Congenital pure kyphosis due to failure of vertebral body segmentation is a relatively rare entity, and surgical intervention is infrequent compared to that for failure of vertebral body formation [1] [2]. There are v...Congenital pure kyphosis due to failure of vertebral body segmentation is a relatively rare entity, and surgical intervention is infrequent compared to that for failure of vertebral body formation [1] [2]. There are very few reports of long-term follow-up of surgical treatment in patients with congenital pure kyphosis, and all the reported cases were diagnosed as failure of formation and had an age at the time of surgery of less than 18 years. It is important for orthopedic surgeons to follow the postoperative course of rare cases over 30 years. Here, we present a surgically treated case with ultra-long term follow-up of a 50-year-old patient with congenital pure kyphosis of the lumbar spine. Imaging of the lumbar spine showed six vertebrae and an unsegmented bar at L3-4 causing a pure kyphosis of 54°. The wedge-shaped block vertebra had 4 pedicles with the neural foramen between the pedicles without concomitant disc space, with compensatory thoracic hypokyphosis and lower lumbar hyperlordosis. One-stage correction and fusion surgery using anterior opening and posterior closing osteotomy was successfully performed. Both clinical and radiographic results were excellent and have been maintained for over 30 years postoperatively. The basic principle in the surgical treatment of adult spinal deformity is to achieve and maintain a good global sagittal balance over time. This case reaffirms the importance of spinopelvic harmony.展开更多
Surgical treatment for cervical kyphotic deformity is still controversial. Circumferential approach has been well described in the literature but long terms outcomes are not well reported. Important to decide the corr...Surgical treatment for cervical kyphotic deformity is still controversial. Circumferential approach has been well described in the literature but long terms outcomes are not well reported. Important to decide the correct treatment option is the preoperative radiological exams to value the type of deformity(flexible or fixed). We report the case of a 67-year-old woman affected by a severe cervical kyphotic deformity who underwent combined anterior/posterior surgical approach, getting a good reduction of the deformity and an optimal stability in a long term follow up.展开更多
BACKGROUND Spinal deformities in Ehlers-Danlos syndrome(EDS; type VI) are generally progressive and severe. Surgical treatment has been described for kyphoscoliosis in the thoracolumbar spine. However, there are few s...BACKGROUND Spinal deformities in Ehlers-Danlos syndrome(EDS; type VI) are generally progressive and severe. Surgical treatment has been described for kyphoscoliosis in the thoracolumbar spine. However, there are few studies describing the consequences of an anterior approach in cervical kyphosis. An anterior approach may not be able to fully decompress the spinal canal and restore the normal curvature of the cervical spine. Therefore, the anterior approach for cervical kyphosis in young children is hard. We describe the first case in an EDS girl with cervical kyphosis who received satisfactory anterior cervical corpectomy decompression and fusion.CASE SUMMARY The chief complaints of a 16-year-old girl with EDS were double upper limb weakness for 7 years and double lower limb walking instability for 2 years.Moreover, the imaging results revealed that the degree of kyphosis from cervical vertebra 2 to 4 accompanying with spinal cord compression was 30°. An anterior cervical corpectomy involving cervical vertebra 3 and a titanium mesh implant were performed with internal fixation. The results at 3 mo after surgery demonstrated that the anterior fusion was solid, and the kyphosis of the cervical spine was corrected. Additionally, the power of all four extremities was significantly improved.CONCLUSION The incidence rate of cervical kyphosis in EDS is rare. The surgical treatment for these patients, especially an anterior approach, is challenging. Therefore, to develop safer and more effective strategies to treat cervical kyphosis in EDS,there is still much work to do.展开更多
Introduction: This study is designed to explore the biomechanical principles of posterior bilateral pedicle screw on steps progressively and tight closure on every step for severe angular kyphosis and the indication c...Introduction: This study is designed to explore the biomechanical principles of posterior bilateral pedicle screw on steps progressively and tight closure on every step for severe angular kyphosis and the indication conditions and clinical pathways of above new technique. Materials and Methods: A total of 90 patients have severe angular kyphosis, 37 males and 53 females, with an average age of 47 years. All patients were treated with posterior bilateral pedicle screw and step tight closure for gradual shortening and orthopedic technology. Results: Average intraoperative blood loss was 2089 ml. Average operation time was 326 minutes. Kyphotic angle changed from 90.1° averagely preoperatively to 41.6° averagely postoperatively with an improvement rate of 65%. The distance from C<sub>7</sub> plumb line to posterior upper edge of the S<sub>1</sub> vertebral body was averagely 5.2 mm postoperatively, with a correction rate of 73%. Neurological complications occurred in 2 cases, accounting for 6%. Non-neurological complications occurred in 2 cases, accounting for 6%. Anatomical parameters were significantly improved postoperatively (P < 0.05). All patients were averagely followed up for 28 months. Segments undergoing osteotomy achieved bone fusion, without loss of orthopedic angle. Conclusions: The orthopedic technology of bilateral pedicle screw and step tight closure designed by human physiology and biomechanical principles can protect spinal cord cells from injury to the utmost. To choose an appropriate osteotomy plane during pre-surgical planning can make the repair results closer to the normal function of the spine. Intraoperative nerve root protection, full release and bone graft fusion are effective safeguards to ensure kyphosis correction and to avoid spine lateral offset.展开更多
Objective:To analyze the effect of posterior V-osteotomy in the treatment of traumatic kyphosis.Methods:From August 2018 to August 2020,40 patients with kyphosis were randomly divided into observation group and contro...Objective:To analyze the effect of posterior V-osteotomy in the treatment of traumatic kyphosis.Methods:From August 2018 to August 2020,40 patients with kyphosis were randomly divided into observation group and control group.Results:The postoperative Cobb angle of the observation group was(8.29±1.24)°better than that of the control group(15.68±2.73)°,P<0.05;The preoperative Cobb angle of the observation group was(49.78±4.15)°compared with that of the control group(50.11±4.23)°,P>0.05;The incidence of postoperative complications and recurrence rate in the observation group were 5.00%and 5.00%respectively,which were lower than 25.00%and 30.00%in the control group(P<0.05).Conclusion:Posterior V-osteotomy for traumatic kyphosis can improve Cobb angle,reduce the risk of postoperative complications and recurrence,which is safe and feasible.展开更多
