Aim:

AIS causes a loss of trunk height. This paper documents this loss against sitting height standards and assesses formulae for adjusting height loss back to the standard.

Background. Scoliosis is described as a lateral spinal curvature exceeding ten degrees on radiograph with vertebral rotation. Approximately 80% of scoliosis presentations are adolescent idiopathic scoliosis (AIS). Current management for AIS in the UK occurs in Surgeon or Paediatrician-led clinics and can be conservative or surgical. The musculoskeletal assessment and triage of AIS appears well-suited to an advanced physiotherapist practitioner (APP) skill set. The aim of this service evaluation was to scope, develop, implement and evaluate a four-month pilot of an APP-led AIS triage pathway. Method and Results. Spinal Consultant deformity and scoliosis clinics were scoped and observed. Clinic inclusion criteria and a patient assessment form was developed. An APP AIS clinic was set up beside a consultant led clinic. All patients assessed were discussed with a spinal surgeon. Consultant and APP agreement (% of total), waiting times, surgical conversion, and patient satisfaction were reviewed. A clinical competency package was developed for training and development of APPs. A total of 49 patients were seen (20 sessions). Waiting list reduced from 10 weeks to 6 weeks. 45%(n=22) of new patients seen were diagnosed with AIS, 27% (n=6) were directly listed for surgery. Consultant/ APP percentage agreement was high for Cobb angle measurement (82%), management plans (90%), and further diagnostic requests (94%). There were no adverse events and high patient satisfaction levels (n=20), (100% Very satisfied or satisfied) were reported. Conclusion. APP-led AIS clinics can provide similar levels of management and assessment as Spinal Consultants with improved waiting times and high levels of satisfaction. Conflicts of interest: No conflicts of interest. Sources of funding: No funding obtained

The aim of this study is to clarify the implication of ciliary pathway on the onset of the spinal curvature that occurs in Adolescent Idiopathic Scoliosis (AIS) patients through functional studies of two genes: POC5 and TTLL11. Since the genetic implication for AIS is accepted, many association and candidate gene analysis revealed the implication of ciliary genes. The characterisation of these two proteins was assessed by qPCR, WB and immunofluorescence in vitro using control cells and cells derived from AIS patients. The impact of genetic modification of these genes on the functionality of the proteins in vitro and in vivo was analysed in zebrafish model created by CRISPR/Cas9 using microCT and histologic analysis. Our study revealed that mutant cells, for both gene, were less ciliated and the primary cilia was significantly shorter compared to control cells. We also observed a default in cilia glutamylation by immunofluorescence and Western Blot. Moreover, we observed in both zebrafish model, a 3D spine curvature similar to the spinal deformation in AIS. Interestingly, our preliminary results of immunohistology showed a retinal defect, especially at the cone cell layer level. This study strongly supports the implication of the ciliary pathway in the onset of AIS and this is the first time that a mechanism is described for AIS. Indeed, we show that shorter cilia could be less sensitive to environmental factors due to lower glutamylation and result in altered signalling pathway. Identifying the biological mechanism involved is crucial for elucidating AIS pathogenesis

Linear spinal cord distraction, in animal models, leads to elevated intra-compartmental spinal cord pressure. We developed an in vitro model of distraction, with increasing tensile force, to demonstrate the relationship between the degree of spinal curvature and the proportional elevation of intra-compartmental pressure. Six Porcine spinal sections, two cervical, two thoracic, and two lumbar were harvested from 30kg pigs. These cord sections were individually stretched in a saline solution with increasing tensile force applied. Cord interstitial pressure (CIP) was monitored with an arterial line pressure monitor. The sections were each tested six times fresh, and then thawed and tested an additional six times. An additional ten freshly thawed cords were tested in linear distraction and over forty-five degree and ninety degree curved surfaces with CIP monitoring. Increased tension, by adding increasing weights of distraction, lead to a proportionally elevated CIP in the linear model (R=0.986). We achieved a 99% confidence interval via paired T testing to demonstrate that there was no significant difference between fresh specimens and recently thawed cords. As the degree of spinal curvature increased from a linear model, to a forty-five and ninety degree (cobb) curve, there were significant increases in CIP at the same distraction force. The more significant the curve, the greater the CIP for each increment in distraction force; ninety degree curves produced a 2.3x higher pressure than linear distraction. High cord interstitial pressure (CIP) can be achieved through spinal cord distraction (> 140mm Hg). This CIP is no only directly proportional to tension, but also proportionally magnified by the degree of spinal curvature. It is not affected by freezing/thawing. This may suggest that spinal cord compartment syndrome is a potential mechanism for spinal cord distraction injury, and these distraction pressures are potentially magnified in the setting of scoliosis

