Hubert Labelle

CHU Sainte-Justine, Montréal, Quebec, Canada

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Publications (405)484.62 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Study Design Cross-sectional descriptive study. Objectives To characterize breast asymmetry (BA), as defined by breast volume difference, in girls with significant adolescent idiopathic scoliosis (AIS), using magnetic resonance imaging (MRI). Summary and Background BA is a frequent concern among girls with AIS. It is commonly believed that this results from chest wall deformity. Although many women exhibit physiological BA, the prevalence is not known in adolescents and it remains unclear if it is more frequent in AIS. Breasts vary in shape and size and many ways of measuring them have been explored. MRI shows the highest precision at defining breast tissue. Methods Thirty patients were enrolled on the basis of their thoracic curvature, skeletal and breast maturity, without regard to their perception on their BA. MRI acquisitions were performed in prone with a 1.5-Tesla system using a 16-channel breast coil. Segmentation was achieved using the ITK-SNAP 2.4.0 software and subsequently manually refined. Results The mean left breast volume (528.32 ± 205.96 cc) was greater compared with the mean right breast volume (495.18 ± 170.16 cc) with a significant difference between them. The mean BA was found to be 8.32% ± 6.43% (p < .0001). A weak positive correlation was observed between BA and thoracic Cobb angle (0.177, p = .349) as well as thoracic gibbosity angle (0.289, p = .122). The left breast was consistently larger in 65.5% of the patients. Twenty patients (66.7%) displayed BA ≥5%. Conclusions We have described BA in patients with significant AIS using MRI. This method is feasible, objective, and very precise. The majority of patients had a larger left breast, which could compound the apparent BA secondary to trunk rotation. In many cases, BA is present independently of thoracic deformity. This knowledge will assist in counseling AIS patients in regards to their concerns with BA.
    Spine Deformity. 09/2014; 2(5):374–379.
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    ABSTRACT: Study Design Feasibility study to compare the effectiveness of 2 brace design and fabrication methods for treatment of adolescent idiopathic scoliosis: a standard plaster-cast method and a computational method combining computer-aided design and fabrication and finite element simulation. Objectives To improve brace design using a new brace design method. Summary of Background Data Initial in-brace correction and patient's compliance to treatment are important factors for brace efficiency. Negative cosmetic appearance and functional discomfort resulting from pressure points, humidity, and restriction of movement can cause poor compliance with the prescribed wearing schedule. Methods A total of 15 consecutive patients with brace prescription were recruited. Two braces were designed and fabricated for each patient: a standard thoracolumbo-sacral orthosis brace fabricated using plaster-cast method and an improved brace for comfort (NewBrace) fabricated using a computational method combining computer-aided design and fabrication software (Rodin4D) and a simulation platform. Three-dimensional reconstructions of the torso and the trunk skeleton were used to create a personalized finite element model, which was used for brace design and predict correction. Simulated pressures on the torso and distance between the brace and patient's skin were used to remove ineffective brace material situated at more than 6 mm from the patient's skin. Biplanar radiographs of the patient wearing each brace were taken to compare their effectiveness. Patients filled out a questionnaire to compare their comfort. Results NewBraces were 61% thinner and had 32% less material than standard braces with equivalent correction. NewBraces were more comfortable (11 of 15 patients) or equivalent to (4 of 15 cases) standard braces. Simulated correction was simulated within 5° compared with in-brace results. Conclusions This study demonstrates the feasibility of designing lighter and more comfortable braces with correction equivalent to standard braces. This design platform has the potential to further improve brace correction efficiency and its compliance.
    Spine Deformity. 07/2014; 2(4):276–284.
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    ABSTRACT: In both scoliosis and spondylolisthesis, the progression of the spine deformation leads to the degeneration of intervertebral discs characterized by a change in its structure and biochemical composition. The MRI images of 79 patients (32 with scoliosis, 32 with spondylolisthesis and 15 with herniated discs) were analysed using texture parameters extracted from the intensity histograms of the grey level, contrast, correlation, energy and homogeneity images. The results validated our hypothesis: the calculated tissue-specific texture features can effectively discriminate the pathologies and some of their severities. This method has the advantage of supporting the interesting possibility of developing robust non-invasive predictive methods for the diagnosis of the severities of spine pathologies.
