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Cerillo JL, Becsey AN, Sanghadia CP, Root KT, Lucke-Wold B. Spine Bracing: When to Utilize-A Narrative Review. BIOMECHANICS (BASEL, SWITZERLAND) 2023; 3:136-154. [PMID: 36949902 PMCID: PMC10029751 DOI: 10.3390/biomechanics3010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Spinal bracing is a common non-surgical technique that allows clinicians to prevent and correct malformations or injuries of a patient's spinal column. This review will explore the current standards of practice on spinal brace utilization. Specifically, it will highlight bracing usage in traumatic injuries, pregnancy, pediatrics, osteoporosis, and hyperkyphosis; address radiological findings concurrent with brace usage; and provide an overview of the braces currently available and advancements in the field. In doing so, we aim to improve clinicians' understanding and knowledge of bracing in common spinal pathologies to promote their appropriate use and improve patient outcomes.
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Affiliation(s)
- John L. Cerillo
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, FL 33759, USA
| | | | - Chai P. Sanghadia
- Department of Molecular and Cellular Biology, University of Arizona, Tucson, AZ 85721, USA
| | - Kevin T. Root
- College of Medicine, University of Florida, Gainesville, FL 32608, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
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Beauséjour M, Aubin D, Fortin C, N'dongo Sangaré M, Carignan M, Roy-Beaudry M, Martinez C, Bourassa N, Jourdain N, Labelle P, Labelle H. Parents can reliably and accurately detect trunk asymmetry using an inclinometer smartphone app. BMC Musculoskelet Disord 2022; 23:752. [PMID: 35932044 PMCID: PMC9354306 DOI: 10.1186/s12891-022-05611-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE An inclinometer smartphone application has been developed to enable the measurement of the angle of trunk inclination (ATI) to detect trunk surface asymmetry. The objective was to determine the reliability and validity of the smartphone app in the hands of non-professionals. METHODS Three non-professional observers and one expert surgeon measured maximum ATI twice in a study involving 69 patients seen in the spine clinics to rule out scoliosis or for regular follow-up (10-18 y.o., Cobb [0°-58°]). Observers were parents not familiar with scoliosis screening nor use of an inclinometer. They received training from a 4-minute video. Intra and inter-observer reliability was determined using the generalizability theory and validity was assessed from intraclass correlation coefficients (ICC), agreement with the expert on ATI measurements using Bland-Altman analysis, and correct identification of the threshold for consultation (set to ≥6° ATI). RESULTS Intra-observer and inter-observer reliability coefficients were excellent ϕ = 0.92. The standard error of measurement was 1.5° (intra-observer, 2 measurements) meaning that a parent may detect a change of 4° between examinations 95% of the time. Comparison of measurements between non-professionals and the expert resulted in ICC varying from 0.82 [0.71-0.88] to 0.84 [0.74-0.90] and agreement on the decision to consult occurred in 83 to 90% of cases. CONCLUSION The use of a smartphone app resulted in excellent reliability, sufficiently low standard error of measurement (SEM) and good validity in the hands of non-professionals. The device and the instructional video are adequate means to allow detection and regular examination of trunk asymmetries by non-professionals.
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Affiliation(s)
- Marie Beauséjour
- Research Center, Sainte-Justine University Hospital Center, Montreal, Québec, Canada. .,Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne - Bureau 200, Longueuil, Québec, J4K 0A8, Canada. .,Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada. .,Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada.
| | - Delphine Aubin
- Research Center, Sainte-Justine University Hospital Center, Montreal, Québec, Canada
| | - Carole Fortin
- Research Center, Sainte-Justine University Hospital Center, Montreal, Québec, Canada.,School of Rehabilitation, Université de Montréal, Montreal, Québec, Canada
| | | | - Mathilde Carignan
- Research Center, Sainte-Justine University Hospital Center, Montreal, Québec, Canada
| | | | | | - Nathalie Bourassa
- Research Center, Sainte-Justine University Hospital Center, Montreal, Québec, Canada.,Polytechnique Montréal, Montreal, Québec, Canada
| | - Nathalie Jourdain
- Research Center, Sainte-Justine University Hospital Center, Montreal, Québec, Canada
| | - Philippe Labelle
- Research Center, Sainte-Justine University Hospital Center, Montreal, Québec, Canada
| | - Hubert Labelle
- Research Center, Sainte-Justine University Hospital Center, Montreal, Québec, Canada.,Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada.,Orthopedic Division, Sainte-Justine University Hospital Center, Montreal, Québec, Canada
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Simoni P, Negro G, Moeremans M, Leucio AD. The Adolescent Spine. Semin Musculoskelet Radiol 2022; 26:501-509. [PMID: 36103891 DOI: 10.1055/s-0042-1755392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) is the most characteristic disorder of the adolescent spine. It is a three-dimensional (3D) disorder that occurs from 10 years of age and comprises 90% of all idiopathic scolioses. Imaging plays a central role in the diagnosis and follow-up of patients with AIS. Modern imaging offers 3D assessment of scoliosis with less radiation exposure. Imaging helps rule out occult conditions that cause spinal deformity. Various imaging methods are also used to assess skeletal maturity in patients with AIS, thus determining the growth spurt and risk of progression of scoliosis. This article provides a brief overview of the pathophysiology, biomechanics, clinical features, and modern imaging of AIS relevant to radiologists in clinical settings.
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Affiliation(s)
- Paolo Simoni
- Department of Pediatric Imaging, Reine Fabiola Children's University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Giulia Negro
- Department of Pediatric Imaging, Reine Fabiola Children's University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Marine Moeremans
- Department of Pediatric Imaging, Reine Fabiola Children's University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Alessandro De Leucio
- Department of Pediatric Imaging, Reine Fabiola Children's University Hospital, Université libre de Bruxelles, Brussels, Belgium
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Phillips WA. Scoliosis Management for Primary Care Practitioners. Pediatr Rev 2021; 42:475-485. [PMID: 34470867 DOI: 10.1542/pir.2019-0007] [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: 11/24/2022]
Abstract
For many families, the possibility that their child may have scoliosis causes great anxiety because their child may be deformed for life, may need to wear a brace for years, or may need to undergo a large and dangerous operation. For most families, these fears are groundless. Up to 3% of the population has a spinal curvature, most of which are small curves that may not need referral or repeated imaging. Many adolescents with scoliosis do well and do not need to wear a brace or have surgery.
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Weiss HR, Lay M, Seibel S, Kleban A. [Is it possible to improve treatment safety in the brace treatment of scoliosis patients by using standardized CAD algorithms?]. DER ORTHOPADE 2021; 50:435-445. [PMID: 33025038 PMCID: PMC8189986 DOI: 10.1007/s00132-020-04000-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hintergrund Die Versorgung von Skoliosepatienten mit korrigierenden Rumpforthesen führt auch heutzutage noch zu recht unterschiedlichen Ergebnissen. Publizierte Erfolgsquoten zwischen 50 und 90 % führen zwangsläufig zu der Frage, wie sich die Erfolgsquoten der Korsettversorgung steigern und vereinheitlichen lassen. Die Ergebnisse einer mit dieser Zielsetzung weiterentwickelten computerunterstützen (CAD/„Computer Aided Design“) Chêneau-Versorgung werden dargestellt. Methodik Am Stichtag (08.12.2019) wurde die prospektiv angelegte Datenbank unserer Abteilung retrospektiv ausgewertet. Es waren ausschließlich unreife Mädchen mit einer Adoleszentenskoliose, Alter 10–14 Jahre, Risser 0–2 in die Datenbank aufgenommen worden. Ergebnisse Sowohl die Gesamtgruppe mit einem Beobachtungszeitraum von mindestens 18 Monaten als auch die Patientinnengruppen mit bereits erreichtem Behandlungsabschluss zeigten Erfolgsraten zwischen 86 und 88 %. Die Ergebnisse insgesamt waren signifikant besser als die Erfolgsrate der Boston-Brace-Kontrollgruppe (BRAIST) von 72 %. Auch im Vergleich mit den Ergebnissen anderer Chêneau-Derivate war die Erfolgsrate unserer Serie teils deutlich besser. Schlussfolgerungen Die Behandlungssicherheit für die Patienten mit Skoliosen sollte verbessert werden. Ein Ansatz hierzu kann die Verwendung standardisierter CAD-Bibliotheken sein. Weitere Untersuchungen mit Studiendesigns höherer Evidenz sind notwendig, um die in unserer Untersuchung gefundenen Ergebnisse zu untermauern.
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Affiliation(s)
- Hans-Rudolf Weiss
- Gesundheitsforum Nahetal, Alzeyer Str. 23, 55457 Gensingen, Deutschland
- Haarbergweg 2, 55546 Neu Bamberg, Deutschland
| | - Manuel Lay
- Orthopädie-Technik Lay, Straße von Triptis 8, 56856 Zell-Barl, Deutschland
| | - Sarah Seibel
- Gesundheitsforum Nahetal, Alzeyer Str. 23, 55457 Gensingen, Deutschland
| | - Alexander Kleban
- Lomonosov Moscow State University, 119234, Leninskie Gory 1, Moskau, Russland
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Senkoylu A, Ilhan MN, Altun N, Samartzis D, Luk KDK. A simple method for assessing rotational flexibility in adolescent idiopathic scoliosis: modified Adam's forward bending test. Spine Deform 2021; 9:333-339. [PMID: 33030701 DOI: 10.1007/s43390-020-00221-2] [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: 04/11/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to evaluate the diagnostic aptitude of a modified Adams forward bending test (MAFBT), which addresses the coupling phenomenon of axial rotation with reference to the side-bending movement. Also, this evaluation was facilitated by the introduction of our rotational flexibility index (RFI). METHODS Thirty-two female and eight male AIS patients were included in this study from a single institution. In the MAFBT, subjects were asked to bend to the convex side of the curve in the forward bending position. Scoliometric measurements were done during the AFBT and MAFBT. Utilizing anteroposterior standing plain radiographs curve flexibility indices were calculated. The diagnostic aptitude of the MAFBT was evaluated based on the receiver operating characteristic (ROC) curves and area under the curve (AUC). The RFI was also assessed, which considered AFBT and MAFBT parameters as a specified function. RESULTS Significant correlations were noted between the Cobb angle and AFBT (p = 0.005), fulcrum bending and the MAFBT (p = 0.0001), side-bending and MAFBT (p = 0.0001). There were significant positive correlations between rotational flexibility as based on fulcrum bending radiograph to that of the RFI (r = 0.4, p = 0.036) and side-bending technique (r = 0.4, p = 0.008). Based on ROC analyses (AUC range 0.7-0.8), the MAFBT demonstrated high specificity and sensitivity rates for flexible and rigid curves, respectively. CONCLUSIONS This is the first study to report that the MAFBT is a simple and reliable test for the clinical assessment of rotational flexibility in AIS patients. The study further noted that the novel RFI has clinical utility in the assessment of AIS.
