Predictability of Supine Radiographs for Determining In-Brace Correction for Adolescent Idiopathic Scoliosis

Cheung, Jason Pui Yin; Yiu, Karen; Vidyadhara, S; Chan, Peggy Pui Yee; Mak, Kin Cheung

doi:10.1097/brs.0000000000002503

Cited by 39 publications

(57 citation statements)

References 33 publications

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“…Hence, the results of this study do not indicate the duration of brace wear required. In addition, curve flexibility has been shown to greatly influence the outcomes of bracing and surgery [ 32 33 34 35 ]. This aspect of bracing, as well as the varied responses of different curve patterns, is beyond the intent of this study and should be addressed in future studies.…”

Section: Discussionmentioning

confidence: 99%

APSS-ASJ Best Clinical Research Award: Predictability of Curve Progression in Adolescent Idiopathic Scoliosis Using the Distal Radius and Ulna Classification

Samartzis

Luk

2018

Asian Spine J

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Study DesignProspective study.PurposeTo determine the risk of clinically significant curve progression in adolescent idiopathic scoliosis (AIS) based on the initial Cobb angle and to test the utility of the distal radius and ulna (DRU) classification in predicting these outcomes.Overview of LiteratureDetermining the remaining growth potential in AIS patients is necessary for predicting prognosis and initiating treatment. Limiting the maturity Cobb angle to <40° and <50° reduces the risk of adulthood progression and need for surgery, respectively. The risk of curve progression is the greatest with skeletally immature patients and thus warrants close monitoring or early intervention. Many parameters exist for measuring the skeletal maturity status in AIS patients, but the DRU classification has been shown to be superior in predicting peak growth and growth cessation. However, its predictive capabilities for curve progression are unknown.MethodsTotally, 513 AIS patients who presented with Risser 0–3 were followed until either skeletal maturity or the need for surgery, with a minimum 2-year follow-up period. Outcomes of 40° and 50° were used for probability analysis based on the cut-offs of adulthood progression risk and surgical threshold, respectively.ResultsAt the R6/U5 grade, most curves (probability of ≥48.1%–55.5%) beyond a Cobb angle of 25° progressed to the 40° threshold. For curves of ≥35°, there was a high risk of unfavorable outcomes, regardless of skeletal maturity. Most patients with the R9 grade did not progress, regardless of the initial curve magnitude (probability of 0% to reach the 50° threshold for an initial Cobb angle of ≥35°).ConclusionsThis large-scale study illustrates the utility of the DRU classification for predicting curve progression and how it may effectively guide the timing of surgery. Bracing may be indicated for skeletally immature patients at an initial Cobb angle of 25°, and those with a scoliosis ≥35° are at an increased risk of an unfavorable outcome, despite being near skeletal maturity.

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Section: Discussionmentioning

confidence: 99%

APSS-ASJ Best Clinical Research Award: Predictability of Curve Progression in Adolescent Idiopathic Scoliosis Using the Distal Radius and Ulna Classification

Samartzis

Luk

2018

Asian Spine J

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“…It is also important to note the potential effects of anesthesia on curve magnitude. Similar to human studies where effects of posture may lead to changes in spinal alignment and severity (7,25), variations in muscle tone may lead to measurement variability. The mean RSD was 125.3% which indicated a big variation and this serves as a guide to the degree of variability that exists in every radiographic measurement.…”

