Evaluation of functional and structural leg length discrepancy in patients with adolescent idiopathic scoliosis using the EOS imaging system: a prospective comparative study

ABSTRACT Objective The objective of this study is to evaluate leg length discrepancy in adolescent idiopathic scoliosis. Methods A retrospective study of 80 subjects with adolescent idiopathic scoliosis (AIS) was conducted. The inclusion criteria were patients aged 10 to 18 years old with posteroanterior (PA) and lateral full-length radiographs. The exclusion criteria were patients subjected to surgery or orthotic treatment, those with other spinal disease, and those with poor quality x-rays. The parameters evaluated were: age, sex, Risser stage (RS), triradiate cartilage (TC), scoliotic curvatures, differentiated according to Lenke classification, sagittal (SB) and coronal balance (CB), and leg length discrepancy, which was assessed through the difference between the femoral heads (LLD) and through the assessment of pelvic obliquity (PO). Results The majority of patients with AIS demonstrated a mild LLD (<1 cm). The mean LLD was significantly different (p<0.01) between the scoliotic population with a main thoracolumbar curvature and those with a main lumbar curvature. When there was an LLD, it was the left limb that was shortened in most cases. The side of the longer lower limb had a direct influence on the CB (p=0.052). Conclusions This study demonstrates that in an AIS population with small LLD values, the extent of the shortening has a stronger impact on coronal balance and location than on the dimension of the main scoliotic curvature. These results demonstrate the importance of a more in-depth study on the effects of LLD <1 cm in the development of AIS and coronal imbalance. Level of evidence IV; Case Series.

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Leg length discrepancy and adolescent idiopathic scoliosis: clinical and radiological characteristics

Spine Deformity ◽

10.1007/s43390-021-00417-0 ◽

2021 ◽

Author(s):

Ahsen Buyukaslan ◽

Kadir Abul ◽

Haluk Berk ◽

Hurriyet Yilmaz

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Leg Length Discrepancy ◽

Leg Length ◽

Length Discrepancy

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Correction to: Leg length discrepancy and adolescent idiopathic scoliosis: clinical and radiological characteristics

Spine Deformity ◽

10.1007/s43390-021-00442-z ◽

2021 ◽

Author(s):

Ahsen Buyukaslan ◽

Kadir Abul ◽

Haluk Berk ◽

Hurriyet Yilmaz

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Leg Length Discrepancy ◽

Leg Length ◽

Length Discrepancy

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Microdose acquisition in adolescent leg length discrepancy using a low-dose biplane imaging system

Acta Radiologica ◽

10.1177/0284185116682381 ◽

2017 ◽

Vol 58 (9) ◽

pp. 1108-1114 ◽

Cited By ~ 2

Author(s):

Janni Jensen ◽

Bo R Mussmann ◽

John Hjarbæk ◽

Zaid Al-Aubaidi ◽

Niels W Pedersen ◽

...

Keyword(s):

Low Dose ◽

Imaging System ◽

Statistical Significance ◽

Leg Length Discrepancy ◽

Leg Length ◽

Planar Imaging ◽

Length Discrepancy ◽

Significant Difference ◽

Length Measurements ◽

Total Leg

Background Children with leg length discrepancy often undergo repeat imaging. Therefore, every effort to reduce radiation dose is important. Using low dose preview images and noise reduction software rather than diagnostic images for length measurements might contribute to reducing dose. Purpose To compare leg length measurements performed on diagnostic images and low dose preview images both acquired using a low-dose bi-planar imaging system. Material and Methods Preview and diagnostic images from 22 patients were retrospectively collected (14 girls, 8 boys; mean age, 12.8 years; age range, 10–15 years). All images were anonymized and measured independently by two musculoskeletal radiologists. Three sets of measurements were performed on all images; the mechanical axis lines of the femur and the tibia as well as the anatomical line of the entire extremity. Statistical significance was tested with a paired t-test. Results No statistically significant difference was found between measurements performed on the preview and on the diagnostic image. The mean tibial length difference between the observers was −0.06 cm (95% confidence interval [CI], −0.12 to 0.01) and −0.08 cm (95% CI, −0.21 to 0.05), respectively; 0.10 cm (95% CI, 0.02–0.17) and 0.06 cm (95% CI, −0.02 to 0.14) for the femoral measurements and 0.12 cm (95% CI, −0.05 to 0.26) and 0.08 cm (95% CI, −0.02 to 0.19) for total leg length discrepancy. ICCs were >0.99 indicating excellent inter- and intra-rater reliability. Conclusion The data strongly imply that leg length measurements performed on preview images from a low-dose bi-planar imaging system are comparable to measurements performed on diagnostic images.

