Anatomy-Aware Inference of the 3D Standing Spine Posture from 2D Radiographs

An important factor for the development of spinal degeneration, pain and the outcome of spinal surgery is known to be the balance of the spine. It must be analyzed in an upright, standing position to ensure physiological loading conditions and visualize load-dependent deformations. Despite the complex 3D shape of the spine, this analysis is currently performed using 2D radiographs, as all frequently used 3D imaging techniques require the patient to be scanned in a prone position. To overcome this limitation, we propose a deep neural network to reconstruct the 3D spinal pose in an upright standing position, loaded naturally. Specifically, we propose a novel neural network architecture, which takes orthogonal 2D radiographs and infers the spine’s 3D posture using vertebral shape priors. In this work, we define vertebral shape priors using an atlas and a spine shape prior, incorporating both into our proposed network architecture. We validate our architecture on digitally reconstructed radiographs, achieving a 3D reconstruction Dice of 0.95, indicating an almost perfect 2D-to-3D domain translation. Validating the reconstruction accuracy of a 3D standing spine on real data is infeasible due to the lack of a valid ground truth. Hence, we design a novel experiment for this purpose, using an orientation invariant distance metric, to evaluate our model’s ability to synthesize full-3D, upright, and patient-specific spine models. We compare the synthesized spine shapes from clinical upright standing radiographs to the same patient’s 3D spinal posture in the prone position from CT

Three-Dimensional Biplanar Reconstruction of the Scoliotic Spine for Standard Clinical Setup

Tese de Doutoramento. Engenharia Informática. Faculdade de Engenharia. Universidade do Porto. 201

The development and validation of a movement evaluation system for children with cerebral palsy

The development of objective assessment tools for evaluation in physiotherapy is vital. Currently, the outcomes resulting from an intervention are generated by clinical assessments that are almost exclusively based on subjective criteria which rely upon the assessor’s expertise and consistency. The aim of this project was to develop an objective clinical tool to measure head and trunk postural control in sitting for children with cerebral palsy (CP). It is preferable for any objective measurement tool to be useable with as wide a range of patients and conditions as possible. Ideally, the tool should also be ‘clinically-friendly’ for both therapist and patient. This project took children with CP as a starting point, as representing one of the most challenging groups to assess and to quantify. The project was specifically focused on head-trunk control in sitting because of the importance of this posture for activities of daily living. The Literature Reviews confirmed that head-trunk control status in sitting could be defined by an aligned sitting posture without any external support for the head, trunk and upper limbs. The Method selected was video-based (Dartfish) to meet the requirement of ‘clinically-friendly’ and developed to quantify alignment (and deviations from alignment) of the head and trunk with small errors when compared to a 3D motion capture system (Vicon). The Dartfish method was also used to classify the positions of the upper limbs in comparison with the standard clinical classification; it showed that a simplified representation of the hands and elbows can reflect the clinical judgement. The combination of both these elements enabled the quantification of head/trunk control in children with CP for the first time. The work presented in this thesis makes a new and major contribution to postural assessment. It also provides the basis for the development of a fully automated system for the objective assessment of control using 2D-video recording. This work confirmed that clinical assessments can be objectively replicated, representing a major advance in the validation of physiotherapy interventions

Generalizable Methods for Modeling Lumbar Spine Kinematics

A more complete understanding of lumbar spine kinematics could improve diagnoses and treatment of low back pathologies and may advance the development of biomechanical models. Kinematics describes motion of the five lumbar vertebrae without consideration for the forces that cause the motion. Despite considerable attention from researchers and clinicians, lumbar spine kinematics are not fully understood because the anatomy is not accessible for direct observation and the complex governing biomechanics produce small magnitude, coupled intervertebral movements. The overall goal of this project was to develop a descriptive model of intervertebral lumbar spine kinematics that is applicable to a generalizable subject population with diverse anthropometry. To accomplish this, a method was developed for measuring three-dimensional vertebral configuration using positional magnetic resonance imaging (MRI). The method makes use of automated vertebral registration to address time limitations in current data processing techniques and improves the ability to power experimental investigations. Finally, a geometric model of lumbar vertebral kinematics was developed using principal component regression applied to in vivo vertebral measurement data across the range of flexion and extension joint motion. This principal component-based approach offers unique advantages for predicting and interpreting performance of complex systems such as lumbar joint biomechanics because no assumptions are made regarding the governing mechanisms. This provides an opportunity to infer mechanistic characteristics about intervertebral joint kinematics and to use in vivo data to validate musculoskeletal models

