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Birhiray DG, Chilukuri SV, Witsken CC, Wang M, Scioscia JP, Gehrchen M, Deveza LR, Dahl B. Machine learning identifies clusters of the normal adolescent spine based on sagittal balance. Spine Deform 2024:10.1007/s43390-024-00952-6. [PMID: 39167356 DOI: 10.1007/s43390-024-00952-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/11/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE This study applied a machine learning semi-supervised clustering approach to radiographs of adolescent sagittal spines from a single pediatric institution to identify patterns of sagittal alignment in the normal adolescent spine. We sought to explore the inherent variability found in adolescent sagittal alignment using machine learning to remove bias and determine whether clusters of sagittal alignment exist. METHODS Multiple semi-supervised machine learning clustering algorithms were applied to 111 normal adolescent sagittal spines. Sagittal parameters for resultant clusters were determined. RESULTS Machine learning analysis found that the spines did cluster into distinct groups with an optimal number of clusters ranging from 3 to 5. We performed an analysis on both 3 and 5-cluster groups. The 3-cluster groups analysis found good consistency between methods with 96 of 111, while the analysis of 5-cluster groups found consistency with 105 of 111 spines. When assessing for differences in sagittal parameters between the groups for both analyses, there were differences in T4-12 TK, L1-S1 LL, SS, SVA, PI-LL mismatch, and TPA. However, the only parameter that was statistically different for all groups was SVA. CONCLUSIONS Based on machine learning, the adolescent sagittal spine alignments do cluster into distinct groups. While there were distinguishing features with TK and LL, the most important parameter distinguishing these groups was SVA. Further studies may help to understand these findings in relation to spinal deformities.
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Affiliation(s)
- Dion G Birhiray
- Georgetown University School of Medicine, Washington, D.C, USA.
| | | | | | - Maggie Wang
- Baylor College of Medicine, Houston, TX, USA
| | | | - Martin Gehrchen
- Righospitalet and University of Copenhagen, Copenhagen, Europe, Denmark
| | | | - Benny Dahl
- Righospitalet and University of Copenhagen, Copenhagen, Europe, Denmark
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Solla F, Ilharreborde B, Clément JL, Rose EO, Monticone M, Bertoncelli CM, Rampal V. Patient-Specific Surgical Correction of Adolescent Idiopathic Scoliosis: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:106. [PMID: 38255419 PMCID: PMC10814112 DOI: 10.3390/children11010106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/03/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
The restoration of sagittal alignment is fundamental to the surgical correction of adolescent idiopathic scoliosis (AIS). Despite established techniques, some patients present with inadequate postoperative thoracic kyphosis (TK), which may increase the risk of proximal junctional kyphosis (PJK) and imbalance. There is a lack of knowledge concerning the effectiveness of patient-specific rods (PSR) with measured sagittal curves in achieving a TK similar to that planned in AIS surgery, the factors influencing this congruence, and the incidence of PJK after PSR use. This is a systematic review of all types of studies reporting on the PSR surgical correction of AIS, including research articles, proceedings, and gray literature between 2013 and December 2023. From the 28,459 titles identified in the literature search, 81 were assessed for full-text reading, and 7 studies were selected. These included six cohort studies and a comparative study versus standard rods, six monocentric and one multicentric, three prospective and four retrospective studies, all with a scientific evidence level of 4 or 3. They reported a combined total of 355 AIS patients treated with PSR. The minimum follow-up was between 4 and 24 months. These studies all reported a good match between predicted and achieved TK, with the main difference ranging from 0 to 5 degrees, p > 0.05, despite the variability in surgical techniques and the rods' properties. There was no proximal junctional kyphosis, whereas the current rate from the literature is between 15 and 46% with standard rods. There are no specific complications related to PSR. The exact role of the type of implants is still unknown. The preliminary results are, therefore, encouraging and support the use of PSR in AIS surgery.
