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IntroductionMotor evoked potentials (MEPs) are currently considered as a more useful method for neurophysi-ological intraoperative monitoring than somatosensory evoked potentials in cases of surgery applied to patients with adolescent idiopathic scoliosis. The non-invasive approach is preferred to modify MEP recordings, criticizing, in many cases, the fundamentalism for neurophysiological monitoring based only on needle recordings. The aim of the review is to provide our own experience and prac-tical guidelines with reference to neuromonitoring innovations.Material and MethodsRecordings of MEPs with surface electrodes instead of needle electrodes including nerve instead of muscle combinations during neurophysiological monitoring associated with surgical interventions to the spine have become more relevant for pediatric purposes, avoiding the anesthesiology-related influences. Observations on 280 patients with Lenke A–C types of spine curvature are presented before and after the surgical correction.ResultsThe MEPs recorded from nerves do not undergo fluctuations at different stages of scoliosis correc-tions and the anesthesia effect more than MEPs recorded from muscles. The use of non-invasive surface electrodes during neuromonitoring for MEP recordings shortens the total time of the surgical procedure without diminishing the precision of the neural transmission evaluation. The quality of MEP recordings during intraoperative neuromonitoring from muscles can be significantly influ-enced by the depth of anesthesia or administration of muscle relaxants but not those recorded from nerves.ConclusionsThe proposed definition of “real-time” neuromonitoring comprises the immediate warning from a neurophysiologist about the changes in a patient’s neurological status during scoliosis surgery (es-pecially during pedicle screws’ implantation, corrective rods’ implantation, correction, distraction and derotation of the spine curvature) exactly during the successive steps of corrective procedures. This is possible due to the simultaneous observation of MEP recordings and a camera image of the surgical field. This procedure clearly increases safety and limits financial claims resulting from possible complications.

Introduction. Pulmonary impairment may be observed in patients with severe idiopathic scoliosis (IS). The aim of the study was to analyze spirometry parameters and identify the pulmonary status of patients prior to scoliosis surgery. Materials and methods. Ninety-two adolescent girls with IS, aged 10-18 underwent a spirometry examination and radiographic evaluation. The body height loss was calculated from Stokes’ formula. The values of the pulmonary parameters were interpreted against the measured versus the corrected body height. Results. The mean thoracic Cobb angle was 68.3°, range 50°-89°. A restrictive pattern was observed in over 40% of patients. The use of reference values calculated for corrected body height decreased the number of patients presenting pulmonary parameters within the normal range (48.9% versus 56.5%) and increased the number of patients with a possible restrictive pattern (42.4% versus 32.6%). Airway obstruction was observed in 10.9% of patients when measured body height was used versus 8.7% of patients while corrected body height was used. Conclusions. More than half of patients with severe thoracic idiopathic scoliosis present pulmonary impairment, mainly of a restrictive pattern. The calculations of reference values from the corrected body height as a substitute for the measured one may influence the interpretation of the spirometry examination results.

Introduction. Skeletal maturity assessment in Idiopathic Scoliosis (IS) is used for the evaluation of deformation progression risk, as well as selecting a method of treatment. The Sanders Maturity Scale (SMS) is based on the ossification of phalanges, metacarpal bones and radius rated on AP radiograms of the left hand. Aim. This retrospective study aimed to compare SMS to other skeletal maturity assessment methods used in daily practice. Materials and methods. We included 39 female patients with IS (50 series of radiograms) with a mean age of 13.4, ranging from 10.3 to 17.3. Each series of radiograms was evaluated by three observers with different experience. Skeletal maturity was assessed using the Sanders Maturity Scale (SMS), Risser sign, Greulich and Pyle (GP) atlas, as well as the closure of the triradiate cartilage. Results. The majority of patients, 17 out of 50 (34 %) were classified as type 3 (adolescent rapid – early). Intra-observer and inter-observer reliability for the SMS was very good (Krippendorff’s alpha >0.95). The GP and Risser method showed good reliability, whereas the triradiate cartilage closure assessment showed lower reliability. The Risser 0 grade corresponded with as many as four Sanders stages, 16 out of 20 (80 %) were rated Sanders 3. All radiograms with open triradiate cartilage (7/50, 14 %) were rated Sanders 2 or 3; they all received a Risser 0 grading. Conclusions. The SMS proved to have a very good intra-observer and inter-observer reliability, it is easy to be used by physicians and does not require an atlas. The SMS enhances the assessment of skeletal maturity of IS patients by providing additional stages in the early phase of growth (Risser 0).

The study compared pulmonary parameters, registered at the preoperative examination, in adolescent boys versus girls, both with severe thoracic idiopathic scoliosis. Thirty consecutive boys and 30 consecutive girls with Lenke 1 or 3 type, in the age range 14–18 years, with a Cobb angle of >50° and Risser sign ≥ 3 were enrolled. Corrected body height was used to calculate pulmonary parameters according to the Global Lung Function (GLI 2012) reference values. Significantly higher values of the calculated predicted pulmonary parameters and the upper and lower limit of normal (ULN and LLN), as well as significantly higher absolute values of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), were observed in boys than girls; however, the registered FVC and FEV1, expressed as percentages of the predicted values, tended to be lower in boys. The FEV1 z-score difference between boys and girls may suggest a need for more intensive preoperative pulmonary rehabilitation in boys.

