Monday, 30 June 2014

Effects of a 10- Week Exercise Intervention on Thoracic Kyphosis, Pulmonary Function, Endurance, Back Extensor Strength, and Quality of Life in Women with Osteoporosis

Book Description :

An estimated 10 million women in the United States have osteoporosis. Pronounced kyphosis of the thoracic spine is one of the most common clinical manifestations of spinal osteoporosis, with one quarter of all women over the age of 60 developing vertebral deformities as a consequence of spinal osteoporosis. Kyphotic posture can result in mid-back pain, impaired pulmonary function, decreased back extensor strength, diminished aerobic capacity, functional disability, and decreased quality of life in women with osteoporosis. The purpose of this study was to examine the effects of a 10-week home exercise program on thoracic kyphosis, pulmonary function, 6-minute walk distance, back extensor muscle strength, and "quality of life" in women with osteoporosis. Forty-four women with densitometric diagnosis of osteoporosis in the spine and an index of kyphosis ≥ 13 completed the study. Index of kyphosis, forced vital capacity, peak expiratory flow, maximum inspiratory pressure, 6-minute walk test, back extensor strength, and quality of life measurements were performed. Twenty-three participants (experimental group) performed an exercise program comprising of 8 strengthening exercises performed three sessions per week, over a 10-week period. Twenty-one participants served as the control group.

A MANOVA comparing index of kyphosis, peak expiratory flow, forced vital capacity, maximum inspiratory pressure, 6-minute walk test and back extensor strength for pre and post test measurements by exercise and control group, revealed a significant group by time interaction. Univariate tests (ANOVAs) exposed a significant group by time interaction for index of kyphosis and back extensor strength. Subsequent post-hoc tests revealed a significant improvement in index of kyphosis and back extensor strength in the exercise group, but no improvement in the control group. The results of the Wilcoxon Signed Ranks test for Osteoporosis Targeted Quality of Life survey scores, pre- and post-int

Comparison of Pedicle Subtraction and Smith-Petersen Osteotomies in Correcting Thoracic Kyphosis When Closed With a Central Hook-Rod Construct

Retrospective analysis. To demonstrate the effectiveness of hook-rod constructs in closing thoracic osteotomies safely and effectively. of Data. The outcomes of hook-rod instrumentation in osteotomies for the correction of kyphosis at the lumbar region of the spine have been described. Little literature exists on the outcomes at the thoracic level. Methods.

The radiographs and clinical scores of 38 patients who underwent pedicle subtraction osteotomy or Smith-Petersen osteotomy in the thoracic spine with the osteotomies closed using a central rod were retrospectively reviewed. Measurements included osteotomy angle, thoracic kyphosis (T2–T12), and maximum kyphosis.

Perioperative and long-term complications were reviewed. Thirty-eight patients underwent thoracic level osteotomies. There were 8 males and 30 females with a mean age of 51.9 years (range, 18–76 yr) at the time of surgery. The mean construct length was 13.2 levels (4–25). Kyphosis correction was equal in the 2 groups.

In the pedicle subtraction osteotomy group, a mean of 24.7° (4°–47°) correction was obtained through the osteotomies compared with 24.0° (9°–65°) in the Smith-Petersen osteotomy group. Correction per osteotomy was 23.7° (4°–47°) in the pedicle subtraction osteotomy group compared with 11.8° (2.8°–46.0°) in the Smith-Petersen osteotomy group.

No difference in the amount of correction achieved at the different regions of the thoracic spine was observed with either type of osteotomy with central rod closure. Central hook-rod constructs provide a safe and effective means of closing thoracic osteotomies and result in good correction of rigid sagittal plane deformities. Level of Evidence: 4.

Source : Science Index , 29th June 2014

Hyderabad marks Scoliosis Day

Three out of every 1,000 children develop scoliosis which requires immediate medical intervention, experts said at a programme held to mark World Scoliosis Day in the city on Sunday.

In this condition, the spine of a patient is curved from side to side and under scanner, the spine resembles the shape of an 'S' or '?', said doctors. "I myself see around 170 scoliosis patients every year, out of which at least 70 percent require surgical intervention. As far as reasons of scoliosis are concerned, most of the patients face this problem due to congenital curve," said Dr V Surya Prakash Rao, consultant spine surgeon at Kamineni Hospital, King Koti. Due to lack of information or awareness about the condition, most patients fail to seek medical advice, said the doctor.

