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1.
J Vet Intern Med ; 38(4): 2368-2372, 2024.
Article in English | MEDLINE | ID: mdl-38662636

ABSTRACT

Granuloprival degeneration is an uncommon form of cerebellar cortical degeneration (CCD). A 3-month-old Yorkshire Terrier and a 7-month-old Lagotto Romagnolo dog were presented with a history of progressive cerebellar dysfunction including wide-based stance, cerebellar ataxia, intention tremors, and loss of menace response despite normal vision. Magnetic resonance imaging of the brain identified marked diffuse decrease of the cerebellum size. Euthanasia was performed in both cases because of progression of clinical signs. Histopathological examination identified marked diffuse thinning of the granular cell layer with almost complete loss of the granular cell neurons, providing a definitive diagnosis of granuloprival CCD. Granuloprival CCD should be considered as a differential diagnosis in Yorkshire Terrier and Lagotto Romagnolo dogs with post-natal progressive clinical signs of cerebellar dysfunction.


Subject(s)
Dog Diseases , Animals , Dogs , Dog Diseases/pathology , Dog Diseases/diagnosis , Dog Diseases/diagnostic imaging , Magnetic Resonance Imaging/veterinary , Male , Cerebellar Cortex/pathology , Female
2.
J Clin Med ; 13(8)2024 Apr 18.
Article in English | MEDLINE | ID: mdl-38673638

ABSTRACT

(1) Background: Previous data show that patients with idiopathic scoliosis (IS) can be classified into two groups according to pain intensity. This paper aims to determine which factors can independently predict the likelihood of belonging to a high-level pain group. (2) Methods: The study used a prospective, multicenter, cross-sectional design. Two-hundred and seventy-two patients with IS (mean age 18.1 years) (females 83.5%) were included. The sample was divided into two groups. The PAIN group comprised 101 patients (37.1%) with an average NRS of 5.3. The NO-PAIN group consisted of 171 patients (62.9%) with an average NRS of 1.1. Data on various factors such as comorbidities, family history, curve magnitude, type of treatment, absenteeism, anxiety, depression, kinesiophobia, family environment, and social relationships were collected. Statistical analysis consisted of multivariate logistic regression analysis to identify independent predictors of high-level pain. (3) Results: In the final model, including modifiable and non-modifiable predictors, age (OR 1.07 (1.02-1.11)); Absenteeism (OR 3.87 (1.52-9.87)), HAD anxiety (OR 1.18 (1.09-1.29)) and an indication for surgery (OR 2.87 (1.28-6.43)) were associated with an increased risk of pain. The overall model is significant at p = 0.0001 level and correctly predicts 72.6% of the responses. (4) Conclusions: Age, an indication for surgery, anxiety, and work/school absenteeism are the variables that independently determine the risk of belonging to the high-level pain group (NRS > 3).

3.
Eur Spine J ; 31(4): 1006-1012, 2022 04.
Article in English | MEDLINE | ID: mdl-35128586

ABSTRACT

OBJECTIVE: A pain intensity of 3 can reliably distinguish idiopathic scoliosis (IS) patients with acceptable pain or not. This research aims to analyze psychosocial, family and quality of life differences in patients according to their pain status. MATERIAL AND METHODS: Patients with IS, without previous surgery, Cobb ≥ 30° and age (12-40) were included in the study. They completed the questionnaires Numerical Rate Scale (NRS), Tampa Scale for Kinesiophobia (TSK)-11, SRS22r, Hospital Anxiety-Depression Scale (HADS), COMI item 7 (work/school absenteeism) and family APGAR. Comorbidities and family health history were collected. Analysis of covariance was performed to compare means between the PAIN (NRS > 3), (NRS < = 3) groups controlling for the effect of age and the magnitude of the curve. RESULTS: In total, 272 patients were included. 37.1% belonged to the PAIN group (PG). The PG showed a significantly higher Cobb grade and age than the NO-PAIN group. After controlling for these variables, the PG had worse pain, mental health and SRS22-subtotal values. However, they did not differ in function or self-image. PG showed higher levels of kinesiophobia, anxiety, depression, absenteeism from work/school and impact on social/family environment. PG patients reported a higher prevalence of comorbidities and family history of nonspecific spinal pain. CONCLUSIONS: Patients with IS and unacceptable pain constitute a group with a different incidence of psychological, social, family and comorbidities factors than those with acceptable pain. In contrast, the severity of IS was not substantially different between the groups. This profile is similar to that observed in patients with nonspecific spinal pain.


Subject(s)
Scoliosis , Humans , Pain , Pain Measurement , Quality of Life , Scoliosis/surgery , Spine , Surveys and Questionnaires
4.
J Am Vet Med Assoc ; 259(S2): 1-4, 2022 02 21.
Article in English | MEDLINE | ID: mdl-35171819

ABSTRACT

In collaboration with the American College of Veterinary Pathologists.


