Analysis of sagittal profile of spine using 3D ultrasound imaging: a phantom study and preliminary subject test

ABSTRACT Radiographic Cobb’s angle is the gold standard for evaluation of spinal curvature, however, X-ray is ionising. In contrast, ultrasound is non-ionising and inexpensive. However, no study has reported the reliability and accuracy of ultrasound on sagittal curvature analysis. Ultrasound and X-ray scanning were conducted on 16 sets of spine phantoms with different deformities. Intra-rater and inter-rater reliability, correlations, mean absolute differences (MAD) and linear regression of ultrasound spinous process angles (USSPA), X-ray spinous process angles (XSPA) and X-ray Cobb’s angles (XCA) together with the intra-operator reliability of USSPA were investigated. In addition, USSPA and XCA of five AIS subjects were obtained using the ultrasound system. In the phantom study, excellent intra-rater and inter-rater reproducibility for the three angles and excellent intra-operator reproducibility for USSPA were demonstrated. Good to moderate or better correlations were obtained among the angles. All three angles indicated positive linear relationships with MAD ≤ 6.0°. The results of the preliminary study demonstrated a high intra-reliability for the ultrasound measurements. The measured difference between the USSPA and XCA methods was 6.3° ± 5.4°. The results showed that ultrasound is feasible for measuring sagittal curvature and has the potential for monitoring the curve progression and evaluating sagittal spinal profiles.

[1]  Qinghua Huang,et al.  2.5-D Extended Field-of-View Ultrasound , 2018, IEEE Transactions on Medical Imaging.

[2]  X. Liu,et al.  Analysis of the relationship between coronal and sagittal deformities in adolescent idiopathic scoliosis , 2016, European Spine Journal.

[3]  Tadeusz J. Janik,et al.  Reliability of Centroid, Cobb, and Harrison Posterior Tangent Methods: Which to Choose for Analysis of Thoracic Kyphosis , 2001, Spine.

[4]  M. Solomonow,et al.  Biomechanics and electromyography of a cumulative lumbar disorder: response to static flexion. , 2003, Clinical biomechanics.

[5]  I. Kingma,et al.  Effects of Dorsal Versus Ventral Shear Loads on the Rotational Stability of the Thoracic Spine: A Biomechanical Porcine and Human Cadaveric Study , 2007, Spine.

[6]  P. Roussouly,et al.  Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases , 2007, European Spine Journal.

[7]  L. Lenke,et al.  An Analysis of Sagittal Spinal Alignment Following Long Adult Lumbar Instrumentation and Fusion to L5 or S1: Can We Predict Ideal Lumbar Lordosis? , 2006, Spine.

[8]  A. Hadjipavlou.  American academy of orthopaedic surgeons: instructional course lectures , 2005 .

[9]  DANIEL E. FOX,et al.  Evaluation of Lumbar Lordosis: A Prospective and Retrospective Study , 1985, Spine.

[10]  J. Auerbach,et al.  Is Radiation-Free Diagnostic Monitoring of Adolescent Idiopathic Scoliosis Feasible Using Upright Positional Magnetic Resonance Imaging? , 2013, Spine.

[11]  Yong-Ping Zheng,et al.  Ultrasound Volume Projection Imaging for Assessment of Scoliosis , 2015, IEEE Transactions on Medical Imaging.

[12]  M Bernhardt,et al.  Segmental Analysis of the Sagittal Plane Alignment of the Normal Thoracic and Lumbar Spines and Thoracolumbar Junction , 1989, Spine.

[13]  L. Lenke,et al.  Three-Dimensional Analysis of Thoracic Apical Sagittal Alignment in Adolescent Idiopathic Scoliosis , 2009, Spine.

[14]  C. Candotti,et al.  Validation, repeatability and reproducibility of a noninvasive instrument for measuring thoracic and lumbar curvature of the spine in the sagittal plane. , 2011, Revista brasileira de fisioterapia (Sao Carlos (Sao Paulo, Brazil)).

