Distraction of lumbar vertebrae in gravitational traction

STUDY DESIGN: Experimental study of 30 patients diagnosed with low back pain resulting from lumbar disc herniation, disc degeneration, and segmental instability. Patients underwent gravitational traction, and widening of the intervertebral space and posterior facets was measured on radiographs. This same procedure was performed with a group of 30 healthy individuals. OBJECTIVES: To determine the effect of gravitational traction on the widening of the intervertebral space and the other vertebral structures in patients with low back pain and in healthy individuals. SUMMARY OF BACKGROUND DATA: Gravitational traction is performed by suspending the patient in a hanging, upright position for an extended period of time. In spite of disagreement among authors about the effect of lumbar traction, recent innovations have enabled the distraction of vertebrae. METHODS: A specially designed apparatus was used to apply gravitational traction. Pre- and post-traction radiographs were obtained to study the changes in the L2-L3, L3-L4, L4-L5, and L5-S1 intervertebral spaces; Ferguson's angle; L1-S1 total distance; and blood pressure. RESULTS: Distraction was more than approximately 3 mm in each intervertebral space in both groups. CONCLUSION: Gravitational traction had a very apparent effect on intervertebral space and was found to be an effective method to distract lumbar vertebrae. Discomfort experienced by the patient during suspension may be overcome by making biomedical changes to the suspension corset.     

A comparison of radiographic and electrogoniometric angles in adolescent idiopathic scoliosis

STUDY DESIGN: This was a cross-sectional study of a consecutive group of adolescent patients presenting to a scoliosis clinic for routine assessment or monitoring of their scoliosis, excluding postsurgical patients. SUMMARY OF BACKGROUND DATA: In vitro studies suggested electrogoniometry could be useful in the evaluation of scoliosis. No prior in vitro study had been performed. OBJECTIVES: To determine the reliability and validity of an electrogoniometric instrument, the Metrecom Skeletal Analysis System, in assessing adolescent idiopathic scoliosis. METHODS: Thirty-one patients were examined, radiographed, and scanned with the Metrecom Skeletal Analysis System twice by two different examiners. The magnitudes of the curves derived from the Metrecom Skeletal Analysis System scans were compared with each other and with the Cobb angles measured from standing radiographs. RESULTS: The intraclass correlation coefficient (a measure of agreement, ranging from 0 to 1, where 1 represents complete agreement) for the intraexaminer reliability of the Metrecom Skeletal Analysis System ranged from 0.71 to 0.83. The interexaminer reliability intraclass correlation coefficient of the Metrecom Skeletal Analysis System was 0.58, with a mean difference between examiners of 5.5 degrees (SD = 5 degrees), and limits of agreement (mean difference +/-2 SD) ranging from -4.5 degrees to 15.6 degrees. The Metrecom Skeletal Analysis System and the radiographically derived Cobb angle correlation was 0.64, but the mean difference between the methods was 3.7 degrees (SD = 11.1), with limits of agreement from 18.4 degrees to 25.9 degrees. CONCLUSION: The Metrecom Skeletal Analysis System does not provide sufficient clinical precision to substitute for the Cobb angle measured from spinal radiographic measurements in the management of adolescents with scoliosis.     

Effect of a bicycle safety program and free bicycle helmet distribution on the use of bicycle helmets by elementary school children

A retrospective follow-up study was performed on 40 patients, in which tuberculous spondylitis was treated conservatively between 1969 and 1985 with orthotic supports for an average of 16 months (range, 10-30 months) and with anti-tuberculous agents. All had persistent back pain, but none had neurological deficits. The mean follow-up period was 17 years (range, 10-26 years). Diagnosis was confirmed histopathologically. The spinal segments involved ranged from T5 to L5. The kyphotic angle was calculated according to Cobb. At final follow-up, 22 patients were pain free, 11 had occasional pain, 6 complained of pain in the morning, and 1 had chronic pain and needed frequent analgesics. Solid bony union was found in 75% of patients. The kyphotic deformity occurred in the thoracic spine with a mean angle of 20 degrees (range, 13-28 degrees) and in the lumbar spine with a mean angle 12 degrees (range, 5-26 degrees). The long-term follow-up of conservative treatment showed only slightly increased kyphosis. Conservative treatment is an alternative to surgical intervention in cases with kyphosis < 35 degrees.     