Subject(s)
Pathology, Veterinary , Veterinarians , Animals , Humans , United States
5.
Spine (Phila Pa 1976) ; 46(21): 1455-1460, 2021 Nov 01.
Article in English | MEDLINE | ID: mdl-34618706

ABSTRACT

STUDY DESIGN: Prospective, multi-centric, cross-sectional study. OBJECTIVE: To analyze the construct validity of the Tampa Scale of Kinesiophobia (TSK) in a cohort of patients with adolescent idiopathic scoliosis (AIS). SUMMARY OF THE BACKGROUND DATA: Back pain is not uncommon in AIS. The fear of movement (kinesiophobia) in response to pain is related to back pain. TSK psychometric properties in AIS patients have not been properly analyzed. METHODS: Patients with AIS and no prior spine surgery were prospectively included. They fulfilled the Spanish version of the TSK-11 questionnaire, a pain intensity numerical rating scale (NRS), refined SRS-22 (SRS-22r), the Hospital Anxiety and Depression Scale (HADS), and item 7 of the Core Outcome Measurement Index (COMI). The sample was split into two groups for the statistical analysis: adolescents and young adults. Cronbach alpha was used to assess internal consistency. Discriminant and concurrent validity were obtained by computing Pearson correlation coefficients between the TSK score and several criterion measures. RESULTS: A total of 275 patients were included-198 adolescents (mean age of 14.6 yrs) and 77 young adults (mean age of 26.9 yrs). The Cobb of largest curve means were 44.9° and 48.9°, respectively. In the adolescent group, the TSK mean (±SD) was 21.5 (±5.93), with a floor effect of 2.5%. In the adult group, the TSK mean was 24.2 (±6.63), with a floor effect of 3.9%. The ceiling effect was 0% in both groups. Cronbach alphas for the adolescent and adult groups were 0.76 and 0.79, respectively. No correlation was found in any group between the TSK score and the curve magnitude or pattern (Lenke classification). The TSK was significantly correlated with HAD depression and SRS-22r in both groups. However, these correlations were weaker in adolescents. In adults, the TSK also significantly correlates with NRS and work/school absenteeism. CONCLUSION: The Spanish version of TSK-11 is a reliable and valid instrument to analyze kinesiophobia in AIS. However, the weak correlation between kinesiophobia and pain intensity, disability, and emotional condition in adolescents requires further study.Level of Evidence: 4.


Subject(s)
Phobic Disorders , Scoliosis , Adolescent , Adult , Back Pain , Cross-Sectional Studies , Humans , Pain Measurement , Phobic Disorders/diagnosis , Phobic Disorders/epidemiology , Prospective Studies , Quality of Life , Reproducibility of Results , Scoliosis/diagnosis , Scoliosis/epidemiology , Young Adult
6.
J Comp Pathol ; 185: 108-117, 2021 May.
Article in English | MEDLINE | ID: mdl-34119227

ABSTRACT

In captive gorillas, ulcerative colitis is an important cause of morbidity and mortality with no established definitive aetiopathogenesis. The aim of the study was to characterize histopathologically colonic lesions in captive western lowland gorillas (Gorilla gorilla ssp gorilla) and to apply the Nancy index, a disease activity scoring system for ulcerative colitis in humans. Colon samples from 21 animals were evaluated on the basis of histopathological characteristics for the diagnosis of inflammatory bowel disease in humans and divided into acute or chronic changes. The most common acute changes included the presence of neutrophils in the lamina propria (17/18; 94%), mucosal and submucosal oedema (12/18; 67%) and crypt abscesses (8/18; 44%). The most common chronic changes were lamina proprial lymphoplasmacytic infiltrates (17/18; 94%) and crypt dilation or distortion (6/18; 33%). Based on the Nancy index, 4/21 (19%) cases were grade 4 (the highest grade), 2/21 (10%) were grade 3, 11/21 (52%) were grade 2 and 4/21 (19%) cases were grade 0. The colonic changes were comparable to the acute phase of ulcerative colitis in humans. No unifying aetiopathogenesis could be identified. The Nancy index proved to be a valuable tool for the standardization of disease grading and established a basis for future studies of gorilla colitis.


