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Chen X, Ye Y, Zhu Z, Zhang R, Wang W, Wu M, Lu X, Yan B, Liang Q. Association between incorrect postures and curve magnitude of adolescent idiopathic scoliosis in china. J Orthop Surg Res 2024; 19:300. [PMID: 38760821 PMCID: PMC11100037 DOI: 10.1186/s13018-024-04767-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/29/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Despite advancements in school scoliosis screening (SSS), there are still no effective indicators to estimate the severity of spinal curvature. We aim to investigate the association between incorrect postures and curve magnitude of adolescent idiopathic scoliosis (AIS) among Chinese adolescents. METHODS In this SSS program, we examined the incorrect posture, Adam's forward bending test (FBT) results, and angle of trunk rotation (ATR) in adolescents. Those with suspected scoliosis were referred for a standing anteroposterior whole-spine radiography as outpatients. The radiographic data of 426 students with lateral Cobb angles were collected from 2016 to 2022 and the associations were studied using logistic regression (LR) models and receiver operating characteristic (ROC) curves. RESULTS Univariate LR revealed that female gender [odds ratio (OR) = 2.92, 95% confidence interval (CI) 1.67-5.09, P < 0.001], age 16-19y (OR = 2.83, 95%CI 1.10-7.28, P = 0.031), right shoulder height (OR = 2.15, 95%CI 1.23-3.75, P = 0.007), right scapula tilt (OR = 2.03, 95%CI 1.18-3.50, P = 0.010), right rib hump (OR = 1.88, 95%CI 1.23-2.85, P = 0.003), right thoracic rotation ≥ 5° (OR = 2.14, 95%CI 1.43-3.20, P < 0.001), and left thoracolumbar kyphosis (OR = 3.79, 95%CI 1.06-13.56, P = 0.041) were all significantly associated with the severity of the curve magnitude. Multivariate LR showed that female gender [adjusted OR (AOR) = 3.23, 95%CI 1.81-5.73, P < 0.001], those aged 16-19y (AOR = 5.08, 95%CI 1.86-13.91, P = 0.002), and with a right rib hump (AOR = 1.72, 95%CI 1.11-2.64, P = 0.015) presented with a higher risk of severe curve magnitude than men, those aged 7-12y, and without a rib hump, respectively. ROC curves further proved that sex, age, shoulder-height difference, scapula tilt, flat back, rib hump, angle of thoracic rotation were the risk predictors for curve magnitude. CONCLUSION Incorrect posture and ATR, especially the right rib hump, were significantly associated with the curve magnitude of AIS. Early screening for incorrect postures and ATR could be an effective and economical strategy to predict the severity of AIS through SSS in Chinese adolescents.
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Affiliation(s)
- Xiaosheng Chen
- Department of spine surgery, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Sungang west road, Futian district, Number 3002, Shenzhen, 518035, China
- Shenzhen Youth Spine Health Center, Shenzhen, China
| | - Yongyu Ye
- Department of Orthopedic Surgery, Guangdong Provincial People's Hospital, Southern Medical University, Guangzhou, China
| | - Zhixiang Zhu
- Department of spine surgery, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Sungang west road, Futian district, Number 3002, Shenzhen, 518035, China
- Shenzhen Youth Spine Health Center, Shenzhen, China
| | - Rui Zhang
- Department of spine surgery, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Sungang west road, Futian district, Number 3002, Shenzhen, 518035, China
- Shenzhen Youth Spine Health Center, Shenzhen, China
| | - Weijun Wang
- Shenzhen Youth Spine Health Center, Shenzhen, China
| | - Miaoling Wu
- Shenzhen Youth Spine Health Center, Shenzhen, China
| | - Xinhai Lu
- Shenzhen Youth Spine Health Center, Shenzhen, China
| | - Bin Yan
- Department of spine surgery, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Sungang west road, Futian district, Number 3002, Shenzhen, 518035, China.
- Shenzhen Youth Spine Health Center, Shenzhen, China.
| | - Qian Liang
- Department of spine surgery, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Sungang west road, Futian district, Number 3002, Shenzhen, 518035, China.
- Shenzhen Youth Spine Health Center, Shenzhen, China.
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Cai J, Zhou Y, Chen X, Huang X, Li L, Zhu Y, Cai Q, Huang J, Sun Z. Is refractive error a factor affecting scoliosis? PLoS One 2024; 19:e0303324. [PMID: 38739623 PMCID: PMC11090344 DOI: 10.1371/journal.pone.0303324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Scoliosis is one of the most common surgical disorders of the pediatric spine. Refractive errors are commonly associated with vision impairment worldwide. However, it is currently unclear whether refractive error correlates directly with the development of scoliosis. METHODS A cross-sectional study was performed in 2023, and a stratified cluster sampling technique was employed among school-aged students in Nantong City, China. Univariate and multivariate logistic regression analyses were used to investigate specific correlations between scoliosis and related parameters; various types of refractive errors were also included in the study. RESULTS The prevalence of scoliosis among school-aged students was 2.2% in Nantong city. Multiple logistic regression analyses showed that myopia, hyperopia, astigmatism, and anisometropia were not correlated with the development of scoliosis (all, p≥0.05). Lower body mass index (BMI) [adjusted odds ratio (aOR) = 0.92; 95% confidence interval (CI): 0.88-0.95; p<0.001], living in rural areas (aOR = 1.40; 95% CI: 1.05-1.86; p = 0.020), and older age (aOR = 1.32; 95% CI: 1.25-1.38; p<0.001) had significantly higher risks of scoliosis. CONCLUSIONS Refractive errors did not correlate with the development of scoliosis. However, BMI, living in rural areas and older age did correlate with the development of scoliosis.
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Affiliation(s)
- Jianru Cai
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Yue Zhou
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Xiaojuan Chen
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Xiaobo Huang
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Lele Li
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Yan Zhu
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Qi Cai
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Jianping Huang
- Nantong Center for Disease Control and Prevention in Jiangsu Province, Jiangsu Province, China
| | - ZhiMin Sun
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
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Zheng JL, Li Y, Hogue G, Johnson M, Anari JB, Baldwin KD. Adolescent Idiopathic Scoliosis Minimum Data Set: Towards Standardization of Data Elements in History and Physical Examination. Cureus 2024; 16:e58332. [PMID: 38752033 PMCID: PMC11095914 DOI: 10.7759/cureus.58332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Nonoperative care represents a cornerstone of adolescent idiopathic scoliosis (AIS) management, although no consensus exists for a minimal data set. We aimed to determine a consensus in critical data points to obtain during clinical AIS visits. METHODS A REDCap-based survey was distributed to Pediatric Orthopedic Society of America (POSNA), Pediatric Spine Study Group (PSSG), and International Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT). Respondents ranked the importance of data points in history, physical examination, and bracing during AIS visits. Results: One hundred eighty-one responses were received (26% response rate), of which 86% were physicians and 14% were allied health professionals. About 80% of respondents worked at pediatric hospitals or pediatric spaces within adult hospitals, and 82% were academic, with the majority (57%) seeing 150+ unique AIS patients annually. Most respondents recommended six-month follow-up for patients under observation (60%) and bracing (54%). Most respondents (75%) considered family history and pain important (69%), with the majority (69%) asking about pain at every visit. Across all time points, Adam's forward bend test, shoulder level, sagittal contour, trunk shift, and curve stiffness were all considered critically important (>60%). At the first visit, scapular prominence, leg lengths, motor and neurological examination, gait, and iliac crest height were also viewed as critical. At the preoperative visit, motor strength and scapular prominence should also be documented. About 39% of respondents use heat sensors to monitor bracing compliance, and average brace wear since the prior visit was considered the most important (85%) compliance data point. CONCLUSIONS This study establishes recommendations for a 19-item minimum data set for clinical AIS evaluation, including history, physical exam, and bracing, to allow for future multicenter registry-based studies.
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Affiliation(s)
- Jenny L Zheng
- Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Ying Li
- Orthopedic Surgery, C.S. Mott Children's Hospital, Ann Arbor, USA
| | - Grant Hogue
- Orthopedic Surgery, Boston Children's Hospital, Boston, USA
| | - Megan Johnson
- Orthopedic Surgery, Scottish Rite for Children, Dallas, USA
| | - Jason B Anari
- Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Keith D Baldwin
- Division of Orthopedics, Children's Hospital of Philadelphia, Philadelphia, USA
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Lau KKL, Law KKP, Kwan KYH, Cheung JPY, Cheung KMC. Proprioception-related gene mutations in relation to the aetiopathogenesis of idiopathic scoliosis: A scoping review. J Orthop Res 2023; 41:2694-2702. [PMID: 37203456 DOI: 10.1002/jor.25626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/20/2023]
Abstract
Since idiopathic scoliosis is a multifactorial disorder, the proprioceptive defect is considered one of its etiological factors. Genetic studies have separately revealed this relationship, yet it remains indeterminate which specific genes that related to proprioception contributed to the initiation, progression, pathology, and treatment outcomes of the curvature. A systematic search was conducted on four online databases, including PubMed, Web of Science, Embase, and Academic search complete. Studies were included if they involved human or animal subjects with idiopathic scoliosis and evaluated with proprioceptive genes. The search period was the inception of the database to February 21, 2023. Four genes (i.e., Ladybird homeobox 1 [LBX1], Piezo type mechanosensitive ion channel component 2 [PIEZO2], Runx family transcription factor 3 [RUNX3], and neurotrophin 3 [NTF3]) investigated in 19 studies were included. LBX1 has confirmed the correlation with the development of idiopathic scoliosis in 10 ethnicities, whereas PIEZO2 has shown a connection with clinical proprioceptive tests in subjects with idiopathic scoliosis. However, curve severity was less likely to be related to the proprioceptive genes. The potential pathology took place at the proprioceptive neurons. Evidence of proprioception-related gene mutations in association with idiopathic scoliosis was established. Nevertheless, the causation between the initiation, progression, and treatment outcomes with proprioceptive defect requires further investigation.
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Affiliation(s)
- Kenney K L Lau
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Karlen K P Law
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kenny Y H Kwan
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- Department of Orthopaedics and Traumatology, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- Department of Orthopaedics and Traumatology, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
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Ito Y, Doi T, Ohtomo N, Fujii Y, Ono K, Kojima E, Yamada T, Tran HH, Goffinet F, Endo Y, Kato S, Matsubayashi Y, Tanaka S, Oshima Y, Taniguchi Y. A Novel Screening Method for Scoliosis Using a Bodysuit and 3-Dimensional Imaging. Spine (Phila Pa 1976) 2023; 48:1289-1294. [PMID: 37389986 DOI: 10.1097/brs.0000000000004658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/20/2023] [Indexed: 07/02/2023]
Abstract
STUDY DESIGN A single-center prospective observational study. OBJECTIVE To clarify the usefulness of a novel scoliosis screening method using a 3-dimensional (3D) human fitting application and a specific bodysuit. SUMMARY OF BACKGROUND DATA Several scoliosis screening methods, such as scoliometer and Moiré topography, are available for detecting scoliosis. In the present study, a novel screening method for scoliosis using a 3D human fitting application and a specific bodysuit was developed. PATIENTS AND METHODS Patients with scoliosis or suspected scoliosis, patients with non-scoliosis, and healthy volunteers were enrolled. They were divided into "non-scoliosis" and "scoliosis" groups. The scoliosis group was further subdivided into "mild," "moderate," and "severe-scoliosis" groups. Patients' characteristics and Z values, which were calculated by a 3D virtual human body model created by a 3D human fitting application and a specific bodysuit to evaluate trunk asymmetry caused by scoliosis, were compared between the non-scoliosis and scoliosis groups or among the non, mild, moderate and severe-scoliosis groups. Finally, the optimal cutoff of the Z value was determined to detect moderate to severe scoliosis using receiver operating characteristic curve analysis. RESULTS A total of 101 patients were included. The non-scoliosis group consisted of 47 patients, and the scoliosis group included 54 patients, with 11, 31, and 12 patients in the mild, moderate, and severe-scoliosis groups, respectively. The scoliosis group showed a significantly higher Z value than the non-scoliosis group. The moderate or severe-scoliosis group had a significantly higher Z value than the non or mild-scoliosis group. The receiver operating characteristic curve analysis revealed that the optimal cutoff of the Z value was 19.9 mm (sensitivity, 95.3% and specificity, 58.6%). CONCLUSION A novel scoliosis screening method consisting of a 3D human fitting application and a specific bodysuit may be useful for detecting moderate to severe scoliosis.
