AIS & Spinal Deformities - Spine & Trunk

Spine Journal report about the methodology of evaluation of morphology of the spine and the trunk in idiopathic scoliosis and other spinal deformities - 6th SOSORT consensus paper

Authors: Tomasz Kotwicki, Stefano Negrini, Theodoros B Grivas, Manuel Rigo, Toru Maruyama, Jacek Durmala, Fabio Zaina and the Members of the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT)

Published: 26 November 2009

Background
Comprehensive evaluation of the morphology of the spine and of the whole body is essential in order to correctly manage patients suffering from progressive idiopathic scoliosis. Although methodology of clinical and radiological examination is well described in manuals of ortho-paedics, there is deficit of data which clinical and radiological parameters are considered in every-day practise. Recently, an increasing tendency to extend scoliosis examination beyond the measure of the Cobb angle can be observed, reflecting a more patient-oriented approach. Such evaluation often involves surface parameters, aesthetics, function and quality of life. Aim of the study: To investigate current recommendations of experts on methodology of evaluation of the patient with spinal deformity, essentially idiopathic scoliosis.

Methods
Structured Delphi procedure for collecting and processing knowledge from a group of experts with a series of questionnaires and controlled opinion feedback was performed. Experience and opinions of the professionals - physicians and physiotherapists managing scoliosis patients - were studied. According to Delphi method a Meeting Questionnaire (MQ) has been developed, resulting from a preliminary Pre-Meeting Questionnaire (PMQ) which had been previously discussed and approved on line. The MQ was circulated among the SOSORT experts during Consensus Ses-sion on "Measurements" which took place at the Annual Meeting of the Society, totally 23 panellists being engaged. Clinical, radiological and surface topography parameters were checked for agreement.

Results
90% agreement or more was reached in 35 items and superior than 75% agreement was reached in further 25 items. An evaluation form was proposed to be used by clinicians and re-searchers.

Conclusion
The consensus was reached on evaluation of the morphology of the patient with idio-pathic scoliosis, comprising clinical, radiological and, to less extend, surface topography assessment. Considering the variety of parameters indicated by the panellists, the Cobb angle, yet the gold standard, can be seen neither as the unique nor the only decisive parameter in the management of patients with idiopathic scoliosis.

To read the complete article in PDF format to learn more about the Spine Journal report about the methodology of evaluation of morphology of the spine and the trunk in idiopathic scoliosis and other spinal deformities - 6th SOSORT consensus paper.

Scoliosis and Respiratory Muscle Strength

Spine Health released a new study to examine the Curvature of the Spine, Neuromuscular Disorders and Lung Function

By: Chris Maynard

Online Content Manager, Spine-health

Nov 24, 2009 (Spine-Health) -- Patients with neuromuscular disorders had diminished respiratory muscle strength and pulmonary function compared with a healthy control group, according to a new study also examining how scoliosis affects lung function.

As detailed in a recent edition of The Spine Journal, neuromuscular disorders are known to lead to lung volume loss and respiratory muscle weakness, but the effects of scoliosis on lung function are unknown, a point that served as a basis of this study.

For some context, neuromuscular disorders occur when the neurons, or nerve cells that send messages that control voluntary muscles like the arms and legs, become unhealthy and die. As a result of this breakdown in communication between the nervous system and muscles, the muscles weaken, possibly leading to a wide variety of symptoms (including twitching, cramps, aches, pains, and joint and movement problems) and even affecting heart function and breathing ability.

Scoliosis is an abnormal curvature of the spine that is often marked by one shoulder, side of the rib cage or hip appearing higher than its respective other, the waist appearing uneven, the body tilting to one side, or one leg looking shorter than the other. Back pain is not usually considered a symptom of scoliosis.

For the study, approximately 22 patients with neuromuscular disorders and scoliosis, 17 patients with neuromuscular disorders without scoliosis, and 24 age- and sex-matched healthy controls were subjected to various tests comparing their respiratory muscle strength and pulmonary function, which specifically measures how well the lungs take in and release air and move this oxygen throughout the body.

