Current classification systems for adult degenerative scoliosis

Introduction Adult scoliosis is a complex three-dimensional rotational deformity of the spine result in a progressive degeneration, with a Cobb angle greater than 10 degrees in the coronal plane, which alters the sagittal and axial planes, it occurs in a previously straight spine; most often in elderly. The adult degenerative or de novo scoliosis is believed to develop as the result of asymmetric degeneration of the discs, osteoporosis, and vertebral body compression fractures; this causes increased asymmetric loading and therefore a progression of degeneration and deformity. The main symptom is pain; and the surgical treatment is preferred for patients with neurological deficit, severe pain, or radiculopathy. Risk factors are female gender, age over 50 years, osteoporosis; and for curve progression may be a curve size over 30 degrees, an asymmetric disc above and below the apical vertebra, lateral subluxation of the apical vertebra over 6 mm, and L5 vertebra being located above rather than below the intercrestal line. The degenerative scoliosis prevalence varies from 2.5 to 15% in controlled populations. The increase in life expectancy in our population and the pursuit of improving the quality of life has turned degenerative scoliosis in a common problem of medical care. The main objective of this study is to examine the epidemiological, clinical, and radiographical features of patients with this disease who have been diagnosed and treated in an institution of concentration in the past 20 years. Patients and Methods We retrospectively analyzed electronic and radiographic records of patients between 40 to 80 years, diagnosed with adult degenerative scoliosis who have undergone surgery in our institute, during the period from January 1995 to December 2013. Results The prevalence was 0.087%, with a total of 61 individuals. We observed increased frequency of degenerative lumbar scoliosis in women (72.1%), at a rate of 2.6:1 and also an increase in the frequency in older adults (70.5%) (43/61). The prevalence of degenerative spondylolisthesis associated with lumbar scoliosis was 21%. In a gender analysis in women, increased prevalence was 3.52%; women have an increased frequency of spondylolisthesis compared with men. Women had 2.4 times the risk of degenerative lumbar scoliosis. Men had 1.9 times the risk of degenerative spondylolisthesis associated with lumbar scoliosis. The most affected level was L4–L5. Conclusion Although degenerative scoliosis is a common disease that affects the adult population, the prevalence in our institute is low compared with international literature and the age of our sample was higher than that the of the series presented, this is because patients come late to the care for not having medical service. The distribution of gender, the severity of the curvature, and the presence of spondylolisthesis and olisthesis was similar to the literature review.

Adult degenerative scoliosis results from age-related changes leading to segmental instability, deformity, and stenosis. Patients with degenerative adult scoliosis demonstrate an altered gait pattern. Use of a walker tends to cause a more kyphotic posture due to its lower hand grips, and due to the way patients must reach forward with this position using both hands, forcing a kyphotic moment into their gate cycle. Whereas a walker forces patients into kyphosis, the higher grips of walking sticks allow for more upright posture and improved sagittal alignment. The purpose of this study is to compare and contrast the benefits of walking sticks versus a walker on the biomechanics of the lower extremity in people with degenerative scoliosis, as evaluated by gait analysis. Ten patients with symptomatic degenerative scoliosis have been deemed appropriate surgical candidates. Each patient performed a series of overground gait trials with a comfortable self-selected speed under three testing conditions: 1. with walking sticks, 2. with a walker, and 3. without any device. The use of walking sticks resulted in significantly slower, longer stride and step times along with bigger ankle, knee, and hip flexion range of motions in comparison to the walker. Walking sticks did improve the biomechanics and did facilitate positioning of the trunk and lower extremity during walking in adult degenerative scoliosis patients.

To review current classification systems for adolescent and adult scoliosis. The literature was reviewed in reference to scoliosis classification systems for adolescent and adult scoliosis. There are multiple classification systems for scoliosis. Classification of scoliosis is dependent on patient age, spinal abnormality, scoliotic curve, and global spinal alignment. To date, classification systems have focused predominantly on adolescent idiopathic scoliosis or adult/degenerative scoliosis; a single classification system evaluating scoliotic deformities of different ages and spinal abnormalities has not been identified. The importance of scoliosis classification schemes lies in their ability to standardize communication among health care providers. With regard to the classification of adolescent scoliosis, the Lenke system has addressed many of the significant limitations of the King system and is now the standard classification scheme. Classification schemes for adult scoliosis have been reported only recently, and each offers specific advantages (the simple pathogenesis-based system of Aebi, the strong clinical relevance of the Schwab system, and the richly descriptive Scoliosis Research Society system). This article highlights the salient features of currently used scoliosis classification systems.

