Interrater reliability of three-dimensional reconstruction of the spine: Low-dose stereoradiography for evaluating bracing in adolescent idiopathic scoliosis

Validity of a fast automated 3d spine reconstruction measurements for biplanar radiographs: SOSORT 2024 award winner

PURPOSE

To validate a fast 3D biplanar spinal radiograph reconstruction method with automatic extract curvature parameters using artificial intelligence (AI).

METHODS

Three-hundred eighty paired, posteroanterior and lateral, radiographs from the EOS X-ray system of children with adolescent idiopathic scoliosis were randomly selected from the database. For the AI model development, 304 paired images were used for training; 76 pairs were employed for testing. The validation was evaluated by comparing curvature parameters, including Cobb angles (CA), apical axial vertebral rotation (AVR), kyphotic angle (T1-T12 KA), and lordotic angle (L1-L5 LA), to manual measurements from a rater with 8 years of scoliosis experience. The mean absolute differences ± standard deviation (MAD ± SD), the percentage of measurements within the clinically acceptable errors, the standard error of measurement (SEM), and the inter-method intraclass correlation coefficient ICC[2,1] were calculated. The average reconstruction speed of the 76 test images was recorded.

RESULTS

Among the 76 test images, 134 and 128 CA were exported automatically and measured manually, respectively. The MAD ± SD for CA, AVR at apex, KA, and LA were 3.3° ± 3.5°, 1.5° ± 1.5°, 3.3° ± 2.6° and 3.5° ± 2.5°, respectively, and 98% of these measurements were within the clinical acceptance errors. The SEMs and the ICC[2,1] for the compared parameters were all less than 0.7° and > 0.94, respectively. The average time to display the 3D spine and report the measurements was 5.2 ± 1.3 s.

CONCLUSION

The developed AI algorithm could reconstruct a 3D scoliotic spine within 6 s, and the automatic curvature parameters were accurately and reliably extracted from the reconstructed images.

Radiophobia Overreaction: College of Chiropractors of British Columbia Revoke Full X-Ray Rights Based on Flawed Study and Radiation Fear-Mongering

Fears over radiation have created irrational pressures to dissuade radiography use within chiropractic. Recently, the regulatory body for chiropractors practicing in British Columbia, Canada, the College of Chiropractors of British Columbia (CCBC), contracted Pierre Côté to review the clinical use of X-rays within the chiropractic profession. A "rapid review" was performed and published quickly and included only 9 papers, the most recent dating from 2005; they concluded, "Given the inherent risks of radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine." The CCBC then launched an immediate review of the use of X-rays by chiropractors in their jurisdiction. Member and public opinion were gathered but not presented to their members. On February 4, 2021, the College announced amendments to their Professional Conduct Handbook that revoked X-ray rights for routine/repeat assessment and management of patients with spine disorders. Here, we highlight current and historical evidence that substantiates that X-rays are not a public health threat. We also point out critical and insurmountable flaws in the single paper used to support irrational and unscientific policy that discriminates against chiropractors who practice certain forms of evidence-based X-ray-guided methods.

Accuracy of EOS Imaging Technology in Comparison to Computed Tomography in the Assessment of Vertebral Rotational Orientation in Instrumented Spines in Adolescent Idiopathic Scoliosis

STUDY DESIGN

Retrospective radiographic reliability study.

OBJECTIVE

The aim of this study was to assess the validity of EOS 3D imaging technology in the determination of vertebral rotations in the spine of patients with previous instrumentation.

SUMMARY OF BACKGROUND DATA

There is a lack of evidence on the accuracy of vertebral rotational measurement using EOS 3D morphological analysis in the instrumented spine.

METHODS

A retrospective review of 31 patients with adolescent idiopathic scoliosis (AIS) who underwent instrumented fusion and postoperative computed tomography (CT) scans of the spine was performed. Vertebral rotations of the apex vertebra, the uppermost (UIV) and lowermost (LIV) instrumented vertebra, the noninstrumented vertebra one level cranial to the UIV (UIV + 1) and one level caudal to LIV (LIV + 1) were determined using EOS 3D reconstruction. The vertebral rotation was also measured using reformatted CT axial images. Relative vertebral rotational difference (VRD) were calculated for UIV to apex, UIV + 1 to apex, LIV to apex, LIV + 1 to apex, UIV to LIV and UIV + 1 to LIV + 1. Paired t tests were used to compare the VRD measured using the two different imagining modalities. For values where P > 0.05, the Bland-Altman plot was used to assess the agreement between the measures. Interclass correlation (ICC) was used to determine interobserver and intraobserver reliabilities of EOS and CT measurements.

