Automatic Assessment of Ultrasound Curvature Angle for Scoliosis Detection Using 3-D Ultrasound Volume Projection Imaging.

OBJECTIVE: Scoliosis is a spinal deformation in which the spine takes a lateral curvature, generating an angle in the coronal plane. The conventional method for detecting scoliosis is measurement of the Cobb angle in spine images obtained by anterior X-ray scanning. Ultrasound imaging of the spine is found to be less ionising than traditional radiographic modalities. For posterior ultrasound scanning, alternate indices of the spinous process angle (SPA) and ultrasound curve angle (UCA) were developed and have proven comparable to those of the traditional Cobb angle. In SPA, the measurements are made using the spinous processes as an anatomical reference, leading to an underestimation of the traditionally used Cobb angles. Alternatively, in UCA, more lateral features of the spine are employed for measurement of the main thoracic and thoracolumbar angles; however, clear identification of bony features is required. The current practice of UCA angle measurement is manual. This research attempts to automate the process so that the errors related to human intervention can be avoided and the scalability of ultrasound scoliosis diagnosis can be improved. The key objective is to develop an automatic scoliosis diagnosis system using 3-D ultrasound imaging. METHODS: The novel diagnosis system is a three-step process: (i) finding the ultrasound spine image with the most visible lateral features using the convolutional RankNet algorithm; (ii) segmenting the bony features from the noisy ultrasound images using joint spine segmentation and noise removal; and (iii) calculating the UCA automatically using a newly developed centroid pairing and inscribed rectangle slope method. RESULTS: The proposed method was evaluated on 109 patients with scoliosis of different severity. The results obtained had a good correlation with manually measured UCAs (R2=0.9784 for the main thoracic angle andR2=0.9671 for the thoracolumbar angle) and a clinically acceptable mean absolute difference of the main thoracic angle (2.82 ± 2.67°) and thoracolumbar angle (3.34 ± 2.83°). CONCLUSION: The proposed method establishes a very promising approach for enabling the applications of economic 3-D ultrasound volume projection imaging for mass screening of scoliosis.

The Improvement of Trunk Muscle Endurance in Adolescents with Idiopathic Scoliosis Treated with ScoliBrace® and the ScoliBalance® Exercise Approach.

The impact of scoliosis bracing combined with physiotherapeutic scoliosis-specific exercises (PSSE) on trunk muscle endurance in adolescents with idiopathic scoliosis is unknown. ScoliBrace®, a rigid, three-dimensional, over-corrective thoraco-lumbar-sacral orthosis (TLSO), and ScoliBalance®, a PSSE program, were used to treat adolescent idiopathic scoliosis (AIS) patients. A retrospective study of the trunk muscle endurance of 33 AIS patients who received ScoliBrace® and ScoliBalance® was conducted. The patients were treated with ScoliBrace® and an individualized ScoliBalance® program. Trunk extensor muscle endurance (TE) and abdominal muscle endurance (AE) tests were performed at initial assessment and then at averages of 6.6 and 24.4 weeks of treatment. The data were analyzed using the Wilcoxon signed-rank test, Stata version 15.1. The participants were aged 13.24 years (SD = 1.64) with a mean Cobb angle of 38.97° (SD = 9.49°). TE improved significantly (p < 0.001) at both short- and medium-term intervals using ScoliBalance® and ScoliBrace® in the AIS patients. AE also showed significant improvement between baseline and short-term follow-up, with non-significant improvement at medium-term follow-up. Overall, trunk muscle endurance showed improvement in the AIS patients using ScoliBrace® and ScoliBalance®. Future research is required to determine the individual and combined effects of each treatment. However, it seems likely that trunk muscle endurance will not deteriorate in AIS patients with this combined treatment.

The impact of pregnancy on women with adolescent idiopathic scoliosis: a scoping review.

