Jump to content

Software Applications for Scoliosis Assessment

Original Editors - Aya Alhindi, Afaf Tahoon with contributions from Sabah Abdlnaser Hassan Ali, Fatma Mostafa, Mayar Othman, Omnia Mustafa, Jana Fouad as a part of PTCU Excellence and Innovation Unit Project

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

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 [1].The threshold for diagnosis is typically defined as a Cobb angle measurement of> 10°

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 ; or type III—(a) secondary degenerative scoliosis in response to primary anomaly located in the spine, trunk or extremities or (b) any systemic condition that may affect bone metabolism combined with asymmetrical arthritis or vertebral fractur[2]. Primary scoliosis (PS) that develops in patients with no prior history of scoliosis, typically present with postural deformity accompanied by axial back pain. [3]Scoliosis can also be secondary due to neuropathic and myopathic conditions can lead to a loss of muscular support for the spinal column so that the spinal column is pulled in abnormal directions. Some conditions which may cause secondary scoliosis as poliomyelitis, spinal cord trauma, and neuromuscular conditions, tumours, trauma or syndromic conditions. [4]

Contributing Factors to Scoliosis

Contributing risk factors to adult degenerative scoliosis (ADS) development include:

  • Aging: It is widely acknowledged that asymmetric loads on the disc and facet joints caused by degenerative alterations eventually result in progressive deformity [5] and with aging the extensor muscles of the spine show increase in fatty infiltration and decrease in density. This process affects lower segments then extends to the proximal segments[6].
  • Disc impairment due to smoking: It has been demonstrated that smoking increases catabolic activity in the annulus and nucleus pulposus, which alters the matrix and cell architecture [5].
  • Genetic inheritance: a genetic study showed that COL2A1 polymorphism and adult degenerative scoliosis (ADS) in Korean patients are correlated, indicating a potential hereditary component [7].
  • Osteoporosis:  ADS patients and normal populations have an equivalent prevalence of osteoporosis and there is no apparent association between the magnitude of the curve and the osteopenia degree [8].

Regarding adolescents: 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 [9]. 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).[10]

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.[11]

Strabismus: 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[12].

Leg length discrepancy: Leg Length Discrepancy could lead to functional scoliosis. The scoliotic curve could be thoracolumbar, lumbar, thoracic or double major curve.[13]

Traditional Assessment

The gold standard for idiopathic scoliosis diagnosis is X- ray imaging, through it Cobb angle is calculated for evaluating spine curvature in coronal plane. Other methods are used as inclinometers, pantographs, and even plaster casts of the back [14]to measure different angles, such as axial vertebral rotation, which is a rotation of a vertebra around its longitudinal axis when projected onto the transverse plane. 2D and 3D images are utilized as well to evaluate axial vertebral rotation. [15][16]Another angle called trunk rotation angle (TRA) that is reflects the inclination of the trunk from horizontal plane which is measured by scoliometer

Cobb angle

The most widely used measurement for quantifying and evaluate the degree of scoliosis spine curvature severity. 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.[17]

The gold-standard parameter that is 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.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.[17] However manual assessment of spine curvature is gold standard, time consuming and experience factors affect its precision [18]

If the Cobb angle is less than 10 degrees, it is considered within normal range. 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.[18]

Adam's Forward Bend test

One of the simpler screening 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 clinician 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[19][20].

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. [17][20]Before placing the scoliometer on the back, the patients were asked to do a standing forward bend. In this position, they looked down and kept their feet apart, their shoulders loose, and knees extended, and put their hands in front of their knees with their elbows straight and palms opposed[21]. A scoliometer was then used at two areas of interest: one at the thoracic hump and the other at the lumbar hump, The inclination is measured by placing the scoliometer on the back hump according to Adam’s forward bending test.

Korovessis et al. published a study describing how to predict scoliotic Cobb angle with one parameter using a scoliometer. The formulas were TC = 1.62 TI + 6.30 (TC = predicted thoracic angle, TI = apical thoracic scoliometer value) and LC = 1.58 LI + 7.36 (LC = predicated lumbar Cobb angle, LI = apical lumbar scoliometer value).[22]The two-parameter formulas can be used in clinical practice to test for scoliosis in schools. In order to anticipate scoliotic curvature, the scoliometer can be a very useful tool when using these two-parameter formulas. When screening for idiopathic scoliosis, a scoliometer and these two-parameter formulas are likely to be more effective than X-rays. This can alleviate worries about radiation exposure while also reducing medical expenses. Additionally, healthcare providers without X-ray equipment can more easily obtain scoliometers. For the evaluation of thoracic curves, the interexaminer reliability of the Scoliometer and Adam's forward bend tests is sufficient. In the lumbar spine, the Scoliometer has superior interexaminer agreement.

