! STOP BENDING NOW !

Tuesday, 14 May 2013

Gene associated with adolescent idiopathic scoliosis identified

Researchers from the RIKEN Center for Integrative Medical Sciences in Japan have identified the first gene to be associated with adolescent idiopathic scoliosis (also called AIS) across Asian and Caucasian populations. The gene is involved in the growth and development of the spine during childhood.  Their study is published today in the journal Nature Genetics.  



This is a girl with adolescent idiopathic scoliosis (left) and posterior-anterior standing x-ray of spine (right).

AIS is the most common pediatric skeletal disease, affecting approximately 2% of school-age children. The causes of scoliosis remain largely unknown and brace treatment and surgery are the only treatment options. However, many clinical and genetic studies suggest a contribution of genetic factors. 

 To understand the causes and development of scoliosis, Dr Ikuyo Kou, Dr Shiro Ikegawa and their team have tried to identify genes that are associated with a susceptibility to develop the condition

By studying the genome of 1,819 Japanese individuals suffering from scoliosis and comparing it to 25,939 Japanese individuals, the team identified a gene associated with a susceptibility to develop scoliosis on chromosome 6. The association was replicated in Han Chinese and Caucasian populations.


The researchers show that the susceptibility gene, GPR126, is highly expressed in cartilage and that suppression of this gene leads to delayed growth and bone tissue formation in the developing spine. GPR126 is also known to play a role in human height and trunk length. 

"Our finding suggest the interesting possibility that GPR126 may affect both AIS susceptibility and height through abnormal spinal development and growth," explain the authors. 

"Further functional studies are necessary to elucidate how alterations in GPR126 increase the risk of AIS in humans," they conclude.


Source : Science Codex , 12th May 2013

Adolescent Idiopathic Scoliosis Gene Identified

Adolescent Idiopathic Scoliosis Gene Identified 

The condition, adolescent idiopathic scoliosis (AIS), is a type of scoliosis afflicting patients between 10 and 18 years of age, and is the most common type of pediatric skeletal disease in which the specific cause is not known. Therefore it is termed “idiopathic,” meaning is arises spontaneously from an obscure or unknown cause.

However, many clinical and genetic studies suggest a contribution of genetic factors as approximately 30 percent of AIS patients have some family history of scoliosis. AIS affects about two percent of school-age children, and primarily in those of Asian or Caucasian decent. 

Scoliosis is a medical condition in which a person’s spine is curved from side to side in a complex three-dimensional deformity, which exceeds more than 10 degrees when viewed from the coronal plane or sagittal plane. On isolated imaging the spine of a scoliosis patient may look like an “S” or a “C”, rather than a straight line.

Scoliosis is classified as either congenital – caused by vertebral anomalies present at birth, idiopathic – cause unknown, or is secondary to another primary condition. Secondary scoliosis may be the result of any number of neuromuscular conditions like spina bifida, cerebral palsy, or physical trauma.

An estimated 65 percent of scoliosis cases are idiopathic, about 15 percent are congenital, and about 10 percent are secondary to a neuromuscular disease.

The onset of adolescent idiopathic scoliosis generally does not result in immediate discomfort or neurologic symptoms. The curve of the spine does not put pressure on organs nor is there a noticeable shortness of breath seen with AIS, according to the Scoliosis Research Society (SRS).

When scoliosis begins in adolescent patients, often there is some lower back pain. However, lower back pain is not uncommon as  many teens participate in a large number of activities without having good core abdominal and back strength or flexibility. Therefore, the condition is diagnosed by a doctor using tactile and imaging tests.

To correct the curvature, treatments include physical therapy, casting, bracing, and surgery – anterior and posterior fusion.

Research has been ongoing to identify the cause of AIS, including genetic factors. Thus far there are no identifiable causes for this condition, but researchers from the RIKEN Center for Integrative Medical Sciences in Japan believes they’ve isolated the first gene to be associated with AIS.

In the study, published in the journal Nature Genetics, doctors Ikuyo Kou and Shiro Ikegawa, and their team wanted to identify the genes associated with a susceptibility of acquiring the condition, in hopes of understanding the causes and development of scoliosis.
The genome of 1,819 Japanese individuals afflicted with scoliosis were compared it to 25,939 other Japanese individuals. This process allowed the team to identify a gene associated with a susceptibility to develop scoliosis on chromosome 6, GPR126. The association was replicated in Han Chinese and Caucasian populations.

Probable G-protein coupled receptor 126 is a protein that in humans is encoded by the GPR126 gene. This gene encodes a member of the adhesion-GPCR receptor family, characterized by an extended extracellular region with a variable number of N-terminal protein modules coupled to a TM7 region via a domain known as the GPCR-Autoproteolysis INducing (GAIN) domain. It is involved in the process of myelination.

