Measuring procedures to determine the Cobb angle in idiopathic scoliosis: a systematic review.

BACKGROUND: Scoliosis of the vertebral column can be assessed with the Cobb angle (Cobb 1948). This examination is performed manually by measuring the angle on radiographs and is considered the gold standard. However, studies evaluating the reproducibility of this procedure have shown high variability in intra- and inter-observer agreement. Because of technical advancements, interests in new procedures to determine the Cobb angle has been renewed. This review aims to systematically investigate the reproducibility of various new techniques to determine the Cobb angle in idiopathic scoliosis and to assess whether new technical procedures are reasonable alternatives when compared to manual measurement of the Cobb angle. METHOD: Systematic review. Studies examining procedures used to determine the Cobb angle were selected. Two review authors independently selected studies for inclusion, extracted data and assessed risk of bias. Statistical results of reliability and agreement were summarised and described. RESULTS: Eleven studies of new measuring procedures were included, all reporting the reproducibility. The new procedures can be divided into computer-assisted procedures, automatic procedures and smartphone apps. CONCLUSIONS: All investigated measuring procedures showed high degrees of reliability. In general, digital procedures tend to be slightly better than manual ones. For all other measurement procedures (automatic or smartphone), results varied. Studies implementing vertebral pre-selection and observer training achieved better agreement.

Reshaping of vertebrae during treatment with neridronate or pamidronate in children with osteogenesis imperfecta.

BACKGROUND/AIMS: Osteogenesis imperfecta (OI) is a hereditary disease causing increased bone fragility. Pamidronate (PAM), which has to be administered as a 3-day course according to the original protocol by Glorieux, is the most frequently used therapy. Other bisphosphonates like neridronate (NER), which can be infused during an outpatient visit, have also proven to be effective. This is the first analysis comparing the effect of PAM and NER using vertebral morphometry. METHODS: 28 patients with OI type III and IV were retrospectively analyzed by matched pairs. RESULTS: No differences were detected between patients treated with PAM or NER at the start of therapy: mean age 4.4 years (p = 0.730), mean height 86.8 cm/85.3 cm (p = 0.854), lumbar vertebral area 208.9 mm(2)/206.0 mm(2) (p = 0.555), and in all vertebral indices. After 1 year of treatment (mean 1.16 years; p = 0.854) both groups showed a significant increase in the vertebral area and improved vertebral indices. Again there were no differences between the groups in the vertebral area (p = 0.590). CONCLUSION: In this study there was no difference between patients treated with PAM or NER regarding vertebral morphometry during the first year of therapy. Because of the possibility of an outpatient setting, NER is convenient for these children.

Mechanographic analyses in pediatrics: allometric scaling of 'peak jump force' and its relationship to 'maximal isometric grip force' in childhood and adolescence.

