scholarly journals Lack of In-Brace X-Rays in Compliant AIS Patients Wearing Full-Time TLSO Braces Associates with Failure

2021 ◽  
Author(s):  
Isabel Alvarez ◽  
Kiley Poppino ◽  
Lori Karol ◽  
Amy L McIntosh
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Successful Treatment ◽  
Univariate Analysis ◽  
Full Time ◽  
X Rays ◽  
Skeletally Immature ◽  
X Ray ◽  
Total Treatment ◽  
Registration Date

Abstract BackgroundIn-brace correction and brace compliance with Thoraco-Lumbo-Sacral Orthotic (TLSO) braces are associated with successful treatment of Adolescent Idiopathic Scoliosis (AIS). This paper compares patients who had consistent radiographic documentation of in-brace correction to those who did not.MethodsAll skeletally immature (Risser 0–2) patients were treated for AIS (25°-45°) with full-time TLSO braces that had compliance temperature monitors. All patients wore their braces at least 12 hours a day. Brace failure was defined as curve progression to a surgical magnitude (≥ 50°). All patients were followed until brace discontinuation.Results90 patients (F:82, M:8) with an average age of 12.1(10.1–15.0) years, Risser grade 0(0–2), BMI percentile 48.5(0.0-98.8), and daily brace wear of 16.5(12.1–21.6) hrs/day were treated for 24.3(8.0-66.6) months. Patients went through 1.7(1–4) braces on average. 42/90(46.7%) patients had some amount of brace time with an unknown in-brace correction, which, on average, was 66.1% of their total treatment course (11.5–100). On univariate analysis, patients that did not have a repeat in-brace x-ray with major brace adjustments or new brace fabrication tended to be more skeletally immature (Risser 0 and tri-radiate open, p = 0.028), wear more braces throughout their treatment (2.0 vs 1.4, p < 0.001), were treated for a longer period of time (27 vs 22 months, p = 0.022), and failed bracing more often (47.6% vs 22.9%, p = 0.014).ConclusionsPatients who did not have new in-brace x-rays with major brace adjustments and/or new brace fabrication were 3.1(95% CI 1.2–7.6) times more likely to fail bracing than patients who were re-checked with new in-brace x-rays.Trial Registration:ClinicalTrials.gov - NCT02412137, Initial Registration Date April 2015

scholarly journals Lack of in-brace x-rays in compliant AIS patients wearing full-time TLSO braces associates with failure

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Isabel Alvarez ◽  
Kiley Poppino ◽  
Lori Karol ◽  
Amy L. McIntosh
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Univariate Analysis ◽  
Full Time ◽  
X Rays ◽  
Skeletally Immature ◽  
Level Of Evidence ◽  
X Ray ◽  
Total Treatment ◽  
Registration Date

Abstract Background In-brace correction and brace compliance with thoraco-lumbo-sacral orthotic (TLSO) braces are associated with successful treatment of adolescent idiopathic scoliosis (AIS). This paper compares patients who had consistent radiographic documentation of in-brace correction to those who did not. Methods All skeletally immature (Risser 0-2) patients were treated for AIS (25-45°) with full-time TLSO braces that had compliance temperature monitors. All patients wore their braces at least 12 h a day. Brace failure was defined as curve progression to a surgical magnitude (≥ 50°). All patients were followed until brace discontinuation. Results Ninety patients (F 82, M 8) with an average age of 12.1 (10.1-15.0) years, Risser grade 0 (0-2), BMI percentile 48.5 (0.0-98.8), and daily brace wear of 16.5 (12.1-21.6) h/day were treated for 24.3 (8.0-66.6) months. Patients went through 1.7 (1-4) braces on average. Forty-two out of 90 (46.7%) patients had some amount of brace time with an unknown in-brace correction, which, on average, was 66.1% of their total treatment course (11.5-100). On univariate analysis, patients that did not have a repeat in-brace x-ray with major brace adjustments or new brace fabrication tended to be more skeletally immature (Risser 0 and tri-radiate open, p = 0.028), wear more braces throughout their treatment (2.0 vs 1.4, p < 0.001), were treated for a longer period of time (27 vs 22 months, p = 0.022), and failed bracing more often (47.6% vs 22.9%, p = 0.014). Conclusions Patients who did not have new in-brace x-rays with major brace adjustments and/or new brace fabrication were 3.1 (95% CI 1.2-7.6) times more likely to fail bracing than patients who were re-checked with new in-brace x-rays. Trial registration ClinicalTrials.gov—NCT02412137, initial registration date April 2015 Level of evidence III