If Scoliosis goes unreported in such children, the spine would begin to curve and if left untreated, it could invade in the space that is required for lungs and heart, the experts said. If such cases are left neglected the spine tends to curve even further and at this point doctors suggest surgical intervention. 

Source : TOI , 30th June 2014

Saturday, 14 June 2014

Teen runner back on her feet

A promising teenage runner who developed a rare condition which caused her spine to curve has been given a new lease of life.

Shona Hargreave

                                             Shona Hargreave

Shona Hargreaves feared she may never compete again after being diagnosed with scoliosis, an ailment which affects around four percent of the population.

If left untreated, it can led to heart and lung problems and the only current NHS treatment is a major operation in which metal rods are inserted either side of the spine.

Shona’s parents were unhappy with the risks involved and contacted a clinic offering non-surgical treatment.

Run by Erika Maude, Scoliosis SOS has helped hundreds of sufferers, and Shona and her parents quickly noticed results.

As well as an almost immediate reduction in pain, the youngster noticed improvements in her breathing capacity and a more symmetrical appearance.

Most importantly to sports-mad Shona, of Broad Lane, Parr, she was told she would be able to return to training.

The 13-year-old, who is currently being home-schooled, said: “When I was told that I had scoliosis, I didn’t really understand to start with. No one ever sat me down and explained what was going on in my back until I got to the SOS clinic.

“The staff encouraged me to carry on living a normal life when all of the specialists at the hospital were telling me that I needed to be careful and not put too much pressure on my body by doing too much sport. I am the sort of person to put 100 per cent into everything I do and I believe that’s why I got such good results.”
jjjj# 13 year old, Shona Hardgreeve from St Helens was a normal teenage girl right up until the age of 11, when she was diagnosed with a severe curve in her spine and told that she needed an operation to save her mobility. Left devastated and with very few options the Shona family had almost agreed to the brutal surgery when they discovered an exercise routine which has drastically changed Shona’s prognosis.

Shona had been a typical child; she loved being outside and always wanted to be involved in anything remotely sporty. When she about 10 years old, she started running. At first it was a bit of fun and then she started to get competitive. The school picked up on her talent and soon entered her into school competitions. However, all of this came to a standstill when Shona’s PE teacher noticed her shoulders were protruding through her skin on one side.

This led on to a spiral of events which involved endless x-rays, appointments with specialists and eventually Shona was diagnosed with scoliosis. The family were told that her curve was severe and that she needed to be put on the waiting list for surgery immediately. Shona was also told that she should stop running and playing any sports that were particularly one sided.

Scoliosis causes the spine to excessively curve sideways. The condition affects more than four percent of the population and if left un-treated can lead to fatal heart and lung problems. Current treatment in this country is to wait until the curve becomes so severe, that the only option left is to operate. The major operation is an incredibly risky procedure which involves metal rods being inserted either side of the spine, before the spine is fused solid.

Shona’s mother, Terrie was left in pieces, she did not want her daughter to have surgery as she knew the risks involved but she also knew if Shona did not have the surgery she could end up unable to move properly.

Disgusted with the lack of options the NHS was giving them, Shona’s mother decided to start looking into alternative treatments and it was around this time that she discovered Scoliosis SOS.

Founded and run by Erika Maude, who has Scoliosis herself, the clinic opened 8 years ago and has since brought relief to hundreds of sufferers. Located in central London, it is the only clinic in the world to offer treatment following the ScolioGold method, which is the combination of internationally renowned non-surgical treatments, which have been practiced separately in Europe for several decades.

After finding the clinic it was decided that this treatment had to be the answer they were looking for. Shona and her parents knew it was not going to be easy, but with major invasive surgery as their only other option, they decided they had nothing to lose.

After attending an initial consultation, Shona’s parents immediately booked her in for a four week course of treatment. She found the treatment gave her almost instant relief from the aching she felt across the top of her back on a daily basis. She also noticed a dramatic change in her cosmetic appearance by the end of the first week.

Shona continued to notice improvements over the course including reduced pain, improvements in her breathing capacity and a more symmetrical appearance. However, the main thing Shona was concerned about was her running and how quickly she could get back to training.

Within weeks of completing the treatment Shona’s condition has dramatically improved. Her confidence has soared and she is overwhelmed by the results she has achieved.

