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Der Orthopade Jun 2019The majority of growth disturbances of the spine are acquired and their etiology is still unknown. Both scolioses and sagittal profile disorders are most commonly of... (Review)
Review
BACKGROUND
The majority of growth disturbances of the spine are acquired and their etiology is still unknown. Both scolioses and sagittal profile disorders are most commonly of idiopathic origin.
ETIOLOGY
The etiology is multifactorial and besides genetic, hormonal and mechanical factors also metabolic components seem to be involved. The risk of progression of an existing deformity is particularly high during the pubertal growth spurt. Accordingly, regular clinical and radiological controls should be carried out in this vulnerable period. Recently, spinal deformities have been classified according to the time of diagnosis rather than according to their etiology, considering the increasing knowledge about the correlation between spinal and thoracic growth and the associated maturation of the lungs. Therefore, the term "early onset scoliosis" considers all deformities of the spine diagnosed before the age of 10 years.
TREATMENT
In the case of failure of conservative treatment options, which have to be applied for as long as possible, definitive spinal fusion surgery should be delayed by the use of growth-sparing surgical techniques, aiming to achieve as normal pulmonary function as possible.
Topics: Disease Progression; Humans; Radiography; Scoliosis; Spinal Diseases; Spine
PubMed: 31069449
DOI: 10.1007/s00132-019-03739-0 -
Pain Research & Management 2021Scheuermann's kyphosis can cause severe back pain and cosmetic disorders to patients. Previous studies on surgical procedure selection for correction of Scheuermann's... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Scheuermann's kyphosis can cause severe back pain and cosmetic disorders to patients. Previous studies on surgical procedure selection for correction of Scheuermann's kyphosis have drawn controversial conclusions. Here, a meta-analysis was performed to figure out a better way between anterior-posterior (AP) combined procedures and posterior-only (PO) procedures.
METHODS
We searched PubMed database and Ovid database, as well as Cochrane Library (between January 2009 and December 2020, around recent ten years), for studies reporting Scheuermann's kyphosis correction in an anterior way or a posterior way. Random effects meta-analysis regarding correction degrees and incidence of proximal junctional kyphosis (PJK) was performed.
RESULTS
Finally, 13 unique studies including 586 patients (AP: 300; PO: 286) were identified and included for this meta-analysis. Overall, 6 AP cohorts and 10 PO cohorts were pooled regarding the correction degrees of kyphosis in the analysis, respectively. Pooled correction degrees in AP cohorts were 33.31 (95% CI: 27.48-39.15; = 86%, < 0.001) and in PO cohorts were 31.16 (95% CI: 26.97-35.35; = 81.1%, < 0.001). Comparison of correction between AP and PO cohorts did not indicate any significant difference. Likewise, postoperative PJK incidence showed no difference. Back pain can be caused by both AP and PO procedures, but which causes less pain remains to be conclusive. The PO approach showed less blood loss and shorter surgical duration as compared to the AP approach.
CONCLUSIONS
In summary, this meta-analysis shows similar treatment effects between AP and PO procedures in correcting Scheuermann's kyphosis, suggesting the advantage of PO procedures due to less blood loss and surgical duration. However, the postoperative complications PJK and distal junctional kyphosis (DJK) cannot be well concluded due to the limitation of existing data.
Topics: Humans; Postoperative Complications; Scheuermann Disease; Spinal Fusion; Time Factors
PubMed: 34725561
DOI: 10.1155/2021/2142964 -
International Orthopaedics Apr 2019Surgical treatment of thoracic disc herniation (TDH) is technically demanding due to its proximity to the spinal cord. (Review)
Review
BACKGROUND
Surgical treatment of thoracic disc herniation (TDH) is technically demanding due to its proximity to the spinal cord.
METHODS
Literature review.