BACKGROUND: Kinetic analyses of the neuromuscular system have become an important part in the diagnostics of metabolic bone disorders in pediatrics because of the relevance of the 'Functional Muscle-Bone Unit'. Because muscle function is associated with muscle metabolism, it is suggested that the association of maximal forces with anthropometric variables (e. g., body weight) is characterized by allometric scaling. The present manuscript aims to describe the scaling exponent for the association of maximal forces of mechanography and dynamometry to body weight and exemplarily applies the prediction of 'Peak Jump Force' (PJF) by 'Maximal Isometric Grip Force' (MIGF) for the characterization of the unconditioned neuromuscular system in subjects with congenital heart disease (CHD). SUBJECTS: MIGF was measured in a reference population of 135 school boys and 177 school girls who were not randomized individuals of a German primary and high-school. In addition, data of the neuromuscular system were analyzed in 29 individuals with CHD. METHODS: Participants performed counter-movement jumping on a force plate to measure PJF and v (max). MIGF was determined by dynamometric measurement. RESULTS: PJF scaled (body mass) (0.97) in girls and (body mass) (1.05) in boys. PJF was not different from the scaling exponent=1 in both genders. After having taken the logarithm, MIGF predicted PJF with R (2)(adjusted)=0.774 in boys, R (2)(adjusted)=0.720 in girls (p<0.001 each) and R (2)(adjusted)=0.209 (p=0.007) in patients with CHD. The mean of the predicted PJF was lower than the mean of the measured PJF in subjects with CHD (p<0.001). The difference between the predicted and the measured PJF (DeltaPJF) was associated with v (max) (R (2)(adjusted)=0.113, p=0.042). CONCLUSIONS: PJF scales body weight in an isometric way as recently describe for other vertebrates. MIGF is a good predictor of PJF in healthy children, but not in unconditioned individuals. DeltaPJF indicates conditioning of the individual and may be used to describe inter- and intramuscular coordination in children. HINTERGRUND: Mechanografische Analysen des neuromuskulären Systems haben mittlerweile auch einen diagnostischen Stellenwert in der Pädiatrie erlangt. Ziel der vorliegenden Untersuchung ist die kinetische Analyse des Counter-movement-Sprungs durch die Messung der Bodenreaktionskräfte in Hinblick auf seine allometrische Skalierung und im Vergleich zur Entwicklung der ,Maximalen isometrischen Griffstärke' (MIGF) bei Kindern und Jugendlichen. PROBANDEN: Die Studienpopulation umfasste 135 Schüler und 177 Schülerinnen, die nicht randomisiert wurden und Schüler einer deutschen Grundschule und eines deutschen Gymnasiums waren. Zudem wurden Daten von 29 Patienten mit kongenitalen Herzfehlern analysiert. METHODEN: Die Studienteilnehmer absolvierten Counter-movement-Sprünge auf einer Sprungplatte, sodass die maximale Sprungkraft (Peak Jump Force, PJF) und die maximale Geschwindigkeit des Massenschwerpunktes beim Absprung (v (max)) ermittelt werden konnten. MIGF wurde durch Messung mit einem Dynamometer bestimmt. ERGEBNISSE: PJF-skalierte (Körpermasse) (0,97) bei den Mädchen und (Körpermasse) (1,05) bei den Jungen. Der Skalierungsfaktor von PJF war bei Mädchen und Jungen nicht signifikant vom Faktor=1 verschieden. Nach Lograithmierung sagte die Variable MIGF den Parameter PJF in der Gruppe der Jungen mit R (2)(adjusted)=0,774, in der Gruppe der Mädchen mit R (2)(adjusted)=0,720 (jeweils p<0,001) und in der Gruppe der Herzkranken mit R (2)(adjusted)=0,209 (p=0,007) voraus. Der Mittelwert des vorhergesagten Wertes für PJF war niedriger als der Wert der gemessenen PJF in Patienten mit Herzerkrankung (p<0,001). Die Differenz zwischen vorhergesagter und gemessener PJF (DeltaPJF) stand statistisch mit v (max) (R (2)(adjusted)=0,113; p=0,042) in Zusammenhang. SCHLUSSFOLGERUNGEN: PJF skaliert isometrisch zur Körpermasse, wie es bereits für andere Vertebraten beschrieben wurde. MIGF ist ein guter Prädiktor für PJF bei gesunden Kindern und Jugendlichen, jedoch nicht bei Menschen mit einem unkonditionierten neuromuskulären System. DeltaPJF kann als Marker für die Konditionierung eines neuromuskulären Systems angesehen werden und beschreibt inter- und intramuskuläre Koordination.

Mechanical influences on bone development in children.

This review focuses on methodological concepts in the evaluation of skeletal muscle function and on adaptation. It is now thought that the critical property of bone is strength rather than weight, and that control of bone strength is mainly exercised through the effect of the mechanical loads brought to bear on bone. Muscle contraction places the greatest physiological load on bone, and so the stability of bone must be adapted to muscle strength (the functional muscle-bone unit). The described suggestions and recommendations outline a new concept: bone mass and strength should not be related to age. There is now more and more evidence that bone mass and strength should be related to muscle function. Thus analyzed, there is no such entity as 'peak bone mass'. Many studies are presently under way to evaluate whether these novel approaches increase the sensitivity and specificity of fracture prediction in an individual. Furthermore, the focus of many bone researchers is shifting away from bone mass to bone geometry or bone strength and their relationship with the driving muscle system.