Background: Back pain is a common complaint in the Western World with a sedentary lifestyle contributing to its recurrence. The aim of this study was to establish differences in lumbar and thoracic posture after a period of unsupported sitting between subjects with a history of back pain but no current symptoms (BP) and those without a history of back pain (NBP). Method: Twenty subjects (10 BP and 10 NBP group) fulfilling specific inclusion criteria were recruited. Ethical approval was obtained from the Institutions Ethical Committee. Following placement of markers on the vertebrae L5, T12 and C7, subjects sat unsupported on a plinth following standardisation of hip and knee position. A digital image (sagittal view) was taken at 1, 5 and 10 minutes. Spinal curvature was measured using Matlab, two-dimensional analysis system. Repeated measures ANOVA with Post Hoc analysis were calculated to determine the differences between groups and time points. Results: The NBP group demonstrated no difference in thoracic or lumbar curvature at 1, 5 and 10 minutes. The BP group showed a statistically significant difference in lumbar spine curvature between one and ten minutes (p=0.006). No significant differences in thoracic curvature in BP group were found (F =.524 p = 0.601). Conclusion: This study showed that subjects with BP demonstrate a change in lumbar curvature following a period of unsupported sitting compared to NBP group. The thoracic kyphosis in both group remained unchanged. Further studies investigating differences in spinal curvature between specific sub-sets of LBP population could provide useful information on sitting postures

Objective: To document an unusual pattern of clinical presentation simulating cerebral palsy and investigate the evolution of spinal deformity in relation to patients’ growth and responsiveness to levodopa therapy. Study Design-Material: A retrospective study was performed including 3 pediatric patients with dopa-responsive dystonia who developed in the course of their disease spinal curvatures. Summary of Background Data: Dopa-responsive dystonia has been recognized as a separate type of idiopathic dystonia with early onset, gradual generalized involvement, diurnal fluctuation of symptoms, spinal malalignment, and remarkable response to levodopa. Nevertheless, it can present with atypical features including prominent spastic elements and intrafamilial variability of expression. Methods: The medical records and radiographs of the 3 patients were reviewed. Results: All 3 siblings were normal at birth and had negative family history of neurological disease or spinal imbalance. Soon they developed progressive neurological impairment with exaggerated spasticity, underestimated dystonic patterns, and marked phenotypic variation, leading to the initial misdiagnosis of spastic-dystonic cerebral palsy of familial inheritance. With further growth, patient 1 and 3 developed spinal deformity, which responded dramatically to levodopa treatment and resolved spontaneously, while the neurological symptoms persistently ameliorated. Patient 2 developed a rigid C-shaped thoracolumbar scoliotic curve measuring at age 10 years 88o; even though she demonstrated considerable overall improvement with levodopa, the spinal curvature remained unresponsive and necessitated surgical correction through a combined anterior-posterior instrumented spinal fusion extending to the sacrum. However, her ambulatory function was preserved. Conclusions: Spinal decompensation is a common manifestation of dopa-responsive dystonia with excellent prognosis if adequate diagnosis and initiation of levodopa treatment are made early. On the contrary, if diagnosis and levodopa treatment are delayed, spinal deformity may progress following the rapid evolution pattern of neuromuscular curves, necessitating surgical intervention. When spinal arthrodesis is required, inclusion of the lumbosacral joint does not preclude latter ambulatory function

