Spinal Curvature Measurements Research Articles

Is Radiation-Free Diagnostic Monitoring of Adolescent Idiopathic Scoliosis Feasible Using Upright Positional Magnetic Resonance Imaging?

Prospective clinical trial. The purpose of this study was to determine if an upright positional magnetic resonance imaging (MRI) protocol could produce reliable spinal curvature images and measurements compared with traditional radiograph. Concerns about the oncological potential from cumulative doses of ionizing radiation in children and adolescents being monitored for adolescent idiopathic scoliosis (AIS) initiated a search for radiation-free diagnostic imaging modalities, including MRI. We submit that upright, positional MRI (uMRI) produces reliable spinal curvature images compared with traditional radiograph. Twenty-five consecutive patients (16 female; 9 male; average age, 14.6 yr; range, 12-18 yr) with a diagnosis of AIS were enrolled. Average major curve magnitude was 30° (range, 6°-70°). Subjects received anterior-posterior and lateral plain radiographical scoliosis imaging followed within 1 week by uMRI. MRI data acquisition was performed in less than 7 minutes. Two independent observers performed all Cobb angle, T5-T12 kyphosis, and vertebral rotation measurements for comparison. The Pearson correlation method was performed to compare radiograph to uMRI measurements, while inter-rater and intrarater correlations were performed to assess reliability. We found outstanding correlation between all plain film radiography and uMRI measurements (P = 0.01); major Cobb angles (R = 0.901), minor Cobb angles (R = 0.838), and kyphosis (R = 0.943). Inter-rater reliability for both radiographical and MRI measurements of major Cobb angles (R = 0.959, 0.896, respectively), minor Cobb angles (R = 0.951, 0.857, respectively), and vertebral rotation (R = 0.945) were outstanding. Intrarater reliability for both radiographical and MRI measurements of major Cobb angles (R = 0.966, 0.966, respectively) and minor Cobb angles (R = 0.945, 0.943, respectively) were also outstanding. Our results show that uMRI is capable of producing coronal and sagittal plane measurements that highly correlate with traditional plain film radiographical measurements. This, in addition to reliable vertebral rotation measurements, makes uMRI a valuable, radiation-free alternative/substitute for diagnostic evaluation in AIS.

Relationship of thoracic kyphosis and lumbar lordosis to bone mineral density in women

The relationship between spinal curvature and bone mineral density (BMD) in women was examined. Significant relationships were observed between spinal curvature and BMD in both pre- and postmenopausal women. Excessive spinal curvature may be associated with low bone mass in premenopausal women. The purpose of this study was to examine the associations between spinal measurements of thoracic and lumbar curvatures and bone mineral density in pre- and postmenopausal women. The data for this study were obtained from the Texas Woman's University Pioneer Project. Female participants (n = 242; premenopausal n = 104, postmenopausal n = 138) between the ages of 18 and 60 years were evaluated on multiple health measures. Thoracic and lumbar curvatures were measured with a 24-in. (60 cm) flexicurve. Bone mineral density was assessed via dual-energy X-ray absorptiometry (Lunar DPX IQ, version 4.6e). Pearson correlations and logistic regression analysis were used to examine the associations between the obtained spinal curvature measurements and bone mineral density. Significance was set at p < .05. Significant correlations were observed for the femoral neck and lumbar spine bone mineral density with thoracic and lumbar curve in premenopausal women (r = -.344 to - .525; p < .001). Slightly weaker, but significant, correlations were observed for femoral neck and lumbar spine in relation to thoracic and lumbar curve in postmenopausal women (r = -.288 to -.397; p < .01). Premenopausal women with thoracic curvature greater than 4 cm had a greater risk of having low bone mass compared to premenopausal women with less than 4 cm of curvature (odds ratio = 3.982, 95 % CI = 1.206, 13.144). The observed negative relationship suggests that as either thoracic or lumbar curvature increases, the regional bone mineral density decreases in both pre- and postmenopausal women.