Background:Andersson lesions(ALs),also known as spondylodiscities,destructive vertebral lesions and spinal pseudarthrosis,usually occur in patients with ankylosing spondylitis(AS).Inflammatory and traumatic causes hav...Background:Andersson lesions(ALs),also known as spondylodiscities,destructive vertebral lesions and spinal pseudarthrosis,usually occur in patients with ankylosing spondylitis(AS).Inflammatory and traumatic causes have been proposed to define this lesion.Different surgical approaches including anterior,posterior,and combined anterior and posterior procedure have been used to address the complications,consisting of mechanical pain,kyphotic deformity,and neurologic deficits.However,the preferred surgical procedure remains controversial.The aim of this study was to illustrate the safety,efficacy,and feasibility of a modified posterior wedge osteotomy for the ALs with kyphotic deformity in AS.Methods:From June 2008 to January 2013,23 patients(18 males,5 females)at an average age of 44.8 years(range 25–69 years)were surgically treated for thoracolumbar kyphosis with ALs in AS via a modified posterior wedge osteotomy in our department.All sagittal balance parameters were assessed by standing lateral radiography of the whole spine before surgery and during the followup period.Assessment of radiologic fusion at follow-up was based on the Bridwell interbody fusion grading system.Ankylosing spondylitis quality of life(ASQoL)and visual analog scale(VAS)scores were performed to evaluate improvements in daily life function and back pain pre-operatively and post-operatively.Paired t tests were used to compare clinical data change in parametric values before and after surgery and the Mann-Whitney U test was employed for non-parametric comparisons.The radiographic data change was evaluated by repeated measure analysis of variance.Results:The mean operative duration was 205.4 min(range 115–375 min),with an average blood loss of 488.5 mL(range 215–880 mL).Radiographical and clinical outcomes were assessed after a mean of 61.4 months of follow-up.The VAS back pain and ASQoL scores improved significantly in all patients(7.52±1.31 vs.1.70±0.70,t=18.30,P<0.001;13.87±1.89 vs.7.22±1.24,t=18.53,P<0.001,respectively).The thoracolumbar kyphosis(TLK)changed from 40.03±17.61°pre-operatively to 13.86±6.65°post-operatively,and 28.45±6.63°at final follow-up(F=57.54,P<0.001),the thoracic kyphosis(TK)changed from 52.30±17.62°pre-operatively to 27.76±6.50°post-operatively,and 28.45±6.63°at final follow-up(F=57.29,P<0.001),and lumbar lordosis(LL)changed from29.56±9.73°pre-operatively to20.58±9.71°post-operatively,and20.73±10.27°at final follow-up(F=42.50,P<0.001).Mean sagittal vertical axis(SVA)was improved from 11.82±4.55 cm pre-operatively to 5.12±2.42 cm post-operatively,and 5.03±2.29 cm at final follow-up(F=79.36,P<0.001).No obvious loss of correction occurred,according to the lack of significant differences in the sagittal balance parameters between post-operatively and the final follow-up in all patients(TK:27.76±6.50°vs.28.45±6.63°,TLK:13.86±6.65°vs.14.42±6.7°,LL:20.58±9.71°vs.20.73±10.27°,and SVA:5.12±2.42 cm vs.5.03±2.29 cm,all P>0.05,respectively).Conclusions:The modified posterior wedge osteotomy is an accepted surgical procedure for treating thoracolumbar kyphosis with ALs in AS and results in satisfactory local kyphosis correction,solid fusion,and good clinical outcomes.展开更多
Pott’s spine,commonly known as spinal tuberculosis(TB),is an extrapulmonary form of TB caused by Mycobacterium TB.Pott’s paraplegia occurs when the spine is involved.Spinal TB is usually caused by the hematogenous s...Pott’s spine,commonly known as spinal tuberculosis(TB),is an extrapulmonary form of TB caused by Mycobacterium TB.Pott’s paraplegia occurs when the spine is involved.Spinal TB is usually caused by the hematogenous spread of infection from a central focus,which can be in the lungs or another location.Spinal TB is distinguished by intervertebral disc involvement caused by the same segmental arterial supply,which can result in severe morbidity even after years of approved therapy.Neurological impairments and spine deformities are caused by progressive damage to the anterior vertebral body.The clinical,radiographic,microbiological,and histological data are used to make the diagnosis of spinal TB.In Pott’s spine,combination multidrug antitubercular therapy is the basis of treatment.The recent appearance of multidrug-resistant/extremely drug-resistant TB and the growth of human immunodeficiency virus infection have presented significant challenges in the battle against TB infection.Patients who come with significant kyphosis or neurological impairments are the only ones who require surgical care.Debride-ment,fusion stabilization,and correction of spinal deformity are the cornerstones of surgical treatment.Clinical results for the treatment of spinal TB are generally quite good with adequate and prompt care.展开更多
AIM To find accompanying anomalies of typical and atypical Scheuermann's disease(SD) is reported in the present study. METHODS Study included 20 patients(16 men and 4 women) who had radiological imaging radiograph...AIM To find accompanying anomalies of typical and atypical Scheuermann's disease(SD) is reported in the present study. METHODS Study included 20 patients(16 men and 4 women) who had radiological imaging radiography, magnetic resonance imaging(MRI) and computed tomography, if available, due to back pain, curved back and low back pain in November 2011-February 2016 period. Patients were categorized into typical and atypical patterns based on the region involved. Thoracic kyphosis values were measured using real Cobb angle. Accompanying disc degeneration, herniations and spinal cord pathologies were studied using MRI.RESULTS Age of the patients ranged from 11.0 to 23.0(mean 17.2 ± 3.0). Typical pattern of SD were detected in 15 patients while atypical pattern were detected in 5 patients. Cobb angle range was 40.2-67.2(mean 55.5 ± 8.7) in typical Scheuermann's patients and 24.7-49.9(mean 36.7 ± 10.8) in atypical ones. Intervertebral level was affected and had the measures of 3-8(mean 5.3 ± 1.6) and 7-9(mean 8.2 ± 0.8) in typical and atypical Scheuermann's patients, respectively. Level of degenerative disc disease in MRI was 1-7 discs(mean 4.1 ± 1.7) in typical patients and 5-10 discs(mean 7.6 ± 1.9) in atypical patients.CONCLUSION SD can be seen in typical and atypical patterns, typical being more frequent. Because degenerative disc diseases,herniations and cord pathologies such as syringomyelia can accompany SD(albeit more common in atypical pattern), it is necessary to evaluate these patients with plain radiography and MRI together.展开更多
AIM:To analyzed whether laparoscopy-assisted percutaneous endoscopic gastrostomy(PEG)could be a valuable option for patients with complicated anatomy.METHODS:A retrospective analysis of twelve patients(seven females,f...AIM:To analyzed whether laparoscopy-assisted percutaneous endoscopic gastrostomy(PEG)could be a valuable option for patients with complicated anatomy.METHODS:A retrospective analysis of twelve patients(seven females,five males;six children,six young adults;mean age 19.2 years)with cerebral palsy,spastic quadriparesis,severe kyphoscoliosis and interposed organs and who required enteral nutrition(EN)due to starvation was performed.For all patients,standard PEG placement was impossible due to distorted anatomy.All the patients qualified for the laparoscopyassisted PEG procedure.RESULTS:In all twelve patients,the laparoscopy-assisted PEG was successful,and EN was introduced four to six hours after the PEG placement.There were no complications in the perioperative period,either technical or metabolic.All the patients were discharged from the hospital and were then effectively fed using bolus methods.CONCLUSION:Laparoscopy-assisted PEG should become the method of choice for gastrostomy tube placement and subsequent EN if PEG placement cannot be performed safely.展开更多
