Διαφάνεια 1 - ResearchGate

Tzaneio”” General Hospital of Piraeus, Greece
Trauma & Orthopaedic Department “Tzaneio
ISICO meeting, Milano, Italy, 15 March 2014
The double rib contour sign (DRCS) & the
rib index (RI): aetiological implications for
idiopathic scoliosis & clinical applications
15 min lecture
Dr Theodoros B. GRIVAS, MD PhD
Orthopaedic & Spinal Surgeon
Director of the Trauma and Orthopaedic Department
“Tzanio” General Hospital of Piraeus, Greece
“Scoliosis” Chief Editor http://www.scoliosisjournal.com/
President of International Research Society of Spinal Deformities (IRSSD) &
Past President of Society on Scoliosis Orthopaedic and Rehabilitation Treatment SOSORT
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
Key points
1. what is the DRCS and the RI – Description
2. the study source origin – School screening for IS – the history of
presentation - publication
3. quantification of the DRC sign - RI
4. reliability study
5. how much the rib index is affected by the distance between the
radiation source and the irradiated individual
6. implications on aetiology of IS
7. clinical application in physiotherapy
8. clinical application in brace treatment
9. clinical application in surgical treatment
10. implications for Screening policies
11. inclusion in textbooks
12. references
13. citations in Google Scholar
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
1. DRCS & RI
DRCS & RI ?
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
1. Description
All lateral spinal radiographs in
IS show a DRC sign of the
thoracic cage, a radiographic
expression of the rib hump.
The outline of the one hemithorax (convex) overlies the
contour of the other hemi-thorax
(concave) ribs.
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
1. Description
the rib index (RI) method extracted
from the double rib contour sign
(DRCS) was introduced to evaluate
rib hump deformity in IS patients,
attempting to create a safe
reproducible way to assess the rib
hump deformity based on lateral
radiographs
Radiological evaluation of thoracic cage
deformity (assessment of hump severity)
d2
d1
d2
d1
6
1. Description
Lenke 1AN curve
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
2. the study source origin – School screening for IS
Studies derived from scoliosis
school screening referrals
2. the history of presentation - publication
3. quantification of the DRC sign
“rib index” is defined as the
d1/d2 ratio (calculated by the
ratio of spine distances d1/d2 ) where
d1 = the distance between the most
extended point of the most extending rib
contour & the posterior margin of the
corresponding vertebra on the lateral scoliosis
films, while
d1
d2 = the distance from the least projected rib
contour & the posterior margin of the same
vertebra.
A symmetric & non-deformed thorax the
RC lines are practically superimposed &
the “rib index” is
1
d2
3. quantification of the DRC sign
rib index =
d1
d1
d2
d
2
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
4. Reliability study
RELIABILITY STUDY FOR THE “RIB
INDEX” IN CHEST RADIOGRAPHS OF
A CONTROL GROUP
Soultanis K, Tsiavos K, Grivas TB, Stavropoulos N, Sakellariou V,
Mavrogenis A, Papagelopoulos P: 2014 SOSORT Meeting Wiesbaden
intra-observer error = 0.0080
inter-observer error = 0.0213
5. HOW MUCH THE RIB INDEX IS AFFECTED BY THE
DISTANCE BETWEEN THE RADIATION SOURCE AND THE
IRRADIATED INDIVIDUAL?
SOSORT Wiesbaden Meeting 2014
Using the Euclidean geometry it is shown that in a normal child 12 years of age,
provided that the distance ∆Z ≈ 12cm (11,84) & EA = 180cm, with transverse ribcage
diameter of the child 22 cm, then d1/d2 = 1.073.
