Three-dimensional imaging of the spine using the EOS system

Al-Aubaidi, Zaid; Lebel, David E; Oudjhane, Kamaldine; Zeller, Reinhard

doi:10.1097/bpb.0b013e328361ae5b

Cited by 57 publications

(29 citation statements)

References 18 publications

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“…Therefore, it is important to define where these techniques overlap, in order to reduce costs and radiation exposure. Previous studies have already described the differences in morphology of the spine in AIS between different imaging methods and between different body positions [ 20 – 26 ]. This study is, however, to the best of our knowledge, the first to look into the relationship between the three different positions in all three planes of the body to visualize the scoliotic spine.…”

Section: Discussionmentioning

confidence: 99%

Upright, prone, and supine spinal morphology and alignment in adolescent idiopathic scoliosis

et al. 2017

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BackgroundPatients with adolescent idiopathic scoliosis (AIS) are usually investigated by serial imaging studies during the course of treatment, some imaging involves ionizing radiation, and the radiation doses are cumulative. Few studies have addressed the correlation of spinal deformity captured by these different imaging modalities, for which patient positioning are different. To the best of our knowledge, this is the first study to compare the coronal, axial, and sagittal morphology of the scoliotic spine in three different body positions (upright, prone, and supine) and between three different imaging modalities (X-ray, CT, and MRI).MethodsSixty-two AIS patients scheduled for scoliosis surgery, and having undergone standard pre-operative work-up, were included. This work-up included upright full-spine radiographs, supine bending radiographs, supine MRI, and prone CT as is the routine in one of our institutions. In all three positions, Cobb angles, thoracic kyphosis (TK), lumbar lordosis (LL), and vertebral rotation were determined. The relationship among three positions (upright X-ray, prone CT, and supine MRI) was investigated according to the Bland-Altman test, whereas the correlation was described by the intraclass correlation coefficient (ICC).ResultsThoracic and lumbar Cobb angles correlated significantly between conventional radiographs (68° ± 15° and 44° ± 17°), prone CT (54° ± 15° and 33° ± 15°), and supine MRI (57° ± 14° and 35° ± 16°; ICC ≥0.96; P < 0.001). The thoracic and lumbar apical vertebral rotation showed a good correlation among three positions (upright, 22° ± 12° and 11° ± 13°; prone, 20° ± 9° and 8° ± 11°; supine, 16° ± 11° and 6° ± 14°; ICC ≥0.82; P < 0.001). The TK and LL correlated well among three different positions (TK 26° ± 11°, 22° ± 12°, and 17° ± 10°; P ≤ 0.004; LL 49° ± 12°, 45° ± 11°, and 44° ± 12°; P < 0.006; ICC 0.87 and 0.85).ConclusionsAlthough there is a generalized underestimation of morphological parameters of the scoliotic deformity in the supine and prone positions as compared to the upright position, a significant correlation of these parameters is still evident among different body positions by different imaging modalities. Findings of this study suggest that severity of scoliotic deformity in AIS patients can be largely represented by different imaging modalities despite the difference in body positioning.

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Section: Discussionmentioning

confidence: 99%

Upright, prone, and supine spinal morphology and alignment in adolescent idiopathic scoliosis

et al. 2017

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“…EOS ® 3D reconstruction vs CT scan Al-Aubaidi et al compared measurements of apical vertebral orientation (AVO) between EOS ® 3D reconstructions and CT-scan 3D reconstructions in seven patients with scoliosis [ 18 ]. There was no statistically significant difference in intra- or interobserver reliability for the measurement of AVO between EOS ® and 3D CT-scan, and both yielded similar measurements.…”

