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Bedre Duygu O, Govsa F, Bicer A. Using Photogrammetry to Analyze Anatomical Changes in the Nipple in Juvenile and Adolescent Scoliosis Patients. Aesthetic Plast Surg 2024:10.1007/s00266-024-04039-5. [PMID: 38691177 DOI: 10.1007/s00266-024-04039-5] [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: 11/07/2023] [Accepted: 03/28/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND The need for an objective set of anterior trunk measurements, such as nipple and clavicular shoulder joints, is essential to quantify the anterior asymmetry present in scoliosis. This study aims to characterize breast asymmetry (BA) in young individuals with scoliosis using photogrammetry. METHODS Digital photographs of the anterior trunk of the 51 scoliosis patients aged 4-20 years were taken from an anterior perspective. These images were then transferred to a computer. Ten parameters were measured using the ImageJ software. The positions of patients' nipples were classified into 6 types based on ratios on the x-axis. RESULTS The majority of patients had a right breast that was larger, intensifying the apparent BA due to trunk rotation. The apical vertebra level in patients was found at T8 in 23.6% and T9 in 45.1%. In 92.5% of the patients, the right breast was consistently larger. The lengths between the lateral boundaries and nipples of the right and left breasts and between the medial boundary and nipple of the right breast were statistically significantly higher in males than in females (p < 0.05). Significant differences were found when comparing the values of the lengths between the medial boundaries and nipples of the right and left breasts, the difference in length between the right and left acromioclavicular joint lines, and the angles of the nipple and acromioclavicular joint with the degrees of scoliosis in juvenile and adolescents (p < 0.05). Pearson regression analysis revealed a significant correlation between BA differences and the Cobb angle with a correlation coefficient of 0.901. Factors related to breast aesthetics, like differences in the height of nipples and the distance from the sternal notch to the nipple, represent 30% of the overall score. CONCLUSION The study concluded that there is a significant correlation between the severity of scoliosis and BA differences. Augmentation mammaplasty for BA not only decreased the breast difference but also leveled the nipple disparities. Photogrammetry is considered to be an alternative to other methods and is believed to contribute to the follow-up of BA. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Ozden Bedre Duygu
- Department of Anatomy, Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University, 35100, Izmir, Turkey
- Department of Anatomy, Faculty of Medicine, Izmir Bakircay University, Izmir, Turkey
| | - Figen Govsa
- Department of Anatomy, Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University, 35100, Izmir, Turkey.
- Department of Anatomy, Faculty of Medicine, Izmir Bakircay University, Izmir, Turkey.
| | - Ahmet Bicer
- Department Plastic and Reconstructive Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
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Babaee T, Moradi V, Rouhani N, Shariat A, Parent-Nichols J, Safarnejad H, Nakhaee M. Assessment of reliability and validity of the adapted Persian version of the Spinal Appearance Questionnaire in adolescents with idiopathic scoliosis. Spine Deform 2022; 10:317-326. [PMID: 34533776 DOI: 10.1007/s43390-021-00414-3] [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: 04/21/2021] [Accepted: 09/04/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This study investigates the reliability and validity of the adapted Persian version of the Spinal Appearance Questionnaire (P-SAQ). METHODS The stages of cross-cultural adaptation were conducted according to an internationally accepted guidelines. Reliability of the P-SAQ was measured by evaluating internal consistency and test-retest reproducibility using Cronbach's α and intraclass correlation coefficient (ICC). Validity of the P-SAQ was assessed by factor analysis, and convergent and known-groups validities. Convergent validity was assessed through participant response on the P-SAQ and the revised 22-item Persian version of the Scoliosis Research Society (SRS-22r) questionnaire. Known-groups validity was assessed by comparing the P-SAQ scores according to the patients curve magnitude and treatment type. RESULTS A total of 106 patients with a diagnosis of adolescent idiopathic scoliosis (AIS) were included. The P-SAQ demonstrated an acceptable internal consistency with a Cronbach's α of 0.77 (range 0.65-0.72). The test-retest reliability was excellent (range ICC 0.85-0.98). There was a correlation between the total score, average scores of the general, curve, rib prominence, kyphosis, and trunk shift subscales of the P-SAQ and subtotal and total scores of the SRS-22r, r = - 0.2 to - 0.4, p < 0.05. The P-SAQ discriminated between patients with differing Cobb angle magnitudes and treatment types (p < 0.01). Factor analysis supported the use of the appearance and expectations items as separate scales for the P-SAQ. CONCLUSION The P-SAQ is a valid and reliable tool that could be utilized to evaluate the perception of appearance for Persian-speaking AIS patients with different curve magnitude and treatment strategies. LEVEL OF EVIDENCE Level I- diagnostic studies.
