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Yiallourou A, Pantavou K, Markozannes G, Pilavas A, Georgiou A, Hadjikou A, Economou M, Christodoulou N, Letsos K, Khattab E, Kossyva C, Constantinou M, Theodoridou M, Piovani D, Tsilidis KΚ, Bonovas S, Nikolopoulos GK. Non-genetic factors and breast cancer: an umbrella review of meta-analyses. BMC Cancer 2024; 24:903. [PMID: 39061008 PMCID: PMC11282738 DOI: 10.1186/s12885-024-12641-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Previous research has found associations between various non-genetic factors and breast cancer (BrCa) risk. This study summarises and appraises the credibility of the available evidence on the association between non-genetic factors and BrCa risk. METHODS We conducted an umbrella review of meta-analyses. Medline, Scopus, and the Cochrane databases were systematically searched for meta-analyses examining non-genetic factors and BrCa incidence or mortality. The strength of the evidence was graded in four categories (i.e., weak, suggestive, highly suggestive, convincing). RESULTS A total of 781 meta-analyses from 280 publications were evaluated and graded. We included exposures related to anthropometric measurements, biomarkers, breast characteristics and diseases, diet and supplements, environment, exogenous hormones, lifestyle and social factors, medical history, medication, reproductive history, and pregnancy. The largest number of examined associations was found for the category of diet and supplements and for exposures such as aspirin use and active smoking. The statistically significant (P-value < 0.05) meta-analyses were 382 (49%), of which 204 (53.4%) reported factors associated with increased BrCa risk. Most of the statistically significant evidence (n = 224, 58.6%) was graded as weak. Convincing harmful associations with heightened BrCa risk were found for increased body mass index (BMI), BMI and weight gain in postmenopausal women, oral contraceptive use in premenopausal women, increased androstenedione, estradiol, estrone, and testosterone concentrations, high Breast Imaging Reporting and Data System (BIRADS) classification, and increased breast density. Convincing protective factors associated with lower BrCa risk included high fiber intake and high sex hormone binding globulin (SHBG) levels while highly suggestive protective factors included high 25 hydroxy vitamin D [25(OH)D] levels, adherence to healthy lifestyle, and moderate-vigorous physical activity. CONCLUSIONS Our findings suggest some highly modifiable factors that protect from BrCa. Interestingly, while diet was the most studied exposure category, the related associations failed to reach higher levels of evidence, indicating the methodological limitations in the field. To improve the validity of these associations, future research should utilise more robust study designs and better exposure assessment techniques. Overall, our study provides knowledge that supports the development of evidence-based BrCa prevention recommendations and guidance, both at an individual level and for public health initiatives. TRIAL REGISTRATION PROSPERO CRD42022370675.
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Affiliation(s)
- Anneza Yiallourou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | - Katerina Pantavou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | - Georgios Markozannes
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, SW7 2AZ, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, 45110, Greece
| | - Antonis Pilavas
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | - Andrea Georgiou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | - Andria Hadjikou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | - Mary Economou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | | | | | - Elina Khattab
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | | | - Maria Constantinou
- Medical School, University of Cyprus, P.O. Box 20537, Nicosia, 1678, Cyprus
| | | | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, 20072, Italy
- IRCCS Humanitas Research Hospital, Milan, 20089, Italy
| | - Konstantinos Κ Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, SW7 2AZ, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, 45110, Greece
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, 20072, Italy
- IRCCS Humanitas Research Hospital, Milan, 20089, Italy
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Sugawara R, Watanabe H, Taki N, Onuma S, Kikkawa I, Takeshita K. Radiation exposure in pediatric patients with early onset scoliosis: A longitudinal single-center study. J Orthop Sci 2024; 29:1103-1107. [PMID: 37507317 DOI: 10.1016/j.jos.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND There is no consensus regarding the acceptable level of medical radiation exposure in patients with early-onset scoliosis. This study aimed to quantify radiation exposure in these patients and investigate factors associated with high exposure. METHODS Patients with early-onset scoliosis who received care for their spine deformity and other comorbidities in our institution were retrospectively reviewed. Cumulative radiation exposure and total number of imaging studies were recorded. Patients with ≥30 mSv exposure were classified as high exposure and analyzed to clarify factors associated with high exposure. RESULTS Thirty-five patients were included for analysis. The etiology of scoliosis was idiopathic in 8 patients, congenital in 7, syndromic in 8, and neuromuscular in 12. Fifteen patients underwent 19 spinal surgeries. The types of operation performed were definitive fusion (n = 12), vertebrectomy for hemivertebra (n = 2), growing rod (n = 1), lengthening (n = 3), and revision/partial implant removal (n = 1). The mean cumulative radiation dose was 22.3 mSv (range, 2.5-94.5 mSv). Spine radiography and computed tomography combined accounted for 15.0 mSv (range, 2.4-52.5 mSv, 67.3% of the mean cumulative dose). The mean radiation dose was significantly higher in patients who underwent spinal surgery than in those who did not (31.2 mSv vs. 15.6 mSv). The high-exposure group comprised 10 patients (1 idiopathic, 1 congenital, 5 syndromic, and 3 neuromuscular scoliosis) and 8 underwent 11 spinal operations. Among 8 patients who underwent spinal surgery, the cumulative radiation dose for spine was ≥30 mSv and spine computed tomography was performed an average of 4.0 times. CONCLUSIONS Nearly one-third of patients with early-onset scoliosis and half of patients who underwent spinal surgery had >30 mSv radiation exposure due to multiple computed tomography. Medical radiation exposure and associated cancer risk should be considered when treating these patients.
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Affiliation(s)
- Ryo Sugawara
- Department of Orthopedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Hideaki Watanabe
- Department of Pediatric Orthopedics, Jichi Children's Medical Center, Tochigi. 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Naoya Taki
- Department of Pediatric Orthopedics, Jichi Children's Medical Center, Tochigi. 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Saki Onuma
- Department of Pediatric Orthopedics, Jichi Children's Medical Center, Tochigi. 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Ichiro Kikkawa
- Department of Orthopedic Surgery, Nasu Central Hospital, 1453 Shimoishigami, Otawara, Tochigi, 324-0036, Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Luo CL, Wu HD, Beygi BH, Liu S, Zou YY, Shang LJ, Wong MS. The effect of stretching exercises before orthotic treatment on the immediate in-orthosis correction of the patients with adolescent idiopathic scoliosis: A pilot study. Prosthet Orthot Int 2024:00006479-990000000-00257. [PMID: 38896541 DOI: 10.1097/pxr.0000000000000364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 04/10/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Stretching exercise is generally used for improving flexibility. However, its application to promote orthotic treatment for patients with adolescent idiopathic scoliosis (AIS) remains unknown. OBJECTIVE This study was to explore the effect of pre-orthosis stretching exercises on spinal flexibility and initial in-orthosis correction for the patients with AIS. STUDY DESIGN A pilot-controlled study. METHODS An experimental group (EG) of 13 subjects (10 girls and 3 boys) with AIS allocating to self-stretching exercises and a control group (CG) of 19 AIS subjects (14 girls and 5 boys) with no stretching before orthosis fitting were recruited. The spinal flexibility of the EG was evaluated with an ultrasound imaging system and physical measurements. The initial in-orthosis correction rates between the 2 groups were compared with the independent t test, and the correlation analysis between the spinal flexibility measured from ultrasound images and physical measurement was performed with the Pearson correlation test. RESULTS The initial Cobb angle of EG and CG were 25.70° ± 7.30° and 28.09° ± 5.58°, respectively. No significant difference was observed between the initial in-orthosis Cobb angle of EG (11.13° ± 6.80°) and CG (15.65° ± 9.10°) (p = 0.06). However, the spinal flexibility after stretching exercises was improved (p < 0.001), and the spinal flexibility changes measured with ultrasound and physical forward-bending method were significantly correlated (r = 0.57, p < 0.05). CONCLUSION Stretching exercises before orthotic treatment could improve the spinal flexibility but did not cause a better in-orthosis correction. A study with a larger sample size and longer follow-up period should be conducted to investigate the long-term effect of stretching exercises.