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.[17]

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.[17] 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.[23]

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.[17]

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. [17]

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. [17]

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.[17]

CobbMeter

Cobb meter app

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 excellent reliability[17]

Investigating the accuracy and repeatability of CobbMeter, It was proven that it 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[24]

Scolio Detector

scolio detector app

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, works as a traditional scoliometer and measures angle of trunk rotation (ATR).

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.[17]


Scoliosis Tracker

Scoliosis tracker is designed to measure, record and track adolescent scoliosis. It's a sensor based application that uses Accelerometer Gyroscope, providing a digital scoliometer to measure ATR. It also provides a checklist to track patient's compliance to traditional such as (bracing, vitamin D and physical therapy)[17]

It has an advantage of Tracking curve progression over time but it can be affected by biases due to the gyroscope drift.

Validity

In a study that was designed to test the accuracy, precision, and calibration of several scoliometer applications available on both the Apple iPhone and Samsung Galaxy platforms in comparison with the gold standard (manual scoliometer), It was found that The Apple iPhone applications (scolitrack and scoligauge apps) showed minimum bias, maximum precision, maximum accuracy, and fine calibration and were superior to both the Android application (scoliometer app and scoliosis measurement app) and the traditional manual scoliometer. Furthermore, pricing had no effect on quality or efficacy, and the free program outperformed the pricey program.

It's also worth mentioning that the study found that the Android (scoliosis measurement app) made severe overestimates of 4–5 degrees, all of which were associated with an angle between 25 and 30 degrees. [25]

