Abstract

Sarcopenia is recognized as a major health problem among older adults. This syndrome is associated with serious health consequences in terms of frailty, disability, morbidity and mortality. The aim of this study is to review sarcopenia and its impact on quality of life (QoL). MEDLINE database was searched from January to March 2016 using predefined search terms “sarcopenia”, quality of life”. Based on extensive literature search, 32 articles were identified while only 6 studies met the inclusion criteria and were associated with sarcopenia and QoL. Quality of life level was measured using generic self-reported tools; the Medical Outcomes Survey Short-form General Health Survey (SF-36) in 4 studies and EuroQol-5D instrument (EQ-5D) in 2 studies. Subjects with sarcopenia demonstrated a significantly high proportion of problems relating to several dimensions of QoL. More studies based on Sarcopenia and QoL are needed. Although the impact of sarcopenia on QoL was assessed in all studies with QoL generic instruments, it would be more insightful to utilise a disease-specific quality of life questionnaire, such as the SarQoL for sarcopenic subjects.

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 Abstract

BACKGROUND:

Scoliosis X-rays are the gold standard for assessing preoperative lumbar lordosis; however, particularly for flexible lumbar deformities, it is difficult to predict from these images the extent of correction required, as standing radiographs cannot predict the thoracolumbar alignment after intraoperative positioning.

OBJECTIVE:

To determine the utility of preoperative MRI in surgical planning for patients with flexible sagittal imbalance.

METHODS:

We identified 138 patients with sagittal imbalance. Radiographic parameters including pelvic incidence and lumbar lordosis were obtained from images preoperatively.

RESULTS:

The mean difference was 2.9° between the lumbar lordosis measured on supine MRI as compared to the intraoperative X-rays, as opposed to 5.53° between standing X-rays and intraoperative X-ray. In patients with flexible deformities (n = 24), the lumbar lordosis on MRI measured a discrepancy of 3.08°, as compared to a discrepancy of 11.46° when measured with standing X-ray.

CONCLUSION:

MRI adequately determined which sagittal deformities were flexible. Furthermore, with flexible sagittal deformities, lumbar lordosis measured on MRI more accurately predicted the intraoperative lumbar lordosis than that measured on standing X-ray. The ability to preoperatively predict intraoperative lumbar lordosis with positioning helps with surgical planning and patient counseling regarding expectations and risks of surgery.

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 Abstract

BACKGROUND:

In spinal deformity treatment, the increased utilization of 3-column (3CO) osteotomies reflects greater comfort and better training among surgeons. This study aims to evaluate the longitudinal performance and adverse events (complications or revisions) for a multicenter group following a decade of 3CO.

OBJECTIVES:

To investigate if performance of 3CO surgeries improves with years of practice.

METHODS:

Patients who underwent 3CO for spinal deformity with intra/postoperative and revision data collected up to 2 yr were included. Patients were chronologically divided into 4 even groups. Demographics, baseline deformity/correction, and surgical metrics were compared using Student t -test. Postoperative and revision rates were compared using Chi-square analysis.

RESULTS:

Five hundred seventy-three patients were stratified into: G1 (n = 143, 2004-2008), G2 (n = 142, 2008-2009), G3 (n = 144, 2009-2010), G4 (n = 144 2010-2013). The most recent patients were more disabled by Oswestry disability index (G4 = 49.2 vs G1 = 38.3, P = .001), and received a larger osteotomy resection (G4 = 26° vs G1 = 20°, P = .011) than the earliest group. There was a decrease in revision rate (45%, 35%, 33%, 30%, P = .039), notably in revisions for pseudarthrosis (16.7% G1 vs 6.9% G4, P = .007). Major complication rates also decreased (57%, 50%, 46%, 39%, P = .023) as did excessive blood loss (>4 L, 27.2 vs 16.7%, P = .023) and bladder/bowel deficit (4.2% vs 0.7% P = .002). Successful outcomes (no complications or revision) significantly increased ( P = .001).

CONCLUSION:

Over 9 yr, 3COs are being performed on an increasingly disabled population while gaining a greater correction at the osteotomy site. Revisions and complication rate decreased while success rate improved during the 2-yr follow-up period.

