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Percutaneous Vertebroplasty (PV) has gained widespread popularity in the treatment of Vertebral Body Fractures (VBFs). The procedure involves the injection of polymethylmethacrylate (PMMA) cement into the fractured vertebral body via a needle that is placed percutaneously using either a transpedicular or extrapedicular approach. Health Related Quality of Life (HRQoL) evaluation is a widespread method of measure of the disease severity and the outcome of the treatment. The subjective feeling of pain in VBFs is crucial for the HRQoL. The aim of the study was to determine the effectiveness of percutaneous vertebroplasty in the treatment of VBFs. A group of 187 patients with VBFs of different etiology resulting from osteoporosis, trauma or tumors were treated with PV in Pomeranian Center of Tramatology in Gdansk from 2010 to 2011. The effectiveness of the treatment was evaluated with Visual Analog Scale (VAS), Hospital Anxiety and Depression Scale (HADS-M), Rolland Morris Scale (RMS), 36-Item Short Form Health Survey (SF-36) and Oswestry Disability Index (ODI) questionaires administered before and one month after surgery. PV decreased significantly VAS score, depression and anxiety level, what improved significantly HRQoL in patients with VBFs. [ABSTRACT FROM AUTHOR]

Background: This report is the SOSORT Consensus Paper on Terminology for use in the treatment of conservative spinal deformities. Figures are provided and relevant literature is cited where appropriate. Methods: The Delphi method was used to reach a preliminary consensus before the meeting, where the terms that still needed further clarification were discussed. Results: A final agreement was found for all the terms, which now constitute the base of this glossary. New terms will be added after being discussed and accepted. Discussion: When only one set of terms is used for communication in a place or among a group of people, then everyone can clearly and efficiently communicate. This principle applies for any professional group. Until now, no common set of terms was available in the field of the conservative treatment of scoliosis and spinal deformities. This glossary gives a common base language to draw from to discuss data, findings and treatment. [ABSTRACT FROM AUTHOR]

An abstract of the article "Adolescent girls with idiopathic scoliosis >45 degrees, treated with TLSO brace, reveal less clinical deformity than non-treated girls having similar scoliosis angle" is presented.

An abstract of the article "Sitting forward bending position versus standing position for studying the back shape in scoliotic children" is presented.

An abstract of the article "Adolescent girls with idiopathic scoliosis >40 degrees, treated with TLSO brace, reveal less clinical deformity than non-treated girls having similar scoliosis angle" is presented.

The relationships between the results of pre- and intraoperative motor evoked potential recordings during neuromonitoring and whether idiopathic scoliosis (IS) surgical correction improves the spinal efferent transmission have not been specified in detail. This study aims to compare the results of surface-recorded electromyography (EMG), electroneurography (ENG, M, and F-waves), and especially motor evoked potential (MEP) recordings from tibialis anterior muscle (TA) bilaterally in 353 girls with right idiopathic scoliosis (types 1–3 according to Lenke classification). It has not yet been documented whether the results of MEP recordings induced by transcranial single magnetic stimulus (TMS, pre- and postoperatively) and trains of electrical stimuli (TES; intraoperatively in T0—before surgery, T1—after pedicle screws implantation, and T2—after scoliosis curvature distraction and derotation following two-rod implantation) can be compared for diagnostic verification of the improvement of spinal cord neural transmission. We attempted to determine whether the constant level of optimal anesthesia during certain surgical steps of scoliosis treatment affects the parameters of MEPs recorded during neuromonitoring procedures. No neurological deficits have been observed postoperatively. The values of amplitudes but not latencies in MEP recordings evoked with TMS in IS patients compared before and after surgery indicated a slight improvement in efferent neural transmission. The results of all neurophysiological studies in IS patients were significantly asymmetrical and recorded worse on the concave side, suggesting greater neurological motor deficits at p = 0.04. The surgeries brought significant improvement (p = 0.04) in the parameters of amplitudes of sEMG recordings; however, the consequences of abnormalities in the activity of TA motor units were still reflected. ENG study results showed the symptoms of the axonal-type injury in peroneal motor fibers improving only on the concave side at p = 0.04, in parallel with F-wave parameters, which suggests that derotation and distraction might result in restoring the proper relations of the lumbar ventral roots in the spinal central canal, resembling their decompression. There were no significant differences detected in the amplitudes or latencies of MEPs induced with TMS or TES when comparing the parameters recorded preoperatively and intraoperatively in T0. The amplitudes of TES-evoked MEPs increased gradually at p = 0.04 in the subsequent periods (T1 and T2) of observation. A reduction in MEP latency at p = 0.05 was observed only at the end of the IS surgery. Studies on the possible connections between the level of anesthesia fluctuations and the required TMS stimulus strength, as well as the MEP amplitude changes measured in T0–T2, revealed a lack of relationships. These might not be the factors influencing the efferent transmission in spinal pathways beside the surgical procedures. Pre- (TMS-evoked) and intraoperative (TES-evoked) recordings are reliable for evaluating the patient's neurological status before and during surgical scoliosis correction procedures. An increase in MEP amplitude parameters recorded on both sides after scoliosis surgery proves the immediate improvement of the total efferent spinal cord transmission. Considering comparative pre- and postoperative sEMG and ENG recordings, it can be concluded that surgeries might directly result in additional lumbar ventral root decompression. We can conclude that MEP parameter changes are determined by the surgery procedures during neuromonitoring, not the anesthesia conditions if they are kept stable, which influences a decrease in the number of false-positive neuromonitoring warnings. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Comments on an article about ultrasound measurements of hips in newborns. Acetebular developments; Cartilage deformation; Response of the authors.

