Ultrasound-assisted brace casting for adolescent idiopathic scoliosis, IRSSD Best research paper 2014

Scoliosis

Doug L Hill¹  Melissa Tilburn³  Andreas Donauer³  Amanda CY Chan²  Edmond H Lou¹ 

[1] Department of Research and Technology Development, Glenrose Rehabilitation Hospital, Edmonton T5G 0B7, AB, Canada;Department of Surgery, University of Alberta, Edmonton T6G 2B7, AB, Canada;Department of Prosthetics and Orthotics, Glenrose Rehabilitation Hospital, Edmonton T5G 0B7, AB, Canada

关键词: Optimum brace pressure;    Brace design;    Brace treatment;    3D ultrasound imaging;    Adolescent idiopathic scoliosis;   

Others  :  1174915
DOI  :  10.1186/s13013-015-0037-8

 received in 2015-01-06, accepted in 2015-03-19,  发布年份 2015

【 摘 要 】

Background

Brace treatment is the most effective non-surgical treatment for AIS. High initial in-brace correction increases successful brace treatment outcomes. The objective of this study was to investigate if real-time ultrasound (US) can aid orthotists in selecting the pad pressure level and location resulting in optimal in-brace correction of the spine.

Methods

Twenty six AIS subjects participated in this pilot study with 17 (2 M, 15 F) in the control group and 9 (2 M, 7 F) in the intervention group. For the control group, the standard method was used to design their braces. In addition to the standard of care, a medical 3D ultrasound (US) system, a custom pressure measurement system and in-house software were used to select pad placement and pressure levels for the intervention group. The orthotist used a custom standing Providence brace design system to apply pressures against the patient’s torso. The applied pad pressures were recorded. A real-time US spinal image was displayed. Cobb angle measurements from the baseline and the assessment scan were performed. The orthotist then decided if an adjustment was needed in terms of altering the pad locations and pressure levels. The procedures may be repeated until the orthotist attained the best simulated in-brace correction configuration to cast the brace.

Results

In the control group, 8 of 17 (47%) subjects needed a total of 16 brace adjustments after initial fabrication requiring a total of 33 in-brace radiographs. For the intervention group, the orthotist tried additional configurations in 7 out of 9 cases (78%). Among these 7 revised cases, 5 showed better stimulated in-brace corrections and were subsequently used to cast the brace. As a result, only 1 subject required a minor adjustment after initial fabrication. The total number of in-brace radiographs in the intervention group was 10.

Conclusions

The use of the 3D ultrasound system provided a radiation-free method to determine the optimum pressure level and location to obtain the best stimulated in-brace correction during brace casting. The average number of radiographs per subject taken prior to final brace implementation with the interventional group was significantly lower than the control group.

【 授权许可】

   
2015 Lou et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Danielsson AJ, Nachemson AL: Back pain and function 22 years after brace treatment for adolescent idiopathic scoliosis: a case–control study-part I. Spine 2003, 28(18):2078-85.
• [2]Weinstein SL, Dolan LA, Spratt KF, et al.: Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA 2003, 289(5):559-67.
• [3]Weinstein SL, Zavala DC, Ponseti IV: Idiopathic scoliosis: long-term follow-up and prognosis in untreated patients. J Bone Joint Surg 1981, 63(5):702-12.
• [4]Fowles JV, Drummond DS, L’Ecuyer S, Roy L, Kassab MT: Untreated scoliosis in the adult. Clin Orthop Relat Res 1978, 134:212-7.
• [5]Rowe D: The scoliosis research SCoiety brace manual. 2003.
• [6]Negrini S, Aulisa AG, Aulisa L, Circo AB, de Mauroy JC, Durmala J, et al.: 2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis 2012, 7:3. BioMed Central Full Text
• [7]Dolan LA, Wright JG, Weinstein SL: Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 2014, 370(7):681.
• [8]Aulisa AG, Guzzanti V, Galli M, et al.: Treatment of thoraco-lumbar curves in adolescent females affected by idiopathic scoliosis with a progressive action short brace (PASB): assessment of results according to the SRS committee on bracing and nonoperative management standardization criteria. Scoliosis 2009, 4:21. BioMed Central Full Text
• [9]Negrini S, Minozzi S, Bettany-Saltikov J, et al.: Braces for idiopathic scoliosis in adolescents. Spine (Phila Pa 1976) 2010, 35:1285-93.
• [10]Aulisa AG, Guzzanti V, Perisano C, et al.: Treatment of lumbar curves in scoliotic adolescent females with progressive action short brace: a case series based on the Scoliosis Research Society Committee Criteria. Spine (Phila Pa 1976) 2012, 37(13):E786-91.
• [11]Lou E, Hill DL, Raso VJ, Moreau MJ, Mahood JK, Hedden D: Preliminary results of prediction of brace treatment outcomes by monitoring brace usage, Scoliosis 2009, 4(Suppl 1):O39. doi: 10.1186/1748-7161-4-S1-o39.
• [12]Lou E, Moreau M, Mahood JK, et al.: How quantity and quality of brace wear affect the brace treatment outcomes for AIS patients. The 49th Annual Meeting & Course, Scoliosis Research Society, Anchorage, Alaska US; 2014.
• [13]Cheng FH, Shih SL, Chou WK, Liu CL, Sung WH, Chen CS: Finite element analysis of the scoliotic spine under different loading conditions. Biomed Mater Eng 2010, 20:251-9.
• [14]Clin J, Aubin CE, Parent S, Labelle H: Correlation between immediate in-brace correction and biomechanical effectiveness of brace treatment in adolescent idiopathic scoliosis. Spine 2010, 35(18):1706-13.
• [15]Clin J, Aubin CE, Parent S, Sangole A, Labelle H: Comparison of the biomechanical 3D efficiency of different brace designs for the treatment of scoliosis using a finite element model. Eur Spine J 2010, 19:1169-78.
• [16]Li M, Cheng J, Ying M, Zheng YP, Lam TP, et al.: Application of 3-D ultrasound in assisting the fitting procedure of spinal orthosis to patients with adolescent idiopathic scoliosis. Stud Health Technol Inform 2010, 158:34-7.
• [17]Li M, Cheng J, Ng KW, et al.: Could clinical ultrasound improve the fitting of spinal orthosis for the patients with AIS? Eur Spine J 2012, 21:1926-35.
• [18]Zheng R, Chan A, Chen W, Hill L, Le L, Moreau M, et al.: Reliability study of coronal curvature measurement on AIS using ultrasonic imaging method. J Spine Deformity 2015, 3(2):151-158.
• [19]Chen W, Le L, Lou E: Ultrasound imaging of spinal vertebrae to study scoliosis. Open J Acoust 2012, 2(3):95-103.
• [20]Chen W, Lou EH, Zhang Q, Le LH, Hill D: Reliability of assessing the coronal curvature of children with scoliosis by using ultrasound images. J Child Orthop 2013, 7(6):521-9.
• [21]Chalmers E, Lou E, Hill D, Zhao V, Wong MS: Development of a pressure control system for brace treatment for scoliosis. IEEE Trans Neural Syst Rehabil Eng 2012, 20(4):557-63.