Lumbosacral part of the dural sac and the topography of its contents

The course of the fila radicularia in the caudal part of the dural sack is described (Diagram 1, Fig. 1), also the length of the dorsal fila is estimated (f.e. L5 = 138,6 mm), the height of the segments (f.e. S3 = 5,41, S4 = 3,88 mm), the length of the vaginae radiculares (f.e. L5 = 24,6 mm), its angle with the side border of the dural sack (f.e. L5 = 142 degrees) and the distances between the vaginae radiculares (f.e. L4-L5 = 26,67 (21-33) mm). The filum terminale of the spinal cord has a length of 153 (123-178) mm, the filum of the dural sack is 67,8 (48-92) mm long.     

L5 root compression caused by degenerative spinal stenosis of the L1-L2 and L2-L3 spaces

STUDY DESIGN: A severe bilateral L5 root lesion associated with spinal stenosis at L1-L2 and L2-L3 is described. OBJECTIVE: To describe clinical findings and the difficulty in obtaining a correct diagnosis of L5 Root Compression. SUMMARY OF BACKGROUND DATA: The disorder reported in this study has not been reported previously. Only one similar case has been described in the literature: an L5 root compression at L1-L2 caused by disc herniation. METHODS: Diagnosis was obtained by using computed tomography scanning, magnetic resonance imaging, and computed tomography myelography. The findings at L5-S1 were minimal to justify the patient's clinical symptoms, but a detailed study of the upper levels revealed spinal stenosis at L1-L2 and L2-L3, which could have been causing L5 and S1 root compression. A decompressive laminectomy and partial facetectomy in both levels were performed. RESULTS: The patient's pain and claudication disappeared, and clinical symptoms associated with the right L5 root improved. The left L5 root deficit remained stable. CONCLUSION: An unusual case of L5 root compression caused by degenerative stenosis of L1-L2 and L2-L3 is described.     

Anatomic relations of the thoracic pedicle to the adjacent neural structures

STUDY DESIGN: This study analyzed anatomic parameters between the thoracic pedicles and the spinal nerve roots. OBJECTIVES: To quantitatively determine the anatomic relations of the thoracic pedicle to the adjacent neural structures. SUMMARY OF BACKGROUND DATA: Pedicular screw placement carries with it potential hazard to the surrounding neural structures, especially in the thoracic spine. No studies exist regarding the anatomic relations of the thoracic pedicle to the adjacent nerve roots. METHODS: Fifteen cadavers were obtained for study of the thoracic spine. All soft tissue was dissected off the thoracic spine. Laminectomy and total removal of the superior and inferior articular facets was then performed on C7-T1 through T12-L1 to expose the pedicles, nerve roots, and dura. Measurements were taken from the pedicle to the nerve root superiorly and inferiorly as well as between the pedicles. Also, the superoinferior diameter of the nerve root and the frontal angle of the nerve root were measured. Symmetrical structures were measured bilaterally. RESULTS: The results showed that no epidural space could be found between the dural sac and the pedicle in all 15 cadavers. The average distances from the thoracic pedicle to the adjacent nerve roots superiorly or inferiorly at all levels ranged from 1.9 to 3.9 mm and from 1.7 to 2.8 mm, with a minimum of 1.3 mm, respectively. The interpedicular distance increased from T1 (13.8 mm) to T3, slightly decreased in T4-T5, then gradually increased to T12 (16.6 mm). The superoinferior diameter of the nerve root increased consistently from 2.9 mm at T1 to 4.6 mm at T11. The frontal nerve root angle decreased consistently from T1 (120.1 degrees) to T12 (57.1 degrees), except at T4-T5. CONCLUSIONS: This study suggested that more care be taken into consideration in placing a transpedicular screw in the transverse plane than in placing a screw in the sagittal plane in the thoracic spine.     

Reliability of eccentric isokinetic knee flexion and extension measurements

This study assessed the test-retest reliability of knee isokinetic eccentric muscle performance in subjects with and without a history of tibio-femoral pathology. Nineteen adults were tested at 60 degrees/sec and 180 degrees/sec on three occasions using a standardized protocol that incorporates a same-session learning phase. Results revealed moderate to excellent reliability for average peak torque test-retest ICC (2,1) = .58 to .96, total work ICC = .63 to .93, and power ICC = .67 to .93. Joint angle at peak torque was unreliable (ICC = .01 to .69) for both muscle groups at both angular velocities. Knee flexion reliability was higher than extension reliability at both 60 degrees/sec and 180 degrees/sec. Subjects with tibio-femoral pathologies had ICC values lower than the healthy subjects. Reliable eccentric isokinetic measurements can be obtained for average peak torque, total work, and power. Clinicians should not assume the same degree of reliability in testing patients as in testing healthy subjects.     