Background: The age at menarche (AAM) is commonly in use in patients with IS as one of the maturity indicator suggesting deceleration of the growth velocity. The AAM was suggested to be related to predisposition and curve progression potential of IS. The late age at menarche was reported to be associated with higher prevalence of adolescent idiopathic scoliosis. The age at menarche is determined by both genetic and environmental factors as well as their interactions. Estrogen receptors 1 and 2 polymorphism were reported to be associated with AAM: in ESR1 XbaI and PvuII site polymorphism and in ESR2 AluI site polymorphism.The purpose of the study was to investigate associations of the ESR1 and ESR2 polymorphisms with AAM in IS patients and to evaluate association of AAM with IS severity.Methods: 208 females with IS Caucasian females from Central Europe underwent clinical, radiological and genetic examinations. Four SNPs were selected XbaI (A/Grs9340799) and PvuII (C/T rs2234693) in ESR1and AluI (A/G rs4986938) and RasI (A/G rs1256049) in ESR2. Samples were analyzed with polymerase chain reaction followed by restriction fragments length polymorphism analysis (PCR-RFLP). The age of a menarche was established during personal interview with the patients and in case of children with their parents. The Cobb angle was measured.Results: All genotypes followed HWE. Mean AAM for patients was 154.8 ± 14.7 months (12.9 ± 1.2 years). The earliest AAM was 121 and latest 192 months. There was no statistically significant difference between AAM mean values in each genotype, for the XbaI, PvuII, AluI and RsaI site polymorphisms the p values were p=0.7141, p=0.9774, p=0.7973 and p=0.2282, respectively. Patients divided according to Cobb into mild (<30°), moderate (30°-49°) or severe (≥ 50°) IS revealed tendency to delay AAM: 151.9 ± 14.7; 155.2 ± 14.8 and 157.9 ± 14.0 months, respectively. There was statistical significant difference between patients with mild <30° and severe ≥ 50° IS, p=0.0267.Conclusions: In IS patients estrogen receptors polymorphisms did not show association with the AAM. Patients with severe IS form revealed delayed AAM than patients with mild IS form. [ABSTRACT FROM AUTHOR]

An abstract of the article "Joint hypermobility in girls with idiopathic scoliosis: relation with age, curve pattern and curve size" by Dariusz Czaprowski and colleagues is presented.

An abstract of the article "Replication study of estrogen receptor 1 XbaI polymorphism in adolescent idiopathic scoliosis (AIS) Caucasian population" by Janusz Piotr and colleagues is presented.

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. [ABSTRACT FROM AUTHOR]

Aim: The 22q11 deletion syndrome (22q11DS), also called the DiGeorge or velocardiofacial syndrome, is the most common deletion syndrome. In this multisystem disorder, scoliosis may also occur. This has thus far received little attention, probably because other associated anomalies (cardiac, psychiatric, palatal) have more severe implications for everyday functioning. The aim of this study was to describe scoliosis in 22q11DS. Materials and Methods: 222 patients with 22q11DS (mean age 11.5y, range 0.8-29y) were included. The majority was first evaluated by other specialists before being assessed by an orthopaedic surgeon or paediatrician. They were analysed by reviewing their clinical evaluations, using semi-structured questionnaires and assessing available radiographs of the spine. Results: Scoliosis was found in 18%, and affected more females (68%). In the scoliosis-group, 17% required surgery and 3/7 patients required two surgeries because of progression despite earlier spinal fusion. When reviewing the radiographs (n=28), 43% of the curve patterns did not resemble typical AIS curves. Vertebral defects were seen in 4%. In this study, cardiac anomalies (p=0.242) as well as cardiac surgery (p=0.274), both very common in 22q11DS, had no influence on the development of scoliosis. Hypotonia/ligamentous laxity were also frequently seen. Discussion: Scoliosis was found in 18% of this population, with 17% of them requiring surgery. Given the retrospective design of our study and the young population, it seems likely that the true prevalence and risk for developing more severe and atypical curves will even be higher. Scoliosis is much more common in 22q11DS than in the general population and may represent a clinically significant problem. Based on our findings, we have initiated a prospective study. A proactive approach towards the diagnosis and management is recommended. Awareness of the syndrome and its consequences is of great importance for the treating orthopaedic surgeon. [ABSTRACT FROM AUTHOR]

