Author Interviews, CMAJ, Orthopedics, Rheumatology, Surgical Research / 02.02.2021

MedicalResearch.com Interview with: Codie Primeau, MSc Physical Therapy Student & Ph.D. Candidate (Combined MPT/Ph.D.) Wolf Orthopaedic Biomechanics Lab, Fowler Kennedy Sport Medicine Clinic Western University London, ON, Canada MedicalResearch.com: What is the background for this study? Response: High tibial osteotomy (HTO) is a surgery for patients with varus alignment (bowed legs) and earlier-stage knee osteoarthritis. By correcting alignment, HTO shifts load to less diseased parts of the knee. One of the goals of HTO is to delay or even prevent the need for knee replacement surgery later.  (more…)
Author Interviews, Genetic Research, Orthopedics / 18.12.2020

MedicalResearch.com Interview with: Karin Magnusson PT, PhD Associate Researcher Lund University and Norwegian Institute of Public Health MedicalResearch.com: What is the background for this study? Response: Anterior cruciate ligament (ACL) injury is one of the most common knee injuries, for which very limited data has been presented on the genetic contribution. Based on our knowledge of the role of genetics in the development of ACL-rupture related traits, such as joint hypermobility and knee osteoarthritis, we hypothesized that heritability might play a role also in ACL injury. Using the Swedish Twin Registry, which is the world's largest twin registry and in this study including more than 88.000 twins, we had unique data to for the first time reliably estimate the heritability for this common knee injury.  (more…)
Author Interviews, NYU, Orthopedics / 10.08.2020

MedicalResearch.com Interview with: Bruce N. Cronstein, MD Paul R. Esserman Professor of Medicine NYU School of Medicine Director, NYU-H+H Clinical and Translational Science Institute Director, Division of Translational Medicine NYU Langone Health New York, NY 10016  MedicalResearch.com: What is the background for this study? Response: Osteoarthritis is the most common type of arthritis affecting about 10% of the adult population and 25% of the population over 60. We had previously found that adenosine, a molecule generated by nearly all cell types, is critical for maintaining cartilage health by activating specific adenosine receptors on the surface of cells (A2A receptors). Moreover, giving adenosine into the joint could prevent deterioration of cartilage (progression of osteoarthritis) in a rat model of osteoarthritis. Because people do not usually go for treatment of osteoarthritis until they have developed symptoms we asked whether administration of adenosine or adenosine that had been modified to be a more potent and specific stimulus for A2A receptors, carried in fat bubbles called liposomes, could reverse osteoarthritis after it had already started. (more…)
Author Interviews, JAMA, Orthopedics, Race/Ethnic Diversity, Surgical Research / 19.05.2020

MedicalResearch.com Interview with: Alyson Cavanaugh, PT, PhD Joint Doctoral Program in Epidemiology University of California, San Diego/ San Diego State University MedicalResearch.com: What is the background for this study? Response: More than 700,000 total knee replacements are performed annually in the United States, but there is a racial disparity in outcomes after the surgery. If the knee replacement procedure is considered a highly effective treatment, why don't black women present with the same outcomes as whites? Physical function when going into surgery has a large impact on the potential functional outcomes after surgery. Our hypothesis was that black women were presenting to surgery with poorer physical function, which was contributing to poorer functional outcomes after surgery. (more…)
Author Interviews, Orthopedics, Surgical Research / 23.03.2020

MedicalResearch.com Interview with: Pincus MD PhD Division of Orthopaedic Surgery, Department of Surgery University of Toronto Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery ICES, Toronto, Ontario, Canada MedicalResearch.com: What is the background for this study? Response: Controversy exists among arthroplasty surgeons and patients about the best surgical approach for total hip arthroplasty (THA) - one of the most common operations performed worldwide. In the last few years, the direct anterior approach has become increasingly popular compared to posterior and lateral approaches, partially as a result of advertising to patients.  We sought to determine whether a direct anterior surgical approach was associated with lower surgical complications compared to lateral and posterior approaches. (more…)
Author Interviews, Hip Fractures, JAMA, Orthopedics / 31.01.2020