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Affiliation(s)
- Chang Liang Luo
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- School of Rehabilitation, Kunming Medical University, Kunming, China
| | - Hui Dong Wu
- School of Rehabilitation, Kunming Medical University, Kunming, China
| | - Babak Hassan Beygi
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Shan Liu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yi Ying Zou
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Lin Jing Shang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Man Sang Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Striano BM, Crawford AM, Verhofste BP, Hresko AM, Hedequist DJ, Schoenfeld AJ, Simpson AK. Intraoperative navigation increases the projected lifetime cancer risk in patients undergoing surgery for adolescent idiopathic scoliosis. Spine J 2024; 24:1087-1094. [PMID: 38262498 DOI: 10.1016/j.spinee.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND CONTEXT Adolescent idiopathic scoliosis (AIS) is a common condition, often requiring surgical correction. Computed tomography (CT) based navigation technologies, which rely on ionizing radiation, are increasingly being utilized for surgical treatment. Although this population is highly vulnerable to radiation, given their age and female predominance, there is little available information elucidating modeled iatrogenic cancer risk. PURPOSE To model lifetime cancer risk associated with the use of intraoperative CT-based navigation for surgical treatment of AIS. STUDY DESIGN/SETTING This retrospective cross-sectional study took place in a quaternary care academic pediatric hospital in the United States. PATIENT SAMPLE Adolescents aged 10-18 who underwent posterior spinal fusion for a diagnosis of AIS between July 2014 and December 2019. OUTCOMES MEASURES Effective radiation dose and projected lifetime cancer risk associated with intraoperative doses of ionizing radiation. METHODS Clinical and radiographic parameters were abstracted, including total radiation dose during surgery from flat plate radiographs, fluoroscopy, and intraoperative CT scans. Multivariable regression analysis was used to assess differences in radiation exposure between patients treated with conventional radiography versus intraoperative navigation. Radiation exposure was translated into lifetime cancer risk using well-established algorithms. RESULTS In total, 245 patients were included, 119 of whom were treated with navigation. The cohort was 82.9% female and 14.4 years of age. The median radiation exposure (in millisieverts, mSv) for fluoroscopy, radiography, and navigation was 0.05, 4.14, and 8.19 mSv, respectively. When accounting for clinical and radiographic differences, patients treated with intraoperative navigation received 8.18 mSv more radiation (95%CI: 7.22-9.15, p<.001). This increase in radiation projects to 0.90 iatrogenic malignancies per 1,000 patients (95%CI 0.79-1.01). CONCLUSIONS Ours is the first work to define cancer risk in the setting of radiation exposure for navigated AIS surgery. We project that intraoperative navigation will generate approximately one iatrogenic malignancy for every 1,000 patients treated. Given that spine surgery for AIS is common and occurs in the context of a multitude of other radiation sources, these data highlight the need for radiation budgeting protocols and continued development of lower radiation dose technologies. LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Brendan M Striano
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Alexander M Crawford
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Bram P Verhofste
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Andrew M Hresko
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Daniel J Hedequist
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Tanaka M, Schol J, Sakai D, Sako K, Yamamoto K, Yanagi K, Hiyama A, Katoh H, Sato M, Watanabe M. Low Radiation Protocol for Intraoperative Robotic C-Arm Can Enhance Adolescent Idiopathic Scoliosis Deformity Correction Accuracy and Safety. Global Spine J 2024; 14:1504-1514. [PMID: 36695112 DOI: 10.1177/21925682221147867] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
STUDY DESIGN Retrospective case-series study. OBJECTIVES To assess (1) low cone beam CT (CBCT) mediated intraoperative navigation to limit radiation exposure without compromising surgical accuracy, and (2) the potential of intraoperative C-arm CBCT navigation to augment pedicle screw (PS) placement accuracy in AIS surgery compared to pre-surgery CT-based planning. METHODS The first part involved a prospective phantom study, comparing radiation doses for conventional CT, and standard (6sDCT) and a low dose (5sDCT) Artis Zeego®-imaging. Next, 5sDCT- and 6sDCT-navigation were compared on PS accuracy and radiation exposure during AIS correction. The final part compared surgical AIS deformity correction through intraoperative 5sDCT navigation to a matched cohort treated using conventional pre-surgery CT-scans for navigation. Outcome parameters included operation time, skin dose (SD), dose area product (DAP), intraoperative blood loss, postoperative complications, and PS deviation rates. RESULTS The phantom study demonstrated a reduction in radiation for the 5sDCT protocol. Moreover, 5sDCT-imaged patients (n = 15) showed a significantly lower SD (-27.41%) and DAP (-30.92%), without compromising PS accuracy compared with 6sDCT-settings (n = 15). Finally, AIS correction through intraoperative CBCT C-arm navigation (n = 27) significantly reduced screw deviation rates (6.83% versus 10.75%, P = .016) without increasing operation times, compared with conventional CT (n = 37). CONCLUSIONS Intraoperative navigation using a CBCT C-arm system improved the accuracy of PS insertion and reduced surgery time. Moreover, it reduced radiation exposure compared with conventional CT, which was further curtailed by adapting the low-dose 5sDCT protocol. In short, our study highlights the benefits of intraoperative CBCT navigation for PS placement in AIS surgery.
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Affiliation(s)
- Masahiro Tanaka
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Jordy Schol
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Kosuke Sako
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Kazuyuki Yamamoto
- Department of Diagnostic Radiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Kensuke Yanagi
- Department of Diagnostic Radiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Akihiko Hiyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Masato Sato
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
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Grünwald ATD, Roy S, Lampe R. Measurement of distances and locations of thoracic and lumbar vertebral bodies from CT scans in cases of spinal deformation. BMC Med Imaging 2024; 24:109. [PMID: 38745329 PMCID: PMC11094998 DOI: 10.1186/s12880-024-01293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Spinal deformations, except for acute injuries, are among the most frequent reasons for visiting an orthopaedic specialist and musculoskeletal treatment in adults and adolescents. Data on the morphology and anatomical structures of the spine are therefore of interest to orthopaedics, physicians, and medical scientists alike, in the broad field from diagnosis to therapy and in research. METHODS Along the course of developing supplementary methods that do not require the use of ionizing radiation in the assessment of scoliosis, twenty CT scans from females and males with various severity of spinal deformations and body shape have been analysed with respect to the transverse distances between the vertebral body and the spinous process end tip and the skin, respectively, at thoracic and lumbar vertebral levels. Further, the locations of the vertebral bodies have been analysed in relation to the patient's individual body shape and shown together with those from other patients by normalization to the area encompassed by the transverse body contour. RESULTS While the transverse distance from the vertebral body to the skin varies between patients, the distances from the vertebral body to the spinous processes end tips tend to be rather similar across different patients of the same gender. Tables list the arithmetic mean distances for all thoracic and lumbar vertebral levels and for different regions upon grouping into mild, medium, and strong spinal deformation and according to the range of spinal deformation. CONCLUSIONS The distances, the clustering of the locations of the vertebral bodies as a function of the vertebral level, and the trends therein could in the future be used in context with biomechanical modeling of a patient's individual spinal deformation in scoliosis assessment using 3D body scanner images during follow-up examinations.