It is demonstrated that the DRCS is substantially true & practically
the RI is not affected by the distance between the radiation source & the
irradiated child
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
6. Implications on aetiology of IS
the DRC sign was assessed in
children w/ & w/out late onset
idiopathic scoliosis (LOIS) w/
10 - 20 Cobb angle & was
examined whether the
deformity of the thorax or that
of the spine develops first in
IS
6. Implications on aetiology of IS
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
material & methods
spinal radiographs
n=133 children
47 boys mean age 13.28 years
86 girls, mean 13.39 years
ATI  7 
• Cobb
angle
• Lateral spinal profile
angle made by a line drawn down the posterior surface
of each vertebral body (T1- L5) & by the vertical
T1 - L5 segmentally
6. Implications on aetiology of IS
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
material & methods
group 1 no scoliosis straight spines
n = 27 (12boys 15girls)
group 2 no scoliosis, spinal curvature having
a Cobb angle 1° - 9°
n=13, (6 boys + 7 girls )
group 3 thoracic scoliosis 10° - 20°
n=47 (17 boys + 30 girls )
group 4 thoracolumbar scoliosis 10° - 20°
n=14 (4 boys + 10 girls)
group 5 lumbar scoliosis 10° - 20°
n=28 (7 boys + 21 girls)
Group 1 = no scoliosis - straight spines
n = 27 (12boys 15girls)
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
6. Implications on aetiology of IS
material & methods
Statistical analysis
•
•
•
•
•
•
SPSS-PC v 10 package
frequencies
descriptive (mean, range, min, max, sd dev,
sd err, kurtosis, skewness)
ANOVA
Kruskal-Wallis test & scatter plot
Pearson Correlation coefficient
independent Samples T-test
6. Implications on aetiology of IS
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
results
There are no
sex differences
for the “rib
index”
6. Implications on aetiology of IS
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
results
mean “rib index”
Group 1 = 1.45
Group 2 = 1.51
Group 3 = 1.56
Group 4 = 1.59
Group 5 = 1.47
6. Implications on aetiology of IS
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
results
for boys + girls there is no
correlation of the Cobb angle
to the “rib index” of
• thoracic,
• thoraco-lumbar &
• lumbar mild IS groups
(scoliosis 10°-20° Cobb angle )
6. Implications on aetiology of IS
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
Discussion
In all school-screening
referrals, (having ATI  7º),
the thorax deformity, in
terms of the DRCS has
been already developed
6. Implications on aetiology of IS
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
Discussion
• straight spines
20 %
• curves w/ Cobb angle 1º- 9º
10 %
• IS
70%
The non-scoliotics were followed due to
the existing RH, they were 1,5-2 years
younger than the ones who had already
developed IS and they had both a RI  1,5
6. Implications on aetiology of IS
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
Discussion
The DRC sign is present in all
referrals;
in contrary there is no scoliotic
spine without it, as the DRC sign
is always present in scoliotic
lateral spinal radiographs w/ no
exception
6. Implications on aetiology of IS
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
Discussion
The DRCS results primarily
due to rib deformation and
secondarily to vertebral
rotation, because DRCS
could be present in straight
spines with no vertebral
rotation
6. Implications on aetiology of IS
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
Discussion
This observation supports
the hypothesis that in AIS
the deformity of the thorax
develops first & the
deformity of the spine
succeeds
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
7. Application in PT
Rib Index, an objective measure to document changes of the rib hump
deformity in a Risser 4 progressive AIS patient treated with the Schroth
Method
Andrea Lebel, RPT MCPA, MPT, Victoria Lebel, B.A.Sc., M.Sc., Saba University School of Medicine
(2016)
SOSORT Wiesbaden Meeting 2014
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
8. Application in Brace treatment
8. Application in Brace treatment
Lenke 1AN curve
We can Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
Brace
treatment
T8.-Application
L curve AISin
girl
presentation
AIS T- L curve
9. Application in Surgery for IS
Assessment of Rib Hump Deformity Correction in
Adolescent IS w/ & w/out Costoplasty Using the Double
Rib Contour Sign.
Lykissas MG, Sharma V, Crawford AH.
J Spinal Disord Tech. 2012 Sep 28. [Epub ahead of print]
[PubMed - as supplied by publisher]
PMID: 23027365
9. Application in Surgery for IS
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
9. Application in Surgery for IS
9. Application in Surgery for IS
Measurement of rib hump deformity correction in adolescent
idiopathic scoliosis treated with full screw or hybrid constructs using
the double rib contour sign.