    Joint Annual Meeting ISMRM-ESMRMB 2014, Milan; 05/2014
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    11th International Conference on Conservative Management of Spinal Deformities, 9th SOSORT Annual Meeting, Wiesbaden, Germany; 05/2014
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    ABSTRACT: This is a prospective case-control study. The objective of this study was to compare 3-dimensional (3D) morphological parameters of the spine at the first visit between a nonprogressive (NP) and a progressive (P) group of immature adolescent idiopathic scoliosis (AIS). Prediction of curve progression remains challenging in AIS at the first visit. Prediction of progression is based on curve type, curve magnitude, and skeletal or chronological age. A prospective cohort of 133 AIS was followed from skeletal immaturity to maturity (mean, 37 mo). The first group was made up of patients with AIS with a minimum 6-degree progression of the major curve between the first and last follow-up (P) (n = 53) and the second group was composed of patients with NP who reached maturity with less than 6-degree progression (n = 81). Computerized measurements were taken on reconstructed 3-dimensional (3D) spine radiographs of the first visit. There were 6 categories of measurements: angle of plane of maximum curvature, Cobb angles (kyphosis, lordosis), 3D wedging (apical vertebra, apical disks), rotation (upper and lower junctional vertebra, apical vertebra, and thoracolumbar junction), torsion, and slenderness (height/width ratio). t tests were also conducted. There was no statistical difference between the 2 groups for age and initial Cobb angle. P presented significant hypokyphosis, and parameters related to rotation presented significant statistical differences between NP and P (plane of maximal curvature, torsion, and apical axial rotation). Depth slenderness also presented statistical differences. This study confirms that even at the initial visit, 3D morphological differences exist between P and NP AIS. It supports the use of 3D reconstructions of the spine in the initial evaluation of AIS to help predict outcome.Level of Evidence: 3.
    Spine 05/2014; 39(10):E601-6. · 2.16 Impact Factor
  • K C Assi, H Labelle, F Cheriet
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    ABSTRACT: One of the major concerns of scoliosis patients undergoing surgical treatment is the aesthetic aspect of the surgery outcome. It would be useful to predict the postoperative appearance of the patient trunk in the course of a surgery planning process in order to take into account the expectations of the patient. In this paper, we propose to use least squares support vector regression for the prediction of the postoperative trunk 3D shape after spine surgery for adolescent idiopathic scoliosis. Five dimensionality reduction techniques used in conjunction with the support vector machine are compared. The methods are evaluated in terms of their accuracy, based on the leave-one-out cross-validation performed on a database of 141 cases. The results indicate that the 3D shape predictions using a dimensionality reduction obtained by simultaneous decomposition of the predictors and response variables have the best accuracy.
    Computers in biology and medicine 03/2014; 48C:85-93. · 1.27 Impact Factor
  • Samuel Kadoury, Hubert Labelle, Stefan Parent
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    ABSTRACT: The quantitative assessment of surgical outcomes using personalized anatomical models is an essential task for the treatment of spinal deformities such as adolescent idiopathic scoliosis. However an accurate 3D reconstruction of the spine from postoperative X-ray images remains challenging due to presence of instrumentation (metallic rods and screws) occluding vertebrae on the spine. In this paper, we formulate the reconstruction problem as an optimization over a manifold of articulated spine shapes learned from pathological training data. The manifold itself is represented using a novel data structure, a multi-level manifold ensemble, which contains links between nodes in a single hierarchical structure, as well as links between different hierarchies, representing overlapping partitions. We show that this data structure allows both efficient localization and navigation on the manifold, for on-the-fly building of local nonlinear models (manifold charting). Our reconstruction framework was tested on pre- and postoperative X-ray datasets from patients who underwent spinal surgery. Compared to manual ground-truth, our method achieves a 3D reconstruction accuracy of 2.37 +/- 0.85 mm for postoperative spine models and can deal with severe cases of scoliosis.
    01/2014; 17(Pt 3):361-8.
  • K.C. Assi, H. Labelle, F. Cheriet
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    ABSTRACT: The main objective of this letter is to formulate a new approach of learning a Mahalanobis distance metric for nearest neighbor regression from a training sample set. We propose a modified version of the large margin nearest neighbor metric learning method to deal with regression problems. As an application, the prediction of post-operative trunk 3-D shapes in scoliosis surgery using nearest neighbor regression is described. Accuracy of the proposed method is quantitatively evaluated through experiments on real medical data.
