The Trunk Appearance Perception Scale (TAPS): a new tool to evaluate subjective impression of trunk deformity in patients with idiopathic scoliosis

<p>Abstract</p> <p>Background</p> <p>Outcome assessment in idiopathic scoliosis should probably include patients' perception of their trunk deformity in addition to self-image. This can be accomplished with the Walter Reed Visual Assessment Scale (WRVAS). Nevertheless, this instrument has some shortcomings: the drawings are abstract and some figures do not relate to the corresponding radiological deformity. These considerations prompted us to design the Trunk Appearance Perception Scale (TAPS).</p> <p>Methods</p> <p>Patients with idiopathic scoliosis and no prior surgical treatment were included. Each patient completed the TAPS and SRS-22 questionnaire and underwent a complete radiographic study of the spine. The magnitude of the upper thoracic, main thoracic, and thoracolumbar/lumbar structural curves were recorded. The TAPS includes 3 sets of figures that depict the trunk from 3 viewpoints: looking toward the back, looking toward the head with the patient bending over and looking toward the front. Drawings are scored from 1 (greatest deformity) to 5 (smallest deformity), and a mean score is obtained.</p> <p>Results</p> <p>A total of 186 patients (86% females), with a mean age of 17.8 years participated. The mean of the largest curve (CMAX) was 40.2°. The median of TAPS sum score was 3.6. The floor effect was 1.6% and ceiling effect 3.8%. Cronbach's alpha coefficient was 0.89; the ICC for the mean sum score was 0.92. Correlation coefficient of the TAPS mean sum and CMAX was -0.55 (<it>P </it>< 0.01). Correlation coefficients between TAPS mean sum score and SRS-22 scales were all statistically significant, ranging from 0.45 to 0.52 (<it>P </it>< 0.05).</p> <p>Conclusions</p> <p>The TAPS is a valid instrument for evaluating the perception patients have of their trunk deformity. It shows excellent distribution of scores, internal consistency, and test-retest reliability, and has good capacity to differentiate the severity of the disease. It is simple and easy to complete and score, the figures are natural, and a new frontal view is included.</p

Proximal junctional vertebral fracture-subluxation after adult spine deformity surgery. Does vertebral augmentation avoid this complication? A case report

<p>Abstract</p> <p>Background</p> <p>To report to the orthopedic community a case of vertebral fracture and adjacent vertebral subluxation through the upper instrumented vertebra after thoracolumbar fusion with augmentation of the cranial level.</p> <p>Methods</p> <p>This report reviewed the patient`s medical record, her imaging studies and related literature. The possible factors contributing to this fracture are hypothesized.</p> <p>Results</p> <p>A 70-year-old woman underwent decompressive surgery and posterolateral fusion for adult lumbar scoliosis. We used pedicular screws from T10 to S1 and iliac screw at the right side, augmented with cement at T10, T11, L1, L5 and S1; and prophylactic vertebroplasty at T9 to avoid the "topping-off syndrome".</p> <p>Thirty days after discharge, without recognizable inciting trauma, the patient complained of pain in the lower thoracic area. The exam revealed overall neurological deficit below the level of fracture.</p> <p>CT scan and MRI demonstrated a T10 vertebral collapse and T9 vertebral subluxation with morphologic features of flexion-distraction fracture through the upper edge of the screw.</p> <p>At this point, the authors performed posterior decompression at T9 to T10 and extended posterolateral arthrodesis from T2 to T10.</p> <p>To our knowledge, this is an unreported fracture.</p> <p>Conclusions</p> <p>Augmentation of the cranial level in a long thoracolumbar fusion has been developed to avoid the junctional kyphosis and compression fractures at that level. We alert the orthopedic community that this augmentation may lead to further and more severe fractures, although this opinion requires investigation for confirmation.</p

Gradual scoliosis correction over time with shape-memory metal: a preliminary report of an experimental study

We gratefully acknowledge SECOT (Spanish Society of Traumatology and Orthopedic Surgery) for economic suppor

Association between sagittal alignment and loads at the adjacent segment in the fused spine: a combined clinical and musculoskeletal modeling study of 205 patients with adult spinal deformity

PurposeSagittal malalignment is a risk factor for mechanical complications after surgery for adult spinal deformity (ASD). Spinal loads, modulated by sagittal alignment, may explain this relationship. The aims of this study were to investigate the relationships between: (1) postoperative changes in loads at the proximal segment and realignment, and (2) absolute postoperative loads and postoperative alignment measures. MethodsA previously validated musculoskeletal model of the whole spine was applied to study a clinical sample of 205 patients with ASD. Based on clinical and radiographic data, pre-and postoperative patient-specific alignments were simulated to predict loads at the proximal segment adjacent to the spinal fusion. ResultsWeak-to-moderate associations were found between pre-to-postop changes in lumbar lordosis, LL (r = - 0.23, r = - 0.43; p < 0.001), global tilt, GT (r = 0.26, r = 0.38; p < 0.001) and the Global Alignment and Proportion score, GAP (r = 0.26, r = 0.37; p < 0.001), and changes in compressive and shear forces at the proximal segment. GAP score parameters, thoracic kyphosis measurements and the slope of upper instrumented vertebra were associated with changes in shear. In patients with T10-pelvis fusion, moderate-to-strong associations were found between postoperative sagittal alignment measures and compressive and shear loads, with GT showing the strongest correlations (r = 0.75, r = 0.73, p < 0.001). ConclusionsSpinal loads were estimated for patient-specific full spinal alignment profiles in a large cohort of patients with ASD pre-and postoperatively. Loads on the proximal segments were greater in association with sagittal malalignment and malorientation of proximal vertebra. Future work should explore whether they provide a causative mechanism explaining the associated risk of proximal junction complications.ISSN:0940-6719ISSN:1432-0932ISSN:00199115

Fundamentals of orthopedics and traumatology

Fundamentos de ortopedia y traumatología nace en el seno del Departamento de Ortopedia de la Pontificia Universidad Javeriana, gracias a la iniciativa de una estudiante de octavo semestre de Medicina. Su interés fue recuperar el texto como aliado fundamental de las dinámicas estudiantiles en los procesos de enseñanza y aprendizaje de la educación superior y, de esta manera, que aquel sirva como herramienta de consulta para los estudiantes de Medicina, los médicos generales, los ortopedistas en formación, los terapeutas y otros profesionales de la salud que requieran acercarse a esta especialidad.Bogot

Divulgación Científica No.3

La investigación constituye en sí misma un valioso instrumento para ser empleado por la sociedad, es mucho más que un objeto —sin abandonar lo que por naturaleza le compete: garantizar procesos de calidad—, puede entregar valiosa información sobre diferentes temas de interés, para avanzar en el análisis y propiciar la creación de redes de conocimiento.Research constitutes in itself a valuable instrument to be used by society, it is much more than an object —without abandoning what by nature is its responsibility: guaranteeing quality processes—, it can provide valuable information on different topics of interest, to advance in analysis and promote the creation of knowledge networks