Genetic heterogeneity for idiopathic scoliosis (IS) is presumed from a limited consensus for loci. For such complex syndromes, this heterogeneity can be reduced by using well characterized endophenotypes. We previously reported a hypofunctionality of Gi proteins in IS patients, and three distinct groups associated with different biochemical activities and clinical profiles. To discover differentially expressed genes among these endophenotypes, we used microarray (Affymetrix GeneChipTM Human gene 1.0 ST) analysis on osteoblasts and Peripheral Blood Mononuclear Cells from 30 patients and 10 controls. This allowed for the analysis of 38,000 genes. Previous gene expression work in IS has been prohibited due to conflict about which tissue is most appropriate. Because we previously demonstrated a systemic Gi protein signaling dysfunction, we avoid such issues. Raw data was normalized using the Robust Multi-array Analysis method and analysed by the EB (Wright & Simons) statistic method on FlexArray software. Candidate gene selection criterion for single-gene (qPCR) analysis was filtered by the expression fold-change and a significant false discovery rate corrected p value (p ≤ 0.01). Statistical analyses for qPCR results were conducted using ANOVA. We found that generally, the expression profiles of groups 2 and 3 were similar to each other, in contrast to that of group 1. This difference between group 1 and groups 2 and 3 reflects observed functional responses to OPN. From the initial microarray results 6 candidate genes were chosen for qPCR analysis on 24 new patients. This study will identify differentially expressed genes between the IS biochemical endophenotypes, thereby directing hypotheses to relevant molecular pathways, thus allowing us to direct therapeutic efforts for different prognoses and co-morbidities. (Research project supported by grants from The Yves Cotrel Foundation, Canadian Health Research Institutes, Genome Quebec and Fourth Dimension Spine LLC) [ABSTRACT FROM AUTHOR]

Introduction: Correlation of results from X-rays and CT studies as well as neurophysiological examinations may supplement data regarding etiopathogenesis of the adolescent idiopathic scoliosis (AIS). Materials and methods: Results of examinations in 136 AIS patients (aged 11-18 years) with main angle of curvature (II and III according to King and Moe) from 16° to 92° treated conservatively (N=48) with kinesiotherapy and the corset or surgically (N=88) with Cotrel-Dubousset implants before therapy and after 6 years were compared. Bilateral EMG and ENG tests within upper and lower extremities were performed as well as somatosensory evoked potentials (SEPs) with overcranial recordings. Results of MEPs recordings following bilateral transcranial stimulation and stimulations at cervical and lumbo-sacral levels were compared. Results: In all patients with AIS before treatment, there were ascertained significant, asymmetrical deficits in both afferent (in SEPs examinations) and efferent (MEPs tests) transmissions, especially in spinal transmission at the level of apical vertebrae in main curvature of the secondary origin. Changes in transmission were also found at the level of brainstem. They seem to be primary in AIS etiology. CT studies showed structural changes in spinal cord and brainstem in 45 out of 65 patients. After treatment there was found the improvement in parameters of transmission mainly at spinal level in a group of patients treated surgically. The stage of pathology in a group of patients treated conservatively did not undergo such an improvement, also it was less at the beginning of observation. There was estimated the asymmetry in spinal transmission more on the concave than convex side of scoliosis and it underwent better improvement in a group of surgically treated patients in final trial. Conclusions: Neurological basis of changes at the supraspinal level may influence induction and progression of AIS. There exists a correlation of magnitude in main thoracic curvature above 45°, critical for appearing the clear cut changes in parameters of neurophysiological tests of spinal transmission, which was similar in mothers and daughters with AIS. This pathology seems to be related to the structural changes in spinal cord and brainstem areas well. [ABSTRACT FROM AUTHOR]

Background: Single nucleotide polymorphisms (SNPs) in CHD7 gene were reported to be associated with susceptibility to idiopathic scoliosis (IS). The A/G SNP rs 4738824 was considered to be one of the most concerned SNP in North American families. Objective: To investigate if rs 4738824 SNP is associated with susceptibility and/or severity of IS in Central European population. Materials and methods: The 44 females from Central Europe aged 13 to 43 years were divided into three groups. Group I (progressive IS) consisted of patients with right thoracic IS, Cobb angle >45°, Risser ≥4 and after menarche (n=16). Group II (non progressive IS) consisted of patients with right thoracic IS, Cobb angle 10-25°, Risser≥4 and after menarche (n=15). Group III (controls) comprised healthy females with no family history of scoliosis, completed growth and after menarche (n=13). DNA was obtained from peripheral blood. Polymerase chain reactions were performed with gene's specific primer set and the products were sequenced and analyzed with ClustalX algorithm for occurrence of selected SNP. Results: The alleles frequency was as follows: G=81.3% versus A=18.7% in the group I, G= 83.3% versus A=16.7% in the group II and G=76.9% versus A=23.1% in the group III. There were no significant difference in alleles frequency (p=0.82) among groups. The proportion of homozygotes versus heterozygotes was as follows: 62.5% of homozygotes GG versus 37.5% of heterozygotes A/G in the group I, 66.7% of homozygotes GG and 33.3% of heterozygotes A/G in the group II and 61.5% homozygotes GG, 7.7% of homozygotes AA and 30.8% of heterozygotes A/G in group III. Conclusions: Preliminary study for Central European population have not revealed differences in frequencies of A/G SNP rs 4738824 in research groups. Our data has not shown any association with neither susceptibility to IS nor with severity of the disease. [ABSTRACT FROM AUTHOR]