Technical Considerations of Uniportal Endoscopic Posterolateral Lumbar Interbody Fusion: A Review of Its Early Clinical Results in Application in Adult Degenerative Scoliosis

Study Design. A retrospective study. Purpose. Posterolateral fusion with pedicle screw instrumentation used for degenerative lumbar scoliosis can lead to several complications. In elderly patients without sagittal imbalance, dynamic stabilization could represent an option to avoid these adverse events. Methods. 57 patients treated by dynamic stabilization without fusion were included. All patients had degenerative lumbar de novo scoliosis (average Cobb angle 17.2°), without sagittal imbalance, associated in 52 cases (91%) with vertebral canal stenosis and in 24 (42%) with degenerative spondylolisthesis. Nineteen patients (33%) had previously undergone lumbar spinal surgery. Results. At an average followup of 77 months, clinical results improved with statistical significance. Scoliosis Cobb angle was 17.2° (range, 12° to 38°) before surgery and 11.3° (range, 4° to 26°) at last follow-up. In the patients with associated spondylolisthesis, anterior vertebral translation was 19.5% (range, 12% to 27%) before surgery, 16.7% (range, 0% to 25%) after surgery, and 17.5% (range, 0% to 27%) at followup. Complications incidence was low (14%), and few patients required revision surgery (4%). Conclusions. In elderly patients with mild degenerative lumbar scoliosis without sagittal imbalance, pedicle screw-based dynamic stabilization is an effective option, with low complications incidence, granting curve stabilization during time and satisfying clinical results.

The objective of this study was to evaluate differences in clinical and radiographic outcomes between short (<3 levels) and long (≥3 levels) fusions in the setting of degenerative lumbar scoliosis. A literature search was performed from six electronic databases. The key terms of "degenerative scoliosis" OR "lumbar scoliosis" AND "fusion" were combined and used as MeSH subheadings. From relevant studies identified, demographic data, complication rates, Oswestry Disability Index (ODI), and radiographic parameters were extracted and the data was pooled and analyzed. Long fusion was associated with comparable overall complication rates to short fusion (17% vs 14%, P = 0.20). There was a significant difference in the incidence of pulmonary complications when comparing short versus long fusion (0.42% vs 2.70%; P = 0.02). No significant difference was found in terms of motor, sensory complications, infections, construct-related or cardiac complications, pseudoarthrosis, dural tears, cerebrospinal fluid (CSF) leak, or urinary retention. A longer fusion was associated with a greater reduction in coronal Cobb angle and increases in lumbar lordosis, but both findings failed to achieve statistical significance. The ODI was comparable across both cohorts. If shorter fusion lengths are clinically indicated, they should be used instead of longer fusion lengths to reduce perioperative time, costs, and some other complications. However, there are no statistically significant differences in terms of radiographically measurable restoration associated with a short or long fusion.

The purpose of this study was to review existing principles of oro-facial pain classifications and to specify design recommendations for a new system that would reflect recent insights in biomedical classification systems, terminologies and ontologies. The study was initiated by a symposium organised by the International RDC/TMD Consortium Network in March 2013, to which the present authors contributed. The following areas are addressed: problems with current classification approaches, status of the ontological basis of pain disorders, insufficient diagnostic aids and biomarkers for pain disorders, exploratory nature of current pain terminology and classification systems, and problems with prevailing classification methods from an ontological perspective. Four recommendations for addressing these problems are as follows: (i) develop a hypothesis-driven classification structure built on principles that ensure to our best understanding an accurate description of the relations among all entities involved in oro-facial pain disorders; (ii) take into account the physiology and phenomenology of oro-facial pain disorders to adequately represent both domains including psychosocial entities in a classification system; (iii) plan at the beginning for field-testing at strategic development stages; and (iv) consider how the classification system will be implemented. Implications in relation to the specific domains of psychosocial factors and biomarkers for inclusion into an oro-facial pain classification system are described in two separate papers.

