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Upright, prone and supine spinal morphology in adolescent idiopathic scoliosis
Posters / The Spine Journal 16 (2016) S72–S93 PURPOSE: To investigate if there is a positive correlation between low vitamin D and intervention in symptomatic spinal pathology. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: All patients with low vitamin D and spinal intervention. OUTCOME MEASURES: Requirement for spinal surgery or injection. METHODS: A retrospective analysis of patients seen in a spine clinic in a major institution over 2 years was undertaken. Patients were selected if they had low vitamin D. Findings were compared to age, sex and pathology matched controls. Demographics and type of intervention were analysed. RESULTS: 450 patients with low vitamin D were identified. 180 patients (40%) had either spinal surgery or injections, compared to controls, which had only 15% (chi-squared p-value: 8E-06; significance: <.05). The average Vitamin D level was 42.3 nmol/L. This was greater in the injection group (40.7 nmol/L) and lower in the surgery group (31.85 nmol/L). The average age was 52 years (injections: 53, surgery: 47). The majority of patients had caudal epidurals and lumbar facet injections. The commonest surgical intervention was decompression, followed by fusion. CONCLUSIONS: The commonest procedure in patients with low vitamin D was injections (older population and higher vitamin D). Those undergoing surgery were younger and had lower vitamin D levels, perhaps due to comorbidities. Further analysis into outcomes will be made. There is a positive link with low vitamin D and the requirement for spinal intervention. This confirms the need to normalise levels before any intervention is planned for spinal patients. CONFLICTS OF INTEREST: None. FUNDING SOURCES: None. http://dx.doi.org/10.1016/j.spinee.2016.01.109
The effect of fluid flow on intervertebral disc cells Cate Wilson, Tom Joyce, Phil Hyde, Mark Birch, Kenneth Rankin, Ria Toumpaniari, Simon Partridge; Newcastle University, Stephenson Building, Claremont Road, Newcastle University, Newcastle-Upon-Tyne NE1 7RU BACKGROUND CONTEXT: Spinal exercises are recommended by National Institute of Clinical Excellence (NICE) guidelines for the treatment of low back pain, but research surrounding which exercises are most beneficial has been inconclusive. Spinal movement creates pressure change and fluid flow, which are essential for disc health. PURPOSE: Investigating how Intervertebral Disc (IVD) cells react to different fluid flows and determining which exercises are most effective for disc health would be beneficial to clinicians and patients. STUDY DESIGN/SETTING: The effect of ten flow rates on gene expression in bovine IVD cells was tested. Each flow was repeated four times with four samples in each run, and controls with no flow were tested simultaneously. PATIENT SAMPLE: Nil. OUTCOME MEASURES: Nil. METHODS: Bovine cells were seeded onto Ibidi Leur VI0.4 slides and introduced to fluid flow rates ranging from 0.1 mL/min to 8 mL/min compared to a control with no flow. Gene expression including aggrecan, collagen, aggrecanase and collagenases was analysed using real-time Polymerase Chain Reaction (PCR). RESULTS: Preliminary results demonstrated statistically significant catabolic changes in flow rates above 0.3 mL/min, no effect on gene expression at 0.2 mL/min and anabolic changes at 0.1 mL/min. CONCLUSIONS: Bovine IVD cells are responsive to different fluid flow rates. Further investigation of flow rates below 0.1 mL/min, protein expression in cells and in the culture supernatant, bovine cells in 3D culture, and studies using human cells are planned. CONFLICTS OF INTEREST: No conflicts of interest. FUNDING SOURCES: No funding obtained. http://dx.doi.org/10.1016/j.spinee.2016.01.110
S81
