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Lin AJ, Chen V, Wong C, Tamrazi B, Skaggs DL, Illingworth KD, Heffernan MJ, Andras LM. How Many Imaging Studies Do Patients With Neuromuscular Early Onset Scoliosis (EOS) Receive? J Pediatr Orthop 2024; 44:e727-e731. [PMID: 38938111 DOI: 10.1097/bpo.0000000000002734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
BACKGROUND Children with neuromuscular early onset scoliosis (EOS) receive numerous radiographic studies both from orthopaedic and other specialties. Ionizing radiation doses delivered by computed tomography (CT) are reportedly 100 times higher than conventional radiography. The purpose of this study was to evaluate the number of radiographic studies ordered for neuromuscular EOS patients during their care. METHODS Retrospective review at a tertiary children's hospital from January 2010 to June 2021 included all patients with neuromuscular EOS followed by an orthopaedic specialist for a minimum of 3 years. Patients were excluded if the majority of their nonorthopaedic care was provided by outside institutions. RESULTS Eighteen patients met inclusion criteria with mean follow up of 6.4±2.3 years. A total of 1312 plain radiographs and 35 CT scans were performed. Of the plain radiographs, 34.7% were ordered by orthopaedic providers and 65.3% (857/1312) were ordered by other providers. Of the CT scans, 4 were ordered by orthopaedic providers, while 88.5% (21/35) were ordered by other providers. An average of 74.7 (range: 29 to 124) radiographs and 1.9 (range: 0 to 9) CT scans ordered over the course of each patient's treatment for an average of 13.0±6.0 radiographs and 0.3 CT scans per year. CONCLUSIONS With an average of 75 radiographs and 1.9 CT scans performed per patient, consideration for steps to limit exposure to ionizing radiation should be made a particularly high priority in this unique subset of patients. This requires interdisciplinary coordination as 65% of the radiographs and over 80% of the CT scans were ordered by nonorthopaedic providers. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | - Cynthis Wong
- Department of Radiology, Children's Hospital Los Angeles
| | - Benita Tamrazi
- Department of Orthopaedics, Cedars-Sina Medical Center, Los Angeles, CA
| | - David L Skaggs
- Department of Orthopaedics, Baylor Scott and White Health, Dallas, TX
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Nguyen TNN, Le LH, Emery DJ, Stampe K, Hryniuk Southon S, Lou E. Reliability and accuracy of scoliotic parameters on using a wireless handheld 3D ultrasound for children with adolescent idiopathic scoliosis: a pilot study. 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 2024:10.1007/s00586-024-08445-w. [PMID: 39129033 DOI: 10.1007/s00586-024-08445-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/02/2024] [Accepted: 08/05/2024] [Indexed: 08/13/2024]
Abstract
PURPOSE To report the accuracy and reliability of Cobb angle (CA), axial vertebral rotation (AVR), kyphotic and lordotic angles (KA and LA) measurements on using a new 3D ultrasound (US) system. METHODS Forty participants (34 F, 6 M, aged 14.0 ± 2.3 years) were recruited. The first 20 participants were scanned by the validated US system and the new US system. The other 20 participants were scanned with the new US system only. Two raters (R1 and R2) performed the measurements: R1 has 10 years of experience in radiology but is new in ultrasound scoliosis, while R2 has 30 years of scoliosis experience. All US images were measured twice by R1, and once by R2. Forty posteroanterior and 30 lateral standing radiographs were obtained and measured once by R1. Statistical analysis consisted of mean absolute difference (MAD), intraclass correlation coefficient (ICC (2,1)), and Bland-Altman plots. RESULTS R1 showed excellent intra-rater and inter-rater reliability for US measurements with ICCs(2,1) ≥ 0.91. The inter-method reliability was good between the two US systems for all parameters with ICCs(2,1) ≥ 0.85 and maximum MAD of 3.4°. The new US showed good reliability and accuracy compared to radiographs for CA, AVR and KA with ICCs(2,1) ≥ 0.81 and maximum MAD of 5.8°, but poor results for LA with ICCs(2,1) of 0.27-0.35 and MADs of 14.0°-15.4°. CONCLUSION The new 3D US system showed good reliability and accuracy for CA, AVR and KA measurements, but a large measurement discrepancy on LA. A new measurement method for US LA may need to investigate.
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Affiliation(s)
| | - Lawrence H Le
- University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Derek J Emery
- University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Kyle Stampe
- University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | | | - Edmond Lou
- University of Alberta, Edmonton, AB, T6G 2R3, Canada.
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Duncombe P, Ng PTT, Izatt MT, Duncombe G, Tucker K. Using B-mode ultrasound to evaluate Risser grading for the determination of skeletal maturity in adolescents. Radiography (Lond) 2024; 30:1297-1305. [PMID: 39038406 DOI: 10.1016/j.radi.2024.07.001] [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: 03/05/2024] [Revised: 06/02/2024] [Accepted: 07/01/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Rapid adolescent growth is associated with an increased risk of disease and disease progression. This study assesses the reliability and validity of non-ionising B-mode ultrasound for the assessment of skeletal maturity (Risser Grade) and offers procedural guidelines for its use. METHODS Twenty-three female adolescents with primary-right-thoracic scoliosis (age: 13.8 (1.6) years) and twenty age-matched female control participants without scoliosis (age: 13.1 (1.8) years) were recruited. Skeletal maturity was determined from (i) a series of nine B-mode ultrasound images collected at sites equally spaced between the anterior and posterior superior iliac spines of the pelvis and (ii) clinical spine radiographs obtained as part of standard scoliosis care. Inter-rater reliability was assessed between a novice researcher and an experienced medical doctor. Concurrent-validity was assessed by comparing the location and degree of apophysis growth and fusion obtained via ultrasound with that obtained using radiograph Risser grading for scoliosis participants only. RESULTS The inter-rater reliability of ultrasound Risser grading was strong [ICC(2,1): 0.99, p < 0.001]. High concurrent-validity was determined, with no difference in Risser grading identified between the radiograph and ultrasound grading methods (Wilcoxon signed-rank: Z = -1.93, p = 0.053). CONCLUSION Ultrasound provides a reliable non-ionising alternative to the gold standard of Risser grading from radiographs to determine and monitor skeletal maturity. This study provides a detailed methodology for using ultrasound to assess skeletal maturity. IMPLICATIONS FOR PRACTICE Rapid adolescent growth is associated with an increased risk of disease and disease progression. Therefore, accurately determining and monitoring skeletal maturity in these adolescents is crucial. This study assesses the reliability and validity of non-ionising B-mode ultrasound for the assessment of skeletal maturity and offers procedural guidelines for its use.
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Affiliation(s)
- P Duncombe
- The University of Queensland, School of Biomedical Sciences, Brisbane, Queensland, Australia.
| | - P T T Ng
- The University of Queensland, School of Biomedical Sciences, Brisbane, Queensland, Australia; KK Women's and Children's Hospital, Physiotherapy Department, Singapore
| | - M T Izatt
- Queensland University of Technology at the Centre for Children's Health Research, Biomechanics and Spine Research Group, Brisbane, Queensland, Australia; Orthopaedics Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - G Duncombe
- Department of Obstetrics and Gynaecology, Logan and Beaudesert Hospital, Brisbane, Queensland, Australia; The University of Queensland, Faculty of Medicine, Brisbane, Queensland, Australia
| | - K Tucker
- The University of Queensland, School of Biomedical Sciences, Brisbane, Queensland, Australia
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Vlădăreanu L, Iliescu MG, Andronache IT, Danteș E. Incidence and Importance of Peripheral Vestibular Dysfunction in Adolescent Idiopathic Scoliosis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:723. [PMID: 38929302 PMCID: PMC11201755 DOI: 10.3390/children11060723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/05/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
Adolescent idiopathic scoliosis (AIS) is a common form of scoliosis. As the name suggests, etiopathogenesis is not clearly defined, so treatment is still anchored in the musculoskeletal theory and correction/prevention of high Cobb angle values. This study aimed to determine whether there is any connection between developing scoliotic curvature and a positive history of motion sickness as a symptom of a peripheral vestibular dysfunction/deficit, and if vestibular rehabilitation exercises could be integrated into the treatment plan. The study was conducted over 12 months on a selected population of 159 patients to evaluate or treat scoliotic curvatures in a private clinic. The collected data were analyzed using IBM SPSS Statistics 25 and illustrated using Microsoft Office Excel/Word 2021. Patients with peripheral vestibular dysfunction had significantly higher Cobb angle values when compared to patients with a negative result in an instrumental test for peripheral vestibular dysfunction. Motion sickness was considerably more associated with peripheral vestibular dysfunction, and a positive Fukuda stepping test was associated with a positive history of motion sickness. Adolescent idiopathic scoliosis with higher Cobb angles is related to positive motion sickness history as part of peripheral vestibular dysfunction. Conservative treatment for scoliosis could incorporate sensory integration techniques, and a positive history of motion sickness could be an indicator of a higher risk of progression in adolescent idiopathic scoliosis.
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Affiliation(s)
- Liliana Vlădăreanu
- Doctoral School of Medicine, “Ovidius” University of Constanta, 1 University Alley, 900470 Constanta, Romania; (L.V.); (I.T.A.); (E.D.)
- Rehabilitation Department, Faculty of Medicine, “Ovidius” University of Constanta, 1 University Alley, 900470 Constanta, Romania
- Pediatric Neurorehabilitation Department, Techirghiol Balneal and Rehabilitation Sanatorium, 34-41 Climescu Blvd., 906100 Techirghiol, Romania
| | - Mădălina Gabriela Iliescu
- Doctoral School of Medicine, “Ovidius” University of Constanta, 1 University Alley, 900470 Constanta, Romania; (L.V.); (I.T.A.); (E.D.)
- Rehabilitation Department, Faculty of Medicine, “Ovidius” University of Constanta, 1 University Alley, 900470 Constanta, Romania
- Pediatric Neurorehabilitation Department, Techirghiol Balneal and Rehabilitation Sanatorium, 34-41 Climescu Blvd., 906100 Techirghiol, Romania
| | - Iulia Tania Andronache
- Doctoral School of Medicine, “Ovidius” University of Constanta, 1 University Alley, 900470 Constanta, Romania; (L.V.); (I.T.A.); (E.D.)
- Department of Rheumatology, Internal Medicine Clinic, “Alexandru Gafencu” Military Emergency Hospital Constanta, Mamaia Blvd., 900527 Constanța, Romania
| | - Elena Danteș
- Doctoral School of Medicine, “Ovidius” University of Constanta, 1 University Alley, 900470 Constanta, Romania; (L.V.); (I.T.A.); (E.D.)
- Rehabilitation Department, Faculty of Medicine, “Ovidius” University of Constanta, 1 University Alley, 900470 Constanta, Romania
- Clinical Hospital of Pulmonology, 40 Sentinelei Street, 900002 Constanta, Romania
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Xie LZ, Dou XY, Ge TH, Han XG, Zhang Q, Wang QL, Chen S, He D, Tian W. Deep learning-based identification of spine growth potential on EOS radiographs. Eur Radiol 2024; 34:2849-2860. [PMID: 37848772 DOI: 10.1007/s00330-023-10308-9] [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: 04/14/2023] [Revised: 07/21/2023] [Accepted: 08/15/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES To develop an automatic computer-based method that can help clinicians in assessing spine growth potential based on EOS radiographs. METHODS We developed a deep learning-based (DL) algorithm that can mimic the human judgment process to automatically determine spine growth potential and the Risser sign based on full-length spine EOS radiographs. A total of 3383 EOS cases were collected and used for the training and test of the algorithm. Subsequently, the completed DL algorithm underwent clinical validation on an additional 440 cases and was compared to the evaluations of four clinicians. RESULTS Regarding the Risser sign, the weighted kappa value of our DL algorithm was 0.933, while that of the four clinicians ranged from 0.909 to 0.930. In the assessment of spine growth potential, the kappa value of our DL algorithm was 0.944, while the kappa values of the four clinicians were 0.916, 0.934, 0.911, and 0.920, respectively. Furthermore, our DL algorithm obtained a slightly higher accuracy (0.973) and Youden index (0.952) compared to the best values achieved by the four clinicians. In addition, the speed of our DL algorithm was 15.2 ± 0.3 s/40 cases, much faster than the inference speeds of the clinicians, ranging from 177.2 ± 28.0 s/40 cases to 241.2 ± 64.1 s/40 cases. CONCLUSIONS Our algorithm demonstrated comparable or even better performance compared to clinicians in assessing spine growth potential. This stable, efficient, and convenient algorithm seems to be a promising approach to assist doctors in clinical practice and deserves further study. CLINICAL RELEVANCE STATEMENT This method has the ability to quickly ascertain the spine growth potential based on EOS radiographs, and it holds promise to provide assistance to busy doctors in certain clinical scenarios. KEY POINTS • In the clinic, there is no available computer-based method that can automatically assess spine growth potential. • We developed a deep learning-based method that could automatically ascertain spine growth potential. • Compared with the results of the clinicians, our algorithm got comparable results.
