ABSTRACT
UNLABELLED: The progression of adolescent idiopathic scoliosis is typically monitored via regular radiographic follow-up. The Cobb angle (as measured on whole-spine radiographs) is considered as the gold standard in scoliosis monitoring. OBJECTIVE: To determine the sensitivity and specificity of back surface topography parameters, with a view to detecting changes in the Cobb angle. PATIENT AND METHOD: One hundred patients (mean age: 13.3) with Cobb angles greater than 10 degrees were included. Topographic parameters were measured in a standard position and in a position with hunched shoulders. Gibbosities and spinal curvatures were evaluated. RESULTS: An increase of more than 2 degrees in any one gibbosity or in the sum of the gibbosities (in either of the two examination positions) enabled the detection of a five-degree increase in the Cobb angle with a sensitivity of 86% and a specificity of 50%. CONCLUSION: If the present results are confirmed by other studies, analysis with back surface topography parameters may reduce the number of X-ray examinations required to detect increases in the Cobb angle.
Subject(s)
Back/pathology , Disease Progression , Scoliosis/diagnosis , Adolescent , Back/diagnostic imaging , Child , False Negative Reactions , Humans , Predictive Value of Tests , Prospective Studies , Radiography , Scoliosis/diagnostic imaging , Young AdultABSTRACT
Even though new prevention techniques have been developed and are being used during thoraco-abdominal aortic repairs, spinal cord infarction remains a severe and relatively frequent complication of aortic surgery. Infarctions in the territory of the anterior spinal artery are considered the most common. Different clinical pictures related to spinal cord transverse extension wounds are drawn up. In this paper, we present a case report of a subject having presented an isolated motor deficit of the lower limbs and a favorable prognosis, suggesting selective involvement of the anterior horns of the spinal cord subsequent to surgical repair of an aortic dissection. We wish to review the relevant anatomical, clinical and diagnostic characteristics along with current techniques of spinal cord ischemia prevention during and after surgery.
Subject(s)
Aorta, Thoracic/surgery , Infarction/etiology , Paraparesis/etiology , Postoperative Complications , Spinal Cord/blood supply , Aged , Aortic Dissection/surgery , Aortic Aneurysm/surgery , Humans , Infarction/diagnosis , Magnetic Resonance Imaging , Male , Neurologic Examination , Paraparesis/rehabilitationABSTRACT
UNLABELLED: Idiopathic scoliosis is a three-dimensional deformation of the spine. As its name suggests, its pathogenesis remains poorly understood. Enhanced comprehension of its pathogenesis would be likely to improve current therapeutic results. While the hereditary and genetic origin of scoliosis appears unassailable and several chromosomes are known to be involved in transmission, the role assumed by each individual chromosome remains uncertain, and the mechanisms leading to the expression of scoliosis have yet to be determined. Even though a large number of pathogenetic hypotheses have been put forward and numerous studies carried out, none of these hypotheses have won unanimous approval, and the controversy remains persistent. OBJECTIVE: The objective of this paper is to identify the existing hypotheses and to group them within large-scale etiological categories. METHODS: We examined the Pubmed and Goggle databases using as keywords "idiopathic scoliosis" and "pathogenesis". The search was limited to articles in English and French. RESULTS: The vicious cycle hypothesis is markedly preponderant. However, no existing pathogenetic model adequately accounts for the formation of scolioses. CONCLUSION: We are proposing four main pathogenetic mechanisms: asymmetric bone growth dysregulation, susceptibility of bones to deformation, abnormal passive spinal system maintenance and disturbed active spinal system maintenance.