Subject(s)
Colitis , Gorilla gorilla , Animals , Animals, Zoo , Colitis/pathology , Colitis/veterinary , Colon/pathology
7.
Porcine Health Manag ; 7(1): 30, 2021 Apr 07.
Article in English | MEDLINE | ID: mdl-33827694

ABSTRACT

BACKGROUND: The present paper reviews the occurrence of neoplasms in swine and presents a case series of 56 tumors submitted to the Slaughterhouse Support Network (Servei de Suport a Escorxadors [SESC] IRTA-CReSA]) from slaughtered pigs from 1998 to 2018 (April) in Catalonia (Spain). The aim of the study was to describe the spectrum of spontaneous neoplastic lesions found in slaughtered pigs and to compare the reported tumor cases with previous published data. Lymphoid neoplasms were characterized and classified using the WHO classification adapted for animals. RESULTS: The most reported neoplasm during this period was lymphoma (28). Within lymphomas, the B-cell type was the most common, being the diffuse large B-cell lymphoma (15/28) the most represented subtype. Other submitted non-lymphoid neoplasms included melanoma (7), nephroblastoma (3), mast cell tumor (2), liposarcoma (2), osteochondromatosis (2), papillary cystadenocarcinoma (1), peripheral nerve sheath tumor (1), lymphoid leukemia (1), fibropapilloma (1), hemangiosarcoma (1), hepatoma (1), histiocytic sarcoma (1), pheochromocytoma (1) and osteosarcoma (1). CONCLUSIONS: The existence of a well-established Slaughterhouse Support Network allowed the compilation of comprehensive data for further epidemiological and pathological studies, particularly about less commonly reported lesions in livestock such as neoplasms in pigs.

8.
Spine Deform ; 8(6): 1239-1246, 2020 Dec.
Article in English | MEDLINE | ID: mdl-32638334

ABSTRACT

INTRODUCTION: Body image and trunk appearance perception are two crucial attributes in determining the quality of life of individuals with spinal deformities. The Trunk Appearance Perception Scale (TAPS) is a drawing-based instrument used to evaluate this feature. The TAPS does not include a sagittal view of the trunk so it is never been used to assess trunk deformity perception in hyperkyphotic patients. This study aims to analyze the effect of introducing a new drawing on the TAPS scale representing the trunk view in the sagittal plane. PATIENTS: 170 non-surgical patients were included (mean age 16.9 years and 77.4% women) distributed in three groups. CONTROL group (no deformity): 22 cases; KYPHOSIS group (sagittal deformity): 49 cases and SCOLIOSIS group (coronal deformity): 99 cases (mean Cobb 42.4º). METHOD: Cross-sectional study. A new drawing (TAPS4) was designed to represent the deformity in the sagittal plane with five response options. Clinical (SRS-22 and TAPS 4-items) and radiological (kyphosis T4-T12) data were collected in all patients. The statistical analysis consisted in determining for each group the internal consistency of the 3-items TAPS vs 4-items TAPS, as well as the discriminant validity (correlation with kyphosis magnitude) and convergent validity (correlation with the SRS-22 image subscale). In addition, test-retest reliability of new item 4 was determined in a subgroup of 30 kyphotic patients. During control visit, the patients received a complete physical examination and a full-spine AP and lateral X-ray in standing position using a low-radiation technique and fulfilled instruments TAPS 4 items and SRS-22r. RESULTS: The three groups were found to have statistically significant differences in the magnitude of kyphosis, quality of life, body image perception, the 3-items TAPS, 4-items TAPS and new item 4 score. The addition of the item 4 to TAPS 3 items did not cause a significant change in the internal consistency of the scales (Cronbach's alpha) (TAPS 3-items 0.8 vs. TAPS 4-items 0.8). Kyphosis magnitude was not correlated with the 3-items TAPS and 4-items TAPS scores; however, in the KYPHOSIS group, a significant negative correlation was observed between kyphosis and item 4 (Rho = - 0.4, p = 0.0001). A significant correlation was found in all groups between TAPS 3-items and TAPS 4-items and SRS-22 image domain; the correlation between item 4 and SRS-22 body image domain was 0.3 in the Scoliosis group and 0.7 in the Kyphosis group. CONCLUSIONS: The 4-items TAPS scale does not provide advantages in the assessment of trunk deformity over the 3-items scale. However, in patients with kyphosis, the item 4 (Kypho-TAPS) alone is a valid and reliable instrument to monitor the perception of the trunk deformity.