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Affiliation(s)
- Lin-Zhen Xie
- Peking University Fourth School of Clinical Medicine, Beijing, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin-Yu Dou
- Peking University Fourth School of Clinical Medicine, Beijing, China
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Teng-Hui Ge
- Peking University Fourth School of Clinical Medicine, Beijing, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao-Guang Han
- Peking University Fourth School of Clinical Medicine, Beijing, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Zhang
- Peking University Fourth School of Clinical Medicine, Beijing, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi-Long Wang
- Peking University Fourth School of Clinical Medicine, Beijing, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuo Chen
- Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Da He
- Peking University Fourth School of Clinical Medicine, Beijing, China.
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China.
| | - Wei Tian
- Peking University Fourth School of Clinical Medicine, Beijing, China.
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China.
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Heijboer RRO, Heemskerk JL, Vorrink SNW, Kempen DHR. The Prevalence of Cancer in Dutch Female Patients with Idiopathic Scoliosis Compared with the General Population. J Clin Med 2024; 13:2616. [PMID: 38731145 PMCID: PMC11084711 DOI: 10.3390/jcm13092616] [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: 02/25/2024] [Revised: 04/13/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
Background and Objectives: Epidemiological studies have demonstrated the potential oncogenic effects of cumulative radiation exposure, particularly during childhood. One group experiencing repeated exposure to radiation at an early age for multiple years is patients treated for idiopathic scoliosis (IS). This study aimed to determine the relationship between childhood radiological exposure and adult cancer prevalence in children treated for IS. Materials and Methods: Data from 337 predominantly female patients treated at our hospital between January 1981 and January 1995 were gathered and compared to the Dutch national cancer rates. The standardized prevalence ratios for cancer in IS patients were compared with the cancer prevalence rates from the general Dutch population. Results: The overall cancer prevalence in women was 5.0%, with no significant difference compared to the general population (p = 0.425). The results of this study do not suggest that female patients treated for idiopathic scoliosis during childhood have an increased risk of cancer later in life. Conclusion: Despite being the largest recent study in its field, the modest participant number limits its ability to draw conclusions. However, the detailed data collected over a long observation period, alongside data from a period with comparable radiation rates, contributes to refining clinical practice and laying the groundwork for future systematic reviews.
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Affiliation(s)
- Reinout R. O. Heijboer
- Department of Orthopedic Surgery, OLVG, 1091 AC Amsterdam, The Netherlands (S.N.W.V.); (D.H.R.K.)
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, 1012 WP Amsterdam, The Netherlands
| | - Johan L. Heemskerk
- Department of Orthopedic Surgery, OLVG, 1091 AC Amsterdam, The Netherlands (S.N.W.V.); (D.H.R.K.)
| | - Sigrid N. W. Vorrink
- Department of Orthopedic Surgery, OLVG, 1091 AC Amsterdam, The Netherlands (S.N.W.V.); (D.H.R.K.)
| | - Diederik H. R. Kempen
- Department of Orthopedic Surgery, OLVG, 1091 AC Amsterdam, The Netherlands (S.N.W.V.); (D.H.R.K.)
- Department of Orthopedic Surgery, Amsterdam University Medical Center, 1012 WP Amsterdam, The Netherlands
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Pizones J, Moreno-Manzanaro L, Pupak A, Núñez-Pereira S, Larrieu D, Boissiere L, Richner-Wunderlin S, Loibl M, Zulemyan T, Yücekul A, Zgheib S, Charles YP, Chang DG, Kleinstueck F, Obeid I, Alanay A, Sánchez Pérez-Grueso FJ, Pellisé F. Reliability of a New Digital Tool for Photographic Analysis in Quantifying Body Asymmetry in Scoliosis. J Clin Med 2024; 13:2114. [PMID: 38610880 PMCID: PMC11012662 DOI: 10.3390/jcm13072114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Advancements in non-ionizing methods for quantifying spinal deformities are crucial for assessing and monitoring scoliosis. In this study, we analyzed the observer variability of a newly developed digital tool for quantifying body asymmetry from clinical photographs. Methods: Prospective observational multicenter study. Initially, a digital tool was developed using image analysis software, calculating quantitative measures of body asymmetry. This tool was integrated into an online platform that exports data to a database. The tool calculated 10 parameters, including angles (shoulder height, axilla height, waist height, right and left waistline angles, and their difference) and surfaces of the left and right hemitrunks (shoulders, waists, pelvises, and total). Subsequently, an online training course on the tool was conducted for twelve observers not involved in its development (six research coordinators and six spine surgeons). Finally, 15 standardized back photographs of adolescent idiopathic scoliosis patients were selected from a multicenter image bank, representing various clinical scenarios (different age, gender, curve type, BMI, and pre- and postoperative images). The 12 observers measured the photographs at two different times with a three-week interval. For the second round, the images were randomly mixed. Inter- and intra-observer variabilities of the measurements were analyzed using intraclass correlation coefficients (ICCs), and reliability was measured by the standard error of measurement (SEM). Group comparisons were made using Student's t-test. Results: The mean inter-observer ICC for the ten measurements was 0.981, the mean intra-observer ICC was 0.937, and SEM was 0.3-1.3°. The parameter with the strongest inter- and intra-observer validity was the difference in waistline angles 0.994 and 0.974, respectively, while the highest variability was found with the waist height angle 0.963 and 0.845, respectively. No test-retest differences (p > 0.05) were observed between researchers (0.948 ± 0.04) and surgeons (0.925 ± 0.05). Conclusion: We developed a new digital tool integrated into an online platform demonstrating excellent reliability and inter- and intra-observer variabilities for quantifying body asymmetry in scoliosis patients from a simple clinical photograph. The method could be used for assessing and monitoring scoliosis and body asymmetry without radiation.
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Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.M.-M.); (F.J.S.P.-G.)
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.M.-M.); (F.J.S.P.-G.)
| | - Anika Pupak
- Spine Research Unit, Vall d’Hebron Institute of Research, 08035 Barcelona, Spain;
| | - Susana Núñez-Pereira
- Spine Surgery Unit, Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain (F.P.)
| | - Daniel Larrieu
- Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France; (D.L.); (I.O.)
| | - Louis Boissiere
- Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France; (D.L.); (I.O.)
| | | | - Markus Loibl
- Department of Orthopedics, Schulthess Klinik, 8008 Zurich, Switzerland (M.L.); (F.K.)
| | - Tais Zulemyan
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey; (T.Z.); (A.Y.); (A.A.)
| | - Altug Yücekul
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey; (T.Z.); (A.Y.); (A.A.)
| | - Sara Zgheib
- Spine Surgery Unit, University Hospital Strasbourg, 67000 Strasbourg, France; (S.Z.); (Y.P.C.)
| | - Yann Philippe Charles
- Spine Surgery Unit, University Hospital Strasbourg, 67000 Strasbourg, France; (S.Z.); (Y.P.C.)
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, 01757 Seoul, Republic of Korea;
| | - Frank Kleinstueck
- Department of Orthopedics, Schulthess Klinik, 8008 Zurich, Switzerland (M.L.); (F.K.)
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France; (D.L.); (I.O.)
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey; (T.Z.); (A.Y.); (A.A.)
| | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain (F.P.)
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Lai KKL, Lee TTY, Lau HHT, Chu WCW, Cheng JCY, Castelein RM, Schlösser TPC, Lam TP, Zheng YP. Monitoring of Curve Progression in Patients with Adolescent Idiopathic Scoliosis Using 3-D Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:384-393. [PMID: 38114347 DOI: 10.1016/j.ultrasmedbio.2023.11.011] [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: 07/29/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE The aim of the work described here was to determine whether 3-D ultrasound can provide results comparable to those of conventional X-ray examination in assessing curve progression in patients with adolescent idiopathic scoliosis (AIS). METHODS One hundred thirty-six participants with AIS (42 males and 94 females; age range: 10-18 y, mean age: 14.1 ± 1.9 y) with scoliosis of different severity (Cobb angle range: 10º- 85º, mean: of 24.3 ± 14.4º) were included. Each participant underwent biplanar low-dose X-ray EOS and 3-D ultrasound system scanning with the same posture on the same date. Participants underwent the second assessment at routine clinical follow-up. Manual measurements of scoliotic curvature on ultrasound coronal projection images and posterior-anterior radiographs were expressed as the ultrasound curve angle (UCA) and radiographic Cobb angle (RCA), respectively. RCA and UCA increments ≥5º represented a scoliosis progression detected by X-ray assessment and 3-D ultrasound assessment, respectively. RESULTS The sensitivity and specificity of UCA measurement in detecting scoliosis progression were 0.93 and 0.90, respectively. The negative likelihood ratio of the diagnostic test for scoliosis progression by the 3-D ultrasound imaging system was 0.08. CONCLUSION The 3-D ultrasound imaging method is a valid technique for detecting coronal curve progression as compared with conventional radiography in follow-up of AIS. Substituting conventional radiography with 3-D ultrasound is effective in reducing the radiation dose to which AIS patients are exposed during their follow-up examinations.
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Affiliation(s)
- Kelly Ka-Lee Lai
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Timothy Tin-Yan Lee
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong; Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong
| | - Heidi Hin-Ting Lau
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Winnie Chiu-Wing Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jack Chun-Yiu Cheng
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - René Marten Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tom P C Schlösser
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tsz-Ping Lam
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong; Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong.
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Slongo T, Stranzinger E. [Imaging in pediatric traumatology and orthopedics]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2024; 36:56-72. [PMID: 38319324 PMCID: PMC10861404 DOI: 10.1007/s00064-023-00839-1] [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: 06/06/2023] [Revised: 07/25/2023] [Accepted: 08/14/2023] [Indexed: 02/07/2024]
Abstract
Conventional or digital radiography is still the basis of imaging diagnostics of the skeletal system in pediatric patients. It is considered the gold standard for diagnosis, treatment selection, and follow-up. In addition, procedures such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and also nuclear medicine techniques can and should be used. It is advantageous to use trained radiology technicians who are familiar with the handling of children in X‑ray diagnostics. If there is no dedicated pediatric radiology department, it is recommended to follow the guidelines from radiology societies (as low as reasonably achievable [ALARA]) and radiation protection commissions. The present article describes how state-of-the-art tools such as dose monitoring systems and software-controlled image processing and also postprocessing can be used. The article provides information on how the various modalities can be optimally used in order to achieve the best result, i.e., diagnosis, with the least possible effort and burden for the child.
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Affiliation(s)
- Theddy Slongo
- Kinderorthopädie / Kindertraumatologie, Medizinbereich Kinder und Jugendliche, Universitätsklinik für Kinderchirurgie, Juli-von-Jenner-Haus, Freiburgstr. 15, 3010, Bern, Schweiz.
| | - Enno Stranzinger
- Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie (DIPR), Inselspital, Universitätsspital Bern, Anna-Seiler-Haus, Freiburgstr. 20, 3010, Bern, Schweiz
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10
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Patel M, Liu XC, Yang K, Tassone C, Escott B, Thometz J. 3D Back Contour Metrics in Predicting Idiopathic Scoliosis Progression: Retrospective Cohort Analysis, Case Series Report and Proof of Concept. CHILDREN (BASEL, SWITZERLAND) 2024; 11:159. [PMID: 38397270 PMCID: PMC10886742 DOI: 10.3390/children11020159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/14/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
Adolescent Idiopathic Scoliosis is a 3D spinal deformity commonly characterized by serial radiographs. Patients with AIS may have increased average radiation exposure compared to unaffected patients and thus may be implicated with a modest increase in cancer risk. To minimize lifetime radiation exposure, alternative imaging modalities such as surface topography are being explored. Surface topography (ST) uses a camera to map anatomic landmarks of the spine and contours of the back to create software-generated spine models. ST has previously shown good correlation to radiographic measures. In this study, we sought to use ST in the creation of a risk stratification model. A total of 38 patients met the inclusion criteria for curve progression prediction. Scoliotic curves were classified as progressing, stabilized, or improving, and a predictive model was created using the proportional odds logistic modeling. The results showed that surface topography was able to moderately appraise scoliosis curvatures when compared to radiographs. The predictive model, using demographic and surface topography measurements, was able to account for 86.9% of the variability in the future Cobb angle. Additionally, attempts at classification of curve progression, stabilization, or improvement were accurately predicted 27/38 times, 71%. These results provide a basis for the creation of a clinical tool in the tracking and prediction of scoliosis progression in order to reduce the number of X-rays required.