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Affiliation(s)
- Federico Solla
- Paediatric Orthopaedic Unit, Lenval Foundation, 57, Avenue de la Californie, 06200 Nice, France; (J.-L.C.); (C.M.B.); (V.R.)
| | - Brice Ilharreborde
- Paediatric Orthopaedic Unit, Hôpital Robert Debré, AP-HP, 75019 Paris, France;
| | - Jean-Luc Clément
- Paediatric Orthopaedic Unit, Lenval Foundation, 57, Avenue de la Californie, 06200 Nice, France; (J.-L.C.); (C.M.B.); (V.R.)
| | - Emma O. Rose
- Krieger School of Arts & Sciences, Homewood Campus, John Hopkins University, Baltimore, MD 21218, USA
| | - Marco Monticone
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy;
| | - Carlo M. Bertoncelli
- Paediatric Orthopaedic Unit, Lenval Foundation, 57, Avenue de la Californie, 06200 Nice, France; (J.-L.C.); (C.M.B.); (V.R.)
| | - Virginie Rampal
- Paediatric Orthopaedic Unit, Lenval Foundation, 57, Avenue de la Californie, 06200 Nice, France; (J.-L.C.); (C.M.B.); (V.R.)
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Langlais T, Bouy A, Eloy G, Mainard N, Skalli W, Vergari C, Vialle R. Sagittal plane assessment of manual concave rod bending for posterior correction in adolescents with idiopathic thoracic scoliosis (Lenke 1 and 3). Orthop Traumatol Surg Res 2023; 109:103654. [PMID: 37399990 DOI: 10.1016/j.otsr.2023.103654] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 07/05/2023]
Abstract
OBJECTIVES The objectives of this study were to evaluate the repeatability and reproducibility of a method for measuring freehand rod bending and to analyze the relationship between the rod's bend and the resulting sagittal correction. MATERIALS AND METHODS All the children who underwent correction by posterior translation using pedicle screws at all levels were included prospectively in 2018 and 2019. The rod's sagittal parameters were measured retrospectively by three independent surgeons on two separate occasions using the same protocol. After the rods were bent but before they were inserted, the surgeon traced the contours of the rods on a sheet of paper that was later scanned and analyzed semiautomatically. The spinal parameters were calculated based on biplanar radiographs taken preoperatively, postoperatively and at the final follow-up visit. Patients who had less than 10° thoracic kyphosis (T5-T12) made up the "Lenke N-" subgroup. RESULTS Thirty patients were included (14 of whom were Lenke N-) who had a Cobb angle of 59.2±11.3° preoperatively and 13.3±8.4° postoperatively (p<0.00001). The inter- and intrarater ICC for the rod measurements were>0.9 (excellent). The mean kyphosis of the concave rod was 48.4±5.7° (38.3-60.9°). The mean change in T5-T12 kyphosis was 9.7±10.8° (-14.3-30.8°) (p<0.0001) in the entire population, while it was 17.7±7.1° (5.5-30.8°) (p<0.0001) in the Lenke N- subgroup. The change in thoracic kyphosis was positively correlated with the kyphosis of the concave rod (rho=0.52; p=0.003). CONCLUSION This study found excellent reproducibility and repeatability of measuring freehand rod bending. The kyphosis applied to the concave rod is positively correlated to the change in the resulting kyphosis and made it possible to restore satisfactory thoracic kyphosis. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tristan Langlais
- Service d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France; Institut de Biomécanique Humaine Georges Charpak-IBHGC, Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, HESAM Université, 75013 Paris, France; Service d'orthopédie pédiatrique, hôpital des Enfants, Purpan, Toulouse université, Toulouse, France.
