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Gong J, Zhang Z, Cheng Y, Cheng L, Dong Y, Sha L, Fan Q, Chen J, Wu C, Sui W, Zhang Y, Liu F, Hu W, Wei W, Yang J. An Innovative Stepwise C-Means Clustering Approach for Classification of Adolescent Idiopathic Scoliosis. Orthop Surg 2025. [PMID: 40285640 DOI: 10.1111/os.70042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Revised: 03/31/2025] [Accepted: 03/31/2025] [Indexed: 04/29/2025] Open
Abstract
OBJECTIVE Existing 3D classification systems for scoliosis primarily guide surgical treatment, with limited application in conservative management. This study aims to establish a preliminary 3D classification system for moderate adolescent idiopathic scoliosis patients in China, providing a theoretical foundation for the standardization and automation of conservative treatment plans. METHODS Data from 404 adolescent idiopathic scoliosis patients who did not undergo surgery were retrospectively collected from 2022 to 2025. EOS imaging technology was used to perform 3D reconstruction for each patient. The parameters included the 3D centroid coordinates of the vertebrae and vertebral angular displacement. A total of 102 features were extracted per model, and dimensionality reduction yielded 30 final features by the Stacked Autoencoder method. Fuzzy C-means clustering with two classification approaches is used: direct clustering and iterative clustering. Iterative clustering was performed based on coronal plane parameters for initial classification, followed by further clustering. Direct classification involved immediate clustering without further subdivision. RESULTS Clustering identified 8 distinct 2D curve types, which were further subdivided into 13 3D subtypes. A comparison of the 13 clusters from direct classification with those obtained from iterative clustering was made using Euclidean and Mahalanobis distances between cluster centers and clinical data. The difference in similarity was higher for direct classification, indicating greater variability. CONCLUSION EOS imaging technology combined with Fuzzy C-Means iterative clustering enables a preliminary 3D classification of AIS by capturing more detailed and individualized morphological features. Compared to direct clustering, the iterative method not only improves geometric interpretability but also enhances classification accuracy by better identifying subtle variations in spinal curvature. It further improves specificity, particularly in distinguishing sagittal and axial plane deformities, which are often overlooked in 2D systems. This enhanced resolution provides a stronger basis for developing personalized conservative treatment plans, such as brace design and rehabilitation strategy. Although the proposed method shows promise, further clinical validation is needed to confirm its effectiveness in guiding conservative treatment decisions.
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Affiliation(s)
- Jiale Gong
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Zifang Zhang
- Spine Surgery Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunzhang Cheng
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Liang Cheng
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yating Dong
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Lin Sha
- Spine Surgery Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin Fan
- Spine Surgery Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Chen
- Spine Surgery Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chaomeng Wu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Wenyuan Sui
- Spine Surgery Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaqing Zhang
- Spine Surgery Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuyun Liu
- Department of Pediatric Orthopedics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weiming Hu
- Department of Pediatric Orthopedics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenqing Wei
- Spine Surgery Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junlin Yang
- Spine Surgery Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wei W, Cheng L, Dong Y, Zhang T, Deng Y, Gong J, Xie F, Yang J. 2D and 3D Classification Systems for Adolescent Idiopathic Scoliosis: Clinical Implications and Technological Advances. Orthop Surg 2025; 17:999-1020. [PMID: 39825698 PMCID: PMC11962298 DOI: 10.1111/os.14362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Revised: 12/30/2024] [Accepted: 01/03/2025] [Indexed: 01/20/2025] Open
Abstract
Classification systems for Adolescent Idiopathic Scoliosis (AIS) play an important role in guiding both surgical planning and conservative treatments. Traditional 2D classification systems, such as the Lenke, King and Lehnert-Schroth classifications, have been widely used for the clinical diagnosis and treatment of scoliosis. However, with the growing understanding of the three-dimensional nature of scoliosis and advancements in 3D reconstruction technologies, 3D classification systems are gaining increasing attention. This paper reviews the current applications, advantages, and limitations of different 2D and 3D classification systems, focusing on their clinical significance in treatment planning. While 3D classification systems offer clear advantages in capturing the complexity of spinal deformities, their clinical implementation faces challenges such as high costs and technical complexity. Additionally, studies show that computer-assisted technologies, artificial intelligence can significantly improve the accuracy and consistency of classification systems, reducing human errors. The paper also explores the future directions of classification system development, emphasizing the potential of combining 2D and 3D technologies and the impact of these advancements on personalized scoliosis treatment.
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Affiliation(s)
- Wenqing Wei
- Spine Surgery Center, Xinhua HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Liang Cheng
- School of Health Science and EngineeringUniversity of Shanghai for Science and TechnologyShanghaiChina
| | - Yating Dong
- School of Health Science and EngineeringUniversity of Shanghai for Science and TechnologyShanghaiChina
| | - Tianyuan Zhang
- Spine Surgery Center, Xinhua HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yaolong Deng
- Spine Surgery Center, Xinhua HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jiale Gong
- School of Health Science and EngineeringUniversity of Shanghai for Science and TechnologyShanghaiChina
| | - Fang Xie
- Shanghai Marine Diesel Engine Research InstituteShanghaiChina
| | - Junlin Yang
- Spine Surgery Center, Xinhua HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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Shaw KA, O'Sullivan M, Wang X, Aubin CE. Biomechanical Principles of Spinal Deformity Correction in the Thoracolumbar Spine. J Am Acad Orthop Surg 2025:00124635-990000000-01234. [PMID: 39879382 DOI: 10.5435/jaaos-d-24-01156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 12/15/2024] [Indexed: 01/31/2025] Open
Abstract
Thoracolumbar spinal deformities are a pervasive condition affecting the adolescent and adult patient population. These deformities represent three-dimensional alterations in the coronal, sagittal, and transverse planes with implication on the local, regional, and global alignment. With continued studies, the importance of the overall correction on long-term outcomes has been established. Surgical techniques for correcting deformities aim to restore coronal and sagittal alignment of the spine, as well as manage the rotational components in the transverse plane. Through a proper understanding of spinal biomechanics and spinal instrumentation, we can gain better understanding of how to harness the biomechanical properties of the spinal anatomy through the application of deformity correction techniques to optimize the three-dimensional correction of spinal deformities.
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Affiliation(s)
- K Aaron Shaw
- From the Children's Mercy Hospital, Kansas City, MO (Shaw), Children's Health Ireland at Temple Street, Dublin, Ireland (O'Sullivan), the Department of Mechanical Engineering, Polytechnique Montreal, Montreal, Quebec, Canada (Wang and Aubin), and the Sainte-Justine University Hospital Center, Montreal, Quebec, Canada (Wang and Aubin)
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Chui CS(E, He Z, Lam TP, Mak KK(K, Ng HT(R, Fung CH(E, Chan MS, Law SW, Lee YW(W, Hung LH(A, Chu CW(W, Mak SY(S, Yau WF(E, Liu Z, Li WJ, Zhu Z, Wong MY(R, Cheng CY(J, Qiu Y, Yung SH(P. Deep Learning-Based Prediction Model for the Cobb Angle in Adolescent Idiopathic Scoliosis Patients. Diagnostics (Basel) 2024; 14:1263. [PMID: 38928678 PMCID: PMC11203267 DOI: 10.3390/diagnostics14121263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 06/02/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Scoliosis, characterized by spine deformity, is most common in adolescent idiopathic scoliosis (AIS). Manual Cobb angle measurement limitations underscore the need for automated tools. This study employed a vertebral landmark extraction method and Feedforward Neural Network (FNN) to predict scoliosis progression in 79 AIS patients. The novel intervertebral angles matrix format showcased results. The mean absolute error for the intervertebral angle progression was 1.5 degrees, while the Pearson correlation of the predicted Cobb angles was 0.86. The accuracy in classifying Cobb angles (<15°, 15-25°, 25-35°, 35-45°, >45°) was 0.85, with 0.65 sensitivity and 0.91 specificity. The FNN demonstrated superior accuracy, sensitivity, and specificity, aiding in tailored treatments for potential scoliosis progression. Addressing FNNs' over-fitting issue through strategies like "dropout" or regularization could further enhance their performance. This study presents a promising step towards automated scoliosis diagnosis and prognosis.
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Affiliation(s)
- Chun-Sing (Elvis) Chui
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Zhong He
- Division of Spine Surgery, Department of Orthopedic Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, China; (Z.H.); (Z.L.); (Z.Z.)
| | - Tsz-Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Ka-Kwan (Kyle) Mak
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Hin-Ting (Randy) Ng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Chun-Hai (Ericsson) Fung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Mei-Shuen Chan
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Sheung-Wai Law
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Yuk-Wai (Wayne) Lee
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Lik-Hang (Alec) Hung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong, China;
| | - Chiu-Wing (Winnie) Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China;
| | - Sze-Yi (Sibyl) Mak
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China;
| | | | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, China; (Z.H.); (Z.L.); (Z.Z.)
| | - Wu-Jun Li
- National Institute of Healthcare Data Science, Nanjing University, Nanjing 210023, China;
- National Key Laboratory for Novel Software Technology, Department of Computer Science and Technology, Nanjing University, Nanjing 210023, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, China; (Z.H.); (Z.L.); (Z.Z.)
| | - Man Yeung (Ronald) Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Chun-Yiu (Jack) Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, China; (Z.H.); (Z.L.); (Z.Z.)
| | - Shu-Hang (Patrick) Yung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China (T.-P.L.); (M.-S.C.); (S.-W.L.)
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Xiao B, Zhang Y, Yan K, Jiang J, Ma C, Xing Y, Liu B, Tian W. Where should Scoliometer and EOS Imaging be Applied when Evaluating Spinal Rotation in Adolescent Idiopathic Scoliosis -A Preliminary Study with Reference to CT Images. Global Spine J 2024; 14:577-582. [PMID: 35929422 PMCID: PMC10802522 DOI: 10.1177/21925682221116824] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE Our purpose was to evaluate spinal rotation measurement by scoliometer or EOS Imagings with reference to that by CT images, and to clarify their applicability in clinical practice. METHODS Patients with adolescent idiopathic scoliosis (AIS) who were indicated for surgery were enrolled and the informed consents were obtained. The angle of trunk rotation (ATR) was measured by the scoliometer. Apical vertebral rotation (AVR) was measured with EOS Imaging and CT images. Paired T tests were used to compare the measurements between ATR or AVR-EOS and AVR-CT. Pearson correlation analysis was performed to explore the relationship between ATR or AVR-EOS and AVR-CT. Then subgroup analysis was performed. RESULTS Forty-seven consecutive AIS patients with 62 curves were identified. In the whole group, the ATR, as well as AVR-EOS, was significantly smaller than the AVR-CT. Both ATR and AVR-EOS correlated with AVR-CT, although AVR-EOS correlated better. In thoracic group, there was no significant difference between ATR and AVR-CT (P = .236). A significant correlation was found between ATR and AVR-CT(r = .574, P < .001). In TL/L group, no significant difference was noted between AVR-EOS and AVR-CT (P = .414), and a significant correlation was found between AVR-EOS and AVR-CT(r = .824, P < .001). CONCLUSION ATR by scoliometer is numerically similar to AVR by CT and may evaluate the spinal rotation more appropriately in thoracic spine. AVR by EOS is numerically similar to AVR by CT and may be more applicable in TL/L spine. Appropriate methods could be selected according to the location of the curve.