Section: Spinementioning

confidence: 99%

EOS^® biplanar X-ray imaging: Concept, developments, benefits, and limitations

Melhem

Assi

Rachkidi

et al. 2016

Journal of Children's Orthopaedics

216

136

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PurposeIn 1992, Georges Charpak invented a new type of X-ray detector, which in turn led to the development of the EOS® 2D/3D imaging system. This system takes simultaneous anteroposterior and lateral 2D images of the whole body and can be utilized to perform 3D reconstruction based on statistical models. The purpose of this review is to present the state of the art for this EOS® imaging technique, to report recent developments and advances in the technique, and to stress its benefits while also noting its limitations.MethodsThe review was based on a thorough literature search on the subject as well as personal experience gained from many years of using the EOS® system.ResultsWhile EOS® imaging could be proposed for many applications, it is most useful in relation to scoliosis and sagittal balance, due to its ability to take simultaneous orthogonal images while the patient is standing, to perform 3D reconstruction, and to determine various relationships among adjacent segments (cervical spine, pelvis, and lower limbs). The technique has also been validated for the study of pelvic and lower-limb deformity and pathology in adult and pediatric populations; in such a study it has the advantage of allowing the measurement of torsional deformity, which classically requires a CT scan.ConclusionsThe major advantages of EOS® are the relatively low dose of radiation (50–80 % less than conventional X-rays) that the patient receives and the possibility of obtaining a 3D reconstruction of the bones. However, this 3D reconstruction is not created automatically; a well-trained operator is required to generate it. The EOS® imaging technique has proven itself to be a very useful research and diagnostic tool.

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“…While the radiation dose is a concern for patients who require repeated imaging and appears to be a clear advantage offered by EOS over the standard radiographic technology, it is difficult to quantify the reductions in the radiation dose with this system in terms of patient health benefits [ 40 ]. While the accuracy of the 3D reconstruction obtained with EOS is equivalent to that obtained with two-dimensional (2D) radiography images and computed tomography scans [ 41 - 43 ], the extraction of information is considerably more difficult from 3D images than from 2D images. Furthermore, manual measurement in 3D images requires navigation through a 3D image, which may be time consuming and difficult to interpret.…”

Section: Possible Reasons For the Failure Of The Current Sagittal Defmentioning

confidence: 99%

Spinal Deformity Surgery: A Critical Review of Alignment and Balance

2018

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Correction of the overall coronal and/or sagittal plane deformities is one of the main predictors of successful spinal surgery. In routine clinical practice, spinal alignment is assessed using several spinal and pelvic parameters, such as pelvic incidence and tilt, sacral slope, lumbar lordosis, thoracic kyphosis, and sagittal vertical axis. Standard values have been defined for all these parameters, and the formulas of correction have been set for determining the surgical strategy. However, several factors can potentially bias these formulas. First, all standard values are measured using conventional plain radiographs and are, therefore, prone to bias. The radiologist, measuring surgeon, and patient are possible confounding influencing factors. Second, spino-pelvic compensatory effects and biomechanically relevant structures for the patient’s posture, including ligaments, tendons, and muscles, have received minimal consideration in the literature. Therefore, even in cases of appropriately planned deformity correction surgeries, complications, revision rates, and surgical outcomes significantly vary. This study aimed to illustrate the current clinical weaknesses of the assessment of spinal alignment and the importance of holistically approaching the musculoskeletal system for any spinal deformity surgery. We believe that our detailed insights regarding spinal, sagittal, and coronal alignments as well as the considerations of an individual’s spinal balance will contribute toward improvement in routine patient care.

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Three-dimensional imaging of the spine using the EOS system

Cited by 57 publications

References 18 publications

Upright, prone, and supine spinal morphology and alignment in adolescent idiopathic scoliosis

Upright, prone, and supine spinal morphology and alignment in adolescent idiopathic scoliosis

EOS^® biplanar X-ray imaging: Concept, developments, benefits, and limitations

Spinal Deformity Surgery: A Critical Review of Alignment and Balance

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Three-dimensional imaging of the spine using the EOS system

Cited by 57 publications

References 18 publications

Upright, prone, and supine spinal morphology and alignment in adolescent idiopathic scoliosis

Upright, prone, and supine spinal morphology and alignment in adolescent idiopathic scoliosis

EOS® biplanar X-ray imaging: Concept, developments, benefits, and limitations

Spinal Deformity Surgery: A Critical Review of Alignment and Balance

Contact Info

Product

Resources

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EOS^® biplanar X-ray imaging: Concept, developments, benefits, and limitations