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Affiliation(s)
- Taher Babaee
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Vahideh Moradi
- Iran-Helal Institute of Applied Science and Technology, Tehran, Iran
| | - Naeimeh Rouhani
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ardalan Shariat
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Masoomeh Nakhaee
- Department of Rehabilitation, Faculty of Allied Medicine, Kerman University of Medical Sciences, Medical University Campus, Haft-Bagh Highway, Kerman, Iran.
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Atici Y, Polat B, Erdogan S, Gürpınar T, Demiröz S. Can Breast Asymmetry Following the Treatment of Juvenile Idiopathic Scoliosis with Growing Rod Be Prevented? : A Preliminary Analysis. J Korean Neurosurg Soc 2020; 63:228-236. [PMID: 32024355 PMCID: PMC7054115 DOI: 10.3340/jkns.2019.0192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/09/2019] [Indexed: 11/30/2022] Open
Abstract
Objective It can be assumed that the progression of scoliosis in the juvenile period will increase the asymmetry in the rib cage, and thus will contribute to an increase in the breast asymmetry (BA) in the future. We are looking for answers to the questions; “How will the breasts look with respect to each other and what is the possibility of developing BA in the early follow-up period following the early surgical treatment and final fusion surgery of juvenile idiopathic scoliosis (JIS)?” For this reason, in this study, we aimed to evaluate the breast asymmetries of patients in the period after the final fusion.
Methods Following growing rod treatment, final fusion was achieved in 12 females with JIS. We used the anthropomorphic measurement of the modified BREAST-V formula to assess whether there was an asymmetry between the breasts after an average of 4.8 years (2–11) following final fusion.
Results In comparison, the mean volume of the left breast (222.4 mL [range, 104.1–330.2]) was larger than the mean volume of the right breast volume (214.5 mL [range, 95.2–326.7]) (p=0.034). The left breast was larger in 75% of the patients. BA was observed in 50% of the patients. No correlation was detected between the Cobb angle of the patient after final fusion and BA (p=0.688).
Conclusion In the late follow-up period, BA was detected in 50% of the patients with JIS who achieved final fusion after treatment with growing rod. In majority of the patients, left breast was larger. The patients with JIS and their families can be informed prior to the operation about the probability of BA seen in the follow-up period after fusion.
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Affiliation(s)
- Yunus Atici
- Department of Orthopedics and Traumatology, Medical Park Gebze Hospital, Kocaeli, Turkey
| | - Barış Polat
- Department of OrthopedicsandTraumatology, University of Kyrenia, Kyrenia, Turkish Republic of Northern Cyprus
| | - Sinan Erdogan
- Department of Orthopedics and Traumatology, Baltalimanı Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Tahsin Gürpınar
- Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Serdar Demiröz
- Department of Orthopedics and Traumatology, Medical Park Gebze Hospital, Kocaeli, Turkey
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Little JP, Loch-Wilkinson TJ, Sundberg A, Izatt MT, Adam CJ, Labrom RD, Askin GN. Quantifying Anterior Chest Wall Deformity in Adolescent Idiopathic Scoliosis: Correlation With Other Deformity Measures and Effects of Anterior Thoracoscopic Scoliosis Surgery. Spine Deform 2019; 7:436-444. [PMID: 31053314 DOI: 10.1016/j.jspd.2018.09.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/22/2018] [Accepted: 09/23/2018] [Indexed: 10/26/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES This study investigated how anterior chest wall deformity is affected by thoracoscopic anterior scoliosis fusion (TASF) surgery in adolescent idiopathic scoliosis patients. We aimed to determine correlations pre- and postoperatively with other clinical and radiological scoliosis measures. BACKGROUND DATA Scoliosis surgery aims to halt progression of the deformity, and to reduce its severity. Currently, deformity correction is clinically measured in terms of Cobb angle and rib hump (RH); however, a significant cosmetic concern for patients is anterior chest wall deformity. METHODS Pre- and postoperative CT scans of 28 female, Lenke type 1 patients with a mean preoperative Cobb angle of 50.2° ± 7.1° were retrieved from the Research Group's surgical database. Using ImageJ, 3D reconstructions of the thorax were created. Two observers measured the anterior chest wall deformity as a chest wall angle (CWA) and posterior deformity as a posterior apical deformity angle (PDA). We investigated pre- to postoperative changes in CWA, PDA, RH, and Cobb angle as well as their interrelationship. RESULTS All deformity parameters (Cobb angle, RH, CWA, and PDA) showed statistically significant improvement post TASF. Correlation was found between RH and Cobb angle pre- and postoperatively, Cobb angle and CWA preoperatively and between postoperative change in Cobb angle and CWA. No relationship was found between CWA and RH or PDA. CONCLUSIONS Anterior chest wall deformity is independent from the posterior chest wall measures RH and PDA, indicating that the anterior chest wall deformity is not reflected in the posterior rib cage. The correlation between Cobb angle and CWA indicates that the deformity in the spine and the deformity in the ribs are related, and shows that the anterior chest wall deformity is improved post thoracoscopic anterior scoliosis fusion surgery as the lateral deviation of the spine is corrected. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- J P Little
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane 4101, Queensland, Australia.
