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How to measure kyphosis in everyday clinical practice: a reliability study on different methods.
No full textIntroduction. The sagittal plane measures have a relevant role both in Idiopathic Scoliosis (AIS) and in Hyperkyphosis (HK) management. Nevertheless, clinical tools for everyday use are scarce and not adequately studied. Aim. To assess the repeatability of different methods for the collection of the sagittal profile of patients with spinal deformities during everyday clinics. Methods. We performed 4 different studies in 4 different populations of AIS and HK patients. In the first study we reported the normative data and measurement error of the plumbline measures in a general population of 180 adolescents. In the second study we compared the sagittal distances from the plumbline of C7, T12, L3, and Sagittal Index (SI = C7+L3) with the measures of the Video Rasterstereography at the same levels and the angles of kyphosis and lordosis in 100 AIS patients. In the third study we evaluated the intra and inter-rater repeatability and the measurement error of kyphosis and lordosis angles measured with the Inclimed in 100 AIS patients. In the last study we evaluated the repeatability of the sagittal distances from the plumbline, by using a 1 mm change instead of 5 mm in a population of 40 patients. Statistical analysis: repeatability has been evaluated according to Bland and Altman, to identify the limits of variation that are clinically significant. Results. Study 1: the normative data were: females: 34 ± 11 mm for C7; 34 ± 15 mm for L3, males: 34 ± 10 mm for C7; 48 ± 10 mm for L3;. Study 2: a coefficient of correlation was calculated in order to compare measures. Study 3: the k value for Inclimed varied from fair to good. Study 4: the repeatability was fair for this measure. Conclusion. Some clinical instruments are now available for sagittal plane assessment in AIS and hyperkyphosis. The results of the present study report the limits during measurements in a clinical setting of parameters that are routinely collected by some clinicians
Correlation between in-brace radiographic correction and short time brace results.
No full textIntroduction. In-brace radiographic correction is considered a reliable check of brace efficacy. The aim of this study was to correlate the in-brace correction with the short term results of treatment (6 months). Methods Design: pre-post study Population: 41 consecutive adolescent girls with idiopathic scoliosis who were prescribed a brace treatment (39 thoracic curves, 37±12°; 16 thoracolumbar, 38±13°; 12 lumbar, 31±8°. Risser 0-3). In-brace radiographic correction and 6 months treatment out of brace X-ray results were correlated, according to curve localization. The in-brace/out-of-brace ratio was calcutated, curves were grouped according to the Risser sign, the results (45°). Statistical analysis: Correlation Coefficient. Results. The in-brace/out-of-brace ratio varied according to localization of curve and Risser, achieving the best results for thoracic curves (38-45\%). The groups of thoracolumbar and lumbar had higher variability (17-65\% and 17-40\%). The correlation coefficient between in-brace correction and out-of-brace results was statistically significant: 0.85 for thoracic curves, 0.64 thoracolumbar, 0.72 lumbar. Risser groups: 0.65-0.98 thoracic, 0,78-0.90 thoracolumbar, 0.94-0.98 lumbar. For Results groups, the correlation was better for the group with high degree of correction (High results) in lumbar and the group with low degree of correction (Low results) for thoracolumbar, no differences for thoracic. Low in-brace correction had a low correlation coefficient for thoracic and lumbar curves. No differences for Magnitude. Conclusion. The in-brace correction ranges from 17 to 47\% of the curve magnitude. The correlation between in-brace correction and short time results of brace is significant, range 0.64-0.98. The in-brace correction seems able to predict the short time results of treatment
Characteristics of patients with more than 20° of improvement or worsening during conservative treatment of adolescent idiopathic scoliosis.