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Intra-operative digital imaging

The Bone & Joint Journal ◽

10.1302/0301-620x.100b1.bjj-2017-0596.r1 ◽

2018 ◽

Vol 100-B (1_Supple_A) ◽

pp. 36-43 ◽

Cited By ~ 6

Author(s):

D. Hambright ◽

M. Hellman ◽

R. Barrack

Keyword(s):

Acetabular Component ◽

Digital Imaging ◽

Imaging System ◽

High Volume ◽

Leg Length Discrepancy ◽

Leg Length ◽

Retrospective Case ◽

Femoral Offset ◽

Length Discrepancy ◽

Surgical Data

AimsThe aims of this study were to examine the rate at which the positioning of the acetabular component, leg length discrepancy and femoral offset are outside an acceptable range in total hip arthroplasties (THAs) which either do or do not involve the use of intra-operative digital imaging.Patients and MethodsA retrospective case-control study was undertaken with 50 patients before and 50 patients after the integration of an intra-operative digital imaging system in THA. The demographics of the two groups were comparable for body mass index, age, laterality and the indication for surgery. The digital imaging group had more men than the group without. Surgical data and radiographic parameters, including the inclination and anteversion of the acetabular component, leg length discrepancy, and the difference in femoral offset compared with the contralateral hip were collected and compared, as well as the incidence of altering the position of a component based on the intra-operative image.ResultsDigital imaging took a mean of five minutes (2.3 to 14.6) to perform. Intra-operative changes with the use of digital imaging were made for 43 patients (86%), most commonly to adjust leg length and femoral offset. There was a decrease in the incidence of outliers when using intra-operative imaging compared with not using it in regard to leg length discrepancy (20% versus 52%, p = 0.001) and femoral offset inequality (18% versus 44%, p = 0.004). There was also a difference in the incidence of outliers in acetabular inclination (0% versus 7%, p = 0.023) and version (0% versus 4%, p = 0.114) compared with historical results of a high-volume surgeon at the same centre.ConclusionThe use of intra-operative digital imaging in THA improves the accuracy of the positioning of the components at THA without adding a substantial amount of time to the operation. Cite this article: Bone Joint J 2018;100B(1 Supple A):36–43.

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Flexibility analysis in adolescent idiopathic scoliosis on side-bending images using the EOS imaging system

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2016.01.021 ◽

2016 ◽

Vol 102 (4) ◽

pp. 495-500 ◽

Cited By ~ 12

Author(s):

C. Hirsch ◽

B. Ilharreborde ◽

K. Mazda

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Imaging System ◽

Flexibility Analysis ◽

Eos Imaging ◽

Side Bending

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Sequential spine-hand radiography for assessing skeletal maturity with low radiation EOS imaging system for bracing treatment recommendation in adolescent idiopathic scoliosis: a feasibility and validity study

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.13.190007 ◽

2019 ◽

Vol 13 (4) ◽

pp. 385-392 ◽

Cited By ~ 2

Author(s):

L. C. M. Lau ◽

A. L. H. Hung ◽

W. W. Chau ◽

Z. Hu ◽

A. Kumar ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Imaging System ◽

Skeletal Maturity ◽

Intraobserver Agreement ◽

Maturity Assessment ◽

Eos Imaging ◽

Hand Radiographs ◽

Hand Radiography

Purpose The EOS-imaging system is increasingly adopted for clinical follow-up in scoliosis with the advantages of simultaneous biplanar imaging of the spine in an erect position. Skeletal maturity assessment using a hand radiograph is an essential adjunct to spinal radiography in scoliosis follow-up. This study aims at testing the feasibility and validity of a newly proposed EOS workflow with sequential spine-hand radiography for skeletal maturity assessment and bracing recommendation. Methods EOS spine-hand radiographs from patients with diagnosis of idiopathic scoliosis, including both sexes and an age range of ten to 14 years, were scored using the Thumb Ossification Composite Index (TOCI), Sanders and Risser methods. Intraclass correlation coefficients (ICCs) were calculated for inter/intraobserver agreement and were tested with Cronbach’s alpha values. Results In all, 60 EOS-spine hand radiographs selected from subjects with diagnosis of adolescent idiopathic scoliosis (AIS), including 32 male patients (mean age 11.53 years; 10 to 14) and 28 female patients (mean age 11.50 years; 10 to 13) who underwent sequential spine-hand low dose EOS imaging were generated for analysis. The overall interobserver (ICC = 0.997) and intraobserver agreement (α > 0.9) demonstrated excellent agreement for TOCI staging; ICC > 0.994 for both TOCI and Sanders staging comparing traditional digital versus EOS hand radiography; ICC ≥ 0.841 for agreement on bracing recommendation among TOCI versus the Risser and Sanders system. Conclusion With the proposed new EOS workflow it was feasible to produce high image quality for skeletal maturity assessment with excellent reliability and validity to inform consistent bracing recommendation in AIS. The workflow is applicable for busy daily clinic settings in tertiary scoliosis centres with reduced time cost, improved efficiency and throughput of the radiology department. Level of evidence III

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