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Wendy B Katzman - One of the best experts on this subject based on the ideXlab platform.
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cross sectional and longitudinal associations of diffuse idiopathic skeletal hyperostosis and thoracic kyphosis in older men and women
Arthritis Care and Research, 2017Co-Authors: Wendy B Katzman, Lynn M Marshall, Deborah M Kado, Peggy M Cawthon, Neeta Parimi, Ziba Mansoori, Lorenzo Nardo, John T Schousboe, Nancy E LaneAbstract:Author(s): Katzman, Wendy B; Parimi, Neeta; Mansoori, Ziba; Nardo, Lorenzo; Kado, Deborah M; Cawthon, Peggy M; Marshall, Lynn M; Schousboe, John T; Lane, Nancy E; Osteoporotic Fractures in Men Study Research Group and the Study of Osteoporotic Fractures | Abstract: To investigate cross-sectional and longitudinal associations of diffuse idiopathic skeletal hyperostosis (DISH) and thoracic kyphosis in older persons.DISH and kyphosis were assessed in 1,500 men from the Osteoporotic Fractures in Men (MrOS) study and in 1,267 women from the Study of Osteoporotic Fractures (SOF). DISH was assessed using baseline lateral spine radiographs, and Cobb Angle of kyphosis was measured from baseline and followup radiographs, a mean 4.6 years later in men, and 3.7 and 15 years later in women. Linear regression was used to analyze associations of DISH with baseline Cobb Angle and with percent annualized change in Cobb Angle. We tested for heterogeneity among studies.DISH was identified in 222 participants in MrOS (15%) and in 156 participants in SOF (12%). Participants with DISH in both cohorts had higher baseline Cobb Angles (P l 0.05), after adjustment for covariates. After approximately 4 years of followup, there was no significant difference in annualized percent change in Cobb Angle in those with DISH compared to those without DISH (P g 0.05) for men or women. Women with DISH had less kyphosis progression over 15 years (0.25% less annualized change in Cobb) than those without DISH.Prevalent DISH is associated with greater kyphosis in older men and women, and is not significantly associated with a change in kyphosis over 4-5 years. However, in women followed over 15 years, DISH was associated with less progression of kyphosis. These results suggest that DISH influences kyphosis and may slow progression over the long term. Additional studies of DISH/kyphosis associations are warranted to understand the functional implications of this finding.
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diffuse idiopathic skeletal hyperostosis association with thoracic spine kyphosis a cross sectional study for the health aging and body composition study
Spine, 2014Co-Authors: Lorenzo Nardo, Nancy E Lane, Peggy M Cawthon, Neeta Parimi, Bo Fan, John A Shepherd, Jane A Cauley, Audrey Zuckerlevin, Rachel A Murphy, Wendy B KatzmanAbstract:Author(s): Nardo, Lorenzo; Lane, Nancy E; Parimi, Neeta; Cawthon, Peggy M; Fan, Bo; Shepherd, John; Cauley, Jane; Zucker-Levin, Audrey; Murphy, Rachel A; Katzman, Wendy B | Abstract: STUDY DESIGN:A descriptive study of the association between diffuse idiopathic skeletal hyperostosis (DISH) and kyphosis. OBJECTIVE:To investigate the association of DISH with Cobb Angle of kyphosis in a large cohort of older subjects from the Health Aging and Body Composition Study. SUMMARY OF BACKGROUND DATA:DISH and thoracic kyphosis are well-defined radiographical findings in spines of older individuals. Characteristics of DISH (ossifications between vertebral segments) reflect changes of spine anatomy and physiology that may be associated with Cobb Angle of kyphosis. METHODS:Using data from 1172 subjects aged 70 to 79 years, we measured DISH and Cobb Angle of kyphosis from computed tomographic lateral scout scans. Characteristics of participants with and without DISH were assessed using the χ² and t tests. Association between DISH and Cobb Angle was analyzed using linear regression. Cobb Angle and DISH relationship was assessed at different spine levels (thoracic and lumbar). RESULTS:DISH was identified on computed tomographic scout scan in 152 subjects with 101 cases in only the thoracic spine and 51 in both thoracic and lumbar spine segments. The mean Cobb Angle of kyphosis in the analytic sample was 31.3° (standard deviation = 11.2). The presence of DISH was associated with a greater Cobb Angle of 9.1° and 95% confidence interval (95% CI) (5.6-12.6) among African Americans and a Cobb Angle of 2.9° and 95% CI (0.5-5.2) among Caucasians compared with those with no DISH. DISH in the thoracic spine alone was associated with a greater Cobb Angle of 10.6° and 95% CI (6.5-14.7) in African Americans and a Cobb Angle of 3.8° and 95% CI (1.0-6.5) in Caucasians compared with those with no DISH. CONCLUSION:DISH is associated with greater Cobb Angle of kyphosis, especially when present in the thoracic spine alone. The association of DISH with Cobb Angle is stronger within the African American population.
