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Gordana Stankovic-Babic,Nevenka Despotovic
Acta Facultatis Medicae Naissensis , 2009,
Abstract: Deformities of the spinal column and refractive errors deserve a special attention and follow-up in the period of adolescence. The aim of the paper was to analyze the presence of refractive errors in children with deformities of the spinal column.Thirty children (22 F: 8 M) aged between 5 and 16 years were referred to ophthalmological examination with clinically diagnosed deformities of the spinal column, such as scoliosis, kyphosis, kyphoscoliosis and scoliotic posture. Children were evaluated according to refraction, visual function, ortoptic values and all of them exercised corrective gymnastics.Scoliotic posture and scoliosis were prevalent and three times more frequent in girls (n= 16, 12 F: 4 M), followed by kyphoscoliosis (n= 8, 4F:4M) and kyphosis (n=6, 2F:4M). The results of ophthalmological examinations: emmetropia was found in 60 %, myopia in 33.3 %, and hypermetropia in 6.6 % cases.Preventive measures against deformities of the spinal column and refractive errors (particularly myopia) are necessary for an adequate therapeutic treatment. The significance of systematic health examinations is to be emphasized as they are the best way of early detection and diagnosing a refractive error, any disease or body deformities. Also, a full cooperation of parents, children, teachers, and all the subjects involved in the treatment is required.
Spinal deformities rehabilitation - state of the art review
Hans-Rudolf Weiss
Scoliosis , 2010, DOI: 10.1186/1748-7161-5-28
Abstract: A Pub Med review was completed in order to reveal substantial evidence for inpatient rehabilitation as performed in Germany. No evidence has been found in general to support claims for actual inpatient rehabilitation programmes as used today. Nevertheless, as there is some evidence that inpatient rehabilitation may be beneficial to patients with spinal deformities complicated by certain additional conditions, the body of evidence there is for conservative treatment of spinal deformities has been reviewed in order to allow suggestions for outpatient conservative treatment and inpatient rehabilitation.Today, for both children and adolescents, we are able to offer intensive rehabilitation programmes lasting three to five days, which enable the patients to acquire the skills necessary to prevent postures fostering scoliosis in everyday life without missing too much of school teaching subjects at home. The secondary functional impairments adult scoliosis patients might have, as in the opinion of the author, still today require the time of 3-4 weeks in the clinical in-patient setting. Time to address psychosocial as well as somatic limitations, namely chronic pains and cardiorespiratory malfunction is needed to preserve the patients working capability in the long-term.Outpatient treatment/rehabilitation is sufficient for adolescents with spinal deformities.Inpatient rehabilitation is recommended for patients with spinal deformities and pain or severe restrictive ventilation disorder.Medical rehabilitation aims at an improvement in function, capacity and participation [1]. Outpatient and inpatient programmes are available worldwide for the rehabilitation of patients with impairments or disabilities in various medical fields. Particularly in Germany, there is a long history of inpatient rehabilitation for various diseases. The German Pension Insurance scheme has introduced a comprehensive practice guidelines programme for the development of process guidelines for inpatient
Craniofacial features of children with spinal deformities
Emil Segatto, Carsten Lippold, András Végh
BMC Musculoskeletal Disorders , 2008, DOI: 10.1186/1471-2474-9-169
Abstract: Twenty-three children with Scheuermann's disease participated in the study (mean age: 14Y8M; SD: 1Y8M), 28 with Scoliosis (mean age: 14Y7M; SD: 2Y3M) and a control group of 68 orthopedically healthy children (mean age: 14Y8M; SD: 0Y11M). Standardized orthodontic screening protocols were used to map the occlusal relations in the sagittal, vertical, and transversal dimensions, space relations of the maxillary and mandibular frontal segment, and the TMJ status and function. The examinations for the children with orthopedic disorders were supplemented by the evaluation of routine orthodontic radiograms – lateral cephalograms and panoramic X-rays.The majority of the dentofacial features examined revealed more and greater abnormalities among patients in the Scheuermann's disease group than in the scoliosis group. In the latter group the proportion of the TMJ symptoms and the consecutive functional deviations were greater. When comparing the values of the two spinal-disorder groups and the control group, statistically significant differences (p < .05) occurred for the following measurements: frequency of unilateral Cl.II. molar occlusion, overjet and extreme overjet mean value (Scheuermann's disease group), as well as the frequency of TMJ pathological symptoms (scoliosis group). The evaluation of the panoramic X-rays showed significant differences among the mandibular measurements of the two spinal-disorder groups. Within the framework of the evaluation of the cephalograms significant differences (p < .05) were found only in the case of dental relations. However, several values differed significantly from the Ricketts' norms, none of the indices strictly characterized any of the groups with spinal disorders.The more extended treatment of the malocclusions closely correlated to postural disorders draws attention to the indicators of a higher frequency and severity occurring in the case of the dentofacial deviations in the patients of the MSCH group who had previously been l