scholarly journals May bending radiographs be replaced by recumbent CT scans in patients with adolescent idiopathic scoliosis?

2021 ◽  
Author(s):  
Max Prost ◽  
Joachim Windolf ◽  
Markus Rafael Konieczny
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Strong Correlation ◽  
Ct Scans ◽  
X Rays ◽  
Exclusion Criteria ◽  
X Ray ◽  
A Minor ◽  
Main Curve

Abstract Purpose There is no data that show if it is possible to determine if a curve is structural or non-structural or to assess flexibility of an adolescent idiopathic scoliosis (AIS) by recumbent images like a CT scan (CTS) instead of bending radiographs (BR). We investigated if the results of BR may be compared to those of CTS. Methods We retrospectively analyzed prospectively collected data of patients with AIS in whom a selective spinal fusion was performed and in whom a CTS, BR, and full spine x-rays were made preoperatively. We measured the Cobb angles of the main and the minor curve in full spine x-ray, BR, and CTS. Results After applying inclusion and exclusion criteria, 39 patients were included. We found a strong correlation (r = 0.806, p < 0.01) between the Cobb angle of the main curve in BR and the Cobb angle of the main curve in the CTS and between the Cobb angle of the minor curve in BR and the Cobb angle of the minor curve in the CTS (r = 0.601, p < 0.01). All patients with a minor curve of less than 25 degrees in the BR had a Cobb angle of less than 35 degrees in the CTS. Conclusion Spinal curves showed a significant correlation between bending radiographs and recumbent images (CTS). In our group of patients, a Cobb angle of the minor curve of less than 35 degrees in the CTS indicated that this minor curve was non-structural.

What happens to the unfused upper thoracic curve after posterior spinal fusion for adolescent idiopathic scoliosis?

2021 ◽  
pp. 1-7
Author(s):  
M. Omar Iqbal ◽  
Amer F. Samdani ◽  
Joshua M. Pahys ◽  
Peter O. Newton ◽  
Suken A. Shah ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Univariate Analysis ◽  
Posterior Spinal Fusion ◽  
Research Society ◽  
Curve Correction ◽  
Scoliosis Research Society ◽  
Lenke Classification ◽  
Upper Instrumented Vertebra ◽  
Upper Thoracic

OBJECTIVE Spontaneous lumbar curve correction after selective thoracic fusion in surgery for adolescent idiopathic scoliosis (AIS) is well described. However, only a few articles have described the course of the uninstrumented upper thoracic (UT) curve after fusion, and the majority involve a hybrid construct. In this study, the authors sought to determine the outcomes and associated factors of uninstrumented UT curves in patients with AIS. METHODS The authors retrospectively reviewed a prospectively collected multicenter AIS registry for all consecutive patients with Lenke type 1–4 curves with a 2-year minimum follow-up. UT curves were considered uninstrumented if the upper instrumented vertebra (UIV) did not extend above 1 level from the lower end vertebra of the UT curve. The authors defined progression as > 5°, and divided patients into two cohorts: those with improvement in the UT curve (IMP) and those without improvement in the UT curve (NO IMP). Radiographic, demographic, and Scoliosis Research Society (SRS)–22 survey outcome measures were compared using univariate analysis, and significant factors were compared using a multivariate regression model. RESULTS The study included 450 patients (370 females and 80 males). The UT curve self-corrected in 86% of patients (n = 385), there was no change in 14% (n = 65), and no patients worsened. Preoperatively, patients were similar with respect to Lenke classification (p = 0.44), age (p = 0.31), sex (p = 0.85), and Risser score (p = 0.14). The UT curves in the IMP group self-corrected from 24.7° ± 6.5° to 12.6° ± 5.9°, whereas in the NO IMP group UT curves remained the same, from 20.3° ± 5.8° to 18.5° ± 5.7°. In a multivariate analysis, preoperative main thoracic (MT) curve size (p = 0.004) and MT curve correction (p = 0.001) remained significant predictors of UT curve improvement. Greater correction of the MT curve and larger initial MT curve size were associated with greater likelihood of UT curve improvement. CONCLUSIONS Spontaneous UT curve correction occurred in the majority (86%) of unfused UT curves after MT curve correction in Lenke 1–4 curve types. The magnitude of preoperative MT curve size and postoperative MT curve correction were independent predictors of spontaneous UT curve correction.