MedicalResearch.com Interview with: Alison M. Cogan, PhD, OTR/L Polytrauma/TBI Advanced Fellow Washington DC VA Medical Center Washington DC MedicalResearch.com: What is the background for this study? Response: Medicare is shifting from a volume- to value-based payment for postacute care services, in which value is determined by patient characteristics and functional outcomes. Matching therapy time and length of stay (LOS) to patient needs is critical to optimize functional outcomes and manage costs. The objective of this study was to investigate the association among therapy time, LOS, and functional outcomes for patients following hip fracture surgery. This retrospective cohort study analyzed data on patients from 4 inpatient rehabilitation facilities and 7 skilled nursing facilities in the eastern and midwestern United States. Participants were patients aged 65 years or older who received inpatient rehabilitation services for hip fracture and had Medicare fee-for-service as their primary payer. We categorized patients into nine recovery groups based on low, medium, and high therapy minutes per day and low, medium, or high rate of functional gain per day. We measured the groups for functional mobility independence and self-care capabilities at the time each patient was discharged. (more…)
Author Interviews, Orthopedics, PLoS / 12.08.2019

MedicalResearch.com Interview with: Prof. Inger Mechlenburg, PhD, DMSc Orthopaedic Department, Aarhus University Hospital Department of Clinical Medicine Aarhus University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Traditionally, displaced 2-part humerus fractures have been operatively treated using a metal plate and screws. However, there are no studies showing a benefit of operation of those fractures. Therefore, we were interested in investigating, in a direct comparison between operation and non-operative treatment, whether there was a difference in patient-reported function, pain and health-related quality of life two years after the fracture. In this Nordic research collaboration http://nitep.eu/en/ between Finland, Sweden, Estonia and Denmark we showed that there is no difference in functional results between operative and non-operative treatment in persons aged 60 or more with displaced proximal humerus fractures. In the study, only fractures with a significant displacement between bone fragments were included. In the non-operative treatment group, patients used a collar and cuff sling for three weeks and underwent instructed physiotherapy. (more…)
Author Interviews, Brigham & Women's - Harvard, Opiods, Orthopedics, Pain Research, Surgical Research / 16.05.2019

MedicalResearch.com Interview with: Marilyn M. Heng, MD, MPH, FRCSC Orthopaedic Trauma Surgeon Assistant Professor of Orthopaedic Surgery Harvard Medical School  MedicalResearch.com: What is the background for this study?   Response: The ultimate background for this study does come from the larger context of the opioid epidemic that is seen worldwide but particularly in North America. Orthopaedic surgeons should take responsibility as being among the top prescribers of opioids. The more specific background that led to this specific study was the observation that several colleagues would insist that a drug like hydromorphone was so dangerous that they would not prescribe it but seemed okay prescribing large amounts of oxycodone.  It seemed like an urban myth that the type of opioid was what made it dangerous, so that led us to do the study to see if there was evidence for that.  (more…)
Author Interviews, Orthopedics, Pain Research / 19.03.2019

MedicalResearch.com Interview with: Geoffrey Westrich, MD Director of Research Adult Reconstruction and Joint Replacement Service Hospital for Special Surgery NYC  MedicalResearch.com: What is the background for this study? Response: Recent mortality trends in the U.S. associated with opioid use disorders have brought to the forefront of national debate the desirability of minimizing the use of potentially addictive pain management therapies.  Pain management after hip replacement surgery is an important part of patient care, and  opioids are frequently given as a major part of postoperative pain management. At the same time, multimodal analgesia, the administration of anesthetic agents and medications agents targeting multiple pain pathways, has seen increased popularity in pain management after hip replacement surgery.  At Hospital for Special Surgery (HSS), the multimodal protocol entails the use of several different anesthetic agents and medications both during and after surgery to control pain, minimize the use of opioids and reduce side effects. The use of non-opioid analgesics such as acetaminophen allows for a reduction in opioid administration after surgery [1]. Acetaminophen, commonly known as Tylenol, has traditionally been administered orally, but more recently an intravenous (IV) preparation has become available.  IV acetaminophen after major orthopedic surgery was shown to provide effective analgesia and reduce morphine administration by 33%, compared to placebo [2]. Unless a patient is unable to take acetaminophen, it is commonly used as part of the multimodal protocol due to its efficacy and minimal contraindications. Although intravenous (IV) acetaminophen presents pharmacokinetic benefits, such as increasing both serum blood and cerebrospinal fluid levels more rapidly, there is limited analysis of its potential clinical advantages compared to oral acetaminophen.  We hypothesized that there could be a reduction in pain with activity, opioid usage, or opioid- related side effects among patients receiving IV acetaminophen compared to oral acetaminophen following hip replacement surgery  (more…)
Author Interviews, Opiods, Orthopedics / 18.03.2019