Aims: The aetiology of Adolescent Idiopathic Scoliosis (AIS) is unknown. Prior work by Moreau et al has demonstrated that AIS patients have Gi protein signalling defect and high levels of circulating OPN. Our primary goal was to identify the mechanisms regulating the cellular response to OPN in AIS. Methods: We chose to investigate Tyrosine Phosphatase x (PTPx) and a second molecule termed HSJ-1, which controls the activity of this tyrosine phosphatase, as candidate genes. In parallel, we studied other HSJ-1 related family members to determine their potential contribution in the control of OPN receptor activity. Primary osteoblast cell cultures derived from biopsies of AIS patients and control subjects were used to determine expression profiles. In parallel PTPx, HSJ-1 and the other HSJ family members were knockdown in MG63 cell line using siRNA technique to determine expression profiles and assess Gi protein signalling through a functional assay termed Cellular Dielectric Spectroscopy (CDS). Bipedal PTPx knockout (KO) mice were used as an animal model. Results: Bipedal PTPx KO mice developed scoliosis more often (80%) than bipedal control C57Bl/6 mice (45%) and displayed a more severe phenotype, which cannot be explained by changes in OPN circulating levels. Functional analysis of osteoblasts derived from PTPx KO mice by CDS method showed also an inhibition of Gi protein coupled receptor signalling similar to the one seen in a specific AIS patient subgroup. Furthermore, PTPx and HSJ-1 mRNA and protein levels were decreased in all AIS patients (n=34) tested when compared to control subjects (n=17). HSJ-2 and HSJ-7 were up-regulated in subgroup 1, HSJ-4 expression was down-regulated in subgroup 2 while HSJ-5 was up-regulated in subgroup 3. Conclusion: PTPx and some of HSJ family members have potential roles in AIS etiopathogenesis as disease-modifying factors exacerbating scoliosis development triggered by OPN. [ABSTRACT FROM AUTHOR]

Introduction: Melatonin signaling pathway has been suggested to be one of the key etiopathogenic factors of adolescent idiopathic scoliosis (AIS). Our previous pilot study showed that melatonin receptor 1B (MTNR1B) was not detected in the osteoblast of some AIS girls which may be related to abnormal melatonin signaling. However, it is necessary to clarify whether it is a quantitative or qualitative change. The present study aimed to investigate the possible problem of MTNR1B expression in AIS. Methods: Intra-operative bone biopsies were obtained from 41 AIS girls and 9 normal controls. Osteoblasts were cultured from the biopsies and harvested for protein and mRNA extraction. Semi-quantification for both MTNR1A and 1B protein expressions was done by Western blotting. mRNA expression of the 2 receptors were quantified using Taqman Real Time PCR. Student's t-test was employed to compare the expression level of the receptors between AIS girls and controls. Results: Both MTNR1A and MTNR1B were found in all examined individuals. While the protein and mRNA expression of MTNR1A was similar between AIS and controls, the expression of MTNR1B was significantly lower in AIS for protein (p<0.01) and mRNA (p=0.019). Conclusion: In this study with larger sample size, the relatively lower MTNR1B expression in AIS girls suggested that its abnormal expression was a quantitative change rather than qualitative as shown in the previous study. The lower MTNR1B expression in AIS patients may lead to the irresponsiveness of melatonin and eventually contribute to the development of the disease. Previous studies also suggested the stoichiometry of MTNR1A and 1B could affect their function. Further studies on melatonin receptor and its related signaling pathways would provide a better understanding on the etiopathogenesis of AIS. [ABSTRACT FROM AUTHOR]

Introduction: Low bone mineral density (BMD) has been shown to associate with adolescent idiopathic scoliosis (AIS) girls. Osteopontin (OPN) was known to play an important role in bone mineralization. Recent report suggested that AIS subjects have higher OPN level than their healthy peers. This study aimed to document the OPN levels in AIS girls and its associations with BMD vs. normal control girls. Materials and Methods: 45 AIS and 20 normal age-matched girls were recruited. Anthropometric and clinical data of AIS girls were recorded. Plasma OPN level was quantified with ELISA. The non-dominant distal radius BMD was measured with standardized peripheral quantitative computed tomography (pQCT). The relationships between OPN, BMD, and anthropometric data were analysed with multivariate regression analysis. Results: AIS girls was found to have longer arm span and lower body weight than the healthy controls. The OPN level of AIS girls is significantly higher than the controls. The BMD in AIS girls was significantly lower than the controls. Multivariate regression showed that OPN was the independent variables predicting cortical BMD in AIS group but not in normal controls. Discussion and conclusion: This is the first study demonstrating the low cortical BMD in AIS is significantly correlated with high OPN level. Bone mineralization in cortical bone is dependent on the composition of the bone matrix protein. The high OPN level in plasma may reflect the underlying abnormalities in bone mineralization in AIS. The detail mechanism warrant further studies. [ABSTRACT FROM AUTHOR]

Background: Although phenotypic presentation of scoliosis may be similar among cases its genetic background may differ in relation to sex, age at presentation, curve type etc. It is difficult to compare results of genetic association studies published in last 10 years because of different inclusion criteria and research approach. Objective: To analyse genetic association studies of IS published up to date with the aim of evaluating selection biases. Material and methods: We have evaluated available English language articles from past ten years (2001-2011). Initial search was performed through PubMed, Medline, Google Scholar with key words such as: idiopathic scoliosis, gene, genetic, SNP, association studies. As a result more than 700 papers were obtained. Research method of each study was assessed. We included only genetic association studies or genome wide association studies. We ascertained 26 studies available for further analysis. Results: In total, studies report on 11797 patients and 23867 controls tested. Out of those 15 were performed on Chinese population, 4 studies on Japanese population, 4 studies on Caucasian population, 1 on Korean population and 2 on mixed or uncertain populations. 13 of the studies were performed on females only, and 13 on males and females with known or unknown male to female ratio. One study did not report any IS inclusion criteria. 3 studies did not report any Cobb angle inclusion criteria, 11 included patients with Cobb angle below 20, 8 included patients with Cobb from 20 to 30 and 4 with Cobb angle over 30. Sixteen studies did not report curve types, 10 had mixed type curve pattern. Conclusions: Most of the studies conducted up to date did not select cases on the basis of common inclusion criteria. This gives rise to risk of selection bias, population stratification and other biases rendering the results questionable. Common inclusion criteria for genetic association studies are needed. [ABSTRACT FROM AUTHOR]

