Introduction:. Due to absence of fusion in guided-growth devices for EOS (growing rods, Shilla, LSZ) movement of the rods against their attachment is possible resulting in wear debris formation. It is important to understand the wear resistance of materials used in these devices under appropriate conditions. Aim:. The aim of our work was to investigate wear resistance of titanium alloy Ti-6Al-4V and superelastic Nitinol. Nitinol has been used recently for correcting scoliosis and may provide a better and more gradual correction than other materials. Methodology:. Wear tests were conducted using pin-on-disc configuration in diluted calf serum, as required by ISO 18192 for spinal devices. Pins were made of titanium alloy Ti-6Al-4V and Nitinol (simulation of rods material). All discs were made of Ti6-Al-4V alloy. Results and Discussion:. Superelastic Nitinol has better wear resistance since its volume wear loss is 100 times less than that of Ti-6Al-4V. However volumetric loss from Nitinol/Ti-6Al-4V friction pair (sum of both components) was found to be just about 3 times less in comparison with Ti-6Al-4V/Ti-6Al-4V pair due to wear of the titanium component. Deposition of ceramic coatings of titanium nitride (TiN) and diamond like carbon (DLC) significantly improves the wear resistance of Nitinol/Ti-6Al-4V friction pair due to effective protection of Ti-6Al-4V alloy component from the wear damage. Wear of Nitinol used for spinal rods is not expected to be as great as the wear of titanium, additionally it is possible to reduce the wear of Nitinol/titanium combination further by using coatings on the titanium alloy. Conflict Of Interest Statement: No conflict of interest

Thermal sensors have been used in bracing research as self-reported diaries are inaccurate. Little is known about new low-profile sensors, optimal location within a brace, locational thermal micro-climate and effect of brace lining. Our objective is to Determine an optimal temperature threshold for sensor-measured and true wear time agreement. Identify optimal sensor location. Assess all factors to determine the best sensor option for the Bracing AdoleScent Idiopathic Scoliosis (BASIS) multicentre RCT. Seven Orthotimer and five iButton (DS1925L) sensors were synchronised to record temperature at five-minute intervals. Three healthy participants donned a rigid spinal brace, embedded with both sensors across four anatomical locations (abdomen/axilla/lateral-gluteal/sacral). Universal-coordinated-time wear protocols were performed in/out-doors. Intraclass correlation coefficient (ICC) assessed sensor-measured and true wear time agreement at thresholds 15–36oC. Optimal thresholds, determined by largest ICC estimate: Orthotimer: Abdomen=26oC, axilla=27oC, lateral-gluteal=24.5oC, sacral=22.5oC. iButton: Abdomen=26oC, axilla=27oC, lateral-gluteal=23.5oC, sacral=23.5oC. Warm-up time and error at optimal thresholds increased for moulded sensors covered with 6mm lining. Location: anterior abdominal wall. Excellent reliability and higher optimal thresholds, less likely to be exceeded by ambient temperature; not a pressure area. Sensor: iButton, longer battery life and larger memory than Orthotimer; allows recording at 10 min intervals for life of brace. Orthotimer only able to record every 30 mins, increasing error between true and measured wear time; Orthotimer needs 6-monthly data download. Threshold: 26oC is optimal threshold to balance warm-up and cool-down times for accurately measuring wear time. Sensor should not be covered by lining foam as this significantly prolongs warm-up time