According to the study’s findings, patients with neuromuscular disorders, regardless of having or not having scoliosis, had diminished respiratory muscle strength when compared to the healthy subjects. Furthermore, patients with neuromuscular disorders and scoliosis had significantly lower pulmonary function scores than not only the control group of healthy patients but the patients who had neuromuscular disorders but were without scoliosis.

The researchers indicated that these findings could mean that the effects of neuromuscular disorders on respiratory function are independent of scoliosis and suggested that clinicians should be aware of the possibility of compromised respiratory function when treating patients with neuromuscular disorders.

Update on my scoli appt- Tuesday

So I had my half-yearly back check up at the hospital on Tuesday the 24th.

Here's a quick report:

X-RAYS

Bone development: My hand was x-rayed. It revealed that I only had a small amount of growth left. Yay!:D

SPINAL:
My current curves are both 18 - 19 degrees, same as last time. They aren't progressing.

ORTHOPEDIC:

My doctor looked at the wounds on my back and saw the x-rays. He concluded that I only needed to wear my brace 18 hours a day from now on! He told me that 6 hours wouldn't make much of a difference, seeing as I only have a small amount of growth left and the brace wouldn't be able to fix a huge amount.

ORTHOTIC:

My orthotist looked at the scars and told me to wear my brace looser. He put padding in the lower side as well. He advised me to wear my brace to school, as it involves sitting down, which is the worst of the three postures. He said the best time not to wear it is when I'm asleep.

Best news: the orthotist said next time I come in March, I probably will only have to wear my brace 12 HOURS a day! they're slowly "weaning" me out of it. lol :)

But I've been braced for so long that it feels wierd not wearing it for more than an hour. I feel guilty!

Other thing: I don't know if I've mentioned this here but I've been super excited about this dance camp in january. Then I remembered my brace. The orthopedist said it was perfectly okay to go and just wear my brace at night. :D

Last thing. Work experience next year. I have applied for the orthopedics, medical imaging and physiotherapy units at the hospital. I've also applied at an Orthotics and Prosthetics Clinic. I'm so excited! Hope I get one (or 2, seeing as the hospital work experience is during the holidays).

Medtronic introduces 3-D vascular imaging service

MINNEAPOLIS, Minnesota — Device-maker Medtronic Inc. has partnered with an imaging software firm to introduce a service that provides three-dimensional images of veins, which the company says will help surgeons treat aortic aneurysms.

Author: Brandon Glenn

Medtronic says the service will help surgeons better visualize the inside of a patient’s vein before an operation and better view an implanted stent graft after the operation.

The service, called 3D Recon, converts two-dimensional computed tomography images to three-dimensional images and removes bone and anatomy from the images, according to a statement from Medtronic.

An aortic aneurysm is a weakened and bulging area in the body’s largest blood vessel, a condition that can cause life-threatening bleeding.

The service has been cleared by the U.S. Food and Drug Administration, thanks to a 510(k) granted to Vital Images, a Minnetonka, Minnesota-based visualization software firm that partnered with Medtronic.

A Medtronic spokesman did not immediately return a call.

Earlier this week, Medtronic announced the launch of a spine-fixation system to treat scoliosis.

Shriners Search for Best Treatment

Three to five of every 1,000 children develop spinal curves serious enough to warrant medical attention. And yet, in general terms, the cause of these curves – known as “scoliosis” – remains unknown, and the effectiveness of the most common treatment is in question.

Researchers at Shriners Hospitals for Children are working hard to discover answers to these questions, and to improve the quality of care and quality of life for children with scoliosis, a curvature of the spine greater than 10 degrees, which makes the spine look more like an “S” or a “C” than a straight line when viewed on an X-ray. Once scoliosis has been diagnosed, the primary concern is whether the curve will progress, and treatment is aimed at stopping that progression.

While scoliosis can occur at any age, the most common type, adolescent idiopathic scoliosis (AIS), affects 2 to 4 percent of children between the ages of 10 and 16, particularly girls. Treatment options include observation for small curves, bracing in hopes of preventing curve progression in patients felt to be at risk, and surgery to fuse the spine in larger and progressive curves.

