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Lacroix M, Khalifé M, Ferrero E, Clément O, Nguyen C, Feydy A. Scoliosis. Semin Musculoskelet Radiol 2023; 27:529-544. [PMID: 37816361 DOI: 10.1055/s-0043-1772168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Scoliosis is a three-dimensional spinal deformity that can occur at any age. It may be idiopathic or secondary in children, idiopathic and degenerative in adults. Management of patients with scoliosis is multidisciplinary, involving rheumatologists, radiologists, orthopaedic surgeons, and prosthetists. Imaging plays a central role in diagnosis, including the search for secondary causes, follow-up, and preoperative work-up if surgery is required. Evaluating scoliosis involves obtaining frontal and lateral full-spine radiographs in the standing position, with analysis of coronal and sagittal alignment. For adolescent idiopathic scoliosis, imaging follow-up is often required, accomplished using low-dose stereoradiography such as EOS imaging. For adult degenerative scoliosis, the crucial characteristic is rotatory subluxation, also well detected on radiographs. Magnetic resonance imaging is usually more informative than computed tomography for visualizing associated canal and foraminal stenoses. Radiologists must also have a thorough understanding of postoperative features and complications of scoliosis surgery because aspects can be misleading.
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Affiliation(s)
- Maxime Lacroix
- Department of Radiology, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, Paris, France
- Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France
| | - Marc Khalifé
- Department of Orthopaedic Surgery, Hôpital Européen Georges- Pompidou, AP-HP Centre, Université Paris Cité, Paris, France
| | - Emmanuelle Ferrero
- Department of Orthopaedic Surgery, Hôpital Européen Georges- Pompidou, AP-HP Centre, Université Paris Cité, Paris, France
| | - Olivier Clément
- Department of Radiology, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, Paris, France
| | - Christelle Nguyen
- Department of Physical and Rehabilitation Medicine, Hôpital Cochin, Université Paris Cité, Paris, France
| | - Antoine Feydy
- Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France
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Sato T, Nojiri H, Okuda T, Miyagawa K, Kobayashi N, Takahashi R, Shimura A, Tamagawa S, Ohara Y, Hara T, Ishijima M. Three-dimensional morphological analysis of the thoracic pedicle and related radiographic factors in adolescent idiopathic scoliosis. BMC Musculoskelet Disord 2022; 23:847. [PMID: 36068555 PMCID: PMC9450434 DOI: 10.1186/s12891-022-05799-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to investigate the laterality of the pedicle morphology at the apical vertebra (AV) level and identify the radiographic factors associated with the laterality ratio of the pedicle morphology at the AV level in patients with adolescent idiopathic scoliosis (AIS). Methods Overall, 684 pedicles in 57 AIS patients aged 10–20 years, who underwent preoperative computed tomography (CT) and had Lenke type 1 or 2 with right convex main thoracic curves (MTC), were evaluated. Pedicle diameters of the MTC were assessed. We defined and compared the region containing two vertebrae adjacent to the AV (APEX±1) and the region containing two vertebrae adjacent to the neutral vertebra. We analyzed the pedicle diameter and laterality ratio of APEX±1 and performed multiple linear regression analysis to identify the radiographic factors associated with the laterality of the pedicle diameter. Results On the concave side of APEX±1, the pedicles of 15 patients (26.3%) did not accept a 4-mm-diameter pedicle screw (PS), even with 25% cortical bone width expansion. Laterality ratio differences in the pedicle diameters of the cortical bone width in APEX±1 were large in patients with more proximal AV level (p < 0.001) and smaller apical vertebral rotation (AVR) (p = 0.029). Conclusions Preoperative planning to accurately select and insert the PS in AIS should be based on the anatomical limitations in APEX±1, AV level, and AVR degree. In APEX±1, the correlation between AVR and the laterality ratio of the pedicle diameter may be useful for pathoetiological interpretation of the AIS deformity. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05799-4.