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Affiliation(s)
- Milan Patel
- Department of Orthopedic Surgery, Children’s Wisconsin, Medical College of Wisconsin, Greenfield, WI 53227, USA
| | - Xue-Cheng Liu
- Department of Orthopedic Surgery, Children’s Wisconsin, Medical College of Wisconsin, Greenfield, WI 53227, USA
| | - Kai Yang
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Channing Tassone
- Department of Orthopedic Surgery, Children’s Wisconsin, Medical College of Wisconsin, Greenfield, WI 53227, USA
| | - Benjamin Escott
- Department of Orthopedic Surgery, Children’s Wisconsin, Medical College of Wisconsin, Greenfield, WI 53227, USA
| | - John Thometz
- Department of Orthopedic Surgery, Children’s Wisconsin, Medical College of Wisconsin, Greenfield, WI 53227, USA
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11
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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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12
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Roggio F, Trovato B, Sortino M, Onesta MP, Petrigna L, Musumeci G. The Role of Muscle Biomarkers in Adolescent Idiopathic Scoliosis. J Clin Med 2023; 12:7616. [PMID: 38137689 PMCID: PMC10743897 DOI: 10.3390/jcm12247616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is the predominant orthopedic disorder in children, affecting 1-3% of the global population. Research in this field has tried to delineate the genetic factors behind scoliosis and its association with heredity since AIS is considered a polygenic disease and has different genetic and epigenetic factors. The current study conducted a narrative review of the literature, focusing on biomarkers in the pathophysiology of muscle in AIS patients. Articles were collected from Scopus, Pubmed, and Web of Science. The key screening parameters were scoliosis classification, sampling, and the biomarkers evaluated. This review emphasizes potential key mechanisms and molecular regulators in muscle tissue. While there has been limited focus on the proteins contributing to muscle changes in AIS, significant attention has been given to genomic studies of single-nucleotide polymorphisms, particularly in LBX1. Despite these efforts, the exact causes of AIS remain elusive, with several theories suggesting genetic and hormonal factors. This review identified critical protein biomarkers such as Gi-protein alpha subunits, fibrillin-1 and -2, and various differentially expressed proteins, which may be linked to muscle alterations in AIS. This field of research is still limited due to a lack of homogeneity in the distinction of patients by groups and curve severity. Although the pathophysiology of AIS is still unclear, molecular research is important to guide the treatment of AIS before achieving skeletal maturity, thus avoiding serious problems associated with posture changes and low quality of life. In the future, a more comprehensive synergy between orthopedic and molecular research might ameliorate the diagnosis and treatment of AIS patients.
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Affiliation(s)
- Federico Roggio
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n 97, 95123 Catania, Italy; (F.R.); (B.T.); (M.S.); (L.P.)
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144 Palermo, Italy
| | - Bruno Trovato
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n 97, 95123 Catania, Italy; (F.R.); (B.T.); (M.S.); (L.P.)
| | - Martina Sortino
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n 97, 95123 Catania, Italy; (F.R.); (B.T.); (M.S.); (L.P.)
| | | | - Luca Petrigna
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n 97, 95123 Catania, Italy; (F.R.); (B.T.); (M.S.); (L.P.)
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n 97, 95123 Catania, Italy; (F.R.); (B.T.); (M.S.); (L.P.)
- Research Center on Motor Activities (CRAM), University of Catania, Via S. Sofia n 97, 95123 Catania, Italy
- Department of Biology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA
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13
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Fehr BJ, Visser A, Parent EC. Systematic review of imaging comparisons of spinal alignment among standing positions in healthy adolescents or adolescents with idiopathic scoliosis: SOSORT 2023 award winner. 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; 32:3941-3960. [PMID: 37393596 DOI: 10.1007/s00586-023-07815-0] [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: 05/30/2023] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Clinicians detect scoliosis worsening over time using frequent radiographs during growth. Arms must be elevated when capturing sagittal radiographs to visualize the vertebrae, and this may affect the sagittal angles. The aim was to systematically review the published evidence of the effect of arm positions used during radiography on spinal alignment parameters in healthy participants and those with AIS. METHODS Design was registered in PROSPERO (CRD42022347494). A search strategy was run in Medline, Embase, CINAHL, and Web of Science. Healthy participants ≥ 10 years old and participants with AIS between 10 and 18 years old, with Cobb angles > 10° were included. Study quality was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS). Meta-analysis was performed where possible. RESULTS Overall, 1332 abstracts and 33 full texts were screened. Data was extracted from 7 included studies. The most common positions were habitual standing, fists on clavicle, and active (arms raised unsupported). Kyphosis, lordosis, and sagittal vertical axis (SVA) were most measured. Meta-analysis showed significantly decreased kyphosis (SMD = 0.78, 95%CI 0.48, 1.09) and increased lordosis (SMD = - 1.21, 95%CI - 1.58, - 0.85) when clavicle was compared to standing. Significant posterior shifts in SVA were shown in clavicle compared to standing (MD = 30.59 mm, 95%CI 23.91, 37.27) and active compared to clavicle (MD = - 2.01 mm, 95%CI - 3.38, - 0.64). Cobb angles and rotation were rarely studied (1 study). CONCLUSION Meta-analysis evidence showed elevated arm positions modify sagittal measurements compared to standing. Most studies did not report on all relevant parameters. It is unclear which position best represent habitual standing.
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Affiliation(s)
- Brianna J Fehr
- Department of Physical Therapy, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Annika Visser
- Department of Physical Therapy, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Eric C Parent
- Department of Physical Therapy, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
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14
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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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15
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Xing Q, Hong R, Shen Y, Shen Y. Design and validation of depth camera-based static posture assessment system. iScience 2023; 26:107974. [PMID: 37810248 PMCID: PMC10551660 DOI: 10.1016/j.isci.2023.107974] [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: 04/14/2023] [Revised: 07/20/2023] [Accepted: 09/16/2023] [Indexed: 10/10/2023] Open
Abstract
Postural abnormalities have become a prevalent issue affecting individuals of all ages, resulting in a diminished quality of life. Easy-use and reliable posture assessment tools can aid in screening for and correcting posture deviation at an early stage. In this study, we present a depth camera-based static posture assessment system to screen for common postural anomalies such as uneven shoulders, pelvic tilt, bowlegs and knock-knees, forward head, scoliosis, and shoulder blade inclination. The system consists of an Azure Kinect camera, a laptop, and evaluation software. Our system accurately measures skeleton and posture indexes and shows favorable agreement with a golden standard optical infrared motion capture system. The findings indicate that the system is a low-cost posture assessment tool with high precision and accuracy, suitable for initial screening of postural abnormalities in individuals of all ages.
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Affiliation(s)
- Qingjun Xing
- School of Sport Science, Beijing Sport University, Beijing 100084, China
| | - Ruiwei Hong
- School of Sport Engineering, Beijing Sport University, Beijing 100084, China
| | - Yuanyuan Shen
- School of Sport Engineering, Beijing Sport University, Beijing 100084, China
| | - Yanfei Shen
- School of Sport Engineering, Beijing Sport University, Beijing 100084, China
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16
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Mehta B, Chockalingam N, Shannon T, Jevtic N, Lazic F, Jasani V, Eddison N, Healy A, Needham R. Non-Invasive Assessment of Back Surface Topography: Technologies, Techniques and Clinical Utility. SENSORS (BASEL, SWITZERLAND) 2023; 23:8485. [PMID: 37896577 PMCID: PMC10610923 DOI: 10.3390/s23208485] [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: 08/28/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
(1) Background: Frequent exposure to ionising radiation is often used to determine the diagnosis of adolescent idiopathic scoliosis (AIS), a lateral curvature of the spine in those aged between 10 and 18 years, and a treatment plan according to Cobb angle. This narrative review outlines the clinical utility of surface topography (ST), a radiation-free imaging modality. (2) Methods: Publicly available databases were searched to yield literature related to ST. Identified articles were classified based on the equipment used and in order of how it was developed, i.e., historical, recent developments, and state-of-the-art developments. (3) Conclusions: ST is a reliable cost-effective non-invasive technique that provides an alternative to radiation-based imaging to aid with the diagnosis and potential screening of AIS. Several scanning methods are available, which allows ST to be used in several clinical environments. Limitations of inter-reliability and differences of apparatus resulting in variations of data have been noted through this narrative review.
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Affiliation(s)
- Bhavna Mehta
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2DF, UK; (B.M.); (T.S.); (N.E.); (A.H.); (R.N.)
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2DF, UK; (B.M.); (T.S.); (N.E.); (A.H.); (R.N.)
| | - Thomas Shannon
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2DF, UK; (B.M.); (T.S.); (N.E.); (A.H.); (R.N.)
| | - Nikola Jevtic
- ScolioCentar, Novisad, 403916 Novi Sad, Serbia; (N.J.); (F.L.)
| | - Filip Lazic
- ScolioCentar, Novisad, 403916 Novi Sad, Serbia; (N.J.); (F.L.)
| | - Vinay Jasani
- Centre for Biomechanics, University Hospitals of North Midlands NHS Trust, Stoke on Trent ST4 6QG, UK;
| | - Nicola Eddison
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2DF, UK; (B.M.); (T.S.); (N.E.); (A.H.); (R.N.)
- Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
| | - Aoife Healy
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2DF, UK; (B.M.); (T.S.); (N.E.); (A.H.); (R.N.)
| | - Robert Needham
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2DF, UK; (B.M.); (T.S.); (N.E.); (A.H.); (R.N.)
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17
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Angrisani L, De Benedetto E, Duraccio L, Lo Regio F, Ruggiero R, Tedesco A. Infrared Thermography for Real-Time Assessment of the Effectiveness of Scoliosis Braces. SENSORS (BASEL, SWITZERLAND) 2023; 23:8037. [PMID: 37836867 PMCID: PMC10574976 DOI: 10.3390/s23198037] [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: 07/28/2023] [Revised: 09/05/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023]
Abstract
This work proposes an innovative method, based on the use of low-cost infrared thermography (IRT) instrumentation, to assess in real time the effectiveness of scoliosis braces. Establishing the effectiveness of scoliosis braces means deciding whether the pressure exerted by the brace on the patient's back is adequate for the intended therapeutic purpose. Traditionally, the evaluation of brace effectiveness relies on empirical, qualitative assessments carried out by orthopedists during routine follow-up examinations. Hence, it heavily depends on the expertise of the orthopedists involved. In the state of the art, the only objective methods used to confirm orthopedists' opinions are based on the evaluation of how scoliosis progresses over time, often exposing people to ionizing radiation. To address these limitations, the method proposed in this work aims to provide a real-time, objective assessment of the effectiveness of scoliosis braces in a non-harmful way. This is achieved by exploiting the thermoelastic effect and correlating temperature changes on the patient's back with the mechanical pressure exerted by the braces. A system based on this method is implemented and then validated through an experimental study on 21 patients conducted at an accredited orthopedic center. The experimental results demonstrate a classification accuracy slightly below 70% in discriminating between adequate and inadequate pressure, which is an encouraging result for further advancement in view of the clinical use of such systems in orthopedic centers.
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Affiliation(s)
- Leopoldo Angrisani
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, 80125 Naples, Italy; (L.A.); (F.L.R.)
| | - Egidio De Benedetto
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, 80125 Naples, Italy; (L.A.); (F.L.R.)
| | - Luigi Duraccio
- Department of Electronics and Telecommunications, Polytechnic University of Turin, 10129 Turin, Italy;
| | - Fabrizio Lo Regio
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, 80125 Naples, Italy; (L.A.); (F.L.R.)
| | | | - Annarita Tedesco
- Department of Chemistry, University of Naples Federico II, 80126 Naples, Italy;
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18
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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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19
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Parent EC, Donzelli S, Yaskina M, Negrini A, Rebagliati G, Cordani C, Zaina F, Negrini S. Prediction of future curve angle using prior radiographs in previously untreated idiopathic scoliosis: natural history from age 6 to after the end of growth (SOSORT 2022 award winner). 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; 32:2171-2184. [PMID: 37059884 DOI: 10.1007/s00586-023-07681-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/16/2023] [Accepted: 03/22/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE Treatment selection for idiopathic scoliosis is informed by the risk of curve progression. Previous models predicting curve progression lacked validation, did not include the full growth/severity spectrum or included treated patients. The objective was to develop and validate models to predict future curve angles using clinical data collected only at, or both at and prior to, an initial specialist consultation in idiopathic scoliosis. METHODS This is an analysis of 2317 patients with idiopathic scoliosis between 6 and 25 years old. Patients were previously untreated and provided at least one prior radiograph prospectively collected at first consult. Radiographs were re-measured blinded to the predicted outcome: the maximum Cobb angle on the last radiograph while untreated. Linear mixed-effect models were used to examine the effect of data from the first available visit (age, sex, maximum Cobb angle, Risser, and curve type) and from other visits while untreated (maximum Cobb angle) and time (from the first available radiograph to prediction) on the Cobb angle outcome. Interactions of the first available angle with time, of time with sex, and time with Risser were also tested. RESULTS We included 2317 patients (83% of females) with 3255 prior X-rays where 71% had 1, 21.1% had 2, and 7.5% had 3 or more. Mean age was 13.9 ± 2.2yrs and 81% had AIS. Curve types were: 50% double, 26% lumbar/thoracolumbar-lumbar, 16% thoracic, and 8% other. Cobb angle at the first available X-ray was 20 ± 10° (0-80) vs 29 ± 13° (6-122) at the outcome visit separated by 28 ± 22mths. In the model using data at and prior to the specialist consult, larger values of the following variables predicted larger future curves: first available Cobb angle, Cobb angle on other previous X-ray, and time (with Time2 and Time3) to the target prediction. Larger values on the following variables predicted a smaller future Cobb angle: Risser and age at the first available X-ray, time*Risser and time*female sex interactions. Cross-validation found a median error of 4.5o with 84% predicted within 10°. Similarly, the model using only data from the first specialist consult had a median error of 5.5o with 80% of cases within 10° and included: maximum Cobb angle at first specialist consult, Time, Time2, age, curve type, and both interactions. CONCLUSIONS The models can help clinicians predict how much curves would progress without treatment at future timepoints of their choice using simple variables. Predictions can inform treatment prescription or show families why no treatment is recommended. The nonlinear effects of time account for the rapid increase in curve angle at the beginning of growth and the slowed progression after maturity. These validated models predicted future Cobb angle with good accuracy in untreated idiopathic scoliosis over the full growth spectrum.