Section: Discussionmentioning

confidence: 99%

Proper positioning of mice for Cobb angle radiographic measurements

Chen

Song

Gao

2020

Preprint

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BackgroundThere is no recommended standard for positioning of a mouse for radiographic assessment of the spine. This is necessary to have reproducible radiographic data and avoid false positive results. The objective of this study was to investigate the impact of various postures on Cobb angle measurements and to set up a positioning standard for imaging mouse spines. MethodsThis study was conducted in three parts. Firstly, we identified the problem of lack of posture standardization for radiographs. We collected 77 C57BL/6J mice for spine radiographs and found a scoliosis prevalence of 28.6% with large variations in curve magnitude. Secondly, 24 C57BL/6J mice underwent 4 consecutive weekly radiographs and observed high variations (relative standard deviation: 125.3%) between radiographs. Thirdly, we collected another 82 C57BL/6J mice and designed 14 different postures that could take place during imaging. These postures were related to curling of the limbs, and head, pelvic and tail tilting. ResultsThe results showed that head and pelvic tilting significantly affects the curve magnitude with effect size (Glass’s delta) over 1.50. Avoiding these incorrect positions during radiographs is warranted. The standard recommended posture for mouse imaging entails positioning the snout, interorbital space, neck and whole spine in one line, and with the limbs placed symmetrical to the trunk, whilst avoiding stretching the body of the mouse. ConclusionsOur work exemplified the importance of standard protocol during imaging when using animal model in the scoliosis study. We recommend utilizing this standard in studying various disorders of the spine.

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“…The negative correlation between CA and IBC has been confirmed in our study and previous studies. Studies also revealed that sagittal or coronal imbalance of the spine can decrease IBC and suggested that IS is a complex 3-dimensional deformity of the spine and that sagittal imbalance can affect the curve correction in the coronal plane [7,11]. Georges and Pierre et al made the same conclusion that pelvis morphology and standing balance parameters are correlated with CA, they suggested that IS is not only a question of trunk morphology distortion by itself, but is also related to pelvis asymmetrical bone growth and standing neuromuscular imbalance [12].…”

Section: Discussionmentioning

confidence: 99%

“…IBC refers to the percentage of improvement in the curve size at the initial brace prescription. Given the significance of IBC, some studies have been performed to find related imaging parameters to predict the IBC [7]. Self-parameters of IS, such as primary Cobb angle and coronal deformity angular ratio, was found to correlate with IBC [8].…”

Section: Introductionmentioning

confidence: 99%

Pelvic rotation parameters related to in-brace correction in patients with idiopathic scoliosis

Zhang

2020

Eur J Med Res

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Background To identify the pelvic parameters affecting in-brace correction (IBC) in patients with idiopathic scoliosis (IS). Methods Patients with IS receiving Chêneau brace treatment in our scoliosis center from January 2019 to November 2019 were retrospectively analyzed. Pelvic rotation parameters, including pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), L/R ratio, were collected. Other radiographic data, such as Risser sign, coronal and sagittal balance, curve location, kyphosis, lordosis of each patient were also recorded to analyze their correlations with IBC. Correlation analyses were performed to identify the classified variables influencing IBC. The principal component analysis was used to extract common factors of radiographic parameters to eliminate interaction effects. The linear regression equation was established using principal components, the variables influencing IBC were identified. Results A cohort of 44 patients with IS (36 girls and 8 boys) were included in the present study. The mean IBC was 49.87% (range, 3%–100%). IBC of lumbar IS was negatively correlated with apical rotate factor (ARF, B = –0.385), mainly consisted of pelvic coronal plane rotation (PCPR, 0.449), Cobb angle (CA, 0.575), apical vertebral rotation (AVR, 0.918), and pelvic rotate factor (PRF, B = –0.387), mainly consisted of PT (0.861), PI (0.728), PCPR (–0.570). The regression equation of lumbar IS had statistical significance (F = 6.500, P = 0.005, R2 = 0.317), whereas statistically significance was not found in the regression equation of thoracic IS (F = 2.913, P = 0.106). The remaining parameters were not related to IBC. Conclusions For lumbar IS, ARF and PRF have negative effects on IBC, coronal and sagittal rotation of the pelvis is related to IBC.

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Predictability of Supine Radiographs for Determining In-Brace Correction for Adolescent Idiopathic Scoliosis

Abstract: 3.

Cited by 39 publications

References 33 publications

APSS-ASJ Best Clinical Research Award: Predictability of Curve Progression in Adolescent Idiopathic Scoliosis Using the Distal Radius and Ulna Classification

APSS-ASJ Best Clinical Research Award: Predictability of Curve Progression in Adolescent Idiopathic Scoliosis Using the Distal Radius and Ulna Classification

Proper positioning of mice for Cobb angle radiographic measurements

Pelvic rotation parameters related to in-brace correction in patients with idiopathic scoliosis

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