The Reliability and Minimum Detectable Change of Spinal Curvature Measurements in the Prone Position with a Spinal Mouse

The Reliability and Minimum Detectable Change of Spinal Curvature Measurements in the Prone Position with a Spinal Mouse

Accuracy and reliability of coronal and sagittal spinal curvature data based on patient-specific three-dimensional models created by the EOS 2D/3D imaging system

Three-dimensional (3D) deformations of the spine are predominantly characterized by two-dimensional (2D) angulation measurements in coronal and sagittal planes, using anteroposterior and lateral X-ray images. For coronal curves, a method originally described by Cobb and for sagittal curves a modified Cobb method are most widely used in practice, and these methods have been shown to exhibit good-to-excellent reliability and reproducibility, carried out either manually or by computer-based tools. Recently, an ultralow radiation dose-integrated radioimaging solution was introduced with special software for realistic 3D visualization and parametric characterization of the spinal column. Comparison of accuracy, correlation of measurement values, intraobserver and interrater reliability of methods by conventional manual 2D and sterEOS 3D measurements in a routine clinical setting. Retrospective nonrandomized study of diagnostic X-ray images created as part of a routine clinical protocol of eligible patients examined at our clinic during a 30-month period between July 2007 and December2009. In total, 201 individuals (170 females, 31 males; mean age, 19.88 years) including 10 healthy athletes with normal spine and patients with adolescent idiopathic scoliosis (175 cases), adult degenerative scoliosis (11 cases), and Scheuermann hyperkyphosis (5 cases). Overall range of coronal curves was between 2.4° and 117.5°. Analysis of accuracy and reliability of measurements were carried out on a group of all patients and in subgroups based on coronal plane deviation: 0° to 10° (Group 1, n=36), 10° to 25° (Group 2, n=25), 25° to 50° (Group 3, n=69), 50° to 75° (Group 4, n=49), and more than 75° (Group 5, n=22). Coronal and sagittal curvature measurements were determined by three experienced examiners, using either traditional 2D methods or automatic measurements based on sterEOS 3D reconstructions. Manual measurements were performed three times, and sterEOS 3D reconstructions and automatic measurements were performed two times by each examiner. Means comparison t test, Pearson bivariate correlation analysis, reliability analysis by intraclass correlation coefficients for intraobserver reproducibility and interrater reliability were performed using SPSS v16.0 software (IBM Corp., Armonk, NY, USA). No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article. In comparison with manual 2D methods, only small and nonsignificant differences were detectable in sterEOS 3D-based curvature data. Intraobserver reliability was excellent for both methods, and interrater reproducibility was consistently higher for sterEOS 3D methods that was found to be unaffected by the magnitude of coronal curves or sagittal plane deviations. This is the first clinical report on EOS 2D/3D system (EOS Imaging, Paris, France) and its sterEOS 3D software, documenting an excellent capability for accurate, reliable, and reproducible spinal curvature measurements.

Measurement of Spinal Curvature: A comparison of two manual methods

Aim: In correction of angular deformities of the spine, assessment of spinal curvature from radiographs is important. The methods used for such assessment vary from simple to sophisticated techniques depending on the facilities that are available. There is the need to use a simple, yet reliable method in a health care setting with limited resources. To ascertain the level of concordance between two manual methods of measuring the spinal curvature of spinal angular deformities. Method: The traditional protractor method and the goniometer method were used to measure the angle of curvature in seventy standard erect anteroposterior and lateral spine radiographs of patients who had thoracic and thoracolumbar scoliosis or kyphosis and were managed in 4 tertiary hospitals in Nigeria. Correlation analysis was then applied to determine the association between both methods, with the level of significance set at p<0.01. Result: A strong association between the two manual methods was obtained for both kyphosis and scoliosis (r= 0.99; p> 0.01). Measurement variability increased with magnitude of curvature. Conclusion: The traditional protractor method as well as the goniometer method has clinical utility but for practical purposes, the goniometer should be preferred to the protractor method of measuring spinal curvature because of its simplicity and that it obviates intrinsic sources of error associated with the latter.

Automatic Quantification of Spinal Curvature in Scoliotic Radiograph using Image Processing

Choosing the most suitable treatment for the scoliosis relies heavily on accurate and reproducible spinal curvature measurement from radiographs. Our objective is to reduce the variability in spinal curvature measurement by reducing the user intervention and bias. In order to determine the reliability of the spinal curvature measurement as it is in the clinical measurement of scoliosis a methodological survey has been carried out that concludes with inter and intra observer error variation. The proposed method list out horizontal inclination of all the vertebrae's in terms of slopes using active contour models and morphological operators. This facilitates the radiologist to decide end vertebrae and hence inter/intra observer variation is completely eliminated. Tables1 and 2 shows the observer error variation between manual and proposed methods in terms of mean and standard deviation.

