Search

Spinal alignment can be assessed without radiation using three-dimensional ultrasound imaging (3DUS). Reliable measurements could inform the ideal arm position for scoliosis radiographs. This study determined the inter-evaluator reliability of axial vertebral rotation (AVR) measurements and sagittal curve angles in healthy females from 3DUS spinal images in standing with two common radiograph arm positions: Chin and abduction (Abd). Three novice evaluators (R1, R2, and R3) measured images once. The Bland–Altman bias and limits of agreement (LOA) were calculated. T5-T12 kyphosis measurements met our bias and LOA error threshold only for R1 vs R2 in the Chin position [−0.53° (−10.7,9.7)]. The distance between the bias and the LOA also met our acceptable threshold of 5° for all mean AVRTwist, and all but one AVRTwist measurements (R1-R2_Chin = 5.9°). Three lordosis measurements did not meet our acceptable threshold (R1-R2_Chin, R1-R3_Chin, and R2-R3_Abd). The inter-evaluator reliability of novice evaluators was adequate and did not differ significantly between positions. [ABSTRACT FROM AUTHOR]

The response to concerns raised about the study on the reliability and accuracy of scoliotic parameters using a wireless handheld 3D ultrasound system for children with adolescent idiopathic scoliosis highlights the need for broader comparisons with other imaging modalities like MRI and CT. The study addresses the learning curve associated with the new system, emphasizing its user-friendly design and minimal training requirements. It also acknowledges potential biases in measurements and suggests future research with larger sample sizes and diverse populations to validate findings. The study is considered a pilot study, with plans for more extensive research using the portable ultrasound system. [Extracted from the article]

Adolescent idiopathic scoliosis (AIS) is a three-dimensional curvature of spine. Children with AIS and low bone quality have higher chance to get curve progression leading to bigger spinal curvature. In addition, bone quality affects acoustic impedance of bone, thus influencing the reflection coefficient of ultrasound signal from the soft tissue-bone interface. This study aimed to estimate the bone quality of AIS patients based on the reflection coefficients to determine the correlation of the bone quality with curve severity. A simple bone model was used to develop an equation to calculate the reflection coefficient value. Experiments were conducted on five different phantoms. Acrylic was used to design a vertebral shape to study the effect of surface roughness and inclination, including: smooth flat surface (SFS), smooth curved surface (SCS), rough curved surface (RCS), and the rough curved inclined surface (RCIS). A clinical study with 37 AIS patients were recruited. The estimated reflection coefficient values of plate phantoms agreed well with the predicted values and the maximum error was 6.7%. The reflection coefficients measured from the acrylic-water interface for the SFS, SCS, RCS, RCIS (3° and 5°) were 0.37, 0.33, 0.28, (0.23 and 0.12), respectively. The surface roughness and inclination increased the reflection loss. From the clinical data, the average reflection coefficients for children with AIS were 0.11 and 0.07 for the mild curve group and the moderate curve group, respectively. A moderate linear correlation was found between the reflection coefficients and curve severity (r2 = 0.3). Patients with lower bone quality have observed to have larger spinal curvature. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the test–retest, intra- and inter-rater reliabilities of an ultrasound (US) reflection coefficient (RC) index measured in a lumbar vertebra to reflect bone strength on children with AIS. Methods: Fifty-eight participants (47F; 11M) were scanned by an US imager in standing position. Twenty-four were scanned twice for a test–retest study. The RC index measures the US signal reflected from L5 to indicate bone strength. Five measurements were obtained using three different methods: (i) the maximum RC (MRC) values on the left and right sides, (ii) the average RC (ARC) values on left and right sides, and (iii) the combined average RC (CARC) from both sides. Only rater 1 measured the 24 repeated US scans once. Raters 1 and 2 measured the RC index twice on all 58 images in 1 week apart. The intraclass correlation coefficient ICC [3, 1] for test–retest and ICC [2, 1] for intra- and inter-rater reliabilities as well as the standard error of measurements (SEM) were reported. Results: The means of scan 1 versus scan 2 were 0.16 ± 0.08 versus 0.16 ± 0.07 for left-MRC, 0.17 ± 0.11 versus 0.18 ± 0.11 for right-MRC, 0.08 ± 0.04 versus 0.09 ± 0.04 for left-ARC, 0.09 ± 0.04 versus 0.09 ± 0.05 for right-ARC and 0.08 ± 0.04 versus 0.09 ± 0.03 for CARC and all ICC[3, 1] ≥ 0.77. Among these 5 approaches, the CARC provided the best intra-rater and inter-rater reliabilities with ICC [2, 1] ≥ 0.84 and SEM ≤ 0.01. Conclusions: The RC index could be measured repeatably and reliably. The high RC value may reduce the risk of progression of scoliosis. [ABSTRACT FROM AUTHOR]