RESULTS
Symptomatic TDH is a rare condition predominantly localized between T8 and L1. Surgical indications include intractable back or radicular pain, neurological deficits, and myelopathy signs. Giant calcified TDH (> 40% spinal canal occupation) are frequently associated with myelopathy, intradural extension, and post-operative complications. Careful pre-operative planning helps reduce the risk of complications. Pre-operative CT and MRI identify the hernia's location and size, calcifications, and intradural extension. The approach must provide adequate dural sac visualization with minimal manipulation of the cord. Non-anterior approaches are favoured if they provide at least equal exposure than anterior approach owing to higher risk of pulmonary morbidity associated with anterior approach. A transthoracic approach is recommended for central calcified herniated discs. A posterolateral approach is often suitable for non-calcified lateralized TDH. Thoracoscopic approaches are less invasive but have a substantial learning curve. Retropleural mini-thoracotomy is an acceptable alternative. Pre-operative identification of the pathological level is confirmed by intra-operative level check. Intra-operative cord monitoring is preferable but warrant further studies. Magnification and adequate lightening of the surgical field are paramount (microscope, thoracoscopy). Intra-operative CT scan with navigation is becoming increasingly popular since it provides real-time control on the decompression. Indications of fusion consist of pre-operative back pain, Scheuermann's disease, multilevel resection, wide vertebral body resection (> 50%), and herniation at thoracolumbar junction. Neurological deterioration, dural tear, and subarachnoid-pleural fistula are the most severe complications.
CONCLUSION
Further improvements are still warranted in thoracic spine surgery despite the advent of minimally invasive techniques. Intra-operative CT scan will probably enhance the safety of the TDH surgery.
Topics: Decompression, Surgical; Female; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lung; Magnetic Resonance Imaging; Male; Postoperative Complications; Spinal Cord Diseases; Thoracic Vertebrae; Thoracoscopy; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 30406842
DOI: 10.1007/s00264-018-4224-0 -
Asian Spine Journal Feb 2019Cross-sectional analytical study.
STUDY DESIGN
Cross-sectional analytical study.
PURPOSE
To evaluate the spinal radiological features in patients with Scheuermann's disease and the association between the thoracic kyphosis angle and clinical presentation. Overview of the Literature: Scheuermann's disease is the most common cause of hyperkyphosis of the thoracic and thoracolumbar spine in adolescents; however, literature is limited in this area.
METHODS
Data regarding 150 successive X-ray images of 95 males and 55 females diagnosed with Scheuermann's disease were retrieved from the digital archives of the Maccabi Healthcare Services in Tel Aviv. Data included thoracic kyphosis angle (T3-T12), cervical lordosis (C2-C7), lumbar lordosis (L1-S1), sacral slope (SS), number and location of the anterior wedged vertebrae (AWV, minimum 5°), and C7 plumb line. Other data included age, sex, height, family history, Risser sign, self-perceived body image (rated by the Numeric Rating Scale [NRS]), and back pain during the previous week (rated by the Numeric Pain Rating Scale [NPRS]).
RESULTS
Significant positive associations were observed between the Cobb angle of thoracic kyphosis and age (r =0.186, p =0.023), cervical lordosis (r =0.263, p <0.001), lumbar lordosis (r =0.576, p <0.001), SS (r =0.236, p <0.004), T10-T12 Cobb angle (r =0.319, p <0.001), and number of AWV (r =0.519, p <0.001). The highest frequency of vertebral wedging was noted in T7 (68%), followed by T8 (65%) and T9 (44%). The NPRS showed a significant association only with SS (r =0.219, p =0.014). Significant positive associations were observed between the NRS for self-perceived body image, the thoracic kyphosis (r =0.494, p <0.001), and the number of AWV (r =0.361, p <0.001).
CONCLUSIONS
Thoracic kyphosis was significantly associated with cervical and lumbar lordosis, SS, T10-T12 Cobb angle, and AWV number. Pain was not substantial; however, self-perceived body image, the most common complaint of patients with Scheuermann's disease, was high and significantly associated with thoracic kyphosis and the number of AWV.
PubMed: 30326689
DOI: 10.31616/asj.2018.0025 -
Clinics in Laboratory Medicine Dec 2017Flow cytometry is used in cell-based diagnostic evaluation for blood-borne malignancies including leukemia and lymphoma. The current practice for cytometry data analysis... (Review)
Review
Flow cytometry is used in cell-based diagnostic evaluation for blood-borne malignancies including leukemia and lymphoma. The current practice for cytometry data analysis relies on manual gating to identify cell subsets in complex mixtures, which is subjective, labor-intensive, and poorly reproducible. This article reviews recent efforts to develop, validate, and disseminate automated computational methods and pipelines for cytometry data analysis that could help overcome the limitations of manual analysis and provide for efficient and data-driven diagnostic applications. It demonstrates the performance of an optimized computational pipeline in a pilot study of chronic lymphocytic leukemia data from the authors' clinical diagnostic laboratory.
