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Background: The Cobb angle is proposed as the "disease process" outcome for scoliosis research because therapies aim to correct or stop curve progression. While the Scoliosis Research Society recommends the Cobb angle as the primary outcome, the Society on Scoliosis Orthopaedic and Rehabilitation Treatment prioritises, as a general goal, patient related outcomes over Cobb angle progression., Objective: To determine the threshold of change in the Cobb angle in adolescents with idiopathic scoliosis (AIS) who perceive improvement in a 6-months randomized controlled trial comparing a Schroth exercise intervention added to the standard of care to the standard of care alone., Methods: This is a secondary analysis of data from a randomized controlled trial of 50 patients with AIS, with curves ranging from 10° to 45°, with or without a brace. Participants with diagnoses other than AIS, surgical candidates or patients who had scoliosis surgery were excluded. The 6-month interventions consisted of Schroth exercises added to standard-of-care (observation or bracing) with daily home exercises and weekly therapy sessions (Schroth) or standard-of-care alone (Control). The anchor method for estimating the minimal important difference (MID) in the largest Cobb angles (LC) was used. Patient-reported change in back status over the 6-month treatment period was measured using the Global Rating of Change (GRC) scale as anchor varying from - 7 ("great deal worse") to + 7 ("great deal better"). Participants were divided into two groups based on GRC scores: Improved (GRC ≥2) or Stable/Not Improved (GRC ≤1). MID was defined as the change in the LC that most accurately predicted the GRC classification as per the receiver operating characteristic curve (ROC)., Results: The average age was 13.4 ± 1.6 years and the average LC was 28.5 ± 8.8 °s. The average GRC in the control group was - 0.1 ± 1.6, compared to + 4.4 ± 2.2 in the Schroth group. The correlation between LC and GRC was adequate (r = - 0.34, p < 0.05). The MID for the LC was 1.0 °. The area under the ROC was 0.69 (0.52-0.86), suggesting a 70% chance to properly classify a patient as perceiving No Improvement/Stable or Improvement based on the change in the LC., Conclusion: Patients undergoing Schroth treatment perceived improved status of their backs even if the Cobb angle did not improve beyond the conventionally accepted threshold of 5°. Standard of care aims to slow/stop progression while Schroth exercises aim to improve postural balance, signs and symptoms of scoliosis. Given the very small MID, perceived improvement in back status is likely due to something other than the Cobb angle. This study warrants investigating alternatives to the Cobb angle that might be more relevant to patients., Trial Registration: ClinicalTrials.gov , NCT01610908 . Retrospectively registered on April 2, 2012 (first posted on June 4, 2012 - https://clinicaltrials.gov/ct2/keydates/NCT01610908 ).

Background: Recent randomized controlled trials (RCTs) support using physiotherapeutic scoliosis-specific exercises (PSSE) for adolescents with idiopathic scoliosis (AIS). All RCTs reported statistically significant results favouring PSSE but none reported on clinical significance. The number needed to treat (NNT) helps determine if RCT results are clinically meaningful. The NNT is the number of patients that need to be treated to prevent one bad outcome in a given period. A low NNT suggests that a therapy has positive outcomes in most patients offered the therapy. The objective was to determine how many patients require Schroth PSSE added to standard care (observation or brace treatment) to prevent one progression (NNT) of the Largest Curve (LC) or Sum of Curves (SOC) beyond 5° and 10°, respectively over a 6-month interval., Methods: This was a secondary analysis of a RCT. Fifty consecutive participants from a scoliosis clinic were randomized to the Schroth PSSE + standard of care group ( n  = 25) or the standard of care group ( n  = 25).We included males and females with AIS, age 10-18 years, all curve types, with curves 10°- 45°, with or without brace, and all maturity levels. We excluded patients awaiting surgery, having had surgery, having completed brace treatment and with other scoliosis diagnoses. The local ethics review board approved the study (Pro00011552).The Schroth intervention consisted of weekly 1-h supervised Schroth PSSE sessions and a daily home program delivered over six months in addition to the standard of care. A prescription algorithm was used to determine which exercises patients were to perform. Controls received only standard of care.Cobb angles were measured using a semi-automatic system from posterior-anterior standing radiographs at baseline and 6 months.We calculated absolute risk reduction (ARR) and relative risk reduction (RRR). The NTT was calculated as: NNT = 1/ARR. Patients with missing values (PSSE group; n  = 2 and controls; n  = 4) were assumed to have had curve progression (worst case scenario). The RRR is calculated as RRR = ARR/CER., Results: For LC, NNT = 3.6 (95% CI 2.0-28.2), and for SOC, NNT = 3.1 (95% CI 1.9-14.2). The corresponding ARR was 28% for LC and 32% for the SOC. The RRR was 70% for LC and 73% for the SOC. Patients with complete follow-up attended 85% of prescribed visits and completed 82.5% of the home program. Assuming zero compliance after dropout, 76% of visits were attended and 73% of the prescribed home exercises were completed., Conclusions: The short term of Schroth PSSE intervention added to standard care provided a large benefit as compared to standard care alone. Four (LC and SOC) patients require treatment for the additional benefit of a 6-month long Schroth intervention to be observed beyond the standard of care in at least one patient., Trial Registration: NCT01610908 April 2, 2012.