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Affiliation(s)
- Bin Xiao
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yanbin Zhang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Kai Yan
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Jile Jiang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Chaoyi Ma
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Yonggang Xing
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Bo Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
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Sequeira SB, Hasenauer MD, McKinstry R, Ebert F, Boucher HR. Scoliosis Without Fusion and Increased Risk of Early Medical and Surgery-Related Complications After Total Hip Arthroplasty: A Propensity-score Analysis. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202402000-00001. [PMID: 38320265 PMCID: PMC10846773 DOI: 10.5435/jaaosglobal-d-23-00132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/07/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION There is a paucity of literature that examines how the abnormal spinopelvic alignment of scoliosis affects outcomes after total hip arthroplasty (THA) in the absence of a lumbar fusion. METHODS Patients with a history of scoliosis (idiopathic, adolescent, degenerative, or juvenile) without fusion and those without a history of scoliosis who underwent primary THA were identified using a large national database. Ninety-day incidence of various medical complications, emergency department (ED) visit, and readmission and 1-year incidence of surgery-related complications and cost of care were evaluated in both the scoliosis and control cohorts. Propensity score matching was used to control for patient demographic factors and comorbidities as covariates. RESULTS After propensity matching, 21,992 and 219,920 patients were identified in the scoliosis and control cohorts, respectively. Patients with scoliosis were at increased risk of several 90-day medical complications, including pulmonary embolism (odds ratio [OR] 1.96; P < 0.001), deep vein thrombosis (1.49; P < 0.001), transfusion (OR, 1.13; P < 0.001), pneumonia (OR, 1.37; P < 0.001), myocardial infarction (OR, 1.38; P = 0.008), sepsis (OR, 1.59; P < 0.001), acute anemia (OR, 1.21; P < 0.001), and urinary tract infection (OR, 1.1; P = 0.001). Patients with a history of scoliosis were at increased 1-year risk of revision (OR, 1.31; P < 0.001), periprosthetic joint infection (OR, 1.16; P = 0.0089), dislocation (OR, 1.581; P < 0.001), and aseptic loosening (OR, 1.39; P < 0.001) after THA. Patients with scoliosis without a history of fusion were more likely to return to the emergency department (OR, 1.26; P < 0.001) and be readmitted (OR, 1.78; P < 0.001) within 90 days of THA. DISCUSSION Patients with even a remote history of scoliosis without fusion are at increased risk of 90-day medical and surgery-related complications after hip arthroplasty. Hip and spine surgeons should collaborate in future studies to best understand how to optimize these patients for their adult reconstructive procedures.
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Affiliation(s)
- Sean B. Sequeira
- From the Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD
| | - Mark D. Hasenauer
- From the Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD
| | - Robert McKinstry
- From the Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD
| | - Frank Ebert
- From the Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD
| | - Henry R. Boucher
- From the Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD
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Schelfaut S, Moens P, Overbergh T, Cornelis S, Van Campenhout A, Moke L, Scheys L, Ackermans T. Three- instead of two-dimensional evaluation of key parameters alters the choice of the lowest instrumented vertebra in Lenke 1 and 2 AIS patients. Spine Deform 2023; 11:1137-1143. [PMID: 37284907 DOI: 10.1007/s43390-023-00711-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/20/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE Treatment of AIS, a three-dimensional spinal (3D) deformity, is guided by a two-dimensional (2D) evaluation. Novel 3D approaches that address the 2D limitations have not been adopted in AIS care due to their lengthy and complex 3D reconstruction procedures. This study aims to introduce a simple 3D method that translates the 2D key parameters (Stable vertebra (SV), Lenke lumbar modifier, Neutral vertebra (NV)) into 3D and to quantitively compare these 3D corrected parameters to the 2D assessment. METHODS The key parameters of 79 surgically treated Lenke 1 and 2 patients were measured in 2D by two experienced spine surgeons. Next, these key parameters were measured in 3D by indicating relevant landmarks on biplanar radiographs and using the 'true' 3D CSVL which was perpendicular to the pelvic plane. Differences between the 2D and 3D analysis were examined. RESULTS A 2D-3D mismatch was identified in 33/79 patients (41.8%) for at least one of the key parameters. More specifically, a 2D-3D mismatch was identified in 35.4% of patients for the Sag SV, 22.5% of patients for the SV and 17.7% of patients for the lumbar modifier. No differences in L4 tilt and NV rotation were found. CONCLUSION The findings highlight that a 3D evaluation alters the choice of the LIV in Lenke 1 and 2 AIS patients. Although, the true impact of this more precise 3D measurement on preventing poor radiographic outcome needs further investigation, the results are a first step toward establishing a basis for 3D assessments in daily practice.
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Affiliation(s)
- Sebastiaan Schelfaut
- Division of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Pierre Moens
- Division of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Thomas Overbergh
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Steven Cornelis
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Anja Van Campenhout
- Division of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Lieven Moke
- Division of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Lennart Scheys
- Division of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Thijs Ackermans
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Louvain, Belgium.
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Tabard-Fougère A, de Bodman C, Dhouib A, Bonnefoy-Mazure A, Armand S, Dayer R. Three-Dimensional Spinal Evaluation Using Rasterstereography in Patients with Adolescent Idiopathic Scoliosis: Is It Closer to Three-Dimensional or Two-Dimensional Radiography? Diagnostics (Basel) 2023; 13:2431. [PMID: 37510176 PMCID: PMC10377872 DOI: 10.3390/diagnostics13142431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Adolescent Idiopathic Scoliosis (AIS) is a three-dimensional (3D) spine deformity. The Cobb angle, evaluated with 2D radiography, is the gold standard to determine curve severity. The primary aim of this study was to evaluate the 3D spinal evaluation with rasterstereography in patients with AIS. The hypothesis was that rasterstereography reached higher accuracy than the gold standard 2D radiography. The second aim was to compare rasterstereography with 3D radiography. The hypothesis was that the rasterstereographic evaluation of patients with severe major scoliosis curves is closer to 3D radiography compared to the gold standard (2D radiography). (2) Methods: This is a prospective comparative study of a consecutive series of 53 patients, with the scoliosis curve evaluated with two 3D methods and the gold standard (2D radiography). (3) Results: The hypothesis that rasterstereography reached higher accuracy than the gold standard 2D radiography was validated for all curves. Even if all curves were highly correlated, both rasterstereography and 2D radiography scoliosis evaluation were underestimated for moderate/severe curves compared to 3D radiography. (4) Conclusions: The rasterstereographic evaluation of major curve scoliosis is not accurate enough to replace 2D radiography for moderate/severe curves. A longitudinal follow-up should be assessed in future studies to define the sensitivity of the detection of a significant change in the scoliotic mild and moderate curve (<40°).
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Affiliation(s)
- Anne Tabard-Fougère
- Division of Pediatric Orthopaedics, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland
| | - Charlotte de Bodman
- Division of Pediatric Orthopaedics, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland
| | - Amira Dhouib
- Department of Radiology, Reseau Hospitalier Neuchatelois, 2000 Neuchatel, Switzerland
| | - Alice Bonnefoy-Mazure
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Romain Dayer
- Division of Pediatric Orthopaedics, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland
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Nonoperative management of adolescent idiopathic scoliosis (AIS) using braces. Prosthet Orthot Int 2022; 46:383-391. [PMID: 35320151 DOI: 10.1097/pxr.0000000000000117] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 01/06/2022] [Indexed: 02/03/2023]
Abstract
This review presents the state of the art according to the current evidence on nonoperative treatment for adolescent idiopathic scoliosis, focusing on bracing. The definition of braces for the treatment of adolescent idiopathic scoliosis and a short history are provided. The analysis includes biomechanics, types, existing classifications, indications for treatment, time of brace wear and weaning, adherence, three-dimensional modeling, use of ultrasound imaging for bracing, management of treatment, issue of immediate in-brace correction, and documentation of the outcomes usually assessed for brace treatment, including the quality-of-life issues. According to the current evidence, there are two randomized control trials in favor of bracing. There are insufficient data on the superiority of one brace over another, although it is possible to classify and grade braces for efficacy from nonrigid to rigid and very rigid. Nevertheless, there is consensus on patients' management on the need for teamwork focusing on adherence to treatment, acceptability, and family and patient involvement.
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Pasha S, Rajapaske CR, Reddy R, Diebo B, Knott P, Jones BC, Kumar D, Zhu W, Lou E, Shapira N, Noel P, Ho-Fung V, Jaramillo D. Quantitative imaging of the spine in adolescent idiopathic scoliosis: shifting the paradigm from diagnostic to comprehensive prognostic evaluation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2021; 31:1273-1285. [PMID: 33517495 DOI: 10.1007/s00590-021-02883-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE We aimed to provide a perspective review of the available quantitative imaging modalities of the spine for prognostic evaluation of the adolescent idiopathic scoliosis (AIS). METHODS A technical description of the current imaging technologies for quantitative assessment of the pediatric spine with scoliosis was provided, and the pros and cons of each method were discussed. Imaging modalities that quantify the overall 3D alignment of the spine as well as the structural specification of the spinal bone, intervertebral disc, endplates, and ligaments as it pertains to development and progression of the idiopathic spinal deformities in adolescents were discussed. RESULTS Low-dose and microdose stereoradiography, ultrasound, and rasterstereography provide quantitative imaging of the 3D spinal alignment with low or no radiation in standing posture which allows repetitive imaging for early detection of the curve development. Quantitative magnetic resonance imaging, including ultrashort dual-echo time and T1-rho can provide quantitative assessment of the spinal tissues relevant to development of idiopathic spinal deformity in pediatric population. New computed tomography scans that uses dual-energy can provides high-resolution measure of the current-state of the bone quality and morphology as well as the osteogenic properties of the bone by quantitative evaluation of the bone marrow. CONCLUSION The presented imaging modalities can provide a wide spectrum of quantifiable information relevant to development and progression of the spinal deformity. Clinical application of these technologies can change the paradigm in clinical assessment of the pediatric scoliosis by improving our understanding of the pathogenesis of the idiopathic scoliosis.
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Affiliation(s)
- Saba Pasha
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, USA.
| | - Chamith R Rajapaske
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, USA
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Ravinder Reddy
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Bassel Diebo
- State University of New York Downstate Medical Center, New York, USA
| | - Patrick Knott
- Rosalind Franklin University of Medicine and Science, Chicago, USA
| | - Brandon C Jones
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Dushyant Kumar
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Winnie Zhu
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Edmond Lou
- Department of Electrical Computer Engineering, University of Alberta, Edmonton, Canada
| | - Nadav Shapira
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Peter Noel
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Victor Ho-Fung
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, USA
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Intra-operative forecasting of growth modulation spine surgery outcomes with spatio-temporal dynamic networks. Int J Comput Assist Radiol Surg 2021; 16:1641-1651. [PMID: 34302263 DOI: 10.1007/s11548-021-02461-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE In adolescent idiopathic scoliosis (AIS), non-invasive surgical techniques such as anterior vertebral body tethering (AVBT) enable to treat patients with mild and severe degrees of deformity while maintaining lower lumbar motion by avoiding spinal fusion. However, multiple features and characteristics affect the overall patient outcome, notably the 3D spine geometry and bone maturity, but also from decisions taken intra-operatively such as the selected tethered vertebral levels, which makes it difficult to anticipate the patient response. METHODS We propose here a forecasting method which can be used during AVBT surgery, exploiting the spatio-temporal features extracted from a dynamic networks. The model learns the corrective effect from the spine's different segments while taking under account the time differences in the initial diagnosis and between the serial acquisitions taken before and during surgery. Clinical parameters are integrated through an attention-based decoder, allowing to associate geometrical features to patient status. Long-term relationships allow to ensure regularity in geometrical curve prediction, using a manifold-based smoothness term to regularize geometrical outputs, capturing the temporal variations of spine correction. RESULTS A dataset of 695 3D spine reconstructions was used to train the network, which was evaluated on a hold-out dataset of 72 scoliosis patients using the baseline 3D reconstruction obtained prior to surgery, yielding an overall reconstruction error of [Formula: see text]mm based on pre-identified landmarks on vertebral bodies. The model was also tested prospectively on a separate cohort of 15 AIS patients, demonstrating the integration within the OR theatre. CONCLUSION The proposed predictive network allows to intra-operatively anticipate the geometrical response of the spine to AVBT procedures using the dynamic features.