It has also been found that variations in this gene can affect a person’s stature as the gene is involved in the growth and development of the spine during childhood. GPR126 is highly expressed in cartilage and that suppression of this gene leads to delayed growth and bone tissue formation in the developing spine. GPR126 is also plays a role in human height and trunk length.

The researchers concluded, further studies will be necessary to properly elucidate how alterations in the GPR126 amplifies the risk of AIS.


 Source : The Enquisitr , 13th May 2013


Monday, 22 April 2013

Keep it straight, say spine docs : Pune

When 17-year-old Swati Billary from Akola began to have severe problems walking and urinating at the age of 12, doctors diagnosed her with 40 per cent scoliosis — a condition in which aperson’s spine is curved. She was put on medication, exercises and had to wear braces, but this troika seemed to have no effect, as the scoliosis progressed to a severe 98 per cent curve.



Swati (down), who is now recuperating at Sancheti Hospital, had a 98 per cent curvature on her spine, necessitating surgery. After two rods and 22 screws were inserted into her spine on Saturday, the teen now has a straight back










It was then, five years later, that Swati was referred to Pune’s Sancheti Hospital for specialised treatment, and advised to undergo surgery. On Saturday, Swati underwent a six-hour scoliosis correction surgery, in which two rods and 22 screws were inserted into her spine to straighten it.

Her father Tanaji Billary said, “At 12, Swati could not walk even half a kilometre without breathing hard, and experienced many other problems. We were advised surgery, which cost around Rs 2 lakh. Now Swati’s spine is only 4-5 per cent curved and it is under control.

Finally there is relief for my daughter.” Medical experts say that out of all patients diagnosed with scoliosis, common in a small percentage of adolescents, only 50 per cent require surgery. However, early detection prevents surgery, and surgical results are becoming increasingly satisfactory, with awareness rising among parents, doctors and teachers.

Dr Ketan Khurjekar, head of the Spine department at Sancheti Hospital, who conducted Swati’s surgery, said, “Three to four per cent of all adolescents are found to have some form of scoliosis or the other. Most are girls — it is four times more common in girls than boys — and the extremity of the curvature is more progressive.

There is a genetic pre-disposition in some adolescents for it; several cases have been observed in consanguineous marriages.” He added, “Around five years ago, around 80 per cent of patients came in late and needed surgery. Today, only around 40-50 per cent need surgery due to early intervention. In 2012, we saw at least 160 patients for this condition, out of which 85 required surgery.”

Dr Rajesh Parasnis, spine surgeon at the Oyster & Pearl Hospital, said, “The ideal age for surgery depends on premenarchal status, type of curve, degree and severity of spinal deformity. Broadly, 12-16 years is ideal for surgery, as curves are flexible and skeletal maturity is around the corner. Curves less than 15-20 degrees are observed for a while.

Curves between 20-40 degrees require bracing to prevent further progression, and those beyond need surgery.” Dr Jaydev Panchwagh, a neuro and spine surgeon at the Deenanath Mangeshkar Hospital, said, “Last year, I saw around 20 patients, of which only 30 per cent needed surgery. Early signs can be noticed by pediatricians. Increased awareness in the medical fraternity is helping it get getting detected at an early stage.

For very small children, plaster techniques and body molded jackets called braces or corsets are good options. Even if surgery is required, it should be done early on to attain maximum results.”

Scoliosis surgery involves the insertion of special surgical implants like rods, hooks, screws, and wires. The goal is to straighten and balance the spine and secure it in place, so that curve progression stops before skeletal maturity is reached.


Source : Pune Mirror ( 22nd April 2013 ) 

Friday, 12 April 2013

MIRACLE SCOLIOSIS !

Teenager grows FIVE INCHES overnight after operation to straighten the crooked spine that was killing him

 

 

  • Harvey Legge, 14, was suffering from scoliosis, or curvature of the spine
  • At a 90 degree angle, bend was so severe it was crushing his vital organs
  • Operation saw him grow from 4'10" to 5'3" and curve reduce to 20 degrees

A teenager has grown an incredible five inches overnight after an operation to straighten his spine.
Harvey Legge, 14, was suffering from scoliosis, or curvature of the spine - and the bend was so severe it was crushing his vital organs.
He was referred to a paediatrician at Sheffield Children’s hospital who said his case was so severe he would have to have surgery.
The operation saw him grow five inches overnight, taking him from 4'10" to 5'3". His spine has gone from being at a 90 degree angle, to just a 20 degree angle.


