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Intra-and inter-rater reliabilities and differences of kyphotic angle measurements on ultrasound images versus radiographs for children with adolescent idiopathic scoliosis: a preliminary study

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

Intra-and inter-rater reliabilities and differences of kyphotic angle measurements on ultrasound images versus radiographs for children with adolescent idiopathic scoliosis: a preliminary study

Tehzeeb Sayed, Mahdieh Khodaei, Doug Hill, Edmond Lou 

Spine Deform. 2022 Jan 29.PMID: 35091992 doi: 10.1007/s43390-021-00466-5

Abstract

Purpose: To develop a new method based on 3D ultrasound information to measure the kyphotic angle (KA) on ultrasound (US) images in adolescents with idiopathic scoliosis (AIS) and to evaluate the intra-rater and inter-rater reliabilities and accuracy of the US measurements.

Methods: Twenty subjects with AIS (17F, 3 M, aged 13.7 ± 2.2 years old) were recruited. One 20 + years experienced rater (R3) measured the KA on radiographs twice using the Cobb method. Two raters (R1, R2), both have at least 1-year experience measured US images twice using the new spinous processes method. The intraclass correlation coefficients (ICC[2,1]) of the intra-rater and inter-rater reliabilities of US KA measurements were calculated. An equation based on US KA measurements to calculate the radiographic KA was generated.

Results: The intra-rater reliability ICC[2,1] (R3) of the X-ray measurement was 0.92 and US KA measurements for R1 and R2 were 0.94 and 0.95, respectively. The inter-rater reliability ICC[2,1] for R1 versus R2 were 0.85 and 0.86, respectively. The mean absolute differences (MAD) of US versus radiography measurements were 4.2 ± 3.0° (R1 vs R3) and 5.0 ± 4.1° (R2 vs R3), respectively. The radiographic equivalent KA = 0.82 × US KA – 5.6°. When using this equation, the overall MAD between US and radiographic KA was 2.9 ± 1.6°.

Conclusions: The ultrasound spinous process method was reliable to measure the KA. Although there was a systematic bias on the US measurements, after the correction, the MAD of the US and radiographic KA was 2.9 ± 1.6°. Using US allows clinicians to monitor KA without exposing children to ionizing radiation.

Keywords: Accuracy; Adolescent idiopathic scoliosis; Kyphotic Angle; Reliability; Ultrasound.

https://pubmed.ncbi.nlm.nih.gov/35091992/

Coronal deformity angular ratio as a predictive factor for in-brace curve correction and long-term outcome of brace treatment in adolescents with idiopathic scoliosis

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

Coronal deformity angular ratio as a predictive factor for in-brace curve correction

and long-term outcome of brace treatment in adolescents with idiopathic scoliosis

Taher Babaee, Mojtaba Kamyab, Mohammad Saleh Ganjavian, Naeimeh Rouhani, Adel Khorramrouz , James G Jarvis 

Spine Deform. 2022 Jan 16. PMID: 35034344 DOI: 10.1007/s43390-021-00452-x

Abstract

Purpose: To investigate the relationship between coronal deformity angular ratio (C-DAR) and in-brace correction (IBC) and their role in predicting the long-term bracing outcome in adolescents with idiopathic scoliosis (AIS).

Methods: In this retrospective multicenter study, the patient’s sex, age, primary curve Cobb angle (at initiation of brace treatment, best in-brace, before spinal fusion, and final follow-up), curve pattern, duration of brace treatment, brace type, and C-DAR at initiation of bracing were recorded. The C-DAR values were classified as < 5, 5 ≤ to ≤ 6, and > 6. The IBC values were classified as ≥ 50%, 40% ≤ to ≤ 49%, and < 40%. We classified the patients into two groups of success and failure according to the Cobb angle at the final follow-up.

Results: A total of 164 patients (25 boys and 119 girls) were included. Bracing was successful in 60.4% of them. There was a significant association between C-DAR and bracing outcome (p < 0.0001). 63.9% of the patients with C-DAR < 5 had an IBC ≥ 50%. However, when C-DAR was 5 ≤ to ≤ 6 and > 6, 29.2% and 16.9% of the patients had an IBC of ≥ 50%, respectively. For patients with IBC ≥ 50%, the success rate of bracing was 89.2%. Results of logistic regression analysis revealed that the strongest predictor for brace treatment outcome was the C-DAR, with an odds ratio of 2.11.

