AIS Linked to Abnormal Pronation.pdf (original) (raw)
Journal of Manipulative and Physiological Therapeutics, 2010
Objective-The purpose of this study was to develop a novel pelvic model and determine the accuracy, inter-and intra-examiner reliability of anterior superior iliac spine (ASIS) positional asymmetry assessment from both sides of the model by osteopathic pre-doctoral fellows and osteopathic physicians and to evaluate the effect of training. Methods-Five osteopathic pre-doctoral fellows and 5 osteopathic physicians assessed 13 settings of varied ASIS asymmetry of a novel pelvic model for superior/inferior positional asymmetry from both sides of the model in a random order. Assessment from the right and left sides of the model occurred on 2 separate days. Fellows were trained for a week and retested. Results-Average inter-examiner reliability was greatest from the left side of the model for physicians and right side for fellows (physicians k=0.46; fellows k=0.37 respectively) while intraexaminer reliability was greatest from the right in both groups (physicians k=0.49; fellows k=0.52). Following training of fellows, inter-examiner reliability remained highest from the right side of the model (right: k=0.48; left: k=0.36) while intra-examiner reliability was higher from the left side (right: k=0.53; left: k=0.59). Physicians and fellows before training were more accurate from the right side of the model (k=0.56 and k=0.52 respectively). Following training of fellows, accuracy increased from both sides of the model (right: k=0.59; left: k=0.53). Conclusions-A novel, pelvic model was developed to allow assessment of accuracy and reliability of ASIS asymmetry assessment. Individually, physicians and fellows varied in accuracy and inter-/intra-examiner reliability. Further investigation is warranted to understand the clinical and educational application of these results.
Surgical and Radiologic Anatomy, 2018
Purpose To assess the prevalence of anterior inferior iliac spine (AIIS) types, and to investigate the quantitative measurements that characterize AIIS morphology in an asymptomatic adult population. Methods In this prospective study, 358 hips from 179 consecutive subjects (age range, 19-82 years; 91 males, 88 females), who underwent CT examination for reasons other than hip problems and were negative for hip impingement test, were analyzed. AIIS types were determined (1, flat wall of the ilium between distal end of AIIS and acetebular rim; 2, bony eminence between distal end of AIIS and acetebular rim; and 3, extension of AIIS to the anterior superior acetebular rim) and AIIS tip angle (TA), direct distance (DD) of the anterior acetabular rim to AIIS as well as projectional distances in vertical (VD) and horizontal (HD) planes were measured. Age-and gender-related factors were searched using two-way ANOVA test under three age groups (18-39, 40-59, and ≥ 60 years). Results There were 238 (66.5%) type 1, 118 (33.0%) type 2, and two (0.5%) type 3 AIISs, with significant difference between AIIS types among age groups and genders (P < 0.001). VD and DD showed age-and gender-related (P < 0.001, P < 0.001), and TA demonstrated gender-related differences (P < 0.001). Inter-observer agreement was good for TA and moderate to poor for other measurements. Conclusions Type 1 AIIS is the most common shape across all age groups in adult females and in young and middle-aged adult males. TA, DD, and VD might be reliably used for the evaluation of AIIS morphology.
PLoS ONE, 2012
Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis and usually affects young girls. Studies mostly describe the differences between scoliotic and non-scoliotic girls and focus primarily on a single set of parameters derived from spinal and pelvis morphology, posture or standing imbalance. No study addressed all these three biomechanical aspects simultaneously in pre-braced AIS girls of different scoliosis severity but with similar curve type and their interaction with scoliosis progression. The first objective of this study was to test if there are differences in these parameters between pre-braced AIS girls with a right thoracic scoliosis of moderate (less than 27u) and severe (more than 27u) deformity. The second objective was to identify which of these parameters are related to the Cobb angle progression either individually or in combination of thereof. Forty-five scoliotic girls, randomly selected by an orthopedic surgeon from the hospital scoliosis clinic, participated in this study. Parameters related to pelvis morphology, pelvis orientation, trunk posture and quiet standing balance were measured. Generally moderate pre-brace idiopathic scoliosis patients displayed lower values than the severe group characterized by a Cobb angle greater than 27u. Only pelvis morphology and trunk posture were statistically different between the groups while pelvis orientation and standing imbalance were similar in both groups. Statistically significant Pearson coefficients of correlation between individual parameters and Cobb angle ranged between 0.32 and 0.53. Collectively trunk posture, pelvis morphology and standing balance parameters are correlated with Cobb angle at 0.82. The results suggest that spinal deformity progression is not only a question of trunk morphology distortion by itself but is also related to pelvis asymmetrical bone growth and standing neuromuscular imbalance.
