The effect of arm positions used during radiography on spinal alignment parameters assessed by 3D ultrasound imaging in adolescents with and volunteers without idiopathic scoliosis.

PURPOSE

Clinicians monitor scoliosis progression using multiple radiographs during growth. During imaging, arms must be elevated to visualize vertebrae, possibly affecting sagittal alignment. This study aimed to determine the arm position that best represents habitual standing (and possibly allowing hand-based skeletal maturity assessment) to obtain frontal and lateral stereo-radiographs as measured using frontal, sagittal, and transverse angles.

METHODS

Females with and without, and males with Adolescent Idiopathic Scoliosis (AIS) were recruited consecutively. Patients were scanned using 3D Ultrasound imaging (3DUS), in 10 arm positions; habitual standing, arms supported anteriorly at 60° flexion, fingers to clavicle, chin, zygomatic, and eyebrows, arms abducted 90°, hands on wall, on blocks, and unsupported. Axial vertebral rotation (AVR) differences, frontal, and sagittal curve angles were measured. Repeated measures ANOVAs with Sidak post-hoc tests compared positions.

RESULTS

Ninety females with and without AIS with mean age, and height of 17 ± 4 years, and 162 ± 6 cm, and ten males with AIS of 16 ± 3 years, and 174 ± 11 cm, respectively, were included. Female AIS single-curve showed larger curves in standing in all positions excluding hands on blocks (p > 0.05). Sagittal parameters showed decreases in kyphosis in arms abducted 90° and increases in lordosis in fingers to cheeks/eyebrows (p > 0.05). AVR twist was not significantly affected by position. Male AIS showed comparable results to females, but no significant differences were detected.

CONCLUSION

No position represented habitual standing for all groups. When arms are raised, decreases in curve angle were shown in single-curve patients, kyphosis decreased, and lordosis increased in all groups. Most accurate positioning for all parameters was in fingers to clavicle/chin position.