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The relationship between thoracic kyphosis and age, and normative values across age groups: a systematic review of healthy adults.
Zappalá, M, Lightbourne, S, Heneghan, NR
Journal of orthopaedic surgery and research. 2021;(1):447
Abstract
BACKGROUND Thoracic kyphosis is reported to increase with ageing. However, this relationship has not been systematically investigated. Peoples' kyphosis often exceeds 40°, but 40° is the widely accepted cut-off and threshold for normality. Consequently, patients may be misclassified. Accurate restoration of kyphosis is important to avoid complications following spinal surgery. Therefore, specific reference values are needed. The objective of the review is to explore the relationship between thoracic kyphosis and age, provide normative values of kyphosis for different age groups and investigate the influence of gender and ethnicity. METHODS Two reviewers independently conducted a literature search, including seven databases and the Spine Journal, from inception to April 2020. Quantitative observational studies on healthy adults (18 years of age or older) with no known pathologies, and measuring kyphosis with Cobb's method, a flexicurve, or a kyphometer, were included. Study selection, data extraction, and study quality assessment (AQUA tool) were performed independently by two reviewers. The authors were contacted if clarifications were necessary. Correlation analysis and inferential statistics were performed (Microsoft Excel). The results are presented narratively. A modified GRADE was used for evidence quality assessment. RESULTS Thirty-four studies (24 moderate-quality, 10 high-quality) were included (n = 7633). A positive moderate correlation between kyphosis and age was found (Spearman 0.52, p < 0.05, T5-T12). Peoples' kyphosis resulted greater than 40° in 65% of the cases, and it was significantly smaller in individuals younger than 40 years old (x < 40) than in those older than 60 years old (x > 60) 75% of the time (p < 0.05). No differences between genders were found, although a greater kyphosis angle was observed in North Americans and Europeans. CONCLUSION Kyphosis increases with ageing, varying significantly between x < 40 and x > 60. Furthermore, kyphosis appears to be influenced by ethnicity, but not gender. Peoples' thoracic sagittal curvature frequently exceeds 40°. TRIAL REGISTRATION The review protocol was devised following the PRISMA-P Guidelines, and it was registered on PROSPERO ( CRD42020175058 ) before study commencement.
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Three-dimensional pelvic incidence is much higher in (thoraco)lumbar scoliosis than in controls.
Brink, RC, Vavruch, L, Schlösser, TPC, Abul-Kasim, K, Ohlin, A, Tropp, H, Castelein, RM, Vrtovec, T
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2019;(3):544-550
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Abstract
PURPOSE The pelvic incidence (PI) is used to describe the sagittal spino-pelvic alignment. In previous studies, radiographs were used, leading to less accuracy in establishing the three-dimensional (3D) spino-pelvic parameters. The purpose of this study is to analyze the differences in the 3D sagittal spino-pelvic alignment in adolescent idiopathic scoliosis (AIS) subjects and non-scoliotic controls. METHODS Thirty-seven female AIS patients that underwent preoperative supine low-dose computed tomography imaging of the spine, hips and pelvis as part of their general workup were included and compared to 44 non-scoliotic age-matched female controls. A previously validated computerized method was used to measure the PI in 3D, as the angle between the line orthogonal to the inclination of the sacral endplate and the line connecting the center of the sacral endplate with the hip axis. RESULTS The PI was on average 46.8° ± 12.4° in AIS patients and 41.3° ± 11.4° in controls (p = 0.025), with a higher PI in Lenke type 5 curves (50.6° ± 16.2°) as compared to controls (p = 0.042), whereas the Lenke type 1 curves (45.9° ± 12.2°) did not differ from controls (p = 0.141). CONCLUSION Lenke type 5 curves show a significantly higher PI than controls, whereas the Lenke type 1 curves did not differ from controls. This suggests a role of pelvic morphology and spino-pelvic alignment in the pathogenesis of idiopathic scoliosis. Further longitudinal studies should explore the exact role of the PI in the initiation and progression of different AIS types. These slides can be retrieved under Electronic Supplementary Material.
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Management of brown tumor of spine with primary hyperparathyroidism: A case report and literature review.