Idiopathic scoliosis (IS) is a multifactorial disease with a genetic background. The association of Ladybird Homeobox 1 (LBX1) polymorphisms with IS has been proven in multiple studies. However, the epigenetic mechanisms have not been evaluated. This study aimed to evaluate the LBX1 methylation level in deep paravertebral muscles in order to analyze its association with IS occurrence and/or IS severity. Fifty-seven IS patients and twenty non-IS patients were examined for the paravertebral muscles’ methylation level of the LBX1 promoter region. There was no significant difference in methylation level within paravertebral muscles between patients vs. controls, except for one CpG site. The comparison of the paravertebral muscles’ LBX1 promoter region methylation level between patients with a major curve angle of ≤70° vs. >70° revealed significantly higher methylation levels in 17 of 23 analyzed CpG sequences at the convex side of the curvature in patients with a major curve angle of >70° for the reverse strand promoter region. The association between LBX1 promoter methylation and IS severity was demonstrated. In patients with severe IS, the deep paravertebral muscles show an asymmetric LBX1 promoter region methylation level, higher at the convex scoliosis side, which reveals the role of locally acting factors in IS progression.

Idiopathic scoliosis (IS) is one of the most common spinal disorders in adolescents. Despite many studies, the etiopathogenesis of IS is still poorly understood. In recent years, the role of epigenetic factors in the etiopathogenesis of IS has been increasingly investigated. It has also been postulated that the development and progression of the disease is related to gender and puberty, and could be associated with estrogen action. Estrogen hormones act via estrogen receptor 1 (ESR1) and estrogen receptor 2 (ESR2). It has been suggested that ESR2 expression is dependent on methylation within its gene promoter. So far, no studies have evaluated local, tissue-specific DNA methylation in patients with IS. Thus, our study aimed to analyze the methylation and expression level of ESR2 in the paraspinal muscles of the convex and concave side of the IS curvature. The methylation level within ESR2 promoter 0N, but not exon 0N, was significantly higher on the concave side of the curvature compared to the convex side. There was no significant correlation between ESR2 expression and methylation level in the promoter 0N on the convexity of thoracic scoliosis, whereas, on the concave side of the curvature, we observed a moderate negative correlation. There was no difference in the methylation levels of the ESR2 promoter and exon 0N between groups of patients with Cobb angle ≤ 70° and > 70° on the concave and convex side of the curvature. We also found no statistically significant correlation between the Cobb angle value and the mean methylation level in either the ESR2 promoter or exon 0N on the convex or concave side of the curvature. Our findings demonstrate that DNA methylation at the ESR2 promoter in deep paravertebral muscle tissue is associated with the occurrence but not with the severity of idiopathic scoliosis.

Background Three-dimensional idiopathic scoliosis cannot be accurately assessed with the aid of a single plane parameter – the Cobb angle. We propose a novel method for evaluating the three-dimensional (3D) pattern of scoliosis based on two X-rays (PA and lateral). The proposed method consists of the measurements of the angles between the upper endplate of the upper-end vertebra and the lower endplate of the lower-end vertebra (3D scoliosis angle). Methods The 3D-angles of thirty scoliosis curves were measured with either computed tomography (CT) or digitally reconstructed radiographs (DRRs): PA and lateral. CT was used as a reference. In the case of CT, the 3D angle was calculated based on the coordinates of three points situated on the upper endplate and those of three points situated on the lower endplate of the scoliosis curve. In the case of the DRR, the 3D angle was calculated using the four-angle method: the angles formed by the endplates of the curve with the transverse plane. The results were tested with the Student’s t-test, and the agreement of measurements was tested with the intraclass correlation coefficient. Results There was no significant difference between the 3D-angle measurements obtained with DRRs versus CT, p > 0.05. There was, however, a significant difference between the 3D-scoliosis angle and the Cobb angle measurements performed based on the X-rays. The reproducibility and reliability of 3D angle measurements were high. Conclusions Based on two standard radiographs, PA and lateral, it is possible to calculate the 3D scoliosis angle. The proposed method facilitates 3D-scoliosis assessment without the use of sophisticated devices. Considering the 3D nature of AIS, the 3D parameters of the spine may help to apply a more effective treatment and estimate a more precise prognosis for patient with scoliosis.

The study aimed to detect the presence and assess the expression levels of the estrogen receptors type 1 (ESR1) and type 2 (ESR2) within paravertebral skeletal muscles of female patients with idiopathic scoliosis (IS) in relation to phenotype parameters. Intraoperatively, the muscle samples were obtained from 35 adolescent females. The RT-qPCR, western blot and immunohistochemistry techniques were applied. The ESR1 and ESR2 were detected within paravertebral skeletal muscle cells, either the superficial or the deep ones. The ESR1 expression level was significantly higher in the deep muscles compared to the superficial ones. A left-right asymmetry of the ESR1 and ESR2 expression level was demonstrated in the deep muscles. There was a significant relationship between the expression asymmetry and either the Cobb angle or the progression risk factor: both parameters decreased to the smallest values in the case of symmetric ESR1 or ESR2 expression, while they increased with increasing expression asymmetry. In conclusion, the ESR1 and ESR2 presence was confirmed in skeletal paravertebral muscles of patients with idiopathic scoliosis. The increased expression level and asymmetry of estrogen receptors in deep skeletal muscles was related to increasing scoliotic deformity magnitude or increasing risk of deformity deterioration. These findings may highlight the etiopathogenesis of IS in children.