INTRODUCTION: Adolescent idiopathic scoliosis is the most common spinal deformity encountered in adolescents and larger curves are more prevalent in girls. For females with scoliosis, women's health issues are of particular concern, especially pregnancy. The aim of this review was to summarise the best available evidence to determine the influence of pregnancy on scoliosis-related outcomes in women with scoliosis and whether scoliosis affects maternal-health outcomes, differentiating between patients who have been managed conservatively and/or surgically. EVIDENCE ACQUISITION: A search was conducted using CINAHL, Scopus, Cochrane Database, MEDLINE, and EMBASE from inception to May 2023 to identify relevant articles in any language. The scoping review followed the PRISMA-ScR guidelines. Studies were eligible if they included pregnant women (primiparous or multiparous) with a diagnosis of scoliosis of unknown aetiology. The results were summarized by outcomes, including pregnancy and scoliosis-related outcomes and type of management. EVIDENCE SYNTHESIS: Our comprehensive search strategy identified 6872 articles, of which 50 articles were eligible for this review. Back pain appears to be more prevalent in this population during pregnancy and associated with the major curve and the decrease of lumbar lordosis. There have been reports of failed attempted spinal anaesthesia among patients with instrumented scoliosis correction and minor complications related to epidural anaesthesia at a higher rate compared to non-instrumented patients and healthy controls, however successful spinal analgesia can be achieved in patients with instrumented scoliosis correction. Overall, the caesarean section rate was similar in scoliosis patients compared to controls without scoliosis and to national averages. Curve progression occurs in some but not all patients during pregnancy, and this phenomenon occurs irrespective of the treatment received. CONCLUSIONS: Higher-quality prospective longitudinal research is needed to understand the relationship between pregnancy and adolescent idiopathic scoliosis. Further, the patient's perspective, concerns and fears surrounding pregnancy with scoliosis are yet to be explored. Exploring the impact of pregnancy on women with adolescent idiopathic scoliosis would have clinically relevant outcomes and could help provide pertinent answers to patients and healthcare workers and help guide future research.

Current Knowledge on the Different Characteristics of Back Pain in Adults with and without Scoliosis: A Systematic Review.

Patients with scoliosis have a high prevalence of back pain (BP). It is possible that scoliosis patients present with specific features when experiencing back or leg pain pathology. The aim of this systematic review is to report the signs, symptoms and associated features of BP in patients with scoliosis compared to adults without scoliosis during adulthood. From inception to 15 May 2023, we searched the following databases: PubMed, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus. We found 10,452 titles, selected 25 papers for full-text evaluation and included 8 in the study. We found that scoliosis presents with asymmetrical pain, most often at the curve's apex, eventually radiating to one leg. Radiating symptoms are usually localised on the front side of the thigh (cruralgia) in scoliosis, while sciatica is more frequent in non-scoliosis subjects. These radiating symptoms relate to rotational olisthesis. The type and localization of the curve have an impact, with lumbar and thoracolumbar curves being more painful than thoracic. Pain in adults with scoliosis presents specific features: asymmetrical localization and cruralgia. These were the most specific features. It remains unclear whether pain intensity and duration can differentiate scoliosis and non-scoliosis-related pain in adults.

Novel Screening Tool for Adolescent Idiopathic Scoliosis: A Reliability Study.

OBJECTIVE: The aim of this study was to assess the agreement between a web-based scoliosis screening tool and a standard screening procedure. METHODS: Sixty participants were selected (median age, 12 years; 75% were women) and separated into 2 groups: those with unknown spinal curvature status and those with confirmed scoliosis. Each participant was assessed by 2 blinded assessors, with one measuring the angle of trunk rotation using a scoliometer and the second using a web-based screening application. The app provided a relative risk score for having scoliosis based on a weighted algorithm. Those with an angle of trunk rotation ≥7° or risk score >2 were deemed as being at risk for having scoliosis. RESULTS: There was fair agreement (kappa = 0.34; 95% confidence interval [CI], 0.14-0.55; P < .001) between the app and the scoliometer among the unconfirmed cases. The McNemar test indicated a difference in the proportion of positive tests (P = .001), whereby the screening app produced a significantly higher number of positive tests (15/53 = 28.3%) compared to the standard screening procedure (4/53 = 7.5%) for unconfirmed cases. Among the confirmed cases, the app correctly identified 5 out of 7 (sensitivity: 71%; 95% CI, 29%-96%) participants, whereas the scoliometer correctly identified 6 out of 7 (sensitivity: 86%; 95% CI, 42%-100%) participants. CONCLUSION: These findings indicate fair agreement between the app and the scoliometer, though it was not possible to precisely estimate the sensitivity of the app in this study.