Adolescent idiopathic scoliosis (AIS) is a 3-D spinal deformity that affects 1%–3% of youth. Severe cases require surgical intervention involving the insertion of pedicle screws near the spinal cord, making accurate placement imperative. Currently, surgeons use either CT-navigation methods to guide the placement of screws or free-hand methods. The free-hand method has higher breach rates; however, CT-navigation exposes children to sensitive ionizing radiation. A novel custom 3-D ultrasound (3DUS) system has been developed to provide accuracy benefits similar to traditional CT-navigation systems without exposing patients to ionizing radiation. This study evaluates the accuracy of the custom 3DUS guidance system for localizing 3-D reconstructions of vertebral phantoms and tracking handheld surgical tools in the surgical space. Tool tracking was evaluated with commercial motion tracking cameras using a 3-D-printed pointer device and a high-precision probe device. Experiments were performed on 3-D-printed vertebral phantoms to investigate the positional and orientational accuracy using a high precision reference grid. The 3-D-printed pointer device was shown to be inferior to the high-precision probe, finding positional accuracy of 1.1 ± 1.1 mm versus 0.7 ± 0.4 mm. The rotational accuracy was 0.0° ± 1.7°, which met the surgical objective. The 3DUS localization, which was also evaluated using the vertebral phantoms and reference grid, showed positional accuracy of 0.8 ± 0.6 mm, making it a promising image-guidance tool for scoliosis surgery. [ABSTRACT FROM AUTHOR]

Purpose: Surgical treatment of severe adolescent idiopathic scoliosis (AIS) with posterior spinal instrumentation and fusion with pedicle screws is common, requiring careful screw insertion to prevent pedicle breaches and neurologic complications. Image guidance has been suggested to improve breach rates, though the radiation risk for AIS precludes its common usage. The purpose of this systematic review and meta-analysis was to compare the breach rates and screw-related complications for AIS patients undergoing spine surgery with pedicle screws between freehand screw insertion and image guidance methods.Methods: A comprehensive search of MEDLINE, EMBASE, CINAHL, CENTRAL and Web of Science databases was conducted. Two reviewers independently screened abstracts, full-texts, extracted data and performed risk of bias assessment using the QUIPS quality appraisal tool. Level of evidence summary statements were formulated based on consistency and quality of reporting.Results: Ninety-four studies were found, with 18 studies of moderate risk of bias or better. Moderate evidence from two head-to-head studies shows CT guidance has lower breach rates than freehand methods (OR 0.28 [0.20-0.40, I2 = 1%]), with no complications in either study. From individual studies, moderate evidence showed lower breach rates for image guidance versus freehand methods (13%, I2 = 98% vs. 20%, I2 = 95%). Complication rates were conflicting (0-1.6% for image guidance, 0-1.7% for freehand). Moderate evidence showed increased surgical time for image guidance versus freehand (257.7 min vs. 226.8 min).Conclusions: Meta-analyzed breach rates show moderate evidence of decreased breaches with CT navigation compared with freehand methods. Complication rates remain unknown due to the low complication rates from small sample sizes. These slides can be retrieved under Electronic Supplementary Material. [ABSTRACT FROM AUTHOR]

The measurements of spinal curvatures using the ultrasound (US) imaging method on children with scoliosis have been comparable with radiography. However, factors influencing the reliability and accuracy of US measurement have not been studied. The purpose of this study is to investigate the effects of curve features and patients’ demographics on US measurements and to determine which factors influence the reliability and accuracy. Two hundred children with scoliosis were recruited and scanned with US by one experienced operator and three trainees. One experienced rater measured the proxy Cobb angles from US images twice one week apart and compared the results with clinical radiographic records. The correlation and accuracy between the US and radiographic measurements were subdivided by different curve severities, curve types, subjects’ weight status and US acquisition experiences. A total of 326 and 313 curves were recognized from radiographs and US images, respectively. The mean Cobb angles of the 13 missing curves were 17.4±7.4° and 11 at the thoracic region. Among the 16 curves showing large discrepancy (≥6°) between US and radiographic measurements, 7 were main thoracic and 6 were lumbar curves. Twelve had axial vertebral rotation (AVR) greater than 8°. The US scans performed by the experienced operator showed fewer large discrepancy curves, smaller difference and higher correlation than the scans from the trainees (3%, 1.7±1.5°, 0.95 vs 6%, 2.4±1.8°, 0.90). Only 4% missing and 5% large discrepancy curves were demonstrated for US measurements in comparison to radiography. The missing curves were mainly caused by small severity and in the upper spinal region. There was a higher chance of the large discrepancy curves in the main thoracic and lumbar regions with AVR>8°. A skilled operator acquired better US images and led to more accurate measurements especially for those subjects with larger curvatures, AVR and body mass index (BMI). [ABSTRACT FROM AUTHOR]