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Affiliation(s)
- Alexander T D Grünwald
- Department of Clinical Medicine, Center for Digital Health and Technology, Klinikum rechts der Isar, Department of Orthopaedics and Sports Orthopaedics, Research Unit of the Buhl-Strohmaier Foundation for Cerebral Palsy and Paediatric Neuroorthopaedics, Technical University of Munich, TUM School of Medicine and Health, Munich, Germany
| | - Susmita Roy
- Department of Clinical Medicine, Center for Digital Health and Technology, Klinikum rechts der Isar, Department of Orthopaedics and Sports Orthopaedics, Research Unit of the Buhl-Strohmaier Foundation for Cerebral Palsy and Paediatric Neuroorthopaedics, Technical University of Munich, TUM School of Medicine and Health, Munich, Germany
| | - Renée Lampe
- Department of Clinical Medicine, Center for Digital Health and Technology, Klinikum rechts der Isar, Department of Orthopaedics and Sports Orthopaedics, Research Unit of the Buhl-Strohmaier Foundation for Cerebral Palsy and Paediatric Neuroorthopaedics, Technical University of Munich, TUM School of Medicine and Health, Munich, Germany.
- Markus Würth Professorship, Technical University of Munich, Munich, Germany.
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Pérez-Grueso FJS, Moreno-Manzanaro L, Pizones J. The reunion with my patients: their journey and experience 30 years after their intervention for adolescent idiopathic scoliosis via CD instrumentation. Spine Deform 2024; 12:671-679. [PMID: 38305991 DOI: 10.1007/s43390-023-00814-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/23/2023] [Indexed: 02/03/2024]
Abstract
PURPOSE Our objective was to collect the experience and current attitude of those patients, now adults, operated on for adolescent idiopathic scoliosis (AIS) more than 25 years ago with CD instrumentation (CDI). METHODS Prospective qualitative cross-sectional study with interpretive phenomenological analysis approach of AIS patients operated in a single center with CDI between 1985 and 1995. Patients underwent a semi-structured interview with their original surgeon. Seven agreed themes were open for conversation, and several subthemes emerged related to their experience during their journey in life. Filed notes were recorded and transcribed verbatim. We used the method of content, semantic and pragmatic analysis. RESULTS We contacted 103 patients, 100 agreed to participate. Mean age was 47.5 ± 3.3, mean follow-up was 30.9 ± 2.7 years. Three fundamental concerns stood out: discomfort with self-image; low back pain with daily activities; and lack of spinal flexibility. 50% were engaged in continuous physical exercise, and only some referred limitations with load-bearing work. Patients commonly described negative memories of the conservative treatment, but positive memories of the surgical process. In general, there was a good adaptation to social life (occupation, social and family relationships). Two-thirds were married, and 65 women had offspring. A frequent concern was the excess of radiographs over the years, and three developed breast cancer. CONCLUSIONS Factors such as dissatisfaction with self-image, low back pain, and spine stiffness were relevant to patients throughout their journeys. Despite this, the great majority were satisfied with the treatment received, which allowed them to lead an integrated life in society. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Javier Pizones
- Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
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Manzetti M, Ruffilli A, Barile F, Viroli G, Traversari M, Vita F, Cerasoli T, Arceri A, Artioli E, Mazzotti A, Faldini C. Is there a skeletal age index that can predict accurate curve progression in adolescent idiopathic scoliosis? A systematic review. Pediatr Radiol 2024; 54:299-315. [PMID: 38158439 DOI: 10.1007/s00247-023-05834-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The diagnosis of adolescent idiopathic scoliosis requires clinical and radiographic evaluation; the management options vary depending on the severity of the curve and potential for progression. Identifying predictors of scoliosis progression is crucial to avoid incorrect management; clinical and radiographic factors have been studied as potential predictors. The present study aims to review the literature on radiological indexes for the peak height velocity or curve acceleration phase to help clinicians manage treatment of patients with adolescent idiopathic scoliosis. METHODS This systematic review was carried out in accordance with Preferential Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search was carried out including only peer-reviewed articles written in English that described the radiological indexes assessing skeletal maturity in patients with adolescent idiopathic scoliosis and evaluated their correlation with curve progression, expressed as peak height velocity and/or curve acceleartion phase. RESULTS Thirteen studies were included and showed promising results in terms of reliable radiological indexes. Risser staging gives a general measure of skeletal maturity, but it cannot be used as a primary index for driving the treatment of patients with adolescent idiopathic scoliosis since more reliable indexes are available. CONCLUSION Skeletal maturity quantification for adolescent idiopathic scoliosis has the potential to significantly modify disease management. However, idiopathic scoliosis is a complex and multifactorial disease: therefore, it is unlikely that a single index will ever be sufficient to predict its evolution. Therefore, as more adolescent idiopathic scoliosis progression-associated indexes are identified, a collective scientific effort should be made to develop a therapeutic strategy based on reliable and reproducible algorithms.
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Affiliation(s)
- Marco Manzetti
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy.
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - Alberto Ruffilli
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Francesca Barile
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Giovanni Viroli
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Matteo Traversari
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Fabio Vita
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Tosca Cerasoli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Alberto Arceri
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Elena Artioli
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Antonio Mazzotti
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Cesare Faldini
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
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Stecher N, Heinke A, Żurawski AŁ, Harder MR, Schumann P, Jochim T, Malberg H. Torsobarography: Intra-Observer Reliability Study of a Novel Posture Analysis Based on Pressure Distribution. SENSORS (BASEL, SWITZERLAND) 2024; 24:768. [PMID: 38339484 PMCID: PMC10857123 DOI: 10.3390/s24030768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
Postural deformities often manifest themselves in a sagittal imbalance and an asymmetric morphology of the torso. As a novel topographic method, torsobarography assesses the morphology of the back by analysing pressure distribution along the torso in a lying position. At torsobarography's core is a capacitive pressure sensor array. To evaluate its feasibility as a diagnostic tool, the reproducibility of the system and extracted anatomical associated parameters were evaluated on 40 subjects. Landmarks and reference distances were identified within the pressure images. The examined parameters describe the shape of the spine, various structures of the trunk symmetry, such as the scapulae, and the pelvic posture. The results showed that the localisation of the different structures performs with a good (ICC > 0.75) to excellent (ICC > 0.90) reliability. In particular, parameters for approximating the sagittal spine shape were reliably reproduced (ICC > 0.83). Lower reliability was observed for asymmetry parameters, which can be related to the low variability within the subject group. Nonetheless, the reliability levels of selected parameters are comparable to commercial systems. This study demonstrates the substantial potential of torsobarography at its current stage for reliable posture analysis and may pave the way as an early detection system for postural deformities.
