Author: He, Chen
Title: Using spinal flexibility to predict the initial in-orthosis correction on the patients with adolescent idiopathic scoliosis
Degree: Ph.D.
Year: 2018
Subject: Hong Kong Polytechnic University -- Dissertations
Scoliosis -- Rehabilitation
Scoliosis -- Treatment
Adolescence
Pages: xv, 144 pages : color illustrations
Language: English
Abstract: Adolescent idiopathic scoliosis (AIS) is characterized as a three-dimensional spinal deformity with lateral curvature over 10° in adolescence without known causes. The incidence of AIS was reported as 1 - 3%. Orthotic treatment is generally prescribed for the patients with moderate AIS and surgical treatment will be considered if the deformity becomes severe. The response of the scoliotic spine to the initial orthosis application (initial in-orthosis correction) is essential for clinical decision because it determines the long-term treatment effectiveness. Spinal flexibility has been used to predict the initial in-orthosis correction on the patients with AIS, as more flexible spines are estimated to experience better correction by spinal orthosis. However, various methods are proposed to assess the spinal flexibility and which method is more effective for this prediction is unknown. A comparison among different spinal flexibilities is needed, but the high ironizing radiation of radiographic imaging technique increases the risk of breast cancer on adolescent thus making this comparison less feasible. Ultrasound imaging technique can be an alternative option since it is radiation-free and reliable for scoliosis assessment. Therefore, this study aimed to investigate an effective assessment method of spinal flexibility to predict the initial in-orthosis correction using ultrasound imaging technique. Before orthosis fitting, the spinal flexibility was assessed by an ultrasound system in standing and other four positions (supine, prone, sitting with lateral bending and prone with lateral bending) on the patients with moderate scoliosis (n=35). The pre-orthosis spinal curvature was also routinely assessed by a radiographic system in standing and supine position. After orthosis fitting, the initial in-orthosis correction was assessed by both ultrasound and radiographic system in standing position. Comparison and correlation analyses were performed between the ultrasound and radiographic measurements. Comparison and correlation analyses were also performed between the four spinal flexibilities and the initial in-orthosis correction. The results showed that the ultrasound measurements were highly correlated with the X-ray measurements in standing, supine and in-orthosis position (R = 0.77, 0.82 and 0.84 respectively), which indicated that ultrasound imaging technique could be regarded as a valid technique for the assessment of spinal flexibility. This novel clinical application of ultrasound imaging technique quantifies essential parameters to assist orthosis design, modification and evaluation from the fitting process to the end of orthotic treatment. Besides, spinal flexibility in the prone position was found not significantly different from (P > 0.05) and showed the highest correlation to the initial in-orthosis correction (R = 0.87) among the four studied positions. Therefore, the prone position test could be an effective method to predict the initial effect of orthotic treatment for the patients with AIS. This finding provides useful data basis to formulate an individualized guideline in orthosis design and contribute to an evidence-based treatment planning, thus potentially improving the effectiveness of conservative treatment and reducing the chances of surgery intervention.
Access: open access

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