Exequibilidade da Técnica de Moiré de sombra na identificação de desvios posturais em escolares / Feasibility of shadow Moiré Technique to identify postural disorders in schoolchildren

O objetivo deste estudo foi examinar a exequibilidade do uso da Técnica de Moiré de Sombra (TMS) em triagens periódicas no ambiente escolar e estabelecer o estado da prevalência de desvios posturais em uma escola pública do município do Rio de Janeiro. A amostra se compôs por 304 alunos. O exame da TMS baseou-se na diferença do número de franjas nas regiões dorsal e cintura escapular. A exequibilidade foi identificada considerando-se parâmetros preestabelecidos. Identificaram-se 225 sujeitos com diferença de franjas na região dorsal, e 224 com diferença de franjas na cintura escapular. Quanto à exequibilidade, a amostra foi examinada em sete dias e não houve dificuldades na execução da técnica, no processamento das imagens e nos materiais requeridos. Considerou-se a TMS exequível para triagens populacionais, permitindo exames periódicos em larga escala. A TMS pode ser uma estratégia na implementação de programas de saúde pública na escola, objetivando a melhora da qualidade de vida.

This study aimed to examine the feasibility of the Shadow Moiré Technique (SMT) in carrying out periodic school screenings and to identify the prevalence of postural disorders in students from a public school in Rio de Janeiro. The sample was comprised of 304 students. The SMT exam was based on the difference in the number of fringes in the dorsal and scapulothoracic regions. The feasibility of the SMT was identified based on predetermined parameters. Two hundred and twenty-five subjects were identified with fringe difference in the dorsal region and 224 were identified with fringe difference in the scapulothoracic region. Regarding feasibility, the sample was examined over the period of 7 days. There were no difficulties in obtaining the materials, in the use of the technique or in the processing of the images. SMT was considered feasible to screen the population and it allows for large-scale periodic examination. The SMT can be a strategy for implementing public health programs at school aiming at improving the quality of life.

Cuantificación de cambios en la morfología externa de la espalda mediante topografía de superficie basada en luz estructurada en la escoliosis idiopática del adolescente tras un año de tratamiento con corsé ortopédico / Quantification of changes in the external morphology of the back by means of surface topography based on structured light in idiopathic scoliosis in adolescents after a year of treatment with orthopedic corse

Resumen: Antecedentes: Cuantificar los cambios morfológicos producidos en la superficie de la espalda de adolescentes con escoliosis idiopática como resultado del tratamiento mediante corsé y correlacionarlos con las variaciones radiográficas. Material y métodos: Estudio analítico, de cohortes, prospectivo, sobre una muestra de 31 adolescentes con escoliosis idiopática divididos en dos grupos: 11 con tratamiento mediante corsé y 20 sin corsé. Se realizó una cuantificación de la deformidad en dos ocasiones separadas entre sí por un intervalo de un año mediante tres sistemas: 1) ángulo de rotación del tronco (escoliómetro); 2) topografía de superficie; 3) radiografía simple de raquis completo. Resultados: No se detectaron diferencias estadísticamente significativas entre la valoración inicial y final de las variables topográficas y radiográficas en el grupo con corsé. En el grupo no tratado, sólo hubo diferencias significativas para las medidas del escoliómetro. Se encontró una correlación positiva entre la diferencia del ángulo de Cobb de la curva principal con la de dos variables topográficas que cuantifican la asimetría en el plano axial y en el coronal, respectivamente. Discusión: En el seguimiento de pacientes con escoliosis tratados con corsé, se deben tener en cuenta y valorar no sólo parámetros radiográficos como el ángulo de Cobb, sino también parámetros clínicos y topográficos que cuantifiquen la deformidad externa de la espalda, ya que existe una discrepancia clínico-radiográfica demostrada de manera amplia en la literatura. La mejoría de la forma externa de la espalda es un factor muy importante para el paciente y es lo que va a percibir fundamentalmente, lo que puede influir en una mejor cumplimentación del tratamiento ortopédico. En nuestro estudio, la curva escoliótica, así como la deformidad externa de la espalda, se mantuvo estable en el período de seguimiento tanto en los pacientes tratados con corsé como en los no tratados.