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Affiliation(s)
- Yusuke Ito
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Toru Doi
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
- Department of Next Generation Locomotive Imaging System, The University of Tokyo Hospital, Tokyo, Japan
| | - Nozomu Ohtomo
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
- Department of Next Generation Locomotive Imaging System, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Kengo Ono
- ZOZO, Inc., Chiba city, Chiba, Japan
| | | | | | | | | | - Yui Endo
- National Institute of Advanced Industrial Science and Technology, Koto-ku, Tokyo, Japan
| | - So Kato
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Sakae Tanaka
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuki Taniguchi
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
- Surgical Center, The University of Tokyo Hospital, Tokyo, Japan
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Zhang H, Yang G, Li J, Xiao L, Guo C, Wang Y. Impaired autophagy activity-induced abnormal differentiation of bone marrow stem cells is related to adolescent idiopathic scoliosis osteopenia. Chin Med J (Engl) 2023; 136:2077-2085. [PMID: 36728938 PMCID: PMC10476821 DOI: 10.1097/cm9.0000000000002165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Osteopenia has been well documented in adolescent idiopathic scoliosis (AIS). Bone marrow stem cells (BMSCs) are a crucial regulator of bone homeostasis. Our previous study revealed a decreased osteogenic ability of BMSCs in AIS-related osteopenia, but the underlying mechanism of this phenomenon remains unclear. METHODS A total of 22 AIS patients and 18 age-matched controls were recruited for this study. Anthropometry and bone mass were measured in all participants. Bone marrow blood was collected for BMSC isolation and culture. Osteogenic and adipogenic induction were performed to observe the differences in the differentiation of BMSCs between the AIS-related osteopenia group and the control group. Furthermore, a total RNA was extracted from isolated BMSCs to perform RNA sequencing and subsequent analysis. RESULTS A lower osteogenic capacity and increased adipogenic capacity of BMSCs in AIS-related osteopenia were revealed. Differences in mRNA expression levels between the AIS-related osteopenia group and the control group were identified, including differences in the expression of LRRC17 , DCLK1 , PCDH7 , TSPAN5 , NHSL2 , and CPT1B . Kyoto Encyclopedia of Genes and Genomes enrichment analyses revealed several biological processes involved in the regulation of autophagy and mitophagy. The Western blotting results of autophagy markers in BMSCs suggested impaired autophagic activity in BMSCs in the AIS-related osteopenia group. CONCLUSION Our study revealed that BMSCs from AIS-related osteopenia patients have lower autophagic activity, which may be related to the lower osteogenic capacity and higher adipogenic capacity of BMSCs and consequently lead to the lower bone mass in AIS patients.
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Affiliation(s)
- Hongqi Zhang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
| | - Guanteng Yang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
| | - Jiong Li
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
| | - Lige Xiao
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
| | - Chaofeng Guo
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
| | - Yuxiang Wang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital, Central-South University, Changsha, Hunan 410008, China
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Baymurat AC, Daldal I, Tokgoz MA, Yilmaz BK, Senkoylu A. The effect of brace on apical vertebral derotation in adolescent idiopathic scoliosis. Spine Deform 2023; 11:1101-1107. [PMID: 37221316 DOI: 10.1007/s43390-023-00703-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 05/06/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE The current study aims to evaluate the effect of Boston brace treatment on apical vertebral derotation in adolescent idiopathic scoliosis (AIS) patients receiving conservative treatment. METHODS The study included 51 AIS patients, consisting of 8 males and 43 females, with Cobb angles between 25° and 45° and Risser's findings ranging from 0 to 4. The mean age of the participants was 12.20 ± 1.34 years. All patients were treated with the Boston brace for a minimum of 2 years and evaluated before the brace, during early brace use, and at the last follow-up. Radiographs were assessed to measure apical vertebral rotation (AVR) and vertebral translation (AVT). The SRS-22 questionnaire was used to evaluate patient outcomes. RESULTS The radiographs of patients were evaluated over a mean follow-up period of 32.42 ± 8.65 months. Before the brace, the mean AVR was 2.1 ± 0.6, while it was 1.1 ± 0.5 with the brace. At the last follow-up, the mean AVR was 1.3 ± 0.5 (p < 0.001). Before the brace, the mean AVT was 36.4 ± 9.6 mm, which decreased to 16.7 ± 7.3 mm with the brace (p < 0.001). At the last follow-up, the mean AVT was 19.8 ± 8.1 mm (p < 0.001). The use of the brace had a significant corrective effect on thoracolumbar and lumbar curvatures compared to before the brace (p < 0.001). CONCLUSION The findings of the current study suggest that the use of a Boston brace in the conservative treatment of AIS is effective in correcting the coronal and sagittal plane deformities, including thoracic, thoracolumbar, and lumbar curvatures, and in reducing apical vertebral rotation and translation.
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Affiliation(s)
- Alim Can Baymurat
- Department of Orthopaedics and Traumatology, Gazi University Medical Faculty, Ankara, Turkey
| | - Ismail Daldal
- Department of Orthopaedics and Traumatology, Medicana International Istanbul-Beylikdüzü Hospital, Istanbul, Turkey
| | - Mehmet Ali Tokgoz
- Department of Orthopaedics and Traumatology, Gazi University Medical Faculty, Ankara, Turkey
| | - Bilge Kagan Yilmaz
- Department of Orthopaedics and Traumatology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Alpaslan Senkoylu
- Department of Orthopaedics and Traumatology, Gazi University Medical Faculty, Ankara, Turkey.
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Zheng Q, Xie L, Xu J, Xia N, Ma CZH. A feasibility study of applying two-dimensional photogrammetry for screening and monitoring of patients with adolescent idiopathic scoliosis in clinical practice. Sci Rep 2023; 13:14273. [PMID: 37652928 PMCID: PMC10471746 DOI: 10.1038/s41598-023-41267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023] Open
Abstract
Standing posteroanterior radiographs have been the golden standard to quantify the severity of scoliosis deformity. However, it exposes ionizing radiation to scoliosis patients, and cannot be used for routine screening and monitoring. This study aimed to develop a protocol of measuring postural indexes by using the noninvasive and radiation-free two-dimensional (2D) photogrammetry method and identify its clinical value in scoliosis screening and monitoring. The five postural indexes were measured from the posterior view of 110 participants. One-way ANOVA with post hoc Tukey HSD/Games-Howell analysis was used to compare the differences between the participants in the scoliosis group and the non-scoliosis group. Pearson coefficients of correlation were analyzed to identify the relationships between Cobb angles and each of the five quantitative postural indexes. Based on 2D photogrammetry, the postural indexes of C7 deviation (p = 0.02), shoulder alignment (p < 0.001), scapula alignment (p < 0.001), waist angle discrepancy (p < 0.001), and PSIS alignment (p < 0.001) could significantly differentiate scoliosis and non-scoliosis patients during screening. The waist angle discrepancy (r = 0.4, p = 0.01; r = 0.8, p = 0.03; r = 0.7, p = 0.01) and shoulder alignment (r = 0.6, p = 0.03) had moderate to strong positive correlations with the Cobb angles, which supported their clinical values in monitoring scoliotic curvature changes of adolescent idiopathic scoliosis (AIS) patients.
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Affiliation(s)
- Qian Zheng
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430030, China
| | - Lingfeng Xie
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430030, China.
| | - Jiang Xu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430030, China
| | - Nan Xia
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430030, China
| | - Christina Zong-Hao Ma
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, 999077, Hong Kong SAR, China
- Research Institute for Smart Aging, The Hong Kong Polytechnic University, Hung Hom, 999077, Hong Kong SAR, China
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9
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Meng N, Wong KYK, Zhao M, Cheung JP, Zhang T. Radiograph-comparable image synthesis for spine alignment analysis using deep learning with prospective clinical validation. EClinicalMedicine 2023; 61:102050. [PMID: 37425371 PMCID: PMC10329130 DOI: 10.1016/j.eclinm.2023.102050] [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: 12/11/2022] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/11/2023] Open
Abstract
Background Adolescent idiopathic scoliosis (AIS) is the most common type of spinal disorder affecting children. Clinical screening and diagnosis require physical and radiographic examinations, which are either subjective or increase radiation exposure. We therefore developed and validated a radiation-free portable system and device utilising light-based depth sensing and deep learning technologies to analyse AIS by landmark detection and image synthesis. Methods Consecutive patients with AIS attending two local scoliosis clinics in Hong Kong between October 9, 2019, and May 21, 2022, were recruited. Patients were excluded if they had psychological and/or systematic neural disorders that could influence the compliance of the study and/or the mobility of the patients. For each participant, a Red Green Blue-Depth (RGBD) image of the nude back was collected using our in-house radiation-free device. Manually labelled landmarks and alignment parameters by our spine surgeons were considered as the ground truth (GT). Images from training and internal validation cohorts (n = 1936) were used to develop the deep learning models. The model was then prospectively validated on another cohort (n = 302) which was collected in Hong Kong and had the same demographic properties as the training cohort. We evaluated the prediction accuracy of the model on nude back landmark detection as well as the performance on radiograph-comparable image (RCI) synthesis. The obtained RCIs contain sufficient anatomical information that can quantify disease severities and curve types. Findings Our model had a consistently high accuracy in predicting the nude back anatomical landmarks with a less than 4-pixel error regarding the mean Euclidian and Manhattan distance. The synthesized RCI for AIS severity classification achieved a sensitivity and negative predictive value of over 0.909 and 0.933, and the performance for curve type classification was 0.974 and 0.908, with spine specialists' manual assessment results on real radiographs as GT. The estimated Cobb angle from synthesized RCIs had a strong correlation with the GT angles (R2 = 0.984, p < 0.001). Interpretation The radiation-free medical device powered by depth sensing and deep learning techniques can provide instantaneous and harmless spine alignment analysis which has the potential for integration into routine screening for adolescents. Funding Innovation and Technology Fund (MRP/038/20X), Health Services Research Fund (HMRF) 08192266.
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Affiliation(s)
- Nan Meng
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- CoNova Medical Technology Limited, Hong Kong SAR, China
| | - Kwan-Yee K. Wong
- Department of Computer Science, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Moxin Zhao
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Jason P.Y. Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Teng Zhang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- CoNova Medical Technology Limited, Hong Kong SAR, China
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10
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Zhou Y, Zhang XF, Chen XJ, Wang M, Cai JR, Xiong YJ, Song Y, Sun ZM. Prevalence of anisometropia and influencing factors among school-age children in Nantong, China: a cross-sectional study. Front Public Health 2023; 11:1190285. [PMID: 37397717 PMCID: PMC10307961 DOI: 10.3389/fpubh.2023.1190285] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To investigate the prevalence of anisometropia and associated parameters among school-aged children in Nantong, China. Methods This school-based, cross-sectional study examined students from primary schools, junior high schools, and senior high schools in an urban area of Nantong, China. Univariate and multivariate logistic regression analyses were used to investigate the specific correlations between anisometropia and related parameters. Non-cycloplegic autorefraction was assessed for each student. Anisometropia was defined as the spherical equivalent refraction (SE) difference ≥ 1.0 D between eyes. Results A total of 9,501 participants were validated for analyses, of which 53.2% (n = 5,054) were male, and 46.8% (n = 4,447) were female. The mean of age was 13.32 ± 3.49 years, ranging from 7-19 years. The overall prevalence of anisometropia was 25.6%. Factors such as myopia, scoliosis screening positive, hyperopia, female sex, older age, and higher weight had a significantly higher risk of anisometropia (p < 0.05). Conclusion There was a high prevalence of anisometropia in school-age children. Some physical examination parameters are closely related to children's anisometropia, especially myopia and scoliosis. Preventing myopia and controlling its progression may be the most important ways to reduce the prevalence of anisometropia. Correcting scoliosis may be an important factor in controlling the prevalence of anisometropia, and maintaining good reading and writing posture may be helpful in controlling the prevalence of anisometropia.
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Affiliation(s)
- Yue Zhou
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Xiao Fang Zhang
- Department of Nantong Fifth People’s Hospital, Nantong, Jiangsu, China
| | - Xiao Juan Chen
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Min Wang
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jian Ru Cai
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Yao Jia Xiong
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Yu Song
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Zhi Min Sun
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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11
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Catanzariti JF, Rimetz A, Genevieve F, Renaud G, Mounet N. Idiopathic adolescent scoliosis and obesity: prevalence study. 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 2023; 32:2196-2202. [PMID: 37097342 DOI: 10.1007/s00586-023-07709-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 02/26/2023] [Accepted: 04/06/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that affects 5% of the population. This pathology has multiple known etiological factors such as family predisposition, female gender, low body mass index, decrease in lean and fat masses. However, recent studies suggest that ciliary dysfunction could be the origin of certain types of obesity and AIS. This study aims to verify the existence of a link between these two pathologies. METHODS A retrospective, cross-sectional, descriptive and monocentric study, based on a cohort of adolescents with obesity treated in a paediatric rehabilitation centre for specific care between 1 January 2010 and 1 January 2019. The prevalence of AIS was calculated by radiographic measurements. The diagnosis of AIS was established if the Cobb angle was ≥ 10°, associated with intervertebral rotation. RESULTS 196 adolescents with obesity were included in the study (mean age 13.2 years, mean BMI 36 kg/cm2, gender ratio 2.1 of female to male.) The prevalence of AIS in adolescents with obesity was 12.2%, twice the prevalence of AIS in the general population. The characteristics of AIS in adolescents with obesity are predominantly female, 58.3% left thoracolumbar or lumbar principal curvatures, mean Cobb angle 26° and progressive in 29% of cases. CONCLUSIONS Our study established a correlation between AIS and obesity with a higher prevalence than in the general population. The morphology of these adolescents makes screening for AIS more difficult.