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Affiliation(s)
- Tatsuya Sato
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo, Japan
| | - Hidetoshi Nojiri
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo, Japan.
| | - Takatoshi Okuda
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo, Japan
| | - Kei Miyagawa
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo, Japan
| | - Nozomu Kobayashi
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo, Japan
| | - Ryosuke Takahashi
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo, Japan
| | - Arihisa Shimura
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo, Japan
| | - Shota Tamagawa
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo, Japan
| | - Yukoh Ohara
- Department of Neurosurgery, Juntendo University, Tokyo, Japan
| | - Takeshi Hara
- Department of Neurosurgery, Juntendo University, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo, Japan
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Fiore M, Ruffilli A, Viroli G, Barile F, Manzetti M, Faldini C. Minimally invasive surgery using posterior-only Pedicle screw fixation in treatment of Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis. J Clin Neurosci 2022; 99:317-326. [PMID: 35339852 DOI: 10.1016/j.jocn.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/22/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
Minimally invasive surgery (MIS) techniques for posterior spine pedicle-screw fusion (PSF) may reduce the AIS surgery invasiveness, although they require a certain degree of patient selection based on the severity of the curve. The aim of this article is to systematically review the Literature to determine efficacy and safety of MIS-PSF in AIS correction, and to compare its outcomes with open-PSF. A systematic search of electronic databases from eligible articles was conducted. Only studies adopting MIS-PSF for AIS were included. Clinical and radiographic outcomes were extracted and summarized. Meta-analyses were performed. P-value < 0.05 was considered significant. Thirteen studies for a total of 635 patients ungergoing MIS-PSF were included in this review. Pre-operative Cobb's angle ranged from 48.3°±4.2° to 59.8°±6.6°, coronal correction from 58.1% to 79.1%, average operative time ranged from 252 to 526.8 min, average estimated blood loss from 138.8 ± 50 to 1250 mL. Sixty-seven complications were recorded (9.9%), with 19 revisions (3.8%), resulting similar to those described in Literature using open-PSF. At meta-analysis, MIS-PSF (321 patients) compared to open-PSF (429 patients) showed lower coronal correction (although no statistically significant difference was found), estimated blood loss and length of hospital stay, but higher operative time. No differences in SRS-22, complications and revision rate were found. In conclusion, open-PSF shows a trend towards higher correction in the coronal plane and requires a shorter operative time when compared to MIS-PSF. It remains the gold standard for AIS correction, although MIS-PSF seems to be a viable and promising technique for selected patients. - KEYWORDS: minimally invasive surgery, minimally invasive techniques, adolescent idiopathic scoliosis, posterior spinal fusion, pedicle-screws-only instrumentation.
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Affiliation(s)
- Michele Fiore
- Alma Mater Studiorum - University of Bologna, Bologna, Italy.
| | | | - Giovanni Viroli
- First Orthopaedic and Traumatologic Clinic - IRCCS Istituto Ortopedico Rizzoli (IOR), Bologna, Italy
| | - Francesca Barile
- First Orthopaedic and Traumatologic Clinic - IRCCS Istituto Ortopedico Rizzoli (IOR), Bologna, Italy
| | - Marco Manzetti
- First Orthopaedic and Traumatologic Clinic - IRCCS Istituto Ortopedico Rizzoli (IOR), Bologna, Italy
| | - Cesare Faldini
- Alma Mater Studiorum - University of Bologna, Bologna, Italy
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Faldini C, Viroli G, Fiore M, Barile F, Manzetti M, Di Martino A, Ruffilli A. Power-assisted pedicle screws placement: Is it as safe and as effective as manual technique? Narrative review of the literature and our technique. Musculoskelet Surg 2021; 105:117-123. [PMID: 34050490 PMCID: PMC8324584 DOI: 10.1007/s12306-021-00714-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
Pedicle screws are the gold standard in spine surgery, allowing a solid tricolumnar fixation which is unmatched by hooks and wires. The freehand technique is the most widely adopted for pedicle screws placing. While freehand technique has been classically performed with manual tools, there has been a recent trend toward the use of power tools. The aim of this review is to summarize and expose potential risks and advantages of power pedicle screws placing. The literature showed that the use of power tools offers an acceptable safety profile, comparable to manual technique. With an adequate training, the power technique may speed up the screw placing, reduce the fluoroscopy time and the physical stress to the spine surgeon. Regarding differences in pull-out strength between power and manual techniques, the literature is still uncertain and inconsistent, both in clinical and preclinical studies. The choice between the use of power and manual freehand pedicle screws placing is still based on the surgeon's own preference.
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Affiliation(s)
- C Faldini
- Department of Biomedical and Neuromotor Science-DIBINEM, 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - G Viroli
- Department of Biomedical and Neuromotor Science-DIBINEM, 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy.
| | - M Fiore
- Department of Biomedical and Neuromotor Science-DIBINEM, 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - F Barile
- Department of Biomedical and Neuromotor Science-DIBINEM, 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - M Manzetti
- Department of Biomedical and Neuromotor Science-DIBINEM, 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - A Di Martino
- Department of Biomedical and Neuromotor Science-DIBINEM, 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - A Ruffilli
- Department of Biomedical and Neuromotor Science-DIBINEM, 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
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