Hu, J, He, S, Yang, J, Ye, C, Yang, X, Xiao, J
Medicine. 2019;(14):e15007
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RATIONALE Brown tumor (BT) is a rare benign lesion in skeletal system. It is especially rare secondary to primary hyperparathyroidism (HPT). The differential diagnosis can be misleading due to its diversified clinical characteristics. Final diagnosis mainly relies on excessive elevated parathyroid hormone and biopsy. Treatments include surgical interventions and drugs. Only 19 articles (total 22 cases) reported BT of spine caused by primary HPT. PATIENT CONCERNS A 50-year-old woman was admitted to our hospital complaining left elbow and thoracodorsal pain with the lower limbs weakness. DIAGNOSES Multifocal BT. INTERVENTIONS The patient received intramuscular injection of Miacalcic and incense of Calcitonin (Salmon) Nasal Spray to decrease serum calcium level. Surgery was performed later to excise the ectopia parathyroidoma. OUTCOMES At 1-year follow-up, the patient was able to lead an independent life in her full capacity, even though she occasionally complained mild weakness of lower limbs. LESSONS BT of spine with HPT is rarely seen in the clinical practice. Treating the primary parathyroid diseases can be effective. For patients with vertebral fractures and neural deficits, immediately surgical intervention will be necessary to prevent the worse of neurological function.
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Experimentally induced neck pain causes a decrease in thoracic but not lumbar spine stability.
Pinto, BL, Beaudette, SM, Graham, RB, Brown, SHM
Journal of biomechanics. 2019;:78-83
Abstract
Maintenance of spine stability is considered to be a critical component of spine health. Ross et al. (2015) used a topical capsaicin/heat pain sensitization model to experimentally induce lower back pain, and demonstrated that the experimental pain experience caused a decrease in the muscular contribution to lumbar spine rotational stiffness (related to mechanical stability) as well as lower back local dynamic stability (LDS). It has yet to be established if pain elsewhere in the body, specifically in other regions of the spine, can similarly affect the stability of the lower back. The purpose of this investigation was therefore to quantify thoracic and lumbar spine LDS as well as the muscular contribution to lumbar spine rotational stiffness after an experimental neck pain protocol. Results demonstrated that LDS of the thoracic spine decreased in response to the capsaicin/heat induced neck pain. Limited adaptation was required at the lumbar spine as demonstrated by the lack of statistically significant changes in lower back LDS or rotational stiffness.
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Solitary juvenile xanthogranuloma in the spine pretreated with neoadjuvant denosumab therapy followed by surgical resection in a 5-year-old child: case report and literature review.
Irmola, T, Laitinen, MK, Parkkinen, J, Engellau, J, Neva, MH
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2018;(Suppl 3):555-560
Abstract
PURPOSE We present a case report that describes neoadjuvant denosumab therapy initiated in a child with a solitary giant cell-rich juvenile xanthogranuloma tumor involving the spine, and review the current literature. METHODS A giant cell-rich histiocytic lesion involving the 11th thoracic vertebral body was identified in a healthy 5-year-old girl with persistent back and pelvic pain for several months. Imaging examinations and an open biopsy were performed to obtain a definite pathologic diagnosis. As the tumor appeared to be aggressive in nature, we administered adjuvant therapy with denosumab preoperatively and then performed a total spondylectomy. RESULTS Histopathology confirmed that the tumor was juvenile xanthogranuloma. No tumor metastases or recurrence were detected at the 3-year follow-up, and the patient was asymptomatic. CONCLUSIONS In giant cell-rich tumors, denosumab is occasionally used as neoadjuvant or adjuvant therapy, especially for tumors in difficult locations or with substantial soft tissue extensions. Rare adverse events in children include skin infections and disruption of calcium homeostasis. Surgical treatment is aimed at removing the tumor and relieving the symptomatic spinal cord compression. Use of denosumab as neoadjuvant therapy for juvenile xanthogranuloma involving the spine has not been reported previously.
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Selective alpha adrenergic antagonist reduces severity of transient hypertension during sexual stimulation after spinal cord injury.
