Markerless Surface Topography for Adolescent Idiopathic Scoliosis Screening, Torso Aesthetic Appearance Assessment, and Postural Outcomes Evaluation
Creators: Mohamed, Nada
Publisher: name: University of Alberta Library
Year: 2024

<p>The primary goal of conservative treatment for adolescents with idiopathic scoliosis (AIS) is to prevent the spinal curve from worsening. Other goals of treatment are to improve aesthetic outcomes through postural correction, address respiratory dysfunction, and treat pain symptoms.<br>
The likelihood of curve worsening during growth depends on several factors, such as age at diagnosis, skeletal age, and menarche presence for females. The spinal curvature may worsen during the rapid growth period, especially in girls. Screening for scoliosis aims to detect the condition early and treat it to avoid progression, potentially allowing for less invasive options. Screening for AIS involves conducting a surface assessment by a clinical expert in order to recommend a referral for radiographic exam evaluation for scoliosis confirmation. The Cobb angle measured from a standing posterior-anterior radiograph is used to confirm and diagnose scoliosis. However, current screening techniques like the Adam’s forward bend test and the angle of trunk measurement have high referral rates with many false-positives and expose patients to unnecessary radiation from x-rays.<br>
Additionally, aesthetic appearance of the torso is emphasized in scoliosis treatment since AIS patients are concerned with their appearance, which affects their self-image and their quality of life. Surface topography (ST) systems, trunk asymmetry scales, and back photography have been proposed to analyze aesthetic outcomes objectively. However, there is a lack of consensus and research on how to measure aesthetic outcomes effectively.<br>
One of the highlighted goals of scoliosis treatment is to improve appearance and posture, which can be achieved through exercise regimens. The Schroth method is a physiotherapeutic scoliosis-specific exercise (PSSE) designed to correct posture. Although the Schroth method has shown promising results in reducing the Cobb angle, improving muscle endurance, and improving quality of life aspects, its impact on external deformity and aesthetics requires further investigation.<br>
Surface topography (ST) presents a noninvasive approach for assessing torso asymmetry, which was developed previously to estimate curve severity and progression. The ST method is an alternative tool for screening and detecting idiopathic scoliosis in adolescents. ST also offers the potential for objectively evaluating posture and aesthetic outcomes.<br>
The purpose of this thesis was to develop the ST method for scoliosis screening, and to assess the ST method as a tool for aesthetic torso appearance evaluation to determine the effect of Schroth program on posture outcomes. <br>
In the first objective of the thesis, patterns of asymmetry revealed from the ST method and extracted parameters were evaluated to develop a classification scoliosis screening model. This work developed a scoliosis screening model using ST deviation and torso depth maps to detect AIS from children with typically developing spines using convolutional neural networks (CNN, a deep learning algorithm). A sensitivity of 97% and a specificity of 90% for classifying positive and negative AIS cases were observed. The model was also validated with external data and compared with clinical screening tools, where preliminary results of the developed model obtained a higher specificity than the Adam’s forward bend test and comparable specificity with the scoliometer test. <br>
Another objective of the thesis, which was to determine the potential use of ST as an aesthetic assessment tool, parameters from ST analysis were also evaluated to assess responsiveness and association with patient perception of their back condition during six months of conservative treatment. The effect of the Schroth PSSE program added to the standard of care on external asymmetries and aesthetics was evaluated using the ST method. This work determined the minimally important change (MIC) in surface topography asymmetry measurements for patients to perceive an improvement in their back condition. This work has shown an overall accuracy of 68%, a sensitivity of 62%, and a specificity of 74% for the MIC thresholds to detect perceived back improvement.  In addition to routine care (observation or bracing), Schroth exercise therapy reduced asymmetry measurements in AIS and exceeded the estimated MIC of the ST parameters.<br>
This thesis revealed the markerless ST technique as a potential method for scoliosis screening tool, and a posture and aesthetics evaluation tool, in addition to previous research of using ST to predict curve severity and progression.</p>