Twisted: Harvey Legge, 14, was suffering from scoliosis, or curvature of the spine. The bend was so severe it was crushing his vital organs
Twisted: Harvey Legge, 14, was suffering from scoliosis, or curvature of the spine. The bend was so severe it was crushing his vital organs


His mother Claire Walker, 39, said: ‘It really is wonderful to see. He now stands as tall as me - he literally grew five inches overnight after the operation once surgeons had straightened out his spine.
‘To see the X-rays of his spine before and after the operation really is remarkable. The surgeons have done a wonderful job.’
Mrs Walker, from Holton Le Clay, Lincolnshire, said: ‘It was a shock when he was first diagnosed with it.
 

'I’d noticed that his rib cage didn’t look level when he bent down, but I had no idea that it was anything as serious as scoliosis.
‘When I was told he would have to have surgery to correct it, I was devastated. But I knew that it was the only option for him.


‘The bend in his spine was so severe that it was crushing all his organs. His rib cage was banging on his hip and he used the other hip as a shelf to rest his arm. He couldn’t walk very far because he was so twisted.’


Harvey Legge
Harvey Legge
The operation saw him grow five inches overnight, taking him from 4'10" to 5'3". His spine has gone from being at a 90 degree angle, to just a 20 degree angle.



Doctors decided that because Harvey's case was so severe, they couldn’t wait any longer to operate on him. 

Mrs Walker said: ‘We knew that he was very young to have this operation and it was nerve-wracking, but there was no choice.

‘Two months previously we had been on holiday to Italy and while we were sat around the pool, people were watching Harvey with their jaws dropping open. He was very conscious about what he looked like, too.’

Doctors warned the couple that there was a risk of paralysis with the operation, but they knew it was Harvey’s only chance as he was being suffocated by his own spine.

Harvey
Harvey
But complications from the operation left surgeons fearing Harvey was brain dead after he lost his entire body’s worth of blood. He has since made a full recovery 


The eight hour operation was carried out in November 2011 at Sheffield Children’s Hospital, where doctors put titanium rods either side of his spine to straighten it.
But complications from the operation left surgeons fearing he was brain dead after he lost his entire body’s worth of blood and his brain shut down.

Mrs Walker said: 'It was terrifying when he lost so much blood - we thought we were going to lose him. Harvey spent nine days recovering in hospital, and then a further three months recovering at home. 

Mrs Walker added: ‘It was so amazing when he stood up and he was so much taller. He had always been the smallest in his class and now he is of average height which is great.

Harvey
Harvey
Standing tall: Harvey with his mother Clare and surgeon Ashley Cole. He had always been the smallest in his class but is now of average height


‘He can now do contact sports and he can run too. He won’t grow any more, but it is fantastic that he is now so much taller than he was.

Ashley Cole, the consultant spinal surgeon who performed Harvey’s operation said: ‘It was a huge success and Harvey has recovered fantastically well.

‘We had to do the surgery much sooner with Harvey than many other children because his condition was progressing at such a fast rate.’


Source : Daily Mail , UK ( 12th feb 2013 ) 

Saturday, 9 March 2013

Risk Factors ID’d for Massive Blood Loss in Scoliosis Surgery

For patients undergoing scoliosis surgery, the risk of massive blood loss is increased with preoperative Cobb angles bigger than 50 degrees and for those undergoing osteotomy or fusion of more than six levels, according to a study published in the Feb. 15 issue of Spine.
 

 For patients undergoing scoliosis surgery, the risk of massive blood loss is increased with preoperative Cobb angles bigger than 50 degrees and for those undergoing osteotomy or fusion of more than six levels, according to a study published in the Feb. 15 issue of Spine.

  

Include pre-op Cobb angle larger than 50 degrees, osteotomy, or fusion of more than six levels 




Xuerong Yu, M.D., from Peking Union Medical College Hospital in Beijing, and colleagues retrospectively analyzed data from patients undergoing scoliosis surgery, from June 1, 2011 to Oct. 31, 2011, based on their classification as having lost more than 30 percent of estimated blood volume (group A; 95 patients) and those who lost 30 percent or less of their blood volume (group B; 64 patients). Total blood loss was defined as the sum of intraoperative and postoperative estimated blood loss.

The researchers found that 59.7 percent of the patients had massive blood loss. There were significant differences between the groups with patients in group A shorter, with larger preoperative Cobb angles, more levels fused, and more osteotomies than patients in group B. Independent risk factors for massive blood loss included preoperative Cobb angle of more than 50 degrees (odds ratio [OR], 2.47), more than six levels fused (OR, 3.70), and osteotomy (OR, 4.64).
"In conclusion, patients with preoperative Cobb angle larger than 50 degrees or patients planning to undergo osteotomy or fusion of more than six levels have an increased risk of massive blood loss," write the authors. "This may contribute to an improved use of blood conservation strategy."

Source : Doctors Lounge ( 8th march 2013 )