Zezhang Zhu - One of the best experts on this subject based on the ideXlab platform.
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ineffective treatment technique of convex epiphysiodesis for congenital scoliosis
China Journal of Orthopaedics and Traumatology, 2020Co-Authors: Chao Xia, Yong Qiu, Wei Pan, Fei Sheng, Zezhang ZhuAbstract:OBJECTIVE To discuss the long-term outcome of convex epiphysiodesis in the treatment for congenital scoliosis (CS). METHODS The clinical data of 22 patients with hemivertebral deformity undergoing convex epiphysiodesis from the October 1998 to Febuary 2008 were respectively analyzed. There were 12 males and 10 females. The whole spine anteroposterior radiographs were taken preoperatively, at 3-month postoperatively and at the final follow-up to measure the main curve and the compensatory curve. The progression rate was calculated for each patient. Observing the correlation between the progression rate and annual progression of the scoliosis and age, gender, hemivertebral number, hemivertebral position, preoperative main curve Cobb Angle and compensatory curve Cobb Angle, comparing different ages, genders, hemivertebral number and position, and preoperative main curve Cobb Angle on the progression of postoperative curve. RESULTS The mean Cobb Angle of main curve changed from (40.5±9.8) ° before surgery to (39.5±11.1) ° at 3 months after surgery, which significantly increased to (46.8±13.9) ° in the final follow-up. Meanwhile the mean Cobb Angle of compensatory curve was changed from (20.1±10.8) ° before surgery to (23.0±11.1) °, which significantly increased to (29.9±11.5) ° in the final follow-up. There were no significant differences in the Cobb Angle of the main curve and the compensatory curve between postoperative 3 months and before operation (P>0.05). The difference between the final follow-up and the preoperative, postoperative 3 months was statistically significant (P<0.01). Twenty patients experienced progression of both main curve and compensatory curve, with a mean progression rate of (19.2±17.9)% for main curve and (39.6±37.0)% for compensatory curve. The annual progression volume was (1.5± 1.4) ° for main curve and (1.4±1.3) ° for compensatory curve. Three patients underwent lateral convex orthopedic internal fixation due to postoperative scoliosis progression. The curve progression was significantly correlated with age at the time of surgery and hemivertebral number. There was a significant correlation between the age of the operation, the main curve Angle, the preoperative compensatory curve Angle and the annual progression volume of the main curve (P<0.05). CONCLUSION The convex epiphysiodesis technique cannot effectively prevent curve progression of CS patients in the long-term follow-up. It is not recommended to apply this technique to the treatment of patients with congenital hemivertebrae.
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initial Cobb Angle reduction velocity following bracing as a new predictor for curve progression in adolescent idiopathic scoliosis
European Spine Journal, 2016Co-Authors: Alec Likhang Hung, Tsz Ping Lam, Saihu Mao, Benlong Shi, Zhiwei Wang, Kwong Man Lee, Jack C Y Cheng, Zezhang ZhuAbstract:The initial correction rate (ICR) has been widely used as a predictor for curve progression in adolescent idiopathic scoliosis (AIS) undergoing bracing treatment. We proposed a new parameter, the initial Cobb Angle reduction velocity (ARV), for prediction of curve progression. The purpose of this study was to identify whether the initial ARV was a more effective predictor than ICR for curve progression in AIS patients undergoing brace treatment, and to evaluate the ideal cut-off point of initial ARV for prediction of curve progression. This was a retrospective cohort study on AIS girls receiving standardized bracing treatment regularly followed up every 3–6 months. Standardized SRS criteria for bracing study were utilized in the case selection. The demographic data, maturity status and Cobb Angle of each visit were recorded. The initial ARV and ICR were identified. Patients were divided into progressive (≥6°) and non-progressive (<6°) groups based on their final bracing outcome. Differences between two groups were identified and logistic regression analysis was applied to compare the predictive values of initial ARV and ICR for curve progression during bracing treatment. Seventy-six patients were included in the non-progressive group and 19 in the progressive group. Significant differences between non-progressive and progressive groups were found in terms of initial ARV (12.8 ± 21.4°/year vs −5.4 ± 15.2°/year, P = 0.001) and ICR (12.1 ± 20.7 % vs −5.8 ± 18.0 %, P = 0.001). The logistic regression analysis revealed that age at initial visit (OR 1.742, P = 0.043) and initial ARV (OR 1.057, P = 0.002) had higher predictive values than ICR (P = 0.601) for curve progression in braced AIS girls. The ideal cut-off point of initial ARV was 10°/year (OR 8.959, P = 0.005) for the prediction of curve progression. The initial Cobb Angle reduction velocity serves as a better predictor for curve progression than initial correction rate in braced AIS patients with follow-up interval of 3–6 months. At the second visit following bracing prescription, those AIS patients with reduction velocity in Cobb Angle lower than 10°/year have significantly higher risk of curve progression.