References

  1. ↑ Illés, Tamás S., et al. “The Third Dimension of Scoliosis: The Forgotten Axial Plane.” Orthopaedics & Traumatology: Surgery & Research, vol. 105, no. 2, Apr. 2019, pp. 351–359.
  2. ↑ Lenz M, Oikonomidis S, Harland A, Fürnstahl P, Farshad M, Bredow J, et al. Scoliosis and Prognosis—a systematic review regarding patient-specific and radiological predictive factors for curve progression. European Spine Journal. 2021 Mar 26;30(7):1813–22.
  3. ↑ Sun XY, Kong C, Zhang TT, Lu SB, Wang W, Sun SY et al (2019) Correlation between multifdus muscle atrophy, spinopelvic parameters, and severity of deformity in patients with adult degenerative scoliosis: the parallelogram efect of LMA on the diagonal through the apical vertebra. J Ortho Surg Res 14(1):276
  4. ↑ Shahnawaz Haleem, Colin Nnadi, Scoliosis: a review,Paediatrics and Child Health,Volume 28, Issue 5,2018,Pages 209-217,ISSN 1751-7222,
  5. ↑ 5.0 5.1 York, P.J. and Kim, H.J., 2017. Degenerative scoliosis. Current reviews in musculoskeletal medicine, 10, pp.547-558.
  6. ↑ Lee, S.H., Park, S.W., Kim, Y.B., Nam, T.K. and Lee, Y.S., 2017. The fatty degeneration of lumbar paraspinal muscles on computed tomography scan according to age and disc level. The Spine Journal, 17(1), pp.81-87.
  7. ↑ Hwang, D.W., Kim, K.T., Lee, S.H., Kim, J.Y. and Kim, D.H., 2014. Association of COL2A1 gene polymorphism with degenerative lumbar scoliosis. Clinics in orthopedic surgery, 6(4), pp.379-384.
  8. ↑ Lee, S.H., Park, S.W., Kim, Y.B., Nam, T.K. and Lee, Y.S., 2017. The fatty degeneration of lumbar paraspinal muscles on computed tomography scan according to age and disc level. The Spine Journal, 17(1), pp.81-87.
  9. ↑ Scaturro D, Costantino C, Terrana P, Vitagliani F, Falco V, Cuntrera D, et al. Risk Factors, Lifestyle and Prevention among Adolescents with Idiopathic Juvenile Scoliosis: A Cross Sectional Study in Eleven First-Grade Secondary Schools of Palermo Province, Italy. International Journal of Environmental Research and Public Health. 2021 Nov 24;18(23):12335.
  10. ↑ Scaturro D, Costantino C, Terrana P, Vitagliani F, Falco V, Cuntrera D, et al. Risk Factors, Lifestyle and Prevention among Adolescents with Idiopathic Juvenile Scoliosis: A Cross Sectional Study in Eleven First-Grade Secondary Schools of Palermo Province, Italy. International Journal of Environmental Research and Public Health. 2021 Nov 24;18(23):12335.
  11. ↑ de Assis SJC, Sanchis GJB, de Souza CG, Roncalli AG. Influence of physical activity and postural habits in schoolchildren with scoliosis. Archives of Public Health. 2021 Apr 29;79
  12. ↑ Pan XX, Huang CA, Lin JL, Zhang ZJ, Shi YF, Chen BD, et al. Prevalence of the thoracic scoliosis in children and adolescents candidates for strabismus surgery: results from a 1935-patient cross-sectional study in China. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society [Internet]. 2020 Apr 1;29(4):786–93.
  13. ↑ Nasr, A.S. et al. (2024) The effect of limb length discrepancy on spinopelvic posture, International Journal of Orthopaedics Sciences.
  14. ↑ Stokes I.A. Axial Rotation Component of Thoracic Scoliosis. J. Orthop. Res. Off. Publ. Orthop. Res. Soc. 1989;7:702–708.
  15. ↑ Shin, G.-D., Kim, S.-G., & Kim, K. (2022). Reliability and validity of angle of trunk rotation measurement using smartphone and 3D printing technology in scoliosis. The Journal of Korean Physical Therapy, 34(6), 283–291.
  16. ↑ Vrtovec, T., Pernus, F., & Likar, B. (2009). A review of methods for quantitative evaluation of axial vertebral rotation. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 18(8), 1079–1090.
  17. ↑ 17.00 17.01 17.02 17.03 17.04 17.05 17.06 17.07 17.08 17.09 17.10 17.11 Bottino L, Settino M, Promenzio L, Cannataro M. Scoliosis management through apps and software tools. International Journal of Environmental Research and Public Health. 2023 Apr 14;20(8):5520.
  18. ↑ 18.0 18.1 Horng M-H, Kuok C-P, Fu M-J, Lin C-J, Sun Y-N. Cobb Angle measurement of spine from X-ray images using convolutional neural network. Comput Math Methods Med [Internet]. 2019;2019:6357171. Available from:
  19. ↑ Karpiel I, Ziębiński A, Kluszczyński M, Feige D. A survey of methods and technologies used for diagnosis of scoliosis. Sensors (Basel) [Internet]. 2021;21(24):8410.
  20. ↑ 20.0 20.1 Chowanska J., Kotwicki T., Rosadzinski K., Sliwinski Z. School Screening for Scoliosis: Can Surface Topography Replace Examination with Scoliometer? Scoliosis. 2012;7:9.
  21. ↑ Horne JP, Flannery R, Usman S. Adolescent idiopathic scoliosis: diagnosis and management. Am Fam Physician. 2014;89:193–198.
  22. ↑ Korovessis PG, Stamatakis MV. Prediction of scoliotic Cobb angle with the use of the scoliometer. Spine. 1996;21:1661–1666.
  23. ↑ Akazawa T, Torii Y, Ueno J, Saito A, Niki H. Mobile application for scoliosis screening using a standard 2D digital camera. Cureus. 2021 Mar 17
  24. ↑ Qiao, J., Liu, Z., Xu, L., Wu, T., Zheng, X., Zhu, Z., Zhu, F., Qian, B., & Qiu, Y. (2012). Reliability analysis of a smartphone-aided measurement method for the Cobb angle of scoliosis. Journal of Spinal Disorders & Techniques, 25(4), E88–E92.
  25. ↑ Naziri Q, Detolla J, Hayes W, Burekhovich S, Merola A, Akamnanu C, et al. A systematic review of all smart phone applications specifically aimed for use as a scoliosis screening tool. Journal of Long-Term Effects of Medical Implants. 2018;28(1):25–30.
Retrieved from "https://www.physio-pedia.com/w/index.php?title=Software_Applications_for_Scoliosis_Assessment&oldid=375719"