Understanding breast asymmetry and its relation to AIS
Spine Deformity, 2020
Study design Literature Review. Objective Review the pathophysiology, causes, and treatment of breast asymmetry in patients with adolescent idiopathic scoliosis (AIS), as well as postoperative patient assessment and health-related quality of life. Background data Female breast development begins at 35-day gestation and continues 2-4-year post-thelarche to achieve final volume and shape. During the post-pubertal period, errors in growth and development may result in breast asymmetry. Breast asymmetry typically attenuates with time, but can be pronounced in individuals with AIS. During adolescence, there is rapid development and, thus AIS patients are increasingly sensitive, physically and emotionally, to breast changes. While breast asymmetry can be monitored through radiographic measures and surface topography, pre-and postoperative patient assessment is also critical in determination of optimal patient treatment. Methods A comprehensive literature review was performed on the pathophysiology, causes, and treatment of breast asymmetry. The advantages and limitations of various treatment options based on patient satisfaction were also investigated. Results Various treatment options exist for breast asymmetry correction in AIS patients. Surgical correction involves an aesthetic outcome, as well as social, physical, and psychological impact on the patient. Despite the benefit of correction surgery, in terms of function and self-image, patient-reported outcomes still appear lower postoperatively in the domains of pain and mental health. Conclusion Breast asymmetry is very common, especially among AIS patients, and is often corrected with surgical augmentation. AIS correction surgery has been shown to aggravate breast asymmetry and negatively affect patient-reported outcomes. Other treatment modalities should thus be considered when presented with an adolescent patient. Understanding patient concerns and their relation to quality of life will help guide surgical and medical interventions in correction of AIS deformities. Long-term follow-up studies are necessary to determine whether such interventions are successful and if patients remain healthy. Level of evidence N/A.
European Spine Journal
Learning objectives • To explain the concept of three-dimensional deformity correction in adolescent idiopathic scoliosis • To explain the Lenke Classification of AIS • To explain effects of translation on frontal, sagittal and axial planes • To explain how direct vertebral rotation works
Geometric morphometrics of adolescent idiopathic scoliosis: a prospective observational study
European Spine Journal, 2020
Objective Adolescent idiopathic scoliosis is the most prevalent type of scoliosis, and its consequences on the human torso have not been deeply studied. In spite of being a 3D condition, clinical management is circumscribed to 2D images among health-care professionals. GMM is a well-recognized tool in the study of 3D shape and symmetry. Methods Twenty-four subjects with AIS and 24 controls were subjected to surface scan. Digitization and shape data were extracted and submitted to GMM analysis. 3D shape and asymmetry were correlated with Cobb angle in subjects with X-ray availability. Comparisons of mean shapes were done between each group and its symmetric average shape and between each group at two states: initial and 6 months after. Results AIS and controls show similar areas of asymmetry, being significantly higher in quantity in AIS (PD = 0.045; PD 0.037; p < 0.001). Significant correlation was observed between Cobb angle and Procrustes asymmetry (r = 0.38; p = 0.01) as happened with 3D shape (r = 0.11; p < 0.001). No significant changes were observed in the 3D shape of both groups 6 months after (AIS, p = 0.51; control, p = 0.304). Conclusion The greater asymmetry observed in AIS was expectable, but the similarity of areas of asymmetry in both groups made us suspect of directional asymmetry in the human torso that could explain the high prevalence of right scoliosis observed in nature. The shape of the torso and the asymmetry should be considered as variables to study in AIS due to its correlation with Cobb angle. Progression of the deformities was not observed in our study, maybe due to short-term follow-up.
