1/28. scoliosis in proteus syndrome: case report.STUDY DESIGN: The case of patient with scoliosis based on a rare hamartomatous, proteus syndrome, is reported. OBJECTIVES: To present the characteristics of scoliosis associated with proteus syndrome, and to investigate the mechanisms that cause it. SUMMARY OF BACKGROUND DATA: proteus syndrome, a rare hamartomatous disorder first coined by Wiedemann, manifests many clinical morphologic abnormalities including scoliosis. The characteristics and cause of scoliosis in this syndrome are fully unknown. methods: A patient with proteus syndrome was followed from the age of 3 months to the age of 21 years. This patient received spinal corrective surgery for severe scoliosis. Detailed investigations of the scoliosis as well as the physical and imaging examinations were performed to characterize the scoliosis. RESULTS: Computed tomography showed exclusive asymmetric appearance of lumbar spine, hypertrophy of the only right facet joints, and pedicles at L1-L4, which accorded with the right-side hemihypertrophy of the patient's extremities. CONCLUSIONS: scoliosis with proteus syndrome seems to be based on hemihypertrophy, with no influence of mechanical stress.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/28. spinal cord injury in children.The spinal injured child has speical needs owing to the processes of physical, mental and social growth. goals of physical treatment programs include prevention of: genitourinary complications; contractures; pressure sores; long bone fractures, hip subluxation and dislocation; spinal deformity. Nonoperative treatment of spinal deformity employing external support should be initiated when the potential for spinal deformity exists. External support delays the development of spinal deformity, improves sitting balance and allows free upper extremity use. The overall treatment programs must consider altered body proportions, immaturity of strength and coordination. Case examples of children with spinal injury are presented above to illustrate specific problems stemming from immaturity of physical, cognitive, and social development. Spinal surgery can be a conservative measure in the growing child when there is radiologic evidence of progressive spinal deformity. Posterior spinal fusion with Harrington instrumentation and external support permits immediate return to vertical activity.- - - - - - - - - - ranking = 3keywords = physical (Clic here for more details about this article) |
3/28. chiropractic and pilates therapy for the treatment of adult scoliosis.OBJECTIVE: To describe the use of Pilates therapy and sacro-occipital technique in the management of a 39-year-old woman with scoliosis who had undergone spinal fusion many years earlier. Clinical Features: The patient had progressive severe low back pain that had worsened over the years after her surgery and had prevented her from activities such as carrying her son or equipment necessary for her job as a photographer. Intervention and Outcome: The patient was provided a series of Pilates exercises used to overcome her chronic habituation and muscle weakness. Although this therapy went on for some time, she did begin to stabilize and increase physical activity. At present, she is no longer limited in her physical activity, although she still exhibits some symptoms from her scoliosis. CONCLUSION: The addition of Pilates therapy can be useful to care for patients with chronic low back pain and deconditioning.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/28. Chiari I malformation in the very young child: the spectrum of presentations and experience in 31 children under age 6 years.INTRODUCTION: The entity of hindbrain herniation without myelodysplasia in the very young child has been poorly described. A retrospective analysis of children diagnosed with Chiari I malformation (CM I) before their sixth birthday is presented. methods: Since 1985, 31 children with CM I (0.3-5.8) years of age have been diagnosed at University of iowa hospitals and Clinics. Their records were reviewed for presenting symptoms, signs, radiographic findings, treatment, complications, and outcome. RESULTS: The average age at diagnosis was 3.3 years. Sixteen patients were under age 3. Chief presenting complaints included impaired oropharyngeal function (35%), scoliosis (23%), headache or neck pain (23%), sensory disturbance (6%), weakness (3%), and other (10%). Sixty-nine percent of children under age 3 had abnormal oropharyngeal function. Three patients under age 3 (19%) had undergone fundoplication and/or gastrostomy before diagnosis of CM I. Common physical findings included abnormal tendon reflexes (68%), scoliosis (26%), abnormal gag reflex (13%), and normal examination (13%). vocal cord dysfunction (26%, all under age 3) and syringohydromyelia (52%) were also seen. Twenty-five patients were treated surgically at our institution with posterior fossa decompression, duraplasty, and cerebellar tonsillar