Purpose. To investigate associations between sagittal thoracolumbar spine shape with sex and measures of adiposity throughout adulthood. Methods. Thoracolumbar spine shape was characterised using statistical shape modelling on lateral dual-energy x-ray absorptiometry images, recorded for vertebral fracture analysis, of the spine from 1529 participants of the MRC National Survey of Health and Development, acquired at age 60–64 years. Associations between spine shape modes (SM) and 1) sex, 2) contemporaneous measures of overall and central adiposity (indicated by body mass index and waist circumference, respectively), 3) changes in total and central adiposity during earlier stages of adulthood and age at onset of overweight, were investigated. Results. Four of the first eight spine modes (SM) describing lumbar spine shape differed by sex; on average, women had more lordotic spines than men with relatively smaller but caudally increasing anterior-posterior (a-p) vertebral diameters. Greater BMI and waist circumference and earlier onset of overweight were associated with uneven (or snaking) spinal curvatures (SM2) and larger a-p vertebral diameters (SM3). Central adiposity was also associated with larger caudal disc heights (SM4) in women, especially increases between 36–43 years. Conclusions. Sagittal spine shapes differed by sex and associations with overall and central adiposity also differed. Overweight and greater central adiposity earlier in adulthood were particularly important, and were associated with a straighter but more unevenly curved spine with larger vertebrae and caudal discs heights, possibly explained by a chronic effect of increased mechanical loading on the spine. Conflicts of interest: None. Funding received from MRC

Aims

The aim of this study was to evaluate the reliability and validity of a patient-specific algorithm which we developed for predicting changes in sagittal pelvic tilt after total hip arthroplasty (THA).

Aims

This systematic review aims to identify 3D predictors derived from biplanar reconstruction, and to describe current methods for improving curve prediction in patients with mild adolescent idiopathic scoliosis.

Most studies on LBP have focused on adults although many investigations have shown that the roots of LBP lie in adolescence. Several mechanical, physical and behavioral factors have associated with non-specific LBP in adolescents. To our knowledge no previous study has investigated using advanced statistics all previously reported parameters together with psychological and psychosocial factors on LBP in adolescents aged 15–19 years. 688 students aged 16± 1 years from 5 randomly selected high schools participated in this multifactorial study and completed a questionnaire containing questions on daily activity, backpacks carrying, psychological and psychosocial behavior. Anthropometric data as well biplane spinal curvatures together with questionnaire results were included in the analysis using advanced statistics. LBP reported 41% of the participants. Generally, statistically significant correlations were found between LBP(0.002), physical activity(P< 0.001), physician consultation(P=0.024) and depression (P< 0.001) Gender-related differences were shown regarding LBP intensity(P=0.005) and frequency(P=0.013), stress(P< 0.03), depression (P=0.005) and nervous mood(P=0.036) in favor of male students. Male adolescents had continuously energy (P=0.0258) and were calm (P=0.029) in contrast to female counterparts. LBP was gender-related and was less common in adolescents with frequent activity. Adolescent girls with stress, depressive mood and low energy have more LBP than boys that makes physician consultation for LBP more common in female adolescents. Systematic physical activity and control of psychological profile should decrease LBP frequency and intensity

Study design: Prospective multifactorial study on low back pain (LBP) in adolescents. Background data: Most studies on LBP have focused on adults although may investigations have shown that the roots of LBP lie in adolescence. Several mechanical, physical and behavioral factors have associated with non-specific LBP in adolescents. To our knowledge no previous study has investigated using advanced statistics all previously reported parameters together with psychological and psychosocial factors on LBP in adolescents aged 15–19 years. Material and Methods: 688 students aged 16± 1 years from 5 randomly selected high schools participated in this study and completed a questionnaire containing questions on daily activity, backpacks carrying, psychological and psychosocial behavior. Anthropometric data as well biplane spinal curvatures together with questionnaire results were included in the analysis using advanced statistics. Results: LBP reported 41% of the participants. Generally, statistically significant correlations were found between LBP(0.002), physical activity(P< 0.001), physician consultation(P=0.024) and depression (P< 0.001) Gender-related differences were shown regarding LBP intensity(P=0.005) and frequency(P=0.013), stress(P< 0.03), depression (P=0.005) and nervous mood(P=0.036) in favor of male students. Male adolescents had continuously energy (P=0.0258) and were calm (P=0.029) in contrast to female counterparts. Discussion: LBP was gender-related and was less common in adolescents with frequent activity. Adolescent girls with stress, depressive mood and low energy have more LBP than boys that makes physician consultation for LBP more common in female adolescents. Conclusion: Systematic physical activity and control of psychological profile should decrease LBP frequency and intensity

