Study of Posterior Trunk Surface Changes by Age and Sex Using Moiré Topography

Size: px

Start display at page:

Download "Study of Posterior Trunk Surface Changes by Age and Sex Using Moiré Topography"

Thomas Rose
6 years ago
Views:

5 Study of Posterior Trunk Surface Changes by Age and Sex Using Moiré Topography Grivas T.B.*, Karras G.E.**, Katrabasas J.*, Papavasiliou N.* Spinal Disorders and Moiré Topography Laboratory, A Orthopaedic Department, "Evangelismos" Hospital, 45 Ipsilandou Str., GR-10676, Athens, Greece* Department of Surveying, N.T.U.A., GR-15780, Athens Greece** Abstract: This paper is a cross-sectional study of posterior trunk surface morphology variations in healthy Greek controls, by age and sex, using Moiré Topography (MT), and a database for comparison with the counterpart data of low back pain patients. Moiré images of 131 controls (65 men aged and 74 women aged 8-82) were examined and assessed with a modified Moreland classification. No subject was suffering scoliosis clinically or radiographically. Frequencies of the various contour prototypes are presented for the right and left parts of the posterior trunk surface. Statistically significant changes were found by age: In women, results indicate that kyphosis increases by age due to trunkal changes of the upper thoracic and lower cervical region. Lumbar lordosis decreases by age due to changes of the lower lumbar region and inclination of pelvis, in both women and men. In men, unlike women, no change was basically found by age in the upper thoracic region. These findings reflect 3-D change by age in the posterior trunk surface. Our hypothesis is that these changes are related to osteoporosis, especially in women, and probably form part of the aetiological base for low back pain. INTRODUCTION In the last two decades, MT has been widely used for screening and documentation of scoliosis and other trunk deformities, in the assessment and treatment of chronic back pain, in the study of trunkal posture in pregnancy, of variations in breast geometry during pregnancy and of change in breast form resulting from certain brassières. For the classification of human standing postures, in particular, various reports using the moiré technique have been reported [4]. The objective of this contribution is the cross-sectional study of variations of posterior trunk surface morphology in healthy Greek controls, by age and sex, using MT, and the creation of a database for comparison with the counterpart data of low back pain patients. MATERIALS AND METHODS For the last three years, our MT set-up functions at the Spinal Disorders & Moiré Topography Laboratory of the A Orthopaedic Department of Evangelismos Hospital (Athens) and has been well documented. For assessment of fringes, a modified Moreland fringe classification [3] was used, in that we also added A-patterns for the cervical region, i.e. the Λ-shaped fringes over M1. In total, 131 controls (65 men + 74 women, aged and 9-82, respectively, as shown in Fig. 1) have been examined; none among them was suffering scoliosis clinically or radiographically. The statistical analysis techniques used were: histograms frequencies, Mann-Whitney and Kruskal-Wallis tests and multiple linear regression analysis (MLRA) Men age in years Figure 1: Age distribution of sample Women age in years