Automatic analysis of electron backscatter diffraction patterns

The ability to measure lattice orientation in individual crystallites enables a more complete characterization of microstructure by combining lattice orientation with morphological features. Lattice orientation can be obtained by analyzing electron backscatter diffraction patterns (EBSPs). However, current computer-aided EBSP analysis techniques make it impractical to obtain the number of measurements needed for statistically reliable characterizations of microstructure. An effective fully automated technique for determining crystallographic orientation from EBSPs is described. Bands are identified by linear regions of correlation in the image intensity gradient direction. The most probable orientation is then found using the angles between the detected bands. The reliability of the technique was tested using a set of 1000 patterns obtained from annealed oxygen-free electrical grade (OFEC) copper. The orientation of each test pattern found using automatic indexing was checked against the corresponding orientation as determined by manual indexing. Ninety-nine percent of auto-indexed orientations were found to lie within 5 deg of the misorientation angle of the manual-indexed orientations. By simulating noise in the test patterns, it was found that image quality has a strong effect on the reliability of the technique. An image quality parameter is described which allows the reliability of the technique to be predicted for a pattern of given quality.     

Morphometric characteristics of the scoliotic spine

GOAL: Results from a morphometric investigation performed on a rare complete scoliotic specimen are presented. The aim of the study is to describe the vertebral body wedging. MATERIALS: The specimen used in the study presented a thoracic curve of 150 degrees Cobb angle with the apex at T8. The measures were made using 3D-computer graphics models. The wedging in the frontal and sagittal planes as well as the 3D wedging were measured. The height variation of the vertebral bodies was also measured. RESULTS: The wedging measures show that it increases progressively with the vertebral level to reach a maximum of 27 degrees at the apex. Perdriolle has found a linear relation between the vertebral body wedging and the Cobb angle. The relation predicts a wedging of 24 degrees for 150 degrees of Cobb angle. An inflection point was identified on the vertebral end plate on the convex side. These inflection points were described by Perdriolle as being on the concave side of the vertebra. CONCLUSION: Our measures follow the relation between the Cobb angle and the wedging of the vertebral body, even for very large Cobb angles. Furthermore, inflection points on the vertebral body were identified on the convex side as opposed to the concave side in the literature. This leads us to believe that the vertebral body wedging progressively affects the vertebral endplates.     

Innervation of the lumbar facet joints. Origins and functions

STUDY DESIGN: The levels of dorsal root ganglia and paravertebral sympathetic ganglia innervating the lumbar facet joint were investigated in rats using the retrograde transport method. The pathways and functions of the nerve fibers supplying the lumbar facet joint were determined immunohistochemically. OBJECTIVES: To study lumbar facet pain in relation to its innervation. SUMMARY OF BACKGROUND DATA: The lumbar facet joints have been reported to be innervated segmentally. Little is known, however, about the origins and functions of the nerve fibers. METHODS: Cholera toxin B subunit, a neural tracer, was placed in the L5-L6 facet joint, and the bilateral dorsal root ganglia and paravertebral sympathetic ganglia were examined immunohistochemically. The serial sections of lumbar vertebrae of newborn rats and the sections of the facet joint capsules, dorsal root ganglia, and paravertebral sympathetic ganglia of adult rats were investigated immunohistochemically. The pathways of the nerve fibers supplying the facet joint were reconstituted. RESULTS: Labeled neurons existed in ipsilateral dorsal root ganglia from L1 to L5 and in paravertebral sympathetic ganglia from T12 to L6. The dorsal ramus of the spinal nerve and rami communicantes were connected to each other by calcitonin gene-related peptide immunoreactive fibers and dopamine beta-hydroxylase immunoreactive fibers. CONCLUSIONS: The L5-L6 facet joint was innervated by ipsilateral dorsal root ganglia and paravertebral sympathetic ganglia, segmentally and nonsegmentally. Some of the sensory fibers from the facet joint may pass through the paravertebral sympathetic trunk, reaching L1 and/or L2 dorsal root ganglia. Inguinal and/or anterior thigh pain with lower lumbar facet joint lesions may be explained as referred pain.     

