The impact of directed versus non-directed standing postures in clinical decision making for patients with adolescent idiopathic scoliosis

Dr Cheung, Wing Hang Prudence   (Principal Investigator (PI))

Professor Cheung Jason Pui Yin   (Co-principal investigator)

24

2023-05-01

150000

The impact of directed versus non-directed standing postures in clinical decision making for patients with adolescent idiopathic scoliosis

Postures, alignment, scoliosis, curve magnitude, decision making

Orthopaedics/TraumatologyPersonalized Medicine

2201101571

Seed Fund for Basic Research for New Staff

2022

On-going

The objectives are:i) To investigate whether the presentation of curve size (in coronal Cobb angle) has any clinically significant difference (>5⁰) between directed and non-directed positioning during whole spine radiographs in adolescent idiopathic scoliosis (AIS);ii) To define what presenting Cobb angles are most susceptible to differences resulting from postural changes;iii) To assess the changes in balance and alignment between directed and non-directed positioning; iv) To determine whether the observed discrepancy may affect clinical decision-making for bracing referral or surgery.Significance of the project            For the patients with spinal deformities, biplanar stereoradiography provides low-dose whole spine radiographs and is becoming the standard imaging with the advantages of reduced radiation exposure and three-dimension reconstruction.1-4 Proper positioning for radiographs is important for the assessment of the usual functional posture in standing, so that clinical management strategies can be tailored to the standing alignment of the patients. Better visibility for sagittal alignment can be achieved by asking the patient to stand upright with the arms slightly forward, and the elbows bent with fists on clavicles.5 Previously a guiding device was developed for conventional posteroanterior spine radiographs of healthy individuals,6 however, its use is not catered for spinal curvature and it is not designed for biplanar stereoradiography. There is the lack of a rigid jig, hence postural variability occurs despite instructions by the radiographers.  Visual cues or verbal instructions can be followed by some but not all patients, especially younger patients like children and adolescents. Concern lies in whether the natural posture of the patients affects coronal and sagittal radiological parameters, as this remains unknown. Since patients acquire their relaxed posture during daily life rather than the position directed by radiographers for spine radiographs, the differences between non-directed posture and directed positioning may lead to Cobb angle and balance variations that warrant different treatment. This project aims to develop and enrich the understanding of the impact of posture on radiographic evaluation of curve magnitude and alignment, and this can aid in clinical decision-making and treatment planning in AIS.References:1.            Deschênes S, Charron G, Beaudoin G, et al. Diagnostic imaging of spinal deformities: reducing patients radiation dose with a new slot-scanning X-ray imager. Spine (Phila Pa 1976) 2010;35:989-94.2.            Amzallag-Bellenger E, Uyttenhove F, Nectoux É, et al. Idiopathic scoliosis in children and adolescents: assessment with a biplanar X-ray device. Insights into Imaging 2014;5:571-83.3.            Al-Aubaidi Z, Lebel D, Oudjhane K, et al. Three-dimensional imaging of the spine using the EOS system: is it reliable? A comparative study using computed tomography imaging. J Pediatr Orthop B 2013;22:409-12.4.            Stokes IA. Three-dimensional terminology of spinal deformity. A report presented to the Scoliosis Research Society by the Scoliosis Research Society Working Group on 3-D terminology of spinal deformity. Spine (Phila Pa 1976) 1994;19:236-48.5.            Faro FD, Marks MC, Pawelek J, et al. Evaluation of a functional position for lateral radiograph acquisition in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2004;29:2284-9.6.            Dewi DE, Veldhuizen AG, Burgerhof JG, et al. Reproducibility of standing posture for X-ray radiography: a feasibility study of the BalancAid with healthy young subjects. Ann Biomed Eng 2010;38:3237-45.