Topics: Cluster Analysis; Computational Biology; Flow Cytometry; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Neoplasm, Residual
PubMed: 29128077
DOI: 10.1016/j.cll.2017.07.011 -
European Spine Journal : Official... Mar 2017Anterior release for Scheuermann's disease was considered an important technique for decades. However, posterior-only surgery for Scheuermann's disease has shown a... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Anterior release for Scheuermann's disease was considered an important technique for decades. However, posterior-only surgery for Scheuermann's disease has shown a promising potential to manage this deformity, as well. Correction loss could happen post-operatively, especially when posterior-only surgery is performed in the early days. Therefore, a dispute regarding anterior release for Scheuermann's disease exists.
METHODS
We performed a systematic review of studies, reporting the outcomes of anterior release and posterior fusion surgery (AP group) or posterior-only surgery (PO group) for Scheuermann's disease. Data pooling and a meta-analysis with a random-effects model were performed to evaluate the results.
RESULTS
Twenty-three studies met the inclusion criteria. The pooled correction loss of Cobb angle for the AP group was 4.1(3.4, 4.8), and for the PO group, it was 3.8(3.3, 4.4). The overall effects of blood loss, surgery time, proximal junctional kyphosis (PJK), distal junctional kyphosis (DJK), self-image improvement, pain relief, and return-to-surgery were compared between the two groups.
CONCLUSIONS
A systematic review of the outcomes of Scheuermann's disease demonstrated a very similar correction loss for the AP group and the PO group. A meta-regression supported that correction loss did decrease as time moved on for the PO procedure, which could be explained by the improvements to instrumentation and techniques. For other outcomes, the PO group showed advantages in blood loss, surgery time, and junctional kyphosis. Similar outcomes were observed in relation to aspects of cosmetic improvement and pain relief for the AP and PO groups. The revision rate was mildly lower in the PO group than in the AP group.
Topics: Blood Loss, Surgical; Humans; Operative Time; Scheuermann Disease; Spinal Fusion; Treatment Outcome
PubMed: 27384777
DOI: 10.1007/s00586-016-4632-z -
Translational Pediatrics Jul 2017Lower back pain in young athletes is a common problem. The prevalence of back pain from different causes in adolescent age group is between 20% and 30%. However, the... (Review)
Review
Lower back pain in young athletes is a common problem. The prevalence of back pain from different causes in adolescent age group is between 20% and 30%. However, the incidence of low back pain in young athletes varies widely in different sports. Overuse injuries are the most common cause of low back pain in young athletes. In case of overuse injuries, the cause and effect relationship between back pain and specific condition is often difficult to establish. In adolescent athletes, the most common underlying identified cause of low back pain is lumbar spondylolysis. During adolescent growth spurt, the severity of the pain generally correlates with adolescent growth spurt. Participation in sports starting at an early age and for a longer duration tends to increase the risk for back pain. Numerous conditions cause low back pain in athletes. These include acute trauma, chronic overuse or repetitive trauma, and referred pain. Our focus in here will be on selected conditions that cause recurrent or chronic low back pain.
PubMed: 28795014
DOI: 10.21037/tp.2017.06.01 -
European Spine Journal : Official... Aug 2020To investigate the impact of Scheuermann's Kyphosis (SK) on health -related quality of life (HRQOL) in adult patients and compare it to the general population. Moreover,... (Review)
Review
PURPOSE
To investigate the impact of Scheuermann's Kyphosis (SK) on health -related quality of life (HRQOL) in adult patients and compare it to the general population. Moreover, to assess whether location of the kyphosis affects pelvic parameters, HRQOL, and pulmonary function.
METHODS
Of a cohort of 251 patients seen for a pediatric spinal deformity in the years 1972-1982 in our outpatient clinic, 55 had radiologically verified SK. Thirty-eight participated in the study and responded to HRQOL questionnaires, 34 had radiographs taken and 31 had pulmonary function testing. The patients were divided into two groups according to location of the SK apex: thoracic (Th) above Th10 and thoracolumbar (TL) from Th10 and below. Spinopelvic parameters were measured for all radiographs. The HRQOL scores for all SK patients were compared with normative data from a Scandinavian population. Pulmonary function measurements were compared between the Th and TL SK groups.