scholarly journals Uniplanar cannulated pedicle screws in the correction of Lenke type 1 adolescent idiopathic scoliosis (AIS)

2020 ◽  
Author(s):  
Yiwei Zhao ◽  
Wubo Liu ◽  
Suomao Yuan ◽  
Yonghao Tian ◽  
Xinyu Liu
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screws ◽  
Vertebral Rotation ◽  
Concave Side ◽  
Convex Side ◽  
X Rays ◽  
Group A ◽  
Group B

Abstract Background In the present study, we reported the clinical use of uniplanar cannulated pedicle screws for the correction of Lenke type 1 adolescent Idiopathic scoliosis (AIS), and its safety and clinical outcomes were also evaluated. Methods 68 patients with Lenke type 1 AIS were included, among which 38 patients were treated with uniplanar cannulated screws at the concave side of periapical levels and multiaxial screws at the other levels (group A). Moreover, the remaining 30 patients were treated with all multiaxial screws (group B). The preoperative and postoperative radiographic parameters of the Lenke type 1 AIS, axial vertebral rotation, and the safety of the pedicle screws were evaluated by X-rays and computed tomography (CT). Results Preoperative data was comparable between two groups. The postoperative proximal thoracic (PT) curve, main thoracic (MT) curve, thoracolumbar/lumbar (TL/L) curve, and apical vertebral rotation were significantly improved compared with the preoperative data. The coronal correction rates in group A and B were 83% and 81.9%, respectively (P > 0.05). The derotation rates in group A and B were 60.8% and 43.2%, respectively (P < 0.05). The rotation classification in the group A was also better compared with the group B. The misplacement rate in group A and B was 7.9% and 11.8%, respectively (P < 0.05), and the total misplacement rate on the concave side (11.4%) was higher than that of convex side (8.4%). The lateral perforation was found at the concave side, while the medial perforation was found at the convex side. On the concave side, the misplacement rate in group A and B was 9.7% and 12.3%, respectively (P < 0.05). The grades 2 and 3 perforations were three (3.5%) in the group A and eight (8.2%) in the group B (P < 0.05). On the convex side, the misplacement rate in group A and B was 5.9% and 11.1%, respectively (P < 0.05). The grades 2 and 3 perforations were one (0.9%) in the group A and four (4.4%) in the group B (P < 0.05). Conclusion Collectively, uniplanar cannulated pedicle screws could effectively increase the accuracy of pedicle screws and facilitate the derotation of the apical vertebra compared with the multiaxial pedicle screws. Trial registration retrospectively registered

Dose Reduction Protocol for Full Spine X-ray Examination Using Copper Filters in Patients With Adolescent Idiopathic Scoliosis

Spine ◽  
2019 ◽  
Vol 44 (3) ◽  
pp. 203-210 ◽  
Author(s):  
Kaori Minehiro ◽  
Satoru Demura ◽  
Katsuhiro Ichikawa ◽  
Takeshi Sasagawa ◽  
Naoki Takahashi ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Dose Reduction ◽  
X Ray

scholarly journals IN-BRACE CORRECTION (IBC) TERHADAP TIPE DAN BESARAN KURVA PADA PASIEN ADOLESCENT IDIOPATHIC SKOLIOSIS (AIS)