Introduction: Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional deformity of the spine that most commonly occurs in girls between ages 10-16 during the pubertal growth spurt. Despite its high prevalence and clinical impact in adolescents, etiology of AIS remains unknown but one possible mechanism is related to low bone mineral density (BMD). There are different speculations on why the bone mineral density is low in AIS girls. One of them is related to the bone mineralization process because the process directly affects the bone mineral deposition in bone matrix after bone formation. This study aimed to evaluate quantitatively the bone mineralization in the bone matrix in AIS with quantitative microCT and histomorphometry. Materials and Methods: Trabecular bone from iliac crest samples was obtained from 22 AIS and 6 normal age-matched girls intraoperatively. Material bone mineral density (mBMD) was evaluated with quantitative microCT and undecalcified histomorphometry with Goldner's trichrome staining. The correlation of the degree of mineralization between two methods was performed. Results: With microCT analysis, the amount of mBMD in AIS girls was significantly lower than that of control. This is in accord with the finding in Goldner's trichrome staining. The amount of non-mineralized bone matrix (red staining) in AIS girls was significantly higher than controls while the mineralized bone matrix (green staining) in AIS girls was lower (p<0.05).The correlation of amount of mBMD by microCT and mineralized bone matrix was statistically significant. Discussion and conclusion: The present study showed that AIS girls had lower bone mineralization than their peers. It is likely a possible cause of generalized lower BMD in AIS girls. This study provided new insight on the abnormality of bone matrix which could play an important role in the etiopathogenesis of AIS. [ABSTRACT FROM AUTHOR]

Introduction: The lack of a good animal model system has hindered studying the etiology of idiopathic scoliosis. Recently, it has become clear that several fish species appear to exhibit spinal curvatures. Objective: To determine if the affected tissue in a line of zebrafish with spinal deformities resembles the pathology observed in pediatric populations with scoliosis. Methods: Potential founder fish with spinal curvatures were outcrossed with a wild type zebrafish line (AB) and the resulting siblings (F1 generation) crossed and the offspring (F2 generation) examined for signs of spinal curvature beginning at 14 days post fertilization (dpf). Spinal curvatures of the affected fish were visualized using either a Faxitron or by Alizarian red staining of the skeletons and the curvature measured from the resulting images in the thoracic, thoracolumbar, or lumbar regions. Affected and normal zebrafish were fixed, embedded, section and stained with hemotoxylin and eosin. Results: The degrees of curvatures ranged from 18° to 40° Histological data demonstrated structural changes as compared to normal fish spine. Out of 212 individuals in the F2 generation 28, or 13.2%, were observed to have spinal deformities at 21 dpf. Importantly, we did not observe spinal deformities in the F1 generation fish and similar age wild type fish, indicating the observed spinal deformities were due to a recessive mutation(s). Discussion: An increase of scoliosis in family members and the occurrence of abnormal spinal curvatures in twins suggest a polygenetic inheritance pattern. We have noticed several fish in our zebrafish colony with spinal curvatures reminiscent of human idiopathic scoliosis. We suspect that 'scoliosis' in these zebrafish results from mutation(s) in the zebrafish genome. And these fish can be the source of a zebrafish line in which the offspring exhibit a predictable frequency of scoliosis which can be used to study the etiology and progression of scoliosis. [ABSTRACT FROM AUTHOR]

Aim: The objectives of this study were to investigate various factors involved in AIS and specifically to highlight the possible effect of biomechanical stress and estrogen on human osteoblasts derived from AIS patients and healthy subjects. Methods: Human osteoblasts were derived from tissues obtained at surgery, and cultured in presence or absence of estradiol. We used microarray analysis to examine differences in the gene transcription profile between primary human osteoblasts RNA extracted from AIS patients was compared to the RNA of healthy patients. In addition, osteoblasts were exposed to biomechanical stress (0-2 g/cm2) and then examined for changes in their cell proliferation and the level of biochemical factors produced by cultured cells such as NO, COX-2, OPN and ATP. Results: Biomechanical stress differentially influenced cell proliferation of the control osteoblasts to AIS cells. Following the biomechanical stress, we found that NO, COX-2, OPN and ATP levels were increased in both control cells and AIS cells, but a significantly higher levels of NO and COX-2 were observed in AIS cells. Using microarray analysis, we found that 86 genes were expressed at relatively higher levels in AIS osteoblasts compared to controls, while 59 genes were expressed at lower levels. These genes are involved in various bone regulatory and developmental pathways. Conclusion and significance: We demonstrated that biomechanical stress and hormonal factor are involved expression of certain genes. These factors could be associated to the spinal curve progression and consequently they could impact AIS progression. Our study provided a previously unrecognized list of AIS candidate genes. These genes are mainly involved in bone metabolism and embryonic development. Thus, our study suggests various gene interaction and pathways in AIS pathogenesis. Supported by Yves Cotrel Foudation [ABSTRACT FROM AUTHOR]

