No previous studies have examined the physical characteristics of patients with cauda equina syndrome (CES). We compared the anthropometric features of patients who developed CES after a disc prolapse with those who did not but who had symptoms that required elective surgery. We recorded the age, gender, height, weight and body mass index (BMI) of 92 consecutive patients who underwent elective lumbar discectomy and 40 consecutive patients who underwent discectomy for CES. On univariate analysis, the mean BMI of the elective discectomy cohort (26.5 kg/m. 2. (16.6 to 41.7) was very similar to that of the age-matched national mean (27.6 kg/m. 2. , p = 1.0). However, the mean BMI of the CES cohort (31.1 kg/m. 2. (21.0 to 54.9)) was significantly higher than both that of the elective group (p < 0.001) and the age-matched national mean (p < 0.001). A similar pattern was seen with the weight of the groups. Multivariate logistic regression analysis was performed, adjusted for age, gender, height, weight and BMI. Increasing BMI and weight were strongly associated with an increased risk of CES (odds ratio (OR) 1.17, p < 0.001; and OR 1.06, p <  0.001, respectively). However, increasing height was linked with a reduced risk of CES (OR 0.9, p < 0.01). The odds of developing CES were 3.7 times higher (95% confidence interval (CI) 1.2 to 7.8, p = 0.016) in the overweight and obese (as defined by the World Health Organization: BMI ≥ 25 kg/m. 2. ) than in those of ideal weight. Those with very large discs (obstructing > 75% of the spinal canal) had a larger BMI than those with small discs (obstructing < 25% of the canal; p < 0.01). We therefore conclude that increasing BMI is associated with CES

The purpose was to investigate back pain and disability and their relationship to vertebral changes in patients with untreated Scheuermann's. Overall, 136 patients who had attended the outpatient clinics between 1950 and 1990 for Scheuermann's were contacted, 49 of them (12 females, 37 males) responded. There was no difference in the baseline data between responders and non-responders. From radiographs, th-kyphosis, l-lordosis, and scoliosis were measured. The number of affected vertebrae and the degree of wedging were registered. Anthropometric data, occurrence of back pain, disability scores, and employment status were compared to a representative sample (n=3835) of the normal population. After mean follow-up of 37 (6.5;25.9-53.7) y, their average age was 58.8 (8.2;44.4.-79.3) y. Male patients were significantly taller than the control subjects. Female patients were on average 6 kg heavier (P=0.016) and their mean BMI was higher (23.9 kg/m. 2. vs 20.8 kg/m. 2. ,P=0.001) at age 20 than in the controls. Females had a greater mean kyphosis than males (51.7 vs. 43.2°, p=0.11). There was no correlation between the degree of thoracic kyphosis and disability. Scheuermann's patients had an increased risk for constant back pain (P=0.003), a 2.6-fold risk for disability because of back pain during the past 5 years (P=0.002), a 3.7-fold risk for back pain during the past 30 days (P<0.001), and a 2.3-fold risk for sciatic pain (P=0.005). They reported a poorer quality of life (p<0.001) and general health (p<0.001). There was no difference in working ability and employment status between patients and controls