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reliability analysis of a smartphone aided measurement method for the Cobb Angle of scoliosis
Journal of Spinal Disorders & Techniques, 2012Co-Authors: Jun Qiao, Zezhang Zhu, Feng Zhu, Zhen Liu, Xin Zheng, Bangpin Qian, Yong QiuAbstract:STUDY DESIGN A comparison between the smartphone-aided measurement method and the manual measurement method for the Cobb Angle in adolescent idiopathic scoliosis. OBJECTIVE To evaluate the reliability and measurement error for the smartphone-aided Cobb Angle measurement method and compare its reliability and measurement error with those of the manual method. SUMMARY OF BACKGROUND DATA The development of smartphones has provided new opportunities that integrate mobile technology into daily clinical practice. Smartphone applications can provide quick assistance in the diagnosis and treatment of disease. Cobbmeter is a smartphone application designed for the measurement of Cobb Angle on Apple iPhone smartphones. There is no study on the reliability and measurement error of this smartphone-aided measurement method. METHODS : Fifty-three posteroanterior radiographs of adolescent idiopathic scoliosis patients with thoracic scoliosis were used for the standard Cobb method of measurement (manual set) and the smartphone-aided Cobb method of measurement (smartphone set). Five spinal surgeons measured the Cobb Angle with the use of both the manual method and the smartphone-aided method. The measurement time was recorded for every measurement. The frequency and the cumulative percent distribution for intraobserver differences were tabulated, both for the individual examiners and for the overall results for the 5 examiners. The intraclass correlation coefficient (ICC) 2-way mixed model on absolute agreement was used to analyze measurement reliability. Summary statistics from analyses of variance calculations were used to provide 95% prediction limits for the error in measurements. A paired t test was used to compare the time consumed for the measurement between both sets. RESULTS The intraobserver and interobserver ICCs were excellent in the smartphone set and in the manual set. Both the intraobserver ICC and the interobserver ICC were better in the smartphone set than in the manual set. The mean Cobb Angle of all measured x-rays was 29.3 degrees (range, 17-58 degrees) in the manual set and 29.1 degrees (range, 18-56 degrees) in the smartphone set. The mean time consumed was 13.7 seconds (range, 8.6-18.5 s) for the smartphone set, whereas it was 37.9 seconds (range, 30.1-46.9 s) for the manual set, and the mean time consumed for the smartphone set was significantly shorter than that of the manual set (P<0.05). CONCLUSIONS Smartphone-aided measurement for Cobb Angle showed excellent reliability and efficiency. It is suggested to popularize the use of this method in clinical practice.