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Affiliation(s)
- Alpaslan Senkoylu
- Department of Orthopaedics and Traumatology, Gazi University, Besevler, 06510, Ankara, Turkey.
| | - Mustafa N Ilhan
- Department of Public Health, Gazi University, Besevler, Ankara, Turkey
| | - Necdet Altun
- Department of Orthopaedics and Traumatology, Gazi University, Besevler, 06510, Ankara, Turkey
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Keith D K Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China
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Kröönström LA, Eriksson P, Johansson L, Zetterström AK, Giang KW, Cider Å, Dellborg M. Post-operative musculoskeletal outcomes in patients with coarctation of the aorta following different surgical approaches. Int J Cardiol 2020; 327:80-85. [PMID: 33186668 DOI: 10.1016/j.ijcard.2020.11.018] [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: 12/02/2019] [Revised: 10/21/2020] [Accepted: 11/05/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to examine range of motion and muscle function in the upper extremity and spine in patients with coarctation of the aorta (CoA) comparing different surgical approaches. METHODS From October 2017 to February 2019, 150 patients were assessed for inclusion. A total of 99 patients (n = 75 CoA, n = 24 control), were included and assessed regarding muscle function, arm length and circumference, and spinal and thoracic mobility. RESULTS There were significant differences between the right and left arm in patients with CoA, operated with the subclavian flap technique compared to controls in regards to shoulder flexion (p < 0.001), elbow flexion (p = 0.001), shoulder abduction (p = 0.02), handgrip strength (p = 0.01), length of upper arm (p < 0.001), lower arm (p < 0.001), and of whole arm (p < 0.001), circumference regarding upper arm (p = 0.001), lower arm (p < 0.001), and wrist (p < 0.001). Structural scoliosis was more frequent in patients who had undergone thoracotomy (25.4%) than patients who had not undergone a thoracotomy (5.9%, p = 0.04), and were often located in the thoracic part of the spine. CONCLUSION Patients with CoA operated on using the subclavian flap technique have impaired muscle function as well as reduced arm length and circumference. An increased rate of structural scoliosis was found in patients who underwent thoracotomy, in comparison with patients who had not undergone a thoracotomy. Further research is needed to determine whether muscle function impaired by surgical procedures can be improved with exercise.
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Affiliation(s)
- Linda Ashman Kröönström
- Occupational and Physical Therapy Department, Sahlgrenska University Hospital, Diagnosvägen 11, 416 50 Gothenburg, Sweden; Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30 Gothenburg, Sweden.
| | - Peter Eriksson
- ACHD Unit, Sahlgrenska University Hospital, Diagnosvägen 11, 416 85 Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, P.O. Box 428, S-405 30 Gothenburg, Sweden.
| | - Linda Johansson
- Occupational and Physical Therapy Department, Sahlgrenska University Hospital, Diagnosvägen 11, 416 50 Gothenburg, Sweden.
| | - Anna-Klara Zetterström
- Occupational and Physical Therapy Department, Sahlgrenska University Hospital, Diagnosvägen 11, 416 50 Gothenburg, Sweden.
| | - Kok Wai Giang
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, 416 85 Gothenburg, Sweden.
| | - Åsa Cider
- Occupational and Physical Therapy Department, Sahlgrenska University Hospital, Diagnosvägen 11, 416 50 Gothenburg, Sweden; Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30 Gothenburg, Sweden.
| | - Mikael Dellborg
- ACHD Unit, Sahlgrenska University Hospital, Diagnosvägen 11, 416 85 Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, P.O. Box 428, S-405 30 Gothenburg, Sweden.
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Inter-and intra-observer reliability of scoliogauge app to assess the axial trunk rotation of scoliosis: Prospective reliability analysis study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Larson JE, Meyer MA, Boody B, Sarwark JF. Evaluation of angle trunk rotation measurements to improve quality and safety in the management of adolescent idiopathic scoliosis. J Orthop 2018; 15:563-565. [PMID: 29881194 DOI: 10.1016/j.jor.2018.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/06/2018] [Indexed: 02/07/2023] Open
Abstract
Purpose The evaluation, management and follow-up of adolescent idiopathic scoliosis (AIS) occur frequently within a pediatric orthopedic surgery practice. Curve status can be assessed with Scoliometer measurements of angle trunk rotation (ATR), which are reliable and reproducible to within 3°. This study assessed the longitudinal efficacy, safety and cost savings of integrating ATR measurements to monitor curve status and progression in AIS, and suggests a quality-based management strategy. Methods A retrospective review of medical records between 2004 and 2014 included patients with AIS between 10-17 years, excluding those with Cobb angle >52° at presentation. Two cohorts were analyzed based on presentation prior to menarche (PRE) or after menarche (POST). The PRE groups was further classified based on whether the curve was Stable or Unstable. The cost of a single PA thoracolumbar radiograph was defined based on the 2015 CMS fee schedule ($36.27). Safety was defined based on the effective radiation dose avoided (0.14 millisieverts/radiograph). Results A total of 59 children were included with 45 in PRE and 14 in the POST cohort. The use of ATR measurements provided a cost benefit in both the PRE Stable and Unstable cohorts, by avoiding radiographs with an average savings of $161.76 and $147.50 respectively. Similarly in POST, there was an average cost savings of $105.18 per patient. The safety benefit of using ATR measurements included avoiding an average of 0.62, 0.56 and 0.4 millisieverts of radiation in the PRE Stable, PRE Unstable and POST groups respectively. Conclusions An evaluation strategy with ATR measurements provides for a reliable, cost-effective and safety advantage in the monitoring of curve progression in both skeletally mature and immature patients with AIS. These findings suggest that stable ATR measurements are a safe and cost effective alternative to serial radiographs in the clinical monitoring of AIS. Recent evidence from 25 years of scoliosis treatment in Denmark noted a cancer rate 17 times that of an age-matched population. Thus, reducing radiation exposure during scoliosis monitoring using ATR measurements has important clinical significance for cancer risk reduction.
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Affiliation(s)
- Jill E Larson
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, United States
| | - Maximilian A Meyer
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Barrett Boody
- Department of Orthopaedic Surgery, The Rothman Institute, Philadelphia, PA, United States
| | - John F Sarwark
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, United States
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Tyrakowski M, Czaprowski D, Szczodry M, Siemionow K. Cobb angle measurements on digital radiographs using Bunnell scoliometer: Validation of the method. J Back Musculoskelet Rehabil 2018; 30:667-673. [PMID: 27858675 DOI: 10.3233/bmr-150338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Electronic rulers on computer screen are used to measure the Cobb angle (CA) instead of traditional methods with rulers, protractors and pens. The variety of software used to assess radiographs might make the CA measurements cumbersome in everyday clinical practice. OBJECTIVE The aim of the study was to verify the method of CA measurements on digital radiographs using Bunnell scoliometer (BS). METHODS Eighty patients with idiopathic scoliosis were enrolled into the study. CA of each curve was measured by use of Centricity software and BS. CA on 30 randomly chosen patients were measured 3 times by one researcher using only scoliometer. Three researchers measured CA on the same 30 radiographs using BS. RESULTS The mean CA of 224 curves measured by Centricity and BS were 29° ± 12.2° and 28° ± 11.7°, respectively. The ICC for agreement for 2 methods was 0.96 with SEM of 1.7°. Excellent intra- and interobserver reliability of CA measurements with scoliometer was noted: ICC of 0.96 with SEM of 1.4° and ICC of 0.93 with SEM of 1.9°, respectively. CONCLUSIONS The study revealed excellent reliability of CA measurements on digital radiographs using the BS. The proposed method of using the Bunnell scoliometer for CA measurements may be clinically useful.
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Affiliation(s)
- Marcin Tyrakowski
- Department of Orthopedics, Pediatric Orthopedics and Traumatology, The Centre of Postgraduate Medical Education in Warsaw, Otwock, Poland
| | - Dariusz Czaprowski
- Department of Physiotherapy, Józef Rusiecki University College, Olsztyn, Poland
| | - Michal Szczodry
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Kris Siemionow
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, IL, USA
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Romano M, Mastrantonio M. Torsion bottle, a very simple, reliable, and cheap tool for a basic scoliosis screening. SCOLIOSIS AND SPINAL DISORDERS 2018; 13:4. [PMID: 29445775 PMCID: PMC5799901 DOI: 10.1186/s13013-018-0150-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/03/2018] [Indexed: 11/14/2022]
Abstract
Background One of the reasons that make scoliosis a disease that scares so much the parents is its specific characteristic of being difficult to detect on its onset. The aim of this paper is to check the possible usefulness of a simple tool (the torsion bottle) that has been developed with the aim to offer an instrument for home use by parents but also for screening purposes in the low-income countries. Methods Study design: retrospective analysis to evaluate intra-operator reliability of the tools and inter-operator repeatability using the torsion bottle. For the first and the second part of the study, 35 subjects were measured. The goal of the first experiment was to evaluate the reliability of the torsion bottle to identify all individuals who experienced a thoracic or lumbar prominence equal or greater than 7°. The secondary aim was to verify the reliability of blinded inter-operator assessments, performed with the torsion bottle by two physiotherapists on the same patients. Results The reliability of the assessments of the torsion bottle has been performed with the Kappa statistic to evaluate the measurement agreement. The results have shown that the intra-operator reliability of the tool is very high between the measurements collected with the scoliometer® and those collected with the torsion bottle (kappa = 0.9278; standard error = 0.7094). The data of the second part of the study show that the inter-operator reliability is good (kappa = 0.7988; standard error 0.1368). Conclusion The collected data showed that the torsion bottle revealed itself as an efficient tool to execute a basic screening to identify the presence of a prominence in a significant group of adolescents.
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Affiliation(s)
- Michele Romano
- ISICO (Italian Scientific Spine Institute), Via Bellarmino 13/1, Milan, Italy
| | - Matteo Mastrantonio
- ISICO (Italian Scientific Spine Institute), Via Bellarmino 13/1, Milan, Italy
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Ma HH, Tai CL, Chen LH, Niu CC, Chen WJ, Lai PL. Application of two-parameter scoliometer values for predicting scoliotic Cobb angle. Biomed Eng Online 2017; 16:136. [PMID: 29202876 PMCID: PMC5716015 DOI: 10.1186/s12938-017-0427-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent idiopathic scoliosis, in which obvious curves are visible in radiographic images, is also seen in combination with lumps in the back. These lumps contribute to inclination, which can be measured by a scoliometer. To the authors' knowledge, there are no previous formulas combining thoracic and lumbar scoliometer values simultaneously to predict thoracic and lumbar Cobb angles, respectively. This study aimed to create more accurate two-parameter mathematical formulas for predicting thoracic and lumbar Cobb angles. METHODS Between Dec. 2012 and Jan. 2013, patients diagnosed with idiopathic scoliosis in an outpatient clinic were enrolled. The maximal trunk rotations at the thoracic and lumbar regions were recorded with a scoliometer. Right asymmetry hump was deemed positive (+), and left asymmetry hump was deemed negative (-). The Cobb angles were measured with a Picture Archiving and Communication System. Statistical analysis included Pearson's correlation coefficient, multivariate regression and Bland-Atman analysis. RESULTS One-hundred and one patients were enrolled in our study. The average thoracic curve (TC) was 23.3 ± 1.8°, while the average lumbar curve (LC) was - 23.3 ± 1.4°. The thoracic inclination (TI) and lumbar inclination (LI) were 4.5 ± 0.7 and - 5.9 ± 0.6, respectively. The one-parameter formula for the thoracic curve was TC = 2.0 TI + 14.3 (r = 0.813); for the lumbar curve, it was LC = 0.9 LI - 16.9 (r = 0.409). By multivariate regression, the two-parameter formulas for the thoracic and lumbar curves were TC = 2.6 TI - 1.4 LI (r = 0.931) and LC = - 1.5 TI + 2.0 LI (r = 0.874), respectively. The two-parameter formulas were more accurate than the one-parameter formulas. CONCLUSIONS Based on the results of these two-parameter formulas for thoracic and lumbar curves, the Cobb angles can be predicted more accurately by the readings of the scoliometer. Physicians and other healthcare practitioners can thus evaluate patients with scoliosis more precisely than before with a scoliometer.