For years, bracing has been the most frequent treatment method for growing patients with moderate-size curves. Despite the fact that bracing is so commonly used in this clinical situation, there is no good scientific data demonstrating that bracing actually slows or prevents curve progression.

“Bracing a child with scoliosis is not an easy task,” said Matthew Dobbs, M.D., orthopaedic surgeon at Shriners Hospitals for Children — St. Louis and associate professor of pediatric orthopaedic surgery at Washington University School of Medicine. “Adolescents do not want to wear a brace that makes them look and feel different from their friends. Bracing has been the accepted treatment for years for adolescents with a curve of 20 to 40 degrees, but there is no hard data to support that it works. We honestly don’t know what the right treatment is for patients with curves in this range. Some with braces do fine, as do some without. This is definitely a medical question that needs to be answered.”

Shriners Hospitals for Children, together with the National Institutes of Health, is conducting a multi-center research study, Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST), to answer this question. Dr. Dobbs is the lead investigator for the Shriners Hospitals for Children portion of this trial. The results could lead to improved care and treatment, improved screening efforts and programs, and improved quality of life for those with AIS, and help determine precisely which patients benefit from bracing and which do not.

A difficult issue surrounding bracing adolescents is compliance – determining whether patients are wearing the brace for the prescribed amount of time, which is often 20 hours a day. In the study, compliance will be determined through data provided by a heat sensor implanted in the brace.

“The braces are uncomfortable and awkward, and generally we are dealing with adolescent girls concerned about appearance and fitting in,” said Dr. Dobbs. “Every day in the scoliosis clinics we deal with tears from the adolescents not wanting to wear the brace and frustration from the parents trying to convince their teens to wear it.

“Bracing is very expensive, as are the school screening programs,” said Dr. Dobbs. “If we find that bracing is not effective, then screening programs to identify scoliosis in early stages could be stopped. On the other hand, if bracing is found to be effective, then more effort and resources could be employed toward improved screening programs to identify children with curves early enough that they can benefit from bracing.

“I believe the findings won’t be that simple. It is likely that we will identify a subset of scoliosis patients that benefit from bracing and others that don’t,” Dr. Dobbs said. “If we can define the patient population based on age and curve type that benefit from bracing, that would be a huge contribution. Whatever the findings, the results of the study will be a major step forward in our understanding of how to treat this relatively common disorder.”

Many children with other conditions, including spinal cord injuries, cerebral palsy and osteogenesis imperfecta, are at a very high risk for developing scoliosis, as well. The same question – whether bracing is the best treatment for scoliosis – needs to be answered for these cases. Studies, in varying stages of development, are also underway at Shriners Hospitals for Children to address these questions.

Medtronic Launch TSRH Spine System

Medtronic, Inc. (NYSE: MDT), today announced the launch of the TSRH ® 3Dx ™ Spinal System. Designed with procedural efficiency in mind, the TSRH 3Dx Spinal System offers two screws designed to address multiple pathologies. The Multi Planar Adjusting (MPA ® ) Screw option provides surgeons a variable angle posted screw for targeted, controlled correction maneuvers. The OSTEOGRIP ® Screw enhances bone fixation by incorporating a dual-lead thread pattern that reduces toggle at the bone-screw interface.

Building on more than 20 years of clinical success, this next generation pedicle screw system includes competitive differentiating technology for addressing multiple spinal pathologies, from degenerative disc disease to spinal deformity. The system also offers CHROMALOY™ rods and a minimally invasive capability.

“The TSRH 3Dx Spinal System allows me to better match solutions to specific patient needs,” said Dr. Brett Scott. “It gives me confidence by marrying new technologies with a long clinical history of success.”

In 1987, Medtronic’s collaboration with the Texas Scottish Rite Hospital for Children in Dallas, Texas, to develop a system to treat scoliosis, led to the development of the TSRH Spinal System – a hook, rod, and screw system used in complex spinal procedures. Since then, the TSRH System has evolved into one of the most popular spinal systems on the market.

For the approximately 268,000 people who suffer degenerative spinal conditions, deformity, or injury of the thoracic, lumbar, and sacral spine, the TSRH 3Dx Spinal System offers an alternative for spinal stabilization with fusion.