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Pasha S, Shen J, Kadoury S. True 3D parameters of the spinal deformity in adolescent idiopathic scoliosis. Spine Deform 2021; 9:703-710. [PMID: 33400230 DOI: 10.1007/s43390-020-00254-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Spinal deformities in adolescent idiopathic scoliosis (AIS) are measured on 2D radiographs. Due to the 3D nature of the curve in AIS, such 2D measurements fail to differentiate between the true curve patterns, which in turn may adversly impact the clinical care and surgical planning. The use of 3D models of the spinal radiographs largely remains limited to the 3D measurements of the 2D parameters. The use of the true 3D variables of the spinal curves in describing the differences between the AIS patients is not fully explored. METHODS A cohort of 141 Lenke 1 AIS with two-view spinal stereoradiographs and 3D models of the spines were included. The 3D model of the spine was used to determine the spinal centerlines. The writhe and torsion of the 3D centerlines, which, respectively, quantify the coiling and twist of the curve, were calculated using differential geometry. Patients were clustered based on the writhe and torsion values to determine the patient groups with significantly different 3D curve characteristics. The relationship between the writhe and torsion was statistically determined. The distribution of the writhe and torsion groups between the lumbar modifier types was determined. RESULTS Two writhe and two torsion clusters were determined. Lumbar orientation of plane of maximum curvature (PMC) was significantly different between the torsion clusters and thoracic and lumbar PMC and thoracic Cobb angles were significantly different between the writhe groups, p < 0.05. More than 50% of the patients had high writhe and low torsion except for Lumbar modifier C that mainly belonged to the low writhe group. DISCUSSION Two geometrical parameters of the spinal centerline determine true 3D characteristics of the scoliotic curves. The parameters were complimentary and weakly correlated, quantifying different characteristics of the scoliotic spines.
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Affiliation(s)
- Saba Pasha
- Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | - Jesse Shen
- CHU Sainte-Justine, Montreal, QC, Canada
| | - Samuel Kadoury
- CHU Sainte-Justine, Montreal, QC, Canada
- Polytechnique Montreal, Montreal, QC, Canada
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Mandel W, Oulbacha R, Roy-Beaudry M, Parent S, Kadoury S. Image-Guided Tethering Spine Surgery With Outcome Prediction Using Spatio-Temporal Dynamic Networks. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:491-502. [PMID: 33048671 DOI: 10.1109/tmi.2020.3030741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Recent fusionless surgical techniques for corrective spine surgery such as Anterior Vertebral Body Growth Modulation (AVBGM) allow to treat mild to severe spinal deformations by tethering vertebral bodies together, helping to preserve lower back flexibility. Forecasting the outcome of AVBGM from skeletally immature patients remains elusive with several factors involved in corrective vertebral tethering, but could help orthopaedic surgeons plan and tailor AVBGM procedures prior to surgery. We introduce an intra-operative framework forecasting the outcomes during AVBGM surgery in scoliosis patients. The method is based on spatial-temporal corrective networks, which learns the similarity in segmental corrections between patients and integrates a long-term shifting mechanism designed to cope with timing differences in onset to surgery dates, between patients in the training set. The model captures dynamic geometric dependencies in scoliosis patients, ensuring long-term dependency with temporal dynamics in curve evolution and integrated features from inter-vertebral disks extracted from T2-w MRI. The loss function of the network introduces a regularization term based on learned group-average piecewise-geodesic path to ensure the generated corrective transformations are coherent with regards to the observed evolution of spine corrections at follow-up exams. The network was trained on 695 3D spine models and tested on 72 operative patients using a set of 3D spine reconstructions as inputs. The spatio-temporal network predicted outputs with errors of 1.8 ± 0.8mm in 3D anatomical landmarks, yielding geometries similar to ground-truth spine reconstructions obtained at one and two year follow-ups and with significant improvements to comparative deep learning and biomechanical models.
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Restoration of Thoracic Kyphosis in Adolescent Idiopathic Scoliosis Over a Twenty-year Period: Are We Getting Better? Spine (Phila Pa 1976) 2020; 45:1625-1633. [PMID: 32890296 DOI: 10.1097/brs.0000000000003659] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A multicenter, prospectively collected database of 20 years of operatively treated adolescent idiopathic scoliosis (AIS) was utilized to retrospectively examine pre- and postoperative thoracic kyphosis at 2-year follow-up. OBJECTIVE To determine if the adoption of advanced three-dimensional correction techniques has led to improved thoracic kyphosis correction in AIS. SUMMARY OF BACKGROUND DATA Over the past 20 years, there has been an evolution of operative treatment for AIS, with more emphasis on sagittal and axial planes. Thoracic hypokyphosis was well treated with an anterior approach, but this was not addressed sufficiently in early posterior approaches. We hypothesized that patients with preoperative thoracic hypokyphosis prior to 2000 would have superior thoracic kyphosis restoration, but the learning curve with pedicle screws would reflect initially inferior restoration and eventual improvement. METHODS From 1995 to 2015, 1063 patients with preoperative thoracic hypokyphosis (<10°) were identified. A validated formula for assessing three-dimensional sagittal alignment using two-dimensional kyphosis and thoracic Cobb angle was applied. Patients were divided into 1995-2000 (Period 1, primarily anterior), 2001-2009 (Period 2, early thoracic pedicle screws), and 2010-2015 (Period 3, modern posterior) cohorts. Two-way repeated measures analysis of variance and post-hoc Bonferroni corrections were utilized with P < 0.05 considered significant. RESULTS Significant differences were demonstrated. Period 1 had excellent restoration of thoracic kyphosis, which worsened in Period 2 and improved to near Period 1 levels during Period 3. Period 3 had superior thoracic kyphosis restoration compared with Period 2. CONCLUSION Although the shift from anterior to posterior approaches in AIS was initially associated with worse thoracic kyphosis restoration, this improved with time. The proportion of patients restored to >20° kyphosis with a contemporary posterior approach has steadily improved to that of the era when anterior approaches were more common. LEVEL OF EVIDENCE 3.
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Zimmermann EA, Fiedler IAK, Busse B. Breaking new ground in mineralized tissue: Assessing tissue quality in clinical and laboratory studies. J Mech Behav Biomed Mater 2020; 113:104138. [PMID: 33157423 DOI: 10.1016/j.jmbbm.2020.104138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/15/2020] [Accepted: 10/07/2020] [Indexed: 02/07/2023]
Abstract
Mineralized tissues, such as bone and teeth, have extraordinary mechanical properties of both strength and toughness. This mechanical behavior originates from deformation and fracture resistance mechanisms in their multi-scale structure. The term quality describes the matrix composition, multi-scale structure, remodeling dynamics, water content, and micro-damage accumulation in the tissue. Aging and disease result in changes in the tissue quality that may reduce strength and toughness and lead to elevated fracture risk. Therefore, the capability to measure the quality of mineralized tissues provides critical information on disease progression and mechanical integrity. Here, we provide an overview of clinical and laboratory-based techniques to assess the quality of mineralized tissues in health and disease. Current techniques used in clinical settings include radiography-based (radiographs, dual energy x-ray absorptiometry, EOS) and x-ray tomography-based methods (high resolution peripheral quantitative computed tomography, cone beam computed tomography). In the laboratory, tissue quality can be investigated in ex vivo samples with x-ray imaging (micro and nano-computed tomography, x-ray microscopy), electron microscopy (scanning/transmission electron imaging (SEM/STEM), backscattered scanning electron microscopy, Focused Ion Beam-SEM), light microscopy, spectroscopy (Raman spectroscopy and Fourier transform infrared spectroscopy) and assessment of mechanical behavior (mechanical testing, fracture mechanics and reference point indentation). It is important for clinicians and basic science researchers to be aware of the techniques available in different types of research. While x-ray imaging techniques translated to the clinic have provided exceptional advancements in patient care, the future challenge will be to incorporate high-resolution laboratory-based bone quality measurements into clinical settings to broaden the depth of information available to clinicians during diagnostics, treatment and management of mineralized tissue pathologies.
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Affiliation(s)
| | - Imke A K Fiedler
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Gardner A, Berryman F, Pynsent P. A cluster analysis describing spine and torso shape in Lenke type 1 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 2020; 30:620-627. [DOI: 10.1007/s00586-020-06620-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
Abstract
Purpose
The purpose of this work is to identify the variability and subtypes of the combined shape of the spine and torso in Lenke type 1 adolescent idiopathic scoliosis (AIS).
Methods
Using ISIS2 surface topography, measures of coronal deformity, kyphosis and skin angulation (as a measure of torso asymmetry) in a series of children with Lenke 1 convex to the right AIS were analyzed using k-means clustering techniques to describe the combined variability of shape in the spine and torso. Following this, a k-nearest neighbor algorithm was used to measure the ability to automatically identify the correct cluster for any particular datum.
Results
There were 1399 ISIS2 images from 691 individuals available for analysis. There were 5 clusters identified in the data representing the variability of the 3 measured parameters which included mild, moderate and marked coronal deformity, mild, moderate and marked asymmetry alongside normal and hypokyphosis. The k-nearest neighbor identification of the correct cluster had an accuracy of 93%.
Conclusion
These clusters represent a new description of Lenke 1 AIS that comprises both coronal and sagittal measures of the spine combined with a measure of torso asymmetry. Automated identification of the clusters is accurate. The ability to identify subtypes of deformity, based on parameters that affect both the spine and the torso in AIS, leads to as better understanding of the totality of the deformity seen.
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Wu HD, Chu WCW, He CQ, Wong MS. Assessment of the plane of maximum curvature for patients with adolescent idiopathic scoliosis via computed tomography. Prosthet Orthot Int 2020; 44:298-304. [PMID: 32693677 DOI: 10.1177/0309364620941297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In the assessment of three-dimensional features of adolescent idiopathic scoliosis, the plane of maximum curvature was compared with the coronal Cobb angle. OBJECTIVES To investigate the intrarater reliability, variability, and difference of the prone plane of maximum curvature measurements taken from computed tomography using the constrained and unconstrained Cobb methods; to assess the difference and correlation between the prone plane of maximum curvature measurements obtained using the constrained and unconstrained Cobb methods; and to examine differences and correlation between the prone plane of maximum curvature Cobb angle and coronal Cobb angle measurements. STUDY DESIGN Retrospective study. METHODS Records of 29 subjects with adolescent idiopathic scoliosis aged 15.8 ± 3.5 years were reviewed (25 thoracic and 24 thoracolumbar/lumbar curves). An experienced rater measured the plane of maximum curvature using the constrained and unconstrained Cobb methods, and the coronal Cobb angles using the conventional Cobb method on computed tomography images 3 times each with 1-week interval. The intraclass correlation coefficient (2,1), Pearson correlation coefficient (r), one-way repeated measures analysis of variance, and paired t test were applied for various analyses. RESULTS The intraclass correlation coefficients for all intrarater reliability assessments were greater than 0.87. The plane of maximum curvature measurements of the two Cobb methods were excellently correlated (r ⩾ 0.97) with no significant difference (P > 0.05). The mean plane of maximum curvature Cobb angle was moderately correlated with (r > 0.72) but significantly greater (P < 0.001) than the mean coronal Cobb angle. CONCLUSION The plane of maximum curvature measurements obtained from computed tomography were found to be reliable while the plane of maximum curvature measurements of the two Cobb methods were comparable. The mean plane of maximum curvature Cobb angle was moderately correlated with but significantly greater than the mean coronal Cobb angle. CLINICAL RELEVANCE The plane of maximum curvature measurements taken from computed tomography was found to be reliable, hence it could be used as a supplement to the coronal Cobb angle in the assessment and management of adolescent idiopathic scoliosis. With technological advancement, the radiation dose of computed tomography can be further reduced to a safer level for a broader range of cases.