An analysis of the shape of the spine and torso in those with and without scoliosis

Abstract The shape of the spine and torso are central to the management of scoliosis, a condition with a three-dimensional rotation in the spine associated with asymmetry of the torso. It is not clear what the variability in shape and symmetry of both the spine and the torso is in a non-scoliotic cohort. Using ISIS2 surface topography, the torsos of a non-scoliotic cohort were measured yearly for seven years, allowing true longitudinal analysis. Parameters of growth and symmetry were measured and analysed to demonstrate the variability of normal shape during the adolescent growth spurt using linear mixed effect modelling and data ellipses, examining for the effects of age and sex. This demonstrated a range of normal shape and the differences between males and females. The non-scoliotic shape was then analysed alongside a group of matched pre and post-operative scoliotic subjects using data ellipses and Procrustes analysis. This showed that scoliosis increases the asymmetry of the spine and torso as an amplification of the variability in the non-scoliotic cohort. This asymmetry is reduced by surgery in nearly all parameters measured. However, some appreciable differences remain when compared to the non-scoliotic cohort

Low Back Pain (LBP)

Low back pain (LBP) is a major public health problem, being the most commonly reported musculoskeletal disorder (MSD) and the leading cause of compromised quality of life and work absenteeism. Indeed, LBP is the leading worldwide cause of years lost to disability, and its burden is growing alongside the increasing and aging population. The etiology, pathogenesis, and occupational risk factors of LBP are still not fully understood. It is crucial to give a stronger focus to reducing the consequences of LBP, as well as preventing its onset. Primary prevention at the occupational level remains important for highly exposed groups. Therefore, it is essential to identify which treatment options and workplace-based intervention strategies are effective in increasing participation at work and encouraging early return-to-work to reduce the consequences of LBP. The present Special Issue offers a unique opportunity to update many of the recent advances and perspectives of this health problem. A number of topics will be covered in order to attract high-quality research papers, including the following major areas: prevalence and epidemiological data, etiology, prevention, assessment and treatment approaches, and health promotion strategies for LBP. We have received a wide range of submissions, including research on the physical, psychosocial, environmental, and occupational perspectives, also focused on workplace interventions

A qualitative and quantitative investigation of structural morphology in the neonatal ilium

Cortical and trabecular bone characteristics can be used to make predictions regarding previous loading regimes and developmental milestones which a bone has encountered. This has led to the suggestion that in the adult pelvis, bone patterning is related to the remodeling forces generated during bipedal locomotion. However, during the neonatal period the pelvic complex is non-load bearing, therefore, structural organisation of the ilium cannot reflect direct stance related forces. This study considers the cortical and trabecular bone structure in the ilium of the fetal and newborn infant, a structural configuration which until now has remained largely neglected in the literature. Only recently, with the advent of imaging modalities, has a greater insight and understanding of previously unexplored human bone structural composition and developing bone structure been made possible. In this study, multiple imaging techniques were applied to establish the optimal modality for application to the assessment of bone microstructure. Plain plate macroradiography and micro-computed tomography were identified as the gold standard imaging modalities for bone structural analysis for respective qualitative and quantitative assessment. These techniques were applied to gain a perspective of bone form from a sample of fetal and neonatal ilia selected from the Scheuer collection of juvenile remains. Initially, qualitative analysis highlighted consistent and well-defined patterns of cortical and trabecular bone organisation within the fetal and neonatal ilium, which corresponded with previously recognised regions in the adult that have been attributed directly to forces associated with bipedal locomotion. This was highly unexpected as the early developmental ilium is non-load bearing. Subsequently, quantification of the neonatal cortical and trabecular structure reinforced radiographic observations by identifying regions of significant architectural arrangement. Further investigation of this precocious patterning led to a revised proposal for the mode of growth in the human ilium during the neonatal developmental period. Analysis revealed statistically significant differences in regional trabecular characteristics and cortical thicknesses which have formed the basis of a proposed growth model for the ilium. The presence of ‘progressive growth regions’ and ‘restricted growth regions’ which appear to relate to metaphyseal and non-metaphyseal borders of the ilium have been demonstrated. Analysis of the early iliac bone pattern is important for understanding the relationship between trabecular bone patterning and cortical bone structure during the earliest stages of development in response to the specific functional forces acting during this period. It is suggested that the seemingly organised rudimentary scaffold observed in the early developmental ilium may be attributable to early ossification patterning, non-weight bearing anatomical interactions or even to a predetermined genetic blueprint. It must also be postulated that whilst the observed patterning may be indicative of a predetermined inherent template, early non-load bearing locomotive influences may subsequently be superimposed upon this scaffolding and perhaps reinforced and likely remodelled at a later age. Ultimately, the analysis of this fundamental primary pattern has core implications for understanding the earliest changes in iliac trabecular architecture and provides a baseline insight into future ontogenetic development and bipedal capabilities. Finally, the structural data and statistical analysis presented challenge the current concept of implied centrifugal ossification within the human ilium and present evidence of an alternative pattern of ossification that is largely dictated and controlled by basic anatomical principles.EThOS - Electronic Theses Online ServiceLeng TrustWenner-Gren FoundationBiotechnology and Biological Sciences Research CouncilGBUnited Kingdo

