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Clinics in Orthopedic Surgery Jun 2022Scheuermann's disease is the most common cause of hyperkyphosis of the thoracic spine during the adolescence period. It causes neck and lower back pain, restriction of... (Randomized Controlled Trial)
Randomized Controlled Trial
Assessment of Quality of Life for Scheuermann's Kyphosis Patients with Cobb's Angle 50°-65° Treated Conservatively or Surgically in North Jordan: A Prospective Comparative Study.
BACKGROUND
Scheuermann's disease is the most common cause of hyperkyphosis of the thoracic spine during the adolescence period. It causes neck and lower back pain, restriction of lung expansion, traction of the spinal cord, increased vulnerability to vertebral fracture, and a hump. Patients with curves < 60° are treated conservatively, while surgery is used for patients with curves > 60°. The purpose of this prospective cohort study was to assess the quality of life and functional changes in conservatively or surgically treated Scheuermann's disease patients with a curve size of 50°-65° in north Jordan.
METHODS
Sixty-three adolescent patients with Scheuermann's kyphosis (aged between 10 and 18 years) were treated at our hospital between January 2014 and August 2018. All patients were investigated clinically, radiologically (Cobb's angle), and functionally (Oswestry Disability Index [ODI], Scoliosis Research Society 22 revision [SRS-22r] questionnaire, and pulmonary function test [PFT]) pre- and post-treatment (final follow-up). Patients were randomly selected for treatment method (conservative versus surgical).
RESULTS
There were 31 patients (mean age, 15.48 ± 2.50 years) and 32 patients (mean age, 16.19 ± 1.51 years) treated conservatively and surgically, respectively. Mean ± standard deviation of ODI, SRS-22r, and Cobb's angle of the surgical group improved from 16.8% ± 14.3%, 3.5 ± 0.5, and 58.75° ± 3.59°, respectively, pre-surgery to 13.4% ± 10.8%, 4.2 ± 0.5, and 41.53° ± 3.94°, respectively, post-surgery, while those of the conservative group became worse from 12.6% ± 13.4%, 3.9 ± 0.7, and 56.1° ± 3.3°, respectively, to 20.1% ± 13.6%, 3.5 ± 0.7, and 58.8° ± 5.8°, respectively. The surgical group showed better improvement in all scores than the conservative group ( < 0.05), as well as in PFT.
CONCLUSIONS
Surgical treatment of Scheuermann's kyphosis with curves of 50°-65° resulted in better QOL, Cobb's angle, and PFT than conservative treatment. This was because of lower patient cooperation in the conservative management group, which made the curve less flexible for exercises and bracing.
Topics: Adolescent; Child; Humans; Jordan; Prospective Studies; Quality of Life; Radiography; Scheuermann Disease; Spinal Fusion
PubMed: 35685985
DOI: 10.4055/cios20219 -
Is sagittal spinopelvic alignment a cause of low back pain in pediatric spine pathologies? A review.Journal of Children's Orthopaedics Dec 2023Altered spinopelvic morphology is observed in many spine pathologies occurring during growth. The aim of the study is to better understand the sagittal compensatory... (Review)
Review
PURPOSE
Altered spinopelvic morphology is observed in many spine pathologies occurring during growth. The aim of the study is to better understand the sagittal compensatory mechanisms and their possible influence on the occurrence of pain in selected pediatric spine pathologies.
METHODS
A bibliographic search in the PubMed database included articles published between September 1965 and July 2023. The keywords contained in the search were "spondylolysis," "spondylolisthesis," "scoliosis," "kypho," "sagittal," "pediatric," "child," "adolescent," "grow," "development," and "pain."
RESULTS
The largest diversity in sagittal alignment patterns was reported in idiopathic scoliosis, with global flattening of the spine being the most common. Kyphotic deformations occurring during growth are characterized by structural thoracic or thoracolumbar kyphosis compensated by lumbar hyperlordosis and lower pelvic incidence. Whereas in spondylolisthesis, altered morphology of the spinopelvic junction with high values of pelvic incidence is observed. Pain does not seem to be related to sagittal alignment in idiopathic scoliosis. In Scheuermann disease, it is localized at the apex of the deformity and is associated with the curve pattern, whereas in spondylolisthesis, sagittal alignment correlates with pain scores only in high-grade slips.
