DOCSLIB.ORG

Spondylolysis and Spondylolisthesis in Children and Adolescents: I

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Spondylolysis and Spondylolisthesis in Children and Adolescents: I Spondylolysis and Spondylolisthesis in Children and Adolescents: I. Diagnosis, Natural History, and Nonsurgical Management Ralph Cavalier, MD Abstract Martin J. Herman, MD Spondylolysis and spondylolisthesis are often diagnosed in children Emilie V. Cheung, MD presenting with low back pain. Spondylolysis refers to a defect of Peter D. Pizzutillo, MD the vertebral pars interarticularis. Spondylolisthesis is the forward translation of one vertebral segment over the one beneath it. Isth- Dr. Cavalier is Attending Orthopaedic mic spondylolysis, isthmic spondylolisthesis, and stress reactions Surgeon, Summit Sports Medicine and involving the pars interarticularis are the most common forms seen Orthopaedic Surgery, Brunswick, GA. Dr. Herman is Associate Professor, in children. Typical presentation is characterized by a history of Department of Orthopaedic Surgery, activity-related low back pain and the presence of painful spinal Drexel University College of Medicine, mobility and hamstring tightness without radiculopathy. Plain ra- St. Christopher’s Hospital for Children, Philadelphia, PA. Dr. Cheung is Fellow, diography, computed tomography, and single-photon emission Department of Orthopaedic Surgery, computed tomography are useful for establishing the diagnosis. Mayo Clinic, Rochester, MN. Dr. Symptomatic stress reactions of the pars interarticularis or adjacent Pizzutillo is Professor, Department of vertebral structures are best treated with immobilization of the Orthopaedic Surgery, Drexel University College of Medicine, St. Christopher’s spine and activity restriction. Spondylolysis often responds to brief Hospital for Children. periods of activity restriction, immobilization, and physiotherapy. None of the following authors or the Low-grade spondylolisthesis (≤50% translation) is treated similarly. departments with which they are The less common dysplastic spondylolisthesis with intact posterior affiliated has received anything of value elements requires greater caution. Symptomatic high-grade spondy- from or owns stock in a commercial company or institution related directly or lolisthesis (>50% translation) responds much less reliably to non- indirectly to the subject of this article: surgical treatment. The growing child may need to be followed Dr. Cavalier, Dr. Herman, Dr. Cheung, clinically and radiographically through skeletal maturity. When and Dr. Pizzutillo. pain persists despite nonsurgical interventions, when progressive Reprint requests: Dr. Herman, St. vertebral displacement increases, or in the presence of progressive Christopher’s Hospital for Children, Department of Orthopaedic Surgery, neurologic deficits, surgical intervention is appropriate. Front Street at Erie Avenue, Philadelphia, PA 19134-1095. pondylolysis and spondylolisthe- conditions; there are no reported cas- J Am Acad Orthop Surg 2006;14:417- sis are common causes of low es in nonambulators.1 Spondylolysis 424 S back pain in children and adoles- has been rarely reported in infancy, Copyright 2006 by the American cents. Upright posture and ambula- but by age 6 years, the reported inci- Academy of Orthopaedic Surgeons. tion appear to be contributing fac- dence of 5% approximates that of tors to the development of these the adult population.2-5 Most chil- Volume 14, Number 7, July 2006 417 Spondylolysis and Spondylolisthesis: I. Diagnosis, Natural History, and Nonsurgical Management Table 1 olescent. Type I, the dysplastic type, defines spondylolisthesis secondary Classification Systems for Spondylolisthesis to congenital abnormalities of the Wiltse-Newman Marchetti-Bartolozzi lumbosacral articulation, including maloriented or hypoplastic facets I. Dysplastic Developmental and sacral deficiency. The pars is II. Isthmic High dysplastic poorly developed, which allows for IIA, Disruption of pars as a With lysis elongation or eventual separation result of stress fracture With elongation IIB, Elongation of pars without Low dysplastic and forward slippage of L5 on the disruption related to repeated, With lysis sacrum with repetitive loading over healed microfractures With elongation time. This type is less common, IIC, Acute fracture through pars Acquired comprising 14% to 21% of cases in