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Affiliation(s)
- Hui-Dong Wu
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.,Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, China
| | - Winnie Chiu-Wing Chu
- Department of Imaging & Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Cheng-Qi He
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China.,Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, China
| | - Man-Sang Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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Wu HD, He C, Chu WCW, Wong MS. Estimation of plane of maximum curvature for the patients with adolescent idiopathic scoliosis via a purpose-design computational method. 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 2020; 30:668-675. [PMID: 32767126 DOI: 10.1007/s00586-020-06557-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 06/25/2020] [Accepted: 07/27/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE The coronal Cobb angle is commonly used for assessing the adolescent idiopathic scoliosis (AIS); however, it may underestimate the severity of AIS while the plane of maximum curvature (PMC) could be a promising descriptor for three-dimensional assessment of AIS. This study aimed to develop a computational method (CM) for estimating the PMC based on the coronal and sagittal images of the spine, and to verify the results with computed tomography (CT). METHODS Twenty-eight thoracic and 24 lumbar curves from 30 subjects with AIS were analysed. For the CM, PMC was estimated via identifying the two corner points at the superior endplate of upper-end vertebra and the inferior endplate of lower-end vertebra in the coronal and sagittal CT images separately (eight corner points in total). For the CT, PMC was determined through rotating the spine images axially until the maximum Cobb angle was found. Intraclass correlation coefficient (ICC), Bland-Altman method and linear regression analysis were used for the statistical analyses. RESULTS The high ICC values (intra- > 0.91; inter- > 0.84) suggested very good intra- and inter-rater reliability of the CM in PMC estimation. The high ICC values (> 0.91) and assessment of Bland-Altman method demonstrated a good agreement between the PMC acquired using the CM and CT. The generated linear regression equations (R2 > 0.69) could allow to estimate the PMC (originally measured through the CT) via the CM. CONCLUSION The developed computational method could estimate reliable and valid PMC for the patients with AIS, and become feasible for three-dimensional assessment of AIS. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hui-Dong Wu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute for Disaster Management and Reconstruction, Sichuan University-Hong Kong Polytechnic University, Chengdu, Sichuan, China
| | - Chen He
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
| | - Winnie Chiu-Wing Chu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Man-Sang Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
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Główka P, Politarczyk W, Janusz P, Woźniak Ł, Kotwicki T. The method for measurement of the three-dimensional scoliosis angle from standard radiographs. BMC Musculoskelet Disord 2020; 21:475. [PMID: 32693786 PMCID: PMC7372870 DOI: 10.1186/s12891-020-03494-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022] Open
Abstract
Background Three-dimensional idiopathic scoliosis cannot be accurately assessed with the aid of a single plane parameter – the Cobb angle. We propose a novel method for evaluating the three-dimensional (3D) pattern of scoliosis based on two X-rays (PA and lateral). The proposed method consists of the measurements of the angles between the upper endplate of the upper-end vertebra and the lower endplate of the lower-end vertebra (3D scoliosis angle). Methods The 3D-angles of thirty scoliosis curves were measured with either computed tomography (CT) or digitally reconstructed radiographs (DRRs): PA and lateral. CT was used as a reference. In the case of CT, the 3D angle was calculated based on the coordinates of three points situated on the upper endplate and those of three points situated on the lower endplate of the scoliosis curve. In the case of the DRR, the 3D angle was calculated using the four-angle method: the angles formed by the endplates of the curve with the transverse plane. The results were tested with the Student’s t-test, and the agreement of measurements was tested with the intraclass correlation coefficient. Results There was no significant difference between the 3D-angle measurements obtained with DRRs versus CT, p > 0.05. There was, however, a significant difference between the 3D-scoliosis angle and the Cobb angle measurements performed based on the X-rays. The reproducibility and reliability of 3D angle measurements were high. Conclusions Based on two standard radiographs, PA and lateral, it is possible to calculate the 3D scoliosis angle. The proposed method facilitates 3D-scoliosis assessment without the use of sophisticated devices. Considering the 3D nature of AIS, the 3D parameters of the spine may help to apply a more effective treatment and estimate a more precise prognosis for patient with scoliosis.
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Affiliation(s)
- Paweł Główka
- Department of Spine Disorders and Pediatric Orthopedics, Poznan University of Medical Sciences, 28 Czerwca 1956 135/147, 61-545, Poznan, Poland.
| | | | - Piotr Janusz
- Department of Spine Disorders and Pediatric Orthopedics, Poznan University of Medical Sciences, 28 Czerwca 1956 135/147, 61-545, Poznan, Poland
| | - Łukasz Woźniak
- Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, 28 Czerwca 1956 135/147, 61-545, Poznan, Poland
| | - Tomasz Kotwicki
- Department of Spine Disorders and Pediatric Orthopedics, Poznan University of Medical Sciences, 28 Czerwca 1956 135/147, 61-545, Poznan, Poland
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Garcia-Cano E, Cosio FA, Torres Robles F, Fanti Z, Bellefleur C, Joncas J, Labelle H, Duong L. A freehand ultrasound framework for spine assessment in 3D: a preliminary study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:2096-2100. [PMID: 33018419 DOI: 10.1109/embc44109.2020.9176689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
X-ray imaging is currently the gold standard for the assessment of spinal deformities. The purpose of this study is to evaluate a freehand 3D ultrasound system for volumetric reconstruction of the spine. A setup consisting of an ultrasound scanner with a linear transducer, an electromagnetic measuring system and a workstation was used. We conducted 64 acquisitions of US images of 8 adults in a natural standing position, and we tested three setups: 1) Subjects are constrained to be close to a wall, 2) Subjects are unconstrained, and 3) Subjects are constrained to performing fast and slow acquisitions. The spinous processes were manually selected from the volume reconstruction from tracked ultrasound images to generate a 3D point-based model depicting the centerline of the spine. The results suggested that a freehand 3D ultrasound system can be suitable for representing the spine. Volumetric reconstructions can be computed and landmarking can be performed to model the surface of the spine in the 3D space. These reconstructions promise to generate computer-based descriptors to analyze the shape of the spine in the 3D space.Clinical Relevance- We provide clinicians with a protocol that could be integrated in clinical setups for the assessment and monitoring of AIS, based on US image acquisitions, which constitutes a radiation-free technology.
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A Predictive Model of Progression for Adolescent Idiopathic Scoliosis Based on 3D Spine Parameters at First Visit. Spine (Phila Pa 1976) 2020; 45:605-611. [PMID: 31703055 DOI: 10.1097/brs.0000000000003316] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED MINI: The aim of this prospective cohort study was to improve the prediction of curve progression in AIS. By adding the 3D morphology parameters at first visit, the predictive model explains 65% of the variability. It is one of the greatest advances in the understanding of scoliosis progression in the last 30 years. STUDY DESIGN Prospective cohort study. OBJECTIVE The objective of the present study was to design a model of AIS progression to predict Cobb angle at full skeletal maturity, based on curve type, skeletal maturation, and 3D spine parameters available at first visit. SUMMARY OF BACKGROUND DATA Adolescent idiopathic scoliosis (AIS) is a three-dimensional (3D) spinal deformity that affects 1% of adolescents. Curve severity is assessed using the Cobb angle. Prediction of scoliosis progression remains challenging for the treating physician and is currently based on curve type, severity, and maturity. The objective of this study was to develop a predictive model of final Cobb angle, based on 3D spine parameters at first visit, to optimize treatment. METHODS A prospective cohort of AIS patients at first orthopedic visit was enrolled between 2006 and 2010, all with 3D reconstructions. Measurements of five types of descriptors were obtained: angle of plane of maximum curvature, Cobb angles, 3D wedging, rotation, and torsion. A general linear model analysis with backward selection was done with final Cobb angle (either just before surgery or at skeletal maturity) as outcome and 3D spine parameters and clinical parameters as predictors. RESULTS Of 195 participants, 172 (88%) were analyzed; average age at presentation was 12.5 ± 1.3 years and mean follow-up to outcome, 3.2 years. The final model includes significant predictors: initial skeletal maturation, curve type, frontal Cobb angle, angle of plane of maximal curvature, and 3D disk wedging (T3-T4, T8-T9) and achieved a determination coefficient (R) = 0.643. Positive and negative predictive values to identify a curve of 35 degrees are 79% and 94%. CONCLUSION This study developed a predictive model of spinal curve progression in scoliosis based on first-visit information. The model will help the treating physician to initiate appropriate treatment at first visit. LEVEL OF EVIDENCE 3.
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Emerging Techniques in Diagnostic Imaging for Idiopathic Scoliosis in Children and Adolescents: A Review of the Literature. World Neurosurg 2020; 136:128-135. [DOI: 10.1016/j.wneu.2020.01.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/18/2022]
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PRATALI RAPHAELDEREZENDE, DAHER MURILOTAVARES, MEVES ROBERT. BIPLANAR IMAGING WITH TRIDIMENSIONAL CAPABILITIES: APPLICABILITY OF THIS NEW EXAMINATION TO SPINAL DEFORMITIES. COLUNA/COLUMNA 2020. [DOI: 10.1590/s1808-185120201901222631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT This study presents details about the applicability of the new image acquisition system, called the biplanar imaging system, with three-dimensional capabilities (EOS®) to the treatment of spinal deformities. This system allows radiographic acquisition of the entire body, with a great reduction in the dose of radiation absorbed by the patient and three-dimensional (3D) stereoradiographic image reconstruction of bone structures, including the spine. In the case of adolescent idiopathic scoliosis, the analysis of the spinal deformity with 3D reconstruction allows better understanding of the deformity and surgical planning. In the case of adult spinal deformity, full-body analysis allows an evaluation of the spinopelvic deformity, including loss of sagittal alignment, in addition to an evaluation of compensatory mechanisms recruited by the individual in an attempt to maintain the sagittal balance. Level of evidence III; Descriptive Review.
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Affiliation(s)
| | | | - ROBERT MEVES
- Santa Casa de São Paulo, Faculdade de Ciências Médicas, Brazil
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Abstract
STUDY DESIGN A bibliometric analysis. OBJECTIVE To identify and analyze the 100 top-cited articles on spinal deformity. SUMMARY OF BACKGROUND DATA The nature of spinal deformity leads to the complexity of its treatment. There is a scarcity of guidelines for the treatment of spinal deformity despite of the growing literature. So it is crucial to discern researches with higher impact and quality. METHODS A keyword search using the Thomson Reuters Web of Science was conducted to select articles relevant to spinal deformity. The 100 top-cited articles were identified based on titles and abstracts, and then analyzed. RESULTS The citation count for the final 100 articles ranged from 154 to 775, with an average of 243.0 citations. Most studies were published in the journal Spine (49/100). The most productive publication time was from 2000 to 2009. The natural history of scoliosis was the most frequent topic (10 articles), followed by pedicle screw instrumentation (8), outcome of nonoperative treatment for adolescent idiopathic scoliosis (AIS) (8), health-related quality of life (7), relationship between sagittal parameters and clinical symptoms (7), and complications of surgical treatment (7). Despite AIS was the most common deformity, the top two most frequently cited articles were all about adult spinal deformity, both describing the correlation between sagittal parameters and symptoms. CONCLUSION The current study attempted to develop a resource with detailed information on 100 top-cited articles on spinal deformity. It demonstrated the essential advances in spinal deformity. Although the most common spinal deformity is AIS, the adult spinal deformity is of greater impact. These insights into priorities and trends of the researches could help future academic pursuits. LEVEL OF EVIDENCE 5.