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Affiliation(s)
- Nico Stecher
- Institute of Biomedical Engineering, Dresden University of Technology, 01307 Dresden, Germany
| | - Andreas Heinke
- Institute of Biomedical Engineering, Dresden University of Technology, 01307 Dresden, Germany
| | | | | | - Paula Schumann
- Institute of Biomedical Engineering, Dresden University of Technology, 01307 Dresden, Germany
| | - Thurid Jochim
- Institute of Biomedical Engineering, Dresden University of Technology, 01307 Dresden, Germany
| | - Hagen Malberg
- Institute of Biomedical Engineering, Dresden University of Technology, 01307 Dresden, Germany
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10
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Don S, Moore QT, Hensley P. Commentary: Achieving ALARA in scoliosis examinations by using body measurements to set techniques and eliminating physical anti-scatter grids. Pediatr Radiol 2024; 54:154-156. [PMID: 38047922 DOI: 10.1007/s00247-023-05810-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Steven Don
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Quentin T Moore
- Center for Devices and Radiological Health, U.S. FDA, Silver Spring, MD, USA
| | - Pam Hensley
- Radiologic Technology, St. Louis Community College Forest Park, St. Louis, MO, USA
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11
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Lim KBL, Yeo ISX, Ng SWL, Pan WJ, Lee NKL. The machine-vision image guided surgery system reduces fluoroscopy time, ionizing radiation and intraoperative blood loss in posterior spinal fusion for scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3987-3995. [PMID: 37428212 DOI: 10.1007/s00586-023-07848-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/10/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE To determine if the novel 3D Machine-Vision Image Guided Surgery (MvIGS) (FLASH™) system can reduce intraoperative radiation exposure, while improving surgical outcomes when compared to 2D fluoroscopic navigation. METHODS Clinical and radiographic records of 128 patients (≤ 18 years of age) who underwent posterior spinal fusion (PSF), utilising either MvIGS or 2D fluoroscopy, for severe idiopathic scoliosis were retrospectively reviewed. Operative time was analysed using the cumulative sum (CUSUM) method to evaluate the learning curve for MvIGS. RESULTS Between 2017 and 2021, 64 patients underwent PSF using pedicle screws with 2D fluoroscopy and another 64 with the MvIGS. Age, gender, BMI, and scoliosis aetiology were comparable between the two groups. The CUSUM method estimated that the MvIGS learning curve with respect to operative time was 9 cases. This curve consisted of 2 phases: Phase 1 comprises the first 9 cases and Phase 2 the remaining 55 cases. Compared to 2D fluoroscopy, MvIGS reduced intraoperative fluoroscopy time, radiation exposure, estimated blood loss and length of stay by 53%, 62% 44%, and 21% respectively. Scoliosis curve correction was 4% higher in the MvIGS group, without any increase in operative time. CONCLUSION MvIGS for screw insertion in PSF contributed to a significant reduction in intraoperative radiation exposure and fluoroscopy time, as well as blood loss and length of stay. The real-time feedback and ability to visualize the pedicle in 3D with MvIGS enabled greater curve correction without increasing the operative time.
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Affiliation(s)
- Kevin Boon Leong Lim
- Division of Surgery, KK Women's and Children's Hospital, Singapore, Singapore.
- Department of Orthopaedic Surgery, KK Women's & Children's Hospital, Singapore, Singapore.
| | - Inez Su Xian Yeo
- Division of Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Stacy Wei Ling Ng
- Department of Orthopaedic Surgery, KK Women's & Children's Hospital, Singapore, Singapore
| | - Woei Jack Pan
- Department of Orthopaedic Surgery, KK Women's & Children's Hospital, Singapore, Singapore
| | - Nicole Kim Luan Lee
- Division of Surgery, KK Women's and Children's Hospital, Singapore, Singapore
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12
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Wei JZ, Cheung BKC, Chu SLH, Tsang PYL, To MKT, Lau JYN, Cheung KMC. Assessment of reliability and validity of a handheld surface spine scanner for measuring trunk rotation in adolescent idiopathic scoliosis. Spine Deform 2023; 11:1347-1354. [PMID: 37493936 PMCID: PMC10587198 DOI: 10.1007/s43390-023-00737-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/08/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE To assess the reliability and validity of a handheld scanner (SpineScan3D) for trunk rotation measurement in adolescent idiopathic scoliosis (AIS) subjects, as compared with Scoliometer. METHODS This was a cross-sectional study with AIS subjects recruited. Biplanar spine radiographs were performed using an EOS imaging system with coronal Cobb angle (CCA) determined. The angle of trunk rotation (ATR) was measured using Scoliometer. SpineScan3D was employed to assess the axial rotation of subjects' back at forward bending, recorded as surface tilt angle (STA). Intra- and inter-examiner repeats were conducted to evaluate the reliability of SpineScan3D. RESULTS 97 AIS patients were recruited. Intra- and inter-examiner reliability of STA measures were good to excellent in major thoracic and lumbar curves (p < 0.001). A strong correlation was found between STA and ATR measures in both curve types (p < 0.001) with a standard error of the ATR estimate of between 1 and 2 degrees from linear regression models (R squared: 0.8-0.9, p < 0.001). A similar correlation with CCA was found for STA and ATR measures (r: 0.5-0.6, p < 0.002), which also demonstrated a similar sensitivity (72%-74%) and specificity (62%-77%) for diagnosing moderate to severe curves. CONCLUSION SpineScan3D is a handheld surface scanner with a potential of wide applications in subjects with AIS. The current study indicated that SpineScan3D is reliable and valid for measuring trunk rotation in AIS subjects, comparable to Scoliometer. Further studies are planned to investigate its measurements in coronal and sagittal planes and the potential of this device as a screening and monitoring tool. TRIAL REGISTRATION NUMBER (DATE OF REGISTRATION) HKUCTR-2288 (06 Dec 2017). LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jack Z Wei
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | | | - Sunny L H Chu
- Avalon SpineCare (HK) Ltd., Hong Kong, Hong Kong SAR, China
| | | | - Michael K T To
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | | | - Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China.
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13
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Sakai D, Schol J, Kawachi A, Sako K, Hiyama A, Katoh H, Sato M, Watanabe M. Adolescent Idiopathic Scoliotic Deformity Correction Surgery Assisted by Smart Glasses Can Enhance Correction Outcomes and Accuracy and Also Improve Surgeon Fatigue. World Neurosurg 2023; 178:e96-e103. [PMID: 37423337 DOI: 10.1016/j.wneu.2023.06.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE Augmented reality (AR) is becoming more common and slowly being integrated into the surgical field. With the continuous progression of navigation and visualization techniques, AR has great potential to improve surgical quality and safety. Nevertheless, the effects of AR on surgical outcomes and surgeons' well-being remains poorly studied. The present prospective controlled study aims to assess the effect of surgery assisted with AR smart glasses on adolescent idiopathic scoliosis (AIS) deformity correction outcomes and surgeon fatigue. METHODS AIS patients scheduled for surgical deformity correction were prospectively recruited and assigned to standard or AR-supported surgery, using lightweight AR smart glasses. The demographic and clinical features were recorded. The pre- and postoperative spinal features, operative time, and blood loss were recorded and compared. Finally, the participating surgeons were asked to complete a questionnaire (e.g., visual analog scale for fatigue) to compare the effects of AR on their well-being. RESULTS Our results have shown enhanced spinal deformity corrections with Cobb angle (-35.7° vs. -46.9°), thoracic kyphosis (8.1° vs. 11.6°), and vertebral rotation (-9.3° vs. -13.8°) changes favoring AR-supported surgery. Moreover, AR resulted in significantly lower violation rates per patient (7.5% vs. 6.6%; P = 0.023). Finally, the visual analog scale for fatigue scores consistently showed a significant reduction in fatigue (5.7 ± 1.7 vs. 3.3 ± 1.2; P < 0.001) and other fatigue classifiers for the surgeons after AR-supported surgery. CONCLUSIONS Our controlled study has highlighted the enhanced spinal correction rates in AR-supported surgery and also improved surgeons' well-being and fatigue. These results endorse the adaptation of AR techniques to support AIS surgical correction.