Účel: Studie prokázaly, že ortéza je účinnou léčbou pacientů s idiopatickou skoliózou. Podle současné klasifikace spadají téměř všechny ortézy do kategorie torakolumbosakrálních ortéz (TLSO). V důsledku toho je zobecnění vědeckých výsledků buď nemožné, nebo zavádějící. Cílem této studie je vytvořit klasifikaci typů ortéz. Metody: Čtyři vědecké společnosti (SOSORT, SRS, ISPO a POSNA) vyzvaly všechny své členy, aby se zúčastnili studie. Šest odborníků 1. úrovně vypracovalo počáteční klasifikace. Na konsenzuálním setkání s dalšími 26 odborníky a představiteli společností umožnila tematická analýza a obecná diskuse definovat klasifikaci (minimálně 80% shoda). Klasifikace byla použita na ortézy publikované v literatuře a oficiálně schválena 4 vědeckými společnostmi a ESPRM. Výsledky: Klasifikace je založena na následujících klasifikačních položkách: anatomie (CTLSO, TLSO, LSO), tuhost (velmi tuhá, tuhá, pružná), primární korekční rovina (frontální, sagitální, transverzální, frontální a sagitální, frontální a transverzální, sagitální a transverzální, třídimenzionální), konstrukce - ventily (jednokotoučové, dvoukotoučové, vícesegmentové), konstrukce - uzávěr (dorzální, laterální, ventrální) a primární působení (ohyb, detorze, prodloužení, pohyb, push-up, tříbodové). Odborníci vypracovali definici pro každou položku a byli schopni klasifikovat 15 publikovaných ortéz do devíti skupin. Závěry: V rámci studie byly vybrány dvě skupiny ortéz, které se zabývají problematikou ortéz: Klasifikace je založena na nejlepších současných odborných znalostech (nejnižší úroveň důkazů). Odborníci uznávají, že se jedná o první vydání a že se bude měnit s budoucími poznatky a výzkumem. Široké uplatnění této klasifikace by mohlo mít význam pro výzkum rovnátek, vzdělávání, klinickou praxi a růst v této oblasti. Purpose: Studies have shown that bracing is an effective treatment for patients with idiopathic scoliosis. According to the current classification, almost all braces fall in the thoracolumbosacral orthosis (TLSO) category. Consequently, the generalization of scientific results is either impossible or misleading. This study aims to produce a classification of the brace types. Methods: Four scientific societies (SOSORT, SRS, ISPO, and POSNA) invited all their members to be part of the study. Six level 1 experts developed the initial classifications. At a consensus meeting with 26 other experts and societies’ officials, thematic analysis and general discussion allowed to define the classification (minimum 80% agreement). The classification was applied to the braces published in the literature and officially approved by the 4 scientific societies and by ESPRM. Results: The classification is based on the following classificatory items: anatomy (CTLSO, TLSO, LSO), rigidity (very rigid, rigid, elastic), primary corrective plane (frontal, sagittal, transverse, frontal & sagittal, frontal & transverse, sagittal & transverse, three-dimensional), construction—valves (monocot, bivalve, multisegmented), construction—closure (dorsal, lateral, ventral), and primary action (bending, detorsion, elongation, movement, push-up, three points). The experts developed a definition for each item and were able to classify the 15 published braces into nine groups. Conclusion: The classification is based on the best current expertise (the lowest level of evidence). Experts recognize that this is the first edition and will change with future understanding and research. The broad application of this classification could have value for brace research, education, clinical practice, and growth in this field.

Loss of body height is observed in patients with idiopathic scoliosis (IS) due to spine curvatures. The study compared pulmonary parameters obtained from spirometry examination considering the measured versus the corrected body height. One hundred and twenty adolescents with Lenke type 1 or 3 IS who underwent preoperative spirometry examination and radiographic evaluation were enrolled. The mean thoracic Cobb angle was 68° ± 12.6, range 48–102°. The difference between the measured and the corrected body height increased with the greater Cobb angle. Using the corrected body height instead of the measured body height significantly changed the predicted values of pulmonary parameters and influenced the interpretation of the pulmonary testing results.

This study aimed to compare the Italian Spine Youth Quality of Life Questionnaire (ISYQOL-PL) versus the Scoliosis Research Society-22 (SRS-22) questionnaire scores evaluating the validity of the concurrent and known-groups. Eighty-one girls (mean age 13.5 ± 1.8 years) with idiopathic scoliosis (IS) with a mean Cobb angle of 31.0 (±10.0) degrees were examined, all treated with a corrective TLSO brace for an average duration of 2.6 (±1.9) years. The patients’ scores were compared as follows: (1) age: ≤13 years vs. &gt, 13 years), (2) scoliosis severity: mild (Cobb angle 10–30°) vs. moderate (Cobb angle &gt, 30°), (3) single curve pattern vs. double curve pattern. Lin’s concordance correlation coefficient was used to evaluate the strength of the association between ISYQOL-PL and SRS-22 scores. T-tests were applied to assess if the ISYQOL-PL measure and SRS-22 total score were significantly different in the different groups of patients. The concurrent validity analysis showed a moderate correlation (Lin pccc = 0.47). The ISYQOL-PL showed a significantly better quality of life in mild than moderate scoliosis. The severity of scoliosis but not the age or the curve pattern demonstrated a direct statistically significant effect on patients’ quality of life only when evaluated using the ISYQOL-PL.

Body posture develops during the growing period and can be documented using trunk photography. The study aims to evaluate the body posture in children aged 7–10 years undergoing a dedicated physical activities program versus regular school sport. A total of 400 children, randomly chosen from a cohort of 9300 participating in a local scoliosis screening program, were evaluated twice at a one-year interval. A total of 167 children were involved in regular school sport (control group), while 233 received both school sport and a dedicated physical activities program (intervention group). Standardized photographic habitual body posture examination was performed at enrollment (T0) and one-year after (T1). Sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), chest inclination (CI), and head protraction (HP) were measured. At T0, the body posture parameters did not differ between groups. At T1 in the controls, all five parameters tended to deteriorate (insignificant): SS p = 0.758, LL p = 0.38, TK p = 0.328, CI p = 0.081, and HP p = 0.106. At T1 in the intervention group, the SS decreased (p = 0.001), the LL tended to decrease (p = 0.0602), and the TK, CI, and HP remained unaltered. At T1, the SS and LL parameter differed between groups statistically (p = 0.0002 and p = 0.0064, respectively) and clinically (2.52° and 2.58°, respectively). In 7–10-year-old children, participation in dedicated physical activities tends to improve their body posture compared to regular school sport.