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Westberry DE, Carpenter AM. 3D Modeling of Lower Extremities With Biplanar Radiographs: Reliability of Measures on Subsequent Examinations. J Pediatr Orthop 2020; 39:521-526. [PMID: 31599863 DOI: 10.1097/bpo.0000000000001046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Biplanar radiography with 3-dimensional (3D) modeling (EOS) provides a comprehensive assessment of lower limb alignment in an upright weight-bearing position with less radiation than conventional radiography. A study was performed to assess the consistency and reliability of 2 lower extremity 3D biplanar radiograph models created at least 1 year apart in a pediatric population. METHODS All patients who had 2 lower extremity radiographic evaluations with EOS performed at visits a minimum of 1 year apart were reviewed. Digital radiographs, of lower extremities in both frontal and sagittal planes, were acquired simultaneously, using the EOS system. The 3D reconstruction of the images was achieved utilizing the SterEOS software. Pelvic position, femoral and tibial anatomy, and the torsional profile were evaluated and compared using t tests. RESULTS In total, 53 patients with a mean age of 11.7 years (range, 6.1 to 18.9 y) met inclusion criteria. When comparing 3D models between visits, minimal differences were noted in proximal femoral anatomy and pelvic alignment (pelvic incidence, sacral slope, sagittal tilt, neck shaft angle). Expected differences in femoral and tibial length corresponded with normal longitudinal growth between visits. Sagittal plane knee position varied widely between examinations. Femoral and/or tibial rotational osteotomies were performed in 37% of extremities between examinations. After femoral derotational osteotomy, a significant difference in femoral anteversion was appreciated when comparing preoperative and postoperative 3D models. However, this difference was less than the expected difference based on the anatomic correction achieved intraoperatively. No differences were noted in tibial torsion measures after tibial derotational osteotomy. CONCLUSIONS The 3D modeling based on biplanar radiographs provides consistent and reliable measures of pelvic and hip joint anatomy of the lower extremity. Patient positioning may influence the reproducibility of knee alignment. The torsional profile assessment did not accurately reflect changes obtained by derotational osteotomy. LEVEL OF EVIDENCE Level III.
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Aubert B, Vazquez C, Cresson T, Parent S, de Guise JA. Toward Automated 3D Spine Reconstruction from Biplanar Radiographs Using CNN for Statistical Spine Model Fitting. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:2796-2806. [PMID: 31059431 DOI: 10.1109/tmi.2019.2914400] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
To date, 3D spine reconstruction from biplanar radiographs involves intensive user supervision and semi-automated methods that are time-consuming and not effective in clinical routine. This paper proposes a new, fast, and automated 3D spine reconstruction method through which a realistic statistical shape model of the spine is fitted to images using convolutional neural networks (CNN). The CNNs automatically detect the anatomical landmarks controlling the spine model deformation through a hierarchical and gradual iterative process. The performance assessment used a set of 68 biplanar radiographs, composed of both asymptomatic subjects and adolescent idiopathic scoliosis patients, in order to compare automated reconstructions with ground truths build using multiple experts-supervised reconstructions. The mean (SD) errors of landmark locations (3D Euclidean distances) were 1.6 (1.3) mm, 1.8 (1.3) mm, and 2.3 (1.4) mm for the vertebral body center, endplate centers, and pedicle centers, respectively. The clinical parameters extracted from the automated 3D reconstruction (reconstruction time is less than one minute) presented an absolute mean error between 2.8° and 4.7° for the main spinal parameters and between 1° and 2.1° for pelvic parameters. Automated and expert's agreement analysis reported that, on average, 89% of automated measurements were inside the expert's confidence intervals. The proposed automated 3D spine reconstruction method provides an important step that should help the dissemination and adoption of 3D measurements in clinical routine.
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Valdovino AG, Bastrom TP, Reighard FG, Cross M, Bartley CE, Shah SA, Yaszay B, Newton PO, Upasani VV. Obesity Is Associated With Increased Thoracic Kyphosis in Adolescent Idiopathic Scoliosis Patients and Nonscoliotic Adolescents. Spine Deform 2019; 7:865-869. [PMID: 31731995 DOI: 10.1016/j.jspd.2019.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/25/2019] [Accepted: 03/30/2019] [Indexed: 11/28/2022]
Abstract
STUDY DESIGN Retrospective comparative cohort study. OBJECTIVE To compare radiographic parameters between adolescents with a greater body mass index (BMI) percentile to underweight individuals. SUMMARY OF BACKGROUND DATA Increased BMI percentile has been associated with increased complications after surgical correction of adolescent idiopathic scoliosis (AIS). However, association between BMI percentile and preoperative sagittal plane alignment has not been evaluated. The purpose of this study was to evaluate the effect of BMI percentile on sagittal alignment in AIS patients compared with nonscoliotic adolescents. METHODS Posterior-anterior and lateral spinal radiographs of 1,551 AIS patients with a thoracic major curve (Lenke 1-4) and 70 nonscoliotic adolescent patients were compared. BMI percentile was determined based on age and sex, and patients were divided into four categories: underweight (<5th percentile), normal-weight (5th-85th percentile), overweight (85th-95th percentile), and obese (≥95th percentile). RESULTS Coronal plane deformity magnitude was not significantly different between the 4 categories of AIS patients (p = .51). Increased BMI percentile was associated with increased thoracic kyphosis globally (T2-T12: p < .005) as well as segmentally (T2-T5: p < .001; T5-T12: p < .001) in patients with AIS. This was also true in obese adolescents without spinal deformity (p < .04). Lumbar lordosis, pelvic incidence, and pelvic tilt were not significantly different between AIS patients in the four BMI percentile categories (p > .07). Pelvic incidence was significantly greater in AIS patients compared with nonscoliotic adolescents (54 ± 13 vs. 46 ± 11; p = .01). CONCLUSION Increased BMI percentile is associated with increased thoracic kyphosis in AIS patients and nonscoliotic adolescents. Excess weight may reduce anterior vertebral growth. AIS patients have an increased pelvic incidence compared with nonscoliotic adolescents; however, this variable is not influenced by body mass. These relationships should be taken into account when planning sagittal plane deformity correction or considering neuro axis disorders (also associated with increased kyphosis) in patients with scoliosis. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Alan G Valdovino
- University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0021, USA
| | - Tracey P Bastrom
- Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, 3020 Children's Way, San Diego, CA 92123, USA
| | - Fredrick G Reighard
- Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, 3020 Children's Way, San Diego, CA 92123, USA
| | - Madeline Cross
- Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, 3020 Children's Way, San Diego, CA 92123, USA
| | - Carrie E Bartley
- Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, 3020 Children's Way, San Diego, CA 92123, USA
| | - Suken A Shah
- Department of Orthopedics, Nemours Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, USA
| | - Burt Yaszay
- Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, 3020 Children's Way, San Diego, CA 92123, USA
| | - Peter O Newton
- Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, 3020 Children's Way, San Diego, CA 92123, USA
| | - Vidyadhar V Upasani
- University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0021, USA; Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, 3020 Children's Way, San Diego, CA 92123, USA.
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Almansour H, Pepke W, Bruckner T, Diebo BG, Akbar M. Three-Dimensional Analysis of Initial Brace Correction in the Setting of Adolescent Idiopathic Scoliosis. J Clin Med 2019; 8:jcm8111804. [PMID: 31661811 PMCID: PMC6912396 DOI: 10.3390/jcm8111804] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/29/2019] [Accepted: 10/25/2019] [Indexed: 11/24/2022] Open
Abstract
The three-dimensional nature of adolescent idiopathic scoliosis (AIS) necessitates a tridimensional assessment and management. Bracing constitutes the mainstay conservative treatment for mild adolescent idiopathic scoliosis. In the literature hitherto, there has been uncertainty regarding the behavior of the spine, pelvis, and vertebral orientations in the context of bracing, especially in the transverse plane. This poses a challenge to healthcare providers, patients, and their families, as brace treatment, although not as invasive as surgery, is laden with medical and psychological complications and could be considered traumatizing. Hence, a thorough understanding of initial three-dimensional spinal behavior in the context of bracing is important. The purpose of this retrospective study was to investigate the immediate 3D impact of Chêneau-type brace. Thirty-eight patients with AIS undergoing Chêneau-type bracing were included. Patients were stratified according to their structural curve topography into thoracic, thoracolumbar, and lumbar groups. 3D reconstruction of the spine using a dedicated biplanar stereoradiography software with and without the brace was performed. The examined anthropometric radiographic measures were pre- to in-brace variations and differences of spinopelvic parameters and vertebral orientations in the coronal, sagittal, and transverse planes. The complex impact of the Chêneau-type brace on different curves in three planes was delineated. In the coronal plane, the Cobb angle was significantly decreased in all types of curves, and the coronal tilt correction was concentrated in specific segments. The impact of the brace in this study on the sagittal profile was variable, including the loss of thoracic kyphosis and lumbar lordosis. In the transverse plane, an axial vertebral rotation change and detorsion above the apex occurred in the thoracolumbar curves. The results from this exploratory study could shed some light on the initial 3D spinal behavior in the context of bracing and may be of beneficial for treating physicians and brace makers.
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Affiliation(s)
- Haidara Almansour
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany.
| | - Wojciech Pepke
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany.
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, 69118 Heidelberg, Germany.
| | - Bassel G Diebo
- Department of Orthopedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York, NY 11203, USA.
| | - Michael Akbar
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany.
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Idiopathic Scoliosis in Children and Adolescents: Emerging Techniques in Surgical Treatment. World Neurosurg 2019; 130:e737-e742. [DOI: 10.1016/j.wneu.2019.06.207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/25/2022]
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Brink RC, Homans JF, Schlösser TPC, van Stralen M, Vincken KL, Shi L, Chu WCW, Viergever MA, Castelein RM, Cheng JCY. CT-based study of vertebral and intravertebral rotation in right thoracic 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; 28:3044-3052. [DOI: 10.1007/s00586-019-06138-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
Abstract
Abstract
Purpose
To define the longitudinal rotation axis around which individual vertebrae rotate, and to establish the various extra- and intravertebral rotation patterns in thoracic adolescent idiopathic scoliosis (AIS) patients, for better understanding of the 3D development of the rotational deformity.
Methods
Seventy high-resolution CT scans from an existing database of thoracic AIS patients (Cobb angle: 46°–109°) were included to determine the vertebral axial rotation, rotation radius, intravertebral axial rotation, and local mechanical torsion for each spinal level, using previously validated image processing techniques.
Results
For all levels, the longitudinal rotation axis, from which the vertebrae rotate away from the midline, was localized posterior to the spine. The axis became closer to the spine at the apex: apex, r = 11.5 ± 5.1 cm versus two levels above (radius = 15.8 ± 8.5 cm; p < 0.001) and beneath (radius = 14.2 ± 8.2 cm; p < 0.001). The vertebral axial rotation, intravertebral axial rotation, and local mechanical torsion of the vertebral bodies were largest at the apex (21.9° ± 7.4°, 8.7° ± 13.5° and 3.0° ± 2.5°) and decreased toward the neutral, junctional zones (p < 0.001).
Conclusion
In AIS, the vertebrae rotate away around an axis that is localized posterior to the spine. The distance between this axis and the spine is minimal at the apex and increases gradually to the neutral zones. The vertebral axial rotation is accompanied by smaller amounts of intravertebral rotation and local mechanical torsion, which increases toward the apical region. The altered morphology and alignment are important for a better understanding of the 3D pathoanatomical development of AIS and better therapeutic planning for bracing and surgical intervention.
Graphic abstract
These slides can be retrieved under Electronic Supplementary Material.