MedicalResearch.com Interview with: Paul Cagle, Jr. MD Assistant Professor of Orthopedic Surgery Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? What are the main findings ie What are some of the significant comorbidities?  Response: In this study our goal was to better understand what medical issues (medical comorbidities) can cause trouble or issue for patients with a proximal humerus fracture (shoulder fracture).  To tackle this issue we used a large national sample of patients and sorted our the different medical issues the patients had. We found that patients with increased medical issues had longer hospital stays and higher use of opioid medications (pain medications). (more…)
Author Interviews / 18.03.2019

MedicalResearch.com Interview with: Darwin Chen, MD Assistant Professor of Orthopedic Surgery Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? What are the main findings? Response: Periprosthetic joint infection unfortunately remains a leading cause of total knee arthroplasty failure. One method of mitigating the risk of PJI is to use antibiotic loaded bone cement in a prophylactic fashion. While the use of antibiotic cement makes inherent sense, the decision is not as simple as it seems. There are potential side effects such as renal damage, antibiotic hypersensitivity, and antibiotic resistance. Antibiotics decrease the mechanical strength of cement fixation, which may impact component loosening. Additionally, antibiotic cement is significantly more expensive than standard cement, driving up cost. Currently there is no consensus on if antibiotic cement truly reduces infection risk and there are many conflicting studies. The purpose of our study is the use a large national database to evaluate real world utilization patterns of antibiotic cement, and assess outcomes, complications, and cost associated with antibiotic cement usage. Our hypothesis was that antibiotic cement is associated with a decreased risk of infection and no increased risk of systemic complications.  (more…)
Author Interviews, Orthopedics, Pharmacology, Rheumatology / 28.02.2019

MedicalResearch.com Interview with: Dr. Andrew Spitzer MD Co-director Joint Replacement Program Cedars-Sinai Orthopedic Center Los Angeles, CA MedicalResearch.com: What is the background for this study? How does this product differ from other steroid injections for inflammatory arthritis? Dr. Spitzer: Many patients receive repeat injections of intra-articular corticosteroids to manage recurrent osteoarthritis pain and other symptoms. However, in most clinical trials to date, patients only received a single corticosteroid injection, and patients were only followed for 12 to 24 weeks after treatment. For trials that have evaluated repeated injections of corticosteroids over a longer period of time—2 years, for example—injections were administered every 3 months, regardless of the timing of the return of OA symptoms. This is not reflective of what is done in clinical practice, where corticosteroids are administered again in response to the return of pain or a flare of inflammation in the knee. In this study, we used a flexible dosing schedule based on the patients’ symptoms, meaning that patients received the second injection of a recently approved extended-release corticosteroid only when their pain and/or symptoms returned, not before. Safety was monitored for 52 weeks—this length of time should be sufficient to identify any associated side effects, including any potential impact on the knee tissue. Triamcinolone acetonide extended-release (TA-ER; Zilretta®) was approved in late 2017 as an intra-articular injection for the management of osteoarthritis pain of the knee. The formulation utilizes microspheres which enable a slow release of the active agent (triamcinolone acetonide) into the synovial fluid for 12 weeks following injection. Previously, a Phase 3 study demonstrated safety and efficacy of a single injection of TA-ER (Conaghan PG, et al. J Bone Joint Surg Am. 2018;100:666-77). This is the first study evaluating the safety and patient response to repeat administration of TA-ER. This study also included patients that were more typical of who we see in the clinic—those who have higher body mass index, more severe disease, and received prior treatments for their osteoarthritis pain. (more…)
Author Interviews, Orthopedics, Technology / 02.02.2019