AIS is present in 3–5% of the general population. Large curves are associated with increased pain and reduced quality of life. However, no information is available on the impact of smaller curves, many of which do not reach secondary care. The objective of this project was to identify whether or not there is any hidden burden of disease associated with smaller spinal curves. The Avon Longitudinal Study of Parents and Children (ALSPAC) is a population-based birth cohort that recruited over 14,000 pregnant women from the Bristol area between 1991–1992 and has followed up their offspring regularly. At aged 15 presence or absence of spinal curvature ≥6degrees was identified using the validated DXA Scoliosis Measure in 5299 participants. At aged 18 a structured pain questionnaire was administered to 4083 participants. Chi-squared was used to investigate any association between presence of a spinal curve at aged 15 and self-reported pain at aged 18 years. Sensitivity analyses were performed by rerunning analyses after excluding those who were told at aged 13 they had a spinal curve (n=27), and using a higher spinal curve cut-off of ≥10degrees. Full data was available for 3184 participants. Of these, 56.8% were female, and 4.2% non-white reflecting the local population. 202 (6.3%) had a spinal curve ≥6degrees and 125 (3.9%) had a curve ≥10degrees. The mean curve size was 12degrees. 140/202 (69.3%) had single curves, and 57.4% of these were to the right. In total 46.3% of the 3184 participants reported aches and pains that lasted for a day or longer in the previous month, consistent with previous literature. 16.3% reported back pain. Those with spinal curves ≥6degrees were 42% more likely to report back pain than those without (OR 1.42, 95%CI 1.00 to 2.02, P=0.047). In addition, those with spinal curves had more days off school, were more likely to avoid activities that caused their pain, were more likely to think that something harmful is happening when they get the pain, and were more afraid of the pain than people without spinal curves (P<0.05). Sensitivity analyses did not change results. We present the first results from a population-based study of the impact of small spinal curves and identify an important hidden burden of disease. Our results highlight that small scoliotic curves that may not present to secondary care are nonetheless associated with increased pain, more days off school and avoidance of activities

Purpose of the study. Monitoring of scoliosis is traditionally done with radiographs which can be associated with an increased risk of cancer secondary to multiple exposures over many years. This study investigates whether lateral asymmetry (LA) from ISIS2 surface topography can predict radiographic cobb angle, to provide an alternative non- invasive means of monitoring scoliosis patients. Methods. A total of 72 untreated patients with scoliosis (77 curves) with a Cobb angle of 55 degrees or less were included in the study. They had clinical assessment, cobb angle measurement taken from a standard radiograph and surface topography done on the same day. The cobb angle were measured by single surgeon using digital PACS system. The surgeon was unaware of the LA score. Lateral asymmetry was measured using ISIS2 surface topography done by a research nurse who was also unaware of the cobb angle as previously described. Lateral asymmetry was calculated using the standard ISIS2 software. A comparison of cobb angle and LA was performed. Linear regression analysis was performed to define an equation predicting Cobb from LA. The predicted Cobb angles were then compared with the measured radiographic Cobb angles using Bland-Altman analysis. All statistical analysis was carried out using R. Results. The regression equation is: Predicted Cobb = 1.04∗LA + 9.972 with a Pearson correlation coefficient of 0.85 for Cobb angles less than 55 degrees. Bland-Altman analysis of the difference between radiographic Cobb and predicted Cobb from LA gave a mean difference of 0.08 degrees, standard deviation of 6.71 degrees and 95% limits of agreement of −13.3 to 13.5 degrees. For cobb angle less than 55 degrees on radiograph, ISIS2 was able to predict the cobb angle within 13 degrees. Conclusion. Cobb angles themselves display poor reliability, estimates ranging from 3 degrees to 10 degrees. Even so, the 95% confidence limits on the prediction of Cobb angle from ISIS2 LA are too wide to use it alone for monitoring spinal curvature. Whether or not LA is capable of monitoring change in curvature will be investigated as more longitudinal data is built up. Ethics approval: None. Interest Statement: None