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Affiliation(s)
- Daisuke Sakai
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.
| | - Jordy Schol
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan
| | - Asami Kawachi
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan; TUNZ Pharma Co. Ltd, Osaka, Japan
| | - Kosuke Sako
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan
| | - Akihiko Hiyama
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan
| | - Hiroyuki Katoh
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan
| | - Masato Sato
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan
| | - Masahiko Watanabe
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan
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14
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Kim DJ, Dermott JA, Howard AW, Lebel DE. How useful is pre-referral pediatric spine imaging? Spine Deform 2023; 11:1065-1070. [PMID: 37060518 PMCID: PMC10425477 DOI: 10.1007/s43390-023-00687-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/01/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE Primary care physicians rely on radiology reports to confirm a scoliosis diagnosis and inform the need for spine specialist referral. In turn, spine specialists use these reports for triage decisions and planning of care. The objectives were to determine (1) the adequacy of index images to inform treatment decisions at the initial consultation and (2) the utility of index radiology reports for appropriate triage decisions. METHODS A retrospective chart review was conducted including all idiopathic scoliosis patients seen for initial consultation, aged three to 18 years, between January 1 and April 30, 2021. A score out of five was generated based on the adequacy of index images to provide accurate Cobb angle measurements and determine skeletal maturity. Index images were considered inadequate if repeat imaging was necessary. Index radiology reports, associated imaging, and new imaging, if obtained at the initial consultation, were compared. RESULTS Of the 94 patients reviewed, 79% (n = 74) required repeat imaging at the initial consultation, of which 74% (n = 55) were due to insufficient quality and/or limited field of view. Of index images available for review at the initial consult (n = 80), 41.2% scored five out of five, and 32.5% scored two or below. Comparing index radiology reports to initial visit evaluation with ≤ 60 days between imaging (n = 49), discrepancies in Cobb angle were found in 24.5% (95% CI 14.6, 38.1) of patients. The Risser stage was reported in 14% of index radiology reports. CONCLUSION Although pre-referral pediatric spine radiographs serve a diagnostic purpose, most are inadequate for comprehensive idiopathic scoliosis evaluation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Dorothy J Kim
- Hospital for Sick Children, 555 University Avenue, Room S229, Toronto, ON, M5G 1X8, Canada.
| | - Jennifer A Dermott
- Hospital for Sick Children, 555 University Avenue, Room S229, Toronto, ON, M5G 1X8, Canada
| | - Andrew W Howard
- Hospital for Sick Children, 555 University Avenue, Room S229, Toronto, ON, M5G 1X8, Canada
| | - David E Lebel
- Hospital for Sick Children, 555 University Avenue, Room S229, Toronto, ON, M5G 1X8, Canada
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15
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Ansorge A, Sarwahi V, Bazin L, Vazquez O, De Marco G, Dayer R. Accuracy and Safety of Pedicle Screw Placement for Treating Adolescent Idiopathic Scoliosis: A Narrative Review Comparing Available Techniques. Diagnostics (Basel) 2023; 13:2402. [PMID: 37510146 PMCID: PMC10378125 DOI: 10.3390/diagnostics13142402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/15/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
Posterior spinal fusion and segmental spinal instrumentation using pedicle screws (PS) is the most used procedure to correct adolescent idiopathic scoliosis. Computed navigation, robotic navigation, and patient-specific drill templates are available, besides the first described free-hand technique. None of these techniques are recognized as the gold standard. This review compares the PS placement accuracy and misplacement-related complication rates achieved with the techniques mentioned above. It further reports PS accuracy classifications and anatomic PS misplacement risk factors. The literature suggests a higher PS placement accuracy for robotic relative to computed navigation and for the latter relative to the free-hand technique (misplacement rates: 0.4-7.2% versus 1.9-11% versus 1.5-50.7%) using variable accuracy classifications. The reported PS-misplacement-related complication rates are, however, uniformly low (0-1.4%) for every technique, while robotic and computed navigation induce a roughly fourfold increase in the patient's intraoperative radiation exposure relative to the free-hand technique with fluoroscopic implant positioning control. The authors, therefore, recommend dedicating robotic and computed navigation for complex deformities or revisions with altered landmarks, underline the need for a generally accepted PS accuracy classification, and advise against PS placement in grade 4 pedicles yielding higher misplacement rates (22.2-31.5%).
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Affiliation(s)
- Alexandre Ansorge
- Department of Spine Surgery, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland
| | - Vishal Sarwahi
- Department of Pediatric Orthopedics, Cohen Children's Medical Center, Northwell Health System, New Hyde Park, NY 11040, USA
| | - Ludmilla Bazin
- Pediatric Orthopedic Unit, Geneva University Hospital, 1211 Geneva, Switzerland
| | - Oscar Vazquez
- Pediatric Orthopedic Unit, Geneva University Hospital, 1211 Geneva, Switzerland
| | - Giacomo De Marco
- Pediatric Orthopedic Unit, Geneva University Hospital, 1211 Geneva, Switzerland
| | - Romain Dayer
- Pediatric Orthopedic Unit, Geneva University Hospital, 1211 Geneva, Switzerland
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16
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Rose LD, Williams R, Ajayi B, Abdalla M, Bernard J, Bishop T, Papadakos N, Lui DF. Reducing radiation exposure and cancer risk for children with scoliosis: EOS the new gold standard. Spine Deform 2023; 11:847-851. [PMID: 36947393 PMCID: PMC10261215 DOI: 10.1007/s43390-023-00653-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/21/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Children are exposed to significant radiation doses during the investigation and treatment phases of scoliosis. EOS is a new form of low-dose radiation scan which also yields great image quality. However, currently its use is discouraged in the UK due to higher costs. We aimed to quantify the additional radiation dose and cancer risk. METHODS We retrospectively reviewed all paediatric cases who received both standing whole spine roentgenograms and EOS scans as part of their investigations for scoliosis during a six-month period. We compared the radiation doses between the two modalities and estimated the additional mean lifetime cancer risk per study. RESULTS We identified 206 children (mean age 14.4) who met the criteria of having both scans. Dose area products (dGycm2) were converted to estimated effective doses (mSv). The total mean doses were 0.68 mSv (PA 0.49 + Lat 0.19) for plain films, and 0.13 mSv (PA 0.08 + Lat 0.04) for EOS scans (p < 0.001). Additional lifetime cancer risk of a plain film was 543% greater than EOS for both sexes (1/10727 versus 1/5827 in males, 1/34483 versus 1/6350 in females). CONCLUSION There is approximately 5.4-fold increase in risk of cancer for both boys and girls with roentgenograms over EOS, with girls being the most impacted. This carries a significant impact when considering the need for repeat imaging on additional lifetime malignancy risk in children. In our opinion, EOS dual planar scanning is the new gold standard when X-ray of the whole spine is required. LEVEL OF EVIDENCE III.
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Affiliation(s)
- L. D. Rose
- Department of Trauma and Orthopaedic Surgery, St George’s University Hospital, London, UK
| | - R. Williams
- Department of Trauma and Orthopaedic Surgery, St George’s University Hospital, London, UK
| | - B. Ajayi
- Department of Trauma and Orthopaedic Surgery, St George’s University Hospital, London, UK
| | - M. Abdalla
- Department of Trauma and Orthopaedic Surgery, St George’s University Hospital, London, UK
| | - J. Bernard
- Department of Trauma and Orthopaedic Surgery, St George’s University Hospital, London, UK
| | - T. Bishop
- Department of Trauma and Orthopaedic Surgery, St George’s University Hospital, London, UK
| | - N. Papadakos
- Department of Trauma and Orthopaedic Surgery, St George’s University Hospital, London, UK
| | - D. F. Lui
- Department of Trauma and Orthopaedic Surgery, St George’s University Hospital, London, UK
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Laurier D, Billarand Y, Klokov D, Leuraud K. The scientific basis for the use of the linear no-threshold (LNT) model at low doses and dose rates in radiological protection. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:024003. [PMID: 37339605 DOI: 10.1088/1361-6498/acdfd7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/20/2023] [Indexed: 06/22/2023]
Abstract
The linear no-threshold (LNT) model was introduced into the radiological protection system about 60 years ago, but this model and its use in radiation protection are still debated today. This article presents an overview of results on effects of exposure to low linear-energy-transfer radiation in radiobiology and epidemiology accumulated over the last decade and discusses their impact on the use of the LNT model in the assessment of radiation-related cancer risks at low doses. The knowledge acquired over the past 10 years, both in radiobiology and epidemiology, has reinforced scientific knowledge about cancer risks at low doses. In radiobiology, although certain mechanisms do not support linearity, the early stages of carcinogenesis comprised of mutational events, which are assumed to play a key role in carcinogenesis, show linear responses to doses from as low as 10 mGy. The impact of non-mutational mechanisms on the risk of radiation-related cancer at low doses is currently difficult to assess. In epidemiology, the results show excess cancer risks at dose levels of 100 mGy or less. While some recent results indicate non-linear dose relationships for some cancers, overall, the LNT model does not substantially overestimate the risks at low doses. Recent results, in radiobiology or in epidemiology, suggest that a dose threshold, if any, could not be greater than a few tens of mGy. The scientific knowledge currently available does not contradict the use of the LNT model for the assessment of radiation-related cancer risks within the radiological protection system, and no other dose-risk relationship seems more appropriate for radiological protection purposes.
