Evaluation Of Adolescent Idiopathic Scoliosis Research Articles

Assessment of the reliability of hand-held surface scanner in the evaluation of adolescent idiopathic scoliosis.

Spinal deformities due to adolescent idiopathic scoliosis (AIS) result in impairment in the back surface topography. Sophisticated interventions are needed that address different aspects of deformity. The purpose of our study is to test the reliability of hand-held 3D scanners on the assessment of AIS. Forty-two AIS patients were included in our study. The back surfaces of the patients were scanned with the hand-held 3D scanner, while the patients were in the standing position with the arms hanging at the sides (P1), with the arms extended (P2), and forward bending position (P3). The acquired original image was superimposed with the mirror image. Root mean square (RMS) of the point-to-point distance was calculated, and the differences between the surfaces were determined. Correlation between RMS, Cobb, POTSI, scoliometer, radiographic rotations, TRACE results was calculated. A significant correlation coefficency (r) was found between the RMS and Cobb values in the thoracic (P1 = 0.80, P2 = 0.76, P3 = 0.71) and lumbal region (P1 = 0.56, P2 = 0.65, P3 = 0.63); between RMS and Raimondi in the thoracic (r, P1 = 0.80, P2 = 0.81, P3 = 0.78) and lumbar regions (P1 = 0.54, P2 = 0.64, P3 = 0.59); between RMS and scoliometer measurements in the thoracic (r, P1 = 0.58, P2 = 0.50, P3 = 0.41) and lumbar regions (P1 = 0.35, P2 = 0.41, P3 = 0.59); in thoracolumbar region between RMS and POTSI (P1 = 0.50, P2 = 0.25, P3= 0.36), between RMS and TRACE (P1 = 0.68, P2 = 0.5, P3 = 0.52), CONCLUSION: The hand-held scanners may contribute to gaining new insight into diagnosis and follow-up of AIS by its mobility that enables the acquisition of data in desired body position and place such as bedside or our patient clinics. Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Spinal phantom comparability study of Cobb angle measurement of scoliosis using digital radiographic imaging

SummaryBackgroundComputed radiography (CR), digital radiography (DR) and biplanar radiography (EOS™ imaging system) are common imaging tools for radiographic evaluation of adolescent idiopathic scoliosis (AIS). The effect of imaging methods in relation to later-on Cobb angle measurements on radiographs is not yet quantified. The study aimed to examine the compatibility between CR, DR and EOS for scoliotic quantification by evaluating the reliability, agreement of different imaging methods, and assessing the prediction performance for EOS measurement from that of CR and DR.MethodA flexible spine phantom was used to simulate 32 different scoliotic curves ranging from 10° to 60°. Each curvature was imaged using DR, CR and EOS systems accordingly. Each of the six observers independently measured Cobb angle twice on each image at a two-week interval. Intraclass correlation coefficient (model 2 and 3), Bland-Altman plot and linear regression analysis were completed to evaluate the reliability, agreement, and the prediction of Cobb angle measurement, respectively.ResultsReliability analysis showed excellent intra-observer reliability (Intraclass correlation coefficient >0.9) for each observer and good inter-observer reliability (Intraclass correlation coefficient = 0.84 for EOS; 0.739 for CR; 0.877 for DR) for each method. Bland-Altman plots demonstrated good agreement between imaging methods without fixed or proportional bias. Excellent coefficient of determination was achieved, with 0.980 for CR versus EOS measurements, and 0.973 for DR versus EOS measurements.ConclusionsRadiographs produced by all of the three methods can provide reliable and accurate Cobb angle measurements for scoliosis assessments. None of the methods systemically underestimates or overestimates the Cobb angle measurement. Additionally, all of the evaluated methods are satisfactory in obtaining images for Cobb angle measurement in AIS. However, the 3D post-processing techniques offered by EOS should also be taken into consideration as it takes a vital role in treatment and monitoring of 3D deformity in the case of scoliosis.The translational potential of this articleIn view of the limited availability of biplanar radiography (EOS™ imaging system), computed radiography and digital radiography are demonstrated to be reliable alternatives in scoliosis monitoring as evident in the reliability, agreement and prediction of Cobb angle measurement.

