In vivo deformation of the spine canal before and after surgical corrections of severe and rigid kyphoscoliosis

Han, Chaofan; Hai, Yong; Yin, Peng; Cha, Thomas; Li, Guoan

doi:10.1016/j.jot.2020.03.009

Cited by 5 publications

(5 citation statements)

References 31 publications

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“…Previously, we have investigated 3D geometries of the human spinal canal by reconstruction of the 3D spinal canal volume 19,20 . Using this technique, we investigated the SCL changes of a group of scoliotic patients before and after corrective surgeries and the relationship between the SCL changes and clinical outcomes after the surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Previously, we have investigated 3D geometries of the human spinal canal by reconstruction of the 3D spinal canal volume. 19 , 20 Using this technique, we investigated the SCL changes of a group of scoliotic patients before and after corrective surgeries and the relationship between the SCL changes and clinical outcomes after the surgery. It was hypothesized that the spinal canal of idiopathic scoliosis experiences inhomogeneous deformation in 3D space after the corrective surgeries and the SCL changes are correlated to the clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Investigation of in vivo three‐dimensional changes of the spinal canal after corrective surgeries of the idiopathic scoliosis

et al. 2021

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Objective To determine the three‐dimensional (3D) changes of the spinal canal length (SCL) after corrective surgeries and their association with the radiographic and clinical outcomes of idiopathic scoliosis patients. The length of the spinal cord has been demonstrated to be strongly correlated with the SCL. Understanding the changes in SCL could help determine the morphologic changes in the spinal cord to prevent spinal cord injury. Methods Twenty‐seven scoliotic patients' 3D spinal canal were investigated using computed tomography images. The SCL between the upper and lower end vertebrae (U/L‐EV) was measured at five locations. The radiographic parameters of each patient and the patient‐reported outcomes (PROs) scores were also collected. The correlations of the changes of the SCLs with the other factors were analyzed. Results The SCL between the U/L‐EV changed non‐uniformly at different locations. The post‐operative SCLs were significantly elongated by 7.5 ± 3.5 mm (6.0 ± 2.5%, P < .001) at the concave side and compressed by −2.6 ± 2.6 mm (−1.9 ± 1.9%, P < .001) at the convex side. The elongations of the SCL at the concave and posterior locations were correlated with the radiographic parameters including the pre‐operative main Cobb angles (r = .511, P = .006; r = .613, P = .001) and apical vertebral translation (AVT) (r = .481, P = .011; r = .684, P = .000). No PRO scores were found to correlate with the SCL changes. Conclusion The corrective surgeries elongated the spinal canal mainly at the concave side and compressed at the convex side. The main thoracic Cobb angle, the changes of AVT, and Cobb angles were moderately associated with the changes of the SCLs, but no PRO score was found to associate with the changes of the SCLs. The data could be instrumental for the improvement of corrective surgeries that are aimed to maximize the correction of scoliosis and minimize the negative effect on the spinal cord to prevent neurological complications.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Investigation of in vivo three‐dimensional changes of the spinal canal after corrective surgeries of the idiopathic scoliosis

et al. 2021

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“…Pulmonary function is substantially impaired in patients with extremely severe scoliosis, and correction is usually possible after major spinal release or osteotomy 28,29 . However, patients with severe restrictive pulmonary dysfunction have a higher rate of postoperative pulmonary complications 7 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Pulmonary Function After Halo-Pelvic Traction for Severe and Rigid Kyphoscoliosis Utilizing CT with 3D Reconstruction