The effect of interspinous implant surgery on back surface shape and radiographic lumbar curvature

Background Interspinous process implants, used to augment lumbar spine surgery, putatively induce a local segmental lumbar kyphosis yet few investigations outline the effect in vivo on thoracolumbar sagittal curvature. Changes in lumbar skeletal alignment and posture have traditionally relied upon radiographic and back surface spinal curvature measurements, respectively. Methods Lumbar lordosis curvature in 10 healthy subjects (6F, 4M; mean age 36 years) and 10 interspinous implant lumbar surgery patients (5F, 5M; mean age 51 years) was assessed with rasterstereography at baseline and at 6 weeks. Skeletal lumbar lordosis in standing was measured from lateral erect radiography pre- and 6 weeks post-operatively in the surgical cohort, and compared to angulation obtained for surface lordosis curvature derived from rasterstereography. Findings Repeatable measurement of standing lumbar lordosis from rasterstereographic back shape imaging in healthy volunteers and lumbar surgery cases was demonstrated. Reductions of 0.6 (NS) in healthy and 3.1 (significant, P < 0.001) in surgical subjects were recorded for surface lumbar lordosis angle between the 6 week time-points. Slight flattening of the segmental angle and regional lordosis after DIAM surgery was revealed by radiography. Skeletal and surface lumbar lordosis changes were uncorrelated preoperatively ( ρ = 0.28) and postoperatively ( ρ = 0.26). Interpretation Rasterstereography is sensitive in assessing lumbar lordosis changes in healthy and lumbar surgical individuals over time. Surgery with DIAM for lumbar pathology may result in an initial mild flattening of lordosis. Serial investigations of spinal curvature after surgery with DIAM interspinous implant are warranted in order to better understand the time-course of spinal posture changes of such cases.

Computer-Generated Index for Evaluation of Idiopathic Scoliosis in Digital Chest Images: A Comparison with Digital Measurement

An intelligence system was used to generate index for scoliosis. Tests were designed to evaluate the consistency of the automatic computer-generated index and to quantify the correlation between Cobb angle and computer generated scoliosis classification index (SCI). A fully automatic computer-generated index can be used to assess the extent of spinal curvature rather than manual measurement on radiographs. This study aims to evaluate the relation of an automatic computer-generated index in assessing the spinal curvature of scoliosis quantitatively on digital chest images. Sixty chest radiographs were obtained in this study. Cobb angle measurement and the index generated were compared by parametric statistical tests. The SCI method was demonstrated to be reproducible. There was also statically significant positive correlation between Cobb angle and SCI (Pearson's correlation: r = 0.9229). The Computer-generated index method is valid and reliable in quantifying measurement of spinal curvature of scoliosis as the correlation between Cobb's angle and SCI in nearly perfect positive for Cobb angle more than 10 degree. It is noted that with widely use of this computer method, this quantitative method proposed is a promising method in improving the reliability of scoliosis assessment and reducing the workload of clinical staff.

A buckling analysis related to adolescent idiopathic scoliosis

Objectives. To develop and validate a new method of predicting the neutral lumbar spine curve from external (non-invasive electrogoniometer) measurements.Background. Non-invasive techniques for lumbar spine geometry prediction suffer from a lack of a complete geometry description, problems with applicability to field conditions, or both.Methods.The study consisted of three steps. First, utilizing lateral imaging (MRI and X-ray pictures) of the lumbosacral junction, the torso geometry was described using measures of lumbar lordosis via the Cobb method. Second, the relationship between imaging based measurement of lumbar spinal curvature and externally measured torso flexion angle in the sagittal plane using a goniometer was determined. Finally, method validation was performed with an independent set of nine subjects. The predicted lumbar spine curve was determined and the prediction errors were analyzed against the measured curves from digitized lateral X-ray images of the lumbosacral junction.Results.The shape of the lumbar curve was described as function of three externally measured parameters. The lumbar spine Cobb angle, segmental centroid positions (S1−T12), and segmental orientations were predicted from the external lumbar motion monitor measurements, with average precisions of 5.8°, 4.4 mm, and 3.9°, respectively.Conclusions.The position and orientation of each segment (vertebrae and disc), along with the lumbar spine lordosis, can be predicted in the neutral posture using data from back angular measurements.RelevanceThe consideration of the spine as a curve is necessary to accurately quantify and describe the forces acting along the (lumbar) vertebral column for any given loading. The method could be a very useful prediction tool for industrial and laboratory experiments, as well as analytical models.

