14 Jan 2016

Department of Orthopaedics and Traumatology of Li Ka Shing Faculty of Medicine, The University of Hong Kong (HKU) will collaborate with a team of international experts led by Dr Stefan Parent from CHU Sainte-Justine, University of Montreal, Canada to study a new predictive model for the progression of adolescent idiopathic scoliosis (AIS) with the use of EOS Imaging System, a Nobel-Prize winning detection technology for orthopaedic imaging. This new model helps predicting the curve of spine severity at the end of skeletal development based on three-dimensional (3D) reconstructions of the spine and other maturity parameters.

Professor Kenneth Cheung Man-chee, Jessie Ho Professor in Spine Surgery, Clinical Professor and Head of Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, HKU, says, “Experts from Canada, Hong Kong, the United States, France, Japan and Singapore join hands to study this new predictive model, which allows doctors to identify patients who are at higher risk of progression, so the patients may have early treatment to prevent further progression.”

Present situation of AIS patients in Hong Kong

AIS is a 3D deformity of spine that affects adolescents aged 11 to 14, of unknown cause, and affects girls more than boys. If it progresses during puberty, it can lead to cosmetic, functional and respiratory problems. They may also have a higher incidence of back pain, accelerated intervertebral disc degeneration, and continue to progress in adulthood. Around 3% of students in Hong Kong were found to have the AIS symptoms, and among them, 4 out of 5 are female. In 2015, 1,500 new cases were seen at The Duchess of Kent Children’s Hospital at Sandy Bay, and 5,000 cases were followed up.

Currently there is no reliable method that can determine which curves will progress when the adolescent is first seen by a spine specialist. Subsequently the treatment may not be standardised, and surgical correction and fusion of the spine is frequently needed, which may result in significant morbidity. Moreover, many AIS patients require X-ray examination every half year to monitor their spinal growth and treatment progress and they are exposed to large radiation doses repeatedly under conventional X-ray.

New predictive model for the progression of AIS

Experts from CHU Sainte-Justine, University of Montreal, Canada have developed a new predictive model. The research study demonstrated in a small cohort of patients that it is possible to predict how the curve will behave based on 3D parameters measured at their first visit to the doctor, combined with the traditional risk factors for deterioration. The predictive model can help doctors to advise patients and their families on the patient’s individual risk for curve progression after the first clinic visit.

The 3D modeling relies on the EOS Imaging System to capture simultaneous frontal and lateral head-to-toe images in the upright weight-bearing position. The 2 perpendicular X-ray beams come from 2 detectors born out of Nobel Prize-winning technology from French physicist Dr George Charpak. The system, newly installed in The Duchess of Kent Children’s Hospital at Sandy Bay, enables doctors to perform low-dose radiation checks on patients. Dr Kenny Kwan, Clinical Assistant Professor of Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, HKU, points out, “The system allows detailed evaluation of the curvature in different axes without exposing the patient to further radiation. It also allows researchers to identify further patterns and characteristics of the curves that may predict progression, as this information was previously unavailable.”

Research project in Hong Kong

To study the validation of the predictive model in Hong Kong, Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, HKU, has launched a research project, in collaborative effort with experts from other countries. The team plans to recruit 150 new patients diagnosed with AIS, who are 10 years old or above, and do not have previous spinal disorders. The participants have to fill in questionnaires and perform X-ray checks using the EOS Imaging System. They will receive follow-up every 6 months till maturity. The team hopes to obtain more accurate information to make decision for bracing and surgery through the research project and have more psychological preparation for patients based on individualised prediction rather than international figures.

About the research team

The research at the Li Ka Shing Faculty of Medicine, HKU will be led by Professor Kenneth Cheung Man-chee, Jessie Ho Professor in Spine Surgery, Clinical Professor and Head of Department of Orthopaedics and Traumatology, Dr Kenny Kwan Yat-hong, Clinical Assistant Professor of Department of Orthopaedics and Traumatology, and Dr Jason Cheung Pui-yin, Clinical Assistant Professor of Department of Orthopaedics and Traumatology. Li Ka Shing Faculty of Medicine, HKU is a world leading institution in the history of spinal deformity surgery. Department of Orthopaedics and Traumatology has a vast experience in the natural history, conservative and operative treatment of AIS. It developed the fulcrum bending radiographs used to assess the flexibility of the curvatures for pre-operative assessment, and this method is now widely-accepted and utilised worldwide. It is also the first centre in the world to implant a magnetically controlled growing rod in the treatment of early onset scoliosis, which leads to fewer surgeries for the children. Currently the Department is actively involved in looking at other factors that contribute to the cause and progression of scoliosis, including genetic testing and this study of 3D modeling. It is also conducting researches in other flexibility assessments, and fusion methods.

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