Zhou,

Zhang,

Yang

et al. 2023

Journal of Bone and Joint Surgery

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Background: The purpose of the present study was to evaluate changes in pulmonary function, caused by preoperative halo-pelvic traction (HPT) for the treatment of extremely severe and rigid kyphoscoliosis, with use of 3-dimensional computed tomography (3D-CT) reconstruction and pulmonary function tests (PFTs). Methods: Twenty-eight patients with severe and rigid scoliosis (Cobb angle, >100°) underwent preoperative HPT and staged posterior spinal fusion. CT, radiographic assessment, and PFT were performed during pre-traction and post-traction visits. The changes in total lung volume were evaluated with use of 3D-CT reconstruction, and the changes in pulmonary function were evaluated with PFTs at each time point. Differences were analyzed with use of 2-tailed paired Student t tests, and correlations were analyzed with use of Spearman rank tests. Results: None of the patients had pulmonary complications during traction, and all radiographic spinal measurements improved significantly after HPT. The main Cobb angle was corrected from 143.30° ± 20.85° to 62.97° ± 10.83° between the pre-traction and post-traction evaluations. Additionally, the C7-S1 distance was lengthened from 280.48 ± 39.99 to 421.26 ± 32.08 mm between the pre-traction and post-traction evaluations. Furthermore, 3D lung reconstruction demonstrated a notable increase in total lung volume (TLV) (from 1.30 ± 0.25 to 1.83 ± 0.37 L) and maximum lung height (from 176.96 ± 27.44 to 202.31 ± 32.45 mm) between the pre-traction and post-traction evaluations. Moreover, PFTs showed that total lung capacity (TLC) improved between the pre-traction and post-traction evaluations (from 2.06 ± 0.32 to 2.98 ± 0.82 L) and that the changes in T1-T12 distance and maximum lung height were correlated with changes in TLV (p = 0.0288 and p = 0.0007, respectively). Conclusions: The application of HPT is a safe and effective method for improving pulmonary function in patients with extremely severe and rigid scoliosis before fusion surgery. The TLV as measured with CT-based reconstruction was greatly increased after HPT, mainly because of the changes in thoracic height. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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“…[27][28][29] Vertebral column resection typically permits as much as 45 to 60°of curve correction usually at the apex of the major curve. [30][31][32] Even though VCR-based technique acknowledges maximum correction amongst the osteotomy phenotypes, it is associated with a higher incidence of complications including neurological deterioration. [33][34][35] There are non-VCR-based techniques for achieving satisfactory corrective and patient outcomes in severe rigid spinal deformity, including posterior column osteotomies (PCOs), also known as such as Smith-Petersen osteotomy (SPO) and Ponte osteotomy (PO), or pedicle subtraction osteotomy (PSO), bone-disc-bone osteotomy (BDBO), anterior release, internal distraction, among others.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Overall Complication Rates in VCR-Based vs Non-VCR-Based Corrective Techniques in Severe Rigid Kyphoscoliosis Patients: A Systematic Review and Meta-Analysis

Halm-Lutterodt

Saidi

Mandalia

et al. 2022

Global Spine Journal

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Study Design Systematic review and meta-analysis. Objective Compilation of complication outcomes data from the surgical management of severe rigid kyphoscoliosis patients using VCR-based vs non-VCR-based corrective maneuvers is lacking. This meta-analysis aimed to compare complication outcomes between those classified osteotomy approaches. Methods Thorough literature review and meta-analysis were conducted between January 2000 and September 2021. The selection criteria were studies: i) reporting major curve Cobb angle of ≥80° and flexibility of <25% or 30%; ii) comparing VCR or ≥ Type V Schwab osteotomy defined as VCR-based vs [non-VCR-based] techniques, (any osteotomy or technique other than VCR); iii) published in English with ≥10 patients; iv) reporting complication rates; and v) having minimum of 2-year follow-up. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Significance level was set at ( P < .05). Results Of the 174 patients included, 52.30% (n = 91) and 47.70% (n = 83) were VCR-based and non-VCR-based, respectively. The incidence of dural tears/nerve injuries/significant intraoperative-neuromonitoring changes was significantly higher; [OR = 6.78, CI= (1.75 to 26.17), I2 = 0%, ( P = .006)] in the VCR-based group than the non-VCR-based group. The ‘overall surgical and medical’ complication rate was significantly higher in the VCR-based group, [OR = 1.94, CI= (1.02 to 3.67), I2 = 31%, ( P = .04)]. Conclusion Both VCR-based and non-VCR-based surgical techniques for management of severe rigid scoliosis and kyphoscoliosis patients pose comparable overall surgical complication rates, while a significantly higher perioperative neurological complication incidence was associated with VCR-based technique compared to the non-VCR-based techniques. The VCR-based technique was associated with 6.78 times higher incidence of neurological complications compared to non-VCR-based techniques.

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In vivo deformation of the spine canal before and after surgical corrections of severe and rigid kyphoscoliosis

Cited by 5 publications

References 31 publications

Investigation of in vivo three‐dimensional changes of the spinal canal after corrective surgeries of the idiopathic scoliosis

Investigation of in vivo three‐dimensional changes of the spinal canal after corrective surgeries of the idiopathic scoliosis

Evaluation of Pulmonary Function After Halo-Pelvic Traction for Severe and Rigid Kyphoscoliosis Utilizing CT with 3D Reconstruction

Comparison of Overall Complication Rates in VCR-Based vs Non-VCR-Based Corrective Techniques in Severe Rigid Kyphoscoliosis Patients: A Systematic Review and Meta-Analysis

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