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Sagittal Alignment Profile Following Selective Thoracolumbar/Lumbar Fusion in Patients With Lenke Type 5C Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976) 2019; 44:1193-1200. [PMID: 30921290 DOI: 10.1097/brs.0000000000003043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective case series. OBJECTIVE This study aimed to report the sagittal outcome measures in patients with Lenke type 5C adolescent idiopathic scoliosis (AIS) undergoing thoracolumbar/lumbar (TL/L) fusion surgery. SUMMARY OF BACKGROUND DATA Previous studies have demonstrated coronal correction of Lenke type 5C AIS by selective TL/L fusion surgery. However, little is known about the sagittal influence of selective TL/L curve correction in Lenke type 5C AIS. METHODS Thirty-nine patients with Lenke type 5C AIS underwent selective posterior TL/L curves fusion (mean age, 15.9 ± 2.1 yrs). Preoperative and postoperative radiographic and clinical parameters were analyzed at a minimum 2-year follow-up period. Radiographic parameters were compared between patients with Lenke sagittal modifier normal (Group N) to those with Lenke sagittal modifier minus (Group M). RESULTS The main TL/L Cobb angle was 46.3° ± 7.7° preoperatively and 20.7° ± 5.3° (P < 0.0001) at 2-year follow-up. Also, thoracic kyphosis (TK) (T1-12) angle was 29.0° ± 11.3° preoperatively and 36.4° ± 10.3° at follow-up (P < 0.001), and TK (T5-12) angle was 18.1° ± 10.2° preoperatively and 25.9° ± 8.9° at follow-up (P < 0.001). The cervical lordosis (CL) was 9.6° ± 11.6° preoperatively and 6.1° ± 10.9° at follow-up (P = 0.037). Compared with the Lenke sagittal modifier groups, preoperative TK (T1-12), TK (T5-12), thoracolumbar kyphosis (TLK), and CL were significantly different from both the groups; and after the surgery, no significant differences in these parameters were observed between the two groups. CONCLUSION After the selective TL/L posterior fusion surgery in patients with Lenke type 5C AIS, the sagittal alignment profile, including TK, TLK, C7 sagittal vertical axis, T1 slope, and CL, was significantly changed. With regard to the sagittal aspect, selective TL/L surgery was more likely to affect Group M than Group N. LEVEL OF EVIDENCE 4.
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Knez D, Nahle IS, Vrtovec T, Parent S, Kadoury S. Computer‐assisted pedicle screw trajectory planning using CT‐inferred bone density: A demonstration against surgical outcomes. Med Phys 2019; 46:3543-3554. [DOI: 10.1002/mp.13585] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/28/2019] [Accepted: 05/03/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Dejan Knez
- Faculty of Electrical Engineering University of Ljubljana Tržaška c. 25 Ljubljana 1000Slovenia
| | - Imad S. Nahle
- CHU Sainte‐Justine Hospital Research Center 3175 Cote‐Sainte‐Catherine Rd. Montréal H3T 1C5QuébecCanada
| | - Tomaž Vrtovec
- Faculty of Electrical Engineering University of Ljubljana Tržaška c. 25 Ljubljana 1000Slovenia
| | - Stefan Parent
- CHU Sainte‐Justine Hospital Research Center 3175 Cote‐Sainte‐Catherine Rd. Montréal H3T 1C5QuébecCanada
| | - Samuel Kadoury
- CHU Sainte‐Justine Hospital Research Center 3175 Cote‐Sainte‐Catherine Rd. Montréal H3T 1C5QuébecCanada
- Department of Computer and Software Engineering Polytechnique Montreal P.O. Box 6079, Succ. Centre‐ville Montréal H3C 3A7QuébecCanada
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Nouh MR. Imaging of the spine: Where do we stand? World J Radiol 2019; 11:55-61. [PMID: 31110605 PMCID: PMC6503457 DOI: 10.4329/wjr.v11.i4.55] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/11/2019] [Accepted: 03/16/2019] [Indexed: 02/06/2023] Open
Abstract
The number of patients presenting with spine-related problems has globally increased, with an enormous growing demand for the use of medical imaging to address this problem. The last three decades witnessed great leaps for diagnostic imaging modalities, including those exploited for imaging the spine. These developments improved our diagnostic capabilities in different spinal pathologies, especially with multi-detector computed tomography and magnetic resonance imaging, via both hardware and software improvisations. Nowadays, imaging may depict subtle spinal instability caused by various osseous and ligamentous failures, and could elucidate dynamic instabilities. Consequently, recent diagnostic modalities can discern clinically relevant spinal canal stenosis. Likewise, improvement in diagnostic imaging capabilities revolutionized our understanding of spinal degenerative diseases via quantitative biomarkers rather than mere subjective perspectives. Furthermore, prognostication of spinal cord injury has become feasible, and this is expected to be translated into better effective patient tailoring to management plans with better clinical outcomes. Meanwhile, our confidence in diagnosing spinal infections and assessing the different spinal instrumentation has greatly improved over the past few last decades. Overall, revolutions in diagnostic imaging over the past few decades have upgraded spinal imaging from simple subjective and qualitative indices into a more sophisticated yet precise era of objective metrics via deploying quantitative imaging biomarkers.
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Affiliation(s)
- Mohamed R Nouh
- Faculty of Medicine, Alexandria University, Alexandria 21521, Egypt
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Illés TS, Lavaste F, Dubousset JF. The third dimension of scoliosis: The forgotten axial plane. Orthop Traumatol Surg Res 2019; 105:351-359. [PMID: 30665877 DOI: 10.1016/j.otsr.2018.10.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/19/2018] [Accepted: 10/05/2018] [Indexed: 02/02/2023]
Abstract
Idiopathic scoliosis is a three-dimensional (3D) deformity of the spine. In clinical practice, however, the diagnosis and treatment of scoliosis consider only two dimensions (2D) as they rely solely on postero-anterior (PA) and lateral radiographs. Thus, the projections of the deformity are evaluated in only the coronal and sagittal planes, whereas those in the axial plane are disregarded, precluding an accurate assessment of the 3D deformity. A universal dogma in engineering is that designing a 3D object requires drawing projections of the object in all three planes. Similarly, when dealing with a 3D deformity, knowledge of the abnormalities in all three planes is crucial, as each plane is as important as the other two planes. This article reviews the chronological development of axial plane imaging and spinal deformity measurement.
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Affiliation(s)
- Tamás S Illés
- Orthopaedic and Trauma Surgery, CHU-Brugmann, Université Libre de Bruxelles/Vrije Universiteit Brussel, Brussels, Belgium; Orthopaedic and Trauma Surgery, CHU-Odense and Clinical Research Institute, Denmark South University, Odense, Denmark; Académie Nationale de Médecine, 16, rue Bonaparte, 75006 Paris, France.
| | - Francois Lavaste
- Institute of Biomechanics Human Georges-Charpak, Arts et métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France
| | - Jean F Dubousset
- Académie Nationale de Médecine, 16, rue Bonaparte, 75006 Paris, France
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Interrater reliability of three-dimensional reconstruction of the spine. DER ORTHOPADE 2019; 49:350-358. [DOI: 10.1007/s00132-019-03712-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Galbusera F, Casaroli G, Bassani T. Artificial intelligence and machine learning in spine research. JOR Spine 2019; 2:e1044. [PMID: 31463458 PMCID: PMC6686793 DOI: 10.1002/jsp2.1044] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 12/21/2022] Open
Abstract
Artificial intelligence (AI) and machine learning (ML) techniques are revolutionizing several industrial and research fields like computer vision, autonomous driving, natural language processing, and speech recognition. These novel tools are already having a major impact in radiology, diagnostics, and many other fields in which the availability of automated solution may benefit the accuracy and repeatability of the execution of critical tasks. In this narrative review, we first present a brief description of the various techniques that are being developed nowadays, with special focus on those used in spine research. Then, we describe the applications of AI and ML to problems related to the spine which have been published so far, including the localization of vertebrae and discs in radiological images, image segmentation, computer-aided diagnosis, prediction of clinical outcomes and complications, decision support systems, content-based image retrieval, biomechanics, and motion analysis. Finally, we briefly discuss major ethical issues related to the use of AI in healthcare, namely, accountability, risk of biased decisions as well as data privacy and security, which are nowadays being debated in the scientific community and by regulatory agencies.
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Affiliation(s)
- Fabio Galbusera
- Laboratory of Biological Structures MechanicsIRCCS Istituto Ortopedico GaleazziMilanItaly
| | - Gloria Casaroli
- Laboratory of Biological Structures MechanicsIRCCS Istituto Ortopedico GaleazziMilanItaly
| | - Tito Bassani
- Laboratory of Biological Structures MechanicsIRCCS Istituto Ortopedico GaleazziMilanItaly
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Bagheri A, Liu XC, Tassone C, Thometz J, Tarima S. Reliability of Three-Dimensional Spinal Modeling of Patients With Idiopathic Scoliosis Using EOS System. Spine Deform 2019; 6:207-212. [PMID: 29735127 DOI: 10.1016/j.jspd.2017.09.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/25/2017] [Accepted: 09/29/2017] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Three-dimensional (3D) spinal models of children with idiopathic scoliosis (IS) were created using the EOS imaging system (EOS) and sterEOS software. OBJECTIVE To determine the inter- or intraobserver reproducibility of the 3D spinal models in children with IS of different apex locations. SUMMARY OF BACKGROUND DATA 3D spinal model measurements include the Cobb angle, kyphosis, lordosis, and axial vertebral rotation (AVR). Variation of these measurements between two investigators and two different trials by the same investigator were analyzed by inter- and intraclass correlation coefficients (ICCs). METHODS Biplanar radiographic images of 15 patients (age: 6-15 years) with IS were uploaded into the sterEOS software. Spinal and pelvic markers were manually identified to construct a 3D spinal model and measure spinal parameters. Two trained examiners independently performed modeling and performed modeling in spaced out trials. The ICC between inter- and intraobservers were calculated. RESULTS ICCs between inter- and intraobservers were significant for all parameters (p < .05). Both the inter- and intraobservers showed excellent agreement for the Cobb angles in the thoracic segment, kyphosis and lordosis. Substantial interobserver agreement and excellent intraobserver agreement were determined for the Cobb angle in the thoracolumbar or lumbar (TL/L) segment, with less than 6° difference between two raters and less than 2° difference between two trials. Substantial interobserver agreement for the AVR in the TL/L region and substantial interobserver agreement for the AVR in the thoracic region were found, with less than 4° difference between raters. One rater had substantial intraobserver agreement for the AVR in the TL/L region whereas another rater reported moderate to substantial intraobserver agreement in both the thoracic and TL/L regions, with less than 3° difference between trials. CONCLUSION The EOS system shows reliable and repeatable results in 3D spinal modeling of children with IS. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Aria Bagheri
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Xue-Cheng Liu
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Deptartment of Orthopedic Surgery, Children's Hospital of Wisconsin, 9000 W Wisconsin Avenue, PO Box 1997, Pediatric Orthopedics, Suite C360, Milwaukee, WI 53201, USA.
| | - Channing Tassone
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Deptartment of Orthopedic Surgery, Children's Hospital of Wisconsin, 9000 W Wisconsin Avenue, PO Box 1997, Pediatric Orthopedics, Suite C360, Milwaukee, WI 53201, USA
| | - John Thometz
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Deptartment of Orthopedic Surgery, Children's Hospital of Wisconsin, 9000 W Wisconsin Avenue, PO Box 1997, Pediatric Orthopedics, Suite C360, Milwaukee, WI 53201, USA
| | - Sergey Tarima
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Division of Biostatistics, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Jankowski PP, Yaszay B, Cidambi KR, Bartley CE, Bastrom TP, Newton PO. The Relationship Between Apical Vertebral Rotation and Truncal Rotation in Adolescent Idiopathic Scoliosis Using 3D Reconstructions. Spine Deform 2019; 6:213-219. [PMID: 29735128 DOI: 10.1016/j.jspd.2017.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/03/2017] [Accepted: 10/07/2017] [Indexed: 11/19/2022]
Abstract
STUDY DESIGN Retrospective review of prospective data. OBJECTIVES To evaluate the relationship between absolute apical vertebral rotation (AVR) evaluated with upright 3D imaging and angle of trunk rotation (ATR) before and after surgery for thoracic and lumbar curves in adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA New imaging technology allows for improved radiographic assessment of the degree of AVR pre- and postoperatively through 3D spine models created from biplanar, simultaneous spine radiographs. METHODS A prospective registry was queried and identified 55 AIS patients with major thoracic or major thoracolumbar/lumbar curves who underwent posterior spinal fusion. All patients had biplanar upright imaging of their spine and ATR measurements assessed via scoliometer pre- and postoperatively. RESULTS There were 33 major thoracic and 22 major lumbar curves. The mean Cobb angles for thoracic and thoracolumbar/lumbar curves were 54° ± 10° and 47° ± 8° preoperatively, and 11 ± 6° and 12 ± 7° postoperatively. The differences in the mean preoperative ATR measurements for both major curve types was not statistically significant; however, the difference in AVR between thoracic curves (13 ± 6°) and lumbar curves (22 ± 7°) was significant (p < .001). There was a significant decrease in the ATR and AVR for both thoracic and thoracolumbar/lumbar curves (p < .001) postoperatively. A significant correlation between ATR and AVR was found only for the major thoracolumbar/lumbar curves (p < .001). The relationship between ATR and AVR changes for both curves was not statistically significant. CONCLUSION ATR measured via scoliometer strongly correlates with 3D measurements of AVR in both thoracic and lumbar curves before and after surgery for AIS. No significant relationship was found between the changes in ATR and AVR due to surgery. Postoperatively, greater clinical rotational deformity remains in the thoracic spine compared to the lumbar spine, despite greater apical vertebra axial plane correction in thoracic curves. LEVEL OF EVIDENCE Level II, diagnostic.
