An effective assessment method of spinal flexibility to predict the initial in-orthosis correction on the patients with adolescent idiopathic scoliosis (AIS)

He, Chen; To, Michael; Cheung, Jason Pui-Yin; Cheung, Kenneth M.C.; Chan, Chi-kwan; Jiang, Weiwei; Zhou, Guang-Quan; Lai, Kelly Ka-Lee; Zheng, Yongping; Wong, Man Sang

doi:10.1371/journal.pone.0190141

Cited by 33 publications

(40 citation statements)

References 27 publications

(28 reference statements)

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“…For the supine position, the hands were placed by the patient’s side, and patients were instructed to lie down facing up on a scanning couch and then to straighten their trunk and legs maximally [24]. In the sitting position, patients were instructed to sit on a chair with a panel on the back, with the hip to be placed appropriately on the chair.…”

Section: Methodsmentioning

confidence: 99%

Scoliosis in Duchenne muscular dystrophy children is fully reducible in the initial stage, and becomes structural over time

Choi

Shin

2019

BMC Musculoskelet Disord

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Background Patients with Duchenne muscular dystrophy (DMD) often develop scoliosis that progresses rapidly after loss of ambulation. Management of scoliosis is crucial because it affects both life expectancy and quality of life of patients with DMD. Spinal orthosis attempts to prevent or delay scoliosis using spinal support at three points of the controlling mechanism; the curve should be flattened by the pressure. Therefore, it is assumed that spine flexibility could be a significant influencing factor for the effectiveness of braces. Hence, we attempted to investigate the flexibility of scoliosis in non-ambulant patients with DMD. Methods We reviewed the medical records of 273 boys who were genetically identified as having DMD, and finally, 50 boys with serial records of radiographs after loss of ambulation were finally enrolled. And among them, only 31 patients developed scoliosis. Spine radiographs in sitting and supine positions were also reviewed to obtain Cobb angle, curve flexibility, and pelvic obliquity. Flexibilities (%) were calculated by the difference in angles between the sitting and supine positions divided by the angle at the sitting position, multiplied by 100. Results Among 31 boys who had scoliosis, all but 2 boys with curves went through a sequential course of 1) no scoliosis, 2) nonstructural scoliosis, when scoliosis was only measurable in the sitting position, and 3) structural scoliosis, when scoliosis was also detectable in the supine position. Flexibility decreased each year after detection of scoliosis in those who developed scoliosis the first year, from 75.5 ± 5.0% to 57.1 ± 10.5% and to 49.1 ± 10.0% (mean ± standard deviation). Spinal flexibility was significantly correlated with curve magnitude of scoliosis in both sitting and supine position ( p < 0.05, respectively). Conclusions There is a period of fully reducible curve in DMD patients at the initial stage of scoliosis. Afterward, as spinal curve progresses, flexibility decreases over time. To detect the scoliosis when the curve is fully reducible, scoliosis curve in DMD patients should be evaluated dynamically, including radiographs of at least in two different positions.

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Section: Methodsmentioning

confidence: 99%

Scoliosis in Duchenne muscular dystrophy children is fully reducible in the initial stage, and becomes structural over time

Choi

Shin

2019

BMC Musculoskelet Disord

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“…49 In the same vein, Khodaei et al 50 in an exploratory study on curve magnitude differences between standing, prone, and voluntary maximum side bending postures to assess the reliability of spinal deformity using 3D ultrasound found that ultrasound was reliable, especially when the Cobb angle at the prone position was not close to zero. He et al 51 also showed the usefulness of ultrasound in assessing spinal flexibility in AIS subjects in different positions (supine, prone, sitting with lateral bending, and prone with lateral bending). They further found that the prone position is the most effective to predict the initial effect of orthotic treatment on patients with AIS.…”

Section: Three-dimensional Ultrasoundmentioning

confidence: 99%

“…They further found that the prone position is the most effective to predict the initial effect of orthotic treatment on patients with AIS. 51 Jiang et al 52 used 3D ultrasound (Scolioscan) to investigate the effects of postural changes in spine deformity in the coronal plane of AIS patients and found that 3D ultrasound was able to demonstrate spine deformities. They concluded that these deformities of AIS subjects vary with different positions, and the patterns of changes in sitting or sitting forward bending positions are highly subject dependent.…”

