BMD Bone mineral density DXA Dual-energy X-ray absorptiometry LDF Lateral distal femur AIM To assess lower extremity bone mineral density (BMD) of children with congenital spinal dysfunction and examine factors that may influence BMD in this population.METHOD Forty-four children (25 females, 19 males) aged 6 to 18 years (mean 11y 11mo, SD 3y 6mo) with congenital spinal dysfunction (35 with myelomeningocele, seven with lipomas, one with sacral agenesis, one with caudal regression) were enrolled in the study. A health survey including ambulatory status, history of bladder augmentation, and history of fracture was administered. Each participant had a physical examination including Tanner stage and neurological level. Dual-energy X-ray absorptiometry scans of the lateral distal femur (LDF) and, when possible, lumbar spine were obtained. We reported LDF BMD results as z-scores for three regions of interest (metaphyseal, metadiaphyseal, and diaphyseal). Univariable and multivariable analyses examined relationships between LDF BMD and the other variables.RESULTS BMD was significantly related to ambulatory status (14 non-ambulatory, 15 partly ambulatory, 15 fully ambulatory) and neurological level (13 with low-level lesions, 15 mediumlevel, 16 high-level) in the univariable analysis (p<0.01 for both in all three regions). Neither history of fracture, nor Tanner stage, nor history of bladder augmentation showed a significant relationship to BMD. The significance of ambulatory status and neurological level in the univariable analysis failed to persist in the multivariable analysis of this study with a small sample size. INTERPRETATIONThe LDF measurement proved to be a viable technique for assessing BMD in children with congenital spinal dysfunction. LDF BMD was sensitive to differences in three categories of ambulation. The overall influence of neurological level was not deemed as important as ambulation.Osteoporosis has been identified as a medical problem in adults with myelomeningocele. 1 Although typically considered an adult disease, osteoporosis starts in childhood. 2,3 The age at which abnormalities in bone mineral density (BMD) first present in the population with congenital spinal dysfunction is not known. Because bone mass accrual occurs during childhood, it would be ideal to initiate assessment of BMD during this time. 4,5 Such assessment in children with congenital spinal dysfunction might reveal critical factors that influence BMD.The International Society for Clinical Densitometry recommends assessment of the lumbar spine and whole body when evaluating bone density by dual-energy X-ray absorptiometry (DXA) in children. 6 Assessment of BMD at the lumbar spine in patients with congenital spinal dysfunction can be challenging owing to bone malformations of the lumbar spine yielding uninterpretable results. The abnormal spine is also reflected in measurement of the whole body, rendering that site equally invalid. We developed a technique for assessing BMD at the lateral distal femur (LDF) and established norms f...

Purpose of the Review A concussion is a mild traumatic brain injury (mTBI) that results in a change in how a person feels or functions after a force transmitted to the head. Nearly 10% of all sports-related injuries are mild traumatic brain injuries. Concussion/mTBIs have accounted for more than 3 million emergency department visits between 2005 and 2009 and present as an important public health concern. Recent Findings Physical, cognitive, and psychological functioning are known to be affected by concussion/mTBI, and various tools are readily available to guide clinicians through the initial evaluation. Summary Evaluation of patients with concussion/mTBI should include symptom report and balance, vestibular-ocular, and neurocognitive testing. Awareness of past medical history and pre-injury history of social, behavioral, and emotional functioning is essential to better understand the injury and to predict the expected course of recovery. No tool available can be used alone to diagnose concussion/mTBI or evaluate for recovery.

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