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Affiliation(s)
- Hsuan-Hsiao Ma
- Department of Orthopaedics and Traumatology, Veterans General Hospital, Taipei, Taiwan
| | - Ching-Lung Tai
- Graduate Institute of Medical Mechatronics, Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan.,Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, 5 Fushing St. Kweishan, Taoyuan, 33305, Taiwan
| | - Lih-Huei Chen
- Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, 5 Fushing St. Kweishan, Taoyuan, 33305, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chien Niu
- Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, 5 Fushing St. Kweishan, Taoyuan, 33305, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Jer Chen
- Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, 5 Fushing St. Kweishan, Taoyuan, 33305, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Liang Lai
- Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, 5 Fushing St. Kweishan, Taoyuan, 33305, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Reynolds LA, Izatt MT, Huang EM, Labrom RD, Askin GN, Adam CJ, Pearcy MJ. Is vertebral rotation correction maintained after thoracoscopic anterior scoliosis surgery? A low-dose computed tomography study. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:22. [PMID: 28825043 PMCID: PMC5559869 DOI: 10.1186/s13013-017-0131-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 04/28/2017] [Indexed: 11/11/2022]
Abstract
Background Axial vertebral rotation is a key characteristic of adolescent idiopathic scoliosis (AIS), and its reduction is one of the goals of corrective surgery. Recurrence of deformity after surgical correction may relate to rotation changes that occur in the anterior vertebral column after surgery, but whether any change occurs within the fused segment or in adjacent unfused levels following thoracoscopic anterior spinal fusion (TASF) is unknown. An analysis of measurements from an existing postoperative CT dataset was performed to investigate the occurrence of inter- and intra-vertebral rotation changes after TASF within and adjacent to the fused spinal segment and look for any relationships with the Cobb angle and rib hump in the two years after surgery. Methods 39 Lenke Type 1 main thoracic patients underwent TASF for progressive AIS and low dose computed tomography scanning of the instrumented levels of the spine at 6 and 24 months after surgery. Vertebral rotation was measured at the superior and inferior endplates on true axial images for all vertebral levels in the fused segment plus one adjacent level cranially and caudally. Intra-observer variability for rotation measurements was assessed using 95% limits of agreement to detect significant changes in inter/intra-vertebral rotation. Results Significant local changes in inter- and intra-vertebral rotation were found to have occurred between 6 and 24 months after anterior surgical fusion within the fused spinal segment, albeit with no consistent pattern of location or direction within the instrumented fusion construct. No significant en-bloc movement of the entire fused spinal segment relative to the adjacent un-instrumented cranial and caudal intervertebral levels was found. No clear correlation was found between any vertebral rotation changes and Cobb angle or rib hump measures. Conclusions Localised inter- and intra-vertebral rotation occurs between 6 and 24 months after TASF, both within the instrumented spinal segments and in the adjacent un-instrumented levels of the adolescent spine. The lack of measurable en-bloc movement of the fused segment relative to the adjacent un-instrumented levels suggests that overall stability of the instrumented construct is achieved, however the vertebrae within the fusion mass continue to adapt and remodel, resulting in ongoing local anatomical and biomechanical changes in the adolescent spine.
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Affiliation(s)
- Luke A Reynolds
- Paediatric Spine Research Group, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane, 4101 Queensland Australia
| | - Maree T Izatt
- Paediatric Spine Research Group, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane, 4101 Queensland Australia
| | - Eric M Huang
- Paediatric Spine Research Group, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane, 4101 Queensland Australia
| | - Robert D Labrom
- Paediatric Spine Research Group, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane, 4101 Queensland Australia
| | - Geoffrey N Askin
- Paediatric Spine Research Group, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane, 4101 Queensland Australia
| | - Clayton J Adam
- Paediatric Spine Research Group, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane, 4101 Queensland Australia
| | - Mark J Pearcy
- Paediatric Spine Research Group, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane, 4101 Queensland Australia
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Minghelli B, Oliveira R, Nunes C. Postural habits and weight of backpacks of Portuguese adolescents: Are they associated with scoliosis and low back pain? Work 2017; 54:197-208. [PMID: 27061692 DOI: 10.3233/wor-162284] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The adoption of incorrect postures or carrying overweight backpacks may contribute to the development of musculoskeletal disorders in school children. OBJECTIVE This study evaluated the weight of backpacks and the postural habits adopted in schools by Portuguese adolescents, and their association with scoliosis and low back pain (LBP). METHOD The sample comprised 966 Portuguese students, aged between 10 and 16 years. The instruments included a questionnaire to characterize the presence of LBP and the postural habits adopted by students, the weighing of backpacks and a scoliometer to evaluate scoliosis. RESULTS No association was observed between assuming incorrect postures and carrying overweight backpacks, in students with scoliosis. Students who adopted incorrect sitting postures had 1.77 times the risk (95% CI: 1.32-2.36; p < 0.001) of developing LBP; those positioned incorrectly whilst watching TV and playing games had 1.44 times the risk (95% CI: 1.08-1.90; p = 0.012) of developing LBP; and those standing incorrectly had 2.39 the risk (95% CI: 1.52-3.78; p < 0.001) of developing LBP. CONCLUSIONS The results revealed that students who sat with the spine positioned wrongly, as well as those who were standing incorrectly, were more likely to present with LBP.
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Affiliation(s)
- Beatriz Minghelli
- School of Health Jean Piaget-Algarve, Piaget Institute, Silves, Portugal.,National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - Raul Oliveira
- Faculty of Human Kinetics, Technical University of Lisbon, Lisbon, Portugal
| | - Carla Nunes
- National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
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Prowse A, Aslaksen B, Kierkegaard M, Furness J, Gerdhem P, Abbott A. Reliability and concurrent validity of postural asymmetry measurement in adolescent idiopathic scoliosis. World J Orthop 2017; 8:68-76. [PMID: 28144582 PMCID: PMC5241548 DOI: 10.5312/wjo.v8.i1.68] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/17/2016] [Accepted: 10/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the reliability and concurrent validity of the Baseline® Body Level/Scoliosis meter for adolescent idiopathic scoliosis postural assessment in three anatomical planes.
METHODS This is an observational reliability and concurrent validity study of adolescent referrals to the Orthopaedic department for scoliosis screening at Karolinska University Hospital, Stockholm, Sweden between March-May 2012. A total of 31 adolescents with idiopathic scoliosis (13.6 ± 0.6 years old) of mild-moderate curvatures (25°± 12°) were consecutively recruited. Measurement of cervical, thoracic and lumbar curvatures, pelvic and shoulder tilt, and axial thoracic rotation (ATR) were performed by two trained physiotherapists in one day. The intraclass correlation coefficient (ICC) was used to determine the inter-examiner reliability (ICC2,1) and the intra-rater reliability (ICC3,3) of the Baseline® Body Level/Scoliosis meter. Spearman’s correlation analyses were used to estimate concurrent validity between the Baseline® Body Level/Scoliosis meter and Gold Standard Cobb angles from radiographs and the Orthopaedic Systems Inc. Scoliometer.
RESULTS There was excellent reliability between examiners for thoracic kyphosis (ICC2,1 = 0.94), ATR (ICC2,1 = 0.92) and lumbar lordosis (ICC2,1 = 0.79). There was adequate reliability between examiners for cervical lordosis (ICC2,1 = 0.51), however poor reliability for pelvic and shoulder tilt. Both devices were reproducible in the measurement of ATR when repeated by one examiner (ICC3,3 0.98-1.00). The device had a good correlation with the Scoliometer (rho = 0.78). When compared with Cobb angle from radiographs, there was a moderate correlation for ATR (rho = 0.627).
CONCLUSION The Baseline® Body Level/Scoliosis meter provides reliable transverse and sagittal cervical, thoracic and lumbar measurements and valid transverse plan measurements of mild-moderate scoliosis deformity.
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McMaster MJ, McMaster ME. Does an Internal Thoracoplasty Correct and Prevent a Reassertion of the Rib Cage Deformity After Spine Surgery for an Adolescent Idiopathic Thoracic Scoliosis Greater Than 70 Degrees. Spine Deform 2016; 4:40-47. [PMID: 27852499 DOI: 10.1016/j.jspd.2015.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 04/13/2015] [Accepted: 06/14/2015] [Indexed: 10/22/2022]
Abstract
STUDY DESIGN Prospective observational study. OBJECTIVE To evaluate the effect of internal thoracoplasty and anterior spine release combined with posterior spinal instrumentation in correcting and preventing a reoccurrence of the rib cage deformity in adolescent idiopathic thoracic scoliosis >70 degrees. SUMMARY OF BACKGROUND DATA The rib cage deformity rather than the lateral curvature of the spine is usually the major cosmetic deformity in severe adolescent idiopathic thoracic scoliosis. This can be difficult to treat and assess the effect of surgery. METHODS The Integrated Shape Imaging System was used to assess rib cage deformity before surgery and during follow-up for more than 2 years in 37 patients with an adolescent idiopathic thoracic scoliosis (Lenke 1) >70° (mean 81°) treated by internal thoracoplasty and anterior spine release combined with posterior spinal instrumentation using a hybrid construct. RESULTS The mean Cobb angle was reduced from 81° to 30° (63% correction). The rib cage deformity was improved in 30 patients (81%) because of a combination of both a reduction of the convex rib hump and an elevation of the concave rib depression. However, the effect on patients with an angle of thoracic inclination <16° was not as reliable. One year after surgery, additional improvement of the chest deformity had occurred in 9 patients. In none of the 37 patients was there any further progression of the rib cage deformity. CONCLUSION An internal thoracoplasty was effective in improving and/or stabilizing the rib cage deformity as well as achieving good correction of the scoliosis in patients with adolescent idiopathic thoracic scoliosis and severe deformity.
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Affiliation(s)
- Michael J McMaster
- Spire Murrayfield Hospital, 122 Corstorphine Road, Edinburgh EH12 4UD, United Kingdom.
| | - Marianne E McMaster
- Spire Murrayfield Hospital, 122 Corstorphine Road, Edinburgh EH12 4UD, United Kingdom
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Reliability and validity of inexpensive and easily administered anthropometric clinical evaluation methods of postural asymmetry measurement in adolescent idiopathic scoliosis: a systematic review. 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 2015; 25:450-66. [PMID: 25917824 DOI: 10.1007/s00586-015-3961-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/13/2015] [Accepted: 04/13/2015] [Indexed: 12/24/2022]
Abstract
PURPOSE As accurate and reproducible measurements of spinal curvature are crucial in the examination of patients with adolescent idiopathic scoliosis (AIS), this systematic review aims to report on the reliability and validity of a range of inexpensive and easily administered anthropometric methods of postural asymmetry measurement in an AIS population, to inform practice in a clinical setting. METHODS A systematic search of health research databases located studies assessing reliability and validity of inexpensive and easily administered anthropometric measures. RESULTS Fourteen studies satisfied eligibility criteria. The methodological quality of included studies ranged from low to high. Validity studies were of moderate to high quality. In total, nine clinically applicable, inexpensive and easily administered anthropometric methods were identified, for assessing AIS curvature. All methods demonstrated high to very high inter-observer and intra-observer reliability. Reported criterion validity of the scoliometer and 2D photographs, when compared to Cobb angle assessed from radiographs, ranged from low to very high. iPhone measurements correlated well with scoliometer measurements. 2D photography results had a moderate to high correlation with 3D topography results. CONCLUSIONS Overall, strong levels of evidence exist for iPhone and scoliometer measurements, with a high to very high reliability and moderate to very high validity. Moderate levels of evidence exist for scoliometer with mathematical formula and clinical examination with moderate and low validity, respectively. Limited evidence exists for aesthetic tools TRACE and AI and 2D photography. These results indicate there are accurate and reproducible anthropometric measures that are inexpensive and applicable in therapy settings to assess postural asymmetry; however, these only exist for measurement in the transverse plane, despite 3D characteristics of AIS. Further research is required into an inexpensive and easily administered method that can assess postural asymmetry in all anatomical planes.