RESULTS

EOS analysis of relative VRD was found to be significantly different from that of CT for UIV to apex (P = 0.006) and UIV + 1 to apex (P = 0.003). No significant differences were found for LIV to apex (P = 0.06), LIV + 1 to apex (P = 0.06), UIV to LIV (P = 0.59) and UIV + 1 to LIV + 1 (P = 0.64). However, Bland-Altman plots showed that agreement was poor, and variance was beyond acceptable. ICC showed good interobserver and good to very good intraobserver reliability for EOS.

CONCLUSION

EOS 3D morphological analysis of VRD in the instrumented levels of the spine demonstrated significant difference and unacceptable variance in comparison to CT measurement.Level of Evidence: 4.

Brace Effectiveness Is Related to 3-Dimensional Plane Parameters in Patients with Adolescent Idiopathic Scoliosis

BACKGROUND

Although scoliosis is a 3-dimensional (3D) deformity, little research has been performed on the use of 3D imaging in brace curve correction. The purpose of the present study was to determine the effect of axial-plane parameters on the outcomes of bracing with a thoracolumbosacral orthosis for adolescent idiopathic scoliosis.

METHODS

This prospective longitudinal cohort study included patients with adolescent idiopathic scoliosis who fulfilled the criteria for bracing according to the Scoliosis Research Society, and was conducted from the time the patient began wearing the brace through a minimum follow-up of 2 years or until a surgical procedure was performed. Radiographs made with use of an EOS Imaging System were used to reconstruct 3D images of the spine at the pre-brace, immediate in-brace, 1-year in-brace, and latest follow-up out-of-brace stages. Univariate and multiple linear regressions were performed to determine the association between axial rotation correction and curve progression at the time of the latest follow-up. Logistic regressions were performed to model the probability of risk of progression.

RESULTS

Fifty-three patients were enrolled, and 46 patients were included in the analysis. At the time of the latest follow-up, 30 patients did not experience curve progression and 16 patients had curve progression. There was no difference in baseline demographic characteristics between groups. For the transverse-plane parameters, there was a significant difference between non-progression and progression groups in pre-brace apical vertebral rotation (4.5° ± 11.2° compared with -2.4° ± 9.8°, respectively; p = 0.044) and in 1-year in-brace apical vertebral rotation correction velocity (2.0° ± 5.0°/year compared with -1.7° ± 4.4°/year, respectively; p = 0.016). Logistic regression analysis showed that pre-brace apical vertebral rotation (odds ratio, 1.063; 95% confidence interval, 1.000 to 1.131; p = 0.049) and 1-year in-brace apical vertebral rotation correction velocity (odds ratio, 1.19; 95% confidence interval, 1.021 to 1.38; p = 0.026) were associated with an increased risk of curve progression. There was no difference in Scoliosis Research Society 22-Item scores between patients who experienced curve progression and those who did not.

CONCLUSIONS

In this prospective study, we demonstrated that axial-plane parameters and the correction of these parameters during bracing are related to the successful use of the brace.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Three-Dimensional Analysis of Initial Brace Correction in the Setting of Adolescent Idiopathic Scoliosis

The three-dimensional nature of adolescent idiopathic scoliosis (AIS) necessitates a tridimensional assessment and management. Bracing constitutes the mainstay conservative treatment for mild adolescent idiopathic scoliosis. In the literature hitherto, there has been uncertainty regarding the behavior of the spine, pelvis, and vertebral orientations in the context of bracing, especially in the transverse plane. This poses a challenge to healthcare providers, patients, and their families, as brace treatment, although not as invasive as surgery, is laden with medical and psychological complications and could be considered traumatizing. Hence, a thorough understanding of initial three-dimensional spinal behavior in the context of bracing is important. The purpose of this retrospective study was to investigate the immediate 3D impact of Chêneau-type brace. Thirty-eight patients with AIS undergoing Chêneau-type bracing were included. Patients were stratified according to their structural curve topography into thoracic, thoracolumbar, and lumbar groups. 3D reconstruction of the spine using a dedicated biplanar stereoradiography software with and without the brace was performed. The examined anthropometric radiographic measures were pre- to in-brace variations and differences of spinopelvic parameters and vertebral orientations in the coronal, sagittal, and transverse planes. The complex impact of the Chêneau-type brace on different curves in three planes was delineated. In the coronal plane, the Cobb angle was significantly decreased in all types of curves, and the coronal tilt correction was concentrated in specific segments. The impact of the brace in this study on the sagittal profile was variable, including the loss of thoracic kyphosis and lumbar lordosis. In the transverse plane, an axial vertebral rotation change and detorsion above the apex occurred in the thoracolumbar curves. The results from this exploratory study could shed some light on the initial 3D spinal behavior in the context of bracing and may be of beneficial for treating physicians and brace makers.