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Affiliation(s)
- Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Yann Billarand
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Dmitry Klokov
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Klervi Leuraud
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
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18
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Cool J, Streekstra GJ, van Schuppen J, Stadhouder A, van den Noort JC, van Royen BJ. Estimated cumulative radiation exposure in patients treated for adolescent idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1777-1786. [PMID: 36943485 DOI: 10.1007/s00586-023-07651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/23/2023] [Accepted: 03/10/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Adolescent idiopoathic scoliosis (AIS) is a progressive spinal deformity, most often observed in female patients of pubescent age. The deformity's severity, its progression through time, its treatment and subsequent follow-up are assessed with routine radiological evaluation of the patient's full spine. This study aimed to determine the cumulative radiation exposure in average patients with AIS treated by brace or surgery throughout their treatment. METHODS The average number of imaging procedures and corresponding radiation doses were retrospectively obtained from the medical charts of AIS patients treated conservatively and/or surgically at our institution. The median radiation exposure of all imaging modalities was stated in effective dose (mSv). The estimated cumulative effective radiation dose of the each treatment group was determined by multiplication of the average number of imaging conducted, and the median effective radiation dose per imaging modality. RESULTS In total, 73 AIS patients were included (28 brace, 45 surgically). Patients treated with a brace were subjected to an average of 9.03 full spine radiographs, resulting in an estimated effective cumulative dose of 0.505 mSv over a median treatment period of 3.23 years. Patients treated surgically received an average of 14.29 full spine radiographs over a median treatment period of 2.76 years. The estimated effective cumulative dose amounted from 0.951 to 1.841 mSv, depending on the surgical technique. CONCLUSION The cumulative effective radiation doses rendered to AIS patients as part of their treatment and follow-up were relatively low. However, every exposure to ionising radiation for medical imaging purposes should be minimised.
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Affiliation(s)
- J Cool
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam and Vrije Universiteit, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - G J Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - J van Schuppen
- Department of Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - A Stadhouder
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam and Vrije Universiteit, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - J C van den Noort
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - B J van Royen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam and Vrije Universiteit, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Amsterdam, The Netherlands.
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19
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Suresh S, Perera P, Izatt MT, Labrom RD, Askin GN, Little JP. Development and validation of a semi-automated measurement tool for calculating consistent and reliable surface metrics describing cosmesis in Adolescent Idiopathic Scoliosis. Sci Rep 2023; 13:5574. [PMID: 37019938 PMCID: PMC10076386 DOI: 10.1038/s41598-023-32614-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
Adolescent Idiopathic Scoliosis (AIS) is a 3D spine deformity that also causes ribcage and torso distortion. While clinical metrics are important for monitoring disorder progression, patients are often most concerned about their cosmesis. The aim of this study was to automate the quantification of AIS cosmesis metrics, which can be measured reliably from patient-specific 3D surface scans (3DSS). An existing database of 3DSS for pre-operative AIS patients treated at the Queensland Children's Hospital was used to create 30 calibrated 3D virtual models. A modular generative design algorithm was developed on the Rhino-Grasshopper software to measure five key AIS cosmesis metrics from these models-shoulder, scapula and hip asymmetry, torso rotation and head-pelvis shift. Repeat cosmetic measurements were calculated from user-selected input on the Grasshopper graphical interface. InterClass-correlation (ICC) was used to determine intra- and inter-user reliability. Torso rotation and head-pelvis shift measurements showed excellent reliability (> 0.9), shoulder asymmetry measurements showed good to excellent reliability (> 0.7) and scapula and hip asymmetry measurements showed good to moderate reliability (> 0.5). The ICC results indicated that experience with AIS was not required to reliably measure shoulder asymmetry, torso rotation and head-pelvis shift, but was necessary for the other metrics. This new semi-automated workflow reliably characterises external torso deformity, reduces the dependence on manual anatomical landmarking, and does not require bulky/expensive equipment.
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Affiliation(s)
- Sinduja Suresh
- Biomechanics and Spine Research Group (BSRG), Centre for Biomedical Technologies (CBT) at the Centre for Children's Health Research (CCHR), School of Mechanical Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia.
| | - Pasan Perera
- Biomechanics and Spine Research Group (BSRG), Centre for Biomedical Technologies (CBT) at the Centre for Children's Health Research (CCHR), School of Mechanical Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia
| | - Maree T Izatt
- Biomechanics and Spine Research Group (BSRG), Centre for Biomedical Technologies (CBT) at the Centre for Children's Health Research (CCHR), School of Mechanical Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia
- Orthopaedics Department, Queensland Children's Hospital (QCH), Brisbane, Australia
| | - Robert D Labrom
- Biomechanics and Spine Research Group (BSRG), Centre for Biomedical Technologies (CBT) at the Centre for Children's Health Research (CCHR), School of Mechanical Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia
- Orthopaedics Department, Queensland Children's Hospital (QCH), Brisbane, Australia
| | - Geoffrey N Askin
- Biomechanics and Spine Research Group (BSRG), Centre for Biomedical Technologies (CBT) at the Centre for Children's Health Research (CCHR), School of Mechanical Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia
- Orthopaedics Department, Queensland Children's Hospital (QCH), Brisbane, Australia
| | - J Paige Little
- Biomechanics and Spine Research Group (BSRG), Centre for Biomedical Technologies (CBT) at the Centre for Children's Health Research (CCHR), School of Mechanical Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia
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Hartley L, Jones C, Lui D, Bernard J, Bishop T, Herzog J, Chan D, Stokes O, Gardner A. An Examination of the Number of Adolescent Scoliotic Curves That Are Braceable at First Presentation to a Scoliosis Service. Healthcare (Basel) 2023; 11:healthcare11030445. [PMID: 36767020 PMCID: PMC9914198 DOI: 10.3390/healthcare11030445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
Adolescent idiopathic scoliosis (AIS) affects between 0.5% and 5.2% of adolescents and is progressive in two-thirds of cases. Bracing is an effective non-operative treatment for AIS and has been shown to prevent up to 72% of curves from requiring surgery. This paper explores the presentation of AIS in the UK and identifies who would be suitable for bracing, as per guidelines published by the Scoliosis Research Society (SRS) and British Scoliosis Society (BSS), through curve severity and skeletal maturity at presentation. There were 526 patients with AIS eligible for inclusion across three tertiary referral centres in the UK. The study period was individualised to each centre, between January 2012 and December 2021. Only 10% were appropriate for bracing via either SRS or BSS criteria. The rest were either too old, skeletally mature or had a curve size too large to benefit. By the end of data collection, 38% had undergone surgery for their scoliosis. In the UK, bracing for AIS is only suitable for a small number at presentation. Future efforts to minimise delays in specialist review and intervention will increase the number of those with AIS suitable for bracing and reduce the number and burden of operative interventions for AIS in the UK.
