Changing curve pattern in infantile idiopathic scoliosis: family report with a follow-up of 15 years.

STUDY DESIGN: The authors monitored a father and his six children, all of whom had idiopathic scoliosis for more than 13 years. OBJECTIVE: To analyze the similarities and differences in curve pattern between the family members. SUMMARY OF BACKGROUND DATA: The etiology and pathogenesis of idiopathic scoliosis are not well understood. Genetic factors play an important role, as is shown by the high concordance in monozygotic twins. METHODS: Radiographs from all family members were analyzed. Location and direction of the curve, Cobb angle, location of the apex, and rib-vertebra angle difference were compared. RESULTS: A father and his six children had idiopathic scoliosis. The curves differed within the family and changed during follow-up. The father had a left convex thoracic scoliosis of 42 degrees. Only three of the children had a curve of similar severity, and only four children had a left convex thoracic scoliosis. In three children the curve pattern changed during follow-up. CONCLUSIONS: This report of idiopathic scoliosis in a father and six children supports the present theories on a genetic origin of the disorder but also stresses the importance of dynamic processes in the development of scoliosis.

Curve characteristics in monozygotic twins with adolescent idiopathic scoliosis: 3 new twin pairs and a review of the literature.

Most authors state that there is strong evidence for a genetic origin of adolescent idiopathic scoliosis (AIS). This conclusion is mainly based on the fact that the rate of concordance for AIS in monozygotic twins is significantly higher than that in dizygotic twins. However, it is of interest to determine whether all elements of scoliosis formation are genetically predetermined. If this were the case, there would perhaps be less place for closed treatment. We surveyed the literature for monozygotic twin pairs in which both members suffered from idiopathic scoliosis and added 3 pairs from our own patient group. The total group consisted of 32 twin pairs. We found that gender, direction of the convexity, the level of the apex and the kyphotic angle were determined more by genetic factors than the lateral Cobb angle of the scoliotic curve. This suggests that variations in the environment may affect the curve patterns in monozygotic twins.

Vertebral osteomyelitis caused by thoracic empyema, or vice versa?

Thoracic empyema and vertebral osteomyelitis is a rare combination. We report a case of vertebral osteomyelitis possibly caused by a progressive thoracic empyema. The causative pathogen was Escherichia coli. Computed tomographic (CT) scan and magnetic resonance imaging (MRI) suggested the diagnosis of vertebral osteomyelitis, confirmed by transthoracic needle aspiration and operative findings. Aetiology and treatment are discussed.

The effect of four types of support on the segmental mobility of the lumbosacral spine.

With the aid of flexion-extension lateral radiographs, we investigated the effect of the canvas corset, the Raney and Baycast jackets, and the Baycast spica on the segmental sagittal mobility of the lumbosacral spine in separate groups of five volunteers each. The canvas corset reduced the mean angular movements at each level to two-thirds of normal. The Raney and Baycast jackets reduced the mean angular movements in the middle of the lumbar spine to approximately one-third of normal. The Baycast spica was the most effective in restricting angular movements below the third lumbar vertebra, and especially at the fourth lumbar-fifth lumbar level and the lumbosacral level.

Influence of a diphosphonate on the cellular aspect of young bone tissue.

Stimulated by the rather sparse information in the literature on cellular changes induced by EHDP, we carried out electron microscopic investigations on young bone tissue and on de novo bone formation. Cellular changes could be observed during continuous administration of EHDP. The osteoblasts demonstrated temporary storing of crystalloid structures in the mitochondria, and atypical osteocytes showed persistent changes indicative of hyperactivity. The osteoclasts exhibited varying ultrastructural features with respect to the number and appearance of nuclei, Golgi, RER, and lysosomes. These changes under the influence of EHDP could be an indication of altered activity of the osteoclast. The possible interference of EHDP with bone cell metabolism is discussed.

The effect of ethane-1-hydroxy-1, 1-diphosphonic acid (EHDP) on matrix induced ectopic bone formation.

The effect of diphosphonates (EHDP) was studied on induced ectopic osteoneogenesis. Decalcified allogeneic bone matrix was implanted into the lumbar muscles in rabbits for an ectopic osteoinductor. The ectopic new bone formation was studied under continuous EHDP administration and after discontinuation of EHDP. Although there was no inhibitory effect of EHDP on the osteoinduction, the calcification of the new bone and the resorption of the implanted matrix was retarded. The induced "osteoid-like" tissue had an atypical structure with a small number of cells and a deficiency in collagen fiber bundles. There were also large fields of new cartilage formation. Thus remodelling and mineralization were inhibited under the influence of continuous administration of EHDP. After discontinuation of EHDP administration a recovery phase was observed which seemed to lead to the formation of a normal ossicle.