1
|
Blouin V, Jullien V, Chémaly O, Roy-Beaudry M, Deschênes S, Barchi S, Nault ML, Flynn JM, Parent S. A modified position for optimized skeletal maturity assessment of AIS patients and its impact on 3D spinal and pelvic parameters. Spine Deform 2024; 12:1639-1645. [PMID: 38819535 DOI: 10.1007/s43390-024-00903-1] [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: 12/21/2023] [Accepted: 05/18/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE A hands-on-wall (HOW) position for low-dose stereoradiography of adolescent idiopathic scoliosis (AIS) patients would allow for skeletal maturity assessment of the hand and wrist. Our aims were twofold: confirm the reliability and validity of skeletal maturity assessment using the HOW radiographs and compare the spinal and pelvic 3D parameters to those of standard hands-on-cheeks (HOC) stereoradiographs. METHODS Seventy AIS patients underwent two successive stereoradiographs and a standard hand and wrist radiograph on the same day. Patients were randomly assigned to begin with HOW and follow with HOC, or vice versa. Raters assessed digital skeletal age (DSA), Sanders Simplified Skeletal Maturity (SSMS) and Thumb Ossification Composite Index (TOCI). 3D reconstructions of the spine and pelvis bones were performed for each stereoradiograph to measure nine clinically relevant spinal and pelvic 3D parameters. RESULTS Inter-rater and intra-rater reliabilities were excellent for DSA, SSMS and TOCI with both standard radiographs and HOW (ICC > 0.95). Strong correlation was found between ratings of both imaging types (ICC > 0.95). In the 3D reconstructions, kyphosis and sacral slope were slightly decreased in the HOW position, but within the clinical margin of error. All other parameters did not differ significantly between positions (p < 0.05). CONCLUSION The results suggest that HOW stereoradiographs allow clinicians to assess skeletal maturity of the hand and wrist with adequate reliability and validity. We recommend that scoliosis clinics adopt the HOW position to assess skeletal maturity because there is no significant clinical impact on the spinal and pelvic evaluation, and on radiation exposure, cost or time.
Collapse
Affiliation(s)
- Victoria Blouin
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Victor Jullien
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Olivier Chémaly
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Center, Centre hospitalier universitaire Sainte-Justine, Montréal, QC, Canada
| | | | - Sylvain Deschênes
- Research Center, Centre hospitalier universitaire Sainte-Justine, Montréal, QC, Canada
| | - Soraya Barchi
- Research Center, Centre hospitalier universitaire Sainte-Justine, Montréal, QC, Canada
| | - Marie-Lyne Nault
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Center, Centre hospitalier universitaire Sainte-Justine, Montréal, QC, Canada
| | - John M Flynn
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Stefan Parent
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.
- Research Center, Centre hospitalier universitaire Sainte-Justine, Montréal, QC, Canada.
| |
Collapse
|
2
|
Chen S, LaBarge ME, Henry AL, Pennings J, Martus JE. Forearm Fractures in Older Children and Adolescents: ORIF is Safer Than IMN With Equivalent Outcomes. J Pediatr Orthop 2024:01241398-990000000-00688. [PMID: 39445700 DOI: 10.1097/bpo.0000000000002853] [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: 10/25/2024]
Abstract
BACKGROUND Greater understanding of the impact of skeletal maturity on outcomes is needed to guide operative treatment of diaphyseal forearm fractures in children and adolescents. The purpose of this study was to compare the complications and outcomes of pediatric diaphyseal forearm fractures treated with intramedullary nailing (IMN) or open reduction internal fixation (ORIF) and to identify a radiographic marker of skeletal maturity that will aid in selecting between treatment options. METHODS A retrospective review of patients aged 10 to 16 years treated operatively for diaphyseal forearm fractures was performed. Markers of skeletal maturity including the olecranon apophysis score, the presence of the thumb adductor sesamoid, and radial epiphyseal capping. Complications were graded with the modified Clavien-Dindo system. Outcomes were scored based on final postoperative range of motion combined with complication grade. RESULTS A total of 260 patients were included: 163 treated with IMN, 97 treated with ORIF, mean age 12.7 years, 72% male. Among closed forearm fractures treated with IMN, open reduction was required in 45% (53/118). Patients treated with IMN had a higher complication rate than ORIF (27.0% vs. 9.3%, P<0.05), including when stratified by age. Complication rates were not impacted by greater skeletal maturity as indicated by the presence of thumb sesamoid or radial epiphyseal capping. There was no significant difference in outcomes between the ORIF and IMN groups. More skeletally immature patients, as identified by a lack of either the thumb adductor sesamoid or radial epiphyseal capping, had significantly better outcomes with ORIF than patients with greater maturity. CONCLUSIONS Across all age groups and levels of skeletal maturity, ORIF had a significantly lower rates of complications compared with IMN with equivalent outcomes. More skeletally immature patients had significantly better outcomes with ORIF treatment when compared with older patients. The thumb adductor sesamoid, radial epiphyseal capping, and the olecranon apophysis score did not provide useful information to select between ORIF over IMN in this population. LEVEL OF EVIDENCE Level III-retrospective comparative study.
