Juvenile/Adolescent Idiopatic Scoliosis and Rapid Palatal Expansion. A Pilot Study

The question of whether orthodontic therapy by means of rapid palatal expansion (RPE) affects the spine during development is important in clinical practice. RPE is an expansive, fixed therapy conducted with heavy forces to separate the midpalatal suture at a rate of 0.2–0.5 mm/day. The aim of the study was to evaluate the influence of RPE on the curves of the spine of juvenile/adolescent idiopathic scoliosis patients. Eighteen patients under orthopedic supervision for juvenile/adolescent idiopathic scoliosis and independently treated with RPE for orthodontic reasons were included in the study: Group A, 10 subjects (10.4 ± 1.3 years), first spinal radiograph before the application of the RPE, second one during the orthodontic therapy with RPE; Group B, 8 patients (11.3 ± 1.6 years), first radiograph during the use of RPE second one after the removal. Group A showed a significant worsening of the Cobb angle (p ≤ 0.005) at the second radiograph after RPE. Group B showed a significant improvement of the Cobb angle (p = 0.01) at the second radiograph after removal of RPE. Based on the results, the use of RPE during adolescence might influence the spinal curves of patients with idiopathic scoliosis.

Neglected bodily senses in women living with vertebral fracture: a focus group study

Objective Older women are at particular risk of osteoporosis. Among women with osteoporosis, fractures of the vertebra (vertebral fracture) are common, hard to detect and associated with risk of further fracture. Identifying vertebral fracture in a timely manner allows instigation of preventive measures to reduce the risk of further fracture. Although detection of vertebral fracture requires spinal radiograph, many women do not receive referral. To begin development of a screening tool to identify women in need of referral we undertook a qualitative study to characterize women’s experiences of vertebral fracture, using Eccleston’s ‘Ten Neglected Bodily Senses’. Methods Four qualitative focus groups were conducted with women who had been diagnosed with vertebral fracture (n = 19, age 60–91 years). Data were audio-recorded, transcribed and analysed thematically using the ‘Ten Neglected Bodily Senses’. Results Women’s experiences of vertebral fractures related to seven senses: pain, movement, fatigue, balance, pressure, appetite and breathing. Pain was the dominant sense and all participants explained how pain increased with activity, reaching a crescendo, and described strategies to minimize this disruption. Most participants had become physically shorter, making some feel ‘squashed’, putting pressure on other body parts. Some described appetite loss or a sense of restricted breathing. Participants experienced a sense of being ‘pulled’ forwards, impacting on balance and exacerbating fear of falling. Conclusion The study found senses that have not been previously described in the experiences of women with vertebral fracture. These will be used to inform the design of a new screening tool for use in primary care.

Delayed Diagnosis of Psoriatic Arthritis Mutilans due to Arthritis Prior to Skin Lesion

Psoriatic arthritis (PsA) is a type of inflammatory arthritis characterized by cutaneous psoriasis, peripheral joint damage, axial joint damage, and enthesitis and is usually diagnosed after the appearance of psoriatic skin disease. PsA mutilans is relatively rare in Japan. In the present case, the patient was diagnosed with PsA with foot mutilans deformity only. Hand and spinal radiograph findings were unremarkable. As in the present case arthritis is occurred prior to the onset of skin lesion, we should make early diagnosis to prevent mutilans deformity.

Bone quality, as measured by trabecular bone score, in patients with primary hyperparathyroidism

ObjectiveIn primary hyperparathyroidism (PHPT), vertebral fractures (VFx) occur regardless of bone mineral density (BMD) and may depend on decreased bone quality. Trabecular bone score (TBS) is a texture measurement acquired during a spinal dual-energy X-ray absorptiometry (DXA). Recently, TBS has been proposed as an index of bone micro-architecture.DesignWe studied 92 PHPT patients (74 females, age 62.1±9.7 years) and 98 control subjects. In all patients at baseline, in 20 surgically treated patients and in 10 conservatively treated patients after 24 months, TBS, spinal (lumbar spine (LS)) and femoral (total hip (TH) and femoral neck (FN)) BMD were assessed by DXA and VFx by spinal radiograph.ResultsPHPT patients had lower TBS (−2.39±1.8) and higher VFx prevalence (43.5%) than controls (−0.98±1.07 and 8.2% respectively, bothP<0.0001). TBS was associated with VFx (odds ratio 1.4, 95% CI 1.1–1.9,P=0.02), regardless of LS-BMD, age, BMI and gender, and showed a better compromise between sensitivity (75%) and specificity (61.5%) for detecting VFx than LS-BMD, TH-BMD and FN-BMD (31 and 75%, 72 and 44.2%, and 64 and 65% respectively). In surgically treated patients, TBS, LS-BMD, TH-BMD and FN-BMD increased (+47±44.8,+29.2±34.1,+49.4±48.7 and +30.2±39.3% respectively, allP<0.0001). Among patients treated conservatively, TBS decreased significantly in those (n=3) with incident VFx (−1.3±0.3) compared with those without (−0.01±0.9,P=0.048), while BMD changes were not statistically different (LS 0.3±1.2 vs −0.8±0.9 respectively,P=0.19; TH 0.4±0.8 vs −0.8±1.4 respectively,P=0.13 and FN 0.4±0.9 vs −0.8±1.4 respectively,P=0.14).ConclusionsIn PHPT, bone quality, as measured by TBS, is reduced and associated with VFx and improves after surgery.

Association of Bone Morphogenetic Proteins with Spinal Fusion in Ankylosing Spondylitis

Objective.To measure serum concentrations of bone morphogenetic proteins (BMP) in patients with ankylosing spondylitis (AS), and to investigate the relationship between BMP and clinical manifestations and radiographic changes.Methods.We studied 60 consecutive AS patients with and 60 patients without spinal fusion. Spinal radiographs were assessed using the Bath Ankylosing Spondylitis Radiology Index (BASRI) and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Spinal fusion was defined as the presence of total bony bridging between 2 adjacent vertebral bodies in either the lumbar or cervical spine. Serum levels of BMP were determined by enzyme-linked immunosorbent assay.Results.Patients with spinal fusion had higher serum levels of BMP-2 and BMP-4 than either the healthy controls or patients without spinal fusion (p < 0.001), but there was no difference between the latter 2 groups. Serum BMP-7, erythrocyte sedimentation rate, and C-reactive protein (CRP) levels were elevated in patients with spinal fusion compared with those without (p < 0.05). Serum BMP-4 and BMP-7 levels were higher in patients with hip involvement than in those without (p < 0.05). BMP-2 and BMP-4 levels had a significant correlation with spinal radiograph scores, especially for BASRI of the lumbar spine (r = 0.356 and 0.348, respectively, p < 0.001). CRP showed a significant correlation with spine BASRI and mSASSS scores (r = 0.261 and 0.260, respectively, p < 0.05).Conclusion.Rising levels of BMP in AS patients with spinal fusion and the positive correlation between BMP and spinal radiograph scores indicate that BMP may play a role in the process of spinal ankylosis. Serum levels of BMP may reflect radiographic progression of the spine and hip joints.