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La escoliosis idiopática del Adolescente (EIA) es una deformidad tridimensional de la columna vertebral que aqueja de diversas formas la condición de vida de quien la padece, afectando el desarrollo físico y psicológico del paciente. Proponemos evaluar el resultado clínico, radiológico y el componente de calidad de vida de pacientes tratados quirúrgicamente con EIA, en el servicio de Neurocirugía, Hospital Jesús Yerena del Lídice. Se evaluó patrón de la curva, clasificación según Lenke, ángulo de Cobb pre y postquirúrgico, edad de tratamiento quirúrgico, gradode corrección, calidad de vida según cuestionario SRS-22 pre y postquirúrgica, valoración funcional mediante la escala de discapacidad de Oswestry (ODI) y complicaciones postoperatorias. Se estudiaron 22 casos (95 % femenino), el principal grupo etario fue de 11-14 años (55 %), la escoliosis tipo 1 fue la predominante (60 %), el ángulo de Cobb inicial fue mayor a 50° (50 %) y la madurez esquelética principal fue Risser 3 (55 %). La edad de resolución quirúrgica predominante fue entre 15-18 años (60 %), el grado de corrección postoperatorio fue de 75-100 % (73 %) y la densidad de los tornillos pediculares fue de 1.4-1.7 (64 %). En el cuestionario SRS-22, hubo mayor afectación en las dimensiones de autoimagen con una media de 1.8 y la valoración por ODI mostró un índice de incapacidad mínima, que fue mejorando en los controles sucesivos. Nuestra principal complicación fueron las infecciones (36 %). Concluimos que la cirugía correctiva temprana en la EIA ofrece a una mejoría clínica, radiológica y de la calidadde vida de estos paciente(AU)

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine that affects the living condition of those who suffer from it in various ways, affecting the physical and psychological development of the patient. We propose to evaluate the clinical and radiological outcome and the quality-of-life component of patients treated surgically with EIA, in the Neurosurgery Service, Hospital Jesús Yerena del Lídice. Curve pattern, Lenke classification, pre-and post-surgical Cobb angle, age at surgical treatment, degree of correction, quality of life according to pre-and post-surgical SRS-22 questionnaire, functional assessment using the Oswestry Disability Scale (ODI) and postoperative complications were evaluated. 22 cases were studied (95% female), the main age group was 11-14 years (55%), type 1 scoliosis was predominant (60%), the initial Cobb angle was greater than 50° (50%) and the main skeletal maturity was Risser 3 (55%). The predominant age of surgical resolution was between 15-18 years (60%), the degree of postoperative correction was 75-100% (73%) and the density of pedicle screws was 1.4-1.7 (64%). In the SRS-22 questionnaire, there was greater impairment in the self-image dimensions with a mean of 1.8 and the ODI assessment showed aminimal disability index, which improved in successive controls. Our main complication was infections (36%). We conclude that early corrective surgery in AIS offers clinical, radiological and quality of life improvement for these patient(AU)

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Scoliosis is a disease estimated to affect more than 8% of adults in the United States. It is diagnosed with use of radiography by means of manual measurement of the angle between maximally tilted vertebrae on a radiograph (ie, the Cobb angle). However, these measurements are time-consuming, limiting their use in scoliosis surgical planning and postoperative monitoring. In this retrospective study, a pipeline (using the SpineTK architecture) was developed that was trained, validated, and tested on 1310 anterior-posterior images obtained with a low-dose stereoradiographic scanning system and radiographs obtained in patients with suspected scoliosis to automatically measure Cobb angles. The images were obtained at six centers (2005-2020). The algorithm measured Cobb angles on hold-out internal (n = 460) and external (n = 161) test sets with less than 2° error (intraclass correlation coefficient, 0.96) compared with ground truth measurements by two experienced radiologists. Measurements, produced in less than 0.5 second, did not differ significantly (P = .05 cutoff) from ground truth measurements, regardless of the presence or absence of surgical hardware (P = .80), age (P = .58), sex (P = .83), body mass index (P = .63), scoliosis severity (P = .44), or image type (low-dose stereoradiographic image vs radiograph; P = .51) in the patient. These findings suggest that the algorithm is highly robust across different clinical characteristics. Given its automated, rapid, and accurate measurements, this network may be used for monitoring scoliosis progression in patients. Keywords: Cobb Angle, Convolutional Neural Network, Deep Learning Algorithms, Pediatrics, Machine Learning Algorithms, Scoliosis, Spine Supplemental material is available for this article. © RSNA, 2023.