Collapse
Affiliation(s)
- Stephen Chen
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Matthew E LaBarge
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Abigail L Henry
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jacquelyn Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jeffrey E Martus
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
3
|
Yang KG, Lee WYW, Hung ALH, Kumar A, Chui ECS, Hung VWY, Cheng JCY, Lam TP, Lau AYC. Distinguishing risk of curve progression in adolescent idiopathic scoliosis with bone microarchitecture phenotyping: a 6-year longitudinal study. J Bone Miner Res 2024; 39:956-966. [PMID: 38832703 DOI: 10.1093/jbmr/zjae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 04/16/2024] [Accepted: 05/31/2024] [Indexed: 06/05/2024]
Abstract
Low bone mineral density and impaired bone quality have been shown to be important prognostic factors for curve progression in adolescent idiopathic scoliosis (AIS). There is no evidence-based integrative interpretation method to analyze high-resolution peripheral quantitative computed tomography (HR-pQCT) data in AIS. This study aimed to (1) utilize unsupervised machine learning to cluster bone microarchitecture phenotypes on HR-pQCT parameters in girls with AIS, (2) assess the phenotypes' risk of curve progression and progression to surgical threshold at skeletal maturity (primary cohort), and (3) investigate risk of curve progression in a separate cohort of girls with mild AIS whose curve severity did not reach bracing threshold at recruitment (secondary cohort). Patients were followed up prospectively for 6.22 ± 0.33 years in the primary cohort (n = 101). Three bone microarchitecture phenotypes were clustered by fuzzy C-means at time of peripubertal peak height velocity (PHV). Phenotype 1 had normal bone characteristics. Phenotype 2 was characterized by low bone volume and high cortical bone density, and phenotype 3 had low cortical and trabecular bone density and impaired trabecular microarchitecture. The difference in bone quality among the phenotypes was significant at peripubertal PHV and continued to skeletal maturity. Phenotype 3 had significantly increased risk of curve progression to surgical threshold at skeletal maturity (odd ratio [OR] = 4.88; 95% CI, 1.03-28.63). In the secondary cohort (n = 106), both phenotype 2 (adjusted OR = 5.39; 95% CI, 1.47-22.76) and phenotype 3 (adjusted OR = 3.67; 95% CI, 1.05-14.29) had increased risk of curve progression ≥6° with mean follow-up of 3.03 ± 0.16 years. In conclusion, 3 distinct bone microarchitecture phenotypes could be clustered by unsupervised machine learning on HR-pQCT-generated bone parameters at peripubertal PHV in AIS. The bone quality reflected by these phenotypes was found to have significant differentiating risk of curve progression and progression to surgical threshold at skeletal maturity in AIS.
