Morphology, Development and Deformation of the Spine in Mild and Moderate Scoliosis: Are Changes in the Spine Primary or Secondary?

Introduction and aim of the study: We aim to determine whether the changes in the spine in scoliogenesis of idiopathic scoliosis (IS), are primary/inherent or secondary. There is limited information on this issue in the literature. We studied the sagittal profile of the spine in IS using surface topography. Material and methods: After approval of the ethics committee of the hospital, we studied 45 children, 4 boys and 41 girls, with an average age of 12.5 years (range 7.5–16.4 years), referred to the scoliosis clinic by our school screening program. These children were divided in two groups: A and B. Group A included 17 children with IS, 15 girls and 2 boys. All of them had a trunk asymmetry, measured with a scoliometer, greater than or equal to 5 degrees. Group B, (control group) included 26 children, 15 girls and 11 boys, with no trunk asymmetry and scoliometer measurement less than 2 degrees. The height and weight of children were measured. The Prujis scoliometer was used in standing Adam test in the thoracic (T), thoraco-lumbar (TL) and lumbar (L) regions. All IS children had an ATR greater than or equal to 5 degrees. The Cobb angle was assessed in the postero-anterior radiographs in Group A. A posterior truncal surface topogram, using the “Formetric 4” apparatus, was also performed and the distance from the vertebra prominence (VP) to the apex of the kyphosis (KA), and similarly to the apex of the lumbar lordosis (LA) was calculated. The ratio of the distances (VP-KA) for (PV-LA) was calculated. The averages of the parameters were studied, and the correlation of the ratio of distances (VP-KA) to (VP-KA) with the scoliometer and Cobb angle measurements were assessed, respectively (Pearson corr. Coeff. r), in both groups and between them. Results: Regarding group A (IS), the average height was 1.55 m (range 1.37, 1.71), weight 47.76 kg (range 33, 65). The IS children had right (Rt) T or TL curves. The mean T Cobb angle was 24 degrees and 26 in L. In the same group, the kyphotic apex (KA (VPDM)) distance was −125.82 mm (range −26, −184) and the lordotic apex (LA (VPDM)) distance was −321.65 mm (range −237, −417). The correlations of the ratio of distances (KA (VPDM))/(LA (VPDM)) with the Major Curve Cobb angle measurement and scoliometer findings were non-statistically significant (Pearson r = 0.077, −0.211, p: 0.768, 0.416, respectively. Similarly, in the control group, KA (VPDM))/(LA (VPDM) was not significantly correlated with scoliometer findings (Pearson r = −0.016, −p: 0.939). Discussion and conclusions: The lateral profile of the spine was commonly considered to be a primary aetiological factor of IS due to the fact that the kyphotic thoracic apex in IS is located in a higher thoracic vertebra (more vertebrae are posteriorly inclined), thus creating conditions of greater rotational instability and therefore greater vulnerability for IS development. Our findings do not confirm this hypothesis, since the correlation of the (VP-KA) to (VP-KA) ratio with the truncal asymmetry, assessed with the scoliometer and Cobb angle measurements, is non-statistically significant, in both groups A and B. In addition, the aforementioned ratio did not differ significantly between the two groups in our sample (0.39 ± 0.11 vs. 0.44 ± 0.08, p: 0.134). It is clear that hypokyphosis is not a primary causal factor for the commencing, mild or moderate scoliotic curve, as published elsewhere. We consider that the small thoracic hypokyphosis in developing scoliosis adds to the view that the reduced kyphosis, facilitating the axial rotation, could be considered as a permissive factor rather than a causal one, in the pathogenesis of IS. This view is consistent with previously published views and it is obviously the result of gravity, growth and muscle tone.

Effect of adjunct thoracoplasty on Adolescent Idiopathic Scoliosis patients’ 3D back contour

The aims of this study were to evaluate the effect of a thoracoplasty procedure in addition to a posterior spinal fusion and instrumentation on an Adolescent Idiopathic Scoliosis (AIS) patient’s 3D back contour as measured by surface topography. We performed a retrospective review to identify patients who were treated with posterior spinal fusion with spinal instrumentation and those who were treated with an additional thoracoplasty procedure. We analyzed changes in surface topography measurements between these two groups using t-test and ANCOVA statistical analyses. Although there were no statistically significant differences in 11 of 12 variables, thoracoplasty-posterior spinal fusion (n=10) group had a mean 6.6 unit reduction in trunk asymmetry while the posterior spinal fusion group (n=26) had a mean 22.8 unit reduction in trunk asymmetry (p-value<0.05). The posterior spinal fusion group and thoracoplasty-posterior spinal fusion group were not shown to have clinically significant differences in 3D back contour correction. An additional thoracoplasty procedure does not provide better correction in the transverse plane and in fact had a smaller degree of trunk asymmetry correction. This supports the current trends of decreasing use of thoracoplasty in AIS patients to address severe rib hump deformities given concerns for decreased post-operative lung function and alternative methods of vertebral body derotation, such as thoracic pedicle screws.