6 FINDINGS The frequencies of the various contour prototypes (A, M1, O1, W, M2, O2) are presented for the right and left halves of the posterior trunk surface for men and women (Fig. 2). Using MLRA, we found the following statistically significant changes by age. In women: both legs (right and left) of A and M1 increase numerically. The right O1 decreases, while both legs of M2 also decrease. In men: the left O1 increases, while both legs of M2 decrease. Results of fringe asymmetries (right minus left) in men and in women for the six regions of interest is presented in Table 1. Asymmetry of ±3 fringes is a rare but existing phenomenon. TABLE 1. Fringe asymmetry (D: right minus-left difference) MEN WOMEN 0 ±1 ±2 ±3 0 ±1 ±2 ±3 DA 100% % DM1 100% % DO1 32.3% 46.2% 18.5% 3.1% 37.8% 40.5% 16.3% 5.4% DW 58.5% 30.8% 10.8% 1.5% 68.9% 23.0% 14.9% 1.4% DM2 80.0% 15.4% 4.6% % 25.7% 2.7% - DO2 53.8% 30.8% 15.4% % 31.1% 8.1% 2.7% DISCUSSION Σφάλμα! Λανθασμένη σύνδεση. Σφάλμα! Λανθασμένη σύνδεση. Figure 2: Frequencies of contour prototypes for women and men Our results indicate that in women kyphosis increases by age due to trunkal changes in the upper thoracic and lower cervical regions. Lumbar lordosis decreases by age due to changes in the lower lumbar region and inclination of pelvis, in both men and women. In men, dissimilarly to women, no changes by age were found in the upper thoracic region except a left O1 increase. Similar findings as to the postural changes have been reported [4] for a sample of healthy Japanese a- dults. It is stated that the degrees of lumbar lordosis and thoracic kyphosis are mutually related in the group under forty years of age. In the group over forty years, their correlation coefficient decreases. The most apparent changes with age are seen in the thoracic region which, it is believed, influences the upper and lower parts of the spine. When compensation for these changes becomes insufficient within the spinal column, it occurs in the pelvis, the hip joint and the knee joints. Changes caused by age are more apparent in females than in males: they begin with the fifth decade in males and with the third in females. The final posture resembles that of an anthropoid. The same group reports that in aged people a severe round back decreases the ability of physical activity due to the inadequate position of the centre of gravity. When kyphosis increases, the cervical lordosis increases, too. This change can lead to severe spondylotic changes in the cervical spine causing neck and shoulder pain. Thus, it is suggested that appropriate posture education is useful in very young children while they are still flexible, both physically and emotionally, since it is completely impossible to correct malpostures in adults. Some recent findings suggest that thoracic cage (remodelling) changes, which seem to be part of the aging process, have a role in the LBP aetiology [2]. Other reports have indicated that the topograms of individuals suffering low back pain (LBP) before and after a one-month programme of physiotherapy showed a reduction of kyphotic and lordotic curves which coincided with a reduction in back pain. A clockwise axial rotation of the trunk about the hips observed prior to treatment was absent following treatment. It is evident from our results, that asymmetries are more frequent in the O1, W, M2 and O2 regions, as described above. Thus, when considering a moiré topogram of a patient we must take into account the possibility of these constitutional asymmetries. It is reported [1] that in children with clinically straight spines main findings were: about 1:4 had objectively detectable rib lumbar humps; female to male ratios were 1.2:1 for the thoracic region and 1.4:1 for the lumbar region; right humps were about 10 times more common than left. TASs in the boys and girls at each spinal level had normal distributions about means to the right of zero (where zero represents perfect symmetry). Willner [5] reported that children with small clinical and moiré asymmetries (deviations of less than one fringe) had no or very small lateral deviations seen on the x-ray and should, therefore, be regarded rather as normal variations of the shape of the trunk. Other investigators reported that their study confirmed a wide prevalence of clinically evident asymmetries of the trunk. These asymmetries were ac-

7 companied by a measurable rib hump and/or lumbar prominence. For the rib hump, an asymmetry is regarded as physiological when not exceeding 0.8 mm (a 2 fringe discrepancy for our system); for lumbar prominence not exceeding 0.5cm (corresponding to 1 fringe in our system). The mechanisms for the above changes is probably quite complicated and may include CNS and myosceletal system changes, involved in the aging process. CONCLUSIONS The findings of this study reflect 3-D change by age in the posterior trunk surface. In our sample, the most pronounced changes with age are seen in the upper thoracic and lower cervical regions (women) and in the lower lumbar region (men). Change caused by age is more apparent in females than in males. We make the hypothesis that these changes are related to osteoporosis, especially in women, and are probably part of the aetiological base for low back pain. A thorough attention to fringe asymmetries can be the next step in LBP and adult scoliosis research; it could probably give some information regarding the reasons of failed LBP surgery. REFERENCES [1] Burwell RG, James NJ, Johnson F, Webb JK, Wilson VG, Standardised trunk asymmetry scores: a study of back contour in healthy schoolchildren. J. Bone Joint Surg., 65B, pp [2] Grivas TB, Zoulos D, Papavasiliou N, Is lumbar spine the only responsible for low back pain (LBP)? Segmental study of rib vertebrae angles in control and suffering LBP women. Eurospine '96. First Combined Meeting of the Leading European Spine Societies, October 16-19, Z rich. [3] Moreland MS, Barce CA, Pope MH, Moiré topography in scoliosis. pattern regognition and analysis. In: Moreland MS, Pope MH, Armstrong GWD (eds.), Moiré Fringe Topography and Spinal Deformity. Pergamon Press, N. York, pp [4] Suzuki N, Studies on postures of healthy Japanese adults: classificasion of postures and their relation to changes in different age groups. J. Jap. Otrhop. Ass., 52(4), pp [5] Willner S, Prevelence study of trunk asymmetries and structural scoliosis in 10-year-old school children. Spine, 9(6), pp

Dr. Theodoros B Grivas MD, PhD

Dr. Theodoros B Grivas MD, PhD 11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) Idiopathic Scoliosis definitions, detection, clinical picture