Subject(s)
Body Image/psychology , Monitoring, Physiologic/methods , Perception/physiology , Physical Appearance, Body , Psychology, Adolescent , Scheuermann Disease/pathology , Scheuermann Disease/psychology , Adolescent , Cross-Sectional Studies , Female , Humans , Male , Quality of Life , Scheuermann Disease/diagnostic imaging
9.
Eur Spine J ; 28(12): 3018-3025, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31396690

ABSTRACT

PURPOSE: Clinical photography has proven to be reliable for posture assessment in adolescents and young adults with idiopathic scoliosis. This paper attempts to elucidate whether clinical photography is capable of distinguishing the distinctive characteristics in trunk deformity of the different Lenke patterns in patients with severe scoliosis candidate for surgery. METHODS: One hundred and seventy-three patients (82% women), average age of 20.8 years and average largest curve magnitude of 58.7° were included. PA standing full-spine X-rays and digital photographs from the back of the trunk were measured. RADIOLOGICAL MEASUREMENTS: It is used to measure magnitude of the proximal thoracic (PTC), main thoracic (MTC) and thoracolumbar/lumbar (TL/LC) curves, T1 tilt and the clavicle-rib intersection angle. PHOTOGRAPHIC MEASUREMENTS: It is used to measure shoulder height angle, axilla height angle, waist height angle (WHA), right and left waist angles and trunk areas. STATISTICAL ANALYSIS: One-way ANOVA to test mean differences among Lenke types for radiological and photographic measurements was performed. ROC curve analysis was conducted to find out cutoff values in photographic measurements to differentiate among curve patterns. RESULTS: Most radiological and photographic measurements differ among curve patterns. On ROC curve analysis, solid cutoff values were found for WHA (AUC = 0.8), left waist angle (AUC = 0.81), right waist angle (AUC = 0.81) and the difference between left and right waist angles (AUC = 0.86) to differentiate between types 1 and 2 and the other three types (3, 5 and 6). CONCLUSIONS: Clinical photography is a valid method for assessing trunk asymmetry in severe idiopathic scoliosis. Specifically, for waist area measurements, robust cutoff values can be determined to discriminate among different curve patterns according to Lenke classification. These slides can be retrieved under Electronic Supplementary Material.


Subject(s)
Photography/methods , Scoliosis , Adolescent , Adult , Humans , Radiography , Scoliosis/classification , Scoliosis/diagnostic imaging , Scoliosis/pathology , Spine/diagnostic imaging , Spine/pathology , Torso/diagnostic imaging , Torso/pathology , Young Adult
10.
Eur Spine J ; 28(5): 1209-1216, 2019 05.
Article in English | MEDLINE | ID: mdl-30798453

ABSTRACT

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Analyze the rate and risk factors associated with Unplanned Surgeries (US) during the first 30 days in patients treated for cervical spondylotic myelopathy. BACKGROUND: US are often regarded as a potentially useful quality of care indicator. METHODS: We defined US as any, non-planned, surgical procedure as a complication after "index" surgery. Demographic data, comorbidities, ASA, smoking status, surgical details and postoperative complications were collected. We conducted a subjective outcome test using the Global Outcome Score (GOS). To assess risk factors, a bivariate analysis was performed using T Student or Chi-square. Risk is shown as odds ratio (OR) with 95% confidence interval (CI). Multivariable logistic regression models with bootstrap resampling procedure were performed. RESULTS: The study included 303 patients (200 men) with mean age of 57.7 years (27-86) and mean follow-up of 75.35 months (16-126 m). 63.3% patients were ASA 1 or 2 and 41.9% were smokers. 77.9% of patients had some comorbidity. Anterior approach surgeries were 65.7%. Perioperative complications: 29% medical, 8.9% intraoperative and 3% implant related. US rate was 2.6%. Causes for revision were postoperative infection or deep hematomas. After bivariate analysis, the risk factors associated were diabetes mellitus (OR 2.6; 95% CI 1-5.5) and intraoperative complications (OR 6.5, 95% CI 1-40). The presence of US does not have influence in satisfaction using GOS score. CONCLUSIONS: Our US rate was 2.6%, similar to the literature. Diabetics and patients suffering an intraoperative complication are more likely to need an early reinterventions (OR 2.2 and 6.5, respectively). US did not alter the patient's outcomes. These slides can be retrieved under Electronic Supplementary Material.


Subject(s)
Cervical Vertebrae/surgery , Reoperation/statistics & numerical data , Spinal Cord Diseases/surgery , Spondylosis/surgery , Adult , Aged , Aged, 80 and over , Diabetes Mellitus/epidemiology , Female , Hematoma/surgery , Humans , Intraoperative Complications/epidemiology , Male , Middle Aged , Postoperative Complications , Retrospective Studies , Risk Factors , Surgical Wound Infection/surgery
11.
Spine Deform ; 6(4): 417-423, 2018.
Article in English | MEDLINE | ID: mdl-29886913