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Affiliation(s)
- Pawel P Jankowski
- Department of Orthopedics and Neurosurgery, New York University, New York, NY 10003, USA
| | - Burt Yaszay
- Department of Orthopedic Surgery, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA; Department of Orthopedic Surgery, Rady Children's Hospital and Health Center, San Diego, 3020 Children's Way, San Diego, CA 92123, USA.
| | - Krishna R Cidambi
- Department of Orthopedic Surgery, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Carrie E Bartley
- Department of Orthopedic Surgery, Rady Children's Hospital and Health Center, San Diego, 3020 Children's Way, San Diego, CA 92123, USA
| | - Tracey P Bastrom
- Department of Orthopedic Surgery, Rady Children's Hospital and Health Center, San Diego, 3020 Children's Way, San Diego, CA 92123, USA
| | - Peter O Newton
- Department of Orthopedic Surgery, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA; Department of Orthopedic Surgery, Rady Children's Hospital and Health Center, San Diego, 3020 Children's Way, San Diego, CA 92123, USA
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Three-Dimensional Radiographic Analysis of Two Distinct Lenke 1A Curve Patterns. Spine Deform 2019; 7:66-70. [PMID: 30587323 DOI: 10.1016/j.jspd.2018.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/31/2018] [Accepted: 06/06/2018] [Indexed: 11/23/2022]
Abstract
STUDY DESIGN Retrospective review of three-dimensional (3D) imaging from a multicenter database of surgically treated adolescent idiopathic scoliosis (AIS) patients. OBJECTIVE To use 3D analysis software to compare Lenke 1AR and 1AL curves in the coronal, sagittal, and axial planes. BACKGROUND DATA The Lenke 1AR and AL curve patterns have been shown to be two distinct curve types, with 1AL curves being more likely to add on after fusion. Analysis in 3D may help define some of the intricacies of these two curves. METHODS Ninety-four AIS patients with Lenke 1A curves and upright biplanar scanned radiographs were reviewed. Analysis was performed using 3D reconstruction software to evaluate the 3D coronal, sagittal and axial plane deformities. Coronal L4 tilt was used to distinguish between the two curve patterns. RESULTS The main thoracic Cobb was not significantly different between the AR (n = 43) and AL (n = 51) curves (52° ± 8° vs. 50° ± 5°; p = .25). The thoracolumbar/lumbar Cobb was significantly smaller in the AR curves (28° ± 8° vs. 32° ± 7°; p = .02). In the sagittal plane, T5-T12 kyphosis and T12-S1 lordosis were not significantly different (p >.2); however, the T10-L2 alignment was significantly more lordotic in the AR curves (11° ± 8° vs. 4° ± 10° lordosis; p <.001). In the axial plane, thoracic apical rotation was significantly greater in AR curves (21° ± 6° vs. 14° ± 6°; p <.001) and lumbar apical rotation was significantly smaller in AR curves (1° ± 5° vs. 6° ± 5°; p <.001). CONCLUSION 3D spinal analysis demonstrates that 1AR and AL curves are distinctly different in all three planes. Although the treatment-based Lenke classification system combines these two curve patterns into one curve type, the 3D assessment suggests there are clear features that differentiate these curve patterns. The differing features of the nonstructural lumbar curves may help define the variance in fusion level selection and risk of adding-on for these two curve patterns. LEVEL OF EVIDENCE Level II, prognostic.
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Prediction of spinal curve progression in Adolescent Idiopathic Scoliosis using Random Forest regression. Comput Biol Med 2018; 103:34-43. [DOI: 10.1016/j.compbiomed.2018.09.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/28/2018] [Accepted: 09/30/2018] [Indexed: 11/20/2022]
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New sagittal classification of AIS: validation by 3D characterization. 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 2018; 28:551-558. [PMID: 30483962 DOI: 10.1007/s00586-018-5819-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND AIM In order to improve surgical planning of sagittal correction in AIS, we proposed a new sagittal classification-Abelin-Genevois et al. Eur Spine J (27(9):2192-2202, 2018. https://doi.org/10.1007/s00586-018-5613-1 ). The main criticism is related to the fact that 2D lateral view results from the projection of the 3D deformity. The aim of this study is to show that the new sagittal classification system is a reliable system to describe the different sagittal scenarios that AIS could create both in 2D and 3D. METHODS We performed retrospective radiograph analysis of prospectively collected data from 93 consecutive AIS patients who underwent an examination of the whole spine using the EOS® imaging system. 2D (Keops®) and 3D analyses (sterEOS®) provided frontal and sagittal spinal and spinopelvic parameters. In addition, 3D analysis provided apical vertebra rotation (AVR). RESULTS Comparing 2D and 3D measurements for the general cohort, excellent correlation can be found for all parameters, but only fairly good for T10L2 and L1S1 angles. The highest variability was observed for T10L2, differences between 2D and 3D measurements being greater when the Cobb angle increased. AVR did not influence concordance between 2D and 3D measurements. Eighty-two percent were similarly classified in 2D and 3D according to the new classification. Misclassified patients were all AIS sagittal type 3 in 3D analysis, thoracolumbar junction (TLJ) lordosis being underestimated on 2D view. DISCUSSION In conclusion, for the majority of cases (82%), 2D analysis may provide enough information for decision making when using a semi-automated 2D measurement system. However, in severe cases, especially when Cobb angle exceeds 55°, 3D analysis should be used to get a more accurate view on the thoracolumbar junction behavior. These slides can be retrieved under Electronic Supplementary Material.
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The Effectiveness of Full-body EOS Compared With Conventional Chest X-ray in Preoperative Evaluation of the Chest for Patients Undergoing Spine Operations: A Preliminary Study. Spine (Phila Pa 1976) 2018; 43:1502-1511. [PMID: 30113535 DOI: 10.1097/brs.0000000000002845] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective radiographic comparative study. OBJECTIVE The aim of this study was to compare full-body EOS with conventional chest X-ray (CXR) for use in the preoperative evaluation of the chest in patients undergoing spine operations. SUMMARY OF BACKGROUND DATA The full-body EOS reproduces an image of the chest similar to a routine CXR. The potential for the former replacing the latter is plausible. This is especially applicable in spine patients who would routinely have a preoperative full-body EOS performed. METHODS A radiographic comparative study of 266 patients was conducted at a single tertiary center from January 2013 to July 2016. Each patient had EOS and CXR done in random order <2 weeks apart. Two radiologists reported the image findings using a checklist. A third radiologist was consulted in cases of discrepancy. Interobserver agreement was calculated using Gwet AC1 and a comparison between EOS and CXR findings was analyzed using paired Chi-squared test. Multivariate analysis was performed to identify predictors for abnormal radiological findings. The institutional ethics committee approved this prospective study and waiver of informed consent was obtained. RESULTS There were 84 males (31.6%) and 182 females (68.4%). The mean age was 38.9 years (SD = 25.0 years). High interobserver agreement was found for EOS and CXR (Gwet AC1 0.993 and 0.988, respectively). There were no significant differences between both imaging modalities. Rare diagnoses precluded comparison of certain conditions. Age >18 years [odds ratio (OR) 7.69; P = 0.009] and American Society of Anesthesiologists physical status 3 (OR 6.64; P = 0.018) were independent predictors of abnormal radiological findings. CONCLUSION EOS is not inferior to, and may be used to replace CXR in preoperative radiological screening of thoracic conditions especially in low-risk patients ≤18 years old and patients with ASA <3. Preoperative assessment should never rely on a single modality. High-risk patients should be sent for a thorough work-up before spine surgery. LEVEL OF EVIDENCE 4.
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A reduced micro-dose protocol for 3D reconstruction of the spine in children with scoliosis: results of a phantom-based and clinically validated study using stereo-radiography. Eur Radiol 2018; 29:1874-1881. [DOI: 10.1007/s00330-018-5749-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/16/2018] [Accepted: 09/10/2018] [Indexed: 11/30/2022]
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Aubry S, Padoin P, Petegnief Y, Vidal C, Riethmuller D, Delabrousse E. Can three-dimensional pelvimetry using low-dose stereoradiography replace low-dose CT pelvimetry? Diagn Interv Imaging 2018; 99:569-576. [PMID: 29567122 DOI: 10.1016/j.diii.2018.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/31/2018] [Accepted: 02/20/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the reliability of pelvimetric measurements performed using stereoradiographic imaging (SRI), and to assess maternal and fetal radiation doses compared to low-dose computer tomography (CT) pelvimetry. MATERIALS AND METHODS Thirty-five pregnant women (mean age, 29.6±5.5 [SD] years; range: 20-41 years) were prospectively included. All women underwent simultaneous frontal and lateral low-dose SRI and low-dose CT examination of the pelvis. Pelvimetry measurements were obtained from both examinations and radiation doses obtained with the two techniques were compared. RESULTS SRI-CT correlation (Pearson coefficient correlation [r]; mean bias [mb]) was strong for transverse inlet diameter (r=0.92; mb=-0.09cm), anteroposterior diameter of the pelvic inlet (r=0.92; mb = 0.47cm), maximal transverse diameter (r=0.9; mb=0.21cm), sacrum length (r=0.9; mb=0.09cm). Correlation was good. Correlation was good for the sacrum depth (r=0.75; mb=0.06cm) and Magnin's index (r=0.7; mb=0.5cm). Correlation was moderate for anteroposterior diameter of pelvic outlet (r=0.6; mb=0.52cm). The fetal dose was 13.1 times lower using SRI (87±26μGy) than CT (1140±220μGy, P<0.0001). The effective maternal dose was 3.1 times lower using SRI (97±21μSv) than CT (310±60μSv; P<0.0001). CONCLUSION Pelvic inlet measurements using SRI are reliable. Compared to CT pelvimetry, SRI leads to a significant decrease in fetal and maternal radiation doses. These findings should prompt physicians to use SRI as the first-line approach for pelvimetry.
