Association between trunk aesthetics and underling scoliosis severity and curve type in adolescents: evaluation of traditional clinical scores and novel automated indices from rasterstereographic imaging.

IF 3.4 3区 医学 Q1 REHABILITATION
Tito Bassani, Alessandra Negrini, Marco Rampi, Maria Parzini, Stefano Negrini
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引用次数: 0

Abstract

Background: Trunk aesthetics is an important aim in treating adolescent idiopathic scoliosis (AIS). While subjective measures like the Scoliosis Research Society-22 questionnaire are commonly used, objective methods, such as the Trunk Aesthetic Clinical Evaluation (TRACE) index, are less explored. Non-invasive imaging techniques like rasterstereography (RST) have been studied to reduce radiographic exposure in AIS, though their correlation with Cobb angles remains weak. Notwithstanding, RST provides detailed trunk shape information that could enhance aesthetic evaluations.

Aim: To evaluate the correlation between aesthetic indices (TRACE and novel automated RST-based) and radiographic characteristics.

Design: Cross-sectional observational controlled diagnostic study.

Setting: Outpatient rehabilitation center for conservative treatment of spinal deformities.

Population: 675 AIS subjects (age 13±2 years; Cobb angles 10-45°) with trunk photographs, RST scans, and standing radiographs within three months.

Methods: Two automated RST aesthetic evaluations (l_match and l_dist) were developed based on TRACE principles, providing total and sub-scores for shoulders, scapulae, hemithorax, and waist. TRACE assessments on RST images and photographs were conducted by two raters, with intra- and inter-rater reliability tested in a subset of 28 participants. Correlations among TRACE (photographic and RST), automated RST evaluations, scoliosis severity, and curve type were analyzed.

Results: TRACE confirmed strong intra-rater (0.73-0.96) and moderate inter-rater (0.61-0.74) reliability. Correlations between aesthetic measures were weak: RST and photographic TRACE (0.3 overall, 0.02-0.4 sub-scores), and RST TRACE with automated evaluations (0.27-0.28 overall, 0.06-0.29 sub-scores). Correlations between Cobb angles and aesthetic evaluations ranged from weak to moderate: RST TRACE (0.35-0.42), photographic TRACE (0.13-0.53), l_match (-0.05 to -0.44), and l_dist (0.03-0.49). Waist sub-scores showed strongest correlations in thoracic and thoracolumbar curves, with thoracic curves yielding best results for automated RST evaluations.

Conclusions: The new automated RST-based aesthetic evaluation did not show clear superiority on TRACE. In the current absence of a gold standard, choices should prioritize reliability, validity, and clinical utility. Aesthetic and radiographic evaluations were weakly correlated but showed consistent patterns across trunk areas and curve types, highlighting the multifactorial nature of scoliosis-related aesthetics warranting further exploration.

Clinical rehabilitation impact: While the development of robust tools to assess aesthetics beyond radiography is ongoing, TRACE remains a reliable and cost-effective instrument for routine clinical use.

Abstract Image

Abstract Image

Abstract Image

青少年躯干美学与脊柱侧凸严重程度和弯曲类型之间的关系:传统临床评分和新型光栅立体成像自动指标的评估。
背景:躯干美学是治疗青少年特发性脊柱侧凸(AIS)的重要目的。虽然像脊柱侧凸研究协会-22问卷这样的主观测量方法是常用的,但客观方法,如躯干美学临床评价(TRACE)指数,却很少被探索。非侵入性成像技术,如光栅立体成像(RST),已经被研究用于减少AIS的放射暴露,尽管它们与Cobb角的相关性仍然很弱。尽管如此,RST提供了详细的树干形状信息,可以提高美学评价。目的:评价美学指标(TRACE和新型自动rst)与影像学特征的相关性。设计:横断面观察对照诊断研究。单位:脊柱畸形保守治疗门诊康复中心。人群:675名AIS患者(年龄13±2岁;Cobb角10-45°),在三个月内进行躯干照片、RST扫描和站立x线片。方法:基于TRACE原则,开发两种自动RST美学评价(l_match和l_dist),提供肩部、肩胛骨、半胸和腰部的总分和分值。对RST图像和照片的跟踪评估由两名评分者进行,在28名参与者的一个子集中测试了评分者内部和内部的可靠性。分析了TRACE(照相和RST)、自动RST评估、脊柱侧凸严重程度和曲线类型之间的相关性。结果:TRACE证实了较强的评估内信度(0.73-0.96)和中等的评估间信度(0.61-0.74)。美学测量之间的相关性较弱:RST和摄影TRACE(总体0.3,0.02-0.4分),RST TRACE与自动评估(总体0.27-0.28,0.06-0.29分)。Cobb角与审美评价之间的相关性从弱到中等:RST TRACE(0.35-0.42)、摄影TRACE(0.13-0.53)、l_match(-0.05 - -0.44)和l_dist(0.03-0.49)。腰部分值与胸部和胸腰椎曲线的相关性最强,其中胸部曲线在自动RST评估中效果最好。结论:新的基于rst的自动美学评价在TRACE上没有明显的优势。在目前缺乏黄金标准的情况下,选择应该优先考虑可靠性、有效性和临床实用性。美学和x线评价相关性较弱,但在躯干区域和曲线类型中显示一致的模式,突出了脊柱侧凸相关美学的多因素性质,值得进一步探索。临床康复影响:虽然除了x线摄影之外,评估美学的强大工具仍在发展中,但TRACE仍然是常规临床使用的可靠且具有成本效益的工具。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.50
自引率
4.40%
发文量
162
审稿时长
6-12 weeks
期刊介绍: The European Journal of Physical and Rehabilitation Medicine publishes papers of clinical interest in physical and rehabilitation medicine.
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