Aims. To investigate metallosis in patients with magnetically controlled growing rods (MCGRs) and characterize the metal particle profile of the tissues surrounding the rod. Methods. This was a prospective observational study of patients with early onset scoliosis (EOS) treated with MCGRs and undergoing rod exchange who were consecutively recruited between February 2019 and January 2020. Ten patients were recruited (mean age 12 years (SD 1.3); 2 M:8 F). The configurations of the MCGR were studied to reveal the distraction mechanisms, with crucial rod parts being the distractable piston rod and the magnetically driven rotor inside the barrel of the MCGR. Metal-on-metal contact in the form of ring-like wear marks on the piston was found on the distracted portion of the piston immediately outside the barrel opening (BO) through which the piston rod distracts. Biopsies of paraspinal muscles and control tissue samples were taken over and away from the wear marks, respectively. Spectral analyses of the rod alloy and biopsies were performed to reveal the metal constituents and concentrations. Histological analyses of the biopsies were performed with haematoxylin and eosin staining. Results. Titanium (Ti), vanadium (V), and neodymium (Nd) concentrations in the biopsies taken near the wear marks were found to be significantly higher than those in the control tissue samples. Significantly increased Nd concentrations were also found in the tissues near the barrel of the MCGR. Chronic inflammation was revealed by the histological studies with fibrosis and macrophage infiltration. Black particles were present within the macrophages in the fibrotic tissues. Conclusion. Ti and V were generated mainly at the BO due to metal-on-metal contact, whereas the Nd from the rotor of the MCGR is likely released from the BO during distraction sessions. Phagocytotic immune cells with black particles inside raise concern regarding the long-term implications of metallosis. Cite this article: Bone Joint J 2020;102-B(10):1375–1383

Purpose and Background. Work-related musculoskeletal disorders (WRMSD) can affect 56–80% of physiotherapists. Patient handling is reported as a significant risk factor for developing WRMSD with the back most frequently injured. Physiotherapists perform therapeutic handling to manually assist and facilitate patients’ movement to aid rehabilitation, which can increase physiotherapists risk of experiencing high forces during patient handling. Methods and Results. A descriptive cross-sectional study was completed to explore and quantitatively measure the movement of ten physiotherapists during patient handling, over one working day, in a neurological setting. A wearable 3-dimensional motion analysis system, Xsens (Movella, Henderson, NV), was used to measure physiotherapist movement and postures in the ward setting during patient treatment sessions. The resulting joint angles were reported descriptively and compared against a frequently used ergonomic assessment tool, the Rapid Upper Limb Assessment (RULA). Physiotherapists adopted four main positions during patient handling tasks: 1) kneeling; 2) half-kneeling; 3) standing; and 4) sitting. Eight patient handling tasks were identified and described: 1) Lie-to-sit; 2) sit-to-lie; 3) sit-to-stand; facilitation of 4) upper limb; 5) lower limb; 6) trunk; and 7) standing treatments; and 8) walking facilitation. Kneeling and sitting positions demonstrated greater neck extension and greater lumbosacral flexion during treatments which scores highly with the RULA. Conclusion. This research identified that patient treatment tasks were more often performed in kneeling or sitting positions than standing. Current moving and handling guidance teaches moving and handling in a standing position; loading and stresses experienced by the physiotherapists may differ in sitting or kneeling positions. Conflicts of interest. None. Sources of funding. None. This work has been presented as a poster at the CSP conference Glasgow 2023

There is a need for non-radiographic, objective outcome measures for children with Adolescent Idiopathic Scoliosis (AIS). Standing balance and stability is altered in children with AIS. The Margin of Stability (MoS) has been used to compare gait stability in clinical populations. Our objective was to compare the MoS in anterior-posterior (MoS. AP. ) and mediolateral (MoS. ML. ) directions in girls with AIS to Controls. Girls with AIS and healthy girls walked at three speeds on an instrumented treadmill wearing retroreflective markers, surrounded by motion capture cameras. The MoS. AP/ML. was calculated at left and right heel strike. Data was processed in Visual 3D. A two-way ANOVA was used to compare MoS. AP/ML. between group, speed and the interaction between group and speed. Pearson's correlation coefficient was used to compare the MoS to Cobb angle. Statistical significance was accepted when p > 0.05. A priori power analysis suggested 12 participants per group. Three Cases and four Controls were recruited. Girls with AIS all had right-sided main thoracic curves (Lenke type 1a, 61.3° ± 10.0°). MoS. AP. was significantly bigger for Cases compared to Controls on the left (p=0.038) and right foot (p=0.041). There was no significant difference between Cases and Controls for MoS. ML. , but there was a visual trend for a smaller MoS. ML. in Cases. There was no significant difference for speed or the interaction between group and speed for MoS. AP. or MoS. ML. In Cases, MoS. AP. increased with increasing Cobb angle on the left (r. 2. =0.687, p=0.054) and right (r. 2. =0.634, p=0.067) and MoS. ML. decreased with increasing Cobb angle on the left (r. 2. =-0.912, p=0.002). Further subjects are being recruited. Girls with Lenke type 1a AIS are more stable in the AP direction and less stable in the ML direction than Controls during treadmill walking. AP stability increases and ML stability decreases with increasing Cobb angle. This research suggests that the MoS could be used as an outcome measure for children with AIS. Continued work is required to increase the power of this study. Further work could consider these changes during walking overground, measuring an MoS or MoS-like measure using a wearable device, and in different curve types