[15]  Wang Weijun,et al.  Comparison of Sagittal Spinopelvic Alignment in Chinese Adolescents With and Without Idiopathic Thoracic Scoliosis , 2012, Spine.

[16]  Jeremy S. Lewis,et al.  Clinical measurement of the thoracic kyphosis. A study of the intra-rater reliability in subjects with and without shoulder pain , 2010, BMC musculoskeletal disorders.

[17]  J. V. van Dieën,et al.  The role of dorsal shear forces in the pathogenesis of adolescent idiopathic scoliosis--a hypothesis. , 2005, Medical hypotheses.

[18]  Moyo C Kruyt,et al.  A reliability and validity study for different coronal angles using ultrasound imaging in adolescent idiopathic scoliosis. , 2017, The spine journal : official journal of the North American Spine Society.

[19]  Kevin W. McEnery,et al.  An Analysis of Sagittal Spinal Alignment in 100 Asymptomatic Middle and Older Aged Volunteers , 1995, Spine.

[20]  J. Coyle,et al.  Backpack Use in Children , 2002, Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association.

[21]  Mohsen Makhsous,et al.  Sitting with Adjustable Ischial and Back Supports: Biomechanical Changes , 2003, Spine.

[22]  Justin K Scheer,et al.  The Impact of Standing Regional Cervical Sagittal Alignment on Outcomes in Posterior Cervical Fusion Surgery. , 2012, Neurosurgery.

[23]  M. Moore,et al.  Association of relative backpack weight with reported pain, pain sites, medical utilization, and lost school time in children and adolescents. , 2007, The Journal of school health.

[24]  K. Vincken,et al.  Differences in early sagittal plane alignment between thoracic and lumbar adolescent idiopathic scoliosis. , 2014, The spine journal : official journal of the North American Spine Society.

[25]  S. Shin,et al.  Surgical Treatment of Adult Degenerative Scoliosis , 2014, Asian spine journal.

[26]  L. Lenke,et al.  Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). , 1999, Spine.

[27]  V. Deviren,et al.  Measurement of Vertebral Rotation in Standing Versus Supine Position in Adolescent Idiopathic Scoliosis , 2001, Journal of pediatric orthopedics.

[28]  Won-Sook Lee,et al.  Freehand 3-D Ultrasound Imaging: A Systematic Review. , 2017, Ultrasound in medicine & biology.

[29]  T Yamamuro,et al.  Ultrasound measurement of vertebral rotation in idiopathic scoliosis. , 1989, The Journal of bone and joint surgery. British volume.

[30]  Guang-Quan Zhou,et al.  Freehand three-dimensional ultrasound system for assessment of scoliosis , 2015, Journal of orthopaedic translation.

[31]  Xuelong Li,et al.  Scoliotic Imaging With a Novel Double-Sweep 2.5-Dimensional Extended Field-of-View Ultrasound , 2019, IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control.

[32]  Reinald Brunner,et al.  Using Skin Markers for Spinal Curvature Quantification in Main Thoracic Adolescent Idiopathic Scoliosis: An Explorative Radiographic Study , 2015, PloS one.

[33]  C. Bach,et al.  Inter- and intraobserver reliability assessment of the Cobb angle: manual versus digital measurement tools , 2007, European Spine Journal.

[34]  M. Bond,et al.  Scoliosis Research Society–Schwab Adult Spinal Deformity Classification: A Validation Study * , 2018, 50 Landmark Papers.

[35]  Michiel M. A. Janssen,et al.  Analysis of Preexistent Vertebral Rotation in the Normal Infantile, Juvenile, and Adolescent Spine , 2011, Spine.

[36]  B. Dawson-Saunders,et al.  Basic and Clinical Biostatistics , 1993 .

[37]  S. Park,et al.  Effect of Coronal Scoliotic Curvature on Sagittal Spinal Shape: Analysis of Parameters in Mature Adolescent Scoliosis Patients , 2015, Clinical spine surgery.

[38]  L. Le,et al.  Reliability of the axial vertebral rotation measurements of adolescent idiopathic scoliosis using the center of lamina method on ultrasound images: in vitro and in vivo study , 2016, European Spine Journal.