Objective: To investigate whether low intensity transcranial electrical stimulation (TES) can be used to condition post-activation depression of the H-reflex and simultaneously monitor the integrity of spinal motor pathways during spinal deformity correction surgery., Methods: In 20 pediatric patients undergoing corrective surgery for spinal deformity, post-activation depression of the medial gastrocnemius H-reflex was initiated by delivering two pulses 50-125ms apart, and the second H-reflex was conditioned by TES., Results: Low intensity TES caused no visible shoulder or trunk movements during 19/20 procedures and the stimulation reduced post-activation depression of the H-reflex. The interaction was present in 20/20 patients and did not diminish throughout the surgical period. In one case, the conditioning effect was lost within minutes of the disappearance of the lower extremity motor evoked potentials., Conclusion: Post-activation depression was used to detect the arrival of a subthreshold motor evoked potential at the lower motor neuron. The interaction produced minimal movement within the surgical field and remained stable throughout the surgical period., Significance: This is the first use of post-activation depression during intraoperative neurophysiological monitoring to directly assess the integrity of descending spinal motor pathways., (Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity. Brace treatment is a common non-surgical treatment, intended to prevent progression (worsening) of the condition during adolescence. Estimating a braced patient's risk of progression is an essential part of planning treatment, so method for predicting this risk would be a useful decision support tool for practitioners. This work attempts to discover whether failure of brace treatment (progression) can be predicted at the start of treatment. Records were obtained for 62 AIS patients who had completed brace treatment. Subjects were labeled as "progressive" if their condition had progressed despite brace treatment and "non-progressive" otherwise. Wrapper-based feature selection selected two useful predictor variables from a list of 14 clinical measurements taken from the records. A logistic regression model was trained to classify patients as "progressive" or "non-progressive" using these two variables. The logistic regression model's simplicity and interpretability should facilitate its clinical acceptance. The model was tested on data from an additional 28 patients and found to be 75 % accurate. This accuracy is sufficient to make the predictions clinically useful. It can be used online: http://www.ece.ualberta.ca/~dchalmer/SimpleBracePredictor.html .

Background: In North America, care recommendations for adolescents with small idiopathic scoliosis (AIS) curves include observation or bracing. Schroth scoliosis-specific exercises have demonstrated promising results on various outcomes in uncontrolled studies. This randomized controlled trial (RCT) aimed to determine the effect of Schroth exercises combined with the standard of care on quality-of-life (QOL) outcomes and back muscle endurance (BME) compared to standard of care alone in patients with AIS., Material and Methods: Fifty patients with AIS, aged 10-18 years, with curves 10-45 °, recruited from a scoliosis clinic were randomized to receive standard of care or supervised Schroth exercises plus standard of care for 6 months. Schroth exercises were taught over five sessions in the first two weeks. A daily home program was adjusted during weekly supervised sessions. The assessor and the statistician were blinded. Outcomes included the Biering-Sorensen (BME) test, Scoliosis Research Society (SRS-22r) and Spinal Appearance Questionnaires (SAQ) scores. Intention-to-treat (ITT) and per protocol (PP) linear mixed effects models were analyzed. Because ITT and PP analyses produced similar results, only ITT is reported., Results: After 3 months, BME in the Schroth group improved by 32.3 s, and in the control by 4.8 s. This 27.5 s difference in change between groups was statically significant (95 % CI 1.1 to 53.8 s, p = 0.04). From 3 to 6 months, the self-image improved in the Schroth group by 0.13 and deteriorated in the control by 0.17 (0.3, 95 % CI 0.01 to 0.59, p = 0.049). A difference between groups for the change in the SRS-22r pain score transformed to its power of four was observed from 3 to 6 months (85.3, 95 % CI 8.1 to 162.5, p = 0.03), where (SRS-22 pain score)(4) increased by 65.3 in the Schroth and decreased by 20.0 in the control group. Covariates: age, self-efficacy, brace-wear, Schroth classification, and height had significant main effects on some outcomes. Baseline ceiling effects were high: SRS-22r (pain = 18.4 %, function = 28.6 %), and SAQ (prominence = 26.5 %, waist = 29.2 %, chest = 46.9 %, trunk shift = 12.2 % and shoulders = 18.4 %)., Conclusions: Supervised Schroth exercises provided added benefit to the standard of care by improving SRS-22r pain, self-image scores and BME. Given the high prevalence of ceiling effects on SRS-22r and SAQ questionnaires' domains, we hypothesize that in the AIS population receiving conservative treatments, different QOL questionnaires with adequate responsiveness are needed., Trial Registration: Schroth Exercise Trial for Scoliosis NCT01610908.