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Affiliation(s)
- S Aubry
- Department of Musculoskeletal Imaging, CHRU Besançon, 25000 Besançon, France; Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, 25000 Besançon, France.
| | - P Padoin
- Department of Musculoskeletal Imaging, CHRU Besançon, 25000 Besançon, France
| | - Y Petegnief
- Department of Nuclear Medicine, CHRU Besançon, 25000 Besançon, France
| | - C Vidal
- Clinical Investigation Center, Inserm CIT808, CHRU Besançon, 25000 Besançon, France
| | - D Riethmuller
- Department of Obstetrics and Gynecology, CHRU Besançon, 25000 Besançon, France
| | - E Delabrousse
- Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, 25000 Besançon, France; Department of Abdominal Imaging, CHRU Besançon, 25000 Besançon, France
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Aubin CÉ, Clin J, Rawlinson J. Biomechanical simulations of costo-vertebral and anterior vertebral body tethers for the fusionless treatment of pediatric scoliosis. J Orthop Res 2018; 36:254-264. [PMID: 28685857 DOI: 10.1002/jor.23648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 06/30/2017] [Indexed: 02/04/2023]
Abstract
Compression-based fusionless tethers are an alternative to conventional surgical treatments of pediatric scoliosis. Anterior approaches place an anterior (ANT) tether on the anterolateral convexity of the deformed spine to modify growth. Posterior, or costo-vertebral (CV), approaches have not been assessed for biomechanical and corrective effectiveness. The objective was to biomechanically assess CV and ANT tethers using six patient-specific, finite element models of adolescent scoliotic patients (11.9 ± 0.7 years, Cobb 34° ± 10°). A validated algorithm simulated the growth and Hueter-Volkmann growth modulation over a period of 2 years with the CV and ANT tethers at two initial tensions (100, 200 N). The models without tethering also simulated deformity progression with Cobb angle increasing from 34° to 56°, axial rotation 11° to 13°, and kyphosis 28° to 32° (mean values). With the CV tether, the Cobb angle was reduced to 27° and 20° for tensions of 100 and 200 N, respectively, kyphosis to 21° and 19°, and no change in axial rotation. With the ANT tether, Cobb was reduced to 32° and 9° for 100 and 200 N, respectively, kyphosis unchanged, and axial rotation to 3° and 0°. While the CV tether mildly corrected the coronal curve over a 2-year growth period, it had sagittal lordosing effect, particularly with increasing initial axial rotation (>15°). The ANT tether achieved coronal correction, maintained kyphosis, and reduced the axial rotation, but over-correction was simulated at higher initial tensions. This biomechanical study captured the differences between a CV and ANT tether and indicated the variability arising from the patient-specific characteristics. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:254-264, 2018.
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Affiliation(s)
- Carl-Éric Aubin
- Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079, Station Centre-Ville, Montréal, Québec, Canada H3C 3A7.,Sainte-Justine University Hospital Center, 3175 Côte-Ste-Catherine Rd., Montréal, Québec, Canada H3T 1C5
| | - Julien Clin
- Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079, Station Centre-Ville, Montréal, Québec, Canada H3C 3A7.,Sainte-Justine University Hospital Center, 3175 Côte-Ste-Catherine Rd., Montréal, Québec, Canada H3T 1C5
| | - Jeremy Rawlinson
- Medtronic, Spinal Applied Research, 1800 Pyramid Place, Memphis 38132, Tennessee
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Mainard-Simard L, Lan L, Fort D. [The advantages of 3D imagery in diagnosing and supervising children's and teenagers' scoliosis]. Arch Pediatr 2017; 24:1029-1035. [PMID: 28893487 DOI: 10.1016/j.arcped.2017.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 05/30/2017] [Accepted: 07/13/2017] [Indexed: 10/18/2022]
Abstract
Scoliosis is an abnormal curvature of the spine. One or several curves of more than 10 degrees in the frontal plane can be seen with the rotation of vertebrae in the axial plane, which modifies sagittal curves. In addition to esthetic harm, the morbidity of a scoliosis depends on the extent of the deformation. Treatment, whether it be orthopedic or surgical, is aggressive and never completely cures the condition. At best the deformation will be stabilized at the end of growth. Therefore, it is essential to detect any slight curve and quickly identify any potential progressive form in order to treat it. Visualization of scoliosis in 3D through spine modeling has several advantages at each stage of care. First, with slight curvatures, 3D modeling allows the medical staff to confirm the scoliosis by showing the modification in the three different planes. All curvatures will not progress. Orthopedic treatment is constraining and expensive; only progressive forms will receive it. When the curvature is slight and does not need immediate treatment, 3D modeling at each successive check-up will help detect any sign of likely progression quickly and reliably. Moreover, the medical observation of corset treatment and the preoperative work-up are improved because all 3D parameters of the deformation are accessible. The need for 3D modeling for scoliosis has been known for a long time, but no tool allowing a vertical study with a low level of radiation was available. The EOS imagery system meets these criteria through an optimal analysis of deformations caused by scoliosis.
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Affiliation(s)
- L Mainard-Simard
- Service de radiologie, hôpital d'enfants, allée du Morvan, 54511 Vandoeuvre-les-Nancy, France.
| | - L Lan
- Service de radiologie, hôpital d'enfants, allée du Morvan, 54511 Vandoeuvre-les-Nancy, France
| | - D Fort
- Médecine physique et réadaptation, 153, rue André-Bisiaux, 54320 Maxeville, France
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Cobetto N, Aubin CÉ, Parent S, Barchi S, Turgeon I, Labelle H. 3D correction of AIS in braces designed using CAD/CAM and FEM: a randomized controlled trial. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:24. [PMID: 28770254 PMCID: PMC5525241 DOI: 10.1186/s13013-017-0128-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 06/16/2017] [Indexed: 11/13/2022]
Abstract
Background Recent studies showed that finite element model (FEM) combined to CAD/CAM improves the design of braces for the conservative treatment of adolescent idiopathic scoliosis (AIS), using 2D measurements from in-brace radiographs. We aim to assess the immediate effectiveness on curve correction in all three planes of braces designed using CAD/CAM and numerical simulation compared to braces designed with CAD/CAM only. Methods SRS standardized criteria for bracing were followed to recruit 48 AIS patients who were randomized into two groups. For both groups, 3D reconstructions of the spine and patient’s torso, respectively built from bi-planar radiographs and surface topography, were obtained and braces were designed using the CAD/CAM approach. For the test group, 3D reconstructions of the spine and patient’s torso were additionally used to generate a personalized FEM to simulate and iteratively improve the brace design with the objective of curve correction maximization in three planes and brace material minimization. Results For the control group (CtrlBraces), average Cobb angle prior to bracing was 29° (thoracic, T) and 25° (lumbar, L) with the planes of maximal curvature (PMC) respectively oriented at 63° and 57° on average with respect to the sagittal plane. Average apical axial rotation prior to bracing was 7° (T) and 9° (L). For the test group (FEMBraces), initial Cobb angles were 33° (T) and 28° (L) with the PMC at 68° (T) and 56° (L) and average apical axial rotation prior to bracing at 9° (T and L). On average, FEMBraces were 50% thinner and had 20% less covering surface than CtrlBraces while reducing T and L curves by 47 and 48%, respectively, compared to 25 and 26% for CtrlBraces. FEMBraces corrected apical axial rotation by 46% compared to 30% for CtrlBraces. Conclusion The combination of numerical simulation and CAD/CAM approach allowed designing more efficient braces in all three planes, with the advantages of being lighter than standard CAD/CAM braces. Bracing in AIS may be improved in 3D by the use of this simulation platform. This study is ongoing to recruit more cases and to analyze the long-term effect of bracing. Trial registration ClinicalTrials.gov, NCT02285621
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Affiliation(s)
- Nikita Cobetto
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7 Canada
| | - Carl-Éric Aubin
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7 Canada
| | - Stefan Parent
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7 Canada
| | - Soraya Barchi
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7 Canada
| | - Isabelle Turgeon
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7 Canada
| | - Hubert Labelle
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7 Canada
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Abstract
STUDY DESIGN An actuarial "survivorship" analysis. OBJECTIVE The aim of this study was to define the incidence and cause of surgical revision 5 years after scoliosis surgery. SUMMARY OF BACKGROUND DATA Data on contemporary revision surgery rates after idiopathic scoliosis surgery beyond the 2 years postoperatively in the adolescent and young adult population are limited. METHODS Patients enrolled in a prospective, multicenter, idiopathic scoliosis surgical registry from 1995 to 2009 were reviewed. Any spine reoperation was defined as a "terminal event." An actuarial survivorship analysis that adjusts for patients lost to follow-up was performed to determine cumulative survival. Time intervals were defined as 0 to <3 months, 3 months to <1 year, 1 to <2 years, 2 to <5 years, and 5 to 10 years. Registry data and radiographs were reviewed and five categories for reoperation assigned: 1) implant failure and/or pseudarthrosis, 2) implant misplacement and/or prominence, 3) wound complication and/or infection, 4) residual deformity and/or progression, and 5) other. RESULTS One thousand four hundred thirty-five patients from 12 sites were included. The majority were female (80%), with major thoracic curves (76% Lenke 1-4), and average age of 15 ± 2 years (10-22) at surgery. Most had posterior spinal instrumentation and fusion (81%). At this time, 75 (5.2%) patients required reoperation. Twenty-two occurred within 3 months postop, 10 more before 1 year, 12 more before 2 years, another 20 by 5 years, and 10 more after 5 years. This corresponded to an actuarial cumulative survival of 98.3% at 3 months, 97.5% at 1 year, 96.6% at 2 years, 93.9% at 5 years, and 89.8% at the final interval (5-10 yrs). CONCLUSION Revisions for scoliosis continue to occur well after 2 years with a 5-year survivorship of 93.9%. Reasons for reoperation are not uniformly distributed over time, with implant-related issues and infection the leading cause for early revision, while late infection was the most common cause after 2 years. Long-term follow-up of these postoperative patients remains important. LEVEL OF EVIDENCE 3.
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Geometric Torsion in Adolescent Idiopathic Scoliosis: A New Method to Differentiate Between Lenke 1 Subtypes. Spine (Phila Pa 1976) 2017; 42:E532-E538. [PMID: 28441683 DOI: 10.1097/brs.0000000000001866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Consecutive case series. OBJECTIVE To study geometric torsion in thoracic adolescent idiopathic scoliosis (AIS) to propose it as a numerical three-dimensional (3D) parameter that quantifies the scoliosis deformity. SUMMARY OF BACKGROUND DATA AIS is a 3D deformity of the spine. The most widely accepted and used classification systems, however, still rely on two-dimensional aspects of x-rays. Yet, a 3D classification of AIS remains elusive because there is no widely accepted 3D parameter in the clinical practice. METHODS Analysis of 141 patients with Lenke type-1 deformity recruited in our institution. The Lenke classification was identified by two observers and 3D reconstructions were obtained using biplanar radiographs. Geometric torsion measuring the twisting effect of the spine was computed using a novel technique by approximating local arc lengths at the neutral vertebra in the thoracolumbar segment. An inter- and intragroup statistical analysis was performed to evaluate the torsion index, and how it relates to other 3D indices. RESULTS A statistically significant increase in torsion was observed between Lenke 1A (1.15 mm) and Lenke 1C (2.10 mm) subgroups. No differences were found between the Lenke 1B (1.75 mm) subgroup with either of the other two subgroups. An automatic classification based on torsion indices identified two groups: one with high torsion values (3.02 mm) and one with low torsion values (0.82 mm). Statistically significant differences were found between the main thoracic planes of maximum curvature (PMC) orientation of the high-torsion group (73.72°) and the low-torsion group (79.85°). Statistically significant differences were also found for the thoracolumbar/lumbar PMC orientation between the high-torsion group (56.41°) and the low-torsion group (49.25°). CONCLUSION These results suggest that a numerical method of describing scoliosis in 3D is within reach. They also suggest the existence of two subgroups of 3D deformations based on torsion values (high and low) with links to PMC orientation. LEVEL OF EVIDENCE 4.
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