Anterior approaches to the spinal column: considerations of the surgical technic

The anterior approach to the vertebral column is indicated in the tumors or traumas of the vertebral body with prevalent anterior expression. This method allows to control easily all the structures in front of the rachis. Furthermore, the current reconstructive techniques require the exposure of a long tract of the vertebral column. The Authors report their experience with the anterior approach in 22 patients (9 males, 13 females) affected by different pathologies: 10 primary tumors divided as follows: 4 sacral chordomas, 1 L1 chordoma, 2 sacral neurinomas, 1 L5 malignant melanotic schwannoma, 1 D9 osteoblastoma, 1 D6 intraspinal cavernoma, and 1 D3 myeloma; 4 metastatic tumors (2 D10, 1 L4 and 1 L5); 5 fractures of the vertebral body (1 L1, 1 L1-L2, 2 L4 and 1 L5); 2 echinococcal cysts respectively arising from the D11 body, the sacrum and ilium. The Authors overall performed 8 thoracotomies, 6 for dorsal location; in 1 case of L1-L2 fracture a thoracophrenolaparotomy was performed; in 7 cases involving the L3-L5 segment an abdominal anterolateral extraperitoneal approach was followed; finally in 6 cases a transperitoneal laparotomy to approach the sacrum and ilium was performed.     

Interrater reliability of six tests of trunk muscle function and endurance

Some studies have shown a relationship between trunk muscle strength and low back pain. Measures of trunk muscle strength and endurance, which are feasible in the clinical setting, are needed. The purpose of this study was to determine interrater reliability of six tests of abdominal and trunk extensor muscle strength and endurance. The tests included abdominal and extensor dynamic endurance, hand-held dynamometry of isometric flexion and extension, and abdominal and extensor static endurance. Thirty-nine healthy workers were recruited as subjects. Each was tested by three raters on 3 days within 1 week. Intraclass correlation coefficients (ICC) and the standard error of measurement (SEM) were calculated: abdominal dynamic endurance ICC = .89, SEM = 8 repetitions; extensor dynamic endurance ICC = .78, SEM = 9 repetitions; abdominal isometric force ICC = .25, SEM = 60 N; extensor isometric force ICC = .24, SEM = 68 N; abdominal static endurance ICC = .51, SEM = 35 seconds; extensor static endurance ICC = .59, SEM = 20 seconds. The dynamic endurance tests had acceptable interrater reliability. For the others, reliability was poor and the SEMs were large.     

The ligamento-muscular stabilizing system of the spine

STUDY DESIGN: Electrical and mechanical stimulation of the lumbar supraspinous ligament of three patients with L4-L5 spinal deficits and of the feline model, respectively, was applied while recording electromyography on the multifidus muscles. OBJECTIVES: To determine if mechanoreceptors in the human spine can reflexively recruit muscle force to stabilize the lumbar spine, and to demonstrate, in the feline model, that such ligamento-muscular synergy is elicited by mechanical deformation of the lumbar supraspinous ligament (and possibly of other spinal ligaments), the facet joint capsule, and the disc. SUMMARY OF BACKGROUND DATA: The literature repeatedly confirms that ligaments have only a minor mechanical role in maintaining spine stability, and that muscular co-contraction of anterior and posterior muscles is the major stabilizing mechanism of the spine. The literature also points out that various sensory receptors are present in spinal ligaments, and that the ligaments are innervated by spinal and autonomic nerves. Data that describe how ligaments and muscles interact to provide stability to the spine were not found. METHODS: The supraspinous ligament at L2-L3 and L3-L4 was electrically stimulated in three patients undergoing surgery to correct deficits at L4-L5. Electromyography was performed from the multifidus muscles at L2-L3 and L3-L4, bilaterally. In 12 cats, the supraspinous ligaments from L1-L2 to L6-L7 were mechanically deformed, sequentially, while electromyography was performed from the multifidus muscles of the six levels. Loading of the ligament was applied before and after each of the two vertebrae were externally fixed to prevent motion. RESULTS: Electromyograms were recorded from the multifidus muscles, bilaterally, in the two of the three patients, demonstrating a direct relationship to receptors in the supraspinous ligament. Electromyograms were recorded from the feline multifidus muscle with mechanical loading of the supraspinal ligament at each of the L1-L2 to L6-L7 motion segments. In the free-spine condition the largest electromyographic discharge was present in the level of ligament deformation, and lower electromyographic discharge was recorded in two rostral and caudal segments. After immobilizing any two vertebrae, loading of the ligament resulted in electromyographic discharge in the muscles of the same level and at least one level above and/or below. CONCLUSIONS: Deformation or stress in the supraspinous ligament, and possibly in other spinal ligaments, recruits multifidus muscle force to stiffen one to three lumbar motion segments and prevent instability. Strong muscular activity is seen when loads that can cause permanent damage to the ligament are applied, indicating that spastic muscle activity and possibly pain can be caused by ligament overloading.     