Laparoscopic cholecystectomy is a standard operation for benign gallbladder disease. As experience with laparoscopic cholecystectomy has increased, the procedure has become possible in patients with anesthetic problem...Laparoscopic cholecystectomy is a standard operation for benign gallbladder disease. As experience with laparoscopic cholecystectomy has increased, the procedure has become possible in patients with anesthetic problems. Patients with ankylosing spondylitis or severe kyphosis represent a challenging group to anesthesiologists and laparoscopic surgeons since these diseases are associated with difficult intubation, restrictive ventilatory defects, and cardiac problems. The relatively new approach of awake fiberoptic intubation is considered to be the safest option for patients with anticipated airway difficulties. Laparoscopic cholecystectomy is usually performed under general anesthesia but considerable difficulties in anesthetic management are encountered during laparoscopic surgery; for example, hemodynamic instability may develop in patients with cardiopulmonary dysfunction due to pneumoperitoneum and position changes during the operation. Nonetheless, regional anesthesia can be considered as a valid option for patients with gallbladder disease who are poor candidates for general anesthesia due to cardiopulmonary problems. We report three cases of laparoscopic cholecystectomy successfully performed in patients with anesthetic problems that included cardiopulmonary disease, severe kyphosis, and ankylosing spondylitis.展开更多
This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture(OVCF),who received b...This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture(OVCF),who received balloon kyphoplasty.Patients were divided into four groups:Group 1 had no superior endplate fracture,Group 2 had fractures on the anterior portion of the superior endplate,Group 3 had fractures on the posterior portion of the superior endplate,and Group 4 had complete superior endplate fractures.Anterior and middle vertebral body height,vertebral compression ratio,vertebral height loss rate,and kyphosis Cobb angle of each patient were measured and visual analogue scale(VAS) and Oswestry disability index(ODI) scores were recorded.The anterior vertebral height and kyphosis deformity of all groups significantly improved after the surgery,whereas substantial anterior vertebral height loss and increased Cobb angle were observed in all patients at the last follow-up.Although the vertebral height loss rate and the Cobb angle in Group 2,3 and 4 were larger compared with Group 1 at the last follow-up,only the vertebral height loss rate in Group 4 and the increase in the Cobb angle in Group 2 and 4 were statistically different from those in Group 1.The VAS and ODI scores in all groups measured after the surgery and at the last follow-up were significantly lower compared with preoperative scores,but there was no significant difference among these groups.Balloon kyphoplasty significantly improved vertebral fracture height and kyphosis.Vertebral height loss and increased kyphotic deformity were observed in OVCF patients with endplate fractures after the surgery.Postoperative aggravation of kyphosis was observed in Group 2.Furthermore,severe vertebral height loss and increased kyphotic deformity were confirmed in Group 4 after the surgery.Our results suggested that postoperative vertebral height loss and aggravation of kyphosis may be associated with biomechanical changes in the vertebral body caused by endplate fracture.Therefore,surgery should not only restore compressed vertebral body height and correct kyphosis,but also correct the deformity of endplate to achieve an effective treatment of OVCF patients with endplate fracture.展开更多
Purpose:This study investigated the effects of obesity on breast size,thoracic spine structure and function,upper torso musculoskeletal pain and physical activity participation in women living independently in the com...Purpose:This study investigated the effects of obesity on breast size,thoracic spine structure and function,upper torso musculoskeletal pain and physical activity participation in women living independently in the community.Methods:A total of 378 women were divided into 3 groups(Not Overweight:body mass index(BMI)=22.5±0.2 kg/m^2(mean±SE);Overweight:BMI=27.4±0.3 kg/m^2;Obese:BMI=35.4±0.3 kg/m^2).Outcome variables of breast volume(mL),thoracic flexion torque(N·m),thoracic kyphosis(degrees),upper torso musculoskeletal pain(score) and time spent in physical activity(min) were calculated and compared among the 3 groups,adjusting for between-group differences in age.Results:There was a significant main effect of BMI on all outcome variables.Participants classified as Obese displayed significantly larger breasts,had greater thoracic flexion torques and reported less time participating in physical activity relative to the participants who were classified as Not Overweight and Overweight.Participants in the Obese group also displayed significantly more thoracic kyphosis and reported significantly more upper torso musculoskeletal pain compared to their counterparts who were classified as Not Overweight.Conclusion:This study is the first to demonstrate that increased obesity levels were associated with compromised kyphosis and loading of the thoracic spine,as well as increased symptoms of upper torso musculoskeletal pain and reduced time spent in physical activity in women living in the community.We recommend further research to determine whether evidence-based interventions designed to reduce the flexion torque generated on the thoracic spine can improve these symptoms of upper torso musculoskeletal pain and the ability of women with obesity to participate in physical activity.展开更多
AIM To describe,using gait analysis,the development of spinal motion in the growing child.METHODS Thirty-six healthy children aged from 3 to 16 years old were included in this study for a gait analysis(9m-walk).Variou...AIM To describe,using gait analysis,the development of spinal motion in the growing child.METHODS Thirty-six healthy children aged from 3 to 16 years old were included in this study for a gait analysis(9m-walk).Various kinematic parameters were recorded and analyzed such as thoracic angle(TA),lumbar angle(LA)and sagittal vertical axis(SVA).The kinetic parameters were the net reaction moments(N.m/kg)at the thoracolumbar and lumbosacral junctions.RESULTS TA and LA curves were not statistically correlated to the age(respectively,P=0.32 and P=0.41).SVA increased significantly with age(P<0.001).Moments in sagittal plane at the lumbosacral junction were statistically correlated to the age(P=0.003),underlining the fact that sagittal mechanical constraints at the lumbosacral junction increase with age.Moments in transversal plane at the thoracolumbar and lumbosacral junctions were statistically correlated to the age(P=0.0002and P=0.0006),revealing that transversal mechanical constraints decrease with age.CONCLUSION The kinetic analysis showed that during growth,a decrease of torsional constraint occurs while an increase of sagittal constraint is observed.These changes in spine biomechanics are related to the crucial role of the trunk for bipedalism acquisition,allowing stabilization despite lower limbs immaturity.With the acquisition of mature gait,the spine will mainly undergo constraints in the sagittal plane.展开更多