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Abstract
STUDY DESIGN This was a prospective blinded validity and reliability analysis. OBJECTIVE The aim of this study was validation and reliability evaluation of the Scoligauge iPhone app. BACKGROUND The scoliometer is used to clinically measure the rib hump in scoliosis as a means to evaluate the axial trunk rotation. The increasing availability of smartphone with built-in accelerometer led to the development of a vast number of applications to measure angles. Of these, the Scoligauge mimics a scoliometer. The aim of this study was to compare the validity of the Scoligauge iPhone application without an associated adapter with the traditional scoliometer and to test the reliability of the application in a clinical setting. METHODS Two observers measured the rib hump deformity on 34 consecutive patients with idiopathic scoliosis with an average Cobb angle of 24.2 ± 13.5 degrees (range, 4 to 65 degrees). Measurements were made with an iPhone without the adapter and with a scoliometer. The validity as well as the interobserver and intraobserver reliability were calculated using the intraclass coefficient (ICC) and the Bland-Altman test. RESULTS The mean difference between the scoliometer and the Scoligauge application was 0.4 degrees [95% confidence interval (CI) of ± 3.1 degrees] with an ICC of 0.947 (P < 0.001). The intraobserver and interobserver ICC were 0.961 (P < 0.001) and 0.901 (P < 0.001), respectively. The mean intraobserver difference was 0.0 degrees (95% CI of ± 2.7 degrees) and the mean interobserver difference was 0.1 degrees (95% CI of ± 4.4 degrees). CONCLUSIONS The intraobserver and interobserver reliability of the Scoligauge iPhone app, as well as its validity compared with the scoliometer, are excellent. The mean differences between measurements are small and clinically not significant. Thus, the Scoligauge application is valid for clinical evaluation even without special adapter. LEVEL OF EVIDENCE Level I (Diagnostic Study).
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Qiao J, Xu L, Zhu Z, Zhu F, Liu Z, Qian B, Qiu Y. Inter- and intraobserver reliability assessment of the axial trunk rotation: manual versus smartphone-aided measurement tools. BMC Musculoskelet Disord 2014; 15:343. [PMID: 25305758 PMCID: PMC4198676 DOI: 10.1186/1471-2474-15-343] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 10/03/2014] [Indexed: 11/20/2022] Open
Abstract
Background Scoliogauge, has been developed for the measurement of ATR on iPhone smartphones. This study was to evaluate the reliability for the smartphone-aided ATR measurement method and to compare its reliability with that of the manual method. Methods Sixty-four AIS patients with single thoracic or lumbar curve participated in this study. Of these patients, thirty-two patients had main thoracic scoliosis while other thirty-two had main thoracolumbar/lumbar scoliosis. Two spine surgeons performed the measurements with Scoliometer and Scoliogauge. The Scoliogauge measurements were conducted on an iPhone 4 smartphone. The intraclass correlation coefficient (ICC) 2-way mixed model on absolute agreement was used to analyze the reliability categorized according to regions: thoracic or lumbar, and Cobb angles: <20 degrees and >40 degrees. ICC < 0.40 is considered as poor, 0.40–0.59 as fair, 0.60–0.74 as good, and 0.75–1.00 as excellent. Results The overall intraobserver variability was 0.954 and the overall interobserver variability was 0.943 for the scoliometer set, whereas the intraobserver variability was 0.965 and interobserver variability was 0.964 for the scoliogauge set. Both the intraobserver and interobserver ICCs reached the excellent value in the 2 sets for both observers. The mean Cobb angle of thoracic curves in patients with main thoracic scoliosis was similar to that of lumbar curves in those with main thoracolumbar/lumbar scoliosis (35.7 degrees vs. 36.1 degrees). The intraobserver and interobserver reliability was similar between two groups (thoracic vs. lumbar) in the 2 sets. There were 21 patients having Cobb angles < 20 degrees, while 20 patients >40 degrees. The intraobserver and interobserver reliability was better in severe curve(>40 degrees) group. Conclusion Smartphone-aided measurement for ATR showed excellent reliability, and the reliability of measurement with either scoliometer or scoliogauge could be influenced by Cobb angle that reliability was better for curves with larger Cobb angles. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-343) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Zezhang Zhu
- Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China.
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Haber LL, Hughes JD, Womack ED, Roberson RM, Wright PB. Screw Versus Hybrid Constructs for Flexible Thoracic Curves in Adolescent Idiopathic Scoliosis: A Prospective, Randomized Study. Spine Deform 2014; 2:367-373. [PMID: 27927334 DOI: 10.1016/j.jspd.2014.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 04/29/2014] [Accepted: 05/08/2014] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Prospective, computer-randomized design. OBJECTIVE Compare screw and hybrid constructs in flexible, thoracic curves for adolescent idiopathic scoliosis (AIS) in a prospective randomized fashion. SUMMARY OF BACKGROUND The consensus in scientific literature is that all-screw constructs correct AIS better than hooks in the lumbar and in large, stiff thoracic curves. However, debate continues whether all-screw constructs outperform hybrid constructs in small, flexible thoracic AIS. To our knowledge, this is the first prospective, randomized scoliosis study that examines measures of correction and patient satisfaction with the Scoliosis Research Society-30 (SRS-30) questionnaire. METHODS A total of 45 enrolled AIS patients with flexible, thoracic curves were given an identification number with an associated computer-generated randomization to the hybrid (n = 22) or screw group (n = 23). The treating surgeon received the randomization 2-3 days before surgery. Data including major Cobb (MC), truncal rotation (TR), rib index (RI), secondary curve (SC), and SRS-30 questionnaire were collected preoperatively and postoperatively at 4 weeks and 3, 6, 12, and 24 months. RESULTS Thirty-seven patients in the hybrid (n = 18) and screw (n = 19) groups completed the study with a mean follow-up of 26 months (range, 24-49 months). Hybrid versus screw group means for preoperative, postoperative, and final follow-up were: MC 58° ± 8° versus 55° ± 6°, 18° ± 8° versus 15° ± 7°, and 23°± 8° versus 14° ± 6°; TR 14° ± 6° versus 16° ± 4°, 10° ± 5° versus 7° ± 3°, and 11° ± 5° versus 7° ± 4°; RI 3.0° ± 1.2° versus 3.4° ± 1.4°, 2.5° ± 0.7° versus 1.8° ± 0.6°, and 2.5° ± 0.8° versus 2.0° ± 0.5°; SC 35° ± 13° versus 31° ± 8°, 13° ± 11° versus 7° ± 9°, and 13° ± 12° versus 7° ± 7°; and SRS-30 3.9 ± 0.2 versus 3.9 ± 0.2, 4.1 ± 0.4 versus 4.0 ± 0.3, and 4.1 ± 0.3 versus 4.0 ± 0.2. CONCLUSIONS Intergroup preoperative and early postoperative values were comparable (p > .05). At final follow-up, owing to loss of correction in the hybrid group, differences in MC (9°; p = .000), RI (0.54; p = .016), and TR (4°; p = .039) correction were statistically significant as SC trended toward significance (6°; p = .052). All-screw constructs outperformed hybrid constructs, especially over time. No differences in SRS-30 scores occurred between groups.
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Affiliation(s)
- Lawrence L Haber
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
| | - Joshua D Hughes
- Department of Neurosurgery, Mayo Graduate School of Medical Education, 200 1st Street SW, Rochester, MN 55905, USA
| | - Erika D Womack
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
| | - Rowland M Roberson
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
| | - Patrick B Wright
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
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Knott P, Pappo E, Cameron M, Demauroy J, Rivard C, Kotwicki T, Zaina F, Wynne J, Stikeleather L, Bettany-Saltikov J, Grivas TB, Durmala J, Maruyama T, Negrini S, O'Brien JP, Rigo M. SOSORT 2012 consensus paper: reducing x-ray exposure in pediatric patients with scoliosis. SCOLIOSIS 2014; 9:4. [PMID: 24782912 PMCID: PMC4002921 DOI: 10.1186/1748-7161-9-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 02/25/2014] [Indexed: 11/30/2022]
Abstract
This 2012 Consensus paper reviews the literature on side effects of x-ray exposure in the pediatric population as it relates to scoliosis evaluation and treatment. Alternative methods of spinal assessment and imaging are reviewed, and strategies for reducing the number of radiographs are developed. Using the Delphi technique, SOSORT members developed consensus statements that describe how often radiographs should be taken in each of the pediatric and adolescent sub-populations.
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Affiliation(s)
| | - Eden Pappo
- The 2012 SOSORT Conference, Milan, Italy
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Grivas TB, Burwell GR, Dangerfield PH. Body mass index in relation to truncal asymmetry of healthy adolescents, a physiopathogenetic concept in common with idiopathic scoliosis: summary of an electronic focus group debate of the IBSE. SCOLIOSIS 2013; 8:10. [PMID: 23799971 PMCID: PMC3702412 DOI: 10.1186/1748-7161-8-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 05/06/2013] [Indexed: 02/01/2023]
Abstract
There is no generally accepted scientific theory for the cause of adolescent idiopathic scoliosis (AIS). As part of its mission to widen understanding of scoliosis etiology, the International Federated Body on Scoliosis Etiology (IBSE).introduced the electronic focus group (EFG) as a means of increasing debate on knowledge of important topics. This has been designated as an on-line Delphi discussion. The text for this debate was written by Dr TB Grivas. It is based on published research from Athens, Greece evaluating schoolchildren age 11-17 years for the relation of body mass index (BMI) to each of truncal asymmetry (TA) and menarcheal status. Girls with relatively lower BMI were found to have a significant excess of severe TAs and significantly later menarche confirming the well-known relation of BMI to menarche. Together with other evidence linking nutritional status to skeletal growth, the observations suggest energy balance via the hypothalamus is related to trunk asymmetry. As with a recent speculative hypothesis for the pathogenesis of AIS in girls, Grivas et al. suggest that the severe TAs involve a genetically-determined selectively increased sensitivity (up-regulation) of the hypothalamus to circulating leptin with asymmetry as an adverse response to stress (hormesis). The TA is expressed bilaterally via the sympathetic nervous system to produce left-right asymmetry in ribs and/or vertebrae leading to severe TAs when beyond the capacity of postural mechanisms of the somatic nervous system to control the shape distortion in the trunk. This EFG discusses the findings and interpretations of the paper by Grivas and colleagues as research at the borderland between the genesis of TA (physiogenesis) and AIS (pathogenesis). It is suggested that TAs, here regarded in common with AIS, result from the combination of secondary sexual development affecting body composition, adolescent skeletal growth velocity, and an asymmetry process. The possible involvement of epigenetic factors is not considered.
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Affiliation(s)
- Theodoros B Grivas
- Department of Trauma and Orthopedics, “Tzanio” General Hospital, Tzani and Afendouli 1st, Piraeus 18536, Greece
| | - Geoffrey R Burwell
- Centre for Spinal Studies and Surgery, Nottingham University Hospitals Trust, Queen’s Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK
| | - Peter H Dangerfield
- University of Liverpool, Ashton Street, L69 3GE, Liverpool, UK
- Staffordshire University, Leek Road, Stoke-on-Trent ST4 2DF, UK
- Royal Liverpool Children’s Hospital, Eaton Road, Liverpool L12 2AP, UK
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Abstract
Adolescent idiopathic scoliosis (AIS) affects 2-4 % of children and is diagnosed between age 10 and skeletal maturity. The female to male ratio for mild curves less than 20° is 1.5:1; however, progression to a severe deformity occurs more often in females (Weinstein in JAMA 289(5):559-567, 2003). Despite significant ongoing research, including into the genetic basis for AIS, there are currently no identifiable causes, and therefore the disorder still remains a diagnosis of exclusion. History, physical examination and radiographic assessment must exclude other possible causes of spinal deformity and are crucial in predicting the risk of curve progression. History should focus on family history, menarche, presence or absence of pain, sports activities and neurologic changes. Physical examination concentrates on anthropometric data, pubertal staging, neurologic testing and specific investigation of the spine, with the Adams' forward bending test being the most meaningful step to evaluate trunk rotation. Definitive diagnosis cannot be made without imaging. The gold standard remains plain radiography with assessment of the Cobb angle on a standing coronal radiograph of the entire spine. A lateral X-ray is used for assessing sagittal balance and for evaluating the deformity in the sagittal plane. If available, surface topography can accompany the follow-up in AIS, reducing the radiation exposure. The role of magnetic resonance imaging (MRI) in AIS is an ongoing matter of debate. Common indications for MRI are the presence of an atypical curve pattern and abnormal neurological findings.