Aims

Scoliosis is a lateral curvature of the spine with associated rotation, often causing distress due to appearance. For some curves, there is good evidence to support the use of a spinal brace, worn for 20 to 24 hours a day to minimize the curve, making it as straight as possible during growth, preventing progression. Compliance can be poor due to appearance and comfort. A night-time brace, worn for eight to 12 hours, can achieve higher levels of curve correction while patients are supine, and could be preferable for patients, but evidence of efficacy is limited. This is the protocol for a randomized controlled trial of ‘full-time bracing’ versus ‘night-time bracing’ in adolescent idiopathic scoliosis (AIS).

Aims

The aim of this study was to assess the ability of morphological spinal parameters to predict the outcome of bracing in patients with adolescent idiopathic scoliosis (AIS) and to establish a novel supine correction index (SCI) for guiding bracing treatment.

Abstract

MAGnetic Expansion Control (MAGEC) rods are used in the surgical treatment of children with early onset scoliosis. The magnetically controlled lengthening mechanism enables rod distractions without the need for repeated invasive surgery. The CE certification of these devices was suspended in March 2021 due, primarily, to performance evidence gaps in the documents provided by the manufacturer to regulators and notified bodies. MAGEC rods are therefore not permitted for use in countries requiring CE marking. This was a survey of 18 MAGEC rod surgeons in the UK about their perception of the impact of the CE suspension on the clinical management of their patients. Unsurprisingly, virtually all perceived a negative impact, reflecting the complexity of this patient group. Reassuringly, these surgeons are highly experienced in alternative treatment methods.

Cite this article: Bone Jt Open 2022;3(2):155–157.

Purposes of the study and background. Clinical assessment of spinal function is a routine part of low back pain (LBP) assessment, yet there is no clear consensus on what constitutes ‘spinal dysfunction’ and how this informs treatment. This study's aims to develop a spinal function classification framework by gaining expert academic and clinical consensus on (i) spinal function assessment tests (ii) encountered LBP motor control/movement impairment (MCI/MI) sub-types (iii) their characteristics and (iii) exercises and feedback for each sub-type. Methods and Results. An online 2-round Delphi-survey of 4 world-leading academic experts and 36 clinical physiotherapists world-wide was employed. A five-point response scale was used to rate level of agreement on 174 items with a priori consensus defined by a ≠>80% level of agreement (LOA). Out of 15 spinal function assessment tests, 5 reached consensus with forward bend and sitting/standing tests highest scoring. 7 MCI/MI sub-types reached consensus as clinically encountered. 12 out of 128 of posture/movement descriptors within the 7 sub-types reached consensus. 7 exercises gained consensus in being considered as ‘important’ or ‘very important’ with exercises involving sitting, standing, forward bend scoring highest. Consensus was reached on MCI/MI sub-type specific exercises, compensation strategies and feedback to remedy these compensations. Conclusion. Academic and clinical expert consensus derived list of movement/posture descriptors, assessment tests and exercises considered clinically important provides a first to date, spinal function assessment classification framework for non-specific LBP. This offers a conceptual model for developing technologies (e.g. wearable sensors) to harness clinically useful information relating to spinal function, exercise performance and feedback for effective implementation of exercise therapies for non-specific LBP. No conflicts of interest. Sources of Funding: Health and Care Research Wales, RCBC Postdoctoral Research Fellowship

Aims

To describe the clinical, radiological, and functional outcomes in patients with isolated congenital thoracolumbar kyphosis who were treated with three-column osteotomy by posterior-only approach.

