Search

Lockdown measures to combat the COVID-19 pandemic restricted social interactions and travel. This retrospective, observational study was conducted to evaluate the effect of lockdown restrictions on Oswestry Disability Index (ODI) scores in patients with spinal conditions.Prospectively collected data from the British Spine Registry were retrospectively analysed in two groups. The study group included patients' baseline pre-operative ODI scores collected during the first national lockdown in the UK between March and May 2020. The reference group included ODI scores recorded during the same period in 2019, before the pandemic. Scores were compared between groups using the Mann-Whitney U test. We also calculated modified scores that omitted responses to questions related to travel and social life. These were compared using Wilcoxon matched-pairs signed-rank test and Bland-Altman analyses.The median ODI scores for the reference and lockdown groups were 49 and 45, respectively, with no significant differences in the mean ranks (p = 0.068). Comparisons of original and modified ODI scores showed different outcomes for each study group. No significant differences were observed in the lockdown group (p = 0.06). However, for the pre-COVID-19 reference group, there was a significant difference (p 0.01). Bland-Altman analyses showed reasonable agreement between the methods for calculating ODI in both groups.We found no clinically important differences in ODI scores between the two groups. The findings suggest that the ODI is reliable during lockdown situations and can be used with confidence in the future research using both retrospective and prospective data.Level 3.

Scoliosis is a 3D-torsional rotation of the spine, but risk factors for initiation and progression are little understood. Research is hampered by lack of population-based research since radiographs cannot be performed on entire populations due to the relatively high levels of ionising radiation. Hence we have developed and validated a manual method for identifying scoliosis from total body dual energy X-ray absorptiometry (DXA) scans for research purposes. However, to allow full utilisation of population-based research cohorts, this needs to be automated. The purpose of this study was therefore to automate the identification of spinal curvature from total body DXA scans using machine learning techniques. To validate the automation, we assessed: (1) sensitivity, specificity and area under the receiver operator curve value (AUC) by comparison with 12,000 manually annotated images; (2) reliability by rerunning the automation on a subset of DXA scans repeated 2–6 weeks apart and calculating the kappa statistic; (3) validity by applying the automation to 5000 non-annotated images to assess associations with epidemiological variables. The final automated model had a sensitivity of 86.5%, specificity of 96.9% and an AUC of 0.80 (95%CI 0.74–0.87). There was almost perfect agreement of identification of those with scoliosis (kappa 0.90). Those with scoliosis identified by the automated model showed similar associations with gender, ethnicity, socioeconomic status, BMI and lean mass to previous literature. In conclusion, we have developed an accurate and valid automated method for identifying and quantifying spinal curvature from total body DXA scans.

Scoliosis is a 3D-torsional rotation of the spine, but risk factors for initiation and progression are little understood. Research is hampered by lack of population-based research since radiographs cannot be performed on entire populations due to the relatively high levels of ionising radiation. Hence we have developed and validated a manual method for identifying scoliosis from total body dual energy X-ray absorptiometry (DXA) scans for research purposes. However, to allow full utilisation of population-based research cohorts, this needs to be automated. The purpose of this study was therefore to automate the identification of spinal curvature from total body DXA scans using machine learning techniques. To validate the automation, we assessed: (1) sensitivity, specificity and area under the receiver operator curve value (AUC) by comparison with 12,000 manually annotated images; (2) reliability by rerunning the automation on a subset of DXA scans repeated 2-6 weeks apart and calculating the kappa statistic; (3) validity by applying the automation to 5000 non-annotated images to assess associations with epidemiological variables. The final automated model had a sensitivity of 86.5%, specificity of 96.9% and an AUC of 0.80 (95%CI 0.74-0.87). There was almost perfect agreement of identification of those with scoliosis (kappa 0.90). Those with scoliosis identified by the automated model showed similar associations with gender, ethnicity, socioeconomic status, BMI and lean mass to previous literature. In conclusion, we have developed an accurate and valid automated method for identifying and quantifying spinal curvature from total body DXA scans.