Objective To investigate the risk factors of degenerative scoliosis patients with osteoporotic vertebral compression fracture. Methods The data of 150 cases of degenerative scoliosis were retrospectively reviewed from October 2007 to October 2015. According to the occurrence of vertebral compressive fractures, the 150 patients were divided into the experiment group(fracture) and control group(non-fracture). Visual analogue scale(VAS) was used to assess the back pain, and the bone mineral density were measured in patients by using dual-energy X-ray absorptiometry, Cobb angle was measured to evaluate the severity of scoliosis. The occurrence of osteopontin in scoliosis were observed and analyzed. Logistic analysis was used to investigate the risk factors of vertebral compression fractures. Results ①In experiment group, there were T11 vertebral compression fractures in 4 cases, T12 vertebral compression fractures in 13 cases, L1 vertebral compression fractures in 16 cases, and both T12 and L1 vertebral fracture in 5 cases. ②The gender composition of the two groups had no significant difference(χ2=0.253, P=0.615). Compared with the control group, the average age of the experiment group was lower(t=4.392, P<0.01), VAS score was higher(t=14.350, P<0.01), more severe osteoporosis(t=13.296, P<0.01), a higher incidence of osteopontin(χ2=11.824, P=0.001). The Cobb angle of the two groups had no significant difference(t=1.749, P=0.082). After analysis of Logistic regression, trauma history(OR=1.57, 95% CI: 1.09-2.11), bone bridge formation(OR=3.46, 95% CI: 2.10-5.38) and bone osteoporosis(OR=2.48, 95% CI: 1.58-4.36) will increase the chances of patients with fractures. Conclusions Osteoporotic vertebral compression fracture usually occur in thoraco-lumbar region in patients with degenerative scoliosis, and its risk factor are trauma, history, osteoporosis and bone bridge formation. Key words: Osteoporotic fractures; Vertebral compression frature; Degenerative scoliosis; Risk factors

ADVERTISEMENT RETURN TO ISSUEPREVReviewNEXTBioinformatics and Systems Biology of the LipidomeShankar Subramaniam*†‡§, Eoin Fahy†, Shakti Gupta†, Manish Sud§, Robert W. Byrnes§, Dawn Cotter§, Ashok Reddy Dinasarapu†, and Mano Ram Maurya†View Author Information† †Department of Bioengineering and ‡Departments of Chemistry and Biochemistry and of Cellular and Molecular Medicine, University of California at San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States§ San Diego Supercomputer Center, 9500 Gilman Drive, La Jolla, California 92093, United StatesE-mail: [email protected]Cite this: Chem. Rev. 2011, 111, 10, 6452–6490Publication Date (Web):September 23, 2011Publication History Received31 July 2011Published online23 September 2011Published inissue 12 October 2011https://pubs.acs.org/doi/10.1021/cr200295khttps://doi.org/10.1021/cr200295kreview-articleACS PublicationsCopyright © 2011 American Chemical SocietyRequest reuse permissionsArticle Views3830Altmetric-Citations136LEARN ABOUT THESE METRICSArticle Views are the COUNTER-compliant sum of full text article downloads since November 2008 (both PDF and HTML) across all institutions and individuals. These metrics are regularly updated to reflect usage leading up to the last few days.Citations are the number of other articles citing this article, calculated by Crossref and updated daily. Find more information about Crossref citation counts.The Altmetric Attention Score is a quantitative measure of the attention that a research article has received online. Clicking on the donut icon will load a page at altmetric.com with additional details about the score and the social media presence for the given article. Find more information on the Altmetric Attention Score and how the score is calculated. Share Add toView InAdd Full Text with ReferenceAdd Description ExportRISCitationCitation and abstractCitation and referencesMore Options Share onFacebookTwitterWechatLinked InRedditEmail Other access optionsGet e-Alertsclose SUBJECTS:Biological databases,Chemical structure,Lipids,Metabolism,Peptides and proteins Get e-Alerts

Background Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a heterogeneous inflammatory disease with multiple underlying etiologies. Although several CRSwNP endotypes have been detailed, the current classification system does not adequately represent all patients with nasal polyps. We describe 2 patients meeting established diagnostic criteria for both aspirin-exacerbated respiratory disease (AERD) and allergic fungal rhinosinusitis (AFRS), which are considered distinct CRSwNP endotypes. Objective To describe patients meeting established diagnostic criteria for both AERD and AFRS in order to highlight deficits in the current CRSwNP endotype classification system as well as to expand awareness of the potential for aspirin desensitization as a treatment option in a subset of patients with AFRS. Methods Retrospective chart review with description of patient and diagnostic characteristics. AERD was diagnosed based on the presence of nasal polyps, asthma, and a documented history of sensitivity to nonsteroidal anti-inflammatory drugs. AFRS was diagnosed based on Bent and Kuhn criteria. Results Patients met established diagnostic criteria for both AERD and AFRS. Microscopic examination of sinus tissue revealed reactive bone, tissue eosinophilia (&gt;10/high-powered field), and allergic mucin with noninvasive fungal elements. Subjects had an average of 4 endoscopic sinus surgeries and are currently maintained with adjunctive aspirin desensitization and/or anti-IL-5 biologic therapy. Conclusions This case series suggests that although they are treated as distinct CRSwNP endotypes, AERD and AFRS may have more overlap than was previously appreciated. Further research is needed to accurately identify discrete endotypes and associated treatment outcomes as we seek individualized patient care.

