Effect of Spinal Bracing on Curve Magnitude in Coronal and Axial Planes in Adolescent Scoliosis Utilising EOS Imaging.

Abstract Purpose. This study aimed to investigate the efficacy of spinal bracing in treating progressive scoliosis deformity utilizing EOS (bi-planer) imaging and SterEOS reconstruction software. Methods. EOS images of scoliosis patients being treated with bracing were obtained both in and out of their brace. These images were processed using SterEOS software to allow 3D representation, which was then compared to traditional coronal 2D parameters. Between January 2019 and January 2020, 29 patients were recruited for participation. Of these participants, 25 had a single episode of EOS imaging out of and in their brace. Additionally, 19 of the 25 participants had further episodes of EOS imaging within the study period, separated by mean 144+/-44 days. This allowed a total of 44 EOS single scan episodes for parameter analysis out of, and in the brace. Longitudinal analysis was also performed on the 19 patients who had sequential scans.Results. Participants were mean 13.8±1.1 years old at the first scan. Coronal 2D parameters, specifically Cobb Angle measurement, were accurately reproducible with SterEOS 3D measurements. Across all EOS scans (n=44) the mean major coronal curve measurement was 42.3±13.3° out of brace and 37.2±13.8° in the brace. This produced a mean correction of 4.6±4.4° (p<0.05). The correction achieved in this cohort with bracing appeared more modest than those reported in previous studies using traditional 2D coronal curve measurements1–3. The mean axial vertebral rotation (AVR) was 10.6±7.1° out of the brace and 9.6±6.8° in the brace, with a mean correction of 1.4±5.3°(p=0.14). The current study results suggested no significant change in axial vertebral rotation with brace treatment. Notably, in 17 of the 44 AVR measured, the differences were negative. That is, the AVR worsened in the brace. There was a significant moderate correlation between 3D coronal Cobb angle measured and AVR measured out of the brace for all curves. However, the change in Cobb and change in AVR with bracing did not correlate.Over sequential EOS episodes (n=19), there appeared no significant progression of 3D parameters, interpreted as the brace preventing curve progression.Conclusions. There appeared to be a consistent reduction in the scoliosis Cobb angle of the major curve with brace treatment. AVR demonstrated no significant change with bracing, with instances of worsening of AVR in the brace, which was not reflected by Cobb angle measurement. Despite this, bracing appears to have been effective with limited curve progression in sequential scans, though not in the anticipated manner of immediate in-brace curve correction.

Download Full-text

Supine fulcrum bending test and in-cast correction of Scheuermann juvenile kyphosis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190431 ◽

2019 ◽

Vol 5 (2) ◽

pp. 206

Author(s):

Piotr Janusz ◽

Wioleta Ostiak-Tomaszewska ◽

Mateusz Kozinoga ◽

Tomasz Kotwicki

Keyword(s):

Cobb Angle ◽

Lumbar Lordosis ◽

Standing Position ◽

Angle Measurement ◽

Bending Test ◽

Lateral Radiograph ◽

Kyphosis Angle ◽

Scheuermann Disease ◽

Cobb Angle Measurement ◽

The Mean

Background: Patients with Scheuermann disease often require conservative management with a series of corrective casts, followed by anti-kyphotic brace. Flexibility of the kyphosis can be assessed during a supine fulcrum bending test. The aim of the study was to analyze the radiological flexibility of kyphosis and immediate in-cast correction in a series of patients conservatively treated.Methods: Eighty-six adolescents were conservatively treated for Scheuermann disease of thoracic location. Charts of 55 patients, 39 boys and 16 girls, were accessible. The mean age was 14.6±1.6 years. On the lateral full-cassette standing radiograph, the angle of thoracic and lumbar lordosis were measured. The flexibility of kyphosis was assessed on a supine fulcrum bending lateral radiograph. The in-cast kyphosis angle was measured on a standing lateral radiograph.Results: In 18 patients, a mild non-progressive scoliotic curvature was present; it did not exceed a Cobb angle measurement of 25°. The initial kyphosis angle was 59.2°±9.3°. The lordosis angle was 76.3°±9.3°. The kyphosis angle on supine fulcrum bending test was 30.4°±9.7°. The kyphosis angle in the reclining cast was 44.3°±12.5°. There was no correlation between age and the supine bending correction. There was a correlation between the correction obtained with the supine bending test and the immediate correction in the cast (r=0.64, p=0.0012).Conclusions: The reduction of the kyphosis Cobb angle by supine fulcrum bending was 50% on average, while in the cast in standing position, only half of this correction was maintained.

