Gatehouse SC^1,2*, Izatt MT¹, Labrom RD^1,2, Askin GN^1,2, Grant CA¹, Pivonka P¹ and Little JP¹

¹Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
²Queensland Children’s Hospital, Brisbane, Australia

*Corresponding Author: Gatehouse SC, Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.

Received: February 04, 2022; Published: March 10, 2022

Abstract

This study aimed to investigate the use of EOS (bi-planer) imaging and SterEOS reconstruction software to study the efficacy of spinal bracing in adolescent idiopathic scoliosis (AIS).

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. Over a 12-month period 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.

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 measurements [1-3].

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.

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 limited curve progression in sequential scans, though not in the anticipated manner of immediate in-brace curve correction.

 Keywords: Scoliosis; Adolescent Idiopathic Scoliosis (AIS); Bi-planer Imaging = EOS^TM imaging = EOS Imaging; SterEOS^TM = SterEOS; Spinal Bracing; Boston Brace; Verteotation; Axial Vertebral Rotation (AVR); Spine.bral R

References

1. J Clin., et al. “Correlation between immediate in-brace correction and biomechanical effectiveness of brace treatment in adolescent idiopathic scoliosis”. Spine (Phila. Pa. 1976)18 (2010): 1706-1713.
2. S S Upadhyay., et al. “New prognostic factors to predict the final outcome of brace treatment in adolescent idiopathic scoliosis”. Spine 20.5 (1995): 537-545.
3. E Melhem., et al. “EOS?? biplanar X-ray imaging: concept, developments, benefits, and limitations”. Journal of Children's Orthopaedics1 (2016): 1-14.
4. MA Asher and DC Burton. “Adolescent idiopathic scoliosis: natural history and long term treatment effects”. Scoliosis1 (2006): 2.
5. S L Weinstein., et al. “Adolescent idiopathic scoliosis”. Lancet 9623 (2008): 1527-1537.
6. F Altaf., et al. “Adolescent idiopathic scoliosis”. BMJ 7906 (2013): 1-8.
7. SL Weinstein., et al. “Effects of Bracing in Adolescents with Idiopathic Scoliosis”. The New England Journal of Medicine 16 (2013): 1512-1521.
8. E Laurnen., et al. “The Boston brace in thoracic scoliosis. A preliminary report.”. Spine (Phila. Pa. 1976)4 (1983): 388-395.
9. D Ovadia., et al. “Factors associated with the success of the Rigo System Chêneau brace in treating mild to moderate adolescent idiopathic scoliosis”. Journal of Children's Orthopaedics 4 (2012): 327-331.
10. L Rivett., et al. “The effect of compliance to a Rigo System Cheneau brace and a specific exercise programme on idiopathic scoliosis curvature: a comparative study: SOSORT 2014 award winner”. Scoliosis1 (2014): 5.
11. A G Aulisa., et al. “Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies - SOSORT award 2013 winner.”. Scoliosis 1 (2014): 3.
12. S Negrini., et al. “Brace technology thematic series - The Sforzesco and Sibilla braces, and the SPoRT (Symmetric, Patient oriented, Rigid, Three-dimensional, active) concept”. Scoliosis (2011): 8.
13. S Donzelli., et al. “The three dimensional analysis of the Sforzesco brace correction”. Scoliosis Spinal DisorderS2 (2016): 34.
14. H Berdishevsky., et al. “Physiotherapy scoliosis-specific exercises-a comprehensive review of seven major schools”. (2016).
15. B Heidari., et al. “Correlation of an induced rotation model with the clinical categorisation of scoliotic deformity-a possible platform for prediction of scoliosis progression” (2006).
16. S Lupparelli., et al. “Biomechanical factors affecting progression of structural scoliotic curves of the spine”. (2002).
17. A Courvoisier., et al. “EOS 3D Imaging: assessing the impact of brace treatment in adolescent idiopathic scoliosis”. Expert Review of Medical Devices1 (2014): 1-3.
18. T Illés., et al. “Breakthrough in three-dimensional scoliosis diagnosis: Significance of horizontal plane view and vertebra vectors”. European Spine Journal 1 (2011): 135-143.
19. T S Illés., et al. “The third dimension of scoliosis: The forgotten axial plane”. Orthopaedics and Traumatology: Surgery and Research2 (2019): 351-359.
20. H Labelle., et al. “Seeing the spine in 3D: how will it change what we do?”. Journal of Pediatric Orthopaedics 1 (2011): S37--45.
21. A Bagheri., et al. “Reliability of Three-Dimensional Spinal Modeling of Patients With Idiopathic Scoliosis Using EOS System”. Spine Deform3 (2018): 207-212.
22. S Deschênes., et al. “Diagnostic imaging of spinal deformities: reducing patients radiation dose with a new slot-scanning X-ray imager”. Spine (Phila. Pa. 1976)9 (2010): 989-994.
