Three-dimensional True Spine Length: A Novel Technique for Assessing the Outcomes of Scoliosis Surgery

Spurway, Alan J.; Hurry, Jennifer; Gauthier, Luke; Orlik, Ben; Chukwunyerenwa, Chukwudi; Kishta, Waleed; El-Hawary, Ron

doi:10.1097/bpo.0000000000001031

Cited by 16 publications

(7 citation statements)

References 17 publications

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“…For future studies, we recommend considering the 3-dimensional measurement of true spine length that takes into account both the arc of curvature in the sagittal plane as well as the arc of curvature in the coronal plane. 10 In conclusion, at a minimum of 5-year follow-up, distraction-based surgeries increased spine length for patients with nonidiopathic EOS regardless of proximal anchor type; however, spine-based patients had higher preoperative spine length compared with rib-based patients and maintained that difference until the 15th lengthening. Once the gains in spine height were normalized to the preoperative spine height, the rib-based group achieved a more relative increase in spine height over time.…”

Section: Discussionmentioning

confidence: 73%

The Effect of Proximal Anchor Choice During Distraction-based Surgeries for Patients With Nonidiopathic Early-onset Scoliosis: A Retrospective Multicenter Study

ElBromboly

Hurry

Padhye

et al. 2021

Journal of Pediatric Orthopaedics

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Background: It is unclear whether the type of proximal anchor affects the spine length achieved with distraction-based surgeries in patients with nonidiopathic early-onset scoliosis (EOS). Since distraction may produce kyphosis, spine length should be assessed in the sagittal plane using the sagittal spine length (SSLcurved arc length of the spine in the sagittal plane). Our purpose was to determine if the type of proximal anchor in distractionbased surgeries will affect final spine length. Methods: Patients with nonidiopathic EOS treated with distraction-based systems (minimum 5 y follow-up, 5 lengthenings) were identified from 2 EOS registries. Radiographic analysis preoperative, postimplant (L1), and after each lengthening (L2-L5, L6-L10, L11-L15) was performed with the primary outcome of T1-S1 SSL. Results: We identified 126 patients-70 had rib-based implants (52 congenital, 9 syndromic, 9 neuromuscular) and 56 had spine-based implants (15 congenital, 29 syndromic, 12 neuromuscular) with preoperative age 4.6 years, scoliosis 75 degrees, and kyphosis 48 degrees. After initial correction (P < 0.05), scoliosis remained constant [58 degrees (13 to 104 degrees) at L11-L15] and kyphosis increased over time [38 degrees (9 to 108 degrees) at L1 to 60 degrees (17 to 134 degrees) at L11-L15] (P < 0.05). Preoperative SSL was higher in the spine-based group (29.6 cm) when compared with the rib-based group (25.2 cm) (P < 0.05). This difference was maintained after initial implantation (spine-based: 32.2 cm vs. rib-based: 26.7 cm, P < 0.05) and at final follow-up (spine-based: 37.0 cm vs. rib-based: 34.4 cm, P < 0.05). As preoperative SSL differed between groups, maximum SSL gains per interval were also normalized to preoperative SSL. There was no statistically significant difference between groups at L1, L2-L5, and L6-L10. However, at L11-L15, the rib-based group achieved a more relative increase in spine length compared with the spine-based group (45% vs. 31%, P < 0.05). Conclusion: At minimum 5 year follow-up, distraction-based surgeries increased spine length for patients with nonidiopathic EOS; regardless of proximal anchor type.

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Section: Discussionmentioning

confidence: 73%

The Effect of Proximal Anchor Choice During Distraction-based Surgeries for Patients With Nonidiopathic Early-onset Scoliosis: A Retrospective Multicenter Study

ElBromboly

Hurry

Padhye

et al. 2021

Journal of Pediatric Orthopaedics

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“…Modern technologies in diagnostics, such as the EOS system, together with work in the field of 3D spinal morphology may provide us with the ultimate classification to improve our results in taking care of AIS patients (86)(87)(88)(89)(90)(91). Valuable input is also coming from authors studying early-onset scoliosis, as Spurway et al presented their new method of measuring the true length of a spine affected by scoliosis, so we can better rate the all-important spinal growth during treatment and follow-up (92).…”

