Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
Department of Radiology, Duchess of Kent Children's Hospital, Hong Kong, Sandy Bay, Hong Kong SAR, China.
Spine (Phila Pa 1976). 2023 Oct 1;48(19):1354-1364. doi: 10.1097/BRS.0000000000004731. Epub 2023 Jul 3.
Prospective study.
To investigate the difference in major curve Cobb angle and alignment between directed and nondirected positioning for adolescent idiopathic scoliosis (AIS) and to evaluate implications on treatment decision-making.
Proper positioning of patients with spinal deformities is important for assessing usual functional posture in standing, so management strategies can be customized accordingly. Whether postural variability affects coronal and sagittal radiologic parameters and the impact of posture on management decisions remains unknown.
Patients with adolescent idiopathic scoliosis presenting for an initial consultation at a tertiary scoliosis clinic were recruited. They were asked to stand in two positions: passive, nondirected position; and directed position by the radiographer. Radiologic assessment included major and minor Cobb angle, coronal balance, spinopelvic parameters, sagittal balance, and alignment. Cobb angle difference >5° between directed and nondirected positioning was considered clinically impactful. Patients with or without such differences were compared. Overestimation or underestimation of the major curve (at 25° or 40°) by nondirected positioning were examined due to its relevance to bracing and surgical indications.
This study included 198 patients, with 22.2% experiencing Cobb angle difference (>5°) between positioning. The major curve Cobb angle was smaller in nondirected than directed positioning (median difference: -6.0°, upper and lower quartile: -7.8, 5.8), especially for curves ≥30°. Patients with a Cobb angle difference had changes in shoulder balance ( P =0.007) when assuming a directed position. Nondirected positioning had 14.3% of major Cobb 25° underestimated and 8.8% overestimated, whereas 11.1% of curves >40° were underestimated.
Strict adherence to a standardized radiographic protocol is mandatory for reproducing spine radiographs reliable for curve assessment, as a nondirected position demonstrates smaller Cobb angles. Postural variation may lead to overestimation, or underestimation, of the curve size which is relevant to both bracing and surgical decision-making.
Level-II.
前瞻性研究。
研究特发性脊柱侧凸（AIS）患者定向和非定向定位时主弯 Cobb 角和对线的差异，并评估其对治疗决策的影响。
对于评估脊柱畸形患者站立时的常规功能姿势，正确的体位非常重要，以便能够据此定制相应的管理策略。姿势的可变性是否会影响冠状位和矢状位影像学参数，以及姿势对管理决策的影响尚不清楚。
本研究招募了在三级脊柱侧弯诊所就诊的青少年特发性脊柱侧凸患者。他们被要求站在两种体位：被动、非定向体位；以及由放射技师引导的定向体位。影像学评估包括主弯和次弯 Cobb 角、冠状位平衡、脊柱骨盆参数、矢状位平衡和对线。定向和非定向体位的 Cobb 角差值＞5°被认为有临床意义。比较了有和没有这种差异的患者。由于与支具和手术适应证相关，还检查了非定向定位对主弯（25°或 40°）的高估或低估。
本研究纳入了 198 例患者，其中 22.2%的患者定位时 Cobb 角差值＞5°。非定向定位时主弯 Cobb 角小于定向定位（中位数差值：-6.0°，上下四分位数：-7.8，5.8），特别是在主弯≥30°的患者中。在定向体位下，Cobb 角差值较大的患者肩部平衡发生变化（P=0.007）。非定向定位低估了 14.3%的主弯 25°，高估了 8.8%；11.1%的曲线＞40°被低估。
为了可靠地评估曲线，必须严格遵守标准化的放射学协议，因为非定向位置显示较小的 Cobb 角。姿势的变化可能导致对曲线大小的高估或低估，这与支具和手术决策都相关。
Ⅱ级。