No full textIntroduction. Since the beginning of history of Medicine, it has been possible to learn from the worst and best results of treatments. Our aim was to verify which patients can reach the best and worst results during conservative treatment. Methods. All AIS patients with more than 2 visits included in a prospective clinical database started in September 2003 were reviewed on August 31st 2010. A cut-off of 20 degrees (improvement or worsening) from the first observation was used to select patients. Patients were analysed for diagnosis, morphology, Cobb degrees at start, curve improved/worsened, treatment, gender, Body Mass Index, clinical parameters. Results. Out of 1886 consecutive patients, 62 (3.3\%) changed 20° or more: 26 (1.4\%) improved (range 20-34°), 36 (1.9\%) progressed (20-60°). Relative Risk of progression of 20° or more was increased more than 10 times in cases of thoracic curve or secondary scoliosis, 5 times for Moe scoliosis and BMI <15 kg/mq, 3 times for age <12 years, and congenital or juvenile scoliosis. Relative Risk of improvement of 20° statistically was increased more than 3 times in cases of previous exercises, female gender, thoracolumbar curve or scoliosis, ISICO treatment, and age <12 years. Conclusion. Not all our results correspond to the usually reported prognostic factors in ample case series, but it must be taken into account that only wide variations (20° or more) have been considered here. In this population we had 1.9\% of patients who improved at least 20° with conservative treatment, and this is notable as well. Finally, since these results are not similar to what would be expected according to the known natural history, conservative treatment appears able to change it
Bracing can reduce high degree curves and improve aesthetics immediately after the end of growth. Final results of a etrospective case series.
No full textIntroduction. Recently it has been shown that idiopathic scoliosis (IS) curves can be reduced with bracing, and it has been proposed that this could be useful in non-surgically treated high degree curves even after Risser 3. Moreover, bracing has been shown to be able to improve aesthetics, and this could be another reason to treat some patients with cosmetic needs. Our aim is to preliminary check if results can be obtained in IS patients after Risser 3. Methods. Design. Retrospective uncontrolled cohort study. Inclusion criteria. All IS patients treated on a voluntary basis for aesthetic reasons and/or for curve reduction; Risser 4-5 at start; end of treatment reached. Population. 34 females and 2 males, age 16.2±1.6 years, Cobb angle 27.6°±8.9°. Treatment. Lyon or SPoRT braces 18 to 24 hours/day, specific SEAS exercises, rapid weaning (2-3 hours every 6 months). Outcome criteria: SRS (unchanged; worsened over 6°; over 45° at the end of treatment; surgically treated), radiographic and clinical. Statistics. ANOVA and chi-test. Results. The reported compliance during the 2.8 ± 1.1 treatment years was 95.1\%, while residual growth was 0.9 ± 1.1 cm. Improvements were found in 39\% of this cohort, (46\% in curves over 30°). Only 1 patient progressed 6°. We found highly statistically significant reductions of maximal (-4.4°), thoracic (-6.0°) and thoracolumbar (-6.6°) curves. Statistically significant improvements were found for Aesthetic Index. Conclusion. Before 20 years of age, even in skeletally mature patients, it is possible to reach radiographic and aesthetic improvements, although not as good as during growth. Correction is based on bone growth, but ligaments and neuromuscular control of posture can also be involved
In favour of the definition "adolescents with idiopathic scoliosis": juvenile and adolescent idiopathic scoliosis braced after ten years of age, do not show different end results. SOSORT award winner 2014.
Get PDFThe most important factor discriminating juvenile (JIS) from adolescent idiopathic scoliosis (AIS) is the risk of deformity progression. Brace treatment can change natural history, even when risk of progression is high. The aim of this study was to compare the end of growth results of JIS subjects, treated after 10 years of age, with final results of AIS.prospective observational controlled cohort study nested in a prospective database.outpatient tertiary referral clinic specialized in conservative treatment of spinal deformities.idiopathic scoliosis; European Risser 0-2; 25 degrees to 45 degrees Cobb; start treatment age: 10 years or more, never treated before.secondary scoliosis, neurological etiology, prior treatment for scoliosis (brace or surgery). Groups: 27 patients met the inclusion criteria for the AJIS, (Juvenile Idiopathic Scoliosis treated in adolescence), demonstrated by an x-ray before 10 year of age, and treatment start after 10 years of age. AIS group included 45 adolescents with a diagnostic x-ray made after the threshold of age 10 years. Results at the end of growth were analysed; the threshold of 5 Cobb degree to define worsened, improved and stabilized curves was considered.Mean and SD were used for descriptive statistics of clinical and radiographic changes. Relative Risk of failure (RR), Chi-square and T-test of all data was calculated to find differences among the two groups. 95\% Confidence Interval (CI) , and of radiographic changes have been calculated.We did not find any Cobb angle significant differences among groups at baseline and at the end of treatment. The only difference was in the number of patients progressed above 45 degrees, found in the JIS group. The RR of progression of AJIS was, 1.35 (IC95\% 0.57-3.17) versus AIS, and it wasn't statistically significant in the AJIS group, in respect to AIS group (p = 0.5338).There are no significant differences in the final results of AIS and JIS, treated with total respect of the SRS and SOSORT criteria, in adolescence. Brace efficacy can neutralize the risk of progression
Brace treatment is effective in idiopathic scoliosis over 45°: an observational prospective cohort controlled study.
