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Patel M, Liu XC, Tassone C, Escott B, Yang K, Thometz J. Correlation of transverse rotation of the spine using surface topography and 3D reconstructive radiography in children with idiopathic scoliosis. Spine Deform 2024:10.1007/s43390-024-00838-7. [PMID: 38403800 DOI: 10.1007/s43390-024-00838-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/02/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE The relationship between axial surface rotation (ASR) measured by surface topography (ST) and axial vertebral rotation (AVR) measured by radiography in the transverse plane is not well defined. This study aimed to: (1) quantify ASR and AVR patterns and their magnitudes from T1 to L5; (2) determine the correlation or agreement between the ASR and AVR; and (3) investigate the relationship between axial rotation differences (ASR-AVR) and major Cobb angle. METHODS This is a retrospective study evaluating patients (age 8-18) with IS or spinal asymmetry with both radiographic and ST measurements. Demographics, descriptive analysis, and correlations and agreements between ASR and AVR were evaluated. A piecewise linear regression model was further created to relate rotational differences to Cobb angle. RESULTS Fifty-two subjects met inclusion criteria. Mean age was 14.1 ± 1.7 and 39 (75%) were female. Looking at patterns, AVR had maximal rotation at T8, while ASR had maximal rotation at T11 (r = 0.35, P = .006). Cobb angle was 24.1° ± 13.3° with AVR of - 1° ± 4.6° and scoliotic angle was 20.9° ± 11.5° with ASR of - 2.3° ± 6.6°. (ASR-AVR) vs Cobb angle was found to be very weakly correlated with a curve of less than 38.8° (r = 0.15, P = .001). CONCLUSION Our preliminary findings support that ASR measured by ST has a weak correlation with estimation of AVR by 3D radiographic reconstruction. This correlation may further help us to understand the application of transverse rotation in some clinical scenarios such as specific casting manipulation, padding mechanism in brace, and surgical correction of rib deformity.
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Affiliation(s)
- Milan Patel
- Department of Orthopedic Surgery, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Xue-Cheng Liu
- Department of Orthopedic Surgery, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
- Musculoskeletal Functional Assessment Center, Greenfield Clinic, Children's Wisconsin, Medical College of Wisconsin, 3365 S 103rd St, Suite 2206, Greenfield, WI, 53227, USA.
| | - Channing Tassone
- Department of Orthopedic Surgery, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
- Musculoskeletal Functional Assessment Center, Greenfield Clinic, Children's Wisconsin, Medical College of Wisconsin, 3365 S 103rd St, Suite 2206, Greenfield, WI, 53227, USA
| | - Benjamin Escott
- Department of Orthopedic Surgery, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
- Musculoskeletal Functional Assessment Center, Greenfield Clinic, Children's Wisconsin, Medical College of Wisconsin, 3365 S 103rd St, Suite 2206, Greenfield, WI, 53227, USA
| | - Kai Yang
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John Thometz
- Department of Orthopedic Surgery, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
- Musculoskeletal Functional Assessment Center, Greenfield Clinic, Children's Wisconsin, Medical College of Wisconsin, 3365 S 103rd St, Suite 2206, Greenfield, WI, 53227, USA
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Sowula PT, Izatt MT, Labrom RD, Askin GN, Little JP. Assessing progressive changes in axial plane vertebral deformity in adolescent idiopathic scoliosis using sequential magnetic resonance imaging. Eur Spine J 2024; 33:663-672. [PMID: 37962687 DOI: 10.1007/s00586-023-08004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 09/24/2023] [Accepted: 10/14/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To understand how the axial plane deformity contributes to progression of the three-dimensional spinal deformity of Adolescent Idiopathic Scoliosis (AIS), with a main thoracic curve type, using a series of sequential magnetic resonance images (MRI). METHODS Twenty-seven AIS patients (at scan 1: mean 12.4 years (± 1.5), mean Cobb angle 29.1°(± 8.8°)) had 3 MRI scans (T4-L1) performed at intervals of mean 0.7 years (± 0.4). The outer profile of the superior and inferior endplates were traced on a reformatted axial image using ImageJ (NIH). Endplate AVR, and intravertebral rotation (IVR), defined as the difference between superior and inferior endplate AVR, was calculated for each vertebral level. RESULTS For all patients and scans, the mean AVR was greatest at the curve apex, with AVR diminishing in a caudal and cephalic direction from the apex. At scan 3 the mean apical AVR was 15.1°(± 4.6°) with a mean change in apical AVR between MRI 1 and 3 of 2.7°(± 2.9°). The increase in standing height between MRI 1 and 3 was mean 7.4 cm (± 4.6). Linear regression showed a positive correlation between apical AVR and Cobb angle (R2 = 0.57, P < 0.001), and a positive correlation between apical AVR and rib hump (R2 = 0.54, p < 0.001). The mean change in IVR was greater 3 vertebral levels cephalic and caudal to the apex (1.4°(± 4.1°) and 1.2°(± 2.0°), respectively), compared to the apex (0.4°(± 3.1°)). CONCLUSIONS AVR increased, during curve progression, most markedly at the curve apex. The greatest IVR was observed at the periapical levels, with the apex by contrast having only a modest degree of rotation, suggesting the periapical vertebral levels of the scoliosis deformity may be a significant driver in the progression of AIS.