Collapse
Affiliation(s)
- Kenneth Guangpu Yang
- SH Ho Scoliosis Research Laboratory, Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
- Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wayne Yuk-Wai Lee
- SH Ho Scoliosis Research Laboratory, Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
- Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alec Lik-Hang Hung
- SH Ho Scoliosis Research Laboratory, Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
- Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR, China
| | - Anubrat Kumar
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR, China
| | - Elvis Chun-Sing Chui
- Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vivian Wing-Yin Hung
- Bone Quality and Health Centre, Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jack Chun-Yiu Cheng
- SH Ho Scoliosis Research Laboratory, Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
- Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tsz-Ping Lam
- SH Ho Scoliosis Research Laboratory, Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
- Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Adam Yiu-Chung Lau
- SH Ho Scoliosis Research Laboratory, Joint Scoliosis Research Centre of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
- Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR, China
| |
Collapse
|
4
|
Xu J, Chen M, Wang X, Xu L, Luo X. Global research hotspots and trends in non-surgical treatment of adolescent idiopathic scoliosis over the past three decades: a bibliometric and visualization study. Front Pediatr 2024; 11:1308889. [PMID: 38269292 PMCID: PMC10806138 DOI: 10.3389/fped.2023.1308889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024] Open
Abstract
Background In recent years, research on the non-surgical treatment of AIS has been increasingly conducted. To the best of our knowledge, this field doesn't yet have a comprehensive and structured pulse combing analysis. In order to provide inspiration and resources for subsequent researchers, we thus reviewed the literature studies on the non-surgical treatment of AIS from the previous thirty years and highlighted the hotspots and frontiers of research in this field. Methods Main using Citespace 6.1 software, the data from the core dataset of the WOS database pertaining to the non-surgical management of AIS from 1990 to 2022 was gathered, displayed, and analyzed. Results 839 papers in all were included in the literature. With 215 papers, the USA came in first place. Chinese Univ Hong Kong ranked first with 32 papers. Research hotspots are adolescent idiopathic spondylitis, Schroth-based physiotherapy-specific exercise efficacy, curve development, Cobb angle, TLSO brace-based clinical efficacy, quality of life, reliability, health-related quality of life questionnaires, finite element biomechanical models, follow-up, and clinical guidelines. Conclusion There aren't many studies that compare the clinical effectiveness of various non-surgical treatments, and because of variations in inclusion eligibility standards and outcome measures, these studies cannot be directly compared. In addition, the inconsistency of existing growth potential and progression risk assessment systems further affects comparative studies of clinical efficacy; it is recommended to establish primary assessment indicators centered on patient treatment outcomes (including appearance, disability, pain, and quality of life), as well as standardized scoliosis progression risk assessment criteria.
Collapse
Affiliation(s)
- Jie Xu
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| | - Meng Chen
- Department of Emergency Medicine, Nanchong Hospital of Traditional Chinese Medicine, Nanchong, China
| | - Xin Wang
- Health Science Center, Peking University, Beijing, China
| | - Lin Xu
- Department of Outpatient Nursing, Nanchong Central Hospital, Nanchong, China
| | - Xiaobing Luo
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| |
Collapse
|
5
|
Wang H, Lu QD, Liu CX, Yang S, Qi BH, Bai HA, Qu JN, Yang Y, Jin XH, Yang M, Su F, Yang YT, Jie Q. The Interrater and Intrarater Reliability of the Humeral Head Ossification System and the Proximal Femur Maturity Index Assessments for Patients with Adolescent Idiopathic Scoliosis. Front Pediatr 2023; 11:1131618. [PMID: 36969277 PMCID: PMC10035882 DOI: 10.3389/fped.2023.1131618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
Background Skeletal maturity can evaluate the growth and development potential of children and provide a guide for the management of adolescent idiopathic scoliosis (AIS). Recent studies have demonstrated the advantages of the Humeral Head Ossification System (HHOS) and the Proximal Femur Maturity Index (PFMI), based on standard scoliosis films, in the management of AIS patients. We further assessed the HHOS and the PFMI method's reliability in the interrater and intrarater. Methods The data from 38 patients, including the humeral head and proximal femur on standard scoliosis films, were distributed to the eight raters in the form of a PowerPoint presentation. On 38 independent standard spine radiographs, raters utilized the HHOS and PFMI to assign grades. The PPT sequence was randomly changed and then reevaluated 2 weeks later. For every system, the 95% confidence interval (95% CI) and intraclass correlation coefficient (ICC) were calculated to evaluate the interrater and intrarater reliability. Results The HHOS was extremely reliable, with an intraobserver ICC of 0.802. In the first round, the interobserver ICC reliability for the HHOS was 0.955 (0.929-0.974), while in the second round, it was 0.939 (0.905-0.964). The PFMI was extremely reliable, with an intraobserver ICC of 0.888. In the first round, the interobserver ICC reliability for the PFMI was 0.967 (0.948-0.981), while in the second round, it was 0.973 (0.957-0.984). Conclusions The HHOS and PFMI classifications had excellent reliability. These two methods are beneficial to reduce additional exposure to radiation and expense for AIS. There are advantages and disadvantages to each classification. Clinicians should choose a personalized and reasonable method to assess skeletal maturity, which will assist in the management of adolescent scoliosis patients.