Background: Four factors have been reported to affect brace treatment outcome: (1) growth or curve based risk, (2) the in-brace correction, (3) the brace wear quantity, and (4) the brace wear quality. The quality of brace design affects the in-brace correction and comfort which indirectly affects the brace wear quantity and quality. This paper reported the immediate benefits and results on using ultrasound (US) to aid orthotists to design braces for the treatment of scoliosis. Methods: Thirty-four AIS subjects participated in this study with 17 (2 males, 15 females) in the control group and 17 (2 males, 15 females) in the intervention (US) group. All participants were prescribed full time TLSO, constructed by either of the 2 orthotists in fabrication of spinal braces. For the control group, the Providence brace design system was adopted to design full time braces. For the intervention group, the custom standing Providence brace design system, plus a medical ultrasound system, a custom pressure measurement system and an in-house software were used to assist brace casting. Results: In the control group, 8 of 17 (47%) subjects needed a total of 11 brace adjustments after initial fabrication requiring a total of 28 in-brace radiographs. Three subjects (18%) required a second adjustment. For the US group, only 1 subject (6%) required adjustment. The total number of in-brace radiographs was 18. The p value of the chi-square for requiring brace adjustment was 0.006 which was a statistically significant difference between the two groups. In the intervention group, the immediate in-brace correction as measured from radiographs was 48 ± 17%, and in the control group the first and second in-brace correction was 33 ± 19% and 40 ± 20%, respectively. The unpaired 2 sided Student's t test of the in-brace correction was significantly different between the US and the first follow-up of the control group (p = 0.02), but was not significant after the second brace adjustment (p = 0.22). Conclusions: The use of the 3D ultrasound system provided a radiation-free method to determine the optimum pressure level and location to assist brace design, resulting in decreased radiation exposure during follow-up brace evaluation, increased the in-brace correction, reduced the patients' visits to both brace adjustment and scoliosis clinics. However, the final outcomes could not be reported yet as some of patients are still under brace treatment. Trial registration: NCT02996643, retrospectively registered in 16 December 2016 [ABSTRACT FROM AUTHOR]

Background: In North America, care recommendations for adolescents with small idiopathic scoliosis (AIS) curves include observation or bracing. Schroth scoliosis-specific exercises have demonstrated promising results on various outcomes in uncontrolled studies. This randomized controlled trial (RCT) aimed to determine the effect of Schroth exercises combined with the standard of care on quality-of-life (QOL) outcomes and back muscle endurance (BME) compared to standard of care alone in patients with AIS. Material and Methods: Fifty patients with AIS, aged 10-18 years, with curves 10-45 °, recruited from a scoliosis clinic were randomized to receive standard of care or supervised Schroth exercises plus standard of care for 6 months. Schroth exercises were taught over five sessions in the first two weeks. A daily home program was adjusted during weekly supervised sessions. The assessor and the statistician were blinded. Outcomes included the Biering-Sorensen (BME) test, Scoliosis Research Society (SRS-22r) and Spinal Appearance Questionnaires (SAQ) scores. Intention-to-treat (ITT) and per protocol (PP) linear mixed effects models were analyzed. Because ITT and PP analyses produced similar results, only ITT is reported. Results: After 3 months, BME in the Schroth group improved by 32.3 s, and in the control by 4.8 s. This 27.5 s difference in change between groups was statically significant (95 % G 1.1 to 53.8 s, p = 0.04). From 3 to 6 months, the self-image improved in the Schroth group by 0.13 and deteriorated in the control by 0.17 (0.3, 95 % CI 0.01 to 0.59, p = 0.049). A difference between groups for the change in the SRS-22r pain score transformed to its power of four was observed from 3 to 6 months (85.3, 95 % O 8.1 to 162.5, p = 0.03), where (SRS-22 pain score)4 increased by 65.3 in the Schroth and decreased by 20.0 in the control group. Covariates: age, self-efficacy, brace-wear, Schroth classification, and height had significant main effects on some outcomes. Baseline ceiling effects were high: SRS-22r (pain = 18.4 %, function = 28.6 %), and SAQ (prominence = 26.5 %, waist = 29.2 %, chest = 46.9 %, trunk shift = 12.2 % and shoulders = 18.4 %). (Continued on Conclusions: Supervised Schroth exercises provided added benefit to the standard of care by improving SRS-22r pain, self-image scores and BME. Given the high prevalence of ceiling effects on SRS-22r and SAQ questionnaires' domains, we hypothesize that in the AIS population receiving conservative treatments, different QOL questionnaires with adequate responsiveness are needed. [ABSTRACT FROM AUTHOR]