Variation in pelvic morphology may prevent the identification of anterior pelvic tilt
The Journal of manual & manipulative therapy, 2008
Pelvic tilt is often quantified using the angle between the horizontal and a line connecting the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS). Although this angle is determined by the balance of muscular and ligamentous forces acting between the pelvis and adjacent segments, it could also be influenced by variations in pelvic morphology. The primary objective of this anatomical study was to establish how such variation may affect the ASIS-PSIS measure of pelvic tilt. In addition, we also investigated how variability in pelvic landmarks may influence measures of innominate rotational asymmetry and measures of pelvic height. Thirty cadaver pelves were used for the study. Each specimen was positioned in a fixed anatomical reference position and the angle between the ASIS and PSIS measured bilaterally. In addition, side-to-side differences in the height of the innominate bone were recorded. The study found a range of values for the ASIS-PSIS of 0-23...
International Orthopaedics, 2009
The Anterior Pelvic Plane (APP), defined by the anterior superior iliac spines and the pubic tubercle, was commonly used as reference for positioning and postoperative evaluation of the orientation of the acetabular cup in total hip arthroplasty. APP was assumed to be vertical, but was not observed always so, mostly because of associated spinal diseases inducing perturbations in the harmony of the sagittal balance of the pelvi-spinal unit. Consequently a sagittal rotation of the pelvis occurs, and so a tilt of the APP which alters directly the orientation of the cup in upright position. An analysis of the APP tilt related to the sagittal balance of the spine was provided and its implication on the cup orientation. It appeared essential for an individual adjustment of the cup positioning to avoid a functional malposition which can lead to an increased risk of dislocation and impingement. Résumé Le plan antérieur pelvien (APP) définit par les crêtes iliaques et le pubis est communément appelé plan de référence pour le positionnement et l'orientation de la cupule acétabulaire dans les prothèses totales de hanche. Ce plan peut être modifié par la position verticale et du fait de pathologies associées au niveau de la colonne vertébrale entraînant une perturbation des courbures et de la balance pelvienne. En conséquence, une rotation sagittale du pelvis peut survenir avec conséquences sur le plan pelvien antérieur APP. Ceci peut avoir des conséquences directes sur l'orientation de la cupule en position debout. Une analyse de ce plan pelvien antérieur APP et des modifications entraînées par la balance pelvienne sont indispensa-bles. Il apparaît essentiel d'ajuster le positionnement de la cupule de façon à éviter une mal position qui peut être responsable d'un risque accru de luxations ou de conflits.
How ‘Idiopathic’ Is Adolescent Idiopathic Scoliosis? A Systematic Review on Associated Abnormalities
PLoS ONE, 2014
Background: Despite more than a century of dedicated research, the etiology and pathogenesis of adolescent idiopathic scoliosis (AIS) remain unclear. By definition, 'idiopathic' implies an unknown cause. Nevertheless, many abnormalities concomitant to AIS have been described, often with the suggestion that these abnormalities are related to etiopathogenesis. Insight in the concomitant abnormalities may assist in improving the understanding of the etiological pathways of AIS. We aimed to systematically review and synthesize available studies on abnormalities concomitant to AIS. Methods: Original studies comparing untreated AIS patients with healthy adolescents on abnormalities other than the deformity of the spine were retrieved from PubMed and Embase. We followed PRISMA guidelines and to quantify the relationship between each abnormality and AIS we used a best-evidence-syntheses for relating risk-of-bias to consistency of effect sizes. Results: We identified 88 relevant citations, forty-seven carried high risk-of-bias and twenty studies did not report quantitative data in a sufficient manner. The remaining twenty-one publications failed to report data from before initiation of the deformity and blind assessments. These cross-sectional studies provided data on fourteen abnormalities concomitant to AIS. With our best-evidence-syntheses we were unable to find both strong evidence and a consistent pattern of occurrence for AIS and any of these abnormalities. From moderate risk-of-bias studies a relatively consistent pattern of occurrence for AIS and impaired gait control (4 studies; 155 subjects; Cohen's d = 1.00) and decreased bone mineral density (2 studies; 954 subjects; Cohen's d = 20.83) was found. For nine abnormalities a consistent pattern of occurrence with AIS was found, but the evidence for these was weak. Conclusions: Based on the available literature, strong evidence is lacking for a consistent pattern of occurrence of AIS and any abnormality. The relevance for understanding the multifactorial etiology of AIS is very limited.