Collapse
Affiliation(s)
- Huan Wang
- Pediatric Orthopedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Qing-da Lu
- Pediatric Orthopedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Chen-xin Liu
- Pediatric Orthopedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Shuai Yang
- Pediatric Orthopedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Bo-hai Qi
- Pediatric Orthopedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Huan-an Bai
- Pediatric Orthopedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Ji-ning Qu
- Pediatric Orthopedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Ye Yang
- Department of Pediatric Surgery, Baoji Maternal and Child Health Care Hospital, Baoji, China
| | - Xiao-hui Jin
- Department of Radiology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Ming Yang
- Pediatric Orthopedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Fei Su
- Pediatric Orthopedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Ya-ting Yang
- Pediatric Orthopedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
| | - Qiang Jie
- Pediatric Orthopedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Xi'an, China
- Correspondence: Qiang Jie
| |
Collapse
|
6
|
The thumb ossification composite index is the optimal intersection between Sanders and low-dose scoliosis sterioradiography. Spine Deform 2022; 10:1071-1076. [PMID: 35583608 DOI: 10.1007/s43390-022-00520-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Skeletal maturity assessment may be performed using low-dose scoliosis radiographs (LDSS) with simultaneous imaging of the hand or proximal humerus. We sought to compare the practicality, reliability and validity of the Sanders skeletal maturity staging (SMSS), proximal humerus ossification system (PHOS) and the thumb ossification composite index (TOCI) as skeletal maturity assessment tools using LDSS. METHODS A survey including 85 LDSS and 42 hand radiographs was administered to four orthopedic clinicians. Each rater assessed the TOCI, SMSS and PHOS stage for each image. Standing LDSS with hands at the patient's side were used for TOCI, SMSS, and PHOS measurements. SMSS and TOCI measurements on dedicated hand radiographs were assessed as a comparison. Interobserver reliability was calculated for each scale using Fleiss' kappa. For SMSS and TOCI, intraobserver correlation between measurements on LDSS and measurements on hand radiographs were also assessed. RESULTS 472 TOCI measurements, 288 SMSS measurements, and 340 measurements were collected. Kappa interobserver reliability for TOCI was 0.79 (strong) using hand radiographs and 0.74 (strong) using LDSS. Kappa for SMSS was 0.66 (strong) using hand radiographs and 0.45 (moderate) using LDSS. Kappa for PHOS was 0.51 (moderate) using LDSS. Intraobserver agreement between LDSS and hand imaging averaged 0.78 (strong) for TOCI and 0.34 (weak) for SMSS. CONCLUSION Skeletal maturity assessment with TOCI using LDSS demonstrates strong interobserver reliability when hands are placed at the patient's side and correlates well with assessment on hand radiographs. TOCI achieved better inter- and intraobserver reliability compared to SMSS and PHOS, likely because the thumb readily assumes a good position in standing scoliosis sterioradiographs. LEVEL OF EVIDENCE Diagnostic-Level III.