In addressing spinal sagittal imbalance through a posterior approach, the surgeon now may choose from among a variety of osteotomy techniques. Posterior column osteotomies such as the facetectomy or Ponte or Smith-Pet...In addressing spinal sagittal imbalance through a posterior approach, the surgeon now may choose from among a variety of osteotomy techniques. Posterior column osteotomies such as the facetectomy or Ponte or Smith-Petersen osteotomy provide the least correction, but can be used at multiple levels with minimal blood loss and a lower operative risk. Pedicle subtraction osteotomies provide nearly 3 times the per-level correction of Ponte/Smith-Petersen osteotomies; however, they carry increased technical demands, longer operative time, and greater blood loss and associated significant morbidity, including neurological injury. The literature focusing on pedicle subtraction osteotomy for fixed sagittal imbalance patients is reviewed. The longterm overall outcomes, surgical tips to reduce the complications and suggestions for their proper application are also provided.展开更多
Background: The relationship between chronic neck and shoulder pain and posture remains controversial. The purpose of this study was to investigate the relationship between chronic neck and shoulder pain and spinal sa...Background: The relationship between chronic neck and shoulder pain and posture remains controversial. The purpose of this study was to investigate the relationship between chronic neck and shoulder pain and spinal sagittal alignment in standing posture in younger generation. Methods: Subjects included 57 females and 32 males (average age, 29.9 ± 5.7 years). All subjects were 20s or 30s. Spinal curvature was assessed using SpinalMouse. The subjects were also divided into a normal group (VAS zero group) and a pain group by VAS results. Statistical analysis was performed by Student’s t-test. Significance was defined as p < 0.05. Results: The normal group and pain group included 29 and 60 subjects, respectively. In terms of location of pain, thirty-one subjects felt neck pain, 50 felt pain above the scapula, and 17 felt pain between the thoracic spine and scapula. Thoracic kyphosis and lumbar lordosis in the pain group were significantly higher than those in the normal group (p = 0.013 and p = 0.020, respectively). Thoracic kyphosis in subjects with neck pain or pain above scapula was significantly higher than that in subjects without pain (p = 0.0075 and p = 0.025, respectively). Lumbar lordosis in subjects with pain above the scapula or interscapula was significantly higher than that in subjects without pain (p = 0.016).展开更多
AIM:To evaluate the use of photogrammetry and identify the mathematical procedures applied when evaluating spinal posture.METHODS:A systematic search using keywords was conducted in the Pub Med,EMBASE,Scopus,Science a...AIM:To evaluate the use of photogrammetry and identify the mathematical procedures applied when evaluating spinal posture.METHODS:A systematic search using keywords was conducted in the Pub Med,EMBASE,Scopus,Science and Medicine®databases.The following inclusion criteria adopted were:(1)the use of photogrammetry as a method to evaluate spinal posture;(2)evaluations of spinal curvature in the sagittal and/or frontal plane;(3)studies published within the last three decades;and(4)written entirely in English.The exclusion criteria were:(1)studies which objective involved the verification of some aspect of validation of instruments;(2)studies published as abstracts and those published in scientific events;and(3)studies using evaluation of the anteriorization of the head to determine the angular positioning of the cervical spine.The articles in this review were included and evaluated for their methodological quality,based on the Downs and Black scale,by two independent reviewers.RESULTS:Initially,1758 articles were found,76 of which were included upon reading the full texts and 29 were included in accordance with the predetermined criteria.In addition,after analyzing the references in those articles,a further six articles were selected,so that 35 articles were included in this review.This systematic review revealed that the photogrammetry has been using in observational studies.Furthermore,it was also found that,although the data collection methodologies are similar across the studies,in relation to aspects of data analysis,the methodologies are very different,especially regarding the mathematical routines employed to support different postural evaluation software.CONCLUSION:With photogrammetry,the aim of the assessment,whether it is for clinical,research or collective health purposes,must be considered when choosing which protocol to use to evaluate spinal posture.展开更多
Objective:To describe the occurrence of various spinal deformations in a captive-bred wild line of Poecilia wingei(P.wingei).Methods:Fish belonging to a wild line of P.wingei caught from Laguna de Los Patos,Venezuela,...Objective:To describe the occurrence of various spinal deformations in a captive-bred wild line of Poecilia wingei(P.wingei).Methods:Fish belonging to a wild line of P.wingei caught from Laguna de Los Patos,Venezuela,were bred in an aquarium home-breeding system during a period of three years(2006-2009).The spinal curvature was observed to study spinal deformities in P.wingei.Results:Out of a total of 600 fish,22 showed different types of deformities(scoliosis,lordosis,kyphosis),with a higher incidence in females.Growth,swimming and breeding of deformed fish were generally normal.Conclusions:Possible causes for spinal curvature in fish are discussed on the basis of the current literature.While it is not possible to determine the exact cause(s)of spinal deformities observed in the present study,traumatic injuries,nutritional imbalances,genetic defects or a combination of these factors can be supposed to be involved in the pathogenesis of such lesions.展开更多
BACKGROUND The correction surgery for severely multidimensional spinal deformity in neurofibromatosis type I is very difficult and it is still a very big challenge for spine surgeons.CASE SUMMARY A 44-year-old woman p...BACKGROUND The correction surgery for severely multidimensional spinal deformity in neurofibromatosis type I is very difficult and it is still a very big challenge for spine surgeons.CASE SUMMARY A 44-year-old woman presented with progressive kyphosis for more than 10 years and low back pain for 2 years.She had been diagnosed with neurofibromatosis at a local hospital many years ago.Conservative treatments had been applied,but the symptoms got worse rather than alleviated.Therefore,surgery was required.CONCLUSION For this patient with severe deformity,the correction treatment of Ponte osteotomy followed by satellite rod technique in the region of the apical vertebra and the technique of pedicle screws and dual iliac screws had been applied,and successful clinical outcomes were achieved.展开更多
Background: In order to detect possible abnormalities of the spine posture of an individual patient, it is mandatory to dispose of adequate reference values based on measurements in a normal, symptom-free population. ...Background: In order to detect possible abnormalities of the spine posture of an individual patient, it is mandatory to dispose of adequate reference values based on measurements in a normal, symptom-free population. The Diers formetric?system allows for non-invasive and accurate assessment of the vertebral column based on the registration of external aspect of the back surface using the Moiré principle. Objective: To create a qualitative spine profile based on the percentile ranking of measurements obtained by the Diers formetric system taking into account possible confounding factors. Materials and Methods: Statistical analysis of formetric recordings in 216 symptom-free volunteers. Results: Maximal kyphotic angle, maximal scoliotic angle, sagittal imbalance, flèche cervicale, and pelvic inclination are significantly influenced by gender and by body mass index (BMI). A synoptic chart was created presenting the percentile ranking taking into account gender and BMI. The percentile ranking was summarized in both a table with colour code and depicted in a histogram of the individual’s Qualitative Spine Profile (QSP). Clinical Significance: Percentile ranking and the Quantitative Spine Profile taking into account gender and BMI should permit a more precise and reliable assessment of possible posture deviations related to the patient’s complaints, and may assist the therapist in selecting the best mode of treatment.展开更多