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Affiliation(s)
- Laura Hartley
- The Royal Orthopaedic Hospital, NHS Foundation Trust, Birmingham B31 2AP, UK
| | - Conor Jones
- The Royal Devon and Exeter, NHS Foundation Trust, Exeter EX2 5DW, UK
| | - Darren Lui
- St George’s University Hospitals, NHS Foundation Trust, London SW17 0OT, UK
| | - Jason Bernard
- St George’s University Hospitals, NHS Foundation Trust, London SW17 0OT, UK
| | - Timothy Bishop
- St George’s University Hospitals, NHS Foundation Trust, London SW17 0OT, UK
| | - Jan Herzog
- St George’s University Hospitals, NHS Foundation Trust, London SW17 0OT, UK
| | - Daniel Chan
- The Royal Devon and Exeter, NHS Foundation Trust, Exeter EX2 5DW, UK
| | - Oliver Stokes
- The Royal Devon and Exeter, NHS Foundation Trust, Exeter EX2 5DW, UK
| | - Adrian Gardner
- The Royal Orthopaedic Hospital, NHS Foundation Trust, Birmingham B31 2AP, UK
- Correspondence: ; Tel.: +44-7841-638236
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21
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Cao CF, Ma KL, Shan H, Liu TF, Zhao SQ, Wan Y, Jun-Zhang, Wang HQ. CT Scans and Cancer Risks: A Systematic Review and Dose-response Meta-analysis. BMC Cancer 2022; 22:1238. [PMID: 36451138 PMCID: PMC9710150 DOI: 10.1186/s12885-022-10310-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There is still uncertainty on whether ionizing radiation from CT scans can increase the risks of cancer. This study aimed to identify the association of cumulative ionizing radiation from CT scans with pertaining cancer risks in adults. METHODS Five databases were searched from their inception to November 15, 2020. Observational studies reporting cancer risks from CT scans in adults were included. The main outcome included quantified cancer risks as cancer case numbers in exposed/unexposed adult participants with unified converted measures to odds ratio (OR) for relative risk, hazard ratio. Global background radiation (2.4 mSv per year) was used as control for lifetime attribution risk (LAR), with the same period from incubation after exposure until survival to 100 years. RESULTS 25 studies were included with a sum of 111,649,943 participants (mean age: 45.37 years, 83.4% women), comprising 2,049,943 actual participants from 6 studies with an average follow-up period as 30.1 years (range, 5 to 80 years); 109,600,000 participants from 19 studies using LAR. The cancer risks for adults following CT scans were inordinately increased (LAR adults, OR, 10.00 [95% CI, 5.87 to 17.05]; actual adults, OR, 1.17 [95%CI, 0.89 to 1.55]; combined, OR, 5.89 [95%CI, 3.46 to 10.35]). Moreover, cancer risks elevated with increase of radiation dose (OR, 33.31 [95% CI, 21.33 to 52.02]), and multiple CT scan sites (OR, 14.08 [95% CI, 6.60 to 30.05]). The risk of solid malignancy was higher than leukemia. Notably, there were no significant differences for age, gender, country, continent, study quality and studying time phrases. CONCLUSIONS Based on 111.6 million adult participants from 3 continents (Asia, Europe and America), this meta-analysis identifies an inordinately increase in cancer risks from CT scans for adults. Moreover, the cancer risks were positively correlated with radiation dose and CT sites. The meta-analysis highlights the awareness of potential cancer risks of CT scans as well as more reasonable methodology to quantify cancer risks in terms of life expectancy as 100 years for LAR. PROSPERO TRIAL REGISTRATION NUMBER CRD42019133487.
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Affiliation(s)
- Chun-Feng Cao
- grid.203458.80000 0000 8653 0555Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Hua Road, No. 439, Yongchuan, 402160 Chongqing, People’s Republic of China
| | - Kun-Long Ma
- grid.203458.80000 0000 8653 0555Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Hua Road, No. 439, Yongchuan, 402160 Chongqing, People’s Republic of China
| | - Hua Shan
- grid.449637.b0000 0004 0646 966XInstitute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi’an, 712046 Shaanxi Province People’s Republic of China
| | - Tang-Fen Liu
- grid.449637.b0000 0004 0646 966XInstitute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi’an, 712046 Shaanxi Province People’s Republic of China
| | - Si-Qiao Zhao
- grid.412262.10000 0004 1761 5538Department of Orthopedics, No.1 Hospital of Xi’an City, Northwestern University, Xi’an, 710002 Shaanxi Province People’s Republic of China
| | - Yi Wan
- grid.233520.50000 0004 1761 4404Department of Health Services, Fourth Military Medical University, Xi’an, 710032 No.169 West Changle Road, Shaanxi Province People’s Republic of China
| | - Jun-Zhang
- grid.489934.bBaoji Central Hospital, 8 Jiangtan Road, Baoji, 721008 Shaanxi Province People’s Republic of China ,grid.43169.390000 0001 0599 1243School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 Shaanxi Province People’s Republic of China
| | - Hai-Qiang Wang
- grid.449637.b0000 0004 0646 966XInstitute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi’an, 712046 Shaanxi Province People’s Republic of China
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22
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Epigenetic and Genetic Factors Related to Curve Progression in Adolescent Idiopathic Scoliosis: A Systematic Scoping Review of the Current Literature. Int J Mol Sci 2022; 23:ijms23115914. [PMID: 35682604 PMCID: PMC9180299 DOI: 10.3390/ijms23115914] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 02/06/2023] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is a progressive deformity of the spine. Scoliotic curves progress until skeletal maturity leading, in rare cases, to a severe deformity. While the Cobb angle is a straightforward tool in initial curve magnitude measurement, assessing the risk of curve progression at the time of diagnosis may be more challenging. Epigenetic and genetic markers are potential prognostic tools to predict curve progression. The aim of this study is to review the available literature regarding the epigenetic and genetic factors associated with the risk of AIS curve progression. This review was carried out in accordance with Preferential Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search was carried out in January 2022. Only peer-reviewed articles were considered for inclusion. Forty studies were included; fifteen genes were reported as having SNPs with significant association with progressive AIS, but none showed sufficient power to sustain clinical applications. In contrast, nine studies reporting epigenetic modifications showed promising results in terms of reliable markers. Prognostic testing for AIS has the potential to significantly modify disease management. Most recent evidence suggests epigenetics as a more promising field for the identification of factors associated with AIS progression, offering a rationale for further investigation in this field.
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Abstract
PURPOSE This study introduces a novel surface-topographic scanning system capable of automatically generating a suite of objective measurements to characterize torso shape. RESEARCH QUESTION what is the reliability of the proposed system for measurement of trunk alignment parameters in patients with adolescent idiopathic scoliosis (AIS) and controls? METHODS Forty-six adolescents (26 with AIS and 20 controls) were recruited for a prospective reliability study. A series of angular, volumetric, and area measures were computed from topographic scans in each of three clinically relevant poses using a fully automated processing pipeline. Intraclass correlation coefficients (ICC(2,1)) were computed within (intra-) and between (inter-) raters. Measurements were also performed on a torso phantom. RESULTS Topographic measurements computed on a phantom were highly accurate (mean RMS error 1.7%) compared with CT. For human subjects, intra- and inter-rater reliability were both high (average ICC > 0.90) with intrinsic (pose-independent) measurements having near-perfect reliability (average ICC > 0.98). CONCLUSION The proposed system is a suitable tool for topographic analysis of AIS; topographic measurements offer an objective description of torso shape that may complement other imaging modalities. Further research is needed to compare topographic findings with gold standard imaging of spinal alignment, e.g., standing radiography. CONCLUSION clinical parameters can be reliably measured in a fully automated system, paving the way for objective analysis of symmetry, body shape pre/post-surgery, and tracking of pathology without ionizing radiation.