Download Full-text

Computer-assisted Cobb angle measurement from posteroanterior radiographs by a curve fitting method

TURKISH JOURNAL OF ELECTRICAL ENGINEERING & COMPUTER SCIENCES ◽

10.3906/elk-1502-203 ◽

2016 ◽

Vol 24 ◽

pp. 4604-4610 ◽

Cited By ~ 1

Author(s):

İbrahim YILDIZ

Keyword(s):

Cobb Angle ◽

Curve Fitting ◽

Angle Measurement ◽

Computer Assisted ◽

Fitting Method ◽

Cobb Angle Measurement ◽

Curve Fitting Method

Download Full-text

Cobb Angle Measurement of Scoliosis Using Computer Measurement of Digitally Acquired Radiographs-Intraobserver and Interobserver Variability

Asian Spine Journal ◽

10.4184/asj.2008.2.2.90 ◽

2008 ◽

Vol 2 (2) ◽

pp. 90 ◽

Cited By ~ 17

Author(s):

S Srinivasalu ◽

Hitesh N Modi ◽

Satyen SMehta ◽

Seung-Woo Suh ◽

Ting Chen ◽

...

Keyword(s):

Cobb Angle ◽

Interobserver Variability ◽

Angle Measurement ◽

Computer Measurement ◽

Cobb Angle Measurement

Download Full-text

A New Trend in Cobb Angle Measurement: The Use of iPhones

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2014.1268 ◽

2014 ◽

Vol 4 (3) ◽

pp. 382-383 ◽

Cited By ~ 3

Author(s):

Serhat Mutlu ◽

Olcay Guler ◽

Harun Mutlu ◽

Baran Komur ◽

Gurkan Caliskan ◽

...

Keyword(s):

Cobb Angle ◽

Angle Measurement ◽

Cobb Angle Measurement

Download Full-text

Maximal Axial Vertebral Rotation in Adolescent Idiopathic Scoliosis: Is the Apical Vertebra the Most Rotated?

Global Spine Journal ◽

10.1177/2192568220948830 ◽

2020 ◽

pp. 219256822094883

Author(s):

Kristóf József ◽

Ádám Tibor Schlégl ◽

Máté Burkus ◽

István Márkus ◽

Ian O’Sullivan ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Axial Rotation ◽

Cross Sectional Study ◽

Vertebral Rotation ◽

Rank Test ◽

Cross Sectional ◽

Apical Vertebra ◽

Axial Vertebral Rotation

Study Design: Retrospective cross-sectional study. Objectives: It is generally believed that the apical vertebra has the largest axial rotation in adolescent idiopathic scoliosis. We investigated the relationship between apical axial vertebral rotation (apicalAVR) and maximal axial vertebral rotation (maxAVR) in both major and minor curves using biplanar stereo-imaging. Methods: EOS 2D/3D biplanar radiograph images were collected from 332 patients with adolescent idiopathic scoliosis (Cobb angle range 10°-122°, mean age 14.7 years). Based on the X-ray images, with the help of 3D full spine reconstructions Cobb angle, curvature level, apicalAVR and maxAVR were determined. These parameters were also determined for minor curves in Lenke 2, 3, 4, 6 type patients. Maximal thoracic rotation and maximal thoracolumbar/lumbar rotation were calculated. Statistical analysis was performed with descriptive statistics, Shapiro-Wilk test, and Wilcoxon signed-rank test. Results: The apical vertebrae were the most rotated vertebra in only 40.4% of the major curves, and 31.7% in minor curves. MaxAVR significantly exceeded apicalAVR values in the major curves ( P < .001) as well as in minor curves ( P < .001). The 2 parameters differed significantly in each severity group and Lenke type. Conclusions: The apical vertebrae were not the most rotated vertebra in more than half of cases investigated indicating that apicalAVR and maxAVR should be considered as 2 distinct parameters, of which maxAVR fully describes the axial dimension of scoliosis. Furthermore, the substitution of maxAVR for the apicalAVR should be especially avoided in double and triple curves, as the apical vertebra was even less commonly the most rotated in minor curves.

Download Full-text