Vitamin A Deficiency Induces Congenital Spinal Deformities in Rats  [PDF]
Zheng Li, Jianxiong Shen, William Ka Kei Wu, Xiaojuan Wang, Jinqian Liang, Guixing Qiu, Jiaming Liu
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0046565
Abstract: Most cases of congenital spinal deformities were sporadic and without strong evidence of heritability. The etiology of congenital spinal deformities is still elusive and assumed to be multi-factorial. The current study seeks to elucidate the effect of maternal vitamin A deficiency and the production of congenital spinal deformities in the offsping. Thirty two female rats were randomized into two groups: control group, which was fed a normal diet; vitamin A deficient group, which were given vitamin A-deficient diet from at least 2 weeks before mating till delivery. Three random neonatal rats from each group were killed the next day of parturition. Female rats were fed an AIN-93G diet sufficient in vitamin A to feed the rest of neonates for two weeks until euthanasia. Serum levels of vitamin A were assessed in the adult and filial rats. Anteroposterior (AP) spine radiographs were obtained at week 2 after delivery to evaluate the presence of the skeletal abnormalities especially of spinal deformities. Liver and vertebral body expression of retinaldehyde dehydrogenase (RALDHs) and RARs mRNA was assessed by reverse transcription-real time PCR. VAD neonates displayed many skeletal malformations in the cervical, thoracic, the pelvic and sacral and limbs regions. The incidence of congenital scoliosis was 13.79% (8/58) in the filial rats of vitamin A deficiency group and 0% in the control group. Furthermore, vitamin A deficiency negatively regulate the liver and verterbral body mRNA levels of RALDH1, RALDH2, RALDH3, RAR-α, RAR-β and RAR-γ. Vitamin A deficiency in pregnancy may induce congenital spinal deformities in the postnatal rats. The decreases of RALDHs and RARs mRNA expression induced by vitamin A deprivation suggest that vertebral birth defects may be caused by a defect in RA signaling pathway during somitogenesis.
Historical overview of spinal deformities in ancient Greece
Elias S Vasiliadis, Theodoros B Grivas, Angelos Kaspiris
Scoliosis , 2009, DOI: 10.1186/1748-7161-4-6
Abstract: Medicine was not clearly distinguished from religion and mysticism in the ancient world. Ancient works of philosophy, religion, myths, and fairy tales dating back as far as 3500 BC invoke images of people with spinal deformity. In the third millennium BC, wall paintings and statues from Knossos, in Crete island, depicted female figures wearing tight bodices that expose their breasts (Figure 1). Minoan Crete is considered as the origin of the corset. The Boxing Boys fresco (1600 BC) in Akrotiri in the Greek island of Santorini is the first monumental image of a compound spinal disorder that is diagnostically recognizable by current medical standards [1]. The painting reflects a rigid abnormality, probably a spinal deformity (Figure 2). Ancient descriptions and statues typically portray Alexander the Great with an underlying scoliotic condition with a cervical neck deformity [2], typically with a gaze looking upward and outward with the added possibility of ocular muscle deficits and facial asymmetry (Figure 3).Classical Greek philosophers were not an exemption and there are a lot of references in their work about the origin and function of the spine. Plato (427-347 BC) (Figure 4), who influenced the disciplines of philosophy, psychology, logic, and politics, through his conceptualization that mathematics is the life force of science, implicated biomechanics in function of the spine. However he believed that a divine intervention contributed to the creation of the flexible spine [3]. In contrary, Empedocles (490-430 BC) (Figure 5) thought that the vertebrae are initially unified (rigid spine) and subsequently this solid osseous column brake down (segmented) into pieces as a result of movements of the body [4]. Aristotle (384-322 BC) (Figure 6), who was the most prominent research scientist in ancient Greece, lived in a period when athletics, sports, and gymnastics was part of philosophy of developing the human being as a whole to optimize functional capacity and harmo
The International Research Society of Spinal Deformities (IRSSD) and its contribution to science
Keith M Bagnall, Theodoros B Grivas, Nathalie Alos, Marc Asher, Carl-Eric Aubin, Geoffrey R Burwell, Peter H Dangerfield, Thomas Edouard, Doug Hill, Edmond Lou, Alain Moreau, Joe O'Brien, Ian Stokes, Hans-Rudolf Weiss, Jim Raso
Scoliosis , 2009, DOI: 10.1186/1748-7161-4-28