Anisotropic Textile Brace for Adolescent Idiopathic Scoliosis: Immediate in-brace effect and biomechanics

Background Rigid bracing is a universal effective treatment for scoliosis. However, body movement restriction and discomfort usually are its shortcomings. The purpose of this case series study was to investigate the feasibility of novel anisotropic textile braces with an artificial hinge adopting the direct three-point pressure system for the initial spinal correction and its biomechanics. Methods Five scoliotic female patients who were on average 12.2 years old with a BMI of 18.7, Risser grade of 1.6 and Cobb’s angle of 22.3˚ were recruited. The outcome measures are spinal correction, contour asymmetry, and interface pressure distribution of the brace. The correlation between the rate of in-brace correction and variables such as the Cobb’s angle, posterior trunk asymmetry index and interface pressure were studied. Results The initial in-brace rate of spinal correction ranged between 9.7% and 87%. The rate of correction based on posterior trunk asymmetry index ranged between 14.1% and 43.2%. The interface pressure from the brace ranged from 4.1 kPa to 25.6 kPa, which is comparable to that exerted by rigid braces. Based on the data in this study, no correlation was found between the in-brace rate of correction and the Cobb’s angle and the pressure exerted by the pads. Conclusions The main finding is that the anisotropic textile brace offers good initial in-brace correction through the application of the three-point pressure system with textile materials. Nevertheless, further follow-up work is recommended to investigate its long-term efficacy. Trial registration: This study was registered at ClinicalTrials.gov (NCT02271256 – Registration date 22nd October 2014).

Special Investigation of Developmental of Mandibular Asymmetry and Imbalance Body Posture: A Literature Review

BACKGROUND: Previous studies have reported comprehensive visions about the correlation between the development of dentofacial problems and postural disorder. Mostly of dentofacial issues related to mandibular asymmetry, which can lead to erroneous treatment plans that end in frustration for both patient and orthodontist. AIM: This paper aims to describe some evidence bases dentistry of malocclusions with asymmetry in mandibular and trunk. METHODS: We used different electronic databases such as PubMed Health and Google Scholar with specific keywords such as development mandibular asymmetry, trunk asymmetry, and body posture asymmetry. In this preliminary study, the term of imbalance body posture leads to trunk and body posture asymmetry. RESULTS: Most of the studies reported the involvement of temporomandibular disorder in those asymmetries. We assumed the necessity for considering development asymmetry in an examination and should be regarded as a particular investigation procedure in orthodontic treatment. CONCLUSION: However, the limitation in understanding the developmental asymmetries in determining the etiology and risk factor of development mandibular asymmetry and imbalanced body posture require special investigation.

Trunk asymmetry at children aged 10-15 years: relation between amount of asymmetry and risk factors.

Objective: This study focuses on the possible associations between the trunk asymmetry (TA) and different risk factors, such as: Body Mass Index (BMI), place of residence (rural/urban area), the gender of the subjects and the level of the physical activity. Methods: The data for this study was obtained from a cross-sectional survey of school children carried out in 2015 in Cluj-Napoca, Romania. In this study 487 pupils (260 boys and 227 girls) aged 10-15 years were included. The angle of trunk rotation (ATR) was obtained from scoliometer readings. The level of the physical activity was calculated from the Physical Activity Questionnaire for Older Children. The statistical analysis was carried out on the obtained mean values (independent sample t-test, paired-sample t-test, ANOVA), and the relation between variables was analyzed by the Pearson correlation coefficient. Results: In case of subjects from urban area the degree of TA was 2.75º(±2.85º), and in case of those from rural area 2.09º(±2.23º), t= 2.813, p = 0.005. The TA was lower in subjects who live in rural area, in houses: 2.07º(±2.21), than in case of those who live in flats in urban area: 2.86º(±2.94), (p = 0.032 ). The level of physical activity in case of boys is higher than in case of girls (boys 2.82±(0.68), girls 2.62(±0.67)). The Pearson correlation test did not find any correlation between the angle of trunk rotation and the level of physical activity: r= 0.000, p = 0.998. The degree of TA is higher in case of girls, than in case of boys (girls 2.88º(±2.91º), boys 2.19º(±2.38º)), t = - 2.601, p = 0.010. However, we found small correlation between the BMI and the TA in case of boys who have a degree of trunk asymmetry ≥5º: r = - 0.289, p = 0.044. Conclusions: The study revealed the lack of correlation between the TA and BMI, place of residence and the level of physical activity practiced. However, in case of boys we found a small correlation between the BMI and sever asymmetry.