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Updated / Wednesday, 27 Sep 2017 10:56

There are five spinal surgeons in Crumlin with only three theatre days, says the Scoliosis Advocacy Network

A spokesperson for the Scoliosis Advocacy Network has said the theatre at Our Lady’s Children’s Hospital, Crumlin will have to be opened for five days a week, if the Government and Health Service Executive are to fulfil a commitment to drastically reduce waiting lists for scoliosis surgery.

Co-founder of the Scoliosis Advocacy Network Michelle Long said there are five spinal surgeons in Crumlin with only three theatre days.

She said she did not know why this was the case and only management at the hospital could answer that question.

Speaking on RTÉ’s Morning Ireland, Ms Long said outsourcing now seemed to be the preferred method of clearing, with suitable children being sent abroad for surgery.

She said this option was unfair to parents and children, who feel under pressure to travel because they cannot get a surgery date in Ireland.

“If you don’t go to Germany for example, there’s no surgery date free in Ireland and it’s emotional blackmail. Parents are really left with no choice if they’re told that if they stay in Ireland, there is no date,” she said.

Ms Long said there would be a backlog of surgeries carried over to 2018, unless a considerable number of children went abroad for treatment.

report from the Ombudsman for Children in March found that children have been experiencing significant waiting times for scoliosis surgery, up to 18 months in some cases.

Speaking at the Oireachtas Joint Committee on Health todayMinister for Health Simon Harris said waiting lists for scoliosis, even in ‘Celtic Tiger’ times, had been unacceptably high for children.

He said an additional €10 million had been provided along with consultant posts and theatre nurses.

Mr. Harris said there were more surgeries in Temple Street and Crumlin hospitals this year compared to 2016.

He defended international outsourcing to deal with the backlog, saying that while outsourcing was not the answer, it was necessary to reduce waiting lists.

“I don’t apologise offering parents an additional route,” he said.

 

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By Emily Harrison | 9/29/17 3:22pm

Michaela Jacobs is reigning Miss Florida 2017, she is past Miss Teen USA 2016, and as of this year, a member of Elon’s class of 2021.

With such big accomplishments in the pageantry world, it may seem like Jacobs is experienced in participating in beauty pageants. However, this is not the case. Jacobs first entered a beauty pageant on a whim at seventeen and proceeded to win on a national level.

Jacobs still describes the event as a surreal moment.

“There is that initial moment where you are like ‘OMG,’ is this me?’” Jacobs said. “Did this really just happen? Just utter elation. And sheer joy. I still can’t believe it.”

At her first pageant, when Jacobs became the Miss Teen USA 2016, her career as a beauty pageant queen started. She traveled across the United States, where she met other important figures in the pageantry world. From there Jacobs added to her growing resume the title of Miss Florida 2017, which she still holds.

Jacobs says the pageantry world changed her life for the better.

“I was so pleasantly surprised,” Jacobs said. “It really has shaped my path, who I am and the choices that I’ve made. I am just so honored to be involved in a community of women who are so driven, so passionate and so committed to their platform topics — whatever they may be.”

Jacobs acts as an ambassador for beauty pageant queens across the United States, and platform topics is one of the requirements of being a pageant contestant. Platform topics are causes that contestants choose to stand for and represent while competing.Throughout her years competing, Jacobs has represented two causes, one of which being The Crown Cares. The Crown Cares, or otherwise known as Creating A Respectful Environment in School, is specifically designed to promote awareness about bullying in schools in students of every grade. Through social clubs, anti-bullying books, and various craft activities, Jacobs says there is so much more to being a beauty queen than meets the eye; it’s about being a role model.

“I like to say there are ‘trials and triumphs’ and I know that defines my story. I’ve had so many trials in my life leading up to this point,” Jacobs said. “That the triumph that I have to now hold the title of Miss Florida and to encourage young girls who are going through trials of their own, that there’s hope for them.”

Jacobs has faced many trials throughout her life including scoliosis. She was first diagnosed during her freshman year of high school, and was told to not dance during the talent competitions.

“When I was diagnosed I was initially told that I shouldn’t dance, that it wasn’t healthy for me, that it wasn’t recommended,” Jacobs said. “But it was my passion and how could I walk away from that?”