Conclusion: C-DAR may be used as a predictive factor for the long-term outcome of brace treatment in AIS.

Level of evidence: IV.

Keywords: Adolescent idiopathic scoliosis; Brace; Coronal deformity angular ratio; In-brace correction; Predictive factor.

https://pubmed.ncbi.nlm.nih.gov/35034344/

Psychometric performance of proxy-reported EQ-5D youth version 5-level (EQ-5D-Y-5L) in comparison with three-level (EQ-5D-Y-3L) in children and adolescents with scoliosis

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

Psychometric performance of proxy-reported EQ-5D youth version 5-level (EQ-5D-Y-5L) in comparison

with three-level (EQ-5D-Y-3L) in children and adolescents with scoliosis

Jiaer Lin, Carlos King Ho Wong, Jason Pui Yin Cheung, Prudence Wing Hang Cheung, Nan Luo 

Eur J Health Econ. 2022 Feb 4. PMID: 35122171 DOI: 10.1007/s10198-022-01435-z

Abstract

Objectives: To assess the psychometric performance of proxy-reported EQ-5D-Y-5L (Y-5L) in comparisons with EQ-5D-Y-3L (Y-3L) administered by caregivers of patients with juvenile (JIS) or adolescent idiopathic scoliosis (AIS).

Methods: A consecutive sample of caregivers of JIS or AIS patients were recruited. Redistribution property, ceiling effects, and discriminative power were examined. Known-group validity was determined by examining their ability to detect differences across clinical known groups. Test-retest reliability was assessed using intraclass correlation coefficient (ICC) for EQ-VAS score and Gwet’s agreement coefficient (GAC) and percentage agreement (PA) for dimension responses. Furthermore, subgroups were analyzed for comparing test-retest reliability.

Results: A total of 130 caregivers were involved in the study. Consistencies between proxy-reported Y-3L and Y-5L were very high for all dimensions (93.8-99.2%). The ceiling effect in the Y-5L was slightly reduced in four dimensions (AR: 0.8-2.3%) whereas increased in “Having pain/discomfort”. Greater informativity was found in the Y-5L than the Y-3L. In known-group comparisons of curvature magnitude, curvature type, and treatment modality, Y-5L and Y-3L dimension scales showed hypothesized results. For example, more full-health responses were found in the mild Cobb angle group (Y-5L: 63.1%; Y-3L: 62.2%) than the severe Cobb angle group (Y-5L: 55.6%, Y-3L: 55.6%). EQ-VAS score exhibited low test-retest reliability (ICC: 0.41), whereas dimension scales of both instruments showed satisfactory test-retest reliability (GAC ≥ 0.7 and PA ≥ 70% for all). In most known groups, hard-to-observe dimensions were more reliable for proxy-reported Y-5L than Y-3L.

Conclusion: Both the proxy-reported Y-5L and Y-3L are valid and reliable instruments for assessing the HRQoL of JIS or AIS patients.

Keywords: Adolescent idiopathic scoliosis; EQ-5D-Y-3L; EQ-5D-Y-5L; Proxy; Psychometric performance.

https://pubmed.ncbi.nlm.nih.gov/35122171/

Kinesiophobia and its association with treatment choice in individuals with idiopathic scoliosis

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

Kinesiophobia and its association with treatment choice in individuals with idiopathic scoliosis 

Gozde Yagci, Damlagul Aydin Ozcan, Cigdem Ayhan Kuru, Yavuz Yakut  

Back Musculoskelet Rehabil. 2021 Oct 29PMID: 34744071 DOI:10.3233/BMR-210111

Abstract

Background: Previous studies have reported increased kinesiophobia in adults with degenerative scoliosis or adolescents who have undergone spinal surgery. However, little is known about the phenomenon of kinesiophobia among adolescents with idiopathic scoliosis (IS).

Objectives: The aim of this study was to investigate levels of kinesiophobia and its association with treatment choice in IS.

Methods: The study included 98 IS patients with a mean age of 14 years and 20 healthy controls. Participants with IS were divided into groups based on treatment conditions, as follows: (1) untreated (n= 33); (2) treated with exercise (n= 32); and (3) treated with a brace (n= 33). Kinesiophobia was measured using the Tampa Scale for Kinesiophobia (TSK). Comparisons were made between four groups.

