TIMP2 Polymorphisms Association With Curve Initiation and Progression of Thoracic Idiopathic Scoliosis in the Caucasian Females.

Idiopathic scoliosis (IS) etiology remains unclear, but strong genetic background is suggested. Previously reported TIMP2 study indicates an association of genic rs8179090 with IS progression in a Han Chinese population. However, there has been a lack of investigation into intragenic TIMP2 polymorphisms in IS patients. We recruited 100 Caucasian females with IS and 100 controls. Patients were subdivided accordingly to: progression rate, curve severity, joint mobility, and curve pattern. Allele-specific-polymerase chain reaction based on fluorescence resonance energy transfer was applied to evaluate nine TIMP2 polymorphisms. Distribution of genotype and allele frequency in only one polymorphism (rs11658743) differed in case-control study. Four of the polymorphisms (rs2277700, rs11077401, rs2376999, and rs4789934) showed non-equal distributions either in genotype or/and allele distributions in the patients of different progression rates. The rs11077401 was related to curve severity patients distinction and the rs8179090 distinguished patients with different joint mobility level. Two polymorphisms either differed statistically in case of curve patterns subgrouping (rs8068674 and rs8179090) or showed a slight tendency toward significance in the recessive model of allele distributions (rs9916809 and rs8179090). The remaining two polymorphisms (rs2377005, rs11658743) showed no association with either clinical or radiographic IS characteristics. The influence of the G allele of the rs8179090 on the clinical course of IS has not yet been confirmed. We identified four TIMP2 polymorphisms (rs11077401, rs2376999, rs2277700, and rs4789934) that were associated with a higher risk of the progressive IS form. Further genetic association studies based on suggested clinical criteria would be necessary to validate TIMP2 polymorphisms associated with the curve progression. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2217-2225, 2019.

Incidence and risk factors of hip joint pain in children with severe cerebral palsy.

PURPOSE: Pain is a serious complication associated with hip dislocation in cerebral palsy (CP), limiting patient independence and quality of life. This study aimed to determine the frequency of pain in severe CP patients with hip dislocation and to reveal factors associated with the hip pain. METHODS: Seventy-three consecutive new-intervention CP patients admitted to authors' institution with spastic quadriplegia, mean age 10.8 years (range 4.0-18.0 years) were enrolled: 31 females and 42 males, totally 99 dislocated hips. All patients were assessed level IV or V according to the Gross Motor Function Classification Scale (GMFCS) and had poor communication skills. Pain severity was evaluated according to the Numeric Rating Scale (NRS-11). Data concerning previously applied physiotherapy was collected to divide the patients into subgroups: A - no abduction therapy (n = 24), B - abduction therapy (n = 35) and C - abduction therapy and horse-back riding (n = 13). On the pelvic antero-posterior radiographs head migration percentage was measured to reveal hip dislocation. Femoral head cartilage degenerative lesions were evaluated for size and location in 45 hips undergoing surgical treatment. RESULTS: Overall pain prevalence was 56%. The appearance of pain was associated with the patient age (p = 0.048), previous abduction physiotherapy (p < 0.00001), previous horse-back riding therapy (p < 0.00001) and anterior location of degenerative changes of the femoral head (p = 0.03). Pain intensity was related to the size of the degenerative cartilage lesions (p = 0.004) and to the degree of femoral anteversion (p < 0.0001). CONCLUSIONS: Extensive abduction exercises, hippotherapy and presence of degenerative cartilage lesions on the anterior part of femoral head may be considered risk factors for hip pain appearance in the dislocated hip of a child with severe spastic CP. Other associated factors are abduction exercise intensity, age, excessive femoral anteversion and size of degenerative cartilage lesions.

The use of computer tomography for preoperative planning and outcome assessment in surgical treatment of idiopathic scoliosis with pedicle screw based constructs - case presentation.

