The metabolic basis of adolescent idiopathic scoliosis: 2011 report of the “metabolic” workgroup of the Fondation Yves Cotrel

OBJECTIVE: The purpose of this review is to elucidate the metabolic processes involved in the pathogenesis of adolescent idiopathic scoliosis (AIS) in light of research by the present authors as well as current literature. METHODS: Pathogenetic mechanism

Is decreased bone mineral density associated with development of scoliosis? A bipedal osteopenic rat model

<p>Abstract</p> <p>Background</p> <p>An association between adolescent idiopathic scoliosis and osteopenia has been proposed to exist. It is still not clear whether there is such an association and if so, whether osteopenia is a causative factor or a consequence. Our previous pilot studies have suggested the presence of osteopenia in scoliotic animals. The aim of this study was to investigate the development of scoliosis in an unpinealectomized bipedal osteopenic rat model, implementing osteoporosis as a causative factor.</p> <p>Methods</p> <p>Fifty Sprague-Dawley rats were rendered bipedal at the 3^rdpostnatal week and separated into control (25 rats) and heparin (25 rats receiving 1 IU/gr body weight/day) groups. DEXA scans after 4 weeks of heparin administration showed low bone mass in the heparin group. Anteroposterior and lateral x-rays of the surviving 42 animals (19 in heparin and 23 in control groups) were taken under anesthesia at the 40^thweek to evaluate for spinal deformity. Additional histomorphometric analysis was done on spine specimens to confirm the low bone mass in heparin receiving animals. Results of the DEXA scans, histomorphometric analysis and radiological data were compared between the groups.</p> <p>Results</p> <p>Bone mineral densities of rats in the heparin group were significantly lower than the control group as evidenced by both the DEXA scans and histomorphometric analyses. However, the incidence of scoliosis (82% in heparin and 65% in control; p > 0.05) as well as the curve magnitudes (12.1 ± 3.8 in heparin versus 10.1 ± 4.3 degrees in control; p > 0.05) were not significantly different. Osteopenic rats were significantly less kyphotic compared to control specimens (p = 0.001).</p> <p>Conclusions</p> <p>This study has revealed two important findings. One is that bipedality (in the absence of pinealectomy) by itself may be a cause of scoliosis in this animal model. Further studies on animal models need to consider bipedality as an independent factor. Secondly, relative hypokyphosis in osteopenic animals may have important implications. The absence of sagittal plane analyses in previous studies makes comparison impossible, but nonetheless these findings suggest that osteopenia may be important in the development of 3D deformity in adolescent idiopathic scoliosis.</p

Repair, regenerative and supportive therapies of the annulus fibrosus: achievements and challenges

Lumbar discectomy is a very effective therapy for neurological decompression in patients suffering from sciatica due to hernia nuclei pulposus. However, high recurrence rates and persisting post-operative low back pain in these patients require serious attention. In the past decade, tissue engineering strategies have been developed mainly targeted to the regeneration of the nucleus pulposus (NP) of the intervertebral disc. Accompanying techniques that deal with the damaged annulus fibrous are now increasingly recognised as mandatory in order to prevent re-herniation to increase the potential of NP repair and to confine NP replacement therapies. In the current review, the requirements, achievements and challenges in this quickly emerging field of research are discussed

Effects of Drug Compliance on Quality of Life in Patients with Epilepsy

Objectives: The aim of the present descriptive study was to determine the effect of patient compliance with antiepileptic drug therapy on quality of life. Methods: The study population comprised 115 patients with epilepsy who applied to the neurology clinic of a state hospital in western Turkey between February and December 2011. Ethics committee approval and informed consent were obtained. Data were collected using a personal information form and the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) in face-to-face interviews. Descriptive statistics, parametric tests, and non-parametric tests were used to evaluate data. Results: Mean age of the population was 36.10 +/- 14.95 years, and mean age at onset was 21.35 +/- 17.00. Males comprised 50.4% of the population, and 59.1% of patients took medication regularly. Patients received the highest scores on the subscales of language, social isolation, and physical function, and the lowest on the subscales of health perception, energy/fatigue, and seizure concerns. Total QOLIE-89 scores were found to be slightly above average, while subscale scores were generally below. There were significant differences between QOLIE-89 subscale scores and rates of regular medication use (p<0.05); subscale scores were higher, as were indications of quality of life. Conclusion: Quality of life was found to be low. Patients and their relatives should be better informed of the benefits of treatment compliance on quality of life