There is an increasing body of research suggesting that low body weight is associated with scoliosis, but this is based on case-control studies, which are prone to bias. No studies have investigated the components of body weight: fat and lean mass. We have therefore carried out the first population-based prospective study of the association between fat and lean mass at age 10 years assessed by dual-energy X-ray absorptiometry (DXA), with presence of scoliosis at age 15 years using the Avon Longitudinal Study of Parents and Children (ALSPAC). All children with scoliosis at age 10 years were excluded. Of 5299 children at age 15 years, 312 (5.9%) had scoliosis. Our results show a negative association between body mass index (BMI)/body weight at age 10 years and scoliosis at age 15 years, with a 20% reduced risk of scoliosis per SD increase in BMI (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.70–0.92; p = 0.001). This association with BMI/body weight reflects associations with both fat mass and lean mass. After adjustment for age, gender, leg length, and fat mass per SD increase in lean mass, there was a 20% reduced risk of scoliosis (OR, 0.80; 95% CI, 0.65–0.97) and per SD increase in fat mass there was a 13% reduced risk of scoliosis (OR, 0.87; 95% CI, 0.74–1.03). In terms of adipocyte function, an inverse association was seen between leptin at age 10 years and scoliosis (OR for scoliosis per SD increase in leptin of 0.78; 95% CI, 0.63–0.99), and a positive association between adiponectin at age 10 years and scoliosis (OR for scoliosis per SD increase in adiponectin of 1.44; 95% CI, 0.99–2.10). This is the first study to address the association between the individual components of body weight and scoliosis in a prospective cohort study, and shows altered body composition that is present before the onset of clinically detected scoliosis. © 2014 American Society for Bone and Mineral Research.

Background: Studies concerning adult patients with spastic flexion contracture of the knee are rare. Such patients frequently have cutaneous and vascular complications as well as recurrence of the contracture after treatment. We present a strategy consisting of simultaneous correction of all deformities of both lower limbs, distal hamstring releases, and application of femorotibial external fixation when extension of the knee is limited by excessive posterior soft-tissue tension. Methods: A consecutive series of fifty-nine patients (ninety-seven knees) between the ages of twenty-one and seventy-seven years received surgical treatment for a flexion contracture of the knee secondary to neurological impairment. The flexion contracture was bilateral in thirty-eight patients. Preoperatively, the mean flexion contracture angle was 69° and the mean passive range of motion was 61°. The contracture was corrected, through medial and lateral approaches, with distal hamstring lengthening. A posterior capsulotomy was performed in thirty-five knees. Full extension of thirty-four knees was achieved intraoperatively. In seventy-seven knees, partial correction was maintained with a unilateral external fixator, and passive and active mobilization was performed four times daily after temporary removal of the spanning external fixator rod. Results: At the time of final follow-up, ranging from one to five years postoperatively, the mean residual flexion contracture was 6.2°. Forty-five knees had complete extension, and thirty-nine knees had a residual flexion contracture of

We report the outcome of humeral head surface replacement hemiarthroplasty performed at our institution using the Copeland prosthesis. We followed 56 shoulders (52 patients) for a mean of 34.2 months (range, 24-63 months). Two were lost to follow-up, and there were six deaths unrelated to the shoulder surgery. Preoperative diagnoses in the remainder were osteoarthritis (20), rheumatoid arthritis (26), rotator cuff tear arthropathy (1), and post-traumatic arthrosis (1). The mean age was 68 years. Constant scores for the whole group improved from a mean preoperative score of 16.4 (range, 8-36) to 54.0 (range, 20-83) at last follow-up (P.05). Three cases underwent subsequent arthroscopic subacromial decompression for impingement symptoms. One case required revision for aseptic loosening to a stemmed implant. Contained, nonprogressive osteolysis was seen in 2 cases. One periprosthetic humeral neck fracture was managed successfully nonoperatively. These results are comparable to those obtained with a modern stemmed hemiarthroplasty and are similar to Copeland's own series.

STUDY DESIGN: A retrospective analysis of patients with idiopathic scoliosis treated with Schollner costoplasty. OBJECTIVE: To evaluate the long-term effects of Schollner costoplasty on rib hump and respiratory function SUMMARY BACKGROUND DATA: Costoplasty is an established technique to improve chest wall deformity in patients with scoliosis. Concerns have been raised of the long-term effects of costoplasty on respiratory function in adults. No long-term studies of this procedure exist. METHODS: A total of 25 patients with idiopathic scoliosis rib hump deformity underwent Schollner costoplasty. There were 12 patients who underwent surgery on the convexity alone, and 13 underwent additional "concave surgery" (6 Silastic [Dow Corning Corp., Midland, MI] implants, 7 concave lengthenings). Five patients underwent simultaneous spinal arthrodesis. The remaining patients underwent delayed procedures (0.4 -19 years) following the index operation. Vital capacity (VC) and rib hump were measured before and after surgery, and at each attendance thereafter. RESULTS: Mean follow-up was 10.8 years. Average reduction in rib hump was 38 mm at 6 months and 29 mm at long-term. There was no significant difference in the preoperative and long-term VC (P = 0.4), although at 6 months after surgery, there was a significant reduction in VC of 5.1%(P = 0.03). Subgroup analysis (convex only, concave lengthening, concave Silastic) revealed a similar pattern for rib hump correction and maintenance of VC in the long-term for each group. There was no significant difference between adults and adolescents in terms of both the reduction in rib hump and the VC (P = 0.2 and 0.3) CONCLUSIONS: Rib hump correction and lung function are preserved in the long-term following Schollner costoplasty in both adults and adolescents.