Introduction: The NPRT classification system was first described in 2016 and was initially designed specifically for male pattern hair loss (MPHL). We introduce additions that allow for a more comprehensive classification system that encompasses almost all of the patterns of hair loss in both males and females. Objective: To propose a revised NPRT classification system that encompasses male and female hair loss patterns. Results: The current NPRT classification system has been revised and various patterns of male and female hair loss have been included that encompass a wide variety of hair loss patterns. Conclusion: The revised NPRT classification system has become a universal hair loss classification and documentation system because it is easy to understand, can replicate the exact picture of the hair loss pattern, and has good reproducibility.

The research outlined in this paper is part of a collaborative fund to propose an innovative classification framework for restoration of historical/cultural heritage assets. Most of the previous research/applications in applying BIM to Heritage have focused on the physical or geometric reporting of assets. This typically involves laser scanning for creating as-built models and recording asset components, for operations and maintenance. However to efficiently identify/record general asset component requirements, standardised classification systems must be used which categorise different components, their characteristics, attributes, and maintenance requirements. Furthermore as will be demonstrated, current database, knowledge and classification systems available for new builds might not be suitable to categorise components in historical buildings, which differ according to historical eras and architectural periods, hence might render their restoration process inefficient. There is currently no research dedi- cated towards investigating appropriate classification systems to be used for heritage buildings. This paper provides a comparative study between current international classification systems within the construction industry, and investigates their suitability for heritage buildings. This includes CI/SFB, CAW, SFG20, Omniclass, Uniclass versions etc. Properties of suitability will also be investigated e.g. object types, hierarchy of tables/schedules, depth levels and appropriateness for different archi- tectural styles and parametric geometries (e.g. origin, material, allowed stresses, proportions etc.). This study provides evidence for the lack of appropriate classification systems for Heritage and provides recommendations for a taxonomical representation for suitable classification systems of Heritage assets from different historical and architectural periods. This includes information descriptors of hierarchical classes, historical, social and technological context, allowing usage of standardised Heritage BIM data for documentation, operations, maintenance and restoration management, and also allowing searching for similarities/differences between different buildings in the global heritage domain, replacement components and comparing artefacts, which might impact historical significance.

A Clue to Diagnosing Connective Tissue Disease-Associated Interstitial Lung Disease

PurposeThe purpose of the study was to evaluate the clinical efficacy and safety of using Ponte osteotomy combined with posterior lumbar interbody fusion in the treatment of patients with degenerative scoliosis.MethodThe medical records and imaging data of degenerative scoliosis patients in our department from 2013 to 2022 were retrospectively collected. A total of 47 patients were included, including 16 male patients and 31 female patients. The mean follow-up was 47.8 months. Whole spine X-rays in the standing position were performed on all patients preoperatively, postoperatively, and at the latest follow-up. The length of hospital stay, complications, operative duration, estimated blood loss, instrumented segment, fused segment, clinical scores, and various radiological indicators were recorded.ResultsThe coronal vertical axis improved from 3.1 ± 1.9 cm preoperatively to 1.2 ± 1.0 cm postoperatively with an average reduction of 1.9 ± 1.7 cm. The preoperative coronal Cobb angle was 18.1 ± 10.6°, the immediate postoperative Cobb angle was 6.6 ± 3.9°, and the Cobb angle at the last follow-up was 5.8 ± 3.7°. The sagittal vertical axis decreased from 5.6 ± 3.7 cm preoperatively to 2.7 ± 1.9 cm immediately after the operation and was well maintained at the last follow-up (3.1 ± 2.5 cm). Lumbar lordosis increased from 22.2 ± 10.2° preoperatively to 40.4 ± 8.3° postoperatively and 36.0 ± 8.8° at the last follow-up. The ODI score, VAS low back pain score, and VAS leg pain score were also improved to varying degrees.ConclusionPonte osteotomy combined with posterior lumbar interbody fusion can significantly improve coronal and sagittal plane deformities and postoperative functional scores in patients with adult degenerative scoliosis.

In 1712 the poet Elkanah Settle (1648–1724) published a funeral poem, Threnodia Apollinaris , dedicated to the memory of Dr Martin Lister.[1][1] Settle had a good deal of material to draw upon, because Lister had been Vice-President of the Royal Society, a physician to Queen Anne, and the first