Collaborative Orthopaedic Research (CORe)



Many of our projects involve comparing patients with Scoliosis to teenagers without Scoliosis.
We invite those interested to contribute to such projects to complete an enrollment form for  Healthy Infants and Children Clinical Research Program (HICCUP)

Current Projects

  • A Systematic Review of Motor Control Deficits of the Torso in Adolescents with Idiopathic Scoliosis
    Principal Investigator: Eric Parent
    This review aims to document the deficits in torso motor control function affecting patients with idiopathic scoliosis which could be targeted using rehabilitation strategies .

  • A Study of the Reliability, Validity and Ability to Detect Changes of Quality of Life Questionnaires in Adolescents with Idiopathic Scoliosis and Adult Scoliosis
    Principal Investigator: Eric Parent
    The team has translated the Italian Spine Youth Quality of Life questionnaire to English. This questionnaire was developed based on the patients and parents preoccupations and scaled used modern methods. It is compared to questionnaires currently in use at our clinic, the Scoliosis Research Society 22r and the Spinal Appearance questionnaire, as well as to recently proposed new questionnaires (Body Image Disturbance questionnaire and Trunkal Anterior Asymmetry Scoliosis Questionnaire.)

  • Immediate Effects of Scoliosis Specific Exercises in Adolescents with Idiopathic Scoliosis Determined Using 3D Ultrasound Imaging
    Principal Investigator: Eric Parent
    Using 3D Ultrasound imaging, the spinal alignment (Curve angle, vertebra rotation and lateral vertebra displacements) is determined while performing 16 different exercises positions. This study aims to provide evidence for skeptics that patients can achieve important improvements in spinal alignments using the complex correction instructions provided by exercise therapists. This evidence may help develop improved teaching strategies.

  • Using Ultrasound and Health’ Records to Non-Invasively Identify Cases with Curve Progression or not in Children with AIS
    Principal Investigator: Edmond Lou
    This study will develop and validate a model that uses ultrasound imaging and the frequency amplitude index (FAI) methods plus the patients’ information, rather than radiographs, to detect cases with curve progression or not at a 6-month follow-up visit in children who have adolescent idiopathic scoliosis (AIS). The goal is to reduce the radiation exposure to children with AIS who have curves which do not progress.

  • A New Spinal Brace Design Concept for the Treatment of Adolescent Idiopathic Scoliosis (AIS)
    Principal Investigator: Edmond Lou
    The objectives of this study are to 1) develop a low cost real-time 3D ultrasound-camera system that is capable of imaging the spine and capturing the body’s shape while the spine’s alignment is manipulated by changing the brace pad locations and pressure levels during brace casting, 2) based on the optimal spinal alignment, fabricate an orthosis using the CAD/CAM method, 3) investigate the clinical and economic benefits, costs and effectiveness of the proposed ultrasound-camera assisted method versus the traditional orthosis manufacturing method and 4) investigate the effectiveness of 3D printed brace.

  • The Correlation of Brace Compliance and the In-Brace Correction to the Treatment Outcomes of Scoliosis Patients
    Principal Investigator: Edmond Lou
    Thirty new Adolescent Idiopathic Scoliosis (AIS) brace candidates will be recruited from the scoliosis clinics in both Edmonton and Ottawa. The objective of this study is to investigate the outcomes of the brace treatment for AIS and their relationship to brace compliance and the in-brace correction.

  •  Using the EOS System to Validate 3D Ultrasound Measurements in Children with Adolescent Idiopathic Scoliosis (AIS)
     Principal Investigator: Edmond Lou

     The 3D ultrasound measurements such as the Cobb angle in the plane of maximum curvature, the vertebral rotation at the apex and the angle of the plane of maximum curvature have not   been validated by in-vivo data. The goals of this study are 1) to validate the 3D reconstructed in-vivo ultrasound images and 2) to determine the reliability and accuracy of the 3D ultrasound  measurements and compare them to the 3D information obtained from the EOS system, which is a new low dosage bi-planar x-ray system.

  • Using Ultrasound Images to Guide the Insertion of Pedicle Screws During Scoliosis Surgery
    Principal Investigator: Edmond Lou

    Spinal surgery is a complicated process which involves the insertion of pedicle screws into selected vertebrae. A misaligned pedicle screw can potentially cause permanent neurological spinal cord injury or even a life-threatening vascular injury. This project is to develop a non-ionizing radiation method to assist the positioning and aligning of pedicle screws during surgery.