Patterns of Coronal and Sagittal Deformities in Adolescent Idiopathic Scoliosis
Research Square (Research Square), 2020
Background: Thoracic scoliosis has been shown to be associated with hypokyphosis in adolescent idiopathic scoliosis (AIS). However, the relationship of sagittal spino-pelvic parameters with different coronal curve patterns and their in uence on patient-perceived quality of life is unknown. This study aims to determine the association between coronal and sagittal malalignment in patients with AIS and to determine their effects on SRS-22r scores. Methods: A cross-sectional study was conducted on 1054 consecutive patients with AIS. The coronal Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), PILL mismatch (PI-LL), pelvic tilt (PT), and sacral slope (SS) were measured on standing radiographs. The coronal Cobb angle (mild: 10-20°; moderate: >20-40°; severe: >40°) and PI (low: <35°; average: 35-50°; high: >50°) were divided into 3 subgroups for comparison. Relationship between coronal curve magnitudes and sagittal parameters was studied as was their association with SRS-22r scores. Results: Low PI had smaller SS (30.1±8.3° vs 44.8±7.7°; p<0.001), PT (-0.3±8.1° vs 14.4±7.5°; p<0.001), and LL (42.0±13.2° vs 55.1±10.6°; p<0.001), negative PILL mismatch (-12.1±13.1° vs 4.1±10.5°; p<0.001) as compared to large PI. There were no signi cant relationships with PI and TK (p=0.905) or curve magnitude (p=0.431). No differences in sagittal parameters were observed for mild, moderate or severe coronal Cobb angles. SRS-22r scores only correlated with coronal Cobb angle and larger Cobb angles were negatively correlated with the function, appearance and pain domains. Conclusions: The sagittal pro le for AIS is associated with the pelvic parameters especially PI but not with the coronal curve pattern. All patients have a similar TK regardless of coronal curve type. However, it appears that the coronal deformity is a greater in uence on quality of life outcomes especially those >40°.
Structural asymmetry of anterior insula: Behavioral correlates and individual differences
Brain and Language, 2013
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Specific sagittal alignment patterns are already present in mild adolescent idiopathic scoliosis
European Spine Journal, 2021
Purpose The complex three-dimensional spinal deformity in AIS consists of rotated, lordotic apical areas and neutral junctional zones that modify the spine’s sagittal profile. Recently, three specific patterns of thoracic sagittal ‘malalignment’ were described for severe AIS. The aim of this study is to define whether specific patterns of pathological sagittal alignment are already present in mild AIS. Methods Lateral spinal radiographs of 192 mild (10°–20°) and 253 severe (> 45°) AIS patients and 156 controls were derived from an international consortium. Kyphosis characteristics (T4–T12 thoracic kyphosis, T10–L2 angle, C7 slope, location of the apex of kyphosis and of the inflection point) and sagittal curve types according to Abelin-Genevois were systematically compared between the three cohorts. Results Even in mild thoracic AIS, already 49% of the curves presented sagittal malalignment, mostly thoracic hypokyphosis, whereas only 13% of the (thoraco) lumbar curves and 6% of t...