Results: Untreated participants with IS were found to have greater kinesiophobia than healthy controls (p< 0.001). Participants treated with a brace (p= 0.046) and exercise (p= 0.064) had similar kinesiophobia levels as the healthy control group.

Conclusions: Kinesiophobia was found to be higher in adolescents with IS compared to healthy peers. Brace or exercise treatment both had a positive impact on kinesiophobia. These findings should be considered when organizing rehabilitation programs to achieve the best results for adolescents with IS.

Keywords: Scoliosis; brace; exercise therapy; fear; movement.

https://pubmed.ncbi.nlm.nih.gov/34744071/

Long-term follow-up of untreated Scheuermann’s kyphosis

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

Long-term follow-up of untreated Scheuermann’s kyphosis

Enrique Garrido, Simon B Roberts, Andrew Duckworth, Joseph Fournier

Spine Deform. 2021 Nov;9(6):1633-1639. doi: 10.1007/s43390-021-00354-y

Abstract

Study design: Long-term cross-sectional study.

Objectives: To investigate the long-term effects of untreated Scheuermann’s kyphosis on quality of life, and its relationship to radiographic parameters of spinal deformity. Previous studies reported reduced self-image, increased pain and impaired physical status. Little is known of the long-term impact of sagittal plane deformity in untreated SK.

Methods: One hundred and thirteen consecutive untreated patients with SK were identified from a national service database prior to 2000, when surgery was not offered at this unit. 81 of these patients were available for evaluation; 66 (81%) consented to questionnaire and clinical evaluation, and 47 (58%) consented to additional radiological evaluation. Health-related quality of life (HRQoL) was compared to normative population values. Mean age was 45.1 years (31-65), and mean follow-up was 27 years (16-36). 57 patients had thoracic kyphosis and 9 had thoracolumbar deformity.

Results: SRS-22 and SF-36 scores were lower, and ODI was greater in patients with untreated SK compared to normative population values. Kyphosis progressed from mean 66° at skeletal maturity to 78° (p < 0.001) after mean follow-up of 27 years. Long-term progression of untreated SK was 0.45°/year (n = 47). Multilinear regression showed good correlation between increasing SVA and worse ODI scores (r = 0.59; p = 0.001). Increasing SVA also correlated with worse function, pain and mental health scores reported by SRS-22, and with worse physical function and bodily pain scores reported by SF-36. Increasing CL correlated with worse SF-36 physical function scores. Increasing cSVA and increasing TK correlated with worse SRS-22 self-image scores.

Conclusion: SRS-22 and SF-36 scores were lower, and ODI was greater in patients with untreated SK compared to normative data. Long-term progression of untreated SK was 0.45°/year (n = 47). Increasing SVA correlated with worse SF-36 physical function, SRS-22 function, SRS-22 pain and higher ODI scores. Total kyphosis (TK) and cSVA were independent predictors of low SRS self-image.

Level of evidence: III.

Keywords: Disease; Kyphosis; Natural history; Outcome; Scheuermann’s.

https://pubmed.ncbi.nlm.nih.gov/34212306/

Correlation of Paraspinal Muscle Mass With Decompensation of Sagittal Adult Spinal Deformity After Setting of Fatigue Post 10-Minute Walk

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

Correlation of Paraspinal Muscle Mass With Decompensation of Sagittal Adult Spinal Deformity After Setting of Fatigue Post 10-Minute Walk

Junseok Bae, Ashwin Sathe, Shih-Min Lee, Alexander A Theologis, Vedat Deviren, Sang-Ho Lee
Neurospine, PMID: 3461068 PMCID: PMC8497245, DOI: 10.14245/ns.2142510.255

Abstract

Objective: The purpose of this study was to investigate the changes in spinopelvic parameters before and after the setting of muscle fatigue along with its correlation with pre-existing paraspinal and psoas muscle mass.

Methods: Single-center retrospective review of prospectively collected data was conducted on 145-adults with symptomatic loss of lumbar lordosis (LL). Radiographs were taken before and after walking for 10 minutes. Magnetic resonance imaging was used to calculate paraspinal muscle (PSM) cross-sectional area (CSA), mean signal intensity, fatty infiltration (FI), and lean muscle mass at thoracolumbar junction (T12) and lower lumbar level (L4). Psoas CSA was calculated at L3. Patients were divided into 2 groups namely compensated sagittal deformity (CSD) (SVA ≤ 4 cm, PT > 20°) and decompensated sagittal deformity (DSD) (SVA > 4 cm, PT > 20°) based on prewalk measurements.