Aims

To report the outcome of spinal deformity correction through anterior spinal fusion in wheelchair-bound patients with myelomeningocele.

Aims

The aim of the present study was to answer the question whether curve morphology and location have an influence on rigid conservative treatment in patients with adolescent idiopathic scoliosis (AIS).

It has been noted that bony union of a pars defect can be achieved in children if they wear a trunk brace. Our aim was to evaluate how the stage of the defect on CT and the presence or absence of high signal change in the adjacent pedicle on T2-weighted MRI were related to bony healing. We treated 23 children conservatively for at least three months. There were 19 boys and four girls with a mean age of 13.5 years (7 to 17). They were asked to refrain from sporting activity and to wear a Damen soft thoracolumbosacral type brace. There were 41 pars defects in 23 patients. These were classified as an early, progressive or terminal stage on CT. The early-stage lesions had a hairline crack in the pars interarticularis, which became a gap in the progressive stage. A terminal-stage defect was equivalent to a pseudarthrosis. On the T2-weighted MR scan the presence or absence of high signal change in the adjacent pedicle was assessed and on this basis the defects were divided into high signal change-positive or -negative. Healing of the defect was assessed by CT. In all, 13 (87%) of the 15 early defects healed. Of 19 progressive defects, only six (32%) healed. None of the seven terminal defects healed. Of the 26 high signal change-positive defects 20 (77%) healed after conservative treatment whereas none of the high signal change-negative defects did so. We concluded that an early-stage defect on CT and high signal change in the adjacent pedicle on a T2-weighted MR scan are useful predictors of bony healing of a pars defect in children after conservative treatment

Background. The clinical assessment of Chronic Low Back Pain (CLBP) is usually undertaken at a single time point at clinic rather than through continuous monitoring. To address this, a wearable prototype sensor to monitor motion of the lumbar spine and pelvis has been developed. Sensor Development, Testing and Results. The system devised was based on inertial sensor technology combined with wireless Body Sensor Network (BSN) platform. This was tested on 16 healthy volunteers for ten common movements (including sit to stand, lifting, walking, and stairs) with results validated by optical tracking. Preliminary findings suggest good agreement between the optical tracker and device with mean average orientation error (°) ranging from 0.1 ± 2.3 to 4.2 ± 2.6. The sensor repeatability errors range from 0 to 4° while subject movement variability ranged from 4% to 14%. Parameters of angular motion suggest greater movement of the lumbar spine compared to the pelvis with mean velocities (°/s) for lumbar spine ranging from 15.3 to 74.13 and pelvis ranging from 5.6 to 40.74. Further analysis revealed the extent to which the pelvis was engaged, as a proportion of the total movement. This demonstrated that the pelvis underwent smooth transitions from low (0.02), moderate (0.4) to high (0.99) use during different movement phases. Conclusion. A wearable sensor has been developed to record and quantify lumbar and pelvic movement. This permits an understanding of the lumbo-pelvic relationship to be characterized in an objective way during daily tasks. The next stage of the project will involve testing with CLBP patients

Background:. Larger breasted women are at higher risk of wearing ill-fitting breast-support garments. Failure to support breasts during everyday activity can lead to physiological conditions including back and breast pain. This study aimed to identify initial and short-term (4 weeks) biomechanical change and patient reported outcome measures (PROMS) in larger breasted women with non-specific back pain (NSBP) when wearing different breast-support garments. Methods & Results:. 20 females (Age: 32.1±9.4 years; Bra sizes: 36DD-32K) with NSBP were recruited using modified red flags screening. Participants were tested initially in their usual bra, followed by the professionally-fitted and Optifit bras, in randomised order. Pre/post assessments comprised an established bra-fit assessment, body chart analysis, frequency of wear and pain, continuous-pain intensity (SF-MPQ-2), back stiffness and discomfort, neck disability and thoracic posture in standing using 3D-movement analysis. 100% of Usual and 90% of professionally-fitted bras failed the bra-fit assessment, compared to 5% with the Optifit. Though worn the least on average, a short-term intervention with the Optifit bra resulted in significant reductions in reported thoracic pain, clinically important reductions in neck disability, back pain frequency, continuous-pain intensity, stiffness and discomfort compared to the other bras. The Optifit and professionally-fitted bras significantly reduced reported lumbosacral pain compare to the usual bra. There was no initial change in thoracic posture with the Optifit bra however, significant improvements in flexion-extension posture were seen post-intervention. Conclusions:. Following a short-term intervention, larger breasted women with NSBP appear to show some clinically important improvements. Provision of correctly fitting breast-support garments may contribute to better clinical management of NSBP in these women