MedicalResearch.com Interview with: Professor Sherry Towfighian PhD Mechanical Engineering Binghamton University   MedicalResearch.com: What is the background for this study? What are the main findings?  Response: We wanted to avoid using batteries in a load monitor that can be placed in total knee replacement. We looked into energy scavenging technologies and studied the most appropriate one for this application. Energy scavenging is converting wasted energy such as walking to electricity for low power sensors. Our research study showed walking can provide enough electrical energy (about 6 microwatts) for low power load sensors. These load sensors are important in providing information about the mechanical load throughout different activities. It can be used in the future to create a self -awareness device for the patient to avoid certain activities.  (more…)
Author Interviews, BMJ, Orthopedics / 28.01.2019

MedicalResearch.com Interview with: Tero Kortekangas, MD, PhD Orthopaedic trauma surgeon Oulu University Hospital Oulu, Finland MedicalResearch.com: What is the background for this study? What are the main findings? Response: Isolated, stable, Weber B type fibula fracture is by far the most common type of ankle fracture. Traditionally these fractures are treated with below the knee cast for six weeks. Although the clinical outcome of this treatment strategy has been shown to be generally favourable, prolonged cast immobilisation is associated with increased risk of adverse effects, prompting attempts to streamline the treatment. However, perhaps because of absence of high quality evidence on the effectiveness and safety of more simple non-operative treatment strategies, the current tenet of six weeks of cast immobilisation still remains the “gold standard” treatment of stable Weber B type fractures. (more…)
Author Interviews, Orthopedics, Pediatrics / 19.12.2018

MedicalResearch.com Interview with: Dana L. Duren, PhD Professor, Director of Orthopaedic Research Director of Skeletal Morphology Laboratory Thompson Laboratory for Regenerative Orthopaedics Department of Orthopaedic Surgery Missouri Orthopaedic Institute, University of Missouri Columbia, MO 6521 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The motivation for this study is the apparent accelerated maturity in children in the United States.   We previously demonstrated that skeletal maturity (bone age) is more advanced in today’s children compared to children born in the first half of the 20thCentury (Duren et al., 2015). n the current study (Boeyer et al., 2018) we show that a significant component of this advanced maturity status is the timing of epiphyseal fusion. In our study, nearly half of the epiphyses of the hand and wrist began or completed fusion significantly earlier in children born after 1995 than those born in the early part of the century, with differences as great as six to ten months for some bones, and mean differences on the order of 4 months in boys and 6 months in girls.  (more…)
Author Interviews, Cost of Health Care, Geriatrics, Osteoporosis / 08.10.2018

MedicalResearch.com Interview with: Kandice A. Kapinos, Ph.D. Economist Professor RAND Corporation Pardee RAND Graduate School  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The economic burden of osteoporotic fractures is substantial with studies estimating the annual healthcare cost burden between $10 to 17 billion. Although estimates from individual studies vary, most studies assessing costs after a fracture only explore up to twelve months following a fracture. There is little investigation of how fracture patients’ costs evolve over a longer post-fracture period. As osteoporotic fractures are one of the most common causes of disability among older adults and can translate into greater medical costs, we focused on studying Medicare beneficiaries. In fact, previous research has suggested that most of the increase in Medicare spending over time can be explained from costs associated with treating higher risk Medicare beneficiaries. Our objective in this study was to compare health care costs over a 3-year period of those who experienced a fracture to those who did not among a sample of Medicare beneficiaries who were at an increased risk of having a fracture. Consistent with previous studies, we found a significant increase in expenditures in the year immediately following a fracture relative to controls: almost $14,000 higher for fractures relative to controls. However, at 2 and 3-years post-fracture, there were no significant differences in the change in expenditures between fracture cases and controls. We note that these findings may be different for beneficiaries living in skilled nursing facilities or other non-community-based settings. (more…)
Author Interviews, JAMA, Orthopedics, Surgical Research / 03.10.2018

