Rapid Destructive Arthropathy of the Knee in Parkinson’s Disease with Pisa Syndrome: A Case of Knee-Spine Syndrome

The changes occurring in knee osteoarthritis often cause alterations in the spinal loading condition, which further lead to degenerative changes. This close relationship of the knee and spine has been reported as knee-spine syndrome. A 60-year-old woman with Parkinson’s disease (PD; Hoehn-Yahr stage IV) had severe knee pain with moderate lateral osteoarthritis of the knee (Kellgren-Lawrence classification grade II). Conservative therapy had no effect at all, and the knee developed destructive osteoarthritis rapidly without any traumatic episodes. The radiographic findings progressed to Kellgren-Lawrence grade IV within a month. Magnetic resonance imaging revealed partial depression of the joint surface, including shredded ossicles and substantial amounts of synovial fluid. The imaging findings were considered to be caused by a subchondral insufficiency fracture (SIF). Total knee arthroplasty was performed using a semiconstrained prosthesis. The alignment of her lower extremity improved, and the patient could walk without knee pain. The patient had Pisa syndrome, a lateral flexion of the trunk, which is a postural deformity of the trunk secondary to long-standing PD. The postural deformity in PD is not based on spinal deformity itself but on the loss of postural reflexes and the imbalance of muscle tonus. Her left knee pain appeared 1 month after L1-L4 posterior lumbar interbody fusion (PLIF) as the Pisa syndrome to her left side worsened. The more the trunk tilts to the lateral side, the center of the gravity axis will shift and pass through more lateral points of the knee and result in higher knee load. The stress concentration from the spine to the lateral joint of the knee caused lateral knee osteoarthritis, namely, knee-spine syndrome. When patients undergo correction surgery for adult spinal disorder with impairment of postural reflexes, they need to be followed up carefully regarding not only the spinal alignment but also the lower extremities.

Body composition indices in a sample of female adolescents with postural deformity: a case control study

Objectives Normal posture is considered to be an indicative of good musculoskeletal health in school aged adolescents. Little is known about the body composition indices in relation with postural deformities in adolescents. The aim of this study was to assess relation of body composition analysis indices with postural deformities in a sample of female high school adolescents. Results In this case–control study, 37 eligible female adolescents with any postural deformities and 33 normal posture subjects enrolled in the study by random cluster sampling. Body composition analysis performed by bioelectrical impedance analysis (BIA) method to quantity body fat mass (BFM), soft lean mass (SLM) and lean body mass (LBM). The binary logistic regressions were performed to evaluate the associations of body composition indices which were significantly different between two groups at significance level of 0.05 with postural disorders in the two groups. There was no significant difference between subjects with postural disorders with their normal controls concerning demographic variables. We observed an inverse association between postural deformity risk and LBM (OR = 0.803; 95% CI 0.690–0.934) and SLM (OR = 0.774; 95% CI 0.649–0.922) after adjusting the analysis by height of participants.

Results of Minimally Invasive Bipolar Tenotomy of Congenital Muscular Torticollis

Background Congenital muscular torticollis is the postural deformity of the head and of the neck. The purpose of the present study is to evaluate the results of bipolar sternocleidomastoid (SCM) muscle tenotomy in children. Methods The present prospective study was conducted at the Department of Orthopedic Surgery from December 2010 to December 2014. A total of 34 children with congenital muscular torticollis and a mean age of 4.8 years (range: 1–14 years) were recruited from the Outpatient Department. They were treated with bipolar SCM muscle release under general anesthesia. The functional and cosmetic results were rated on a scoring system modified from Lim et al (2014). All of the children were followed-up for 2 years. Results At the final follow-up, the neck range of movement and head tilt improved and their appearance were cosmetically improved despite the long-standing nature of the deformity. The results were excellent in 30 patients (88.23%) and good in 4 patients (11.76%). No postoperative complications were found in any of the 34 patients. Conclusion Bipolar tenotomy of the SCM muscle is a good method for correcting difficult cases of congenital muscular torticollis. It is a safe, effective and complication-free method for these patients.

A STUDY OF POSITIVE MENTAL HEALTH IN SCHOOL GIRLS WITH POSTURAL DEFORMITIES : WITH REFERENCE TO YOGA INTERVENTION PROGRAM

The aim of the present study was to analyse the effect of three months yoga program on positive mental health of school girls diagnosed with postural deformity. To conduct the study 2000 school children from various schools in Mumbai were screened with the help of kypholordometry to determine the presence of postural kyphosis. Out of the surveyed subjects, 72 school girls between age of six to twelve years were found to be suffering from postural kyphosis. Out of these 60 school girls were selected and took part in the present study. Selected Kriyas, Asanas and Pranayam respectively forms the basis of three months yogic program. Junior Positive mental health inventory prepared by Agashe and Helode (2009) was used as psychological instrument in the present study.Results reveal significant impact of yoga program on positive mental health of school girls carrying postural deformity in the form of kyphosis. It was concluded that positive mental health among school girls carrying kyphotic deformity can be enhanced with a well chalked out yoga program of short duration.

Relationship between Postural Deformities and Frontal Function in Parkinson’s Disease

Postural deformities and executive dysfunction (ED) are common symptoms of Parkinson’s disease (PD); however, the relationship between postural deformities and ED in patients with PD remains unclear. This study assessed the relationship between postural deformities and ED in patients with PD. Sixty-five patients with sporadic PD were assessed for the severity of postural deformities and executive function. The severity of postural deformities was scored using the United Parkinson’s Disease Rating Scale item 28 score: no postural deformity (0), mild postural deformities (1), or severe postural deformities (2–4). Executive function was assessed using the Behavioral Assessment of the Dysexecutive Syndrome (BADS) and an age-controlled standardized BADS score <70 was defined as ED. Age-controlled standardized BADS scores were compared across the three groups using the Kruskal-Wallis test. Relationship between ED and the severity of postural deformities was assessed using the Mann-WhitneyUtest. Age-controlled standardized BADS score significantly differed among the three groupsP=0.005. ED was significantly related to the severity of postural deformitiesP=0.0005. The severity of postural deformities was associated with a lower age-controlled standardized BADS score and ED, and these findings suggest that postural deformities were associated with frontal dysfunction in patients with PD.