Do Intraoperative Radiographs in Scoliosis Surgery Reflect Radiographic Result?

Abstract

It is often difficult to predict postoperative radiographic curve magnitude and balance parameters while performing intraoperative correction during scoliosis surgery. We asked whether there was a radiographic correlation between intraoperative long-cassette scoliosis film and postoperative standing radiographs of adolescent idiopathic scoliosis with pedicle screw instrumentation. We retrospectively reviewed 44 patients with adolescent idiopathic scoliosis who underwent posterior instrumentation with pedicle screws. We made preoperative, intraoperative (after instrumentation and correction), and standing postoperative radiographic measurements (eg, curve magnitudes, coronal and sagittal balance, disc angles) and compared those for the intra-and postoperative radiographs. The intraoperative long-cassette scoliosis film correlated with the immediate postoperative standing film for all curve correction and balance parameters. The routine use of a long-cassette intraoperative scoliosis film provides the surgeon with a valuable tool to guide intraoperative decision-making and foreshadows the correction and balance obtained on the immediate postoperative film.

Comparison of intraoperative supine and postoperative standing radiographs after posterior instrumentation for adolescent idiopathic scoliosis

“…Similar to previous researchers [12] we found a strong correlation for proximal thoracic, main thoracic, and thoracolumbar/lumbar curves (r = 0.73, 0.83, and 0.84, respectively; P < 0.05) between the IO and IPO radiographs. The strong correlation persisted when the IO radiographs were compared with the standing radiographs done several months later (r = 0.77, 0.72, and 0.88, respectively; P < 0.05).…”

“…Recently, Lehman et al [12] reported on 44 patients with AIS from two different centers who underwent posterior spinal fusion with pedicle screw instrumentation and compared coronal plane alignment based on IO-prone radiograph with those measured on a standing full-length radiograph done in the early postoperative period. Their overall findings were quite similar to ours, as they suggested that IO radiography is a valuable tool that foreshadows the coronal plane correction noted on standing radiographs performed in the early postoperative period.…”

“…Thus, based on surgeons' preference and technique of pedicle screw placement, either IO radiographic technique may be appropriate. Second, the IO radiograph was only compared with the standing full-length radiograph done in the early postoperative period within a week of surgery in the former study [12], whereas we compared the findings of the IO radiographs with the postoperative images in the initial and later postoperative period, separated by an average of 17 months. We found that the Cobb measurements noted intraoperatively were clinically similar to the findings noted not only in the early postoperative but at a later time point as well.…”

“…However, there is paucity of literature comparing the measurement of postinstrumentation residual scoliosis using IO radiographs with those obtained in the postoperative period using fulllength standing radiographs of the spine. To our knowledge, there has been only one study to date that has attempted to correlate prone IO radiograph with a standing radiograph that was performed in the early postoperative period after surgical correction of scoliosis in 44 patients at two different centers with different radiographic imaging systems [12]. However, there was neither subgroup analysis based on type or extent of instrumentation, nor was there any correlation of IO radiographs with standing radiographs performed beyond the first week postoperatively.…”

Data-driven Classification of the 3D Spinal Curve in Adolescent Idiopathic Scoliosis with an Applications in Surgical Outcome Prediction

“…For a more heterogeneous cohort, Fuzzy clustering offers solution by assigning membership grades and further developing a probabilistic path for determining the outcome groups 57 . Despite the significant relationship between the intraoperative radiographs and the surgical outcome of AIS spinal fusion 58 , a study that associates the imparted intraoperative changes in the spine and the early post-operative alignment in a larger database can better guide surgical decision making.…”