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Purpose: Preoperative preparation with halo gravity traction (HGT) has several advantages but is still controversial. A multicenter, observational, retrospective study was conducted to determine whether HGT provides better frontal correction in surgery for adolescent idiopathic scoliosis (AIS). Methods: Between 2010 and 2020, all patients who underwent posterior spinal fusion (PSF) AIS with a Cobb angle greater than 80° were included. The included patients who underwent HGT were compared (complications rate and radiographic parameters) to patients who did not undergo traction (noHGT). For patients who underwent HGT, a spinal front X-ray at the end of the traction procedure was performed. Results: Sixty-four in noHGT and forty-seven in HGT group were analyzed with a 31-month mean follow-up. The mean ratio of Cobb angle correction was 58.8% in noHGT and 63.6% in HGT group (p = 0.023). In HGT, this ratio reached 9% if the traction lasted longer than 30 days (p = 0.009). The complication rate was 11.7% with a rate of 6.2% in noHGT and 19.1% in HGT group (p = 0.07). In patient whose preoperative Cobb angle was greater than 90°, the mean ratio of Cobb angle correction increases to 6.7% (p = 0.035) and the complications rate increased to 14% in the no HGT group and decreased to 13% in the HGT group (p = 0.9). Conclusion: HGT preparation in the management of correction of AIS with a Cobb angle greater than 90° is a technique providing a greater frontal correction gain with similar complication rate than PSF correction alone. We recommend a minimum halo duration of 4 weeks. [ABSTRACT FROM AUTHOR]

Objectives: Determine the relationship between the importance of spine deformity and postural control efficiency in mild adolescent idiopathic scoliosis (AIS). Introduction: AIS is related to postural control disorders where vision, proprioception and vestibule could be involved. The aim of the study was to investigate the postural control of early-detected AIS, of which the Cobb angle is still low, evaluating whether the amplitude spine deformation is an important balance destabilization parameter. Material & Methods: 71 patients with AIS (mean age: 11.5 ± 2.0 years) were submitted at time of diagnosis to clinical and radiological assessments and to posturographic evaluation including static with and without sensory conflict and dynamic tests. Two groups were constituted according to mean Cobb angle value of the primary curve of the whole population. Results: Mean Cobb angle being 14.6 ± 5.4°, 41 patients with AIS presented a Cobb angle comprised between 5 to 14° (Group I) and 30 patients presented a Cobb angle comprised between 15 to 25° (Group II). The latter displayed higher body sways in static tests (eyes open and eyes closed conditions) and higher lateral oscillations only in eyes closed condition. In sensory organization test, Group II patients displayed a weaker balance control mainly in visual and somatosensory conflicting conditions despite no significant difference in vestibular utilization. Moreover, Group II patients used less anticipatory strategies to stabilize body oscillations, especially in the more challenging sensory conflicting and dynamic situations. Conclusions: Patients with a Cobb angle greater or equal to 15° displayed lesser postural performances, especially in sensory conflicting situations. Significance: Posturographic tests represents an accurate tool to assess postural control in AIS even at the onset of their evolution. [ABSTRACT FROM AUTHOR]

Introduction: Vision, proprioception and vestibule are involved in adolescent idiopathic scoliosis (AIS). The aim of this study was to determine if some posturographic parameters could predict the progression of AIS just at the first screening when the spine deformation is very mild. Materials and Methods: 82 subjects with AIS were followed during a 5-year period of time. At the first screening, just at the diagnosis time, clinical and radiological examination and posturographic tests were performed. These last tests included static tests with and without sensory conflicts, dynamic and dynamised tests. The population was followed establishing 2 groups: Group P included 26 subjects with progressive AIS (Cobb angle increased greater than 5° during a 6 month-period of time), Group NP included non progressive AIS at skeletal maturity (31 subjects). Comparison of posturographic parameters at the first screening was performed to seek some significant differences between P and NP Groups. Results: At the first screening, no significant differences were highlighted between the 2 groups in regard of age, gender, height, weight, body mass index, skeletal maturity, scoliosis type, and Cobb angle. We showed significant differences in static tests in eyes-opened condition, in slow dynamic test in eyes-opened condition and in sensory organization tests. Conclusion: Situations soliciting proprioceptive and vestibular cues, especially in conflict, showed significant differences between the 2 groups P and NP. Complex posturographic tasks are more discriminant. Significance: If predictive thresholds could be found further, these posturographic tests could predict the AIS progression and could allow to treat evolutive AIS very early. [ABSTRACT FROM AUTHOR]

Background: Upper-extremity movement is limited in individuals with muscular weakness. This paper describes a novel, articulated upper-extremity orthosis, the Wilmington Robotic Exoskeleton (WREX), which helps people overcome this movement deficit., Methods: This prospective, case-controlled study involved an ambulatory patient with arthrogryposis multiplex congenita and 2 nonambulatory patients with spinal muscular atrophy type II. The WREX uses elastic bands to negate the effects of gravity; it allows a person with neuromuscular weakness to move their arm in 3 dimensions. The WREX can be fixed on a brace for ambulatory patients and on the wheelchair for nonambulatory patients. Assessment was performed through motion analysis (with and without the WREX), clinical examination, and qualitative questionnaire., Results: Motion analysis showed a marked improvement in upper-extremity function with the WREX. The questionnaire illustrated enhanced functionality with the WREX including self-feeding, fine motor control, and use of a television remote control. Enhanced functionality resulted in improved quality of life by increasing participation in school, raising self-esteem, and increasing social interaction. Two unexpected outcomes were increased security with trunk inclination and amelioration of the effects of contractures., Conclusions: The WREX provided an increase in functionality and improved the quality of life of the patients. The device has become an integral part of the lives of the 3 patients., Level of Evidence: Level III in Therapeutic Studies-Investigating the Results of Treatment.

Sports injuries are common in children and adolescents. Typical musculoskeletal disorders include overuse injuries such as stress fractures and apophyseal avulsions. Gymnastics has one of the highest injury rates of all girls' sports. Intensive gymnastics can cause chronic spine and wrist trauma. Prevention of sport injuries should be a priority for parents, coaches and children themselves. Protection (helmet, padding) is mandatory for some activities. Proper education and preparation are necessary for all sports activities.