Mutation of the MAPK7 gene was related to human scoliosis.Mapk7 regulated the development of limb bones and skulls in mice.However,the role of MAPK7 in vertebral development is still unclear.In this study,we construct...Mutation of the MAPK7 gene was related to human scoliosis.Mapk7 regulated the development of limb bones and skulls in mice.However,the role of MAPK7 in vertebral development is still unclear.In this study,we constructed Col2a1-cre;Mapk7 f/f transgenic mouse model to delete Mapk7 in cartilage,which displayed kyphosis and osteopenia.Mechanistically,Mapk7 loss decreased MEF2C expression and thus activated PTEN to oppose PI3K/AKT signaling in vertebral growth plate chondrocytes,which impaired chondrocyte hypertrophy and attenuated vertebral ossification.In vivo,systemic pharmacological activation of AKT rescued impaired chondrocyte hypertrophy and alleviated mouse vertebral defects caused by Mapk7 deficiency.Our study firstly clarified the mechanism by which MAPK7 was involved in vertebral development,which might contribute to understanding the pathology of spinal deformity and provide a basis for the treatment of developmental disorders of the spine.展开更多
文摘Congenital pure kyphosis due to failure of vertebral body segmentation is a relatively rare entity, and surgical intervention is infrequent compared to that for failure of vertebral body formation [1] [2]. There are very few reports of long-term follow-up of surgical treatment in patients with congenital pure kyphosis, and all the reported cases were diagnosed as failure of formation and had an age at the time of surgery of less than 18 years. It is important for orthopedic surgeons to follow the postoperative course of rare cases over 30 years. Here, we present a surgically treated case with ultra-long term follow-up of a 50-year-old patient with congenital pure kyphosis of the lumbar spine. Imaging of the lumbar spine showed six vertebrae and an unsegmented bar at L3-4 causing a pure kyphosis of 54°. The wedge-shaped block vertebra had 4 pedicles with the neural foramen between the pedicles without concomitant disc space, with compensatory thoracic hypokyphosis and lower lumbar hyperlordosis. One-stage correction and fusion surgery using anterior opening and posterior closing osteotomy was successfully performed. Both clinical and radiographic results were excellent and have been maintained for over 30 years postoperatively. The basic principle in the surgical treatment of adult spinal deformity is to achieve and maintain a good global sagittal balance over time. This case reaffirms the importance of spinopelvic harmony.
文摘Surgical treatment for cervical kyphotic deformity is still controversial. Circumferential approach has been well described in the literature but long terms outcomes are not well reported. Important to decide the correct treatment option is the preoperative radiological exams to value the type of deformity(flexible or fixed). We report the case of a 67-year-old woman affected by a severe cervical kyphotic deformity who underwent combined anterior/posterior surgical approach, getting a good reduction of the deformity and an optimal stability in a long term follow up.
文摘BACKGROUND Spinal deformities in Ehlers-Danlos syndrome(EDS; type VI) are generally progressive and severe. Surgical treatment has been described for kyphoscoliosis in the thoracolumbar spine. However, there are few studies describing the consequences of an anterior approach in cervical kyphosis. An anterior approach may not be able to fully decompress the spinal canal and restore the normal curvature of the cervical spine. Therefore, the anterior approach for cervical kyphosis in young children is hard. We describe the first case in an EDS girl with cervical kyphosis who received satisfactory anterior cervical corpectomy decompression and fusion.CASE SUMMARY The chief complaints of a 16-year-old girl with EDS were double upper limb weakness for 7 years and double lower limb walking instability for 2 years.Moreover, the imaging results revealed that the degree of kyphosis from cervical vertebra 2 to 4 accompanying with spinal cord compression was 30°. An anterior cervical corpectomy involving cervical vertebra 3 and a titanium mesh implant were performed with internal fixation. The results at 3 mo after surgery demonstrated that the anterior fusion was solid, and the kyphosis of the cervical spine was corrected. Additionally, the power of all four extremities was significantly improved.CONCLUSION The incidence rate of cervical kyphosis in EDS is rare. The surgical treatment for these patients, especially an anterior approach, is challenging. Therefore, to develop safer and more effective strategies to treat cervical kyphosis in EDS,there is still much work to do.
文摘Introduction: This study is designed to explore the biomechanical principles of posterior bilateral pedicle screw on steps progressively and tight closure on every step for severe angular kyphosis and the indication conditions and clinical pathways of above new technique. Materials and Methods: A total of 90 patients have severe angular kyphosis, 37 males and 53 females, with an average age of 47 years. All patients were treated with posterior bilateral pedicle screw and step tight closure for gradual shortening and orthopedic technology. Results: Average intraoperative blood loss was 2089 ml. Average operation time was 326 minutes. Kyphotic angle changed from 90.1° averagely preoperatively to 41.6° averagely postoperatively with an improvement rate of 65%. The distance from C<sub>7</sub> plumb line to posterior upper edge of the S<sub>1</sub> vertebral body was averagely 5.2 mm postoperatively, with a correction rate of 73%. Neurological complications occurred in 2 cases, accounting for 6%. Non-neurological complications occurred in 2 cases, accounting for 6%. Anatomical parameters were significantly improved postoperatively (P < 0.05). All patients were averagely followed up for 28 months. Segments undergoing osteotomy achieved bone fusion, without loss of orthopedic angle. Conclusions: The orthopedic technology of bilateral pedicle screw and step tight closure designed by human physiology and biomechanical principles can protect spinal cord cells from injury to the utmost. To choose an appropriate osteotomy plane during pre-surgical planning can make the repair results closer to the normal function of the spine. Intraoperative nerve root protection, full release and bone graft fusion are effective safeguards to ensure kyphosis correction and to avoid spine lateral offset.
文摘Objective:To analyze the effect of posterior V-osteotomy in the treatment of traumatic kyphosis.Methods:From August 2018 to August 2020,40 patients with kyphosis were randomly divided into observation group and control group.Results:The postoperative Cobb angle of the observation group was(8.29±1.24)°better than that of the control group(15.68±2.73)°,P<0.05;The preoperative Cobb angle of the observation group was(49.78±4.15)°compared with that of the control group(50.11±4.23)°,P>0.05;The incidence of postoperative complications and recurrence rate in the observation group were 5.00%and 5.00%respectively,which were lower than 25.00%and 30.00%in the control group(P<0.05).Conclusion:Posterior V-osteotomy for traumatic kyphosis can improve Cobb angle,reduce the risk of postoperative complications and recurrence,which is safe and feasible.