| | - T J Loch-Wilkinson
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane 4101, Queensland, Australia
| | - A Sundberg
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane 4101, Queensland, Australia
| | - M T Izatt
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane 4101, Queensland, Australia
| | - C J Adam
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane 4101, Queensland, Australia
| | - R D Labrom
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane 4101, Queensland, Australia
| | - G N Askin
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane 4101, Queensland, Australia
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Duri R, Brown K, Johnson M, McIntosh A. Patients' Perceptions of Breast Asymmetry Improve After Spinal Fusion for Adolescent Idiopathic Scoliosis. Spine Deform 2019; 7:80-83. [PMID: 30587325 DOI: 10.1016/j.jspd.2018.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/14/2018] [Accepted: 06/23/2018] [Indexed: 10/27/2022]
Abstract
STUDY DESIGN Adolescent idiopathic scoliosis (AIS) patients undergoing spine fusion (SF) had their data prospectively collected. The SRS Spine Appearance Questionnaire (SAQ) was the primary outcome measure. The data were reviewed in a retrospective manner. OBJECTIVES Patient concerns about breast/chest wall asymmetry in AIS is high. This study sought to determine the improvement after spinal fusion (SF). SUMMARY Breast/chest wall asymmetry is a significant physical deformity associated with AIS. No literature exists on patient satisfaction related to improved breast/chest wall appearance after SF surgery. METHODS 474 patients undergoing SF for AIS from 2006 to 2014 completed the SRS SAQ preoperation and at two years postoperation. Data were prospectively collected and reviewed in a retrospective manner. The SAQ includes two statements regarding breast/chest wall asymmetry (19 and 20). Statistical analysis was performed to determine a relationship between improved SAQ responses and any clinical/radiographic or surgical parameters. RESULTS 395 females and 79 males (14.4 ± 2.0 years) with preoperation and two-year postoperation Cobb angle 60.6 ± 11.5 and 26.6 ± 12.1 were reviewed. Before surgery, 68.0% of patients identified with the statement "I want to have more even breasts" compared with 37.0% at two years postoperation. In addition, 78.9% identified with the statement "I want to have a more even chest in the front" preoperatively compared with 34.0% at two years postoperation. Positive preoperative responses correlated with scoliometer (p = .029) (p = .044) and Cobb angle of the major curve (p = .048 and p = .006). At two years postoperation, there was a significant number of patients (76%) who had at least a two-point decrease in their response to either statement (p < .0001). CONCLUSION Breast asymmetry is a significant concern of many AIS patients, including males, and correlates with preoperative curve magnitude. SF results in significant improvement in patient perception of breast/chest wall asymmetry, with 76% of patients reporting good outcomes at two years postoperation. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Rudo Duri
- Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219, USA
| | - Kaitlyn Brown
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75930, USA
| | - Megan Johnson
- The Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN 37232, USA
| | - Amy McIntosh
- Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219, USA.