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variations of the position of the cerebellar tonsil in idiopathic scoliotic adolescents with a Cobb Angle 40 a magnetic resonance imaging study
Spine, 2007Co-Authors: Xu Sun, Yong Qiu, Zezhang Zhu, Feng Zhu, Bin Wang, Bangping QianAbstract:Study design A retrospective study was performed through measurements on MRI images in adolescent idiopathic scoliosis (AIS) patients and age-matched adolescents. Objectives To investigate the position of the cerebellar tonsil in AIS patients with a Cobb Angle >40 degrees in comparison with age-matched healthy adolescents and to determine the relationships of the tonsil position with age, sex, curve severity, and curve patterns. Summary of background data There have been increasing evidences implying that AIS patients may present with subtle or subclinical neurologic dysfunction and a higher incidence of tonsillar ectopia was documented in AIS patients. However, the tonsil position has not been clearly addressed in AIS patients with a severe curve. Methods According to the method described by Aboulezz et al, measurements of the tonsil position relative to the magnum foramen on magnetic resonance images were performed in 203 AIS patients with a Cobb Angle >40 degrees and 86 age-matched healthy adolescents. The inferior displacement of the cerebellar tonsil with an extent within 5 mm was defined as tonsillar ectopia when it located below the magnum foramen. On the basis of measurement results, the incidence of tonsillar ectopia was determined in both AIS and control groups. The associations of tonsillar ectopia with curve severity and curve patterns for AIS patients and the relationships of the tonsil positions with age and gender in all subjects were analyzed. Results In AIS patients and healthy controls, the median position of the cerebellar tonsil was 0.8 and 2.9 mm above the magnum foramen, respectively. The incidence of tonsillar ectopia (0-4.8 mm below the magnum foramen) in AIS was found to be significantly higher than healthy adolescents (range 0-1.8 mm vs. 0-4.8 mm below the magnum foramen; ratio 34.5% vs. 5.8%; P Conclusion Tonsillar ectopia with the extent >2 mm in AIS patients should be regarded as abnormal. AIS patients had a lower tonsil position and a higher prevalence of tonsillar ectopia than controls, and tonsillar ectopia was found to be associated with curve patterns. It is suggested that a lower position of the cerebellar tonsil might be associated with the etiopathogenesis of AIS and might contribute to subclinical neurologic dysfunction in AIS patients.
Tsz Ping Lam - One of the best experts on this subject based on the ideXlab platform.
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abnormal lacuno canalicular network and negative correlation between serum osteocalcin and Cobb Angle indicate abnormal osteocyte function in adolescent idiopathic scoliosis
The FASEB Journal, 2019Co-Authors: Yong Qiu, Huanxiong Chen, Jiajun Zhang, Yujia Wang, Kayee Cheuk, Alec Likhang Hung, Tsz Ping Lam, Jian Q FengAbstract:Adolescent idiopathic scoliosis (AIS) is a prevalent spinal deformity occurring during peripubertal growth period that affects 1-4% of adolescents globally without clear etiopathogenetic mechanism. Low bone mineral density is an independent and significant prognostic factor for curve progression. Currently, the cause underlying low bone mass in AIS remains elusive. Osteocytes play an important role in bone metabolism and mineral homeostasis, but its role in AIS has not been studied. In the present study, iliac bone tissues were harvested from 21 patients with AIS (mean age of 14.3 ± 2.20 yr old) with a mean Cobb Angle of 55.6 ± 10.61° and 13 non-AIS controls (mean age of 16.5 ± 4.79 yr old) intraoperatively. Acid-etched scanning electron microscopy (SEM) images of AIS demonstrated abnormal osteocytes that were more rounded and Cobblestone-like in shape and were aligned in irregular clusters with shorter and disorganized canaliculi. Further quantitative analysis with FITC-Imaris technique showed a significant reduction in the canalicular number and length as well as an increase in lacunar volume and area in AIS. SEM with energy-dispersive X-ray spectroscopy analysis demonstrated a lower calcium-to-phosphorus ratio at the perilacunar/canalicular region. Moreover, microindentaion results revealed lower values of Vickers hardness and elastic modulus in AIS when compared with controls. In addition, in the parallel study of 99 AIS (27 with severe Cobb Angle of 65.8 ± 14.1° and 72 with mild Cobb Angle of 26.6 ± 9.1°) with different curve severity, the serum osteocalcin level was found to be significantly and negatively associated with the Cobb Angle. In summary, the findings in this series of studies demonstrated the potential link of abnormal osteocyte lacuno-canalicular network structure and function to the observed abnormal bone mineralization in AIS, which may shed light on etiopathogenesis of AIS.-Chen, H., Zhang, J., Wang, Y., Cheuk, K.-Y., Hung, A. L. H., Lam, T.-P., Qiu, Y., Feng, J. Q., Lee, W. Y. W., Cheng, J. C. Y. Abnormal lacuno-canalicular network and negative correlation between serum osteocalcin and Cobb Angle indicate abnormal osteocyte function in adolescent idiopathic scoliosis.
