Software Application for Scoliosis Assessment

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Original Editors - Aya Alhindi

Top Contributors - Sabah Abdlnaser Hassan Ali, Omnia Mustafa, Aya Alhindi, Fatma Mostafa, Mayar Othman, Jana Fouad and Afaf Tahoon  

Introduction

Scoliosis refers to a complex deformity of the spine in three planes. It is diagnosed by measuring the angle of curvature of the spine in the frontal plane and the axial rotation in the horizontal plane, as well as being characterized by spinal deformities in the sagittal plane . There are many different types of scoliosis that may present at different points across the lifespan. With respect to adult populations,  described three main types of scoliosis: type I—primary scoliosis; type II—progressive idiopathic scoliosis in an adult patient; or type III—(a) secondary degenerative scoliosis in response to idiopathic or other forms of scoliosis or primary deformity/anomaly located in the spine, trunk or extremities or (b) any systemic condition that may affect bone metabolism (e.g. osteoporosis) combined with asymmetrical arthritis or vertebral fractu

Contributing Factors to Scoliosis

There is no conclusive correlation has been found between scoliosis and adopting poor postures or carrying heavy backpacks. However, prolonged incorrect sitting posture or the heavy weight of  backpacks may cause paravertebral muscle fatigue and increased ligament pressure, which increases the risk of developing scoliosis. Unfortunately, there is insufficient evidence to support this association .

Moreover, a potential relationship between strabismus and scoliosis has recently been identified. Patients with strabismus are much more likely to develop dorsal scoliosis because they have altered visual-spatial perception and asymmetrical postural responses. Adolescents are more likely to develop scoliosis if they suffer from back pain for more than 3 hours per day, have developmental dysmorphism (pectus excavatum and hip dysplasia) or participate in a high-risk sport (such as gymnastics).

Schoolchildren are particularly vulnerable to scoliosis due to environmental factors such as school furniture, prolonged sitting, excess weight, asymmetrical backpack support, and daily habits. In the context of daily habits, children are increasingly using cell phones, video games, and desktop computers, which may encourage sedentary behavior. Sedentary behavior is associated with a variety of diseases, including musculoskeletal disorders that may cause inappropriate postures in students, as well as causing discomfort.

A previous study showed that Leg Length Discrepancy could lead to functional scoliosis. The scoliotic curve could be thoracolumbar, lumbar, thoracic or double major curve.

Traditional Assessment

Traditional Methods of Measuring the Degree of Scoliosis :scoliosis was analyzed using inclinometers, pantographs, and even plaster casts of the back.

is:

Cobb angle

There are several approaches to determine the Cobb angle, such as: manual procedure (conventional methods), digital computer-assisted (semi-automated) procedure, automatic procedure, and smartphone app procedure.

The gold-standard parameter that cis the Cobb angle, is estimated by measuring  spine curvature is measured using anterior-posterior (AP) view spinal X-ray in which the angle between two lines drawn perpendicular to the top endplate of the uppermost vertebra and the lower endplate of the lowest vertebrae involved. However, manual assessment of spine curvature .

with a pencil and a goniometer. The lines are manually placed onto a radiographic film of the spine, and the angle resulting from the most inclined vertebrae is measured using a protractor.

When the Cobb angle is less than 10 degrees, the problem associated with a ssis.

A Cobb angle of 10 to 20 degrees is mild scoliosis. Scoliosis severity is moderate when the Cobb angle is between 20 and 40 degrees. A Cobb angle greater than 40 degrees indicates severe scoliosis.

Adam's Forward Bend test

One of the simpler diagnostic procedures is the Adam's Forward Bend test, it allows for an assessment of posture and the possible determination of scoliosis. The Adams test belongs to the so-called functional tests. It is a short, non-invasive and painless test. During the test, the patient bends forward as the stands behind their back and checks the horizontal plane of the spine for irregularities in the spinal curve and figures out the angle of trunk rotation.

Scoliometer

A simple handheld device called a scoliometer which is characterized by a metal sphere inside a water recipient that moves in a range of 0-30° on both sides and indicates the angle of axial trunk rotation. The scoliometer, which is placed over the spine while performing Adams test to measures the angle of trunk rotation.