RESUMO

BACKGROUND: Scoliosis is a health problem that causes a side-to-side curvature in the spine. The curvature may have an "S" or "C" shape. To evaluate scoliosis, the Cobb angle has been commonly used. However, digital image processing allows the Cobb angle to be obtained easily and quickly, several researchers have determined that Cobb angle contains high variations (errors) in the measurements. Therefore, a more reproducible computer aided-method to evaluate scoliosis is presented. MATERIAL AND METHODS: In this analytical study, several polynomial curves were fitted to the spine curvature (4th to 8th order) of thirty plain films of scoliosis patients to obtain the Curvature-Length of the spine. Each plain film was evaluated by 3 physician observers. Curvature was measured twice using the Cobb method and the proposed Curvature-Length Technique (CLT). Data were analyzed by a paired-sample Student t-test and Pearson correlation method using SPSS Statistics 25. RESULTS: The curve of 7th order polynomial had the best fit on the spine curvature and was also used for our proposed method (CLT) obtaining a significant positive correlation when compared to Cobb measurements (r=0.863, P<0.001). The Intraclass Correlation (ICC) was between 0.863 and 0.948 for Cobb method and0.974 to 0.984 for CLT method. In addition, mean measurement of the inter-observer COV (Coefficient of Variation) for Cobb method was of 0.185, that was significantly greater than the obtained with CLT method of 0.155, this means that CLT method is 16.2% more repeatable than Cobb Method. CONCLUSION: Based on results, it was concluded that CLT method is more reproducible than the Cobb method for measuring spinal curvature.

RESUMO

Adolescent idiopathic scoliosis is a 3D spinal deformity in frontal, sagittal and axial planes, with high relevance in the pediatric population especially in adolescents and females between 10 years of age and the end of growth spurt and skeletal maturity. The radiographic manifestation is a curve greater than 10° measured by Cobb method associated with vertebral rotation. "Idiopathic" diagnosis has to be done after neuroanatomical anomalies of the posterior cerebral fosa and spinal canal have been ruled out. The physical finding of a thoracic or lumbar hump is the clinical manifestation of vertebral rotation seen in a forward bending test (Adam's Test). It is recommended that all curves with a magnitude greater than 20° have to be controlled and treated by a spinal surgeon being observation, bracing and surgery the different treatment options based on the extent, progression of deformity and basically the clinical condition of the patient.

La escoliosis es una condición patológica de la columna vertebral caracterizada por una deformidad espinal en las tres dimensiones del raquis (planos coronal, sagital y axial). Constituye una entidad de alta incidencia en la población pediátrica, especialmente en los adolescentes y en el sexo femenino. Se caracteriza por la presencia radiográfica de una curva en el plano frontal, cuya magnitud es mayor de 10° (técnica de Cobb). Puede ser idiopática o estar asociada a otras patologías. La escoliosis idiopática del adolescente (EIA) es aquella que se manifiesta entre los 10 años de edad y la madurez esquelética. Es más frecuente en mujeres (70%). Su diagnóstico de "idiopática" es de exclusión, ya que su presencia también puede ser originada por anomalías neuroanatómicas de la fosa cerebral posterior o del conducto raquídeo. En el examen físico, la presencia de giba/s visible/s con la maniobra de Adams (inclinación del tronco hacia adelante) expresa clínicamente la rotación vertebral. Toda curva mayor de 20° debe ser evaluada por el especialista. Las opciones de seguimiento y tratamiento son la observación, el tratamiento ortésico y la cirugía, dependiendo de la magnitud, de la progresión de la deformidad y, fundamentalmente, de la clínica del paciente.

