Global geometric torsion estimation in adolescent idiopathic scoliosis

Several attempts have been made to measure geometrical torsion in adolescent idiopathic scoliosis (AIS) and quantify the three-dimensional (3D) deformation of the spine. However, these approaches are sensitive to imprecisions in the 3D modeling of the anatomy and can only capture the effect locally at the vertebrae, ignoring the global effect at the regional level and thus have never been widely used to follow the progression of a deformity. The goal of this work was to evaluate the relevance of a novel geometric torsion descriptor based on a parametric modeling of the spinal curve as a 3D index of scoliosis. First, an image-based approach anchored on prior statistical distributions is used to reconstruct the spine in 3D from biplanar X-rays. Geometric torsion measuring the twisting effect of the spine is then estimated using a technique that approximates local arc-lengths with parametric curve fitting centered at the neutral vertebra in different spinal regions. We first evaluated the method with simulated experiments, demonstrating the method's robustness toward added noise and reconstruction inaccuracies. A pilot study involving 65 scoliotic patients exhibiting different types of deformities was also conducted. Results show the method is able to discriminate between different types of deformation based on this novel 3D index evaluated in the main thoracic and thoracolumbar/lumbar regions. This demonstrates that geometric torsion modeled by parametric spinal curve fitting is a robust tool that can be used to quantify the 3D deformation of AIS and possibly exploited as an index to classify the 3D shape.