The analysis of the salt dependence of protein-DNA complexes provides useful information about the non-specific electrostatic and sequence-specific parameters driving complex formation and stability. The differential scanning fluorimetry of GFP-tagged protein (DSF-GTP) assay has been geared with an automatic Tm peak recognition system and was applied for the high-throughput (HT) determination of salt-induced effects on the GFP-tagged DNA replication protein Tus in complex with various Ter and Ter-lock sequences. The system was designed to generate two-dimensional heat map profiles of Tus-GFP protein stability allowing for a comparative study of the effect of eight increasing salt concentrations on ten different Ter DNA species at once. The data obtained with the new HT DSF-GTP allowed precise dissection of the non-specific electrostatic and sequence-specific parameters driving Tus-Ter and Tus-Ter-lock complex formation and stability. The major factor increasing the thermal resistance of Tus-Ter-lock complexes in high-salt is the formation of the TT-lock, e.g. a 10-fold higher Kspe was obtained for Tus-GFP:Ter-lockB than for Tus-GFP:TerB. It is anticipated that the system can be easily adapted for the study of other protein-DNA complexes.

In E. coli, DNA replication termination occurs at Ter sites and is mediated by Tus. Two clusters of five Ter sites are located on each side of the terminus region and constrain replication forks in a polar manner. The polarity is due to the formation of the Tus-Ter-lock intermediate. Recently, it has been shown that DnaB helicase which unwinds DNA at the replication fork is preferentially stopped at the non-permissive face of a Tus-Ter complex without formation of the Tus-Ter-lock and that fork pausing efficiency is sequence dependent, raising two essential questions: Does the affinity of Tus for the different Ter sites correlate with fork pausing efficiency? Is formation of the Tus-Ter-lock the key factor in fork pausing? The combined use of surface plasmon resonance and GFP-Basta showed that Tus binds strongly to TerA-E and G, moderately to TerH-J and weakly to TerF. Out of these ten Ter sites only two, TerF and H, were not able to form significant Tus-Ter-locks. Finally, Tus's resistance to dissociation from Ter sites and the strength of the Tus-Ter-locks correlate with the differences in fork pausing efficiency observed for the different Ter sites by Duggin and Bell (2009).

The measurement of protein-DNA interactions is difficult and often involves radioisotope-labelled DNA to obtain the desired assay sensitivity. More recently, high-throughput proteomic approaches were developed but they generally lack sensitivity. For these methods, the level of technical difficulties involved is high due to the need for specialised facilities or equipment and training. The new qPCR-based DNA-binding assay involves immunoprecipitation of a GFP-tagged DNA-binding protein in complex with various DNA targets (Ter sites) followed by qPCR quantification, affording a very sensitive and quantitative method that can be performed in polyplex. Using a single binding reaction, the binding specificity of the DNA replication terminator protein Tus for ten termination sites TerA-J could be obtained for the first time in just a few hours. This new qPCR DNA-binding assay can easily be adapted to determine the binding specificity of virtually any soluble and functional epitope-tagged DNA-binding protein.

