Scoliosis and kyphosis treatment commonly involves diagnosing the spinal curve with an x-ray as well as consistent follow-up using x-rays to see if the curve is getting worse. Many times, if a child with scoliosis is braced, they will also have x-rays to check the fit of that brace.
Receiving this many x-rays during adolescence has been shown to increase the cancer risk for these kids by up to 5 times (1). This is usually associated with an average of 22 x-rays being taken over a 3 year period while monitoring the curve (2). Of course, there is a lot of variability in this data, but the message is clear: We need to reduce the number of x-rays for adolescents with scoliosis and kyphosis!
Surface Topography
In the pursuit of this objective, at Align Therapy, we purchased a surface topography machine called the Diers Formetric, in 2015, and have been using this to monitor spinal curves since. It is an amazing machine and has helped us in many ways to treat scoliosis and kyphosis with better results. If a patient isn’t showing worsening of their curve on topography, we can usually delay an x-ray. This helps us limit the exposure to radiation, and the resulting elevated cancer risk.
(Check out a video showing how we use the Diers Formetric in the clinic HERE!)
As I have been treating scoliosis and kyphosis since 2015, I have had many patients travel to see us in Lehi, Utah. It is not uncommon to have someone drive 2-3 hours to see us, and we have even had many patients come from other states to be trained in The Schroth Method.
With patients traveling from further away, I started to look for ways to monitor spinal curves remotely to achieve the same result of limiting radiation exposure. My search turned up a few new options with ultrasound imaging and manual devices, but it wasn’t until I went to the annual SOSORT (International Society on Scoliosis Orthopedic and Rehabilitation Treatment) conference in Boston this year that I really found a solution to this problem.
At SOSORT, I met Evan Dimentberg who is a co-founder of Momentum Health. He has developed a phone app that can use the camera on your phone to create a topographical image of the spine. Our phones can do almost anything now, so why not this? I was intrigued.
Because I had been using surface topography for 10 years at that point, I was skeptical that a phone app could do what we needed it to do to avoid imaging. Then, I did a podcast episode with Evan and really got intrigued in the Momentum Spine App.
(You can listen to my podcast episode with Evan HERE)
The Momentum Spine App
After talking to Evan, we decided to start using the app with some of our patients to get their feedback and see if we can use it as a remote monitoring option.
Check out this video showing how to do a topography scan with the Momentum Spine App.
In the above video we go over the process of scanning someone’s back using the Momentum Spine App. Holding your phone, you walk around the person 3 times in standing, and then 3 times bent over. Then it sends the video to Momentum Health and creates a 3D image as well as a prediction of the Cobb Angle. After the scan, this happens fairly quickly.
Benefits of the Momentum Spine App
We have been very impressed with the Momentum Spine App, and we have started to use it with many of our patients. Here are a few highlights of what it can do:
- Remotely scan someone’s back in the comfort of their own home. This is a big advantage where we can track and monitor patients who live further away from the clinic. It also helps us monitor the spine without having a formal visit scheduled.
- AI Prediction of the Cobb Angle. After you do the scan, the video goes to the cloud and Momentum Health uses AI modeling to predict what your curve angle is, based on the contours of the back. This does not always agree with an x-ray completely, but as the AI improves, we will see improvements in this prediction.
- Side by side comparisons of follow up scans. The real benefit of topography scanning is not as much to diagnose scoliosis, but to check for progression. You are able to compare scans side by side to determine differences in posture or symmetry. In adolescents, no change in the topography is a good indication that we might be able to skip the next x-ray, but this needs to be done carefully.
- Other spinal setrics. The topographical image gives the ability to compare other metrics that are important to scoliosis. Things like balance in the coronal and frontal planes and pelvic balance are helpful to educate the patient and aide in treatment.
- Therapist assisted assessment. Since this scan is housed online, you can give your health care professional access to see your topography. If we can get those involved in the multidisciplinary care of these patients on the app, we could have true collaboration. This should improve our results.
- No need to remove all clothing on the trunk. Traditional topography for scoliosis or kyphosis involves the scan being directly on the skin without clothing to interfere with the image. With the Momentum Spine App, it can predict the topography with still having a sports bra or other tight clothing on. This improves patient comfort.
There are many other aspects of this technology that are cool and amazing, and I expect to see advances in the future that will help us use this to create an even better treatment and user experience.
Future Benefits of Surface Topography
One use for the Momentum Spine App we are exploring in my clinic is if we can use it to identify when adolescents are in Peak Growth Velocity. This is what we would normally call “growth spurts”. Basically, when someone with kyphosis or scoliosis is growing the fastest, which is usually around puberty.
Why is this so important? Because that is when we tend to see the most growth of scoliosis or kyphosis. This is when the spine is growing, and if it is asymmetrical, then we get more asymmetrical growth, leading to more curve. It is a crucial time in the treatment of adolescent idiopathic scoliosis.
If we could predict, or detect, when a child is starting their higher velocity of growth, then we could dose their treatment accordingly. We could encourage bracing and Schroth Method exercises more during that time, and really emphasize the need for being consistent. This would really increase the effectiveness of all treatment modalities.
Specifically for children who are diagnosed at age 9 or 10, we see a struggle with consistency while they are growing. Basically, they may have 3, 4, or even 8 years left of growth, and that is a long time to ask them to be consistent with bracing and Schroth. There is a high burnout rate for kids that are in treatment for scoliosis for a long time.
If we could identify the times when they need to be more diligent in their exercises, and reinforce the importance during that time, we could get better results and limit burning them out on treatment before it is essential.
Having a measurement and model of their height using the Momentum Spine App every other week would help us to see when that growth is starting to increase in velocity. Then, when we see that, we could meet with the child and parents and inform them of the need to increase the intensity of treatment because it is “go time”!
I am not suggesting we do nothing until that time, but maybe we lessen the intensity until it is really needed. With the patients I have tried this with, we have gotten better buy in and consistently with treatment. It also doesn’t feel to the child like it is an endless treatment that they never will get out of.
As of this blog post, the Momentum Spine App doesn’t have the function to alert for growth, but it is something we have been discussing with them. I hope it is possible in the near future and we can really dose treatment better with these kids.
Adult Scoliosis and The App
The Momentum Spine App has been studied and developed more with adolescent idiopathic scoliosis in mind, but we have also been using it with our adult scoliosis patients. To be able to remotely monitor spinal curves in adults is a game changer because usually their biggest concern is that they don’t want the curve to get worse. We can see that!
We wouldn’t be using the app to determine their peak growth velocity, but we could use it to determine if we are seeing more asymmetry or imbalance, as well as height loss. This could then trigger an x-ray which would help us determine if we are seeing progression or not.
As AI technology continues to develop, we will most likely see more advances in the treatment of scoliosis and kyphosis. AI modeling with 3D printing of braces is something just on the horizon. Less invasive monitoring and treatment will most likely come to pass. Who knows what else is in the future!
If you are looking to check out the Momentum Spine App for yourself, you can find it on Android or Apple app stores. You can also check out the Momentum Health website for more information on what they are doing.
I will make sure to write updates as we use this technology in our clinic. So stay tuned for more in the future!
David Butler, Physical Therapist