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24
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3D quasi-automatic spine length assessment using low dose biplanar radiography after surgical correction in thoracic idiopathic scoliosis. Med Eng Phys 2022; 99:103735. [DOI: 10.1016/j.medengphy.2021.103735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/12/2021] [Accepted: 12/05/2021] [Indexed: 11/18/2022]
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25
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da Casa C, Suárez ÁV, Asensio N, Blanco JF. Quality assessment of orthopedic surgery referral request letters from primary care consultation: Evaluation of a Spanish healthcare area. J Family Community Med 2021; 28:189-195. [PMID: 34703379 PMCID: PMC8496696 DOI: 10.4103/jfcm.jfcm_133_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/15/2021] [Accepted: 06/29/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND One of the most requested referrals for specialist consultations from primary care (PC) is orthopedic surgery (OS). The purpose of this work was to analyze the number, characteristics, and quality of PC referral request letters in a Spanish healthcare area to their OS reference department. MATERIALS AND METHODS The referral rates for 10 years were collected, and a total of 6,225 referral letters issued during the first half of 2019 were analyzed in detail. Gender, age, patient provenance, as well as priority and other process descriptors (type of pathology, suspected diagnosis, exploratory signs, imaging tests) were assessed. A scoring system was developed to evaluate the quality of the referral to an OS consultation: Quality evaluation in OS (QEOS) model. RESULTS The rate of referral to OS is rising. The mean age of the referred patient was 53 years and 59.3% were women. Degenerative pathologies justified most referral requests (65.7%), most of which related to the spine (24.2%) or the knee (23.2%). In the QEOS analysis of the referral request letters, we noted that only 36.5% described some physical exploration, 32.9% image tool request, 25.8% indicated the pharmacological treatment, and 11.2% subsequent physiotherapy, resulting in a poor average quality of PC to OS patient referral. CONCLUSION There is a growing demand for patient referral from PC to OS, however, the number, content, and quality of referral request letters varies greatly. The QEOS tool can be the germ of a simple evaluation system that would help in the improvement of the process of continuous care.
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Affiliation(s)
- Carmen da Casa
- IBSAL - Biomedical Research Institute of Salamanca, Spain.,Department of Surgery, Faculty of Medicine, USAL - University of Salamanca, Salamanca, Spain
| | - Ángel V Suárez
- Salamanca Primary Health Care Management. SACYL - Castilla y León Health Service, Salamanca, Spain
| | - Nuria Asensio
- Primary Healthcare Centre "Pizarrales", SACYL - Castilla y León Health Service, Salamanca, Spain
| | - Juan F Blanco
- IBSAL - Biomedical Research Institute of Salamanca, Spain.,Department of Surgery, Faculty of Medicine, USAL - University of Salamanca, Salamanca, Spain.,Orthopaedic Surgery and Traumatology, University Hospital of Salamanca, Salamanca, Spain
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Madiraju A, Mulcahey PJ, Knott PT, Haas AR, Cuddihy LA, Antonacci MD, Betz RR. Assessing clinical trunk change with surface topography: anterior scoliosis correction as a model to evaluate curve progression. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3533-3539. [PMID: 34609617 DOI: 10.1007/s00586-021-06998-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 06/24/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Previous work has suggested that surface topography can be used for repeated measurements of deformity during curve monitoring following an initial radiograph. Changes in deformity during natural curve progression may be subtle. An important preemptive question to answer is whether topography can follow a large change in spine deformity, as in scoliosis correction. We assess the ability of surface topography to track the evolution of spine deformity during anterior scoliosis correction relative to traditional radiographs. Anterior scoliosis correction was chosen for this analysis because it changes the shape of the trunk without leaving a surgical scar and muscle atrophy along the posterior spine. METHODS Following IRB approval, 18 patients aged 14.6 ± 2.0 years at surgery were enrolled in a retrospective review of coronal radiographs and topographic scans acquired before and after scoliosis correction. Radiographic and topographic measures for the coronal curve angle before and after surgery were compared. RESULTS Surface topography estimates correlate with radiographic measures of the pre- (r = 0.7890, CI = [0.4989 0.9201], p < 0.00001), postsurgical (r = 0.7485, CI = [0.4329 0.9006], p = 0.0004), and the change in the coronal curve angle (r = 0.6744, CI = [0.3028 0.8680], p = 0.0021) due to surgery. CONCLUSIONS We provide evidence open for further extension that topography can follow changes in the coronal curve angle comparably to radiographs. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Alekhya Madiraju
- The Institute for Spine and Scoliosis, 3100 Princeton Pike Bldg. 1-D, Lawrenceville, NJ, 08648, USA
| | - Patrick J Mulcahey
- The Institute for Spine and Scoliosis, 3100 Princeton Pike Bldg. 1-D, Lawrenceville, NJ, 08648, USA
| | - Patrick T Knott
- Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL, 60064, USA
| | - Allison R Haas
- The Institute for Spine and Scoliosis, 3100 Princeton Pike Bldg. 1-D, Lawrenceville, NJ, 08648, USA
| | - Laury A Cuddihy
- The Institute for Spine and Scoliosis, 3100 Princeton Pike Bldg. 1-D, Lawrenceville, NJ, 08648, USA
| | - M Darryl Antonacci
- The Institute for Spine and Scoliosis, 3100 Princeton Pike Bldg. 1-D, Lawrenceville, NJ, 08648, USA
| | - Randal R Betz
- The Institute for Spine and Scoliosis, 3100 Princeton Pike Bldg. 1-D, Lawrenceville, NJ, 08648, USA.
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28
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Response to Letter-to-the-Editor: Ionizing Radiation Exposure and Cancer Risks: Matter or not Matter? Spine (Phila Pa 1976) 2021; 46:E286-E287. [PMID: 33475280 DOI: 10.1097/brs.0000000000003837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Luan FJ, Zhang J, Mak KC, Liu ZH, Wang HQ. Low Radiation X-rays: Benefiting People Globally by Reducing Cancer Risks. Int J Med Sci 2021; 18:73-80. [PMID: 33390775 PMCID: PMC7738971 DOI: 10.7150/ijms.48050] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/13/2020] [Indexed: 12/29/2022] Open
Abstract
Modern medical imaging facilitates the diagnosis and treatment of human diseases. However, few people are aware of the cons of radiation exposure from medical imaging. Emerging evidence reveals that cumulative doses of radiation exposure will increase the morbidity and mortality of pertaining cancer. As a special young population, patients with adolescent idiopathic scoliosis (AIS) suffer more radiation harms from repeated diagnostic imaging, most of which can be avoided in clinical practice. Accumulating evidence highlights reduced cancer risks of radiation exposure for AIS patients with low/zero radiation imaging modalities proposed, amongst which easy conversion from anterior-posterior (AP) to posterior-anterior (PA) projection for whole-spine radiographs should be stressed. It can greatly reduce radiation doses without compromising the quality of diagnostic imaging. Tight collimation combined with PA projection can further reduce radiation harms, and need to be spread to benefit people globally.
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Affiliation(s)
- Fu-Jun Luan
- Department of Orthopaedics, Yongchuan Hospital of Chongqing Medical University, Chongqing City, P. R. China, 402160
| | - Jun Zhang
- Department of Orthopaedics, Baoji Municipal Central Hospital, Baoji, Shaanxi, China, 721008
| | - Kin-Cheung Mak
- Spine Central, Specialist Central, The Hong Kong Adventist Hospital, Hong Kong SAR, China
| | - Zhi-Heng Liu
- Department of Orthopaedics, Chinese PLA No.986 Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, P. R. China, 710054
| | - Hai-Qiang Wang
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, P. R. China, 712046
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