The classification of scoliosis braces developed by SOSORT with SRS, ISPO, and POSNA and approved by ESPRM.

PURPOSE: Studies have shown that bracing is an effective treatment for patients with idiopathic scoliosis. According to the current classification, almost all braces fall in the thoracolumbosacral orthosis (TLSO) category. Consequently, the generalization of scientific results is either impossible or misleading. This study aims to produce a classification of the brace types. METHODS: Four scientific societies (SOSORT, SRS, ISPO, and POSNA) invited all their members to be part of the study. Six level 1 experts developed the initial classifications. At a consensus meeting with 26 other experts and societies' officials, thematic analysis and general discussion allowed to define the classification (minimum 80% agreement). The classification was applied to the braces published in the literature and officially approved by the 4 scientific societies and by ESPRM. RESULTS: The classification is based on the following classificatory items: anatomy (CTLSO, TLSO, LSO), rigidity (very rigid, rigid, elastic), primary corrective plane (frontal, sagittal, transverse, frontal & sagittal, frontal & transverse, sagittal & transverse, three-dimensional), construction-valves (monocot, bivalve, multisegmented), construction-closure (dorsal, lateral, ventral), and primary action (bending, detorsion, elongation, movement, push-up, three points). The experts developed a definition for each item and were able to classify the 15 published braces into nine groups. CONCLUSION: The classification is based on the best current expertise (the lowest level of evidence). Experts recognize that this is the first edition and will change with future understanding and research. The broad application of this classification could have value for brace research, education, clinical practice, and growth in this field.

Treatment of infantile idiopathic scoliosis using a novel thoracolumbosacral orthosis: a case report.

BACKGROUND: The recommended treatment for mild to moderate infantile idiopathic scoliosis curves involves serial casting. There are concerns, however, regarding the safety of repeated casting in very young children owing to the requirement for anesthetization during the casting process. Very little research has been conducted on the influence of bracing as an initial treatment for scoliosis in this age group. This report details the successful treatment of a large thoracic curve using a thoracolumbosacral orthosis in an infant diagnosed with infantile idiopathic scoliosis. CASE PRESENTATION: The Dutch-Australian patient presented at 11 weeks of age with a 44° thoracic scoliosis and a rib vertebral angle difference of 14°. The history and physical examination failed to reveal a cause of the curvature, and a diagnosis of infantile idiopathic scoliosis was made. The patient was prescribed a thoracolumbosacral orthosis (ScoliBrace) to be worn on a part-time basis for a period of 8 months. At the end of the bracing program, the patient's curve had been reduced to 7° and a rib-vertebral angle difference of 0°. A final follow-up of the patient at 2 years after the cessation of treatment revealed no evidence of scoliosis. The parents were compliant with the bracing protocol and reported that the treatment was tolerated by the infant. CONCLUSION: The use of an orthosis as a standalone treatment in this patient resulted in significant reduction in a large thoracic scoliosis. Based on the results witnessed in this patient, further investigation into bracing as an alternative to casting is warranted.

The prevalence of adult de novo scoliosis: A systematic review and meta-analysis.

INTRODUCTION: Primary degenerative scoliosis represents a new scoliosis developing in patients with no prior history of spinal curvature. Researchers sought to determine the prevalence of this type of scoliosis. METHODS: MEDLINE, Embase, CINAHL, Web of Science and PubMed were searched from inception to 28th March, 2018. Studies that assessed adults from the general population for scoliosis using imaging techniques were included. Studies were included only if the study authors had excluded participants with previously diagnosed scoliosis and/or spinal disorders. Mixed-effects logistic-regression was used to establish an overall prevalence estimate with 95% confidence intervals (primary outcome) and to examine the effect of age and sex (secondary outcomes). RESULTS: Four cross-sectional studies and one cohort study, involving 4069 participants (66.6% Female), aged between 41 and 94 years, were eligible for inclusion. Reported prevalence figures ranged from 13 to 68%. The pooled prevalence estimate from the mixed-effects logistic regression analysis was 37.6% (95% CI 18.7-61.8). Females were more likely to suffer from scoliosis compared with males (p < 0.001), with prevalence figures of 41.2% (95% CI 20.7-65.8) versus 27.5% (95% CI 12.2-51.1), respectively. Individuals aged < 60 years had a prevalence of 13% (95% CI 5.2-30.2), whereas the prevalence estimates were substantially higher in the > 60 age group [36% (95% CI 17.4-60.6)]. CONCLUSION: Primary degenerative scoliosis is a highly prevalent condition, especially in females. Further research targeting this type of scoliosis is required to obtain more precise global prevalence estimates and to understand the influence of age and sex.