Information about the stability of proteins is paramount to determine their optimal storage or reaction conditions. It is also essential to determine protein stability in high-throughput when screening for new or improved functions of proteins obtained from large mutant libraries. In drug discovery programs, monitoring of ligand-induced stabilization effects can be used to identify lead compounds in high-throughput. These studies require expensive biophysical instrumentation and large quantities of purified proteins. To address these issues, we developed a new method, using GFP as a reporter system to quantify the stability of a protein and its ligand-associated stabilization effects that requires neither special equipment nor extensive purification steps. Here, GFP is fused to a protein of interest (POI) through a linker and is used as a reporter system for protein unfolding and aggregation. The three POIs used in this study include the Ter-binding protein Tus, glycerol kinase and chloramphenicol acetyl transferase. The fluorescent fusion protein is subjected to irreversible thermal denaturation leading to formation of aggregates, which are eliminated by a centrifugation step. The residual fluorescence of the soluble fraction can be directly related to the stability of the POI and can be quantitatively monitored using a fluorescence plate reader. The GFP-based stability assay (GFP-Basta) was able to identify stabilizing compounds and afforded a new quantitative method for the screening and ranking of ligands for three different proteins. These applications are particularly useful for drug discovery, directed evolution, structural and functional genomics.

Investigations into the photocrosslinking kinetics of the protein Tus with various bromodeoxyuridine-substituted Ter DNA variants highlight the potential use of this complex as a photoactivatable connector between proteins of interest and specific DNA sequences.

The subunits of the presumptive replicative helicase of archaea and eukaryotes, the MCM complex, are members of the AAA+ (ATPase-associated with various cellular activities) family of ATPases. Proteins within this family harness the chemical energy of ATP hydrolysis to perform a broad range of cellular processes. Here, we investigate the function of the AAA+ site in the mini-chromosome maintenance (MCM) complex of the archaeon Sulfolobus solfataricus (SsoMCM). We find that SsoMCM has an unusual active-site architecture, with a unique blend of features previously found only in distinct families of AAA+ proteins. We additionally describe a series of mutant doping experiments to investigate the mechanistic basis of intersubunit coordination in the generation of helicase activity. Our results indicate that MCM can tolerate catalytically inactive subunits and still function as a helicase, leading us to propose a semisequential model for helicase activity of this complex.

Many of the aches and pains of adults are the result not of injuries, but of the long-term effects of distortions in posture or alignment. Postural kyphosis in adolescence may be one of the effects of poor standing and sitting habits. Kyphosis is an excessive rounding of the upper spine. A smart garment that can monitor and provide vibration feedback to children has been developed to investigate an alternative treatment possibility. Laboratory tests verified that the accuracy of the system was +/-2 degrees within the full 180 degrees range. A clinical trial has been conducted and it showed that the system can aid subjects to improve by 20% the proportion of time in a more balanced posture. The long term effect is still under investigation.

There is considerable controversy regarding the effectiveness of orthotic treatment for patients with adolescent idiopathic scoliosis. Most researchers believe that, to be effective, the orthosis must be worn as prescribed for both compliance and tightness. Compliance is the time the brace is worn relative to the prescribed time. A battery-powered microcomputer system was developed to monitor and maintain the loads exerted by orthoses used to treat children with spinal deformities during daily living. This system not only records how well and for how much time the brace has been used, but also helps patients to ensure that the brace is being worn at the prescribed tightness. Laboratory tests were performed, and five patients used the system for four weeks. The patients reported that the system helped them to wear the orthoses correctly and comfortably. The time that the patients wore the orthoses at the prescribed tightness level increased from 53 +/- 9% during the monitoring period (first 2 weeks) to 68 +/- 14% during the automatic adjustment period (last 2 weeks).

Study Design: Retrospective cross-sectional assessment of the reproducibility and reliability of radiographic parameters., Objective: To measure the intra-examiner and interexaminer reproducibility and reliability of salient radiographic features., Summary of Background Data: The management and treatment of adolescent idiopathic scoliosis (AIS) depends on accurate and reproducible radiographic measurements of the deformity., Methods: Ten sets of radiographs were randomly selected from a sample of patients with AIS, with initial curves between 20 degrees and 45 degrees. Fourteen measures of the deformity were measured from posteroanterior and lateral radiographs by 2 examiners, and were repeated 5 times at intervals of 3-5 days. Intra-examiner and interexaminer differences were examined. The parameters include measures of curve size, spinal imbalance, sagittal kyphosis and alignment, maximum apical vertebral rotation, T1 tilt, spondylolysis/spondylolisthesis, and skeletal age., Results: Intra-examiner reproducibility was generally excellent for parameters measured from the posteroanterior radiographs but only fair to good for parameters from the lateral radiographs, in which some landmarks were not clearly visible. Of the 13 parameters observed, 7 had excellent interobserver reliability., Conclusions: The measurements from the lateral radiograph were less reproducible and reliable and, thus, may not add value to the assessment of AIS. Taking additional measures encourages a systematic and comprehensive assessment of spinal radiographs.