Correction of rotational deformity and restoration of thoracic kyphosis are inversely related in posterior surgery for adolescent idiopathic scoliosis

Adolescent Idiopathic Scoliosis (AIS) is a complex three dimensional deformity the treatment of which remains to be surgical correction of the deformity as it had progressed over certain thresholds. The main focus in surgical treatment had, for decades, been the amount of correction in the coronal plane whereas corrections in sagittal and rotational (axial) planes have also been recognized as almost as important as the coronal over the recent decades. The hypotheses presented and discussed in this study is the virtual adversity between the rates of correction in these two (sagittal and axial) planes. Namely, we are suggesting that due to an elongated anterior spinal column as an intrinsic component of AIS, posterior surgery cannot correct both the axial plane deformity and the thoracic hypokyphosis in the sagittal plane at the same time, unless the posterior spinal column is substantially lengthened. This hypothesis is supported by 3D modeling of the AIS spine as well as the relative inability in changing the sagittal alignment of the thoracic spine demonstrated by a literature search by us. Understanding and internalization of this hypothesis by AIS surgeons is important as it suggests that by posterior instrumentation, unless a riskier approach of substantially lengthening the spinal column is taken, surgeons need to make the choice of correcting the hypokyphosis OR axial rotation

Correction of rotational deformity and restoration of thoracic kyphosis are inversely related in posterior surgery for adolescent idiopathic scoliosis

Adolescent Idiopathic Scoliosis (AIS) is a complex three dimensional deformity the treatment of which remains to be surgical correction of the deformity as it had progressed over certain thresholds. The main focus in surgical treatment had, for decades, been the amount of correction in the coronal plane whereas corrections in sagittal and rotational (axial) planes have also been recognized as almost as important as the coronal over the recent decades. The hypotheses presented and discussed in this study is the virtual adversity between the rates of correction in these two (sagittal and axial) planes. Namely, we are suggesting that due to an elongated anterior spinal column as an intrinsic component of AIS, posterior surgery cannot correct both the axial plane deformity and the thoracic hypokyphosis in the sagittal plane at the same time, unless the posterior spinal column is substantially lengthened. This hypothesis is supported by 3D modeling of the AIS spine as well as the relative inability in changing the sagittal alignment of the thoracic spine demonstrated by a literature search by us. Understanding and internalization of this hypothesis by AIS surgeons is important as it suggests that by posterior instrumentation, unless a riskier approach of substantially lengthening the spinal column is taken, surgeons need to make the choice of correcting the hypokyphosis OR axial rotation

Three-dimensional evolution of scoliotic curve during instrumentation without fusion in young children

This study respectively evaluated 12 Young children with progressive curves who underwent subcutaneous rod instrumentation (SCRI) without fusion and were followed until definitive surgery. The mean curve Cobb angle was 58degrees at the time of SCRI. The mean apical vertebral rotation at the time of presentation was 20degrees. Curves were observed to have progressed to an average of 59degrees before definitive surgery and were corrected to 34degrees with instrumentation. The average apical vertebral rotation was found to be 34degrees before the definitive treatment. This value was significantly larger than the pre-SCRI value (P 0.002). The average number of lengthening operations per patient was 4.6, and the number of all operations per patient was 7. Six patients developed complications. The average time spent in hospital was 101 days. The findings demonstrate that the Curves were essentially unchanged in the frontal plane during the period of lengthening. The sagittal Curves remained mostly within normal limits, but there was an alarming increase in rotation

Risk factors associated with corrective surgery in congenital scoliosis with tethered cord

Severe neglected congenital scoliosis with tethered cord presents major difficulties in management. The primary objective of this study was to identify the risk factors associated with corrective scoliosis surgery in neglected cases presenting with severe deformity