Shona has also been given the all clear to return to running so long as she continues with her exercises.
Shona said:

“When I was told that I had scoliosis, I didn’t really understand to start with. No one ever sat me down and explained what was going on in my back until I got to the SOS clinic.

The staff at the SOS clinic were amazing, they made me feel normal again. They also encouraged me to carry on living a normal life when all of the specialists at the hospital were telling me that I needed to be careful and not put too much pressure on my body by doing too much sport.

The exercises weren’t hard; you just had to think about what you were doing. I am the sort of person to put 100% into everything I do and I believe that’s why I got such good results. I cannot wait to get back to running, I am also so excited about the future again, maybe one day I will be as good as some of the professional athletes!

Everything has changed this year, I feel alive, healthy and happy..

Source : St Helens The Reporter ,  12th June 2014

Study Ties Severe Scoliosis with Rare Mutation in Genes

Study Ties Severe Scoliosis with Rare Mutation in Genes

Study Ties Severe Scoliosis with Rare Mutation in Genes (Photo : Washington University School of Medicine/ Matthew Dobbs )


The risk of developing severe scoliosis is much more in children with rare mutation in two genes, a new research reveals.

Researchers at Washington University School of Medicine, St Louis, successfully identified the genetic risk factor that increases children's chances of developing a curved spine or scoliosis. They claim that this occurs due to a rare mutation.

The sideways curvature of the spine is called Scoliosis and this condition often occurs during the growth spurt before puberty. This condition might occur due to cerebral palsy and muscular dystrophy but the cause is mostly unknown. Severe scoliosis is disabling as reduces the space within the chest making it difficult for the lungs to function well.

Mutation in two genes increases the risk of developing scoliosis by four-fold.

"We've had a difficult time finding ways to predict who will develop severe scoliosis, and these newly identified mutations have the potential to be very helpful," senior author Christina A. Gurnett, MD, PhD, said in a press statement.

Drugs currently used in the clinical trial are able to block the growth pathway that the two mutated genes fibrillin-1 and fibrillin-2 control. And the researchers state that if it is this pathway that is involved in scoliosis, then the same drugs can be used to prevent scoliosis in children with this rare mutation.

One to 3 percent of the general population has a mild curvature in the spine and in 1 in 10,000 children, scoliosis leads to curvature that can be corrected with surgery.

"These children often don't have any curvature of the spine early in adolescence, but then they go through a growth spurt, and that's when the curve appears," said Gurnett, associate professor of neurology. "Others have tried to predict severe disease using gender, age of onset and type of spine curve but haven't been very successful."

In this study the researchers looked at 91 subjects with acute scoliosis in which they sequenced the part of the DNA that encode the proteins.  Fibrillin-1 was the most mutated.

 Further, they sequenced the genes in 852 patients with scoliosis and 699 subjects with healthy spines. It was seen that those with the mutation in the two genes were four times more vulnerable to the risk of severe scoliosis.

The finding was documented in the Human Molecular Genetics.

Source : Science World Report , 14th June 2014

3D Systems completes pilot program for scoliosis orthosis

3D Systems has successfully completed a pilot program for its new Bespoke Brace, a customized, 3-D printed orthosis for children and young adults with idiopathic scoliosis.
Researchers tested the orthosis in 22 patients at Children’s Hospital of Oakland, who reported strong levels of wear and compliance, according to a press release.

To create the orthosis, a digitized, customized prototype check-socket orthosis is manipulated and adjusted to suit the patient’s needs. The final orthosis is then 3-D printed using selective laser sintering.

“It will take data to convince the insurers and medical community the value of this technology, but common sense dictates that if the children like their braces and are more comfortable wearing the devices, we will see higher compliance and greater success,” James Policy, MD, Stanford University School of Medicine, stated in the release. “The early data from our pilot study appears to support this. The Bespoke Brace promises to be an important advancement for these children.”

Source : Healio , 11th June 2014

Four Youngsters Undergo Surgery for Spinal Deformity : Chennai

Eighteen-year-old Sumitra from Ambur was not able to do her daily chores  as she suffered unbearable back pain and palpitation for years. At Rajiv Gandhi Government General Hospital, she was one among four youngsters who underwent corrective surgery for scoliosis, a spinal deformity, recently.