文摘Background:Andersson lesions(ALs),also known as spondylodiscities,destructive vertebral lesions and spinal pseudarthrosis,usually occur in patients with ankylosing spondylitis(AS).Inflammatory and traumatic causes have been proposed to define this lesion.Different surgical approaches including anterior,posterior,and combined anterior and posterior procedure have been used to address the complications,consisting of mechanical pain,kyphotic deformity,and neurologic deficits.However,the preferred surgical procedure remains controversial.The aim of this study was to illustrate the safety,efficacy,and feasibility of a modified posterior wedge osteotomy for the ALs with kyphotic deformity in AS.Methods:From June 2008 to January 2013,23 patients(18 males,5 females)at an average age of 44.8 years(range 25–69 years)were surgically treated for thoracolumbar kyphosis with ALs in AS via a modified posterior wedge osteotomy in our department.All sagittal balance parameters were assessed by standing lateral radiography of the whole spine before surgery and during the followup period.Assessment of radiologic fusion at follow-up was based on the Bridwell interbody fusion grading system.Ankylosing spondylitis quality of life(ASQoL)and visual analog scale(VAS)scores were performed to evaluate improvements in daily life function and back pain pre-operatively and post-operatively.Paired t tests were used to compare clinical data change in parametric values before and after surgery and the Mann-Whitney U test was employed for non-parametric comparisons.The radiographic data change was evaluated by repeated measure analysis of variance.Results:The mean operative duration was 205.4 min(range 115–375 min),with an average blood loss of 488.5 mL(range 215–880 mL).Radiographical and clinical outcomes were assessed after a mean of 61.4 months of follow-up.The VAS back pain and ASQoL scores improved significantly in all patients(7.52±1.31 vs.1.70±0.70,t=18.30,P<0.001;13.87±1.89 vs.7.22±1.24,t=18.53,P<0.001,respectively).The thoracolumbar kyphosis(TLK)changed from 40.03±17.61°pre-operatively to 13.86±6.65°post-operatively,and 28.45±6.63°at final follow-up(F=57.54,P<0.001),the thoracic kyphosis(TK)changed from 52.30±17.62°pre-operatively to 27.76±6.50°post-operatively,and 28.45±6.63°at final follow-up(F=57.29,P<0.001),and lumbar lordosis(LL)changed from29.56±9.73°pre-operatively to20.58±9.71°post-operatively,and20.73±10.27°at final follow-up(F=42.50,P<0.001).Mean sagittal vertical axis(SVA)was improved from 11.82±4.55 cm pre-operatively to 5.12±2.42 cm post-operatively,and 5.03±2.29 cm at final follow-up(F=79.36,P<0.001).No obvious loss of correction occurred,according to the lack of significant differences in the sagittal balance parameters between post-operatively and the final follow-up in all patients(TK:27.76±6.50°vs.28.45±6.63°,TLK:13.86±6.65°vs.14.42±6.7°,LL:20.58±9.71°vs.20.73±10.27°,and SVA:5.12±2.42 cm vs.5.03±2.29 cm,all P>0.05,respectively).Conclusions:The modified posterior wedge osteotomy is an accepted surgical procedure for treating thoracolumbar kyphosis with ALs in AS and results in satisfactory local kyphosis correction,solid fusion,and good clinical outcomes.
文摘Pott’s spine,commonly known as spinal tuberculosis(TB),is an extrapulmonary form of TB caused by Mycobacterium TB.Pott’s paraplegia occurs when the spine is involved.Spinal TB is usually caused by the hematogenous spread of infection from a central focus,which can be in the lungs or another location.Spinal TB is distinguished by intervertebral disc involvement caused by the same segmental arterial supply,which can result in severe morbidity even after years of approved therapy.Neurological impairments and spine deformities are caused by progressive damage to the anterior vertebral body.The clinical,radiographic,microbiological,and histological data are used to make the diagnosis of spinal TB.In Pott’s spine,combination multidrug antitubercular therapy is the basis of treatment.The recent appearance of multidrug-resistant/extremely drug-resistant TB and the growth of human immunodeficiency virus infection have presented significant challenges in the battle against TB infection.Patients who come with significant kyphosis or neurological impairments are the only ones who require surgical care.Debride-ment,fusion stabilization,and correction of spinal deformity are the cornerstones of surgical treatment.Clinical results for the treatment of spinal TB are generally quite good with adequate and prompt care.
文摘AIM To find accompanying anomalies of typical and atypical Scheuermann's disease(SD) is reported in the present study. METHODS Study included 20 patients(16 men and 4 women) who had radiological imaging radiography, magnetic resonance imaging(MRI) and computed tomography, if available, due to back pain, curved back and low back pain in November 2011-February 2016 period. Patients were categorized into typical and atypical patterns based on the region involved. Thoracic kyphosis values were measured using real Cobb angle. Accompanying disc degeneration, herniations and spinal cord pathologies were studied using MRI.RESULTS Age of the patients ranged from 11.0 to 23.0(mean 17.2 ± 3.0). Typical pattern of SD were detected in 15 patients while atypical pattern were detected in 5 patients. Cobb angle range was 40.2-67.2(mean 55.5 ± 8.7) in typical Scheuermann's patients and 24.7-49.9(mean 36.7 ± 10.8) in atypical ones. Intervertebral level was affected and had the measures of 3-8(mean 5.3 ± 1.6) and 7-9(mean 8.2 ± 0.8) in typical and atypical Scheuermann's patients, respectively. Level of degenerative disc disease in MRI was 1-7 discs(mean 4.1 ± 1.7) in typical patients and 5-10 discs(mean 7.6 ± 1.9) in atypical patients.CONCLUSION SD can be seen in typical and atypical patterns, typical being more frequent. Because degenerative disc diseases,herniations and cord pathologies such as syringomyelia can accompany SD(albeit more common in atypical pattern), it is necessary to evaluate these patients with plain radiography and MRI together.
文摘AIM:To analyzed whether laparoscopy-assisted percutaneous endoscopic gastrostomy(PEG)could be a valuable option for patients with complicated anatomy.METHODS:A retrospective analysis of twelve patients(seven females,five males;six children,six young adults;mean age 19.2 years)with cerebral palsy,spastic quadriparesis,severe kyphoscoliosis and interposed organs and who required enteral nutrition(EN)due to starvation was performed.For all patients,standard PEG placement was impossible due to distorted anatomy.All the patients qualified for the laparoscopyassisted PEG procedure.RESULTS:In all twelve patients,the laparoscopy-assisted PEG was successful,and EN was introduced four to six hours after the PEG placement.There were no complications in the perioperative period,either technical or metabolic.All the patients were discharged from the hospital and were then effectively fed using bolus methods.CONCLUSION:Laparoscopy-assisted PEG should become the method of choice for gastrostomy tube placement and subsequent EN if PEG placement cannot be performed safely.