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Affiliation(s)
- Eric C Parent
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, Alberta, T6G2G4, Canada.
| | | | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada
| | | | | | | | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | - Stefano Negrini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University "la Statale", Milan, Italy
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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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21
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Roggio F, Petrigna L, Filetti V, Vitale E, Rapisarda V, Musumeci G. Infrared thermography for the evaluation of adolescent and juvenile idiopathic scoliosis: A systematic review. J Therm Biol 2023; 113:103524. [PMID: 37055128 DOI: 10.1016/j.jtherbio.2023.103524] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 01/03/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Adolescent and Juvenile Idiopathic Scoliosis are a three-dimensional spine deformity characterized by a muscle alteration of the convex and concave sides of the scoliosis, which can be evaluated with different non-invasive and radiation-free methods such as infrared thermography. The objective of the present review is to assess infrared thermography as a potential method to evaluate alterations of the scoliosis. MATERIALS AND METHODS A systematic review was performed by collecting articles from PubMed, Web of Science, Scopus, and Google Scholar, published from 1990 to April 2022, on the use of infrared thermography to evaluate adolescent and juvenile idiopathic scoliosis. Relevant data were collected in tables, and the primary outcomes were discussed narratively. RESULTS Of the 587 articles selected, only 5 were in line with the objective of this systematic review and were eligible for the inclusion criteria. The findings of the selected articles corroborate the applicability of infrared thermography as an objective method to assess the thermal differences of the muscles between the convex and concave sides of scoliosis. The overall quality of the research was uneven in the reference standard method and assessment of measures. CONCLUSION Infrared thermography is providing promising results to discriminate thermal differences in scoliosis evaluation, albeit there are still some concerns about considering it as a diagnostic tool for scoliosis evaluation because specific recommendations for collecting data are not met. We propose additional recommendations to existing guidelines to perform thermal acquisition to reduce errors and provide the best results to the scientific community.
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Affiliation(s)
- Federico Roggio
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy; Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, Palermo, 90144, Italy
| | - Luca Petrigna
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
| | - Veronica Filetti
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
| | - Ermanno Vitale
- Department of Clinical and Experimental Medicine, Occupational Medicine, University of Catania, Via Santa Sofia n°78, 95123, Catania, Italy
| | - Venerando Rapisarda
- Department of Clinical and Experimental Medicine, Occupational Medicine, University of Catania, Via Santa Sofia n°78, 95123, Catania, Italy
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy; Research Center on Motor Activities (CRAM), University of Catania, Via S. Sofia n°97, 95123, Catania, Italy; Department of Biology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, 19122, PA, United States.
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22
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Skaggs KF, Bainton NM, Boby AZ, Rymond CC, Fields MW, Roye BD, Vitale MG. Reliability of Preoperative Supine Versus Bending Radiographs in Estimating the Structural Nature of Curves in EOS. J Pediatr Orthop 2023; 43:70-75. [PMID: 36607916 DOI: 10.1097/bpo.0000000000002305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The study sought to evaluate the utility of a single supine radiograph in determining curve flexibility in early-onset scoliosis (EOS) patients. METHODS EOS patients with upright (standing/seated), supine, and side-bending radiographs who underwent spinal deformity surgery were identified. Coronal parameters included: proximal thoracic (PT) curve, main thoracic (MT) curve, and thoracolumbar/lumbar (TL/L) curve. Each radiograph was measured twice by 2 different raters. Correlation coefficients were utilized to investigate associations between the different radiographs. Interrater Correlation Coefficient (ICC) assessed intrarater and interrater reliability. RESULTS Thirty-seven EOS patients were identified (age at diagnosis: 7.0±2.9 y, preoperative age: 13.0±2.9 y; 73% female; etiologies: 54% idiopathic, 30% syndromic, and 16% neuromuscular). Supine PT and MT curve measurements were highly associated with corresponding side-bending measurements (PT: r=0.75, P<0.001; MT: r=0.80, P<0.001), and TL/L curves were very highly associated (TL/L: r=0.92, P<0.001). The mean absolute differences between supine and side-bending measurements were PT: 11.3±7.8 degrees, MT: 14.8±8.3 degrees, and TL/L: 16.2±7.6 degrees, where the side-bending was on average smaller than the supine measurement. The intrarater reliabilities were excellent, with an ICC ranging from 0.93 to 0.96 for side-bending films and 0.94 to 0.97 for supine films. The interrater reliability was excellent with ICC value of 0.88 for side-bending films and 0.93 for supine films. CONCLUSIONS A single, preoperative supine radiograph was highly predictive of side-bending radiographs in patients with EOS. Supine curves measured an average of 15 degrees larger than bending curves in the MT and TL/L region. A single supine film may eliminate the need for effort-related, dual side-bending radiographs. LEVEL OF EVIDENCE Level II-retrospective study.
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Affiliation(s)
- Kira F Skaggs
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Nicole M Bainton
- Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Afrain Z Boby
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Christina C Rymond
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Michael W Fields
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Benjamin D Roye
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center.,Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Michael G Vitale
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center.,Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
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Cheung MC, Yip J, Law D, Cheung JPY. Surface electromyography (sEMG) biofeedback posture training improves the physical and mental health of early adolescents with mild scoliosis: A qualitative study. Digit Health 2023; 9:20552076231203820. [PMID: 37766906 PMCID: PMC10521269 DOI: 10.1177/20552076231203820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Asymmetry in paraspinal muscle activities is observed in adolescent idiopathic scoliosis and may be of value for predicting curve progression. We have reported the effects of the surface electromyography biofeedback posture training program in improving the symmetry of paraspinal muscle activities and reducing the curve progression of early adolescents with mild scoliosis. This study further explored their subjective experience of the training program on posture correction and health-related quality of life. Methods Using purposive sampling, 13 early adolescents aged between 11 and 13 years with mild scoliosis participated in semi-structured in-depth interviews after completing 30 sessions of training. The data were recorded, transcribed, and coded using thematic analysis with NVivo 10. Significant statements and phrases were categorized into themes and subthemes. Results As assessed by X-ray, five early adolescents showed at least a 5° Cobb angle reduction in spinal curvature, while eight showed no significant curve progression (a Cobb angle change under 5°). Several subthemes related to the benefits of the training program on the health-related quality of life were generated, namely (a) posture correction, (b) improvement in body appearance, (c) restoration of muscle relaxation, (d) reduction in bodily pain and fatigue, (e) enhancement of self-confidence/self-image, and (f) improvement in social functioning. Conclusions Given its positive effects, the sEMG biofeedback posture training program has the potential to be an alternative early intervention for early adolescents with mild scoliosis. Further empirical studies need to be carried out to substantiate its effectiveness and evaluate the sustainability of its benefits over time.
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Affiliation(s)
- Mei-Chun Cheung
- Department of Social Work, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Research Center for Neuropsychological Well-Being, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Joanne Yip
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Derry Law
- Department of Design, Caritas Institute of Higher Education and Caritas Bianchi College of Careers, Tseung Kwan O, New Territories, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Jiang W, Yu C, Chen X, Zheng Y, Bai C. Ultrasound to X-ray synthesis generative attentional network (UXGAN) for adolescent idiopathic scoliosis. ULTRASONICS 2022; 126:106819. [PMID: 35926252 DOI: 10.1016/j.ultras.2022.106819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/03/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
Standing X-ray radiograph with Cobb's method is the gold standard for scoliosis diagnosis. However, radiation hazard restricts its application, especially for close follow-up of adolescent patients. Compared with X-ray, ultrasound imaging has advantages of being radiation-free and real-time. To combine advantages of the above two imaging modalities, an ultrasound to X-ray synthesis generative attentional network (UXGAN) was proposed to synthesize ultrasound images into X-ray-like images. In this network, a cyclically consistent network was adopted and was trained end-to-end. An attention module was added and different residual blocks were designed. The quantitative comparison results demonstrated the superiority of our method to the state-of-the-art CycleGAN methods. We further compared the Cobb angle values measured on synthesized images and the real X-ray images, respectively. A good linear correlation (r = 0.95) was demonstrated between the two methods. The above results proved that the proposed method is of great significance for providing both X-ray images and ultrasound images based on the radiation-free ultrasound scanning.
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Affiliation(s)
- Weiwei Jiang
- College of Computer Science & Technology, Zhejiang University of Technology, Hangzhou 310023, China
| | - Chaohao Yu
- Hangzhou Kaiyuan Business Vocational School, Hangzhou 310000, China
| | - Xianting Chen
- College of Computer Science & Technology, Zhejiang University of Technology, Hangzhou 310023, China
| | - Yongping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region
| | - Cong Bai
- College of Computer Science & Technology, Zhejiang University of Technology, Hangzhou 310023, China.
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25
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Grünwald AT, Roy S, Lampe R. Scoliosis assessment tools to reduce follow-up X-rays. J Orthop Translat 2022; 38:12-22. [PMID: 36313977 PMCID: PMC9579751 DOI: 10.1016/j.jot.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/08/2022] [Accepted: 07/26/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Clinical examinations of scoliosis often includes X-rays. Regular clinical monitoring is recommended in particular at young age, because of the high risk of progression during periods of rapid growth. Supplementary methods free of ionizing radiation thus could help to reduce the potential risk of ionizing radiation related health problems. Methods Twelve 3D scan images from female and male patients with different types and severities of spinal deformations were analysed using body scanner image analysis tools. The scan images were captured with a 3D body scanner, which used an infrared sensor and a video camera. To calculate and compare with the patient's specific spinal deformations, simulations based on finite elements methods were performed on biomechanical models of ribcage and spinal column. Results The methods and parameters presented here are in good agreement with corresponding X-rays, used for comparison. High correlation coefficients of ‖ρ s ‖ ≥ 0.87 between Cobb angle and lateral deviation, as well as between Cobb angle and rotation of the vertebrae, indicate that the parameters could provide supplementary informations in the assessment of spinal deformations. So-called apex angles, in addition introduced to relate the results of the present method with Cobb angles, show strong correlations of ‖ρ s ‖ ≥ 0.68 and thus could be used for comparison in later follow-up examinations. Conclusion The user-friendly 3D body scanner image analysis tools enable orthopaedic specialists to simulate, visualize and inspect patient's specific spinal deformations. The method is intended to provide supplementary information in complement to the Cobb angle for the assessment of spinal deformations in clinical daily routine and might have the potential to reduce X-rays in follow-up examinations. The Translational Potential of this article The study presents a new method, based on 3D body scanner images and biomechanical modelling, that has the potential to reduce X-rays when monitoring scoliosis especially in young patients.
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Affiliation(s)
- Alexander T.D. Grünwald
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Orthopaedic Department, Research Unit of the Buhl-Strohmaier Foundation for Cerebral Palsy and Paediatric Neuroorthopaedics, Munich, Germany
| | - Susmita Roy
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Orthopaedic Department, Research Unit of the Buhl-Strohmaier Foundation for Cerebral Palsy and Paediatric Neuroorthopaedics, Munich, Germany
| | - Renée Lampe
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Orthopaedic Department, Research Unit of the Buhl-Strohmaier Foundation for Cerebral Palsy and Paediatric Neuroorthopaedics, Munich, Germany,Markus Würth Professorship, Technical University of Munich, Munich, Germany,Corresponding author. Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany.
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The role of school medicine in the early detection and management of adolescent idiopathic scoliosis. Wien Klin Wochenschr 2022:10.1007/s00508-022-02092-1. [PMID: 36194305 PMCID: PMC9531638 DOI: 10.1007/s00508-022-02092-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/04/2022] [Indexed: 11/03/2022]
Abstract
Objective To analyze the trends in scoliosis screenings over 10 years (2010 vs. 2020). To assess the management of schoolchildren with a preliminary diagnosis of adolescent idiopathic scoliosis by school medicine specialists. Methods Historical data were used for the year 2009/2010, and a cross-sectional study was conducted during the school year 2019/2020 on 18,216 pupils of 5th, 6th, and 8th elementary school grades. A forward bend test was used to detect clinical features of scoliosis and some positive findings were referred to orthopedists or physiatrists for further evaluation. Results In the analyzed 10-year period abnormal forward bend test findings increased from 4.9 to 5.8% (by 18.4%; P < 0.001). While its prevalence escalated markedly in girls (from 5.8 to 8.3%; P < 0.001), a modest but significant decrease, from 3.8 to 3.2% (P = 0.018), was noted in boys. Most pupils had low to moderate curves, and its prevalence was some 6.5 times higher in girls (P < 0.001). The forward bend test positive predictive value was 84.7%. Discrete forward bend test aberrations were managed by school medicine specialists only. Conclusion While actively promoting scoliosis screening in children, we have shown that forward bend test is an acceptable tool for early adolescent idiopathic scoliosis detection in school medicine. In collaboration with other specialists and using additional diagnostic methods, school medicine specialists can ensure early detection and appropriate interventions, avoiding the potential harms of radiation exposure.