    IEEE Signal Processing Letters 01/2014; 21(3):292-296. · 1.67 Impact Factor
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    ABSTRACT: Mobile smartphones are equipped with inclinometers enabling them to acquire angular clinical measures. The Scolioscreen has been developed in conjunction with a smartphone APP to enable the measure of the angle of trunk inclination (ATI) thus offering a convenient and reliable means to measure and screen for spinal deformities. The objective was to compare the reliability and accuracy of a Scolioscreen-smartphone combination, a smartphone alone, and a Scoliometer, for measuring the angle of trunk inclination in spinal deformities under blinded conditions for intra- and inter-observer analyses.
    Scoliosis 01/2014; 9:10. · 1.31 Impact Factor
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    Health ServicesResearch and Managerial Epidemiology. 01/2014;
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    ABSTRACT: Study Design. 3D analysis of the spino-pelvic alignment in adolescent idiopathic scoliosis (AIS).Objective. To study the 3D pelvic alignment with respect to the spinal deformities in AIS subgroups.Summary of Background Data. Spino-pelvic alignment is subject to change in scoliosis. Many sacro-pelvic parameters were developed to characterize spino-pelvic alignment in sagittal plane. However not much is known about the 3D pelvic alignment with respect to the thoracic and lumbar spinal deformities in AIS.Methods. Eighty AIS subjects with right main thoracic curves (MT), 80 AIS with left thoracolumbar-lumbar curves (TL/L), and 35 asymptomatic controls were included. Thoracic and lumbar Cobb angles, kyphosis, lordosis, pelvic incidence, pelvic tilt, and sacral slope were measured. Pelvic tilt and axial rotation in the coronal and transverse planes respectively were computed using the ipsilateral anterior and posterior iliac spine (ASIS and PSIS) positions. Leg length discrepancy was determined by the vertical difference in the position of the center of the femoral heads in the coronal plane.Results. In 59% of the MT subjects and 79% of the TL/L subjects in the erect position, the pelvis was tilted toward the convex side of the major curve in the coronal plane. The direction of the pelvic axial rotation in the transverse plane was in the same direction as the main thoracic apical vertebra rotation in 84% of the MT subjects and 55% of the TL/L group. The pelvic incidence correlated to the lumbar lordosis in AIS (r = 0.41, p<0.001). Pelvic coronal tilt correlated significantly to the leg length discrepancy in MT (r = 0.67) and TL/L (r = 0.61) subjects (p<0.001).Conclusion. Novel pelvic parameters were introduced to characterize the spino-pelvic relative alignment in scoliotic subgroups. The proposed method related the orientation of the pelvis in the coronal and transverse planes to both thoracic and lumbar spinal deformities.
    Spine 12/2013; · 2.16 Impact Factor
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    ABSTRACT: Cross-sectional evaluation of sacro-pelvic morphology and orientation as well as spondylolisthesis prevalence in a cohort of young gymnasts. To evaluate the prevalence of spondylolisthesis in a cohort of gymnasts, as well as the associated demographic characteristics and sacro-pelvic morphology and orientation. Numerous studies have shown that sagittal sacro-pelvic morphology and orientation is abnormal in spondylolisthesis. Sacro-pelvic morphology and orientation in gymnasts and their relationship with spondylolisthesis have never been analyzed. Radiological evaluation of 92 gymnasts was performed to identify spondylolisthesis, and to measure pelvic incidence, pelvic tilt, sacral slope and sacral table angle. In the presence of spondylolisthesis, the slip percentage was measured. Different demographic and training characteristics were evaluated. Radiographic parameters were compared with reference values published for asymptomatic children and adolescents, and for subjects with spondylolisthesis. A 6.5% prevalence of spondylolisthesis was found in our cohort. The weekly training schedule was the only statistically significant different demographic characteristic between the two groups, at 20.6±5.4 vs 14.4±5.6 hours per week for subjects with and without spondylolisthesis, respectively. Pelvic incidence, pelvic tilt, sacral slope and sacral table angle were respectively 69±20°, 15±13°, 54±11° and 88±7° in gymnasts with spondylolisthesis, and 53±11°, 10±6°, 43±9° and 94±6° in gymnasts without spondylolisthesis. When compared to asymptomatic individuals, pelvic incidence and pelvic tilt were slightly superior in gymnasts without spondylolisthesis. Pelvic incidence, sacral slope and sacral table angle were significantly different between gymnasts with and without spondylolisthesis. The prevalence of spondylolisthesis in young gymnasts was similar to that observed in the general population. Sagittal sacropelvic morphology and orientation was abnormal in gymnasts with spondylolisthesis. Sagittal sacropelvic morphology and orientation was also slightly different in gymnasts without spondylolisthesis when compared to the normal population. The present study supports an association between spondylolisthesis and abnormal sacro-pelvic orientation and morphology.