BACKGROUND: In recent years pedicle screw based constructs have been increasingly used in the operative management of scoliosis. The current principles of screw placement are based on normal anatomy and therefore may not be applicable in cases of severe vertebral deformity due to torsion. The aim of this study was to evaluate the usefulness of computer tomography (CT) in preoperative planning and outcome assessment in operative management of idiopathic scoliosis with severe internal vertebral deformity. MATERIAL AND METHODS: The study presents our own experiences based on analysis of diagnostic and therapeutic decision-making in two patients treated surgically due to Lenke type 1A idiopathic scoliosis. Due to extensive vertebral rotation and radiological appearance suggesting thin pedicles, spine CT with 3D reconstruction was performed as part of extended preoperative work-up in order to determine screw length and diameter, the point of screw introduction and angle of introduction in three planes. Vertebral rotation was evaluated according to the Aaro-Dahlborn method. Segments were also identified where pedicle screws could not be applied due to severe rotation or small pedicle diameter. RESULTS: Preoperative planning of screw placement enabled safe and accurate screw application, as confirmed by postoperative spine CT evidence. Satisfactory correction was achieved in both patients in the coronal and frontal planes. CONCLUSIONS: CT allows detailed preoperative planning of scoliosis surgery and identification of segments in which pedicle screws cannot be safely placed. This may lower the incidence of complications associated with inaccurate pedicle screw placement.

[The use of botulinum toxin in the treatment of spastic hip joint instability in children with cerebral palsy]. / Zastosowanie toksyny botulinowej typu A w leczeniu neurogennego podwichniecia stawów biodrowych u dzieci z tetraplegia spastyczna w przebiegu mózgowego porazenia.

UNLABELLED: Authors present the effect of intramuscular injections of botulinum toxin A (BTX-A) in the treatment of hip instability in children with spastic cerebral palsy. MATERIAL AND METHOD: The sixty-seven non walking children (110 hips) with quadriplegia and hip instability (MP > 33% or increase of MP > 20% in the second follow-up after 12 months) were evaluated. The mean age of patients in the beginning of study was 3 years and 8 months (SD = 2 years). The patients were randomly allocated to administrations of BTX-A - group A (52 hips) or to observation - group B (58 hips). The intramuscular injections of BTX-A were performed every 3 months, bilaterally to adductors, medial hamstrings and psoas muscles. The choice of muscles for BTX-A administration was determined by the results of clinical examination consisting in dynamic assessment of joint range of motion. The groups of muscles presenting the dynamic contraction (3 and more in Ashworth Scale) were injected. The a-p radiographs were used to assess the migration percentage (MP). The average length of follow-up was 21 months. RESULTS: The mean value of MP in the group A was 38% at the beginning of treatment and 28% at the end of follow-up (difference statistically significant; p < 0.00001). The mean value of MP in the group B was 36% at the primary examination and 38% at the final examination (difference statistically significant; p < 0.00001). The mean progression (-) for the group A = 10% (improvement) and for the group B +3% (deterioration) (difference statistically significant; p < 0.00001). CONCLUSIONS: Locate specific target intramuscular injections of botulinum toxin A (BTX-A) are a useful method of prevention of the neurogenic hip dislocation in children with spastic cerebral palsy.

[Etiopathogenesis of spastic hip pain and dislocation in children]. / Analiza przyczyn dolegliwosci bólowych w przebiegu zwichniecia stawu biodrowego u chorych z postaczna spastyczna mózgowego porazenia dzieciecego.

UNLABELLED: The hip joint dislocation is one of the most serious complications associated with severe type of spastic cerebral palsy in children. The natural history of this secondary problem is poorly defined: how often and why the dislocated hip joint is going to be painful. The aim of our study was to specify prevalence of hip pain in the quadriplegic spastic type of cerebral palsy children with dislocated one or two hip joints. The next purpose was to establish correlation between cartilage degenerative changes and pain appearance. MATERIAL AND METHOD: The clinical study population consisted of cerebral palsy children, who presented a unilateral or bilateral dislocation of the hip joint, operated in Department of Pediatric Orthopedics during the period 2002 through 2005. Performed surgical procedures allowed us to evaluate degenerative changes of femoral head cartilage. In 45 operated hips (33 patients) we discovered that 33 had degenerative cartilage lesions which in 25 cases (75%) were associated with pain appearance. RESULTS: We observed correlation between anterior location of the femoral head lesion and pain appearance, between the size of the lesion and intensity of pain complaints and also between femoral antetorsion and magnitude of pain. CONCLUSIONS: Risk factors of pain appearance in spastic dislocated hip joint are degenerative lesions on anterior face of femoral head cartilage, age of the patient, large antetorsion angle and cartilage lesion bigger than 1/4 of femoral head surface.