Software Application Assessment

The advancements of ICT technology as well as the portability and simplicity of smartphones have encouraged the shift of measurement and collection of data in the health sector from being doctor-centered to a patient-centered approach in a way benefiting both the doctor and the patient.

The scoliosis assessment using software applications has facilitated the remote monitoring of patients' scoliotic curve, saving doctors time and money. Moreover, they permit the patient to obtain immediate feedback on the accuracy and efficiency of the prescribed rehabilitation program by keeping track of the scoliotic curve progression. In addition, apps can enhance the reliability of screening and consistency of Cobb's angle measurement. While a radiological examination is necessary for a definitive diagnosis of scoliosis, using the software application will minimize radiation exposure and cut down on the number of medical visits.

ScolioTrack

ScolioTrack is a mobile-based application that can operate on both Android and IOS. The app can assess the patient's angle of trunk rotation (ATR) while simultaneously recording age, height, weight, and back photos for future comparisons and follow-up. It has a "Grid view mode" allowing for immediate observation of any visible back deformity, such as rib humps, hip protrusion, body alignment, or spinal deviation. Compared to radiological tests, ScolioTrack has proven to be safer, simpler, and less expensive.

Features:

• Its simplicity allows for self-tracking the spinal curve progression.
• It shows a high degree of accuracy providing professionals with a suitable tool for monitoring multiple patients.
• It allows storage of scoliosis measurements for follow-up.
• It also keeps the patient updated about the latest trends in scoliosis and provides answers to some of the most often-asked concerns about the topic.

Scoliometer

The software offers a quick and easy method for precisely measuring and tracking the ATR. Scoliometer operates with the newest iPhone and Android smartphones and can screen scoliosis curves up to 50 degrees. It offers a user-friendly four-step tutorial that teaches how to measure scoliosis. Scoliometer is a less complicated and more affordable version of the ScolioTrack app.

APECS

The APECS (Artificial Intelligence Posture Evaluation and Correction System) is a free app that can be found both on the Play Store and Apple Store.  APECS is mainly concerned with the evaluation and correction of patient's posture using artificial intelligence. In addition to providing daily advice on how to maintain and improve posture, it enables patients to track their posture and provides feedback on their at-home posture exercises.

In particular, APECS employs photogrammetric algorithms to accurately analyze body symmetry and uses markers placed on the patient's body photo, either manually or by autodetection, to do posture evaluations. APECS is an exercise module that allows the physician to provide a particular workout based on the patient's needs and the posture evaluation, resulting in positive rectification outcomes.

CobbMeter

CobbMeter is an Iphone app that is used to measure cobb's angle, kyphosis angle and sacral slope on vertical spine through radiographic pictures. It is designed for spine professionals and turns the iphone into a precise measuring tool.

The angle calculation process is done through the angle sensors present in the iphone MEMS (micro-electromechanical systems accelerometer) and is considered of.

Scolio Detector

Scolio Detector is a more simple app, designed for parents, teachers and doctors to measure a child's spinal curves through using a built-in scoliometer function.

In addition to measuring spinal curvatures it allows for the recording of measurement readings for continuous monitoring. IT is free of charge and widely used by people all over the world for periodic self-screening.

Scoliosis Tracker

Scoliosis tracker is designed to measure, record and track adolescent scoliosis. provides a digital scoliometer to measure spine rotation and It also provides a checklist to track patient's compliance to traditional such as (bracing, vitamin D and physical therapy)

Reliability

Investigating the accuracy and repeatability of the software that we developed in measuring the adolescent idiopathic scoliosis (AIS) Cobb angle, It was proven that The smartphone scoliosis screening app measures the Cobb angle of AIS more quickly, efficiently, accurately, and consistently than a traditional protractor, allowing it to screen scoliosis patients more extensively for diagnosis.

Validity

The Android scoliosis measurement tool overestimated 4-5 degrees, resulting in angles between 25 and 30 degrees. On the other hand, the applications on the iPhone Apple store in controlled settings can be utilized more successfully as a Scoliometer than the traditional one. Furthermore, pricing had no effect on quality or efficacy, and the free program outperformed the pricey program.