ABSTRACT

STUDY DESIGN: Retrospective study of prospectively collected longitudinal data. OBJECTIVES: To analyze the Trunk Appearance Perception Scale's (TAPS's) responsiveness to surgical treatment of idiopathic scoliosis (IS). SUMMARY OF BACKGROUND DATA: TAPS is a drawing-based instrument to assess trunk deformity in IS. It shows appropriate metric properties, such as internal consistency and discriminant validity. However, no data on responsiveness to surgical treatment is available. METHODS: A total of 109 patients (85.3% females) with IS were included (mean age at surgery 18 years). In all the cases, surgery consisted of posterior spine fusion and instrumentation. The magnitude of the largest curve (MLC) was 63.8° before surgery and 26.3° (correction 58.3%) at a mean follow-up of 20.8 months. Internal and external responsiveness were analyzed on the basis of effect size (ES), standardized response mean (SRM), minimum detectable change (MDC), and correlation between percentage of MLC correction and outcome measure change. Data for TAPS were compared to those of SRS-22 Image domain. RESULTS: TAPS showed somewhat larger internal responsiveness (ES 1.96, SRM 1.73, 86.2% of patients exceeding MDC) than SRS-22 Image scale (ES 1.44, SRM 1.29, 73.4% of patients exceeding MDC). No correlation was found between the percentage of MLC correction and baseline to follow-up change in TAPS or SRS-22 Image scores. CONCLUSION: The TAPS instrument shows adequate responsiveness to surgical treatment of idiopathic scoliosis and is somewhat larger than SRS-22 Image domain data. The lack of correlation between radiologic correction and clinical improvement indicates that the two outcomes must be independently collected. These data on responsiveness complete the TAPS validation process. TAPS is a valid, reliable, and responsive instrument to evaluate the outcome of surgical treatment of idiopathic scoliosis. LEVEL OF EVIDENCE: Level IV.


Subject(s)
Body Image , Scoliosis/psychology , Adolescent , Adult , Age Factors , Child , Female , Humans , Male , Retrospective Studies , Scoliosis/surgery , Surveys and Questionnaires , Young Adult
13.
Article in English | MEDLINE | ID: mdl-27579446

ABSTRACT

BACKGROUND: Evaluation of trunk deformity by physicians in patients with idiopathic scoliosis (IS) has been considered an important part of clinical practice. Different methods to quantify the severity of trunk deformity by external observation have been reported. A valid tool to evaluate patients' perception of trunk deformity, the Trunk Appearance Perception Scale (TAPS), is hereby validated for use by physicians (TAPS-Phy). METHODS: Cross-sectional study of patients with non-surgically treated IS. Patients were prospectively recruited. On the day of the visit, a posterior-anterior radiograph in standard position and clinical photographs in three different views (anterior, posterior and forward bending position) were obtained. Patients also completed a TAPS questionnaire (TAPS-Pat). Three different observers scored the TAPS questionnaire (TAPS-Phy), based on the digital photographs previously obtained, twice a week. The angle of trunk inclination (ATRI) was also measured on digital photographs. Inter and intra-rater reliability was calculated through weighted kappa coefficient. External validity was tested by the Spearman correlation coefficient between the TAPS-Phy score and the scoliosis magnitude determined using the magnitude of the largest curve (MLC), ATRI, and TAPS-Pat. RESULTS: Fifty two patients (46 women; mean age 16.6 years) were included. The average curve magnitude of the major curve was 44°. Mean scores of TAPS-Phy for the three evaluators ranged from 3.4 to 3.5. No differences between the three means were found. TAPS-Phy showed good internal consistency (Cronbach's alpha coefficient 0.84). Inter-observer reliability ranged from slight to substantial (0.14 to 0.63); intra-observer reliability ranged from 0.35 to 0.99. Correlation between TAPS-Phy and ATRI (r = -0.54 to -0.75), MLC (r = -0.47 to -0.6) and TAPS-Pat (r = 0.29 to 0.34) were statistically significant (p < 0.01). CONCLUSIONS: TAPS-Phy is a valid and reliable scale to rate a physician's impression of the severity of the deformity in patients with idiopathic scoliosis and can be useful in routine clinical records.

14.
Eur Spine J ; 25(10): 3170-3179, 2016 10.
Article in English | MEDLINE | ID: mdl-26975856

ABSTRACT

OBJECTIVE: Evaluate the relationship between radiological, clinical and perceived waistline asymmetry (WLA) in a sample of idiopathic scoliosis (IS) patients. METHODS: 77 patients were included (mean age 20.3 years; 85 % women). We obtained a full X-ray of the spine and back clinical photography for all patients. On photographs, waist height angle (WHA), right/left waist angles (WA) and right/left waistline distance ratio were measured. SRS22, Trunk Appearance Perception Scale (TAPS) and Spinal Appearance Questinnaire (SAQ) questionnaires were also completed. The intra and inter-observer reliability of each photographic measure was assessed. A correlation analysis between all variables was done using Pearson Correlations Coefficient. RESULTS: All measures reported have excellent intra- and inter-observer (ICC ≥0.8) reliability. A significant correlation was found between WHA and Cobb angle, mainly with Main Thoracic (MT) (r = -0.56). Right and left waist angles, and especially the difference between them (RLWAD), is related to the thoracolumbar/lumbar (TLL) curve. We have found a significant correlation between RLWAD and TLL curve magnitude (r = -0.54) and with the inclination of the lower end vertebra (LEV) (r = 0.74). Only WHA has a significant, but poor correlation (r â‰… 0.3) with trunk perception scales (TAPS and SAQ). No other significant correlations were found between WLA measures and patient related outcome scores. CONCLUSION: WLA measures proposed in this article are reliable tools to assess WLA. We have found a significant correlation between clinical WLA and skeletal deformity (Cobb angle). WHA is related with MT curve while the RLWAD depends on the TLL curve magnitude and its LEV. We have also found a significant relation between WHA and the patient's perception of the deformity. It seems that WLA is a cosmetic concern to take into account in clinical evaluation of IS patients.


