A simple method for assessing rotational flexibility in adolescent idiopathic scoliosis: modified Adam's forward bending test.

PURPOSE: This study aimed to evaluate the diagnostic aptitude of a modified Adams forward bending test (MAFBT), which addresses the coupling phenomenon of axial rotation with reference to the side-bending movement. Also, this evaluation was facilitated by the introduction of our rotational flexibility index (RFI). METHODS: Thirty-two female and eight male AIS patients were included in this study from a single institution. In the MAFBT, subjects were asked to bend to the convex side of the curve in the forward bending position. Scoliometric measurements were done during the AFBT and MAFBT. Utilizing anteroposterior standing plain radiographs curve flexibility indices were calculated. The diagnostic aptitude of the MAFBT was evaluated based on the receiver operating characteristic (ROC) curves and area under the curve (AUC). The RFI was also assessed, which considered AFBT and MAFBT parameters as a specified function. RESULTS: Significant correlations were noted between the Cobb angle and AFBT (p = 0.005), fulcrum bending and the MAFBT (p = 0.0001), side-bending and MAFBT (p = 0.0001). There were significant positive correlations between rotational flexibility as based on fulcrum bending radiograph to that of the RFI (r = 0.4, p = 0.036) and side-bending technique (r = 0.4, p = 0.008). Based on ROC analyses (AUC range 0.7-0.8), the MAFBT demonstrated high specificity and sensitivity rates for flexible and rigid curves, respectively. CONCLUSIONS: This is the first study to report that the MAFBT is a simple and reliable test for the clinical assessment of rotational flexibility in AIS patients. The study further noted that the novel RFI has clinical utility in the assessment of AIS.

The effect of equine-derived bone protein extract (Colloss-E) in the treatment of cavitary bone defects: an experimental study.

OBJECTIVE: Bone protein extract (BPE) usually requires a carrier or a scaffold for implantation. We aimed to compare the effect of equine-derived BPE, an osteoinductive agent composed of a high amount of type-I collagen and other bone proteins (Colloss-E), with that of human demineralized bone matrix (DBM) for treating cavitary bone defects not requiring scaffold use. METHODS: Rabbit distal femoral condyle was used as a stable cavitary bone defect model. Bone defects of 6-mm diameter and 10-12-mm depth were created in the femoral condyles. Rabbits were assigned into the equine-derived BPE (BPE), human-derived DBM (DBM), and control (C) groups. Approximately 20 mg of BPE was implanted into the defect in the equine-derived BPE group (n=6), whereas 0.3 cc of DBM was implanted in the DBM group (n=6). Defects were left empty in the C group (n=6). The defect area was histologically examined after 6 weeks. RESULTS: There were no instances of macroscopic defect collapse or failure. Histopathological examination revealed that the BPE group had better scores (statistically significant) than both the other groups in terms of quality of union. The BPE group also had higher scores than the DBM group in terms of graft incorporation and new-bone formation. CONCLUSION: The current study revealed results consistent with those of the previous studies concerning BPEs. Equine-derived BPE was found to be successful for treating cavitary bone defects not requiring scaffold use.

Biomechanical comparison of effects of the Dynesys and Coflex dynamic stabilization systems on range of motion and loading characteristics in the lumbar spine: a finite element study.

BACKGROUND: The primary purpose of dynamic stabilization is to preserve the normal range of motion (ROM) by restricting abnormal movement in the spine. Our aim was to analyze the effects of two different dynamic stabilization systems using finite element modeling (FEM). METHODS: Coflex and Dynesys dynamic devices were modeled and implanted at the L4-L5 segment using virtual FEM. A 400 N compressive force combined with 6 N flexion, extension, bending and axial rotation forces was applied to the L3-4 and L4-5 segments. ROM and disc loading forces were analyzed. RESULTS: Both systems reduced ROM and disc loading forces at the implanted lumbar segment, with the exception of the Coflex interspinous device, which increased ROM by 19% and did not change disc-loading forces in flexion. CONCLUSIONS: The Coflex device prevented excessive disc loading, but increased ROM abnormally in flexion. Neither device provided satisfactory motion preservation or load sharing in other directions.

Effect of strontium ranelate on hydrogen peroxide-induced apoptosis of CRL-11372 cells.

In vitro and in vivo studies have proven strontium to be an osteoinductive trace element. The effect of strontium ranelate (SR) on H(2)O(2)-induced apoptosis of CRL-11372 cells and optimization of its anti-apoptotic dose were the aims of this study. After 1 h of pretreatment with SR 1 microM, 50 microM, 100 microM, 500 microM, and 1,000 microM concentrations, CRL-11372 osteoblasts were exposed to 100 microM H(2)O(2) for periods of 6-12 h. The same experiments were repeated without H(2)O(2). The apoptotic index and viability of cells were assessed quantitatively with a fluorescent dye and qualitatively with agarose gel electrophoresis. Concentrations of 1-100 microM of SR with a 6-h treatment and only 1 microM concentration with a 12-h treatment inhibited the apoptotic effect of H(2)O(2) on cultured osteoblasts significantly (P < 0.05). SR was shown to inhibit H(2)O(2)-induced apoptosis of CRL-11372 cells in a dose-dependent manner.

Alcohol neurolysis for persistent pain caused by superior cluneal nerves injury after iliac crest bone graft harvesting in orthopedic surgery: report of four cases and review of the literature.

STUDY DESIGN: Harvesting of autologous bone graft from the posterior iliac crest for lumbar spinal fusions is a frequently performed procedure in orthopedic surgery. The most common complication associated with this procedure is an alteration in sensation over the donor site manifested as chronic pain, hyperesthesia, dysesthesia, or diminished sensitivity resulting from superior cluneal nerve (SCN) injury. OBJECTIVE: To predict the effectiveness of alcohol neurolysis in the treatment of persistent pain caused by the entrapment of superior cluneal nerves. SUMMARY AND BACKGROUND DATA: The subjects of this study were patients with intractable pain in donor area after conventional treatments using a transverse incision, which is parallel to posterior iliac crest. The study group was composed of four patients who underwent surgery in a 1-year period and experienced chronic pain resulting from superior cluneal nerve injury. METHODS: No reports describing alcohol neurolysis of the superior cluneal nerve exist in the relevant literature. All four patients in this study were treated with alcohol neurolysis of the superior cluneal nerves. RESULTS: The study patients were observed up to 4 years, and none of them reported any problems. CONCLUSIONS: The authors suggest that conventional treatments be limited to a 2-month period, and that alcohol neurolysis be applied as soon as possible to prevent lengthy pain experiences.