Idiopathic scoliosis (IS) etiology remains unclear, but strong genetic background is suggested. Previously reported TIMP2 study indicates an association of genic rs8179090 with IS progression in a Han Chinese population. However, there has been a lack of investigation into intragenic TIMP2 polymorphisms in IS patients. We recruited 100 Caucasian females with IS and 100 controls. Patients were subdivided accordingly to: progression rate, curve severity, joint mobility, and curve pattern. Allele-specific-polymerase chain reaction based on fluorescence resonance energy transfer was applied to evaluate nine TIMP2 polymorphisms. Distribution of genotype and allele frequency in only one polymorphism (rs11658743) differed in case-control study. Four of the polymorphisms (rs2277700, rs11077401, rs2376999, and rs4789934) showed non-equal distributions either in genotype or/and allele distributions in the patients of different progression rates. The rs11077401 was related to curve severity patients distinction and the rs8179090 distinguished patients with different joint mobility level. Two polymorphisms either differed statistically in case of curve patterns subgrouping (rs8068674 and rs8179090) or showed a slight tendency toward significance in the recessive model of allele distributions (rs9916809 and rs8179090). The remaining two polymorphisms (rs2377005, rs11658743) showed no association with either clinical or radiographic IS characteristics. The influence of the G allele of the rs8179090 on the clinical course of IS has not yet been confirmed. We identified four TIMP2 polymorphisms (rs11077401, rs2376999, rs2277700, and rs4789934) that were associated with a higher risk of the progressive IS form. Further genetic association studies based on suggested clinical criteria would be necessary to validate TIMP2 polymorphisms associated with the curve progression. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2217-2225, 2019.

The study aimed to determine the impact of 6-month rigid brace on back muscle strength and endurance in adolescents with idiopathic scoliosis. Sixty–one girls, aged 7.0–16.0, were analyzed in two groups: the study group (6–month rigid brace wear) vs. the control group (no brace treatment), recruited consecutively and matched for age, body height, weight, BMI, primary curve location and Cobb angle. All patients underwent clinical and radiological examination, modified Biering–Sorensen test, prone and standing maximum strength and endurance tests. No significant difference between groups in back muscles strength or endurance, both gobal and reported to body weight was found. No relation between the daily brace time and the back muscle strength or endurance was observed. The 6–month use of a rigid brace did not affect the strength or endurance of the back muscles in adolescent girls treated for idiopathic scoliosis.

A standing body height is a variable used to calculate pulmonary parameters during spirometry examination. In adolescents with idiopathic scoliosis, the loss of the body height is observed, and it may potentially influence the results of pulmonary testing. The study aimed to analyze pulmonary parameters in adolescents with idiopathic scoliosis in relation to the measured versus the corrected body height. Preoperative pulmonary testing and radiographic evaluation were performed in 39 children (29 females, 10 males) aged 12–17 years. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were measured. The single best effort was analyzed. Thoracic Cobb angle ranged 50°–104°. Corrected body height was calculated according to the Stokes’ formula. The subgroup analysis was performed for the subjects with curves 50°–74° (N=26) versus 75°–104° curves (N=13). Mean measured body height was 166.1±9.0 cm versus 168.9±8.9 cm mean corrected body height. The %FVC obtained for the measured height was significantly higher than obtained for the corrected height: 84.6% ±15.6 vs. 81.6% ±15.6, p

The Global Lung Function Initiative (GLI 2012) presented multi-ethnic spirometry reference values that are recommended to be used instead previous Zapletals’ reference values. The study aimed to compare the values of the pulmonary parameters calculated according to the Zapletals’ versus the GLI 2012 reference values in adolescents with idiopathic scoliosis. Preoperative pulmonary testing and radiographic evaluation were performed in 39 adolescents (29 females, 10 males) aged 12–17 years. The thoracic Cobb angle ranged 50°–104°. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were measured. The percentages of predicted values of FVC (%FVC) and the FEV1 (%FEV1) were calculated according to the Zapletals’ reference values and to the GLI 2012 reference values. The subgroup analysis was performed for the subjects with Cobb curve 50°–74° (N=26) versus the subjects with Cobb curve 75°–104° (N=13). Mean %FVC was significantly higher using the Zapletals’ reference values 86.1%±16.4 versus 84.6%±15.6 using the GLI 2012 reference values, p=0.0116. Mean %FEV1 was significantly higher using the Zapletals’ reference values 84.5%±18.2 versus 80.0%±16.3 using GLI 2012 reference values, p=0.000001. The subgroup analysis revealed significant difference of %FVC in moderate (p=0.033974) and no difference in severe curves (p=0.1993). The %FEV1 differences were significant in both moderate (p=0.000011) and severe curves (p=0.0334). The study demonstrated that a significant difference might be observed in the spirometry parameters due to the applied reference values. These differences might be taken into account during the spirometry examination interpretation.

The aim of the study is to evaluate the morphology of the intervertebral discs visible in the magnetic resonance image in patients with sudden severe low back pain (with or without radiation of pain to the lower limb). The second goal of the study is to perform a digital three-plane reconstruction of the intervertebral disc and to compare this technique with a standard magnetic resonance imaging test. Twenty-five patients, mean age 35.5 years, all with acute low back pain, were examined. We compared the 3D MR models with standard MRI scans by measuring seven MRI parameters. In patients with sudden, severe low back pain, with clinical symptoms suggesting an etiology within the intervertebral disc, changes in a standard MRI are found consisting of the presence of a hernia / protrusion of the intervertebral disc and lowering the height of the intervertebral disc – with lowering the disc height occurs to a greater extent in the rear section. The 3D reconstruction is a reliable 3D representation of the intervertebral disc and adjacent vertebral bodies.