Orthotic treatment is the most commonly used non-surgical treatment method for adolescent idiopathic scoliosis (AIS). This study determined whether treatment outcome correlates with how often and how well children with AIS wear their orthoses. Eighteen (18) subjects (3M, 15F) who were diagnosed with idiopathic scoliosis and had worn their orthoses from 6 months up to 1 year participated in this study. All subjects were prescribed Boston braces to be worn full time (23 hrs/day). Twelve (12) subjects who completed their brace treatment were included in the data analysis. Three (3) treatment outcomes were classified as improvement, no change and deterioration. The quality of the brace wear was assessed by how often the brace was worn with zero force, below 80%, between 80 to 120%, and above 120% of the load level prescribed in the clinic. The quantity of brace wear was determined by how many hours per day they wore their brace. Subjects who wear their braces tighter and for more hours per day seem to have better outcomes.

A database system with Bluetooth wireless connectivity has been developed so that scoliosis clinics can be run more efficiently and data can be mined for research studies without significant increases in equipment cost. The wireless database system consists of a Bluetooth-enabled laptop or PC and a Bluetooth-enabled handheld personal data assistant (PDA). Each patient has a profile in the database, which has all of his or her clinical history. Immediately prior to the examination, the orthopaedic surgeon selects a patient's profile from the database and uploads that data to the PDA over a Bluetooth wireless connection. The surgeon can view the entire clinical history of the patient while in the examination room and, at the same time, enter in any new measurements and comments from the current examination. After seeing the patient, the surgeon synchronises the newly entered information with the database wirelessly and prints a record for the chart. This combination of the database and the PDA both improves efficiency and accuracy and can save significant time, as there is less duplication of work, and no dictation is required. The equipment required to implement this solution is a Bluetooth-enabled PDA and a Bluetooth wireless transceiver for the PC or laptop.

Study Design: A retrospective cross-sectional review studied the posteroanterior and lateral bending radiographs of 26 preoperative patients with thoracic major adolescent idiopathic scoliosis., Objective: To characterize the relation of vertebral axial rotation, apparent vertebral wedging, and disc wedging with lateral bending in patients with severe adolescent idiopathic scoliosis., Summary of Background Data: Lateral bending radiographs are used commonly in surgical planning to assess the flexibility of the spine and to establish the placement of instrumentation. However, their use in the assessment of motion in the axial plane has not been clearly established., Methods: Data were collected retrospectively from 26 subjects immediately before spinal surgery. All the subjects had adolescent idiopathic scoliosis with right thoracic major curves. Axial rotation, vertebral wedging, and disc wedging were measured from T4 to L4 on left and right supine bending and standing posteroanterior radiographs. The apexes of the major and minor curves, the neutral vertebrae, and the Cobb angles were recorded., Results: No significant differences in axial rotation were found at the thoracic apex, neutral vertebrae, or lumbar apex in response to lateral bending. Most of the wedging occurs in the disc, and is maximal at the apex of the curve. The total amount of wedging was higher in more severe curves., Conclusions: Lateral bending does not improve axial rotation in severe scoliosis (scoliosis for which surgical correction is advised). Structural changes including disc and vertebral wedging may be responsible for the lack of rotational correction of the scoliotic spine. Lack of axial flexibility in the thoracic region may hamper surgical attempts to correct the deformities of the trunk.

An electronically instrumented rod rotator has been developed to monitor forces and moments applied by surgeons during the derotation manoeuver to correct spinal curvature. This instrumented rod rotator consisted of an inclinometer and two pairs of strain gauges, with all the support circuitry. The strain gauge and the inclinometer data were sampled with a data-acquisition system, and the results were displayed in real time. The device was calibrated in the laboratory and used on seven subjects. The precision of the load measurement of this device was +/- 5 N in the range of 5-65N. The distance between the middle of the rod rotator handle to the rod position was 0.21 m. The maximum loads applied by the surgeon during seven surgeries were from 22 to 57N, with a torque (force x distance) from 4.6 to 12 Nm.