CONCLUSION
Most of the patients with spine disorders that occurred during growth present a clinically balanced posture in the sagittal plane. It suggests that compensatory mechanisms before achieving skeletal maturity are really significant. A comprehension of sagittal alignment in spine deformities and its relationship to pain is essential for the proper assessment and treatment of these disorders.
PubMed: 38050600
DOI: 10.1177/18632521231215853 -
EFORT Open Reviews Dec 2022Scheuermann's Kyphosis (SK) is a rigid spinal kyphosis. Several theories have been proposed concerning its pathogenesis, but it is, to this day, still unknown. It has a...
Scheuermann's Kyphosis (SK) is a rigid spinal kyphosis. Several theories have been proposed concerning its pathogenesis, but it is, to this day, still unknown. It has a prevalence of 0.4-8.3% in the population with a higher incidence in females. Clinical examination with x-rays is needed to differentiate and confirm this diagnosis. Non-surgical management is reserved for smaller deformities and in skeletally immature patients, whereas surgery is recommended for higher deformities. Combined anterior and posterior approach was considered the gold standard for the surgical treatment of this disease, but there is an increasing trend toward posterior-only approaches especially with use of segmental fixation. This study reviews the pathophysiology of SK while proposing a treatment algorithm for its management.
PubMed: 36475554
DOI: 10.1530/EOR-22-0063 -
European Spine Journal : Official... Jul 2015Sublaminar bands (SB) are frequently used as implants in spine deviation correction.
BACKGROUND
Sublaminar bands (SB) are frequently used as implants in spine deviation correction.
PURPOSE
Our purpose is to demonstrate their safety on a large series of patients.
STUDY DESIGN
This is a retrospective study.
METHODS
Our department treated 378 spine deviations on children and adolescents via a hybrid posterior technique (lumbar screws, hook and thoracic SB). Each surgery was undertaken using anesthesiologic and a neurophysiologic monitoring using somatosensory evoked potentials (SSEP) and neurogenic mixed evoked potentials (NMEP). An alert was described as an amplitude decrease of 50 % and/or a latency increase of 10 %. Data were analyzed using Student or Wilcoxon tests.
RESULTS
We used 2,223 SB in 378 operative procedures. We described ten neurophysiologic alerts during the passage of the band under the lamina. There were no significative differences between the two groups concerning the age and the severity of the deformation (p > 0.05). These neurophysiologic alerts were associated with a dysautonomic trouble (hypertension and bradycardia). The lesional level was determined using a spinal electrode. In six cases, the responsible SB was removed. Three patients had post-operative neurologic deficiency (0.8 %) without complete recovery for one of them (localized incomplete sensitive deficiency). Within the group of 378 patients, 21 alerts were reported due to a screw or a hook, or during the correction manoeuver, without dysautonomic trouble.
CONCLUSION
SB neurologic complications rate is as high as other implants' complication rate. Simultaneous hemodynamic and neurophysiologic change is an argument for vegetative response due to SB passage. Their optimal use requires a strict learning of their insertion under the lamina to be as less traumatic as possible. SB are as safe as any other spine implants.
Topics: Adolescent; Bone Screws; Bradycardia; Child; Child, Preschool; Device Removal; Evoked Potentials, Somatosensory; Female; Humans; Hypertension; Internal Fixators; Intraoperative Complications; Kyphosis; Lumbosacral Region; Male; Monitoring, Intraoperative; Nervous System Diseases; Orthopedic Procedures; Postoperative Complications; Primary Dysautonomias; Retrospective Studies; Scheuermann Disease; Scoliosis; Spinal Curvatures; Spine; Young Adult
PubMed: 25291975
DOI: 10.1007/s00586-014-3594-2 -
SpringerPlus 2016To examine whether the association between spinal alignment and sacral anatomical orientation (SAO) can be detected in skeletal populations, by comparing SAO values in...
