Reduction Of Cobb Angle Research Articles

Variability of Cobb angle measurement from digital X-ray image based on different de-noising techniques

Scoliosis is a 3D deformity of the spine, which is characterised by both lateral curvature and vertebral rotation. Cobb angle measurement is the golden method for diagnosis of scoliosis. With the increasing trend of digital imaging-based diagnosis system, computerised Cobb angle measurement is gaining much popularity. In general, digital X-ray images are very sensitive to noise, so a good pre-processing step for noise removal is necessary to increase the accuracy and reduce the variability of computerised Cobb angle measurement method. In this paper, we have presented a review work on computerised Cobb angle measurement from digital X-ray images based on the different popular state-of-the-art de-noising techniques. This study helps in selecting the de-noising technique that best suits with different steps of the Cobb angle method and generates a more reliable angular measurement. This type of study based on de-noising technique for reducing Cobb angle measurement variability is the first of its kind. MATLAB2011Rb image processing toolbox was used for the simulation and verification of our proposed methodology.

Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis

Surgical adolescent idiopathic scoliosis (AIS) management can be associated with loss of thoracic kyphosis and a secondary loss of lumbar lordosis leading to iatrogenic flatback. Such conditions are associated with poorer clinical outcomes during adulthood. The aim of this study was to evaluate sagittal plane reciprocal changes after posterior spinal fusion in the setting of AIS. Thirty consecutive adolescents (mean age 14.6years) with AIS Lenke 1, 2 or 3 were included in this retrospective study with 2year follow-up. Full-spine standing coronal and lateral radiographs were obtained preoperatively, at 3 and 24months postoperatively. Coronal Cobb angle, thoracic kyphosis (TK) and lumbar lordosis (LL) were measured. Surgical procedure was similar in all the cases, with use of pedicular screws between T11 and the lowest instrumented vertebra (≥L2), sublaminar hooks applied in compression at the upper thoracic level and sub-laminar bands and clamps in the concavity of the deformity. Statistical analysis was done using t test and Pearson correlation coefficient. Between preoperative and last follow-up evaluations a significant reduction of Cobb angle was observed (53.6° vs. 17.2°, p<0.001). A significant improvement of the instrumented thoracic kyphosis, TK (19.7° vs. 26.2°, p<0.005) was noted, without difference between 3 and 24months postoperatively. An improvement in lumbar lordosis, LL (43.9° vs. 47.3°, p=0.009) was also noted but occurred after the third postoperative month. A significant correlation was found between TK correction and improvement of LL (R=0.382, p=0.037), without correlation between these reciprocal changes and the amount of coronal correction. Results from this study reveal that sagittal reciprocal changes occur after posterior fusion when TK is restored. These changes are visible after 3months postoperatively, corresponding to a progressive adaptation of patient posture to the surgically induced alignment. These changes are not correlated with coronal plane correction of the deformity. In the setting of AIS, TK restoration is a critical goal and permits favorable postural adaptation. Further studies will include pelvic parameters and clinical scores in order to evaluate the impact of the noted reciprocal changes.

Clinical Evaluation of the Pre and Post Operative Anterior Chest Wall Contour in Thoracic Adolescent Idiopathic Scoliosis

Similar spinal deformities in adolescent idiopathic scoliosis (AIS) usually accompany different anterior chest wall appearance. The surgical correction of the deformed chest wall is quite elusive despite excellent Cobb angle reduction. We wonder if the anterior chest wall deformity is independent in the severity on the co-development of spinal curvature, trunk torsion and vertebral rotation.

Does Removing the Spinal Tether in a Porcine Scoliosis Model Result in Persistent Deformity?: A Pilot Study

Using a tethering technique, a porcine model of scoliosis has been created. Ideally, tether release before placement and evaluation of corrective therapies would lead to persistent scoliosis. Does release of the spinal tether result in persistent deformity? Using a unilateral spinal tether and ipsilateral rib cage tethering, scoliosis was initiated on seven pigs. The spinal tether was released after progression to a Cobb angle of 50°. Biweekly radiographs were taken for 18 weeks after tether release to evaluate longitudinal changes in coronal and sagittal Cobb angles. Postmortem fine-cut CT scans were used to evaluate vertebral and disc wedging and axial rotation; results were compared to a previously published data set of 11 animals euthanized before release of the tether (control group). Radiographic analysis demonstrated two responses to tether release: a persistent deformity group and an autocorrective group. Differences between these two groups included number of days with the tether in place before reaching a Cobb angle of 50° and degree of deformity immediately after scoliosis induction. CT analysis of the tether release versus tether intact groups demonstrated progression in vertebral body wedging without differences in apical rotation. With the appropriate inducing parameters, release of the spinal tether does not systematically result in deformity correction. Tether release resulted in a reduction in Cobb angle in the first several weeks followed by steady curve progression. Deformity progression was confirmed using detailed CT morphometric analysis.

