Scoliosis in the community.

Screening for scoliosis at schools has become more and more popular despite the lack of knowledge concerning the clinical course of idiopathic scoliosis. An epidemiological study of 5303 schoolchildren showed three types of scoliosis in the community: (1) pelvic tilt scoliosis (an inconsequential deformity caused by an inequality in the length of the legs but accounting for almost 40% of curves detected); (2) spinal scoliosis (a minor asymmetry of the spine in the coronal plane that tends to remain static or to resolve and which may be normal in growing children, accounting for the remaining 60%); and (3) progressive scoliosis (10% of the spinal scolioses measuring 10 degrees or more that progress by 5 degrees or more a year). Progressive scoliosis resembles idiopathic scoliosis because in girls with right thoracic curves the potential for progression is appreciable. Until the natural history is better established growing awareness in the community of spinal deformity should help earlier detection, and screening should be directed towards providing subjects for further epidemiological work.     

正常小儿胫神经诱发脊髓电位特征和脑瘫小儿该电位的变化

采取刺激后胫神经(PTN)诱发叠加技术,利用体表无创伤性双极记录方法观察了16例正常小儿和43例脑瘫小儿的脊髓诱发电位(SCEP)。正常小儿的SCEP自下而上潜伏时逐渐延长、电压减小。从椎体C6到T10表现为Pa-Na-Pb三相波,T10～T12为Pa-Na1-Na2-Pb波,T12～L4为多相复合波。左右侧SCEP波形相似,潜伏时、电压相同,它们之间无统计学显著差别;但不同节段之间SCEP差异显著;脊髓传导速度为57.14m/s。脑瘫小儿SCEP正常者占14％;全髓反应低下者占20％;左右侧反应不对称者占46％;节段性反应低下者占15％;其它异常约占5％。不但节段间存在显著差异,而且全脊髓左右侧电压间以及颈、腰骶髓的潜伏时间出现显著差异。脊髓传导速度减低(患侧46.22m/s,对侧53.48m/s)。结果提示:(1)正常小儿脊髓活动左右对称,不同脊髓节段对PTN刺激反应不同。(2)脑瘫小儿脊髓活动左右不对称,一侧功能下降时对侧有一定代偿力,脊髓传导速度减慢。     

Postural effects of symmetrical and asymmetrical loads on the spines of schoolchildren

Background

The Walter Reed Visual Assessment Scale (WRVAS) was designed to measure physical deformity as perceived by patients with idiopathic scoliosis. Previous studies have shown that the instrument has excellent internal consistency and a high correlation with the radiological magnitude of scoliotic curves. Nonetheless, it is not known whether the scale can discriminate between the various curve patterns of the deformity, or whether the deformities represented in the scale's drawings relate to the corresponding radiological deformities.

Methods

This study included 101 patients (86 women and 15 men; mean age 19.4 years) with idiopathic scoliosis. In a single visit, patients underwent standing PA radiography of the spine and completed the WRVAS. X-ray measurements included: 1) magnitude (Cobb angle) of the proximal thoracic curve (PT), main thoracic curve (MT), and thoracolumbar/lumbar curve (TL/L); 2) difference in shoulder level; 3) T1 offset from the central sacral line (T1-CSL); 4) apical vertebra (apV) rotation at the MT and TL/L curves and 5) apical vertebra offset of the MT and TL/L curves from the central sacral line. A variable designated Cobbmax was defined as the largest angle of the three curves (PT, MT or TL/L). Patients were grouped onto three patterns: Thoracic (TH Group)(n = 30, mean MT 42.1°, TL/L 20.9°); double major (DM Group) (n = 39, mean MT 38.6°, TL/L 34.4°) and thoracolumbar (TL Group)(n = 32, mean MT 14.3°, TL/L 25.5°). The magnitude of the curves in the TL Group was significantly smaller than in the other groups (P < 0.05). The Spearman partial correlation coefficient was determined between the score for each WRVAS question and the curve pattern, adjusting for the Cobbmax variable. The Spearman correlation coefficient was determined between the WRVAS items and shoulder imbalance, T1-CSL offset, MT Cobb angle, MT apV rotation, MT apV offset, PT Cobb, TL/L Cobb, TL/L apV rotation and TL/L apV offset.