Collapse
|
7
|
Wang W, Chen T, Liu Y, Wang S, Yang N, Luo M. Predictive value of single-nucleotide polymorphisms in curve progression of 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 2022; 31:2311-2325. [PMID: 35434775 DOI: 10.1007/s00586-022-07213-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/24/2022] [Accepted: 04/06/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE Genetic diagnosis is a promising approach because several single-nucleotide polymorphisms (SNPs) associated with adolescent idiopathic scoliosis (AIS) progression have been reported. We review the predictive value of SNPs in curve progression of adolescent idiopathic scoliosis. METHODS We reviewed DNA-based prognostic testing to predict curve progression. Then, the multiple polymorphisms in loci related to AIS progression were also reviewed, and we elucidated the predictive value of SNPs from four functional perspectives, including endocrine metabolism, neuromuscular system, cartilage and extracellular matrix, enzymes, and cytokines. RESULTS The ScoliScores were less successful predictors than expected, and the weak power of predictive SNPs might account for its failure. Susceptibility loci in ESR1, ESR2, GPER, and IGF1, which related to endocrine metabolism, have been reported to predict AIS progression. Neuromuscular imbalance might be a potential mechanism of scoliosis, and SNPs in LBX1, NTF3, and SOCS3 have been reported to predict the curve progression of AIS. Susceptibility loci in SOX9, MATN1, AJAP1, MMP9, and TIMP2, which are related to cartilage and extracellular matrix, are also potentially related to AIS progression. Enzymes and cytokines play essential roles in regulating bone metabolism and embryonic development. SNPs in BNC2, SLC39A8, TGFB1, IL-6, IL-17RC, and CHD7 were suggested as predictive loci for AIS curve progression. CONCLUSIONS Many promising SNPs have been identified to predict the curve progression of AIS. However, conflicting results from replication studies and different ethnic groups hamper their reliability. Convincing SNPs from multiethnic populations and functional verification are needed.
Collapse
Affiliation(s)
- Wengang Wang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan, People's Republic of China
| | - Tailong Chen
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan, People's Republic of China
| | - Yibin Liu
- Department of Emergency, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan, People's Republic of China
| | - Songsong Wang
- Department of Emergency, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan, People's Republic of China
| | - Ningning Yang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan, People's Republic of China. .,Department of Emergency, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan, People's Republic of China.
| | - Ming Luo
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China.
| |
Collapse
|
8
|
Yang KG, Lee WYW, Hung ALH, Hung VWY, Tang MF, Leung TF, Kong APS, Cheng JCY, Lam TP. Decreased cortical bone density and mechanical strength with associated elevated bone turnover markers at peri-pubertal peak height velocity: a cross-sectional and longitudinal cohort study of 396 girls with adolescent idiopathic scoliosis. Osteoporos Int 2022; 33:725-735. [PMID: 34643755 DOI: 10.1007/s00198-021-06200-1] [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: 07/06/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
UNLABELLED Decreased cortical bone density and bone strength at peak height velocity (PHV) were noted in girls with adolescent idiopathic scoliosis (AIS). These findings could provide the link to the previously reported observation that low bone mineral density (BMD) could contribute as one of the prognostic factors for curve progression that mostly occurs during PHV in AIS. INTRODUCTION As part of the studies related to aetiopathogenesis of AIS, we assessed bone qualities, bone mechanical strength and bone turnover markers (BTMs) focusing at the peri-pubertal period and PHV in AIS girls. METHODS 396 AIS girls in two separate cohorts were studied. Skeletal maturity was assessed using the validated thumb ossification composite index (TOCI). Bone qualities and strength were evaluated with high-resolution peripheral quantitative computed tomography (HR-pQCT) and finite element analysis (FEA). RESULTS Cohort-A included 179 girls (11.95 ± 0.95 years old). Girls at TOCI-4 had numerically the highest height velocity (0.71 ± 0.24 cm/month) corresponding to the PHV. Subjects at TOCI-4 had lower cortical volumetric BMD (672.36 ± 39.07 mg/mm3), cortical thickness (0.68 ± 0.08 mm) and apparent modulus (1601.54 ± 243.75 N/mm2) than: (a) those at TOCI-1-3 (724.99 ± 32.09 mg/mm3 (p < 0.001), 0.79 ± 0.11 mm (p < 0.001) and 1910.88 ± 374.75 N/mm2 (p < 0.001), respectively) and (b) those at TOCI-8 (732.28 ± 53.75 mg/mm3 (p < 0.001), 0.84 ± 0.14 mm (p < 0.001), 1889.11 ± 419.37 N/mm2 (p < 0.001), respectively). Cohort-B included 217 girls (12.22 ± 0.89 years old). Subjects at TOCI-4 had higher levels of C-terminal telopeptide of type 1 collagen (1524.70 ± 271.10 pg/L) and procollagen type 1 N-terminal propeptide (941.12 ± 161.39 µg/L) than those at TOCI-8 (845.71 ± 478.55 pg/L (p < 0.001) and 370.08 ± 197.04 µg/L (p < 0.001), respectively). CONCLUSION AIS girls had decreased cortical bone density and bone mechanical strength with elevated BTMs at PHV. Coupling of PHV with decreased cortical and FEA parameters could provide the link to the previously reported observation that low BMD could contribute as one of the prognostic factors for curve progression that mostly occurs during PHV in AIS.