基金Supported by A grant from Kyung Hee University in 2010,KHU-20100653
文摘Laparoscopic cholecystectomy is a standard operation for benign gallbladder disease. As experience with laparoscopic cholecystectomy has increased, the procedure has become possible in patients with anesthetic problems. Patients with ankylosing spondylitis or severe kyphosis represent a challenging group to anesthesiologists and laparoscopic surgeons since these diseases are associated with difficult intubation, restrictive ventilatory defects, and cardiac problems. The relatively new approach of awake fiberoptic intubation is considered to be the safest option for patients with anticipated airway difficulties. Laparoscopic cholecystectomy is usually performed under general anesthesia but considerable difficulties in anesthetic management are encountered during laparoscopic surgery; for example, hemodynamic instability may develop in patients with cardiopulmonary dysfunction due to pneumoperitoneum and position changes during the operation. Nonetheless, regional anesthesia can be considered as a valid option for patients with gallbladder disease who are poor candidates for general anesthesia due to cardiopulmonary problems. We report three cases of laparoscopic cholecystectomy successfully performed in patients with anesthetic problems that included cardiopulmonary disease, severe kyphosis, and ankylosing spondylitis.
基金supported by National Natural and Science Foundation(81271988)Jiangsu Natural and Science Foundation (BK2012876)
文摘This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture(OVCF),who received balloon kyphoplasty.Patients were divided into four groups:Group 1 had no superior endplate fracture,Group 2 had fractures on the anterior portion of the superior endplate,Group 3 had fractures on the posterior portion of the superior endplate,and Group 4 had complete superior endplate fractures.Anterior and middle vertebral body height,vertebral compression ratio,vertebral height loss rate,and kyphosis Cobb angle of each patient were measured and visual analogue scale(VAS) and Oswestry disability index(ODI) scores were recorded.The anterior vertebral height and kyphosis deformity of all groups significantly improved after the surgery,whereas substantial anterior vertebral height loss and increased Cobb angle were observed in all patients at the last follow-up.Although the vertebral height loss rate and the Cobb angle in Group 2,3 and 4 were larger compared with Group 1 at the last follow-up,only the vertebral height loss rate in Group 4 and the increase in the Cobb angle in Group 2 and 4 were statistically different from those in Group 1.The VAS and ODI scores in all groups measured after the surgery and at the last follow-up were significantly lower compared with preoperative scores,but there was no significant difference among these groups.Balloon kyphoplasty significantly improved vertebral fracture height and kyphosis.Vertebral height loss and increased kyphotic deformity were observed in OVCF patients with endplate fractures after the surgery.Postoperative aggravation of kyphosis was observed in Group 2.Furthermore,severe vertebral height loss and increased kyphotic deformity were confirmed in Group 4 after the surgery.Our results suggested that postoperative vertebral height loss and aggravation of kyphosis may be associated with biomechanical changes in the vertebral body caused by endplate fracture.Therefore,surgery should not only restore compressed vertebral body height and correct kyphosis,but also correct the deformity of endplate to achieve an effective treatment of OVCF patients with endplate fracture.
基金support of the Australian Government Research Training Program Scholarshipthe Sports Medicine Australia Research Foundation,which providcd partial funding towards this study。
文摘Purpose:This study investigated the effects of obesity on breast size,thoracic spine structure and function,upper torso musculoskeletal pain and physical activity participation in women living independently in the community.Methods:A total of 378 women were divided into 3 groups(Not Overweight:body mass index(BMI)=22.5±0.2 kg/m^2(mean±SE);Overweight:BMI=27.4±0.3 kg/m^2;Obese:BMI=35.4±0.3 kg/m^2).Outcome variables of breast volume(mL),thoracic flexion torque(N·m),thoracic kyphosis(degrees),upper torso musculoskeletal pain(score) and time spent in physical activity(min) were calculated and compared among the 3 groups,adjusting for between-group differences in age.Results:There was a significant main effect of BMI on all outcome variables.Participants classified as Obese displayed significantly larger breasts,had greater thoracic flexion torques and reported less time participating in physical activity relative to the participants who were classified as Not Overweight and Overweight.Participants in the Obese group also displayed significantly more thoracic kyphosis and reported significantly more upper torso musculoskeletal pain compared to their counterparts who were classified as Not Overweight.Conclusion:This study is the first to demonstrate that increased obesity levels were associated with compromised kyphosis and loading of the thoracic spine,as well as increased symptoms of upper torso musculoskeletal pain and reduced time spent in physical activity in women living in the community.We recommend further research to determine whether evidence-based interventions designed to reduce the flexion torque generated on the thoracic spine can improve these symptoms of upper torso musculoskeletal pain and the ability of women with obesity to participate in physical activity.
文摘AIM To describe,using gait analysis,the development of spinal motion in the growing child.METHODS Thirty-six healthy children aged from 3 to 16 years old were included in this study for a gait analysis(9m-walk).Various kinematic parameters were recorded and analyzed such as thoracic angle(TA),lumbar angle(LA)and sagittal vertical axis(SVA).The kinetic parameters were the net reaction moments(N.m/kg)at the thoracolumbar and lumbosacral junctions.RESULTS TA and LA curves were not statistically correlated to the age(respectively,P=0.32 and P=0.41).SVA increased significantly with age(P<0.001).Moments in sagittal plane at the lumbosacral junction were statistically correlated to the age(P=0.003),underlining the fact that sagittal mechanical constraints at the lumbosacral junction increase with age.Moments in transversal plane at the thoracolumbar and lumbosacral junctions were statistically correlated to the age(P=0.0002and P=0.0006),revealing that transversal mechanical constraints decrease with age.CONCLUSION The kinetic analysis showed that during growth,a decrease of torsional constraint occurs while an increase of sagittal constraint is observed.These changes in spine biomechanics are related to the crucial role of the trunk for bipedalism acquisition,allowing stabilization despite lower limbs immaturity.With the acquisition of mature gait,the spine will mainly undergo constraints in the sagittal plane.
文摘In addressing spinal sagittal imbalance through a posterior approach, the surgeon now may choose from among a variety of osteotomy techniques. Posterior column osteotomies such as the facetectomy or Ponte or Smith-Petersen osteotomy provide the least correction, but can be used at multiple levels with minimal blood loss and a lower operative risk. Pedicle subtraction osteotomies provide nearly 3 times the per-level correction of Ponte/Smith-Petersen osteotomies; however, they carry increased technical demands, longer operative time, and greater blood loss and associated significant morbidity, including neurological injury. The literature focusing on pedicle subtraction osteotomy for fixed sagittal imbalance patients is reviewed. The longterm overall outcomes, surgical tips to reduce the complications and suggestions for their proper application are also provided.