Background: Brace treatment is the most effective non-surgical treatment for AIS. High initial in-brace correction increases successful brace treatment outcomes. The objective of this study was to investigate if real-time ultrasound (US) can aid orthotists in selecting the pad pressure level and location resulting in optimal in-brace correction of the spine. Methods: Twenty six AIS subjects participated in this pilot study with 17 (2 M, 15 F) in the control group and 9 (2 M, 7 F) in the intervention group. For the control group, the standard method was used to design their braces. In addition to the standard of care, a medical 3D ultrasound (US) system, a custom pressure measurement system and in-house software were used to select pad placement and pressure levels for the intervention group. The orthotist used a custom standing Providence brace design system to apply pressures against the patient's torso. The applied pad pressures were recorded. A real-time US spinal image was displayed. Cobb angle measurements from the baseline and the assessment scan were performed. The orthotist then decided if an adjustment was needed in terms of altering the pad locations and pressure levels. The procedures may be repeated until the orthotist attained the best simulated in-brace correction configuration to cast the brace. Results: In the control group, 8 of 17 (47%) subjects needed a total of 16 brace adjustments after initial fabrication requiring a total of 33 in-brace radiographs. For the intervention group, the orthotist tried additional configurations in 7 out of 9 cases (78%). Among these 7 revised cases, 5 showed better stimulated in-brace corrections and were subsequently used to cast the brace. As a result, only 1 subject required a minor adjustment after initial fabrication. The total number of in-brace radiographs in the intervention group was 10. Conclusions: The use of the 3D ultrasound system provided a radiation-free method to determine the optimum pressure level and location to obtain the best stimulated in-brace correction during brace casting. The average number of radiographs per subject taken prior to final brace implementation with the interventional group was significantly lower than the control group. [ABSTRACT FROM AUTHOR]

Abstract: Effectiveness of orthotic treatment for scoliosis depends on how much time and how well the orthosis is worn. Questionnaires and clinical judgment are subjective methods to wear compliance. Even though using a temperature sensor can objectively record how long the orthosis has been used, it may not be able to answer the orthosis effectiveness without knowing the wear tightness. Custom made thoracolumbosacral orthoses (TLSO) were instrumented with low power wireless data acquisition systems to measure the time and loads imposed by the pressure pad during daily activities. Force measurements were recorded at 1sample/min and the system was able to record data up to 4 months without patient-involvement. Ten subjects (9F, 1M), age between 9 and 13.5 years, average 11.6±1.3 years, who prescribed a new TLSO and full-time brace wear were took part in this study over 4.4±1.0 months. Long-term logging of loads within a spinal orthosis is a reliable method to measure compliance objectively. The monthly quantity of brace wear ranged from 33% to 82%, average 60.0±4.3%. The monthly average loads imposed by the pressure pads varied from 39% to 78% relative to the reference level, average 64.3±4.6%. There was a statistically significant decrease in force, but increase in wear time over the period after the brace fitting session. This information may help to better understand the effectiveness of bracing and to predict the brace treatment outcomes. [Copyright &y& Elsevier]

Study Design: Randomized controlled trial.Objective: To compare the effectiveness of the automated pressure-adjustable orthosis (PO) and conventional orthosis (CO) for treatment of adolescent idiopathic scoliosis (AIS).Summary Of Background Data: Orthosis wearing quality may influence its effectiveness for AIS. An automated PO aimed to provide a more optimized and consistent biomechanical environment. Clinical evaluation was conducted to study the effectiveness of this innovative orthosis.Methods: Patients with AIS who met the criteria (Age 10-14, Cobb 20°-40°, and Risser sign 0-2) were recruited from two clinics and randomly assigned to the PO and CO groups. Compliance sensors were embedded in both groups, while the PO group was set to adjust the interfacial pressure as prescribed automatically. Clinical assessments (radiology and quality of life, QoL) were conducted at the baseline, immediate after orthosis fitting and 1-year follow-up. Orthosis wearing compliance was tracked using thermo and pressure sensors.Results: Twenty-four patients were enrolled with one drop-out (PO, n = 11; CO, n = 12). Significant immediate in-orthosis correction was observed in the PO (11.0° ± 6.5°, 42.0%, P < 0.001) and CO (10.3° ± 5.3°, 37.6%, P < 0.001) groups. After 1 year, no patient with PO progressed while two with CO had progression more than 5°. The mean daily wearing duration was 1.1 hours longer in the PO group as compared with the CO group (15.4 ± 4.5 vs. 14.3 ± 3.8 h). Moreover, the wearing quality within the targeted pressure was 33.9% higher in the PO group (56.5 ± 16.5% vs. 23.1 ± 12.1%, P < 0.001). No significant difference in the QoL results was observed between two groups nor within both groups during the study period.Conclusion: This study showed that the automated PO could enhance wearing quality when compared with the CO, thus offering a better biomechanical corrective effect in the study period without adverse effect on the patients' wearing quantity and QoL.Level Of Evidence: 1. [ABSTRACT FROM AUTHOR]

An abstract of the article "Ultrasound image measurements of erector spinae muscle thickness at four spinal levels in adolescents with idiopathic scoliosis: reliability and concave-convex comparison" by Alan Richter and colleagues is presented.