Spinal Deformity Upright, prone and supine spinal morphology in adolescent idiopathic scoliosis Rob Brinka,b,c,d, Tom Schlössera,b,c,d, Dino Coloa,b,c,d, Koen Vinkena,b,c,d, Marijn van Stralena,b,c,d, Steve Huia,b,c,d, Winnie Chua,b,c,d, Jack Chenga,b,c,d, René Casteleina,b,c,d; aDepartment of Orthopaedic Surgery, UMC Utrecht, Utrecht, The Netherlands; bImage Sciences Institute, UMC Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands; c Department of Imaging & Interventional Radiology, Prince of Wales Hospital, CUHK, Hong Kong; dDepartment of Orthopaedics and Traumatology, Prince of Wales Hospital, CUHK, Hong Kong BACKGROUND CONTEXT: Adolescent idiopathic scoliosis (AIS) patients are exposed to ten times more radiation as compared to healthy adolescents; this leads to an increased risk of developing malignancies. In order to minimise the radiation exposure, non-ionising imaging modalities (magnetic resonance imaging [MRI]) can be used. PURPOSE: To evaluate the correlation between the morphology of the spine on conventional radiographs and 3-D scans (prone computed tomography [CT] and supine MRI) in AIS. STUDY DESIGN/SETTING: Cross-sectional. PATIENT SAMPLE: 62 AIS patients had undergone standard preoperative work-up (upright radiographs, supine MRI and prone CT). OUTCOME MEASURES: Cobb angles, thoracic kyphosis, lumbar lordosis and apical vertebral rotation (2-D: Perdriolle, 3-D: semi-automatic software). METHODS: In all positions, the outcome measures were determined. Furthermore, on reconstructed 3-D MRI CT scans, the true sagittal and coronal morphology were measured semi-automatically (previously validated). RESULTS: In the thoracic and (thoraco) lumbar curves, Cobb angles correlated between radiographs (68±15° and 44±17°), supine MRI (57±14° and 35±16°) and prone CT (54±15° and 33±15°; r≥0.89; p<.001). The rotation showed a correlation between the positions (upright: 22±12°; prone: 20±9°; and supine: 16±11°; r≥0.56; p<.001). The thoracic kyphosis and lumbar lordosis on X-rays did not correlate with the true sagittal morphology on MRI or CT. CONCLUSIONS: Although there is underestimation of the morphology of the 3-D spinal curvature in the supine position as compared to upright, there is a significant correlation of the deformation in the different positions and imaging modalities. Therefore, accurate estimation of the upright morphology of AIS is possible using non-ionising supine MRI or prone CT. CONFLICTS OF INTEREST: No conflicts of interest. FUNDING SOURCES: Medtronic Research Grant, K2M Research Grant, Foundation Yves Cotrel Start Up Grant, Alexandre Suerman MD PhD Stipendium and UMC Utrecht. http://dx.doi.org/10.1016/j.spinee.2016.01.111
The effect of magnetically controlled growing rod on the sagittal profile in early-onset scoliosis patients Behrooz Akbarnia, Kenneth Cheung, Kenny Kwan, Dino Samartzis, John Ferguson, Chrishan Thakar, Pavlos Panteliadis, Colin Nnadi, Ilkka Helenius, Muharrem Yazici, Gokhan Halil Demirkiran, Ahmet Alanay; San Diego Center for Spinal Disorders, La Jolla, CA, USA BACKGROUND CONTEXT: Magnetically controlled growing rods (MCGR) have a straight central housing portion that cannot be bent. The effects of gradual lengthening on the regional and overall sagittal profile in early-onset scoliosis (EOS) are unknown. PURPOSE: Report on the changes of the sagittal profile after MCGR implantation.
The effect of fluid flow on intervertebral disc cells Cate Wilson, Tom Joyce, Phil Hyde, Mark Birch, Kenneth Rankin, Ria Toumpaniari, Simon Partridge; Newcastle University, Stephenson Building, Claremont Road, Newcastle University, Newcastle-Upon-Tyne NE1 7RU BACKGROUND CONTEXT: Spinal exercises are recommended by National Institute of Clinical Excellence (NICE) guidelines for the treatment of low back pain, but research surrounding which exercises are most beneficial has been inconclusive. Spinal movement creates pressure change and fluid flow, which are essential for disc health. PURPOSE: Investigating how Intervertebral Disc (IVD) cells react to different fluid flows and determining which exercises are most effective for disc health would be beneficial to clinicians and patients. STUDY DESIGN/SETTING: The effect of ten flow rates on gene expression in bovine IVD cells was tested. Each flow was repeated four times with four samples in each run, and controls with no flow were tested simultaneously. PATIENT SAMPLE: Nil. OUTCOME MEASURES: Nil. METHODS: Bovine cells were seeded onto Ibidi Leur VI0.4 slides and introduced to fluid flow