Curve Magnitude in Patients Referred for Evaluation of Adolescent Idiopathic Scoliosis: Five Years' Experience From a System Without School Screening

Study designRetrospective cross-sectional study. ObjectivesTo analyze the referral pattern of patients with adolescent idiopathic scoliosis (AIS) in a tertiary hospital in a nationalized health care system without school screening and to compare curve magnitude on referral with results reported in the literature. Summary of background dataIn Denmark, school screening for AIS has not been in effect for more than two decades, and there is limited knowledge of curve magnitude and pattern of referral to specialized treatment in our country. Other studies, however, have assessed the effectiveness of school scoliosis screening. Our tertiary institution receives referrals for evaluation of AIS from general practitioners (GPs) and other hospitals or private specialists. MethodA review was conducted on all patients diagnosed with AIS between 2010 and 2015. Data collection included age, gender, menarchal status, recommended treatment, and major curve Cobb angle for all patients aged 10–19 years referred for evaluation of AIS. Major curve magnitude was categorized as 10–19, 20–39, or ≥40 degrees, and the distribution of categories was compared to a screened population reported in the litterature. ResultsA total of 166 of 460 newly referred AIS patients were referred from GP. Mean age was 15 years (standard deviation = 2) and median Cobb angle was 35 degrees. Overall, 33% were initially recommended treatment with a brace. This group had a median curve size of 41 degrees, and 28% presented more than 1 year past menarche. We found a significantly larger curve magnitude at the time of referral in our GP cohort compared to a screened population (p < .001), and 22% versus 8% had a Cobb angle >40 degrees (p < .001). ConclusionThe present study confirms that in a health care system without school screening, patients with AIS referred for evaluation by GPs have larger curve sizes compared to systems with school screening. Level of EvidenceIII

Supine Magnetic Resonance Imaging Cobb Measurements for Idiopathic Scoliosis Are Linearly Related to Measurements From Standing Plain Radiographs

Retrospective. To demonstrate a relationship between adolescent idiopathic scoliosis Cobb angle measurements obtained with standing plain radiographs and standard supine magnetic resonance (MR) images. Patients with adolescent idiopathic scoliosis are exposed to repeated doses of ionizing radiation during the course of their treatment with significant potential long-term health consequences. Supine MR images of the spine may allow measurements of coronal plane spinal deformity equivalent to plain radiographs while minimizing exposure to ionizing radiation. A retrospective chart and radiograph review was conducted for patients with adolescent idiopathic scoliosis. Cobb angle measures were derived from available plain radiographs and MR images obtained within 6 months of each other. Pearson correlation and linear regression analysis was used to test the relationship between plain radiographical and magnetic resonance imaging Cobb measures. Inter- and intraobserver reliability for the Cobb measures was tested with a random sample of 20 patients using intraclass correlation coefficients. Supine MR images tended to underestimate plain radiographs by 10° on average. However, radiographical and MR measures showed a strong positive correlation (r= 0.90-0.94) for all curves, structural or nonstructural, and this correlation was not influenced by patient age or body mass index. The relationship allowed the development of a simple linear equation for converting MR image measures to radiograph measures with an acceptable absolute error of ±5°. Cobb angle measures from supine magnetic resonance imaging of the spine can reliably be translated to the equivalent radiographical measures with an acceptable range of error. The data suggest that standard supine magnetic resonance imaging sequences may be a viable substitute for plain radiographs in the clinical diagnosis and serial evaluation of adolescent idiopathic scoliosis while obviating the associated dangers of ionizing radiation from plain radiographs. 3.

Adolescent idiopathic scoliosis treated with posteromedial translation: radiologic evaluation with a 3D low-dose system

Computed tomography can be used for three-dimensional (3D) evaluation of adolescent idiopathic scoliosis (AIS) patients, but at the expense of high radiation exposure, and with the limitation of being performed in the supine position. These drawbacks can now be avoided with low-dose stereoradiography, even in routine clinical use. The purpose of this study was to determine the 3D postoperative correction of AIS patients treated by posteromedial translation. Forty-nine consecutive patients operated for AIS (Lenke 1-4) using posteromedial translation were included. Corrections were evaluated preoperatively, postoperatively and after at least 2 years using the EOS imaging system. 3D angles were measured in the plane of maximum deformity. Mean number of levels fused and operative time were 13.5 ± 1 and 215 ± 25 min, respectively. Main thoracic, proximal thoracic, and lumbar curves corrections averaged 64.4 ± 18, 31 ± 10 and 69 ± 20 %, respectively. Mean T4-T12 kyphosis increased 18.8° ± 9° in the subgroup of hypokyphotic patients. Mean apical vertebral rotation reduction was 48.3 ± 20 %. Trunk height gain averaged 27.8 ± 14 mm. There was no pseudarthrosis or significant loss of correction in any plane during follow-up. Two patients (4 %) developed asymptomatic proximal junctional kyphosis, despite having normal thoracic kyphosis. Their sagittal balance was shifted posteriorly by 36 and 47 mm, respectively, by the operation, but revision surgery was not performed. Low-dose stereoradiography provided 3D reconstructions of the fused and unfused spine in routine clinical use. Postoperative 3D analysis showed that posteromedial translation enhanced sagittal balance correction, without sacrificing frontal or axial correction of the deformity.