| | - Alois Bouy
- Service d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Gauthier Eloy
- Service d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Nicolas Mainard
- Service d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak-IBHGC, Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, HESAM Université, 75013 Paris, France
| | - Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak-IBHGC, Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, HESAM Université, 75013 Paris, France
| | - Raphaël Vialle
- Service d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
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Wong DLL, Mong PT, Ng CY, Ong CK, Qian Z, Shao MH, Sin LKE, Wong BY, Wong CM, Cheung JPY, To M. Can anterior vertebral body tethering provide superior range of motion outcomes compared to posterior spinal fusion in adolescent idiopathic scoliosis? A systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3058-3071. [PMID: 37256367 DOI: 10.1007/s00586-023-07787-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/03/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE Anterior vertebral body tethering (AVBT) was introduced as a fusionless alternative to treating adolescent idiopathic scoliosis (AIS) while preserving range of motion (ROM). This is the first systematic review to compare the ROM outcomes between AVBT and PSF in treating AIS. METHODS We conducted a comprehensive search on PubMed, EMBASE, MEDLINE, and Cochrane Library. Inclusion criteria were patients with AIS treated with AVBT or PSF or both, and clearly defined ROM outcomes; exclusion criteria were scoliosis other than AIS, biomechanical or cadaveric studies, non-English publications, case reports, conference summaries, unpublished literature, commentaries, and reviews. Primary outcome was ROM. Secondary outcomes included Cobb angle correction, quality of life (QOL), complications, and muscle strength and endurance. RESULTS Twelve studies were included in this review. We found moderate evidence to support that AVBT results in superior ROM outcomes than PSF while achieving comparable Cobb angle correction with low evidence. The comparison of QOL outcomes between AVBT and PSF remained inconclusive. In addition to the complications noted conventionally in PSF, AVBT could result in over-correction and distal adding-on. We also found very low evidence to support that AIS patients treated with AVBT have superior muscle strength and endurance when compared to those treated with PSF. CONCLUSIONS AVBT provides better preservation of ROM and muscle strength postoperatively when compared with PSF, while achieving comparable curve correction. Future studies should explore the spinal growth trajectory to determine the window of opportunity for AVBT in AIS.
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Affiliation(s)
- Darren Li Liang Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Pak Tung Mong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Chun Yin Ng
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Chun Kwan Ong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Zhekai Qian
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Mang Hong Shao
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Ling Kwan Ernest Sin
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Bao Yi Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Chun Ming Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China.
| | - Michael To
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China.
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Wan SHT, Wong DLL, To SCH, Meng N, Zhang T, Cheung JPY. Patient and surgical predictors of 3D correction in posterior spinal fusion: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1927-1946. [PMID: 37079078 DOI: 10.1007/s00586-023-07708-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/18/2023] [Accepted: 04/07/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Restoration of three-dimensional (3D) alignment is critical in correcting patients with adolescent idiopathic scoliosis using posterior spinal fusion (PSF). However, current studies mostly rely on 2D radiographs, resulting in inaccurate assessment of surgical correction and underlying predictive factors. While 3D reconstruction of biplanar radiographs is a reliable and accurate tool for quantifying spinal deformity, no study has reviewed the current literature on its use in evaluating surgical prognosis. PURPOSE To summarize the current evidence on patient and surgical factors affecting sagittal alignment and curve correction after PSF based on 3D parameters derived from reconstruction of biplanar radiographs. METHODS A comprehensive search was conducted by three independent investigators on Medline, PubMed, Web of Science, and Cochrane Library to obtain all published information on predictors of postoperative alignment and correction after PSF. Search items included "adolescent idiopathic scoliosis," "stereoradiography," "three-dimensional," "surgical," and "correction." The inclusion and exclusion criteria were carefully defined to include clinical studies. Risk of bias was assessed with the Quality in Prognostic Studies tool, and level of evidence for each predictor was rated with the Grading of Recommendations, Assessment, Development, and Evaluations approach. 989 publications were identified, with 444 unique articles subjected to full-text screening. Ultimately, 41 articles were included. RESULTS Strong predictors of better curve correction included preoperative normokyphosis (TK > 15°), a corresponding rod contour, intraoperative vertebral rotation and translation, and upper and lower instrumented vertebrae selected based on sagittal and axial inflection points. For example, for Lenke 1 patients with junctional vertebrae above L1, fusion to NV-1 (1 level above the neutral vertebra) achieved optimal curve correction while preserving motion segments. Pre-op coronal Cobb angle and axial rotation, distal junctional kyphosis, pelvic incidence, sacral slope, and type of instrument were identified as predictors with moderate evidence. For Lenke 1C patients, > 50% LIV rotation was found to increase spontaneous lumbar curve correction. Pre-op thoracolumbar apical translation and lumbar lordosis, Ponte osteotomies, and rod material were found to be predictors with low evidence. CONCLUSIONS Rod contouring and UIV/LIV selection should be based on preoperative 3D TK in order to achieve normal postoperative alignment. Specifically, Lenke 1 patients with high-lying rotations should be fused distally at NV-1, while hypokyphotic patients with large lumbar curves and truncal shift should be fused at NV to improve lumbar alignment. Lenke 1C curves should be corrected using > 50% LIV rotation counterclockwise to the lumbar rotation. Further investigation should compare surgical correction between pedicle-screw and hybrid constructs using matched cohorts. DJK and overbending rods are potential predictors of postoperative alignment.
