Evaluation of Brace Treatment Using the Soft Brace Spinaposture: A Four-Years Follow-Up

The braces of today are constructed to correct the frontal plane deformity of idiopathic adolescent scoliosis (AIS). The Spinaposture brace© (Spinaposture Aps, Copenhagen, Denmark) is a soft-fabric brace for AIS and is designed to enhance rotational axial stability by inducing a sagittal plane kyphotic correction. This prospective observational study evaluated the brace in fifteen patients with AIS. The initial average CA was 16.8° (SD: 2.8). They were followed prospectively every 3 to 6 months during their brace usage until skeletal maturity of 25 months and at long-term follow-up of 44 months. In- and out-of-brace radiographs were performed in six subjects at inclusion. This resulted in an immediate in-brace correction of 25.3 percent in CA (14.3°→10.8°) and induced a kyphotic effect of 14.9 percent (40.8°→47.9°). The average in-brace improvement at first follow-up was 4.5° in CA, and the CA at skeletal maturity was 11° (SD: 7.4°) and long-term 12.0° (SD: 6.8°). In conclusion, the Spinaposture brace© had an immediate in-brace deformity correction and a thoracic kyphotic effect. At skeletal maturity, the deformities improved more than expected when compared to that of the natural history/observation and similar to that of other soft braces. No long-term deformity progression was seen. To substantiate these findings, stronger designed studies with additional subjects are needed.

Comparative Study of Spino-pelvic Parameters between Scoliotic versus Non-scoliotic Patients with Multi-level Degenerative Lumbar Spondylosis

Degenerative lumbar scoliosis is a multi-planner deformity seen in the aging spine. Important parameters in the evaluation of balance of the degenerative lumbar scoliosis include spino-pelvic parameters such as the LL, SS, PI, and PT besides the coronal Cobb´s angle. In order to minimize the energy associated with maintaining upright posture, sagittal balance is necessary. Significant sagittal abnormality or imbalance is commonly related to poor functional scores across multiple domains. Aim: The aim of this study was to investigate the role of the spino-pelvic parameters in the development of scoliosis in multi-level degenerative lumber spondylosis disease. Patients and Methods: This cross-sectional study was carried out in Tanta University Hospitals. It included the first 100 patients who visited the outpatient orthopedic department clinic from April 2019. Results: There was a statistically significant (p ≤ 0.05) increase in each of the PI, PT and cobb´s angle and a significant decrease in SS in multi-level DLS with scoliosis patients in correlation to multi-level DLS without scoliosis patients. There were no significant differences between LL in both studied groups. Regarding the age, sex, BMI and occupation in the two studied groups, there were no statistically significant differences. There was a significant correlation between the sex and PT in patients with multi-level DLS without scoliosis, but there was no significant correlation between sex and other parameters in both groups. There wasn´t significant correlation between the two groups by increasing the age. Manual workers in scoliotic group show higher PT and smaller SS than in non-scoliotic group, which give a significant correlation between the occupation and these spino-pelvic parameters. Conclusion: Importance of a thorough discussion of the risks of deformity progression weighed against the anticipated benefits with patient’s during clinical consultation return to the spino-pelvic parameters. Measurement of these spino-pelvic parameters can help in monitoring progression of disease in patients and allow physicians to provide better prevention, treatment and control.

Evaluation of the role of ventral interventions in the surgery of idiopathic scoliosis in patients with active bone growth

BACKGROUND: Today, the question of the tactics of surgical treatment of patients with idiopathic scoliosis during active bone growth, namely, the need for ventral interventions due to the emergence of modern dorsal instruments, remains open. AIM: This study aims to evaluate the role of ventral interventions in the surgical treatment of patients with progressive idiopathic scoliosis Lenke type 1, 2, 3 during the period of active bone growth. MATERIALS AND METHODS: The long-term results of operational correction 352 patients with thoracic idiopathic scoliosis aged from 10 to 14 years old operated in Novosibirsk Research Institute of Traumatology and Orthopedics n.a. Ya.L. Tsivyan from 1998 to 2018 using various methods and different instrumentation types. RESULTS: Among patients (352 people) aged 10 to 14 years with idiopathic thoracic scoliosis (Lenke type 1, 2, 3), statistically significant postoperative progression was observed in patients who underwent surgical deformity correction using laminar (hook) fixation. At the same time, additional ventral stage conduction could not prevent deformity progression in the postoperative period. In those groups where hybrid fixation was used combined with the ventral stage and total transpedicular fixation, no significant progression was observed in the postoperative period. CONCLUSION: Modern dorsal systems for transpedicular fixation narrow the indications for using additional mobilizing and stabilizing ventral interventions in the surgical treatment of progressive idiopathic scoliosis in patients with active bone growth. Total transpedicular fixation provides excellent main curve and anti-curvature arch correction in the absence of scoliotic deformity progression in the postoperative long-term follow-up.