Collapse
Affiliation(s)
- K G Yang
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - W Y W Lee
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A L H Hung
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - V W Y Hung
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - M F Tang
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - T F Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A P S Kong
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J C Y Cheng
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - T P Lam
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
9
|
Welborn MC, Coghlan R, Sienko S, Horton W. Correlation of collagen X biomarker (CXM) with peak height velocity and radiographic measures of growth in idiopathic scoliosis. Spine Deform 2021; 9:645-653. [PMID: 33403656 DOI: 10.1007/s43390-020-00262-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
STUDY DESIGN Prospective comparative study. OBJECTIVES Evaluate the correlation of CXM with established measures of growth. Theoretically higher CXM levels would correlate with rapid longitudinal bone growth and lower levels with growth cessation. Assessment of growth status in patients with pediatric spinal deformity is critical. The current gold standards for assessing skeletal maturity are based on radiographic measures and have large standard errors (SE). Type X collagen (COLX) is produced in the growing physis during enchondral ossification. CXM is a COLX breakdown product that can be measured in blood products. CXM, thus, is a direct measure of enchondral ossification. METHODS IRB-approved prospective study. Q6mo anthropometrics and spine PA biplanar slot scanner images including the hand were assessed for major Cobb, Risser score (RS), triradiate cartilage status (TRC), Greulich and Pyle bone age (BA), and Sanders Score (SS). Serial dried blood spots (DBS) to obtain CXM levels were collected 3 consecutive days Q1-2 months based on SS. RESULTS 47 idiopathic scoliosis patients, Cobb ≥ 20 were enrolled. Mean enrollment age was 11.8 years (range 7.1-16.6 years). 3103 DBS samples were assayed in quadruplicate. CXM results were highly reproducible with a 3% intraassay coefficient of variation (CV), and 12% interassay CV%. The CXM 3-day average was significantly correlated with BA R = 0.9, p < 0.001, RS R = 0.6, p < 0.001, SS R = 0.7, p < 0.001 and with height R = 0.7, p < 0.001. No patient with a CXM level < 5 ng/ml had remaining growth. CONCLUSION CXM is the first identifiable biomarker specific to longitudinal bone growth. Early results indicate that it is a patient-specific, real-time measure of growth velocity with high correlation to the established anthropometric and radiographic measures of growth. It is predictive of cessation of growth. It is highly reproducible with a low SE. Long-term follow-up is required to determine the ability of CXM to guide clinical decision-making.