Results

The median (interquartile range) of the total WRVAS score was 14 (IQR 6). No correlation was found between the curve pattern and the various scores on the scale (partial correlation coefficients ranged from -0.16 to 0.12). WRVAS drawings for items 1, 2, 4 and 7 correlated satisfactorily with the corresponding radiological measurements (correlation coefficients, 0.62, 0.3, 0.48 and 0.53, respectively). Items 3, 5 and 6 did not correlate with the radiological measurements (correlation coefficients -0.06, -0.07 and 0.05, respectively).

Conclusion

The profile of the individual WRVAS scores does not differentiate among specific curve patterns (thoracic, double major and thoracolumbar/lumbar). Moreover, some of the drawings (items 3, 5 and 6) do not correlate with the radiological deformity they were designed to measure.     

Mapping of tachykinins in the cat spinal cord

Using an indirect immunoperoxidase technique, the location of cell bodies and fibers containing substance P, neurokinin A and neurokinin B was studied in the cat spinal cord. The former two neuropeptides showed a widespread distribution throughout the whole spinal cord, whereas the distribution of neurokinin B was more restricted. Neurokinin A-immunoreactive structures showed a more widespread distribution and a higher density than the immunoreactive structures observed to contain substance P. In the cat spinal cord, we observed cell bodies containing neurokinin A, but no cell bodies containing neurokinin B or substance P were found. These cell bodies were located in laminae V (sacral 1 and 2 levels), VI (sacral 1 and 3), VII (lumbar 7, sacral 1 and 3, caudal 1) and X (sacral 1). Laminae I and II showed the highest density of immunoreactive fibers for each of the three tachykinins studied, being in general lamina IV who showed the lowest number of immunoreactive fibers containing substance P, neurokinin A or B. The anatomical distribution of the three tachykinins studied in the cat spinal cord indicates that the neuropeptides could be involved in the neurotransmission and/or in the neuromodulation of nociceptive information, as well as in autonomic and affective responses to pain. Moreover, the involvement of substance P, neurokinin A or B in other functions unrelated to the transmission of pain is also possible (autonomic and motor functions). The distribution of the neuropeptides studied in the cat is compared with the location of the same neuropeptides in the spinal cord of other species. The possible origin of the tachykinergic fibers in the cat spinal cord is also discussed.     

Reissner's fiber and the wall of the central canal in the lumbo-sacral region of the bovine spinal cord

Summary Reissner's fiber (RF) of the subcommissural organ (SCO), the central canal and its bordering structures, and the filum terminale were investigated in the bovine spinal cord by use of transmission electron microscopy, histochemical methods and light-microscopic immunocytochemistry. The primary antisera were raised against the bovine RF, or the SCO proper. Comparative immunocytochemical studies were also performed on the lumbo-sacral region of the rat, rabbit, dog and pig.At all levels of the bovine spinal cord, RF was strongly immunoreactive with both antisera. From cervical to upper sacral levels of the bovine spinal cord there was an increasing number of ependymal cells immunostainable with both antisera. The free surface of the central canal was covered by a layer of immunoreactive material. At sacral levels small subependymal immunoreactive cells were observed. From all these structures sharing the same immunoreactivity, only RF was stained by the paraldehyde-fuchsin and periodicacid-Schiff methods.At the ultrastructural level, ependymal cells with numerous protrusions extending into the central canal were seen in the lower lumbar segments, whereas cells displaying signs of secretory activity were principally found in the ependyma of the upper sacral levels. A few cerebrospinal fluid-contacting neurons were observed at all levels of the spinal cord; they were immunostained with an anti-tubulin serum.The lumbo-sacral segments of the dog, rat and rabbit, either fixed by vascular perfusion or in the same manner as the bovine material, did not show any immunoreactive structure other than RF.The possibilities that the immunoreactive ependymal cells might play a secretory or an absorptive role, or be the result of post-mortem events, are discussed.Supported by Grant I/38259 from the Stiftung Volkswagenwerk, Federal Republic of Germany, and Grant RS-82-18 from the Dirección de Investigaciones, Universidad Austral de ChileThe authors wish to thank Dr. Enrique Romeny from the Valdivia abattoir for kindly providing the bovine spinal cords     

