Assessment of brace local action on vertebrae relative poses

Bracing is a widely used treatment of scoliosis, but there is still no consensus about its actual effect. Previous studies were based on global descriptors of the spine shape (Cobb angle, plane of maximal deformity, etc.). We present a new method to analyze braces effects at a finer scale and to find which vertebral levels are significantly affected by this treatment. The proposed method compares a group of patients treated with a brace and a control group. The 3D spine geometry of the patients from the two groups was digitized on two separate occasions: with and without brace (first group) or two times without brace (control group). The modifications of the vertebrae relative poses (combination of relative translation and rotation between consecutive vertebrae) were then extracted from 3D reconstructions. Centrality and dispersion measures of the relative poses modifications were computed using a method that take into account the non-linearity of the rotation matrix. Then, finally, multivariate hypothesis tests were used to compare the centrality and dispersion of the two groups. The method was applied to 28 untreated scoliotic patients and 41 patients treated with a Boston brace. Significant differences (p<0.01) between the centrality and dispersion measures of the relative poses modifications were respectively found from T1 to T6 and from T8 to L1. Those significant differences concords with the back flattening effect and the spatially limited correction found in other studies; however the proposed method offers a more specific evaluation of the localization of those effects.