Beruflich Dokumente
Kultur Dokumente
3
A. Tanguy and B. Peuchot
(Eds.)
IOS Press, 2002
81
Introduction
Assessment of back shape and posture in current clinical practice is largely
subjective and based on visual, non-standardized criteria and methods [1]. These can be
subject to significant error and provide no objective or reproducible three-dimensional
measurements. Only recently has a consensus been reached on the threshold of clinically
significant frontal plane spinal deformities [2]. However, this is still arbitrary and this is a
result of lessons learnt from the high incidence of false positive referrals of school
screenings. Indeed clinical decision making based on these results influences management,
as postural dysfunction is thought to relate to deformity and pain [3].
Although numerous commercial optical and computer systems are at our disposal
([4], [5], [6]) data on normal adolescent and adult back shape have so far been scarce [7],
[8j. This is obviously affecting the clinical certainty with which we can establish an
observed spinal curve as abnormal and therefore initiate an appropriate treatment. The
purpose of this study was to produce measurable values of normal back shape in young
adults, against which deformity could be defined.
J. A . Bettany
82
Saltikov
Young
Adults
1. Subjects
The participants were 48 volunteering young adults perceiving themselves as
"normal". All subjects had previously been cleared by school screening. Their age (18-28
years old) precluded curve deterioration, but which was close enough to adolescent
measurements at the end of growth.
2. Material and Methods
Back shape was assessed with the ISIS system. The ISIS frame was used in
conjunction with the "Stanmore" footplate so as to increase reliability [9], [10]. While
standing on the footplate within the frame, ten points on the patients' spines were palpated
and marked with black adhesive stickers, according to the protocol [11]. A light projector
scanned each patient's back using a rotating mirror, and the information was fed to and
processed by the ISIS computer. Trunk measurements in the frontal, sagittal and horizontal
planes were collected (a typical scan is shown in figure 1).
3. Results
Only 4 participants (8%) showed no curve. More than half of them (26 subjects 55%) demonstrated a single curve and the remaining, 18 subjects (37%), had a double
curve. Preponderance for a right sided spine shift was more pronounced than the left, as
indicated by the number of right and left sided curves found (77% right compared to only
52% left).
Mean values, standard deviations and confidence intervals for five variables in the
frontal, sagittal and horizontal planes were produced (Table 2). On average, thoracic
kyphosis was almost twice as large as lumbar lordosis.
84
J.A. Bettany
Saltikov
Young
Adults
Maximum skin
surface angle
N = 48
7.2
(3.0)
6.4-8.1
J.A. Bettany
Saltikov
Young
Adults
85
References
1] Gaily P M , Forster A L Human Movement,
A n Introductory
Text for Physiotherapy
Students:
Second
Edition. Churchill Livingstone, London, 1987, pp. 86-97.
[2] British Scoliosis Society. F i s t report of the multi-centre
study. Proceedings of the Annual Meeting 1986.
Exercise, Foundations
and Techniques
(Third Edition). F.A. Davis,
[3] Kisner C, Colby L A Therapeutic
Philadelphia, 1990, pp. 530-550.
[4] Moreland, M S, Pope, M H, Stokes, I F, Weierman, R. the clinical use of Moire topography for spinal
deformity. A perspective challenge. In Drerup, B, Frobin, W, Hierholzer, H, eds, Moire fringe
topography
and spinal deformity Gustav-Fisher, Stuttgart, New York, 1983, pp. 129-140.
[5] Turner-Smith, A R . A television computer three dimensional surface shape measurement system. Journal
of B i o m e c h a n i c s , 21(6), 1988, 515-529.
[6] Poncet, P, Delorme, S, Dudley, R et al. 3-D reconstructions of the external and internal geometries of the
trunk using laser and stereo-radiographic imaging techniques. In I A F Stokes (ed.) Research
into
spinal
deformities
2, 1999, pp. 21-24.
[7] Duff E S, Draper R C. Survey of Normal Adolescent Back Shape as Measured by ISIS. In Stokes, I F,
Pekelsky, Moreland, M S (eds.). Surface Topography
and Spinal Deformity IV, Gustav-Fisher, Stuttgart, New
York, 1987, pp. 163-169.
[8] Carr, A J, Jefferson, R J, Turner-Smith, A R, Beavis, A. An analysis of normal back shape measured by
ISIS scanning, Spine, 16(6), 1991, 656-659.
[9] Bettany, J A, Harrison, D J. The ISIS experience at the Royal National Orthopaedic Hospital. In Alberti,
A, Drerup, B, Hierholzer, E (ed.) Surface topography
and spinal deformity,
Gustav-Fisher, Stuttgart, New
York, 1992, 70-75.
[10] Bettany J A (1993). Topographical,
Kinesilogical
and Psychological
factors in the Surgical
Management
of A d o l e s c e n t Idiopathic
S c o l i o s i s . PhD Thesis, University of London, pp. 116-121.
[11J Oxford Metrics. Isis operating manual version 4.0, 1987, p. 11.
[12] Kendall H, Kendall F, Boynton D. Posture a n d P a i n . Williams and Wilkins, Baltimore, 1952.
[13] Burwell R, James N, Johnson F, Webb J, Wilson Y. Standardized Trunk Asymmetry Scores: A Study of
Back Contour in Healthy Schoolchildren. Journal of Bone and Joint Surgery, 65B(A), 1983 452-463.