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Affiliation(s)
- Daniel Studer
- Orthopaedic Department, University Children’s Hospital, 4031 Basel, Switzerland
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Multilevel analysis of trunk surface measurements for noninvasive assessment of scoliosis deformities. Spine (Phila Pa 1976) 2012; 37:E1045-53. [PMID: 22472809 DOI: 10.1097/brs.0b013e3182575938] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Reliability study. OBJECTIVES To assess between-acquisition reliability of new multilevel trunk cross sections measurements, in order to define what is a real change when comparing 2 trunk surface acquisitions of a same patient, before and after surgery or throughout the clinical monitoring. SUMMARY OF BACKGROUND DATA Several cross-sectional surface measurements have been proposed in the literature for noninvasive assessment of trunk deformity in patients with adolescent idiopathic scoliosis (AIS). However, only the maximum values along the trunk are evaluated and used for monitoring progression and assessing treatment outcome. METHODS Back surface rotation (BSR), trunk rotation (TR), and coronal and sagittal trunk deviation are computed on 300 cross sections of the trunk. Each set of 300 measures is represented as a single functional data, using a set of basis functions. To evaluate between-acquisition variability at all trunk levels, a test-retest reliability study is conducted on 35 patients with AIS. A functional correlation analysis is also carried out to evaluate any redundancy between the measurements. RESULTS Each set of 300 measures was successfully described using only 10 basis functions. The test-retest reliability of the functional measurements is good to very good all over the trunk, except above the shoulders level. The typical errors of measurement are between 1.20° and 2.2° for the rotational measures and between 2 and 6 mm for deviation measures. There is a very strong correlation between BSR and TR all over the trunk, a moderate correlation between coronal trunk deviation and both BSR and TR, and no correlation between sagittal trunk deviation and any other measurement. CONCLUSION This novel representation of trunk surface measurements allows for a global assessment of trunk surface deformity. Multilevel trunk measurements provide a broader perspective of the trunk deformity and allow a reliable multilevel monitoring during clinical follow-up of patients with AIS and a reliable assessment of the esthetic outcome after surgery.
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Izatt MT, Bateman GR, Adam CJ. Evaluation of the iPhone with an acrylic sleeve versus the Scoliometer for rib hump measurement in scoliosis. SCOLIOSIS 2012; 7:14. [PMID: 22846346 PMCID: PMC3479427 DOI: 10.1186/1748-7161-7-14] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 07/12/2012] [Indexed: 11/23/2022]
Abstract
Background Vertebral rotation found in structural scoliosis contributes to trunkal asymmetry which is commonly measured with a simple Scoliometer device on a patient's thorax in the forward flexed position. The new generation of mobile 'smartphones' have an integrated accelerometer, making accurate angle measurement possible, which provides a potentially useful clinical tool for assessing rib hump deformity. This study aimed to compare rib hump angle measurements performed using a Smartphone and traditional Scoliometer on a set of plaster torsos representing the range of torsional deformities seen in clinical practice. Methods Nine observers measured the rib hump found on eight plaster torsos moulded from scoliosis patients with both a Scoliometer and an Apple iPhone on separate occasions. Each observer repeated the measurements at least a week after the original measurements, and were blinded to previous results. Intra-observer reliability and inter-observer reliability were analysed using the method of Bland and Altman and 95% confidence intervals were calculated. The Intra-Class Correlation Coefficients (ICC) were calculated for repeated measurements of each of the eight plaster torso moulds by the nine observers. Results Mean absolute difference between pairs of iPhone/Scoliometer measurements was 2.1 degrees, with a small (1 degrees) bias toward higher rib hump angles with the iPhone. 95% confidence intervals for intra-observer variability were +/- 1.8 degrees (Scoliometer) and +/- 3.2 degrees (iPhone). 95% confidence intervals for inter-observer variability were +/- 4.9 degrees (iPhone) and +/- 3.8 degrees (Scoliometer). The measurement errors and confidence intervals found were similar to or better than the range of previously published thoracic rib hump measurement studies. Conclusions The iPhone is a clinically equivalent rib hump measurement tool to the Scoliometer in spinal deformity patients. The novel use of plaster torsos as rib hump models avoids the variables of patient fatigue and discomfort, inconsistent positioning and deformity progression using human subjects in a single or multiple measurement sessions.
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Affiliation(s)
- Maree T Izatt
- Paediatric Spine Research Group, Queensland University of Technology and Mater Health Services, Level 2, Mater Children's Hospital, Raymond Terrace, South Brisbane, Queensland, 4101, Australia.
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Body appearance and quality of life in adult patients with adolescent idiopathic scoliosis treated with a brace or under observation alone during adolescence. Spine (Phila Pa 1976) 2012; 37:755-62. [PMID: 22037522 DOI: 10.1097/brs.0b013e318231493c] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The Scoliosis Research Society (SRS) brace study (published in the JBJS-A, 1995) was comprised of patients with adolescent idiopathic scoliosis with moderate curve sizes (25°-35°). Forty observed and 37 braced patients (77% of the original group) attended a follow-up, a mean of 16 years after onset of maturity. OBJECTIVE To analyze whether the subjectively evaluated present body appearance affects outcome as measured by quality of life in adult patients, previously treated by observation alone (nonbraced) or with a brace during adolescence. SUMMARY OF BACKGROUND DATA Few reports exist where validated outcome measures for body appearance have been used. METHODS Two quality-of-life questionnaires, the Scoliosis Research Society-22 (SRS-22) questionnaire and the 36-Item Short-Form Survey Instrument (SF-36), were answered. The patient's opinion on body appearance was evaluated pictorially (i.e., sketches) using the spinal appearance questionnaire, in which 7 aspects of asymmetry are graded. These scores were compared with curve sizes, scoliometer measurements for grading trunk asymmetry, and quality-of-life measures. RESULTS At follow-up, both groups were similar in terms of age (mean = 32 years) and curve size (mean = 35°). Distortion was inversely related to SRS-22 total score and satisfaction/dissatisfaction with management subscore, but not related to the SRS-22 function subscore. No difference was found between the groups in terms of trunk rotation, where the means were 10.7° and 10.8° for the nonbraced and braced patients, respectively. The nonbraced patients estimated that their body appearance was significantly less distorted than the braced patients (mean = 12.9 and 15.0, respectively; P = 0.0028). CONCLUSION Patients who experienced less body asymmetry were more satisfied with treatment and had a better quality of life. In spite of similar curve sizes and trunk rotation in both groups, the nonbraced patients felt that their body appearance was less distorted than that of the braced patients.
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Rigo M. Patient evaluation in idiopathic scoliosis: Radiographic assessment, trunk deformity and back asymmetry. Physiother Theory Pract 2011; 27:7-25. [PMID: 21198403 DOI: 10.3109/09593985.2010.503990] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Progressive adolescent idiopathic scoliosis (AIS) produces specific signs and symptoms, including trunk and spinal deformity and imbalance, impairment of breathing function, pain, progression during adult life, and psychological problems, as a whole resulting in an alteration of the health-related quality of life. A scoliosis-specific rehabilitation program attempts to prevent, improve, or minimize these signs and symptoms by using exercises and braces as the main tools in the rehabilitation treatment. Patient evaluation is an essential point in the decision-making process and determines the selection of the specific exercises and the specifications of the brace design. However, this article is not addressed to scoliosis management. In this present article, a complete definition and discussion of radiological aspects, such as the Cobb angle, axial rotation, curve pattern classifications, and sagittal configuration, follow a short description of the three-dimensional nature of AIS. The relationship between AIS and growth is also discussed. There is also a section dedicated to the assessment of trunk deformity and back asymmetry. Other important clinical aspects, such as pain and disability, changes in other regions of the body, muscular balance, breathing function, and health-related quality of life, are not discussed in this present article.
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Hasler C, Schmid C, Enggist A, Neuhaus C, Erb T. No effect of osteopathic treatment on trunk morphology and spine flexibility in young women with adolescent idiopathic scoliosis. J Child Orthop 2010; 4:219-26. [PMID: 21629373 PMCID: PMC2866846 DOI: 10.1007/s11832-010-0258-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 03/31/2010] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Brace treatment is the gold standard for patients with mild adolescent idiopathic scoliosis (Cobb angle 20°-40°). However, negative psychosocial impacts, physical constraints and incompliance cause many patients and parents to seek for so-called holistic and apparently less harmful approaches within the field of complementary and alternative medicine (CAM). Osteopathy-manual interventions on the viscera and locomotor system-is widely used for scoliosis. There is, however, a complete lack of evidence regarding its efficacy. We, therefore, tested the hypothesis that osteopathy alters trunk morphology, a prerequisite to unload the concave side of the scoliosis, and that it halts curve progression. METHODS This was a prospective, controlled trial of 20 post-pubertal young women (20°-40° idiopathic scoliosis) randomly allocated to an observation (group 0) or osteopathic treatment (group 1). The latter comprised three sessions (5 weeks). Trunk morphology (clinical examination, video rasterstereography) and spine flexibility (MediMouse(®)) were assessed at a pre- and post-intervention with a 3-month interval (blinded examiner). We chose scoliometer measurement (rib hump, lumbar prominence) as the main outcome parameter. RESULTS Two patients in the treatment group refused further treatment and the final examination, as they felt no benefit after two osteopathic treatments. Regression analysis for repeat measurements (independent statistician) revealed no therapeutic effect on rib hump, lumbar prominence, plumb line, sagittal profile and global spinal flexibility. CONCLUSIONS We found no evidence to support osteopathy in the treatment of mild adolescent idiopathic scoliosis. Therefore, we caution against abandoning the conventional standard of care for mild idiopathic scoliosis. As for other CAM therapies, the use of osteopathy as a treatment option for scoliosis still needs to be clearly defined.
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Affiliation(s)
- Carol Hasler
- />Orthopaedic Department, University Children’s Hospital, Roemergasse 8, 4005 Basel, Switzerland
| | - Caius Schmid
- />Corpo Sana, Training and Therapy, Münchensteinerstrasse 220, 4053 Basel, Switzerland
| | - Andreas Enggist
- />Enggist Medical Fitness, Bahnhofstrasse 43, 9470 Buchs, Switzerland
| | - Conny Neuhaus
- />Division of Physiotherapy, University Children’s Hospital, Roemergasse 8, 4005 Basel, Switzerland
| | - Thomas Erb
- />Division of Anaesthesiology, University Children’s Hospital, Roemergasse 8, 4005 Basel, Switzerland
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Grivas TB, Vasiliadis ES, Polyzois VD, Mouzakis V. Trunk asymmetry and handedness in 8245 school children. ACTA ACUST UNITED AC 2009; 9:259-66. [PMID: 17050403 DOI: 10.1080/10428190500343027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this report is the appraisal of a possible correlation of trunk asymmetry assessed with a scoliometer and lateralization of the brain as expressed by handedness in a school aged population. Many (8245) students (4173 girls and 4072 boys), 6-18 years of age were examined. A checklist was completed for each student including handedness and trunk asymmetry. The standing forward bending test was performed using the Pruijs scoliometer and the examined children were divided into three groups for each of the three examined regions (mid-thoracic, thoracolumbar and lumbar) according to the recorded asymmetry (no asymmetry, 2-7 degrees and > or =7 degrees ). Ninety-one per cent of children were right-handed, while 9% were left-handed. A significant statistical correlation of trunk asymmetry and handedness was found both in boys and girls in the group of asymmetry 2-7 degrees at mid-thoracic (p < 0.038) but not at thoracolumbar and at lumbar region. These findings show that there is significant correlation of mild mid-thoracic asymmetry and the dominant brain hemisphere in terms of handedness, in children who are entitled at risk of developing scoliosis. These findings are implicating the possible aetiopathogenic role of cerebral cortex function in the determination of the thoracic surface morphology of the trunk.