Collapse
Affiliation(s)
| | - Ryan Coghlan
- Shriners Hospitals for Children, 3101 SW Sam Jackson Park Road, Portland, OR, 97229, USA
| | - Susan Sienko
- Shriners Hospitals for Children, 3101 SW Sam Jackson Park Road, Portland, OR, 97229, USA
| | - William Horton
- Shriners Hospitals for Children, 3101 SW Sam Jackson Park Road, Portland, OR, 97229, USA
| |
Collapse
|
10
|
Ng BW, Chau WW, Hung AH. Gender difference in health-related quality of life of adolescent idiopathic scoliosis patients between the 2 nd and 5 th year of bracing treatment using scoliosis research society-22 questionnaire. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2021. [DOI: 10.4103/jotr.jotr_37_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
11
|
Abstract
Assessment of skeletal maturity is crucial for managing growth related problems. Tanner and Whitehouse (TW) hand and wrist bone age assessment is an accurate method; however, it is complex and labor-intensive. Several simplified methods derived from the TW method were proposed, and each had its own character. The purpose of this study is to explore the relationship between these methods for accurate usage.Between 2018 and 2019, a cross-sectional study was performed with consecutive left hand and wrist x-rays obtained from a pediatric orthopedic clinic. Bone age assessments included the distal radius and ulna (DRU) classification, Sanders staging (S), thumb ossification composite index (T), and TW method. Somers delta correlation was conducted to determine the interchangeability of these stages. The mean bone age and standard deviation (SD) of each subgrade were compared and analyzed.Totally 103 films (92 girls) were analyzed with mean age of 12.1 years (range: 8.0-17.9 years). The radius (R) stages had good correlation with S, T, and U stages with a very high Somers delta correlation (P < .05). R5 had relatively large SD (1.5) and referred to T2 and T3; R6 and R7 had the smallest SD (0.3) with reference to T4 or S2; R8 referred to T5 or S3, S4, S5; R9 referred to S6 and S7.The internal relationship between the DRU and digital stages system was well proven. We also provided a simple and accurate way to assess the bone age by combination of some subgrades with smaller SD: 10y-proximal thumb covered without sesamoid (T2); 10.5y-sesamoid just appearing (T3); 11y-distal radial physis just covered (medial double joint line, R6); 11.5y-medial capping of distal radial physis (R7); 12y-bilateral capping of distal radial physis (R8) / phalangeal capping without fusion (S3); 12.5y-distal phalangeal physes start to fuse (S4); 13y-distal phalangeal physes fused (S5); 13.5y-proximal phalangeal physes start to fuse (S6); 14.5y-proximal phalangeal physes fused (S7); 15y-distal radial physis almost fused (R10).Level of Evidence: Diagnostic study, level III.
Collapse
Affiliation(s)
- Zhen Bian
- Department of Pediatric Orthopaedics, Bei Jing Ji Shui Tan Hospital, Beijing, China
| | - Yuan Guo
- Department of Pediatric Orthopaedics, Bei Jing Ji Shui Tan Hospital, Beijing, China
| | - XueMin Lyu
- Department of Pediatric Orthopaedics, Bei Jing Ji Shui Tan Hospital, Beijing, China
| | - Zheng Yang
- Department of Pediatric Orthopaedics, Bei Jing Ji Shui Tan Hospital, Beijing, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
12
|
Utilization of distal radius and ulna classification scheme in predicting growth peak and curve progression in idiopathic scoliosis girls undergoing bracing treatment. 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; 29:770-778. [PMID: 31950352 DOI: 10.1007/s00586-020-06289-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/09/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Distal radius and ulna (DRU) classification scheme has been proposed for predicting skeletal maturity in patients with idiopathic scoliosis (IS). However, the utilization of DRU classification scheme in the assessment of growth peak and curve progression in IS was still inconclusive. This study aimed to correlate the distal radius and ulna stages with several indicators for growth potential and to evaluate the predictive value of DRU system for curve progression in braced female IS patients. METHODS This was a consecutive longitudinal study including physically immature IS girls receiving standardized bracing treatment and regularly followed up every 3-6 months until brace weaning. The following data of each visit were collected: chronologic age, standing height, Cobb angle, spinal length, Risser sign, digital skeletal age (DSA) scores and DRU scores. The height velocity (HV), spinal growth velocity (SGV) and angle velocity (AV) of each visit were calculated. The correlation among radius stage, ulna stage, Risser sign, height, spinal length, HV, SGV and AV was studied. RESULTS Forty braced IS girls with 349 longitudinal whole spine X-rays were reviewed. The average DRU scores at initial visit were R6.5 ± 1.1 and U4.5 ± 1.2 for radius and ulna, respectively. Both the radius stages between R5 and R8 and ulna stages between U3 and U6 indicated high SGV and high HV. The DSA scores were 402.1 ± 48.8 and 430.8 ± 44.4 at R7 and R8, respectively. The AV values were - 5.9 ± 12.4°/y and - 0.4 ± 1.5°/y at R5 and R6, which increased to 5.9 ± 17.3°/y, 3.1 ± 15.7°/y and 4.2 ± 12.2°/y at R7, R8 and R9, respectively. The DSA scores were 387.3 ± 65.7 for U5 and 432.9 ± 48.5 for U6, respectively. The AV values were - 3.1 ± 0.3°/y at U3, - 1.7 ± 9.3°/y at U4, 2.3 ± 16.1°/y at U5, 5.4 ± 15.5°/y at U6 and 4.4 ± 12.9°/y at U7. CONCLUSIONS Both distal radius and ulna scores correlate with the longitudinal growth potential, and thus, the DRU scoring scheme is an alternative predictor for growth potential and curve progression in girls with IS. These slides can be retrieved under Electronic Supplementary Material.