Phillips, AA, Elliott, SL, Zheng, MM, Krassioukov, AV
Journal of neurotrauma. 2015;(6):392-6
Abstract
On a daily basis, the majority of those with high-level spinal cord injury have autonomic dysreflexia, which describes a life-threatening episode of transient extreme hypertension (i.e., as high as 300 mm Hg) as many as 90% of people living with this condition. Unfortunately, ejaculation is a major initiating factor for autonomic dysreflexia, which discourages sexual activity. In order to obtain a sperm specimen, or for initial assessment of fertility, penile vibrostimulation is clinically performed. Nifedipine, a selective calcium channel blocker, is the most commonly prescribed pharmaceutical for a priori management of autonomic dysreflexia secondary to ejaculation or other causes; however, it is limited because of its potential exacerbation of low resting pressure, which also affects this population. The present study examined the effect of a short-acting selective α1 antagonist (prazosin) on autonomic dysreflexia severity using a randomized placebo trial during medically supervised penile vibrostimulation in six males with cervical spinal cord injury. Beat-by-beat blood pressure and heart rate were recorded throughout penile vibrostimulation during placebo and prazosin-treated days. The increase in systolic blood pressure was mitigated during vibrostimulation in subjects administered prazosin as compared with those administered placebo (+140±19 mm Hg vs. +96±14 mmHg; p<0.05). On average, the peak in systolic blood pressure was 46 mm Hg lower during penile vibrostimulation when patients were administered prazosin (p<0.05), whereas resting blood pressure was not affected. Prazosin appears to be effective at reducing the severity of autonomic dysreflexia during sexual stimulation in patients with spinal cord injury, without exacerbating resting hypotension in high-level spinal cord injury.
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Tissue damage markers after a spinal manipulation in healthy subjects: a preliminary report of a randomized controlled trial.
Achalandabaso, A, Plaza-Manzano, G, Lomas-Vega, R, Martínez-Amat, A, Camacho, MV, Gassó, M, Hita-Contreras, F, Molina, F
Disease markers. 2014;:815379
Abstract
Spinal manipulation (SM) is a manual therapy technique frequently applied to treat musculoskeletal disorders because of its analgesic effects. It is defined by a manual procedure involving a directed impulse to move a joint past its physiologic range of movement (ROM). In this sense, to exceed the physiologic ROM of a joint could trigger tissue damage, which might represent an adverse effect associated with spinal manipulation. The present work tries to explore the presence of tissue damage associated with SM through the damage markers analysis. Thirty healthy subjects recruited at the University of Jaén were submitted to a placebo SM (control group; n = 10), a single lower cervical manipulation (cervical group; n = 10), and a thoracic manipulation (n = 10). Before the intervention, blood samples were extracted and centrifuged to obtain plasma and serum. The procedure was repeated right after the intervention and two hours after the intervention. Tissue damage markers creatine phosphokinase (CPK), lactate dehydrogenase (LDH), C-reactive protein (CRP), troponin-I, myoglobin, neuron-specific enolase (NSE), and aldolase were determined in samples. Statistical analysis was performed through a 3 × 3 mixed-model ANOVA. Neither cervical manipulation nor thoracic manipulation did produce significant changes in the CPK, LDH, CRP, troponin-I, myoglobin, NSE, or aldolase blood levels. Our data suggest that the mechanical strain produced by SM seems to be innocuous to the joints and surrounding tissues in healthy subjects.
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Congential scoliosis in Wilson's disease: case report and review of the literature.
Li, Z, Yu, X, Shen, J, Liang, J
BMC surgery. 2014;:71
Abstract
BACKGROUND Wilson's disease (WD) is an autosomal recessive disorder of copper metabolism, which leads to the accumulation of this metal in liver, brain, cornea and kidney. Little is reported about spinal deformity associated with this syndrome. This study is to present a case of thoracic kyphosis occurring in the setting of Wilson'disease and explore the possible association between the two diseases. CASE PRESENTATION Case report and literature review. A previously unreported thoracic kyphosis in Wislon's disease is decribed. The patient was a 7-year-old Chinese female that underwent a posterior correction, using the Moss-SI spinal system performed at Thoracic 9-Lumbar 1 (T9-L1) levels. At 16-month follow-up, the patient was clinically pain free and well balanced. Plain radiographs showed solid spine fusion with no loss of deformity correction. After evaluating 211 WD patients referred to Peking Union Medical College Hospital from February 1991 to February 2012, the prevalence of congential scoliosis among patients with WD was 5.21% (11/211), much higher than that among general population (1/1000). CONCLUSIONS To the best of our knowledge, this is the first report of WD with thoracic kyphosis. During sugery, surgeons and anesthesiologists must pay particular attention to the abnormal liver and brain function associated with WD. The prevalence of scoliosis is much higher among patients with WD, indicating a potential association between congential scoliosis and WD. However, the exact mechanism how copper-chelating agents induce scoliosis is unclear.
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Measurement of phantomless thoracic bone mineral density on coronary artery calcium CT scans acquired with various CT scanner models.