The influence of auxology and long-term glycemic control on muscle function in children and adolescents with type 1 diabetes mellitus.

We intended to investigate in this pilot-study if long-term glycemic control stands in close relationship with muscle function in children and adolescents with type 1 diabetes mellitus (T1DM). Muscle function (MIGF, maximal isometric grip force; PJF, peak jump force; PJP, peak jump power) was investigated in 40 children and adolescents (males 20, females 20; age 13.5-/+2.5 yr) affected with T1DM. Muscular parameters were correlated with anthropometric parameters (age, height, weight) and with glycosylated hemoglobin (HbA1c) of the presence and the past. Standard deviation scores (SDSs) of weight and MIGF indicated significantly higher weight (mean 0.75-/+1.83 (SD)) and lower MIGF (mean -1.06-/+1.76 (SD)) in individuals with T1DM. When the study group was divided into two groups by the criteria that the actual HbA1c (HbA1c0) was lower (N=25) or higher (N=15) than 8.5%, the comparison showed significantly higher muscular parameters (PJF-SDS, PJP-SDS and MIGF-SDS) in individuals with higher HbA1c0. Multiple regression analyses demonstrated that body weight and height primarily predicted muscle force (MIGF, PJF) in T1DM. In conclusion, skeletal growth is an important determinant for the development of muscle function in children and adolescents with T1DM.

Preliminary results on the mobility after whole body vibration in immobilized children and adolescents.

The present article is a preliminary report on the effect of Whole Body Vibration (WBV) on the mobility in long-term immobilized children and adolescents. WBV was applied to 6 children and adolescents (diagnoses: osteogenesis imperfecta, N=4; cerebral palsy, N=1; dysraphic defect of the lumbar spine, N=1) over a time period of 6 months. WBV was applied by a vibrating platform constructed on a tilt-table. The treatment effect was measured by alternations of the tilt-angle of the table and with the "Brief assessment of motor function" (BAMF). All 6 individuals were characterized by an improved mobility, which was documented by an increased tilt-angle or an improved BAMF-score. The authors concluded WBV might be a promising approach to improve mobility in severely motor-impaired children and adolescents. Therefore, the Cologne Standing-and-Walking- Trainer powered by Galileo is a suitable therapeutic device to apply WBV in immobilized children and adolescents.

The principle of regulation in biology--from bone to eating behavior.

Cell physiology and molecular biology typically follow a reductionistic approach in science. In the last decade, molecular principles and pathogenetic factors involved in the development of many diseases have been successfully discovered. Therefore, early biological concepts based on systemic and cybernetic thoughts have been largely overshadowed by these more recent molecular and pathogenetic factors. This review highlights discoveries on bone development and hypothalamic controlled feeding and eating behavior with a cybernetic and systemic perspective. Interestingly, ancient ideas on bone development and hypothalamic function are still reasonable considerations to embed new molecular discoveries into a systemic concept of principles organizing nature.

Examining the developing skeletal muscle: Why, what and how?

This review focuses on methodological concepts in the evaluation of skeletal muscle function, taking into account classical muscle physiology, the developing motor system in children and anthropometric parameters. Thereby, the classical concept of kinetic and thermodynamic description of muscle function is discussed in relation to data pertaining to human physiology. Emphasis is given to the specific problems that arise when assessing muscle function during development. Two important factors influencing muscle function are discussed in detail: changes in anthropometric characteristics and changes in co-ordinative skills in the developing individual. Finally, we discuss currently available methods for the evaluation of anaerobic muscle function in children and adolescents (maximal isometric grip force, peak jump force, peak jump power, Wingate test, Bosco test).