[39]  R. Winter,et al.  Excessive thoracic lordosis and loss of pulmonary function in patients with idiopathic scoliosis. , 1975, The Journal of bone and joint surgery. American volume.

[40]  Michiel M. A. Janssen,et al.  Sagittal spinal profile and spinopelvic balance in parents of scoliotic children. , 2013, The spine journal : official journal of the North American Spine Society.

[41]  A. Mannion,et al.  A new skin-surface device for measuring the curvature and global and segmental ranges of motion of the spine: reliability of measurements and comparison with data reviewed from the literature , 2004, European Spine Journal.

[42]  L. Kocsis,et al.  Ultrasound based measuring-diagnostic and muscle activity measuring system for spinal analysis. , 2006, Technology and health care : official journal of the European Society for Engineering and Medicine.

[43]  A. Truszczyńska,et al.  Effect of asymmetrical backpack load on spinal curvature in school children. , 2015, Work.

[44]  Youlian Hong,et al.  The effect of school bag design and load on spinal posture during stair use by children , 2011, Ergonomics.

[45]  F. Pernus,et al.  A review of methods for quantitative evaluation of spinal curvature , 2009, European Spine Journal.

[46]  B. Chang,et al.  Clinical and Radiological Predictive Factors to be Related with the Degree of Lumbar Back Muscle Degeneration: Difference by Gender , 2014, Clinics in orthopedic surgery.

[47]  Q H Huang,et al.  Development of a portable 3D ultrasound imaging system for musculoskeletal tissues. , 2005, Ultrasonics.

[48]  J. Bernard,et al.  Muscle assessment in healthy teenagers, Comparison with teenagers with low back pain. , 2008, Annales de readaptation et de medecine physique : revue scientifique de la Societe francaise de reeducation fonctionnelle de readaptation et de medecine physique.

[49]  F. Schwab,et al.  Management of Flatback and Related Kyphotic Decompensation Syndromes , 1997, Spine.

[50]  Tamás Illés,et al.  Sagittal plane correction in idiopathic scoliosis. , 2002, Spine.

[51]  Y. Zheng,et al.  Could clinical ultrasound improve the fitting of spinal orthosis for the patients with AIS? , 2012, European Spine Journal.

[52]  H. Saraste,et al.  Radiographic Measurement of the Lumbar Spine: A Clinical and Experimental Study in Man , 1985, Spine.

[53]  Rui Zheng,et al.  Reliability and accuracy of ultrasound measurements with and without the aid of previous radiographs in adolescent idiopathic scoliosis (AIS) , 2015, European Spine Journal.

[54]  J. Vital,et al.  Cervical spine alignment in the pediatric population: a radiographic normative study of 150 asymptomatic patients , 2014, European Spine Journal.

[55]  H Labelle,et al.  [Comparison between clinical Cobb angles and measurements performed on vertebral bodies, pedicle centroids and spinous processes]. , 1999, Annales de chirurgie.

[56]  P. Klein,et al.  Sagittal Thoracic and Lumbar Spine Profiles in Upright Standing and Lying Prone Positions Among Healthy Subjects: Influence of Various Biometric Features , 2015, Spine.

[57]  R Kohler,et al.  [Backpack and spinal disease: myth or reality?]. , 2004, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur.

[58]  Y P Zheng,et al.  Application of 3-D ultrasound in assisting the fitting procedure of spinal orthosis to patients with adolescent idiopathic scoliosis. , 2010, Studies in health technology and informatics.

[59]  C. Candotti,et al.  Validity and Reproducibility of the Measurements Obtained Using the Flexicurve Instrument to Evaluate the Angles of Thoracic and Lumbar Curvatures of the Spine in the Sagittal Plane , 2012, Rehabilitation research and practice.

[60]  K. Wood,et al.  Sagittal Profile of the Elderly , 2003, Journal of spinal disorders & techniques.

[61]  L. Claes,et al.  New in vivo measurements of pressures in the intervertebral disc in daily life. , 1999, Spine.