This study aimed to assess the validity of 3-D ultrasound measurements on the vertebral rotation of adolescent idiopathic scoliosis (AIS) under clinical settings. Thirty curves (mean Cobb angle: 21.7° ± 15.9°) from 16 patients with AIS were recruited. 3-D ultrasound and magnetic resonance imaging scans were performed at the supine position. Each of the two raters measured the apical vertebral rotation using the center of laminae (COL) method in the 3-D ultrasound images and the Aaro-Dahlborn method in the magnetic resonance images. The intra- and inter-reliability of the COL method was demonstrated by the intra-class correlation coefficient (ICC) (both [2, K] >0.9, p < 0.05). The COL method showed no significant difference (p < 0.05) compared with the Aaro-Dahlborn method. Furthermore, the agreement between these two methods was demonstrated by the Bland-Altman method, and high correlation was found (r > 0.9, p < 0.05). These results validated the proposed 3-D ultrasound method in the measurements of vertebral rotation in the patients with AIS. [ABSTRACT FROM AUTHOR]

Purpose: Clinicians monitor scoliosis progression using multiple radiographs during growth. During imaging, arms must be elevated to visualize vertebrae, possibly affecting sagittal alignment. This study aimed to determine the arm position that best represents habitual standing (and possibly allowing hand-based skeletal maturity assessment) to obtain frontal and lateral stereo-radiographs as measured using frontal, sagittal, and transverse angles.Females with and without, and males with Adolescent Idiopathic Scoliosis (AIS) were recruited consecutively. Patients were scanned using 3D Ultrasound imaging (3DUS), in 10 arm positions; habitual standing, arms supported anteriorly at 60° flexion, fingers to clavicle, chin, zygomatic, and eyebrows, arms abducted 90°, hands on wall, on blocks, and unsupported. Axial vertebral rotation (AVR) differences, frontal, and sagittal curve angles were measured. Repeated measures ANOVAs with Sidak post-hoc tests compared positions.Ninety females with and without AIS with mean age, and height of 17 ± 4 years, and 162 ± 6 cm, and ten males with AIS of 16 ± 3 years, and 174 ± 11 cm, respectively, were included. Female AIS single-curve showed larger curves in standing in all positions excluding hands on blocks (p > 0.05). Sagittal parameters showed decreases in kyphosis in arms abducted 90° and increases in lordosis in fingers to cheeks/eyebrows (p > 0.05). AVR twist was not significantly affected by position. Male AIS showed comparable results to females, but no significant differences were detected.No position represented habitual standing for all groups. When arms are raised, decreases in curve angle were shown in single-curve patients, kyphosis decreased, and lordosis increased in all groups. Most accurate positioning for all parameters was in fingers to clavicle/chin position.Methods: Clinicians monitor scoliosis progression using multiple radiographs during growth. During imaging, arms must be elevated to visualize vertebrae, possibly affecting sagittal alignment. This study aimed to determine the arm position that best represents habitual standing (and possibly allowing hand-based skeletal maturity assessment) to obtain frontal and lateral stereo-radiographs as measured using frontal, sagittal, and transverse angles.Females with and without, and males with Adolescent Idiopathic Scoliosis (AIS) were recruited consecutively. Patients were scanned using 3D Ultrasound imaging (3DUS), in 10 arm positions; habitual standing, arms supported anteriorly at 60° flexion, fingers to clavicle, chin, zygomatic, and eyebrows, arms abducted 90°, hands on wall, on blocks, and unsupported. Axial vertebral rotation (AVR) differences, frontal, and sagittal curve angles were measured. Repeated measures ANOVAs with Sidak post-hoc tests compared positions.Ninety females with and without AIS with mean age, and height of 17 ± 4 years, and 162 ± 6 cm, and ten males with AIS of 16 ± 3 years, and 174 ± 11 cm, respectively, were included. Female AIS single-curve showed larger curves in standing in all positions excluding hands on blocks (p > 0.05). Sagittal parameters showed decreases in kyphosis in arms abducted 90° and increases in lordosis in fingers to cheeks/eyebrows (p > 0.05). AVR twist was not significantly affected by position. Male AIS showed comparable results to females, but no significant differences were detected.No position represented habitual standing for all groups. When arms are raised, decreases in curve angle were shown in single-curve patients, kyphosis decreased, and lordosis increased in all groups. Most accurate positioning for all parameters was in fingers to clavicle/chin position.Results: Clinicians monitor scoliosis progression using multiple radiographs during growth. During imaging, arms must be elevated to visualize vertebrae, possibly affecting sagittal alignment. This study aimed to determine the arm position that best represents habitual standing (and possibly allowing hand-based skeletal maturity assessment) to obtain frontal and lateral stereo-radiographs as measured using frontal, sagittal, and transverse angles.Females with and without, and males with Adolescent Idiopathic Scoliosis (AIS) were recruited consecutively. Patients were scanned using 3D Ultrasound imaging (3DUS), in 10 arm positions; habitual standing, arms supported anteriorly at 60° flexion, fingers to clavicle, chin, zygomatic, and eyebrows, arms abducted 90°, hands on wall, on blocks, and unsupported. Axial vertebral rotation (AVR) differences, frontal, and sagittal curve angles were measured. Repeated measures ANOVAs with Sidak post-hoc tests compared positions.Ninety females with and without AIS with mean age, and height of 17 ± 4 years, and 162 ± 6 cm, and ten males with AIS of 16 ± 3 years, and 174 ± 11 cm, respectively, were included. Female AIS single-curve showed larger curves in standing in all positions excluding hands on blocks (p > 0.05). Sagittal parameters showed decreases in kyphosis in arms abducted 90° and increases in lordosis in fingers to cheeks/eyebrows (p > 0.05). AVR twist was not significantly affected by position. Male AIS showed comparable results to females, but no significant differences were detected.No position represented habitual standing for all groups. When arms are raised, decreases in curve angle were shown in single-curve patients, kyphosis decreased, and lordosis increased in all groups. Most accurate positioning for all parameters was in fingers to clavicle/chin position.Conclusion: Clinicians monitor scoliosis progression using multiple radiographs during growth. During imaging, arms must be elevated to visualize vertebrae, possibly affecting sagittal alignment. This study aimed to determine the arm position that best represents habitual standing (and possibly allowing hand-based skeletal maturity assessment) to obtain frontal and lateral stereo-radiographs as measured using frontal, sagittal, and transverse angles.Females with and without, and males with Adolescent Idiopathic Scoliosis (AIS) were recruited consecutively. Patients were scanned using 3D Ultrasound imaging (3DUS), in 10 arm positions; habitual standing, arms supported anteriorly at 60° flexion, fingers to clavicle, chin, zygomatic, and eyebrows, arms abducted 90°, hands on wall, on blocks, and unsupported. Axial vertebral rotation (AVR) differences, frontal, and sagittal curve angles were measured. Repeated measures ANOVAs with Sidak post-hoc tests compared positions.Ninety females with and without AIS with mean age, and height of 17 ± 4 years, and 162 ± 6 cm, and ten males with AIS of 16 ± 3 years, and 174 ± 11 cm, respectively, were included. Female AIS single-curve showed larger curves in standing in all positions excluding hands on blocks (p > 0.05). Sagittal parameters showed decreases in kyphosis in arms abducted 90° and increases in lordosis in fingers to cheeks/eyebrows (p > 0.05). AVR twist was not significantly affected by position. Male AIS showed comparable results to females, but no significant differences were detected.No position represented habitual standing for all groups. When arms are raised, decreases in curve angle were shown in single-curve patients, kyphosis decreased, and lordosis increased in all groups. Most accurate positioning for all parameters was in fingers to clavicle/chin position. [ABSTRACT FROM AUTHOR]

