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Purpose: To determine the reliability of a prognostic curve progression model and the role of the quantity and quality of brace wear for adolescent idiopathic scoliosis (AIS) brace treatment.Methods: To develop a curve progression model for full-time AIS brace treatment, 20 AIS subjects (Group 1) prescribed full-time thoracolumbar sacral orthosis (TLSO) were monitored and followed for 2 years beyond maturity. The developed curve progression model was: curve progression (in degrees) = 33 + 0.11 × Peterson risk (%) - 0.07 in-brace correction (%) - 0.45 × quality (%) - 0.48 × quantity (%) + 0.0062 × quantity × quality. To validate the model, 40 new (test) subjects (Group 2) who met the same inclusion criteria and used the same type of monitors, were monitored and followed for 2 years after bracing.Results: For the 40 test subjects (Group 2), the average in-brace correction was 40 ± 22 %. The average quantity and quality of the brace wear were 56 ± 19 and 55 ± 17 %, respectively. Twelve subjects (30 %) progressed of which 10 subjects (25 %) required surgery and 28 subjects (70 %) showed no progression. The accuracy of the model to determine which patients would progress was 88 % (35/40) which was better than the Peterson's risk model (68 %; 26/40) alone. Patients who had the combined quantity times the quality over a threshold 43 % had a success treatment rate of 95 %.Conclusions: This study showed the prognostic model of brace treatment outcome on AIS patients treated with full-time TLSO was reliable. Both the quantity and quality of the brace wear were important factors in achieving successful brace treatment. [ABSTRACT FROM AUTHOR]

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity. Brace treatment is a common non-surgical treatment, intended to prevent progression (worsening) of the condition during adolescence. Estimating a braced patient's risk of progression is an essential part of planning treatment, so method for predicting this risk would be a useful decision support tool for practitioners. This work attempts to discover whether failure of brace treatment (progression) can be predicted at the start of treatment. Records were obtained for 62 AIS patients who had completed brace treatment. Subjects were labeled as "progressive" if their condition had progressed despite brace treatment and "non-progressive" otherwise. Wrapper-based feature selection selected two useful predictor variables from a list of 14 clinical measurements taken from the records. A logistic regression model was trained to classify patients as "progressive" or "non-progressive" using these two variables. The logistic regression model's simplicity and interpretability should facilitate its clinical acceptance. The model was tested on data from an additional 28 patients and found to be 75 % accurate. This accuracy is sufficient to make the predictions clinically useful. It can be used online: http://www.ece.ualberta.ca/~dchalmer/SimpleBracePredictor.html . [ABSTRACT FROM AUTHOR]

Background: The North American non-surgical standard of care for adolescent idiopathic scoliosis (AIS) includes observation and bracing, but not exercises. Schroth physiotherapeutic scoliosis-specific exercises (PSSE) showed promise in several studies of suboptimal methodology. The Scoliosis Research Society calls for rigorous studies supporting the role of exercises before including it as a treatment recommendation for scoliosis. Objectives: To determine the effect of a six-month Schroth PSSE intervention added to standard of care (Experimental group) on the Cobb angle compared to standard of care alone (Control group) in patients with AIS. Methods: Fifty patients with AIS aged 10–18 years, with curves of 10°-45° and Risser grade 0–5 were recruited from a single pediatric scoliosis clinic and randomized to the Experimental or Control group. Outcomes included the change in the Cobb angles of the Largest Curve and Sum of Curves from baseline to six months. The intervention consisted of a 30–45 minute daily home program and weekly supervised sessions. Intention-to-treat and per protocol linear mixed effects model analyses are reported. Results: In the intention-to-treat analysis, after six months, the Schroth group had significantly smaller Largest Curve than controls (-3.5°, 95% CI -1.1° to -5.9°, p = 0.006). Likewise, the between-group difference in the square root of the Sum of Curves was -0.40°, (95% CI -0.03° to -0.8°, p = 0.046), suggesting that an average patient with 51.2° at baseline, will have a 49.3° Sum of Curves at six months in the Schroth group, and 55.1° in the control group with the difference between groups increasing with severity. Per protocol analyses produced similar, but larger differences: Largest Curve = -4.1° (95% CI -1.7° to -6.5°, p = 0.002) and (95% CI -0.8 to 0.2, p = 0.006). Conclusion: Schroth PSSE added to the standard of care were superior compared to standard of care alone for reducing the curve severity in patients with AIS. Trial Registration: [ABSTRACT FROM AUTHOR]

Brace treatment is the most commonly used nonsurgical treatment for adolescents with idiopathic scoliosis. However, brace treatment is not always successful and the factors influencing its success are not completely clear. This makes treatment outcome difficult to predict. A computer model which can accurately predict treatment outcomes could potentially provide valuable treatment recommendations. This paper describes a fuzzy system that includes a prediction model and a decision support engine. The model was constructed using conditional fuzzy c-means clustering to discover patterns in retrospective patient data. The model's ability to predict treatment outcome was compared to the ability of eight Scoliosis experts. The model and experts each predicted treatment outcome retrospectively for 28 braced patients, and these predictions were compared to the actual outcomes. The model outperformed all but one expert individually and performed similarly to the experts as a group. These results suggest that the fuzzy model is capable of providing meaningful treatment recommendations. This study offers the first model for this application whose performance has been shown to be at or above the human expert level. [ABSTRACT FROM PUBLISHER]

