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Joarder I, Taniguchi S, Mendoza A, Snow ME. Defining "successful" treatment outcomes in adolescent idiopathic scoliosis: a scoping review. 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; 32:1204-1244. [PMID: 36847911 DOI: 10.1007/s00586-023-07592-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/07/2023] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis that affects children aged 10-18 years old, manifesting in a three-dimensional spinal deformity. This study aimed to explore outcome measures used in defining AIS treatment success. Particularly, analyzing the extent of qualitative and quantitative (radiographic and quality of life domains) measures to evaluate AIS and whether AIS treatment approaches (surgical, bracing and physiotherapy) influences outcomes used as proxies of treatment success. METHODS EMBASE and MEDLINE databases were used to conduct a systematic scoping review with 654 search queries. 158 papers met the inclusion criteria and were screened for data extraction. Extractable variables included: study characteristics, study participant characteristics, type of study, type of intervention approach and outcome measures. RESULTS All 158 studies measured quantitative outcomes. 61.38% of papers used radiographic outcomes whilst 38.62% of papers used quantitative quality of life outcomes to evaluate treatment success. Irrespective of treatment intervention utilized, the type of quantitative outcome measure recorded were similar in proportion. Moreover, of the radiographic outcome measures, the subcategory Cobb angle was predominantly used across all intervention approaches. For quantitative quality of life measures, questionnaires investigating multiple domains such as SRS were primarily used as proxies of AIS treatment success across all intervention approaches. CONCLUSION This study identified that no articles employed qualitative measures of describing the psychosocial implications of AIS in defining treatment success. Although quantitative measures have merit in clinical diagnoses and management, there is increasing value in using qualitative methods such as thematic analysis in guiding clinicians to develop a biopsychosocial approach for patient care.
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Affiliation(s)
- Ishraq Joarder
- Faculty of Medicine, University of British Columbia, #908 - 2233 Allison Road, Vancouver, BC, V6T 1T7, Canada.
| | - Seika Taniguchi
- Faculty of Medicine, University of British Columbia, #908 - 2233 Allison Road, Vancouver, BC, V6T 1T7, Canada
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Surgical correction of Scheuermann’s kyphosis by posterior-only approach: a prospective study. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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de Oliveira RG, de Araújo AO, Gomes CR. Magnetic resonance imaging effectiveness in adolescent idiopathic scoliosis. Spine Deform 2021; 9:67-73. [PMID: 32940878 DOI: 10.1007/s43390-020-00205-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the effectiveness of preoperative magnetic resonance imaging (MRI) in adolescent idiopathic scoliosis (AIS) patients with unremarkable history and physical examination. METHODS The imaging data of consecutive patients with presumed AIS treated with a posterior spinal fusion between 2010 and 2016 were reviewed. The presence of traditional risk factors, atypical curve patterns, and its association with relevant abnormalities on MRI were investigated. The number needed to diagnose (NND) and the number needed to misdiagnose (NNM) were calculated to measure MRI effectiveness. RESULTS A total of 198 consecutive patients were identified and divided according to the presence of MRI findings. Both groups predominantly consisted of females, with a mean age of 15 years and right thoracic curvature. Neural axis abnormalities were detected in 25 patients, and the groups had a similar proportion of atypical findings, as curve magnitude, thoracic kyphosis, curve direction, and sex. The NND was 7.9 patients and NNM was 66 patients, meaning that the management was changed before the spine fusion in 12% of patients with neural axis abnormalities. None of the traditional risk factors could predict a higher incidence of neural axis abnormalities in asymptomatic AIS patients. CONCLUSION Traditional risk factors may not be predictive of patients with a higher risk of changes in MRI. Both NND and NNM are representations easily understood by clinicians. Using these indexes to define if a patient should be submitted for additional imaging tests may facilitate the decision of using MRI as a preoperative screening tool in AIS patients. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Rafael Garcia de Oliveira
- Department of Orthopedics, SARAH Network of Rehabilitation Hospitals, SMHS Qd 301 Bloco A, Brasília, DF, 70335-901, Brazil.