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Affiliation(s)
- Sandra Hiu-Tung Wan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Darren Li-Liang Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Samuel Ching-Hang To
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Nan Meng
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Teng Zhang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Jason Pui-Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
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Zhang X, Yang D, Zhang S, Wang J, Chen Y, Dou X, Liu Y, Li X, Liao B. Do the three-dimensional parameters of brace-wearing patients with AIS change when transitioning from standing to sitting position? A preliminary study on Lenke I. BMC Musculoskelet Disord 2022; 23:419. [PMID: 35509093 PMCID: PMC9066906 DOI: 10.1186/s12891-022-05380-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Bracing is the most common conservative treatment for preventing the progression of adolescent idiopathic scoliosis (AIS) in patients with a curve of 25°–40°. X-ray examinations are traditionally performed in the standing position. However, school-age teenagers may take more time to sit. Thus far, little is known about three-dimensional (3D) correction in the sitting position. Hence, this study aimed to determine the effects of standing and sitting positions on 3D parameters during brace correction. Methods We evaluated a single-center cohort of patients receiving conservative treatment for thoracic curvature (32 patients with AIS with a Lenke I curve). The 3D parameters of their standing and sitting positions were analyzed using the EOS imaging system during their first visit and after bracing. Results At the patients’ first visit, sagittal plane parameters such as thoracic kyphosis (TK), lumbar lordosis (LL), and sacral slope decreased when transitioning from the standing position to the sitting position (standing 29° ± 6°, 42° ± 8°, and 42° ± 8° vs. sitting 22° ± 5°, 27° ± 6°, and 24° ± 4°; p < 0.001), whereas pelvic tilt (PT) increased and sagittal vertical axis shifted forward (standing 9° ± 6° and 1.6 ± 2.7 cm vs. sitting 24° ± 4° and 3.8 ± 2.3 cm; p < 0.001). After bracing, TK and LL decreased slightly (from 29° ± 6° and 42° ± 8° to 23° ± 3° and 38° ± 6°; p < 0.001), whereas the thoracolumbar junction (TLJ) value increased (from 3° ± 3° to 11° ± 3°; p < 0.001). When transitioning to the sitting position, similar characteristics were observed during the first visit, except for a subtle increase in the TLJ and PT values (standing 11° ± 3° and 9° ± 4° vs. sitting 14° ± 3° and 28° ± 4°; p < 0.001). Moreover, the coronal and axial parameters at different positions measured at the same time showed no significant change. Conclusions In brace-wearing patients with thoracic scoliosis, compensatory sagittal plane straightening may be observed with a slight increase in thoracolumbar kyphosis, particularly when transitioning from the standing position to the sitting position, due to posterior rotation of the pelvis. Our results highlight that sagittal alignment in AIS with brace treatment is not completely analyzed with only standing X-Ray. Trial registration The study protocol was registered with the Chinese Clinical Trial Registry (ChiCTR1800018310).
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Affiliation(s)
- Xiaohui Zhang
- Department of Sports Medicine, Guangzhou Sport University, 1268 # Guangzhou Avenue, Guangzhou, 515500, Guangdong Province, China
| | - Daoyang Yang
- Department of Sports Medicine, Guangzhou Sport University, 1268 # Guangzhou Avenue, Guangzhou, 515500, Guangdong Province, China
| | - Shuo Zhang
- Department of Sports Medicine, Guangzhou Sport University, 1268 # Guangzhou Avenue, Guangzhou, 515500, Guangdong Province, China
| | - Jun Wang
- Gosun Medical Imaging Diagnosis Center of Guangdong Province, 117 #Liuhua Road, Guangzhou, 515500, Guangdong Province, China
| | - Yuan Chen
- Department of Sports Medicine, Guangzhou Sport University, 1268 # Guangzhou Avenue, Guangzhou, 515500, Guangdong Province, China
| | - Xiaoran Dou
- Department of Sports Medicine, Guangzhou Sport University, 1268 # Guangzhou Avenue, Guangzhou, 515500, Guangdong Province, China
| | - Yanan Liu
- Department of Sports Medicine, Guangzhou Sport University, 1268 # Guangzhou Avenue, Guangzhou, 515500, Guangdong Province, China
| | - Xianglan Li
- Department of Sports Medicine, Guangzhou Sport University, 1268 # Guangzhou Avenue, Guangzhou, 515500, Guangdong Province, China
| | - Bagen Liao
- Department of Sports Medicine, Guangzhou Sport University, 1268 # Guangzhou Avenue, Guangzhou, 515500, Guangdong Province, China.