Distribution and subtype determination ofβ-receptors in the spinal cord of the adult rat

1. We determined the number of beta-receptors in the whole spinal cord of the adult rat and in the cervical, thoracal, and lumbal/sacral parts. 2. The undivided spinal cord contains 47 +/- 10 fmol/mg beta-receptors (KD = 2066 +/- 982 pmol/liter), and the cervical part of the spinal cord contains 53 +/- 8 fmol/mg protein (KD = 3224 +/- 1775 pmol/liter). The thoracal part shows 40 +/- 1 fmol/mg protein (KD = 3229 +/- 104 pmol/liter), and the lumbal/sacral spinal cord contains 48 +/- 8 fmol/mg protein (KD = 3610 +/- 1610 pmol/liter). 3. Competitive inhibition studies with l-practolol, dl-atenolol, and ICI 118,551 were performed and we calculated by a computer program in the whole spinal cord the following ratio of beta-receptor subtypes: 80 +/- 5% Beta 1-receptors and 20 +/- 5% beta 2-receptors. 4. The basal and (-)-isoproterenol- and NaF-stimulated activity of adenylate cyclase was highest in the cervical part of the spinal cord and equally distributed between the thoracal and the lumbal/sacral parts. 5. The whole synaptosomal protein of the cervical part of the spinal cord contained 132 +/- 20 fmol, the thoracal part 117 +/- 3 fmol, and the lumbal/sacral part 133 +/- 22 fmol.     

Adolescent idiopathic scoliosis: natural history and long term treatment effects

ABSTRACT : Adolescent idiopathic scoliosis is a lifetime, probably systemic condition of unknown cause, resulting in a spinal curve or curves of ten degrees or more in about 2.5% of most populations. However, in only about 0.25% does the curve progress to the point that treatment is warranted.Untreated, adolescent idiopathic scoliosis does not increase mortality rate, even though on rare occasions it can progress to the >100 degrees range and cause premature death. The rate of shortness of breath is not increased, although patients with 50 degrees curves at maturity or 80 degrees curves during adulthood are at increased risk of developing shortness of breath. Compared to non-scoliotic controls, most patients with untreated adolescent idiopathic scoliosis function at or near normal levels. They do have increased pain prevalence and may or may not have increased pain severity. Self-image is often decreased. Mental health is usually not affected. Social function, including marriage and childbearing may be affected, but only at the threshold of relatively larger curves.Non-operative treatment consists of bracing for curves of 25 degrees to 35 degrees or 40 degrees in patients with one to two years or more of growth remaining. Curve progression of >/= 6 degrees is 20 to 40% more likely with observation than with bracing. Operative treatment consists of instrumentation and arthrodesis to realign and stabilize the most affected portion of the spine. Lasting curve improvement of approximately 40% is usually achieved.In the most completely studied series to date, at 20 to 28 years follow-up both braced and operated patients had similar, significant, and clinically meaningful reduced function and increased pain compared to non-scoliotic controls. However, their function and pain scores were much closer to normal than patient groups with other, more serious conditions.Risks associated with treatment include temporary decrease in self-image in braced patients. Operated patients face the usual risks of major surgery, a 6 to 29% chance of requiring re-operation, and the remote possibility of developing a pain management problem.Knowledge of adolescent idiopathic scoliosis natural history and long-term treatment effects is and will always remain somewhat incomplete. However, enough is know to provide patients and parents the information needed to make informed decisions about management options.     

Usefulness of tilt testing in children with syncope: a survey of pediatric electrophysiologists

The role of tilt table testing as a diagnostic modality in children with unexplained syncope is unclear. We sent a questionnaire to members of the Pediatric and Congenital Electrophysiology Society to assess the current practice pattern. Of the 186 members, 97 (52%) replied. Twenty four percent of the pediatric electrophysiologists have completely stopped doing tilt table tests and of those performing the tests, a majority (76%) did < 10 tests/yr (median=3 tilts/yr, range 0-100/yr). Of those performing the test, 95% rarely or never accepted direct referrals from the general practioners and 62% felt that the frequency of tilt table tests being performed had decreased since they had started practicing. The median usefulness of the test was rated at 3 (range 1-9) on a scale of 1 to 10 with 10 being very useful. A majority (68%) felt they rarely or never altered treatment based on the results of the tilt test. Wide variability was noted in the test protocol including the tilt angle, tilt duration, use of pharmacologic agents and the duration of fasting prior to the test. We therefore conclude that there is significant lack of standardization in tilt table tests performed in children. Tilt table testing, as perceived by pediatric electrophysiologists, is of limited utility and progressively less used in children with syncope.     

