Discovering the association between the pre- and post-operative 3D spinal curve patterns in adolescent idiopathic scoliosis

Pasha, Saba; Shah, Suken A.; Yaszay, Burt; Newton, Peter O.

doi:10.1007/s43390-020-00276-1

Cited by 4 publications

(21 citation statements)

References 34 publications

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“…This method used the 3D reconstruction of the biplanar radiographs to extracted 3D information regarding the vertebral position and orientation. 18,20 These clusters include four right thoracic types, three left thoracolumbar/lumbar types, one low apex right thoracic/thoracolumbar type, and one left thoracic type (Figure 1). The preoperative radiographic measurements and the distributions of the preoperative 3D clusters in each of the Lenke classes were described before.…”

Section: Preoperative Factorsmentioning

confidence: 99%

“…The preoperative radiographic measurements and the distributions of the preoperative 3D clusters in each of the Lenke classes were described before. 18 A total of 64 patient-specific variables (42 continuous and 22 categorical) were used as preoperative patient-specific factors.…”

Section: Preoperative Factorsmentioning

confidence: 99%

“…Similar to the preoperative classification of the 3D spinal alignment, the 3D position and alignment of the T1-L5 vertebrae at 2-year follow-up were used to determine the postoperative clusters. 18 A total of three 3D postoperative spinal alignment groups were determined (Figure 2). These clusters were characterized subtypes with residual proximal curve (Type 1), hypokyphotic subtypes (Type 2), and subtype with residual lumbar curve and thoracic and lumbar rotation (Type 3).…”

Section: Surgical Outcomes At 2-year Follow-upmentioning

confidence: 99%

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Machine Learning Predicts the 3D Outcomes of Adolescent Idiopathic Scoliosis Surgery Using Patient–Surgeon Specific Parameters

Pasha

Shah

Newton

2020

Spine

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The aim of this study was to predict the threedimensional (3D) radiographic outcomes of the spinal surgery in a cohort of adolescent idiopathic scoliosis (AIS) as a function preoperative spinal parameters and surgeon modifiable factors. Summary of Background Data. Current guidelines for posterior spinal fusion surgery (PSF) in AIS patients are based on twodimensional classification of the spinal curves. Despite the high success rate, the prediction of the 3D spinal alignment at the follow-ups remains inconclusive. A data-driven surgical decision-making method that determines the combination of the surgical procedures and preoperative patient specific parameters that leads to a specific 3D global spinal alignment outcomes at the follow-ups can lessen the burden of surgical planning and improve patient satisfaction by setting expectations prior to surgery. Methods. A dataset of 371 AIS patients who underwent a PSF with two-year follow-up were included. Demographics, 2D radiographic spinal and pelvic measurements, clinical measurements of the trunk shape, and the surgical procedures were collected prospectively. A previously developed classification of the preoperative global 3D spinal alignment was used as an additional predictor. The 3D spinal alignment (vertebral posi-tions and rotations) at two-year follow-up was used as the predicted outcome. An ensemble learner was used to predict the 3D spinal alignment at two-year follow-up as a function of the preoperative parameters with and without considering the surgeon modifiable factors. Results. The preoperative and surgical factors predicted three clusters of 3D surgical outcomes with an accuracy of 75%. The prediction accuracy decreased to 64% when only preoperative factors, without the surgical factors, were used in the model. Predictor importance analysis determined that preoperative distal junctional kyphosis, pelvic sagittal parameters, end-instrumented vertebra (EIV) angulation and translation, and the preoperative 3D clusters are the most important patient-specific predictors of the outcomes. Three surgical factors, upper and lower instrumented vertebrae, and the operating surgeon, were important surgical predictors. The role of surgeon in achieving a certain outcome clusters for specific ranges of preoperative T10-L2 kyphosis, EIV angulation and translation, thoracic and lumbar flexibilities, and patient's height was significant. Conclusion. Both preoperative patient-specific and surgeon modifiable parameters predicted the 3D global spinal alignment at two-year post PSF. Surgeon was determined as a predictor of the outcomes despite including 20 factors in the analysis that described the surgical moves. Methods to quantify the differences between the implemented surgeon modifiable factors are essential to improve outcome prediction in AIS spinal surgery.