2020 ◽  
Vol 14 (1) ◽  
pp. 46-52
Author(s):  
Raden Candra ◽  
Fika Trifani
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
P Value ◽  
X Ray

Skoliosis adalah kelengkungan tulang belakang ke lateral yang melebihi 10 derajat. Tinjauan lapangan pada klinik dan rumah sakit di Indonesia menunjukan banyaknya kasus pasien Adolescent Idiopathic Scoliosis (AIS) yang telah ditangani dengan penggunaan skoliosis brace. In-brace correction (IBR) merupakan cara menilai kualitas skoliosis brace secara cepat setelah brace dipasangkan kepada pasien dengan metode X-Ray dengan menggunakan brace. Akan tetapi, hasil IBR tersebut sering ditemukan berbeda dari satu pasien dengan yang lainnya sehingga dibutuhkan untuk mengetahui faktor yang dapat menyebabkan perbedaan tersebut. Oleh karena itu, tujuan pada penelitian ini adalah untuk menilai apakah terdapat hubungan antara tipe kurva dan besaran kurva terhadap IBR pada pasien AIS. Analisis retrospective sebanyak 120 data sekunder telah digunakan dalam penelitian ini melalui rekam medis pasien yang menggunakan scoliosis brace dari tahun 2016 - 2018. Data yang diambil berupa Cobb angle tanpa menggunakan brace, In-Brace Cobb angle, dan tipe kurva skoliosis. Rata-rata IBR adalah 56,0% pada besaran kurva ringan (20°-29°), 37,2% pada besaran kurva sedang (30° - 40°), 36,7% pada besaran kurva parah (>40°). Sedangkan, rata-rata IBR tertinggi adalah pada tipe kurva ganda dimana lumbar > thoraks yaitu sebesar 50,3%, lalu disusul dengan kurva tunggal thoraks dan kurva ganda thoraks > lumbar sebesar 40,3% dan 39,1% secara berurutan. terdapat perbedaan yang signifikan IBR bedasarkan Besaran Kurva dan Tipe Kurva pada pasien adolescent idiopatik skoliosis dengan p value 0,000 dan 0,029 secara berurutan. Dapat disimpulkan bahwa tipe dan besaran kurva scoliosis merupakan faktor yang dapat mempengaruhi hasil IBR secara signifikan

scholarly journals Automation analysis X-ray of the spine to objectify the assessment of the severity of scoliotic deformity in idiopathic scoliosis: a preliminary report

2020 ◽  
Vol 8 (3) ◽  
pp. 317-326
Author(s):  
Grigory A. Lein ◽  
Natalia S. Nechaeva ◽  
Gulnar М. Mammadova ◽  
Andrey A. Smirnov ◽  
Maxim M. Statsenko
Keyword(s):  
Neural Network ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Machine Learning Algorithms ◽  
Automated System ◽  
X Rays ◽  
X Ray ◽  
Scoliotic Deformity ◽  
Window Method ◽  
Treatment Type

Background. A large number of studies have focused on automating the process of measuring the Cobb angle. Although there is no practical tool to assist doctors with estimating the severity of the curvature of the spine and determine the best suitable treatment type. Aim. We aimed to examine the algorithms used for distinguishing vertebral column, vertebrae, and for building a tangent on the X-ray photographs. The superior algorithms should be implemented into the clinical practice as an instrument of automatic analysis of the spine X-rays in scoliosis patients. Materials and methods. A total of 300 digital X-rays of the spine of children with idiopathic scoliosis were gathered. The X-rays were manually ruled by a radiologist to determine the Cobb angle. This data was included into the main dataset used for training and validating the neural network. In addition, the Sliding Window Method algorithm was implemented and compared with the machine learning algorithms, proving it to be vastly superior in the context of this research. Results. This research can serve as the foundation for the future development of an automated system for analyzing spine X-rays. This system allows processing of a large amount of data for achieving 85% in training neural network to determine the Cobb angle. Conclusions. This research is the first step toward the development of a modern innovative product that uses artificial intelligence for distinguishing the different portions of the spine on 2D X-ray images for building the lines required to determine the Cobb angle.

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