Idiopathic scoliosis (IS) is a multifactorial disease with epigenetic modifications. Tissue dependent and differentially methylated regions (T-DMRs) may regulate tissue-specific expression of the estrogen receptor 1 gene (ESR1). This study aimed to analyze methylation levels within T-DMR1 and T-DMR2 and its concatenation with ESR1 expression of IS patients. The study involved 87 tissue samples (deep paravertebral muscles, both on the convex and the concave side of the curve, and from back superficial muscles) from 29 girls who underwent an operation due to IS. Patient subgroups were analyzed according to Cobb angle ≤70° vs. &gt, 70°. Methylation was significantly higher in the superficial muscles than in deep paravertebral muscles in half of the T-DMR1 CpGs and all T-DMR2 CpGs. The methylation level correlated with ESR1 expression level on the concave, but not convex, side of the curvature in a majority of the T-DMR2 CpGs. The T-DMR2 methylation level in the deep paravertebral muscles on the curvature’s concave side was significantly lower in patients with a Cobb angle ≤70° in four CpGs. DNA methylation of the T-DMRs is specific to muscle tissue location and may be related to ESR1 expression regulation. Additionally, the difference in T-DMR2 methylation may be associated with IS severity.

Context: Female football is becoming an increasingly popular women’s team sports discipline around the world. The Women’s Football Committee in the Polish Football Association has developed a long-term strategic plan to popularize the discipline across the country and enhance girls’ participation. On one hand, it is postulated to increase the number of female footballers, and on the other hand, it is crucial to decrease the number of girls quitting football prematurely. Objective: To find the reasons for sports career termination among female football players. Design: Cross-sectional with retrospective information about reasons of career termination. Setting: Online questionnaire was filled out by online access. Participants: Ninety-three former female footballers. Main Outcome Measures: Factors leading to career termination. Methods: Participants completed the online questionnaire. The analysis was performed referring to 2 groups: “injury group”—in which the injury was the main reason for quitting football, and “other group”—in which the female player stopped playing football due to all other factors. Results: Thirty percent of former Polish female football players terminated their career due to a long-term treatment for an injury. Over 27% (27.7%) females had ended their careers because they were not able to reconcile sports with work/studying. Over 10% (10.8%) of former football players reported that becoming a wife and/or mother was the reason for career termination. Losing motivation and interest in the sport was reported by 9.2% (n = 6) of present study participants who decided to terminate the career due to noninjury reasons. Conclusions: The results clearly show that more effort is needed to support female football players, especially after an injury, so that they do not quit the sport voluntarily.

Background The CHD7 (chromosome domain helicase DNA binding protein 7) gene has been associated with familial idiopathic scoliosis (IS) in families of European descent. The CHD7 single-nucleotide polymorphisms have never been studied in Polish Caucasian IS patients. Methods The aim of this study was to investigate the relationship of CHD7 gene polymorphisms with susceptibility to or progression of IS in Polish Caucasian females. The study group comprised 211 females who underwent clinical, radiological and genetic examination. The study group was analyzed in three subgroups according to: (1) Cobb angle (Cobb angle ≤30° vs. Cobb angle ≥35°), (2) age of diagnosis (adolescent IS vs. early-onset IS) and (3) rate of progression (non-progressive vs. slowly progressive vs. rapidly progressive IS). The control group comprised 83 females with no scoliosis and with a negative family history who underwent clinical and genetic examination. In total six CHD7 gene polymorphisms were examined. Three polymorphisms (rs1017861, rs13248429, and rs4738813) were examined by RFLP (restriction fragment length polymorphism) analysis, and three were quantified by Sanger sequencing (rs78874766, rs4738824, and rs74797613). Results In rs13248429, rs78874766, and rs74797613 polymorphisms only the wild allele was present. The rs1017861 polymorphism demonstrated an association with IS susceptibility (p p CHD7 gene showed any association with the age of IS onset. Conclusions The polymorphism rs1017861 in CHD7 gene showed an association with IS susceptibility. Two polymorphisms (rs1017861 and rs4738813) were associated with curve severity and progression rate. None of the evaluated polymorphisms in CHD7 gene showed any association with the age of IS onset. Further evaluation of CHD7 gene should be considered as IS modifying factor.

The aim of this work was to analyze postural stability of girls having progressive form of idiopathic scoliosis and undergoing specific period of the adolescent growth spurt. Twenty-seven girls, aged 13.4 ± 1.2 years, presenting structural idiopathic scoliosis, thoracic or thoracolumbar pattern, radiological Cobb angle 41.7 ± 17.4° (study group) and 37 healthy girls (control group) were included. The groups were sex, age, height, weight, and BMI matched. Postural stability examination was performed using two stabilometric platforms with visual control (eyes open) at three stages: (1) both legs’ stance, (2) left leg stance, and (3) right leg stance. The Center of Pressure (COP) sway path length, the area and the displacement amplitude were compared. For the double stance, no difference in postural stability parameters between the groups was found. However, for the right leg stance, the total sway path length was longer (p=0.04) and the mean amplitude of the lateral COP displacement was increased (p=0.03) in the scoliotic group. In conclusion, for double stance, the adolescent girls with progressive form of idiopathic scoliosis revealed fair postural stability compared to control group. An impaired postural control was observed during right leg stance.

Introduction. SUPERknee procedure (SK) is a treatment for complex knee instability in children with congenital deformations. Due to wide surgical approach and long time of surgery (ST) the skin around the knee is in risk of ischemic necrosis (SN) or healing complications (HC). Aim. The purpose of the study is to compare incidence of SN in SK using typical and modified approach.Material and Methods. Sixteen patients underwent SK since 2015 till 2016, in mean age 8.1 (4.3–12.7) y.o. In 8 cases SK and in 8 SK combined with SUPERhip (SK+SH) was performed. In 6 patients (3 SK and 3 SK+SH) the approach was performed from one incision (OIA). In 10 patients (5 SK and 5 SK+SH) a modified approach was performed, involving additional skin incision (DIA). The occurrence of SN, ST and risk factors of HC were evaluated. Results. SN appeared in 2 cases treated with OIA (33%). There was no SN in DIA (0%). With this number of patients the difference was below level of significance, p = 0.1250, OR = 11.7. In one patient treated with SK+SH area of SN was 17.5 cm2. In the other patient treated with SK 35 cm2. Mean ST in SK was 3.4h (2.5–4.0) and in SK+SH 4.6h (4.0–5.5). ST of the surgery with OIA was 4.1h (2.5–5.5) and in DIA 3.7h (3.0–4.5), p = 0.4746. No additional risk factor relevant to SN was found. Keywords: SUPERknee, SUPERhip, super knee, super hip, healing complications, skin necrosis.