Instead, Jacobs uses her scoliosis as her strength, using it to connect with children who also live with the condition. She is an ambassador of Scoliosis Awareness and uses her position as a beauty pageant queen to gain more awareness for the cause. For Jacobs, the point of being a beauty pageant queen is so she can help encourage little girls all over the country.

“Now I can encourage other girls who are facing issues of their own whether it is with a health issue like scoliosis, a mental issue that they are facing, or whatever it might be, that there is hope for them and that they can overcome it,”  Jacobs said. “They can be the best versions of themselves too.”

However, being a beauty pageant queen isn’t just about bettering others, but also herself. Jacobs suffered from insecurity through her middle school and high school years, and being a beauty pageant queen gave her the confidence boost she needed to hold her head up high.

“It really just taught me that the only thing holding me back is myself. That my fears can’t stifle my passions,” Jacobs said. “And once I was able to overcome those and then win that national title, the sky was truly the limit.”

For now, Jacobs has decided to take a short break from the pageant world to focus on her education in Musical Theatre at Elon University. Elon currently has one of the most prestigious Musical Theatre Programs in the country with over 800 applicants applying and only 20 accepted. As a member of this elite group, Jacobs says she is happy to be here, but will not forget her pageant roots as it is a part of her now.

 

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Wirral schoolgirl Julia Carlile speaks to the ECHO about her recovery.

Teenage Britain’s Got Talent star Julia Carlile is set for her first dance performance since Simon Cowell funded her £175,000 spinal operation.

The major step on the West Kirby 15-year-old’s journey to recovery comes after she returned home from America late last month – having undergone the two rounds of major life-changing surgery paid for by the TV mogul.

If the schoolgirl had not accessed the vital treatment and instead been tended to in the UK for her scoliosis condition she says it would have left her “stiff as a board” and unable to fulfil her passion for dance.

Julia captured the nation’s hearts with her ongoing health battle and incredible dancing in the BGT finals with her troupe MerseyGirls.

After the operations, around six weeks ago, Julia said she was still in a lot of pain even when lying on the sofa.

However two weeks ago that all began to change with more movement returning and the soreness in her body easing.

Now, in her excitement at being able to dance again, she has even been practising moves in her lounge – despite her mum telling her to rest and be careful.

In an exclusive chat with the ECHO, Julia said: “I’ll be able to dance in another two months which is crazy because with the other surgery I just wouldn’t have been able to.

“In the future MerseyGirls can carry on dancing for ever and ever, which is what we always dreamt of, so the surgery is literally the best thing that has ever happened.”

Julia says the dance troupe have a lot of plans for the new year after her first performance back with the team but that’s all being kept under wraps at the moment.

The dancer was diagnosed with scoliosis at six years old, she says the condition “slowly got worse and worse” and doctors made a number of attempts to slow her spine from curving, including the use of back braces.

She said: “It wasn’t too bad at first but then I started to get a really big rib hump and my whole body was on a wonk.

“That meant I couldn’t do certain dance moves which really started to affect my life.

“Dancing was really hard, I couldn’t do certain moves and I got really mad. I just wanted it to be gone and be like everyone else.

“I was in a lot more pain so surgery was the only answer. However, the condition made me different and it has got me where I am today.”

In the two years before Julia was due to have diffusion surgery, an operation that would have left her unable to dance, she said she competed in every dance competition she was able to, despite being in “a lot of pain”.

Julia said: “My surgery was going to be just after BGT. I thought that was the last dance I was ever going to do.

“Obviously that all changed. We found this surgery in America a few years ago that could carry out an operation on my back which would still allow me to dance.

“We looked into it but could never afford it. That was completely gone to me.

“Then Simon Cowell read up on it and offered to pay for the surgery which was crazy, it is unreal still now and we cannot thank him enough.”

Before the operation, the angle of Julia’s back curve was more than 100 degrees but it was corrected to around 50.

Julia added: “I had two major surgeries and they halved the curve in my spine. I am really happy with the results.

“I feel like I’m starting to get better and I’m just looking forward to performing with MerseyGirls now – I am itching to dance!

“It’s been really crazy since I’ve been back from America.

“We went to the Reality TV Awards and I was back with MerseyGirls and that felt really good. It was like starting a normal life again being back with the girls.”