III. Degenerative Traumatic large series.12,13 IV. Traumatic Acute fracture Type II, the isthmic type, defines V. Pathologic Stress fracture spondylolisthesis that results from Postsurgery defects of the pars interarticularis. Direct surgery This group is subdivided into three Indirect surgery subtypes. Type IIA, the most com- Pathologic mon subtype, is caused by fatigue Local pathology Systemic pathology failure of the pars from repetitive Degenerative loading, resulting in a complete ra- Primary diolucent defect. Type IIB is caused Secondary by an elongated pars secondary to re- peated microfractures that heal. This type can be difficult to distin- dren are asymptomatic. Hereditary the pars, adjacent lamina, or pedicle, guish radiographically from the dys- factors appear to predispose some in- the term stress reaction is most ap- plastic type. Type IIC refers to a pars dividuals to the development of propriately applied. Magnetic reso- fracture that results from an acute spondylolysis and spondylolisthe- nance imaging (MRI) will demon- injury. Wiltse hypothesized that sis.6,7 Specific sporting activities strate intraosseous edema in the isthmic defects are the result of with repetitive hyperextension and affected areas in these patients. chronic loading of a pars interarticu- rotational loads applied to the lum- When the defect is characterized by laris that is genetically predisposed bar spine may result in the develop- a radiolucent gap with sclerosis of to fatigue failure.14 ment of spondylolysis and spondy- the adjacent bone edges, it is termed Marchetti and Bartolozzi15 pro- lolisthesis in the young athlete. The a spondylolytic or isthmic defect. posed an alternative classification incidence of spondylolysis is as high Spondylolisthesis describes the system with two broad categories— as 47% in elite athletes who partic- forward translation of one vertebra developmental and acquired. The de- ipate in high-risk sports such as div- relative to the next caudal vertebral velopmental category defines spondy- ing and gymnastics.8,9 segment. Spondylolysis occurs most lolisthesis resulting from an inherited Spondylolisthesis may be associ- commonly in the fifth lumbar verte- dysplasia of the pars, lumbar facets, ated with neurologic dysfunction in bra but may occur at more cephalad disks, and vertebral endplates, com- patients with congenital dysplasia of lumbar levels. Patients with L4 bining the dysplastic and isthmic cat- the lumbosacral facets and sacrum. spondylolysis are more frequently egories of Wiltse-Newman. Acquired These congenital changes allow an- symptomatic.10 In children and ado- spondylolysis and spondylolisthesis terior translation of the L5 vertebral lescents, however, spondylolisthesis define failure of the pars secondary to body with intact posterior elements most commonly occurs at the L5-S1 repetitive spinal loading related to that can compress the L5 and sacral motion segment. specific activities. An expanded ver- nerve roots. sion of this classification was later proposed15 ( Table 1). Although some Spondylolysis is the term used to Classification describe an anatomic defect of the aspects of this detailed classification pars interarticularis without dis- The Wiltse-Newman classification are more easily applied to the child placement of the vertebral body. (Table 1) is the most widely used and adolescent than is the Wiltse- When plain radiographs or comput- classification of spondylolisthesis.11 Newman scheme, the Marchetti- ed tomography (CT) reveal sclerosis Of the five types, only types I and II Bartolozzi classification has not yet with incomplete bone disruption at apply commonly to the child and ad- achieved universal acceptance. De- 418 Journal of the American Academy of Orthopaedic Surgeons Ralph Cavalier, MD, et al scriptive terms such as dysplastic, ysis and spondylolisthesis, Wiltse6 Form scores between the study pop- congenital, sclerotic, spondylolytic, and Albanese and Pizzutillo7 noted ulation and the age-matched general developmental, acquired, traumatic, that 26% and 22%, respectively, of population. stress fracture, and stress reaction first-degree relatives demonstrated In most studies, no distinction have resulted in substantial confusion radiographically similar changes. has been made between the dysplas- in taxonomy. Most affected individuals were un- tic and isthmic types of spondylolis- aware of the existing spinal changes