| | - Alex Oliveira de Araújo
- Department of Orthopedics, SARAH Network of Rehabilitation Hospitals, SMHS Qd 301 Bloco A, Brasília, DF, 70335-901, Brazil
| | - Cícero Ricardo Gomes
- Department of Orthopedics, SARAH Network of Rehabilitation Hospitals, SMHS Qd 301 Bloco A, Brasília, DF, 70335-901, Brazil
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High density all-pedicle screw technique in correction of high-degree (≥70 degrees) scoliosis with sequential derotation without osteotomies. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Michoński J, Witkowski M, Glinkowska B, Sitnik R, Glinkowski W. Decreased Vertical Trunk Inclination Angle and Pelvic Inclination as the Result of Mid-High-Heeled Footwear on Static Posture Parameters in Asymptomatic Young Adult Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224556. [PMID: 31752144 PMCID: PMC6888429 DOI: 10.3390/ijerph16224556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/27/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022]
Abstract
The influence of high-heel footwear on the lumbar lordosis angle, anterior pelvic tilt, and sacral tilt are inconsistently described in the literature. This study aimed to investigate the impact of medium-height heeled footwear on the static posture parameters of homogeneous young adult standing women. Heel geometry, data acquisition process, as well as data analysis and parameter extraction stage, were controlled. Seventy-six healthy young adult women with experience in wearing high-heeled shoes were enrolled. Data of fifty-three subjects were used for analysis due to exclusion criteria (scoliotic posture or missing measurement data). A custom structured light surface topography measurement system was used for posture parameters assessment. Three barefoot measurements were taken as a reference and tested for the reliability of the posture parameters. Two 30-degree wedges were used to imitate high-heel shoes to achieve a repeatable foot position. Our study confirmed the significant (p < 0.001) reduced vertical balance angle and pelvis inclination angle with large and medium-to-large effects, respectively, due to high-heel shoes. No significant differences were found in the kyphosis or lordosis angles. High-heeled shoes of medium height in young asymptomatic women can lead to a straightening effect associated with a reduced vertical balance angle and decreased pelvic inclination.
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Affiliation(s)
- Jakub Michoński
- Institute of Micromechanics and Photonics, Faculty of Mechatronics, Warsaw University of Technology, 02525 Warsaw, Poland; (J.M.); (M.W.); (R.S.)
| | - Marcin Witkowski
- Institute of Micromechanics and Photonics, Faculty of Mechatronics, Warsaw University of Technology, 02525 Warsaw, Poland; (J.M.); (M.W.); (R.S.)
| | - Bożena Glinkowska
- Department of Sports and Physical Education, Medical University of Warsaw, 00581 Warsaw, Poland;
| | - Robert Sitnik
- Institute of Micromechanics and Photonics, Faculty of Mechatronics, Warsaw University of Technology, 02525 Warsaw, Poland; (J.M.); (M.W.); (R.S.)
| | - Wojciech Glinkowski
- Centre of Excellence “TeleOrto” for Telediagnostics and Treatment of Disorders and Injuries of the Locomotor System, Medical University of Warsaw, 00581 Warsaw, Poland
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, 00581 Warsaw, Poland
- Polish Telemedicine and eHealth Society, 03728 Warsaw, Poland
- Correspondence: ; Tel.: +48-601-230-577
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Noureldine MHA, Shimony N, Jallo GI, Groves ML. Scoliosis in patients with Chiari malformation type I. Childs Nerv Syst 2019; 35:1853-1862. [PMID: 31342150 DOI: 10.1007/s00381-019-04309-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/10/2019] [Indexed: 02/06/2023]
Abstract
The literature about the association between Chiari malformations (CMs) and scoliosis has been growing over the last three decades; yet, no consensus on the optimal management approach in this patient population has been reached. Spinal anomalies such as isolated syrinxes, isolated CM, and CM with a syrinx are relatively common among patients with presumed idiopathic scoliosis (IS), a rule that also applies to scoliosis among CM patients as well. In CM patients, scoliosis presents with atypical features such as early onset, left apical or kyphotic curvature, and neurological deficits. While spinal X-rays are essential to confirm the diagnosis of scoliosis among CM patients, a magnetic resonance imaging (MRI) is also recommended in IS patients with atypical presentations. Hypotheses attempting to explain the occurrence of scoliosis in CM patients include cerebellar tonsillar compression of the cervicomedullary junction and uneven expansion of a syrinx in the horizontal plane of the spinal cord. Early detection of scoliosis on routine spinal examination and close follow-up on curve stability and progression are essential initial steps in the management of scoliosis, especially in patients with CM, who may require full spine MRI to screen for associated neuro-axial anomalies; bracing and spinal fusion may be subsequently pursued in high-risk patients.