Subject(s)
Back/diagnostic imaging , Posture/physiology , Scoliosis , Adolescent , Adult , Back/pathology , Female , Humans , Male , Photography , Reproducibility of Results , Scoliosis/diagnostic imaging , Scoliosis/pathology , Surveys and Questionnaires , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/pathology , Young Adult
15.
Eur Spine J ; 25(11): 3560-3567, 2016 11.
Article in English | MEDLINE | ID: mdl-25906381

ABSTRACT

OBJECTIVE: To evaluate the relationship between radiological, clinical and perceived shoulder balance (ShB) in a sample of non-operated, moderate, idiopathic scoliosis (IS) patients. METHODS: 80 patients (85 % women) with a mean age of 20.3 years (SD 8.6, 12-40 years) were included. Mean Cobb angle was 45.9° (SD 12.9, 25.1°-77.2°). All patients had full spine X-ray and a digital photography from the front. To determine clinical ShB, shoulder height angle (SHA) and axilla height angle (AHA) were measured on clinical photographs. Radiological ShB was assessed with the clavicle-rib intersection angle and T1-tilt. Patients also completed different patient-reported outcomes (PRO) instruments: SRS-22, TAPS and Spinal Appearance Questionnaire (SAQ). SAQ included two questions concerning the shoulder area (SAQ-6 = perception and SAQ-13 = expectation) which were used to assess perceived ShB. Patients were divided into two groups: balanced (SHA <3.0°), and imbalanced (SHA ≥3.0°) according to minimal detectable change of SHA. The correlations between variables and mean differences between the two groups were analyzed. RESULTS: No statistically significant correlations were found between clinical (SHA and AHA) and perceived ShB (SAQ-6), or with PRO scores. 62.5 % of patients were in the "Balanced" group. 46.6 % (14/30) of patients in the clinically imbalanced group (≥3.0°) perceive themselves as totally balanced (score 1 and 2 in SAQ-6), while 10 % (5/50) of patients in the balanced group (SHA <3.0°) perceive themselves as totally imbalanced (score 4 and 5 in SAQ-13). No differences were found between both groups in terms of radiological and perceived ShB, or in PRO scores. CONCLUSION: We have not found a significant correlation between clinical/radiological ShB and perceived ShB in non-operated IS patients. It seems that ShB is not a key factor in patient trunk deformity perception. In addition, patient expectations regarding improvement with treatment are not directly related to actual clinical imbalance.


Subject(s)
Postural Balance/physiology , Shoulder/diagnostic imaging , Adolescent , Adult , Child , Cross-Sectional Studies , Female , Humans , Male , Radiography, Thoracic , Young Adult
16.
Spine (Phila Pa 1976) ; 40(4): E253-8, 2015 Feb 15.
Article in English | MEDLINE | ID: mdl-25494319

ABSTRACT

STUDY DESIGN: Sagittal pelvic parameters (SPPs) of a representative patient sample drawn from a consecutive adult spinal deformity database were measured using Surgimap Spine. Estimated coefficient of reliability intraclass coefficient (95% confidence interval), standard error of measurement, and mean absolute deviation were used for the analysis. OBJECTIVE: The primary objective of this study was to assess the reliability of SPP measurements using Surgimap Spine. The secondary objective was to evaluate the impact of pelvic instrumentation as well as the impact of user expertise. SUMMARY OF BACKGROUND DATA: The radiographical measurement of SPP is increasingly recognized as playing a critical role in establishing the surgical goals and surgical strategy of many spinal disorders. Although instrumented flatback is a common cause of sagittal malalignment, to our knowledge, SPP measurement reliability has never been assessed in instrumented spines. METHODS: Sixty-three adult full-spine standing lateral radiographs (31 with lumbosacral instrumentation) were measured twice by 13 observers using Surgimap Spine. Observers were stratified into 3 levels of experience: high (research coordinators, 4), mid (senior surgeons, 5), and low (junior surgeons, 4). Research coordinators trained all surgeons for less than 30 minutes. Parameters measured were pelvic incidence, pelvic tilt, and sacral slope. RESULTS: Thirteen observers and 63 radiographs generated 817 observations (2 misses). Overall inter- and intraobserver reliability of SPP measurement was excellent (intraclass coefficient > 0.85). Lumbosacral instrumentation did not modify intraobserver reliability but reduced significantly interobserver reliability of pelvic tilt (P = 0.006) and sacral slope (P = 0.007). Experience did not affect intraobserver reliability but interobserver reliability of highly experienced observers was significantly lower (P < 0.05) than among less experienced observers. CONCLUSION: Measurement of SPP using Surgimap Spine equals or improves previously reported reliability data. Lumbosacral instrumentation reduces interobserver reliability taking it from excellent to moderate in the sacral slope measurement. Inexperienced observers can measure SPP reliably after a short tutorial. LEVEL OF EVIDENCE: 4.