A cybernetic approach to osteoporosis in anorexia nervosa.

A group of 25 female individuals, who had been admitted to the University Hospital with the diagnosis of anorexia nervosa (AN) 3 to 10 years before, was seen for a follow-up visit in the hospital. These women got a psychiatric exploration to detect a present eating disorder. Moreover, parameters of the muskuloskeletal interaction were determined on the non-dominant forearm. Bone mineral content (BMC) of the radius was measured by pQCT and maximal grip force was evaluated by the use of a dynamometer. Eating disorders were present in 12 females. The mean of BMC standard deviation (SD) score was significantly reduced in comparison with reference values. Furthermore, the mean of BMC SD score was also significantly lower than the mean of grip force in SD score. These results gave the suggestion that the adaptation of bone mass to biomechanical forces is disturbed in AN. The linear regression analyses between the parameters grip force and BMC were compared between the study and the reference group. The comparison delivered a significantly lower constant in the regression equation of the study group. This result can be interpreted on the background of the mechanostat theory. The affection with an eating disorder decreases the set point in the feedback loop of bone modeling. The results offer for the first time the possibility to analyse osteoporosis in anorexic females under the paradigm of muskuloskeletal interaction.

The regulation of bone development as a biological system.

A large number of molecular, cellular, and epidemiologic factors have been implicated in the regulation of bone development. A major unsolved problem is how to integrate these disparate findings into a concept that explains the development of bone as an organ. Often, events at the organ level are simply presented as the cumulative effect of all factors that individually are known to influence bone development. In such a cumulative model it must be assumed that each bone cell carries the construction plan of the entire skeletal anatomy in its genes. This scenario is implausible, because it would require an astronomical amount of positional information. We therefore propose a functional model of bone development, which is based on Frost's mechanostat theory. In this model, the genome only provides positional information for the basic outline of the skeleton as a cartilaginous template. Thereafter, bone cell action is coordinated by the mechanical requirements of the bone.

Analysis of cancellous bone turnover by multiple slice analysis at distal radius: a study using peripheral quantitative computed tomography.

We compared the results of peripheral quantitative computed tomography (pQCT) measurements (XCT-900; Stratec) at the 4% site of the distal radius (section 1; slice thickness of 2 mm) and in two proximally adjacent sections (sections 2 and 3). The study population consisted of 138 ambulatory patients (age 16.4 +/- 5.6 yr; mean +/- SD; 71 female) who were referred to a pediatric densitometry unit. Total volumetric bone mineral density (BMD) increased, whereas the area of the radial cross-section decreased in a proximal direction. There was a decrease in bone mineral content between sections 1 and 3, which was more pronounced in subjects under age 16. Cancellous BMD significantly decreased from section 1 to 3 only under the age of 16. In 12 patients under age 17 who suffered from increased bone fragility, cancellous BMD decreased about 2.5 times more between sections 1 and 3 than in age-matched patients who received anticonvulsant therapy but had a normal neurologic and musculoskeletal status (-21.4% +/- 16.9 vs -8.1% +/- 6.3; p = 0.02). This suggests that in the bone fragility group, trabeculae were removed faster during longitudinal growth of the radius. In conclusion, multiple slice analysis may provide information on the dynamic turnover of metaphyseal trabeculae during growth.

Chemiluminescence immunometric assay for measuring osteocalcin in healthy children.

Osteocalcin (OC) was measured in serum samples from 92 children and adolescents (57 females, 35 males) by a two-site chemiluminescence immunometric assay (Nichols Institute Diagnostics, USA), which recognizes the 1-19 region of the whole molecule as well as the large N-terminal midregion fragment representing the main part of OC in serum. The highest OC levels are measured between the age of 10-15 years. The linear correlations between OC and alkaline phosphatase were 0.65 (p < .01) for total alkaline phosphatase (TAP) and 0.61 (p < 0.1) for bone alkaline phosphatase (BAP).