The three-dimensional nature of scoliosis, coupled with changes due to natural history or treatment, is often difficult to quantify and visualise. A difference map was developed to compare the sequential surface topography of subjects over their treatment period. Three-dimensional surface maps representing patients' trunk surfaces were captured with a laser scanner. Patient surface maps from two clinic visits were matched using a manual best-fit technique that accounted for growth and positioning. The surfaces were subtracted, generating a colour-coded three-dimensional difference map displaying the surface changes. The difference maps were compared with known clinical measures, indicating good agreement (78% specific) with the clinical parameters in detecting change. Full agreement or agreement with the clinical parameters occurred in the surgical, brace and no treatment groups: 76%, 80% and 85%, respectively. A difference index (average of the absolute value of differences on a point-by-point basis) was calculated from the difference map, enabling quantification of change. The difference index, with zero being a perfect match, averaged 5 +/- 1 for repeated measures 7 +/- 2 for subjects deemed to have no change, 9 +/- 2 for subjects with slight change, and 14 +/- 2 for subjects with significant change. The difference map showed the extent and location of changes and is a useful tool for assessing surface topography changes.

The efficacy of orthotic treatment for children with abnormal spinal curvature has been hampered by the lack of comprehensive information about wear characteristics. A battery-powered microcomputer system was developed to monitor loads exerted by orthoses used to treat children with spinal deformities during daily living. The system not only records how well the orthosis has been used, but also helps to ensure that the orthosis is being worn as prescribed. Data acquisition is controlled by a microcontroller and can be programmed to have sample intervals ranging from 1 second to 1 hour. Low power control circuitry is designed so that the system can be operated by a battery. In a preliminary study, 16 subjects (3M, 13F) used this system from 1 to 16 days (9.3 +/- 5.0) with the prescribed hours between 16 to 23 hours (22.3 +/- 1.3). This study demonstrated the feasibility of the approach, and that this device may increase the understanding of orthotic mechanics, and may help patients to wear their orthoses in a better way.

A significant complication of surgical correction of the deformed spine is pull out of the vertebral hooks or screws. This complication can be partly attributed to poor bone stock. Currently, there are few methods available for surgeons to assess the mechanical strength and stiffness of the vertebra, and even fewer methods that provide in-vivo measurements. An "upbiter" is often used to form a seat in the lamina for the hook. A typical upbiter was modified and instrumented with strain gauges to investigate the feasibility of determining the forces and displacements needed to cut through laminar bone during surgical procedures. The calibration showed that the system was repeatable and could highly correlated with applied force (R2=0.98) and displacement (R2=0.99) with resolutions of 0.72 N and 0.40 mm respectively. This system was tested on three females, on lamina ranging from T4 to T12 regions. The average maximum force for bone failure was at 470+/-128N.

The application of three-point loading is thought to be the essential basis for effective bracing of adolescent idiopathic scoliosis. Care is taken to ensure that active pressure pad is located to provide maximum support to the apex of the scoliosis while minimizing its lordosising effect. Paradoxically, while cited as an essential factor in the design of braces, there is no consensus as to the importance of such loading to the clinical effectiveness of braces. It may be that braces are effective but that they are effective for reasons unrelated to mechanics. There are few studies that link brace mechanics and change in spinal alignment. Optimal bracing for AIS requires a much better understanding of the role of the mechanical support of braces used to treat AIS. Sixteen subjects, 3 males and 13 females, were participated to this study to determine the correlation between quantity and quality of brace wear and treatment outcomes in AIS. This study showed that the target force levels set for the active pad in braces prescribed for the treatment of AIS vary considerably and that brace applies the desired load 25% of the prescribed time.