Introduction: While bracing may improve the natural history of patients with adolescent idiopathic scoliosis with moderate curves, little attention has been paid to the potential impact of brace treatment on their quality of life. We hypothesized that bracing has a negative affect on the physical and psychosocial health of affected adolescents. Methods: Quality of life (QOL) data was collected from patients with adolescent idiopathic scoliosis and a spinal curvature greater than 10 degrees at our institution. The Child Health Questionnaire (CHQ) and the American Academy of Orthopaedic Surgeons Pediatric Outcomes Data Collection Instrument (PODCI) were administered to parents to measure their children’s QOL. Multivariate analyses were conducted to determine the effect of gender and treatment on QOL. Results: Our cohort consisted of 214 patients, who were mostly female, with an average curve of 28 degrees and an average age of 13.7 years. One hundred thirty four patients were observed (average curve 25 degrees), while 80 patients were treated with bracing (average curve 34 degrees). There were no significant differences in QOL between these two treatment groups, using the Bonfer-roni multiple comparison test. There were no gender-related differences in QOL. Among 15 children with pre- and intra-bracing data, there were no significant differences in QOL between these two time points. Discussion and conclusion: Our patients who were treated with spinal bracing did not seem to have significantly different health-related QOL, as compared with patients in the observation group. These findings are contrary to our initial hypotheses and merit further study

Introduction Vertebral rotation is an important aspect of spinal deformity in idiopathic scoliosis, associated with ribcage asymmetry. Although both lateral curvature and rotation appear to increase together in progressive scoliosis, the mechanisms driving vertebral rotation are not clearly established and it is not known whether lateral curvature precedes rotation, or vice versa. This paper investigates the hypothesis that intravertebral (within the bone) rotation in idiopathic scoliosis is caused by growth in the presence of gravity-induced torsions, the twisting moments generated by body weight forces acting on the scoliotic spine. Methods Three-dimensional spinal curvature was measured for a small group of idiopathic scoliosis patients using standing radiographs and equations of static equilibrium were used to calculate gravity-induced torsion profiles along the length of each spine due to head, neck and torso weight. Intravertebral rotations were then measured for the same patients using Aaro & Dahlborn’s technique (Aaro S, et al; Spine 1982) with reformatted computed tomography images. The gravity-induced torsion curves were compared with rotation measurements to see whether gravity-induced torsion is a likely contributor to intravertebral rotation in scoliosis. Results Gravity-induced torques as high as 7.5Nm act on the spines of idiopathic scoliosis patients due to static body weight in the standing position, and maximum intravertebral rotations (for a single vertebra) are approximately 7°. There appears to be general agreement between the measured intravertebral rotations and profiles of gravity-induced torsion along the length of the spine. Discussion Gravity-induced torsion is a potential cause of vertebral rotation in idiopathic scoliosis. Since the spine must be curved in three-dimensions (out of plane) to produce such torques, vertebral rotation would be expected to occur subsequent to an initial lateral deviation, suggesting that lateral curvature precedes vertebral rotation in idiopathic scoliosis

Introduction. Monitoring of scoliosis is traditionally done with radiographs, which can be associated with an increased risk of cancer secondary to multiple exposures over many years. This study investigated whether the findings from surface topography can be used to monitor scoliosis curves and how much this method affects outcome scores in patients with scoliosis. This study therefore had two subsets: (1) to investigate whether lateral asymmetry (LA) from ISIS2 surface topography can predict radiographic Cobb angle, providing an alternative non-invasive means of monitoring patients with scoliosis (LA and Cobb subset); and (2) to establish the relationships between the magnitude of the deformity in scoliosis, measured by Cobb angle on radiograph and volumetric asymmetry (VA) with the ISIS2 surface topography, and the patient perception of self-image and mental health, measured with SRS-22 scores (Cobb, VA, and SRS subset). Methods. In the LA and Cobb subset, 72 untreated patients with scoliosis (77 curves) with a Cobb angle of 55° or less were included in the study. They had clinical assessment, Cobb angle measurement taken from a standard radiograph, and surface topography done on the same day. A comparison of Cobb angle and LA was done. In the Cobb, VA, and SRS subset, 89 untreated patients with scoliosis were included in the study. They had clinical assessment, Cobb angle measurement of radiograph, and surface topography done on the same day along with SRS-22 questionnaires. A comparison correlation of SRS scores for function, pain, self-image, and mental health against Cobb angle and VA was undertaken. All statistical analysis was done with software R. Results. In the LA and Cobb subset, for Cobb angle less than 55° on radiograph, ISIS2 was able to predict the Cobb angle within 13°. In the VA, Cobb, and SRS subset, Cobb angle contributed only about 10% to self-image, whereas VA contributed 14%. Cobb angle contributed about 6·2% to mental health, whereas VA contributed 8·6%. Conclusions. Cobb angles display poor reliability, with estimates ranging from 3° to 10°. Even so, the 95% CIs on the prediction of Cobb angle from ISIS2 LA are too wide to use it alone to monitor spinal curvature. Whether or not LA is capable of monitoring change in curvature will be investigated as more longitudinal data are built up. VA correlates better with both mental health and self-image than does Cobb angle, but the correlation is still poor. Neither Cobb angle nor VA can be used to predict patient's self-image or mental health. We are pursuing this study further to look at other parameters that may affect SRS-22 such as sex, age, type of deformity, waist asymmetry, and shoulder asymmetry