Multimodal responses of the nonspiking giant interneurons in the brain of the crayfish Procambarus clarkii

Three pairs of nonspiking giant interneurons (NGIs; G1, G2, and G3) of the crayfish brain responded with depolarizing and hyperpolarizing graded potentials to body tilt in roll to the ipsi- and contralateral sides in the dark. The higher and the larger the angle of body tilt, the larger was the amplitude of the geotactic responses. In ipsilaterally statocystectomized animals, all the NGIs responded with hyperpolarizing potentials only to the contralateral side-down tilt, whereas in contralaterally statocystectomized animals, they responded with depolarizing potentials only to the ipsilateral side-down tilt. In bilaterally statocystectomized animals, none of the NGIs responded to body tilt in the dark, but in the presence of an overhead light, they exhibited depolarizing and hyperpolarizing potentials in response to body tilt to the ipsi-and contralateral sides, respectively. All the NGIs responded with depolarizing and hyperpolarizing graded potentials to illumination of the contra- and ipsilateral eyes, respectively. The amplitude of these visual responses, however, varied in association with the amplitude of the geotactic response produced by body tilt. These results indicate that the NGIs integrate the sensory inputs from eyes and statocysts and that the interaction between sensory inputs from the left and right sensory organs with either the same modality or with different modalities enhance the directional sensitivity of NGIs as premotoneurons in the compensatory oculomotor system.     

Observations on the topographical relations of spinal nerve roots in the rat

The spinal cord along with the ventral and dorsal roots (C1-S4) were dissected out in 10 male and 5 female CF rats. The vertebral levels of origin and exit of the spinal nerve roots and termination of the spinal cord were recorded. It was observed that from the mid-cervical to the sacral region, the roots arose increasingly at cranial levels compared to their levels of exit. This disparity was at its maximum in the lumbar and sacral segments. The spinal cord terminated between the third and fourth lumbar vertebrae. There was no sexual dimorphism either at the level of termination of the cord or at the levels of origin and exit of origin and exit of the various nerve roots.     

The use of dynamic elastomeric fabric orthosis suits as an orthotic intervention in the management of children with neuropathic onset scoliosis: A retrospective audit of routine clinical case notes

Background

To date the main treatment approach for neuropathic onset scoliosis has utilised thoracic lumbar sacral orthoses (TLSO) to stabilize the spine and enable stable sitting. Dynamic elastomeric fabric orthoses (DEFOs) may achieve both of these aims if used as an early intervention. Due to a lack of evidence in this area, a retrospective audit of case notes was undertaken to understand current orthotic practice investigating the usage, outcomes and clinical characteristics of treated children with neuropathic onset scoliosis. Clinical notes of 180 children at risk for, or identified with, scoliosis were audited using a search matrix to identify diagnostic group, spinal muscle tone, Gross Motor Functional Classification Scale (GMFCS) level, orthotic treatment modalities, scoliosis specific data, surgical interventions, adaptive technologies used, and outcome measurements reported.

Results

Of the 180 notes examined, 85 were male; mean age nine years one month [SD four years seven months]. Spinal muscle tone was reported in 137 cases: 122/137 presented as low tone, 4/137 high tone, 6/137 fluctuating tone and 5/137 typical tone. Scoliosis was confirmed in (77/180) of whom (39/77) used a DEFO. Another (43/180) had a spinal curve developing, of whom (22/43) used a DEFO. The remaining (60/180) had no report of spinal curvature, but used a DEFO as a preventative measure. GMFCS scores were reported for 49 children of whom 14/49 were graded as level 4 and 17/49 level 5. Of the children with scoliosis who had spinal curve shapes reported, 48/60 had a C-shape presentation and 12/60 had an S-shape.