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Tan Z, Li J, Tao H, Li S, Hu Y. XctNet: Reconstruction network of volumetric images from a single X-ray image. Comput Med Imaging Graph 2022; 98:102067. [DOI: 10.1016/j.compmedimag.2022.102067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/15/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022]
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Souza AFMD, Avila LM, Aguiar CAD, Rocha LEMD. PRE- AND POSTOPERATIVE COMPARATIVE ANALYSIS OF THE SPINOPELVIC AND GLOBAL SAGITTAL PARAMETERS OF PATIENTS WITH ADOLESCENT IDIOPATHIC SCOLIOSIS. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222101250514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To analyze the pre- and postoperative spinopelvic parameters and global sagittal balance of patients with adolescent idiopathic scoliosis (AIS) divided into 3 groups (Group 1 – thoracic arthrodesis, Group 2 - thoracolumbar arthrodesis, and Group 3 – lumbar arthrodesis), observing differences in these two moments and whether the parameter values are maintained or not over a period of up to 2 years following surgery. Methods: We analyzed the radiographs from a single-center database of 99 patients who underwent arthrodesis with posterior instrumentation. Pelvic incidence, pelvic version, sacral slope, lumbar lordosis, thoracic kyphosis, and sagittal vertical axis values were measured in the pre- and postoperative radiographies of each patient. Results: The parameters of pelvic incidence, pelvic version, sacral slope, and sagittal vertical axis did not show statistically significant differences among the 3 groups. There was a difference in preoperative lumbar lordosis between the 3 groups (p = 0.049). Thoracic kyphosis showed differences both in the pre- (p = 0.015) and postoperative (p = 0.042) values, in addition to demonstrating a relationship of dependence between the pre- and postoperative values in the final statistical analysis. Conclusion: The evaluation of the parameters analyzed shows that the study groups have similar values of individual balance, with the exception of thoracic kyphosis and lumbar lordosis, which are measurements that depend on the surgical technique and compensatory mechanisms, but remained within normal ranges. These factors allow the surgeon to be attentive to both the coronal and sagittal planes when planning the correction in order to achieve the equilibrium of the trunk in addition to correction of the deformity. Level of Evidence IIIA: Comparative retrospective study.
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Specific sagittal alignment patterns are already present in mild adolescent idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1881-1887. [PMID: 33638721 DOI: 10.1007/s00586-021-06772-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 07/26/2020] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The complex three-dimensional spinal deformity in AIS consists of rotated, lordotic apical areas and neutral junctional zones that modify the spine's sagittal profile. Recently, three specific patterns of thoracic sagittal 'malalignment' were described for severe AIS. The aim of this study is to define whether specific patterns of pathological sagittal alignment are already present in mild AIS. METHODS Lateral spinal radiographs of 192 mild (10°-20°) and 253 severe (> 45°) AIS patients and 156 controls were derived from an international consortium. Kyphosis characteristics (T4-T12 thoracic kyphosis, T10-L2 angle, C7 slope, location of the apex of kyphosis and of the inflection point) and sagittal curve types according to Abelin-Genevois were systematically compared between the three cohorts. RESULTS Even in mild thoracic AIS, already 49% of the curves presented sagittal malalignment, mostly thoracic hypokyphosis, whereas only 13% of the (thoraco) lumbar curves and 6% of the nonscoliosis adolescents were hypokyphotic. In severe AIS, 63% had a sagittal malalignment. Hypokyphosis + thoracolumbar kyphosis occurred more frequently in high-PI and primary lumbar curves, whereas cervicothoracic kyphosis occurred more in double thoracic curves. CONCLUSIONS Pathological sagittal patterns are often already present in curves 10°-20°, whereas those are rare in non-scoliotic adolescents. This suggests that sagittal 'malalignment' patterns are an integral part of the early pathogenesis of AIS.
