional ability, comorbidities and satisfaction. Statistical analysis was performed using chi-square tests, Pearson correlation and paired t-tests. RESULTS: The mean correction achieved was 42.8%, i.e., 34.17 degrees. Early and late complication rates were low (11.1% each). Almost all of the patients (94.4%) were satisfied with the surgery, and expectations were met for 61.1% of them. Quality of life and aesthetics were improved in 83.4% and 94.4% of cases, respectively. No correlation was found between satisfaction and degree of correction. CONCLUSION: Our surgical results are similar to those of other studies with respect to the degree of correction and patient satisfaction. The disparity between satisfaction and fulfillment of expectations may be due to unrealistic initial expectations or misunderstanding of the objective of surgery. Our findings corroborate the hypothesis that satisfaction is multifactorial and not restricted to a quantitative goal. The satisfaction of patients who undergo operation for neuromuscular scoliosis does not depend directly on the degree of deformity correction. The relationship between satisfaction and the success of the correction procedure is complex and multifactorial.

Syndrome in question: Gorlin-Goltz syndrome

Abstract: The Nevoid Basal Cell Carcinoma Syndrome (NBCCS) is an uncommon disorder caused by a mutation in Patched, tumor suppressor gene. It is mainly characterized by numerous early onset basal cell carcinomas, odontogenic cysts of jaw and skeletal abnormalities. Due to the wide clinical spectrum, treatment and management of its modalities are not standardized and should be individualized and monitored by a multidisciplinary team. We report a typical case in a 30-year-old man with multiple basal cell carcinomas, keratotic pits of palmar creases and bifid ribs, with a history of several corrective surgeries for keratocystic odontogenic tumors, among other lesions characteristic of the syndrome.

Escoliosis en niños y adolescentes / Scoliosis in children and adolescents

La escoliosis es una deformidad de la columna que se presenta como una curva estructural que determina un grado variable de deformidad del tronco. La forma más común es la escoliosis idiopática del adolescente, que se desarrolla en la columna, en la fase de crecimiento y puede tener importantes efectos cosméticos y funcionales, pero es siempre un diagnóstico de exclusión. La escoliosis puede ser tratada con observación seriada, uso de ortesis o cirugía, según su magnitud y potencial evolución de severidad. Sin embargo, el comportamiento de la curva es frecuentemente difícil de predecir durante el desarrollo, por lo que el seguimiento clínico y radiológico seriado es clave en la decisión de tratamiento. Aparte de la cirugía, sólo el tratamiento con corset puede frenar la progresión de una curva, si bien no corregirla. Las curvas severas o que progresen dentro del corset tienen indicación de corrección y fusión quirúrgica. Las curvas noidiopáticas se comportan en forma diferente y su manejo es también distinto. El objetivo de este artículo es presentar los aspectos clave de la evaluación inicial de un paciente con escoliosis y entregar una visión actualizada del tratamiento de las distintas formas de presentación de esta afección.

Scoliosis is a structural deformity of the spine that can determine a varying degree of trunk deformity. It's most common presentation is that of Adolescent Idiopathic Scoliosis. This is a diagnosis of exclusion presenting itself in the growing spine and may result in significant cosmetic and functional effects. Depending on its severity, treatment may consist in serial observation, use of an orthosis or corrective surgery. Curve behaviour is however sometimes difficult to predict and clinical follow-up and serial radiographic review are fundamental during the developmental period. Aside from surgery, only brace treatment has demonstrated a capacity of containing curve progression for some cases. Severe curves or those that exhibit progression in spite of adequate brace treatment should be treated by surgical correction. Nonidiopathic forms of scoliosis present a different behaviour and require specific management. This article is to provides key aspects of the initial evaluation of a patient with scoliosis and offers an update on the management of it's most frequent forms of presentation.

Evaluation of Bone Mineral Status in Adolescent Idiopathic Scoliosis

BACKGROUND: Several reports have suggested low bone mineral density (BMD) in patients with adolescent idiopathic scoliosis (AIS). We determined bone mineral status in patients with AIS to evaluate the effect of brace treatment on BMD. METHODS: BMD was measured in 46 patients (mean age, 17.8 +/- 4.9 years) with AIS (17 with brace and 29 without brace) by dual-energy X-ray absorptiometry scan and compared the results to an age-matched (mean age, 16.6 +/- 3.9 years) control group (n = 54). RESULTS: The AIS group had significantly lower bone mass at the lumbar spine (Z-score, -1.500 vs. -0.832) and hip (Z-score, -1.221 vs. -0.754) except at the femoral neck. No difference in BMD was found between patients with AIS who used a brace and those who did not. CONCLUSIONS: The results confirmed that BMD was low in AIS patients and it was not affected by brace treatment.

Avaliação do posicionamento da aorta em pacientes com escoliose idiopática do adolescente / Evaluation of the positioning of the aorta in patients with adolescent idiopathic scoliosis / Evaluación de la posición de la aorta en pacientes con escoliosis idiopática del adolescente

OBJETIVO: Avaliar o posicionamento da aorta em pacientes com escoliose. MÉTODOS: Foram realizados exames de imagem em pacientes ambulatoriais com escoliose idiopática do adolescente e em um grupo formado por pacientes hígidos, sendo analisados seis parâmetros: comprimento do corpo vertebral, largura, distância aorta-corpo, diâmetro da aorta, distância aorta-canal e ângulo corpo-aorta. RESULTADOS: As curvas variaram entre T3 e L2 com ângulos de Cobb de 46° e 114°. Pela classificação de Lenke os tipos 1AN e 1BN ocorreram em 20% dos casos, além de 1CN, 3BN, 3C+ com 13,3 % e 1B+, 3C- com 6,7 %. As vértebras próximas ao ápice da curva no grupo escoliose apresentam valores superiores às do grupo controle (em T8 com média de 86,93° no grupo escoliose e média 49,07 no grupo controle (p < 0,0001). CONCLUSÃO: Quanto mais próximo do ápice da deformidade, maior a póstero-lateralização da aorta.