This work investigated the use of coded-line patterns to improve image correspondence and 3D reconstruction. The objective was to define an optimum structured light pattern to facilitate the construction of topographic maps of the trunks of scoliosis patients. The system consisted of stereo CCD television cameras, a slide projector to create the coded-line pattern and a computer with video acquisition card. The optimum pattern in terms of generating correct results with minimum computing time was a line pattern consisting of 6 groupings of 3-level grey lines. This chosen pattern was investigated using known 3D objects to determine the effectiveness, resolution and computational time to correlate stereo images. The selected structured light pattern consisted of a repeated pattern of white (W), grey (G) and black (B) lines. Each line was 4mm wide on the back surface. The pattern consisted of 6 groups of 3 lines, WBG WGB GWB GBW BGW BWG. Using known 3D models of a section of a cylinder, a plate with steps and a ramp-like object; the coded line system was tested under typical clinical lighting conditions. For the 3D test objects, errors in correspondence occurred in 2-4 % of stereo pixels. The processing time varied from 10-12 minutes. The 3D resolution obtained was 4mm.

A Minolta VIVID 700 portable non-contact 3D laser scanner was evaluated on 15 subjects with idiopathic scoliosis. The 3D map was compared to two structured light pattern (lines and dots) techniques to determine the reliability, ease of use, speed, and quality. The parameters used for the clinical assessment of scoliosis were measured twice for the Minolta and light projection systems. The edges of the image and areas where occlusion typically occur were examined. The absolute distance in calculated depth between adjacent points was examined to determine errors. The Minolta system and the dot pattern produced regular grids of points. The light projection pattern produced an irregular grid, with more resolution along the video line and less resolution between projected lines, resulted in a somewhat jagged appearance of the surface map. The Minolta system was less sensitive to edge effects, occlusion, and sharp transitions of depth. The comparison of clinical parameters showed good results between repetitions but moderate results between techniques.

There are a number of forces applied during scoliosis surgery, the magnitude and direction of which remains unknown. There is little literature concerning the in vivo distribution of forces along the spine. Computer modelling (ANSYS) was used to investigate the possibility of using an instrumented hook to intra-operatively measure the antero-posterior and distraction/compression forces applied by the surgeon during corrective scoliosis surgery. Three hook designs were evaluated based on specific design criteria. ANSYS provided the preliminary analysis to determine the strain distribution in these hooks. One design, the "membrane" design, was selected and a prototype was manufactured. Preliminary tests demonstrate that this prototype will be able to differentiate between the four major forces applied during the surgical correction.

Trunk images of children with scoliosis were examined to determine features that contribute to the impression of trunk distortion. Twenty subjects with spinal deformity ranging from none to severe were photographed in a relaxed standing position. Seven blinded evaluators subjectively scored their impressions of the trunk appearance, shoulder-height difference, shoulder-angle asymmetry, decompensation, scapula asymmetry, waist crease, waist asymmetry, and pelvic asymmetry. Regression analysis was used with the latter seven features to predict overall impression. The seven measures of the deformity predicted 85% of the overall impression of trunk distortion; scapular asymmetry was the best predictor. Trunk deformity is the most obvious effect of scoliosis to the patients. Objective approaches to the assessment of this important but difficult-to-quantify aspect of idiopathic scoliosis are available and should be used to evaluate treatment outcomes.

Study Design: This study used human cadaveric material to examine the three-dimensional morphology and biomechanics of the superior and lateral costotransverse ligaments and the intertransverse ligament of the spine., Objectives: To provide descriptive and quantitative data on the morphology of the lateral ligaments of the spine and to assess their importance in maintaining lateral stability, especially regarding the pathogenesis of idiopathic scoliosis., Summary of Background Data: Ligaments have been reported as being able to stabilize the spine by mechanical constraint and by neurologic feed-back. Midline spinal ligaments have been well studied but do not appear to be effective in maintaining lateral stability because of their sites of attachment. Lateral ligaments of the spine have not been adequately documented in the literature., Methods: The morphology, sites of attachment, and dimensions of the superior costotransverse ligament, lateral costotransverse ligament, and intertransverse ligament from thoracic level 7 to thoracic level 10 were determined on 32 human cadavers., Results: The intertransverse ligament was found not to be a true ligament. The lateral costotransverse ligament was a true ligament but did not have the characteristics appropriate for involvement in lateral stability. The superior costotransverse ligament also was a true ligament and had all of the characteristics appropriate for involvement in the active lateral balancing of the spine., Conclusions: In contrast to the midline ligaments of the spine, the superior costotransverse ligament perhaps is the most important ligament for active lateral balancing of the spine and warrants further study, particularly regarding the development of idiopathic scoliosis.