Abstract: Ever since the days when deformities of the spine were considered from a topographical point of view at selective meetings of interested people, through the formal creation of the IRSSD itself and at its subsequent bi-annual meetings, there has always been a willingness for the expression of ideas and results that has encouraged the development of understanding of spinal deformities. An environment of friendliness and camaderie has certainly been created and maintained and there has always been an air tolerance, patience and understanding when it comes to scientific thought. Participants have always been encouraged to express their thoughts freely and discuss energetically while feeling comfortable doing so. However, while success might be measured by the size of the pile of small pebbles each contributed by the individual members, the question always remains as to whether or not the pile as a whole represents a coordinated whole and a significant contribution or is just simply a 'pile of small pebbles'. Consequently, this article has been compiled through a desire to evaluate the contribution made by the IRSSD and its members to the scientific literature - an exercise of 'introspection', so to speak.From the programmes of the IRSSD as well as previous meetings, common themes and areas were identified and representative authors (we hope nobody is offended by not being invited) were asked to:- focus on the changes that have occurred in a particular area and provide an assessment of what influence (if any) the Society has had on the health of society in general. We wanted people to read this article not simply put it on their shelves.- make only brief summaries of the specific areas with brevity being a necessity (< 1000 words). The purpose of the paper was not to go through a detailed history of the area but to highlight the important progress that has been made - or not, as the case may be.- include minimal references as the readers could find these elsewhere.Contri
Use of vacuum assisted closure in instrumented spinal deformities for children with postoperative deep infections  [cached]
Canavese Federico,Krajbich Joseph
Indian Journal of Orthopaedics , 2010,
Abstract: Background: Postoperative deep infections are relatively common in children with instrumented spinal deformities, whose healing potential is somewhat compromised. Children with underlying diagnosis of cerebral palsy, spina bifida and other chronic debilitating conditions are particularly susceptible. Vacuum-assisted closure (VAC) is a newer technique to promote healing of wounds resistant to treatment by established methods. This article aims to review the efficacy of the VAC system in the treatment of deep spinal infections following spinal instrumentation and fusion in children and adolescents. Materials and Methods: We reviewed 33 patients with deep postoperative surgical site infection treated with wound VAC technique. We reviewed clinical and laboratory data, including the ability to retain the spinal hardware, loss of correction and recurrent infections. Results : All patients successfully completed their wound VAC treatment regime. None had significant loss of correction and one had persistent infection requiring partial hardware removal. The laboratory indices normalized in all but three patients. Conclusions: Wound VAC technique is a useful tool in the armamentarium of the spinal surgeon dealing with patients susceptible to wound infections, especially those with neuromuscular diseases. It allows for retention of the instrumentation and maintenance of the spinal correction. It is reliable and easy to use.
Posterior and Anterior Spinal Fusion for the Management of Deformities in Patients with Parkinson's Disease  [PDF]
Masashi Sato,Takeshi Sainoh,Sumihisa Orita,Kazuyo Yamauchi,Yasuchika Aoki,Tetsuhiro Ishikawa,Masayuki Miyagi,Hiroto Kamoda,Miyako Suzuki,Gou Kubota,Yoshihiro Sakuma,Kazuhide Inage,Yasuhiro Oikawa,Junichi Nakamura,Masashi Takaso,Gen Inoue,Tomoaki Toyone,Kazuhisa Takahashi,Seiji Ohtori
Case Reports in Orthopedics , 2013, DOI: 10.1155/2013/140916
Abstract: Introduction. Spinal scoliosis and kyphosis in elderly people sometimes cause severe low back pain. Surgical methods such as osteotomy are useful for correcting the deformity. However, complications during and after surgery are associated with the osteotomy procedure. In particular, it is difficult to manage deformity correction surgery for patients with Parkinson's disease. Here, we present two cases of combined anterior and posterior surgery for deformity in patients with adult scoliosis and kyphosis due to Parkinson's disease. Case Presentation. Two 70-year-old women had spinal scoliosis and kyphosis due to Parkinson's disease. They had severe low back pain, and conservative treatment was not effective for the pain. Surgery was planned to correct the deformity in both patients. We performed combined posterior and anterior correction surgery. At first, posterior fusions were performed from T4 to the ilium using pedicle screws. Next, cages and autograft from the iliac crest were used in anterior lumbar surgery. The patients became symptom free after surgery. Bony fusion was observed 12 months after surgery. Conclusions. Combined posterior and anterior fusion surgery is effective for patients who show scoliosis and kyphosis deformity, and symptomatic low back pain due to Parkinson's disease. 