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Affiliation(s)
- Jean-François Catanzariti
- La Maison de la Scoliose, 59650, Villeneuve d'Ascq, France.
- SSR Pédiatrique Marc Sautelet, 59650, Villeneuve d'Ascq, France.
| | | | | | - Gemma Renaud
- SSR Pédiatrique Marc Sautelet, 59650, Villeneuve d'Ascq, France
| | - Natacha Mounet
- SSR Pédiatrique Marc Sautelet, 59650, Villeneuve d'Ascq, France
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12
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Uehara M, Takahashi J, Kosho T. Spinal Deformity in Ehlers-Danlos Syndrome: Focus on Musculocontractural Type. Genes (Basel) 2023; 14:1173. [PMID: 37372353 DOI: 10.3390/genes14061173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Spinal deformity in Ehlers-Danlos syndrome (EDS) is an important symptom that can lead to trunk balance deterioration, respiratory dysfunction, and digestive disorders as the deformity progresses, thereby reducing a patient's quality of life and activities of daily living. The severity of the deformity varies widely, with treatment depending on the extent and the presence of associated complications. The present review addressed the current state of clinical research and treatment of spinal deformities in EDS with a specific focus on the musculocontractural type. Further studies are needed to better understand the underlying mechanisms of spinal deformity in EDS.
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Affiliation(s)
- Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto 390-8621, Nagano, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto 390-8621, Nagano, Japan
| | - Tomoki Kosho
- Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto 390-8621, Nagano, Japan
- Center for Medical Genetics, Shinshu University Hospital, Matsumoto 390-8621, Nagano, Japan
- Division of Clinical Sequencing, Shinshu University School of Medicine, Matsumoto 390-8621, Nagano, Japan
- Division of Instrumental Analysis, Research Center for Advanced Science and Technology, Shinshu University, Matsumoto 390-8621, Nagano, Japan
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13
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Jiang W, Xie Q, Qin Y, Ye X, Wang X, Zheng Y. A novel method for spine ultrasound and X-ray radiograph registration. ULTRASONICS 2023; 133:107018. [PMID: 37163859 DOI: 10.1016/j.ultras.2023.107018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/12/2023]
Abstract
Ultrasound is a promising imaging method for scoliosis evaluation because it is radiation free and provide real-time images. However, it cannot provide bony details because ultrasound cannot penetrate the bony structure. Therefore, registration of real-time ultrasound images with the previous X-ray radiograph can help physicians understand the spinal deformity of patients. In this study, an improved free-from deformation registration method based on mutual registration and hierarchical adaptive grid (MRHA-FFD) was developed. The method first performed registration grid preprocessing and then optimized control points and conducted mutual registration. Finally, a Blur-aware Attention Network was adopted for image deblurring. The performance of each step was verified by ablation experiments. Comparison experiment between the proposed method and traditional registration methods was also conducted. The qualitative and quantitative results suggested that MRHA-FFD is a promising approach for registering spine ultrasound image and X-ray radiograph.
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Affiliation(s)
- Weiwei Jiang
- College of Computer Science & Technology, Zhejiang University of Technology, 310023 Hangzhou, China.
| | - Qiaolin Xie
- College of Computer Science & Technology, Zhejiang University of Technology, 310023 Hangzhou, China
| | - Yingyu Qin
- College of Computer Science & Technology, Zhejiang University of Technology, 310023 Hangzhou, China
| | - Xiaojun Ye
- Department of Ultrasound, Hangzhou Women's Hospital, 310023 Hangzhou, China
| | - Xiaoyan Wang
- College of Computer Science & Technology, Zhejiang University of Technology, 310023 Hangzhou, China
| | - Yongping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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14
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Vendeuvre T, Tabard-Fougère A, Armand S, Dayer R. Test characteristics of rasterstereography for the early diagnosis of adolescent idiopathic scoliosis. Bone Joint J 2023; 105-B:431-438. [PMID: 36924187 DOI: 10.1302/0301-620x.105b4.bjj-2021-1440.r3] [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: 03/18/2023]
Abstract
This study aimed to evaluate rasterstereography of the spine as a diagnostic test for adolescent idiopathic soliosis (AIS), and to compare its results with those obtained using a scoliometer. Adolescents suspected of AIS and scheduled for radiographs were included. Rasterstereographic scoliosis angle (SA), maximal vertebral surface rotation (ROT), and angle of trunk rotation (ATR) with a scoliometer were evaluated. The area under the curve (AUC) from receiver operating characteristic (ROC) plots were used to describe the discriminative ability of the SA, ROT, and ATR for scoliosis, defined as a Cobb angle > 10°. Test characteristics (sensitivity and specificity) were reported for the best threshold identified using the Youden method. AUC of SA, ATR, and ROT were compared using the bootstrap test for two correlated ROC curves method. Of 212 patients studied, 146 (69%) had an AIS. The AUC was 0.74 for scoliosis angle (threshold 12.5°, sensitivity 75%, specificity 65%), 0.65 for maximal vertebral surface rotation (threshold 7.5°, sensitivity 63%, specificity 64%), and 0.82 for angle of trunk rotation (threshold 5.5°, sensitivity 65%, specificity 80%). The AUC of ROT was significantly lower than that of ATR (p < 0.001) and SA (p < 0.001). The AUCs of ATR and SA were not significantly different (p = 0.115). The rasterstereographic scoliosis angle has better diagnostic characteristics than the angle of trunk rotation evaluated with a scoliometer, with similar AUCs and a higher sensitivity.
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Affiliation(s)
- Tanguy Vendeuvre
- Division of Pediatric Orthopaedics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Anne Tabard-Fougère
- Division of Pediatric Orthopaedics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.,Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Romain Dayer
- Division of Pediatric Orthopaedics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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15
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Hartley L, Jones C, Lui D, Bernard J, Bishop T, Herzog J, Chan D, Stokes O, Gardner A. An Examination of the Number of Adolescent Scoliotic Curves That Are Braceable at First Presentation to a Scoliosis Service. Healthcare (Basel) 2023; 11:healthcare11030445. [PMID: 36767020 PMCID: PMC9914198 DOI: 10.3390/healthcare11030445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
Adolescent idiopathic scoliosis (AIS) affects between 0.5% and 5.2% of adolescents and is progressive in two-thirds of cases. Bracing is an effective non-operative treatment for AIS and has been shown to prevent up to 72% of curves from requiring surgery. This paper explores the presentation of AIS in the UK and identifies who would be suitable for bracing, as per guidelines published by the Scoliosis Research Society (SRS) and British Scoliosis Society (BSS), through curve severity and skeletal maturity at presentation. There were 526 patients with AIS eligible for inclusion across three tertiary referral centres in the UK. The study period was individualised to each centre, between January 2012 and December 2021. Only 10% were appropriate for bracing via either SRS or BSS criteria. The rest were either too old, skeletally mature or had a curve size too large to benefit. By the end of data collection, 38% had undergone surgery for their scoliosis. In the UK, bracing for AIS is only suitable for a small number at presentation. Future efforts to minimise delays in specialist review and intervention will increase the number of those with AIS suitable for bracing and reduce the number and burden of operative interventions for AIS in the UK.
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Affiliation(s)
- Laura Hartley
- The Royal Orthopaedic Hospital, NHS Foundation Trust, Birmingham B31 2AP, UK
| | - Conor Jones
- The Royal Devon and Exeter, NHS Foundation Trust, Exeter EX2 5DW, UK
| | - Darren Lui
- St George’s University Hospitals, NHS Foundation Trust, London SW17 0OT, UK
| | - Jason Bernard
- St George’s University Hospitals, NHS Foundation Trust, London SW17 0OT, UK
| | - Timothy Bishop
- St George’s University Hospitals, NHS Foundation Trust, London SW17 0OT, UK
| | - Jan Herzog
- St George’s University Hospitals, NHS Foundation Trust, London SW17 0OT, UK
| | - Daniel Chan
- The Royal Devon and Exeter, NHS Foundation Trust, Exeter EX2 5DW, UK
| | - Oliver Stokes
- The Royal Devon and Exeter, NHS Foundation Trust, Exeter EX2 5DW, UK
| | - Adrian Gardner
- The Royal Orthopaedic Hospital, NHS Foundation Trust, Birmingham B31 2AP, UK
- Correspondence: ; Tel.: +44-7841-638236
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16
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Roggio F, Petrigna L, Filetti V, Vitale E, Rapisarda V, Musumeci G. Infrared thermography for the evaluation of adolescent and juvenile idiopathic scoliosis: A systematic review. J Therm Biol 2023; 113:103524. [PMID: 37055128 DOI: 10.1016/j.jtherbio.2023.103524] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 01/03/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Adolescent and Juvenile Idiopathic Scoliosis are a three-dimensional spine deformity characterized by a muscle alteration of the convex and concave sides of the scoliosis, which can be evaluated with different non-invasive and radiation-free methods such as infrared thermography. The objective of the present review is to assess infrared thermography as a potential method to evaluate alterations of the scoliosis. MATERIALS AND METHODS A systematic review was performed by collecting articles from PubMed, Web of Science, Scopus, and Google Scholar, published from 1990 to April 2022, on the use of infrared thermography to evaluate adolescent and juvenile idiopathic scoliosis. Relevant data were collected in tables, and the primary outcomes were discussed narratively. RESULTS Of the 587 articles selected, only 5 were in line with the objective of this systematic review and were eligible for the inclusion criteria. The findings of the selected articles corroborate the applicability of infrared thermography as an objective method to assess the thermal differences of the muscles between the convex and concave sides of scoliosis. The overall quality of the research was uneven in the reference standard method and assessment of measures. CONCLUSION Infrared thermography is providing promising results to discriminate thermal differences in scoliosis evaluation, albeit there are still some concerns about considering it as a diagnostic tool for scoliosis evaluation because specific recommendations for collecting data are not met. We propose additional recommendations to existing guidelines to perform thermal acquisition to reduce errors and provide the best results to the scientific community.
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Affiliation(s)
- Federico Roggio
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy; Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, Palermo, 90144, Italy
| | - Luca Petrigna
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
| | - Veronica Filetti
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
| | - Ermanno Vitale
- Department of Clinical and Experimental Medicine, Occupational Medicine, University of Catania, Via Santa Sofia n°78, 95123, Catania, Italy
| | - Venerando Rapisarda
- Department of Clinical and Experimental Medicine, Occupational Medicine, University of Catania, Via Santa Sofia n°78, 95123, Catania, Italy
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy; Research Center on Motor Activities (CRAM), University of Catania, Via S. Sofia n°97, 95123, Catania, Italy; Department of Biology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, 19122, PA, United States.
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17
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Jiang W, Yu C, Chen X, Zheng Y, Bai C. Ultrasound to X-ray synthesis generative attentional network (UXGAN) for adolescent idiopathic scoliosis. ULTRASONICS 2022; 126:106819. [PMID: 35926252 DOI: 10.1016/j.ultras.2022.106819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/03/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
Standing X-ray radiograph with Cobb's method is the gold standard for scoliosis diagnosis. However, radiation hazard restricts its application, especially for close follow-up of adolescent patients. Compared with X-ray, ultrasound imaging has advantages of being radiation-free and real-time. To combine advantages of the above two imaging modalities, an ultrasound to X-ray synthesis generative attentional network (UXGAN) was proposed to synthesize ultrasound images into X-ray-like images. In this network, a cyclically consistent network was adopted and was trained end-to-end. An attention module was added and different residual blocks were designed. The quantitative comparison results demonstrated the superiority of our method to the state-of-the-art CycleGAN methods. We further compared the Cobb angle values measured on synthesized images and the real X-ray images, respectively. A good linear correlation (r = 0.95) was demonstrated between the two methods. The above results proved that the proposed method is of great significance for providing both X-ray images and ultrasound images based on the radiation-free ultrasound scanning.