No full textRecently, positive results in bracing patients with idiopathic scoliosis (IS) above 45° who refused surgery have been presented in a retrospective study. Obviously, this can give only an efficacy (EA) analysis, as there is neither a control group, nor it is possible to know failures because of dropouts.To present the prospective results of bracing patients affected by IS above 45° and still growing.Prospective study including all IS patients with 45° or more, Risser stage 0 to 4, who had their first evaluation in our institute, an outpatient clinic specialized in scoliosis evaluation and conservative treatment, from March 1, 2003 to December 21, 2010 and utterly denied any surgical intervention.Of 59 patients, we excluded 2 patients still in treatment and 57 (11 males) patients were included. At the beginning of the study, they were 15 years 3±22 months of age, had 52.5° Cobb (range, 45°-93°), and Risser 2 (0-4). Thirty-nine accepted a full-time brace treatment (BG) to try avoiding surgery, 18 refused any treatment and served as controls (CG).Physiological measures: radiographic and clinical data.Treatment: A year of full-time Sforzesco brace (23 hours/day) or Risser cast (8-12 months) and gradual weaning after Risser 3; all patients performed exercises; and International Society on Scoliosis Orthopaedic and Rehabilitation Treatment management criteria were respected. Analyses: EA in patients who completed treatment/observation (34 in BG and 10 in CG) and intent-to-treat (ITT) with worst case analysis in the whole population. Relative risk (RR) and 95\% confidence interval (CI) have been computed.Efficacy: failures were 23.5\% in BG and 100\% in CG. Intent-to-treat: failures were 20.5\% in BG and 55.6\% in CG. Relative risks of failure in CG were 4.3 (95\% CI, 3.6-4.9) in EA and 2.7 (95\% CI, 2.0-3.5) in ITT (p<.05). Percentage of patients (53.8\%) improved: RRs of improvement in BG were 1.6 (95\% CI, 1.46-1.9) in EA and 1.9 (95\% CI, 1.6-2.2) in ITT (p<.05). Patients who joined the treatment achieved a 10.4°±10.7° Cobb improvement, an ATR reduction of 4.2°±4.3°, and an esthetic improvement of 2.8±1.9 of 12 points (TRACE). At the end, in BG, 24 patients were below 45° and 6 patients below 35°.Through this study we can conclude that the conservative brace plus exercises treatment (if correctly performed and managed) is a suitable alternative for those patients who reject any surgical intervention for IS above 45°. But we could also conclude that a good brace treatment should be considered as the first choice to try avoiding fusion because of the high sanitary and social costs of surgery
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Characteristics of patients with more than 20 degrees of improvement or worsening during conservative treatment of adolescent idiopathic scoliosis
No full textIntroduction. Since the beginning of history of Medicine, it has been possible to learn from the worst and best results of treatments. Our aim was to verify which patients can reach the best and worst results during conservative treatment. Methods. All AIS patients with more than 2 visits included in a prospective clinical database started in September 2003 were reviewed on August 31st 2010. A cut-off of 20 degrees (improvement or worsening) from the first observation was used to select patients. Patients were analysed for diagnosis, morphology, Cobb degrees at start, curve improved/worsened, treatment, gender, Body Mass Index, clinical parameters. Results. Out of 1886 consecutive patients, 62 (3.3%) changed 20° or more: 26 (1.4%) improved (range 20-34°), 36 (1.9%) progressed (20-60°). Relative Risk of progression of 20° or more was increased more than 10 times in cases of thoracic curve or secondary scoliosis, 5 times for Moe scoliosis and BMI <15 kg/mq, 3 times for age <12 years, and congenital or juvenile scoliosis. Relative Risk of improvement of 20° statistically was increased more than 3 times in cases of previous exercises, female gender, thoracolumbar curve or scoliosis, ISICO treatment, and age <12 years. Conclusion. Not all our results correspond to the usually reported prognostic factors in ample case series, but it must be taken into account that only wide variations (20° or more) have been considered here. In this population we had 1.9% of patients who improved at least 20° with conservative treatment, and this is notable as well. Finally, since these results are not similar to what would be expected according to the known natural history, conservative treatment appears able to change it
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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