A systematic literature review of spinal brace/orthosis treatment for adults with scoliosis between 1967 and 2018: clinical outcomes and harms data.

BACKGROUND: There is a paucity of literature regarding the conservative management of adult scoliosis. The authors review and summarize the literature from 1967 to 2018 on the clinical outcomes of spinal brace/orthosis use in this subgroup of the population. METHODS: CINAHL, Embase, CENTRAL, PubMed and PEDro were searched from database inception to the 30th of October, 2018. A combination of medical subject heading terms and keywords pertaining to three core concepts (adult, scoliosis, and braces/orthoses) were used in the search. Studies were included if A) clinical outcomes were collected from B) participants ≥18 years C) receiving spinal brace/orthosis treatment for D) primary degenerative (de novo) scoliosis or progressive idiopathic scoliosis. A step-wise screening process was employed which involved a title and abstract screen for relevancy followed by a full text eligibility appraisal by two authors. Data were extracted, and a risk of bias assessment was performed on the included cohort studies using the Newcastle-Ottawa Scale. Given the overall level and quality of the available evidence, conclusions were drawn based on a qualitative summary of the evidence. RESULTS: Ten studies (four case reports and six cohort studies) were included which detailed the clinical outcomes of soft (2 studies) or rigid bracing (8 studies), used as a standalone therapy or in combination with physiotherapy/rehabilitation, in 339 adults with various types of scoliosis. Most studies included female participants only. Commonly reported outcomes were pain (7 studies), function (3 studies) and Cobb angles (3 studies), with follow-up times ranging from 2 days to 17 years. Brace wear prescriptions ranged from 2 to 23 h per day, and there was mixed brace-compliance reported. Most studies reported modest or significant reduction in pain and improvement in function at follow-up. There were mixed findings with regards to Cobb angle changes in response to bracing. Participants from one study noted discomfort associated with bracing. Each of the six cohort studies demonstrated a high risk of bias. CONCLUSION: There is evidence to suggest that spinal brace/orthosis treatment may have a positive short - medium term influence on pain and function in adults with either progressive primary (de novo) degenerative scoliosis or progressive idiopathic scoliosis. At this point in time the evidence is of low quality and has been focused primarily on female patients with thoracolumbar and lumbar curves. More granular statements regarding the efficacy of different brace types or manufacturers, or the effect of this therapy on different curve types cannot be determined based on the current literature. Properly constructed prospective trials are required to better understand the efficacy of bracing in adult scoliosis.

Does nanoscale porous titanium coating increase lumbar spinal stiffness of an interbody fusion cage? An in vivo biomechanical analysis in an ovine model.

BACKGROUND: Quantitative objective measures to determine fusion achievement further enable the comparison of new technologies, such as interbody cage surface enhancement. Our aims were to compare in vivo biomechanical responses of ovine L4/5 lumbar motion segments with two cages: 1) Polyetheretherketone or 2) Polyetheretherketone with a nanosurfaced titanium porous scaffold from Nanovis, Inc. METHODS: Fourteen Merino sheep randomly received either 1) standard Polyetheretherketone cage or 2) Nanocoated Polyetheretherketone cage at L4/L5 with autologous bone graft. At baseline and one-year follow-up, dynamic spinal stiffness was quantified in vivo using a validated mechanical assessment at 2 Hz, 6 Hz, and 12 Hz. The dorsoventral secant stiffness (ky = force/displacement, N/mm) and L4-L5 accelerations were determined at each frequency. A repeated measures analysis of variance with Bonferonni correction was used to evaluate within and between group differences among the biomechanical variables. FINDINGS: Both implants increased spinal stiffness at 2 Hz (21 and 39%, respectively, p < .005), and at 6 Hz (12 and 27%, p < .0001). Significantly greater spinal stiffness was observed with Nanocoated Polyetheretherketone at one-year for both frequencies (p < .05). No significant differences were observed at 12 Hz within or between groups. L4-L5 dorsoventral accelerations were significantly decreased one year following cage placement only with Nanocoated Polyetheretherketone (p < .05) and greater reductions in acceleration were observed with Nanocoated Polyetheretherketone compared to standard Polyetheretherketone (p < .05). INTERPRETATION: Both cages increased spinal stiffness, yet, nanosurfaced cages resulted in greater spinal stiffness changes and decreases in L4-L5 accelerations. These findings may assist in clinical decision making and post-operative recovery strategies.