    Journal of spinal disorders & techniques 11/2013; · 1.21 Impact Factor
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    ABSTRACT: Routine screening of scoliosis is a controversial subject and screening efforts vary greatly around the world. Consensus was sought among an international group of experts (seven spine surgeons and one clinical epidemiologist) using a modified Delphi approach. The consensus achieved was based on careful analysis of a recent critical review of the literature on scoliosis screening, performed using a conceptual framework of analysis focusing on five main dimensions: technical, clinical, program, cost and treatment effectiveness. A consensus was obtained in all five dimensions of analysis, resulting in 10 statements and recommendations. In summary, there is scientific evidence to support the value of scoliosis screening with respect to technical efficacy, clinical, program and treatment effectiveness, but there insufficient evidence to make a statement with respect to cost effectiveness. Scoliosis screening should be aimed at identifying suspected cases of scoliosis that will be referred for diagnostic evaluation and confirmed, or ruled out, with a clinically significant scoliosis. The scoliometer is currently the best tool available for scoliosis screening and there is moderate evidence to recommend referral with values between 5 degrees and 7 degrees. There is moderate evidence that scoliosis screening allows for detection and referral of patients at an earlier stage of the clinical course, and there is low evidence suggesting that scoliosis patients detected by screening are less likely to need surgery than those who did not have screening. There is strong evidence to support treatment by bracing.Interpretation: This information statement by an expert panel supports scoliosis screening in 4 of the 5 domains studied, using a framework of analysis which includes all of the World Health Organisation criteria for a valid screening procedure.
    Scoliosis 10/2013; 8(1):17. · 1.31 Impact Factor
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    ABSTRACT: This editorial article initiates the school scoliosis screening thematic series of the Scoliosis journal. The various issues on screening policies are discussed; clinical and practical recommendations of setting up school screening programs are also described.
    Scoliosis 10/2013; 8(1):16. · 1.31 Impact Factor
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    ABSTRACT: The Kozlowski type of spondylometaphyseal dysplasia (SMD-K) is characterized by vertebral and metaphyseal abnormalities. The longitudinal evolution of thoracolumbar kyphosis associated with vertebral anomalies in SMD-K is unclear. To document the longitudinal changes in sagittal alignment and vertebral morphology in a patient with SMD-K treated nonoperatively with a Milwaukee brace. Case report. Patient with SMD-K having multiple vertebral anomalies and a thoracolumbar kyphosis. A girl with SMD-K seen initially at 21 months old was followed for 14 years. She presented with thoracolumbar kyphosis associated with multiple vertebral anomalies consisting primarily of hypoplasia at L1, beaking at L2, and ovoid shape of adjacent vertebrae. The patient was treated with a Milwaukee brace and followed until she was 16 years old. After initiation of brace treatment, the thoracolumbar kyphosis gradually resolved and she had a normal sagittal alignment at last follow-up. Normal vertebral morphology was also completely restored in the sagittal plane. The patient developed a main thoracic scoliosis that did not require additional treatment. Nonoperative treatment with bracing can be attempted in patients with SMD-K affected by thoracolumbar kyphosis and multiple vertebral anomalies, because full restoration of normal sagittal alignment and vertebral morphology is possible.
