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The effect of growth on the correlation between the spinal and rib cage deformity: implications on idiopathic scoliosis pathogenesis
Theodoros B Grivas, Elias S Vasiliadis, Constantinos Mihas, Olga Savvidou
Scoliosis , 2007, DOI: 10.1186/1748-7161-2-11
Abstract: Eighty three girls referred on the basis of their hump reading on the scoliometer, with a mean age of 13.4 years old (range 7–18), were included in the study. The spinal deformity was assessed by measuring the thoracic Cobb angle from the postero-anterior spinal radiographs. The rib cage deformity was quantified by measuring the rib-index at the apex of the thoracic curve from the lateral spinal radiographs. The rib-index is defined as the ratio between the distance of the posterior margin of the vertebral body and the most extended point of the most projecting rib contour, divided by the distance between the posterior margin of the same vertebral body and the most protruding point of the least projecting rib contour. Statistical analysis included linear regression models with and without the effect of the variable age. We divided our sample in two subgroups, namely the younger (7–13 years old) and the older (14–18 years old) than the mean age participants. A univariate linear regression analysis was performed for each age group in order to assess the effect of age on Cobb angle and rib index correlation.Twenty five per cent of patients with an ATI more than or equal 7 degrees had a spinal curve under 10 degrees or had a straight spine. Linear regressions between the dependent variable "Thoracic Cobb angle" with the independent variable "rib-index" without the effect of the variable "age" is not statistical significant. After sample split, the linear relationship is statistically significant in the age group 14–18 years old (p < 0.03).Growth has a significant effect in the correlation between the thoracic and the spinal deformity in girls with idiopathic scoliosis. Therefore it should be taken into consideration when trying to assess the spinal deformity from surface measurements. The findings of the present study implicate the role of the thorax, as it shows that the rib cage deformity precedes the spinal deformity in the pathogenesis of idiopathic scoliosis.Numero
Kyphotic deformity in pott’s spine  [PDF]
Sushil Poudel
Journal of Kathmandu Medical College , 2013, DOI: 10.3126/jkmc.v2i4.11790
Abstract: Kyphotic deformity is a well-known complication in spinal tuberculosis patients. This deformity, which is seen in 15% of patients treated conservatively, progresses in two phases: Phase I, which includes the changes in the active?phase, and Phase II, which includes changes after the disease is cured. Factors influencing deformity progression are severity of the angle before treatment, the level of the lesion, and age of the patient. Adults have an increase less than 30? during the active phase with no additional changes in the healed phase. During the growth spurt of the children, there is worsening of the deformity in 39% (Type I), an improvement in 44% (Type II), and no change in 17% (Type III). Spine-at risk radiologic signs aid in early identification of the children at risk of late progressive deformity. Surgery for preventing deformity must be done earlier rather than later and in patients with severe disease. DOI: http://dx.doi.org/10.3126/jkmc.v2i4.11790 Journal of Kathmandu Medical College Vol. 2, No. 4, Issue 6, Oct.-Dec., 2013 Page: 201-204
A new method for measuring torsional deformity in scoliosis
Toshio Doi, Satoshi Kido, Umito Kuwashima, Osamu Tono, Kiyoshi Tarukado, Katsumi Harimaya, Yoshihiro Matsumoto, Kenichi Kawaguchi, Yukihide Iwamoto
Scoliosis , 2011, DOI: 10.1186/1748-7161-6-7
Abstract: Pre-operative CT scans of 25 non-congenital scoliosis patients were recruited and the apical vertebral rotation was measured by a newly developed method and Ho's method. Ho's method adopts the laminae as the rotational landmark. For a new method to measure the apical vertebral rotation, the posterior point just beneath each pedicle was used as a landmark. For quantifying the spinal torsional deformity angle, the rotational angle difference between the two methods was calculated.Intraobserver and interobserver reliability analyses showed both methods to be reliable. Apical vertebral rotation revealed 13.9 ± 6.8 (mean ± standard deviation) degrees by the new method and 7.9 ± 6.3 by Ho's method. Right spinal rotation was assigned a positive value. The discrepancy of rotation (6.1 ± 3.9 degrees), meaning that the anterior component rotated more than the posterior component, was considered to express the spinal torsional deformity to the convex side.We have developed an easy, reliable and practical method