1. Introduction Spinal kyphosis in elderly people sometimes causes serious problems. It occurs as a consequence of the loss of the physiological lordotic curve due to senile kyphosis, which is attributed to osteoporosis, disk degeneration, and impairment of back muscles [1, 2]. The postural abnormality associated with kyphosis can cause chronic low back pain, and in later stages it can also disturb standing and gait by affecting balance [3]. Kyphoscoliosis due to Parkinson’s disease (PD) has been reported since 1999 [4]. It is estimated that about 7% of patients with PD have kyphoscoliosis [5]. The frequency of kyphoscoliosis in the population of PD patients is higher than that of scoliosis in an age-matched population without PD [6]. There have been multiple surgical procedures described for the treatment of spinal kyphotic deformity, including Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), and vertebral column resection (VCR) procedures. The technique used to correct spinal kyphotic deformity depends on factors such as the severity of the deformity, the flexibility of the deformity, and whether the kyphosis is more of a rounded, long sweeping kyphosis or a short, angular one [7, 8]. Suk et al. reviewed the treatment of 70 patients with spinal
A Modified Sagittal Spine Postural Classification and Its Relationship to Deformities and Spinal Mobility in a Chinese Osteoporotic Population  [PDF]
Hua-Jun Wang, Hugo Giambini, Wen-Jun Zhang, Gan-Hu Ye, Chunfeng Zhao, Kai-Nan An, Yi-Kai Li, Wen-Rui Lan, Jian-You Li, Xue-Sheng Jiang, Qiu-Lan Zou, Xiao-Ying Zhang, Chao Chen
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0038560
Abstract: Background Abnormal posture and spinal mobility have been demonstrated to cause functional impairment in the quality of life, especially in the postmenopausal osteoporotic population. Most of the literature studies focus on either thoracic kyphosis or lumbar lordosis, but not on the change of the entire spinal alignment. Very few articles reported the spinal alignment of Chinese people. The purpose of this study was threefold: to classify the spinal curvature based on the classification system defined by Satoh consisting of the entire spine alignment; to identify the change of trunk mobility; and to relate spinal curvature to balance disorder in a Chinese population. Methodology/Principal Findings 450 osteoporotic volunteers were recruited for this study. Spinal range of motion and global curvature were evaluated noninvasively using the Spinal-Mouse? system and sagittal postural deformities were characterized. Results We found a new spine postural alignment consisting of an increased thoracic kyphosis and decreased lumbar lordosis which we classified as our modified round back. We did not find any of Satoh’s type 5 classification in our population. Type 2 sagittal alignment was the most common spinal deformity (38.44%). In standing, thoracic kyphosis angles in types 2 (58.34°) and 3 (58.03°) were the largest and lumbar lordosis angles in types 4 (13.95°) and 5 (?8.61°) were the smallest. The range of flexion (ROF) and range of flexion-extension (ROFE) of types 2 and 3 were usually greater than types 4 and 5, with type 1 being the largest. Conclusions/Significance The present study classified and compared for the first time the mobility, curvature and balance in a Chinese population based on the entire spine alignment and found types 4 and 5 to present the worst balance and mobility. This study included a new spine postural alignment classification that should be considered in future population studies.
Quantification of deficits in lateral paw positioning after spinal cord injury in dogs
Lindsay Hamilton, Robin JM Franklin, Nicholas D Jeffery
BMC Veterinary Research , 2008, DOI: 10.1186/1746-6148-4-47
Abstract: We confirm that errors in lateral positioning of the pelvic limb paws can be quantified and that there is a highly significant difference in variability of foot placement between normal and spinal cord injured dogs. In this study there was no detectable difference in lateral paw positioning variability between complete and incomplete injuries, but it appears that intergirdle limb coordination and appropriate lateral paw placement recover independently from one another.Analysis of lateral paw position in the dog provides an additional tier of analysis of outcome after spinal cord injury that will be of great value in interpreting the effects of putative therapeutic interventions.Previous studies on recovery of pelvic limb function in spinal cord injured quadrupeds have focussed predominantly on assessing the extent to which generation of muscular activity in the pelvic limbs can produce appropriate movement and coordination of movement between pelvic and thoracic limbs in the sagittal plane [e.g. [1-3]]. However, spinal cord injury (SCI) also produces a loss of the ability to place the feet in the correct positions with respect to the body's centre of mass – i.e. the accuracy of placement in the lateral plane. This loss is implicit in many reports on pelvic limb function in experimentally-spinalised animals. For instance: the recognised need for tail support (and stimulation in some cases) to permit SCI animals to maintain walking on a treadmill belt [4,5]; the occurrence of placement errors such as limb crossing in SCI dogs with reasonable stepping ability [6]; the clinically-evident tendency for individuals with an SCI to lose their balance particularly when turning corners [7,8]. Despite recognition of its occurrence, lateral instability has rarely been quantified in animals with SCI.Whilst mechanisms to control body posture have been studied in a range of species, vertebrate neural networks have been most thoroughly described in the lamprey. Lamprey body orientat
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