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Affiliation(s)
- Pawel T Sowula
- Biomechanics and Spine Research Group, Centre for Biomedical Technologies at the Centre for Children's Health Research, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, 62 Graham St, South Brisbane, 4104, Australia.
- Queensland Children's Hospital, Brisbane, Australia.
| | - Maree T Izatt
- Biomechanics and Spine Research Group, Centre for Biomedical Technologies at the Centre for Children's Health Research, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, 62 Graham St, South Brisbane, 4104, Australia
- Queensland Children's Hospital, Brisbane, Australia
| | - Robert D Labrom
- Biomechanics and Spine Research Group, Centre for Biomedical Technologies at the Centre for Children's Health Research, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, 62 Graham St, South Brisbane, 4104, Australia
- Queensland Children's Hospital, Brisbane, Australia
- Mater Hospital, Brisbane, Australia
| | - Geoffrey N Askin
- Biomechanics and Spine Research Group, Centre for Biomedical Technologies at the Centre for Children's Health Research, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, 62 Graham St, South Brisbane, 4104, Australia
- Queensland Children's Hospital, Brisbane, Australia
- Mater Hospital, Brisbane, Australia
| | - J Paige Little
- Biomechanics and Spine Research Group, Centre for Biomedical Technologies at the Centre for Children's Health Research, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, 62 Graham St, South Brisbane, 4104, Australia
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Zhu F, Zhang Y, Wang G, Ning Y, Leng X, Huang B. Posterior Multisegment Apical Convex plus Concave Intervertebral Release Combined with Posterior Column Osteotomy for the Treatment of Rigid Thoracic/Thoracolumbar Scoliosis. World Neurosurg 2023; 170:43-53. [PMID: 36442784 DOI: 10.1016/j.wneu.2022.11.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intervertebral release (IVR) in the apical region is critical for full release of a rigid spine. Previous studies have mainly reported IVR techniques using an anterior approach or posterior apical convex IVR. We first report the surgical procedure of posterior multisegment apical convex plus concave IVR combined with posterior column osteotomy (PCO) for treating rigid thoracic/thoracolumbar scoliosis. METHODS This study retrospectively analyzed clinical, radiologic outcomes and technique notes of 18 patients with rigid scoliosis treated with posterior multisegment convex plus concave IVR combined with PCO. RESULTS The preoperative, postoperative, and final follow-up mean sagittal Cobb angles of the main curve were 75.2° (58.7°-110.2°), 18.4° (9°-35.1°), and 19.0° (8.2°-36.3°), respectively. The mean correction rate was 75.3% (66.7%-86.7%). In cases of thoracolumbar kyphosis, the preoperative, postoperative, and final follow-up mean sagittal Cobb angles were 45.7° (40.5°-52.6°), 18.8° (10.2°-27.5°), and 19.8° (11.1°-29°), respectively. The mean correction rate was 57% (42.1%-72.6%). The mean axial vertebral rotation (AVR) in the IVR region was 24.4° (14.3°-46.3°) preoperatively and was corrected to 10.9° (10.9°-26.6°) postoperatively. The mean correction rate for AVR was 55.9% (41.1%-78.6%). The coronal and sagittal Cobb angles and AVR postoperatively were significantly lower than those preoperatively (P < 0.001). This case series reported 2 cases of pleural effusion and 1 case of wound infection. CONCLUSIONS Single posterior multilevel apical convex plus concave IVR combined with PCO is a safe and effective surgical method for treating rigid thoracic/thoracolumbar scoliosis that does not need 3-column osteotomy.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Yaqing Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Guanzhong Wang
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Ya Ning
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Xue Leng
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Bo Huang
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China.
