Background & Purpose. The co-ordinated contraction of the kinetic chain is responsible for the dissipation of force. Weakness in the kinetic chain, such as the posterior oblique sling (POS), may increase the demand on additional muscles, such as the hamstrings, to compensate. The lumbar extensors may be particularly vulnerable in the kinetic chain, as they appear difficult to strengthen due to the dominant hip extensors. Therefore, this study aimed to investigate whether participants with a history of hamstring injuries presented with low back pain because of greater deficits in lumbar extensor strength, and impaired co-ordination of the POS. Methods. Twenty male footballers were recruited (n: Injured- 9, Controls- 11). Isolated lumbar extension strength, low back pain, and the contraction time of muscles within the POS during a hip extension test were recorded. Participants were then grouped in either the injury or control group. Conclusion. No differences were observed for lumbar extensor strength (P > 0.05) or the onset of muscular contraction (P > 0.05), though 95% confidence intervals revealed the difference in gluteus maximus onset time (−0.11 – 1.06 s) could be large and may have clinical importance. Descriptive data highlighted the prevalence of back pain was 40% greater in HSI participants. Conflicts of interest. None. Sources of funding. This research was funded by the Wellcome Trust as part of their biomedical vacation award

Spinal deformations are posture dependent. Official data from the Netherlands show that youth are encountering increasing problems with the musculoskeletal system (>40% back pain, and sport injury proneness). Prolonged sloth and slumped sitting postures are causative factors. Dutch youth are “champion sitting” in Europe. The effects of sitting on the development of posture and function of locomotion (stiffness) during growth have only been reported clearly in classic textbooks (in German) of practical anatomy and orthopaedics. Research with relevant clinical examinations is being done to understand epidemiological data on the increasing posture-dependent problems. A cohort of adolescents (15–18 years) in secondary school was assessed for sagittal postural deviations while bending. 248 children completed a questionnaire, and tests were done on neuromuscular tightness. The femorotibial angle was used to measure hamstring tightness. Measurement of the dorsiflexion of the foot was used to assess the tightness of calf muscles and Achilles tendons. All adolescents were photographed laterally while performing the finger–floor test (used to test flexibility), assessed as a knockout test: “Can you reach the floor or not?” The spinal profiles while bending were classified as abnormal arcuate or angular kyphosis. Hamstring tightness was present in 62.1% of the cohort in both legs, and in 18.2% unilaterally. Achilles tendon tightness was present bilaterally in 59.3%, and unilaterally in 19.4%. Activities with presence of stiffness (finger–floor distance), in descending order, were football, running, no sports, field hockey, tennis, dance, and gymnastics. 93.5% of the soccer players had tight hamstrings in both legs compared with none of those performing gymnastics. The correlation of the finger–floor test with tight hamstrings was 73.2%. For sagittal bending deformities, the correlation between form and function deficits cannot be made yet. 80 of 248 spines were rated by the examiners as having deformed flexion. Since Andry (1741) and at the zenith of continental orthopaedics and anatomy around 1900, the prolonged flexed positions of a young spine were indicated as being the main cause of deformity by overload and shear loads on immature discs and cartilage, preventing normal development of the discs. Nachemson proved that the intradiscal pressure in sitting adults was extremely high, so it follows that children must also be at risk. Evidence suggests that youth, generally because of their sedentary and “screenful lifestyle”, will encounter serious problems in growth, manifesting as incongruent neuro-osseous growth (Roth), serious neuromuscular tightness (being prone to injury), and spinal deformations, leading to pain

Aims

High-grade dysplastic spondylolisthesis is a disabling disorder for which many different operative techniques have been described. The aim of this study is to evaluate Scoliosis Research Society 22-item (SRS-22r) scores, global balance, and regional spino-pelvic alignment from two to 25 years after surgery for high-grade dysplastic spondylolisthesis using an all-posterior partial reduction, transfixation technique.

Aims

To report the surgical outcome of patients with severe Scheuermann’s kyphosis treated using a consistent technique and perioperative management.