  • Using 3D Ultrasound Imaging and the Spatial Pressure Measurement System to Investigate Spinal Curve Response Imposed by a Simulated Brace
    Principal Investigator: Edmond Lou

    Existing ultrasound imaging technologies cannot monitor the 3D mechanical response of the spine to physical loadings in real time. This project is focused on the technical aspects required to investigate, advance, validate and integrate 3D ultrasound imaging processing tools synchronized with a 3D wireless spatial pressure control sensor network and a high-speed 3D body image capture system to investigate how mechanical loading affects the internal spinal alignment in real-time.

  • Pressure Distribution during Scoliosis Surgery
    Principal Investigator: Kajsa Duke

    During scoliosis surgery damage to the lateral femoral cutaneous nerve (LFCN) has been reported in 20% of patients. The objectives of this study are to characterize intraoperative pressures at the patient cushion interface and examine the LFCN somatosensory evoked potential (SSEP) to determine if they are correlated with the incidence of LFCN injury.

  • The Multicenter Schroth Exercise Trial for Scoliosis
    Principal Investigator: Eric Parent

    Schroth exercises are scoliosis-specific exercises aiming to improve posture and correct curvatures by improving the endurance and control of postural muscles. The effect of Schroth’s exercise has not yet been investigated in a randomized controlled study. Our team, in collaboration with colleagues in Montréal and Calgary, is conducting a multicentre randomized controlled trial with adolescents with idiopathic scoliosis to investigate the effect of adding Schroth exercises to Standard Care in comparison to offering Standard Care alone on curve severity, postural measurements, perceived appearance, back muscle endurance and quality of life.

  • Using Surface Topography to Assess the Severity and Detect Progression of Scoliosis
    Principal Investigator: Samer Adeeb

    Using a 4-Konica-Minolta 910 camera system, we capture full-torso images of scoliotic patients. We are applying our markerless torso symmetry analysis to classify scoliosis within different curve severity and risk of progression categories. Previously developed classification trees are validated using new datasets.

  • Novel MRI Biomarkers of Intervertebral Disc Response to Loading
    Principal Investigator: Eric Parent

    This case control study aims to identify novel biomarkers that are patho-anatomically specific to low back pain by applying compression and traction and extracting quantitative parameters from T2-map images in patients with low back pain and matched healthy controls.

  • Fatigability and Recovery Characteristics in Torso Muscles of Adolescents with Idiopathic Scoliosis Compared to Health Controls
    Principal Investigator: Eric Parent

    This case control study aims to identify torso muscle fatigability deficits during isometric and dynamic rotation fatigue test using Biodex in adolescent with idiopathic scoliosis compared to healthy matched controls. A secondary objective is to determine if fatigability in patients may predict curve progression.

  • A Systematic Review of the Reliability and Validity of Perceived Self-Image Questionnaires in Adolescent Idiopathic Scoliosis
    Principal Investigator: Eric Parent

    This systematic review aims to document the reliability and validity of all perceived self-image questionnaires published to date for use in adolescents with idiopathic scoliosis and appraise the quality of the publications using the COSMIN tool in order to formulate a recommendation about which questionnaire should be used clinically and in research.

  • Novel Neuromonitoring Technique to Detect Motor Pathway Injuries using Reflexes
    Principal Investigator: François Roy
    Demonstrate if the reflex facilitation technique of motor pathways to monitor the integrity during spinal deformity corrective surgeries can be used during anesthesia, produces less movement than standard MEP and if results correlated with physiological changes and surgical events.

Projects completed in the last 5 years

  • Intraoperative Image Guidance and Navigation in Adolescent Idiopathic Scoliosis Posterior Surgery: A Systematic Review on Screw-Related Complications and Breach Rates (Jan 2017)
    Principal Investigator: Edmond Lou

    Severe adolescent idiopathic scoliosis (AIS) is a 3D spinal deformity requiring surgery to stop curve progression. Posterior spinal instrumentation and fusion with pedicle screws is the standard surgery for AIS curve correction. Vascular and neurologic complications related to screw-malpositioning are concerns in surgeries for AIS. Breach rates are reported at 15.7%, implant-related complications at 1.1% and neurologic deficit at 0.8%. Free-hand screw insertion remains the prevailing method of screw placement while image guidance has been suggested to improve placement accuracy. A systematic review was completed to compare the complications associated with each method.