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a reliability and validity study for scolioscan a radiation free scoliosis assessment system using 3d ultrasound imaging
Scoliosis and Spinal Disorders, 2016Co-Authors: Yongping Zheng, Jack C Y Cheng, Timothy Tinyan Lee, Kelly Kalee Lai, Benjamin Hon Kei Yip, Guangquan Zhou, Weiwei Jiang, James Chungwai Cheung, M S Wong, Tsz Ping LamAbstract:Radiographic evaluation for patients with scoliosis using Cobb method is the current gold standard, but radiography has radiation hazards. Several groups have recently demonstrated the feasibility of using 3D ultrasound for the evaluation of scoliosis. Ultrasound imaging is radiation-free, comparatively more accessible, and inexpensive. However, a reliable and valid 3D ultrasound system ready for clinical scoliosis assessment has not yet been reported. Scolioscan is a newly developed system targeted for scoliosis assessment in clinics by using coronal images of spine generated by a 3D ultrasound volume projection imaging method. The aim of this study is to test the reliability of spine deformity measurement of Scolioscan and its validity compared to the gold standard Cobb Angle measurements from radiography in adolescent idiopathic scoliosis (AIS) patients. Prospective study divided into two stages: 1) Investigation of intra- and inter- reliability between two operators for acquiring images using Scolioscan and among three raters for measuring spinal curves from those images; 2) Correlation between the Cobb Angle obtained from radiography by a medical doctor and the spine curve Angle obtained using Scolioscan (Scolioscan Angle). The raters for ultrasound images and the doctors for evaluating radiographic images were mutually blinded. The two stages of tests involved 20 (80 % females, total of 26 Angles, age of 16.4 ± 2.7 years, and Cobb Angle of 27.6 ± 11.8°) and 49 (69 % female, 73 Angles, 15.8 ± 2.7 years and 24.8 ± 9.7°) AIS patients, respectively. Intra-class correlation coefficients (ICC) and Bland-Altman plots and root-mean-square differences (RMS) were employed to determine correlations, which interpreted based on defined criteria. We demonstrated a very good intra-rater and intra-operator reliability for Scolioscan Angle measurement with ICC larger than 0.94 and 0.88, respectively. Very good inter-rater and inter-operator reliability was also demonstrated, with both ICC larger than 0.87. For the thoracic deformity measurement, the RMS were 2.5 and 3.3° in the intra- and inter-operator tests, and 1.5 and 3.6° in the intra- and inter-rater tests, respectively. The RMS differences were 3.1, 3.1, 1.6, 3.7° in the intra- and inter-operator and intra- and inter-rater tests, respectively, for the lumbar Angle measurement. Moderate to strong correlations (R2 > 0.72) were observed between the Scolioscan Angles and Cobb Angles for both the thoracic and lumbar regions. It was noted that the Scolioscan Angle slightly underestimated the spinal deformity in comparison with Cobb Angle, and an overall regression equation y = 1.1797x (R2 = 0.76) could be used to translate the Scolioscan Angle (x) to Cobb Angle (y) for this group of patients. The RMS difference between Scolioscan Angle and Cobb Angle was 4.7 and 6.2°, with and without the correlation using the overall regression equation. We showed that Scolioscan is reliable for measuring coronal deformity for patients with AIS and appears promising in screening large numbers of patients, for progress monitoring, and evaluation of treatment outcomes. Due to it being radiation-free and relatively low-cost, Scolioscan has potential to be widely implemented and may contribute to reducing radiation dose during serial monitoring.
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initial Cobb Angle reduction velocity following bracing as a new predictor for curve progression in adolescent idiopathic scoliosis
European Spine Journal, 2016Co-Authors: Alec Likhang Hung, Tsz Ping Lam, Saihu Mao, Benlong Shi, Zhiwei Wang, Kwong Man Lee, Jack C Y Cheng, Zezhang ZhuAbstract:The initial correction rate (ICR) has been widely used as a predictor for curve progression in adolescent idiopathic scoliosis (AIS) undergoing bracing treatment. We proposed a new parameter, the initial Cobb Angle reduction velocity (ARV), for prediction of curve progression. The purpose of this study was to identify whether the initial ARV was a more effective predictor than ICR for curve progression in AIS patients undergoing brace treatment, and to evaluate the ideal cut-off point of initial ARV for prediction of curve progression. This was a retrospective cohort study on AIS girls receiving standardized bracing treatment regularly followed up every 3–6 months. Standardized SRS criteria for bracing study were utilized in the case selection. The demographic data, maturity status and Cobb Angle of each visit were recorded. The initial ARV and ICR were identified. Patients were divided into progressive (≥6°) and non-progressive (<6°) groups based on their final bracing outcome. Differences between two groups were identified and logistic regression analysis was applied to compare the predictive values of initial ARV and ICR for curve progression during bracing treatment. Seventy-six patients were included in the non-progressive group and 19 in the progressive group. Significant differences between non-progressive and progressive groups were found in terms of initial ARV (12.8 ± 21.4°/year vs −5.4 ± 15.2°/year, P = 0.001) and ICR (12.1 ± 20.7 % vs −5.8 ± 18.0 %, P = 0.001). The logistic regression analysis revealed that age at initial visit (OR 1.742, P = 0.043) and initial ARV (OR 1.057, P = 0.002) had higher predictive values than ICR (P = 0.601) for curve progression in braced AIS girls. The ideal cut-off point of initial ARV was 10°/year (OR 8.959, P = 0.005) for the prediction of curve progression. The initial Cobb Angle reduction velocity serves as a better predictor for curve progression than initial correction rate in braced AIS patients with follow-up interval of 3–6 months. At the second visit following bracing prescription, those AIS patients with reduction velocity in Cobb Angle lower than 10°/year have significantly higher risk of curve progression.