Aims: Idiopathic Scoliosis (IS) is a spinal deformity whose etiology remains unknown. Although the role of genetic factors in the development of IS is widely accepted, the causative gene of this disease is still unidentified. Methods: A large multiplex IS French family was chosen for this study on the basis of clinical and radiological data. Whole genome genotyping of the 20 members of this family led to the mapping of a dominant disease-causing gene to two critical genomic intervals. We then performed a whole-exome capture on 4 affected members of the family to try and identify the gene mutation that is linked to IS. All the novel variants from the exome analysis were assessed for co-segregation with IS within the family. Results: In the IS family, a maximum LOD score of 3·01 was reached on two specific chromosomal regions. The interval lengths of these regions were 7 cM and 12 cM. These two regions contain several genes that might be responsible for AIS. The sequencing of the candidate genes' coding sequences was done on the family members. Sequence analysis showed two rare SNPs located on the coding regions of a gene, we named CH5G1 but these SNPs did not co-segregrate with IS in the family. Whole-exome capture resulted in 6501 genetic variants common between the 4 patients, among which 7 were novel variants. Co-segregration analysis of these variants with the disease in the family was performed using the classical Sanger sequencing. Conclusions: Within the two chromosomic loci linked to IS susceptibility (Edery et al 2011), we found seven novel variants and two of these variants co-segregate perfectly with the disease. Significance: Identification of susceptibility genes for IS will help to better understand the pathogenesis of this disease. Supported by the Yves Cotrel Foundation, Institut de France [ABSTRACT FROM AUTHOR]

Introduction and objectives: A novel fusionless epiphyseal staple aiming at treating pediatric scoliosis was developed by our research team, which necessitated lengthy and expensive experimental testing on animal models. The objective of this project was to develop a porcine spine numerical model as an alternative tool for the validation of our fusionless devices. Methods: A parametric finite element model (FEM), including the epiphyseal growth plate, was developed using anatomical measurements of a porcine spine. The mechanical properties were taken from the literature or defined from calibration tests. The model was validated using experimental data. Vertebral growth modulation was programmed according to the 'Hueter-Volkmann' principle, with a follower type load simulating physiological forces. Using a reverse approach, scoliosis induction was simulated using epiphyseal staples inserted over T5-T8 in the coronal plane. Three months of curve progression was simulated. Resulting Cobb angle and vertebral wedging were compared to longitudinal experimental data. Results: The porcine spine model behavior was in agreement with reported flexibility data for flexion, extension, and lateral bending. Growth simulation resulted in a Cobb angle of 5.6° and local vertebral wedging of 3.4°, which was representative of an experimental scoliosis on pig spines similarly instrumented between T5-T8 over 3 months. Conclusion: The results demonstrated the feasibility of the numerical model to realistically reproduce implant-restraining effects with adequate growth modulation. Ultimately, the developed model would serve for the design optimization of our novel fusionless staple, providing a time and cost effective numerical tool, before proceeding to further experimental surgeries on animals. Acknowledgements: funded by NSERC (industrial research chair with Medtronic). [ABSTRACT FROM AUTHOR]

Introduction: The degree of curvature of the spine is defined by the Cobb angle measured by 2-D postero-anterior full length spine radiographs. Cumulative exposure to radiation from diagnostic radiographs increases patient risk for cancer development. Less exposure to radiation is desired for the patient's health and there is a need for non-invasive tools to measure spine deformity. Objectives: The aims of this study are to determine the reproducibility of the newly developed 3D Milwaukee topographic system (MTS) through inter- and intra-rater measurements, calculate the correlation between the 3D angle obtained by the device and the Cobb angle measured with radiographs, and establish the mean value of the normal range of 3D image parameters. Materials and methods: Two population groups are involved in this study. The control group has a normal patient population of ten children aged 6-18 years. The scoliosis group has twenty children with idiopathic scoliosis (IS) aged 6-18 years and with a range of Cobb angles. The MTS is composed of two wide-angle optical cameras, two electro-magnetic sensors, a light, a software package, a positioning frame, and a desktop computer. The device requires 4 scan sweeps (3 vertical and 1 horizontal) for each subject (5 seconds). Four measurements are performed by two investigators, alternatively. Reliability for the device is measured with intra-class correlation coefficient (ICC) controlling subject effect in a stratified model. Pearson correlations are calculated as well as mean values and confidence intervals for each metric. Results: A Pearson data analysis shows excellent intra-class correlation (ICC > 0.6) between investigators for 10 metrics, moderate ICC (ICC from 0.4 to 0.6) for 4 metrics, and poor ICC (ICC < 0.4) for 3 metrics, only for investigator 2 (P<0.05). A Pearson analysis of intra-investigator ICC demonstrated moderate to excellent ICC in almost all measured parameters (P<0.05). A Pearson correlation coefficient between the 3D angles obtained from the MTS and radiographs was calculated for the Cobb angle, kyphosis, and lordosis as 0.906, 0.675, and -0.014 with p-values of 0.000, 0.096, and 0.976 respectively. Conclusion and significance: The new MTS should be considered a reliable device because of the high intra- and inter-investigator values obtained from this study. It can be used as a desirable alternative to radiography to follow scoliosis progression. [ABSTRACT FROM AUTHOR]