The prediction of lumbar spine geometry: method development and validation

To develop and validate a new method of predicting the neutral lumbar spine curve from external (non-invasive electrogoniometer) measurements. Non-invasive techniques for lumbar spine geometry prediction suffer from a lack of a complete geometry description, problems with applicability to field conditions, or both. The study consisted of three steps. First, utilizing lateral imaging (MRI and X-ray pictures) of the lumbosacral junction, the torso geometry was described using measures of lumbar lordosis via the Cobb method. Second, the relationship between imaging based measurement of lumbar spinal curvature and externally measured torso flexion angle in the sagittal plane using a goniometer was determined. Finally, method validation was performed with an independent set of nine subjects. The predicted lumbar spine curve was determined and the prediction errors were analyzed against the measured curves from digitized lateral X-ray images of the lumbosacral junction. The shape of the lumbar curve was described as function of three externally measured parameters. The lumbar spine Cobb angle, segmental centroid positions (S(1)-T(12)), and segmental orientations were predicted from the external lumbar motion monitor measurements, with average precisions of 5.8 degrees , 4.4 mm, and 3.9 degrees , respectively. The position and orientation of each segment (vertebrae and disc), along with the lumbar spine lordosis, can be predicted in the neutral posture using data from back angular measurements. The consideration of the spine as a curve is necessary to accurately quantify and describe the forces acting along the (lumbar) vertebral column for any given loading. The method could be a very useful prediction tool for industrial and laboratory experiments, as well as analytical models.

Validation of a Non-Invasive Method of Measuring the Surface Curvature of the Erect Spine

AbstractAlthough non-invasive instruments used to measure the surface curvature of the spine have been widely described in the literature, there is inconclusive evidence to substantiate a relationship between their measurement of the erect thoracolumbar spine and measurements taken from radiographs. In addition, such instruments evaluate surface curvature of the spine by measuring the angle between between tangents taken at two surface points along the back, and thus may not precisely quantify the visible shape of a spinal curve. This paper describes a non-invasive method of evaluating the surface curvature of the spine in the sagittal plane which quantifies the shape of a curve more precisely, according to the mathematical definition of curvature. The method is shown to accurately measure the magnitude of a curve and to provide a surface measurement of spinal curvature that bears a reasonable relationship to the curvature of the underlying vertebral column.

Computerized ultrasonic digitization in the measurement of spinal curvature.

A major concern in school screening programs as well as in the clinical assessment of spinal curvature has been the frequent radiation exposure required to ascertain curve progression. Various techniques have been developed to identify scoliosis such as the Moire and ISIS techniques, but these are very sophisticated and expensive. The authors have developed a simple procedure of identifying and documenting spinal curvature during the performance of the Adams forward bend test, using an ultrasonic sound probe, four sound receivers, and a micro-computer. The probe is run along the spinous processes emitting an ultrasonic sound, which is picked up by four receivers mounted at the corners of a rectangle above the patient. The signal is fed into a micro-computer and the spinal curvature is plotted out. The magnitude of the curve is calculated by the computer, and the actual curve plus the magnitude is printed in hard copy to be placed in the chart. The reproducibility error and intermeasurer error has been less than 5%. A series of 30 patients with varying magnitudes of scoliosis from 15 degrees to 73 degrees were examined. The results of the ultrasonic digitization were compared with standard scoliosis radiographs of the patient taken the same week. The average curvature measured from the radiographs was 38 degrees, and from the ultrasonic digitization technique, 30 degrees: The forward bend position contributed to smaller curvature measurement, and measurement in the standing position was thought to be a better technique. Ultrasonic digitization as a method of curve measurement is most accurate in curves over 30 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)