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Affiliation(s)
- Theodoros B Grivas
- Scoliosis Clinic, Orthopaedic Department, Thriasio General Hospital, G. Genimato Avenue, Magula, 19600, Greece.
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Harrop JS, Birknes J, Shaffrey CI. NONINVASIVE MEASUREMENT AND SCREENING TECHNIQUES FOR SPINAL DEFORMITIES. Neurosurgery 2008; 63:46-53. [DOI: 10.1227/01.neu.0000325678.25152.a7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACTOBJECTIVESpinal deformities are caused by a heterogeneous collection of disease processes. The progression of the scoliotic curve can vary depending on the individual patient, as well as the curve etiology. Noninvasive measurement techniques have been developed to obtain a baseline in addition to record curve progression.METHODSWe designed our study based on a comprehensive literature review and clinical experience. A systematic review of Medline for articles related to spinal deformities (scoliosis) and screening techniques was conducted up to and including those journal articles published in March 2007.RESULTSThere are numerous noninvasive modalities available to assess curve progression.CONCLUSIONThe use of a detailed physical examination, serial examinations, and radiographic means serve well to document curve presence and monitor progression.
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Affiliation(s)
- James S. Harrop
- Departments of Neurological and Orthopedic Surgery, Jefferson Medical College, Philadelphia, Pennsylvania
| | - John Birknes
- Departments of Neurological and Orthopedic Surgery, Jefferson Medical College, Philadelphia, Pennsylvania
| | - Christopher I. Shaffrey
- Departments of Neurological and Orthopedic Surgery, University of Virginia, Charlottesville, Virginia
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Grivas TB, Vasiliadis E, Savvidou OD, Triantafyllopoulos G. What a school screening program could contribute in clinical research of idiopathic scoliosis aetiology. Disabil Rehabil 2008; 30:752-62. [PMID: 18432433 DOI: 10.1080/09638280802041086] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Scoliosis school screening (SSS) programs have clinically benefited many children through early detection and treatment, as it is clearly stated in the Consensus Paper which has been published by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). It is also through these SSS programs that almost all of our current knowledge on the natural history and curve progression of IS has been made known. The present study summarizes the contribution of SSS in research of IS aetiology. METHOD We reviewed all the reports in relation to research of IS aetiology, which were published in peer-review journals and were originated from the Thriasio SSS program. RESULTS Analysis comprises of reports for (i) IS prevalence, (ii) aetiological studies originated from school screening referrals which implicate numerous environmental and biological factors in IS pathogenesis, (iii) suggestions for a more efficient screening, (iv) IS natural history, and (v) the evolving aim of SSS based on the reported research. CONCLUSIONS SSS should be adopted by policy makers, because its scope goes beyond the identification of IS at an early stage, contributing significantly into the research for IS aetiology.
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Day GA, McPhee IB, Tuffley J, Tomlinson F, Chaseling R, Kellie S, Torode I, Sherwood M, Cutbush K, Geddes AJ, Brankoff B. Idiopathic scoliosis and pineal lesions in Australian children. J Orthop Surg (Hong Kong) 2007; 15:327-33. [PMID: 18162681 DOI: 10.1177/230949900701500318] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To determine whether treatment of pineal lesions in children is associated with development of idiopathic scoliosis. METHODS 38 boys and 10 girls with pineal lesions were identified. Their mean age at presentation was 10 years. The pineal pathology varied from cysts and epidermoid to teratoma, germinoma, pineocytoma, and glioblastoma. Treatment ranged from biopsy/extirpation to radiotherapy. RESULTS 12 patients died. No scoliosis was found in any females or any of the deceased. Two boys had scoliosis: one had a 12-degree right upper thoracic curve with 32-degree kyphosis and the other had a 60-degree right thoracolumbar idiopathic curve, requiring a 2-stage arthrodesis. CONCLUSION Pineal ablation is not related to the development of idiopathic scoliosis in humans.
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Affiliation(s)
- G A Day
- University of Queensland, Australia.
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Grivas TB, Wade MH, Negrini S, O'Brien JP, Maruyama T, Hawes MC, Rigo M, Weiss HR, Kotwicki T, Vasiliadis ES, Sulam LN, Neuhous T. SOSORT consensus paper: school screening for scoliosis. Where are we today? SCOLIOSIS 2007; 2:17. [PMID: 18039374 PMCID: PMC2228277 DOI: 10.1186/1748-7161-2-17] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2007] [Accepted: 11/26/2007] [Indexed: 12/24/2022]
Abstract
This report is the SOSORT Consensus Paper on School Screening for Scoliosis discussed at the 4th International Conference on Conservative Management of Spinal Deformities, presented by SOSORT, on May 2007. The objectives were numerous, 1) the inclusion of the existing information on the issue, 2) the analysis and discussion of the responses by the meeting attendees to the twenty six questions of the questionnaire, 3) the impact of screening on frequency of surgical treatment and of its discontinuation, 4) the reasons why these programs must be continued, 5) the evolving aim of School Screening for Scoliosis and 6) recommendations for improvement of the procedure.
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Affiliation(s)
- Theodoros B Grivas
- Orthopaedic Department, "Thriasio" General Hospital, G. Gennimata Av. 19600, Magoula, Attica, Greece
| | | | | | - Joseph P O'Brien
- President & CEO, National Scoliosis Foundation (NSF), Boston, USA
| | - Toru Maruyama
- Department of Orthopaedic Surgery, Saitama MedicalCenter, Saitama Medical University, 1981 Kamodatsujido, Kawagoe, Saitama 350-8550, Japan
| | | | | | - Hans Rudolf Weiss
- Asklepios Katharina Schroth Spinal Deformities Rehabilitation Centre, Bad Sobernheim, Germany
| | | | - Elias S Vasiliadis
- Orthopaedic Department, "Thriasio" General Hospital, G. Gennimata Av. 19600, Magoula, Attica, Greece
| | - Lior Neuhaus Sulam
- Bpt physiotherapist specialist in treatment of spinal deformities, Moshe Dayan st. 18 Modiin, 71700, Israel
| | - Tamar Neuhous
- pt physiotherapist specialist in treatment of spinal deformities, Moshe Dayan st. 18 Modiin, 71700, Israel
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Bago J, Climent JM, Pineda S, Gilperez C. Further evaluation of the Walter Reed Visual Assessment Scale: correlation with curve pattern and radiological deformity. SCOLIOSIS 2007; 2:12. [PMID: 17888178 PMCID: PMC2040131 DOI: 10.1186/1748-7161-2-12] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2007] [Accepted: 09/23/2007] [Indexed: 11/16/2022]
Abstract
Background The Walter Reed Visual Assessment Scale (WRVAS) was designed to measure physical deformity as perceived by patients with idiopathic scoliosis. Previous studies have shown that the instrument has excellent internal consistency and a high correlation with the radiological magnitude of scoliotic curves. Nonetheless, it is not known whether the scale can discriminate between the various curve patterns of the deformity, or whether the deformities represented in the scale's drawings relate to the corresponding radiological deformities. Methods This study included 101 patients (86 women and 15 men; mean age 19.4 years) with idiopathic scoliosis. In a single visit, patients underwent standing PA radiography of the spine and completed the WRVAS. X-ray measurements included: 1) magnitude (Cobb angle) of the proximal thoracic curve (PT), main thoracic curve (MT), and thoracolumbar/lumbar curve (TL/L); 2) difference in shoulder level; 3) T1 offset from the central sacral line (T1-CSL); 4) apical vertebra (apV) rotation at the MT and TL/L curves and 5) apical vertebra offset of the MT and TL/L curves from the central sacral line. A variable designated Cobbmax was defined as the largest angle of the three curves (PT, MT or TL/L). Patients were grouped onto three patterns: Thoracic (TH Group)(n = 30, mean MT 42.1°, TL/L 20.9°); double major (DM Group) (n = 39, mean MT 38.6°, TL/L 34.4°) and thoracolumbar (TL Group)(n = 32, mean MT 14.3°, TL/L 25.5°). The magnitude of the curves in the TL Group was significantly smaller than in the other groups (P < 0.05). The Spearman partial correlation coefficient was determined between the score for each WRVAS question and the curve pattern, adjusting for the Cobbmax variable. The Spearman correlation coefficient was determined between the WRVAS items and shoulder imbalance, T1-CSL offset, MT Cobb angle, MT apV rotation, MT apV offset, PT Cobb, TL/L Cobb, TL/L apV rotation and TL/L apV offset. Results The median (interquartile range) of the total WRVAS score was 14 (IQR 6). No correlation was found between the curve pattern and the various scores on the scale (partial correlation coefficients ranged from -0.16 to 0.12). WRVAS drawings for items 1, 2, 4 and 7 correlated satisfactorily with the corresponding radiological measurements (correlation coefficients, 0.62, 0.3, 0.48 and 0.53, respectively). Items 3, 5 and 6 did not correlate with the radiological measurements (correlation coefficients -0.06, -0.07 and 0.05, respectively). Conclusion The profile of the individual WRVAS scores does not differentiate among specific curve patterns (thoracic, double major and thoracolumbar/lumbar). Moreover, some of the drawings (items 3, 5 and 6) do not correlate with the radiological deformity they were designed to measure.
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Affiliation(s)
- Juan Bago
- Spine Unit. Hospital Vall d'Hebron, Barcelona, Spain
| | - Jose M Climent
- Department of Physical Medicine and Rehabilitation, Hospital Universitario. Alicante, Spain
| | - Sonia Pineda
- Department of Physical Medicine and Rehabilitation, Hospital Vall d'Hebron, Barcelona, Spain
| | - Carmen Gilperez
- Department of Physical Medicine and Rehabilitation, Hospital Vall d'Hebron, Barcelona, Spain
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Hackenberg L, Hierholzer E, Bullmann V, Liljenqvist U, Götze C. Rasterstereographic analysis of axial back surface rotation in standing versus forward bending posture in 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 2006; 15:1144-9. [PMID: 16429283 PMCID: PMC3233931 DOI: 10.1007/s00586-005-0057-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Revised: 10/24/2005] [Accepted: 12/23/2005] [Indexed: 10/25/2022]
Abstract
The forward bending test according to Adams and rib hump quantification by scoliometer are common clinical examination techniques in idiopathic scoliosis, although precise data about the change of axial surface rotation in forward bending posture are not available. In a pilot study the influence of leg length inequalities on the back shape of five normal subjects was clarified. Then 91 patients with idiopathic scoliosis with Cobb-angles between 20 degrees and 82 degrees were examined by rasterstereography, a 3D back surface analysis system. The axial back surface rotation in standing posture was compared with that in forward bending posture and additionally with a scoliometer measurement in forward bending posture. The changes of back shape in forward bending posture were correlated with the Cobb-angle, the level of the apex of the scoliotic primary curve and the age of the patient. Averaged over all patients, the back surface rotation amplitude increased from 23.1 degrees in standing to 26.3 degrees in forward bending posture. The standard deviation of this difference was high (6.1 degrees ). The correlation of back surface rotation amplitude in standing with that in forward bending posture was poor (R (2)=0.41) as was the correlation of back surface rotation in standing posture with the scoliometer in forward bending posture measured rotation (R (2)=0.35). No significant correlation could be found between the change of back shape in forward bending and the degree of deformity (R (2)=0.07), likewise no correlation with the height of the apex of the scoliosis (R (2)=0.005) and the age of the patient (R (2)=0.001). Before forward bending test leg length inequalities have to be compensated accurately. Compared to the standing posture, forward bending changes back surface rotation. However, this change varies greatly between patients, and is independent of the type and degree of scoliosis. Furthermore remarkable differences were found between scoliometer measurement of the rib hump and rasterstereographic measurement of the vertebral rotation. Therefore the forward bending test and the identification of idiopathic scoliosis rotation by scoliometer can be markedly different compared to rasterstereographic surface measurement in the standing posture.