Current randomized controlled trials (RCTs) for assessing the efficacy of bracing in patients with adolescent idiopathic scoliosis (AIS) suffer from poor recruitment. Additionally, patients who consent for randomization may be a highly selected group of individuals who have no preference on treatment; thus may limit the assessment of effectiveness. Therefore, we aimed to determine the feasibility of an alternative study design, 'the comprehensive cohort study' that can overcome the concerns of conventional RCTs. AIS patients aged ≥10 years, had Risser sign between 0-II, and had a Cobb angle of 25° to <30° or 20° to <25° with 5° deterioration over the past 4 months were invited to join a RCT. Those who declined were given an option to stay in the study, but choose whether they wish to be braced or observed. A randomization schedule was generated for all patients whether or not they joined the RCT; thus patients who made their own choice may also fit with the randomized choices. For those without brace but had ≥6° curve progression or reached 30° were considered failures, and braces were offered. Patients were followed every 4 months. Over 1 year, there were 87 eligible patients, 68 (78%) patients with mean age of 12.5 years consented to participate with a median follow-up of 57 weeks. Of which, 19 (28%) patients accepted randomization with respectively 13 and 6 patients allotted to brace and observation. For others who declined randomization, 18 (37%) chose brace and 28 (57%) patients had their choice of treatment the same as that on the randomization schedule. This Comprehensive Cohort Study design has the potential to improve the rate of recruitment such that both efficacy and effectiveness of bracing in AIS can be assessed. Our preliminary study showed that it can be feasibly conducted with less recruitment burden. [ABSTRACT FROM AUTHOR]

Introduction: The study aim was to compare postural stability in idiopathic scoliosis (IS) and healthy girls in dependence from feet arch behavior to body mass loading (BML). Material: Thirty girls with thoraco-lumbar IS, mean age 13.4 ± 1.5 yrs, height 160 ± 7.8 cm, weight 50 ± 9 kg, Cobb angle 40.5 ± 18.7°, and 34 healthy controls, matched for age 13.1 ± 1.5 yrs, height 157.7 ± 8.1 cm and weight 49.1 ± 11.3 kg were examined. Methods: Static balance on force platform during single and double lower extremity stance, and dynamic balance during double-limb stance on rolling-rocking board were tested with eyes opened and closed. Sway pathway (mm), area (mm2) of centre of feet pressure during static balance, and platform frontal sway from the horizontal (°), and trunk frontal and sagittal sway from the vertical (°) during dynamic balance were determined. Results: IS girls with flattening of foot and those with correct foot preserved during BML had higher and lower values of sway pathway, respectively, than matched controls. IS girls with correct feet had lower platform frontal sway than controls. Conclusion: Feet arch shape affects differently the control of static and dynamic balance in IS and healthy subjects. [ABSTRACT FROM AUTHOR]

Introduction & aim: Pelvic morphology in the sagittal plane is usually described by the pelvic incidence (PI), pelvic tilt, and sacral slope. However, the ischium is not included in this assessment. Yet, the position and orientation of the ischium relative to the SI-joint is essential for enabling the typical human fully upright way of ambulation with fully extended hips and knees, carrying the weight of the upper body constantly positioned above the pelvis. This provided an evolutionary advantage, and is believed to be the decisive step forward in human evolution. This so called 'pelvic lordosis (PL)' has never been quantified in the normal asymptomatic population. In addition, the significance of the PL in relation to the sagittal spinopelvic alignment is investigated by correlation analysis between the PL and the PI. Materials and methods: PL was defined as the angle between the axis of the ischium, and the line connecting the midpoint of the sacral endplate to the hip axis when the pelvis is projected in the sagittal plane. Using in-house developed software, the PL and PI were measured semi-automatically from three-dimensional CT scan data of the pelvis in a total of 348 normal subjects. Results: The mean PL was 25° (range, 9-46) with an SD of 6.7°. No statistical difference was observed between the genders. A weak but significant correlation between the PL and age was only found in males (r=0.14, P=0.02) but not in females. A strong correlation was observed between the PL and PI in both genders (r=0.51, P=0.00). Discussion & conclusion: A relatively wide range of values for the PL was observed, illustrating a relatively wide natural variation in the normal population. The PL was strongly positively correlated with the PI. A well-developed PL may increase the pelvis's ability to retroflex, and thus might be an important factor in maintaining congruent spinal balance. Therefore the role of the PL in spinal pathology warrants further investigation. [ABSTRACT FROM AUTHOR]

Introduction: The aim is to demonstrate the presence and the importance of the medullar cavity secondary to remodelling due to mechanical stresses of vertebral fusion similar as the cavity of a tubular bone. Methods: In this overview we evaluated remodelling both in non-instrumented fusion, in fusion with elastic instrumentation as Harrington rod and in fusion with stiff instrumentation as Isola system and after removal instrumentation. Standard X-ray, scintigraphy and CT-scan was performed. Results: Great structural differences were found at CT scan between non-instrumented fusion and instrumented fusion: the former shows a big, homogeneous area with corticalized surfaces; the latter has a smaller, inhomogeneous area with incompletely corticalized surfaces. Differences between instrumented and non-instrumented fusion were outlined by scintigraphic evaluation both in amount and distribution of cavitation areas. In non-instrumented fusion cavitation became always homogeneous within two years after surgery. In instrumented fusion cavitation continued to be inhomogeneous at least five years after surgery. Conclusion: Instrumentation on scoliosis surgery used to make an easier fusion is, at the same time, a major hindrance to remodelling of the fusion area after the early stabilization period has passed. As in the long bone the resistance to bending stress would be increased by the medullar cavity of the fusion mass. The fusion mass, as a tubular bone, adapt itself to an uneven distribution of the stresses by changing the width of its walls. The complex fusion area/Harrington instrumentation is less stiff than the complex fusion/double rod instrumentation. The fusion mass without instrumentation is less stiff and reduce the stress concentration on the adjacent mobile segments. Authors suggest to remove early the instrumentation and that this will facilitate optimal turn-over and remodelling of the fusion area and will reduce the shear stress at the junctional area. [ABSTRACT FROM AUTHOR]