Results: Initial mean SVA was 1.8 cm and 11 cm for CSD and DSD respectively (p < 0.01). After walking, significant deteriorations in SVA, PT-LL (p < 0.01) were observed in CSD without significant change in thoracic kyphosis (TK). All sagittal parameters in DSD deteriorated significantly. DSD group had significantly poorer PSM quality at T12 and L4 compared to CSD group. In CSD group, sagittal decompensation correlated with muscle quality, i.e. , decreases in LL (ΔLL) correlated with CSA of PSM/vertebral body (VB) at L4 (r = -0.412, p = 0.046) while increases in TK (ΔTK) correlated with CSA of PSM/VB at T12 (r = 0.477, p = 0.018). ΔSVA and ΔPT correlated with FI at L4 (r = 0.577, p = 0.003 and r = -0.407, p = 0.048, respectively). DSD group, had weak correlations (-0.3 < r < -0.1) between changes in sagittal and PSM parameters.

Conclusion: PSM quality in adults with spinal deformity correlates with patients’ ability to maintain an upright posture and sagittal decompensation after walking for 10 minutes.

Keywords: Deformity; Fatigue; Kyphosis; Paraspinal muscles.

https://pubmed.ncbi.nlm.nih.gov/34610681/

Physical Functioning in Adolescents with Idiopathic Scoliosis: A Systematic Review of Outcome Measures and Their Measurement Properties

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

Physical Functioning in Adolescents with Idiopathic Scoliosis: A Systematic Review of Outcome Measures and Their Measurement Properties

Samia Alamrani, Alison B Rushton, Adrian Gardner, Elena Bini, Deborah Falla, Nicola R Heneghan
PMID: 34033069 DOI: 10.1007/s43390-021-00365-9

Abstract

Study design: A systematic review.

Objective: To summarize evidence on measurement properties of Outcome Measures (OM) used to assess physical functioning in adolescents with idiopathic scoliosis (AIS).

Summary of background data: The AIS is a common spine deformity in those aged 10 to 18 years old. Associated health problems (e.g., back pain) significantly impact the quality of life (QoL). One important domain in QoL is physical functioning, which can be measured with patient-reported outcome measures (PROM), performance-based outcome measures (PBOM), and body structure and function OM. Adequate measurement properties of OM are important for precision in research and practice.

Methods: A two-staged search strategy was performed on electronic databases up to December 2019. Search one revealed a list of OM was used for physical functioning assessment in AIS. Search two identified studies that evaluated the measurement properties of OM in AIS; using the list identified in search one. Two independent reviewers determined study eligibility, risk of bias assessment (COnsensus-based Standards for the selection of health Measurement INstruments [COSMIN] checklist), and performed data extraction. The level of evidence was established using a modified GRADE approach.

Results: Search one yielded: 28 PROM, 20 PBOM, and 10 body structure and function OM. Search two revealed: 16 measurement properties studies for PROM, one for PBOM, and three for body structure and function measures. Construct validity, reliability, and responsiveness of most PROM has been established in AIS, but not content validity or internal consistency (moderate evidence). Construct validity was sufficient for the Timed Up and Go test and body structure and function measures (very low to low evidence).

Conclusion: Currently, physical functioning is evaluated with a variety of measures in AIS. The majority of measurement properties studies evaluated PROM with a paucity of information on measurement properties of PBOM and body structure and function OM. Based on COSMIN methodology, none of the OM identified in this review can be recommended with confidence in individuals with AIS.Level of Evidence: 2.

https://pubmed.ncbi.nlm.nih.gov/33496543/

Low back pain

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

Long-term follow-up of untreated Scheuermann’s kyphosis
  Enrique Garrido, Simon B Roberts, Andrew Duckworth, Joseph Fournier 
PMID: 34212306 DOI: 10.1007/s43390-021-00354-y

Abstract

Study design: Long-term cross-sectional study.