thesis. Also, most of the reported Natural History and were asymptomatic. Although studies are retrospective. In addition, most patients with an isthmic patients with spondylolysis and Stress reactions of the pars, lamina, spondylolysis present with some de- spondylolisthesis have often been and pedicle have been documented gree of slip, <4% of children and ad- considered together in natural histo- in athletes who participate in high- olescents demonstrate slip progres- ry studies. risk sports such as gymnastics, div- sion through skeletal maturity and 9 16,17 ing, football, and rowing. These in- into adulthood. Children who are Clinical Assessment juries are the result of repetitive diagnosed before their adolescent loading of the lumbar spine in exten- growth spurt, girls, and those pre- History and Physical sion and rotation, may be unilateral senting with >50% slip are most Examination or bilateral,
Load more

Recommended publications
  • Tracheal Perforation in a Neonate: a Devastating
    Letters to Editor Tracheal perforation in a size of endotracheal tube, cuff overinflation, cough and vigorous movements of head and neck.[2,3] neonate: A devastating Neonatal tracheal injury is ascribed to factors like complication following traumatic traumatic delivery, weak trachea, congenital tracheal endotracheal intubation stenosis, ring agenesis, metal stylets, rigid endotracheal tube, excessive external laryngeal pressure and [1,4,5] Sir, prolonged ventilation. Tracheal injury in neonates following endotracheal In our case, rigorous attempts at intubation along with intubation represents an uncommon complication excessive hyperextension of head and neck due to altered rarely described in literature but carries high anatomy are likely to have contributed to tracheal injury. morbidity and a mortality rate of 70%.[1] We describe Multiple attempts at intubation are known to result in a [4] a case of neonatal tracheal perforation following false tract and are related to anterior tracheal lesions. multiple attempts at endotracheal intubation due to an Incidentally, our case was an undiagnosed Pierre unanticipated difficulty in an emergency situation in Robins Sequence. A small receding mandible, tongue an undiagnosed case of Pierre Robin Sequence. immobility and cleft palate are identified as independent factors for difficult airway with a risk of upper airway A 4-week-old female baby presented to the emergency obstruction, difficult mask holding, difficult intubation, department with respiratory difficulty. In view of severe leak through the cleft resulting in inadequate ventilation respiratory distress and desaturation (SpO2- 60%) a as well as passage of the endotracheal tube into the decision was made to provide ventilatory support to cleft.[6] Successful airway management in such situation the neonate.
    [Show full text]
  • Spinal Deformity Study Group
    Spinal Deformity Study Group Editors in Chief Radiographic Michael F. O’Brien, MD Timothy R. Kuklo, MD Kathy M. Blanke, RN Measurement Lawrence G. Lenke, MD Manual B T2 T5 T2–T12 CSVL T5–T12 +X° -X +X° C7PL T12 L2 A S1 ©2008 Medtronic Sofamor Danek USA, Inc. – 0 + Radiographic Measurement Manual Editors in Chief Michael F. O’Brien, MD Timothy R. Kuklo, MD Kathy M. Blanke, RN Lawrence G. Lenke, MD Section Editors Keith H. Bridwell, MD Kathy M. Blanke, RN Christopher L. Hamill, MD William C. Horton, MD Timothy R. Kuklo, MD Hubert B. Labelle, MD Lawrence G. Lenke, MD Michael F. O’Brien, MD David W. Polly Jr, MD B. Stephens Richards III, MD Pierre Roussouly, MD James O. Sanders, MD ©2008 Medtronic Sofamor Danek USA, Inc. Acknowledgements Radiographic Measurement Manual The radiographic measurement manual has been developed to present standardized techniques for radiographic measurement. In addition, this manual will serve as a complimentary guide for the Spinal Deformity Study Group’s radiographic measurement software. Special thanks to the following members of the Spinal Deformity Study Group in the development of this manual. Sigurd Berven, MD Hubert B. Labelle, MD Randal Betz, MD Lawrence G. Lenke, MD Fabien D. Bitan, MD Thomas G. Lowe, MD John T. Braun, MD John P. Lubicky, MD Keith H. Bridwell, MD Steven M. Mardjetko, MD Courtney W. Brown, MD Richard E. McCarthy, MD Daniel H. Chopin, MD Andrew A. Merola, MD Edgar G. Dawson, MD Michael Neuwirth, MD Christopher DeWald, MD Peter O. Newton, MD Mohammad Diab, MD Michael F.