OBJECTIVE: to determine the aorta positioning in patients with idiopathic scoliosis. METHODS: We performed imaging studies on outpatients with adolescent idiopathic scoliosis and on a group of healthy patients, and analyzed six parameters: length of the vertebral body, width, aortic-body distance, aortic diameter, distance between spine channel and aorta and aortic-body angle. RESULTS: Curves ranged from T3 to L2 with Cobb angles from 46° to 114°. By Lenk's classification it was observed that types 1AN and 1BN occurred in 20% of cases, 1CN, 3BN, 3C+ in 13,3 % and 1B+, and 3C- in 6,7%. The nearest vertebrae of the apex of the curve in the scoliosis group present higher values than those of the control group (at T8 with a mean of 86.93° in the scoliosis group and average of 49.07° in the control group (p<0.0001). CONCLUSION: The nearer the apex of the deformity, the greater the lateralization and posteriorization of the aorta.

OBJETIVO: Determinar la posición de la aorta en pacientes con escoliosis idiopática. MÉTODOS: Se realizaron estudios de imagen en pacientes ambulatorios con escoliosis idiopática del adolescente y en un grupo de pacientes sanos, y se analizaron seis parámetros: longitud y anchura del cuerpo vertebral, distancia aorta-cuerpo, diámetro de la aorta, distancia orta-canal e ángulo cuerpo-aorta. RESULTADOS: Las curvas van desde T3 a L2 con ángulos de Cobb de 46° hasta 114°. En la clasificación de Lenk, los tipos 1AN 1BN ocurrieron en el 20% de los casos, 1CN, 3BN, 3C+ en 13,3%, 3C- y 1B+ en 6,7%. Las vértebras cerca del vértice de la curva en el grupo escoliosis tienen valores más altos que el grupo control (en T8 con una media de 86,93° en el grupo escoliosis y un promedio de 49,07° en el grupo control (p < 0,0001). CONCLUSIÓN: Cuanto más cerca del ápice de la deformidad, mayor es la lateralización y posteriorización de la aorta.

Video-Assisted Thoracoscopic Surgery for Correction of Adolescent Idiopatic Scoliosis: Comparison of 4.5 mm versus 5.5 mm Rod Constructs

PURPOSE: The purpose of this study is to report the comparative results of thoracoscopic correction achieved via cantilever technique using a 4.5 mm thin rod and the poly-axial reduction screw technique using a 5.5 mm thick rod in Lenke type 1 adolescent idiopathic scoliosis (AIS). MATERIALS AND METHODS: Radiographic data, Scoliosis Research Society (SRS) patient-based outcome questionnaires, and operative records were reviewed for forty-nine patients undergoing surgical treatment of scoliosis. The study group was divided into a 4.5 mm thin rod group (n = 24) and a 5.5 mm thick rod group (n = 25). The radiographic parameters that were analyzed included coronal curve correction, the most caudal instrumented vertebra tilt angle correction, coronal balance, and thoracic kyphosis. RESULTS: The major curve was corrected from 49.8degrees and 47.2degrees pre-operatively to 24.5degrees and 18.8degrees at the final follow-up for the thin and thick rod groups, respectively (50.8% vs. 60.2% correction). There were no significant differences between the two groups in terms of kyphosis, coronal balance, or tilt angle at the time of the final follow-up. The mean number of levels fused was 6.2 in the thin rod group, compared with 5.9 levels in the thick rod group. There were no major intraoperative complications in either group. CONCLUSION: Significant correction loss was observed in the thin rod system at the final follow-up though both groups had comparable correction immediately post-operative. Therefore, the thick rod with poly axial screw system helps to maintain post-operative correction.

An incomplete form of lumbocostovertebral syndrome in association with atrial septal defect, arthrogryposis and clubfeet.

The present study describes a 9-month-old infant who presented with congenital lumbar hernia, kyphoscoliosis, atrial septal defect, congenital talipes equinovarus and arthrogryposis. To the best of our knowledge, this is the first case in English literature with this combination of defects. The case could be considered an incomplete form of the lumbocostovertebral syndrome. We also discuss the etiopathogenesis of these malformations.

Limb-body wall complex, report of 2 cases with their quintessence in prenatal diagnosis.

Limb-body wall complex is a complicated fetal malformation with the essential features of: 1) exencephaly/encephalocele with facial clefts, 2) thoraco- and/or abdominoschisis, and 3) limb defect. The diagnosis was based on two of three of the above features. We report 2 cases of limb-body wall complex. The first case had thoraco-abdominal and limb anomalies while the other had abdominal wall, limb and neuro-facial anomalies. Both cases were diagnosed prenatally by ultrasonography. They were terminated by medical induction. Chromosome studies were evaluated for academic purposes. Autopsies were done to confirm diagnosis. Aspects of their varieties of clinical features, differences in differential diagnosis, and pitfalls in prenatal diagnosis were discussed.