Purpose: Reverse sequencing chewing cycles are dyskinetic chewing patterns occurring with high frequency in patients with unilateral posterior crossbite, during chewing on the affected side. The unilateral posterior crossbite is a serious asymmetric malocclusion, characterized by a severe asymmetry of the masticatory function. It can be associated with Adolescent Idiopathic Scoliosis (AIS). The purpose of this article was to evaluate the reverse sequencing chewing cycles during chewing with and without brace, in a patient with severe AIS and inclusion of a lower incisor. Methods: A 10.3-year-old girl, with a 25° Cobb thoraco-lumbar left side scoliosis, a normal left and right molar relationship (Angle class I) and the inclusion of the left lower lateral incisor, underwent the chewing cycles recording, with soft and hard bolus, with and without brace, seatting on a chair. Chewing patterns were recorded using a kinesiograph (K7-I; Myotronics, Tukwila, WA, USA) that measures jaw movements with an accuracy of 0.1 mm. Multiple sensors array track the motion of a magnet attached at the lower interincisor point. The kinesiograph was interfaced with a computer for data storage and subsequent analysis. Results: The results showed a high percentage of reverse chewing patterns, during chewing without brace, on the side of the impacted tooth only and, with the brace, a statistically significant decrease of the reverse chewing pattern, during chewing on the same side, either with hard (P<0.01) and soft bolus (P<0.05). Without brace, in conditions of asymmetrical posture, mastication was asymmetric with a significant prevalence of reverse chewing cycles on one side only. With brace, the symmetry of the masticatory function was restored, the unilateral reverse chewing cycles significantly decreased and the pattern improved. Conclusions: For the first time, it has been observed that the body posture may have an important and measurable influence on the masticatory function. [ABSTRACT FROM AUTHOR]

Introduction and aim: It has been suggested that the sagittal spinal profile is partly hereditary. The relationship between the sagittal spinal profile and spinal biomechanics has also been established. In this study we test the hypothesis that the well-known familial trend in AIS may be explained by the inheritance of a sagittal spinal profile, that has been shown to make the spine less resistant to rotatory forces. Materials and methods: Freestanding lateral radiographs of 51 parent couples of girls with severe progressive AIS (AIS group) and 102 age-matched controls (control group) were taken. Parents with manifest spinal deformities or spinal pathology were excluded, to avoid distorted sagittal images with unreliable measurements. Parameters of sagittal spinal profile and spinopelvic balance were semi-automatically calculated, and analyzed between the fathers of both groups, and between the mothers of both groups. Results: In the fathers of the AIS group, the plumb line of T4 was significantly less posteriorly positioned relative to the hip axis, vertebrae T11-L2 were significantly less backwardly inclined, and a significantly flatter spine was found as compared to the fathers of the control group. No statistically significant difference was observed between the mothers of both groups. Discussion and conclusion: The sagittal spinal profile of the fathers of scoliotic children was significantly flatter than the sagittal spinal profile of fathers of non-scoliotics. No difference was found in the sagittal spinal profile of the mothers of scoliotics as compared to mothers of nonscoliotics, possibly due to an inevitable normalization of the study population (exclusion of parents with spinal pathology) mainly in the mothers. Although, it is well known that scoliotic mothers have an increased risk of getting scoliotic offspring, this study indicates that fathers may contribute as well through their sagittal spinal profile to the inheritance of AIS. [ABSTRACT FROM AUTHOR]

The aim of this dissertation is to address the question of how child's body posture changes in a period of ten years with particular emphasis on the back symmetry and pelvis symmetry. The examinations were carried out in a group of 100 patients comprising of children and adolescents. This group of children and adolescents was examined twice within the period of 10 years (in 1997 and 2007). Body posture assessment was carried out with the use of a Rippstein plurimeter by the same physician using the same examination methods each time. In 2007 body posture was additionally assessed using the photogrammetric method. The results were statistically analysed using the chi square test. No statistically significant difference in the frequency of occurrence of faulty body posture in both groups was found. It was observed that the frequency of the rounded back in girls decreased while this particular faulty body posture increased in boys. In the girl group the findings revealed that body posture transformations in puberty growth showed decreasing thoracic kyphosis and increasing lumbar lordosis. An opposite tendency was observed in the boys'. A statistically significant difference was found in occurrence frequencies of back asymmetry. It has been observed that left thoracolumbar asymmetry and right thoracic asymmetry as well as left lumbar asymmetry increased in both sexes. They mostly concerned back asymmetry diagnosed in the youngest sub-group (4-7 year-olds), which undoubtedly addresses spine curvatures formation process in puberty. The second examination revealed a statistically significant increase in occurrence of pelvis asymmetry as well as functional shortening of the right lower limb. The comparison of the results obtained in the two examination methods showed their statistically significant consistency. [ABSTRACT FROM AUTHOR]