 

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September 26, 2017

PHILADELPHIA — According to a presenter at the Scoliosis Research Society Annual Meeting, spinal osteotomy may improve quality of life for patients with ankylosing spondylitis kyphosis.

“From our series of clinical research, we had to know what is the sagittal decision-making for these kinds of patients, the proper osteotomy and osteotomy site, and how to calculate the correct angles,” Yan Wang, MD, said during his presentation.

In a retrospective study, Wang and colleagues reviewed information for 448 patients with ankylosing spondylitis kyphosis who underwent spinal osteotomy. Patients either underwent one-level transpedicular spinal osteotomy or two-level transpedicular osteotomy from T12-L3, based on the apex of kyphosis, deformity type and neurological conditions. Radiological parameters were measured preoperatively and postoperatively. Investigators recorded any complications.

Researchers found patients were able to walk with horizontal vision and lie on their backs postoperatively. In patients who underwent two-level osteotomy, the chin-brow vertical angle improved from 68.3° to 8.2°. This measurement went from 46.2° to 4.2° in patients who underwent one-level osteotomy. Investigators noted that in patients who underwent two-level osteotomy, the mean sagittal balance improved from 29.4 cm to 8 cm. This went from 18 cm to 4.3 cm in those who underwent one-level osteotomy.

At the superior site of the osteotomy, the amount of correction in the two-level group was 27.7° and was 42.1° at the inferior site. In the one-level group, it was 46.2°. There were no major complications in the study. Investigators found 32 patients with one or two complications, which included transient neurological deficit, vascular laceration bleeding, infections, postoperative low back pain, a broken spinal rod, pedicle screw pull out, non-fusion at the osteotomy site and cerebrospinal fluid leaks.

“Two-level spinal osteotomy show[s] risk tendency of higher operation-related complications,” the researchers wrote in their abstract. – by Monica Jaramillo

Reference:

Wang Y, et al. Paper #39. Presented at: Scoliosis Research Society Annual Meeting; Sept. 6-9, 2017; Philadelphia.

Disclosure: Wang reports no relevant financial disclosures.

 

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Fabien D. Bitan, MD, Orthopedist and Spine Surgeon at Manhattan Orthopedic Spine, and affiliated with Lenox Hill Hospital, Mount Sinai Beth Israel, and Saint Barnabas Medical Center, has been named a 2017 Top Doctor in New York City, New York. Top Doctor Awards is dedicated to selecting and honoring those healthcare practitioners who have demonstrated clinical excellence while delivering the highest standards of patient care.

Dr. Fabien D. Bitan is a vastly experienced and highly acclaimed surgeon who has been in practice for over 32 years. His distinguished medical career started in his native France in 1985 when he graduated from the University of Paris. Dr. Bitan later completed a residency in Orthopedic Surgery at the Assistance Publique Hopitaux de Paris, followed by a residency in Pediatric Orthopedics at the Institut Francoise Calot in Berck sur Mer in France. After a fellowship in France, Dr. Bitan relocated to the United States and completed further fellowships at New York’s Hospital for Special Surgery and at the Beth Israel Medical Center.

Dr. Bitan is board certified by the American Board of Orthopaedic Surgery, and has a wealth of experience as an orthopedist gained in both France and America. He is particularly renowned, however, as an expert spine surgeon, and has embraced the latest minimally invasive surgical treatments that can accelerate typical recovery times. Conditions treated by him include spinal deformities such as scoliosis and kyphosis, as well as spinal fractures. He is also renowned internationally for being at the forefront of the use of artificial disc replacement technology that is transforming lives today.

Dr. Bitan was awarded a ‘Certificate Of Appreciation’ by the New York State Chiropractic Association, and he is also a member of many other professional organizations including the North American Spine Society, the American College of Spine Surgery, the Scoliosis Research Society, and the International Society of Endoscopic Spine Surgery. His expertise, and his important research, makes Dr. Fabien D. Bitan a very worthy winner of a 2017 Top Doctor Award.