Asymmetry Assessment Using Surface Topography in Healthy Adolescents
Symmetry, 2015
The ability to assess geometric asymmetry in the torsos of individuals is important for detecting Adolescent Idiopathic Scoliosis (AIS). A markerless technique using Surface Topography (ST) has been introduced as a non-invasive alternative to standard diagnostic radiographs. The technique has been used to identify asymmetry patterns associated with AIS. However, the presence and nature of asymmetries in the healthy population has not been properly studied. The purpose of this study is therefore to identify asymmetries and potential relationships to development factors such as age, gender, hand dominance and unilateral physical activity in healthy adolescents. Full torso scans of 83 participants were analyzed. Using Geomagic, deviation contour maps (DCMs) were created by reflecting the torso along the best plane of sagittal symmetry with each spectrum normalized. Two classes of asymmetry were observed: twist and thickness each with subgroupings. Averaged
Journal of Spinal Disorders & Techniques, 2014
The aim of this study was to evaluate the correlation between pelvic tilt (PT) and the sacro-femoral-pubic angle (SFP angle) in AIS patients and to clarify whether the predictability of PT is affected by different curve patterns. Summary of Background Data: Pelvic retroversion is one of the compensatory mechanisms to maintain upright position and is also tied to health-related quality of life in patients with adolescent idiopathic scoliosis (AIS). However, measurement of spino-pelvic parameters including PT may not be accurate because of difficulty in visualizing femoral heads on lateral radiographs in some patients. Materials and Methods: In this study, 101 female AIS patients were recruited. The subjects were divided into 2 groups: thoracic scoliosis (TS) and lumbar scoliosis (LS) group. Long-cassette standing upright radiographs were obtained; PT and SFP angles were measured through digital analysis software (Surgimap Spine Software, New York, NY). The relations between PT and SFP angle were determined by the Pearson correlation coefficient (r). Linear regressions between PT and SFP angle were also performed. Results: The SFP angle was strongly correlated with PT in both groups, and PT could be estimated by the formulas: PT = 74.052 À0.991 Â SFP angle in the TS group and PT = 65.345 À0.881 Â SFP angle in the LS group. In the TS group, the SFP angle correlated with PT strongly with a Pearson coefficient of 0.65. Whereas in the LS group, the coefficient was weaker than that in the TS group (0.48 vs. 0.65); however, it still showed that PT was significantly associated with SFP. Conclusions: Given the high correlation between PT and SFP angle, the SFP angle should be considered a reliable alternative option to PT, which has routinely excellent visibility in coronal films in AIS patients. The predictability was more accurate for AIS patients with thoracic curves than with lumbar curves.
The sagittal balance of the spine in children and adolescents with osteogenesis imperfecta
European Spine Journal, 2008
In severe forms of osteogenesis imperfecta, multiple compression fractures of the spine, as well as vertebral height shortening could be responsible for an increased thoracic kyphosis or a diminished lumbar lordosis. Theses progressive changes in sagittal shapes of the trunk could be responsible for a global sagittal trunk imbalance. We compare the parameters of sagittal spinopelvic balance in young patients with OI to those parameters in a control group of healthy volunteers. Eighteen patients with osteogenesis imperfecta were compared to a cohort of 300 healthy volunteers. A standing lateral radiograph of the spine was obtained in a standardized fashion. The sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis, thoracic kyphosis, T1 and T9 sagittal offset were measured using a computer-assisted method. The variations and reciprocal correlations of all parameters in both groups according to each other were studied. Comparison of angular parameters between OI patients and control group showed an increased T1T12 kyphosis in OI patients. T1 and T9 sagittal offset was positive in OI patients and negative in control group. This statistically significant difference among sagittal offsets in both groups indicated that OI patients had a global sagittal balance of the trunk displaced anteriorly when compared to the normal population. Reciprocal correlations between angular parameters in OI patients showed a strong correlation between lumbar lordosis (L1L5 and L1S1) and sacral slope. The T9 sagittal offset was also strongly correlated with pelvic tilt. Pelvic incidence was correlated with L1S1 lordosis, T1 sagittal offset and pelvic tilt. In OI patients, the T1T12 thoracic kyphosis was statistically higher than in control group and was not correlated with other shape (LL) or pelvic (SS, PT or PI) parameters. Because isolated T1T12 kyphosis increase without T4T12 significant modification, we suggest that vertebral deformations worsen in OI patients at the upper part of thoracic spine. Further studies are needed to precise the exact location of most frequent vertebral deformities.