Epidural epinephrine and clonidine: segmental analgesia and effects on different pain modalities

BACKGROUND: It is not known whether epidural epinephrine has an analgesic effect per se. The segmental distribution of clonidine epidural analgesia and its effects on temporal summation and different types of noxious stimuli are unknown. The aim of this study was to clarify these issues. METHODS: Fifteen healthy volunteers received epidurally (L2-L3 or L3-L4) 20 ml of either epinephrine, 100 microg, in saline; clonidine, 8 microg/kg, in saline; or saline, 0.9%, alone, on three different days in a randomized, double-blind, cross-over fashion. Pain rating after electrical stimulation, pinprick, and cold perception were recorded on the dermatomes S1, L4, L1, T9, T6, T1, and forehead. Pressure pain tolerance threshold was recorded at S1, T6, and ear. Pain thresholds to single and repeated (temporal summation) electrical stimulation of the sural nerve were determined. RESULTS: Epinephrine significantly reduced sensitivity to pinprick at L1-L4-S1. Clonidine significantly decreased pain rating after electrical stimulation at L1-L4 and sensitivity to pinprick and cold at L1-L4-S1, increased pressure pain tolerance threshold at S1, and increased thresholds after single and repeated stimulation of the sural nerve. CONCLUSIONS: Epidural epinephrine and clonidine produce segmental hypoalgesia. Clonidine bolus should be administered at a spinal level corresponding to the painful area. Clonidine inhibits temporal summation elicited by repeated electrical stimulation and may therefore attenuate spinal cord hyperexcitability.     

Measurements of scapular position and rotation: a reliability study

Smooth motion of the scapula and humerus with respect to the thorax is essential for shoulder function and abnormalities may indicate clinical entities. Recent studies have made an attempt to devise simple, practical means of quantifying scapular position. The aim of this study was to examine the intra-tester and inter-tester reliability of two methods and to determine if significant differences existed between the dominant versus non-dominant extremity. Seventeen healthy volunteers (4 M; 13 F) were examined by two testers. The tape measurements consisted of the classic methods of Kibler and DiVeta in three sitting postures, expanded by the measurement of the linear distance from the medial border to the thoracic mid-line, and the scapular size measure. The SAS software package was used for data analysis. The Intraclass Correlation Coefficient (ICC) intra-tester reliability ranged between 0.96-0.8 for both methods without significant differences, whereas the ICC for inter-tester reliability ranged between 0.42-0.9 with higher values (moderate and good) for the Kibler technique. In the additional tests high values were also obtained for ICC intra-tester, except for the measurements of the linear distance of the medial border of the scapula to the thoracic mid-line and the distance of the inferior process of the acromion to the third vertebra, both in 90 degrees abduction and internal rotation. The ICC for inter-tester was only acceptable for the DiVeta measurement on 45 degrees abduction. Significant differences were noted between both testers on the following measures: Kibler in 45 degrees abduction, DiVeta in 45 degrees abduction and 90 degrees abduction and the scapular size measure. The comparison of dominant versus non-dominant extremity revealed larger but not significantly different means for the dominant extremity in the classic methods. Significant differences occurred for Tester 1 in the measurement of the distance of the medial border to the thoracic mid-line and Tester 2 in DiVita in 45 degrees abduction. The SEM values never exceeded 1 cm. We believe that the Kibler technique holds promise for further studies, has the advantage of measuring in three positions and with some familiarisation can be reliable. Further research is necessary in patients with pathological conditions.     