Adolescent idiopathic scoliosis is a spinal deformity affecting 2–3% of adolescents. Brace treatment, the most common non-surgical treatment, uses a hard plastic orthotic shell to prevent progression of the deformity. Previous studies have found association between treatment outcome and patients’ compliance with the prescribed brace-wear regimen. However, the exact relationship between compliance and treatment outcome has yet to be elucidated. Current compliance monitoring techniques may not be providing enough information about patients’ brace-wear habits. Building on previous work, we present a new compliance monitor which records both temperature and force applied to the patient's body. The combination of temperature and force readings shows both how often and how tightly the brace is worn. The new monitor is designed for minimal size and power consumption, measuring 5.2 cm × 2.5 cm × 0.8 cm, with a battery life of approximately one year. Seven patients wore the monitor in this pilot study. The temperature-based compliance estimate differed significantly from the force-based estimate in four out of seven cases. This suggests that some patients may wear their braces very loosely, and that existing temperature-only or force-only compliance monitors may not be giving a complete picture of brace-wear habits. [ABSTRACT FROM AUTHOR]

Force sensors have been reported to be reliable for monitoring spinal orthosis compliance in the treatment of scoliosis. However, the current force sensor used for these compliance monitors has certain limitations and drawbacks. A lower cost force sensor with a 55% larger operating force range was chosen for this application, with modifications required to increase its contact surface, improve comfort, and reduce the manufacturing time. Different designs have been considered and described in this paper. A final prototype using a rubberlike material housing with a stiff nub over the sensing area of the original sensor produced a linear, highly sensitive, large surface area, reliable, and robust sensor. It has a sensitivity of 315 mV/N, accuracy 1.9%, repeatability 0.6%, linearity 0.7%, hysteresis 0.8%, dead band 0.0%, point drift 0.5%, temperature drift 2.2% for the temperature range 25^\circC– 35 ^\circC, and reproducibility 1.3%. These properties are adequate for measuring forces in a spinal orthosis. The total cost of the sensor with housing is $46 when ordered in quantities of 1000, which reduces the price of the existing sensor by 34%. The manufacturing time of the new sensor was reduced and a preliminary subject trial demonstrated that the new sensor did not have significant temperature effect. This will make force systems more affordable and adaptable for the effective treatment of scoliosis. [ABSTRACT FROM PUBLISHER]

Abstract: Scoliosis is a spinal deformity that affects millions of adolescents in the United States. Bracing is the most common non-surgical treatment method for scoliosis, but the biomechanics of such treatment is unclear. The objective of this study is to develop and validate a force logging system that can record forces at multiple locations inside a brace, as well as brace strap tension, and correlate these forces with different body positions. The force logging system can be used to investigate the biomechanics function of a brace to treat scoliosis during the treatment period. Two phases were completed in this study: design phase, involving custom development and calibration of strap tension transducers and modifications of in-brace force transducers; and validation phase, including preliminary testing on a subject with different postures. In-brace force load cell and tension transducer were tested and validated. Their sensitivities were 193.5±4.9mV/N and 35.5±0.2mV/N, respectively, with both linear correlation coefficients were 0.99, reflecting high repeatability and linearity. Qualitative validation was also completed, allowing general relationships to be found between subject posture and force distribution. This study shows an excellent functionality and utility of the developed system. [Copyright &y& Elsevier]

Bracing is a common nonsurgical treatment for scoliosis, but its effectiveness has been debated. Some clinical studies have shown efficacy of brace treatment is correlated to how the brace has been worn. The more often the patients wear their braces to the prescribed tightness as well as the prescribed length of wear each day, the better the treatment outcome. A system of four wireless pressure control devices was developed to understand brace wear-time and regulate a target pressure range at the brace–body interface. Each pressure control device could function independently and be embedded in the brace at key pressure areas. Such a system could improve the quality of brace wear—making the treatment more effective and refining our understanding of the three-pressure-point brace treatment concept during daily activities. This paper reports the system development and validation. The system was tested on four healthy subjects for 2 h without pressure regulation and 2 h with regulation. The results show that the pressure regulation doubled the time spent in a desired pressure range on average (from 31% to 62%). Brace-wear time was logged correctly. The system was also validated through a seven-day continuous test, and a fully charged battery could run for 30 days without requiring recharge. [ABSTRACT FROM PUBLISHER]

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]

