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Dynamic surface topography and its application to the evaluation of adolescent idiopathic scoliosis

Dynamic surface topography is a method to quantify the surface and locations of features acquired from moving and distorting shapes against time. This thesis describes the application of the technique to the potential evaluation of adolescent idiopathic scoliosis patients. Scoliosis or curvature of the spine is one of the major skeletal diseases in adolescents where in the majority of cases the cause is unknown or idiopathic. The progression of the disease occurs in three dimensions with the spine simultaneously curving towards the arms and rotating as it collapses with the first indications usually being changes in body symmetry and back surface shape. Following diagnosis, most children do not exhibit any significant worsening of their condition and are routinely monitored using radiography as frequently as every three months whilst vertebral growth potential remains. In a small number of patients, the lateral curvature can unpredictably worsen requiring, in some cases, surgical intervention to prevent further deterioration and to diminish the deformity. Earlier work by many researchers concentrated on attempting to reduce patient exposure to ionizing radiation by investigating if there was a reliable correlation between progression of the scoliosis and changes in surface topography. The techniques have not gained acceptance as the relational algorithms were found to be insufficiently robust in all cases and measurements acquired from available technologies were prone to artefacts introduced by stance, breathing, 'posture and sway. For many patients the motivation in seeking treatment is for the improvement of their appearance rather than to correct the underlying deformity, so cosmetic concerns and an understanding of the psychosocial and physical impacts of the disease and treatments remain important factors in the clinical decision-making process. In the current environment of evidence based medicine there is a growing need to quantify back surface shape, general body asymmetry and patient capability with the objective of producing an agreed scoring to be used in developing treatment plans and assessing outcomes but to date many clinics continue to rely on qualitative methods to describe cosmetic deformity and ability. The aim of the research was to develop an original, low cost and inherently safe apparatus using well u~derstood video based motion capture technology that overcame the disadvantages of earlier work by simultaneously acquiring multiple samples of back surface shape and the locations of bony landmarks to provide averaged results for a quantitative and reliable analysis of cosmetic defect and physical impairment. 172,650 data samples were acquired from thirty skeletally mature subjects not exhibiting any musculoskeletal disease to define normality limits for