Breakthrough in three-dimensional scoliosis diagnosis: significance of horizontal plane view and vertebra vectors

Illés, Tamás; Tunyogi-Csapó, Miklós; Somoskeőy, Szabolcs

doi:10.1007/s00586-010-1566-8

Cited by 103 publications

(58 citation statements)

References 21 publications

(24 reference statements)

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“…Trunk height gain was estimated by comparing the postoperative and preoperative projections of the center of T1 on the CHVA (z coordinate). The distances between the projection of the center of each vertebra on the different axis and the CHVA were also calculated, and used if necessary to represent vertebral vectors as described by Illes et al [23].…”

Section: D Parametersmentioning

confidence: 99%

Adolescent idiopathic scoliosis treated with posteromedial translation: radiologic evaluation with a 3D low-dose system

et al. 2013

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Purpose Computed tomography can be used for threedimensional (3D) evaluation of adolescent idiopathic scoliosis (AIS) patients, but at the expense of high radiation exposure, and with the limitation of being performed in the supine position. These drawbacks can now be avoided with low-dose stereoradiography, even in routine clinical use. The purpose of this study was to determine the 3D postoperative correction of AIS patients treated by posteromedial translation. Methods Forty-nine consecutive patients operated for AIS (Lenke 1-4) using posteromedial translation were included. Corrections were evaluated preoperatively, postoperatively and after at least 2 years using the EOS imaging system. 3D angles were measured in the plane of maximum deformity. Results Mean number of levels fused and operative time were 13.5 ± 1 and 215 ± 25 min, respectively. Main thoracic, proximal thoracic, and lumbar curves corrections averaged 64.4 ± 18, 31 ± 10 and 69 ± 20 %, respectively. Mean T4-T12 kyphosis increased 18.8°± 9°in the subgroup of hypokyphotic patients. Mean apical vertebral rotation reduction was 48.3 ± 20 %. Trunk height gain averaged 27.8 ± 14 mm. There was no pseudarthrosis or significant loss of correction in any plane during follow-up. Two patients (4 %) developed asymptomatic proximal junctional kyphosis, despite having normal thoracic kyphosis. Their sagittal balance was shifted posteriorly by 36 and 47 mm, respectively, by the operation, but revision surgery was not performed. Conclusions Low-dose stereoradiography provided 3D reconstructions of the fused and unfused spine in routine clinical use. Postoperative 3D analysis showed that posteromedial translation enhanced sagittal balance correction, without sacrificing frontal or axial correction of the deformity.

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Section: D Parametersmentioning

confidence: 99%

Adolescent idiopathic scoliosis treated with posteromedial translation: radiologic evaluation with a 3D low-dose system

et al. 2013

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“…The detailed definition of a vertebra vector and the description of methods for creation of a patient-specific individually calibrated 3D coordinate system, recording vector coordinates and calculation of 3D vector parameters as well as frontal, sagittal and horizontal plane spinal curvature data were published earlier [27].…”

Section: Years (Sd = ±022)mentioning

confidence: 99%

“…To help understanding top view images, to simplify the complex visualization and to create a possibility for mathematical quantification, replacement of vertebrae with vectors furnishing all vertebral features (size, position, orientation and rotation) was proposed recently [27].…”

Section: Introductionmentioning

confidence: 99%

Comparison of scoliosis measurements based on three-dimensional vertebra vectors and conventional two-dimensional measurements: advantages in evaluation of prognosis and surgical results