Budoff, MJ, Malpeso, JM, Zeb, I, Gao, YL, Li, D, Choi, TY, Dailing, CA, Mao, SS
Radiology. 2013;(3):830-6
Abstract
PURPOSE To determine the accuracy and precision of thoracic phantomless bone mineral density (BMD) measurements obtained on coronary artery calcium (CAC) computed tomography (CT) scans by using a variety of commercially available CT scanners. MATERIALS AND METHODS The institutional review board approved this Health Insurance Portability and Accountability Act-compliant study. A total of 4126 asymptomatic subjects (2022 [49%] men, 2104 [51%] women; mean age, 63.7 years ± 11.8 [standard deviation]) underwent CAC CT with the use of a quantitative CT calibration phantom for evaluation of subclinical atherosclerosis. Two hundred eighty subjects also underwent CT of the chest, abdomen, and pelvis (C7 through L5). Mean BMD of three consecutive thoracic vertebrae (in the T7-T10 range) was measured in all 4126 subjects. Individual calibration factors for each phantom insert and a general calibration factor for the spine were determined for each CT scanner model. The study population was then divided into three subgroups: All calibration factors were generated from group 1 (n = 1536) and were applied and tested in group 2 (n = 1587), and effects of various image acquisition parameters were assessed in group 3 (n = 1003). Accuracy (bias) and precision of thoracic phantomless BMD measurements across 14 CT scanner models from five manufacturers were determined. RESULTS Phantomless BMD values correlated highly with standard phantom-based quantitative CT BMD values (r = 0.987, P < .001). Bias was 3.9% ± 1.4 for phantomless BMD measurements, and the mean coefficient of variation for the general calibration factor was 4.9% ± 2.4. CONCLUSION Phantomless BMD can be measured accurately on CAC CT scans acquired with a variety of CT scanners without additional radiation exposure.
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Role of thoracic epidural block in improving post-operative outcome for septic patients: a preliminary report.
Tyagi, A, Seelan, S, Sethi, AK, Mohta, M
European journal of anaesthesiology. 2011;(4):291-7
Abstract
BACKGROUND AND OBJECTIVES Sepsis is considered a relative contraindication for epidural blockade. Recent evidence indicates that thoracic epidural blockade may be of benefit during sepsis by improving gut perfusion. This study was planned to evaluate whether combining thoracic epidural blockade with general anaesthesia could decrease the post-operative mortality and morbidity in patients with sepsis due to perforation peritonitis. METHODS This randomised non-blinded study included consenting adult patients of the American Society of Anesthesiologists grade II-III, undergoing emergency laparotomy for small intestinal perforation peritonitis. Severity of illness was evaluated using Mannheim Peritonitis Index, Acute Physiology and Chronic Health Evaluation III score and clinical indicators of systemic inflammatory response syndrome. Patients were randomised into two groups depending on the anaesthetic technique [general anaesthesia combined with thoracic epidural block (group GT) and general anaesthesia (group GA), n = 33 each. The thoracic block was extended from T5 to T10 using 0.125% bupivacaine in aliquots of 2-3 ml, with 50 μg fentanyl. Post-operatively, patients were followed for occurrence of any major morbidity till discharge from hospital, and 30-day mortality. 'Major morbidity' included development of organ failure. Post-operative markers for gut motility and perfusion, that is, time to passage of flatus, stools, resumption of oral feeds and occurrence of anastomotic leak were also observed. Sample size was calculated at power of 80% and α error of 0.05, aiming to detect a decrease of 50% in the incidence of post-operative major morbidity or mortality. RESULTS Patients in the two groups were similar with respect to demographic profile and severity of sepsis. The number of patients with major morbidity or 30-day mortality were statistically similar between the two groups (group GT, 0/33; group GA 4/33; P = 0.114). A significantly shorter time to pass stools and resume oral feeds in group GT (4 ± 2 vs. 3 ± 1 days) (P = 0.006 and 0.012, respectively) and lesser incidence of anastomotic leak (0/33 vs. 4/33; P = 0.114) showed earlier recovery of gut motility and perfusion in that group. CONCLUSION Use of intra-operative segmental thoracic epidural blockade performed in addition to general anaesthesia suggested some benefit in improving post-operative mortality or major morbidity, but the trend was not significant, perhaps due to the small sample size. There was, however, a significantly earlier return of bowel motility and earlier discharge from hospital.