Different Curve Pattern and Other Radiographic Characteristics in Male and Female Patients with Adolescent Idiopathic Scoliosis.

By London Spine

Different Curve Pattern and Other Radiographic Characteristics in Male and Female Patients with Adolescent Idiopathic Scoliosis.

Spine (Phila Pa 1976). 2012 Mar 1;

Authors: Wang W, Zhu Z, Zhu F, Sun C, Wang Z, Sun X, Qiu Y

Abstract
ABSTRACT: Study design. Retrospective radiographic study.Objective. To compare the gender differences in curve patterns and radiographic characteristics in patients who have adolescent idiopathic scoliosis (AIS).Summary of Background Data. Gender differences in AIS have been documented in the incidence of curve progression, response to bracing, and outcomes of surgical treatment. However, limited information is available about the relation between sex and scoliosis curve patterns and radiographic presentations.Methods. 359 male and 999 female AIS patients with major curve ? 20º were recruited. Standard posteroanterior and lateral radiographs of spine were reviewed to classify scoliosis curve patterns as typical or atypical, and to measure curve severity and thoracic kyphosis. In 351 surgically treated patients, side-bending films were used to assess curve flexibility. Comparisons between male and female patients were made by subgrouping patients according to curve patterns and severity.Results. Atypical curves were more frequently observed in male (19.8%) than in female gender (8.9%) (p < 0.01). Gender differences were also found in the distribution of curve types. Main thoracic curve was the most common curve type in both genders. Furthermore, significantly higher incidence of main thoracic curve in severe AIS than moderate patients was found in male (p < 0.001) but not in female gender. In patients with severe AIS who had typical curve patterns that included a major thoracic curve, male patients had larger magnitude of thoracic curve, more severe thoracic kyphosis, and more rigid thoracic and lumbar curves than female patients.Conclusions. Atypical curve patterns were more predominantly in male than female AIS. The thoracic curve in male AIS patients might have higher incidence of progression than female gender. The higher rigidity of both thoracic and lumbar curves in male AIS with severe curves might contribute to the lower curve correction rate and poor response to brace when compared to female cases.

PMID: 22391440 [PubMed – as supplied by publisher]

Expectations of benefit and tolerance to risk of individuals with spinal cord injury regarding potential participation in clinical trials.

By London Spine
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Expectations of benefit and tolerance to risk of individuals with spinal cord injury regarding potential participation in clinical trials.

J Neurotrauma. 2012 Dec 10;29(18):2727-37

Authors: Kwon BK, Ghag A, Dvorak MF, Tetzlaff W, Illes J

Abstract
We conducted a survey of individuals living with spinal cord injury (SCI) to determine their receptivity to participating in clinical trials of drug therapies or stem cell therapies, their anticipation of therapeutic benefits, and their tolerance to risk. A 46-item questionnaire was administered to individuals with cervical or thoracic SCI identified through a provincial database. The average age was 42 years and the individuals were, on average, 5.5 years post-injury. Receptivity to neuroprotective drug trials in the acute setting was very high, but somewhat less so for stem cell trials in the subacute or chronic (current) setting. With respect to expectation of functional benefit, approximately one third of the respondents indicated that they would want a 5-25% chance of achieving some functional recovery if enrolling in a stem cell therapy clinical trial in the current, chronic injury state. Whereas the majority typically would require the risk of spinal cord damage, cancer, infection, and nerve pain from invasive cell transplantation trials to be ≤1%, 15-30% would participate regardless of the risk of these complications. The factors associated with this high risk tolerance were gender (males>females), age (elderly>young), and self-reported knowledge of SCI research (greater knowledge>less knowledge). Injury severity or chronicity did not have a significant correlation with risk tolerance. Whereas previous studies have shown that the understanding of stem cell science is limited among individuals with SCI, here we show that many still have high hopes for the possibility of neurological benefit, are anxious to participate in invasive stem cell trials, and, in many cases, have high tolerance for risk in such trials. Taken together, the data underscore the need for careful communication with individuals with SCI to avoid unrealistic expectations and therapeutic misconception in experimental trials.

PMID: 22924691 [PubMed – indexed for MEDLINE]