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Akyurek E, Zengin Alpozgen A, Akgul T. The preliminary results of physiotherapy scoliosis-specific exercises on spine joint position sense in adolescent idiopathic scoliosis: A randomized controlled trial. Prosthet Orthot Int 2022; 46:510-517. [PMID: 36215059 DOI: 10.1097/pxr.0000000000000136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 03/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND It has been observed that there are difficulties in maintaining spinal harmony in the absence of proprioceptive information, which has an important role in achieving postural control in scoliosis. One of the tests used to evaluate proprioceptive mechanisms is joint position reproduction. OBJECTIVES The main aim of our study was to investigate the effect of physiotherapy scoliosis-specific exercise (PSSE) on spine joint reposition (JR) sense. The second aim was to determine the effects of PSSE on the angle of trunk rotation (ATR), posture, and deformity perception in adolescent idiopathic scoliosis. METHODS Twenty-nine patients with adolescent idiopathic scoliosis (mean age 13.79 ± 1.82 years) were randomly allocated to two groups. "Schroth" exercises were applied to the PSSE group for 8 weeks (16 sessions). The control group was placed on the waiting list. Patients' JR error (dual inclinometer), ATR (scoliometer), posture parameters (PostureScreen Mobile, Posterior Trunk Asymmetry Index, and Anterior Trunk Asymmetry Index), and deformity perception (Walter Reed Visual Assessment Scale [WRVAS]) were assessed at the first session and at the end of 8 weeks. RESULTS The initial demographic characteristics, Cobb (thoracal: 19.41 ± 7.03 degrees; lumbar: 20.76 ± 7.24 degrees) and ATR (thoracal: 5.86 ± 3.98 degrees; lumbar: 5.66 ± 3.33 degrees) and clinical test parameters of the groups (JR, posture parameters, and WRVAS) were similar (P > .05). According to the findings, thoracal and lumbar JR error values (P < .05), ATR (P ≤ .001), posture parameters (P ≤ .001), and WRVAS (P = .048) were significantly improved in the PSSE group. Besides, when the groups were compared, a significant difference was found in favor of PSSE except for the deformity perception (P < .05). CONCLUSIONS Schroth exercises have a positive contribution for improving JR sense of the spine, vertebral rotation, and posture.
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Affiliation(s)
- Elcin Akyurek
- Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, Institute of Graduate Studies, Istanbul, Turkey
| | - Ayse Zengin Alpozgen
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Turgut Akgul
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, Istanbul, Turkey
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Sung WS, Choi SK, Jo HR, Park SH, Lee SH, Lee YJ, Ha IH, Seo BK, Yang HC, Hong SU, Keum DH, Kim EJ. A survey of the clinical practice followed by Korean medicine doctors for scoliosis: Preliminary data for clinical practice guidelines. Medicine (Baltimore) 2022; 101:e30047. [PMID: 36042654 PMCID: PMC9410691 DOI: 10.1097/md.0000000000030047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Scoliosis is a spinal disease in which the Cobb angle is >10°. Scoliosis treatment can be surgical or conservative, and clinical practice guidelines (CPGs) for conservative treatments have been updated since 2006. There have been several articles regarding the efficacy and safety of Korean medicine (KM) in treating scoliosis, but there are no CPGs. Our study investigated the current clinical practice using a survey for the future establishment of KM-CPGs. The survey mainly comprised clinical practice status, diagnosis, treatment, progress and prognosis, and perception of KM on scoliosis, with reference to existing surveys of other musculoskeletal disorders and scoliosis-related articles. A web-based survey was conducted from February 16, 2021 to February 28, 2021. We found that 60% of KM doctors (KMDs) respondents treated patients with scoliosis, and they valued radiographical measurements and scoliosis-related factors in the diagnosis. KMDs used multiple KM treatments, including acupuncture, Chuna, cupping, pharmacopuncture, and herbal medicine, and they emphasized the importance of KM more in nonstructural scoliosis than in structural scoliosis. Although the perception of the prognosis of scoliosis was in agreement with that suggested by previous guidelines, KMDs showed outstanding focus on reduction of symptoms of scoliosis and improvement of quality of life. Despite some limitations, including low participation and the need for consulting other medical practitioners, our study may be helpful for the development of KM-CPGs because it is the first to analyze the perceptions of KMDs on scoliosis and to collect preliminary data that are of significance for preparing clinical guidelines.
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Affiliation(s)
- Won-Suk Sung
- Department of Acupuncture & Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Seong-Kyeong Choi
- Department of Acupuncture & Moxibustion, Dongguk University graduate School, Seoul, Republic of Korea
| | - Hyo-Rim Jo
- Department of Acupuncture & Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Seo-Hyun Park
- Department of Rehabilitation Medicine of Korean Medicine, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sun-Haeng Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Yoon-Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Byung-Kwan Seo
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Hoe-Cheon Yang
- Korean Society of Chuna Manual Medicine, Seoul, Republic of Korea
| | - Seung-Ug Hong
- Department of Ophthalmology & Otolaryngology & Dermatology, Dongguk University Ilsan Oriental Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Dong-Ho Keum
- Department of Rehabilitation Medicine of Korean Medicine, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Eun-Jung Kim
- Department of Acupuncture & Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- *Correspondence: Eun-Jung Kim, Department of Acupuncture & Moxibustion, Dongguk University Bundang Oriental Hospital, 268, Buljeong-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea (e-mail: )
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Qu B, Cao J, Qian C, Wu J, Lin J, Wang L, Ou-Yang L, Chen Y, Yan L, Hong Q, Zheng G, Qu X. Current development and prospects of deep learning in spine image analysis: a literature review. Quant Imaging Med Surg 2022; 12:3454-3479. [PMID: 35655825 PMCID: PMC9131328 DOI: 10.21037/qims-21-939] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/04/2022] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND OBJECTIVE As the spine is pivotal in the support and protection of human bodies, much attention is given to the understanding of spinal diseases. Quick, accurate, and automatic analysis of a spine image greatly enhances the efficiency with which spine conditions can be diagnosed. Deep learning (DL) is a representative artificial intelligence technology that has made encouraging progress in the last 6 years. However, it is still difficult for clinicians and technicians to fully understand this rapidly evolving field due to the diversity of applications, network structures, and evaluation criteria. This study aimed to provide clinicians and technicians with a comprehensive understanding of the development and prospects of DL spine image analysis by reviewing published literature. METHODS A systematic literature search was conducted in the PubMed and Web of Science databases using the keywords "deep learning" and "spine". Date ranges used to conduct the search were from 1 January, 2015 to 20 March, 2021. A total of 79 English articles were reviewed. KEY CONTENT AND FINDINGS The DL technology has been applied extensively to the segmentation, detection, diagnosis, and quantitative evaluation of spine images. It uses static or dynamic image information, as well as local or non-local information. The high accuracy of analysis is comparable to that achieved manually by doctors. However, further exploration is needed in terms of data sharing, functional information, and network interpretability. CONCLUSIONS The DL technique is a powerful method for spine image analysis. We believe that, with the joint efforts of researchers and clinicians, intelligent, interpretable, and reliable DL spine analysis methods will be widely applied in clinical practice in the future.
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Affiliation(s)
- Biao Qu
- Department of Instrumental and Electrical Engineering, Xiamen University, Xiamen, China
| | - Jianpeng Cao
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Chen Qian
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Jinyu Wu
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Jianzhong Lin
- Department of Radiology, Zhongshan Hospital of Xiamen University, Xiamen, China
| | - Liansheng Wang
- Department of Computer Science, School of Informatics, Xiamen University, Xiamen, China
| | - Lin Ou-Yang
- Department of Medical Imaging of Southeast Hospital, Medical College of Xiamen University, Zhangzhou, China
| | - Yongfa Chen
- Department of Pediatric Orthopedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Liyue Yan
- Department of Information & Computational Mathematics, Xiamen University, Xiamen, China
| | - Qing Hong
- Biomedical Intelligent Cloud R&D Center, China Mobile Group, Xiamen, China
| | - Gaofeng Zheng
- Department of Instrumental and Electrical Engineering, Xiamen University, Xiamen, China
| | - Xiaobo Qu
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
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Moreira R, Fialho R, Teles AS, Bordalo V, Vasconcelos SS, Gouveia GPDM, Bastos VH, Teixeira S. A computer vision-based mobile tool for assessing human posture: A validation study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 214:106565. [PMID: 34936945 DOI: 10.1016/j.cmpb.2021.106565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/15/2021] [Accepted: 11/27/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Non-invasive methods for postural assessment are tools used for tracking and monitoring the progression of postural deviations. Different computer-based methods have been used to assess human posture, including mobile applications based on images and sensors. However, such solutions still require manual identification of anatomical points. This study aims to present and validate the NLMeasurer, a mobile application for postural assessment. This application takes advantage of the PoseNet, a solution based on computer vision and machine learning used to estimate human pose and identify anatomical points. From the identified points, NLMeasurer calculates postural measures. METHODS Twenty participants were photographed in front view while using surface markers over anatomical landmarks. Then, the surface markers were removed, and new photos were taken. The photos were analyzed by two examiners, and six postural measurements were computed with NLMeasurer and a validated biophotogrammetry software. One-sample t-test and Bland Altman procedure were used to assess agreement between the methods, and Intraclass Correlation Coefficient (ICC) was used to assess inter- and intra-rater reliability. RESULTS Postural measurements calculated using the NLMeasurer were in agreement with the biophotogrammetry software. Furthermore, there was good inter- and intra-rater reliability for most photos without surface markers. CONCLUSIONS NLMeasurer demonstrated to be a valid tool method to assess postural measurements in the frontal view. The use of surface markers on specific anatomical landmarks (i.e., ears, iliac spines and ankles) can facilitate the digital identification of these landmarks and improve the reliability of the postural measurements performed with NLMeasurer.
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Affiliation(s)
- Rayele Moreira
- Federal University of Piauí. PhD Program in Biotechnology - Northeast Biotechnology Network, Teresina, Brazil; University Center Inta - UNINTA. Physical Therapy, Sobral, Brazil.
| | - Renan Fialho
- Federal University of Delta do Parnaíba, Parnaíba, Brazil
| | - Ariel Soares Teles
- Federal University of Delta do Parnaíba, Parnaíba, Brazil; Federal Institute of Maranhão, Araioses, Brazil
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Study on the Reliability and Accuracy of Scolioscope, a New Digital Scoliometer. Diagnostics (Basel) 2022; 12:diagnostics12010142. [PMID: 35054308 PMCID: PMC8774419 DOI: 10.3390/diagnostics12010142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/28/2022] Open
Abstract
Early detection of scoliosis with school screening and quick, easy, and reliable assessment of its progress are of paramount importance in the management of patients. There have been several tools described, with the most common being the analog scoliometer. Most recently, smartphone applications have entered this area with and without the use of sleeves for the device. There is no research that has evaluated the accuracy of measurements both left and right in either digital or analog devices. In this study, we evaluated the reliability and validity of a new digital scoliometer called the Scolioscope. Thirty subjects were included for the intra-rater reliability study. ICC values >0.9 were calculated both for same-day and between-day measurements. The device was highly accurate with an average difference from the ones set on the sine bar of 0.03° for right-side measurements and 0.18° for the left. These measurements suggest a highly accurate and reliable tool.
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Wong C, Andersen TB. Evaluation of Brace Treatment Using the Soft Brace Spinaposture: A Four-Years Follow-Up. J Clin Med 2022; 11:264. [PMID: 35012005 PMCID: PMC8745903 DOI: 10.3390/jcm11010264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 02/05/2023] Open
Abstract
The braces of today are constructed to correct the frontal plane deformity of idiopathic adolescent scoliosis (AIS). The Spinaposture brace© (Spinaposture Aps, Copenhagen, Denmark) is a soft-fabric brace for AIS and is designed to enhance rotational axial stability by inducing a sagittal plane kyphotic correction. This prospective observational study evaluated the brace in fifteen patients with AIS. The initial average CA was 16.8° (SD: 2.8). They were followed prospectively every 3 to 6 months during their brace usage until skeletal maturity of 25 months and at long-term follow-up of 44 months. In- and out-of-brace radiographs were performed in six subjects at inclusion. This resulted in an immediate in-brace correction of 25.3 percent in CA (14.3°→10.8°) and induced a kyphotic effect of 14.9 percent (40.8°→47.9°). The average in-brace improvement at first follow-up was 4.5° in CA, and the CA at skeletal maturity was 11° (SD: 7.4°) and long-term 12.0° (SD: 6.8°). In conclusion, the Spinaposture brace© had an immediate in-brace deformity correction and a thoracic kyphotic effect. At skeletal maturity, the deformities improved more than expected when compared to that of the natural history/observation and similar to that of other soft braces. No long-term deformity progression was seen. To substantiate these findings, stronger designed studies with additional subjects are needed.
