The method for measurement of the three-dimensional scoliosis angle from standard radiographs

From 2D to 3D: automatic measurement of the Cobb angle in adolescent idiopathic scoliosis with the weight-bearing 3D imaging

BACKGROUND CONTEXT

Adolescent idiopathic scoliosis (AIS) necessitates accurate spinal curvature assessment for effective clinical management. Traditional two-dimensional (2D) Cobb angle measurements have been the standard, but the emergence of three-dimensional (3D) automatic measurement techniques, such as those using weight-bearing 3D imaging (WR3D), presents an opportunity to enhance the accuracy and comprehensiveness of AIS evaluation.

PURPOSE

This study aimed to compare traditional 2D Cobb angle measurements with 3D automatic measurements utilizing the WR3D imaging technique in patients with AIS.

STUDY DESIGN/SETTING

A cohort of 53 AIS patients was recruited, encompassing 88 spinal curves, for comparative analysis.

PATIENT SAMPLE

The patient sample consisted of 53 individuals diagnosed with AIS.

OUTCOME MEASURES

Cobb angles were calculated using the conventional 2D method and three different 3D methods: the Analytical Method (AM), the Plane Intersecting Method (PIM), and the Plane Projection Method (PPM).

METHODS

The 2D cobb angle was manually measured by 3 experienced clinicians with 2D frontal whole-spine radiographs. For 3D cobb angle measurements, the spine and femoral heads were segmented from the WR3D images using a 3D-UNet deep-learning model, and the automatic calculations of the angles were performed with the 3D slicer software.

RESULTS

AM and PIM estimates were found to be significantly larger than 2D measurements. Conversely, PPM results showed no statistical difference compared to the 2D method. These findings were consistent in a subgroup analysis based on 2D Cobb angles.

CONCLUSION

Each 3D measurement method provides a unique assessment of spinal curvature, with PPM offering values closely resembling 2D measurements, while AM and PIM yield larger estimations. The utilization of WR3D technology alongside deep learning segmentation ensures accuracy and efficiency in comparative analyses. However, additional studies, particularly involving patients with severe curves, are required to validate and expand on these results. This study emphasizes the importance of selecting an appropriate measurement method considering the imaging modality and clinical context when assessing AIS, and it also underlines the need for continuous refinement of these techniques for optimal use in clinical decision-making and patient management.

Automatically measuring the Cobb angle and screening for scoliosis on chest radiograph with a novel artificial intelligence method

OBJECTIVES

To establish an automatic approach for the measurement of the Cobb angle and the diagnosis of scoliosis on chest radiograph.

METHODS

We developed an artificial intelligence (AI) automatic program which contained a supervised learning module and an inference module. After the filtering and pre-processing process, 96 images from the Shenzhen chest X-ray set were used for training with the supervised learning module, and 491 test images were separately gauged by the AI and the corresponding manual methods. The results of the two methods were further compared through statistical analyses.

RESULTS

Among the test images, 6068 (99.49%) vertebral bodies were identified within the deviation of one vertebral segment. The value difference between the Cobb angle obtained by the AI program and that measured by specialists was 0.4020±0.8703. The intraclass correlation coefficient of 0.915 indicated the strong agreement. AI scoliosis diagnosis achieved an accuracy of 98.37%, with a specificity of 98.73%, a sensitivity of 88.24% and a kappa coefficient of 0.781. And the area under the receiver operating characteristic curve of 0.979 confirmed the consistency of the two methods in diagnosis.

CONCLUSIONS

We developed a novel automatic AI method with the abilities to measure the Cobb angle, and to identify the approximate vertebral segment and diagnosis of scoliosis on chest radiograph. The results suggest that this method might be a promising alternative strategy for scoliosis screening on chest radiograph and worth further investigation.

Magnetically controlled growing rods in the management of early onset scoliosis: a systematic review

Background

Early onset scoliosis (EOS) presents in patients younger than 10 years. Magnetically controlled growing rods (MCGR) were developed as an outpatient distraction system for EOS, allowing to avoid multiple surgeries. This systematic review investigated the efficacy and feasibility of MCGR in EOS.

Methods

This systematic review was conducted according to the PRISMA guidelines. PubMed, Google scholar, Embase, and Scopus were accessed in May 2022. All the clinical trials which investigate the role of MCGR for early onset scoliosis were accessed. Only studies reporting data in patients younger than 10 years with a preoperative Cobb Angle greater than 40° were eligible. The following data was extracted at baseline and at last follow-up: mean kyphosis angle, overall mean Cobb angle, mean T1–S1 length. Data from complication were also collected.

Results

Data from 23 clinical studies (504 patients) were included in the present study. 56% (282 of 504) were females. The average length of the follow-up was 28.9 ± 16.0 months. The mean age of the patients was 8.7 ± 1.9 years old. The mean BMI was 17.7 ± 7.6 kg/m². The mean kyphosis angle had reduced by the last follow-up (P = 0.04), as did the overall mean Cobb angle (P < 0.0001), while the overall T1–S1 length increased (P = 0.0002). Implant-associated complications, followed by spinal alignment failure, wound healing ailments, pulmonary complications, progressive trunk stiffness, persistent back pain, and fracture.

Conclusion

The management of EOS remains challenging. The current evidence indicates that MCGR may be effective to distract the spine and model the curve in EOS.

Case series: 3D printed orthopedic brace combined with traditional manipulative physiotherapy to treat new-onset scoliosis in adults

INTRODUCTION

New-onset scoliosis in adults is different from that in congenital and idiopathic scoliosis. We applied personalized custom 3D printed orthopedic braces combined with traditional manipulative physiotherapy to treat adult patients with new-onset scoliosis and observed the effectiveness of the treatment.

PATIENT CONCERNS

Nine patients aged 20-52 years presented with unequal height of hips and asymmetrical waist. One shoulder was obviously protruding or enlarged compared to the other; when lying on the bed, the legs were not equal in length, and when bending down, the back was not equal on the left and right.

DIAGNOSIS

New-onset scoliosis.

INTERVENTIONS

Application of individual customized 3D printing brace combined with traditional treatment. Evaluation of clinical efficacy after treatment, including functional exercise test (FMS) before and after treatment, ability of daily living (ADL), visual analog pain score (VAS), and scoliosis angle (Cobb angle).

OUTCOMES

The total effective treatment rate was 100.00% (9/9). The VAS score, Cobb angle of the spine, FMS test, and ADL test were significantly improved compared with those before treatment.

CONCLUSION

The customized 3D printed orthopedic brace combined with traditional techniques to treat scoliosis and innovatively combined human bionic technology with traditional medicine to achieve the continuity and precise correction of scoliosis treatment is a clinically effective technique.