MedicalResearch.com Interview with: "Meniscus adalah tisu/rawan berbentuk huruf C yang berfungsi mencegah dua tulang bergesel di antara satu sama lain di bahagian lutut. Tisu meniscus yang koyak berpunca kebiasaannya daripada bersukan yang melibatkan pergerakan lutut yang banyak. Warga emas" by Rawatan Alternatif Shah Alam is licensed under CC BY 2.0 Victor A. van de Graaf, MD OLVG Ziekenhuis Amsterdam MedicalResearch.com: What is the background for this study? What are the main findings? Response: Although meniscal surgeries are among the most frequently performed surgical procedures in orthopedic surgery, until just recently there were hardly any randomized trials proving its superiority over conservative treatment. In this randomized clinical trial, including 321 patients with non-obstructive (e.g. no locking of the knee joint) meniscal tears, we found physical therapy non-inferior to arthroscopic partial meniscectomy.  (more…)
Author Interviews, Emory, JAMA, Orthopedics / 25.09.2018

MedicalResearch.com Interview with: Prof. David H. Howard PhD Department of Health Policy and Management Emory University Atlanta, GA 30322 MedicalResearch.com: What is the background for this study? What are the main findings?  Response: There is a lot of skepticism that physicians respond to evidence, especially when trials report that widely-used, separately-reimbursed procedures are not effective. Physicians are reluctant to abandon treatments. This study shows that in the case of knee arthroscopy, evidence has made a difference. The use of knee arthroscopy declined by 23% in Florida between 2002 and 2015. This change occurred despite increases in the prevalence of osteoarthritis.  (more…)
Author Interviews, JAMA, Osteoporosis / 28.06.2018

MedicalResearch.com Interview with: Chien-Wen Tseng, M.D., M.P.H., M.S.E.E. Hawaii Medical Service Association Endowed Chair in health services and quality research Associate professor, and the Associate research director Department of Family Medicine and Community Health University of Hawaii John A. Burns School of Medicine  MedicalResearch.com: What is the background for this recommendation statement? What are the main findings and recommendations? Response: Osteoporosis is a condition where bones become weak and can break or fracture more easily. These fractures can happen at the spine, hip, and other locations, and can have serious health consequences such as pain, limited mobility, or even death. By 2020, more than 12 million Americans over the age of 50 are expected to have osteoporosis and two million fractures occur yearly. Since people often may not know they have osteoporosis until they have a fracture, the U.S. Preventive Services Task Force looked at the evidence to see if screening for osteoporosis can help to prevent fractures. We found that screening for and treating osteoporosis can prevent fractures in women ages 65 and older and in younger women who have been through menopause and have additional factors that put them at increased risk for osteoporosis. In men, more research is needed to know if routine screening and treatment for osteoporosis can prevent fractures. (more…)
Author Interviews, Orthopedics, Rheumatology / 18.06.2018

MedicalResearch.com Interview with: Samuel Hawley | Research Assistant (NIHR PhD Project) | Pharmaco- and Device Epidemiology Group | Centre for Statistics in Medicine | NDORMS | University of Oxford  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The aim was to disentangle some of the potential reasons for the recent decline in joint replacement rates among rheumatoid arthritis (RA) patients in the developed world. The main findings from our UK patient-level analysis indicated that joint replacement rates were not significantly different for users of TNF inhibitors versus the patients who remained only on conventional synthetic DMARDS, however we did find that TNF inhibitor use amongst older RA patients was associated with a 40% reduction in hip replacement rates. (more…)
Author Interviews, Cost of Health Care, Medicare, Orthopedics / 12.06.2018

MedicalResearch.com Interview with: Amol Navathe, MD, PhD Assistant Professor, Health Policy and Medicine Perelman School of Medicine University of Pennsylvania MedicalResearch.com: What is the background for this study? Response: Bundled payment is a key Medicare Alternative Payment Model (APM) developed by the Centers for Medicare and Medicaid Services (CMS) to increase health care value by holding health care organizations accountable for spending across an episode of care. The model provides financial incentives to maintain quality and contain spending below a predefined benchmark. In 2013, CMS launched the Bundled Payments for Care Improvement (BPCI) initiative to expand bundled payment nationwide. BPCI’s bundled payment design formed the basis for CMS’s Comprehensive Care for Joint Replacement (CJR) Model beginning in 2016. While the programs are similar in design, BPCI is voluntary while CJR is mandatory for hospitals in selected markets. Moreover, CJR is narrower in scope, focusing only on lower extremity joint replacement (LEJR) and limiting participation to hospitals. (more…)
Author Interviews, CMAJ, Cost of Health Care, Health Care Systems, Hip Fractures, Surgical Research / 12.06.2018