This research sought a mathematical model to relate the postero-anterior (PA) and lateral (LAT) views of the spinal curve in scoliosis in an attempt to justify the acquisition of only One X-ray, thereby reducing patient exposure to harmful X-radiation while preserving complete 3D characterization of the spine. Using powerful developments in functional statistics and machine learning, no such relation could be found. Thus, this research sustained the clinical decision to acquire two biplanar X-rays and supported current research in 3D spinal curvature analysis. Scoliosis is monitored through full spinal X-rays, and this serial protocol causes an increased incidence of cancer development. This research sustains the clinical decision at Hôpital Sainte-Justine in Montréal and elsewhere to acquire postero-anterior (PA) and lateral (LAT) X-rays, despite the increased exposure to X-radiation. Indeed, geometrically, these two views are required to reconstruct the spine in 3D. However, under the assumption of strong physiological patterns between the PA and LAT views of the spinal curve, one of these X-rays may be redundant for some or all patients. The purpose of this study was to seek this a priori assumption. To this end, a database consisting of three hundred and sixty-nine spinal reconstructions from distinct patients was used. Two powerful geometric modeling approaches were exploited: functional data analysis and minimum noise fractions. These resulted in five comprehensive, uncorrelated and noise-insensitive features in each plane. Simple linear regression yielded no relation that was statistically significant (p< 0.05) and genereralizable to a set of previously unseen samples. Therefore, nonlinear relational modeling was attempted using support vector regression, a recent advance in machine learning theory. This tool was incapable of identifying a robust regression, suggesting that the PA and LAT views are mathematically independent. Thus, this study highlights the necessity of two biplanar X-rays to evaluate scoliotic deformities and fully characterize spinal shape. Further, this study supports the practical insufficiency observed by clinical staff with respect to current 2D scoliosis classifications that has resulted in current efforts to propose 3D classification schemes

In currently used expansive laminoplasty (ELAP) for cervical spondylotic myelopathy (CSM), persistent axial pain, restriction of neck motion and loss of cervical l ordosis have been the significance postoperative problems. To prevent them, the author has developed skip laminectomy in which ordinary laminectomy at appropriate levels is combined with partial laminectomy of the cephalad half of laminae with preservation of the muscular attachments at adjacent levels. Since December 98, the author performed this procedure on 55 patients with CSM who required multilevel posterior decompressions. Twenty-one of these cases with follow-up period longer than 8 months, with an average of 12 months, were observed. In skip laminectomy, a consecutive four-level decompression between C3/4 and C6/7 as an example is accomplished by removing alternate laminae (C4 and C6), the cephalad half of the C5 and C7 lamina and the ligamentum flava at those four levels. The laminae to be removed were selected after analysis of the pre- and postoperative radiological findings. Intraoperative blood loss averaged 34 grams. The operation time averaged 128 minutes. The patients were allowed to sit up or walk on the first postoperative day without neck support of any kind. An average recovery rate according to the Japanese Orthopaedic Association score was 63%. None of these patients complained of residual axial pain. The postoperative ranges of neck motion on lateral X rays averaged 87% of the preoperative ranges. The spinal curvature index, according to Ishihara’s method, was reduced in only one of the 21 cases. Postoperative atrophy of the deep extensor muscles measured on T2 weighed axial MRI was minimal. Skip laminectomy is less damaging to the posterior extensor muscles and its use reduces the postoperative problems commonly seen after ELAP