The PVD Bio-Thesiometer was tested as a tool for measuring vibratory thresholds and for detecting possible differences in these thresholds between adolescents who have idiopathic scoliosis and those who do not. It was found to be limited by low reliability and large errors in measurement, with the metatarsophalangeal joint being the only reliable site for measurement. The vibratory thresholds at this site were significantly higher in the fourteen subjects who had scoliosis than in the twenty-two control subjects. No significant asymmetry in vibratory thresholds was found between the concave and convex or the right and left sides in either the scoliotic or the control group. Because there was no significant difference between the readings from the concave and convex sides, it is unlikely that a lesion of the posterior column is responsible for idiopathic scoliosis. If there is a difference, then the PVD Bio-Thesiometer is not sufficiently reliable to detect it.

Precise mechanical loading is essential in the in vitro evaluation of spinal fixation instrumentation, but the control of experimental variables is difficult because of variations in specimen morphology, size and end conditions, and gross specimen flexibility. This paper describes an end-cap which is simple in design, time efficient in its attachment to the spine and which provides precise positioning and rigid control of the end fixation points, resulting in excellent experimental control. It is easily adapted to human or animal specimens and provides a reliable load application unit, which permits specific physiological end conditions to be applied.

Accurate in vitro evaluation of the efficacy of spinal instrumentation devices requires specialized equipment. A displacement transducer that directly measures motion at the fracture site has been designed. Data are processed on-line by computer. Tests using an earlier photographic technique simultaneously with the transducer show the new method to be more accurate and reliable and the results more readily available. Application of the transducer for monitoring fracture creation and end-cap purchase is also shown.

The use of mature porcine and immature bovine spines as models for the assessment of spinal fracture instrumentation is commonplace. By comparing the load-displacement characteristics of these spine segments and observing the fracture type, this study investigated the tendency of immature bovine spines to fail prematurely at the vertebral physis, disrupting biomechanical evaluation of spinal fracture fixation devices. Load to failure of the spines was determined using the Instron Universal Testing Machine and a specially designed endcap. In axial compression, the 10-16-week-old calf spines failed at 12,845 +/- 1,466 N, compared with mature pig spines at 17,300 +/- 5,170 N (p less than 0.05). Axial compression with flexion caused consistent failure through an end-plate in both species: 995 +/- 156 N for the calf spines and 2,025 +/- 575 N for the porcine spines (p less than 0.005). It was concluded that the tendency for immature bovine spines to fail more readily at the cartilaginous end-plate makes the calf spine a less desirable model.

In-situ pinning of a slipped capital femoral epiphysis is the most common form of treatment for this problem. To find out if remodelling of the upper femur after pinning occurs often enough to justify this form of treatment and whether secondary osteotomies are required for residual deformity, 82 patients with slipped capital femoral epiphyses were reviewed. X-ray films were studied sequentially, noting remodelling changes in the femoral head and neck. Sixty-eight percent of moderate to severe slips that could be properly assessed showed signs of remodelling. The authors recognized two distinct remodelling processes--one, occurring early, affected the neck adjacent to the growth plate, the second appeared later, more distally along the femoral neck. Very few osteotomies were done for residual deformity. Pinning in situ of a slipped capital femoral epiphysis represents a simple, rapid and effective method of treatment, allowing remodelling even in more severe slips.

Lead intoxication was diagnosed in April 1984 in an anuric woman of 65 years of age, whose hemodialysis had begun 9 years previously. Lead poisoning was completely cured by repeated hemofiltration with calcium EDTA. 28.2 mg of lead were extracted during 26 hemofiltration sessions. After the twentieth session, the rate of extracted lead was 500 micrograms per session and the rate of delta-aminolevulinic acid dehydrase was normalized. This exceptional observation allowed a nearly experimental study of the kinetics and metabolism of Ca EDTA chelated lead.

Outpatient percutaneous tendo Achillis lengthening is a quick, complication-free, inexpensive approach to a common pediatric orthopedic problem. The procedure is a known alternative to conventional open procedures, but it is not widely used. This study outlines the advantage of the percutaneous procedure performed in outpatient surgery with the patient under a general anesthetic. Fifty-five patients were operated on between December 1980 and March 1984. Overall results were excellent, with 97% improvement in gait. There were no infections. Percutaneous heel cord lengthening in children is a safe and simple operation, yielding results equal to those of open procedures. The advantage of outpatient surgery adds a further positive dimension to this procedure.