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Affiliation(s)
- Weiwei Jiang
- College of Computer Science & Technology, Zhejiang University of Technology, Hangzhou 310023, China
| | - Chaohao Yu
- Hangzhou Kaiyuan Business Vocational School, Hangzhou 310000, China
| | - Xianting Chen
- College of Computer Science & Technology, Zhejiang University of Technology, Hangzhou 310023, China
| | - Yongping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region
| | - Cong Bai
- College of Computer Science & Technology, Zhejiang University of Technology, Hangzhou 310023, China.
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18
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The preliminary outcomes of vertebral body tethering in treating adolescent idiopathic scoliosis: a systematic review. Spine Deform 2022; 10:1233-1243. [PMID: 35841473 DOI: 10.1007/s43390-022-00546-0] [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: 03/10/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE VBT is a novel alternative to spinal fusion surgery to treat skeletally immature AIS and was approved to correct idiopathic scoliosis in August 2019 by US Federal Drug Administration (FDA). To systemically review the preliminary outcomes of vertebral body tethering (VBT) in treating adolescent idiopathic scoliosis. METHODS The electronic databases PubMed, EMBASE, and Web of Science were queried up to January 2022 for articles regarding VBT. Basic characteristics of patients, changes of radiographic parameters in coronal and sagittal planes, and clinical outcomes of surgical treatment of VBT including complication and revision rates were summarized. RESULTS Twenty five studies met the inclusion criteria. Most studies (23/25) included patients with only skeletal immaturity. The average % correction of the main/tethered curve at final follow-up, and % correction of thoracic kyphosis at final follow-up were reported to be 15.6-106.5% and - 31.8 to 20.0%, respectively. The most common complications for VBT were tether breakage (n = 145;21.3%), pulmonary complications (n = 49; 6.9%), and overcorrection (n = 30; 4.2%). The revision rate was 13.1%. CONCLUSION VBT could effectively and safely correct spinal deformity in skeletally immature patients with AIS and preserve the motion and growth of the spine. However, VBT has a relatively high complication and revision rates. Therefore, surgeons should cautiously consider VBT for treating AIS. Future research efforts are needed to lower the complication and revision rates. Whatever, VBT is still in its infancy and may have a promising future as a non-fusion solution for AIS.
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Lau KKL, Law KKP, Kwan KYH, Cheung JPY, Cheung KMC, Wong AYL. Timely Revisit of Proprioceptive Deficits in Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis. Global Spine J 2022; 12:1852-1861. [PMID: 34911378 PMCID: PMC9609540 DOI: 10.1177/21925682211066824] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES The present review aimed to summarize the evidence regarding differences in proprioception between children with and without adolescent idiopathic scoliosis (AIS). METHODS Seven electronic databases were searched from their inception to April 10, 2021. Articles were included if they involved: (1) AIS patients aged between 10 and 18 years, (2) measurements of proprioceptive abilities, and (3) comparisons with non-AIS controls. Animal studies, case reports, commentaries, conference proceedings, research protocols, and reviews were excluded. Two reviewers independently conducted literature screening, data extraction, risks of bias assessments, and quality of evidence evaluations. Relevant information was pooled for meta-analyses. RESULTS From 432 identified citations, 11 case-control studies comprising 1121 participants were included. The meta-analyses showed that AIS participants displayed proprioceptive deficits as compared to non-AIS controls. Moderate evidence supported that AIS participants showed significantly larger repositioning errors than healthy controls (pooled mean difference = 1.27 degrees, P < .01). Low evidence substantiated that AIS participants had significantly greater motion detection threshold (pooled mean difference = 1.60 degrees, P < .01) and abnormal somatosensory evoked potentials (pooled mean difference = .36 milliseconds, P = .01) than non-AIS counterparts. CONCLUSIONS Consistent findings revealed that proprioceptive deficits occurred in AIS patients. Further investigations on the causal relationship between AIS and proprioception, and the identification of the subgroup of AIS patients with proprioceptive deficit are needed.
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Affiliation(s)
- Kenney K. L. Lau
- Department of Orthopaedics and
Traumatology, The University of Hong
Kong, Hong Kong
| | - Karlen K. P. Law
- Department of Orthopaedics and
Traumatology, The University of Hong
Kong, Hong Kong
| | - Kenny Y. H. Kwan
- Department of Orthopaedics and
Traumatology, The University of Hong
Kong, Hong Kong
| | - Jason P. Y. Cheung
- Department of Orthopaedics and
Traumatology, The University of Hong
Kong, Hong Kong
| | - Kenneth M. C. Cheung
- Department of Orthopaedics and
Traumatology, The University of Hong
Kong, Hong Kong,Kenneth M. C. Cheung, Department of
Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital,
Pokfulam Road, Hong Kong.
| | - Arnold Y. L. Wong
- Department of Rehabilitation
Sciences, The Hong Kong Polytechnic
University, Hong Kong,Arnold Y. L. Wong, Department of
Rehabilitation Sciences, The Hong Kong Polytechnic University, Yuk Choi Road,
Hong Kong.
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20
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AKGÜL H, KILIÇ BB, SELÇUK H, SERMENLİ AYDIN N, METE E, SARI DM, DRAKE S, KURU ÇOLAK T. CURRENT KNOWLEDGE OF SCOLIOSIS IN PHYSIOTHERAPISTS AND PHYSIOTHERAPY STUDENTS TRAINED IN TURKEY. TÜRK FIZYOTERAPI VE REHABILITASYON DERGISI 2022. [DOI: 10.21653/tjpr.945575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Purpose: Present evidence suggests that early detection and correct management is an essential part of scoliosis treatment. Therefore, the physiotherapists and physiotherapy students must have adequate knowledge of scoliosis. The purpose of this study was to evaluate the current knowledge of physiotherapists and physiotherapy students in Turkey on scoliosis.
Methods: A previously designed questionnaire on the basis of International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) guideline consists of two sections was used in this study. The first section included eight questions to evaluate the knowledge level on the definition, cause, development, prevalence, diagnosis, treatment, and bracing of scoliosis. The second section included three multiple-choice questions to analyze the participants’ opinions on exercises for scoliosis. All Turkish universities offering physiotherapy degrees and graduated physiotherapists from certain social media groups were invited to participate in the study.
Results: 649 physiotherapists and 497 students completed the questionnaire. Scoliosis is recognized as a 3-dimensional deformity of the spine by 39.8% of the students and 57.2% of the physiotherapists. Only 19.5% of the students and 30.7% of the physiotherapists correctly identified the diagnostic criteria for scoliosis. For therapeutic exercise, 48.7% of the students and 61.3% percent of the physiotherapists identified the appropriate approach, and also 57.3% of the students and 62.6% of the physiotherapists correctly identified the bracing recommendations.
Conclusion: Results of this study showed that physiotherapists and physiotherapy students do not have sufficient knowledge of scoliosis. Action needs to be taken to improve the awareness and basic knowledge level of scoliosis.
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AlAssiri SS, Aleissa SI, Alhandi AA, Konbaz FM, Alhelal F, Abaalkhail M, Al-Annaim MM, Alhabeeb A, Alshehri KM. Prevalence and Predictors of Scoliosis and Back Pain in 591 Adolescents: A Randomized, Stratified, Cross-Sectional Study in Riyadh, Saudi Arabia. Cureus 2022; 14:e26478. [PMID: 35923496 PMCID: PMC9342667 DOI: 10.7759/cureus.26478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Owing to the difficulty of establishing a screening program for scoliosis and back pain, along with their disabling consequences and the lack of local prevalence rates, we sought to study the prevalence of scoliosis and back pain in adolescents in Saudi Arabia and the burden reported by the affected age group on the health system. Materials and methods A school-based, cross-sectional pilot study covering all school districts in Riyadh, Saudi Arabia, was conducted. Students between 12 and 18 years of age were included. Students with any spinal or neurological disorders were excluded. Physical examinations to screen for scoliosis and student-filled questionnaires to assess back pain and health-related quality of life were performed. Results Of the 700 students, 591 met the inclusion criteria. High suspicion of adolescent idiopathic scoliosis (AIS) was considered in 174 students (29.44%). In addition, 45.42% of the students had a history of back pain. The Oswestry Disability Index showed that 87 students had disabilities. The average Scoliosis Research Society-22 score was 3 out of 5. A significant difference was found in the self-image and mental health domains for AIS (p = 0.04, p = 0.02, respectively). Age showed a significant increase in the odds ratio of a positive physical exam for every increase of one year in age (p < 0.01). Conclusion Identifying the prevalence rates and early associated factors during adolescence would help lower the burden on the health system and benefit public health in general. A nationwide study is required to identify the relationship between scoliosis and back pain.
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Engel R, McAviney J, Graham PL, Anderson PJ, Brown BT. Novel Screening Tool for Adolescent Idiopathic Scoliosis: A Reliability Study. J Manipulative Physiol Ther 2022; 45:358-364. [PMID: 36184322 DOI: 10.1016/j.jmpt.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/25/2022] [Accepted: 08/07/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to assess the agreement between a web-based scoliosis screening tool and a standard screening procedure. METHODS Sixty participants were selected (median age, 12 years; 75% were women) and separated into 2 groups: those with unknown spinal curvature status and those with confirmed scoliosis. Each participant was assessed by 2 blinded assessors, with one measuring the angle of trunk rotation using a scoliometer and the second using a web-based screening application. The app provided a relative risk score for having scoliosis based on a weighted algorithm. Those with an angle of trunk rotation ≥7° or risk score >2 were deemed as being at risk for having scoliosis. RESULTS There was fair agreement (kappa = 0.34; 95% confidence interval [CI], 0.14-0.55; P < .001) between the app and the scoliometer among the unconfirmed cases. The McNemar test indicated a difference in the proportion of positive tests (P = .001), whereby the screening app produced a significantly higher number of positive tests (15/53 = 28.3%) compared to the standard screening procedure (4/53 = 7.5%) for unconfirmed cases. Among the confirmed cases, the app correctly identified 5 out of 7 (sensitivity: 71%; 95% CI, 29%-96%) participants, whereas the scoliometer correctly identified 6 out of 7 (sensitivity: 86%; 95% CI, 42%-100%) participants. CONCLUSION These findings indicate fair agreement between the app and the scoliometer, though it was not possible to precisely estimate the sensitivity of the app in this study.
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Affiliation(s)
- Roger Engel
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Jeb McAviney
- Sydney Scoliosis Clinic, Kogarah, New South Wales, Australia
| | - Petra L Graham
- School of Mathematical and Physical Sciences, Faculty of Science and Engineering, Macquarie University, North Ryde, New South Wales, Australia
| | - Peter J Anderson
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Benjamin T Brown
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia.
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Cheng T, Einarsdottir E, Kere J, Gerdhem P. Idiopathic scoliosis: a systematic review and meta-analysis of heritability. EFORT Open Rev 2022; 7:414-421. [PMID: 35638601 PMCID: PMC9257730 DOI: 10.1530/eor-22-0026] [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] [Indexed: 11/29/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Tian Cheng
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Einarsdottir
- Department of Gene Technology, School of Engineering Sciences in Chemistry, Biotechnology and Health, Royal Institute of Technology, Stockholm, Sweden
| | - Juha Kere
- Department of Biosciences and Nutrition (BioNut), Karolinska Institutet, Stockholm, Sweden.,Folkhälsan Research Center, Helsinki, Finland
| | - Paul Gerdhem
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
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Altered mechanotransduction in adolescent idiopathic scoliosis osteoblasts: an exploratory in vitro study. Sci Rep 2022; 12:1846. [PMID: 35115632 PMCID: PMC8813918 DOI: 10.1038/s41598-022-05918-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is the most prevalent pediatric spinal deformity. We previously demonstrated elongated cilia and an altered molecular mechanosensory response in AIS osteoblasts. The purpose of this exploratory study was to characterize the mechanosensory defect occurring in AIS osteoblasts. We found that cilia length dynamics in response to flow significantly differ in AIS osteoblasts compared to control cells. In addition, strain-induced rearrangement of actin filaments was compromised resulting in a failure of AIS osteoblasts to position or elongate in function of the bidirectional-applied flow. Contrary to control osteoblasts, fluid flow had an inhibitory effect on AIS cell migration. Moreover, flow induced an increase in secreted VEGF-A and PGE2 in control but not AIS cells. Collectively our data demonstrated that in addition to the observed primary cilium defects, there are cytoskeletal abnormalities correlated to impaired mechanotransduction in AIS. Thus, we propose that the AIS etiology could be a result of generalized defects in cellular mechanotransduction given that an adolescent growing spine is under constant stimulation for growth and bone remodeling in response to applied mechanical forces. Recognition of an altered mechanotransduction as part of the AIS pathomechanism must be considered in the conception and development of more effective bracing treatments.