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Castelein RM, Pasha S, Cheng JC, Dubousset J. Idiopathic Scoliosis as a Rotatory Decompensation of the Spine. J Bone Miner Res 2020; 35:1850-1857. [PMID: 32697856 DOI: 10.1002/jbmr.4137] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 11/11/2022]
Abstract
Many years of dedicated research into the etiology of idiopathic scoliosis have not led to one unified theory. We propose that scoliosis is a mechanical, rotatory decompensation of the human spine that starts in the transverse, or horizontal, plane. The human spine is prone to this type of decompensation because of its unique and individually different, fully upright sagittal shape with some preexistent transverse plane rotation. Spinal stability depends on the integrity of a delicate system of stabilizers, in which intervertebral disc stiffness is crucial. There are two phases in life when important changes occur in the precarious balance between spinal loading and the disc's stabilizing properties: (i) during puberty, when loads and moment arms increase rapidly, while the disc's "anchor," the ring apophysis, matures from purely cartilaginous to mineralized to ultimately fused to the vertebral body, and (ii) in older age, when the torsional stiffness of the spinal segments decreases, due to disc degeneration and subsequent laxity of the fibers of the annulus fibrosus. During these crucial periods, transverse plane vertebral rotation can increase during a relatively brief window in time, either as adolescent idiopathic or degenerative de novo scoliosis. Much more is known of the biomechanical changes that occur during disc aging and degeneration than of the changing properties of the disc during maturation. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saba Pasha
- Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jack Cy Cheng
- Department of Orthopaedics and Traumatology, S. H. Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, Hong Kong.,Joint Scoliosis Research Center of The Chinese University of Hong Kong-Nanjing University, The Chinese University of Hong Kong, Shatin, Hong Kong
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Abstract
AIMS Significant correction of an adolescent idiopathic scoliosis in the coronal plane through a posterior approach is associated with hypokyphosis. Factors such as the magnitude of the preoperative coronal curve, the use of hooks, number of levels fused, preoperative kyphosis, screw density, and rod type have all been implicated. Maintaining the normal thoracic kyphosis is important as hypokyphosis is associated with proximal junctional failure (PJF) and early onset degeneration of the spine. The aim of this study was to determine if coronal correction per se was the most relevant factor in generating hypokyphosis. METHODS A total of 95 patients (87% female) with a median age of 14 years were included in our study. Pre- and postoperative radiographs were measured and the operative data including upper instrumented vertebra (UIV), lower instrumented vertebra (LIV), metal density, and thoracic flexibility noted. Further analysis of the post-surgical coronal outcome (group 1 < 60% correction and group 2 ≥ 60%) were studied for their association with the postoperative kyphosis in the sagittal plane using univariate and multivariate logistic regression. RESULTS Of the 95 patients, 71.6% (68) had a thoracic correction of > 60%. Most (97.8%) had metal density < 80%, while thoracic flexibility > 50% was found in 30.5% (29). Preoperative hypokyphosis (< 20°) was present in 25.3%. A postoperative thoracic hypokyphosis was four times more likely to occur in patients with thoracic correction ≥ 60% (odds ratio (OR) 4.08; p = 0.005), after adjusting for confounding variables. This association was not affected by metal density, thoracic flexibility, LIV, UIV, age, or sex. CONCLUSION Our study supports the 'essential lordosis' hypothesis of Roaf and Dickson, i.e. with a greater ability to translate the apical vertebra towards the midline, there is a commensurate lengthening of the anterior column due to the vertebral wedging. Cite this article: Bone Joint J 2020;102-B(4):513-518.