APhA drug treatment protocols: management of patients with generalized anxiety disorder.APha Psychiatric Disorders Panel

STUDY DESIGN: The multidirectional stability potential of anterior, posterior, and combined instrumentations applied at L1-L3 was studied after L2 corpectomy and replacement with a carbon-fiber implant. OBJECTIVES: To evaluate the biomechanical characteristics of short-segment anterior, posterior, and combined instrumentations in lumbar spine tumor vertebral body replacement surgery. SUMMARY OF BACKGROUND DATA: The biomechanical properties of many different spinal instrumentations have been studied in various spinal injury models. Only a few studies, however, investigate the stabilization methods in spinal tumor vertebral body replacement surgery. METHODS: Eight fresh frozen human cadaveric thoracolumbar spine specimens (T12-L4) were prepared for biomechanical testing. Pure moments (2.5 Nm, 5 Nm, and 7.5 Nm) of flexion-extension, left-right axial torsion, and left-right lateral bending were applied to the top vertebra in a flexibility machine, and the motions of the L1 vertebra with respect to L3 were recorded with an optoelectronic motion measurement system after reconditioning. The L2 vertebral body was resected and replaced by a carbon-fiber cage. Different fixation methods were applied to the L1 and L3 vertebrae. One anterior, two posterior, and two combined instrumentations were tested. Load-displacement curves were recorded and neutral zone and range of motion parameters were determined. RESULTS: The anterior instrumentation provided less potential stability than the posterior and combined instrumentations in all motion directions. The anterior instrumentation, after vertebral body replacement, showed greater motion than the intact spine, especially in axial torsion (range of motion, 10.3 degrees vs 5.5 degrees; neutral zone, 2.9 degrees vs. 0.7 degrees; P < 0.05). Posterior instrumentation provided greater rigidity than the anterior instrumentation, especially in flexion-extension (range of motion, 2.1 degrees vs. 12.6 degrees; neutral zone, 0.6 degrees vs. 6.1 degrees; P < 0.05). The combined instrumentation provided superior rigidity in all directions compared with all other instrumentations. CONCLUSIONS: Posterior and combined instrumentations provided greater rigidity than anterior instrumentation. Anterior instrumentation should not be used alone in vertebral body replacement.     

Observer variation in plain radiography of the lumbosacral spine

In this study, interobserver and intraobserver variations in the interpretation of plain radiographs of the lumbosacral spine were evaluated. Three radiologists independently interpreted the radiographs from 200 consecutive outpatients, aged 13-93 years, mostly referred from general practitioners. Interobserver agreement was best for vertebral fractures, osteopenia, spondylolisthesis at L5-S1, lumbosacral junctional vertebra, reduced disc height at L4-S1 and osteophytes at L2-S1 (kappa 0.61-0.95), and poorest for spina bifida of S1, degenerative spondylolisthesis and facet joint arthrosis at T12-L4, sacroiliac joint arthrosis, narrow central spinal canal, film quality, and for decisions concerning evaluation of facet joints and spinal canal (kappa < 0.34). For several diagnoses, the number of abnormal findings differed significantly between observers (p < 0.05, McNemar's test), indicating different diagnostic thresholds. Intraobserver agreement in 36 reevaluated patients was fair to excellent for almost all variables (kappa > 0.46). Although some diagnoses related to low back pain were quite consistently evaluated, the substantial disagreement on many findings should alert clinicians and radiologists against overestimating the validity and usefulness of the examinations. To improve diagnostic consistency, it is important to reduce variation caused by different thresholds for abnormality.     