[62]  Peter M A van Ooijen,et al.  A framework for human spine imaging using a freehand 3D ultrasound system. , 2010, Technology and health care : official journal of the European Society for Engineering and Medicine.

[63]  F. Pigozzi,et al.  Spinal curvature: comparison of frontal measurements with the Spinal Mouse and radiographic assessment. , 2008, The Journal of sports medicine and physical fitness.

[64]  R. Kiss,et al.  Comparison of spinal curvature parameters as determined by the ZEBRIS spine examination method and the Cobb method in children with scoliosis , 2018, PloS one.

[65]  Jack P Callaghan,et al.  Effects of prolonged sitting on the passive flexion stiffness of the in vivo lumbar spine. , 2005, The spine journal : official journal of the North American Spine Society.

[66]  M. Guermazi,et al.  Validité et reproductibilité du Spinal Mouse® pour l'étude de la mobilité en flexion du rachis lombaire , 2006 .

[67]  J. Fleiss,et al.  Intraclass correlations: uses in assessing rater reliability. , 1979, Psychological bulletin.

[68]  Christina Jackson,et al.  Back pain in children: a holistic approach to diagnosis and management. , 2011, Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners.

[69]  S. Koop,et al.  Determination of “Normal” Thoracic Kyphosis: A Roentgenographic Study of 121 “Normal” Children , 2000, Journal of pediatric orthopedics.

[70]  R. Kiss,et al.  The Assessment of the Spinal Curvatures in the Sagittal Plane of Children Using an Ultrasound-Based Motion Analysing System , 2015, Annals of Biomedical Engineering.

[71]  H. Labelle,et al.  Pre- and post-operative sagittal balance in idiopathic scoliosis: a comparison over the ages of two cohorts of 132 adolescents and 52 adults , 2013, European Spine Journal.

[72]  Andras Lasso,et al.  Spinal curvature measurement by tracked ultrasound snapshots. , 2014, Ultrasound in medicine & biology.

[73]  A D Holmes,et al.  Changes in spinal curvature and proprioception of schoolboys carrying different weights of backpack , 2007, Ergonomics.

[74]  Qinghua Huang,et al.  A Review on Real-Time 3D Ultrasound Imaging Technology , 2017, BioMed research international.

[75]  Doug Hill,et al.  Reliability of assessing the coronal curvature of children with scoliosis by using ultrasound images , 2013, Journal of children's orthopaedics.

[76]  J. Mac-Thiong,et al.  Sagittal spino-pelvic alignment in chronic low back pain , 2011, European Spine Journal.

[77]  Hubert Labelle,et al.  Diagnostic Imaging of Spinal Deformities: Reducing Patients Radiation Dose With a New Slot-Scanning X-ray Imager , 2010, Spine.

[78]  A. Alanay,et al.  The Evolution of Sagittal Segmental Alignment of the Spine During Childhood , 2005, Spine.

[79]  Guang-Quan Zhou,et al.  A reliability and validity study for Scolioscan: a radiation-free scoliosis assessment system using 3D ultrasound imaging , 2016, Scoliosis and Spinal Disorders.

[80]  M. Betsch,et al.  Spinal posture and pelvic position during pregnancy: a prospective rasterstereographic pilot study , 2015, European Spine Journal.

[81]  A. Bhattacharya,et al.  School backpacks: it's more than just a weight problem. , 2009, Work.

[82]  Yong-Ping Zheng,et al.  Development of 3-D ultrasound system for assessment of adolescent idiopathic scoliosis (AIS): And system validation , 2013, 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[83]  Pierre Roussouly,et al.  Sagittal plane deformity: an overview of interpretation and management , 2010, European Spine Journal.

[84]  M. Li,et al.  Validity Study of Vertebral Rotation Measurement Using 3-D Ultrasound in Adolescent Idiopathic Scoliosis. , 2016, Ultrasound in medicine & biology.

[85]  G. Costanzo,et al.  Reciprocal Angulation of Vertebral Bodies in a Sagittal Plane: Approach to References for the Evaluation of Kyphosis and Lordosis , 1982, Spine.