    [Show full text]
  • Pars Injection for Lumbar Spondylolysis
    Pars Injection for Lumbar Spondylolysis Issue 4: March 2016 Review date: February 2019 Following your recent investigations and consultation with your spinal surgeon, a possible cause for your symptoms may have been found. Your X-rays and / or scans have revealed that you have a lumbar spondylolysis. This is a stress fracture of the narrow bridge of bone between the facet joints (pars interarticularis) at the back of the spine, commonly called a pars defect. There may be a hereditary aspect to spondylolysis, for example an individual may be born with thin vertebral bone and therefore be vulnerable to this condition; or certain sports, such as gymnastics, weight lifting and football can put a great deal of stress on the bones through constantly over-stretching the spine. Either cause can result in a stress fracture on one or both sides of the vertebra (bone of the spine). Many people are not aware of their stress fracture or experience any problems but symptoms can occasionally occur including lower back pain, pain in the thighs and buttocks, stiffness, muscle tightness and tenderness. vertebra facet joint pars interarticularis sacrum spondylolysis (pars defect) intervertebral disc If the stress fracture weakens the bone so much that it is unable to maintain its proper position, the vertebra can start to shift out of place. This condition is called spondylolisthesis. Page 3 There is a forward slippage of one lumbar vertebra on the vertebra below it. The degree of spondylolisthesis may vary from mild to severe but if too much slippage occurs, the nerve roots can be stretched where they branch out of the spinal canal.
    [Show full text]
  • Spondylolysis and Spondylolisthesis. Congenital Anomalies of the Spine
    Spondylolysis and spondylolisthesis. Congenital anomalies of the spine. Scheurmann’s disease and its treatment. Degenerative changes of the spine. Spinal stenosis. Disc generation and prolapse. Sciatica. Ankylosing spondylitis. University of Debrecen Department of Orthopaedic Surgery 1 Anatomy DE OEC 2 Ortopédiai Klinika Vertebrae • 7 Cervical • 12 Thoracic • 5 Lumbar • 5 Sacral • 4-6 Coccygeal • Same structure, but different localisation, shape and function! • Anatomical – functional segment 3 Joints of the vertebrae ALL JOINT TYPES CAN BE FOUND • SYNDESMOSIS (ligamentous) • SYNCHONDROSIS (fibro cartilage) • SYNOSTOSIS (bone) • REGULAR JOINT (joint capsule, hyalin cartilage, synovial membrane, synovial fluid) 4 DE OEC 5 Ortopédiai Klinika SYNDESMOSIS • Anterior and posterior longitudinal ligament • Yellow ligament • Interspinous ligament • Intertransversal ligament 6 DE OEC 7 Ortopédiai Klinika SYNCHONDROSIS INTERVERTEBRAL DISC (anulus fibrosus, nucleus pulposus) 8 SYNOSTOSIS SACRUM 9 REGULAR JOINTS FACET JOINTS Joint capsule, hyaline cartilage, synovial membrane and fluid! 10 DE OEC 11 Ortopédiai Klinika Movements of the spine • Anteflexion • Retroflexion • Lateralflexion (left and right) • Torsion (left and right) • Pairs of wertebrae –anatomical and functional segment 12 Functions of the vertebral disc • Stability - Stabilizing role (Keeps the ligaments tight by keeping the distance between the vertebrae constant) • Flexibility - Buffer role. 13 Degenerative changes • CAUSE: disc prolapse and protrusion. • Disc flattening causes pain.
    [Show full text]
  • Chapter 4: Massage and Sciatica: an In-Depth Study 2 CE Hours
    Chapter 4: Massage and Sciatica: An In-Depth Study 2 CE Hours By: Kerry Davis, LMT, CIMT, CPT Learning objectives Define the characteristics of sciatica. Discuss how to construct a treatment plan. Recognize the causes of sciatica. Discuss how to assess the client’s posture and gait. Compare sciatica with other conditions of the low back. Describe the evaluation of the client’s pain patterns and symptoms. Distinguish the muscle imbalance patterns attributing to sciatica. Demonstrate practice of test assessments to rule out other Understand the pattern of referred pain resulting from sciatica. conditions of the low back. Illustrate application of massage techniques to treat the client. Overview Low back pain affects more than three million people in the United encounter multiple cases during the course of their practice due to the States each year (Werner, 2002). According to a 2010 survey, low back impact that low back pain has on society. This course will educate the pain was listed as the third most oppressive condition afflicting people. massage therapist about how to identify sciatica. It will also familiarize Low back pain does not discriminate between men and women and the therapist with the most common causes of sciatica, discuss usually presents as early as the age of thirty; in fact, the prevalence differences between sciatica from piriformis syndrome and sacroiliac increases in correlation with age (National Institute of Neurological joint dysfunctions, examine the proper evaluation of the condition, as Disorders and Stroke, 2015). It is likely that massage therapists will well as develop the treatment protocols for sciatica. UNDERSTANDING SCIATICA Sciatica, or lumbar radiculopathy, is characterized as an inflammation in the feet and toes.