文摘Background: The relationship between chronic neck and shoulder pain and posture remains controversial. The purpose of this study was to investigate the relationship between chronic neck and shoulder pain and spinal sagittal alignment in standing posture in younger generation. Methods: Subjects included 57 females and 32 males (average age, 29.9 ± 5.7 years). All subjects were 20s or 30s. Spinal curvature was assessed using SpinalMouse. The subjects were also divided into a normal group (VAS zero group) and a pain group by VAS results. Statistical analysis was performed by Student’s t-test. Significance was defined as p < 0.05. Results: The normal group and pain group included 29 and 60 subjects, respectively. In terms of location of pain, thirty-one subjects felt neck pain, 50 felt pain above the scapula, and 17 felt pain between the thoracic spine and scapula. Thoracic kyphosis and lumbar lordosis in the pain group were significantly higher than those in the normal group (p = 0.013 and p = 0.020, respectively). Thoracic kyphosis in subjects with neck pain or pain above scapula was significantly higher than that in subjects without pain (p = 0.0075 and p = 0.025, respectively). Lumbar lordosis in subjects with pain above the scapula or interscapula was significantly higher than that in subjects without pain (p = 0.016).
文摘AIM:To evaluate the use of photogrammetry and identify the mathematical procedures applied when evaluating spinal posture.METHODS:A systematic search using keywords was conducted in the Pub Med,EMBASE,Scopus,Science and Medicine®databases.The following inclusion criteria adopted were:(1)the use of photogrammetry as a method to evaluate spinal posture;(2)evaluations of spinal curvature in the sagittal and/or frontal plane;(3)studies published within the last three decades;and(4)written entirely in English.The exclusion criteria were:(1)studies which objective involved the verification of some aspect of validation of instruments;(2)studies published as abstracts and those published in scientific events;and(3)studies using evaluation of the anteriorization of the head to determine the angular positioning of the cervical spine.The articles in this review were included and evaluated for their methodological quality,based on the Downs and Black scale,by two independent reviewers.RESULTS:Initially,1758 articles were found,76 of which were included upon reading the full texts and 29 were included in accordance with the predetermined criteria.In addition,after analyzing the references in those articles,a further six articles were selected,so that 35 articles were included in this review.This systematic review revealed that the photogrammetry has been using in observational studies.Furthermore,it was also found that,although the data collection methodologies are similar across the studies,in relation to aspects of data analysis,the methodologies are very different,especially regarding the mathematical routines employed to support different postural evaluation software.CONCLUSION:With photogrammetry,the aim of the assessment,whether it is for clinical,research or collective health purposes,must be considered when choosing which protocol to use to evaluate spinal posture.
基金Supported by a grant from University of Teramo(Research Projects 60%/2009)
文摘Objective:To describe the occurrence of various spinal deformations in a captive-bred wild line of Poecilia wingei(P.wingei).Methods:Fish belonging to a wild line of P.wingei caught from Laguna de Los Patos,Venezuela,were bred in an aquarium home-breeding system during a period of three years(2006-2009).The spinal curvature was observed to study spinal deformities in P.wingei.Results:Out of a total of 600 fish,22 showed different types of deformities(scoliosis,lordosis,kyphosis),with a higher incidence in females.Growth,swimming and breeding of deformed fish were generally normal.Conclusions:Possible causes for spinal curvature in fish are discussed on the basis of the current literature.While it is not possible to determine the exact cause(s)of spinal deformities observed in the present study,traumatic injuries,nutritional imbalances,genetic defects or a combination of these factors can be supposed to be involved in the pathogenesis of such lesions.
基金The National Natural Science Foundation of China,No.U1613224the Shenzhen Double Chain Project for Innovation and Development Industry,No.201806081018272960.
文摘BACKGROUND The correction surgery for severely multidimensional spinal deformity in neurofibromatosis type I is very difficult and it is still a very big challenge for spine surgeons.CASE SUMMARY A 44-year-old woman presented with progressive kyphosis for more than 10 years and low back pain for 2 years.She had been diagnosed with neurofibromatosis at a local hospital many years ago.Conservative treatments had been applied,but the symptoms got worse rather than alleviated.Therefore,surgery was required.CONCLUSION For this patient with severe deformity,the correction treatment of Ponte osteotomy followed by satellite rod technique in the region of the apical vertebra and the technique of pedicle screws and dual iliac screws had been applied,and successful clinical outcomes were achieved.
文摘Background: In order to detect possible abnormalities of the spine posture of an individual patient, it is mandatory to dispose of adequate reference values based on measurements in a normal, symptom-free population. The Diers formetric?system allows for non-invasive and accurate assessment of the vertebral column based on the registration of external aspect of the back surface using the Moiré principle. Objective: To create a qualitative spine profile based on the percentile ranking of measurements obtained by the Diers formetric system taking into account possible confounding factors. Materials and Methods: Statistical analysis of formetric recordings in 216 symptom-free volunteers. Results: Maximal kyphotic angle, maximal scoliotic angle, sagittal imbalance, flèche cervicale, and pelvic inclination are significantly influenced by gender and by body mass index (BMI). A synoptic chart was created presenting the percentile ranking taking into account gender and BMI. The percentile ranking was summarized in both a table with colour code and depicted in a histogram of the individual’s Qualitative Spine Profile (QSP). Clinical Significance: Percentile ranking and the Quantitative Spine Profile taking into account gender and BMI should permit a more precise and reliable assessment of possible posture deviations related to the patient’s complaints, and may assist the therapist in selecting the best mode of treatment.
基金supported by the National Natural Science Foundation of China(No.92068105,82172376,82072385).
文摘Mutation of the MAPK7 gene was related to human scoliosis.Mapk7 regulated the development of limb bones and skulls in mice.However,the role of MAPK7 in vertebral development is still unclear.In this study,we constructed Col2a1-cre;Mapk7 f/f transgenic mouse model to delete Mapk7 in cartilage,which displayed kyphosis and osteopenia.Mechanistically,Mapk7 loss decreased MEF2C expression and thus activated PTEN to oppose PI3K/AKT signaling in vertebral growth plate chondrocytes,which impaired chondrocyte hypertrophy and attenuated vertebral ossification.In vivo,systemic pharmacological activation of AKT rescued impaired chondrocyte hypertrophy and alleviated mouse vertebral defects caused by Mapk7 deficiency.Our study firstly clarified the mechanism by which MAPK7 was involved in vertebral development,which might contribute to understanding the pathology of spinal deformity and provide a basis for the treatment of developmental disorders of the spine.
