Funding outcome

Adolescent idiopathic scoliosis (AIS) is a spinal deformity commonly occurs in adolescent girls. It causes spine deviates, rotates and makes curve. The curve can be identified in two planes, frontal and sagittal. Since most of the AIS cases are in immature children, these children will be monitored by taking radiographs every 4-6 months until skeletal mature. Although radiation exposure is not desirable for the growing children, there is no commonly used non-ionizing imaging method for assessing and predicting progression of scoliosis. Based on our previous work, we already demonstrated we can use ultrasound imaging method to assess the severity of scoliosis. However, a completed study on using ultrasound to assess the spinal flexibility has not been conducted. From the literature, researchers have reported spinal flexibility may associate with the risk of progression. Also, when active treatment such as bracing or surgery is required, more radiographs may be required because spinal flexibility can be estimated from standing and supine bending radiographs. It has been very common to use this method for surgical candidates, but this method is seldom applied to brace candidates due to extra ionizing radiation. Therefore, there is a need to develop a non-ionizing radiation method which can reliably measure the spinal flexibility. Since our group is the leading research team in the world has demonstrated ultrasound can measure the spinal curvature, we would like to extend our knowledge and develop a method to measure the spinal flexibility. There are few goals in this study: 1) complete a comprehensive systematic literature review on what is the existing most accurate method to measure spinal flexibility, 2) develop a new approach to measure the spinal flexibility from the ultrasound images, and 3) determine the intra- and inter-reliabilities of spinal flexibility measurement on using ultrasound spinal images. One hundred AIS patients who have no spinal surgery will be recruited. The ethics approval of this study was granted by the local ethics board already. Four ultrasound scans while patients are in standing, prone, and prone left and right side bending positions will be acquired. Two raters will measure the US images two times with 1 week apart. The intra- and inter-reliabilities of spinal flexibility measurements will be calculated. Patients who are surgical candidates will need bending radiographs prior to their surgeries. The flexibility calculates from the radiographical method will be compared to the ultrasound method. Furthermore, the association between spinal flexibility measurements and curve progression will be investigated. In addition, the flexibility data from brace candidates will also be used to predict the in brace correction.