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Affiliation(s)
- Mohammad Hassan A Noureldine
- Johns Hopkins University School of Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, 600 5th Street South, 4th floor, Saint Petersburg, FL, 33701, USA
| | - Nir Shimony
- Johns Hopkins University School of Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, 600 5th Street South, 4th floor, Saint Petersburg, FL, 33701, USA
- Geisinger Medical Center, Neuroscience Institute, Danville, PA, USA
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - George I Jallo
- Johns Hopkins University School of Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, 600 5th Street South, 4th floor, Saint Petersburg, FL, 33701, USA.
- Johns Hopkins University Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA.
| | - Mari L Groves
- Johns Hopkins University Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
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Wang D, Gao Y, Liu S, Wang S, Chen W, He J, Zhou Z. Diffusion tensor imaging for evaluation of lumbar intervertebral discs in adolescent idiopathic scoliosis: a preliminary prospective study. Clin Radiol 2018. [DOI: 10.1016/j.crad.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Takács M, Orlovits Z, Jáger B, Kiss RM. Comparison of spinal curvature parameters as determined by the ZEBRIS spine examination method and the Cobb method in children with scoliosis. PLoS One 2018; 13:e0200245. [PMID: 29985957 PMCID: PMC6037360 DOI: 10.1371/journal.pone.0200245] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 05/28/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The most common and gold standard method to diagnose and follow-up on scoliosis treatment is to capture biplanar X-ray images and then use these to determine the sagittal frontal spinal curvature angles by the Cobb method. Reducing exposure to radiation is an important aspect for consideration, especially regarding children. The ZEBRIS spinal examination method is an external, non-invasive measurement method that uses an ultrasound-based motion analysis system. The aim of this study is to compare angle values of patients with adolescent idiopathic scoliosis (AIS) determined by the ZEBRIS spine examination method with the angle values defined by the gold standard Cobb method on biplanar X-ray images. METHODS Subjects included 19 children with AIS (mean age 14.5±2.1 years, range 8-16 years, frontal plane thoracic Cobb angle 19.95±10.23°, thoracolumbar/lumbar angle 16.57±10.23°). The thoracic kyphosis and lumbar lordosis in the sagittal plane and the thoracic and lumbar scoliosis values were calculated by the Cobb method on biplanar X-ray images. The sagittal frontal spinal curvature angles were calculated from the position of the processus spinosus of 19 vertebrae, as determined by the ZEBRIS spine examination method. The validity of the ZEBRIS spine examination method was evaluated with Bland-Altman analyses between the sagittal and frontal spinal curvature parameters calculated from data determined by the ZEBRIS spine examination method and data obtained by the Cobb method on the X-ray images. RESULTS AND DISCUSSION Thoracic spinal curvature angles in sagittal and in frontal planes can be measured with sufficient accuracy. The slopes of the linear regression lines for thoracic kyphosis (TK) and thoracic scoliosis (TSC) are close to one (1.00 and 0.79 respectively), and the intercept values are below 5 degrees. The correlation between the TK and TSC values determined by the two methods is significant (p = 0.000) and excellent (rTK = 0.95, rTSC = 0.85). The differences are in the limit of agreement. The lumbar lordosis (LL) in the sagittal plane shows a very good correlation (rLL = 0.76); however the differences between the angles determined by the two methods are out of the limit of agreement in patients with major lumbar lordosis (LL≥50°). The thoracolumbar/lumbar spinal curvature angles in the frontal plane determined by ZEBRIS spine examination were underestimated at curvatures larger than 15°, mainly due to the rotational and pathological deformities of the scoliotic vertebrae. However, the correlation between lumbar scoliosis (LSC) values determined by the two methods is significant (p = 0.000) and excellent (rLSC = 0.84), the slopes are below one (0.71), the intercept values are below 5 degrees, and the differences between the angles determined by the two methods are within the limits of agreement. We could conclude that ZEBRIS spinal examination is a valid and reliable method for determination of sagittal and frontal curvatures during the treatment of patients with scoliosis. However, it cannot replace the biplanar X-ray examination for the visualization of spinal curvatures in the sagittal and frontal planes and the rotation of vertebral bodies during the diagnosis and annual evaluation of the progression.
