Background and purpose. The musculoskeletal system is recognized as a possible source of pain in patients with chest pain. The objectives of the present study were (1) to investigate the interobserver reliability of an overall diagnosis of musculoskeletal chest pain using a standardized examination protocol in a cohort of patients with chest pain suspected to be of non-cardiac origin, (2) to investigate the interobserver reliability of the single components of the protocol, and finally, (3) to investigate the importance of clinical experience on the level of interobserver reliability. Methods and results. Eighty patients with acute chest pain were recruited from a cardiology department. Four observers (two chiropractors and two chiropractic students) performed a physical examination and an extended manual examination of the spine and chest wall. Percentage agreement, Cohen's Kappa and ICC were calculated for observer pairs and overall. Musculoskeletal chest pain was diagnosed in 44.0 % of patients. Interobserver kappa values were substantial for the chiropractors and overall, and moderate for the students. For single items of the protocol, both pairs showed fair to substantial agreement regarding pain provocation tests and poor to fair agreement regarding spinal segmental dysfunction tests. Conclusions. Suspected musculoskeletal chest pain can be identified with substantial interobserver reliability using this standardized protocol if used by experienced and trained observers. Agreement for individual components of the protocol showed, however, considerable variation. Provided training of observers, the examination protocol can be used in selected patients and can be implemented in pre- and post-graduate clinical training

Purpose of the study. We propose a simple classification for adolescent idiopathic scoliosis (AIS) based on two components which include the curve type and shoulder level and suggest a treatment algorithm for AIS. Introduction. Few Classification systems for adolescent idiopathic scoliosis (AIS) have helped in communicating, understanding and selecting a treatment for this condition; however, most of these classifications are complex and include many subtypes, making it difficult for the orthopaedic surgeon to use them in clinical practice. The variable reliability and reproducibility of these studies make recommendations and comparisons between various operative treatments a difficult task. Furthermore, none of these classifications has taken the shoulder imbalance into account, despite its importance as a clinical parameter and outcome measure. Methods. We developed a classification system with two components: curve type (I through III) and shoulder level (A or B). The curve types are divided into type I: Primary lumbar-thoracolumbar +/− secondary dorsal; type II: Primary dorsal secondary lumbar and type III: Dorsal. Each curve pattern is subdivided into type A or B depending on the shoulder level. In type A, the lower shoulder is ipsilateral to the concavity of the primary curve. In type B, the shoulders are level or the lower shoulder is on the convexity of the primary curve. This classification was tested for interobserver reliability and intraobserver reproducibility by six surgeons using radiographs of 28 patients. We performed a retrospective analysis of the radiographs of 232 consecutive AIS cases to assess the prevalence of curve types and tested the surgical treatment against the proposed treatment algorithm. Results. Three major types and six subtypes were identified, of which type I accounted for 30%, type II 28% and type III 42%. The kappa coefficient for interobserver reliability was 0.943, while the kappa value for intraobserver reproducibility was 0.964. There was a complete concordance with the shoulder level component. Of the 232 cases reviewed, with a minimum two-year follow-up, only three patients developed a decompensation distal to the instrumentation requiring fusion extension. Conclusion. This classification is the first of its kind to specifically address shoulder imbalance in the surgical decision-making process. The high interobserver reliability and intraobserver reproducibility is due in part to the simplicity of this classification, which makes it an invaluable tool to describe scoliosis curves and offers a potential treatment algorithm in correcting scoliosis