  • Can Ultrasound Determine the Optimum Pad Positioning During Brace Casting for Scoliosis (May 2015)
    Principal Investigator: Edmond Lou

    The use of the ultrasound system during brace casting provided a radiation-free method of determining the optimum level and location of pressure applied to obtain the best simulated in-brace correction. The average number of radiographs taken per subject in the interventional group was lower than the control group. Acceptable in-brace correction was attained sooner in the intervention group with less burden on the families and patients.

  • Using Ultrasound to Determine Spinal Curve Flexibility (May 2015)
    Principal Investigator: Edmond Lou

    Spinal flexibility of a patient with Adolescent Idiopathic Scoliosis (AIS) affects treatment outcomes. More flexible spines are better corrected in a brace as well as spine surgery. We are the first group to develop an ultrasound imaging method to measure spinal flexibility.

  • How Quantity and Quality of Brace Wear affect Brace Treatment Outcomes (Dec 2014)
    Principal Investigator: Edmond Lou

    The quantity and quality of brace usage are important factors in achieving successful brace treatment. The quantity of brace wear is the amount of brace wear time relative to the prescribed wear time; the quality of brace wear is the amount of time that the brace is worn at or above the prescribed tightness. The more time that brace was worn at the prescribed level; it more likely to have a better treatment result.

  • The Schroth Exercise Trial for Scoliosis Pilot Study (SETS) (August 2014)
    Principal Investigator: Eric Parent

    This study was conducted to determine the feasibility and provide effect estimates for adding a 6-month program of Schroth scoliosis-specific exercises to the standard of care in patients with adolescent idiopathic scoliosis compared to standard care. Schroth exercises have positive effects on the Cobb angle, back muscle endurance time, pain, self-image and surface topography measurements.

  • Full Torso Surface Topography Measurements for the Management of Scoliosis: Reliability, Responsiveness and Correlations with Radiographic Measures of Curve Severity (January 2014)
    Principal Investigator: Eric Parent

    This study determined the intra-rater, inter-rater and test-retest reliability of marker-based torso shape deformity measurements obtained using full-torso compared to back-only parameters. The validity of measurements was compared to radiographic measurements. Curve type affect the strength of association between surface measurements and radiographic measurements.  The ability of parameters to detect changes over time was compared by correlations with radiographic changes and using standardized response mean estimates to identify the best surface topography parameters.

  • Markerless Surface Topography Measurements (September 2014)
    Principal Investigator: S. Adeeb

    Using data from the project above, a novel asymmetry analysis strategy was proposed to complete surface topography analyses without the use of markers placed on bony landmarks of patient achieving a high reliability. This asymmetry analysis allowed to categorize patients with scoliosis according to their curve severity, predict the location of curve apices and develop classification trees predicting whether patients experienced scoliosis curve progression over a one year interval.

  • Reliability of an Algorithm to Guide Schroth Curve Type Classification (August 2014)
    Principal Investigator: Eric Parent

    We developed an algorithm to guide the Schroth curve type classification of patients with adolescent idiopathic scoliosis. The algorithm was taught online to 10 certified Schroth therapist internationally using a web site. We determined that interrater reliability was adequate using the algorithm among therapists reporting full understanding following education procedures.

  • Fatigability of Paraspinal Muscles in Patients with Adolescents Idiopathic Scoliosis and Matched Controls during Side Planks (August 2014)
    Principal Investigator: Eric Parent

    Patients had longer hold time on their convex side and controls during the right side plank. Controls demonstrated more EMG fatigue quantified by the slope of the median frequency. Both groups demonstrated more EMG fatigue during the convex/ right side planks and more fatigue at the upper end vertebra level. Both groups demonstrated more fatigue at the lower end vertebra during the Sorensen back extension test. High variability in fatigue indicators was observed for the side-plank tasks possibly preventing detection of additional differences between groups.

  • A Systematic Review of the Impairments Affecting Paraspinal Muscles in Patients with Adolescent Idiopathic Scoliosis (August 2014)
    Principal Investigator: Eric Parent

    Our review included 24 papers. Evidence is limited on objectives pursued in this review due to the low quality of the evidence available and to the lack of research about muscle impairments in scoliosis. No studies were found on endurance deficits in AIS. Research is needed using large, homogenous samples allowing for a comparison between curve types and examining relation to the risk of progression.