The ever increasing epidemics of overweight and obesity in school children may be one of the reasons of the growing numbers of children with incorrect body posture. The purpose of the study was the assessment of the prevalence of incorrect body posture in children and adolescents with overweight and obesity in Poznań, Poland. The population subject to study consisted of 2732 boys and girls aged 3–18 with obesity, overweight, and standard body mass. The assessment of body mass was performed based on BMI, adopting Cole’s cutoff values. The evaluation of body posture was performed according to the postural error chart based on criteria complied by professor Dega. The prevalence rates of postural errors were significantly higher among children and adolescents with overweight and obesity than among the group with standard body mass. In the overweight group, it amounted to 69.2% and in the obese group to 78.6%. Conclusion: The most common postural deviations in obese children and adolescents were valgus knees and flat feet. Overweight and obesity in children and adolescents, predisposing to higher incidence of some types of postural errors, call for prevention programs addressing both health problems. What is Known: • The increase in the prevalence of overweight and obesity among children and adolescents has drawn attention to additional health complications which may occur in this population such as occurrence of incorrect body posture. What is New: • The modified chart of postural errors proved to be an effective tool in the assessment of incorrect body posture.• This chart may be used in the assessment of posture during screening tests and prevention actions at school.

BACKGROUND Body height (BH) measurement is an important part of the clinical evaluation of children with idiopathic scoliosis (IS) as its progression is defined based on the observation of a growth spurt. OBJECTIVE The aim of the study is to assess diurnal variation of BH in children with IS. METHODS BH was measured in 98 children with IS (Cobb angle: 10∘-52∘, mean 21.2∘± 9.9∘) both in standing and sitting position. The measurements were performed 4 times a day - between: (1) 7:00 and 8:00; (2) 11:00 and 12:00; (3) 15:00 and 16:00 and (4) 19:00 and 20:00. RESULTS A significant decrease in BH during the day was observed in both standing and sitting positions (p< 0.001). The highest decrease in height was observed between the measurements performed between 7:00 and 8:00 and measurements carried out in the evening (19:00-20:00). For standing, the mean loss of height was 0.7 cm (± 0.7), i.e. 0.43% of initial standing height, for sitting the mean decrease in height was 0.7 cm (± 0.7), i.e. 0.79% of initial sitting height. CONCLUSIONS BH decreases in children with IS during daytime. Due to diurnal BH variation, the time of the day should be recorded when measuring patients with IS.

The study introduces a novel method for automatic segmentation of vertebral column tissue from MRI images. The paper describes a method that combines multiple stages of Machine Learning techniques to recognize and separate different tissues of the human spine. For the needs of this paper, 50 MRI examinations presenting lumbosacral spine of patients with low back pain were selected. After the initial filtration, automatic vertebrae recognition using Cascade Classifier takes place. Afterwards the main segmentation process using the patch based Active Appearance Model is performed. Obtained results are interpolated using centripetal Catmull–Rom splines. The method was tested on previously unseen vertebrae images segmented manually by 5 physicians. A test validating algorithm convergence per iteration was performed and the Intraclass Correlation Coefficient was calculated. Additionally, the 10-fold cross-validation analysis has been done. Presented method proved to be comparable to the physicians (FF=90.19±1.01%). Moreover results confirmed a proper algorithm convergence. Automatically segmented area correlated well with manual segmentation for single measurements (r¯=0.8336) and for average measurements (r¯=0.9068) with p=0.05. The 10-fold cross-validation analysis (FF=91.37±1.13%) confirmed a good model generalization resulting in practical performance.

Background The physiological sagittal spinal curvature represents a typical feature of good body posture in the sagittal plane. The cervical and the lumbar spine are curved anteriorly (lordosis), while the thoracic segment is curved posteriorly (kyphosis). The pelvis is inclined anteriorly, and the lower limbs’ joints remain in a neutral position. However, there are many deviations from the optimal body alignment. The aim of this paper is to present the most common types of non-structural misalignments of the body posture in the sagittal plane. Main body of the abstract The most common types of non-structural misalignments of body posture in the sagittal plane are as follows: (1) lordotic, (2) kyphotic, (3) flat-back, and (4) sway-back postures. Each one may influence both the skeletal and the muscular system leading to the functional disturbance and an increased strain of the supporting structures. Usually, the disturbances localized within the muscles are analyzed in respect to their shortening or lengthening. However, according to suggestions presented in the literature, when the muscles responsible for maintaining good body posture (the so-called stabilizers) are not being stimulated to resist against gravity for an extended period of time, e.g., during prolonged sitting, their stabilizing function is disturbed by the hypoactivity reaction resulting in muscular weakness. The deficit of the locomotor system stability triggers a compensatory mechanism—the stabilizing function is overtaken by the so-called mobilizing muscles. However, as a side effect, such compensation leads to the increased activity of mobilizers (hyperactivity) and decreased flexibility, which may finally lead to the pathological chain of reaction within the musculoskeletal system. Conclusions There exist four principal types of non-structural body posture misalignments in the sagittal plane: lordotic posture, kyphotic posture, flat-back posture, and sway-back posture. Each of them can disturb the physiological loading of the musculoskeletal system in a specific way, which may lead to a functional disorder. When planning postural corrective exercises, not only the analysis of muscles in respect to their shortening and lengthening but also their hypoactivity and hyperactivity should be considered.