RESULTS
Mean follow-up was 39 ± 1.6 years, and mean age at follow-up was 53 ± 2.4 years. We found lower score in the TL group for SRS-22r function domain (p = 0.027) compared with the Th group, but no significant difference in the remaining domains and SRS-22r subscore (p > 0.18). The patients had significantly lower mean scores compared to normative values on SRS-22r domains pain (p = 0.049) and self-image (p = 0.006), but no statistically significant difference on SRS-22r subscore (p = 0.064). There was no difference in pelvic parameters between the two SK groups. We did not find a difference in pulmonary function on percent predicted FEV1 (FEV1%) (p = 0.91) and percent predicted FEV1/FVC (FEV1/FVC%) (p = 0.82) between the two SK groups.
CONCLUSION
We found a lower HRQOL in adult patients with SK 39 years after diagnosis regarding SRS-22r domains pain and self-image, and a tendency toward lower overall HRQOL compared with a background population. The location of the SK apex did not seem to have an overall impact on HRQOL. There was no difference in pelvic parameters in the two groups and no difference in pulmonary function. These slides can be retrieved under Electronic Supplementary Material.
Topics: Follow-Up Studies; Humans; Kyphosis; Quality of Life; Retrospective Studies; Scheuermann Disease; Self Concept
PubMed: 32424637
DOI: 10.1007/s00586-020-06384-w -
Global Spine Journal Sep 2019Narrative review of available literature. (Review)
Review
STUDY DESIGN
Narrative review of available literature.
OBJECTIVE
To summarize current trends in pathogenesis and management of spinal epidural lipomatosis (SEL) and suggest areas where more research would be of benefit.
METHODS
The available literature relevant to SEL was reviewed. PubMed, Medline, OVID, EMBASE, Cochrane, and Google Scholar were used to review the literature. Institutional review board approval is not applicable for this study.
RESULTS
This article clearly summarizes current trends in the pathogenesis and management of SEL.
CONCLUSIONS
Possible etiologies of SEL include exogenous steroid use, endogenous steroid hormonal disease, obesity, surgery induced, and idiopathic disease. Comorbidities such as acquired immunodeficiency syndrome and Scheuermann's disease have also been implicated in the pathogenesis of SEL. Steroid-induced SEL seems to have a proclivity for the thoracic region of the spine and has a higher incidence of paraplegia when compared with other forms. Several treatment modalities exist for SEL and are dictated by the underlying cause of the disorder. These include weight reduction, cessation of steroid medications, treatment of underlying endocrine abnormalities, and surgical decompression. Conservative treatments generally aim to decrease the thickness of adipose tissue in the epidural space, but the majority of patients tend to undergo surgical decompression to relieve neurologic symptoms. Surgical decompression provides a statistically significant reduction in symptoms, but postoperative mortality is high, influenced primarily by the patient's preoperative comorbidities. Physicians should consider the underlying cause of SEL in a given patient before pursuing specific treatment modalities, but alarm symptoms, such as the development of acute cauda equina syndrome, should likely be treated with urgent surgical decompression.
PubMed: 31448201
DOI: 10.1177/2192568218793617 -
Scientific Reports Jun 2022Reference cell atlases powered by single cell and spatial transcriptomics technologies are becoming available to study healthy and diseased tissue at single cell...
Reference cell atlases powered by single cell and spatial transcriptomics technologies are becoming available to study healthy and diseased tissue at single cell resolution. One important use of these data resources is to compare cell types from new dataset with cell types in the reference atlases to evaluate their phenotypic similarities and differences, for example, for identifying novel cell types under disease conditions. For this purpose, rigorously-validated computational algorithms are needed to perform these cell type matching tasks that can compare datasets from different experiment platforms and sample types. Here, we present significant enhancements to FR-Match (v2.0)-a multivariate nonparametric statistical testing approach for matching cell types in query datasets to reference atlases. FR-Match v2.0 includes a normalization procedure to facilitate cross-platform cluster-level comparisons (e.g., plate-based SMART-seq and droplet-based 10X Chromium single cell and single nucleus RNA-seq and spatial transcriptomics) and extends the pipeline to also allow cell-level matching. In the use cases evaluated, FR-Match showed robust and accurate performance for identifying common and novel cell types across tissue regions, for discovering sub-optimally clustered cell types, and for cross-platform and cross-sample cell type matching.
Topics: Algorithms; Gene Expression Profiling; RNA; RNA-Seq; Sequence Analysis, RNA; Single-Cell Analysis
PubMed: 35705694
DOI: 10.1038/s41598-022-14192-z