to measure the rotation of the spinal anterior component using a CT scan. Furthermore, we quantified the spinal torsional deformity to the convex side in scoliosis by comparing the rotation between the anterior and posterior components.Besides coronal side curvature, axial deformities are essential in structural scoliosis. Although the rotational deformity has been well-described [1-8], little is known about torsional deformity in scoliosis. Based on observations of 3D images or specimens of scoliosis, the anterior component, such as the vertebral body, has thus been determined to rotate more than the posterior component, such as the spinous process and laminae [9,10]. Clarifying the rotation and the torsion is thus considered to be important for understanding the etiology and for achieving the better management of scoliosis.Various methods have been developed and used to measure the vertebral rotation in scoliosis. For example, Nash and Moe published a practical method
Sprengels deformity: anaesthesia management.  [cached]
Dave S,Naik L
Journal of Postgraduate Medicine , 2000,
Abstract: A 28 years old lady presented with Sprengels deformity and hemivertebrae for Fothergills surgery. Clinically there were no anomalies of the nervous, renal or the cardiovascular systems. She had a short neck and score on modified Mallapati test was grade 2. She was successfully anaesthetised using injection Propofol as a total intravenous anaesthetic agent after adequate premedication with injection Midazolam and injection Pentazocine. Patient had an uneventful intraoperative and postoperative course.
Retrograde intubation in a case of ankylosing spondylitis posted for correction of deformity of spine  [cached]
Raval Chetankumar,Patel Heena,Patel Pranoti,Kharod Utpala
Saudi Journal of Anaesthesia , 2010,
Abstract: Ankylosing spondylitis (AS) patients are most challenging. These patient present the most serious array of intubation and difficult airway imaginable, secondary to decrease or no cervical spine mobility, fixed flexion deformity of thoracolumbar spine and possible temporomandibular joint disease. Sound clinical judgment is critical for timing and selecting the method for airway intervention. The retrograde intubation technique is an important option when fiberoptic bronchoscope is not available, and other method is not applicable for gaining airway access for surgery in prone position. We report a case of AS with fixed flexion deformity of thoracic and thoracolumbar spine, fusion of posterior elements of cervical spine posted for lumbar spinal osteotomy with anticipated difficult intubation. An awake retrograde oral intubation with light sedation and local block is performed.
Wind sock deformity in rectal atresia  [cached]
Hosseini Seyed,Ghahramani Farhad,Shamsaeefar Alireza,Razmi Tannaz
Saudi Journal of Gastroenterology , 2009,
Abstract: Rectal atresia is a rare anorectal deformity. It usually presents with neonatal obstruction and it is often a complete membrane or severe stenosis. Windsock deformity has not been reported in rectal atresia especially, having been missed for 2 years. A 2-year-old girl reported only a severe constipation despite having a 1.5-cm anal canal in rectal examination with scanty discharge. She underwent loop colostomy and loopogram, which showed a wind sock deformity of rectum with mega colon. The patient underwent abdominoperineal pull-through with good result and follow-up. This is the first case of the wind sock deformity in rectal atresia being reported after 2 years of age.
Function Assessment for Rheumatoid Thumb Deformity  [PDF]
Ryo Oda, Daigo Taniguchi, Hiroyoshi Fujiwara, Shogo Toyama, Daisaku Tokunaga, Toshikazu Kubo
Open Journal of Rheumatology and Autoimmune Diseases (OJRA) , 2015, DOI: 10.4236/ojra.2015.53015
Abstract: Objective: Nalebuff’s type I deformity of the rheumatoid thumb, which is the most common thumb deformity with rheumatoid arthritis, can be classified into three stages according to the range of motion of the thumb. However, a functional assessment for each stage has never been undertaken. Methods: The ranges of motion of the thumb metacarpophalangeal and interphalangeal joints were evaluated to determine Nalebuff’s clinical stage, and both the Modified Kapandji Index (MKI) and the simple test for evaluating hand function (STEF) were used to evaluate hand function in 32 rheumatoid arthritis patients with type I deformity. We assessed hand function in each stage, and examined the relationship between the three clinical stages and dysfunction of the hand. Results: The scores for both MKI and STEF were significantly reduced in parallel with advancing stage of thumb deformity. Conclusion: Nalebuff’s staging system is also useful for reflecting the level of thumb function.