rates ranging from 0.1 mL/min to 8 mL/min compared to a control with no flow. Gene expression including aggrecan, collagen, aggrecanase and collagenases was analysed using real-time Polymerase Chain Reaction (PCR). RESULTS: Preliminary results demonstrated statistically significant catabolic changes in flow rates above 0.3 mL/min, no effect on gene expression at 0.2 mL/min and anabolic changes at 0.1 mL/min. CONCLUSIONS: Bovine IVD cells are responsive to different fluid flow rates. Further investigation of flow rates below 0.1 mL/min, protein expression in cells and in the culture supernatant, bovine cells in 3D culture, and studies using human cells are planned. CONFLICTS OF INTEREST: No conflicts of interest. FUNDING SOURCES: No funding obtained. http://dx.doi.org/10.1016/j.spinee.2016.01.110
S81
Spinal Deformity Upright, prone and supine spinal morphology in adolescent idiopathic scoliosis Rob Brinka,b,c,d, Tom Schlössera,b,c,d, Dino Coloa,b,c,d, Koen Vinkena,b,c,d, Marijn van Stralena,b,c,d, Steve Huia,b,c,d, Winnie Chua,b,c,d, Jack Chenga,b,c,d, René Casteleina,b,c,d; aDepartment of Orthopaedic Surgery, UMC Utrecht, Utrecht, The Netherlands; bImage Sciences Institute, UMC Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands; c Department of Imaging & Interventional Radiology, Prince of Wales Hospital, CUHK, Hong Kong; dDepartment of Orthopaedics and Traumatology, Prince of Wales Hospital, CUHK, Hong Kong BACKGROUND CONTEXT: Adolescent idiopathic scoliosis (AIS) patients are exposed to ten times more radiation as compared to healthy adolescents; this leads to an increased risk of developing malignancies. In order to minimise the radiation exposure, non-ionising imaging modalities (magnetic resonance imaging [MRI]) can be used. PURPOSE: To evaluate the correlation between the morphology of the spine on conventional radiographs and 3-D scans (prone computed tomography [CT] and supine MRI) in AIS. STUDY DESIGN/SETTING: Cross-sectional. PATIENT SAMPLE: 62 AIS patients had undergone standard preoperative work-up (upright radiographs, supine MRI and prone CT). OUTCOME MEASURES: Cobb angles, thoracic kyphosis, lumbar lordosis and apical vertebral rotation (2-D: Perdriolle, 3-D: semi-automatic software). METHODS: In all positions, the outcome measures were determined. Furthermore, on reconstructed 3-D MRI CT scans, the true sagittal and coronal morphology were measured semi-automatically (previously validated). RESULTS: In the thoracic and (thoraco) lumbar curves, Cobb angles correlated between radiographs (68±15° and 44±17°), supine MRI (57±14° and 35±16°) and prone CT (54±15° and 33±15°; r≥0.89; p<.001). The rotation showed a correlation between the positions (upright: 22±12°; prone: 20±9°; and supine: 16±11°; r≥0.56; p<.001). The thoracic kyphosis and lumbar lordosis on X-rays did not correlate with the true sagittal morphology on MRI or CT. CONCLUSIONS: Although there is underestimation of the morphology of the 3-D spinal curvature in the supine position as compared to upright, there is a significant correlation of the deformation in the different positions and imaging modalities. Therefore, accurate estimation of the upright morphology of AIS is possible using non-ionising supine MRI or prone CT. CONFLICTS OF INTEREST: No conflicts of interest. FUNDING SOURCES: Medtronic Research Grant, K2M Research Grant, Foundation Yves Cotrel Start Up Grant, Alexandre Suerman MD PhD Stipendium and UMC Utrecht. http://dx.doi.org/10.1016/j.spinee.2016.01.111
The effect of magnetically controlled growing rod on the sagittal profile in early-onset scoliosis patients Behrooz Akbarnia, Kenneth Cheung, Kenny Kwan, Dino Samartzis, John Ferguson, Chrishan Thakar, Pavlos Panteliadis, Colin Nnadi, Ilkka Helenius, Muharrem Yazici, Gokhan Halil Demirkiran, Ahmet Alanay; San Diego Center for Spinal Disorders, La Jolla, CA, USA BACKGROUND CONTEXT: Magnetically controlled growing rods (MCGR) have a straight central housing portion that cannot be bent. The effects of gradual lengthening on the regional and overall sagittal profile in early-onset scoliosis (EOS) are unknown. PURPOSE: Report on the changes of the sagittal profile after MCGR implantation.