Abstract: Background: To quantify the morphological changes in the surface of the back of adolescents with idiopathic scoliosis as a result of treatment with braces and to correlate them with radiographic changes. Material and methods: An analytical, cohort, prospective study on a sample of 31 adolescents with idiopathic scoliosis. We divided them into two groups: eleven treated with braces and twenty without them. Quantification of the deformity was performed on two separate occasions with an interval of one year using three systems: 1) angle of trunk rotation (scoliometer); 2) surface topography; 3) full spine X-rays. Results: No statistically significant differences were detected between the initial and final assessment of the topographic and radiographic variables in the group with braces. In the untreated group, only in measures with the scoliometer significant differences were registered. A positive correlation was found between the Cobb angle difference of the main curve with two topographic variables that quantify the asymmetry in the axial and coronal plane, respectively. Discussion: In following patients with scoliosis treated with braces, we should consider and evaluate not only radiographic parameters such as the Cobb angle, but also clinical and topographic parameters that quantify the external deformity of the back, as there is a clinical-radiographic discrepancy amply demonstrated in the literature. The improvement of the external shape of the back is a very important factor for the patient, and can influence a better completion of the orthopedic treatment. In our study, the scoliotic curve and external deformity of the back remained stable during the follow-up period in both treated and untreated patients.

Correlation between Topographic Parameters Obtained by Back Surface Topography Based on Structured Light and Radiographic Variables in the Assessment of Back Morphology in Young Patients with Idiopathic Scoliosis

STUDY DESIGN: Optical cross-sectional study. PURPOSE: To study the correlation between asymmetry of the back (measured by means of surface topography) and deformity of the spine (quantified by the Cobb angle). OVERVIEW OF LITERATURE: The Cobb angle is considered the gold standard in diagnosis and follow-up of scoliosis but does not correctly characterize the three-dimensional deformity of scoliosis. Furthermore, the exposure to ionizing radiation may cause harmful effects particularly during the growth stage, including breast cancer and other tumors. METHODS: Patients aged 13.15±1.96 years (range, 7–17 years; n=88) with Cobb angle greater than 10° were evaluated with X-rays and our back surface topography method through three variables: axial plane (DHOPI), coronal plane (POTSI), and profile plane (PC). Pearson's correlation was applied to determine the correlation between topographic and radiographic variables. One-way analysis of variance and Bonferroni correction were used to compare groups with different grades of scoliosis. Significance was set at p<0.01 and, in some cases, at p<0.05. RESULTS: We detected a positive, statistically significant correlation between Cobb angle with DHOPI (r=0.810) and POTSI (r=0.629) and between PC variables with thoracic kyphosis angle (r=0.453) and lordosis lumbar angle (r=0.275). In addition, we found statistically significant differences for DHOPI and POTSI variables according to the grade of scoliosis. CONCLUSIONS: Although the back surface topography method cannot substitute for radiographs in the diagnosis of scoliosis, correlations between radiographic and topographic parameters suggest that it offers additional quantitative data that may complement radiologic study.

Adolescent Scoliosis Screening in Nara City Schools: A 23-Year Retrospective Cross-Sectional Study