Spinal Injuries in Children  [PDF]
Saumyajit Basu
Frontiers in Neurology , 2012, DOI: 10.3389/fneur.2012.00096
Abstract: About 5% of spinal injuries occur in children – however the consequences to the society are devastating, all the more so because the cervical spine is more commonly affected. Anatomical differences with adults along with the inherent elasticity of the pediatric spine, makes these injuries a biomechanically separate entity. Hence clinical manifestations are unique, one of which is the Spinal Cord Injury Without Radiological Abnormality. With the advent of high quality MRI and CT scan along with digital X-ray, it is now possible to exactly delineate the anatomical location, geometrical configuration, and the pathological extent of the injury. This has improved the management strategies of these unfortunate children and the role of surgical stabilization in unstable injuries can be more sharply defined. However these patients should be followed up diligently because of the recognized long term complications of spinal deformity and syringomyelia.
Bilateral cleft lip nasal deformity  [cached]
Singh Arun,Nandini R
Indian Journal of Plastic Surgery , 2009,
Abstract: Bilateral cleft lip nose deformity is a multi-factorial and complex deformity which tends to aggravate with growth of the child, if not attended surgically. The goals of primary bilateral cleft lip nose surgery are, closure of the nasal floor and sill, lengthening of the columella, repositioning of the alar base, achieving nasal tip projection, repositioning of the lower lateral cartilages, and reorienting the nares from horizontal to oblique position. The multiplicity of procedures in the literature for correction of this deformity alludes to the fact that no single procedure is entirely effective. The timing for surgical intervention and its extent varies considerably. Early surgery on cartilage may adversely affect growth and development; at the same time, allowing the cartilage to grow in an abnormal position and contributing to aggravation of deformity. Some surgeons advocate correction of deformity at an early age. However, others like the cartilages to grow and mature before going in for surgery. With peer pressure also becoming an important consideration during the teens, the current trend is towards early intervention. There is no unanimity in the extent of nasal dissection to be done at the time of primary lip repair. While many perform limited nasal dissection for the fear of growth retardation, others opt for full cartilage correction at the time of primary surgery itself. The value of naso-alveolar moulding (NAM) too is not universally accepted and has now more opponents than proponents. Also most centres in the developing world have neither the personnel nor the facilities for the same. The secondary cleft nasal deformity is variable and is affected by the extent of the original abnormality, any prior surgeries performed and alteration due to nasal growth. This article reviews the currently popular methods for correction of nasal deformity associated with bilateral cleft lip, it′s management both at the time of cleft lip repair and also secondarily, at a later date. It also discusses the practices followed at our centre.
Frequency of foot deformity in preschool girls  [PDF]
Mihajlovi? Ilona,Smaji? Miroslav,Sente Jelena
Vojnosanitetski Pregled , 2010, DOI: 10.2298/vsp1011928m
Abstract: Background/Aim. In order to determine the moment of creation of postural disorders, regardless of the causes of this problem, it is necessary to examine the moment of entry of children into a new environment, ie. in kindergarten or school. There is a weak evidence about the age period when foot deformity occurs, and the type of these deformities. The aim of this study was to establish the relationship between the occurrence of foot deformities and age characteristics of girls. Methods. The research was conducted in preschools 'Radosno detinjstvo' in the region of Novi Sad, using the method of random selection, on the sample of 272 girls, 4-7 years of age, classified into four strata according to the year of birth. To determine the foot deformities measurement technique using computerized digitized pedografy (CDP) was applied. Results. In preschool population girls pes transversoplanus and calcanei valga deformities occurred in a very high percentage (over 90%). Disturbed longitudinal instep ie flat feet also appeared in a high percentage, but we noted the improvement of this deformity according to increasing age. Namely, there was a statistically significant correlation between the age and this deformity. As a child grows older, the deformity is lower. Conclusion. This study confirmed that the formation of foot arches probably does not end at the age of 3-4 years but lasts until school age.
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