About Top Doctor Awards

Top Doctor Awards specializes in recognizing and commemorating the achievements of today’s most influential and respected doctors in medicine. Our selection process considers education, research contributions, patient reviews, and other quality measures to identify top doctors

Direct link:  https://www.prnewschannel.com/2017/08/29/esteemed-orthopedist-fabien-d-bitan-md-is-to-be-recognized-as-a-2017-top-doctor-in-new-york-new-york/

 

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LONE TREE, Colo. – Dr. Jaren Riley knows his young patients are nervous when he prescribes a back brace for scoliosis, but now he can talk to them about the experience.

The pediatric orthopedic surgeon at Rocky Mountain Hospital for children wore a back brace 18 hours a day for a week.

“I felt like I had good scientific reasons for them to wear the brace, but I didn’t have good answers for them as far as- What does it feel like? What’s it like getting used to it? How do I dress? How do I sleep?   And so I needed more experience to be able to answer those questions,” Dr. Riley said.

While wearing the brace, he says it was not painful, but it was confining.

“What it feels like is that I’m that tube of toothpaste with that last little bit of toothpaste in it, and you are just trying to squeeze me from bottom to top,” Dr. Riley said.

About one in 100 kids have scoliosis of some level.  If the curve in their spine is 25 to 40 degrees, they are a candidate for a brace.  The brace can potentially reduce the need for surgery by 50 percent.  But it can mean some changes for patients.

Aracely Talamantes’s son Andrew has scoliosis.  She says patient families really appreciate Dr. Riley’s efforts.  “It makes them know that he really does care,” she said.

 

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Pediatric Spinal Deformities

Spinal deformities in children may be the result of many conditions, such as congenital malformation of the spinal column, disorders of the neuromuscular system or trauma. They may be progressive in which case their severity increases with age, leading to restrictions of pulmonary growth, nerve function and heart pumping capacity.

Classification

The classification of pediatric spinal disorders has undergone several metamorphoses, such as that by King and Lenke et al. Their usefulness always depends on how well they are able to recognize the impact of the root condition, as well as the predicted effect on normal growth of the child, the natural history, and the extent of disability that is possible and preventable by appropriate management.

Pathological systems of classification focus upon the reason for the deformity, such as abnormal spine development, neuromuscular disease leading to unbalanced strains on the developing cord, or other disorders of spinal column formation. Other systems classify them by the age of onset, whether infancy, early childhood, or adolescence. The most commonly used systems deal with the structural changes that are present, such as the degree of curvature, the direction and rotation of the spine, as well as other anatomical results of the deformity. These structural systems offer the most help with clinical management and are the most reliable with respect to the response to treatment.

The most common spinal deformities in childhood include scoliosis (curving of the spine to one side), kyphosis (curvature of the spine in the backward direction), spondylolysis (stress fractures in the lower back) and spondylolisthesis (one vertebra slips over another).

Diagnosis and treatment

Pediatric spinal deformities can be diagnosed based on the patient history, family history, and complete physical examination. Clinical findings, such as unequal height of shoulders, tilted head or pelvis, difficulty in breathing, limping or back pain, may be found. Imaging modalities are very useful in diagnosing these conditions, such as X-rays, CT, MRI and DEXA scans. Most spinal deformities require only observation to ensure that they are not progressing.

The management of pediatric spinal deformities depends on the extent to which they have been allowed to interfere with normal growth. Growth spurts soon after birth, as well as during adolescence, can aggravate the malformations. These have to be anticipated when planning corrective surgery to prevent undue shortening of the spine.

Treatment may be non-surgical or surgical. Nonsurgical treatment includes brace application and spinal casts. Surgical correction includes fusing a segment of the spine with screws and rods to arrest or reverse the deformity.  In children who are still growing, growing rods are used, which can be expanded every few months to keep up with the increase in spinal length.  Once growth is complete spinal fusion is performed.

References

1. https://www.ncbi.nlm.nih.gov/pubmed/15766220
2. https://www.ncbi.nlm.nih.gov/pubmed/14713581
3. https://www.emoryhealthcare.org/pediatricorthopedics/spinaldeformity.html
4. http://thejns.org/doi/pdf/10.3171/foc.2003.14.1.4
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940247/
6. http://www.chop.edu/conditionsdiseases/spinaldeformities

Reviewed by Jonas Wilson, Ing. Med.

Further Reading

What Causes Pediatric Spinal Deformities?

Testing and Diagnosing Pediatric Spinal Deformities
Last Updated: Aug 22, 2017

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