Physical therapy in the treatment of adult and paediatric spinal deformities: the Spinecor method

The main therapeutic principle utilised in SpineCor Bracing, the Corrective Movement Principle, has been shown to be effective in the treatment of Idiopathic Scoliosis over the past 15 years. More recently the Corrective Movement Principle by the utilisation of the SpineCor brace is being applied for treating abnormal spinal loading and abnormal posture in adult scoliosis patients suffering from back pain. Initial results in adult treatment demonstrated significant reduction in numerical pain scores and a moderate Cobb angle reduction. The SpineCor Brace itself may be considered as a postural re-education tool rather than a brace, providing low impact rehabilitation exercises 10’s of thousands of time per day. These corrective postural exercises have a positive effect on the abnormal loading of the spine as well as provide neuromuscular re-education with the final objective of neuromuscular integration. The SpineCor Physical Therapy Method has been developed and utilised over the past 5 years initially to complement bracing. The therapy follows the same Corrective Movement Principle as the SpineCor brace in order to reinforce the integration of this Corrective Movement by the execution of postural re-education and muscular re-balance exercises which are scoliosis type specific. SpineCor physiotherapy exercises have been designed with the same treatment objectives as the SpineCor brace being the correction/stabilisation of the spinal deformities/misalignments when possible, postural improvement and pain relief.

Initial results of SpineCor treatment of Adolescent Idiopathic Scoliosis in Seville, Spain

Methods Thirty seven patients were treated using the SpineCor Brace in Seville. Of the 37, 33 patients met criteria of the SpineCorporation international multicenter study treatment protocol. These patients were still under treatment and had not yet achieved a definitive outcome (two years follow-up post brace treatment). The girls were premenarchal or less than 1 year postmenarchal. Effectiveness was looked at using the following parameters: (1) a percentage of patients with an initial Cobb angle reduction of 5 degrees or greater; (2) percentage of patients with an initial Cobb angle increase or decrease of less than 5 degrees; (3) percentage of patients with an initial Cobb increase of 5 degrees or greater; (4) the number of cases progressing to require surgery or undergone surgery.

Reviewer’s comment concerning “the effect of intraoperative skeletal (skull-femoral) traction in apical vertebral rotation” by St Lewis et al. (MS-no: ESJO-D-08-00312R1)

This paper by Lewis et al. sets out to quantify the effects of skull-femoral traction on apical vertebral rotations of significant scoliotic curves undergoing surgical intervention. As noted in the paper, there has evolved to be a greater appreciation for the rotational aspect of scoliosis over time. Achieving correction of the Cobb angle and apical rotational aspects of a curvature prior to initiating surgical intervention would be expected to facilitate exposure, instrumentation, and possibly correction of a deformity. Skull-femoral traction is evaluated for this purpose in the current study. The paper did find a significant reduction in Cobb angle and apical vertebral rotation after the application of skull-femoral traction relative to preoperative film measurements. The authors conclude that there are significant potential advantages to this technique. My primary concern with this paper is that the effect of skull-femoral traction is not evaluated as in independent variable as the comparison radiographs were upright preoperative films as opposed to films taken immediately before applying traction. The authors note that there was greater correction than would have been expected with lying the anesthetized patient prone on a surgical frame, but the relative effects of these factors is not evaluated. Clearly, this information is important if the effect of the skull-femoral traction is to be defined. Further, an empirically chosen weight was chosen for the traction. The authors describe approximately 50% of body weight applied through the limbs and 20–25% of body weight applied through the skull as counter-traction. However, there is no suggestion of how these weights were selected. Overall, this paper describes a cohort of patients with significant scoliotic curves for whom skull-femoral traction was used. This is shown to be a technique with significant potential advantages in selected patients. I would suggest that this could be further investigated with the relative effect of graded, skull-femoral traction as an independent variable if the indications and specifics of this technique are to be defined.

