The aim of this study was to evaluate bone age and its correlation with the lower limbs' developing skeletal anatomy during growth. 1005 children and young adults were evaluated for bone age and 14 different parameters measured on lower-limb reconstructions from radiological examinations carried out with an EOS 2D/3D system in the course of routine orthopedic indicated diagnostic practice. Cervical vertebral morphology evaluation for bone age using the Hassel-Farman method, which describes six stages of maturity, was selected. Intra- and inter-observer reliability tests for this method, and for the EOS 3D reconstructions were performed. Statistical analysis were performed using Spearman correlation, multiple linear regression, and t-test. The intra- and inter-observer reliability of the Hassel-Farman method and the EOS 3D lower-limb reconstruction were found to be excellent. Interestingly one bone age stage could include individuals across a 12.1 year range, and conversely individuals of the same calendar age could be of one of 3.2 different bone age stages. In the prepubertal age groups all six bone stages could be observed. Bone age revealed a stronger relationship, lower standard deviations with groups and proved to be a better discriminating variable than the calendar age by collodiaphyseal angle, femoral, and tibial torsion, femorotibial rotation, and mechanical tibiofemoral angle. Bone age is an indicator of skeletal maturity and may more accurately describe the growth of some lower limb parameters. As a result we suggest the consideration of bone age when evaluating lower-limb biomechanic-anatomical parameters. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1431-1441, 2017.
BackgroundScoliosis is a complex three-dimensional deformity. While the frontal profile is well understood, increasing attention has turned to balance in the sagittal plane. The present study evaluated changes in sagittal spino-pelvic parameters in a large Hungarian population with adolescent idiopathic scoliosis.MethodsEOS 2D/3D images of 458 scoliotic and 69 control cases were analyzed. After performing 3D reconstructions, the sagittal parameters were assessed as a whole and by curve type using independent sample t test and linear regression analysis.ResultsPatients with scoliosis had significantly decreased thoracic kyphosis (p < 0.001) with values T1–T12, 34.1 ± 17.1o vs. 43.4 ± 12.7o in control; T4–T12, 27.1 ± 18.8o vs. 37.7 ± 15.1o in control; and T5–T12, 24.9 ± 15.8o vs. 32.9 ± 15.0o in control. Changes in thoracic kyphosis correlated with magnitude of the Cobb angle (p < 0.001). No significant change was found in lumbar lordosis and the pelvic parameters. After substratification according to the Lenke classification and individually evaluating subgroups, results were similar with a significant decrease in only the thoracic kyphosis. A strong correlation was seen between sacral slope, pelvic incidence, and lumbar lordosis, and between pelvic version and thoracic kyphosis in control and scoliotic groups, whereas pelvic incidence was also seen to be correlated with thoracic kyphosis in scoliosis patients.ConclusionAdolescent idiopathic scoliosis patients showed a significant decrease in thoracic kyphosis, and the magnitude of the decrease was directly related to the Cobb angle. Changes in pelvic incidence were minimal but were also significantly correlated with thoracic changes. Changes were similar though not identical to those seen in other Caucasian studies and differed from those in other ethnicities. Scoliotic curves and their effect on pelvic balance must still be regarded as individual to each patient, necessitating individual assessment, although changes perhaps can be predicted by patient ethnicity.
Background. Assessment of the proximal femoral parameters in adolescent idiopathic scoliosis using three-dimensional radiological image reconstructions may allow better characterization than conventional techniques. Methods. EOS 3D reconstructions of spines and femurs of 320 scoliotic patients (10-18 years old) and 350 control children lacking spinal abnormality were performed and 6 proximal femoral parameters measured. Results. Individuals with adolescent idiopathic scoliosis showed a small but statistically significant decrease in neck shaft angle (average difference=2.58°) and a higher (0.22°) femoral mechanical axis–femoral shaft angle. When the two sides were compared based on curve direction, greater changes in the neck shaft angle and femoral mechanical axis–femoral shaft angle were found on the side of the convexity. Conclusions. Patients with adolescent idiopathic scoliosis were found to have a small but significantly lower neck shaft angle and higher femoral mechanical axis–femoral shaft angle, which related to the curve direction. This is postulated to be due to mechanical compensation for altered balance and centre of gravity associated with a scoliosis deformity, although the observed difference likely has negligible clinical effect.
Study Design: Retrospective cross-sectional study. Objectives: It is generally believed that the apical vertebra has the largest axial rotation in adolescent idiopathic scoliosis. We investigated the relationship between apical axial vertebral rotation (apicalAVR) and maximal axial vertebral rotation (maxAVR) in both major and minor curves using biplanar stereo-imaging. Methods: EOS 2D/3D biplanar radiograph images were collected from 332 patients with adolescent idiopathic scoliosis (Cobb angle range 10°-122°, mean age 14.7 years). Based on the X-ray images, with the help of 3D full spine reconstructions Cobb angle, curvature level, apicalAVR and maxAVR were determined. These parameters were also determined for minor curves in Lenke 2, 3, 4, 6 type patients. Maximal thoracic rotation and maximal thoracolumbar/lumbar rotation were calculated. Statistical analysis was performed with descriptive statistics, Shapiro-Wilk test, and Wilcoxon signed-rank test. Results: The apical vertebrae were the most rotated vertebra in only 40.4% of the major curves, and 31.7% in minor curves. MaxAVR significantly exceeded apicalAVR values in the major curves ( P < .001) as well as in minor curves ( P < .001). The 2 parameters differed significantly in each severity group and Lenke type. Conclusions: The apical vertebrae were not the most rotated vertebra in more than half of cases investigated indicating that apicalAVR and maxAVR should be considered as 2 distinct parameters, of which maxAVR fully describes the axial dimension of scoliosis. Furthermore, the substitution of maxAVR for the apicalAVR should be especially avoided in double and triple curves, as the apical vertebra was even less commonly the most rotated in minor curves.
The aim of the study was to assess the correlation between femoral neck-shaft angles (NSAs) and skeletal maturity in EOS reconstructions from a large population of children. Full-body three-dimensional (3D) reconstructions were generated from 1005 children and young adults (4-24 years old; 449 male, 556 female) using the EOS three-dimensional/3D scanner, with images taken during routine clinical practice. The true NSAs were measured and assessed for correlation with individuals' chronological age and bone age, based on cervical vertebral morphology. Statistical analysis was performed using Spearman correlation, independent t-test and multiple linear regression. NSAs of older and younger individuals within each bone age group and chronological age were further assessed by t-test. NSA values fell from mean 131.89° ± 6.07° at 4 years old to 128.85° ± 4.46° at the age of 16, with only minor decreases thereafter. Significantly higher NSAs (3.16° and 4.45°, respectively) were found in those with a bone age advanced or delayed by more two or more stages compared to their peers of the same chronological age (P < 0.001; P < 0.001). Similarly, within most bone age stages, individuals of advanced or delayed chronological age exhibited elevated values (mean difference ranged from 2.9° to 8.9°, P < 0.05). Incorporation of bone age assessment into proximal femoral evaluation allowed identification of 'fast maturing' and 'slow maturing' subcategories in developing children, with different expected NSAs. The earlier ossification seen in faster-maturing individuals may lead to the NSA becoming fixed in a more immature valgus conformation.
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