Dr Nalli R Uvaraj with the kids who underwent corrective procedure for scoliosis, a spinal deformity, at the Government General Hospital | D Sampath kumar
Dr Nalli R Uvaraj with the kids who underwent corrective procedure for scoliosis, a spinal deformity, at the Government General Hospital

 Doctors at the Ortho Spine surgery unit at the hospital said surgeries were the only remedy for them as complications arising from it would compress the spine and affect the nerves and the lungs.

 While Sumitra (18) and two other teens Naveen Kumar (14) and Priyanka (16) underwent the corrective surgery where their spine was straightened with rods fused to it, 9-year-old Abitha was put through a special technique where the rods could be extended by adjusting the screws as she grows.

Sumitra Devi (right) was one of four recent patients at Rajiv Gandhi Government General Hospital who underwent the surgery for correcting a curvature in the spine. Photo: R. Ragu

Sumitra Devi (right) was one of four recent patients at Rajiv Gandhi Government General Hospital who underwent the surgery for correcting a curvature in the spine.

“Scoliosis affects more women than men. With surgeries, we can not only correct the ailment but also make the patient regain weight. It is always good to do such surgeries before the patient reaches 2o. We don’t do surgeries for everybody,” said Prof Nalli R Uvaraj, Ortho Spine Surgery Unit, RGGGH.

While the spine unit was started in 2007 at the hospital, doctors said theirs were the first government hospital to perform such a surgery in 2012. So far, they have performed corrective surgeries for 18 patients. Out of them, 12 had congenital scoliosis and six including the four youngsters were idiopathic which means the cause of the medical condition is unknown.

“Usually it happens due to paralysis or fractures at a young age and those that have birth deformity. But more number of cases are idiopathic,” doctors said.

The complex surgery that could otherwise cost `5 to 7 lakh in a private hospital was performed for free under the Chief Minister’s Comprehensive Health Insurance Scheme for three of the four youngsters.

“I feel confident now and I want to join college and continue my studies,” Sumitra said, beaming with all hope. 

Source :  The New Indian Express , 14th June 2014

Sunday, 1 June 2014

Two-Level Spinal Osteotomy for Severe Thoracolumbar Kyphosis in Ankylosing Spondylitis: Experience With 48 Patients


Authors : Zheng, Guo-Quan MD; Song, Kai MD; Zhang, Yong-Gang MD; Wang, Yan MD; Huang, Peng MD; Zhang, Xue-Song MD; Wang, Zheng MD; Mao, Ke-ya MD, PhD; Cui, Geng MD



Study Design. A retrospective study.
Objective. To report surgical results for severe thoracolumbar kyphosis secondary to ankylosing spondylitis (AS) corrected with 2-level spinal osteotomy.

Summary of Background Data. Transpedicular osteotomy in the lumbar spine is the major approach to correct kyphosis in AS. Most surgical procedures were performed at 1 level and only few literature report 2-level osteotomy in 1 patient.

Methods. From January 2003 to June 2011, we reviewed 48 patients experiencing AS with severe thoracolumbar kyphosis who underwent stage 2-level spinal osteotomy in our hospital. The osteotomies were performed at T12 and L2 or L1 and L3, according to the apex of kyphosis. Preoperative and postoperative height, chin-brow vertical angle, sagittal balance, and the sagittal Cobb angle of the vertebral osteotomy segment were documented. Intraoperative, postoperative, and general complications were recorded.

The chin-brow vertical angle improved from 65.0° ± 28.0° to 5.0°± 10.0° (P = 0.000) and the  sagittal imbalance distance improved from 26.9 ± 10.4 cm to 10.6 ± 5.6 cm (P = 0.000). The mean amount of correction was 24.9° at the superior site of the osteotomy and 38.1° at the inferior site of the osteotomy. Postoperatively, all patients could walk with horizontal vision and lie on their backs. No major acute complications such as death or complete paralysis occurred. Five patients experienced complications such as infections (n = 1) and cerebrospinal fluid leaks (n = 4). Both Oswestry Disability Index and Scoliosis Research Society scores improved largely. Fusion at the osteotomy site was achieved in each patient, and no implant failures were noted.

Conclusion. Single-stage 2-level osteotomy can effectively and safely correct kyphotic deformities of the thoracolumbar spine caused by AS

Source : Spine: ; 01 June 2014 - Volume 39 - Issue 13 - p 1055–1058