Conclusions

The findings confirm previously reported papers in children with neuropathic onset scoliosis in relation to curve shape and GMFCS levels. It provides some evidence of the role DEFOs may have in the management of these children, and highlights the need for further research in this area due to the lack of peer-reviewed publications.

     

Hypopituitarism and stalk agenesis: a congenital syndrome worsened by breech delivery?

Thirty-seven patients with idiopathic hypopituitarism, of whom 12 had multiple pituitary hormone deficiencies (MPHD) and 25 isolated growth hormone deficiency (IGHD), were evaluated by magnetic resonance imaging (MRI). Twenty-two of the 37 showed congenital anterior pituitary hypoplasia, stalk agenesis and ectopic posterior pituitary gland at the infundibular recess (group A), while the remaining 15 presented isolated anterior pituitary hypoplasia (group B). Perinatal histories obtained from all patients demonstrated that 18/22 children of group A (81.81%) had histories of adverse perinatal events, with breech presentation in 15 (68.18%). Twelve of 12 children of group A born by breech delivery developed MPHD; 3 born by cesarean section for breech presentation had only IGHD. Patients of group B had also a high incidence of perinatal insults (12/15, 80%), but breech delivery was markedly less frequent (13.33 vs. 68.18% of group A) and responsible for only IGHD. Group B had also higher percentages of maternal spontaneous abortion and low birth weight. Our study suggests that several factors may play a role in the development of growth hormone deficiency. Some patients had severe perinatal insults apparently leading to hypopituitarism. We were able to define by MRI a group of patients with congenital abnormalities, such as anterior pituitary hypoplasia, stalk agenesis and posterior pituitary ectopia, among whom breech presentation was very common. In this group, breech delivery was always followed by MPHD while cesarean or normal delivery in such patients was followed by IGHD only.     

Incidence of Spinal Perineurial (Tarlov) Cysts among East-European Patients

The spinal perineurial cyst (Tarlov) is a dilatation between the perineurium and endoneurium of spinal nerve roots, located at level of the spinal ganglion and filled with cerebrospinal fluid but without communication with the perineurial subarachnoid space. The aim of the study was to evaluate it incidence among East-European patients. The retrospective data collected during various magnetic resonance spinal examinations and stored on the picture archiving and communication system was analyzed for an incidence of perineurial cysts. From among 842 patients that underwent examination, 75 cases perineurial cysts were revealed. In 22 cases single anomalies were found. In remaining 53 cases, multiple uni- or less frequently bilateral changes were noted. The most common position was the sacral canal, particularly the level of S2 and S3. Occasionally, cysts were also visible on the cervical, thoracic and lumbar level. Incidence of sacral perineurial cysts was significantly higher in females than in males. Similar data was found for single and multiple changes despite of their localization. Insignificant changes were seen for patient age and cyst size. Perineurial spinal cysts were the most frequently observed on the sacral level and such changes were more common in females.     

Truncal changes in children with mild limb length inequality: a surface topography study

Background

Limb length Inequality (LLI) in children and adults may affect posture, gait, and several truncal parameters, and it can cause spinal scoliosis. In literature, however, there is a paucity of assessment of truncal and spinal changes due to mild LLI in children. This report presents children with LLI, and it aims to provide information in pelvic imbalance, spinal posture, and scoliotic curve, using surface topography analysis which is a novel methodological approach for this condition.

Study design

This is an ongoing prospective research study on patient series suffering LLI.

Material and method

Twenty children, attending the Scoliosis Clinic of the department, 7 boys, 13 girls, 9–15?years old, range 7.5–15, mean 15.5?years, having mild LLI, were assessed. The LLI was 0.5 to 2?cm, mean 1.2?cm. There was not any post-traumatic LLI. We evaluated the LLI in correlation to pelvic and spinal posture parameters. The 4D Formetric DIERS apparatus (4DF) was used for the surface topography assessment. The following were assessed: in the coronal plane, the coronal imbalance, the pelvic obliquity, the lateral deviation, and the 4DF scoliosis angle; in the sagittal plane, the sagittal imbalance, the 4DF kyphotic angle, the kyphotic apex, the 4DF lordotic angle, the lordotic apex, the pelvic tilt, and the trunk inclination; and in the transverse plane, the pelvis rotation, the pelvic torsion, the surface rotation, and the 4DF vertebral rotation. LLI was measured using a tape. The data were statistically analyzed, and reliability study for the LLI was also performed.