Subject(s)
Pelvis/diagnostic imaging , Spinal Fusion , Spine/diagnostic imaging , Adult , Female , Humans , Lumbosacral Region/diagnostic imaging , Male , Pelvis/surgery , Posture , Radiography , Reproducibility of Results , Sacrum/diagnostic imaging , Sacrum/surgery , Spine/surgery
17.
Scoliosis ; 9(1): 23, 2014.
Article in English | MEDLINE | ID: mdl-25520746

ABSTRACT

OBJECTIVE: To determine the validity of digital photography as an evaluation method for shoulder balance (ShB) in patients with idiopathic scoliosis. MATERIAL AND METHODS: A total of 80 patients were included (mean age 20.3 years; 85% women). We obtained a full x-ray of the vertebral column and front and back clinical photography for all patients. For antero-posterior x-rays we measured the proximal thoracic curve angles (CPT). To evaluate radiological shoulder balance we calculated the clavicle-rib intersection angle (CRIA) and T1-tilt. For clinical photography we measured shoulder height angle (SHA), axilla height angle (AHA) and the left right trapezium angle (LRTA). We analyzed the reliability of the different photographic measurements and the correlation between these and the radiological parameters. RESULTS: The mean magnitude of PTC, CRIA and T1-tilt were 19°, -0.6° and 1.4° respectively. Mean SHA from the front was -1.7°. All photographic measurements revealed an excellent-near perfect intra and inter-observer reliability in both photographic projections. No correlation was found between the ShB and the magnitude of the PTC. A statistically significant correlation was found between clinical balance of the shoulders and radiological balance (r between 0.37 and 0.51). CONCLUSIONS: Digital clinical photography appears to be a reliable method for objective clinical measurement of ShB. The correlation between clinical and radiological balance is statistically significant although moderate/weak.

18.
Health Qual Life Outcomes ; 12: 81, 2014 Jun 03.
Article in English | MEDLINE | ID: mdl-24894714

ABSTRACT

BACKGROUND: Four patient-reported outcome (PRO) instruments are commonly used to assess body image in idiopathic scoliosis (IS): the Quality of Life Profile for Spinal Deformities (QLPSD), SRS-22 Self-Image scale, Spinal Appearance Questionnaire (SAQ), and Trunk Appearance Perception Scale (TAPS). The aim of this study is to compare the psychometric properties of these instruments in patients with IS and report the translational/cultural adaptation of the SAQ to Spanish. METHODS: The four instruments in a Spanish version were administered to 80 patients with IS aged 10 to 40 years old. The sample was stratified according to scoliosis magnitude (less and more than 45º). Analysis was also conducted for age groups. The psychometric properties studied included convergent and divergent construct validity, as well as internal consistency. Convergent validity was evaluated by correlation analysis between the self-image instruments and Cobb angle. Divergent validity was assessed with correlation analysis between PRO scores and SRS-22 dimensions scores such as Function, Pain and Mental Health. RESULTS: In the overall sample, each of the PRO instruments demonstrated high internal consistency (QLPSD Body Image, α = 0.80; SRS-22 Self Image, α = 0.78; SAQ, α = 0.89; TAPS, α = 0.87), also both for younger and adult patients subgroups. Correlation with curve magnitude was significant for each of the four scales. However, the correlation was higher for the pictorial scales (SAQ Appearance r = 0.61, TAPS r = -0.62) than for the textual scales (QLPSD-bi r = 0.36, SRS-22 Self-Image scale r = -0.41). In the younger group, correlation between Cobb angle and textual scales (QLPSD-bi and SRS-22 Self-Image Scale) was not significant. Body Image scales showed significant correlations with SRS-22 Pain, Function and Mental Health dimensions. CONCLUSIONS: All four instruments tested have good psychometric properties. Pictorial scales (SAQ Appearance and TAPS) correlated better with the radiological magnitude of the curve and this correlation is independent of age. Unexpectedly, all four scales demonstrated significant correlations with non-body image dimensions and the divergent hypothesis was not confirmed. Globally, pictorial scales showed slightly better construct validity to test body image perception than textual scales.