    [Show full text]
  • Failure to Maintain Segmental Lordosis During TLIF for One-Level
    European Spine Journal (2019) 28:745–750 https://doi.org/10.1007/s00586-019-05890-w ORIGINAL ARTICLE Failure to maintain segmental lordosis during TLIF for one‑level degenerative spondylolisthesis negatively afects clinical outcome 5 years postoperatively: a prospective cohort of 57 patients Matevž Kuhta1 · Klemen Bošnjak2 · Rok Vengust2 Received: 14 June 2018 / Revised: 28 November 2018 / Accepted: 13 January 2019 / Published online: 24 January 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Purpose The present study aimed to determine whether obtaining adequate lumbar (LL) or segmental (SL) lordosis during instrumented TLIF for one-level degenerative spondylolisthesis afects midterm clinical outcome. Methods The study was designed as a prospective one, including 57 patients who underwent single-level TLIF surgery for degenerative spondylolisthesis. Patients were analyzed globally with additional subgroup analysis according to pelvic incidence (PI). Radiographic analysis of spinopelvic sagittal parameters was conducted pre- and postoperatively. Clinical examination including ODI score was performed preoperatively, 1 and 5 years postoperatively. Results Signifcant improvement in ODI scores at 1 and 5 years postoperatively (p < 0.001) was demonstrated. There was a signifcant correlation between anterior shift of SVA and failure to improve SL (p = 0.046). Moreover, anterior SVA shift correlated with increased values of ODI score both 1 and 5 years postoperatively. In low-PI group, failure to correct LL correlated with high ODI scores 5 years postoperatively (r = − 0.499, p = 0.005). Conclusions Failure to correct segmental lordosis during surgery for one-level degenerative spondylolisthesis resulted in anterior displacement of the center of gravity, which in turn correlated with unfavorable clinical outcome 1 and 5 years postoperatively.
    [Show full text]
  • Cervical Sagittal Alignment in Adolescent High Dysplastic
    Guo et al. Journal of Orthopaedic Surgery and Research (2020) 15:243 https://doi.org/10.1186/s13018-020-01762-y RESEARCH ARTICLE Open Access Cervical sagittal alignment in adolescent high dysplastic developmental spondylolisthesis: how does the cervical spine respond to the reduction of spondylolisthesis? Xinhu Guo, Weishi Li* , Zhongqiang Chen, Zhaoqing Guo, Qiang Qi, Yan Zeng, Chuiguo Sun and Woquan Zhong Abstract Background: Although pelvic and related parameters have been well stated in lumbar developmental spondylolisthesis, cervical sagittal alignment in these patients is poorly studied, especially in high dysplastic developmental spondylolisthesis (HDDS). The purpose of this study is to investigate the sagittal alignment of the cervical spine in HDDS and how the cervical spine responds to reduction of spondylolisthesis. Methods: Thirty-three adolescent patients with lumbar developmental spondylolisthesis who received preoperative and postoperative whole-spine x-rays were reviewed. They were divided into the HDDS group (n = 24, 13.0 ± 2.2 years old) and the low dysplastic developmental spondylolisthesis (LDDS) group (n = 9, 15.6 ± 1.9 years old). Spinal and pelvic sagittal parameters, including cervical lordosis (CL), were measured and compared between groups. In the HDDS group, the postoperative parameters were measured and compared with those before surgery. Results: HDDS group had a higher proportion of cervical kyphosis (70.8% vs. 22.2%, P = 0.019), and there was a significant difference in CL between the two groups (− 8.5° ± 16.1° vs. 10.5° ± 11.8°, P = 0.003). CL was correlated with the Dubousset’s lumbosacral angle (Dub-LSA), pelvic tilt (PT), and thoracic kyphosis (TK).