Stavropoulos NA, Soultanis KC, Grivas TB, Tsiavos K, Starantzis K, Sarlikiotis T, Karamanis E,
Papagelopoulos PJ. 15th EFORT Congress, London, United Kingdom, 4 - 6 June 2014
RI=1.36
RI=1.40
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
10. implications for screening policies
evidence-based recommendations for the
improvement of SSS effectiveness
10. implications for screening policies
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
Recommendations for improvement of a SSS program
 30% of younger referred girls (aged <13 yrs old)
w/ an ATR ≥ 7° were found to have either a
straight spine or a spinal curve under 10°. In
this age group the correlation between clinical
deformity & radiographic measurement is not
statistically significant, while in older referred
girls (aged 14–18 yrs old) it does.
Therefore, in all younger individuals who are
identified with a surface deformity but w/out a
severe scoliotic curve are at risk for IS
development & need to be kept under
observation & not discharged from regular
follow-up
11. inclusion in textbooks
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
reference as a radiological test in Spinal Textbooks
12. reference
Grivas TB, Dangas S, Polyzois BD, Samelis P: The Double Rib Contour Sign (DRCS) in lateral spinal
radiographs: aetiologic implications for scoliosis. Stud Health Technol Inform. 2002; 88:38-43.
American College of Radiology (ACR) – SPR practice guideline for the performance of radiography for
scoliosis in children. Revised 2009,
http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Scoliosis.pdf
Grivas TB: Survey on the lower limbs of early school age children. 1988, PhD Thesis, National Kapodistrian
University of Athens, Greece, http://www.didaktorika.gr/eadd/handle/10442/3440
Grivas TB, Dangas S, Polyzois BD, Samelis P: The Double Rib Contour Sign (DRCS) in lateral spinal
radiographs: aetiologic implications for scoliosis. Stud Health Technol Inform. 2002; 88:38-43.
Lykissas MG, Sharma V, Crawford AH (2012). Assessment of Rib Hump Deformity Correction in Adolescent
Idiopathic Scoliosis With or Without Costoplasty Using the Double Rib Contour Sign. J Spinal Disord
Tech. 2012, Sep 28. [Epub ahead of print]. PMID: 23027365
Grivas TΒ, Triantafyllopoulos G, Mazioti C: Assessment of early rib hump deformity correction in adolescent
idiopathic scoliosis treated with a dynamic derotation brace using the double rib contour sign. 10th
International Conference on Conservative Management of Spinal Deformities, 8th SOSORT Annual Meeting,
Proceedings Book of the Meeting, 2013, page 37, Chicago, Illinois, USA Wednesday, May 8 through
Saturday, May 11,
Grivas TΒ, Triantafyllopoulos G, Mazioti C: Assessment of early rib hump deformity correction in adolescent
idiopathic scoliosis treated with a dynamic derotation brace using the double rib contour sign.
Scoliosis 2013, 8(Suppl 2):O54.
Stavropoulos NA, Soultanis KC, Grivas TB, Tsiavos K, Starantzis K, Sarlikiotis T, Karamanis E, Papagelopoulos
PJ (2014): Measurement of rib hump deformity correction in adolescent idiopathic scoliosis treated
with full screw or hybrid constructs using the double rib contour sign. 15th EFORT Congress, London,
United Kingdom, 04 - 06 June 2014
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
13. Citations in Google Scholar
Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
Summary
1. what is the DRCS and the RI – Description
2. the study source origin – School screening for IS – the history of
presentation - publication
3. quantification of the DRC sign - RI
4. reliability study
5. how much the rib index is affected by the distance between the
radiation source and the irradiated individual
6. implications on aetiology of IS
7. clinical application in physiotherapy
8. clinical application in brace treatment
9. clinical application in surgical treatment
10. implications for Screening policies
11. inclusion in textbooks
12. references
13. citations in Google Scholar
Trauma and Orthopaedic Department
“Tzanio” General Hospital of Piraeus, 2014
Moutsopoulou Coast
Thank you very much for your attention
Tzanio
Hospital
1864

Download Report