Results/discussion

The LLI was statistically significantly correlated to the 4DF reading of pelvis rotation, pelvic tilt (pelvic obliquity), and surface rotation. The scoliometer readings (angle trunk rotation ATR or trunk inclination ATI) in the lumbar region were statistically significantly correlated to the 4DF readings of pelvic tilt (pelvic obliquity). The normally symmetric truncal parameters were also statistically significantly changed (all these deviating from the line of gravity through the vertebral prominence). Interestingly, LLI was not correlated to the scoliosis angle and the scoliometer reading at the lumbar level.The following 4DF readings are presented: in the coronal plane, the coronal imbalance, pelvic obliquity, lateral deviation, and 4DF scoliosis angle; in the sagittal plane, the sagittal imbalance, kyphotic angle, kyphotic apex, lordotic angle, lordotic apex, pelvic tilt, and trunk inclination; and in the transverse plane, the pelvic rotation, pelvic torsion, surface rotation, and vertebral rotation.

Conclusions

Previous studies have reported the results after simulation of LLI in order to evaluate the effects on the pelvic balance and spinal posture parameters. This report is not a LLI simulation study but it presents the effects of mild LLI on truncal changes in the main cardinal planes in children suffering LLI. These changes undoubtedly affect not only the standing truncal posture but also the gait’s economy as well.As mild LLI affects the pelvic balance and spinal posture parameters, our therapeutic approach is that mild LLI (less than 2.0?cm) has to be corrected using shoe elevation, in order to equalize the pelvic obliquity and, consequently, the spinal posture parameters.

     

Modulation of Glycinergic Transmission in the Rat Spinal Dorsal Commissural Nucleus by Ginkgolide B

The action of ginkgolide B (GB), a powerful compound of Ginkgo biloba extract, on glycine-mediated spontaneous currents in rat spinal sacral dorsal commissural nucleus (SDCN) neurons was examined. IPSCs evoked in spinal cord slices were inhibited in a dose-dependent manner by the addition of GB to the superfusion solution. The amplitude of eIPSCs was reduced to 61 ± 6.4% by 10 μM GB with acceleration of the kinetics of the currents, indicating the effect of GB on channel pores. Both the amplitude and success ratio (R_suc) of eIPSC induced by electrical focal stimulation of single glycinergic nerve endings (boutons) also changed in the presence of 1 μM GB. These data suggest that GB modulates not only post-synaptic glycine receptors but also the pre-synaptic glycine release machinery.     

Discontinuity of primary and secondary neural tube in spina bifida induced by retinoic acid in mice

This report shows by light microscopy the appearance of secondary neurulation separated from primary neurulation and its developmental fate in the spinal cord of mice exposed to retinoic acid in utero. The embryos and fetuses were derived from pregnant mice (ICR strain) given 60, 40, or 0 mg/kg of retinoic acid in olive oil on day 8 of gestation orally and killed 1, 2, or 10 days later. Separation of the primary neural fold from the secondary neural tube was seen in 9- and 10-day-old embryos: the caudal part of the neuroepithelium of the primary neural fold was disarranged with non-closed posterior neuropore, and underneath it the secondary neural tissue extended caudally with abnormal notochord. At term, fetuses showed spina bifida, including myeloschisis, myelocele, and diplomyelia (diastematomyelia) with abnormal distribution of ganglionic cells. These cord lesions were located between the third lumbar and second coccygeal levels. The former two cord anomalies were associated with diplomyelia and split the dorsal and ventral portions of the spinal cord with an overlapping zone between the third lumbar and third sacral levels. These findings suggest that the separation from primary neurulation is due to the lesions in both primary neural folds and notochord induced by retinoic acid and that the spinal cord caudal to the third lumbar level originates from both neuroectoderm and mesenchyme-like cells while that caudal to the third sacral level originates from mesenchyme-like cells only.     