Section: Three-dimensional Ultrasoundmentioning

confidence: 99%

Weight-bearing Imaging in Adolescent Idiopathic Scoliosis

Chiyanika

2019

Semin Musculoskelet Radiol

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This article reviews the weight-bearing imaging methods in the diagnosis and monitoring of patients with adolescent idiopathic scoliosis (AIS), a three-dimensional (3D) deformity of the spine with unknown etiology. The apical vertebrae in AIS rotate away from the midline in a complex 3D pattern that formerly could only be appreciated by computed tomography (CT). Despite its superb anatomical delineation, CT is not ideal due to high radiation and scanning in either the supine or prone position; hence the full effect of gravity on the spinal curvature cannot be assessed. The introduction of low-dose stereoradiography with the capacity of 3D reconstruction has recently opened up a new era of assessment of the scoliotic spine in the upright position at multiple time points during the preoperative and postoperative period. The handheld 3D ultrasound imaging system also provides a radiation-free alternative for close monitoring for disease progression and treatment outcomes for AIS. Upright magnetic resonance imaging is radiation free and superb for the assessment of spinal cord and intervertebral disks; however, its utilization in scoliosis is limited by high cost and limited availability.

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“…Though the exact mechanism of the bracing effect is not known, it has been suggested that a greater immediate curve correction may lead to greater ultimate success 2,5,37 . It is postulated that this may relate to the effect on the bending moment at the apex of the curve.…”

Section: In Clinical Practice Scoliosis Is Most Commonly Characterized By 2d Curve Values As Determined By Thementioning

confidence: 99%

Effect of Spinal Bracing on Curve Magnitude in Coronal and Axial Planes in Adolescent Scoliosis Utilising EOS Imaging.

Gatehouse

Izatt

Labrom

et al. 2021

Preprint

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Purpose. This study aimed to investigate the efficacy of spinal bracing in treating progressive scoliosis deformity utilizing EOS (bi-planer) imaging and SterEOS reconstruction software. Methods. EOS images of scoliosis patients being treated with bracing were obtained both in and out of their brace. These images were processed using SterEOS software to allow 3D representation, which was then compared to traditional coronal 2D parameters. Between January 2019 and January 2020, 29 patients were recruited for participation. Of these participants, 25 had a single episode of EOS imaging out of and in their brace. Additionally, 19 of the 25 participants had further episodes of EOS imaging within the study period, separated by mean 144+/-44 days. This allowed a total of 44 EOS single scan episodes for parameter analysis out of, and in the brace. Longitudinal analysis was also performed on the 19 patients who had sequential scans.Results. Participants were mean 13.8±1.1 years old at the first scan. Coronal 2D parameters, specifically Cobb Angle measurement, were accurately reproducible with SterEOS 3D measurements. Across all EOS scans (n=44) the mean major coronal curve measurement was 42.3±13.3° out of brace and 37.2±13.8° in the brace. This produced a mean correction of 4.6±4.4° (p<0.05). The correction achieved in this cohort with bracing appeared more modest than those reported in previous studies using traditional 2D coronal curve measurements1–3. The mean axial vertebral rotation (AVR) was 10.6±7.1° out of the brace and 9.6±6.8° in the brace, with a mean correction of 1.4±5.3°(p=0.14). The current study results suggested no significant change in axial vertebral rotation with brace treatment. Notably, in 17 of the 44 AVR measured, the differences were negative. That is, the AVR worsened in the brace. There was a significant moderate correlation between 3D coronal Cobb angle measured and AVR measured out of the brace for all curves. However, the change in Cobb and change in AVR with bracing did not correlate.Over sequential EOS episodes (n=19), there appeared no significant progression of 3D parameters, interpreted as the brace preventing curve progression.Conclusions. There appeared to be a consistent reduction in the scoliosis Cobb angle of the major curve with brace treatment. AVR demonstrated no significant change with bracing, with instances of worsening of AVR in the brace, which was not reflected by Cobb angle measurement. Despite this, bracing appears to have been effective with limited curve progression in sequential scans, though not in the anticipated manner of immediate in-brace curve correction.

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An effective assessment method of spinal flexibility to predict the initial in-orthosis correction on the patients with adolescent idiopathic scoliosis (AIS)

Cited by 33 publications

References 27 publications

Scoliosis in Duchenne muscular dystrophy children is fully reducible in the initial stage, and becomes structural over time

Scoliosis in Duchenne muscular dystrophy children is fully reducible in the initial stage, and becomes structural over time

Weight-bearing Imaging in Adolescent Idiopathic Scoliosis

Effect of Spinal Bracing on Curve Magnitude in Coronal and Axial Planes in Adolescent Scoliosis Utilising EOS Imaging.

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