Introduction. Spinopelvic parameters describe the orientation, shape, and morphology of the spine and pelvis. These parameters change during the first 10 years of life in children without spinal deformity; however, spinopelvic parameters have yet to be defined in children with significant early-onset scoliosis (EOS). Sagittal plane alignment could affect the natural history and outcome of interventions for EOS. As a result, spinopelvic parameters are being defined for this population. On the basis of the landmarks used for measurement of these parameters, there may be inherent error in performing these measurements on the immature pelvis. The purpose of this study is to define the variability associatedwith the measurement of spinopelvic parameters in children with EOS. Methods. Standing, lateral radiographs of 11 patients with untreated EOS were evaluated. Sagittal spinopelvic parameters (pelvic incidence [PI], pelvic tilt [PT], sacral slope [SS], and modified pelvic radius angle [PR]) were measured. To assess intraobserver reliability, these measurements were repeated 15 days apart. To define interobserver reliability, radiographs were measured by 2 independent observers. Results. Average age was 5·7 years and average Cobb angle was 80·8°. Repeated measurements by one observer showed no significant differences for any of the parameters. Paired samples correlations showed a moderate correlation between measurements of PI (0·564), whereas stronger correlations were demonstrated for measurements of PT (0·816), SS (0·947), and PR (0·789). Interobserver analysis showed a significant difference in measurement of SS (p=0·003), whereasmeasurements of PI, PT, and PR did not differ significantly between independent observers. Conclusions. Intraobserver variabilty yielded acceptable correlations for PT, SS, and PR; however, we noted only a moderate correlation for PI. Interobserver analysis showed a significant difference only in SS. The intraobserver and interobserver variablity of measurements for PT and PR were superior than were those for PI and SS. This finding may be related to difficulties in determining the orientation of the sacral endplate in the immature pelvis when measuring PI and SS

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This study aimed to evaluate rasterstereography of the spine as a diagnostic test for adolescent idiopathic soliosis (AIS), and to compare its results with those obtained using a scoliometer.

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The aim of this study was to investigate the incidence and characteristics of instrumentation failure (IF) after total en bloc spondylectomy (TES), and to analyze risk factors for IF.

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To identify the incidence and risk factors for five-year same-site recurrent disc herniation (sRDH) after primary single-level lumbar discectomy. Secondary outcome was the incidence and risk factors for five-year sRDH reoperation.

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The aims of this study were first, to determine if adding fusion to a decompression of the lumbar spine for spinal stenosis decreases the rate of radiological restenosis and/or proximal adjacent level stenosis two years after surgery, and second, to evaluate the change in vertebral slip two years after surgery with and without fusion.

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Although lumbosacral transitional vertebrae (LSTV) are well-documented, few large-scale studies have investigated thoracolumbar transitional vertebrae (TLTV) and spinal numerical variants. This study sought to establish the prevalence of numerical variants and to evaluate their relationship with clinical problems.

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The aim of this study was to determine the differences in spinal imaging characteristics between subjects with or without lumbar developmental spinal stenosis (DSS) in a population-based cohort.

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To study the associations of lumbar developmental spinal stenosis (DSS) with low back pain (LBP), radicular leg pain, and disability.

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The aim of this study was to determine the influence of developmental spinal stenosis (DSS) on the risk of re-operation at an adjacent level.

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The primary aim of this study was to evaluate the performance and safety of magnetically controlled growth rods in the treatment of early onset scoliosis. Secondary aims were to evaluate the clinical outcome, the rate of further surgery, the rate of complications, and the durability of correction.

We conducted a prospective follow-up MRI study of originally asymptomatic healthy subjects to clarify the development of Modic changes in the cervical spine over a ten-year period and to identify related factors. Previously, 497 asymptomatic healthy volunteers with no history of cervical trauma or surgery underwent MRI. Of these, 223 underwent a second MRI at a mean follow-up of 11.6 years (10 to 12.7). These 223 subjects comprised 133 men and 100 women with a mean age at second MRI of 50.5 years (23 to 83). Modic changes were classified as not present and types 1 to 3. Changes in Modic types over time and relationships between Modic changes and progression of degeneration of the disc or clinical symptoms were evaluated. A total of 31 subjects (13.9%) showed Modic changes at follow-up: type 1 in nine, type 2 in 18, type 3 in two, and types 1 and 2 in two. Modic changes at follow-up were significantly associated with numbness or pain in the arm, but not with neck pain or shoulder stiffness. Age (≥ 40 years), gender (male), and pre-existing disc degeneration were significantly associated with newly developed Modic changes.

In the cervical spine over a ten-year period, type 2 Modic changes developed most frequently. Newly developed Modic changes were significantly associated with age, gender, and pre-existing disc degeneration.