Monthly Archives: May 2014

3D model provides new insight into King Richard III’s spinal condition

May_Part 2_Orthopedics

In 2012, the skeleton of King Richard III – the king of England from 1483-1485 – was discovered beneath a parking lot in the city of Leicester in the UK. Early analysis of the bones confirmed that the king had scoliosis – a condition that causes the spine to curve to the side. Now, a case study published in The Lancet reveals how the condition would have affected the king’s appearance and mobility.

The mystery surrounding Richard III’s spinal condition had plagued researchers for years. Many historical references describe the King as a “crook-backed” or “hunch-back’d.” William Shakespeare even used such terminology in his 1593 play about the king.

However, it was unclear as to whether such descriptions were accurate or whether they had been conceived by enemies in order to harm his reputation.

Therefore, the discovery of his skeleton was largely significant, allowing researchers to finally put the mystery to rest. And it seems a team led by the researchers from the University of Leicester in the UK may have done just that.

Researchers created 3D replicas of Richard III’s spine

It was archeologists from the University of Leicester, in collaboration with Leicester City Council and the Richard III Society, who uncovered the King’s bones in 2012.

On initial analysis, researchers confirmed that the King had scoliosis. But it was unknown as to what extent the condition may have affected his appearance, how it may have impacted his mobility and whether it was inherited.

The University of Leicester team, alongside researchers from the University of Cambridge, Loughborough University and the University Hospitals of Leicester, all in the UK, set out to answer these questions.

Prof. Bruno Morgan and the forensic imaging team from the University of Leicester closely analyzed Richard III’s remains by creating computer-generated and physical replicas of his spine.

They did this by carrying out computed tomography (CT) scans, and researchers from Loughborough University used these scans to create 3D prints of the bones.

“We analyzed the skeleton macroscopically for evidence of spinal curvature and related lesions. From CT 3D reconstructions of each bone, we created polymer replicas and built a model of the spine to recreate its alignment in life,” the researchers explain.

King had a ‘small, but noticeable’ physical disfigurement

From their analysis, the team were able to determine that Richard III was unlikely to have inherited scoliosis. Instead, they believe he had adolescent onset idiopathic scoliosis – a common form of the condition in which onset primarily occurs between the ages of 10 and 12 years.

In terms of the King’s physical appearance, they found that his spinal curve was well-balanced at around a 70-90 degree angle, meaning any physical disfigurement would have been small, but noticeable, “particularly from the rear if bending forward and bare backed,” Prof. Morgan told us.

Co-author Dr. Piers Mitchell, of the Department of Archaeology and Anthropology at the University of Cambridge, explains:

“His trunk would have been short relative to the length of his limbs, and his right shoulder a little higher than the left. However, a good tailor to adjust his clothing and custom-made armor could have minimized the visual impact of this.”

If left untreated, scoliosis can cause severe damage to the spine, pelvis, chest, heart and lung. But based on their findings, the researchers say it is unlikely that Richard III’s scoliosis would have affected his lung capacity, meaning he would have been able to exercise normally.

In addition, the researchers say his leg bones were well formed and symmetrical, so there is no evidence to suggest he walked with a limp.

Prof. Morgan told Medical News Today that the type of scoliosis that Richard III had would have probably caused him back pain, and if he had survived, the pain would have worsened. But he doubts the condition would have affected his ability to fight.

“Scoliosis of this degree is limiting and leads to loss of mobility and osteoarthritic back pain. However, I would not classify him as disabled. With good armor and a horse he could have fought effectively,” he added.

“A well-trained fighter with this scoliosis would probably be better than a badly trained fighter without. However, we probably would not recommend a modern scoliosis patient to go into battle!”

Prof. Morgan told us that another case study will follow that will provide a detailed forensic analysis of Richard III’s battle injuries.

Late last year, Medical News Today reported on other research led by Dr. Mitchell, which revealed that Richard III may have suffered from a roundworm infection.

Written byHonor Whiteman

Image credit: University of Leicester





Non-invasive focused ultrasound thermal therapy reduces pain from bone metastases

May_Part 1_Orthopedics_Oncology_Radiology

When cancer progresses and spreads to the bone, patients often suffer debilitating pain. Now, a new phase III clinical trial shows that non-invasive magnetic resonance guided focusedultrasound treatment that heats the cancer within the bone, relieves pain and improves function for most patients when other treatment options are limited. The results were published in the Journal of the National Cancer Institute (JNCI).

Magnetic resonance guided focused ultrasound surgery (MRgFUS) is a technique that’s been safely used to treat thousands of women with uterine fibroids. However, “this is the first phase III study to use this technology in the treatment of cancer, ” says the study’s principal investigator and lead author Mark Hurwitz, M.D., Vice Chairman of Quality, Safety and Performance Excellence and Director of Thermal Oncology in the department of Radiation Oncology at Thomas Jefferson University.

Although radiation therapy is commonly used to treat bone-related pain and effective for most patients, not all patients experience pain relief and over time those who do may have recurrence of pain. In addition, it’s possible for a patient to receive the maximum radiation dose that can be safely delivered without fully controlling the pain. In situations where radiation therapy is not an option, alternative treatments are required.

A total of 147 patients from 17 centers in the U.S., Canada, Israel, Italy, and Russia were enrolled in the study and randomized to undergo MRgFUS or a sham treatment. Patients in the treatment group received focused ultrasound precisely targeted to their bone tumors to heat the tumor tissue to between 65 and 85 degrees Celsius, resulting in its destruction. During each treatment, the patients were monitored real-time via magnetic resonance imaging (MRI) to ensure the right tissue was targeted and the right temperatures were reached while ensuring heat in surrounding normal tissues and organs remained at safe levels. The control group underwent the same procedure but without the ultrasound device turned on. Finally, patients who did not respond to the placebo treatment within two weeks were allowed to be unblinded and offered MRgFUS.

Patients responded well to treatment, with 64 percent experiencing either no pain or a significant reduction in their pain at three months as measured by a 2 point or greater decrease in the numeric rating score(NRS) for pain, a clinically validated measurement tool. Many patients were able to reduce or stop use of opiod medications. Notably, most patients experienced pain relief and improved functioning within several days of treatment.

“It’s clear that for many of these patients, pain has a major impact on their everyday lives,” says Dr. Hurwitz. “This approach offers a new way to help alleviate that pain via an out-patient non-invasive procedure.”

The next steps in this line of research, says Hurwitz, is to refine the treatment technique to get an even greater response rate, and to apply radiation and thermal therapy together in treatment of bone metastases noting the established clinical benefits for other malignant conditions with this combination. To that end, Jefferson has opened a new program for thermal oncology within its Department of Radiation Oncology in order to provide patients with access to thermal therapies that have been shown to augment radiation treatment.

“The work provides cancer patients with more options for treatment of cancer pain and the opportunity for patients to reduce opioid use, which has significant side effects,” says Adam Dicker, M.D., Ph.D., Chair of Jefferson’s department of radiation oncology, and not involved in the paper.

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