Determining Optimal Patient Positioning on DEXA for people with Lumbar Scoliosis
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Authors
Schuring, Caleb
Michaels, Walker
Issue Date
2024-04-04
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Abstract
Osteoporosis weakens the bones of around 10 million Americans per year, and the cost we pay to battle the disease averages around 50 billion a year. One way to detect osteoporosis and establish early prevention/management strategies is through a dual energy x-ray absorptiometry (DEXA) scan. However, DEXA scans have been shown in previous research to be unreliable when assessing bone mineral density (BMD) in individuals with lumbar scoliosis. The gravity of this error is further heightened by the fact that people with lumbar scoliosis are more likely to develop osteoporosis, and we cannot use DEXA for assessing or tracking lumbar BMD in this population. The purpose of this study aims to find new ways to position individuals with lumbar scoliosis on the DEXA scanner to achieve reliable BMD readings using a cadaver spine as a model. Four Alma College cadavers were dissected through performing a laminectomy, and further disarticulated. The articulating joints of the lumbar vertebrae were sanded to cause left lateral bending and a cobb angle greater than 10 degrees. Currently, we are collecting data where we place the
vertebrae on a water proof mat at different angles and scan them on the Hologic Horizon W DEXA scanner for BMD. The cadaver spine will be placed on the bed and scanned in the 2D plane according to the Nana protocol. Then, it will be scanned in the upright position. Afterwards, the spine will be scanned with an orientation 45, 30, and 15 degrees posterior to the upright position. Finally, the spine will be reoriented according to the Nana protocol, and rotated along the midline 45 degrees and 90 degrees with the scoliotic side of the spine facing concave down. I believe the most reliable data may emerge from scanning the cadaver spine when rotated 90 degrees from the midline, as this may “hide” the scoliosis during the scan. However, in future studies, researchers should attempt to use cadaver spines with the vertebral bodies attached and should avoid performing a laminectomy for more generalizable results. Furthermore, new positions could be developed that incorporate the dimensions of a full human body on the DEXA scanner to start determining realistic positioning protocols for those with scoliosis.
Description
Dr. Alexander Montoye, Integrative Physiology and Health Science