Adolescent idiopathic scoliosis: current perspectives
Adolescent idiopathic scoliosis (AIS) remains a common and potentially severe musculoskeletal disorder. Although its etiology is largely unknown, ongoing research endeavors continue to improve our understanding of its potential origin and its natural history. Advances in understanding its true three-dimensional nature have sought to improve classification and management strategies. This review will attempt to highlight and give an overview of the current concepts in adolescent idiopathic scoliosis. Etiology The current consensus on adolescent idiopathic scoliosis (AIS) maintains that it has a multifactorial etiology with genetic predisposing factors. Numerous theories continue to span a broad range of plausibilities in the etiopathogenesis of AIS. To date, the literature has focused on genetic links, metabolic and hormonal disturbances, growth asymmetry, central nervous system alterations, and mechanical and connective tissue abnormalities. Multiple reports support the role of inheritance in the development of AIS. Population studies of index patients and their families have reported on an overall risk of inheritance. They suggest an 11% risk to first-degree relatives, 2.4% risk to second-degree relatives, and 1.4% to third-degree relations. 1 A meta-analysis of different twin studies found a 73% concordance rate in monozygotic twins compared to 36% in dizygotic twins. 2,3 A number of different gene loci linked to AIS have been revealed with advances in gene-analysis techniques. 4 Miller 5 suggested candidate regions on chromosomes 6, 9, 16, and 17, and more recently a genetic linkage of chromosome 18 was also found. 6 A clear mode of inheritance of AIS has been confirmed , and reports on autosomal dominant, X-linked, and multifactorial inheritance patterns have all been reported. More recently, the development of genome-wide association studies (GWAS) have provided a more comprehensive picture on the possible genes involved in the potential etiology and pathogenesis of AIS. Candidate susceptible genes have been identified in GWAS of case-control cohorts in AIS. Ward et al 7 used GWAS with 1.8 million genetic markers to compare 1,200 AIS patients with 1,500 controls. They refined their 202 markers down to 30 that were claimed to be most useful prognostic markers for curve progression. They calculated a " risk of progression " score from DNA analysis sampled from saliva, and although potentially promising, these findings require further
Neurospine
Objective: Magnetic resonance imaging (MRI)-verified neural axis abnormalities (NAAs) have been described in adolescent idiopathic scoliosis (AIS), and several risk factors have been associated with the presence of NAAs in AIS patients. However, the clinical significance of these findings is unclear. The purpose of the present study was to determine the prevalence of NAAs in a large consecutive cohort of AIS patients and to evaluate the clinical significance of previously proposed risk factors. Methods: We prospectively included AIS patients referred to a tertiary facility for evaluation. Full-spine MRI scans were performed on all included patients irrespective of curve magnitude or proposed treatment modality. MRI scans were prospectively analyzed by a neuroradiologist and the pathologic findings were confirmed by a second independent radiologist. Results: NAA was observed in 34 of the 381 patients (8.9%): 32 patients had a syrinx, 1 patient had an arachnoid cyst, and 1 patient had a Chiari malformation. Four patients were referred for a neurosurgical evaluation but none received any neurosurgical treatment. No statistically significant difference was observed between the NAA and non-NAA groups in terms of sex, major curve size, thoracic kyphosis, left thoracic curve, curve convexity, curve progression, or level of pain (p > 0.05). Conclusion: In this prospective study examining the risk factors for NAA in AIS patients, we found that previously proposed risk factors could not predict the MRI outcomes. The finding of an NAA had no clinical implications and we do not support MRI scans as a routine diagnostic modality in all AIS patients.
Does Pelvic Asymmetry always Mean Pathology? Analysis of Mechanical Factors Leading to the Asymmetry
Journal of Human Kinetics, 2009
Does Pelvic Asymmetry always Mean Pathology? Analysis of Mechanical Factors Leading to the Asymmetry Pelvic asymmetry is a phenomenon of dual character. Some describe it in terms of pathology, whereas others report that pelvic asymmetry also occurs in healthy subjects. A group of 321 subjects showing symmetrical alignment of the pelvis were involved in the study. Different forms of mechanical loads (jumps, resistance exercises of selected muscle groups) were tested for their ability to alter the configuration of the lower girdle. A hand inclinometer was used to measure pelvic asymmetry in standing. Asymmetrical configuration of the pelvis appears frequently as a consequence of mechanical loading of the lower girdle. It was registered in 25.08% of our study group. The greatest capacity to introduce pelvic asymmetry appeared in cases of asymmetrical loads that were applied in a form of so-called ‘mechanical shock’ (i.e., a force with great impulse). From this viewpoint, pelvic asymmet...