Choosing the most suitable treatment for scoliosis relies heavily on accurate and reproducible Cobb angle measurement from successive radiographs. The objective is to reduce variability of Cobb angle measurement by reducing user intervention and bias. Custom software to increase automation of the Cobb angle measurement from posteroanterior radiographs was developed using active shape models. Validity and reliability of the automated system against a manual and semiautomated measurement method was conducted by two examiners each performing measurements on three occasions from a test set ( N = 22). A training set ( N = 47) of radiographs representative of curves seen in a scoliosis clinic was used to train the software to recognize vertebrae from T4 to L4. Images with a maximum Cobb angle between 20° and 50°, excluding surgical cases, were selected for training and test sets. Automated Cobb angles were calculated using best-fit slopes of the detected vertebrae endplates. Intraclass correlation coefficient (ICC) and standard error of measurement (SEM) showed high intraexaminer (ICC > 0.90, SEM 2°–3°) and interexaminer (ICC > 0.82, SEM 2°–4°), but poor intermethod reliability (ICC = 0.30, SEM 8°–9°). The automated method underestimated large curves. The reliability improved (ICC = 0.70, SEM 4°–5°) with exclusion of the four largest curves (>40°) in the test set. The automated method was reliable for moderate-sized curves, and did detect vertebrae in larger curves with a modified training set of larger curves. [ABSTRACT FROM AUTHOR]

Efficiency of brace treatment for adolescent idiopathic scoliosis is correlated to how the brace has been worn. The more often the patients wear their braces to the prescribed tightness as well as to the prescribed length of time each day, the better the treatment outcomes. This paper describes an active intelligent brace system designed to maintain the interface pressure between the brace and body within the prescribed range during daily activity. The intelligent system consists of a microcomputer, a force transducer and a force feedback component. A subject who has no scoliosis volunteered to test the system for a few hours. Preliminary trials indicate that wearing the system increases the amount of time which a subject wears his brace in the prescribed range of tightness. The test subject wore the brace without feed- back within the prescribed range of tightness for 28% of the time, whereas when the air bladder feedback system was activated, the subject wore the brace effectively for 47 % of the time. [ABSTRACT FROM AUTHOR]

Discusses a posture monitoring system for the treatment of idiopathic scoliosis using electromagnetic and accelerometer technology. Parallel execution of data collection; Key features of the microcontroller; Accelometer duty cycle output.

A six-axis sensor array has been developed to quantify the 3D force and moment loads applied in scoliosis correction surgery. Initially this device was developed to be applied during scoliosis correction surgery and augmented onto existing surgical instrumentation, however, use as a general load sensor is also feasible. The development has included the design, microfabrication, deployment and calibration of a sensor array. The sensor array consists of four membrane devices, each containing piezoresistive sensing elements, generating a total of 16 differential voltage outputs. The calibration procedure has made use of a custom built load application frame, which allows quantified forces and moments to be applied and compared to the outputs from the sensor array. Linear or non-linear calibration equations are generated to convert the voltage outputs from the sensor array back into 3D force and moment information for display or analysis. [ABSTRACT FROM AUTHOR]

Background Context: Severe adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity requiring surgery to stop curve progression. Posterior spinal instrumentation and fusion with pedicle screws is the standard surgery for AIS curve correction. Vascular and neurologic complications related to screw malpositioning are concerns in surgeries for AIS. Breach rates are reported at 15.7%, implant-related complications at 1.1%, and neurologic deficit at 0.8%. Free-hand screw insertion remains the prevailing method of screw placement, whereas image guidance has been suggested to improve placement accuracy.Purpose: This study aimed to systematically review the screw-related complication and breach rates from posterior spinal instrumentation and fusion with pedicle screws for patients with AIS when using free-hand methods for screw insertion compared with image guidance methods.Study Design: This is a systematic review of prognosis, comparing image guidance with no image guidance in surgery.Patient Sample: One randomized controlled trial and multiple prospective cohort studies that reported complication or breach rates in posterior spinal instrumentation and fusion with pedicle screws for AIS.Outcome Measures: Number of complications and breaches reported in databases or recorded from postoperative imaging.Methods: Databases searched included MEDLINE, Embase, CINAHL, CENTRAL, and Web of Science. Studies of Level 3 evidence or greater as defined by the Centre for Evidence-Based Medicine were included. Articles were screened to focus on patients with AIS undergoing posterior fusion with pedicle screws or hybrid systems. Two independent reviewers screened abstracts, full texts, and extracted data. The Quality in Prognostic Studies (QUIPS) appraisal tool was used to determine studyrisk of bias (ROB). Level of evidence summary statements were formulated based on consistency and quality of reporting.Results: Seventy-nine cohort studies were identified, including four comparing computed tomography (CT) guidance with free-hand methods head-to-head, eight on image guidance, and 671. on free-hand methods alone. Moderate evidence from individual head-to-head studies show CT guidance has lower breach rates than free-hand methods. No complications were found in these studies. From individual cohort studies, moderate evidence shows CT guidance has lower point estimates of breach rates than free-hand methods at 7.9% compared with 9.7%-17.1%. Screw-related complication rates are conflicting at 0% in CT navigation compared with 0%-1.7% in 13 low- and moderate-quality studies.Conclusions: Although point estimates on breach rates are decreased with CT navigation compared with free-hand methods, complication rates remain conflicting between the two methods. Current evidence is limited by small sample sizes, lack of comparison groups, and poorly predefined complications. Randomized controlled trials with larger samples with standardized definitions and recording of predefined breach and complication occurrences are recommended. [ABSTRACT FROM AUTHOR]