Edmond Lou - One of the best experts on this subject based on the ideXlab platform.
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Intra- and Interrater Reliability of Cobb Angle Measurements on the Plane of Maximum Curvature Using Ultrasound Imaging Method
Spine Deformity, 2019Co-Authors: Suzana Trac, Rui Zheng, Doug L. Hill, Edmond LouAbstract:Study Design Retrospective reliability study. Objectives To investigate the intra- and interrater reliability of Cobb Angle measurements on the plane of maximum curvature (PMC) using ultrasound (US) images on children with adolescent idiopathic scoliosis (AIS). Summary of Background Data Cobb Angle measurement on posteroanterior (PA) radiographs is the gold standard to assess curve severity. However, the PA Cobb Angle does not reflect the true three-dimensional deformity. Methods One hundred one children with AIS (87 F; 14 M) (age: 13.7 ± 1.7 years) were recruited and 157 curves were recorded by clinicians on radiographs. Three raters, R1, R2, and R3 with 0, 4, and 20+ years of experience, respectively, measured the PA Cobb, vertebral axial rotation (VAR), PMC Cobb, and PMC orientations on US images. The true PMC orientations were determined using 3D reconstructions on the PA and lateral EOS radiographs. The reliability of R1 measurements on PMC orientations were validated using intermethod (US vs. EOS measurements) with the intraclass correlation coefficients (ICCs). Inter- and intrarater reliabilities, standard error measurements, and Bland-Altman’s bias were used to report the PMC Cobb and VAR measurements. Results Intermethod, inter-, and intrarater ICC(2,1) values for all reliability assessments were greater than 0.9. The mean absolute differences and the standard error measurements for both PMC Cobb and VAR were less than 4° and 0.5°, respectively. The PMC orientation was strongly correlated (r^2 = 0.88) between both measurement modalities. There appeared to be a positive association between the difference of PMC and PA Cobb when the PA Cobb and the maximum VAR were greater than 30° and 14°, respectively. Conclusion The PMC Cobb and VAR can be measured reliably on US images. Future studies should validate the PMC Cobb Angle and to include a wider Cobb Angle range on participants.