The role of routine magnetic resonance imaging in the preoperative evaluation of adolescent idiopathic scoliosis

The routine use of magnetic resonance imaging (MRI) in adolescent idiopathic scoliosis remains controversial, and current indications for MRI in idiopathic scoliosis vary from study to study. The purpose of this study was to demonstrate the prevalence of neural axis malformations and the clinical relevance of routine MRI studies in the evaluation of patients with adolescent idiopathic scoliosis undergoing surgical intervention without any neurological findings. A total of 249 patients with a diagnosis of idiopathic scoliosis were treated surgically between the years 2002 and 2007. A routine whole spine MRI analysis was performed in all patients. On the preoperative clinical examination, all patients were neurologically intact. There were 20 (8%) patients (3 males and 17 females) who had neural axis abnormalities on MRI. Three of those 20 patients needed additional neurosurgical procedures before corrective surgery; the remaining underwent corrective spinal surgery without any neurosurgical operations. Magnetic resonance imaging may be beneficial for patients with presumed idiopathic scoliosis even in the absence of neurological findings and it is ideally performed from the level of the brainstem to the sacrum.

Spontaneous Lumbar Curve Correction in Selective Thoracic Fusions of Idiopathic Scoliosis

A retrospective evaluation of adolescent idiopathic scoliosis (AIS) patients treated with selective thoracic instrumentation and fusion. To evaluate the predictors and the effect of surgical approach (anterior versus posterior) on spontaneous lumbar curve correction (SLCC) after selective thoracic fusion in patients with structural thoracic and compensatory lumbar curves. Spontaneous coronal correction of the unfused lumbar curve has been described previously; however controversy continues regarding the effect of surgical approach on SLCC. One hundred thirty-two anterior and 44 posterior selective thoracic fusions instrumented distally to T11, T12, or L1 were identified from a multicenter AIS database. A 2-way ANOVA was used to compare SLCC with regards to surgical approach and the lowest instrumented vertebra (LIV). A Pearson's correlation analysis was utilized to identify radiographic variables associated with SLCC. A secondary analysis of surgical approach was then performed on 28 pairs of patients matching the factors that correlated positively with SLCC. The average SLCC for the anterior approach (44% +/- 19%) was less than that for the posterior approach (49% +/- 19%; P = 0.07), and was found to increase significantly with a more distal LIV (P = 0.03). Pearson's correlation analysis revealed the strongest correlations between SLCC and preoperative lumbar curve flexibility (r = 0.20) and 2-year postoperative thoracic curve percent correction (r = 0.47). A secondary analysis of SLCC in paired curves matched by LIV, lumbar curve flexibility and thoracic percent correction revealed no difference between anterior (48%) and posterior (49%) approaches (P = 0.75). Anterior and posterior instrumented fusions performed selectively on the appropriate curves result in equal SLCC when matched by LIV, flexibility of the lumbar curve, and percent thoracic curve correction achieved. This suggests that the observed phenomenon of SLCC after selective thoracic fusion in AIS is independent of surgical approach and can be reliably achieved with either technique.

Comparison of Observer Variation in Conventional and Three Digital Radiographic Methods Used in the Evaluation of Patients With Adolescent Idiopathic Scoliosis

This study is a reliability analysis of coronal Cobb angle measurements in adolescent idiopathic scoliosis obtained by multiple observers. We sought to quantify and compare the interobserver reliability of conventional radiographs and 3 methods of digital radiography. The use of digital radiography for the evaluation of adolescent idiopathic scoliosis is being widely adopted. Previous studies comparing manual and computer-based measurements have found excellent intraobserver reliability for both techniques. Interobserver reliability of computer-based measurements on digital radiographs has not been compared with manual measurements on conventional radiographs. Other commonly used forms of output of digital radiography have not been studied. Preoperative standing posteroanterior full-length spine radiographs from 40 patients with adolescent idiopathic scoliosis were examined by 4 observers. Patients were divided into 2 groups of 20 patients. In 1 group, radiographs were obtained by conventional technique. In the other group, radiographs were obtained using a digital radiography system. Three types of output of the identical image obtained by a digital radiography system were examined, including computer-based image, printing of the image fitted onto a single film, or printing of the image onto 2 unstitched films. The Cobb angle, upper vertebra, and lower vertebra of the major curve were measured by each observer. Interobserver reliability for each technique was calculated by intraclass correlation coefficient and interobserver variance. Interobserver reliability as described by intraclass correlation coefficient and interobserver variance was excellent (0.93-0.98) for measurements made on conventional, computer-based, and fitted printed radiographs. The intraclass correlation coefficient was good (0.87) in measurements obtained on radiographs printed on 2 unstitched films. Measurements made on conventional and digital radiographs using manual and computer-based techniques have similar good to excellent interobserver reliability. Interobserver reliability was lower for digital radiographs when printed onto 2 unstitched films. The results suggest that different observers will obtain similar measurements when viewing the same image, but care should be taken when interpreting images printed on 2 unstitched films.