Effect of Chêneau style braces on vertebral wedging amongst individuals with adolescent idiopathic scoliosis

Background: It is generally accepted that braces can stop curve progression but little evidence exists regarding structural improvement in the spine using spinal bracing. Our study aimed to investigate the possible structural improvements of vertebral wedging with high correction bracing.Objectives: The aim of our study was to assess whether spinal brace treatment may influence vertebral wedging in adolescent idiopathic scoliosis (AIS).Method: We reviewed our database according to the following inclusion criteria: girls with a diagnosis of AIS, Risser 0–2, age 10–14 years with Cobb angles greater than 35°. Our study cohort consisted of 27 patients fulfilling the inclusion criteria with an average brace wearing time of 16.6 h per day and Cobb angles between 36° and 79°. The target value for our study was the apical vertebra wedging, measured twice before brace treatment commenced and twice after the average follow-up period of 20.5 months of treatment.Results: The average apex wedging noted before brace wearing started was 9.8° (median: 9) and after a period of 20.5 months of brace wearing, it had reduced to an average of 5.8° (median: 4.9), (p 0.001). This would indicate a structural correction of 44%.Conclusions: Our study supports the hypothesis that spinal high correction braces improve the degree of vertebral wedging in skeletally immature girls with AIS.Clinical implications: Structural corrections of the apical vertebra seem possible when high correction asymmetric braces are used in the treatment of patients with AIS.

An Indigenous Design for Management of Congenital Scoliosis - A Case Study

Introduction: Available orthotic brace options for Congenital scoliosis are a few and are quite cumbersome to be tolerated by infants. Considering comfort, acceptance, and effectiveness, we have designed and developed a new spinal Orthosis, incorporating a flexible strap system. The purpose of this study was to investigate the effect of this novel flexible spinal Orthosis on scoliotic curve correction and progression. Methods: A 1-year-old female infant diagnosed with congenital Scoliosis was fitted with the novel flexible spinal orthotic brace to control the curve progression and to maintain an upright posture. The anterior-posterior radiographs were analyzed for measuring the Cobb angle. The plumb line test was used to assess the postural improvements. Before and After tests were conducted with and without the Novel spinal brace with an intervention period of 2 months. Discussion: The Cobb’s angle was found to be 7˚ less after the intervention period of 2 months. There was also a marked improvement in Body posture with a 6mm plumbline shift towards the midline. This indigenous flexible spinal brace can be considered as a new, effective method for the treatment of Congenital Scoliosis and it also can be used for maintaining an aligned posture. Key words: Congenital Scoliosis, Flexible spinal Brace, Cobb’s angle.

Review of Current Spinal Robotic Orthoses

Osteoporotic spine fractures (OSF) are common sequelae of osteoporosis. OSF are directly correlated with increasing age and incidence of osteoporosis. OSF are treated conservatively or surgically. Associated acute pain, chronic disabilities, and progressive deformities are well documented. Conservative measures include a combination of initial bed rest, analgesia, early physiotherapy, and a spinal brace (orthosis), with the aim for early rehabilitation to prevent complications of immobile state. Spinal bracing is commonly used for symptomatic management of OSF. While traditional spinal braces aim to maintain the neutral spinal alignment and reduce the axial loading on the fractured vertebrae, they are well known for complications including discomfort with reduced compliance, atrophy of paraspinal muscles, and restriction of chest expansion leading to chest infections. Exoskeletons have been developed to passively assist and actively augment human movements with different types of actuators. Flexible, versatile spinal exoskeletons are designed to better support the spine. As new technologies enable the development of motorized wearable exoskeletons, several types have been introduced into the medical field application. We have provided a thorough review of the current spinal robotic technologies in this paper. The shortcomings in the current spinal exoskeletons were identified. Their limitations on the use for patients with OSF with potential improvement strategies were discussed. With our current knowledge of spinal orthosis for conservatively managed OSF, a semi-rigid backpack style thoracolumbar spinal robotic orthosis will reduce spinal bone stress and improve back muscle support. This will lead to back pain reduction, improved posture, and overall mobility. Early mobilization is an important part of management of patients with OSF as it reduces the chance of developing complications related to their immobile state for patients with OSF, which will be helpful for their recovery.

CT Metal Artifact Reduction based on Virtual Generated Artifacts Using Modified pix2pix

Background: Metal artifacts introduce challenges in image-guided diagnosis or accurate dose calculations. This study aims to reduce metal artifacts from the spinal brace by using virtual generated artifacts through convolutional neural networks and to compare the performance of this approach with two other methods, namely, linear interpolation metal artifact reduction (LIMAR) and normalized metal artifact reduction (NMAR) .Method: A total of 3,600-slice CT images of 60 vertebral metastases patients were selected. The spinal cord center was marked in each image, metal masks were added to two sides of the marker to generate artifact-insert CT images, and the CT values of the metal parts were copied to original CT images to obtain reference CT images. These images were divided into training (3,000 slices) and test (600) sets. The modified U-Net and pix2pix architecture was applied to understand the relationship between the reference and artifact-insert images. The mean absolute error (MAE), mean square error (MSE), peak signal-to-noise ratio (PSNR), and structural similarity (SSIM) were calculated between the reference CT images and the predicted CT through LIMAR, NMAR, U-Net, and pix2pix. The CT values of organs from different images were compared. Radiotherapy treatment plans for vertebral metastases were designed, and dose calculation was performed. The dose distribution in different types of images was also compared.Results: The MAE values between the reference images and those images generated by LIMAR, NMAR, U-Net, and pix2pix were 15.02, 16.16, 6.12, and 6.48 HU, respectively, and the corresponding PSNR values were 15.37, 152.70, 158.93, and 65.14 dB, respectively. Pix2pix restored more texture than U-Net according to the visual comparison. The average CT values in the artifact-insert images of the liver, spleen, and left and right kidneys were all significantly higher than those of the reference images (p<0.05). The average CT values of the organs in images processed by the four methods showed no significant differences from those of the organs in the reference images. The mean dose of planned target volume in the artifact-insert images was significantly lower than that in the reference CT images. The average γ passing rate (1%, 1 mm) of the artifact-insert images was significantly lower than that of the reference images (95.9±1.4% vs. 99.2±1.4%, p<0.05).Conclusions: U-Net and pix2pix deep learning networks can remarkably reduce metal artifacts and improve critical structure visualization compared with LIMAR and NMAR according to the simulation data of artifact-insert images in the spinal brace. Pix2pix can restore more texture with the help of a discriminator. Metal artifacts increase the dose calculation uncertainty in radiotherapy. The dose calculated through images obtained by U-Net and pix2pix was identical with that calculated through reference images.

