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Background: Children with adolescent idiopathic scoliosis (AIS) have reduced quality of life related to poor self-image, perhaps because of cosmetic concerns. However, there has not been a large-database epidemiologic study on the association between psychiatric disorders and scoliosis.Questions/purposes: Using the Korean National Health Insurance database, we asked: (1) How common are psychiatric disorders among children with AIS? (2) After controlling for gender, age, insurance type, and residential district, are psychiatric disorders more common among children with AIS than among age-matched controls?Methods: A retrospective analysis was conducted using sample datasets from the Health Insurance Review and Assessment Service from 2012 to 2016, which is a 10% randomly extracted sample of total inpatients and outpatients each year. The mean number of total patients in each dataset was 1,047,603 ± 34,534. The mean number of children with AIS was 7409 ± 158 for each year. The age criteria was 10 to 19 years for the matching. Mood disorders, anxiety disorders, and behavioral disorders were selected as disorders possibly associated with AIS. We identified children with AIS who had any of the disorders above, and we obtained the prevalence of these disorders based on diagnostic codes. As an exploratory analysis, clinically meaningful variables were selected among the available codes in the dataset, and a univariable logistic regression test was performed for each variable. A multivariable logistic regression test with advanced variables was performed to identify the adjusted odds ratios of psychiatric disorders in children with AIS.Results: The median (range) prevalence of psychiatric disorders in children with AIS from 2012 to 2016 was 7% (6% to 7%). Compared with children who did not have AIS, and after controlling for gender, age, insurance type, and residential district, children with AIS were more likely to have psychiatric disorders in all 5 years. The adjusted ORs of psychiatric disorders in children with AIS compared with children who did not have AIS ranged from 1.47 to 1.74 (2012: OR 1.60 [95% CI 1.46 to 1.75]; p < 0.001; 2013: OR 1.73 [95% CI 1.58 to 1.89]; p < 0.001; 2014: OR 1.74 [95% CI 1.59 to 1.91]; p < 0.001; 2015: OR 1.71 [95% CI 1.56 to 1.88]; p < 0.001; 2016: OR 1.47 [95% CI 1.33 to 1.62]; p < 0.001).Conclusion: Considering the higher prevalence of psychiatric disorders in children with AIS compared with children who did not have AIS, children with AIS and their parents should be counseled about the increased risk of deteriorating mental health of the patients, and surgeons should provide early referral to pediatric psychiatrists. Further studies should investigate the effect of the factors related to AIS, such as curve type, Cobb angle, and treatment modality.Level Of Evidence: Level III, prognostic study. [ABSTRACT FROM AUTHOR]

Background: Falls are a major factor contributing to fragility fractures. Patients with lumbar spinal stenosis have an increased risk of falling. We are aware of no prior report demonstrating the effect of medical treatment and decompression surgery on the risk of patients with lumbar spinal stenosis falling. Methods: From June to November 2011, seventy-six patients were enrolled into the surgery group and fifty patients, into the nonoperative group. Four functional mobility tests, including the Alternate-Step test, Six-Meter Walk test, Sit-to-Stand test, and timed "Up&Go" test,wereused toevaluate therisk of falling. The Oswestry Disability Index (ODI) and the EuroQoL-5D (EQ-5D) visual analog scale (VAS) were utilized to assess clinical improvement. Results: The mean age was 62.4 years in the surgery group and 64.6 years in the nonoperative group. The results of the Alternate-Step test significantly improved during the follow-up period in the surgery group (p = 0.001). However, the results of the Alternate-Step test significantly worsened during the follow-up period in the nonoperative group (p = 0.001). Comparison between the two groups showed more significant improvement in the surgery group, especially for the Six- Meter Walk test at one year postoperatively (p = 0.042) and for the timed "Up & Go" test at three months and one year (p = 0.046 and 0.000). However, the ODI and EQ-5D VAS scores improved in both groups. In a linear mixed model, age, surgery, and the presence of an osteoporotic compression fracture significantly affected the test results related to the risk of falling (p < 0.05). Conclusions: The surgery group showed a greater decrease in the risk of falling than those in the nonoperative group. Improved physical performance, including walking and balancing, after decompression lumbar spinal surgery reduces the future risk of falling. Level of Evidence: Therapeutic Level II. Retrospective analysis of prospectively collected data. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: While most studies of Duchenne muscular dystrophy scoliosis focus on technical and radiographic indices, functional status is amore important factor to consider in themanagement of Duchenne muscular dystrophy. The objectives of the current study were to compare the pulmonary function, radiographic outcome, and functional recovery, with use of validated questionnaires, in surgically and nonsurgically treated patients with Duchenne muscular dystrophy who have scoliosis. Methods: Sixty-six patients (forty treated surgically and twenty-six treated nonsurgically) with aminimumfollow-up of two years were included in this study. Forced vital capacity, radiographic parameters (the Cobb angle, lordosis, and pelvic obliquity), and functional status, according to the modified Rancho scale and manual muscle test, were measured preoperatively and at the time of the final follow-up. TheMuscular Dystrophy Spine Questionnaire (MDSQ) was completed at the final follow-up evaluation. Results: Pulmonary function, functional scores (manual muscle test and modified Rancho scale), and radiographic measurements, except for lordosis, were similar for both groups at the time of the initial consultation (p > 0.05). At the time of the final follow-up, all radiographic parameters were significantly improved in the surgical group compared with the nonsurgical group. The mean score (and standard deviation) on the manual muscle test was not significantly different between the surgical and nonsurgical groups (23.2 ± 8.3 versus 22.8 ± 6.3; p = 0.828). The mean score on the modified Rancho scale also showed similar results in the groups (3.9 ± 0.3 and 4.04 ± 0.3, respectively; p = 0.088). The surgical group had higher mean MDSQ scores than the nonsurgical group (35.1 ± 14.7 and 26.9 ± 9.9, respectively; p = 0.008). Both groups showed a decrease in forced vital capacity at the time of the final follow-up, but the deterioration of forced vital capacity was significantly slower (p = 0.035) in the surgical group (268 ± 361 mL) than in the nonsurgical group (536 ± 323 mL). Conclusions: Surgery in patients who had Duchenne muscular dystrophy with scoliosis improved function and decreased the rate of deterioration of forced vital capacity compared with patients treated conservatively. However, the muscle power and forced vital capacity decreased in both groups. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