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Little JP, Izatt MT, Adam CJ, Lofgren O, Sundberg A, Labrom RD, Askin GN. Evaluating the Change in Axial Vertebral Rotation Following Thoracoscopic Anterior Scoliosis Surgery Using Low-Dose Computed Tomography. Spine Deform 2017; 5:172-180. [PMID: 28449960 DOI: 10.1016/j.jspd.2016.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/03/2016] [Accepted: 12/15/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND CONTEXT In recent years, there has been increasing appreciation of the need to treat scoliosis as a three-dimensional deformity. PURPOSE Assessment of surgical strategies and outcomes should consider not only the coronal plane correction but also derotation of the transverse plane deformity that can affect trunk appearance. STUDY DESIGN This study included a cohort of 29 female adolescent idiopathic scoliosis patients who received thoracoscopic single rod anterior fusion (TASF) surgery. This study used pre- and postoperative low-dose computed tomographic (CT) scans to accurately measure apical axial vertebral rotation (AVR). METHODS The pre- and postoperative values for clinically measured coronal Cobb correction and rib hump correction as well as AVR were compared to determine whether these values improved postoperatively. There are no conflicts of interest to report for authors of this investigation. RESULTS As expected, statistically significant reductions in coronal Cobb angle (mean preoperative Cobb 51°, reducing to 24° at the two-year follow-up) and rib hump (mean preoperative rib hump 15°, reducing to 7° at two-year follow-up) were achieved. The mean reduction in apical AVR measured using CT was only 3° (mean preoperative AVR 16°, reducing to 13° at two-year follow-up), which was statistically but not clinically significant. Significant correlations were found between Cobb angle and rib hump, between Cobb angle and AVR, and between AVR and rib hump, suggesting that patients with greater coronal Cobb correction also achieve better derotation with this surgical procedure. CONCLUSIONS The historical low-dose CT data set permitted detailed three-dimensional assessment of the deformity correction that is achieved using thoracoscopic anterior spinal fusion for progressive adolescent idiopathic scoliosis.
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Affiliation(s)
- J Paige Little
- Paediatric Spine Research Group, Institute of Health and Biomedical Innovation-Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, 62 Graham Street, South Brisbane, Queensland 4101, Australia.
| | - Maree T Izatt
- Paediatric Spine Research Group, Institute of Health and Biomedical Innovation-Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, 62 Graham Street, South Brisbane, Queensland 4101, Australia
| | - Clayton J Adam
- Paediatric Spine Research Group, Institute of Health and Biomedical Innovation-Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, 62 Graham Street, South Brisbane, Queensland 4101, Australia
| | - Olivia Lofgren
- Paediatric Spine Research Group, Institute of Health and Biomedical Innovation-Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, 62 Graham Street, South Brisbane, Queensland 4101, Australia
| | - Anna Sundberg
- Paediatric Spine Research Group, Institute of Health and Biomedical Innovation-Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, 62 Graham Street, South Brisbane, Queensland 4101, Australia
| | - Robert D Labrom
- Paediatric Spine Research Group, Institute of Health and Biomedical Innovation-Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, 62 Graham Street, South Brisbane, Queensland 4101, Australia
| | - Geoffrey N Askin
- Paediatric Spine Research Group, Institute of Health and Biomedical Innovation-Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, 62 Graham Street, South Brisbane, Queensland 4101, Australia
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Cerny P, Marik I, Pallova I. The radiographic method for evaluation of axial vertebral rotation - presentation of the new method. Scoliosis 2014; 9:11. [PMID: 25120581 PMCID: PMC4130697 DOI: 10.1186/1748-7161-9-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 06/29/2014] [Indexed: 11/10/2022]
Abstract
The objective of this study is to present a new radiographic method for the assessment of vertebral rotation from an antero-posterior view of conventional X-rays which is sufficiently precise in comparison with radiographic methods presently used in clinical practice (methods of Nash-Moe and Perdriolle). This method is based on the properties of the geometric shape of vertebrae and their shared dimensional proportions. It means that the relation between vertebral body width and height doesn't change significantly within the entire thoracic and lumbar sections of the spine. In order to verify the method, we have constructed a special device for vertebral fixation. Subsequently, the X-ray pictures of individual human vertebrae with predefined rotation values (ranging from 0 degrees to 45 degrees by steps of 3 degrees) were radio-graphically measured and then compared with their actual axial rotation on the vertebral rotation device. All arithmetic averages correlate very closely with the actual values. The verification of axial vertebral rotation with the assistance of CT and MRI pictures of six scoliotic patients (in supine position) and the evaluation of axial vertebral rotation by both the new radiographic method and with the Perdriolle method proved the satisfactory accuracy of our method. The main advantage of the newly presented radiographic method is the uncomplicated measurement of vertebral rotation from AP projection of conventional X-ray pictures or from its printed copies. The gold standard of the new radiographic method is the evaluation of axial rotation of vertebrae to 30 degrees approximately and the shape of vertebral bodies without severe structural deformities. The new radiographic method seems to be suitable for use in clinical practice.
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Affiliation(s)
- Pavel Cerny
- Faculty of Physical Education and Sport, Charles University, Prague, Jose Martiho 31 16252 Prague 6, Czech Republic ; ORTOTIKA l.l.c., Area of University Hospital in Motol, V Uvalu 84, 15006 Prague 5, Czech Republic ; Faculty of Medical Studies, West Bohemia University, Pilsner Univerzitni 2732/8, 306 14, Pilsner, Prague, Czech Republic
| | - Ivo Marik
- Ambulant Centre for Defects of Locomotor Apparatus l.l.c., Olsanska 7, 13000 Prague 3, Czech Republic ; Faculty of Medical Studies, West Bohemia University, Pilsner Univerzitni 2732/8, 306 14, Pilsner, Prague, Czech Republic
| | - Iveta Pallova
- Faculty of Physical Education and Sport, Charles University, Prague, Jose Martiho 31 16252 Prague 6, Czech Republic
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