Objectives: To investigate the long-term effects of untreated Scheuermann’s kyphosis on quality of life, and its relationship to radiographic parameters of spinal deformity. Previous studies reported reduced self-image, increased pain and impaired physical status. Little is known of the long-term impact of sagittal plane deformity in untreated SK.

Methods: One hundred and thirteen consecutive untreated patients with SK were identified from a national service database prior to 2000, when surgery was not offered at this unit. 81 of these patients were available for evaluation; 66 (81%) consented to questionnaire and clinical evaluation, and 47 (58%) consented to additional radiological evaluation. Health-related quality of life (HRQoL) was compared to normative population values. Mean age was 45.1 years (31-65), and mean follow-up was 27 years (16-36). 57 patients had thoracic kyphosis and 9 had thoracolumbar deformity.

Results: SRS-22 and SF-36 scores were lower, and ODI was greater in patients with untreated SK compared to normative population values. Kyphosis progressed from mean 66° at skeletal maturity to 78° (p < 0.001) after mean follow-up of 27 years. Long-term progression of untreated SK was 0.45°/year (n = 47). Multilinear regression showed good correlation between increasing SVA and worse ODI scores (r = 0.59; p = 0.001). Increasing SVA also correlated with worse function, pain and mental health scores reported by SRS-22, and with worse physical function and bodily pain scores reported by SF-36. Increasing CL correlated with worse SF-36 physical function scores. Increasing cSVA and increasing TK correlated with worse SRS-22 self-image scores.

Conclusion: SRS-22 and SF-36 scores were lower, and ODI was greater in patients with untreated SK compared to normative data. Long-term progression of untreated SK was 0.45°/year (n = 47). Increasing SVA correlated with worse SF-36 physical function, SRS-22 function, SRS-22 pain and higher ODI scores. Total kyphosis (TK) and cSVA were independent predictors of low SRS self-image.

Level of evidence: III.

Keywords: Disease; Kyphosis; Natural history; Outcome; Scheuermann’s.

https://pubmed.ncbi.nlm.nih.gov/34212306/

Low back pain

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Every year, the Italian Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers. 

Low back pain
 Nebojsa Nick Knezevic, Kenneth D Candido, Johan W S Vlaeyen, Jan Van Zundert, Steven P Cohen
PMID: 34115979 DOI: 10.1016/S0140-6736(21)00733-9

Abstract

Low back pain covers a spectrum of different types of pain (eg, nociceptive, neuropathic and nociplastic, or non-specific) that frequently overlap. The elements comprising the lumbar spine (eg, soft tissue, vertebrae, zygapophyseal and sacroiliac joints, intervertebral discs, and neurovascular structures) are prone to different stressors, and each of these, alone or in combination, can contribute to low back pain. Due to numerous factors related to low back pain, and the low specificity of imaging and diagnostic injections, diagnostic methods for this condition continue to be a subject of controversy.
The biopsychosocial model posits low back pain to be a dynamic interaction between social, psychological, and biological factors that can both predispose to and result from injury, and should be considered when devising interdisciplinary treatment plans.
Prevention of low back pain is recognised as a pivotal challenge in high-risk populations to help tackle high health-care costs related to therapy and rehabilitation. To a large extent, therapy depends on pain classification, and usually starts with self-care and pharmacotherapy in combination with non-pharmacological methods, such as physical therapies and psychological treatments in appropriate patients.
For refractory low back pain, a wide range of non-surgical (eg, epidural steroid injections and spinal cord stimulation for neuropathic pain, and radiofrequency ablation and intra-articular steroid injections for mechanical pain) and surgical (eg, decompression for neuropathic pain, disc replacement, and fusion for mechanical causes) treatment options are available in carefully selected patients.
Most treatment options address only single, solitary causes and given the complex nature of low back pain, a multimodal interdisciplinary approach is necessary. Although globally recognised as an important health and socioeconomic challenge with an expected increase in prevalence, low back pain continues to have tremendous potential for improvement in both diagnostic and therapeutic aspects.
Future research on low back pain should focus on improving the accuracy and objectivity of diagnostic assessments, and devising treatment algorithms that consider unique biological, psychological, and social factors.
High-quality comparative-effectiveness and randomised controlled trials with longer follow-up periods that aim to establish the efficacy and cost-effectiveness of low back pain management are warranted.

https://pubmed.ncbi.nlm.nih.gov/34115979/