    The spine journal: official journal of the North American Spine Society 10/2013; · 2.90 Impact Factor
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    ABSTRACT: Variability in classifying and selecting levels of fusion in adolescent idiopathic scoliosis (AIS) has been repeatedly documented. Several computer algorithms have been used to classify AIS based on the geometrical features, but none have attempted to analyze its treatment patterns. To use self-organizing maps (SOM), a kind of artificial neural networks, to reliably classify AIS cases from a large database. To analyze surgeon's treatment pattern in selecting curve regions to fuse in AIS using Lenke classification and SOM. This is a technical concept article on the possibility and benefits of using neural networks to classify AIS and a retrospective analysis of AIS curve regions selected for fusion. A total of 1,776 patients surgically treated for AIS were prospectively enrolled in a multicentric database. Cobb angles were measured on AIS patient spine radiographies, and patients were classified according to Lenke classification. For each patient in the database, surgical approach and levels of fusion selected by the treating surgeon were recorded. A Kohonen SOM was generated using 1,776 surgically treated AIS cases. The quality of the SOM was tested using topological error. Percentages of prediction of fusion based on Lenke classification for each patient in the database and for each node in the SOM were calculated. Lenke curve types, treatment pattern, and kappa statistics for agreement between fusion realized and fusion recommended by Lenke classification were plotted on each node of the map. The topographic error for the SOM generated was 0.02, which demonstrates high accuracy. The SOM differentiates clear clusters of curve type nodes on the map. The SOM also shows epicenters for main thoracic, double thoracic, and thoracolumbar/lumbar curve types and transition zones between clusters. When cases are taken individually, Lenke classification predicted curve regions fused by the surgeon in 46% of cases. When those cases are reorganized by the SOM into nodes, Lenke classification predicted the curve regions to fuse in 82% of the nodes. Agreement with Lenke classification principles was high in epicenters for curve types 1, 2, and 5, moderate in cluster for curve types 3, 4, and 6, and low in transition zones between curve types. An AIS SOM with high accuracy was successfully generated. Lenke classification principles are followed in 46% of the cases but in 82% of the nodes on the SOM. The SOM highlights the tendency of surgeons to follow Lenke classification principles for similar curves on the SOM. Self-organizing map classification of AIS could be valuable to surgeons because it bypasses the limitations imposed by rigid classification such as cutoff values on Cobb angle to define curve types. It can extract similar cases from large databases to analyze and guide treatment.
    The spine journal: official journal of the North American Spine Society 10/2013; · 2.90 Impact Factor
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    ABSTRACT: Health professionals (HPs) are likely to encounter adolescent idiopathic scoliosis (AIS) patients. Best practice dictates that early detection leads to better decision making regarding optimal management. The aim of our study was to appraise the basic knowledge, evaluation and management skills concerning AIS care among family physicians, pediatricians, chiropractors, and physiotherapists. A semi-structured questionnaire including 3 clinical scenarios was developed. Telephone interviews were conducted with 51 HPs to assess their knowledge of the clinical signs, risk factors, and management options of AIS and their preferences in clinical guidelines for AIS care. The majority of HPs (70-90%) would refer the patient who required prompt referral, but only 38-60% actually rated the case as requiring prompt referral. Forty percent of HPs (predominantly physiotherapists and family physicians) stated that they would not be comfortable providing AIS patient follow-up. Access to specialized care was considered a problem, and nearly all believed that establishment of clinical guidelines would be beneficial. Considerable gaps exist regarding the knowledge of the clinical signs and risk factors of AIS. The importance of a patient in need of a prompt referral is recognized by the majority of the HPs, but they believe that there are problems regarding accessibility to a specialist. Interprofessional collaboration is discussed as a promising approach to improve the management of AIS.
    JCCA. Journal of the Canadian Chiropractic Association. Journal de l'Association chiropratique canadienne 09/2013; 57(3):251-9.
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    ABSTRACT: Literature on scoliosis screening is vast, however because of the observational nature of available data and methodological flaws, data interpretation is often complex, leading to incomplete and sometimes, somewhat misleading conclusions. The need to propose a set of methods for critical appraisal of the literature about scoliosis screening, a comprehensive summary and rating of the available evidence appeared essential. To address these gaps, the study aims were: i) To propose a framework for the assessment of published studies on scoliosis screening effectiveness; ii) To suggest specific questions to be answered on screening effectiveness instead of trying to reach a global position for or against the programs; iii) To contextualize the knowledge through expert panel consultation and meaningful recommendations. The general methodological approach proceeds through the following steps: Elaboration of the conceptual framework; Formulation of the review questions; Identification of the criteria for the review; Selection of the studies; Critical assessment of the studies; Results synthesis; Formulation and grading of recommendations in response to the questions. This plan follows at best GRADE Group (Grades of Recommendation, Assessment, Development and Evaluation) requirements for systematic reviews, assessing quality of evidence and grading the strength of recommendations. In this article, the methods developed in support of this work are presented since they may be of some interest for similar reviews in scoliosis and orthopaedic fields.
