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Title: Could clinical ultrasound improve the fitting of spinal orthosis for patients with AIS?
Authors: Li, Meng
Degree: M.Phil.
Issue Date: 2012
Abstract: Adolescent idiopathic scoliosis (AIS) is described as a structural, lateral, rotated deformity of the spine that arises in children during puberty with unknown causes. Spinal orthosis is generally applied onto the patients with AIS to mechanically support the scoliotic spine and prevent further deterioration. The outcome of orthotic intervention for AIS is considered being associated with accurate orthosis fitting and patients' treatment compliance. In current practice, pre-brace X-ray images are used as references for clinicians to design orthotic intervention, however, the optimum location of pressure pads for maximum deformity control may not be determined because the referred X-ray is not a real-time presentation of the spinal curvature (once forces are applied, the spinal deformities could change three dimensionally). The most commonly used method to assess scoliotic curvature in radiography is the Cobb's method. Besides, spinous process angle (SPA) was proposed to be an alternative method to assess spinal curvature. A correlation study was conducted using X-ray images from 43 patients with AIS, including 37 major curves at the pre-brace stage, and 21 major curves at the in-brace stage. A new method was developed to study the correlation between Cobb's angle and SPA. Intra-rater and Inter-rater reliabilities of this method were found to be high (ICCs>0.9, p<0.05). The results of this study indicated that there was a significant correlation (r=0.80 for the pre-brace stage and r=0.87 for the in-brace stage, p<0.05) between Cobb's angle and SPA for patients with AIS. The findings contribute strong evidence to support this new method for assessing scoliosis.
With the advancement of clinical ultrasound, tracing spinal processes along a scoliotic spine becomes possible, which means SPA can be obtained from ultrasound images. This study aimed to apply 3-dimensional ultrasound (3-D US) technique to monitor the fitting method of spinal orthoses for patients with AIS. By means of ultrasound assessments, SPA could be examined and used as the parameter to evaluate the optimal location for pressure pad. Angle calculation software was developed to measure SPA in this study. Ultrasound-assisted fitting method was conducted on 21 patients as a test group, while conventional fitting method was conducted on 60 patients as a control group. Within these 21 patients in test group, there were 13 patients who were required to adjust the location of pressure pad to achieve better curvature correction. The mean immediate correction (Cobb's angle measured from radiographs) of test group (mean thoracic curve correction: 11.5°, mean lumbar curve correction: 11.0°) was found significantly higher than that of control group (mean thoracic curve correction: 5.6°, mean lumbar curve correction: 6.0°) for both thoracic and lumbar curvature (p<0.005), which indicated that ultrasound-assisted fitting method of spinal orthosis was effective and helpful to 61.9% patients in this study. According to these findings, 3-D US can be further developed to assess spinal curvature especially for determining the optimal location for pressure pad. In summary, 3-D US is proposed to be a non-invasive, effective and real-time approach to assess scoliotic spine in routine clinical visit and helpful to improve the effectiveness of orthotic treatment for scoliosis.
Subjects: Spinal adjustment.
Scoliosis -- Treatment.
Ultrasonic imaging.
Hong Kong Polytechnic University -- Dissertations
Pages: xiv, 116 leaves : ill. (some col.) ; 30 cm.
Appears in Collections:Thesis

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