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schroth physiotherapeutic scoliosis specific exercises added to the standard of care lead to better Cobb Angle outcomes in adolescents with idiopathic scoliosis an assessor and statistician blinded randomized controlled trial
PLOS ONE, 2016Co-Authors: Sanja Schreiber, Eric C Parent, Edmond Lou, Douglas L Hill, Douglas M Hedden, Elham Khodayari Moez, Marc Moreau, Elise M Watkins, Sarah C SouthonAbstract:Background The North American non-surgical standard of care for adolescent idiopathic scoliosis (AIS) includes observation and bracing, but not exercises. Schroth physiotherapeutic scoliosis-specific exercises (PSSE) showed promise in several studies of suboptimal methodology. The Scoliosis Research Society calls for rigorous studies supporting the role of exercises before including it as a treatment recommendation for scoliosis. Objectives To determine the effect of a six-month Schroth PSSE intervention added to standard of care (Experimental group) on the Cobb Angle compared to standard of care alone (Control group) in patients with AIS. Methods Fifty patients with AIS aged 10–18 years, with curves of 10°-45° and Risser grade 0–5 were recruited from a single pediatric scoliosis clinic and randomized to the Experimental or Control group. Outcomes included the change in the Cobb Angles of the Largest Curve and Sum of Curves from baseline to six months. The intervention consisted of a 30–45 minute daily home program and weekly supervised sessions. Intention-to-treat and per protocol linear mixed effects model analyses are reported. Results In the intention-to-treat analysis, after six months, the Schroth group had significantly smaller Largest Curve than controls (-3.5°, 95% CI -1.1° to -5.9°, p = 0.006). Likewise, the between-group difference in the square root of the Sum of Curves was -0.40°, (95% CI -0.03° to -0.8°, p = 0.046), suggesting that an average patient with 51.2° at baseline, will have a 49.3° Sum of Curves at six months in the Schroth group, and 55.1° in the control group with the difference between groups increasing with severity. Per protocol analyses produced similar, but larger differences: Largest Curve = -4.1° (95% CI -1.7° to -6.5°, p = 0.002) and (95% CI -0.8 to 0.2, p = 0.006). Conclusion Schroth PSSE added to the standard of care were superior compared to standard of care alone for reducing the curve severity in patients with AIS. Trial Registration NCT01610908
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validation of 3d surface reconstruction of vertebrae and spinal column using 3d ultrasound data a pilot study
Medical Engineering & Physics, 2015Co-Authors: Duc V Nguyen, Edmond LouAbstract:Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of spine associated with vertebra rotation. The Cobb Angle and axial vertebral rotation are important parameters to assess the severity of scoliosis. However, the vertebral rotation is seldom measured from radiographs due to time consuming. Different techniques have been developed to extract 3D spinal information. Among many techniques, ultrasound imaging is a promising method. This pilot study reported an image processing method to reconstruct the posterior surface of vertebrae from 3D ultrasound data. Three cadaver vertebrae, a Sawbones spine phantom, and a spine from a child with AIS were used to validate the development. The in-vitro result showed the surface of the reconstructed image was visually similar to the original objects. The dimension measurement error was 0.99. The results also showed a high accuracy in vertebral rotation with errors of 0.8 ± 0.3°, 2.8 ± 0.3° and 3.6 ± 0.5° for the rotation values of 0°, 15° and 30°, respectively. Meanwhile, the difference in the Cobb Angle between the phantom and the image was 4° and the vertebral rotation at the apex was 2°. The Cobb Angle measured from the in-vivo ultrasound image was 4° different from the radiograph.
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validity and reliability of active shape models for the estimation of Cobb Angle in patients with adolescent idiopathic scoliosis
Journal of Digital Imaging, 2008Co-Authors: Shannon Allen, Eric C Parent, Edmond Lou, Maziyar Khorasani, Douglas L Hill, James RasoAbstract:Choosing the most suitable treatment for scoliosis relies heavily on accurate and reproducible Cobb Angle measurement from successive radiographs. The objective is to reduce variability of Cobb Angle measurement by reducing user intervention and bias. Custom software to increase automation of the Cobb Angle measurement from posteroanterior radiographs was developed using active shape models. Validity and reliability of the automated system against a manual and semiautomated measurement method was conducted by two examiners each performing measurements on three occasions from a test set (N = 22). A training set (N = 47) of radiographs representative of curves seen in a scoliosis clinic was used to train the software to recognize vertebrae from T4 to L4. Images with a maximum Cobb Angle between 20° and 50°, excluding surgical cases, were selected for training and test sets. Automated Cobb Angles were calculated using best-fit slopes of the detected vertebrae endplates. Intraclass correlation coefficient (ICC) and standard error of measurement (SEM) showed high intraexaminer (ICC > 0.90, SEM 2°–3°) and interexaminer (ICC > 0.82, SEM 2°–4°), but poor intermethod reliability (ICC = 0.30, SEM 8°–9°). The automated method underestimated large curves. The reliability improved (ICC = 0.70, SEM 4°–5°) with exclusion of the four largest curves (>40°) in the test set. The automated method was reliable for moderate-sized curves, and did detect vertebrae in larger curves with a modified training set of larger curves.
Nancy E Lane - One of the best experts on this subject based on the ideXlab platform.