Illés

Somoskeőy

2013

Eur Spine J

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Purpose A new concept of vertebra vectors based on spinal three-dimensional (3D) reconstructions of images from the EOS system, a new low-dose X-ray imaging device, was recently proposed to facilitate interpretation of EOS 3D data, especially with regard to horizontal plane images. This retrospective study was aimed at the evaluation of the spinal layout visualized by EOS 3D and vertebra vectors before and after surgical correction, the comparison of scoliotic spine measurement values based on 3D vertebra vectors with measurements using conventional twodimensional (2D) methods, and an evaluation of horizontal plane vector parameters for their relationship with the magnitude of scoliotic deformity. Methods 95 patients with adolescent idiopathic scoliosis operated according to the Cotrel-Dubousset principle were subjected to EOS X-ray examinations pre-and postoperatively, followed by 3D reconstructions and generation of vertebra vectors in a calibrated coordinate system to calculate vector coordinates and parameters, as published earlier. Conclusions Vertebra vectors provide a key opportunity to visualize spinal deformities in all three planes simultaneously. Measurement methods based on vertebral vectors proved to be just as accurate and reliable as conventional measurement methods for coronal and sagittal plane parameters. In addition, the horizontal plane display of the curves can be studied using the same vertebra vectors. Based on the vertebra vectors data, during the surgical treatment of spinal deformities, the diminution of the lateral translation of the vertebras seems to be more important in the results of the surgical correction than the correction of the axial rotation.

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“…Use of synthetic antifibrinolytic drugs (tranexamic and epsilon-aminocapronic acid) may reduce the perioperative blood transfusion requirement [48,49]. Pre-and postoperative 3D low dose whole body radiographic imaging (e.g., sterEOS) enhances the biomechanical understanding and supports preoperative planning [50,51]. Intraoperative use of navigation to place pedicle screws steepens the learning curve and aids instrumenting in difficult anatomic situations [22,[52][53][54].…”

Section: Additional Improvements Over Timementioning

confidence: 99%

A brief overview of 100 years of history of surgical treatment for adolescent idiopathic scoliosis

Hasler

2013

Journal of Children's Orthopaedics

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The history of surgical correction for adolescent idiopathic scoliosis reaches back about 100 years: the natural course of progressive, crippling and sometimes even lifethreatening deformities which could not be controlled by external means called for effectual, invasive procedures. Hibbs 1911 aimed at halting progression by long, uninstrumented fusions. However, the lack of true correction, long rehabilitation times, high pseudarthrosis and infection rates, and a fusion mass which bent further once exposed to gravity again were not satisfying. The transition from slowing progression to halting progression and truly correcting the deformity lasted almost another half a century: Paul Harrington, confronted with many scoliotic polio patients, successfully introduced a hook-rod system for concavedistraction and convex-compression at the end of the 1950s. Many implant failures, a still-considerable pseudarthrosis rate, flattening of the sagittal profile and the lack of true threedimensional (3D) correction were the shortcomings. In the 1970s the Frenchmen Cotrel and Dubousset took scoliosis surgery to the next level by introducing a versatile hook system and curve-pattern-adapted correction modes. The basics of the so-called derotation-manoeuvre consists in strategic distribution of the anchors along the curve, bending the rod accordingly, and rotating it back into the sagittal plane. The overall correction, stability and the fusion rates improved significantly. However, the effect on the sagittal and transverse plane were still limited. Lately, a better biomechanical understanding and bilateral, polysegmental strong three-column fixation with pedicle screw has become the benchmark method: in conjunction with posterior release techniques, osteotomies or even vertebral column resections for severe cases, it allows better 3D control (vertebral column manipulation), faster rehabilitation and better patient satisfaction.

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Breakthrough in three-dimensional scoliosis diagnosis: significance of horizontal plane view and vertebra vectors

Cited by 103 publications

References 21 publications

Adolescent idiopathic scoliosis treated with posteromedial translation: radiologic evaluation with a 3D low-dose system

Adolescent idiopathic scoliosis treated with posteromedial translation: radiologic evaluation with a 3D low-dose system

Comparison of scoliosis measurements based on three-dimensional vertebra vectors and conventional two-dimensional measurements: advantages in evaluation of prognosis and surgical results

A brief overview of 100 years of history of surgical treatment for adolescent idiopathic scoliosis

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