Computer-aided Measurement System Using Image Processing for Measuring Cobb Angle in Scoliosis

Background: One of the spine deformities is scoliosis, and Cobb angle is generally used to assess it. Objectives: In this study, a computer-aided measurement system (CAMS) was presented as a new repeatable and reproducible approach to assess the Cobb angle in idiopathic scoliosis patients. Methods: Python libraries, including OpenCV and Numpy were used for image processing and design of the software. To assess the repeatability and reproducibility of the CAMS, a series of 98 anterior-posterior radiographs from patients with idiopathic scoliosis were used. Assessments were done by five independent observers. Each radiograph was assessed by each observer three times with a minimum break of two weeks among assessment. The single measure intraclass correlation coefficient (ICC), the mean absolute difference (MAD), and the standard error measurement (SEM) values were used for intra- and inter-observer reliability. Results: The inter-observer analysis indicated that the ICCs ranged from 0.94 - 0.99, and the MAD between manual and CAMS were less than 3°. For intra-observer measurements, the combined SEM between all observers for the manual and CAMS was 1.79° and 1.27°, respectively. An ICC value of 0.97 with 95% confidence interval (CI) was excellent in CAMS for inter-observer reliability. The MAD of CAMS was 2.18 ± 2.01 degrees. Conclusions: The CAMS is an effective and reliable approach for assessing scoliotic curvature in the standing radiographs of thoraco-lumbar. Moreover, CAMS can accelerate clinical visits, and its calculation results are reliable.

P.154 Subcutaneous intrathecal catheter and port implants for administration of Nusinersen in patients with Spinal Muscular Atrophy

Background: Until recently, no effective treatment was available for spinal muscular atrophy (SMA). In 2017, Health Canada approved intrathecal Nusinersen a medication that prevents degeneration of the motor neurons in the spinal cord. The administration is intrathecally most commonly via lumbar puncture (LP) to have a direct effect on the motor neurons of the spinal cord. Many older patients with SMA and concomitant spinal deformities present technical challenges to access the thecal sac. Different routes have been described for delivery of the medication whoever these techniques may require sedation, are associated with radiation exposure, and demand experience personnel. Methods: A new surgical technique has been proposed to overcome these obstacles by combining two Health Canada approved devices: 1) an intrathecal catheter designed for intrathecal baclofen pumps and 2) an implantable subcutaneous port designed for intravascular medication administration Results: We describe the technical nuances and outline the clinical outcomes of six patients with complex spine deformities who have undergone such an implant for administration of Nusinersen. Conclusions: We discuss the benefits of the procedure which includes: 1) administration in the outpatient setting without sedation, 2) avoidance of costly imaging and experienced personnel, and 3) placement of the catheter in the cervicothoracic junction.

Les instrumentations rachidiennes sans fusion vertébrale dans les scolioses neuromusculaires

Less invasive techniques are now available to treat neuromuscular scoliosis efficiently. Rods can be implanted safely and at an early stage to correct and prevent further spine deformities. These techniques are particularly adapted to children with spinal muscular atrophy. The expansion of rods is possible magnetically or mechanically and enables to follow the spine growth timeline optimally. Of note, a risk a metallosis has been reported for some magnetic rods available on the market.

PRELIMINARY RESULTS OF THE BIPOLAR TECHNIQUE IN THE TREATMENT OF NEUROMUSCULAR SCOLIOSIS

ABSTRACT Objective To present the preliminary results of the bipolar technique for the surgical treatment of neuromuscular spine deformities. Methods Five patients with neuromuscular scoliosis (cerebral palsy – 3 patients, spinal amyotrophy – 1 patient, and genetic syndrome – 1 patient) underwent surgical treatment using the bipolar technique and were evaluated 12 months after the operation. Results General care and the ability to sit improved in all patients. The main curve ranged from 64.7 to 84.1 degrees (mean 70.58 ± 7.1) in the preoperative period and from 2.6 to 50.3 degrees (mean 25.50 ± 16.0) in the postoperative period with 64% correction. Corrections of pelvic obliquity (85%), T4-T12 kyphosis (43%), the Pisa angle (69%) and the sacroclavicular angle (60%) were observed 12 months following surgery. Postoperative infection (2 patients) and pneumonia (1 patient) were the complications observed. Conclusion The bipolar technique presented good clinical and radiological results associated with low morbidity in the treatment of neuromuscular spine deformities. Level of evidence IV; Case series.