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Section: Preoperative Factorsmentioning

confidence: 99%

Section: Preoperative Factorsmentioning

confidence: 99%

Section: Surgical Outcomes At 2-year Follow-upmentioning

confidence: 99%

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Machine Learning Predicts the 3D Outcomes of Adolescent Idiopathic Scoliosis Surgery Using Patient–Surgeon Specific Parameters

Pasha

Shah

Newton

2020

Spine

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“…In the light of these drawbacks, other methods to measure the aforementioned shapes have been developed, for the lumbar lordosis [7,35] , for thoracic kyphosis [15] , for cervical lordosis [27] , and for scoliosis [19,28,29] . Some of these methods are readily available as smartphone applications [32,39] .…”

Section: Introductionmentioning

confidence: 99%

“…The spine as a whole is a 3D object and might show variations of interest in multiple planes, particularly in the case of scoliosis. To face this challenge, some virtually two-and-a-half-dimensional assessment methods have been developed, like searching for the plane of maximum curvature [25,41] or axial projections of the spinal column [28] . A fully 3D analysis of spinal shapes has, to our knowledge, not been developed as of yet.…”

Section: Introductionmentioning

confidence: 99%

Augmenting the Cobb angle: Three-dimensional analysis of whole spine shapes using Bézier curves

Rockenfeller

Müller

2022

Computer Methods and Programs in Biomedicine

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Patient and surgical predictors of 3D correction in posterior spinal fusion: a systematic review

Wan

Wong

et al. 2023

Eur Spine J

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Background Restoration of three-dimensional (3D) alignment is critical in correcting patients with adolescent idiopathic scoliosis using posterior spinal fusion (PSF). However, current studies mostly rely on 2D radiographs, resulting in inaccurate assessment of surgical correction and underlying predictive factors. While 3D reconstruction of biplanar radiographs is a reliable and accurate tool for quantifying spinal deformity, no study has reviewed the current literature on its use in evaluating surgical prognosis. Purpose To summarize the current evidence on patient and surgical factors affecting sagittal alignment and curve correction after PSF based on 3D parameters derived from reconstruction of biplanar radiographs. Methods A comprehensive search was conducted by three independent investigators on Medline, PubMed, Web of Science, and Cochrane Library to obtain all published information on predictors of postoperative alignment and correction after PSF. Search items included "adolescent idiopathic scoliosis," "stereoradiography," "three-dimensional," "surgical,” and "correction." The inclusion and exclusion criteria were carefully defined to include clinical studies. Risk of bias was assessed with the Quality in Prognostic Studies tool, and level of evidence for each predictor was rated with the Grading of Recommendations, Assessment, Development, and Evaluations approach. 989 publications were identified, with 444 unique articles subjected to full-text screening. Ultimately, 41 articles were included. Results Strong predictors of better curve correction included preoperative normokyphosis (TK > 15°), a corresponding rod contour, intraoperative vertebral rotation and translation, and upper and lower instrumented vertebrae selected based on sagittal and axial inflection points. For example, for Lenke 1 patients with junctional vertebrae above L1, fusion to NV-1 (1 level above the neutral vertebra) achieved optimal curve correction while preserving motion segments. Pre-op coronal Cobb angle and axial rotation, distal junctional kyphosis, pelvic incidence, sacral slope, and type of instrument were identified as predictors with moderate evidence. For Lenke 1C patients, > 50% LIV rotation was found to increase spontaneous lumbar curve correction. Pre-op thoracolumbar apical translation and lumbar lordosis, Ponte osteotomies, and rod material were found to be predictors with low evidence. Conclusions Rod contouring and UIV/LIV selection should be based on preoperative 3D TK in order to achieve normal postoperative alignment. Specifically, Lenke 1 patients with high-lying rotations should be fused distally at NV-1, while hypokyphotic patients with large lumbar curves and truncal shift should be fused at NV to improve lumbar alignment. Lenke 1C curves should be corrected using > 50% LIV rotation counterclockwise to the lumbar rotation. Further investigation should compare surgical correction between pedicle-screw and hybrid constructs using matched cohorts. DJK and overbending rods are potential predictors of postoperative alignment.

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Discovering the association between the pre- and post-operative 3D spinal curve patterns in adolescent idiopathic scoliosis

Cited by 4 publications

References 34 publications

Machine Learning Predicts the 3D Outcomes of Adolescent Idiopathic Scoliosis Surgery Using Patient–Surgeon Specific Parameters

Machine Learning Predicts the 3D Outcomes of Adolescent Idiopathic Scoliosis Surgery Using Patient–Surgeon Specific Parameters

Augmenting the Cobb angle: Three-dimensional analysis of whole spine shapes using Bézier curves

Patient and surgical predictors of 3D correction in posterior spinal fusion: a systematic review

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