Evaluation of Office Ergonomic Risk Using Rapid Office Strain Assessment (ROSA)

Musculoskeletal Disorders (MSDs) caused by computer use have become the most common ergonomic risks. The risk experienced can be in the form of financial losses or even lives. Therefore, efforts are needed to prevent the occurrence of ergonomic risks so as not to cause large losses. The Rapid Office Strain Assessment (ROSA) has been designed to identify ergonomic risk factors and is reliable for the assessment of office workers' MSDs. This study evaluates the potential risk of ergonomics in female office workers because a previous study found that MSDs were more common in women. From the two workers observed, it was found that workers 1 and 2 received different scores on several assessment components. The different things are the length of the seat holder, armrests, spine brace, and keyboard. This difference is caused by body posture and different types of chairs. The length of the chair and the spinal brace is influenced by the different postures of the two workers. Worker 1 has a shorter upper leg length than worker 2, so she cannot use the backbone section of the chair. Although there are differences in scores on some components of the assessment, both workers have the same final ROSA score, which is 5. This indicates that further posture assessment needs to be done using tools other than ROSA to detect the specific cause of MSDs levels.

Investigation of future 3D printed brace design parameters: evaluation of mechanical properties and prototype outcomes

Aim: Spinal brace wear time affects treatment effectiveness of adolescent idiopathic scoliosis but remains challenging with the brace’s bulkiness. This study aims to determine the appropriate material and thickness to improve wear comfort. Materials & methods: Thirty-one specimens were tested with 13 ULTEM1010 and 13 Nylon12 potential materials and 5 standard polypropylene material in 2.5, 3.25 and 4 mm thicknesses to evaluate mechanical properties. Donning tests of ULTEM1010 and Nylon12 printed braces were conducted. Results: Nylon12 with 2.5–3.25 mm thickness had higher flexibility and the closest mechanical characteristics as 4-mm thick polypropylene. ULTEM1010 brace fractured after 615-times and Nylon12 brace handled 2920-times of opening and closing. Conclusion: Nylon12, 2.5–3.25 mm are appropriate design parameters. Further clinical study can validate long term brace effectiveness.

Spontaneous spondylodiscitis: review, incidence, management, and clinical outcome in 44 patients

OBJECTIVESpontaneous spondylodiscitis remains uncommon but is a serious complication of the vertebral column. Risk factors include diabetes, hemodialysis, intravenous drug abuse, and chronic steroid use, and pain is the most common presenting symptom. This study aims to review the literature and report on the incidence, management, and clinical outcome of spontaneous spondylodiscitis in 44 patients.METHODSThis is a prospective study including 44 patients with spontaneous spondylodiscitis managed in the neurosurgery department of Cairo University Hospitals during the period between January 2012 and October 2017. All patients had a full clinical assessment, laboratory tests, radiological studies in the form of MRI with and without contrast, and a postoperative follow-up of up to 12 months.RESULTSTwelve cases underwent conservative treatment in the form of complete bed rest, intravenous antibiotics, and a spinal brace. Ten cases underwent surgical intervention in the form of laminectomy, debridement, and open biopsy. Twenty-two cases underwent laminectomy and surgical stabilization with fusion. There were 15 cases of tuberculous spondylodiscitis, 6 cases of brucellosis, 6 cases of pyogenic infection, and 17 cases in which no organism could be detected.CONCLUSIONSOnce the primary diagnosis is confirmed, early and adequately prolonged antibiotic therapy is recommended for spontaneous spondylodiscitis. Some cases can be successfully treated with conservative treatment alone, whereas surgery may be needed in other cases such as severe destruction of endplates, spinal abscess formation, mechanical instability, neurological deficits, and severe pain that have failed to respond to conservative treatment.

Concept design of a novel robotic spinal brace for the treatment of scoliosis

This article presents a novel robotic brace for the treatment of scoliosis. The motivation of this new device comes from the shortcomings in current braces including the rigid brace and the soft brace. Besides, the novel active brace can be used not only for applying active corrective forces on spine, but also for the rehabilitation exercise. The design and control architectures are described for the novel brace and genetic algorithm is used to obtain optimal structural parameters. Two Stewart platforms connected in series form this brace which is driven by 12 electric actuators. Each platform can be controlled in motion or force mode independently. The device can move in six orientations in motion mode and apply six-degree-of-freedom forces on the spine in force mode. In order to evaluate the function and performance of the dynamic brace system, a simple proportional–integral–differential control strategy is employed in both the two control modes. Experimental results depict that the proposed device can respond to the desired position/force commands excellently.