Analysis of Vertebral Morphology in Idiopathic Scoliosis With Use of Magnetic Resonance Imaging and Multiplanar Reconstruction

Liljenqvist, Ulf; Allkemper, Thomas; Hackenberg, Lars; Link, Thomas M.; Steinbeck, Jörn; Halm, H.

doi:10.2106/00004623-200203000-00005

Cited by 184 publications

(137 citation statements)

References 36 publications

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“…Others [24] hypothesize a ''definite safe zone'' within 2 mm and ''probable safe zone'' within 2 and 4 mm, and a ''questionable safe zone'' of 4-8 mm of medial encroachment. Recently, however, Liljenqvist et al [32] showed with magnetic resonance imaging that the width of the epidural space was less than 1 mm at the thoracic apical level on the concave side. This means that there is no safety zone on the concavity and therefore screw placement, especially at this level should be very precise.…”

Section: Discussionmentioning

confidence: 99%

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

et al. 2008

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The treatment of thoracic adolescent idiopathic scoliosis (AIS) of more than 80°traditionally consisted of a combined procedure, an anterior release performed through an open thoracotomy followed by a posterior fusion. Recently, some studies have reassessed the role of posterior fusion only as treatment for severe thoracic AIS; the correction rate of the thoracic curves was comparable to most series of combined anterior and posterior surgery, with shorter surgery time and without the negative effect on pulmonary function of anterior transthoracic exposure. Compared with other studies published so far on the use of posterior fusion alone for severe thoracic AIS, the present study examines a larger group of patients (52 cases) reviewed at a longer follow-up (average 6.7 years, range 4.5-8.5 years). The aim of the study was to evaluate the clinical and radiographic outcome of surgical treatment for severe thoracic ([80°) AIS treated with posterior spinal fusion alone, and compare comprehensively the results of posterior fusion with a hybrid construct (proximal hooks and distal pedicle screws) versus a pedicle screw instrumentation. All patients (n = 52) with main thoracic AIS curves greater than 80°(Lenke type 1, 2, 3, and 4), surgically treated between 1996 and 2000 at one institution, by posterior spinal fusion either with hybrid instrumentation (PSF-H group; n = 27 patients), or with pedicle screw-only construct (PSF-S group; n = 25 patients) were reviewed. There were no differences between the two groups in terms of age, Risser's sign, Cobb preoperative main thoracic (MT) curve magnitude (PSF-H: 92°vs. PSF-S: 88°), or flexibility on bending films (PSF-H: 27% vs. PSF-S: 25%). Statistical analysis was performed using the t test (paired and unpaired), Wilcoxon test for nonparametric paired analysis, and the Mann-Whitney test for non-parametric unpaired analysis. At the last follow-up, the PSF-S group, when compared to the PSF-H group had a final MT correction rate of 52.4 versus 44.52% (P = 0.001), with a loss of -1.9°versus -11.3°( P = 0.0005), a TL/L correction of 50 versus 43% (ns), a greater correction of the lowest instrumented vertebra translation (-1.00 vs. -0.54 cm; P = 0.04), and tilt (-19°vs. -10°; P = 0.005) on the coronal plane. There were no statistically significant differences in sagittal and global coronal alignment between the two groups (C7-S1 offset: PSF-H = 0.5 cm vs. PSF-S = 0 cm). In the hybrid series (27 patients) surgery-related complications necessitated three revision surgeries, whereas in the screw group (25 patients) one revision surgery was performed. No neurological complications or deep wound infection occurred in this series. In conclusion, posterior spinal fusion for severe thoracic AIS with pedicle screws only, when compared to hybrid construct, allowed a greater coronal correction of both main thoracic and secondary lumbar curves, less loss of the postoperative correction achieved, and fewer revision surgeries. Posterior-only fusion with pedicle screws enabled a good and...

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Section: Discussionmentioning

confidence: 99%

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

et al. 2008

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“…This "safe zone" of 4 mm was demonstrated on CT myelogram to be composed of a 2-mm epidural space and a 2-mm subarachnoid space. For scoliotic spines, Liljenqvist et al [14] demonstrated a shift of the dural sac towards the concavity, with the epidural space measuring less than 1 mm on the concave side of the thoracic apex and between 3 mm and 5 mm on the convex side of the curve. Recently, Papin et al [16] reported a case of spinal cord compression in a scoliotic patient due to pedicle screws at T8 and T10 that were medially misplaced by exactly 4 mm.…”

Section: Discussionmentioning

confidence: 99%

“…The risk of pedicle wall perforation is thus theoretically reduced for both normal and deformed spines if the TDG is correctly engaged. However, insertion of pedicle screws in the scoliotic spine should be performed with extreme caution, especially in the concave side of the curve where the pedicles are distorted and the epidural space is reduced [14,17]. For these difficult cases, we recommend the use of adequate preoperative and/or intraoperative imaging in combination with the TDG.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a transpedicular drill guide for pedicle screw placement in the thoracic spine

Mac-Thiong

Rooze²,

Feipel³

et al. 2003

European Spine Journal

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“…Low-dose spine CT with at least 20-fold reduction of the radiation doses has recently been introduced as a reliable method in the perioperative work-up of scoliosis [12]. Numerous reports on the pedicle morphometry in normal individuals as well as in cadavers and in patients with AIS have been published [13][14][15][16][17][18][19][20]. Many of these studies have pointed out a significant reduction of pedicle width at the concavity of the curve.…”

Section: Introductionmentioning

confidence: 99%

“…Reports in normal population often include individuals of different age groups that make them unsuitable for comparison with patients with AIS [14,15]. Liljenqvist et al [17,18] were among the first who presented data on pedicle morphometry based on patients data using CT and MRI17, 18, but their assessments were focused only on the morphological changes at the level of scoliotic apex. Upendra et al [19] has recently published a report on pedicle morphometry of the whole spine in patients with scoliosis of King curve type II, III and IV.…”

Section: Introductionmentioning

confidence: 99%

Patients with adolescent idiopathic scoliosis of Lenke type-1 curve exhibit specific pedicle width pattern

Abul-Kasim

Ohlin

2011

Eur Spine J

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Introduction Study aim was to find out if patients with Lenke type 1 curve exhibit smaller pedicles and specific pedicle width pattern compared with individuals with no scoliosis. Materials and methods 4,828 pedicle width measurements (T1-L5) in 61 consecutive patients with adolescent idiopathic scoliosis of Lenke type 1 curve, 61 control subjects, and 20 patients with Lenke type 5 curve, were retrospectively performed by an experienced neuroradiologist. Results Among patients with Lenke type 1 curve, the differences between the width of right and left upper thoracic pedicles were statistically significant; smallest at right T4 (2.6 mm). At scoliotic apex, the pedicles on the concave (left) side were significantly smaller than those on the convex (right) side; smallest at left T7 (3.2 mm). Among patients with Lenke type 1 curve, 97% had pedicle width \4 mm. Conclusions Our study showed that patients with Lenke type 1 curve exhibit smaller pedicles and asymmetric pedicle width compared with control subjects.

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Analysis of Vertebral Morphology in Idiopathic Scoliosis With Use of Magnetic Resonance Imaging and Multiplanar Reconstruction

Cited by 184 publications

References 36 publications

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

Evaluation of a transpedicular drill guide for pedicle screw placement in the thoracic spine

Patients with adolescent idiopathic scoliosis of Lenke type-1 curve exhibit specific pedicle width pattern

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