Scoliotic disease: report to the teacher

It is with gratitude that I dedicate my work to the teacher, Ya.L. Tsivyan, who not only provided a subject for research, but also, on his own example of a person devoted to his work, brought up a generation of scholars for whom life and science are inseparable.The paper presents the results of many years of research on idiopathic scoliosis in the form of a report to the teacher. Several fundamental topics were considered:1) for the first time in world practice, it was established, on the basis of a study of 50 patients with idiopathic scoliosis, that the etiological factor of scoliosis is ectopic localization of neural crest derivatives, which are not genetically determined to chondrogenic differentiation and the growth process, in the vertebral body growth plate;2) a local disturbance of chondrogenesis in the vertebral body growth plate is the cause of the growth asymmetry and formation of spinal deformity in idiopathic scoliosis;3) the degree of structural changes in the spine and the prognosis of the deformity progression depend on the level of disturbance of the morphogenetic processes in the vertebral body growth plate embedded in embryogenesis;4) it is supposed to confirm the proposed hypotheses by inhibition of the PAX3 gene in the chick embryo model of idiopathic scoliosis and to get answers to many more unclear questions concerning scoliotic disease.

Comprehensive assessment of rheumatoid hand using cluster analysis involving parameter analysis of three major hand deformities: a cross-sectional and longitudinal study

Background Although drug therapy in rheumatoid arthritis has recently improved, treating established rheumatoid hand consisting of three major deformities—thumb deformity, finger deformities, and ulnar drift—remains a challenge. Underlying complex pathophysiology makes it difficult to comprehensively understand these deformities, and comprehensive assessment methods require accumulated skill and long learning curves. We aimed to establish an easier composite method of understanding the pathophysiology using data from our cohort and cluster analysis. Methods We established a rheumatoid hand cohort in 2004, and clinically evaluated 134 hands (67 patients). We repeated the evaluations in 2009 and 2015, which provided data for 297 hands and 43 hands for cross-sectional and longitudinal analyses, respectively. Thumb deformities, finger deformities (swan-neck and boutonnière deformity), and ulnar drift were semi-quantified and entered as parameters into a two-step cluster (cross-sectional) analysis. Parameter distributions were considered to clarify each cluster’s characteristics. Next, hands with cluster change over the study period were reviewed to clarify deformity progression (longitudinal analysis). We also performed a stratified analysis between the clusters and the affected period to clarify whether long affected period plays an important role in deformity progression. Results We identified seven clusters: cluster 1: mild finger deformities; cluster 2: type 1 thumb deformity; cluster 3: type 2 thumb deformity and severe ulnar drift; cluster 4: type 3 or 4 thumb deformity and low or moderate swan-neck deformity; cluster 5: various thumb deformities and severe boutonnière deformity; cluster 6: type 1 thumb deformity and severe swan-neck deformity; and cluster 7: type 6 thumb deformity. The ulnar drift parameters were equally distributed among the clusters except for cluster 3. Larger cluster numbers generally indicated lower function. At the study endpoint, cluster 1 had changed mainly to cluster 2 or 4, cluster 2 changed to cluster 3, and cluster 7 was considered the final morphology with the lowest hand function. Patients affected for > 30 years had increased risk of rapid disability progression. Conclusions Our comprehensive assessment indicated seven deformity patterns and a progressive course in rheumatoid hand. Using patterns may provide rheumatologists with easier information for practical interventions and to determine functional prognosis.

A novel growing rod technique to treat early-onset scoliosis (EOS): a step-by-step 2D surgical video

Early-onset scoliosis (EOS) correction techniques have evolved slowly over the past 40 years and still remain a challenge for the spine surgeon. Avoiding spinal fusion in these patients is key to decreasing morbidity and mortality in this population.Current treatments for EOS include both conservative and surgical options. The authors present the modified Luqué technique that has been performed at their institution for the past decade. This modified technique relies on Luqué’s principle, but with newer “gliding” implants through a less disruptive approach. The goal of this technique is to delay fusion as long as possible, with the intent to prevent deformity progression while preserving maximal growth.Normally, these patients will have definitive fusion surgery once they have reached skeletal maturity or as close as possible. Out of 23 patients until present (close to 4-year follow-up), the authors have not performed any revision due to implant failure. Three patients have undergone final fusion as the curve progressed (one patient, 4 years out, had final fusion at age 12 years; two other patients had final fusion at 3 years). These implants, which have the CE mark in Europe, are available in Canada via a special access process with Health Canada. The implants have not yet been submitted to the FDA, as they are waiting on clinical data out of Europe and Canada.In the following video the authors describe the modified Luqué technique step-by-step.The video can be found here: https://youtu.be/k0AuFa9lYXY.