Residual Pain in the Context of Selecting and Switching Biologic Therapy in Inflammatory Rheumatic Diseases

For many years, inflammatory rheumatic diseases (IRDs) represented a source of disappointment in medical care caused by the mediocre efficacy of the available treatments. Some of these diseases, like Rheumatoid Arthritis (RA) or Ankylosing Spondylitis (AS), caused fear in the general population, especially due to associated joint deformities and subsequent disabilities. However, in the last 20 years, a new successful class of antirheumatic drugs has become available: biologic Disease-Modifying Antirheumatic Drugs (bDMARDs). Due to this innovative treatment, the days are over when joint and spine deformities defined the condition of a person with RA or AS. Nonetheless, expectations are higher today, and other clinical problems, (not entirely solved by bDMARDs), seem to drive the drug selection during the span of rheumatic diseases. Most of these issues are covered by the term “unmet needs.” One of the most intriguing of such needs is the residual pain (RP) in patients that are otherwise in the biological remission of the disease. Present in a significant proportion of the patients that enter remission status, RP is poorly understood and managed. In recent years, new data has become available in this area and new conceptual clarifications have occurred. In this review, we explain the various nature of RP and the necessity of treatment diversification in such situations. All in all, we believe this condition is far more complex than simple pain and includes other clinical aspects, too (like fatigue or mood changes) so the terms Post-Remission Syndrome (PRS), and PRS pain might be more appropriate.

The Clinical and Genotypic Spectrum of Scoliosis in Multiple Pterygium Syndrome: A Case Series on 12 Children

Background: Multiple pterygium syndrome (MPS) is a genetically heterogeneous rare form of arthrogryposis multiplex congenita characterized by joint contractures and webbing or pterygia, as well as distinctive facial features related to diminished fetal movement. It is divided into prenatally lethal (LMPS, MIM253290) and nonlethal (Escobar variant MPS, MIM 265000) types. Developmental spine deformities are common, may present early and progress rapidly, requiring regular fo llow-up and orthopedic management. Methods: Retrospective chart review and prospective data collection were conducted at three hospital centers. Molecular diagnosis was confirmed with whole exome or whole genome sequencing. Results: This case series describes the clinical features and scoliosis treatment on 12 patients from 11 unrelated families. A molecular diagnosis was confirmed in seven; two with MYH3 variants and five with CHRNG. Scoliosis was present in all but our youngest patient. The remaining 11 patients spanned the spectrum between mild (curve ≤ 25°) and malignant scoliosis (≥50° curve before 4 years of age); the two patients with MYH3 mutations presented with malignant scoliosis. Bracing and serial spine casting appear to be beneficial for a few years; non-fusion spinal instrumentation may be needed to modulate more severe curves during growth and spontaneous spine fusions may occur in those cases. Conclusions: Molecular diagnosis and careful monitoring of the spine is needed in children with MPS.

The application of three-dimensional prototyping and printing in reconstructive neurosurgery and vertebrology (literature review and own results)

This article is devoted to the analysis of the possibility of using additive technologies in clinical practice. The number of medical specialties that use 3D printing technologies to treat patients is increasing every year. Thanks to the emergence of high-tech qualified medical care, it is possible to carry out the most complex surgical interventions and give a person who is faced with serious diseases a high-quality and fulfilling life. The creation of a 3D model using the data of a specific patient, the use of 3D computer modeling and additive technologies have become a real breakthrough in many areas of surgery. Today, such an approach in planning reconstructive and restorative operations occupies an important position in modern medicine. The authors of the article presented their experience of using additive 3D printing technologies in clinical practice. The researchers paid special attention to the results of the use of additive technologies in the treatment of diseases of the spine: deformities, degenerative-dystrophic and oncological diseases.

Incidence of skeletal deformities in induced triploid rainbow trout Oncorhynchus mykiss (Walbaum, 1792)

Due to the cytogenetic incompatibility, triploid fish are usually infertile and are not affected by a decline in growth, survival and meat quality, which accompanies the process of sexual maturation in diploid specimens. Thus, artificial triploidization has been proposed for fish production in the case of species with early sexual maturation, such as rainbow trout. However, the use of this technique is limited by increased ratios of skeletal deformities observed in triploid specimens. The main objective of this research was to compare the proportion and variety of body abnormalities in diploid and triploid 14-month-old rainbow trout from commercial stocks, using external body shape examination, radiography and whole-mount skeletal staining. Individuals with externally observed body deformities (scoliosis, humpback, shortened tail and jaw deformities) accounted for 0.45% of the diploid stock and 3.83% of the triploid stock. X-rays and whole-mount skeletal staining of deformed individuals showed spine deformities, including compressions and fusions of vertebrae. Abnormalities observed in diploid and triploid rainbow trout examined during this study were non-lethal, however, they may negatively affect the condition of fish. Fish with skeletal deformities are not aesthetically pleasing, thus an increased ratio of such deformations in fish produced for commercial purposes may result in real economic losses.