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Study on the Reliability and Accuracy of Scolioscope, a New Digital Scoliometer. Diagnostics (Basel) 2022; 12:diagnostics12010142. [PMID: 35054308 PMCID: PMC8774419 DOI: 10.3390/diagnostics12010142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/28/2022] Open
Abstract
Early detection of scoliosis with school screening and quick, easy, and reliable assessment of its progress are of paramount importance in the management of patients. There have been several tools described, with the most common being the analog scoliometer. Most recently, smartphone applications have entered this area with and without the use of sleeves for the device. There is no research that has evaluated the accuracy of measurements both left and right in either digital or analog devices. In this study, we evaluated the reliability and validity of a new digital scoliometer called the Scolioscope. Thirty subjects were included for the intra-rater reliability study. ICC values >0.9 were calculated both for same-day and between-day measurements. The device was highly accurate with an average difference from the ones set on the sine bar of 0.03° for right-side measurements and 0.18° for the left. These measurements suggest a highly accurate and reliable tool.
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Kluszczyński M, Pilis A, Czaprowski D. The importance of the size of the trunk inclination angle in the early detection of scoliosis in children. BMC Musculoskelet Disord 2022; 23:5. [PMID: 34980063 PMCID: PMC8725290 DOI: 10.1186/s12891-021-04965-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early detection of idiopathic scoliosis is one factor in determining treatment effectiveness. Therefore, the aim of this study was to assess the importance of the size of the trunk inclination angle (ATI) for the early detection of scoliosis in preschool- and school-age children, taking into account the location and size of the spine curvature. METHODS The study included a group of 216 children (mean age 11.54 years, standard deviation ± 3.05), who had previously untreated idiopathic scoliosis and a Cobb angle of ≥ 10°. The ATI values were compared with the corresponding Cobb angle values. The results of the ATI-Cobb correlation were compared to the ATI thresholds of 5° and 7°. RESULTS In the age groups 6-9, 10-12 and 13-17 years, the method sensitivity for the ATI ≥ 7° criterion was low at 33.90%, 27.69% and 51.29% (p < 0.05), respectively, while for the ATI ≥ 5° criterion, it was 67.8%, 69.23% and 93.48% (p < 0.05), respectively. With respect to location, significantly more frequent misdiagnoses (p < 0.05) were related to the lumbar and thoracolumbar (regions) sections of the spine in the groups aged 6-9 and 10-12 for ATI ≥ 7°; while no significant relationship was found at ATI ≥ 5°. For both ATI levels, the most frequent cases of mis- or undiagnosed scoliosis were observed among children with a Cobb angle of 10°-14° (p = 0.004). CONCLUSION A low predictive ATI value was demonstrated regarding scoliosis detection for the ATI 7° criterion in children aged 6-9 and 10-12 years, particularly for the lumbar and thoracolumbar locations. Adoption of the threshold of ATI 5° in screening tests for children aged 6-12 years, as well as for lower locations of scoliosis, may be more effective in the early detection of scoliosis. TRIAL REGISTRATION This study was approved by the Jan Dlugosz University in Czestochowa Ethics Committee KE-U/7/2021, and conducted under the Declaration of Helsinki.
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Affiliation(s)
- Marek Kluszczyński
- Department of Health Sciences, Jan Dlugosz University, ul. Waszyngtona 4/8, 42-200, Częstochowa, Poland. .,Medical Rehabilitation Center "Troniny", ul. Stanislawa Staszica 34, 42-100, Klobuck, Poland.
| | - Anna Pilis
- Department of Health Sciences, Jan Dlugosz University, ul. Waszyngtona 4/8, 42-200, Częstochowa, Poland
| | - Dariusz Czaprowski
- Department of Rehabilitation, University of Medical Sciences in Poznan, Fredry 10, 61-701, Poznan, Poland
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Labecka MK, Plandowska M. Moiré topography as a screening and diagnostic tool-A systematic review. PLoS One 2021; 16:e0260858. [PMID: 34855885 PMCID: PMC8639098 DOI: 10.1371/journal.pone.0260858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/17/2021] [Indexed: 11/18/2022] Open
Abstract
Diagnostic investigation can be carried out using non-radiological and non-contact methods. Moiré topography (MT) seems to be a viable alternative to radiographic research in evaluating the spine and/or trunk deviations. The aim of this systematic review was to analyze the current knowledge regarding the reliability and validity of Moiré topography as a screening and diagnostic tool. The systematic review was performed from 2010 until March 2021 in the PubMed, EBSCO, Web of Science, and Scopus databases, according to the eligibility criteria. This review fulfilled the following criteria according to the PICO system: population (children and adolescents), intervention (MT measurement), comparison (repeated MT measurements, MT compared to Cobb angle or scoliometer), outcome (reliability and validity of MT). Eight studies fulfilled the inclusion criteria for further analysis. All the studies were assessed to be of high quality. Included studies found that MT had high repeatability and high intraobserver and interobserver correlation, and correlation between MT parameters and radiographic Cobb angle ranged from moderate to high. The authors reported difficulty in defining the cut-off values for MT parameter (Surface Trunk Rotation-STR), and unsatisfactory sensitivity and specificity of MT examination. The studies did not reveal the advantage of MT as a screening method in the detection of idiopathic scoliosis in comparison to radiograph. Based on the evidence from eight studies, the results indicated moderate evidence for reliability and validity of Moiré topography as a screening and diagnostic tool. There is still no strong evidence for the accuracy of MT.
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Affiliation(s)
- Marta Kinga Labecka
- Department of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Biala Podlaska, Poland
| | - Magdalena Plandowska
- Faculty of Physical Education and Health in Biala Podlaska, Jozef Pilsudski University of Physical Education in Warsaw, Biala Podlaska, Poland
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Physical Functioning in Adolescents with Idiopathic Scoliosis: A Systematic Review of Outcome Measures and Their Measurement Properties. Spine (Phila Pa 1976) 2021; 46:E985-E997. [PMID: 33496543 DOI: 10.1097/brs.0000000000003969] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systematic review. OBJECTIVE To summarize evidence on measurement properties of Outcome Measures (OM) used to assess physical functioning in adolescents with idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA The AIS is a common spine deformity in those aged 10 to 18 years old. Associated health problems (e.g., back pain) significantly impact the quality of life (QoL). One important domain in QoL is physical functioning, which can be measured with patient-reported outcome measures (PROM), performance-based outcome measures (PBOM), and body structure and function OM. Adequate measurement properties of OM are important for precision in research and practice. METHODS A two-staged search strategy was performed on electronic databases up to December 2019. Search one revealed a list of OM was used for physical functioning assessment in AIS. Search two identified studies that evaluated the measurement properties of OM in AIS; using the list identified in search one. Two independent reviewers determined study eligibility, risk of bias assessment (COnsensus-based Standards for the selection of health Measurement INstruments [COSMIN] checklist), and performed data extraction. The level of evidence was established using a modified GRADE approach. RESULTS Search one yielded: 28 PROM, 20 PBOM, and 10 body structure and function OM. Search two revealed: 16 measurement properties studies for PROM, one for PBOM, and three for body structure and function measures. Construct validity, reliability, and responsiveness of most PROM has been established in AIS, but not content validity or internal consistency (moderate evidence). Construct validity was sufficient for the Timed Up and Go test and body structure and function measures (very low to low evidence). CONCLUSION Currently, physical functioning is evaluated with a variety of measures in AIS. The majority of measurement properties studies evaluated PROM with a paucity of information on measurement properties of PBOM and body structure and function OM. Based on COSMIN methodology, none of the OM identified in this review can be recommended with confidence in individuals with AIS.Level of Evidence: 2.
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Navarro IJRL, Godinho RAT, Candotti CT. Validating Surface Topography for the Measurement of the Thoracic Kyphosis Angle in Patients With Scoliosis: A Prospective Study of Accuracy. J Manipulative Physiol Ther 2021; 44:497-503. [PMID: 34456044 DOI: 10.1016/j.jmpt.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 09/04/2020] [Accepted: 06/15/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to test the validity and determine the accuracy of surface topography in relation to photogrammetry for measuring the thoracic kyphosis angle in patients with scoliosis. METHODS This was a prospective, cross-sectional study of diagnostic accuracy that followed the guidelines recommended by the Standards for Reporting Diagnostic Accuracy. We consecutively included 51 participants aged 7 to 18 years. Exclusion criteria were surgical treatment of the spine, neurological disease, lower limb discrepancy greater than 1.5 cm, and body mass index above 29 kg/m². Each participant was evaluated using both a surface topography scan and photogrammetry in random order. The measurement obtained through photogrammetry was used as a reference in this study. For statistical purposes, Pearson's correlation test, Bland-Altman graphical analysis, and the receiver operating characteristic curve (P < .05) were performed. RESULTS The correlation between the measurements was strong and significant (r = 0.76, P < .001) with an average difference of 0.4° in the Bland-Altman analysis. The receiver operating characteristic curve area was excellent for hypokyphosis (93.4%) and good for hyperkyphosis (86.4%), both being significant (P < .005). CONCLUSION The agreement and strong correlation between the 2 methods indicate the validity of surface topography to measure the thoracic kyphosis angle. The surface topography provides accurate measures for the thoracic kyphosis angle with cutoff points for hypo- (33.3°) and hyperkyphosis (40.8°) for individuals with scoliosis.
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Affiliation(s)
- Isis J R L Navarro
- Biomechanics Department, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Rúbia A T Godinho
- Biomechanics Department, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cláudia T Candotti
- Biomechanics Department, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
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30
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Bachmann KR. Spinal Deformities in the Adolescent Athlete. Clin Sports Med 2021; 40:541-554. [PMID: 34051945 DOI: 10.1016/j.csm.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Idiopathic scoliosis will be noted in 2% to 3% of typically developing athletes. Sports physicals are an opportunity to screen for spinal deformity and to promote healthy involvement in activities. Bracing is effective at limiting further progression if a curve progresses beyond 20°. If spinal fusion is performed, most surgeons allow return to noncontact and contact sports by 6 to 12 months. There are many other conditions associated with scoliosis that require a more nuanced approach and assessment of the entire patient. Patients with Down syndrome should be examined for myelopathy before participation and a lateral radiograph obtained if concerned for instability.
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Affiliation(s)
- Keith R Bachmann
- Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA 22908, USA.
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Li C, Zhang B, Liu L, Li Y, Xu Y, Wang L, Yun C, Zhao Y. Design, reliability, and validity of a portable electronic device based on ergonomics for early screening of adolescent scoliosis. J Orthop Translat 2021; 28:83-89. [PMID: 33786321 PMCID: PMC7972962 DOI: 10.1016/j.jot.2020.10.014] [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: 06/29/2020] [Revised: 09/24/2020] [Accepted: 10/20/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND/OBJECTIVE The reported incidence of scoliosis among adolescents in China differs according to screening method owing to the lack of uniformity and limitations of certain techniques. We aimed to design, develop, and validate a non-invasive, accurate, portable, fast, and automated tool that would enable the measurement and storage of data during scoliosis screening. METHODS We designed a new portable electronic scoliosis screening device (PESSD)-for the identification of adolescent scoliosis based on ergonomics theory. The device measured the axial deflection angle of the trunk of the human body using a built-in angle sensor. Data obtained using the PESSD, a traditional scoliometer manual ruler, and X-ray measurement of the Cobb angle were compared. RESULTS The PESSD exhibited more sensitive detection of small-angle scoliosis and improved repeatability compared with the scoliometer. The data obtained using the PESSD showed good correlation with Cobb angle data measured from X-ray images. All patients who were indicated to be positive for scoliosis using the PESSD were found to have clinically identifiable scoliosis from X-ray examination. CONCLUSIONS The PESSD may be able to achieve early detection of scoliosis in adolescents. It is non-invasive, highly precise, portable, easy to use, and offers automated data storage and traceability. This study is a pilot or preliminary validation study. With further, more in depth studies, the PESSD has excellent potential for transformation into an effective tool for use in large-scale screening programs for adolescent scoliosis in schools and communities. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE This article is about designing a new portable electronic scoliosis screening device based on ergonomics theory. Because there are currently no uniform screening methods and standards, the results in this article could facilitate the adoption of a uniform screening tool into large-scale screening programs for adolescent scoliosis in schools and communities, preliminary examination in hospitals, and self-testing at home after parent training.