MedicalResearch.com Interview with: Daniel Pincus MD Department of Surgery Institute for Clinical Evaluative Sciences University of Toronto MedicalResearch.com: What is the background for this study? What are the main findings? Response: We chose to look at hip fractures because is the most common reason for urgent surgery complications have be tied to wait times (and in particular wait times greater than 24 hours). (more…)
Author Interviews, Biomarkers, Orthopedics / 06.06.2018

MedicalResearch.com Interview with: Rick Sumner, PhD, FAAA The Mary Lou Bell McGrew Presidential Professor for Medical Research Chair, Department of Cell & Molecular Medicine (formerly, Anatomy and Cell Biology) Rush University Medical Center Chicago, IL  60612   MedicalResearch.com: What is the background for this study? What are the main findings? Response: The main cause of failure for total hip replacements is implant loosening which is often a consequence of particle-induced peri-implant osteolysis. Unfortunately, this condition is usually not diagnosed until it has progressed to the point of needing a revision surgery. We discovered two biomarkers that may be useful for identifying at risk patients much earlier than is currently possible. (more…)
Author Interviews, Hip Fractures, Orthopedics, Osteoporosis / 14.05.2018

MedicalResearch.com Interview with: “Just a hairline fracture...” by Gloria Bell is licensed under CC BY 2.0Brittany Bindon, MD Department of Internal Medicine University of Chicago Chicago, Illinois MedicalResearch.com: What is the background for this study? Response: Bisphosphonates are commonly used in the treatment of osteoporosis, however, they have been associated with rare, severe side effects such as osteonecrosis of the jaw and atypical femoral fractures. As a result, bisphosphonate drug holidays have become common in clinical practice though currently, there are minimal data on the safe duration of these drug holidays. We sought to further characterize the clinical and laboratory parameters associated with increased fracture risk in patients on bisphosphonate drug holiday. (more…)
Author Interviews, Emory, Infections, JACC, Orthopedics / 26.04.2018

MedicalResearch.com Interview with: Robert Taylor, MD, PhD Marcus Chair in Vascular Medicine Executive Vice Chair, Medicine Director, Division of Cardiology Professor of Medicine and Biomedical Engineering Emory University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: The early identification and localization of bacterial infections is a critical step for initiating effective treatment.   This is particularly challenging in the setting of infections associated with implanted medical devices.  We have developed a highly specific probe for bacteria that is based on the fact that bacteria have a specific system for taking up maltodextrins which are polysaccharides that mammalian cells cannot take up directly.  We can label this probe with either a fluorescent of radioactive tag that allows visualization of the bacteria. In the current article, we have used an animal model of implantable cardiac devices to demonstrate that our probe is very specific and sensitive for detecting bacterial infections.  It is worth noting that these are subclinical infections that could not be detected by any other means except for surgical removal. (more…)
Author Interviews, Orthopedics, Pediatrics / 19.03.2018

MedicalResearch.com Interview with: Baron  Lonner, MD Professor of Orthopaedics Icahn School of Medicine at Mount Sinai  MedicalResearch.com: What is the background for this study? What are the main findings? Response: 2-3% of adolescents have idiopathic scoliosis and 1 in 10 of these individuals will require surgery to correct severe scoliosis which if left untreated can lead to back pain and disability as well as pulmonary (breathing) problems later in life. For the adolescent with curvatures that require surgical treatment, body image and self esteem are big issues as they are for all adolescents going through their developmental stages. Scoliosis has an impact on body shape, which is seen by the affected individual looking in the mirror as well as by their peers and those around them. This can lead to self esteem and body image disturbance issues. We set out to explore the body shape distortions that occur with scoliosis, that are not depicted by x-rays that are standardly used to assess curvatures of the spine, and the improvements in parameters of body shape that occur with corrective surgery. We can assess body shape directly through surface topography imaging, that is light-based, thus, not involving x-ray exposure. This technology (Diers Formetrics) uses the same scientific methodology that is used to create modern topographical maps through satellite imagery. We found dramatic improvements in body shape asymmetry with surgery that correlated with some improvements in quality of life for the adolescent in this cohort of 23 patients as well as with the improvements in curvatures evaluated by x-rays.  (more…)