Ear examination

Adolescent idiopathic scoliosis is the single most common form of spinal deformity seen in orthopedic practice. Our knowledge about the epidemiology, etiology, natural history, and treatment has recently increased dramatically. The incidence of small curves is rather high (2% of the population), whereas severe curves are much less common (<0.1%), but we cannot always predict which curve will progress. Abnormalities of the neuromuscular system and of calcium metabolism, and certain growth, genetic, and mechanical factors may all play roles in the pathogenesis of the disorder. The physiologic secondary effects of severe scoliosis relate to restrictive lung disease, but most patients do not have a deformity great enough to affect their cardiorespiratory function. The psychological and social effects of scoliosis are significant for patients but difficult to quantitate. For most patients with moderate scoliosis—that is, more than 25 to 30 degrees—treatment with an underarm brace or electrical stimulation is adequate to “control” progression of the curve. Surgical fusion allows actual correction of the curve but is indicated in only a small percentage of patients—usually those with more than 50 degrees of deformity.     

School screening for scoliosis: can surface topography replace examination with scoliometer?

Background

Although most idiopathic scoliosis patients subject to conservative treatment in daily clinical practice, there have been no ideal methods to evaluate the spinal flexibility for the patients who are scheduled the brace treatment. The purpose of this study was to investigate the value of hanging total spine x-ray to estimate the indicative correction angle by brace wearing in idiopathic scoliosis patients.

Methods

One hundred seventy-six consecutive patients with idiopathic scoliosis who were newly prescribed the Osaka Medical College (OMC) brace were studied. The study included 14 boys and 162 girls with a mean age of 13 years and 1 month. The type of curves consisted of 62 thoracic, 23 thoracolumbar, 22 lumbar, 42 double major, 14 double thoracic, and 13 triple curve pattern. We compared the Cobb angles on initial brace wearing (BA) and in hanging position (HA). Of those, 108 patients who had main thoracic curves were selected and evaluated the corrective ability of OMC brace. These subjects were divided into three groups according to the relation between BA and HA (BA < HA group, BA = HA group, and BA > HA group), and then, maturity was compared among them.

Results

The average Cobb angle in upright position (UA) of all cases was 31.0 ± 7.8°. The average BA and HA of all cases were 20.3 ± 9.5° and 21.1 ± 8.4°, respectively. The average chronological age was lowest in BA < HA group. And also, maturity in BA < HA group was the lowest among each of them. The rate of BA < HA cases were decreased as the Risser stage of the patients were progressed.

Conclusions

The use of hanging total spine x-ray served as a useful tool to estimate the degree of correction possible curve within the OMC brace for main thoracic curve in idiopathic scoliosis. Maturity had some influence on the correlation between HA and BA. Namely, in immature patients, HA tended to be larger than BA. In contrast, in mature patients, HA had a tendency to be smaller than BA. With consideration for spinal flexibility based on maturity, in mature patients, larger BA than HA may be allowed. However, in immature patients, smaller BA than HA should be aimed.     

Distribution of arginine-vasopressin in the trigeminal,dorsal root ganglia and spinal cord of the rat; depletion by capsaicin

We have measured arginine vasopressin in the neural lobe, the trigeminal ganglion (TG), dorsal root ganglia (DRG), spinal cord, trigeminal and sciatic nerves of the rat by radioimmunoassay. In control rats, the neural lobe contained 1600 pg/mg, the ganglia 52.5, 21.0, 8.5, 4.28, 3.85 pg/mg in the lumbar, sacral, cervical, thoracic, and trigeminal ganglion, respectively, the spinal cord contained 5.1, 4.3, 4.2 and 2.6 pg/mg in the lumbar, thoracic, sacral and cervical cord, respectively and the trigeminal and sciatic nerves contained 3.8 and 13 pg/mg. Neonatal capsaicin treatment depleted about 38–67% of AVP in the ganglia. Residual AVP amounted to 526.8, 30.55, 20.75, 12.88, 4.95, 2.74, 2.14, 7.94 and 2.53 pg/mg in the neural lobe, lumbar, thoracic, sacral, cervical DRG, lumbar, thoracic spinal cord, the sciatic and trigeminal nerves respectively. Capsaicin destroyed about 40.5% of total cells and 52% of AVP-immunoreactive neurons.