The article discusses the test-retest reliability of spinal measurements in adolescents with idiopathic scoliosis using ultrasound imaging. The study acknowledges the need for standardized image acquisition and recommends training evaluators to minimize discrepancies. It also highlights the potential of artificial intelligence in expediting measurements. The findings suggest that 3D ultrasound offers a reliable, radiation-free alternative for spinal measurements, with the hands-on-wall position yielding the most reliable results. The study aims to contribute to safer scoliosis monitoring practices and emphasizes the importance of stability during measurements. [Extracted from the article]

• Kyphotic and lordotic angles quantify the sagittal spinal curvature severity. • An automatic measurement method was developed for both angles on lateral radiographs. • The automatic methods were accurate when compared to manual measurements. • The method was quick, measuring both angles in 4 s on average per radiograph. • The method outputs segmentations, illustrating how the angles were measured. Measuring the kyphotic angle (KA) and lordotic angle (LA) on lateral radiographs is important to truly diagnose children with adolescent idiopathic scoliosis. However, it is a time-consuming process to measure the KA because the endplate of the upper thoracic vertebra is normally difficult to identify. To save time and improve measurement accuracy, a machine learning algorithm was developed to automatically extract the KA and LA. The accuracy and reliability of the T1-T12 KA, T5-T12 KA, and L1-L5 LA were reported. A convolutional neural network was trained using 100 radiographs with data augmentation to segment the T1-L5 vertebrae. Sixty radiographs were used to test the method. Accuracy and reliability were reported using the percentage of measurements within clinical acceptance (≤9°), standard error of measurement (SEM), and inter-method intraclass correlation coefficient (ICC 2,1). The automatic method detected 95 % (57/60), 100 %, and 100 % for T1-T12 KA, T5-T12 KA, and L1-L5 LA, respectively. The clinical acceptance rate, SEM, and ICC 2,1 for T1-T12 KA, T5-T12 KA, and L1-L5 LA were (98 %, 0.80°, 0.91), (75 %, 4.08°, 0.60), and (97 %, 1.38°, 0.88), respectively. The automatic method measured quickly with an average of 4 ± 2 s per radiograph and illustrated how measurements were made on the image, allowing verifications by clinicians. Program flow of the developed automatic kyphotic and lordotic angles measurement method for lateral radiographs, with results illustrated after each step [Display omitted] [ABSTRACT FROM AUTHOR]