Subject(s)
Body Image/psychology , Scoliosis/psychology , Adolescent , Adult , Child , Female , Humans , Male , Psychometrics , Quality of Life/psychology , Reproducibility of Results , Spain , Surveys and Questionnaires , Visual Analog Scale , Young Adult
19.
Spine Deform ; 1(3): 223-228, 2013 May.
Article in English | MEDLINE | ID: mdl-27927297

ABSTRACT

STUDY DESIGN: Retrospective review. OBJECTIVES: To determine whether routine periodic radiographic examination is worthwhile in adolescent idiopathic scoliosis (AIS) patients undergoing instrumented fusion with third-generation implants. SUMMARY OF BACKGROUND DATA: In common practice, patients who have undergone surgery for idiopathic scoliosis are followed up for a minimum of 2 years by clinical assessment and routine radiographic study at 3, 6, 12, and 24 months. The radiation related to these examinations is not negligible. To our knowledge, the use of routine radiographic follow-up after posterior spinal fusion for adolescent idiopathic scoliosis has not been evaluated. METHODS: We retrospectively analyzed full-spine X-rays and clinical records from the first 2 postoperative years of 43 patients. We sought any clinical feature (eg, pain, deformity progression, material protrusion) justifying X-ray, and any relevant radiologic finding (eg, loss of correction, instrumentation loosening, junctional kyphosis). RESULTS: Excluding the immediate postoperative films, 14.8% of X-rays were clinically justified, 8.3% were associated with a relevant finding, and 4.3% led to a therapy change. All patients with clinical deformity progression had a relevant X-ray finding. Pain was associated with a relevant finding in 23.5% of cases (positive predictive value, 0.1); 7.4% of films with no clinical justification showed a relevant finding (negative predictive value, 0.86). Lower Risser sign increased the risk of having a relevant radiographic finding (p < .05). CONCLUSIONS: With the current use of third-generation implants, routine biplanar postoperative X-rays at 3, 6, 12, and 24 months do not seem to be justified in AIS and should be avoided in mature, asymptomatic patients.

20.
Spine (Phila Pa 1976) ; 35(21): E1115-9, 2010 Oct 01.
Article in English | MEDLINE | ID: mdl-20838265

ABSTRACT

STUDY DESIGN: Prospective study of patients with chronic back pain from lumbar spine disorders. OBJECTIVE: To evaluate the degree of interchangeability of a 100-mm visual analog scale (VAS) and a 5-point verbal rating scale (VRS) for the assessment of pain intensity. SUMMARY OF BACKGROUND DATA: The fact that VAS and Likert scales are highly intercorrelated does not mean that both types of scales can be used interchangeably. METHODS.: A total of 151 patients (mean age, 52 ± 14.6 years) undergoing elective spine surgery completed a 100-mm VAS and a discrete 5-category VRS corresponding to the first item question of the core set ("How severe was your back pain in the last week?"). Pain intensity on the VAS was rated using the same question than for the VRS. The level of order-consistency (monotonic agreement), disordered pairs (D), percentage of agreement, and systematic disagreement (relative position), and relative concentration ([RC]) were estimated. VAS assessments were transformed into a discrete 5-category, with the cut-off VAS positions being defined by quintiles and equidistantly. RESULTS: For VAS defined equidistantly, monotonic agreement was 0.840, D was 0.080, and the percentage of identical pairs was 53%. The corresponding figures for VAS defined by quintiles were 0.809, 0.096, and 27.8%. Inconsistencies between the VAS and the VRS scales were also demonstrated by the marginal distributions, with PR values of -0.005 (95% confidence interval [CI], -0.011 to -0.002) and RC values of 0.144 (95% CI, 0.137-0.152) for VAS defined equidistantly, and PR values of 0.391 (95% CI, 0.384-0.397) and RC values of 0.265 (95% CI, 0.255-0.275) for VAS defined by quintiles. CONCLUSION: The order-consistency level was low with overlapping of pain records between the 2 scales, indicating that VAS and VRS are not interchangeable and, therefore, a results obtained with the use of each scale cannot be compared.


Subject(s)
Back Pain/diagnosis , Back Pain/etiology , Disability Evaluation , Pain Measurement/methods , Spinal Diseases/complications , Spinal Diseases/diagnosis , Adult , Aged , Diagnostic Self Evaluation , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care/methods , Pain Measurement/standards , Predictive Value of Tests , Prospective Studies , Spain
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