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Affiliation(s)
- Chunxu Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Bojun Zhang
- Department of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, Shanxi, 710049, China
| | - Liang Liu
- National Key Laboratory of Human Factors Engineering, China Astronaut Research and Training Center, Beijing, 100094, China
| | - You Li
- National Key Laboratory of Human Factors Engineering, China Astronaut Research and Training Center, Beijing, 100094, China
| | - Yong Xu
- Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, 100043, China
| | - Li Wang
- National Key Laboratory of Human Factors Engineering, China Astronaut Research and Training Center, Beijing, 100094, China
| | - Cai Yun
- Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, 100043, China
| | - Yu Zhao
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
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Abstract
The national recommendations for school screening programs for scoliosis in the United States have undergone a shift in perspective over the past two decades. In 2004, the United States Preventive Services Task Force recommended against screening programs but changed its recommendation to be inconclusive in 2018. Early diagnosis of scoliosis can allow for close monitoring of the deformity and early initiation of bracing treatment when appropriate, with the goal of preventing costly and invasive surgical intervention. Several different diagnostic tools are available, including Adam's forward bending test alone, Adam's forward bending test with scoliometry, the humpometer, and Moiré topography, each with varying degrees of sensitivity and specificity. Controversy prevails over the cost efficacy of screening programs and possible unnecessary exposure of adolescents to radiation for confirmatory radiographs after a positive screening test. However, the recent definitive evidence of bracing treatment efficacy in slowing the progression of scoliotic curves and preventing the need for surgery indicates that school screening programs may still have a role in allowing early diagnosis.
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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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Park SJ, Lee KH, Lee CS, Kim KT, Jang JH, Shin DH, Kim MS, Kim J, Cho SY, Jin DK. Impact of growth hormone treatment on scoliosis development and progression: analysis of 1128 patients with idiopathic short stature. J Pediatr Endocrinol Metab 2021; 34:243-250. [PMID: 33180047 DOI: 10.1515/jpem-2020-0393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the impact of recombinant human growth hormone (rhGH) on the development and progression of scoliosis in patients with idiopathic short stature (ISS). METHODS Patients with ISS who underwent rhGH treatment from 1997 to 2017 and were followed up for scoliosis screening with serial radiographic examination were included. For assessing scoliosis development, patients who did not have scoliosis at the time of rhGH treatment were included and followed up to determine whether de novo scoliosis developed during the treatment. For evaluating scoliosis progression, patients who already had scoliosis were analyzed. Univariate and multivariate Cox regression analyses of demographic and radiographic variables were performed to determine the related factors in the development and progression of scoliosis. RESULTS For assessing scoliosis development, 1093 patients were included. The average duration of rhGH treatment was about 2 years. De novo scoliosis developed in 32 patients (3.7%). The analysis revealed that sex (p=0.016) and chronological age (p=0.048) were statistically significant factors associated with scoliosis development. However, no relationship was observed between scoliosis development and rhGH treatment types or duration. Among 67 patients who already had scoliosis at the time of rhGH treatment, 11 (16.4%) showed scoliosis progression. However, the rhGH types and duration also did not affect scoliosis progression. CONCLUSIONS De novo scoliosis developed in 3.7% and scoliosis progressed in 16.4% of the patients during rhGH treatment. However, scoliosis development or progression was not affected by the types or duration of rhGH treatment in patients with ISS.
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Affiliation(s)
- Se-Jun Park
- Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keun-Ho Lee
- Department of Orthopedic Surgery, College of Medicine, Hallym University, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Chong-Suh Lee
- Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki-Tack Kim
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Republic of Korea
| | - Jun Hyuk Jang
- Department of Orthopedic Surgery, College of Medicine, Hallym University, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Dae Hun Shin
- Department of Orthopedic Surgery, College of Medicine, Hallym University, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Min Sun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jiyeon Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yoon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Kyu Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Anthony A, Zeller R, Evans C, Dermott JA. Adolescent idiopathic scoliosis detection and referral trends: impact treatment options. Spine Deform 2021; 9:75-84. [PMID: 32780304 PMCID: PMC7775861 DOI: 10.1007/s43390-020-00182-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/31/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective cross-sectional study. OBJECTIVE To analyze the patient demographic referred for scoliosis to the Hospital for Sick Children to determine the proportion of patients suitable for brace treatment, as per the Scoliosis Research Society guidelines. There is level 1 evidence that bracing in adolescent idiopathic scoliosis (AIS) decreases the risk of curve progression and need for surgery, but optimal brace treatment requires early curve detection. METHODS We performed a retrospective review of 618 consecutive patients who underwent initial assessment in our Spine Clinic between Jan. 1 and Dec. 31, 2014. We included children 10-18 years, with scoliosis greater than 10°, excluding those diagnosed with non-idiopathic curves. Primary outcomes were Cobb angle, menarchal status, and Risser score. We analyzed the effect of specific referral variables (family history, the person who first noticed the curve, and geographic location of residence) on presenting curve magnitude. RESULTS During the study period, 335 children met the inclusion criteria, with an average age of 14.1 ± 1.8 years and a mean Cobb angle of 36.8 ± 14.5°. Brace treatment was indicated in 17% of patients; 18% had curves beyond optimal curve range for bracing (> 40°), and 55% were skeletally mature, therefore not brace candidates. The majority of curves (54%) were first detected by the patient or family member and averaged 7° more than curves first detected by a physician. A family history of scoliosis made no difference to curve magnitude, nor did geographic location of residence. CONCLUSION The majority of AIS patients present too late for effective management with bracing. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alison Anthony
- Division of Rehabilitation Services, Hospital for Sick Children, Toronto, ON, Canada.
| | - Reinhard Zeller
- Division of Orthopaedic Surgery, Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cathy Evans
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Jennifer A Dermott
- Division of Rehabilitation Services, Hospital for Sick Children, Toronto, ON, Canada
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Lubkowska A, Gajewska E. Temperature Distribution of Selected Body Surfaces in Scoliosis Based on Static Infrared Thermography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238913. [PMID: 33266229 PMCID: PMC7731444 DOI: 10.3390/ijerph17238913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022]
Abstract
The purpose of the research was to assess the usefulness of thermography as a complementary method in musculoskeletal dysfunction, with particular emphasis on scoliosis. The children, aged 7–16, were classified into one of two groups: the study group—children with scoliosis (n = 20), and the reference group—healthy children (n = 20). All children underwent anthropometric tests, body mass index determination, four pictures each with a FLIR T1030sc HD thermal imaging camera, and measurement of spinal rotation with a scoliometer (Gima, Italy). There is a temperature differential (about 4 °C) within the upper and lower body in children. In healthy children, differences in temperature of contralateral areas of the body do not exceed 0.5 °C. Thermography is a useful and noninvasive method of assessing muscular tension disbalance in the course of scoliosis. In the case of scoliosis, the areas of the body with a significant thermal asymmetry of the surface are the upper back, thighs, and back of the lower legs. Due to the high positive correlation of the spinal rotation angle with the amount of thermal asymmetry, the areas that should be subjected to a detailed thermal assessment in the supplementary diagnosis of scoliosis using thermovision are the upper back, chest, thighs, and back of the lower legs.
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Affiliation(s)
- Anna Lubkowska
- Chair and Department of Functional Diagnostics and Physical Medicine, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 54 Żołnierska Str, 71-210 Szczecin, Poland
- Correspondence:
| | - Ewa Gajewska
- Department of Developmental Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego Str, 60-355 Poznan, Poland;
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Barba N, Ignasiak D, Villa TMT, Galbusera F, Bassani T. Assessment of trunk muscle activation and intervertebral load in adolescent idiopathic scoliosis by musculoskeletal modelling approach. J Biomech 2020; 114:110154. [PMID: 33279818 DOI: 10.1016/j.jbiomech.2020.110154] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine, the aetiology and pathogenesis of which are poorly understood. Unfortunately, biomechanical data describing trunk muscle activation and intervertebral load, which can contribute to understanding the pathomechanics of the AIS spine, cannot be measured in vivo due to the invasiveness of the procedures. The present study provides the biomechanical characterization of the spinal loads in scoliotic subjects by exploiting musculoskeletal modelling approach, allowing for calculating biomechanical measures in an assigned posture. A spine model with articulated ribcage previously developed in AnyBody software was applied. The predicted outcomes were evaluated in the upright posture, depending on scoliosis severity and curve type, in a population of 132 scoliotic subjects with mild, moderate, and severe scoliosis. Radiographic-based three dimensional reconstruction of vertebral orientations and scaling of body segments and trunk muscle cross-section area guaranteed geometrical subject-specificity. Validation analysis supporting the application of the model was performed. Trunk muscles were found more activated in the convex side of the scoliotic curve, in agreement with reference in vivo measurements, with progressive increase with scoliosis severity. The intervertebral lateral shear was found positively correlated with the severity of the scoliosis, demonstrating that the transferred load is not a priori orthogonal to vertebral endplate in the frontal plane, and thus questioning the assumption of the 'follower load' approach in case of experimental or computational study on the scoliotic spine. The study opens the way for the subject-specific characterization of scoliosis in assigned loading and motion conditions.
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Affiliation(s)
- Noemi Barba
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | | | - Tomaso Maria Tobia Villa
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Fabio Galbusera
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. LABS - Laboratory of Biological Structures Mechanics
| | - Tito Bassani
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. LABS - Laboratory of Biological Structures Mechanics..
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Płaszewski M, Grantham W, Jespersen E. Screening for scoliosis - New recommendations, old dilemmas, no straight solutions. World J Orthop 2020; 11:364-379. [PMID: 32999857 PMCID: PMC7507078 DOI: 10.5312/wjo.v11.i9.364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/29/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
This opinion review considers the prevailing question of whether to screen or not to screen for adolescent idiopathic scoliosis. New and improved standards of people-oriented care and person-centredness, as well as improved principles of preventive screening and guideline development, have been postulated and implemented in health care systems and cultures. Recommendations addressing screening for scoliosis differ substantially, in terms of their content, standards of development and screening principles. Some countries have discontinued issuing recommendations. In the last decade, a number of updated and new recommendations and statements have been released. Systematically developed guidelines and recommendations are confronted by consensus and opinion-based statements. The dilemmas and discrepancies prevail. The arguments concentrate on the issues of the need for early detection through screening in terms of the effectiveness of early treatment, on costs and cost-effectiveness issues, scientific and epidemiologic value of screenings, and the credibility of the sources of evidence. The problem matter is of global scale and applies to millions of people. It regards clinical and methodological dilemmas, but also the matter of vulnerable and fragile time of adolescence and, more generally, children's rights. The decisions need to integrate people's values and preferences - screening tests need to be acceptable to the population, and treatments need to be acceptable for patients. Therefore we present one more crucial, but underrepresented in the discussion, issue of understanding and implementation of the contemporary principles of person-centred care, standards of preventive screening, and guideline development, in the context of screening for scoliosis.
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Affiliation(s)
- Maciej Płaszewski
- Department of Rehabilitation in Biała Podlaska, Józef Piłsudski University of Physical Education, Biała Podlaska 21-500, Poland
| | - Weronika Grantham
- Faculty of Physical Education and Health in Biała Podlaska, Józef Piłsudski University of Physical Education, Biała Podlaska 21-500, Poland
| | - Ejgil Jespersen
- Department of Rehabilitation in Biała Podlaska, Józef Piłsudski University of Physical Education, Biała Podlaska 21-500, Poland
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Harasymczuk P, Glowacki M, Wojtkow M. Reliability of a New Smartphone Accessory for Scoliosis Measurements. J Med Device 2020. [DOI: 10.1115/1.4048373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
BACKGROUND: Idiopathic scoliosis is the most common pathology of the children’s spine, identified as spine lateral curvature with Cobb angle greater than 10°. The rapid development of technology allows, even mobile devices, to perform a quick and cheap diagnosis ensuring an accuracy similar to the Bunnell scoliometer.
OBJECTIVE: The study aimed to validate the accuracy of a newly developed accessory for measuring the angle of trunk rotation (ATR) using mobile devices.
METHODS: ATR measurements were carried out on a group of 30 adults using 3 diagnostic tools: the Bunnell scoliometer, Scolioscreen, and mScolio designed by the authors. Scolioscreen and mScolio were used together with a smartphone and the Clinometer app. Three measurements were performed using each of the methods.
RESULTS: The greatest data discrepancy was obtained between the Bunnell scoliometer and Scolioscreen (-3.7°÷4.4°) and was twice larger than between the Bunnell scoliometer and mScolio (-1.8°÷2.1°). The excellent agreement was obtained for the mScolio device, where the concordance correlation coefficient was 0.9381 (95% CI of 0.9076÷0.9588) and the interclass correlation coefficient was 0.9501 (95% CI of 0.9242÷0.9671).
CONCLUSIONS: Tests showed excellent reliability and validity of ATR using the mScolio solution. Obtained results show excellent consistency between mScolio and the Brunnell scoliometer measurements.
