European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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A longitudinal study was undertaken to analyse the development of posture and spinal mobility during growth and its relationship to low back pain and sports activities. A total of 90 children were examined at 5-6 years of age and re-examined at 15-16. Sagittal configuration and mobility were measured using Debrunner's kyphometer. ⋯ The results of the study showed that kyphosis and lordosis increased and mobility decreased in the 90 children who were examined both at age 5-6 and 15-16 years. The relationship between kyphosis and lordosis decreased in girls but not in boys. Occasional low back pain was reported by 38% of the children at the age of 15-16 years, but back pain was not related to posture, spinal mobility or physical activity.
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Lesions of the intervertebral disc accompanying vertebral fractures are the subject of controversy and discussion regarding the extent and manner of surgical intervention. The question of when to perform disc resection and intervertebral fusion, in particular, has not been answered satisfactorily. In order to evaluate short- and medium-term lesions of the discoligamentous complex associated with thoracolumbar burst fractures, magnetic resonance images made after stabilisation and again after implant removal were compared. ⋯ No disruption of the fibrous ring or of the posterior longitudinal ligament was observed, nor was there any prolapse of intervertebral discs. When the intervertebral disk is intact and has normal morphology and a normal T2-weighted MRI signal, resection or fusion of the fracture adjacent discs appears unjustified. In our opinion, the results do not support the possibility of predicting degradation in those discs that showed an altered T2-weighted signal after the first operation.
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Rib cage deformity is an important component of scoliosis, but few authors have reported the three-dimensional (3-D) effect of surgical procedures with posterior instrumentation systems on the shape of the rib cage. The objective of this prospective clinical study was to measure the short-term 3-D changes in the shape of the rib cage at the apex of the curve after corrective surgery of adolescent idiopathic scoliosis by a posterior approach using a multi rod, hook and screw system. The 3-D shape of the spine and rib cage was modelled pre- and postoperatively using a 3-D reconstruction technique based on multi-planar radiography in a group of 29 adolescents with idiopathic scoliosis. ⋯ The frontal spinal curve correction averaged 53% in the frontal plane, while no significant change was noted in the sagittal plane. Significant changes were noted in the shape of the rib cage: rib hump at the apex and at the adjacent lower level were improved (36% and 38%), and small but significant differences were detected in rib frontal orientation in the concavity of the curves at the apex and adjacent lower rib levels. Multi rod, hook and screw instrumentation systems, such as Cotrel-Dubousset instrumentation, are effective in producing significant improvements in the 3-D shape of the rib cage, but these changes are less important than those observed at the spine level.
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The purpose of the present study was to introduce a new magnetic resonance imaging (MRI) procedure showing the whole spine in a coronal and sagittal plane, and to study the assessment of sagittal Cobb angle measurements using this technique. Prospectively we studied 32 patients (average age 14.8 years) with idiopathic scoliosis (mean thoracic Cobb angle 33 degrees on radiograph) and 18 patients (average age 14.5 years) without scoliosis. The MRI investigation was carried out in a standard supine position. ⋯ MR total spine imaging makes it possible to image scoliosis in the sagittal plane. On these MR projections, idiopathic thoracic scoliosis was identified by a reduced sagittal Cobb angle. MR total spine imaging would allow monitoring of scoliosis in the sagittal plane, which can reveal relevant clinical data without radiation exposure.
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The objective of this study was to identify acute spinal and three-dimensional postural adaptations induced by a shoe lift in a population of idiopathic scoliosis (IS) patients. Forty-six IS patients (mean age: 12 +/- 2 years) were evaluated radiologically and with a stereovideographic system for pelvic obliquity. Based on the initial postural and radiological evaluation, a pertinent shoe lift height was chosen for each with the result that 12 patients were tested with 5-mm (S5) lifts, 20 patients were tested with 10-mm (S10) lifts, and 14 patients with 15-mm (S15) lifts. ⋯ The implementation of the shoe lifts also changed the lateral shift of the pelvis. A relative change between the shoulders and pelvis for tilt and anteroposterior shift was also found to be significant. In conclusion, using a shoe lift resulted in acute postural adaptations which specifically affected the spine and the three-dimensional position and orientation of the pelvis and shoulder girdle.