Cut-off point of the Scoliometer in school scoliosis screening

STUDY DESIGN: A large-scale study on school screening for scoliosis was conducted to assess the referral rate, prevalence rate, and positive predictive value using different angles of trunk rotation as criteria for referral. OBJECTIVE: To determine an ideal angle of trunk rotation cut-off point to be used for referral in school screening for scoliosis. SUMMARY OF BACKGROUND DATA: When using the Scoliometer (Orthopedic Systems, Inc., Hayward, CA) in school scoliosis screening, 5 degrees and 7 degrees angles of trunk rotation have been recommended as criteria for referral. Low positive predictive values and over-referral at these levels have been reported. METHODS: The Adams forward bend test and Scoliometer measurement were combined for school scoliosis screening in 33,596 girls from the fifth, sixth and seventh grades. Nurses were the primary screeners. Girls with trunk rotation angles of 5 degrees or more were referred for radiography. RESULTS: The referral rate was 5.2%. By selecting 6 degrees, 7 degrees, 8 degrees, 9 degrees or 10 degrees angles of trunk rotation as criteria for referral, the referral rate became 2.4%, 1.4%, 0.7%, 0.5%, or 0.3%, respectively. The prevalence rate for scoliosis equal to or larger than 10 degrees, 20 degrees, 30 degrees, or 40 degrees of the Cobb angle was 1.47%, 0.21%, 0.04% and 0.02%, respectively, by using a 5 degrees angle of trunk rotation as the criterion for radiography. The positive predictive value was 28.3% for scoliosis of 10 degrees or more, 4% for scoliosis of 20 degrees or more, 0.8% for scoliosis of 30 degrees or more, and 0.4% for scoliosis of 40 degrees or more with a 5 degrees angle of trunk rotation as the criterion for referral. By selecting angles of trunk rotation larger than 5 degrees as criteria for referral for radiography, the positive predictive value increased, but positive cases with larger Cobb angles also decreased markedly. CONCLUSION: The optimal cut-off point for referral when using the Scoliometer in school screening of scoliosis is still difficult to determine.     

An objective measurement technique for posterior scapular displacement

Contemporary shoulder rehabilitation programs emphasize scapular control in the treatment of shoulder pathology. In addition, scapular winging and scapular tipping are often cited as key components to both the evaluative and rehabilitative phase of treatment. However, the lack of objective measurement procedures makes clinical evaluation of these phenomena difficult. The purpose of this project was to develop a reliable technique to quantify posterior scapular displacement (direction of scapular movement for winging and/or tipping). Forty healthy subjects (21 males, 19 females) who reported no current shoulder pain participated in this study. A measurement instrument was designed to quantify, to the nearest whole degree of motion, the posterior displacement of the inferior angle of the scapula from the posterior thorax. Subjects' scapulae were each measured two times without holding weight (unweighted position) and two times while the subjects held 10% of their body weight (weighted position). During all trials, two testers were blinded from the measurement readings. Intraclass correlation coefficients (ICC) were calculated based on a repeated measure analysis of variance to determine intertester and intratester reliability. The standard error of measurement (SEM) was used to determine the measurement error. Intratester within-day reliability ICCs ranged from 0.97 to 0.98, and SEM ranged from 0.6 to 1.1 degrees. Intertester within-day reliability ICCs ranged from 0.92 to 0.97, and SEM ranged between 1.1 and 1.7 degrees. None of the calculated p values for intratester and intertester reliability were statistically significant (p < 0.05). We conclude that this measurement technique is a reliable method to quantify posterior scapular displacement. Further research utilizing this measurement technique is recommended.     

Thrombolysis for stroke

The fate of 89 patients with meningomyelocele operated at the Institute of Orthopedics and Rehabilitation in Poznań between 1970 and 1989 due to paretic deformities of lower extremities has been traced by the authors. Deformities prevented nursing, standing or ambulating; their type and results of treatment have been related to the level of neurosegmental lesion. Modified Sharrard's classification served to group the patients. The level of lesion established during lower extremities muscles testing has been verified after neurological examination supplemented with electrophysiological tests: sensory response within L3-S2 dermatomes, afferent conduction velocity of the peroneal nerve and selected muscles of lower extremity electromyogram. Deformities due to inadequate nursing (hip and knee contractures and equinus foot) were the main obstacle in the rehabilitation in patients with spinal Th12-L2 lesion. In patients with L3-L5 lesion hip contractures were accompanied by dislocation or subluxation of the hip due to muscular imbalance. Knee contracture was less frequent in this group and foot deformities were diverse. Surgical correction of paretic deformity of the hip was the last stage of management designed to promote rehabilitation, following previous foot and knee surgery. In patients with Th12-L2 lesion recurrence of contractures made standing and walking impossible. In patients with L3-L5 neurosegmental lesion surgery for paretic dislocation or subluxation of the hip inclusive of open reduction, varus-derotation osteotomy of the proximal femur, transiliac osteotomy and iliopsoas transfer to the greater trochanter according to Mustard resulted in stable hip. Seventy percent of patients with L3-L4 lesion and all patients with L5 lesion profited from hip surgery with reduced orthotic use and effective gait.