Retrospective cohort study. To identify whether an in vivo correlation exists between lumbar spinal subtype (LSS) and lumbar disc degeneration (LDD) in young adults. Lumbar disc degeneration has largely been ascribed to biomechanical and structural alterations to the disc, which are attributed to aging and pathological physical loading. Sagittal alignment in the asymptomatic spine has also been considered. A biomechanical study by Roussouly and Pinheiro-Franco proposed level-specific patterns in LDD. To date, no in vivo correlation between the LSS and LDD has been established. The authors screened 608 consecutive patients over 5.3 years. Lumbar spinal subtype and pelvic parameters were collected from standing lumbar radiographs and were categorized using the classification of Roussouly and Pinheiro-Franco. Lumbar disc degeneration at all lumbar intervertebral levels was classified using criteria of Pfirrmann et al. A stratified disc degeneration score was derived for each patient. Lumbar disc degeneration in type I, II, and IV LSS was compared using chi-square test. Pelvic incidence was correlated with stratified disc degeneration score using Spearman R, to determine whether a high PI was protective against LDD. Statistical significance was accepted at p

Objective The purpose of this study was to identify factors that may be important in determining whether a degenerative spondylolisthesis at L4–L5 is mobile. Summary of background data Degenerative scoliosis is a common condition among middle-aged and elderly adults. Sacropelvic morphology and orientation modulate the geometry of the lumbar spine and, consequently, the mechanical stresses at the lumbo-sacral junction. To date, no in vivo data exist to describe the relationship between these pelvic parameters and their association with a mobile spondylolisthesis. Method Sixty consecutive patients with a degenerative spondylolisthesis (DS) at L4–L5 with adequate imaging were identified. Patient groups were defined on the basis of whether the DS was mobile (Group A) or nonmobile (Group B) when comparing the upright plain lumbar radiograph to the supine magnetic resonance imaging (MRI). We assessed the grade of slip, lumbar lordosis, pelvic parameters, and facet characteristics (angles, tropism, presents of effusion, degenerative score—cartilage and sclerosis values) as well as disc degenerative score (Pfirrmann) at L4–L5. Results There were 40 patients in Group A and 20 in Group B. No significant differences were found between groups for pelvic incidence (p = .409), pelvic tilt (p = .476), sacral slope (p = .785), lumbar lordosis (p = .695), degree of facet tropism (p = .38), and magnitude of the facet effusions (p = .01). Facet angle differences between groups approached significance (p = .058). Significant differences between groups were found in cartilage degenerative score (p = .01), facet sclerosis grade (p = .01), and disc degenerative score (p Conclusions Sagittal pelvic parameters do not play a significant role in differentiating between mobile and nonmobile DS at L4–L5. However, DS does appear to be associated with more sagittally orientated facets, higher Pfirrmann grade, and higher facet cartilage and sclerosis degenerative scores.

The purpose of this study was to develop and validate a novel method of identifying scoliosis on total-body dual energy X-ray absorptiometric (DXA) scans. Scoliosis was identified on total-body DXA scans by triaging to distinguish true curves from positioning errors, followed by a modified Ferguson method to measure angles. Precision was assessed on 174 children from the Avon Longitudinal Study of Parents and Children (ALSPAC), who underwent repeat DXA scans at age 15, 2–6 weeks apart. In addition, precision of angle estimation was evaluated on 20 scans measured five times. To evaluate accuracy, angle size was compared to spinal radiographs in 13 individuals with known scoliosis. Subsequently, this method was applied to estimate scoliosis prevalence rates and curve patterns from DXA scans previously obtained in 7,298 ALSPAC participants at age 9 and 5,122 at age 15. There was substantial agreement in identifying those with scoliosis on repeat DXA scans taken 2–6 weeks apart (kappa 0.74, 95 % CI 0.59–0.89). Of repeat angle measures, 95 % were within 5°. Angle size was underestimated by approximately 40 %. Prevalence of scoliosis ≥10° in the ALSPAC was 0.3 % at age 9 and 3.5 % at age 15 and was higher in girls at both time points. The mean ± SD curve size was 12 ± 4° at age 9 years and 15 ± 7° at age 15. We have developed and validated a novel method for identifying scoliosis from DXA scans. Comparison with prevalence data using more established techniques suggests our method provides valid estimates of scoliosis prevalence in population-based cohorts.