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Affiliation(s)
- Christian Wong
- Department of Orthopedics, Hvidovre Hospital, Kettegaards Alle 30, 2650 Hvidovre, Denmark
| | - Thomas B. Andersen
- Department of Orthopedics, National University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark;
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Wong C, Adriansen J, Jeppsen J, Balslev-Clausen A. Intervariability in radiographic parameters and general evaluation of a low-dose fluoroscopic technique in patients with idiopathic scoliosis. Acta Radiol Open 2021; 10:20584601211043258. [PMID: 34594575 PMCID: PMC8477696 DOI: 10.1177/20584601211043258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/14/2021] [Indexed: 11/15/2022] Open
Abstract
Background Radiographic images in adolescent idiopathic scoliosis (AIS) have a potential radiation-induced oncogenic effect; thus lowering radiation dose by using fluoroscopic imaging technique of low-dose fluoroscopic technique (LFT) which might be relevant for clinical evaluation. Purpose To compare radiographs of LFT with gold standard radiographs for AIS ordinary radiographic technique (ORT). Material and Methods Image quality was evaluated for LTF and ORT of a child phantom and two 3D-printed models (3DPSs) of AIS. We measured the primary physical characteristics of noise, contrast, spatial resolution, signal-to-noise ratio, and contrast-to-noise ratio. Three independent evaluators assessed the radiographs by observer-based methods of image criteria (ICS) and visual grading analysis(VGAS). Radiation doses were evaluated by the dose-area-product (DAP) of the 25 phantom radiographs. Reliability and agreement of Cobb’s angle (CA) and other radiographic parameters were evaluated on the 3DPSs and reliability on 342 LFT. Results The average noise and contrast were approximately 15-fold higher for LFT. SNR and CNR were similar. Overall, ICS and VGAS were 3-fold higher for ORT than for LFT for L3 and similar for Th6. Reliability and agreement were good for the experimental LFT, and the interclass correlation coefficient for CA was 0.852 for the clinical LFT. The average DAP and effective dose for LFT were 8-fold lower than those for ORT. Conclusion In conclusion, LFT is reliable for CA measurements and is thus useful for clinical outpatient follow-up evaluation. Even though the image quality is lower for LFT than ORT, the merits are the substantially reduced radiation and a lowered malignancy risk without compromising the measurement of Cobb’s angle, thus following the principles of ALARA.
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Affiliation(s)
- Christian Wong
- Department of Orthopedics, University Hospital of Hvidovre, Hvidovre, Denmark
| | - Jens Adriansen
- Department of Radiology, University Hospital of Hvidovre, Hvidovre, Denmark
| | - Jytte Jeppsen
- Center for Health Technology, University Hospital of Hvidovre, Hvidovre, Denmark
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Pang H, Wong YS, Yip BHK, Hung ALH, Chu WCW, Lai KKL, Zheng YP, Chung TWH, Sharma G, Cheng JCY, Lam TP. Using Ultrasound to Screen for Scoliosis to Reduce Unnecessary Radiographic Radiation: A Prospective Diagnostic Accuracy Study on 442 Schoolchildren. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2598-2607. [PMID: 34210559 DOI: 10.1016/j.ultrasmedbio.2021.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/03/2021] [Accepted: 05/25/2021] [Indexed: 06/13/2023]
Abstract
Scoliosis screening is important for timely initiation of brace treatment to mitigate curve progression in skeletally immature children and adolescents. School scoliosis screening programs in Hong Kong follow the protocol of referring children screened positive with a scoliometer and Moiré topography for confirmatory standard radiography. Despite being highly sensitive (88%) in detecting those who require specialist referral, the screening program was found to have a false-positive rate >50%, which could lead to unnecessary X-ray radiation. Radiation-free ultrasound has been reported to be valid and reliable for quantitative assessment of curve severity in scoliosis patients. The aim of this prospective diagnostic accuracy study was to determine the accuracy of ultrasound in determining the threshold of referral that requires X-ray for children screened positive with the scoliometer and Moiré topography. Our study recruited 442 schoolchildren with a mean Cobb angle of 14.0 ± 6.6°. The sensitivity and specificity of ultrasound in predicting the correct referral status, confirmed by X-ray, were 92.3% and 51.6%, with positive and negative predictive values of 29.0% and 96.9%, respectively. Receiver operating characteristic curve analysis revealed area under the curve values of 0.735 for ultrasound alone and 0.832 for ultrasound in combination with measurement of angle of trunk rotation. The finding supports the accuracy of using ultrasound to determine referral status, which could result in a >50% reduction of unnecessary radiation for children undergoing scoliosis screening.
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Affiliation(s)
- Henry Pang
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Yi-Shun Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Benjamin Hon-Kei Yip
- Division of Family Medicine and Primary Health Care, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Alec Lik-Hang Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Winnie Chiu-Wing Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Kelly Ka-Lee Lai
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | | | - Geeta Sharma
- Student Health Service, Department of Health, Hong Kong SAR
| | - Jack Chun-Yiu Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR; S. H. Ho Scoliosis Research Laboratory, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong SAR
| | - Tsz-Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR; S. H. Ho Scoliosis Research Laboratory, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong SAR.
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Navarro IJRL, Godinho RAT, Candotti CT. Validating Surface Topography for the Measurement of the Thoracic Kyphosis Angle in Patients With Scoliosis: A Prospective Study of Accuracy. J Manipulative Physiol Ther 2021; 44:497-503. [PMID: 34456044 DOI: 10.1016/j.jmpt.2021.06.004] [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: 12/30/2019] [Revised: 09/04/2020] [Accepted: 06/15/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to test the validity and determine the accuracy of surface topography in relation to photogrammetry for measuring the thoracic kyphosis angle in patients with scoliosis. METHODS This was a prospective, cross-sectional study of diagnostic accuracy that followed the guidelines recommended by the Standards for Reporting Diagnostic Accuracy. We consecutively included 51 participants aged 7 to 18 years. Exclusion criteria were surgical treatment of the spine, neurological disease, lower limb discrepancy greater than 1.5 cm, and body mass index above 29 kg/m². Each participant was evaluated using both a surface topography scan and photogrammetry in random order. The measurement obtained through photogrammetry was used as a reference in this study. For statistical purposes, Pearson's correlation test, Bland-Altman graphical analysis, and the receiver operating characteristic curve (P < .05) were performed. RESULTS The correlation between the measurements was strong and significant (r = 0.76, P < .001) with an average difference of 0.4° in the Bland-Altman analysis. The receiver operating characteristic curve area was excellent for hypokyphosis (93.4%) and good for hyperkyphosis (86.4%), both being significant (P < .005). CONCLUSION The agreement and strong correlation between the 2 methods indicate the validity of surface topography to measure the thoracic kyphosis angle. The surface topography provides accurate measures for the thoracic kyphosis angle with cutoff points for hypo- (33.3°) and hyperkyphosis (40.8°) for individuals with scoliosis.
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Affiliation(s)
- Isis J R L Navarro
- Biomechanics Department, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Rúbia A T Godinho
- Biomechanics Department, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cláudia T Candotti
- Biomechanics Department, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
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Alvarez I, Poppino K, Karol L, McIntosh AL. Lack of in-brace x-rays in compliant AIS patients wearing full-time TLSO braces associates with failure. J Orthop Surg Res 2021; 16:540. [PMID: 34465348 PMCID: PMC8406839 DOI: 10.1186/s13018-021-02650-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/13/2021] [Indexed: 11/20/2022] Open
Abstract
Background In-brace correction and brace compliance with thoraco-lumbo-sacral orthotic (TLSO) braces are associated with successful treatment of adolescent idiopathic scoliosis (AIS). This paper compares patients who had consistent radiographic documentation of in-brace correction to those who did not. Methods All skeletally immature (Risser 0-2) patients were treated for AIS (25-45°) with full-time TLSO braces that had compliance temperature monitors. All patients wore their braces at least 12 h a day. Brace failure was defined as curve progression to a surgical magnitude (≥ 50°). All patients were followed until brace discontinuation. Results Ninety patients (F 82, M 8) with an average age of 12.1 (10.1-15.0) years, Risser grade 0 (0-2), BMI percentile 48.5 (0.0-98.8), and daily brace wear of 16.5 (12.1-21.6) h/day were treated for 24.3 (8.0-66.6) months. Patients went through 1.7 (1-4) braces on average. Forty-two out of 90 (46.7%) patients had some amount of brace time with an unknown in-brace correction, which, on average, was 66.1% of their total treatment course (11.5-100). On univariate analysis, patients that did not have a repeat in-brace x-ray with major brace adjustments or new brace fabrication tended to be more skeletally immature (Risser 0 and tri-radiate open, p = 0.028), wear more braces throughout their treatment (2.0 vs 1.4, p < 0.001), were treated for a longer period of time (27 vs 22 months, p = 0.022), and failed bracing more often (47.6% vs 22.9%, p = 0.014). Conclusions Patients who did not have new in-brace x-rays with major brace adjustments and/or new brace fabrication were 3.1 (95% CI 1.2-7.6) times more likely to fail bracing than patients who were re-checked with new in-brace x-rays. Trial registration ClinicalTrials.gov—NCT02412137, initial registration date April 2015 Level of evidence III
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Affiliation(s)
| | - Kiley Poppino
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX, 75219, USA
| | - Lori Karol
- Children's Hospital Colorado, Aurora, CO, USA
| | - Amy L McIntosh
- University of Texas-Southwestern, Dallas, TX, USA. .,Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX, 75219, USA.
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Wang Q, Wang C, Liu J, Sun J, Wang C, Zhang X. Plasma proteomics analysis of adolescent idiopathic scoliosis patients revealed by Quadrupole-Orbitrap mass spectrometry. Proteomics Clin Appl 2021; 15:e2100002. [PMID: 33864425 DOI: 10.1002/prca.202100002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/22/2021] [Accepted: 04/12/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We aim to investigate the changes of plasma proteome among mild, severe adolescent idiopathic scoliosis (AIS) patients and healthy controls. METHODS In this retrospective study, there were 84 individuals including 56 confirmed AIS patients (27 follow-up AIS patients and 29 surgical AIS patients) and another 28 healthy teenagers. Plasma samples were obtained and Quadrupole-Orbitrap Mass Spectrometer was performed to identify proteins in AIS patients and control group. T-test and ANOVA were performed to screen for differential proteins. GO and KEGG pathway, Pearson's correlation analysis and PLS model were applied to identify enriched proteins, investigate correlation between proteins and Cobb angles. ELISA was performed to further verify the quantitative proteomics results. RESULTS A total of 349 proteins were identified, among which 55 protein levels changed significantly in AIS group, compared with control group. Post hoc test indicated 36 proteins were significantly different between surgical and control group, 35 proteins between follow-up and control group. Fibronectin, fibrinogen and calmodulin were statistically different among three groups through mass spectrometry and were positively correlated with the Cobb angle. CONCLUSIONS We performed the proteomic study and revealed that fibronectin, fibrinogen and calmodulin might not only be considered as biomarkers for AIS but could be correlated with curve severity.
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Affiliation(s)
- Qi Wang
- Medical School of Chinese PLA General Hospital, Beijing, 100853, China.,Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Chi Wang
- Department of Clinical Laboratory Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jiayu Liu
- Department of Clinical Laboratory Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jingru Sun
- Qlife Lab Co., Ltd, Shenzhen, 518102, China
| | - Chengbin Wang
- Department of Clinical Laboratory Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xuesong Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China
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Juvenile/Adolescent Idiopatic Scoliosis and Rapid Palatal Expansion. A Pilot Study. CHILDREN-BASEL 2021; 8:children8050362. [PMID: 33946317 PMCID: PMC8146753 DOI: 10.3390/children8050362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 12/28/2022]
Abstract
The question of whether orthodontic therapy by means of rapid palatal expansion (RPE) affects the spine during development is important in clinical practice. RPE is an expansive, fixed therapy conducted with heavy forces to separate the midpalatal suture at a rate of 0.2–0.5 mm/day. The aim of the study was to evaluate the influence of RPE on the curves of the spine of juvenile/adolescent idiopathic scoliosis patients. Eighteen patients under orthopedic supervision for juvenile/adolescent idiopathic scoliosis and independently treated with RPE for orthodontic reasons were included in the study: Group A, 10 subjects (10.4 ± 1.3 years), first spinal radiograph before the application of the RPE, second one during the orthodontic therapy with RPE; Group B, 8 patients (11.3 ± 1.6 years), first radiograph during the use of RPE second one after the removal. Group A showed a significant worsening of the Cobb angle (p ≤ 0.005) at the second radiograph after RPE. Group B showed a significant improvement of the Cobb angle (p = 0.01) at the second radiograph after removal of RPE. Based on the results, the use of RPE during adolescence might influence the spinal curves of patients with idiopathic scoliosis.