The purpose was to analyze preoperative symptoms, curve characteristics, and outcome of surgery in patients operated on for isthmic spondylolisthesis with concomitant scoliosis. Overall, 151(9.1%) of 1667 scoliosis patients had spondylolisthesis treated surgically in 21 (13.9%)(19 females, 2 males; 11 low-, 10 high-grade). Patients' age at admission was 13.5(10-17)y. Preoperatively, 5/21 were pain-free (1 high-grade, 4 low-grade), 7 (2 high-grade) had LBP, 2 (both high-grade) radiating pain, and 7 (5 high-grade) had both. Hamstring tightness was present in 5/10 high-grades. Scoliosis was primary thoracic in 3/11 low-grade and secondary lumbar with oblique rotated take-off of L5 in 8/11 low-grade patients. Of the high-grades, 7/10 had sciatic curves and 3 secondary lumbar. In low-grades, the main indication for surgery was pain in 3/11 and lumbar curve progression or the intent to prevent it in 7/11. The operative technique was uninstrumented posterolateral fusion in 8/11, instrumented L4-S1 fusion with reduction of L4-tilt in 2, and direct repair in 1 patient. High-grades were fused to prevent further slipping regardless of subjective symptoms (uninstrumented anterior 5, combined 2, instrumented reduction 3). Selective thoracic fusion for scoliosis was performed in 3 patients. None of the lumbar curves needed fusion. All sciatic curves resolved. The follow-up time was 10.6(2-21)y. Of the low-grade patients, 5 were pain-free, 4 had moderate pain, and 2 had a severe chronic pain syndrome. One had broken pedicle screws without sequelae. Of the high-grade patients, 4 were pain-free, 6 had moderate pain. One had a pain-free peroneal weakness after slip reduction

Aims

We reviewed 34 consecutive patients (18 female-16 male) with isthmic spondylolysis and grade I to II lumbosacral spondylolisthesis who underwent in situ posterolateral arthodesis between the L5 transverse processes and the sacral ala with the use of iliac crest autograft. Ten patients had an associated scoliosis which required surgical correction at a later stage only in two patients with idiopathic curves unrelated to the spondylolisthesis.

The aim of this study was to evaluate the feasibility of using the intact S1 nerve root as a donor nerve to repair an avulsion of the contralateral lumbosacral plexus. Two cohorts of patients were recruited. In cohort 1, the L4–S4 nerve roots of 15 patients with a unilateral fracture of the sacrum and sacral nerve injury were stimulated during surgery to establish the precise functional distribution of the S1 nerve root and its proportional contribution to individual muscles. In cohort 2, the contralateral uninjured S1 nerve root of six patients with a unilateral lumbosacral plexus avulsion was transected extradurally and used with a 25 cm segment of the common peroneal nerve from the injured leg to reconstruct the avulsed plexus.

The results from cohort 1 showed that the innervation of S1 in each muscle can be compensated for by L4, L5, S2 and S3. Numbness in the toes and a reduction in strength were found after surgery in cohort 2, but these symptoms gradually disappeared and strength recovered. The results of electrophysiological studies of the donor limb were generally normal.

Severing the S1 nerve root does not appear to damage the healthy limb as far as clinical assessment and electrophysiological testing can determine. Consequently, the S1 nerve can be considered to be a suitable donor nerve for reconstruction of an avulsed contralateral lumbosacral plexus.

Cite this article: Bone Joint J 2015; 97-B:358–65.

Back pain is a common symptom in children and adolescents. Here we review the important causes, of which defects and stress reactions of the pars interarticularis are the most common identifiable problems. More serious pathology, including malignancy and infection, needs to be excluded when there is associated systemic illness. Clinical evaluation and management may be difficult and always requires a thorough history and physical examination. Diagnostic imaging is obtained when symptoms are persistent or severe. Imaging is used to reassure the patient, relatives and carers, and to guide management.

Cite this article: Bone Joint J 2014;96-B:717–23.

This review of the literature presents the current understanding of Scheuermann’s kyphosis and investigates the controversies concerning conservative and surgical treatment. There is considerable debate regarding the pathogenesis, natural history and treatment of this condition. A benign prognosis with settling of symptoms and stabilisation of the deformity at skeletal maturity is expected in most patients. Observation and programmes of exercise are appropriate for mild, flexible, non-progressive deformities. Bracing is indicated for a moderate deformity which spans several levels and retains flexibility in motivated patients who have significant remaining spinal growth.

The loss of some correction after the completion of bracing with recurrent anterior vertebral wedging has been reported in approximately one-third of patients. Surgical correction with instrumented spinal fusion is indicated for a severe kyphosis which carries a risk of progression beyond the end of growth causing cosmetic deformity, back pain and neurological complications. There is no consensus on the effectiveness of different techniques and types of instrumentation. Techniques include posterior-only and combined anteroposterior spinal fusion with or without posterior osteotomies across the apex of the deformity. Current instrumented techniques include hybrid and all-pedicle screw constructs.

We describe three patients with pre-ganglionic (avulsion) injuries of the brachial plexus which caused a partial Brown-Séquard syndrome.