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Affiliation(s)
- Mária Takács
- Department of Orthopedics, MÁV Hospital Szolnok, Szolnok, Hungary
| | - Zsanett Orlovits
- Institute of Mathematics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Bence Jáger
- Department of Structural Engineering, Budapest University of Technology and Economics, Budapest, Hungary
| | - Rita M. Kiss
- Department of Mechatronics, Optics and Mechanical Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary
- * E-mail:
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Elnady B, El-Sharkawi MM, El-Meshtawy M, Adam FF, Said GZ. Posterior-only surgical correction of adolescent idiopathic scoliosis: an Egyptian experience. SICOT J 2017; 3:69. [PMID: 29227788 PMCID: PMC5725150 DOI: 10.1051/sicotj/2017057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/02/2017] [Indexed: 11/14/2022] Open
Abstract
Introduction: The aim of this prospective case series study is to document safety and effectiveness of high density pedicle screws through posterior only approach with intraoperative wake-up test in correction of adolescent idiopathic scoliosis (AIS). Methods: Between 2011 and 2015, all surgically treated patients for AIS were followed up for a minimum of 2 years. Clinical outcomes were evaluated using scoliosis research society-22 (SRS) questionnaire. All patients were classified according to Lenke classification. Major and minor curves Cobb angle as well as sagittal parameters were measured on whole spine X-rays. All patients underwent an intra-operative wake-up test after deformity correction and a minimum of 80% metal density of implants was used. Results: This study included 50 patients. The mean age at time of surgery was 16.8 years. The mean follow-up period was 38.1 months. The mean correction rate for the coronal Cobb angle of the major curve was 79.12%, while that of the minor curve was 68.9%. The mean thoracic kyphosis angle was 38.4° preoperatively, 29.76° postoperatively and 30.36° at the last follow-up. The mean SRS-22 questionnaire scores improved significantly at the last follow-up (P > 0.001). There were no neurological deficits at the wake-up test. No cases of pseudarthrosis or metal failure were encountered. Conclusion: This is a prospective study of at least 80% metal density pedicle screws technique and intra-operative wake-up test in Egyptian patients with AIS. It proved to be an effective and safe technique in correction of radiological parameters, with no neurological or implant related complications. It allowed excellent scoliotic and kyphotic curves correction with minimal loss of correction. On the whole it led to better quality of life.
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Affiliation(s)
- Belal Elnady
- Department of Orthopedic and Trauma Surgery, Assiut University Medical School, 71111 Assiut, Egypt
| | - Mohammad M El-Sharkawi
- Department of Orthopedic and Trauma Surgery, Assiut University Medical School, 71111 Assiut, Egypt
| | - Mohamed El-Meshtawy
- Department of Orthopedic and Trauma Surgery, Assiut University Medical School, 71111 Assiut, Egypt
| | - Faisal F Adam
- Department of Orthopedic and Trauma Surgery, Assiut University Medical School, 71111 Assiut, Egypt
| | - Galal Zaki Said
- Department of Orthopedic and Trauma Surgery, Assiut University Medical School, 71111 Assiut, Egypt
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Diffusion Tensor Imaging of Lumbar Vertebras in Female Adolescent Idiopathic Scoliosis: Initial Findings. J Comput Assist Tomogr 2017; 42:317-322. [PMID: 28937482 DOI: 10.1097/rct.0000000000000667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to characterize diffusion tensor imaging (DTI) features of lumbar vertebras in adolescent idiopathic scoliosis (AIS) patients. METHODS Fifty-two AIS patients and 20 healthy volunteers underwent 3-T magnetic resonance scanning including DTI sequence. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values on the convex and concave sides of lumbar vertebras were obtained and compared. RESULTS The FA and ADC values differed significantly between the convex and concave side of lumbar vertebras in AIS (P < 0.01). The ADC values in AIS differed significantly with healthy volunteers (P < 0.01). The FA values on the convex side of L1 to L2 were significantly lower than L4 to L5 in AIS. The difference of FA values between the concave and convex sides of the apex vertebra correlated significantly with Cobb angle (r = 0.436, P < 0.01). CONCLUSIONS The convex and concave sides of lumbar vertebras in AIS patients showed different DTI features.
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Cheng JC, Castelein RM, Chu WC, Danielsson AJ, Dobbs MB, Grivas TB, Gurnett CA, Luk KD, Moreau A, Newton PO, Stokes IA, Weinstein SL, Burwell RG. Adolescent idiopathic scoliosis. Nat Rev Dis Primers 2015; 1:15030. [PMID: 27188385 DOI: 10.1038/nrdp.2015.30] [Citation(s) in RCA: 279] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Adolescent idiopathic scoliosis (AIS) is the most common form of structural spinal deformities that have a radiological lateral Cobb angle - a measure of spinal curvature - of ≥10(°). AIS affects between 1% and 4% of adolescents in the early stages of puberty and is more common in young women than in young men. The condition occurs in otherwise healthy individuals and currently has no recognizable cause. In the past few decades, considerable progress has been made towards understanding the clinical patterns and the three-dimensional pathoanatomy of AIS. Advances in biomechanics and technology and their clinical application, supported by limited evidence-based research, have led to improvements in the safety and outcomes of surgical and non-surgical treatments. However, the definite aetiology and aetiopathogenetic mechanisms that underlie AIS are still unclear. Thus, at present, both the prevention of AIS and the treatment of its direct underlying cause are not possible.