A qualitative and quantitative investigation of structural morphology in the neonatal ilium

Cortical and trabecular bone characteristics can be used to make predictions regarding previous loading regimes and developmental milestones which a bone has encountered. This has led to the suggestion that in the adult pelvis, bone patterning is related to the remodeling forces generated during bipedal locomotion. However, during the neonatal period the pelvic complex is non-load bearing, therefore, structural organisation of the ilium cannot reflect direct stance related forces. This study considers the cortical and trabecular bone structure in the ilium of the fetal and newborn infant, a structural configuration which until now has remained largely neglected in the literature. Only recently, with the advent of imaging modalities, has a greater insight and understanding of previously unexplored human bone structural composition and developing bone structure been made possible. In this study, multiple imaging techniques were applied to establish the optimal modality for application to the assessment of bone microstructure. Plain plate macroradiography and micro-computed tomography were identified as the gold standard imaging modalities for bone structural analysis for respective qualitative and quantitative assessment. These techniques were applied to gain a perspective of bone form from a sample of fetal and neonatal ilia selected from the Scheuer collection of juvenile remains. Initially, qualitative analysis highlighted consistent and well-defined patterns of cortical and trabecular bone organisation within the fetal and neonatal ilium, which corresponded with previously recognised regions in the adult that have been attributed directly to forces associated with bipedal locomotion. This was highly unexpected as the early developmental ilium is non-load bearing. Subsequently, quantification of the neonatal cortical and trabecular structure reinforced radiographic observations by identifying regions of significant architectural arrangement. Further investigation of this precocious patterning led to a revised proposal for the mode of growth in the human ilium during the neonatal developmental period. Analysis revealed statistically significant differences in regional trabecular characteristics and cortical thicknesses which have formed the basis of a proposed growth model for the ilium. The presence of ‘progressive growth regions’ and ‘restricted growth regions’ which appear to relate to metaphyseal and non-metaphyseal borders of the ilium have been demonstrated. Analysis of the early iliac bone pattern is important for understanding the relationship between trabecular bone patterning and cortical bone structure during the earliest stages of development in response to the specific functional forces acting during this period. It is suggested that the seemingly organised rudimentary scaffold observed in the early developmental ilium may be attributable to early ossification patterning, non-weight bearing anatomical interactions or even to a predetermined genetic blueprint. It must also be postulated that whilst the observed patterning may be indicative of a predetermined inherent template, early non-load bearing locomotive influences may subsequently be superimposed upon this scaffolding and perhaps reinforced and likely remodelled at a later age. Ultimately, the analysis of this fundamental primary pattern has core implications for understanding the earliest changes in iliac trabecular architecture and provides a baseline insight into future ontogenetic development and bipedal capabilities. Finally, the structural data and statistical analysis presented challenge the current concept of implied centrifugal ossification within the human ilium and present evidence of an alternative pattern of ossification that is largely dictated and controlled by basic anatomical principles.EThOS - Electronic Theses Online ServiceLeng TrustWenner-Gren FoundationBiotechnology and Biological Sciences Research CouncilGBUnited Kingdo