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Article: Reducing radiation exposure in early-onset scoliosis surgery patients: novel use of ultrasonography to measure lengthening in magnetically-controlled growing rods

TitleReducing radiation exposure in early-onset scoliosis surgery patients: novel use of ultrasonography to measure lengthening in magnetically-controlled growing rods
Authors
KeywordsUltrasound
Radiation
Scoliosis
Magnetic
Growing rod
Issue Date2014
PublisherElsevier B.V. The Journal's web site is located at http://www.elsevier.com/locate/spinee
Citation
The Spine journal, 2014, v. 14 n. 10, p. 2397-2404 How to Cite?
AbstractAbstract Background context Magnetically-controlled growing rod (MCGR) technology has been reported for the treatment of early-onset scoliosis (EOS). Such technology allows for regular and frequent outpatient rod distractions without the need for additional surgery. However, pre- and postdistraction spine radiographs are required to verify the amount of lengthening. This increased exposure to ionizing radiation in developing children significantly increases their risk profile for radiation-induced cancer and noncancerous morbidity. Purpose This study addressed the first and novel application and reliability of the use of ultrasonography, that has no ionizing radiation exposure, as an alternative to plain radiographs in the visualizing and confirming of rod distractions. Study design A prospective study. Patient sample Six EOS patients who underwent surgical treatment with MCGRs were prospectively recruited. Outcome measures Imaging measurements based on ultrasound and plain radiographs. Methods All patients were imaged via ultrasound, ease of rod identification was established, and the reliability and reproducibility of optimal reference point selection assessed blindly by three individuals. The clinical algorithm, using ultrasound, was subsequently implemented. Plain radiographs served as controls. Results Assessment of the rod's neck distance on ultrasound demonstrated a high degree of interrater reliability (a=0.99; p<.001). Intrarater reliability remained high on repeat measurements at different time intervals (a=1.00; p<.001). Satisfactory interrater reliability was noted when measuring the rod's neck (a=0.73; p=.010) and high reliability was noted in assessing the housing of the rod (a=0.85; p=.01) on plain radiographs. Under blinded conditions, 2 mm rod distraction measured on radiographs corresponded to 1.7 mm distraction on the ultrasound (standard deviation: 0.24 mm; p<.001). Subsequently, the clinical algorithm using ultrasound, instead of radiographs, has been successfully implemented. Conclusions This is the first study to report the use of a novel technique using noninvasive, nonionizing ultrasound to reliably document rod distractions in EOS patients. A high level of inter- and intrarater reliabilities were noted. More importantly, the use of ultrasonography may result in fewer whole spine radiographs from being taken in patients who have had MCGRs implanted for EOS; thereby decreasing their exposure to ionizing radiation and the potential risk of future radiation-induced diseases.
Persistent Identifierhttp://hdl.handle.net/10722/191692
ISSN
2015 Impact Factor: 2.66
2015 SCImago Journal Rankings: 1.153
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorStokes, OMen_US
dc.contributor.authorO'Donovan, Een_US
dc.contributor.authorSamartzis, Den_US
dc.contributor.authorBow, HYCen_US
dc.contributor.authorLuk, KDKen_US
dc.contributor.authorCheung, KMCen_US
dc.date.accessioned2013-10-15T07:17:47Z-
dc.date.available2013-10-15T07:17:47Z-
dc.date.issued2014en_US
dc.identifier.citationThe Spine journal, 2014, v. 14 n. 10, p. 2397-2404en_US
dc.identifier.issn1529-9430-
dc.identifier.urihttp://hdl.handle.net/10722/191692-
dc.description.abstractAbstract Background context Magnetically-controlled growing rod (MCGR) technology has been reported for the treatment of early-onset scoliosis (EOS). Such technology allows for regular and frequent outpatient rod distractions without the need for additional surgery. However, pre- and postdistraction spine radiographs are required to verify the amount of lengthening. This increased exposure to ionizing radiation in developing children significantly increases their risk profile for radiation-induced cancer and noncancerous morbidity. Purpose This study addressed the first and novel application and reliability of the use of ultrasonography, that has no ionizing radiation exposure, as an alternative to plain radiographs in the visualizing and confirming of rod distractions. Study design A prospective study. Patient sample Six EOS patients who underwent surgical treatment with MCGRs were prospectively recruited. Outcome measures Imaging measurements based on ultrasound and plain radiographs. Methods All patients were imaged via ultrasound, ease of rod identification was established, and the reliability and reproducibility of optimal reference point selection assessed blindly by three individuals. The clinical algorithm, using ultrasound, was subsequently implemented. Plain radiographs served as controls. Results Assessment of the rod's neck distance on ultrasound demonstrated a high degree of interrater reliability (a=0.99; p<.001). Intrarater reliability remained high on repeat measurements at different time intervals (a=1.00; p<.001). Satisfactory interrater reliability was noted when measuring the rod's neck (a=0.73; p=.010) and high reliability was noted in assessing the housing of the rod (a=0.85; p=.01) on plain radiographs. Under blinded conditions, 2 mm rod distraction measured on radiographs corresponded to 1.7 mm distraction on the ultrasound (standard deviation: 0.24 mm; p<.001). Subsequently, the clinical algorithm using ultrasound, instead of radiographs, has been successfully implemented. Conclusions This is the first study to report the use of a novel technique using noninvasive, nonionizing ultrasound to reliably document rod distractions in EOS patients. A high level of inter- and intrarater reliabilities were noted. More importantly, the use of ultrasonography may result in fewer whole spine radiographs from being taken in patients who have had MCGRs implanted for EOS; thereby decreasing their exposure to ionizing radiation and the potential risk of future radiation-induced diseases.-
dc.languageengen_US
dc.publisherElsevier B.V. The Journal's web site is located at http://www.elsevier.com/locate/spinee-
dc.relation.ispartofThe Spine journalen_US
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subjectUltrasound-
dc.subjectRadiation-
dc.subjectScoliosis-
dc.subjectMagnetic-
dc.subjectGrowing rod-
dc.titleReducing radiation exposure in early-onset scoliosis surgery patients: novel use of ultrasonography to measure lengthening in magnetically-controlled growing rodsen_US
dc.typeArticleen_US
dc.identifier.emailStokes, OM: omstokes@hku.hken_US
dc.identifier.emailSamartzis, D: dspine@hku.hken_US
dc.identifier.emailBow, HYC: cbow@hku.hken_US
dc.identifier.emailLuk, KDK: hcm21000@hku.hken_US
dc.identifier.emailCheung, KMC: cheungmc@hku.hken_US
dc.identifier.authoritySamartzis, D=rp01430en_US
dc.identifier.authorityLuk, KDK=rp00333en_US
dc.identifier.authorityCheung, KMC=rp00387en_US
dc.description.naturepostprint-
dc.identifier.doi10.1016/j.spinee.2014.01.039-
dc.identifier.pmid24486476-
dc.identifier.scopuseid_2-s2.0-84908221307-
dc.identifier.hkuros226441en_US
dc.identifier.hkuros249928-
dc.identifier.isiWOS:000343100600015-
dc.publisher.placeUnited Statesen_US

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