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Weiss HR, Seibel S. Hemidystrophic Thorax Mimicking Scoliosis. Open Orthop J 2018; 12:252-260. [PMID: 30123374 PMCID: PMC6062911 DOI: 10.2174/1874325001812010252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 11/25/2022] Open
Abstract
Background: We regularly use Angle of Trunk Rotation (ATR) measurements for scoliosis screening and also for clinical follow-up of our scoliosis patients under treatment. In some patients, when ATR measurements exceed the screening threshold but without a significant degree of curvature on the X-ray (Cobb angle), a Hemidystrophic Thorax (HDT) is diagnosed. The purpose of this paper was to present a case series of patients with this kind of thoracic deformity because this may be mimicking scoliosis to a significant degree. Materials and Methods: This case series is a consecutive series of patients where the first author detected a hemidystrophic thorax instead of or in combination with scoliosis. A 3D scan of the trunk was made and adjusted to the coordinates in order to achieve an upright orientation of the upper trunk. The scan was scaled in order to determine certain anatomic landmarks, as performed in preparation for bracing. The scan was cut horizontally at the xiphoid level and the plane at this level was analysed visually in order to detect deformations that were different to the typical scoliotic deformations in the horizontal plane. Results: Seven cases were analysed and described in more detail. Conclusion: The condition of HDT may lead to significant rib humps that mimic scoliosis. According to our case series, mild scoliosis can also be associated with HDT. HDT, according to the cases presented in this study, seems to be a relatively benign deformity. Long-term observations are necessary before a final conclusion can be drawn with respect to prognosis.
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Affiliation(s)
- Hans-Rudolf Weiss
- Physical Medicine and Rehabilitation, Chiropractor, Gesundheitsforum Nahetal, Alzeyer Str. 23, D-55457, Gensingen, Germany
| | - Sarah Seibel
- Physical Medicine and Rehabilitation, Chiropractor, Gesundheitsforum Nahetal, Alzeyer Str. 23, D-55457, Gensingen, Germany
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Mao SH, Shi B, Sun X, Liu Z, Zhu ZZ, Qian BP, Qiu Y. Morphometric analysis of iatrogenic breast asymmetry secondary to operative breast shape changes in thoracic 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 2016; 25:3075-3081. [PMID: 27137998 DOI: 10.1007/s00586-016-4554-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Spontaneous surgical alterations of the distorted surface shape of thoracic cage in adolescent idiopathic scoliosis (AIS) may relocate and remodel the bilateral breast mounds. The purpose of this study was to analyze the influence of scoliosis correction surgery on female breast morphology and to identify the risk factors for iatrogenic breast asymmetry secondary to operative breast shape changes in AIS. METHODS Thoracic AIS girls undergoing correction surgery were reviewed. Ten parameters concerning morphometric and CT evaluations of breast profile and symmetry were measured. The degree of asymmetry was determined and comparisons were made for evaluation of operative breast shape changes. The morphologically aggravated breast asymmetry would be considered if the concave and convex difference of either sternal notch-nipple length or sternal notch-nipple tilt angle increased post-operatively. Potential risk factors for iatrogenic breast asymmetry were identified. RESULTS Sixty-eight AIS girls were reviewed. The concave breasts showed significantly more linear and less angular changes in morphological parameters post-operatively (p < 0.05). The concave and convex difference was significantly increased in morphological parameters and yet decreased in radiographic parameters. Ratio of aggravated morphological breast asymmetry was 61.2 %, and this patient group trended to have a minor pre-operative breast asymmetry though the difference was not statistically significant (p > 0.05). Moreover, patients with apex located at or above T7 showed greater changes in both morphological and radiographic dimensions as compared with those with apex beneath T7 (p < 0.05). CONCLUSION The incidence of aggravated post-operative breast asymmetry is notable. Those with higher thoracic apex level, combined with minor pre-operative breast asymmetry, were at relatively higher risk of iatrogenic breast asymmetry aggravation post-operatively. Moreover, discrepancy existed between the morphometric and radiographic parameters concerning the surgical influence on breast asymmetry.
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Affiliation(s)
- Sai-Hu Mao
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, Nanjing, 210008, China
| | - Benlong Shi
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, Nanjing, 210008, China
| | - Xu Sun
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, Nanjing, 210008, China
| | - Zhen Liu
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, Nanjing, 210008, China
| | - Ze-Zhang Zhu
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, Nanjing, 210008, China
| | - Bang-Ping Qian
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, Nanjing, 210008, China.
| | - Yong Qiu
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, Nanjing, 210008, China
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