The few number of severe thoracic scoliosis requiring surgical treatment makes the description of its therapeutic course difficult. Twenty-one cases of severe thoracic scoliosis with Cobb's angle >90 degrees were treated surgically in the past 20 years. Surgical treatment was performed because of an evolutive scoliosis or in case of respiratory or functional impairment. All patients underwent posterior approach after a preoperative preparation by the use of halo-traction. In 6 cases, a previous surgical posterior spinal release was performed before the halo-traction period. Fusion achieved in all cases and the final correction was generally better than preoperative reducibility. The surgical course was guided by the poor functional status of these patients, especially concerning respiratory function. Spinal instrumentation was made up of 3 rods with few spinal implants in the majority of the cases. Surgical correction was made by means of rods narrowing without any rod's rotation procedures. Functional improvement, especially respiratory was noted in all the cases. Nevertheless, postoperative spirometries were not significantly different from the preoperative ones. The aesthetic improvement of the rib hump was disappointing making necessary a complementary thoracoplasty in two cases. Surgical treatment of severe thoracic scoliosis remains justified in adults because of a progressive functional and radiological deterioration with respiratory compromise. We performed spinal fusion by posterior approach only, after a preoperative period of halo-traction. The final correction depends on the preoperative reducibility. We noted a functional and respiratory improvement in all the cases.

STUDY DESIGN Descriptive anatomy. OBJECTIVE.: To describe the anatomy associated with the extensive transmuscular paraspinal approach required to perform multiple intercosto-lumbar neurotizations. SUMMARY OF BACKGROUND DATA Neurotization of lumbar roots using lower intercostal nerves is a potential method of treating neurologic deficits after spinal cord injury. It appeared to us that the paraspinal splitting approach was potentially an optimal method to perform intercostal nerve harvesting, rerouting, and intercosto-lumbar neurotizations. METHODS Ninth, 10th, and 11th intercostal nerve harvesting and rerouting down to L2, L3, and L4 roots were performed on 50 cadavers. The descriptive anatomy and topographic landmarks are reported. RESULTS The mean total length of intercostal nerve harvested was 17.96 (range, 10-27) cm for the 9th intercostal nerve, 17.14 cm (range, 10-20) for the 10th intercostal nerve and 15.94 cm (range, 10-25) for the 11th intercostal nerve. The length of harvested nerve was not correlated to the size of the trunk. The length of harvested nerve was sufficient to perform lumbar roots neurotizations in the 300 cases of nerve harvesting. CONCLUSION Multiple lumbar roots neurotizations with lower intercostal nerves already have been proposed by other authors. In this strategy, the use of the spinal cord and intercostal nerves above the spinal cord lesion avoids the axonal regrowth required via the injured central nervous system. Rerouting intercostals nerves down to the lumbar roots at their exit from the intervertebral foraminae is less invasive that the same procedure performed down to the vertebral canal at the level of the cauda equina as we used in previous protocols. Our anatomic study confirms the advantage of the paraspinal sacrospinalis splitting approach in multiple intercosto-lumbar neurotizations. The approach is quick and easy and allows a good exposure of the nerve roots at the thoracic and lumbar levels. The L2, L3, and L4 roots could be satisfactorily neurotized with this procedure.

PURPOSE: To evaluate the efficacy and utility of SPECT/CT as a diagnostic modality and preoperative planning tool in patients undergoing fusion surgery for low back pain and/or leg pain. STUDY DESIGN/SETTING: A prospective cohort study (n525) performed over a 2-year period. PATIENT SAMPLE: All consecutive patients requiring lumbar spondylodesis for back pain and/or leg pain included. OUTCOME MEASURES: Clinical outcome measures included EQ-5D, EQ-5D VAS, ODI and VAS Pain Scores. METHODS: SPECT/CT fusion imaging was performed in conjunction with standard CT and MRI preoperatively to guide patient selection and surgical planning. Clinical outcome measures were collected preoperatively and at 6 weeks, 6 months and 1 year postoperatively. RESULTS: SPECT/CT fusion imaging demonstrated increased sensitivity for facet degeneration when compared to MRI. No difference was identified when comparing SPECT/CT to standard CT to assess disc degeneration. There was a significant improvement in all clinical outcome measures assessed preoperatively and followed out to 1-year postoperatively. Mean ODI score improved from 58.92 to 12.0; VAS back pain score improved from 7.46 preoperatively to 1.0; VAS leg pain score improved from 4.15 to 0.25. CONCLUSIONS: SPECT/CT fusion imaging is an excellent adjunct to existing imaging modalities, facilitating accurate level selection in patients undergoing lumbar fusion surgery for low back pain and/or leg pain. Lumbar fusion surgery guided by SPECT/CT fusion imaging was associated with excellent postoperative health related quality of life (HRQOL) outcome measures. CONFLICTS OF INTEREST: None. FUNDING SOURCES: None.