Osteopenia is considered a common phenomenon in patients who have scoliosis. Quantitative ultrasound has been used to assess skeletal status for decades, and recently ultrasound imaging using reflection signals from vertebrae were as well applied to measure spinal curvatures in children with scoliosis. The objectives of this study were to develop a new method that can robustly extract a parameter from ultrasound spinal data for estimating bone quality of scoliotic patients and to investigate the potential of the parameter in predicting curve progression. The frequency amplitude index (FAI) was calculated based on the spectrum of the original radiofrequency signals reflected from the tissue-vertebra interface. The correlation between FAI and reflection coefficient was validated using decalcified bovine bone samples in vitro, and the FAIs of scoliotic subjects were investigated in vivo with reference to body mass index, Cobb angles and curve progression status. The results revealed that the intra-rater measures were highly reliable between different trials (intra-class correlation coefficient = 0.997). The FAI value was strongly correlated with the reflection coefficient of bone tissue (R2 = 0.824), and the lower FAI indicated the higher risk of curve progression for the non-mild scoliosis cases. This preliminary study found that the FAI method can provide a feasible and robust approach to assessment of the bone quality of spine and may be a promising factor in monitoring curve progression of patients who have adolescent idiopathic scoliosis. [ABSTRACT FROM AUTHOR]

Background Context: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity recognized with lateral curvature of the spine as well as axial vertebral rotation. Surgical interventions are recommended when patients with AIS have severe curvature (Cobb angle >45o). Spinal flexibility is one of important parameters for surgeons to plan surgical treatment. Few radiographic methods have been developed to assess spinal flexibility.Purpose: A systematic review was performed to evaluate which preoperative radiographic methods should be used to estimate spinal flexibility based on the postoperative outcomes.Study Design: Studies which included any of the five radiographic methods: (1) supine side-bending (SBR), (2) fulcrum-bending (FBR), (3) traction, (4) push-prone, and (5) suspension were reviewed and compared to determine which method provided the most accurate estimation of the postoperative outcomes.Patient Sample: Seven case series, one case control, and multiple cohort studies reported the flexibility assessment methods with the estimations of postoperative outcomes on patients with AIS.Outcome Measures: The flexibility index defined as a correction rate relative to flexibility rate was used to estimate the immediate and final follow-up postoperative outcomes.Methods: Seven databases searched included MEDLINE, CENTRAL, EMBASE, CINAHL, Web of Science, LILACS, and Google Scholar. Three independent reviewers were involved for abstracts and full-texts screening as well as data extraction. The Quality in Prognostic Studies quality appraisal tool was used to assess the risk of bias within the studies. Also, the GRADE system rate was used to assess the evidence level across the studies.Results: Forty-six articles were included. The distribution of the five flexibility methods in these 46 studies were SBR 38/46 (83%), fulcrum bending radiograph (FBR) 16/46 (35%), traction radiograph 5/46 (11%), push-prone 1/46 (2%), and suspension 1/46 (2%). Based on the overall assessment of flexibility indices, FBR had the best estimation of postoperative correction among the five methods. FBR method provided the best estimations of immediate and final follow-up postoperative outcomes for moderate (25°-45°) and severe (>45°) curves, respectively. For main thoracic and thoracolumbar/lumbar curves, the best estimations were traction, and FBR. However, in the reviewed articles, the risk of bias was rated moderate and the quality of evidence was rated very low to low so that a strong conclusive statement cannot be made.Conclusions: SBR method was the most commonly used method to assess the spinal flexibility. The FBR method was the most accurate method to estimate the postoperative outcomes based on the limited evidence of the 46 articles. [ABSTRACT FROM AUTHOR]

Study Design: A prospective randomized controlled trial.Objective: The aim of this study was to investigate the effectiveness of orthotic management versus exercise on spinal curvature, body symmetry, and quality of life.Summary Of Background Data: A number of well-designed studies comparing conservative treatment of adolescent idiopathic scoliosis (AIS) have been conducted and the evidence becomes stronger. However, there is a lack of the information on the effectiveness of orthotic management versus exercise.Methods: The inclusion criteria recommended by the Scoliosis Research Society (SRS) and the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) were used during enrollment. Eligible patients were randomly assigned to either bracing group or exercise group. Patients in the bracing group were prescribed with a rigid thoracolumbosacral orthosis and requested to wear 23 h/day, while patients in the exercise group were treated with the protocol of the Scientific Exercise Approach to Scoliosis. Data regarding angle of trunk inclination, Cobb angle, shoulder balance, body image, and quality of life (QoL) were collected every 6 months.Results: Twenty-four patients in the bracing group and 29 patients in the exercise group participated in this study. For the intergroup comparison, the bracing group showed better results about the correction of spinal curvature (Cobb angle at the first 12 months of intervention, P = 0.039), scores concerning QoL, especially function (P < 0.001), mental health (P < 0.001), and total score (P < 0.001), were higher than that of the exercise group. The results of body symmetry evaluation did not differ significantly between the two groups. For the intragroup comparison, parameters of spinal curvature (baseline vs. 12-month, P < 0.03 in the exercise group and P < 0.001 in the bracing group), QoL (baseline vs. 12-month, P < 0.001), and TAPS (baseline vs. 12-month, P < 0.033) significantly improved over the studied period. Shoulder balance (baseline vs. 12-month, P < 0.005) showed significant improvement only in the bracing group.Conclusion: Both interventions of bracing and exercise showed significant treatment effectiveness on the patients with AIS. Bracing was superior to capture corrections in parameters of spinal curvature and body symmetry, while the QoL, especially in aspect of the functional and psychological status, was significantly better in the exercise group.Level Of Evidence: 1. [ABSTRACT FROM AUTHOR]