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Lyu J, Ling SH, Banerjee S, Zheng JY, Lai KL, Yang D, Zheng YP, Bi X, Su S, Chamoli U. Ultrasound volume projection image quality selection by ranking from convolutional RankNet. Comput Med Imaging Graph 2021; 89:101847. [PMID: 33476927 DOI: 10.1016/j.compmedimag.2020.101847] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/15/2020] [Accepted: 12/11/2020] [Indexed: 01/16/2023]
Abstract
Periodic inspection and assessment are important for scoliosis patients. 3D ultrasound imaging has become an important means of scoliosis assessment as it is a real-time, cost-effective and radiation-free imaging technique. With the generation of a 3D ultrasound volume projection spine image using our Scolioscan system, a series of 2D coronal ultrasound images are produced at different depths with different qualities. Selecting a high quality image from these 2D images is the crucial task for further scoliosis measurement. However, adjacent images are similar and difficult to distinguish. To learn the nuances between these images, we propose selecting the best image automatically, based on their quality rankings. Here, the ranking algorithm we use is a pairwise learning-to-ranking network, RankNet. Then, to extract more efficient features of input images and to improve the discriminative ability of the model, we adopt the convolutional neural network as the backbone due to its high power of image exploration. Finally, by inputting the images in pairs into the proposed convolutional RankNet, we can select the best images from each case based on the output ranking orders. The experimental result shows that convolutional RankNet achieves better than 95.5% top-3 accuracy, and we prove that this performance is beyond the experience of a human expert.
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Affiliation(s)
- Juan Lyu
- College of Information and Communication Engineering, Harbin Engineering University, Harbin, China
| | - Sai Ho Ling
- School of Biomedical Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia.
| | - S Banerjee
- School of Biomedical Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - J Y Zheng
- Department of Computer Science, Imperial College London, UK
| | - K L Lai
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hum, Hong Kong
| | - D Yang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hum, Hong Kong
| | - Y P Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hum, Hong Kong
| | - Xiaojun Bi
- College of Information and Communication Engineering, Harbin Engineering University, Harbin, China; College of Information Engineering, Minzu University of China, Beijing, China
| | - Steven Su
- School of Biomedical Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Uphar Chamoli
- School of Biomedical Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia
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Navarro IJRL, Candotti CT, Furlanetto TS, Dutra VH, do Amaral MA, Loss JF. Validation of a Mathematical Procedure for the Cobb Angle Assessment Based on Photogrammetry. J Chiropr Med 2020; 18:270-277. [PMID: 32952472 DOI: 10.1016/j.jcm.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 11/25/2018] [Accepted: 01/16/2019] [Indexed: 12/23/2022] Open
Abstract
Objective This prospective study aimed to assess the concurrent validity and diagnostic accuracy of a mathematical procedure for measurement of the spinal inclination angle, analogous to the Cobb angle, by means of photogrammetry. Methods Sixty-one subjects (aged 7 to 18 years), male and female, underwent radiographic (Cobb angle) and photogrammetric (DIPA [Digital Image-based Postural Assessment] angle) evaluations. The measurement of spinal inclination angle obtained through photogrammetry followed the Digital Image-Based Postural Assessment software protocol. Concurrent validity was appraised using Spearman rank correlation, the coefficient of determination, the root-mean-square error, Bland-Altman plot analysis, and receiver operating characteristic analysis, adopting P ≤ .05. Results The analyses were divided according to the topography of the scoliotic curve (thoracic, lumbar, or thoracolumbar). The correlations were excellent (from 0.72 to 0.81) and significant for all the regions of the spine, and the coefficients of determination ranged between 0.75 and 0.88. The root-mean-square error was between 5° and 11°, and the mean difference was very close to 0. The area under the curve was excellent and significant, ranging between 95% and 99%. Conclusion The mathematical procedure presented is valid to evaluate the spinal inclination angle in photogrammetry, analogous to the Cobb angle in radiography.
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Affiliation(s)
| | - Cláudia T Candotti
- Biomechanics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Tássia S Furlanetto
- Biomechanics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vinícius H Dutra
- Biomechanics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maiane A do Amaral
- Biomechanics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jefferson F Loss
- Biomechanics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Bernstein P, Metzler J, Weinzierl M, Seifert C, Kisel W, Wacker M. Radiographic scoliosis angle estimation: spline-based measurement reveals superior reliability compared to traditional COBB method. 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 2020; 30:676-685. [PMID: 32856177 DOI: 10.1007/s00586-020-06577-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/25/2020] [Accepted: 08/17/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVE Although being standard for scoliosis curve size estimation, COBB angle measurement is well known to be inaccurate, due to a high interobserver variance in end vertebra selection and end plate contour delineation. We propose a stepwise improvement by using a spline constructed from vertebra centroids to resemble spinal curve characteristics more closely. To enhance precision even further, a neural net was trained to detect the centroids automatically. MATERIALS & METHODS Vertebra centroids in AP spinal X-ray images of varying quality from 551 scoliosis patients were manually labeled by 4 investigators. With these inputs, splines were generated and the computed curve sizes were compared to the manually measured COBB angles and to the curve estimation obtained from the neural net. RESULTS Splines achieved a higher interobserver correlation of 0.92-0.95 compared to manual COBB measurements (0.83-0.92) and showed 1.5-2 times less variance, depending on the anatomic region. This translates into an average of 1° of interobserver measurement deviation for spline-based curve estimation compared to 3°-8° for COBB measurements. The neural net was even more precise and achieved mean deviations below 0.5°. CONCLUSION In conclusion, our data suggest an advantage of spline-based automated measuring systems, so further investigations are warranted to abandon manual COBB measurements.
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Affiliation(s)
- Peter Bernstein
- Department for Orthopaedics and Traumatology, University Comprehensive Spine Center, University Hospital Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Johannes Metzler
- Faculty of Informatics/Mathematics, HTW Dresden, Friedrich-List-Platz 1, 01069, Dresden, Germany
| | - Marlene Weinzierl
- Department for Orthopaedics and Traumatology, University Comprehensive Spine Center, University Hospital Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Carl Seifert
- Department for Orthopaedics and Traumatology, University Comprehensive Spine Center, University Hospital Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Wadim Kisel
- Department for Orthopaedics and Traumatology, University Comprehensive Spine Center, University Hospital Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Markus Wacker
- Faculty of Informatics/Mathematics, HTW Dresden, Friedrich-List-Platz 1, 01069, Dresden, Germany
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Alves ME, Marinho DA, Carneiro DN, Alves J, Forte P, Nevill AM, Morais JE. A Visual Scan Analysis Protocol for Postural Assessment at School in Young Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082915. [PMID: 32340242 PMCID: PMC7215995 DOI: 10.3390/ijerph17082915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 11/28/2022]
Abstract
The aim of this study was to compare the X-ray diagnosis with a non-invasive method for spine alignment assessment adopting a visual scan analysis with a plumb line and simetograph in middle-school students. The sample of this study was composed of 31 males and 50 females with an average age of 14.23 (± 3.11) years. The visual scan analysis was assessed at a school; whereas, the X-ray was performed in a hospital. The Wilcoxon signed-rank test was used to assess the differences between methods and scoliosis classifications (non-accentuated <10º and scoliosis >10º), and the Kappa was used to assess the agreement between methods. The comparisons between the methods revealed non-significant differences (z = −0.577; p = 0.564), with almost perfect agreement between tests (K = 0.821; p < 0.001). Moreover, no statistical significance was observed between methods by the scoliosis classification (z = −1.000; p = 0.317), with almost perfect agreement between tests (K = 0.888; p < 0.001). This research supports the conclusion that there are no significant differences between the two methods. Therefore, it should be highlighted that this field test should be used by physical education teachers in their classes, or in a school context, in order to determine misalignments or scoliosis prevalence among middle-school students.
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Affiliation(s)
- Maria E. Alves
- Department of Sports, Higher Institute of Educational Sciences of the Douro, 4560-708 Penafiel, Portugal; (D.N.C.); (J.A.); (P.F.); (J.E.M.)
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
- Correspondence:
| | - Daniel A. Marinho
- Department of Sports Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal;
- Research Center in Sports, Health and Human Development (CIDESD), 6201-001 Covilhã, Portugal
| | - Duarte N. Carneiro
- Department of Sports, Higher Institute of Educational Sciences of the Douro, 4560-708 Penafiel, Portugal; (D.N.C.); (J.A.); (P.F.); (J.E.M.)
| | - Jorge Alves
- Department of Sports, Higher Institute of Educational Sciences of the Douro, 4560-708 Penafiel, Portugal; (D.N.C.); (J.A.); (P.F.); (J.E.M.)
| | - Pedro Forte
- Department of Sports, Higher Institute of Educational Sciences of the Douro, 4560-708 Penafiel, Portugal; (D.N.C.); (J.A.); (P.F.); (J.E.M.)
- Research Center in Sports, Health and Human Development (CIDESD), 6201-001 Covilhã, Portugal
- Department of Sports Sciences, Instituto Politécnico de Bragança, 5300-253 Bragança, Portugal
| | - Alan M. Nevill
- Faculty of Education, Health, and Wellbeing, University of Wolverhampton, Wolverhampton WV1 1LY, UK;
| | - Jorge E. Morais
- Department of Sports, Higher Institute of Educational Sciences of the Douro, 4560-708 Penafiel, Portugal; (D.N.C.); (J.A.); (P.F.); (J.E.M.)
- Research Center in Sports, Health and Human Development (CIDESD), 6201-001 Covilhã, Portugal
- Department of Sports Sciences, Instituto Politécnico de Bragança, 5300-253 Bragança, Portugal
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Wu HD, Liu W, Wong MS. Reliability and validity of lateral curvature assessments using clinical ultrasound for the patients with scoliosis: a systematic 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 2020; 29:717-725. [DOI: 10.1007/s00586-019-06280-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/18/2019] [Accepted: 12/29/2019] [Indexed: 01/18/2023]
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Lv P, Chen J, Dong L, Wang L, Deng Y, Li K, Huang X, Zhang C. Evaluation of Scoliosis With a Commercially Available Ultrasound System. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:29-36. [PMID: 31190407 DOI: 10.1002/jum.15068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/10/2019] [Accepted: 05/19/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Currently, radiography with measurement of the Cobb angle is still considered the reference standard for diagnosing scoliosis. However, the ionizing radiation hazard is drawing wide attention. Can 3-dimensional (3D) ultrasound (US) be an alternative modality for diagnosing and monitoring patients with scoliosis? The aim of our study was to assess the reliability and validity of 3D US imaging in the evaluation of scoliosis. METHODS A commercially available ultrasound system with a magnetic tracking system was selected for long-distance 3D US imaging. Straight phantoms and curved phantoms were scanned with the imaging system to evaluate the stability of the system for curvature measurements. Eight healthy adult volunteers and 28 patients with scoliosis were recruited for long-distance 3D US imaging. The intraclass correlation coefficient was used to test the reproducibility of the interobserver and intraobserver measurements for both the healthy adults and patients with scoliosis. A linear regression analysis and Bland-Altman plot were used to analyze the correlation and to determine the extent of agreement between the angles measured on US images and the Cobb angles measured on conventional radiographs. RESULTS The 28 patients with scoliosis included 10 male and 18 female patients aged 8 to 37 years (mean age ± SD, 17.7 ± 1.4 years; body mass index, <25 kg/m2 ). In the phantom study, there was no statistically significant difference between the angles measured by the 3D US imaging system and those measured by an angle gauge (P > 0.05). In the clinical study, there was very good interobserver and intraobserver reliability (intraclass correlation coefficients, >0.90) for the US imaging system, with a high correlation (r2 = 0.92) and agreement between the US and radiographic methods. CONCLUSIONS The long-distance 3D US imaging system offers a viable modality for diagnosing and monitoring scoliosis without radiation.
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Affiliation(s)
- Pin Lv
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingyuan Chen
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lujie Dong
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Wang
- Departments of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Youbin Deng
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaiyan Li
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolin Huang
- Departments of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao Zhang
- Departments of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Valle MBD, Dutra VH, Candotti CT, Sedrez JA, Wagner Neto ES, Loss JF. Validity of flexicurve for the assessment of spinal flexibility in asymptomatic individuals. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.033.ao14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Spine problems are common, and assessment of spine flexibility provides relevant information; however, alternative evaluation methods need to be validated. Objective: To evaluate the concurrent validity of the Flexicurve using 3D videogrammetry as a reference value to assess spinal flexion and extension in the lumbar and thoracic regions. Method: The consecutive sample consisted of 39 individuals aged between 18 and 50 years. Two consecutive evaluations were performed by the same rater on the same day and at the same location: (1) Flexicurve and (2) 3D videogrammetry. The assessments were performed with the spine in the neutral position, followed by maximum flexion and extension. The range of motion (ROM) in the maximum flexion and extension positions was calculated in MATLAB® and defined as the difference between the maximum flexion or extension angle and that of the neutral position. Statistical analyses used were the Pearson Product-Moment Correlation coefficient, RMS error and Bland-Altman plot (α < 0.05). Results: The ROM between instruments was similar, with high correlations for thoracic flexion (r = 0.751), extension (r = 0.814) and lumbar flexion (r = 0.853), and RMS errors under 8°. The correlation for lumbar extension was moderate (r = 0.613) and the RMS error was more than 10°. The limits of agreement varied between ± 10º and ± 21º. Conclusion: The Flexicurve is valid for assessing maximum flexion and extension of the thoracic spine, and maximum flexion of the lumbar spine. We suggest caution in evaluating the maximum extension of the lumbar spine.