About the Spinal and Biologics Business at Medtronic
The Spinal and Biologics business, based in Memphis, Tenn., is the global leader in today’s spine market and is committed to advancing the treatment of spinal conditions. The Spinal business collaborates with world-renowned surgeons, researchers, and innovative partners to offer state-of-the-art products and technologies for neurological, orthopaedic and spinal conditions. Medtronic is committed to developing affordable, minimally invasive procedures that provide lifestyle friendly surgical therapies.

More information about the company and its spinal treatments can be found at
Medtronic Spinal

And its patient-education Web sites
Back.com
iScoliosis.com
MatureSpine.com
NeckSurgery.com

About Medtronic
Medtronic, Inc., headquartered in Minneapolis, is the global leader in medical technology—alleviating pain, restoring health, and extending life for millions of people around the world.

Any forward-looking statements are subject to risks and uncertainties such as those described in Medtronic’s Annual Report on Form 10-K for the year ended April 24, 2009. Actual results may differ materially from anticipated results.

A Golfing Inspiration: Stacy Lewis

Author: Matt Cooper

I spotted this article on a golf website and as I knew about Stacy Lewis having Scoliosis I decide to re-print some of the article here to share with our members.

Well, it took longer than expected but we all knew it had to happen sooner or later.

The weight of expectancy was huge but one sensed it was coming.

Welcomed by sponsors, officials and even fellow players.

Much anticipated and greeted with scenes of drama and relief.

Yes - finally an American has won again on the LPGA.

One player excited about the tour's first visit to Houston in 20 years is Stacy Lewis, a Houston resident who has played at the nearby Woodlands all of her career.

Lewis' golfing journey has been an extraordinary one - she started playing the game aged eight, quickly gained a reputation as a great talent, was diagnosed with scoliosis (curvature of the spine), wore a brace for six years, then had surgery, became the number ranked amateur in the US and then finished third in the 2008 US Open (her professional debut).

Oh, she also "won" the 2007 NW Arkansas Championship when still an amateur (although only the first round was completed so it remains an "unofficial" result).

She's packed all of that in and yet 2009 is still her rookie year on tour!

Thrilled to be playing in front of her home town fans, Lewis makes an interesting prospect this week because the host course - The Houstonian G&CC - is designed by Rees Jones.

He also created the Champions course at LPGA International in Daytona Beach which has co-hosted the final stage of Q-school in recent years.

Last year the players completed three rounds on it and Lewis came out on top, winning the event by three shots.

She recently finished seventh in Japan and with her home town connections I like her chances of making the places at 80/1.

I was initially attracted to the claims of South Korea's In-Kyung Kim by her short- and long-term form but, like Lewis, she has an intriguing link with Q-school.

Her form first though: having missed the cut in Alabama she has pulled her socks up to rack up the following form figures: 15-9-8.

Both her last two starts could have been much better but for her inability to break par in the final round.

But she has completed two wins in the last two seasons (at Panther Creek and Blackhawk) so she is not afraid to cross the winning line.

As I hinted above, she also has form on the Champions course - she was joint winner of Q-school in 2006, albeit they only played that layout twice that year.

There is plenty in her favour so I'll take the 40/1.

Final pick is Paula Creamer who is one of the Americans struggling to win in 2009, but who might find herself motivated by Michelle Wie's debut triumph - after all she didn't finish too far away in second place.

A recent fourth place finish at Torrey Pines is of interest (it is one of the US Open courses Rees Jones has re-designed), as is the fact she trounced the Q-school field in 2004 by five shots (but her win involved playing the Champions course even fewer times than Lewis and Kim - just the once in her case).

What also interests me with Creamer is the fact that her coach David Whelan is a short-game expert and the two often talk about the needs and requirements of each venue in a manner reminiscent of Phil Mickelson and Dave Pelz.

Rees Jones courses, with their run-off areas and large, undulating greens call for a careful strategy and the Creamer/Whelan partnership might find one.

Add in her habit of making the top five in 33% of her career starts (and in 9 of 22 starts this year) and 16/1 is not a bad price.