    Scoliosis 07/2013; 8(1):12. · 1.31 Impact Factor
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    ABSTRACT: Statistical shape models have become essential for medical image registration or segmentation and are used in many biomedical applications. These models are often based on Gaussian distributions learned from a training set. We propose in this paper a shape model which does not rely on the estimation of a Gaussian distribution, but on similarities computed with a kernel function. Our model takes advantage of the One- Class Support Vector Machine to do so. In this context, we propose in this paper a method for reconstructing the spine of scoliotic patients using OCSVM regularization. Current state-ofart methods use conventional statistical shape models and the reconstruction is commonly processed by minimizing a Mahalanobis distance. Nevertheless, when a shape differs significantly from the statistical model, the associated Mahalanobis distance often overstates the need for statistical regularization. We show that OCSVM regularization is more robust and is less sensitive to weak landmarks definition and is hardly influenced by the presence of outliers in the training data. The proposed OCSVM model applied to 3D spine reconstruction was evaluated on real patient data and results showed that our approach allows precise reconstruction.
    IEEE transactions on bio-medical engineering 07/2013; · 2.15 Impact Factor
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    ABSTRACT: BACKGROUND:: Knowledge concerning morphology of the spine is reported in 2-dimensional (2D) or focuses on modification of parameters with progression of spinal deformation. The objective of this study was to compare 3D morphologic parameters of the spine at the first visit between progressive and a nonprogressive group of immature adolescent idiopathic scoliosis (AIS). METHODS:: The first group was made up of surgically corrected AIS patients (E) (n=19), whereas the second group was composed of nonprogressive AIS that had reached skeletal maturity (n=18). Computerized measurements were undertaken on reconstructed 3D spines. There were 5 categories of measurement: Cobb angles (scoliosis, kyphosis, lordosis), 3D wedging (apical vertebra, mean 2 apical disks), rotation (upper and lower junctional vertebra, apical vertebra, and disk), torsion, and slenderness (height/width ratio of T6, L4, and T1-L5). Nonparametric Mann-Whitney tests were also undertaken. RESULTS:: There was no statistical difference between the 2 groups for age, 3D Cobb angle, lordosis, and kyphosis. Mean 3D wedging of the apical disks, lower junctional vertebral axial rotation, torsion and T6, and whole spine height/width ratio were all significantly affected. CONCLUSIONS:: This study supports the theory that wedging begins in the disks and then in the vertebral body and identifies 3D morphologic parameters that could be used in the prediction of AIS evolution. The findings in the junctional area illustrate that a torsional deformity seems to occur distally from the apex and creates a progressive scoliosis. Curve progression could be predicted based on 3D morphometric parameters, as early as the initial visit. LEVEL OF EVIDENCE:: Level III-this is a case-control retrospective study.
    Journal of pediatric orthopedics 06/2013; · 1.23 Impact Factor

Publication Stats

4k Citations
484.62 Total Impact Points

Institutions

  • 1988–2014
    • CHU Sainte-Justine
      Montréal, Quebec, Canada
  • 2013
    • University of Ottawa
      Ottawa, Ontario, Canada
    • Hôpital du Sacré-Coeur de Montréal
      Montréal, Quebec, Canada
  • 1992–2013
    • Université de Montréal
      • • Department of Surgery
      • • Faculty of Medicine
      • • Department of Kinesiology
      • • Center for Mathematical Research
      Montréal, Quebec, Canada
  • 2010–2012
    • École de Technologie Supérieure
      • • Imaging and Orthopaedics Research Laboratory (LIO)
      • • Software Engineering
      Montréal, Quebec, Canada
  • 1993–2012
    • Montreal Polytechnic
      • • Département de génie mécanique
      • • Institut de génie biomédical
      Montréal, Quebec, Canada
  • 2009
    • Philips
      Eindhoven, North Brabant, Netherlands
  • 2004–2008
    • Centre de recherche informatique de Montréal
      Montréal, Quebec, Canada
  • 2006
    • École Polytechnique
      Paliseau, Île-de-France, France
  • 1993–2004
    • University of Vermont
      • • Department of Mechanical Engineering
      • • Department of Orthopaedics and Rehabilitation
      Burlington, VT, United States
  • 2003
    • Centre hospitalier de l'Université de Montréal (CHUM)
      Montréal, Quebec, Canada
  • 2002
    • University of Valenciennes and Hainaut-Cambresis
      Valenciennes, Nord-Pas-de-Calais, France
    • Clinique du Parc à Castelnau-le-Lez
      Montpelhièr, Languedoc-Roussillon, France
  • 2000–2002
    • The University of Calgary
      • • Department of Surgery
      • • Faculty of Medicine
      Calgary, Alberta, Canada
  • 1995–2002
    • Université du Québec à Montréal
      Montréal, Quebec, Canada