Adolescent idiopathic scoliosis (AIS) is a 3-dimensional spinal deformity involving lateral curvature and axial rotation. Surgical intervention involves insertion of pedicle screws into the spine, requiring accuracies of 1 mm and 5° in translation and rotation to prevent neural and vascular complications. While commercial CT-navigation is available, the significant cost, bulk and radiation dose hinders their use in AIS surgery. The objective of this study was to evaluate a commercial-grade Optitrack Prime 13W motion capture cameras to determine if they can achieve adequate accuracy for screw insertion guidance in AIS. Static precision, camera and tracked rigid body configurations, translational and rotational accuracy were investigated. A 1-h camera warm-up time was required to achieve precisions of 0.13 mm and 0.10°. A three-camera system configuration with cameras at equal height but staggered depth achieved the best accuracy. A triangular rigid body with 7.9 mm markers had superior accuracy. The translational accuracy for motions up to 150 mm was 0.25 mm while rotational accuracy was 4.9° for rotations in two directions from 0° to 70°. Required translational and rotational accuracies were achieved using this motion capture system as well as being comparable to surgical-grade navigators. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective study of the coronal curvature measurement on ultrasound (US) images with the aid of previous radiographs. Objective: To compare the reliability and accuracy of the coronal curvature measurements from US images on children who have adolescent idiopathic scoliosis (AIS) with and without the knowledge of previous radiographs. Summary Of Background Data: Using US imaging technique to measure coronal curvature on children with AIS has demonstrated high intra- and interrater reliabilities. However, the selection of end-vertebrae and the measurement difference between radiography and the US method were only moderately reliable. Methods: Two raters measured the coronal curvatures from 65 AIS standing US spine images, without (measured one time) and with the aid of previous standing radiographs (measured two times). The intra- and interrater reliability, the correlation and the difference between the radiographic and US measurements, and the error index of the end-vertebrae selection were assessed. Results: Overall, 109 curves were investigated. The intraclass correlation coefficients (ICC) of intra- and interrater reliability of the US coronal curvature measurement with the aid of previous radiographs (AOR) were 0.95 and 0.91, respectively. In comparison with the radiographic measurements, the correlation of AOR method (R) was 0.90 and the MAD was 2.8°; the corresponding results of the US measurement without the AOR (blinded US method) were 0.73° and 4.8°, respectively. The average error index on end-vertebral selection improved 43% with the AOR. Conclusion: The AOR method significantly improved reliability and accuracy of the spinal curvature measurement on US images compared with the blinded US method (P<0.001). It indicates that US standing images with the AOR can be used as a reliable and accurate nonionizing imaging method to monitor children with AIS. Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

• Fully automatic axial vertebral rotation measurements on radiographs. • 81% of the measurements are within clinical acceptance error (5°). • It only takes 8.8 s to detect vertebral rotation per vertebra. Adolescent idiopathic scoliosis is a 3D lateral spinal curvature coupled with axial vertebral rotation (AVR). Measuring AVR during clinic is important because it affects treatment options and predicts the risk of scoliosis progression. However, manual measurements are time consuming and have high inter-rater and intra-rater errors. This study aimed to develop a machine learning algorithm based on convolutional neural networks (CNNs) to automatically calculate AVR on posteroanterior radiographs using three different segmentations including spinal column, individual vertebra, and pedicles. Separate labeling and training processes were performed on each of the developed segmentation algorithms. The final machine learning software was tested on 221 vertebrae from 17 spinal radiographs. An experienced rater with over 25 years of experience measured the 221 vertebral rotations manually. By comparing the manual and the fully automatic measurements, 81% (178/221) of the automatic measurements were within the clinical acceptance error (±5°). The mean absolute difference and the standard deviation between the manual and automatic measurements was 4.3° ± 5.7°. Based on the Bland-Altman plot, the manual and automatic measurements had a strong correlation and no bias. The error did not relate to the severity of the rotation. This method is fully automatic, and the result is comparable to others. [ABSTRACT FROM AUTHOR]

The article presents a study which determines the availability of the Scoliosis Research Society questionnaire (SRS)-22. The said questionnaire is used for discrimination between management and scoliosis severity subgroups and correlations between internal and external measures of curve severity. The study concludes that pain, self-image, and satisfaction scores were able to discriminate management subgroups whereas function, mental health, and total scores could not.