    [Show full text]
  • Promising: Process Improvement in Psychosocial Health
    PROMISing: Process Improvement in Psychosocial Health Carly Woodmark MS │ Dereesa Reid MBA │ Daniel Bouton MD SHC-Portland │ Department of Performance Improvement Abstract no. 20 Shriners Team And Patients PROMISing Changes Shriners Hospitals for Children is a network of 22 non-profit medical facilities across North America. Benefits of PROMIS Intervention Pre-op Post-op Since 1924, SHC-Portland has treated a wide range of pediatric orthopedic conditions, from fractures to rare diseases and syndromes. Our Integrated Practice Unit of multi-disciplinary Minor burden of taking PROMIS is offset by quality professionals provide a comprehensive approach through specialized evaluation and treatment communication of meaningful progress between along with rehabilitative services to restore each child physically, emotionally, and socially. Below is patient/family & physician during clinic visit. a list of common conditions treated at SHC-Portland. Medical providers can demonstrate improvements Skeletal abnormalities – Osteogenesis imperfecta (OI), osteochondritis dissecans (OCD lesions), from interventions & adjust care management if Blount disease, skeletal dysplasias, etc. needed. Outcome Performance Improvement Neuromuscular conditions – Cerebral palsy, myelomeningocele (spina bifida), Muscular dystrophy, spinal muscular atrophy After one year of data collection, rates of Minimal Clinical Important Difference (MCID) were assessed for all patient-reported domains in both surgical and non-surgical populations. Multivariate Hand/Upper extremity
    [Show full text]
  • ROCHESTER REGIONAL HEALTH SPINE CENTER Spondylolisthesis
    ROCHESTER REGIONAL HEALTH SPINE CENTER Spondylolisthesis Overview There are different types of spondylolisthesis. The more common types include: Congenital spondylolisthesis – Congenital means “present at birth.” Isthmic spondylolisthesis – This type occurs as the result of spondylolysis, a condition that leads to small stress fractures (breaks) in the vertebrae. In some cases, the fractures weaken the bone so much that it slips out of place. Degenerative spondylolisthesis – This is the most common form of the disorder. With aging, the discs (the cushions between the vertebral bones) lose water, becoming less spongy and less able to resist movement by the vertebrae. The less common forms of spondylolisthesis include: Traumatic spondylolisthesis – An injury that leads to a spinal normal spine lolytic spine fracture or slippage. Causes & Symptoms Many people with spondylolisthesis have no symptoms and don’t even know they have the condition. When symptoms do occur, low back pain is the most common. The pain usually spreads across the lower back, and might feel like a muscle strain. Spondylolisthesis can also cause: • Muscle spasms in the hamstring muscles at the back of the thighs. Tight hamstrings can cause the person to walk with short strides and with the knees slightly bent. • Pain that may spread down the leg to the foot. • Tingling and/or numbness in the foot. Risk Factors Some common factors include: a disc disease, degenerative arthritis, advanced aging and prior back pain or surgery. Diagnosis An X-ray of the lower back can show a vertebra out of place. A CT or MRI scan, which produce more detailed images, might be needed to more clearly see the bones and nerves involved.
    [Show full text]
  • Supplementary Information For
    Supplementary Information for An Abundance of Developmental Anomalies and Abnormalities in Pleistocene People Erik Trinkaus Department of Anthropology, Washington University, Saint Louis MO 63130 Corresponding author: Erik Trinkaus Email: [email protected] This PDF file includes: Supplementary text Figures S1 to S57 Table S1 References 1 to 421 for SI reference citations Introduction Although they have been considered to be an inconvenience for the morphological analysis of human paleontological remains, it has become appreciated that various pathological lesions and other abnormalities or rare variants in human fossil remains might provide insights into Pleistocene human biology and behavior (following similar trends in Holocene bioarcheology). In this context, even though there were earlier paleopathological assessments in monographic treatments of human remains (e.g., 1-3), it has become common to provide details on abnormalities in primary descriptions of human fossils (e.g., 4-12), as well as assessments of specific lesions on known and novel remains [see references in Wu et al. (13, 14) and below]. These works have been joined by doctoral dissertation assessments of patterns of Pleistocene human lesions (e.g., 15-18). The paleopathological attention has been primarily on the documentation and differential diagnosis of the abnormalities of individual fossil remains, leading to the growing paleopathological literature on Pleistocene specimens and their lesions. There have been some considerations of the overall patterns of the lesions, but those assessments have been concerned primarily with non-specific stress indicators and traumatic lesions (e.g., 13, 15, 19-21), with variable considerations of issues of survival 1 w ww.pnas.org/cgi/doi/10.1073/pnas.1814989115 and especially the inferred social support of the afflicted (e.g., 22-27).