Medical imaging is a set of specific examination procedures taking advantage of physical effects for determination of changes that occurred in patient’s body. It’s a domain of biomedical engineering to define the methods of acquiring, analyzing and visualizing medical images in the way useful for diagnostic, therapeutic, educational or research purposes. This work describes an effective method of automatic creation of 3D objects from the DICOM images. At the beginning DICOM images are read. Then tissues are segmented with a simple thresholding algorithm and filtered. After filtering preliminary 3D model is created. Afterwards obtained geometry is smoothed and decimated to relax the model and reduce the size of data. Such prepared model is embedded into PDF file with use of additional scripts. As the result of this work software called DICOM2PDF3D, combining described above stages of building 3D model in a single procedure, was developed. With use of 3D PDF additional measurements of created geometry were made. Measurements confirmed values obtained from standard preoperative evaluation. The presented solution allows creating and opening three-dimensional visualizations on every desktop computer even by inexperienced users. Created 3D PDF can be used for preoperative evaluation as an assistance for standard procedures.

Background The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) produced its first guidelines in 2005 and renewed them in 2011. Recently published high-quality clinical trials on the effect of conservative treatment approaches (braces and exercises) for idiopathic scoliosis prompted us to update the last guidelines’ version. The objective was to align the guidelines with the new scientific evidence to assure faster knowledge transfer into clinical practice of conservative treatment for idiopathic scoliosis (CTIS). Methods Physicians, researchers and allied health practitioners working in the area of CTIS were involved in the development of the 2016 guidelines. Multiple literature reviews reviewing the evidence on CTIS (assessment, bracing, physiotherapy, physiotherapeutic scoliosis-specific exercises (PSSE) and other CTIS) were conducted. Documents, recommendations and practical approach flow charts were developed using a Delphi procedure. The process was completed with the Consensus Session held during the first combined SOSORT/IRSSD Meeting held in Banff, Canada, in May 2016. Results The contents of the new 2016 guidelines include the following: background on idiopathic scoliosis, description of CTIS approaches for various populations with flow-charts for clinical practice, as well as literature reviews and recommendations on assessment, bracing, PSSE and other CTIS. The present guidelines include a total of 68 recommendations divided into following topics: bracing (n = 25), PSSE to prevent scoliosis progression during growth (n = 12), PSSE during brace treatment and surgical therapy (n = 6), other conservative treatments (n = 2), respiratory function and exercises (n = 3), general sport activities (n = 6); and assessment (n = 14). According to the agreed strength and level of evidence rating scale, there were 2 recommendations on bracing and 1 recommendation on PSSE that reached level of recommendation “I” and level of evidence “II”. Three recommendations reached strength of recommendation A based on the level of evidence I (2 for bracing and one for assessment); 39 recommendations reached strength of recommendation B (20 for bracing, 13 for PSSE, and 6 for assessment).The number of paper for each level of evidence for each treatment is shown in Table 8. Conclusion The 2016 SOSORT guidelines were developed based on the current evidence on CTIS. Over the last 5 years, high-quality evidence has started to emerge, particularly in the areas of efficacy of bracing (one large multicentre trial) and PSSE (three single-centre randomized controlled trials). Several grade A recommendations were presented. Despite the growing high-quality evidence, the heterogeneity of the study protocols limits generalizability of the recommendations. There is a need for standardization of research methods of conservative treatment effectiveness, as recognized by SOSORT and the Scoliosis Research Society (SRS) non-operative management Committee. Electronic supplementary material The online version of this article (10.1186/s13013-017-0145-8) contains supplementary material, which is available to authorized users.

Background Digital photogrammetry provides measurements of body angles or distances which allow for quantitative posture assessment with or without the use of external markers. It is becoming an increasingly popular tool for the assessment of the musculoskeletal system. The aim of this paper is to present a structured method for the analysis of posture and its changes using a standardized digital photography technique. Material and methods The purpose of the study was twofold. The first one comprised 91 children (44 girls and 47 boys) aged 7–10 (8.2 ± 1.0), i.e., students of primary school, and its aim was to develop the photographic method, choose the quantitative parameters, and determine the intraobserver reliability (repeatability) along with the interobserver reliability (reproducibility) measurements in sagittal plane using digital photography, as well as to compare the Rippstein plurimeter and digital photography measurements. The second one involved 7782 children (3804 girls, 3978 boys) aged 7–10 (8.4 ± 0.5), who underwent digital photography postural screening. The methods consisted in measuring and calculating selected parameters, establishing the normal ranges of photographic parameters, presenting percentile charts, as well as noticing common pitfalls and possible sources of errors in digital photography. Results A standardized procedure for the photographic evaluation of child body posture was presented. The photographic measurements revealed very good intra- and inter-rater reliability regarding the five sagittal parameters and good reliability performed against Rippstein plurimeter measurements. The parameters displayed insignificant variability over time. Normative data were calculated based on photographic assessment, while the percentile charts were provided to serve as reference values. The technical errors observed during photogrammetry are carefully discussed in this article. Conclusions Technical developments are allowed for the regular use of digital photogrammetry in body posture assessment. Specific child positioning (described above) enables us to avoid incidentally modified posture. Image registration is simple, quick, harmless, and cost-effective. The semi-automatic image analysis, together with the normal values and percentile charts, makes the technique reliable in terms of child’s posture documentation and corrective therapy effects’ monitoring. Electronic supplementary material The online version of this article (10.1186/s13013-017-0146-7) contains supplementary material, which is available to authorized users.