To examine whether the association between spinal alignment and sacral anatomical orientation (SAO) can be detected in skeletal populations, by comparing SAO values in individuals with a typical SD to individuals with normal spinal alignment. 2025 skeletons were screened for Scheuermann's disease. Scheuermann's kyphosis was established by the presence of apophyseal abnormalities associated with more than 5° of anterior wedging in each of three adjacent vertebrae. SAO was measured as the angle created between the intersection of a line running parallel to the superior surface of the sacrum and a line running between the anterior superior iliac spine and the anterior-superior edge of the symphysis pubis (PUBIS). SAO was measured on 185 individuals with normal spines and 183 individuals with Scheuermann's kyphosis. Out of 2025 skeletons, 183 (9 %) were diagnosed with Scheuermann's kyphosis. The sacrum was significantly more horizontally oriented in individuals with Scheuermann's kyphosis compared with the control (SAO: 44.44 ± 9.7° vs. 50 ± 9.9°, p < 0.001). Alteration in spinal biomechanics due to a horizontally orientated sacrum may be an important contributing factor for the development of Scheuermann's kyphosis.
PubMed: 26933639
DOI: 10.1186/s40064-016-1772-x -
Human Molecular Genetics May 2018Cells are fundamental function units of multicellular organisms, with different cell types playing distinct physiological roles in the body. The recent advent of...
Cells are fundamental function units of multicellular organisms, with different cell types playing distinct physiological roles in the body. The recent advent of single-cell transcriptional profiling using RNA sequencing is producing 'big data', enabling the identification of novel human cell types at an unprecedented rate. In this review, we summarize recent work characterizing cell types in the human central nervous and immune systems using single-cell and single-nuclei RNA sequencing, and discuss the implications that these discoveries are having on the representation of cell types in the reference Cell Ontology (CL). We propose a method, based on random forest machine learning, for identifying sets of necessary and sufficient marker genes, which can be used to assemble consistent and reproducible cell type definitions for incorporation into the CL. The representation of defined cell type classes and their relationships in the CL using this strategy will make the cell type classes being identified by high-throughput/high-content technologies findable, accessible, interoperable and reusable (FAIR), allowing the CL to serve as a reference knowledgebase of information about the role that distinct cellular phenotypes play in human health and disease.
Topics: Big Data; Cell Lineage; Gene Expression Profiling; Humans; Sequence Analysis, RNA; Single-Cell Analysis; Transcriptome
PubMed: 29590361
DOI: 10.1093/hmg/ddy100 -
Cytometry. Part a : the Journal of the... Jan 2016
Topics: Algorithms; Computational Biology; Data Interpretation, Statistical; Flow Cytometry; Humans
PubMed: 26812230
DOI: 10.1002/cyto.a.22810 -
European Spine Journal : Official... Mar 2024To determine optimal proximal fusion levels for instrumented spinal fusion for Scheuermann kyphosis. (Review)
Review
OBJECTIVE
To determine optimal proximal fusion levels for instrumented spinal fusion for Scheuermann kyphosis.
METHODS
We reviewed 86 patients (33 women) who underwent corrective instrumented spinal fusion for Scheuermann kyphosis. All patients had long-cassette upright lateral radiographs taken preoperatively, postoperatively, and at 2 years and the last follow-up. Demographic, radiographic, and surgical parameters were compared between patients with and without PJK.
RESULTS
PJK occurred in 28 patients (32%). The mean maximum Cobb angle was 85.8° ± 11.7° preoperatively, 54.8° ± 14.2° postoperatively, and 59.7° ± 16.8° at the last follow-up. Age and sex did not differ between the PJK and non-PJK groups (P > 0.05). The preoperative curve characteristics, fusion levels, and corrective ratio were similar in both groups (P > 0.05). The maximal Cobb angle at 2 years and the last follow-up significantly differed between the 2 groups (P < 0.05). The proportion of patients with the uppermost instrumented vertebra (UIV) at or above the proximal end vertebra (PEV) was similar in both groups (P > 0.05). The proportion of patients with UIV at or above T2 was significantly greater in the non-PJK group (P < 0.05). PJK was significantly associated with a C7 plumb line (C7PL)-sacrum distance ≥ 50 mm (P < 0.05).
CONCLUSION
PJK is the main cause of postoperative correction loss. Proper fusion-level selection can reduce PJK occurrence. We recommend having the UIV at T2 or above, especially when the C7PL-sacrum distance ≥ 50 mm.
Topics: Humans; Female; Scheuermann Disease; Kyphosis; Follow-Up Studies; Retrospective Studies; Sacrum; Spinal Fusion; Postoperative Complications; Risk Factors
PubMed: 37955752
DOI: 10.1007/s00586-023-08029-0 -
BMJ Open Quality Mar 2022Antibiotic overuse threatens global health, food security and human development through the development of antibiotic resistance. Antibiotic resistance is associated...