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Affiliation(s)
- Lars Hackenberg
- Klinik und Poliklinik für Allgemeine Orthopädie, Universitätsklinik Münster, Munster, Germany.
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Abstract
Scoliosis screening has been practiced for nearly 50 years and has provided valuable knowledge about the prevalence and natural history of scoliosis. Early diagnosis allows for nonoperative treatment, like wearing an orthosis that has been shown to be effective by numerous outcome studies. Challenges in scoliosis screening include the low prevalence rate of clinically significant scoliosis, the inverse relationship of sensitivity and specificity in the screening process because of the poor correlation of clinical deformity and radiographic abnormality, and the inflated cost of these programs because of overreferral. Recommendations for improvement include redefinition of what actually constitutes a "significant" scoliosis for screening, diagnostic, and outcome purposes; selective screening of only immature females; the use of objective referral criteria; and re-screening patients rather than referring those who have borderline cases.
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Affiliation(s)
- William P Bunnell
- Department of Orthopaedic Surgery, Loma Linda University, School of Medicine, Loma Linda, CA, USA.
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Abstract
A study was designed to evaluate the joint laxity during scoliosis screening, and to show if there is a relation of joint laxity values to the trunk rotation. One thousand, two hundred and seventy-three children (598 females, 675 males) with an average age of 10.4 years were screened with a scoliometer and forward bending for trunk rotations. Scapular and shoulder elevations, flexible pes planus were recorded and joint laxity was evaluated with the Beighton score. There was high inter-observer and intra-observer reliability for both scoliometer and Beighton scores. In 41 children (3.2%) with Beighton score 7 or higher, trunk rotation measurements were higher than for the rest of the children. Trunk rotation measurements of 7 degrees or higher were found in 30 children, who were more lax than the rest of the group and were invited for radiography, with a detection of curves between 11 and 18 degrees in 10 of them. The Beighton score is a practical and reliable method for defining joint laxity. Although the number of patients with scoliosis was limited, there are findings supporting the relation between joint laxity and scoliosis. Moreover, there was increased laxity in children with increased trunk rotations. Ligamentous laxity may be one of the causes changing the contour of the back.
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Affiliation(s)
- Gürkan Erkula
- Department of Orthopedics, Pamukkale University School of Medicine, Denizli, Turkey.
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Sapkas G, Papagelopoulos PJ, Kateros K, Koundis GL, Boscainos PJ, Koukou UI, Katonis P. Prediction of Cobb angle in idiopathic adolescent scoliosis. Clin Orthop Relat Res 2003:32-9. [PMID: 12782857 DOI: 10.1097/01.blo.0000068360.47147.30] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We did a prospective study of 291 children and adolescents with idiopathic scoliosis to identify possible correlations between clinical (scoliometer value, age, height) and radiographic (Cobb angle, Nash-Moe rotation, Risser iliac apophysis classification) parameters to predict the curve angle. There was a statistically significant correlation between thoracic, thoracolumbar, and lumbar scoliometer values and the thoracic, thoracolumbar, and lumbar Cobb angles, respectively (Pearson's r-0.685, 0.572, and 0.677, respectively). There was a statistically significant correlation between Cobb angle in the thoracic, thoracolumbar, and lumbar spine and the patients' age and height. Mathematical formulas that predict the Cobb angle of thoracic, thoracolumbar, and lumbar scoliosis using the scoliometer measurements are reported.
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Affiliation(s)
- George Sapkas
- 1st Orthopaedic Department of Athens University, Medical School, Athens, Greece.
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Pratt RK, Burwell RG, Cole AA, Webb JK. Patient and parental perception of adolescent idiopathic scoliosis before and after surgery in comparison with surface and radiographic measurements. Spine (Phila Pa 1976) 2002; 27:1543-50; discussion 1551-2. [PMID: 12131715 DOI: 10.1097/00007632-200207150-00012] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This prospective 2-year follow-up study evaluated patients treated surgically for adolescent idiopathic scoliosis (AIS). OBJECTIVE To report parents' perception, patients' perception, and pain and disability before and after surgery and to examine their relationship to anthropometric, back surface, and radiographic measurements. SUMMARY OF BACKGROUND DATA No longitudinal studies have examined these factors and their interrelationships. METHODS Between 1995 and 1999, 39 AIS patients treated by anterior or posterior USS (Universal Spine System, Stratec, Oberdorf, Switzerland) instrumentation had complete prospective questionnaire, back surface, and radiographic appraisal. RESULTS The preoperative Visual Analogue Score (VAS) for pain-predominantly mild backache-was 24 mm (range, 0-78 mm), and the Oswestry Disability Index (ODI) score was 9.2% (0-44.4%). Patients and parents wanted surgery to correct spinal curvature, stop curve progression, and correct the rib-hump (thoracic) and hip and waist asymmetry (thoracolumbar curves). The maximum angle of trunk inclination correlated with VAS and with short-form McGill Pain Questionnaire scores for thoracic curves (P = 0.005, Spearman rank correlation coefficient). Apical vertebral translation correlated with short-form McGill scores and ODI for thoracolumbar curves (P < 0.006, Spearman rank correlation coefficient). Parents rated scoliosis problems more severely than did their children (P < 0.0001, repeated measures of multivariate analysis of variants). There was no change in body image, VAS, ODI, or short-form McGill scores by 2 years' follow-up. Parents and patients perceived scoliosis problems to be less by 2 years' follow-up (P < 0.0005, Wilcoxon matched-pairs signed ranks test). The preoperative surface asymmetry score correlated with the patients' grading of their rib-hump (P = 0.007). CONCLUSIONS Back pain incidence was higher than reported for healthy adolescents. Oswestry Disability Index was within normal adult limits. Pain varied by curve type, related to the maximum angle of trunk inclination and the maximum apical vertebral translation. After surgery, back pain and ODI were unchanged, but concerns regarding scoliosis were reduced.
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Affiliation(s)
- Roland K Pratt
- School of Biomedical Sciences, Nottingham University, Queen's Medical Centre, University Hospital, Nottingham, England.
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Pratt RK, Webb JK, Burwell RG, Cole AA. Changes in surface and radiographic deformity after Universal Spine System for right thoracic adolescent idiopathic scoliosis: is rib-hump reassertion a mechanical problem of the thoracic cage rather than an effect of relative anterior spinal overgrowth? Spine (Phila Pa 1976) 2001; 26:1778-87. [PMID: 11493850 DOI: 10.1097/00007632-200108150-00009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Analysis of preoperative, 8-week, 1-year, and 2-year data from patients with right thoracic adolescent idiopathic scoliosis treated by posterior Universal Spine System (Stratec Medical, Oberdorf, Switzerland). OBJECTIVE Report 2-year results and the association between back surface and radiographic assessments. SUMMARY OF BACKGROUND DATA Few longitudinal studies have related surface and radiographic data in the follow-up of surgical patients. METHODS Of 34 patients with right thoracic adolescent idiopathic scoliosis having posterior Universal Spine System instrumentation, 27 had complete prospective back surface and radiographic appraisal. RESULTS Cobb angle corrected from 58 degrees to 34 degrees (41%), apical vertebral rotation from 26 degrees to 20 degrees (23%), apical vertebral translation from 4.5 to 2.4 cm (47%), and maximum angle of trunk inclination from 17 degrees to 13 degrees (22%) (preoperative to 2 years). Rib-hump reassertion occurred between 8 weeks and 1 year, regardless of age, and correlated with changes in vertebral translation (for 10 vertebral levels corresponding to 10 back surface levels between C7 and S1, P = 0.001 MANOVA). Preoperative frontal tilt of L1 with concave fifth rib-spinal angle predicted the percentage correction of maximum angle of trunk inclination, and the concave ninth rib-spinal angle predicted reassertion of maximum angle of trunk inclination. CONCLUSIONS Almost half of initial back surface correction is lost by 2 years. Segmental vertebral translation measurements most strongly correlate with segmental angle of trunk inclination measurements during follow-up. Rib-hump reassertion is best explained by unwinding of the thoracic cage tensioned by surgery rather than through relative anterior spinal overgrowth. Spine and thoracic cage factors determine rib-hump correction, so surgical disruption of the latter by costoplasty may prevent rib-hump reassertion. Results of scoliosis surgery should include surface data.
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Affiliation(s)
- R K Pratt
- School for Biomedical Sciences, Medical School, Nottingham University, Queen's Medical Centre, Nottingham, England.
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Goldberg CJ, Kaliszer M, Moore DP, Fogarty EE, Dowling FE. Surface topography, Cobb angles, and cosmetic change in scoliosis. Spine (Phila Pa 1976) 2001; 26:E55-63. [PMID: 11224901 DOI: 10.1097/00007632-200102150-00005] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Preliminary analysis of the clinical value of surface topography in a spinal deformity clinic. OBJECTIVES The Cobb angle is the gold standard for the monitoring of scoliosis. This study was designed to determine whether surface topography would reflect Cobb angle status with sufficient reliability to permit its safe use as an alternative means of documentation in some circumstances. SUMMARY OF BACKGROUND DATA Surface topography offers the possibility of describing spinal deformity more fully than radiographic measures alone. To be useful, it must ignore changes due to varying posture and reliably detect differences that are clinically significant, while broadening the ability to assess deformity. METHODS Surface topography using Quantec () was obtained routinely in all patients attending a spinal deformity unit. Intrasubject variation was reduced by taking the mean for each parameter of four repositioned scans, which gives a smallest detectable change on all measures of approximately 10 U. Fifty-nine patients with two sets of radiographs and topography scans were studied to determine the ability of the different measurements to detect significant change. RESULTS There was a significant correlation between Cobb angle and Quantec spinal angle. A significant change in Cobb angle could be identified by associated change in at least one topographic measure in a significant proportion of cases. CONCLUSIONS It is unlikely that topography will supplant radiography for the ascertainment of Cobb angles, because the error margins of both are wide, and the two are not measuring the same aspect of the deformity. The Quantec system is useful in patient monitoring as an alternative to radiography, without diminishing the standard of care.
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Affiliation(s)
- C J Goldberg
- Children's Research Centre and Orthopaedic Department, Our Lady's Hospital for Sick Children; and the Department of Community Health and General Practice, Trinity College, Dublin, Ireland.