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Affiliation(s)
- Piotr Harasymczuk
- Department of Paediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, 61-545 Poznan, Poland
| | - Maciej Glowacki
- Department of Paediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, 61-545 Poznan, Poland
| | - Magdalena Wojtkow
- Department of Department of Mechanics, Material and Biomedical Engineering, Wroclaw University of Science and Technology, 50-371 Wroclaw, Poland
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Predicting Adolescent Idiopathic Scoliosis among Chinese Children and Adolescents. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1784360. [PMID: 32766304 PMCID: PMC7387995 DOI: 10.1155/2020/1784360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/30/2020] [Accepted: 06/11/2020] [Indexed: 12/01/2022]
Abstract
Objective Adolescent idiopathic scoliosis (AIS) affects 1%-4% of adolescents in the early stages of puberty, but there is still no effective prediction method. This study aimed to establish a prediction model and validated the accuracy and efficacy of this model in predicting the occurrence of AIS. Methods Data was collected from a population-based school scoliosis screening program for AIS in China. A sample of 884 children and adolescents with the radiological lateral Cobb angle ≥ 10° was classified as an AIS case, and 895 non-AIS subjects with a Cobb angle < 10° were randomly selected from the screening system. All selected subjects were screened by visual inspection of clinical signs, the Adam's forward-bending test (FBT), and the measurement of angle of trunk rotation (ATR). LR and receiver operating characteristic (ROC) curves were used to preliminarily screen the influential factors, and LR models with different adjusted weights were established to predict the occurrence of AIS. Results Multivariate LR and ROC curves indicated that angle of thoracic rotation (adjusted odds ratios (AOR) = 5.18 − 10.06), angle of thoracolumbar rotation (AOR = 4.67 − 7.22), angle of lumbar rotation (AOR = 6.97 − 8.09), scapular tilt (area under the curve (AUC) = 0.77, 95% CI: 0.75-0.80), shoulder-height difference, lumbar concave, and pelvic tilt were the risk predictors for AIS. LR models with different adjusted weights (by AOR, AUC, and AOR+AUC) performed similarly in predicting the occurrence of AIS compared with multivariate LR. The sensitivity (82.55%-83.27%), specificity (82.59%-83.33%), Youden's index (0.65-0.67), positive predictive value (82.85%-83.58%), negative predictive value (82.29%-83.03%), and total accuracy (82.57%-83.30%) manifested that LR could accurately identify patients with AIS. Conclusions LR model is a relatively high accurate and feasible method for predicting AIS. Increased performance of LR models using clinically relevant variables offers the potential to early identify high-risk groups of AIS.
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Jimbo S, Imai M, Atsuta Y, Kobayashi T, Senoo I, Ito H. Evaluation of a new apparatus combining a mobile device and hand-held roller for the detection of spinal deformities: association with the sum of the right and left angles of trunk inclination. 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 2020; 29:1993-1999. [PMID: 32524285 DOI: 10.1007/s00586-020-06492-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/13/2020] [Accepted: 05/31/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the intra- and inter-observer reliabilities of the newly developed i-Scolioroller for scoliosis screening, and to determine the optimal i-Scolioroller measurement cutoff values for identifying adolescent scoliosis with a Cobb angle ≥ 20°. METHODS The i-Scolioroller displays the right- and left-side maximum inclination angle (Rmax, Lmax) during the forward bending test (FBT), as well as the angle of trunk inclination (ATI, i.e., whether the Rmax or Lmax is greater). Sum-ATI is defined as the sum of Rmax and Lmax. Intra-class correlation coefficients (ICC) of the ATI and sum-ATI measurements were calculated to analyze the intra- and inter-observer reliabilities for 10 plaster torsos in FBT positions obtained from patients with idiopathic scoliosis. The optimal cutoff values for scoliosis were determined using receiver operating characteristic (ROC) analysis of i-Scolioroller measurements versus Cobb angles obtained from the upright whole-spine radiographs of 112 adolescent outpatients. RESULTS The intra-observer ICCs for the ATI/sum-ATI for 3 observers were 0.851/0.856, 0.786/0.900, and 0.772/0.796, respectively, while the corresponding inter-observer ICCs for all participants were 0.733/0.745. On ROC analysis, an ATI of 8° was the optimal cutoff value for scoliosis (sensitivity and specificity: 79.2% and 70.0%, respectively). The optimal cutoff value for sum-ATI was 11° (sensitivity and specificity: 86.1% and 82.5%, respectively). The areas under the ROC curves were 0.859 for ATI and 0.908 for sum-ATI. CONCLUSION The optimal cutoff values for identifying scoliosis using the i-Scolioroller were a combination of 11° for the sum-ATI and 8° for the ATI.
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Affiliation(s)
- Shizuo Jimbo
- Department of Orthopaedic Surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Mitsuru Imai
- Department of Orthopaedic Surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yuji Atsuta
- Department of Orthopaedic Surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Tetsuya Kobayashi
- Department of Orthopaedic Surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Issei Senoo
- Department of Orthopaedic Surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Hiroshi Ito
- Department of Orthopaedic Surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
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Sato T, Yonezawa I, Akimoto T, Nobuyuki T, Shimamura Y, Muto O, Suzuki T, Momomura R, Uno K, Yamazaki K, Fujiwara K, Misawa A, Kaneko K. Novel Hump Measurement System With a 3D Camera for Early Diagnosis of Patients With Adolescent Idiopathic Scoliosis: A Study of Accuracy and Reliability. Cureus 2020; 12:e8229. [PMID: 32582490 PMCID: PMC7306634 DOI: 10.7759/cureus.8229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Adolescent idiopathic scoliosis (AIS) is a potentially progressive deformity, and early detection is crucial for timely intervention. However, the methods and criteria justifying screening for pediatric scoliosis remain controversial. We have, therefore, independently developed a Digital Moiré (DM) as a tool for scoliosis screening. The purpose of this study was to assess the usefulness of DM for scoliosis screening. Methods From March 2016 to March 2017, 126 patients (18 boys, 108 girls, mean age: 13.2 ± 2.2 years) with AIS underwent radiographic imaging of their whole spine. We tested the accuracy and reliability of DM by categorizing the examination results as Class 0 (no abnormality), Class 1 (return visit in one year), and Class 2 (further examination needed) and determined the distribution of the population by Cobb angle. The intra/inter-rater reliability and receiver operating characteristic (ROC) analyses were used to categorize the patients with positive findings into Class 1 or 2. Results Regarding the population distribution per Cobb angle in each of the distributions, 11 patients (8.7%) were Class 0, of which nine and two patients had Cobb angle ≤ 10 ° and > 10 °, respectively. There were 20 (15.9% ) Class 1 cases, of which 17 and three had Cobb angle ≤ 10 ° and > 10 °, respectively. Of the 95 (75.4%) Class 2 cases, five and 90 had a Cobb angle of ≤ 10 ° and > 10 °, respectively. The receiver operating characteristic (ROC) analysis of patients with positive findings showed that the area under the curve (AUC), sensitivity, specificity, and false-positive rate were 0.76, 0.98, 0.53, and 0.47, respectively, when predicting Cobb angle > 10°. Intra-rater and inter-rater reliability were 0.73 and 0.70, respectively. Conclusions This study demonstrated the usefulness of DM for determining whether a child with AIS requires a follow-up observation such as radiograph. Our findings suggest that the novel DM shows high accuracy and reliability for scoliosis screening.
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Affiliation(s)
- Tatsuya Sato
- Orthopaedic Surgery, Juntendo University School of Medicine, Bunkyo-ku, JPN
| | - Ikuho Yonezawa
- Orthopaedics, Sangubashi Spine Surgery Hospital, Tokyo, JPN
| | | | - Terada Nobuyuki
- Science and Engineering: Biomedical Engineering, Toyo University, Bunkyo-ku, JPN
| | | | - Osamu Muto
- Orthopaedic Surgery, Juntendo University, Bunkyo-ku, JPN
| | | | - Rei Momomura
- Orthopaedic Surgery, Juntendo Unversity, Bunkyo-ku, JPN
| | - Koki Uno
- Orthopaedic Surgery, Kobe Medical Center, Kobe, JPN
| | - Ken Yamazaki
- Iwate Spinal Scoliosis Center, Tochinai Daini Hospital, Takizawa, JPN
| | - Kenta Fujiwara
- Orthopaedic Surgery, Osaka Medical College, Takatsuki, JPN
| | - Akiko Misawa
- Orthopaedic Surgery, Prefectural Center on Development and Disability, Akita, JPN
| | - Kazuo Kaneko
- Orthopaedic Surgery, Juntendo Unversity, Bunkyo-ku, JPN
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Xiao L, Zhang H, Wang Y, Li J, Yang G, Wang L, Liang Z. Dysregulation of the ghrelin/RANKL/OPG pathway in bone mass is related to AIS osteopenia. Bone 2020; 134:115291. [PMID: 32087335 DOI: 10.1016/j.bone.2020.115291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/15/2020] [Accepted: 02/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Osteopenia has been well documented in adolescent idiopathic scoliosis (AIS), and ghrelin has been shown to have a positive effect on bone metabolism. However, the circulating level of ghrelin is increased in AIS osteopenia, and the relationship between ghrelin and low bone mass in AIS osteopenia remains unclear. METHOD A total of 563 AIS and 281 age-matched controls were recruited for this study. Anthropometry and bone mass were measured in all participants. Plasma ghrelin levels were determined by enzyme-linked immunosorbent assay (ELISA) in both AIS and control groups. An improved multiplex ligation detection reaction was performed to analyze single-nucleotide polymorphisms (SNPs). Facet joints were collected and subjected to immunohistochemistry; osteogenic gene and protein expression was also measured. Furthermore, primary cells were extracted from facet joints and bone marrow to observe the response to ghrelin stimulation. RESULTS The body mass index was lower and circulating ghrelin was markedly higher in the AIS osteopenia group than in the control group. No significant difference was observed in four ghrelin level-related SNPs between the AIS osteopenia and control groups. RNA and protein analyses revealed higher RANKL/OPG and lower runx2 levels in AIS cancellous bone. Compared with normal primary osteoblasts and BMSCs, AIS osteopenia primary cells were insensitive to the same ghrelin concentration gradient and showed lower osteogenic ability, increases in OPG and decreases in RANKL. CONCLUSION Our results indicate that high circulating ghrelin levels may not result from gene variations in AIS osteopenia. Dysregulation of the ghrelin/RANKL/OPG pathway may lead to decreased osteogenic ability of osteoblasts and BMSCs, which may be related to lower bone mass in AIS osteopenia.
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Affiliation(s)
- Lige Xiao
- Department of Spine Surgery, Xiangya Hospital of Central-South University, Changsha 410008, Hunan, China
| | - Hongqi Zhang
- Department of Spine Surgery, Xiangya Hospital of Central-South University, Changsha 410008, Hunan, China
| | - Yunjia Wang
- Department of Spine Surgery, Xiangya Hospital of Central-South University, Changsha 410008, Hunan, China.
| | - Jiong Li
- Department of Spine Surgery, Xiangya Hospital of Central-South University, Changsha 410008, Hunan, China
| | - Guanteng Yang
- Department of Spine Surgery, Xiangya Hospital of Central-South University, Changsha 410008, Hunan, China
| | - Longjie Wang
- Department of Spine Surgery, Xiangya Hospital of Central-South University, Changsha 410008, Hunan, China
| | - Zhuotao Liang
- Department of Spine Surgery, Xiangya Hospital of Central-South University, Changsha 410008, Hunan, China
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A Predictive Model of Progression for Adolescent Idiopathic Scoliosis Based on 3D Spine Parameters at First Visit. Spine (Phila Pa 1976) 2020; 45:605-611. [PMID: 31703055 DOI: 10.1097/brs.0000000000003316] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED MINI: The aim of this prospective cohort study was to improve the prediction of curve progression in AIS. By adding the 3D morphology parameters at first visit, the predictive model explains 65% of the variability. It is one of the greatest advances in the understanding of scoliosis progression in the last 30 years. STUDY DESIGN Prospective cohort study. OBJECTIVE The objective of the present study was to design a model of AIS progression to predict Cobb angle at full skeletal maturity, based on curve type, skeletal maturation, and 3D spine parameters available at first visit. SUMMARY OF BACKGROUND DATA Adolescent idiopathic scoliosis (AIS) is a three-dimensional (3D) spinal deformity that affects 1% of adolescents. Curve severity is assessed using the Cobb angle. Prediction of scoliosis progression remains challenging for the treating physician and is currently based on curve type, severity, and maturity. The objective of this study was to develop a predictive model of final Cobb angle, based on 3D spine parameters at first visit, to optimize treatment. METHODS A prospective cohort of AIS patients at first orthopedic visit was enrolled between 2006 and 2010, all with 3D reconstructions. Measurements of five types of descriptors were obtained: angle of plane of maximum curvature, Cobb angles, 3D wedging, rotation, and torsion. A general linear model analysis with backward selection was done with final Cobb angle (either just before surgery or at skeletal maturity) as outcome and 3D spine parameters and clinical parameters as predictors. RESULTS Of 195 participants, 172 (88%) were analyzed; average age at presentation was 12.5 ± 1.3 years and mean follow-up to outcome, 3.2 years. The final model includes significant predictors: initial skeletal maturation, curve type, frontal Cobb angle, angle of plane of maximal curvature, and 3D disk wedging (T3-T4, T8-T9) and achieved a determination coefficient (R) = 0.643. Positive and negative predictive values to identify a curve of 35 degrees are 79% and 94%. CONCLUSION This study developed a predictive model of spinal curve progression in scoliosis based on first-visit information. The model will help the treating physician to initiate appropriate treatment at first visit. LEVEL OF EVIDENCE 3.