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O objetivo deste estudo é analisar a variabilidade intra e interobservador do método de Cobb em indivíduos escolióticos. Foram avaliadas trinta e quatro radiografias de sujeitos com escoliose para mensuração do ângulo de Cobb. A avaliação intraobservador foi realizada por um avaliador, enquanto a avaliação interobservador foi realizada por três avaliadores. Foram controlados possíveis erros intrínsecos e extrínsecos de mensuração, mas não houve a pré-seleção das vértebras que caracterizam a escoliose. A concordância intra e interobservador foi avaliada pelo coeficiente de correlação de Pearson (p < 0,05). Não houve diferenças significativas de julgamento na condição intra e interobservadores. A magnitude dos coeficientes de correlação oscilou de bom até excelente nos níveis torácico e tóraco-lombar. Na coluna lombar não houve correlação em ambas as condições

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o objetivo deste estudo é analisar a variabilidade intra e interobservador do método de Cobb em indivíduos escolióticos. Foram avaliadas trinta e quatro radiografias de sujeitos com escoliose para mensuração do ângulo de Cobb. A avaliação intraobservador foi realizada por um avaliador, enquanto a avaliação interobservador foi realizada por três avaliadores. Foram controlados possíveis erros intrínsecos e extrínsecos de mensuração, mas não houve a pré-seleção das vértebras que caracterizam a escoliose. A concordância intra e interobservador foi avaliada pelo coeficiente de correlação de Pearson (p < 0,05). Não houve diferenças significativas de julgamento na condição intra e interobservadores. A magnitude dos coeficientes de correlação oscilou de bom até excelente nos níveis torácico e tóraco-lombar. Na coluna lombar não houve correlação em ambas as condições.(AU)

the aim of this study is to assess intra and interobserver variability of the Cobb method in subjects who have scoliosis. Thirty four scoliosis radiographs were evaluated for measure of the angle of Cobb. The intra-observer assessment was carried out by an observer, while the inter-observer evaluation was carried out by three observers. It was controlled intrinsic and extrinsic errors of measurement, but there was no pre-selection of the vertebrae that characterized the scoliosis. Both intraobserver and interobserver reliabilities were assessed by calculating the Pearson correlation coefficient (p d"0.05). No significant differences were observed between intra-and interobservers. The magnitude of correlation coefficients ranged from very high to unreasonable in chest and thoracolumbar level. Lumbar spine did not correlate in both conditions.(AU)

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INTRODUÇÃO: A dor lombar vem sendo um achado comum em atletas e indivíduos adultos jovens. Das diversas causas deste sintoma, as alterações mecânico-posturais estão entre as mais comuns na população. OBJETIVO: Este estudo foi realizado com o intuito de correlacionar a intensidade e os aspectos da lombalgia com as medidas angulares da curvatura lombar em praticantes de voleibol. MÉTODOS: Participaram desta pesquisa 42 jovens atletas, de ambos os sexos, com idade entre 14 e 18 anos, divididos em dois grupos, o grupo sem dor e o grupo com dor lombar. Ambos responderam a uma ficha de avaliação inicial, porém a escala analógica visual de dor foi aplicada apenas nos indivíduos do grupo com dor. A seguir, todos os participantes foram submetidos ao exame radiológico da coluna lombar e o ângulo de Cobb foi obtido sobre as radiografias no plano sagital. RESULTADOS: Os resultados foram analisados através da estatística descritiva e inferencial, demonstrando que, para p < 0,05, os valores médios dos ãngulos entre os dois grupos analisados não diferem significativamente. CONCLUSÃO: Conclui-se que não houve correlação entre a curvatura da coluna lombar e a lombalgia em jovens praticantes de voleibol.

INTRODUCTION: Although not frequent, lately there have been cases of young adults and athletes complaining of lumbar pain, this being one of the most common causes of mechanical postural alterations. OBJECTIVE: In view of this, it was decided to carry out this study correlating the intensity of lumbar pain with its anatomical/physiological characteristics, using the measurements of the angles of lumbar curvature in volleyball players. METHODS: 42 athletes including males and females from 14 to 18 years of age took part. These volunteers were divided into two groups according to the symptoms of their lumbar pain: one group with lumbar pain and the other with no lumbar pain. The initial procedure for both groups was to complete a structured functional assessment form. Only the group with lumbar pain then had the visual analogical scale of pain applied. After this stage, both groups were submitted to a radiological examination of the lumbar region of the spine, which was used to calculate the Cobb angle examining the x-rays on the sagital plane. RESULTS: The results were analysed using descriptive and inferential statistics, regarding as statistically significant p<0.05 the difference of the mean values of the angles found in the measurements taken in the two groups. Statistical analysis using the qui-square test, the likeli hood ratio test and Student's t-test showed no statistically significant difference. CONCLUSION: this study concluded that the differences found through the measurement of curvature of the lumbar region of the spine have no influence on the appearance and the intensity of lumbar pain in young volleyball players.

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