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Negrini A, Vanossi M, Donzelli S, Zaina F, Romano M, Negrini S. Spinal Coronal and Sagittal Balance in 584 Healthy Individuals During Growth: Normal Plumb Line Values and Their Correlation With Radiographic Measurements. Phys Ther 2019; 99:1712-1718. [PMID: 31504925 DOI: 10.1093/ptj/pzz123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/16/2018] [Accepted: 05/05/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Plumb line distances (PDs) are widely used in conservative clinical practice to evaluate the sagittal shape of the spine. OBJECTIVE The objective was to assess the normative values of PDs in a large, healthy population in an age range representative of the adolescent population with spinal deformities, and to correlate it with x-ray measurements. DESIGN This was a cross-sectional study. METHODS Participants were 584 healthy individuals (341 females) with x-rays showing no spine deformities. The whole sample (OVERALL) was divided into 5 groups: 6 to 9 years old (n = 106); >10 years, Risser 0 with triradiate cartilage open (n = 129) or closed (n = 104); Risser 1 to 2 (n = 126); and Risser 3 to 5 (n = 119).PDs were taken by maintaining a tangent to the thoracic kyphosis apex at C7, T12, L3, and S2. Sagittal index (C7 + L3), and sagittal and coronal balances (C7 related to S2) were calculated. RESULTS In OVERALL, PDs at C7, T12, L3, and S2 were 39.9 ± 16.7, 21.4 ± 15.3, 39.9 ± 15, 20.6 ± 17.0 mm, respectively. Sagittal index was 79.8 ± 26.8, sagittal balance was 19.3 ± 17 mm anterior to S2 plumb line; 13.5% had a coronal imbalance of 11.4 ± 5.4 mm to the right and 24.7% of 13.2 ± 6.0 mm to the left. C7 and L3 PDs, sagittal index, and sagittal balance were significantly lower in ages 6 to 9 compared to older patients in Risser 1 to 2 group. C7 and S2 PDs and sagittal index were significantly larger in males. Sagittal index correlated with thoracic kyphosis Cobb degrees (r = 0.47). LIMITATIONS The participants were not randomly chosen from the general population; and they had an x-ray because of spine pathology suspicion. CONCLUSIONS This study shows normative data to be used in clinical practice. Sagittal spinopelvic alignment has gained more and more importance in the last decades because of its high correlation to Health-Related Quality of Life scores in adults. 1.
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Affiliation(s)
- Alessandra Negrini
- Italian Scientific Spine Institute (ISICO), Via Roberto Bellarmino 13/1, 20141 Milano MI, Italy
| | - Massimiliano Vanossi
- Italian Scientific Spine Institute (ISICO), Via Roberto Bellarmino 13/1, 20141 Milano MI, Italy
| | - Sabrina Donzelli
- Italian Scientific Spine Institute (ISICO), Via Roberto Bellarmino 13/1, 20141 Milano MI, Italy
| | - Fabio Zaina
- Italian Scientific Spine Institute (ISICO), Via Roberto Bellarmino 13/1, 20141 Milano MI, Italy
| | - Michele Romano
- Italian Scientific Spine Institute (ISICO), Via Roberto Bellarmino 13/1, 20141 Milano MI, Italy
| | - Stefano Negrini
- Clinical and Experimental Sciences Department, University of Brescia, Brescia, Italy; and IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
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Wong YS, Lai KKL, Zheng YP, Wong LLN, Ng BKW, Hung ALH, Yip BHK, Chu WCW, Ng AWH, Qiu Y, Cheng JCY, Lam TP. Is Radiation-Free Ultrasound Accurate for Quantitative Assessment of Spinal Deformity in Idiopathic Scoliosis (IS): A Detailed Analysis With EOS Radiography on 952 Patients. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2866-2877. [PMID: 31399250 DOI: 10.1016/j.ultrasmedbio.2019.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/21/2019] [Accepted: 07/05/2019] [Indexed: 06/10/2023]
Abstract
Radiation exposure with repeated radiography required at follow-up poses serious health concerns for scoliosis patients. Although spinous process angle (SPA) measurement of spinal curvatures with ultrasound has been reported with promising results, an evidence-based account on its accuracy for translational application remains undefined. This prospective study involved 952 idiopathic scoliosis patients (75.7% female, mean age 16.7 ± 3.0 y, Cobb 28.7 ± 11.6°). Among 1432 curves (88.1%) detected by ultrasound, there was good correlation between radiologic Cobb angles measured manually on EOS (E_Cobb) whole-spine radiographs and automatic ultrasound SPA measurement for upper spinal curves (USCs) (r = 0.873, apices T7-T12/L1 intervertebral disc) and lower spinal curves (LSCs) (r = 0.740, apices L1 or below) (p < 0.001). Taller stature was associated with stronger correlation. For E_Cobb <30°, 66.6% USCs and 62.4% LSCs had absolute differences between E_Cobb and predicted Cobb angle calculated from SPA ≤5°. Ultrasound could be a viable option in lieu of radiography for measuring coronal curves with apices at T7 or lower and Cobb angle <30°.
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Affiliation(s)
- Yi-Shun Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Kelly Ka-Lee Lai
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Lyn Lee-Ning Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Bobby Kin-Wah Ng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Alec Lik-Hang Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Benjamin Hon-Kei Yip
- Division of Family Medicine and Primary Health Care, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Winnie Chiu-Wing Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Alex Wing-Hung Ng
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Yong Qiu
- Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Nanjing, China
| | - Jack Chun-Yiu Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Nanjing, China; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Tsz-Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Nanjing, China; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR.
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Luković V, Ćuković S, Milošević D, Devedžić G. An ontology-based module of the information system ScolioMedIS for 3D digital diagnosis of adolescent scoliosis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 178:247-263. [PMID: 31416553 DOI: 10.1016/j.cmpb.2019.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/28/2019] [Accepted: 06/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Conventional information systems are built on top of a relational database. The main weakness of these systems is impossibility to define stable data schema ahead when the knowledge of the system is evolving and dynamic. The widely accepted alternatives to relational databases are ontologies that can be used for designing information systems. Many research papers describe various methods for improving reliability and precision in generating the type of the Lenke classification based on the image processing techniques or a computer program, but all of them require radiograph images. The main objective of this paper is to demonstrate the development of an ontology-based module of the information system ScolioMedIS for adolescent idiopathic scoliosis (AIS) diagnosis and monitoring, which uses optical 3D methods to determine the Lenke classification of AIS and to avoid harmful effects of traditional radiation diagnosis. METHODS For creating an ontology-based module of the ScolioMedIS we used the following steps: specification, conceptualization, formalization and implementation. In the specification and conceptualization phase we performed data collection and analysis to define domain, concepts and relationships for ontology design. In the formalization and implementation stage we developed the OBR-Scolio ontology and the ontology-based module of the ScolioMedIS. The module employs the Protégé-OWL API, as a collection of Java interfaces for the OBR-Scolio ontology, which enables the creating, deleting, and editing of the basic elements of the OBR-Scolio ontology, as well as the querying of the ontology. RESULTS The ontology-based module of ScolioMedIS is tested on the datasets of 20 female and 15 male patients with AIS between the ages of 11 and 18, to categorize spinal curvatures and to automatically generate statistical indicators about the frequency of the basic spinal curvatures, degree of progression or regression of deformity and statistical indicators about curvature characteristics according to the Lenke classification system and Lenke scoliosis types. Results are then compared with analysis of the Lenke classification of 315 observed patients, performed using traditional radiation techniques. CONCLUSIONS This part of the system allows continuous monitoring of the progression/regression of spinal curvatures for each registered patient, which may provide a better management of scoliosis (diagnosis and treatment).
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Affiliation(s)
- Vanja Luković
- Faculty of Technical Sciences, University of Kragujevac, Svetog Save 65, 32000 Čačak, Serbia.
| | - Saša Ćuković
- Faculty of Engineering, University of Kragujevac, Sestre Janjić 6, 34000 Kragujevac, Serbia.
| | - Danijela Milošević
- Faculty of Technical Sciences, University of Kragujevac, Svetog Save 65, 32000 Čačak, Serbia.
| | - Goran Devedžić
- Faculty of Engineering, University of Kragujevac, Sestre Janjić 6, 34000 Kragujevac, Serbia.
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Schreiber S, Parent EC, Hill DL, Hedden DM, Moreau MJ, Southon SC. Patients with adolescent idiopathic scoliosis perceive positive improvements regardless of change in the Cobb angle - Results from a randomized controlled trial comparing a 6-month Schroth intervention added to standard care and standard care alone. SOSORT 2018 Award winner. BMC Musculoskelet Disord 2019; 20:319. [PMID: 31286903 PMCID: PMC6615154 DOI: 10.1186/s12891-019-2695-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/26/2019] [Indexed: 12/13/2022] Open
Abstract
Background The Cobb angle is proposed as the “disease process” outcome for scoliosis research because therapies aim to correct or stop curve progression. While the Scoliosis Research Society recommends the Cobb angle as the primary outcome, the Society on Scoliosis Orthopaedic and Rehabilitation Treatment prioritises, as a general goal, patient related outcomes over Cobb angle progression. Objective To determine the threshold of change in the Cobb angle in adolescents with idiopathic scoliosis (AIS) who perceive improvement in a 6-months randomized controlled trial comparing a Schroth exercise intervention added to the standard of care to the standard of care alone. Methods This is a secondary analysis of data from a randomized controlled trial of 50 patients with AIS, with curves ranging from 10° to 45°, with or without a brace. Participants with diagnoses other than AIS, surgical candidates or patients who had scoliosis surgery were excluded. The 6-month interventions consisted of Schroth exercises added to standard-of-care (observation or bracing) with daily home exercises and weekly therapy sessions (Schroth) or standard-of-care alone (Control). The anchor method for estimating the minimal important difference (MID) in the largest Cobb angles (LC) was used. Patient-reported change in back status over the 6-month treatment period was measured using the Global Rating of Change (GRC) scale as anchor varying from − 7 (“great deal worse”) to + 7 (“great deal better”). Participants were divided into two groups based on GRC scores: Improved (GRC ≥2) or Stable/Not Improved (GRC ≤1). MID was defined as the change in the LC that most accurately predicted the GRC classification as per the receiver operating characteristic curve (ROC). Results The average age was 13.4 ± 1.6 years and the average LC was 28.5 ± 8.8 °s. The average GRC in the control group was − 0.1 ± 1.6, compared to + 4.4 ± 2.2 in the Schroth group. The correlation between LC and GRC was adequate (r = − 0.34, p < 0.05). The MID for the LC was 1.0 °. The area under the ROC was 0.69 (0.52–0.86), suggesting a 70% chance to properly classify a patient as perceiving No Improvement/Stable or Improvement based on the change in the LC. Conclusion Patients undergoing Schroth treatment perceived improved status of their backs even if the Cobb angle did not improve beyond the conventionally accepted threshold of 5°. Standard of care aims to slow/stop progression while Schroth exercises aim to improve postural balance, signs and symptoms of scoliosis. Given the very small MID, perceived improvement in back status is likely due to something other than the Cobb angle. This study warrants investigating alternatives to the Cobb angle that might be more relevant to patients. Trial registration ClinicalTrials.gov, NCT01610908. Retrospectively registered on April 2, 2012 (first posted on June 4, 2012 - https://clinicaltrials.gov/ct2/keydates/NCT01610908)
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Affiliation(s)
- Sanja Schreiber
- Faculty of Rehabilitation Medicine, University of Alberta, 3-48 Corbett Hall, 8205 114 Street, Edmonton, Alberta, T6G2G4, Canada.
| | - Eric C Parent
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, Alberta, T6G2G4, Canada
| | - Doug L Hill
- University of Alberta, Alberta Health Services, Glenrose Rehabilitation Hospital, 10230 111 Ave NW, Edmonton, AB, T5G 0B7, Canada
| | - Douglas M Hedden
- Royal College of Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, ON, K1S 5N8, Canada
| | - Marc J Moreau
- University of Alberta, Alberta Health Services, Glenrose Rehabilitation Hospital, 10230 111 Ave NW, Edmonton, AB, T5G 0B7, Canada
| | - Sarah C Southon
- Department of Surgery, Faculty of Medicine & Dentistry, Stollery Children's Hospital room 4D4.21, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada
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Kim W, Porrino JA, Hood KA, Chadaz TS, Klauser AS, Taljanovic MS. Clinical Evaluation, Imaging, and Management of Adolescent Idiopathic and Adult Degenerative Scoliosis. Curr Probl Diagn Radiol 2019; 48:402-414. [DOI: 10.1067/j.cpradiol.2018.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 12/19/2022]
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