Introduction Chicken studies implicate pinealectomy within a week of hatching as a cause of scoliosis. The nature of the scoliosis has been demonstrated to be similar to that of human idiopathic scoliosis. Scoliosis was not induced following pinealectomy in Rhesus monkeys (primate model). No human studies have been reported. The aim of this study is to determine if idiopathic scoliosis is associated with treatment for pineal lesions (presumably resulting in pinealectomy) in a human paediatric population. Methods A medical records search was performed in five Australian States for pineal lesions. Identified patients underwent clinical or radiological evaluation for scoliosis. Pathology varied from germ cell tumour, germinoma, pineoblastoma, teratoma to a pineal cyst and an epidermoid cyst. Treatment ranged from biopsy/ extirpation to radiotherapy/chemotherapy. Results Of 48 identified patients, thirteen are deceased. No scoliosis was present in the last imaging of the deceased. The mean age at presentation was 9.7 years (range 1–18 years). Ten are female. Two males have idiopathic scoliosis (4.2%). One has a 12° right upper thoracic curve (with 32° kyphosis) and the other has a 60° right thoracolumbar curve, requiring a two-stage arthrodesis. Discussion Although the incidence of idiopathic scoliosis in this cohort is greater than expected from Caucasian population studies (2–3%), it is not typical idiopathic-type, which has a female preponderance of larger deformities. New-born chicken studies demonstrate an incidence of between 50 and 100% scoliosis in the three months following pinealectomy. Chickens of both sexes are involved. Fundamental differences exist between chicken and human/primate models including the age at pinealectomy and the anatomical site of the pineal gland. Chickens have a naturally lordotic thoracic spinal curvature whilst humans/primates have a naturally kyphotic thoracic spine. Adolescents with idiopathic scoliosis have either thoracic hypokyphosis or a thoracic lordosis. Contrary to current beliefs, no causal link can be established between pineal lesions and the development of idiopathic scoliosis in a paediatric population

Introduction: The study is aimed to present patient oriented diagnostics, treatment, remote rehabilitation potential and preliminary outcomes assessment in the group of osteoporotic compression fracture cases. Methods: 3D postural assessment originally developed of spinal curvatures, semi quantitative radiographic evaluation and QCT BMD measurement were used in the study. The kyphosis angle based on back shape curve was measured on the 3D surface image utilizing dedicated software mimicking Debrunner kyphometer measurement. Radiographic assessment and measurements were performed on digital images using DICOM viewing analytic software (DICOM Vision, Alteris Ltd.). Radiographic assessment of VCF was based on semiquantitative visual and quantitative morphometric assessment. Bone mineral density were measured utilizing DXA BMD (g/cm2) and QCT BMD (mg/cm3) of the lumbar spine. The polish translation of Oswestry Disability Index (ODI) version 2.1a (. http://www.orthosurg.org.uk/odi/index.htm. ). Telerehabilitation service was served as a supplementary service utilizing Internet videoconferencing. Summary and nonparametric statistical analysis was performed. Results: The group of elderly patients finally enrolled to the study consisted of patients whose data, images, and other examinations were analyzed. Average age of patients was 73,22 years. Average number of fractured vertebra was 3,6 in the study group. The most frequent anatomical location of fractures was lumbar first and third vertebral body. The most frequent fracture types according to Genant et al. classification were Biconcave Grade II (38,6%) and Wedge Grade II (36,9%). The most frequent 53-A1.2 and 53-A2.1 types of fractures. An average QCT bone density was lower than 80 mg/cm3 in whole examined group that represents severe osteoporosis. Bone density lower than 30 mg/cm3 was found in almost one third of the group that coincided with highest number of fractured vertebral bodies. Oswestry disability score was highest along with lowest values of QCT BMD, and significantly improved after vertebral augmentation. Telerehabilitation was considered as successful among computer skilled patients. Discussion: and Conclusion: Described personalized approach shows the flow of the individual patient from Metabolic Bone Diseases and Osteoporosis Unit through diagnostics and surgery to telerehabilitation service opportunities. The 3D structural light method of posture was developed and implemented. Telerehabilitation service may activate patients at home. Complex personalized, team approach to osteoporotic vertebral fractures consisted of new diagnostics, vertebral augmentation and remote rehabilitation