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Karachalios T, Roidis N, Papagelopoulos PJ, Karachalios GG. The efficacy of school screening for scoliosis. Orthopedics 2000; 23:386-91; quiz 392-3. [PMID: 10791591 DOI: 10.3928/0147-7447-20000401-21] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- T Karachalios
- Orthopedic Department, School of Health Sciences, University of Thessaly, Larissa, Hellenic Republic, Greece
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Affiliation(s)
- R T Morrissy
- Department of Orthopaedics, Scottish Rite Children's Medical Center, Atlanta, Georgia, USA
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Karachalios T, Sofianos J, Roidis N, Sapkas G, Korres D, Nikolopoulos K. Ten-year follow-up evaluation of a school screening program for scoliosis. Is the forward-bending test an accurate diagnostic criterion for the screening of scoliosis? Spine (Phila Pa 1976) 1999; 24:2318-24. [PMID: 10586455 DOI: 10.1097/00007632-199911150-00006] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A 10-year follow-up evaluation of the effectiveness of school screening for scoliosis performed in a closed island population. OBJECTIVES To evaluate the diagnostic accuracy of methods used for screening scoliosis and to re-examine the long-term effectiveness of the school scoliosis screening program. SUMMARY OF BACKGROUND DATA The diagnostic accuracy of the forward-bending test and the long-term efficacy of the screening programs have not been clearly established. METHODS In 1987, 2700 pupils aged 8 to 16 years from the island of Samos were screened for scoliosis. The Adams forward-bending test, Moire topography, the scoliometer, and the humpometer were used. Radiologic evaluation of the spine was available for each pupil and the number of false-negative and false-positive results of the screening methods was calculated. Subsequently, sensitivity, specificity, and positive and negative predictive values were estimated for each screening technique. Pupils found positive for spinal deformity were then followed up regularly at yearly intervals. In 1997, all positive subjects attended a 10-year clinical and radiologic follow-up, and the remaining subjects were re-evaluated by a postal questionnaire and were clinically examined if necessary. RESULTS Spinal deformity was found in 153 (5.66%) pupils. Scoliosis (defined as a spinal curvature > or = 10 degrees) was found in 32 pupils, for a prevalence of 1.18%. For scoliosis, the Adams forward-bending test showed a number of false-negative results (in five cases), for a sensitivity of 84.37% and specificity of 93.44%. The sensitivities of Moire topography, the humpometer, and the scoliometer were 100%, 93.75%, and 90.62%, respectively, and specificity was 85.38%, 78.11%, and 79.76% respectively. The negative predictive value of the forward-bending test was inferior to those of the other methods. During this scoliosis screening program, if cutoff limits for referral had been used, such as the asymmetry of two Moire fringes, a humpogram deformity of (D + H) = 10 mm, and 8 degrees of scoliometer angle, it would have been possible to reduce radiologic examination by 89.4%. Three (0.11%) pupils aged between 12 and 14 years with scoliotic deformities greater than 20 degrees underwent satisfactory nonoperative treatment with Boston braces. One pupil with a 40 degrees thoracic curvature, underwent satisfactory surgical treatment because of progression 1 year later. Of the 121 spinal deformities with an initial Cobb angle less than 10 degrees, 44 (35.8%), and of the 29 scoliotic deformities with an initial Cobb angle between 10 degrees and 20 degrees, 14 (48.3%) progressed (a Cobb angle difference of at least 5 degrees in more than one examination). Observation and physiotherapy were the only treatments applied to all except one of the pupils in these groups. CONCLUSIONS The Adams forward-bending test cannot be considered a safe diagnostic criterion for the early detection of scoliosis (especially when it is used as the only screening tool) because it results in an unacceptable number of false-negative findings. For the early detection of scoliosis, a combination of back-shape analysis methods can be safely used with the introduction of cutoff limits for referral being a useful procedure. The incidence of significant scoliosis is low, and its natural history seems to be independent of early detection. The wide-spread use of school scoliosis screening with the use of the forward-bending test must be questioned.
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Affiliation(s)
- T Karachalios
- Orthopaedic Department of Athens University, KAT Hospital, Greece
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Côté P, Kreitz BG, Cassidy JD, Dzus AK, Martel J. A study of the diagnostic accuracy and reliability of the Scoliometer and Adam's forward bend test. Spine (Phila Pa 1976) 1998; 23:796-802; discussion 803. [PMID: 9563110 DOI: 10.1097/00007632-199804010-00011] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Study of the diagnostic accuracy and interexaminer reliability of scoliosis diagnostic tests. OBJECTIVES To estimate the sensitivity, specificity, and predictive value of the Scoliometer (National Scoliosis Foundation, Watertown, MA) and Adam's forward bend test in diagnosing scoliosis, and to determine the interexaminer reliability of the Scoliometer and Adam's forward bend test. SUMMARY OF BACKGROUND DATA Exposure to diagnostic radiation in patients with adolescent idiopathic scoliosis may result in a small but significant increase in cancer rates. The full-spine radiographic examination remains the standard procedure for the assessment of scoliosis. There is a need for a valid and reliable noinvasive test to assess scoliosis. METHODS Two examiners independently assessed 105 patients presenting to a scoliosis clinic for trunk asymmetry with Adam's forward bend test and axial trunk rotation with the Scoliometer. The Cobb method served as the gold standard. RESULTS The interexaminer agreement for the Scoliometer is excellent in the thoracic spine and substantial in the lumbar spine. The interexaminer measurement error shows poor precision for thoracic and lumbar Scoliometer measurements. The interexaminer agreement for Adam's forward bend test is substantial in the thoracic spine and poor in the lumbar spine. Adam's forward bend test is more sensitive than the Scoliometer in detecting thoracic curves measuring 20 degrees or more by the Cobb method. Receiver operating characteristic curve analysis suggests that the use of the Scoliometer marginally improves the ability of diagnosing a scoliosis in the thoracic spine. CONCLUSIONS The Scoliometer and Adam's forward bend tests have adequate interexaminer reliability for the assessment of thoracic curves. The Scoliometer has better interexaminer agreement in the lumbar spine. However, the Scoliometer has a high level of interexaminer measurement error that limits its use as an outcome instrument. Because Adam's forward bend test is more sensitive than the Scoliometer, the authors believe that it remains the best noninvasive clinical test to evaluate scoliosis.
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Affiliation(s)
- P Côté
- Department of Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, Canada
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Abstract
STUDY DESIGN A large-scale study on school screening for scoliosis was conducted to assess the referral rate, prevalence rate, and positive predictive value using different angles of trunk rotation as criteria for referral. OBJECTIVE To determine an ideal angle of trunk rotation cut-off point to be used for referral in school screening for scoliosis. SUMMARY OF BACKGROUND DATA When using the Scoliometer (Orthopedic Systems, Inc., Hayward, CA) in school scoliosis screening, 5 degrees and 7 degrees angles of trunk rotation have been recommended as criteria for referral. Low positive predictive values and over-referral at these levels have been reported. METHODS The Adams forward bend test and Scoliometer measurement were combined for school scoliosis screening in 33,596 girls from the fifth, sixth and seventh grades. Nurses were the primary screeners. Girls with trunk rotation angles of 5 degrees or more were referred for radiography. RESULTS The referral rate was 5.2%. By selecting 6 degrees, 7 degrees, 8 degrees, 9 degrees or 10 degrees angles of trunk rotation as criteria for referral, the referral rate became 2.4%, 1.4%, 0.7%, 0.5%, or 0.3%, respectively. The prevalence rate for scoliosis equal to or larger than 10 degrees, 20 degrees, 30 degrees, or 40 degrees of the Cobb angle was 1.47%, 0.21%, 0.04% and 0.02%, respectively, by using a 5 degrees angle of trunk rotation as the criterion for radiography. The positive predictive value was 28.3% for scoliosis of 10 degrees or more, 4% for scoliosis of 20 degrees or more, 0.8% for scoliosis of 30 degrees or more, and 0.4% for scoliosis of 40 degrees or more with a 5 degrees angle of trunk rotation as the criterion for referral. By selecting angles of trunk rotation larger than 5 degrees as criteria for referral for radiography, the positive predictive value increased, but positive cases with larger Cobb angles also decreased markedly. CONCLUSION The optimal cut-off point for referral when using the Scoliometer in school screening of scoliosis is still difficult to determine.
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Affiliation(s)
- S C Huang
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei
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Samuelsson L, Norén L. Trunk rotation in scoliosis. The influence of curve type and direction in 150 children. ACTA ORTHOPAEDICA SCANDINAVICA 1997; 68:273-6. [PMID: 9246992 DOI: 10.3109/17453679708996700] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We compared the angle of trunk rotation (ATR) from scoliometer readings with Cobb angle measurements of the lateral deviation of the spine in 150 children referred to hospital for evaluation of scoliosis. The mean Cobb angle in thoracic curves was 16 degrees. In thoracolumbar curves 17 degrees and in lumbar curves 20 degrees. In thoracic curves and in right convex curves no patient with a Cobb angle of 25 degrees or more had an ATR below 9 degrees. In thoracolumbar and lumbar and in left convex curves, 7 degrees ATR was occasionally associated with scoliosis of 25 degrees or more. The correlation coefficient between the ATR and Cobb angle in right convex curves was 0.65 compared to 0.57 in left convex curves. We conclude that a criterion of > 7 degrees ATR for thoracic or right convex curves and one of > 6 degrees ATR for thoracolumbar and lumbar or left convex curves seem adequate for identification of patients with Cobb angles of 25 degrees or more, which reduces the need for spinal radiography and follow-up outside the school screening programs.
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Affiliation(s)
- L Samuelsson
- Department of Orthopaedics, Orebro Medical Centre Hospital, Sweden
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Hosman AJ, Slot GH, van Limbeek J, Beijneveld WJ. Rip hump correction and rotation of the lumbar spine after selective thoracic fusion. 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 1996; 5:394-9. [PMID: 8988382 DOI: 10.1007/bf00301967] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In this study a series of 32 patients with idiopathic scoliosis, managed with selective thoracic fusion, was reviewed. Classified according to King and instrumented with the H-frame, the patients were evaluated for curve correction, rib hump correction and postoperative shift in lumbar rotation. Age and follow-up average 19.4 and 2.4 years, respectively. The 32 patients had an average primary and lumbar curve correction of, respectively, 66% (6.0% correction loss) and 53% (3.4% correction loss). The respective values for postoperative rib hump correction and shift in apical lumbar rotation averaged 8 degrees and 9.4 degrees in type II King curves 4.4 degrees and 3.5 degrees in type III and 11 degrees and -5 degrees in Type IV. Significant differences were noted between the curve types in rib hump correction and shift in lumbar rotation. The study showed that en bloc postoperative rotation of the compensatory lumbar segment, directed towards the rib hump, positively influences rib hump correction. This en bloc rotation of the unfused lumbar segments is induced by the correcting forces applied by the instrumentation. The unfused lumbar spine of a patient with a King type II curve shows a larger lumbar rotation shift and subsequent rib hump correction than that of a patient with a King type III curve. Together with factors such as lateral angulation, rib-vertebra angles and structural limitations, the rotational dynamics of the unfused lumbar spine seem to form an important component in the under-standing and surgical management of scoliosis.
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Affiliation(s)
- A J Hosman
- Department of Orthopaedics, Sint Maartenskliniek, Nijmegen, The Netherlands
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Abstract
STUDY DESIGN A prospective study was conducted in a young homogenous adolescent population, with the use of the scoliometer. OBJECTIVES To create a mathematic formula that provides the accurate Cobb angle of idiopathic scoliosis with the use of the scoliometer only. SUMMARY OF BACKGROUND DATA The scoliometer is an accepted method for detection and evaluation of scoliosis during screening programs. To the author's knowledge, there are no previous methods and formulas to estimate the approximate Cobb angle using only the scoliometer. METHODS Several clinical (scoliometer value, age, and sex) and radiographic (Cobb angle, Perdriolle of and apical vertebra, Risser iliac apophysis classification) parameters from 442 (4.37%) of 10,109 screened adolescents who had a scoliometer value of at least 7 degrees were taken and correlated using the simple and multiple linear regression analysis. RESULTS Cobb angle and scoliometer value were statistically significantly correlated to each other. Two mathematic formulas were created to predict the Cobb angle of the thoracic and lumbar scoliosis, with similar sensitivity and accuracy. The thoracic and lumbar scoliometer values were statistic significantly correlated with the thoracic and lumbar Cobb angle (P = 0.0254 and P = 0.0015, respectively). The lumbar scoliometer value was significantly correlated with lumbar apical vertebra Perdriolle value. Also, the thoracic and lumbar Cobb angles were significantly correlated with thoracic and lumbar apical vertebra (P = 0.0001 and P = 0.0015, respectively). CONCLUSIONS In the present study, the authors have constructed two mathematic formulas, which provide accurately the scoliotic Cobb angle in young adolescents using only the scoliometer with a deviation of 5.63 degrees thoracic curves and 5.79 degrees for lumbar curves. The authors recommended that all physicians engaged in scoliosis screening programs use the scoliometer based on the mathematic formulas that the authors developed. They believe that this method will reduce the cost of school screening programs, the overdiagnosis, and the unnecessary exposure to irradiation of this young population in the future.
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Affiliation(s)
- P G Korovessis
- Orthopaedic Department, General Hospital, Patras, Greece
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