The use of the SpineCor Dynamic Corrective Brace in Greece: a preliminary report

Methods From 2003–2007, 109 patients were treated. 82 patients met the inclusion criteria proposed by the SpineCorporation [2]. 26 patients met the criteria for inclusion proposed by the SRS [1]. There were no patients with an outcome. Assessment of the brace effectiveness included (1) percentage of patients who had an initial Cobb angle reduction of 5° or greater; (2) percentage of patients who had an initial Cobb angle increase or decrease of less than 5° (3) percentage of patients who had an initial Cobb increase of 5° or greater and (4) the number of cases progressing to require surgery or undergone surgery.

Scoliosis treatment using spinal manipulation and the Pettibon Weighting System™: a summary of 3 atypical presentations

BackgroundGiven the relative lack of treatment options for mild to moderate scoliosis, when the Cobb angle measurements fall below the 25–30° range, conservative manual therapies for scoliosis treatment have been increasingly investigated in recent years. In this case series, we present 3 specific cases of scoliosis.Case presentationPatient presentation, examination, intervention and outcomes are detailed for each case. The types of scoliosis presented here are left thoracic, idiopathic scoliosis after Harrington rod instrumentation, and a left thoracic scoliosis secondary to Scheuermann's Kyphosis.Each case carries its own clinical significance, in relation to clinical presentation. The first patient presented for chiropractic treatment with a 35° thoracic dextroscoliosis 18 years following Harrington Rod instrumentation and fusion. The second patient presented with a 22° thoracic levoscoliosis and concomitant Scheuermann's Disease. Finally, the third case summarizes the treatment of a patient with a primary 37° idiopathic thoracic levoscoliosis. Each patient was treated with a novel active rehabilitation program for varying lengths of time, including spinal manipulation and a patented external head and body weighting system. Following a course of treatment, consisting of clinic and home care treatments, post-treatment radiographs and examinations were conducted. Improvement in symptoms and daily function was obtained in all 3 cases. Concerning Cobb angle measurements, there was an apparent reduction in Cobb angle of 13°, 8°, and 16° over a maximum of 12 weeks of treatment.ConclusionAlthough mild to moderate reductions in Cobb angle measurements were achieved in these cases, these improvements may not be related to the symptomatic and functional improvements. The lack of a control also includes the possibility of a placebo effect. However, this study adds to the growing body of literature investigating methods by which mild to moderate cases of scoliosis can be treated conservatively. Further investigation is necessary to determine whether curve reduction and/or manipulation and/or placebo was responsible for the symptomatic and functional improvements noted in these cases.

Elliptical Modeling of the Sagittal Lumbar Lordosis and Segmental Rotation Angles as a Method to Discriminate Between Normal and Low Back Pain Subjects

Clinical significance of lumbar lordosis has not been agreed on. Our purpose is to compare lordotic measurements of normal and pain subjects and to test the validity of a new anthropometric model of lumbar curvatures. Digitized radiographic points (body corners) from standing lateral lumbar radiographs were modeled with ellipses in a least-squares method and were used to create segmental angles, a global angle at L1-L5, a Cobb angle from T12 to S1, Ferguson's sacral base angle, and an angle of pelvic tilt. Fifty normal subjects were matched in age, sex, weight, and height with 50 acute pain subjects, 50 chronic pain subjects, and 24 pain subjects with radiographic abnormalities. Of 11 angles, 2 distances, and 2 ratios, statistical analysis was significantly different across groups for 12 of these measurements, with the alternative hypotheses accepted for the other 3 measurements. The lordosis of both normal and low back pain subjects can be successfully modeled with a portion (approximately 86 degrees) of an ellipse, but with different major and minor axis ratios. The normal group's average elliptic lordosis has the smallest least-squares error, approximately 1 mm per digitized point, with (minor axis)/(major axis) ratio = 0.39, L1-L5 global angle = 40 degrees, and Cobb angle = 65 degrees. The chronic and radiographic abnormalities pain groups have an elongated ellipse with hypolordosis, reduced L1-L5 global angle = 29.6-35 degrees, reduced Cobb angle = 57-58 degrees, and elliptic axis ratio = 0.27-0.30. The acute pain group is hyperlordotic with the largest L1-L5 global angle, largest Cobb angle = 70 degrees, largest Ferguson's angle, and largest pelvic tilt angle.