Vertebrae In Scoliosis Research Articles

PROSEDUR PEMERIKSAAN RADIOGRAFI VERTEBRA THORAKOLUMBAL PADA KLINIS SKOLIOSIS

The procedure of radiographic examination of thoracolumbar vertebrae of scoliosis according to Lampignano and Kendrick (2018), journal by Gray (1983) and journal by Levy (1996) in erect patient position further recommends the PA projections because the dose to organs that are sensitive to radiation such as breast, thyroid and gonad and the risk of getting cancer in these organs is significantly reduced compared to AP projections. While the procedure for radiographic examination of thoracolumbar vertebrae of scoliosis in the Radiology Installation RSUD Bendan Pekalongan uses AP and AP right and left bending projections in erect patient position. This study aims to determine the radiographic examination procedures of thoracolumbar vertebrae in scoliosis and the reasons for using AP and AP right and left bending projections in erect patient position. This type of research is a qualitative research with a case study approach. Data was collected in March-April 2020 in the Radiology Installation RSUD Bendan Pekalongan by observation, interview and documentation. Research subjects are patients, radiographers, radiology specialists, and sending doctors. The data obtained were processed and analyzed using open coding and then presented in the form of images, plot and quotations so that conclusions can be drawn. The results showed that the thoracolumbar vertebra radiographic examination procedure in scoliosis clinical in Radiology Installation RSUD Bendan Pekalongan used AP and right and left bending AP projections in erect position because to place the object as close as possible to IR with the hope to minimize the magnification of the object on the radiograph and has been informative to assess the cobb angle in scoliosis curvature. The suggestion from the author is that Radiology Installation should coordinate with related parties such as radiology specialists, radiographers and sending doctors in order to determine what projections are needed in the case of scoliosis because there are many projections on the scoliosis radiography examination.

Reliability and reproducibility of interapical distance assessment of the lateral deviation of vertebrae in scoliosis.

[Purpose] The purpose of this study was to investigate the interobserver reliability and intraobserver reproducibility of interapical distance (IAD) and to analyze its correlation with the Cobb angle (CA). [Subjects and Methods] IAD, a handy tool for assessment of the lateral deviation of vertebrae with a metric scale, was defined as the horizontal distance between one apical vertebra and its counterpart, the opposite apical vertebra in the case of a double curve and the farthest vertebra in the case of a single curve. Fifty full-length, standing anteroposterior radiographs of “idiopathic scoliosis” were reviewed. Three investigators independently measure the CA and IAD at the same time and remeasured the IAD on the same radiograph a week later. [Results] There was no interobserver difference (reliability) in the measurement of IAD or statistical differences in intraobserver reproducibility for each observer. IAD was well correlated with the CA for each observer (r=0.765, r=0.737, and r=0.764). [Conclusion] IAD is useful when assessing lateral deviation in scoliosis and may be a reliable and reproducible index that is well correlated with the CA, and it can be used as a supplementary measure to describe the overall derangement of scoliosis in the coronal plane.

Clinical anatomy of vertebrae in scoliosis: global analysis in four different diseases by multiplanar reconstructive computed tomography

Background contextFew accurate analyses of clinically useful vertebral anatomy have been conducted, and most have focused on thoracic idiopathic scoliosis. PurposeTo evaluate the different anatomic characteristics in scoliosis by disease type and level. Study designObservational cohort study. Patient sampleForty-eight patients with scoliosis were included in this study. Outcome measuresSubjects underwent computed tomography (CT) of the whole spine. MethodsForty-eight patients with scoliosis were included in this study: 15 adolescent idiopathic, 11 cerebral palsy (CP), 10 muscular dystrophy (MD), and 12 congenital (CG) scoliosis patients with similar demographics. Subjects underwent CT of the whole spine, preoperatively. Eight anatomic parameters were measured in multiplanar reconstructive CT images, and statistical analysis was performed to investigate differences. ResultsIn general, values in the anatomic parameters were similar for the four diseases. Each parameter showed the unique change pattern according to the spinal level regardless of curvature shape, direction, or magnitude. In particular, chord length (CL) in MD and CG scoliosis was lower than in adolescent idiopathic scoliosis (AIS) and CP, and pedicle rib unit length was lower in CG scoliosis than in the other diseases (p<.05). Comparisons of convex and concave anatomies in AIS showed that inner pedicle width (PWI) and outer pedicle width (PWO) were wider for convex side, CL, pedicle width, and transverse pedicle angle were greater for concave side (p<.05), and differences were more significant at apices. However, in CP, PWI and PWO were similar between convex and concaves sides (p>.05). Although PWI and PWO were wider for convex sides and CL and pedicle length were greater for concave sides in MD (p<.05), differences were less significant at apices. Particularly, CG scoliosis showed severely deformed anatomy, with differences of seven parameters at apical vertebrae (p<.05). ConclusionClinical anatomies of vertebrae in scoliosis were found to differ significantly at different levels and in terms of convexity and disease type.

Mechanism of Production of Scoliosis

On the basis of previous studies on the vertebral column and thoracic skeleton, the author generated a hypothesis for the mechanism of production of scoliosis. According to this hypothesis, vertical stability of the thoracic spine is maintained by equal support through the ribs from both sides due to the equal load brought to the lamin by both the ribs through the costotransverse articulations and ligaments. Any interference in this balancing mechanism will disturb the mechanism of spinal stability, and the spine will bend toward the more heavier loaded side at the intervertebral joints. On the basis of this hypothesis, mechanisms of production of scoliosis (both in experimental animals and humans) after removal of ribs on one side can be explained. Removal of the ribs from one side produces an imbalance in the symmetric weight transmission through the ribs on the two sides. Pathologic deformations within the vertebrae in scoliosis results from the asymmetric load and the altered route of the load transmission on the convex side of the curve.

Measurement of axial rotation of vertebrae in scoliosis.

The authors report a radiographic method for measuring the axial rotation of vertebrae in degrees and its use in 99 patients with adolescent idiopathic scoliosis. The offset of the pedicle images from the vertebral body center and a "depth" estimate measured radiographically in a population of patients with scoliosis permitted calculation of axial rotation by means of a simple mathematical formula. It was found that measurements of vertebral rotation can be made clinically from single-plane radiographs with a standard deviation of 3.6 degrees (95% confidence limit +/- 7.1 degrees) based on a study of known rotations of a radiographic phantom, and with a standard deviation of 2.44 degrees (95% confidence limit +/- 4.8 degrees) based on comparisons with three-dimensional measurements of the orientation of each vertebra derived from low-dose stereo films of a group of patients. Measurements from clinical films are unlikely to be made more accurately than this, because of inherent geometric constraints.

RADIOGRAPHIC ESTIMATION OF VERTEBRAL ROTATION IN SCOLIOSIS

1. The radiographic appearance of normal thoracic and lumbar vertebrae at 15-degree intervals of rotation is described. Each image can be identified by its characteristic features. 2. The appearance on antero-posterior radiographs of apical vertebrae in scoliosis closely resembles the normal at each phase of rotation, on the basis of which an image-matching method is proposed for estimating rotation in scoliosis. 3. The method gives only approximate values of rotation but has the advantage of being able to monitor rotation through 90 degrees.