shrinkage. Three patients were lost to follow-up. Ninety-one percent of patients reported improved symptomatology at last follow-up (mean: 3.9 years). Three patients required reoperation for recurrence of symptoms. syringomyelia improved in all patients. scoliosis resolved in 2 of 8 patients, improved in 5, and stabilized in 1. There was no permanent morbidity from surgery. DISCUSSION: We show that children with Chiari I abnormality are very likely to present with oropharyngeal dysfunction if under age 3, and either scoliosis or headache or neck pain worsened by valsalva if age 3 to 5. These symptoms are very likely to improve after Chiari decompression, which can be done with low morbidity. CONCLUSIONS: Very young children presenting with oropharyngeal dysfunction, pain worsened by valsalva, or scoliosis should prompt the clinician to consider CM I as a possible cause.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/28. Hemimetameric segmental shift: a case series and review.STUDY DESIGN: A case series of patients with hemimetameric shift. OBJECTIVES: To describe the radiographic and physical findings as well as treatment provided to a subset of patients with congenital scoliosis. SUMMARY OF BACKGROUND DATA: Hemimetameric segmental displacement, or hemimetameric shift, is a clinical entity defined by two contralateral hemivertebrae separated by at least one normal vertebra. Although the entity is briefly described in textbooks, there are no published series to date. methods: From 1974 to 2000, 186 cases of congenital scoliosis were identified from two referral centers. Of these, 27 cases (15%) of hemimetameric shift were identified. medical records and radiographs were reviewed, as well as magnetic resonance imaging when available. RESULTS: There were an average of 2.9 hemivertebrae per patient (range 2-6) with the following distribution: T1-T6 (29), T7-T11 (28), T12-L1 (10), L2-L4 (11), and L5 (1). The average curve magnitude at presentation was 28 degrees (range 9 degrees -55 degrees). Nine patients required surgery-most commonly with involvement of the thoracolumbar or lumbosacral junction. Eleven patients also had associated anomalies to include klippel-feil syndrome (3), goldenhar syndrome (2), imperforate anus (2), tracheoesophageal fistula (2), and a single kidney (2). There was only one patient who had an abnormal magnetic resonance imaging (1 out of 17; 6%). CONCLUSIONS: Hemimetameric shift is a common finding in congenital scoliosis. Hemivertebrae are most commonly found in the thoracic spine; however, surgical intervention is most commonly observed when the caudal hemivertebrae is located from the thoracolumbar to lumbosacral junction. The incidence of abnormal magnetic resonance imaging findings is low (6%).- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/28. Acquired thoracic scoliosis following minimally invasive repair of pectus excavatum.The minimally invasive pectus excavatum repair as described by Nuss et al. is rapidly gaining acceptance as an effective method of repair of severe pectus excavatum deformities in the pediatric population. It potentially offers several advantages over previous techniques. The incidence of major complications of the procedure has been reduced by recent modifications including utilization of video-assisted thoracoscopy during placement of the Lorenz pectus bar as well as utilizing the pectus bar stabilizer that provides more rigid fixation of the strut. We report two cases of acquired thoracic scoliosis following minimally invasive repair of severe pectus excavatum deformity. This particular complication has not been reported in previous literature and warrants concern. In both cases the thoracic scoliosis slowly improved with physical therapy and range-of-motion exercises.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/28. chiropractic management of ehlers-danlos syndrome: a report of two cases.OBJECTIVE: To discuss 2 patients with ehlers-danlos syndrome seeking chiropractic evaluation and management of their disabling musculoskeletal pain and associated disorders. CLINICAL FEATURES: Two disabled patients diagnosed with Ehlers-Danlos syndrome had spinal pain, including neck and back pain, headache, and extremity pain. Commonalities among these 2 cases included abnormal spinal curvatures (kyphosis and scoliosis), joint hypermobility, and tissue fragility. One patient had postsurgical thoracolumbar spinal fusion (T11-sacrum) for scoliosis and osteoporosis. The other patient had moderate anterior head translation. INTERVENTION AND OUTCOME: Both patients were treated with mechanical force and manually assisted spinal adjustments delivered to various spinal segments and extremities utilizing an Activator II Adjusting Instrument and Activator methods chiropractic Technique. patients were also given postural advice, stabilization exercises, and postural corrective exercises, as indicated in chiropractic biophysics Technique protocols. Both patients were