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Affiliation(s)
- Oded Hershkovich
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, UK
| | - Areena D'Souza
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, UK
| | - Paul R P Rushton
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, UK
| | - Ifesemen S Onosi
- University of Nottingham, AR UK Centre for Sports Exercise and Osteoarthritis, Nottingham, UK
| | - Wai Weng Yoon
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, UK
| | - Michael P Grevitt
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, UK
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12
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Schlösser TPC, Castelein RM. The effect of 3D scoliosis correction on the length of the spinal canal. ANNALS OF TRANSLATIONAL MEDICINE 2020; 7:S265. [PMID: 32015984 DOI: 10.21037/atm.2019.12.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tom P C Schlösser
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - René M Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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13
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Fruergaard S, Jain MJ, Deveza L, Liu D, Heydemann J, Ohrt-Nissen S, Dragsted C, Gehrchen M, Dahl B. Evaluation of a new sagittal classification system in adolescent idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:744-753. [PMID: 31802239 DOI: 10.1007/s00586-019-06241-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/21/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of the present study was to validate a new spinal sagittal classification. METHODS We retrospectively included 105 consecutive AIS patients who underwent posterior spinal fusion. Preoperative long-standing EOS radiographs were available on all patients. Patients were classified according to the four suggested sagittal patterns: type 1, 2a, 2b or 3. Several predetermined sagittal parameters were compared between the groups. RESULTS The mean preoperative Cobb angle was 64° ± 12°, and 73% of the patients were female. Of 105 patients, 51 were type 1, 14 were type 2a, one was type 2b and 39 were type 3. The distribution of the four sagittal patterns was significantly different compared with the original publication (p < 0.05). However, the two study populations were comparable in terms of Lenke and Roussouly types (p = 0.49 and 0.47, respectively). In our study population, the sagittal groups differed significantly in terms of thoracic kyphosis, length of thoracic and lumbar curves, lumbar lordosis, thoracic slope, C7 slope, pelvic incidence and sacral slope (p < 0.05). CONCLUSION The distribution of the four sagittal patterns varies between AIS cohorts. Type 2b was rare, which limits the clinical applicability. Contrary to the original publication, we found that the spinopelvic parameters lumbar lordosis, pelvic incidence and sacral slope were significantly different between the Abelin-Genevois types. Hence, the corrective surgical strategy may need to incorporate these spinopelvic parameters to achieve a balanced spine requiring a minimum of energy expenditure. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Sidsel Fruergaard
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA. .,Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Mohit J Jain
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Lorenzo Deveza
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - David Liu
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - John Heydemann
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Søren Ohrt-Nissen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Casper Dragsted
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.,Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Gehrchen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Benny Dahl
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
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Lee TTY, Jiang WW, Cheng CLK, Lai KKL, To MKT, Castelein RM, Cheung JPY, Zheng YP. A Novel Method to Measure the Sagittal Curvature in Spinal Deformities: The Reliability and Feasibility of 3-D Ultrasound Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2725-2735. [PMID: 31303403 DOI: 10.1016/j.ultrasmedbio.2019.05.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 06/10/2023]
Abstract
The objective of this study was to test the reliability of sagittal spinal curvature measurements using 3-D ultrasound in patients with adolescent idiopathic scoliosis (AIS). Ultrasound spinous process angle (USSPA) and ultrasound laminae angle (USLA) were measured on sagittal ultrasound images, while the Cobb angle (XCA) was measured on sagittal X-ray images. Intra-class correlation coefficients (ICC) for the intra- and inter-observer variability, linear regression analysis and Bland-Altman method, including mean absolute difference (MAD), were investigated to evaluate the reliability and validity of the two ultrasound angles compared with XCA. Excellent measurement reliabilities were demonstrated for both ultrasound angles (ICC ≥ 0.91). Moderate to good and significant linear correlations and good agreement were demonstrated between the ultrasound methods and XCA (Thoracic [R2 ≥ 0.574] / Lumbar [R2 ≥ 0.635]). No significant differences were found for the MADs between both corrected ultrasound angles and XCA. Sagittal ultrasound angles were demonstrated to be reliable for assessing sagittal curvature using spinous processes and laminae and to have good and significant correlations with XCAs. Since it is non-ionizing and relatively low cost, this method opens the possibility of providing frequent curve monitoring and evaluation, and screening for AIS patients, particularly based on sagittal profiles.
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Affiliation(s)
- Timothy Tin-Yan Lee
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Wei Wei Jiang
- College of Computer Science and Technology, Zhejiang University of Technology, Hangzhou, China
| | - Connie Lok Kan Cheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Kelly Ka-Lee Lai
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Michael Kai Tsun To
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - René M Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China.
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Courvoisier A, Nesme M, Gerbelot J, Moreau-Gaudry A, Faure F. Prediction of brace effect in scoliotic patients: blinded evaluation of a novel brace simulator—an observational cross-sectional study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1277-1285. [DOI: 10.1007/s00586-019-05948-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/08/2019] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
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