Reduction of Scheuermann's deformity and scoliosis using ScoliBrace and a scoliosis specific rehabilitation program: a case report.

[Purpose] There is a paucity of high-quality data pertaining to the conservative management of adult spinal deformity, particularly Scheuermann's kyphosis. Long-term follow-up data for both treated and untreated Scheuermann's patients is also lacking. Given that changes in sagittal balance are associated with increased morbidity, and that these changes are increasingly prevalent in the spines of ageing populations, it is imperative that potential strategies aimed at reversing or minimizing this type of deformity are explored. As the number of elderly patients in developed countries increases, so does the need for a safe and effective non-surgical management option for patients with spinal deformity/sagittal imbalance. This case study details the influence of ScoliBrace rigid TSLO bracing in combination with a specific rehabilitation program in an adult patient with Kypho-scoliosis. [Participant and Methods] The authors describe a case involving the treatment of a 26-year-old male with Scheuermann's kyphosis and a lumbar scoliosis. The patient received 12 months of bracing with a supplemental exercise program. The patient was followed for a period of approximately 12 months. Patient progress was assessed using ODI, SRS-22r, NPRS, and radiographic Cobb angle measurements throughout treatment. [Results] The patient presented with an initial ODI score of 18/100, a SRS-22r score of 3.0, and an average NPRS score of 4/10. Initial Cobb angle measurements demonstrated a 79° thoracic kyphosis and a 30° (coronal plane) lumbar scoliosis. At the final assessment, the patient reported an ODI score of 6/100, an SRS-22r score of 3.91, and an average NPRS score of 0/10. The coronal plane Cobb angle measured 63°, and the thoracolumbar scoliosis had reduced to 25°. [Conclusion] The findings from this case study highlight that this type of brace in combination with exercise rehabilitation may be useful for reducing the magnitude of curves and reducing symptoms in patients presenting with adult kypho-scoliosis. Further investigation of this style of treatment is warranted in patients with sagittal plane imbalance.

Determining the relationship between cervical lordosis and neck complaints.

OBJECTIVE: To investigate the presence of a "functionally normal" cervical lordosis and identify if this and the amount of forward head posture are related to neck complaints. METHODS: Using the posterior tangent method, an angle of cervical lordosis was measured from C2 through C7 vertebrae on 277 lateral cervical x-rays. Anterior weight bearing was measured as the horizontal distance of the posterior superior body of the C2 vertebra compared to a vertical line drawn superiorly from the posterior inferior body of the C7 vertebra. The measurements were sorted into 2 groups, cervical complaint and noncervical complaint groups. The data were then partitioned into age by decades, sex, and angle categories. RESULTS: Patients with lordosis of 20 degrees or less were more likely to have cervicogenic symptoms (P < .001). The association between cervical pain and lordosis of 0 degrees or less was significant (P < .0001). The odds that a patient with cervical pain had a lordosis of 0 degrees or less was 18 times greater than for a patient with a noncervical complaint. Patients with cervical pain had less lordosis and this was consistent over all age ranges. Males had larger median cervical lordosis than females (20 degrees vs 14 degrees) (2-sided Mann-Whitney U test, P = .016). When partitioned by age grouping, this trend is significant only in the 40- to 49-year-old range (2-sided Mann-Whitney U test, P < .01). CONCLUSION: We found a statistically significant association between cervical pain and lordosis < 20 degrees and a "clinically normal" range for cervical lordosis of 31 degrees to 40 degrees. Maintenance of a lordosis in the range of 31 degrees to 40 degrees could be a clinical goal for chiropractic treatment.