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Carry PM, Duke VR, Brazell CJ, Stence N, Scholes M, Rousie DL, Hadley Miller N. Lateral semi-circular canal asymmetry in females with idiopathic scoliosis. PLoS One 2020; 15:e0232417. [PMID: 32349123 PMCID: PMC7190182 DOI: 10.1371/journal.pone.0232417] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/14/2020] [Indexed: 01/09/2023] Open
Abstract
Purpose Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal structural deformity that occurs in otherwise normal individuals. Although curve progression and severity vary amongst individuals, AIS can lead to significant cosmetic and functional deformity. AIS etiology has been determined to be genetic, however, exact genetic and biological processes underlying this disorder remain unknown. Vestibular structure and function have potentially been related to the etiopathogenesis of AIS. Here, we aimed to characterize the anatomy of the semicircular canals (SCC) within the vestibular system through a novel approach utilizing T2-weighted magnetic resonance images (MRI). Methods Three dimensional, MRI-based models of the SCCs were generated from AIS subjects (n = 20) and healthy control subjects (n = 19). Linear mixed models were used to compare SCC morphological measurements in the two groups. We compared side-to-side differences in the SCC measurements between groups (group*side interaction). Results Side-to-side differences in the lateral SCC were different between the two groups [false discovery rate adjusted p-value: 0.0107]. Orientation of right versus left lateral SCC was significantly different in the AIS group compared to the control group [mean side-to-side difference: -4.1°, 95% CI: -6.4° to -1.7°]. Overall, among subjects in the AIS group, the left lateral SCC tended to be oriented in a more horizontal position than subjects in the control group. Significance Asymmetry within the SCCs of the vestibular system of individuals with AIS potentially results in abnormal efferent activity to postural muscles. Consequences of this muscular activity during periods of rapid growth, which often coincides with AIS onset and progression, warrant consideration.
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Affiliation(s)
- Patrick M. Carry
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Victoria R. Duke
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Christopher J. Brazell
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Nicholas Stence
- Department of Radiology, Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Melissa Scholes
- Department of Otolaryngology, Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | | | - Nancy Hadley Miller
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Children’s Hospital Colorado, Aurora, Colorado, United States of America
- * E-mail:
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Ekşi MŞ, Özcan-Ekşi EE, Huet SE, Dinç T, Özmen BB, Akçal MA. Prevalence of Thoracic Scoliosis in Adolescents in Turkey: Analysis of 1065 Chest Radiographs. World Neurosurg 2020; 135:e527-e540. [DOI: 10.1016/j.wneu.2019.12.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 12/10/2019] [Indexed: 11/30/2022]
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Low Body Mass Index for Early Screening of Adolescent Idiopathic Scoliosis: A Comparison Based on Standardized Body Mass Index Classifications. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:24-29. [DOI: 10.1016/j.anr.2019.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/25/2019] [Accepted: 12/26/2019] [Indexed: 01/25/2023] Open
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Watanabe K, Aoki Y, Matsumoto M. An Application of Artificial Intelligence to Diagnostic Imaging of Spine Disease: Estimating Spinal Alignment From Moiré Images. Neurospine 2019; 16:697-702. [PMID: 31905459 PMCID: PMC6945007 DOI: 10.14245/ns.1938426.213] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/16/2019] [Indexed: 12/25/2022] Open
Abstract
The use of artificial intelligence (AI) as a tool supporting the diagnosis and treatment of spinal diseases is eagerly anticipated. In the field of diagnostic imaging, the possible application of AI includes diagnostic support for diseases requiring highly specialized expertise, such as trauma in children, scoliosis, symptomatic diseases, and spinal cord tumors. Moiré topography, which describes the 3-dimensional surface of the trunk with band patterns, has been used to screen students for scoliosis, but the interpretation of the band patterns can be ambiguous. Thus, we created a scoliosis screening system that estimates spinal alignment, the Cobb angle, and vertebral rotation from moiré images. In our system, a convolutional neural network (CNN) estimates the positions of 12 thoracic and 5 lumbar vertebrae, 17 spinous processes, and the vertebral rotation angle of each vertebra. We used this information to estimate the Cobb angle. The mean absolute error (MAE) of the estimated vertebral positions was 3.6 pixels (~5.4 mm) per person. T1 and L5 had smaller MAEs than the other levels. The MAE per person between the Cobb angle measured by doctors and the estimated Cobb angle was 3.42°. The MAE was 4.38° in normal spines, 3.13° in spines with a slight deformity, and 2.74° in spines with a mild to severe deformity. The MAE of the angle of vertebral rotation was 2.9°±1.4°, and was smaller when the deformity was milder. The proposed method of estimating the Cobb angle and AVR from moiré images using a CNN is expected to enhance the accuracy of scoliosis screening.
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Affiliation(s)
- Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoshimitsu Aoki
- Department of Electronics & Electrical Engineering, Keio University, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Toombs C, Lonner B, Fazal A, Boachie-Adjei O, Bastrom T, Pellise F, Ramadan M, Koptan W, ElMiligui Y, Zhu F, Qiu Y, Shufflebarger H. The Adolescent Idiopathic Scoliosis International Disease Severity Study: Do Operative Curve Magnitude and Complications Vary by Country? Spine Deform 2019; 7:883-889. [PMID: 31731998 DOI: 10.1016/j.jspd.2019.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 04/02/2019] [Accepted: 04/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The prevalence of adolescent idiopathic scoliosis (AIS) in diverse regions of the world has been studied. Access to care varies widely, and differences in disease severity and operative treatment outcomes are not well understood. This study aimed to determine variation in disease presentation and operative complications for AIS patients from an international cohort. METHODS This is a retrospective study carried out at seven surgical centers in the United States (Manhattan and Miami), Ghana, Pakistan, Spain, Egypt, and China. A total of 541 consecutive patients with AIS were evaluated. Preoperative major curve magnitude, operative parameters, and complications were compared among sites using analysis of variance with post hoc tests and Pearson correlation coefficients. Univariate and multivariate forward stepwise binary logistic regressions determined the variables most predictive of complications. RESULTS Countries with lowest-access to care (Ghana, Egypt, and Pakistan) displayed larger curves, more levels fused, longer operative time (OT), and greater estimated blood loss (EBL) than the other countries (p ≤ .001). Increasing curve magnitude was correlated with greater levels fused, longer OT, and greater EBL in all groups (p = .01). In the univariate regression analysis, Cobb magnitude, levels fused, EBL, and OT were associated with complication occurrence. Only OT remained significantly associated with complication occurrence after adjusting for Cobb magnitude, levels fused, and site (odds ratio [OR] = 1.005, 95% confidence interval 1.001-1.007, p = .003). Complications were greatest in Pakistan and Ghana (21.7% and 13.5%, respectively) and lowest in Miami (6.5%). CONCLUSIONS Larger curve magnitudes in the least-access countries correlated with more levels fused, longer OT, and greater EBL, indicating that increased curve magnitude at surgery could explain the difference in operative morbidity between low- and high-access countries. With OT as the prevailing predictive factor of complications, we suggest that increased curve magnitude leads to longer OTs and more complications. A lack of access to orthopedic care may be the largest contributor to the postponement of treatment. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Courtney Toombs
- Department of Orthopaedics & Rehabilitation, Yale New Haven Hospital, 20 York Street, New Haven, CT 06510, USA
| | - Baron Lonner
- Mount-Sinai Beth Israel Medical Center, Department of Orthopedics, 281 1st Ave, New York, NY 10003, USA.
| | - Akil Fazal
- Nairobi Spine and Orthopaedic Centre, Department of Orthopaedics, Fortis Suites, 1st Floor, Hospital Rd, Nairobi, Kenya
| | | | - Tracey Bastrom
- Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA
| | - Ferran Pellise
- Department of Traumatology, Orthopaedic Surgery and Emergency, Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Mohamed Ramadan
- Department of Orthopaedics, Tanta University, El-Gaish, Tanta Qism 2, Tanta, Gharbia Governorate, Tanta, Egypt
| | - Wael Koptan
- Department of Orthopaedics and Traumatology, Cairo University, 1 Gamaa Street, P.O. Box 12613, Giza, Cairo, Egypt
| | - Yasser ElMiligui
- Department of Orthopaedics and Traumatology, Cairo University, 1 Gamaa Street, P.O. Box 12613, Giza, Cairo, Egypt
| | - Feng Zhu
- Spine Surgery, Nanjing University Drum Tower Hospital, 321 Zhongshan Rd, Gulou Qu, Nanjing Shi, Jiangsu Sheng, China 210008
| | - Yong Qiu
- Spine Surgery, Nanjing University Drum Tower Hospital, 321 Zhongshan Rd, Gulou Qu, Nanjing Shi, Jiangsu Sheng, China 210008
| | - Harry Shufflebarger
- Division of Pediatric Spinal Surgery, Miami Children's Hospital, 3100 SW 62nd Ave, Miami, FL 33155, USA
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Yang J, Zhang K, Fan H, Huang Z, Xiang Y, Yang J, He L, Zhang L, Yang Y, Li R, Zhu Y, Chen C, Liu F, Yang H, Deng Y, Tan W, Deng N, Yu X, Xuan X, Xie X, Liu X, Lin H. Development and validation of deep learning algorithms for scoliosis screening using back images. Commun Biol 2019; 2:390. [PMID: 31667364 PMCID: PMC6814825 DOI: 10.1038/s42003-019-0635-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/24/2019] [Indexed: 02/08/2023] Open
Abstract
Adolescent idiopathic scoliosis is the most common spinal disorder in adolescents with a prevalence of 0.5-5.2% worldwide. The traditional methods for scoliosis screening are easily accessible but require unnecessary referrals and radiography exposure due to their low positive predictive values. The application of deep learning algorithms has the potential to reduce unnecessary referrals and costs in scoliosis screening. Here, we developed and validated deep learning algorithms for automated scoliosis screening using unclothed back images. The accuracies of the algorithms were superior to those of human specialists in detecting scoliosis, detecting cases with a curve ≥20°, and severity grading for both binary classifications and the four-class classification. Our approach can be potentially applied in routine scoliosis screening and periodic follow-ups of pretreatment cases without radiation exposure.
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Affiliation(s)
- Junlin Yang
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kai Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong China
- School of Computer Science and Technology, Xidian University, Xi’an, Shanxi China
| | - Hengwei Fan
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zifang Huang
- Department of Spine Surgery, the 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong China
| | - Yifan Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong China
| | - Jingfan Yang
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lin He
- School of Computer Science and Technology, Xidian University, Xi’an, Shanxi China
| | - Lei Zhang
- School of Computer Science and Technology, Xidian University, Xi’an, Shanxi China
| | - Yahan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong China
| | - Ruiyang Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong China
| | - Yi Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong China
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL USA
| | - Chuan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong China
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL USA
| | - Fan Liu
- School of Computer Science and Technology, Xidian University, Xi’an, Shanxi China
| | - Haoqing Yang
- School of Computer Science and Technology, Xidian University, Xi’an, Shanxi China
| | - Yaolong Deng
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weiqing Tan
- Health Promotion Centre for Primary and Secondary Schools of Guangzhou Municipality, Guangzhou, Guangdong China
| | - Nali Deng
- Health Promotion Centre for Primary and Secondary Schools of Guangzhou Municipality, Guangzhou, Guangdong China
| | - Xuexiang Yu
- Department of Sports and Arts, Guangzhou Sport University, Guangzhou, Guangdong China
| | - Xiaoling Xuan
- Xinmiao Scoliosis Prevention of Guangdong Province, Guangzhou, Guangdong China
| | - Xiaofeng Xie
- Xinmiao Scoliosis Prevention of Guangdong Province, Guangzhou, Guangdong China
| | - Xiyang Liu
- School of Computer Science and Technology, Xidian University, Xi’an, Shanxi China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong China
- Center for Precision Medicine, Sun Yat-sen University, Guangzhou, Guangdong China
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