SOSORT is an international scientific society interested in spinal deformities, including idiopathic scoliosis (IS). One of the main tasks of the society is to provide diagnostic and therapeutic recommendations for all professionals involved in the conservative treatment of patients with IS.As a part of treatment of scoliosis we distinguished conservative and surgical treatment. The main purpose of the conservative treatment is to stop the progression of the curvature. The aim of the therapy is to improve the quality of life, improve the aesthetics and physical capacity as well. An important element of the conservative treatment is thephysiotherapy, which can be used as independent part of treatment and as a support of brace and the surgical treatment. SOSORT recommends the use of physiotherapy in the form of Physiotherapeutic Specific Exercises (PSE) and the Special Inpatient Rehabilitation (SIR). PSE used in patients with SI must have confirmed efficacy according to the requirements ofthe Evidence Based Medicine. Moreover, the therapy should be selected individually and include: (1) three dimensional auto-correction of deformation, (2) training in activities of daily living, (3) stabilizing the corrected posture, and (4) education of the patient and her/his parents. SIR based on 3-4-week hospital or sanatorium stay is recommended especially at the beginning of the treatment process.Physiotherapists undertaking the work with children with IS should: (1) be qualified in the use of PSE, (2) have adequate experience in techniques used in pediatric orthopedics, (3) have the ability to analyze the variability of body posture during development, (4) have the ability to exercise choice depending on the stages of formation of motor skills, and (5)work in the therapeutic team led by physician supervising the treatment.

Introduction Postural disorders are classified as simple, often called faulty posture, and complex, which are associated with spine curvature disorders. Postural disorders correctable with passive and active correction need to be distinguished from severe spinal disorders such as idiopathic scoliosis, Scheuermann's disease and congenital spine deformities. Aim The aim of this research was to prove the necessity of combined clinical and instrumental examination in the diagnosis of trunk deformities. Material and methods Trunk abnormalities and deformities in the developmental age affect approximately 50%–60% of population, depending on the region of Poland. In this study, clinical and instrumental diagnosis of trunk deformities was analyzed. Results Clinical assessment with the use of instrumental methods is fundamental in diagnosis of trunk deformities. Causes of faulty posture need to be identified, both in terms of location within the musculoskeletal system and etiology, and pathologies that require different diagnostic and therapeutic approaches need to be excluded. Discussion Diagnosis of the cause of faulty posture is frequently possible only after a clinical and instrumental evaluation is performed. It results in isolating a group of children with structural deformities of musculoskeletal system that require a separate, specific treatment, from a group of children with postural disorders that require physiotherapy. Conclusions There is a need for implementing combined clinical and instrumental examination in the diagnosis of trunk deformities in the developmental age.

Objective To measure the sensitivity and specificity of differences cut-off values for isokinetic Hcon/Qcon ratio in order to improve the capacity to evaluate (retrospectively) the injury of hamstring muscles in professional soccer screened with knee isokinetic tests. Design Retrospective study. Methods Medical and biomechanical data of professional football players playing for the same team for at least one season between 2010 and 2016 were analysed. Hamstring strain injury cases and the reports generated via isokinetic testing were investigated. Isokinetic concentric(con) hamstring(H) and quadriceps(Q) absolute strength in addition with Hcon/Qcon ratio were examined for the injured versus uninjured limbs among injured players, and for the injured and non-injured players. 2 x 2 contingency table was used for comparing variables: predicted injured or predicted uninjured with actual injured or actual uninjured. Sensitivity, specificity, accuracy, positive and negative predictive values, and positive and negative likelihood ratio were calculated for three different cut-off values (0.47 vs. 0.6 vs. 0.658) to compare the discriminative power of an isokinetic test, whilst examining the key value of Hcon/Qcon ratio which may indicate the highest level of ability to predispose a player to injury. McNemar’s chi2 test with Yates’s correction was used to determine agreement between the tests. PQStat software was used for all statistical analysis, and an alpha level of p

Morphological analysis of the scoliotic spine is based on two-dimensional X-rays: coronal and sagittal. The three-dimensional character of scoliosis has raised the necessity for analyzing scoliosis in three planes. We proposed a new user-friendly method of graphical presentation of the spine in the third plane–the Spine Axial Presentation (SAP). Eighty-five vertebrae of patients with scoliosis were analyzed. Due to different positions during X-rays (standing) and computer tomography (CT) (supine), the corresponding measurements cannot be directly compared. As a solution, a software creating Digital Reconstructed Radiographs (DRRs) from CT scans was developed to replace regular X-rays with DRRs. Based on the measurements performed on DRRs, the coordinates of vertebral bodies central points were defined. Next, the geometrical centers of vertebral bodies were determined on CT scans. The reproducibility of measurements was tested with Intraclass Correlation Coefficient (ICC), using p = 0.05. The intra-observer reproducibility and inter-observer reliability for vertebral body central point’s coordinates (x, y, z) were high for results obtained based on DRRs and CT scans, as well as for comparison results obtained based on DRR and CT scans. Based on two standard radiographs, it is possible to localize vertebral bodies in 3D space. The position of vertebral bodies can be present in the Spine Axial Presentation.

Background First author attempted to analyse medical records of patients with idiopathic scoliosis for compliance with the Scoliosis Research Society brace studies criteria. A retrospective analysis of medical records of 2705 girls treated from 1989 to 2002 was carried out. Methods Age, Cobb, Risser and menarchal status were analyzed for compliance with the Scoliosis Research Society brace studies criteria: a) age ≥10 years, b) Risser 0–2, c) 25–40° Cobb angle, d) no earlier treatment, e) patients before first menses or not more than one year from first menses. Results It has been found that 183 girls out of 2705 were ≥10 years old and in the range 25–40° Cobb angle. One hundred two out of 2705 patients revealed eligible for brace effectiveness study according to SRS 2005 criteria. 120 out of 2705 patients revealed eligible for brace brace effectiveness study according to SRS-SOSORT 2014 criteria. Conclusion The excluded patients revealed too old or with too significant Cobb angles. This indicates the changing criteria for scoliosis brace treatment over the time. Direct comparison of current results of brace treatment with historical series of cases turns out to be very difficult.