BACKGROUND
Antibiotic overuse threatens global health, food security and human development through the development of antibiotic resistance. Antibiotic resistance is associated with worse clinical outcomes and increased healthcare costs. Studies suggest urgent cares exceed the national average for inappropriate antibiotic use associated with maintaining patient satisfaction.
LOCAL PROBLEM
Chart audits from an urgent care clinic in the southwest region of the USA revealed that antibiotics were prescribed for upper respiratory infections (URIs) routinely and without patient instruction on methods to reduce their antibiotic use. Further review, exposed that most urgent care sites do not have an Antibiotic Stewardship Plan (ASP) and little-to-no ASP training for medical staff.
METHODS
A quantitative quality improvement project was implemented to determine the impact of delayed antibiotic prescribing on antibiotic usage rates for adult patients with URI symptoms at an urgent care clinic in central Arizona over 4 weeks.
INTERVENTIONS
Implementing the Centers for Disease Control and Prevention's URI adult treatment guidelines for antibiotic use with follow-up phone calls 10 days post-discharge to evaluate the patient's decision-making.
RESULTS
Antibiotic usage rates decreased by 12% in 30 days, N=927, n598 in the comparative and n330 in the implementation group. A Mann-Whitney U test demonstrated a statistically and clinically significant reduction in antibiotic usage rates between groups (=247, p=0.023).
CONCLUSION
Success in meeting the goal was a result of team and patient engagement strategies that reduced outpatient antibiotic use while maintaining high levels of patient satisfaction.
Topics: Adult; Aftercare; Ambulatory Care; Anti-Bacterial Agents; Humans; Patient Discharge; Respiratory Tract Infections
PubMed: 35264330
DOI: 10.1136/bmjoq-2021-001513 -
Journal of Pediatric Orthopedics 2019Surgical indications for Scheuermann kyphosis are variable. We sought to evaluate the characteristics of patients undergoing operative versus nonoperative treatment of...
BACKGROUND
Surgical indications for Scheuermann kyphosis are variable. We sought to evaluate the characteristics of patients undergoing operative versus nonoperative treatment of Scheuermann kyphosis to better understand current practices and the factors which contribute to the decision for surgical management.
METHODS
Multicenter prospective cohort study. We evaluated consecutive patients presenting with Scheuermann kyphosis. Patients underwent either surgical or nonoperative management according to surgeon and patient discretion. Preoperative patient-reported outcome measures (Scoliosis Research Society and Spinal Appearance Questionnaire scores), demographics, and radiographic characteristics were assessed.
RESULTS
Overall, 150 patients with Scheuermann kyphosis were enrolled, with 77 choosing nonoperative treatment and 73 treated operatively. Compared with the nonoperative cohort, patients treated operatively were older (16.3±2.0 vs. 15.1±2.2, P=0.0004), and had higher body mass index (26.3±7.2 vs. 22.7±6.5, P=0.003), had greater T2-T12 kyphosis (71±14 degrees vs. 61±12 degrees, P<0.001), increased pelvic incidence (46 vs. 41 degrees, P=0.03) and pelvic tilt (10 vs. 3 degrees, P=0.03). There was no detected difference in maximal sagittal Cobb angle in the operative versus nonoperative patients (73±11 vs. 70±12 degrees, P=0.11). Functionally, the operative patients had worse Scoliosis Research Society pain scores (3.7±0.9 vs. 4.1±0.7, P=0.0027) and appearance scores (2.9±0.7 vs. 3.4±0.8, P <0.0001).
CONCLUSIONS
Patients undergoing surgical management of Scheuermann disease were more likely to have large body mass index and worse pain scores. Other factors beyond radiographic measurement likely contribute to the decision for surgical management of Scheuermann kyphosis.
LEVEL OF EVIDENCE
Level II.
Topics: Adolescent; Age Factors; Body Mass Index; Female; Humans; Incidence; Kyphosis; Male; Pain; Pelvis; Retrospective Studies; Scheuermann Disease; Scoliosis; Spinal Fusion
PubMed: 30969249
DOI: 10.1097/BPO.0000000000000931