23. “The leader in low dose 2D and 3D medical imaging | EOS imaging” (2019).
24. T Illés and S Somoskeöy. “The EOSTM imaging system and its uses in daily orthopaedic practice”. International Orthopaedics 7 (2012): 1325-1331.
25. L Humbert., et al. “3D reconstruction of the spine from biplanar X-rays using parametric models based on transversal and longitudinal inferences”. Medical Engineering and Physics 6 (2009): 681-687.
26. B E Keenan., et al. “Supine to standing Cobb angle change in idiopathic scoliosis: the effect of endplate pre-selection”. Scoliosis1 (2014): 16.
27. P Wessberg., et al. “Comparison of Cobb angles in idiopathic scoliosis on standing radiographs and supine axially loaded MRI”. Spine (Phila. Pa. 1976) (2006).
28. G Torell., et al. “Standing and supine cobb measures in girls with idiopathic scoliosis”. Spine (Phila. Pa. 1976). (1985).
29. S L Weinstein and I V Ponseti. “Curve progression in idiopathic scoliosis”. Journal of Bone and Joint Surgery - Ser. A (1983).
30. L G Lenke., et al. “Adolescent idiopathic scoliosis. A new classification to determine extent of spinal arthrodesis”. Journal of Bone and Joint Surgery - Ser. A8 (2001): 1169-1181.
31. S Negrini., et al. “Braces for idiopathic scoliosis in adolescents”. Cochrane Review is a Systematic Review23 (2015): CD006850.
32. J Cobb. “Outline for the Study of Scoliosis”. Instructional Course Lectures 5 (1948): 261-275.
33. T R Kuklo., et al. “Reliability analysis for manual adolescent idiopathic scoliosis measurements”. Spine (Phila. Pa. 1976)4 (2005): 444-454.
34. M Shaw., et al. “Use of the iPhone for Cobb angle measurement in scoliosis”. European Spine Journal6 (2012): 1062-1068.
35. BE Keenan., et al. “Supine to standing Cobb angle change in idiopathic scoliosis: The effect of endplate pre-selection”. Scoliosis (2014).
36. S Negrini., et al. “Braces for idiopathic scoliosis in adolescents”. Cochrane Library: Cochrane Reviews 6 (2015): CD006850.
37. C He., et al. “An effective assessment method of spinal flexibility to predict the initial in-orthosis correction on the patients with adolescent idiopathic scoliosis (AIS)”. PLoS One12 (2017).
38. N Cobetto., et al. “3D correction of AIS in braces designed using CAD/CAM and FEM: A randomized controlled trial”. Scoliosis Spinal Disorder1 (2017): 1-8.
39. K Zaborowska-Sapeta., et al. “The Duration of the correction loss after removing cheneau brace in patients with adolescent idiopathic scoliosis”. Acta Orthopaedica et Traumatologica Turcica 1 (2019): 61-67.
40. J A Herring., et al. “Brace Wear Control of Curve Progression in Adolescent Idiopathic Scoliosis”. Journal of Bone and Joint Surgery-American15 (2010): 2616-2617.
41. J E Lange., et al. “Long-term results after Boston brace treatment in late-onset juvenile and adolescent idiopathic scoliosis”. Scoliosis1 (2011): 18.
42. P Knott., et al. “Retrospective analysis of immediate in-brace correction of scoliosis attainable in patients with AIS: a SOSORT initiative”. ScoliosisS1 (2013): O49.
43. F P Castro. “Adolescent idiopathic scoliosis, bracing, and the Hueter-Volkmann principle”. Spine Journal3 (2003): 180-185.
44. E Ameri., et al. “Predictors of Curve Flexibility in Adolescent Idiopathic Scoliosis : a Retrospective Study of 100 Patients”. (2013).
45. A P Sangole., et al. “Three-dimensional classification of thoracic scoliotic curves”. Spine (Phila. Pa. 1976) (2009).
46. M M Panjabi., et al. “Three-dimensional flexibility and stiffness properties of the human thoracic spine”. Journal of Biomechanics (1976).
47. J P Little., et al. “Investigating the change in three dimensional deformity for idiopathic scoliosis using axially loaded MRI”. Clinical Biomechanics (2012).
48. S Weinstein. “Idiopathic scoliosis. Natural history”. Spine8 (1986): 780-783.
49. A Courvoisier., et al. “3D analysis of brace treatment in idiopathic scoliosis”. European Spine Journal11 (2013): 2449-2455.
50. S L Weinstein., et al. “Effects of bracing in adolescents with idiopathic scoliosis”. The New England Journal of Medicine 16 (2013): 1512-1521.
51. A J Danielsson., et al. “A prospective study of brace treatment versus observation alone in adolescent idiopathic scoliosis: A follow-up mean of 16 years after maturity”. Spine (Phila. Pa. 1976)20 (2007): 2198-2207.

Citation

Citation: Gatehouse SC., et al. “The Use of EOS Imaging to Assess Curve Magnitude Changes in Adolescent Idiopathic Scoliosis Undertaking Brace Management".Acta Scientific Orthopaedics 5.4 (2022): 62-70.

Copyright

Copyright: © 2022 Gatehouse SC., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.