able to reduce pain and anti-inflammatory medication usage in association with chiropractic care. Significant improvement in self-reported pain and disability as measured by visual analog score, Oswestry Low-Back Disability Index, and neck pain Disability Index were reported, and objective improvements in physical examination and spinal alignment were also observed following chiropractic care. Despite these improvements, work disability status remained unchanged in both patients. CONCLUSION: chiropractic care may be of benefit to some patients with connective tissue disorders, including ehlers-danlos syndrome. Low-force chiropractic adjusting techniques may be a preferred technique of choice in patients with tissue fragility, offering clinicians a viable alternative to traditional chiropractic care in attempting to minimize risks and/or side effects associated with spinal manipulation. Psychosocial issues, including patient desire to return to work, were important factors in work disability status and perceived outcome.- - - - - - - - - - ranking = 4.7514816035529keywords = physical examination, physical (Clic here for more details about this article) |
8/28. Reversal of the signs and symptoms of moderately severe idiopathic scoliosis in response to physical methods.This report describes improved signs and symptoms of previously untreated symptomatic spinal deformity in an adult female diagnosed with moderately severe thoracic scoliosis at the age of .7 years. Current treatment initiated at the age of forty included massage therapy, manual traction, ischemic pressure, and comprehensive manipulative medicine (CMM). A left-right chest circumference inequity was reduced by >10 cm, in correlation with improved appearance of the ribcage deformity and a 40% reduction in magnitude of Cobb angle, which had been stable for 30 years. The changes occurred gradually over an eight-year period, with the most rapid improvement occurring during two periods when CMM was employed.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
9/28. Childhood-onset osteoarthritis, tall stature, and sensorineural hearing loss associated with Arg75-Cys mutation in procollagen type II gene (COL2A1).OBJECTIVE: To define the clinical, radiologic, and molecular genetic characteristics of a family with early progressive osteoarthritis mimicking childhood rheumatoid arthritis, Scheuermann-like changes of the spine, tall stature, short 3 and 4 metatarsals, and moderate sensorineural hearing loss. methods: We describe a 22-year-old woman and her 54-year-old mother with early progressive osteoarthritis mimicking childhood rheumatoid arthritis. The index case, her mother, and 3 other family members underwent a physical examination, anthropometric measurements, and radiologic studies. Their dna was sequenced for the procollagen type II (COL2A1) gene. RESULTS: Mild scoliosis was noticed in the proband at the age of 6 years, and at the age of 7 years large Schmorl's nodes were found in the vertebrae L1-2. At the age of 11 years, changes resembling Scheuermann's disease were seen, mostly in the thoracic vertebrae. At the same age, she began to have arthralgia in the weight-bearing joints and osteoarthritis progressed fast, necessitating a hip prosthesis at the age of 18 years. The proband and her mother had bilateral sensorineural hearing loss of moderate degree. Both mother and daughter had an Arg75-Cys mutation in the COL2A1 gene. CONCLUSION: This family is the fourth example of the Arg75-Cys mutation in the COL2A1 gene, which appears to lead to a clearly recognizable phenotype. The finding suggests that sensorineural hearing loss may be a part of this syndrome.- - - - - - - - - - ranking = 4.7514816035529keywords = physical examination, physical (Clic here for more details about this article) |
10/28. Familial Chiari type I malformation with syringomyelia in two siblings: case report and review of the literature.OBJECTIVE: Familial cases of Chiari malformation with syringomyelia are rare. The majority of the reported series and case reports detail sporadic cases. The authors report two siblings who presented with Chiari type I malformation and syringomyelia (CMI S). CLINICAL PRESENTATION: We report two sisters who each presented with scoliosis on routine school physicals. Their clinical examination was unremarkable; however, imaging studies demonstrated a Chiari malformation with syringomyelia. Both underwent cervicomedullary decompression, and follow-up imaging studies revealed resolution of the syringomyelia. CONCLUSION: A review of the literature reveals fewer than ten previous reports of familial CMI S in the past 30 years. Although rare, the existence of familial cases of CMI S suggests a genetic component to the pathogenesis of this condition in at least a proportion of patients. Neurosurgeons should be aware of the familial aggregation of CMI S.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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