    [Show full text]
  • Spinopelvic Mobility As It Relates to Total Hip Arthroplasty Cup Positioning: a Case Report and Review of the Literature
    REVIEW Spinopelvic Mobility as it Relates to Total Hip Arthroplasty Cup Positioning: A Case Report and Review of the Literature ABSTRACT Alexander M. Crawford, MD1 Hip-spine syndrome occurs when arthroses of the hip and spine coexist. Patrick K. Cronin, MD1 Hip-spine syndrome can result in abnormal spinopelvic mobility, which is Jeffrey K. Lange, MD2 becoming increasingly recognized as a cause of dislocation following total James D. Kang, MD3 hip arthroplasty (THA). The purpose of this article is to summarize the cur- rent understanding of normal and abnormal spinopelvic mobility as it re- lates to THA component positioning and to provide actionable recommen- dations to prevent spinopelvic mobility-related dislocations. In so doing, we also provide a recommended workup and case-example of a patient AUTHOR AFFILIATIONS with abnormal spinopelvic mobility. 1Harvard Combined Orthopaedic Residency Program, Harvard Medical LEVEL OF EVIDENCE Level V Narrative Review School, Boston, MA 2Department of Adult Reconstruction and Total Joint Arthroplasty, Brigham KEYWORDS Spinopelvic mobility, hip-spine syndrome, fixed sagittal plane and Women’s Hospital, Boston, MA imbalance, total hip arthroplasty 3Department of Orthopaedic Spine Surgery, Brigham and Women’s Hospital, Boston, MA Dislocation following total hip arthroplasty (THA) causes significant morbidity for pa- CORRESPONDING AUTHOR tients, and accounts for approximately 17% of all revision hip replacement surgeries.1 THA Alex Crawford, MD instability can have multiple causes, including component malposition, soft tissue imbal- Massachusetts General Hospital ance, impingement, and late wear.2 Acetabular component positioning has been one major Department of Orthopaedic Surgery consideration historically for optimizing construct stability. The classic ‘safe zone’ for cup 55 Fruit St, White 535 position described by Lewinneck et al.
    [Show full text]
  • Hypermobility Syndrome
    EDS and TOMORROW • NO financial disclosures • Currently at Cincinnati Children’s Hospital • As of 9/1/12, will be at Lutheran General Hospital in Chicago • Also serve on the Board of Directors of the Ehlers-Danlos National Foundation (all Directors are volunteers) • Ehlers-Danlos syndrome(s) • A group of inherited (genetic) disorders of connective tissue • Named after Edvard Ehlers of Denmark and Henri- Alexandre Danlos of France Villefranche 1997 Berlin 1988 Classical Type Gravis (Type I) Mitis (Type II) Hypermobile Type Hypermobile (Type III) Vascular Type Arterial-ecchymotic (Type IV) Kyphoscoliosis Type Ocular-Scoliotic (Type VI) Arthrochalasia Type Arthrochalasia (Type VIIA, B) Dermatosporaxis Type Dermatosporaxis (Type VIIC ) 2012? • X-Linked EDS (EDS Type V) • Periodontitis type (EDS Type VIII) • Familial Hypermobility Syndrome (EDS Type XI) • Benign Joint Hypermobility Syndrome • Hypermobility Syndrome • Progeroid EDS • Marfanoid habitus with joint laxity • Unspecified Forms • Brittle cornea syndrome • PRDM5 • ZNF469 • Spondylocheiro dysplastic • Musculocontractural/adducted thumb clubfoot/Kosho • D4ST1 deficient EDS • Tenascin-X deficiency EDS Type Genetic Defect Inheritance Classical Type V collagen (60%) Dominant Other? Hypermobile Largely unknown Dominant Vascular Type III collagen Dominant Kyphoscoliosis Lysyl hydroxylase (PLOD1) Recessive Arthrochalasia Type I collagen Dominant Dermatosporaxis ADAMTS2 Recessive Joint Hypermobility 1. Passive dorsiflexion of 5th digit to or beyond 90° 2. Passive flexion of thumbs to the forearm 3. Hyperextension of the elbows beyond 10° 1. >10° in females 2. >0° in males 4. Hyperextension of the knees beyond 10° 1. Some knee laxity is normal 2. Sometimes difficult to understand posture- forward flexion of the hips usually helps 5. Forward flexion of the trunk with knees fully extended, palms resting on floor 1.
    [Show full text]