Introduction. Despite extensive research, the cause of adolescent idiopathic scoliosis (AIS) is still largely unclear. Girls with AIS tend to be taller and leaner, and have a lower body-mass index (BMI) and lower bone mass, than do healthy girls. Recent MRI studies have shown the presence of relative anterior spinal overgrowth in girls with AIS. The lower bone mineral status and BMI could be related to dysfunctional central regulation pathway of growth, bodyweight, and bone metabolism. Following several interesting reports on the role of leptin in regulation of the above pathway in animals and human beings, our recent study has shown a low leptin concentration in girls with AIS girls compared with healthy adolescents. This finding leads to our new hypothesis that abnormal leptin bioavailability could be associated with the lower bodyweight, lower bone mineral density, and relatively disproportional endochondral skeletal growth in AIS. This study aimed to investigate the leptin bioavailability in girls with AIS. Methods. 53 girls with AIS and 27 healthy girls (aged 11–16 years) were recruited in this preliminary study. Clinical and anthropometric data were obtained. Blood samples were obtained for ELISA of leptin and soluble leptin receptor (sOB-R). Independent Student's t test and multivariate regression were used in group comparison. Results. The AIS group had significantly lower BMI and longer arm span than did controls. Additionally, girls with AIS had significantly higher soluble leptin receptor concentrations (22·1 ng/mL [□}6·9] vs 17·8 ng/mL [4·4]; p<0·01). However, the leptin concentration (7·6 ng/mL [□}5·3] vs 8·7 ng/mL [□}6·0]) and the leptin/sOB-R ratio (0·38 [□}0·28] vs 0·56 [□}0·47]) were similar to that of the controls. In girls with AIS, the leptin, sOB-R, and the leptin/sOB-R ratio correlated well with bodyweight and BMI. After adjustment for BMI, sOB-R in girls with AIS was significantly higher than in controls (r=0·37, p=0·042). Conclusions. This preliminary report showed that the soluble leptin receptor could be abnormal in girls with AIS. Leptin and sOB-R are related to bodyweight. sOB-R is a major modulator of leptin concentration in circulation, the abnormality of which may lead to the retention of leptin in the circulation and thus abnormal regulatory effect. In this study, girls with AIS had lower BMI and longer arm span, which may reflect the possible change resulting from abnormal leptin bioavailability. Further longitudinal study with larger sample size would be useful to help to understand the long-term effect of the low leptin and high sOB-R in girls with AIS on their bodyweight and skeletal development. It is also noteworthy to study the mechanism of increased sOB-R in AIS

A self-control ratio, the spine-pelvis index (SPI), was proposed for the assessment of patients with adolescent idiopathic scoliosis (AIS) in this study. The aim was to evaluate the disproportionate growth between the spine and pelvis in these patients using SPI. A total of 64 female patients with thoracic AIS were randomly enrolled between December 2010 and October 2012 (mean age 13 years, standard deviation (sd) 2.17; 9 to 18) and a further 73 healthy female patients with a mean age of 12.4 years (mean age 12.4 years, sd 2.24; 9 to 18), were randomly selected from a normal control database at our centre. The radiographic parameters measured included length of spine (LOS), height of spine (HOS), length of thoracic vertebrae (LOT), height of thoracic vertebrae (HOT), width of pelvis (WOP), height of pelvis (HOP) and width of thorax (WOT). SPI was defined as the ratio LOS/HOP. The SPI and LOT/HOP in patients with AIS showed a significant increase when compared with normal girls (p < 0.001 and p < 0.001 respectively), implying an abnormal pattern of growth of the spine relative to the pelvis in patients with AIS.

No significant difference in SPI was found in different age groups in the control group, making the SPI an age-independent parameter with a mean value of 2.219 (2.164 to 2.239). We also found that the SPI was not related to maturity in the control group.

This study, for the first time, used a self-control ratio to confirm the disproportionate patterns of growth of the spine and pelvis in patients with thoracic AIS, highlighting that the SPI is not affected by age or maturity.

Cite this article: Bone Joint J 2015;97-B:1668–74.

Objectives

To evaluate the neck strength of school-aged rugby players, and to define the relationship with proxy physical measures with a view to predicting neck strength.

Low bone mass and osteopenia have been described in the axial and peripheral skeleton of patients with adolescent idiopathic scoliosis (AIS). Recently, many studies have shown that gene polymorphism is related to osteoporosis. However, no studies have linked the association between IL6 gene polymorphism and bone mass in AIS. This study examined the association between bone mass and IL6 gene polymorphism in 198 girls with AIS. The polymorphisms of IL6-597 G→A, IL6-572 G→C and IL6-174 G→A and the bone mineral density in the lumbar spine and femoral neck were analysed and compared with their levels in healthy controls. The mean bone mineral density at both sites in patients with AIS was decreased compared with controls (p = 0.0022 and p = 0.0013, respectively). Comparison of genotype frequencies between AIS and healthy controls revealed a statistically significant difference in IL6-572 G→C polymorphism (p = 0.0305). There was a significant association between the IL6-572 G→C polymorphism and bone mineral density in the lumbar spine, with the CC genotype significantly higher with the GC (p = 0.0124) or GG (p = 0.0066) genotypes.

These results suggest that the IL6-572 G→C polymorphism is associated with bone mineral density in the lumbar spine in Korean girls with AIS.