Dataset Information

Three-Dimensional Computed Tomography Analysis of Spinal Canal Length Increase After Surgery for Adolescent Idiopathic Scoliosis: A Multicenter Study.

ABSTRACT:

Background

The most severe complication after surgery for adolescent idiopathic scoliosis is spinal cord injury. There is a relationship between corrective surgery and subsequent elongation of the spinal canal. We sought to investigate which factors are involved in this phenomenon.

Methods

Seventy-seven patients with adolescent idiopathic scoliosis (49 with Lenke type 1 and 28 with type 2) who underwent spinal correction surgery were included. The mean patient age at surgery was 14.2 years (range, 11 to 20 years). The spines of all patients were fused within the range of T2 to L2, and computed tomography (CT) data were retrospectively collected. We measured the preoperative and postoperative lengths of the spinal canal from T2 to L2 using 3-dimensional (3D) CT-based imaging software. We also examined the association between the change in T2-L2 spinal canal length and the radiographic parameters.

Results

The length of the spinal canal from T2 to L2 was increased by a mean of 8.5 mm in the patients with Lenke type 1, 12.7 mm in those with type 2, and 10.1 mm overall. Elongation was positively associated with the preoperative main thoracic Cobb angle in both the type-1 group (R = 0.43, p < 0.005) and the type-2 group (R = 0.77, p < 0.000001). The greatest elongation was observed in the periapical vertebral levels of the main thoracic curves.

Conclusions

Corrective surgery for adolescent idiopathic scoliosis elongated the spinal canal. The preoperative proximal, main thoracic, and thoracolumbar/lumbar Cobb angles are moderate predictors of postoperative spinal canal length after scoliosis surgery.

Clinical relevance

It is important to understand how much the spinal canal is elongated after surgery to lessen the risk of intraoperative and postoperative neurological complications.

SUBMITTER: Yahara Y

PROVIDER: S-EPMC6319593 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Three-Dimensional Computed Tomography Analysis of Spinal Canal Length Increase After Surgery for Adolescent Idiopathic Scoliosis: A Multicenter Study.

Yahara Yasuhito Y Seki Shoji S Makino Hiroto H Watanabe Kei K Uehara Masashi M Takahashi Jun J Kimura Tomoatsu T

The Journal of bone and joint surgery. American volume 20190101 1

<h4>Background</h4>The most severe complication after surgery for adolescent idiopathic scoliosis is spinal cord injury. There is a relationship between corrective surgery and subsequent elongation of the spinal canal. We sought to investigate which factors are involved in this phenomenon.<h4>Methods</h4>Seventy-seven patients with adolescent idiopathic scoliosis (49 with Lenke type 1 and 28 with type 2) who underwent spinal correction surgery were included. The mean patient age at surgery was 1 ...[more]

PMID: 30601415

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Project description:BackgroundScoliotic braces are the standard of curve for management of moderate spinal deformities in pediatric patients. The effectiveness of this treatment method has been shown; however, the spinal and rib cage parameters, in the three anatomical planes, that are associated with bracing outcome in adolescent idiopathic scoliosis (AIS) are not fully identified.MethodsA total number of 45 right thoracic AIS patients who had received a thoraco-lumbo-scaral brace for the first time were included retrospectively. For each patient, radiographic images at three visits, pre-brace, in-brace, and at least 1 year after the first brace fit were included. Age, sex, Risser sign, and curve type at pre-brace, and thoracic and lumbar frontal and sagittal Cobb angles, thoracic and lumbar apical rotations, sagittal and frontal balances at pre-brace and in-brace were determined. Two sagittal curve types (hypothoracolumbar and normal/hyperthoracolumbar kyphosis), two rib cage types based on the costovertebral joints (drooping and horizontal), and two axial shapes of the spine (S shaped and V shaped) were used to stratify the patients. Feature selection and linear regression with regularization determined the parameters and the interaction terms that predicted the brace effectiveness significantly.ResultsSmaller in-brace thoracic Cobb and larger in-brace lordosis predicted brace effectiveness, p < 0.05. Impact of the out of brace lordosis on the brace success increased as the in brace kyphosis angle decreased, p = 0.046. A larger out of brace lordosis in hypothoracolumbar sagittal profile type patients improved the outcomes, p = 0.031. A smaller out of brace thoracic rotation improved the bracing outcomes in patients with horizontal ribs, p = 0.040.ConclusionBoth 3D patient specific parameters (lordosis, thoracic rotation, shape of the rib cage, and sagittal profile) and brace design (which allows larger in brace lordosis, better in brace Cobb correction) are important predictors of the brace effectiveness in AIS.

Project description:This study aimed to identify the differentiating parameters of the spinal curves' 2D projections through a hierarchical classification of the 3D spinal curve in adolescent idiopathic scoliosis (AIS). A total number of 103 right thoracic left lumbar pre-operative AIS patients were included retrospectively and consecutively. A total number of 20 non-scoliotic adolescents were included as the control group. All patients had biplanar X-rays and 3D reconstructions of the spine. The 3D spinal curve was calculated by interpolating the center of vertebrae and was isotropically normalized. A hierarchical classification of the normalized spinal curves was developed to group the patients based on the similarity of their 3D spinal curve. The spinal curves' 2D projections and clinical spinal measurements in the three anatomical planes were then statistically compared between these groups and between the scoliotic subtypes and the non-scoliotic controls. A total of 5 patient groups of right thoracic left lumbar AIS patients were identified. The characteristics of the posterior-anterior and sagittal views of the spines were: Type 1: Normal sagittal profile and S shape axial view. T1 is leveled or tilted to the right in the posterior view. Type 2: Hypokyphotic and a V shape axial view. T1 is tilted to the left in the posterior view. Type 3: Hypokyphotic (only T5-T10) and frontal imbalance, S shape axial view. T1 is leveled or tilted to the right, and 3 frontal curves. Type 4: Flat sagittal profile (T1-L2), slight frontal imbalance with a V shape axial view, T1 tilted to the left. Type 5: flat sagittal profile and forward trunk shift with a proximal kyphosis and S shape axial view. T1 is leveled or tilted to the right. In conclusion, a hierarchical classification of the 3D scoliotic spine allowed identifying various distinguishing features of the spinal curves in patients with a right thoracic curve in an orderly fashion. The subtypes' characteristics resulting from this 3D classification can be identified from the pairs of the frontal and sagittal spinal curves i.e. X-rays in right thoracic AIS patients.

Dataset Information

Three-Dimensional Computed Tomography Analysis of Spinal Canal Length Increase After Surgery for Adolescent Idiopathic Scoliosis: A Multicenter Study.

Background

Methods

Results

Conclusions

Clinical relevance

Publications

Three-Dimensional Computed Tomography Analysis of Spinal Canal Length Increase After Surgery for Adolescent Idiopathic Scoliosis: A Multicenter Study.

Similar Datasets

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