STUDY DESIGN: Retrospective cross-sectional study. PURPOSE: To determine the prevalence of idiopathic scoliosis, define the distribution of the curve magnitude, evaluate the accuracy of Moire topography as a screening tool, and investigate the cost-effectiveness of our screening system. OVERVIEW OF LITERATURE: Early detection of idiopathic scoliosis provides the opportunity for conservative treatment before the deformity is noticeable. We believe that scoliosis screening in schools is useful for detection; however, screening programs are controversial owing to over referral of students who do not require further testing or follow-up. In Japan, school scoliosis screening programs are mandated by law with individual policies determined by local educational committees. We selected Moire topography as the scoliosis screening tool for schools in Nara City. METHODS: We selected Moire topography as the scoliosis screening tool for schools in Nara City. We screened boys and girls aged 11-14 years and reviewed the school scoliosis screening results from 1990 to 2012. RESULTS: A total of 195,149 children aged 11-14 years were screened. The prevalence of scoliosis (defined as > or =10degrees curvature) was 0.057%, 0.010%, and 0.059% in fifth, sixth, and seventh grade boys and 0.337%, 0.369%, and 0.727% in fifth, sixth, and seventh grade girls, respectively. The false-positive rate of our Moire topography was 66.7%. The minimum cost incurred for scoliosis detection in one student was 2,000 USD. CONCLUSIONS: The overall prevalence of scoliosis was low in the students of Nara City schools. Over 23 years, the prevalence of scoliosis in girls increased compared to that in the first decade of the study.

Moiré topography: an alternative to scoliosis evaluation in student's health

Moire's Topography (MT) is a method that detects scoliosis through shadows assymetry arised in the back. Few studies have discussed time of application, interpretation and operating cost. The aim of this study was to analyze operating aspescts of MT in students and to verify postural alterations by MT in the same group. 58 boys were analyzed in this study and through MT, the presence of shadow (fringes) in the back were evaluated where each assymetry corresponds to about 10º in Cobb's angle. MT marks were used to determine possible deviation. Data of interest received descriptive statistic analysis in variables such as total body mass, body mass index (BMI), weight, scoliosis, average time of analysis and diagnostic, and also the operation cost evaluation of equipment. Subjects (9,91 ± 0,79 years) showed total body mass of 37,83 ± 10,45kg, stature 1,42 ± 0,11m and BDI 18,53 ± 4,15 kg/m². The average time of analysis was 3,25 ± 0,29min. Among subjects 75% had deviation of one fringe in toracolumbar region that shows a scoliosis less than 10º. MT represented a fast method and of low operation cost that could be an important instrument in the screening of scoliosis. We concluded that MS confirmed to be practical and of easy handling where 94,6% subjects showed scoliosis. Our data suggests that the MSP insertion in the students' health care program of scoliosis identification is possible...

A Estereofotografia de Moiré (EFM) é um método que através da assimetria das sombras formadas no dorso detecta escoliose. Poucos os estudos tem discutido o tempo de análise, interpretação e custo operacional desta técnica. Os objetivos deste trabalho foram analisar os aspectos operacionais da (EFM) em escolares e; verificar desvios posturais pela EFM nesse mesmo grupo. Neste estudo foram analisadas 58 meninos e através da EFM, foram avaliadas a presença de sombras (franjas) no dorso, onde cada assimetria corresponde cerca de 10º no ângulo de Cobb. As marcações do EFM foram utilizadas para determinar os possíveis desvios. Os dados interesse receberam tratamento estatístico descritivo nas variáveis massa corporal total, índice de massa corporal (IMC), estatura, escoliose, tempo médio de análise e diagnóstico e, uma avaliação do custo operacional do equipamento. Os sujeitos (9,91 ± 0,79 anos) apresentaram uma massa corporal total de 37,83 ± 10,45kg, estatura 1,42 ± 0,11m e o IMC de 18,53 ± 4,15 kg/m². O tempo médio para análise foi de 3,25 ± 0,29min. Na amostra, 75% tiveram um desvio de até uma franja na região toracolombar o que indica uma escoliose menor que 10º. A EFM constituiu um método rápido e de baixo custo operacional podendo ser um instrumento importante no rastreamento de escoliose. Concluímos que a EFM de confirmou ser prático e de fácil manuseio que 94,6% dos sujeitos apresentaram escoliose. Os nossos dados sugerem que a é viável a inserção da EFM nos programas de saúde em escolares de detecção das escolioses...