The article presents a research study that examined the effect of anabolic growth factors in rabbit nucleus pulposus cells cultured in atelocollagen type I and type II. The tissue-engineered intervertebral disc (IVD) implanted into the degenerative lesion has emerged a promising therapeutic approach because it may restore the structure and function of degenerated IVD. The nutritional environment of IVD renders a challenge to implanted engineered IVD tissue.

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The article examines the biologic effect of "cocktail" therapeutic gene transfer to human intervertebral disc (IVD) cells in three-dimensional cultures. An in vitro experiment was conducted using human IVD cells and adenovirus-therapeutic gene constructs. The article shows that a combination or "cocktail" gene therapy offers a promising mechanism for maximizing matrix synthesis with low dose of adenoviral mixtures, circumventing systemic, local toxic effect, and immune response.

STUDY DESIGN.: The study involves an in vitro experiment using human ligamentum flavum (LF), adenovirus lacZ construct (Ad/lacZ), and recombinant human bone morphogenetic protein-2 (BMP-2). OBJECTIVES.: To demonstrate the feasibility of marker gene transfer to human LF cells and the effect of BMP-2 on the osteogenic differentiation of human LF cells. SUMMARY OF BACKGROUND DATA.: BMP-2 is a widely known pivotal osteoinductive agent. Clinically and experimentally, BMP-2 has proven to be an effective in spinal fusion. Degenerated LF has only been implicated to be of pathophysiological significance in spinal stenosis. However, biologic modifications of LF to enhance osteogenesis have not been attempted previously. MATERIALS AND METHODS.: Human LF and cancellous bone from the ilium were harvested from patients with lumbar spinal stenosis. LF cells and osteoblasts were isolated and cultured, and adenovirus lacZ construct (Ad/ lacZ), luciferase construct (Ad/luciferase), and BMP-2 were designed and produced. LF cell cultures were then exposed to various concentrations of Ad/lacZ (25, 50, 75, 100, 150 multiplicity of infection) and BMP-2 (50, 100, 500, 1,000, and 1,500 ng/mL). Osteoblast cultures were used as a positive control for LF culture. LF cell cultures with Ad/luciferase served as viral controls for culture with Ad/ lacZ. The transgene expression of lacZ was assessed by X-gal stain and ''-galactosidase assay. Alkaline phospha-tase, Von Kossa, and Alizarin red-S stains were used to confirm osteogenic differentiation and bone nodule formation. Immunocytochemical staining was also performed to detect osteocalcin expression. RESULTS.: LF cell cultures transduced with Ad/lacZ showed extensive X-gal expression and increased ''-galactosidase activity compared to viral (Ad/luciferase) and saline controls. In LF cultures treated with BMP-2, robust alkaline phosphatase expression, and bone nodule formations were observed as evidenced by positive Von Kossa and Alizarin red-S staining, and the strong expression of osteocalcin. The osteogenic response of LF cells to BMP-2 was dose dependent. CONCLUSIONS.: Human LF cells were found to be susceptible to adenovirus-mediated marker gene transfer, which offers the possibility of a new range of possible genetic modifications. In human LF cells, BMP-2 was found to markedly up-regulate the expression of osteogenic phenotypes and to induce bone nodule formation. The results of this study support the notion that biologically modified LF cells, i.e., LF cells treated with BMP-2, or with adenovirus-mediated BMP-2 cDNA gene transfer, may facilitate spinal fusion. [ABSTRACT FROM AUTHOR]