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Affiliation(s)
- Jack C Cheng
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.,Joint Scoliosis Research Centre of The Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Winnie C Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Aina J Danielsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Matthew B Dobbs
- Departments of Orthopaedic Surgery Neurology and Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Theodoros B Grivas
- Trauma and Orthopaedic Department, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Christina A Gurnett
- Department of Neurology, Division of Pediatric Neurology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Keith D Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Alain Moreau
- Viscogliosi Laboratory in Molecular Genetics of Musculoskeletal Diseases, Sainte-Justine University Hospital Research Center, Montreal, Quebéc, Canada.,Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, Quebéc, Canada.,Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebéc, Canada
| | - Peter O Newton
- Department of Orthopedic Surgery, University of California, San Diego, California, USA.,Rady Children's Hospital, San Diego, California, USA
| | - Ian A Stokes
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Stuart L Weinstein
- Department of Orthopedic Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - R Geoffrey Burwell
- Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust - Queen's Medical Centre Campus, Nottingham, UK
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Schmid S, Studer D, Hasler CC, Romkes J, Taylor WR, Brunner R, Lorenzetti S. Using Skin Markers for Spinal Curvature Quantification in Main Thoracic Adolescent Idiopathic Scoliosis: An Explorative Radiographic Study. PLoS One 2015; 10:e0135689. [PMID: 26270557 PMCID: PMC4535911 DOI: 10.1371/journal.pone.0135689] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/26/2015] [Indexed: 12/02/2022] Open
Abstract
Background and Purpose Although the relevance of understanding spinal kinematics during functional activities in patients with complex spinal deformities is undisputed among researchers and clinicians, evidence using skin marker-based motion capture systems is still limited to a handful of studies, mostly conducted on healthy subjects and using non-validated marker configurations. The current study therefore aimed to explore the validity of a previously developed enhanced trunk marker set for the static measurement of spinal curvature angles in patients with main thoracic adolescent idiopathic scoliosis. In addition, the impact of inaccurate marker placement on curvature angle calculation was investigated. Methods Ten patients (Cobb angle: 44.4±17.7 degrees) were equipped with radio-opaque markers on selected spinous processes and underwent a standard biplanar radiographic examination. Subsequently, radio-opaque markers were replaced with retro-reflective markers and the patients were measured statically using a Vicon motion capture system. Thoracolumbar / lumbar and thoracic curvature angles in the sagittal and frontal planes were calculated based on the centers of area of the vertebral bodies and radio-opaque markers as well as the three-dimensional position of the retro-reflective markers. To investigate curvature angle estimation accuracy, linear regression analyses among the respective parameters were used. The impact of inaccurate marker placement was explored using linear regression analyses among the radio-opaque marker- and spinous process-derived curvature angles. Results and Discussion The results demonstrate that curvatures angles in the sagittal plane can be measured with reasonable accuracy, whereas in the frontal plane, angles were systematically underestimated, mainly due to the positional and structural deformities of the scoliotic vertebrae. Inaccuracy of marker placement had a greater impact on thoracolumbar / lumbar than thoracic curvature angles. It is suggested that spinal curvature measurements are included in marker-based clinical gait analysis protocols in order to enable a deeper understanding of the biomechanical behavior of the healthy and pathological spine in dynamic situations as well as to comprehensively evaluate treatment effects.
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Affiliation(s)
- Stefan Schmid
- ETH Zurich, Institute for Biomechanics, Zurich, Switzerland
- Bern University of Applied Sciences, Health Division, Bern, Switzerland
- * E-mail:
| | - Daniel Studer
- University of Basel Children’s Hospital, Orthopaedic Department, Basel, Switzerland
| | | | - Jacqueline Romkes
- University of Basel Children’s Hospital, Laboratory for Movement Analysis, Basel, Switzerland
| | | | - Reinald Brunner
- University of Basel Children’s Hospital, Orthopaedic Department, Basel, Switzerland
- University of Basel Children’s Hospital, Laboratory for Movement Analysis, Basel, Switzerland
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