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cross sectional and longitudinal associations of diffuse idiopathic skeletal hyperostosis and thoracic kyphosis in older men and women
Arthritis Care and Research, 2017Co-Authors: Wendy B Katzman, Lynn M Marshall, Deborah M Kado, Peggy M Cawthon, Neeta Parimi, Ziba Mansoori, Lorenzo Nardo, John T Schousboe, Nancy E LaneAbstract:Author(s): Katzman, Wendy B; Parimi, Neeta; Mansoori, Ziba; Nardo, Lorenzo; Kado, Deborah M; Cawthon, Peggy M; Marshall, Lynn M; Schousboe, John T; Lane, Nancy E; Osteoporotic Fractures in Men Study Research Group and the Study of Osteoporotic Fractures | Abstract: To investigate cross-sectional and longitudinal associations of diffuse idiopathic skeletal hyperostosis (DISH) and thoracic kyphosis in older persons.DISH and kyphosis were assessed in 1,500 men from the Osteoporotic Fractures in Men (MrOS) study and in 1,267 women from the Study of Osteoporotic Fractures (SOF). DISH was assessed using baseline lateral spine radiographs, and Cobb Angle of kyphosis was measured from baseline and followup radiographs, a mean 4.6 years later in men, and 3.7 and 15 years later in women. Linear regression was used to analyze associations of DISH with baseline Cobb Angle and with percent annualized change in Cobb Angle. We tested for heterogeneity among studies.DISH was identified in 222 participants in MrOS (15%) and in 156 participants in SOF (12%). Participants with DISH in both cohorts had higher baseline Cobb Angles (P l 0.05), after adjustment for covariates. After approximately 4 years of followup, there was no significant difference in annualized percent change in Cobb Angle in those with DISH compared to those without DISH (P g 0.05) for men or women. Women with DISH had less kyphosis progression over 15 years (0.25% less annualized change in Cobb) than those without DISH.Prevalent DISH is associated with greater kyphosis in older men and women, and is not significantly associated with a change in kyphosis over 4-5 years. However, in women followed over 15 years, DISH was associated with less progression of kyphosis. These results suggest that DISH influences kyphosis and may slow progression over the long term. Additional studies of DISH/kyphosis associations are warranted to understand the functional implications of this finding.
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diffuse idiopathic skeletal hyperostosis association with thoracic spine kyphosis a cross sectional study for the health aging and body composition study
Spine, 2014Co-Authors: Lorenzo Nardo, Nancy E Lane, Peggy M Cawthon, Neeta Parimi, Bo Fan, John A Shepherd, Jane A Cauley, Audrey Zuckerlevin, Rachel A Murphy, Wendy B KatzmanAbstract:Author(s): Nardo, Lorenzo; Lane, Nancy E; Parimi, Neeta; Cawthon, Peggy M; Fan, Bo; Shepherd, John; Cauley, Jane; Zucker-Levin, Audrey; Murphy, Rachel A; Katzman, Wendy B | Abstract: STUDY DESIGN:A descriptive study of the association between diffuse idiopathic skeletal hyperostosis (DISH) and kyphosis. OBJECTIVE:To investigate the association of DISH with Cobb Angle of kyphosis in a large cohort of older subjects from the Health Aging and Body Composition Study. SUMMARY OF BACKGROUND DATA:DISH and thoracic kyphosis are well-defined radiographical findings in spines of older individuals. Characteristics of DISH (ossifications between vertebral segments) reflect changes of spine anatomy and physiology that may be associated with Cobb Angle of kyphosis. METHODS:Using data from 1172 subjects aged 70 to 79 years, we measured DISH and Cobb Angle of kyphosis from computed tomographic lateral scout scans. Characteristics of participants with and without DISH were assessed using the χ² and t tests. Association between DISH and Cobb Angle was analyzed using linear regression. Cobb Angle and DISH relationship was assessed at different spine levels (thoracic and lumbar). RESULTS:DISH was identified on computed tomographic scout scan in 152 subjects with 101 cases in only the thoracic spine and 51 in both thoracic and lumbar spine segments. The mean Cobb Angle of kyphosis in the analytic sample was 31.3° (standard deviation = 11.2). The presence of DISH was associated with a greater Cobb Angle of 9.1° and 95% confidence interval (95% CI) (5.6-12.6) among African Americans and a Cobb Angle of 2.9° and 95% CI (0.5-5.2) among Caucasians compared with those with no DISH. DISH in the thoracic spine alone was associated with a greater Cobb Angle of 10.6° and 95% CI (6.5-14.7) in African Americans and a Cobb Angle of 3.8° and 95% CI (1.0-6.5) in Caucasians compared with those with no DISH. CONCLUSION:DISH is associated with greater Cobb Angle of kyphosis, especially when present in the thoracic spine alone. The association of DISH with Cobb Angle is stronger within the African American population.