Collapse
|
13
|
Ng BW, Illescas V, Chau WW. A case of malignant scoliosis and its relationship with pulmonary lung function and long-term health-related quality of life. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2020. [DOI: 10.4103/jotr.jotr_14_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
14
|
Ng BW, Chau WW. Changes of shoulder balance, sagittal alignments, and curve correction in the treatment of Lenke 1 and 2 adolescent idiopathic scoliosis using a three-dimensional-based correction strategy in correlation to health-related quality of life using the Scoliosis Research Society-22 Questionnaire. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2020. [DOI: 10.4103/jotr.jotr_46_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
15
|
Lau LCM, Hung ALH, Chau WW, Hu Z, Kumar A, Lam TP, Chu WCW, Cheng JCY. Sequential spine-hand radiography for assessing skeletal maturity with low radiation EOS imaging system for bracing treatment recommendation in adolescent idiopathic scoliosis: a feasibility and validity study. J Child Orthop 2019; 13:385-392. [PMID: 31489044 PMCID: PMC6701449 DOI: 10.1302/1863-2548.13.190007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The EOS-imaging system is increasingly adopted for clinical follow-up in scoliosis with the advantages of simultaneous biplanar imaging of the spine in an erect position. Skeletal maturity assessment using a hand radiograph is an essential adjunct to spinal radiography in scoliosis follow-up. This study aims at testing the feasibility and validity of a newly proposed EOS workflow with sequential spine-hand radiography for skeletal maturity assessment and bracing recommendation. METHODS EOS spine-hand radiographs from patients with diagnosis of idiopathic scoliosis, including both sexes and an age range of ten to 14 years, were scored using the Thumb Ossification Composite Index (TOCI), Sanders and Risser methods. Intraclass correlation coefficients (ICCs) were calculated for inter/intraobserver agreement and were tested with Cronbach's alpha values. RESULTS In all, 60 EOS-spine hand radiographs selected from subjects with diagnosis of adolescent idiopathic scoliosis (AIS), including 32 male patients (mean age 11.53 years; 10 to 14) and 28 female patients (mean age 11.50 years; 10 to 13) who underwent sequential spine-hand low dose EOS imaging were generated for analysis. The overall interobserver (ICC = 0.997) and intraobserver agreement (α > 0.9) demonstrated excellent agreement for TOCI staging; ICC > 0.994 for both TOCI and Sanders staging comparing traditional digital versus EOS hand radiography; ICC ≥ 0.841 for agreement on bracing recommendation among TOCI versus the Risser and Sanders system. CONCLUSION With the proposed new EOS workflow it was feasible to produce high image quality for skeletal maturity assessment with excellent reliability and validity to inform consistent bracing recommendation in AIS. The workflow is applicable for busy daily clinic settings in tertiary scoliosis centres with reduced time cost, improved efficiency and throughput of the radiology department. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- L. C. M. Lau
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - A. L. H. Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - W. W. Chau
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Z. Hu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - A. Kumar
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - T. P. Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - W. C. W. Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong
| | - J. C. Y. Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong,Correspondence should be sent to J. C. Y. Cheng, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T. Hong Kong. E-mail:
| |
Collapse
|