Aim. The primary aim of this pilot study was to assess and evaluate the SpineCor Pain Relief Brace as a method of reducing the pain experienced by patients diagnosed with degenerative scoliosis. Method. Participants (n=24) with an average age of 67 (+/− 8) old that fulfilled the study inclusion criteria were randomly allocated into either a treatment or control group. Both sets of participants received questionnaires (ODI, SF 36v2 and EQ5D-5L) at 1,3,6,9 and 18 months. In addition to the questionnaires the treatment group also received the SpineCor Pain Relief Brace and took part in a semi structured interview. Results. The results from the trial were mixed; repeated measures analysis on the quantitative data showed the brace had a small effect on reducing reported pain and increasing activity. Results from the semi-structured interviews were more informative. Analysis revealed the brace enabled patients' to participate in activities at a higher intensity. Problems with the functionality of the brace such as toileting that ultimately limited the amount of time they could wear the brace were also identified. Conclusion. Overall, mild pain relief and improvements in functionality and activity levels were reported in addition to several functional problems with the brace. These problems could be attributed to the average age of the participants. No prior work has examined issues related to wearing a brace from the patient perspective. Further work is needed to develop a better understanding of the benefits and limitations of bracing for Degenerative scoliosis. Conflicts of interest: No conflicts of interest. Sources of funding: No funding obtained

Introduction. Research has suggested baby wearing results in happier healthier babies [1]. Various designs of carrier are available, is there one which has less impact on the biomechanics of the cervical spine?. Methods. 18 volunteers (9 male and female) performed a warm up procedure on the neck (movement through each range of motion), repeated thrice. Measurement of the active cervical range of motion (ACROM) in flexion and extension using a Cervical Range of Motion device, described in previous studies [2]. Volunteers were then allocated a baby carrier to wear including a specially designed “baby” mannequin (dimensions based on population average statistics for a 1yro). Volunteers continued with ADLs, returning after 2 hours. With the carrier removed, measurements were repeated (without warm-up). Volunteers were assessed at the same time of day, thrice (control, single carrier, double carrier) with at least 1 day between carrying. Results. ACROM measurements following the use of either single or double shoulder carrier, or no carrier showed through a paired t-test significance of <0.02, found a change from post-stretching to post-carrying in those wearing the single shoulder carrier, this was the only test period to result in a decrease in both extension and total ACROM for flexion-extension. Conclusions. Carrying an average 1 yro using a single shoulder carrier can lead to accelerated rate of change in extension of ACROM. These results may have an implication to healthy bodies, thus highly likely that choice of carrier in those with extant cervical spine dysfunction might lead to exacerbation of the problems and pain. Conflicts of interest: No conflicts of interest. Sources of funding: No funding obtained

Aims

The aim of this study was to determine the influence of pelvic parameters on the tendency of patients with adolescent idiopathic scoliosis (AIS) to develop flatback deformity (thoracic hypokyphosis and lumbar hypolordosis) and its effect on quality-of-life outcomes.

Aims

Magnetically controlled growing rod (MCGR) systems use non-invasive spinal lengthening for the surgical treatment of early-onset scoliosis (EOS). The primary aim of this study was to evaluate the performance of these devices in the prevention of progression of the deformity. A secondary aim was to record the rate of complications.

Aims

We present a case series of five patients who had revision surgery following magnetic controlled growing rods (MGCR) for early onset scoliosis. Metallosis was found during revision in four out of five patients and we postulated a mechanism for rod failure based on retrieval analysis.