Section: Discussionmentioning

confidence: 99%

Frontal and sagittal imbalance in patients with adolescent idiopathic deformity

Kubat

Ovadia

2020

Ann Transl Med

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The human spinal column underwent many significant changes over the 4.5 million years of our ancestral bipedalism. The main change, however, came with acquiring multiple curvatures in the sagittal plane. This alteration seems to have exposed a weakness in our body's keystone and made us susceptible to thus far unbeknown problems of the spine because it has been noted that idiopathic scoliosis has not been observed in other primates. Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine causing an imbalance of the trunk as it increases in magnitude. A scoliotic curve comprises three components, the coronal, sagittal, and axial so that each curve can affect the global balance of the body differently. Patients with significant scoliotic deformities often find themselves at a biomechanical disadvantage when it comes to energy expenditure and keeping an upright stance. The pioneers of scoliosis research recognized the need for describing and quantifying deformity to better understand it, so they first translated clinical measurements to radiographs and built from there. The development of concepts like defining a curve by its end vertebrae and measuring its magnitude, assessing global spinal balance, describing the stable zone, and pinpointing the stable vertebra all followed suit. The importance of sagittal balance and restoring sagittal parameters during treatment was emphasized. In a quest to bring order to chaos, some tried to classify various scoliotic curve types. These classifications helped steer treatment decisions but were found lacking in many aspects. So far, a widely accepted three-dimensional classification of scoliosis still does not exist. This review aims to provide the reader with an overview of the development of balance and imbalance concepts in scoliosis.

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“…In typical children, normal kyphosis is reported at 20–40 degrees. In this study, we only measured spine height, not spine length 23,24 . The benefit of increased kyphosis over 40 degrees (i.e., increased spine length and not height) on pulmonary function and health-related quality of life measures has not been established in the literature; however, it remains possible that total spine length may prove a more important predictor of improved pulmonary function than height alone.…”

Section: Discussionmentioning

confidence: 99%

Spine Deformity With Fused Ribs Treated With Proximal Rib- Versus Spine-Based Growing Constructs

et al. 2019

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Study Design Retrospective review of prospectively collected data Objective To compare the use of spine-based vs. rib-based implants for the treatment of early onset scoliosis (EOS) in the setting of rib fusions. Summary of Background Data Treatment for severe early-onset spinal deformity with rib fusions includes growing spine devices with proximal rib or spine anchors. The results of treatment, however, have not been compared between spine-based vs. rib-based proximal anchors. Methods 169 patients with rib fusions treated with rib-based or spine-based constructs and minimum 2-year follow-up were included. 16 patients were treated with proximal spine-based anchors and 153 with proximal rib-based devices (VEPTRs). 104 of the patients with rib-based fixation underwent thoracoplasty at the index surgery. We evaluated change in T1-T12 and T1-S1 height, coronal Cobb angle, kyphosis and number of lengthening/revision surgeries. Results Kyphosis increased a mean of 7 degrees in the rib-based group and decreased a mean of 20 degrees in the spine-based group (p=0.002). Major Cobb angle decreased in both groups (p<0.0001); however, the spine-based group had greater Cobb angle improvement (24 vs. 11 degrees, p=0.04). From implant and lengthening of distraction devices, there was a mean 3.3 cm (22%) increase in T1-T12 height and a mean of 8.0 lengthenings in the rib-based group compared to a 5.7 cm increase and 6.3 lengthening surgeries in the spine-based group. Patients with rib-based constructs had a mean of 11 total procedures, whereas spine-based patients had a mean of 8. Conclusions Patients underwent a mean of 8 lengthening surgeries prior to final fusion or cessation of lengthening with a modest 2.3 cm increase in T1-T12 height. Compared to proximal rib anchors, proximal spine anchors controlled kyphosis and improved Cobb angle correction for early onset scoliosis with rib fusions.

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Three-dimensional True Spine Length: A Novel Technique for Assessing the Outcomes of Scoliosis Surgery

Abstract: Level II-diagnostic study-development of a diagnostic criteria on basis of consecutive patients, with gold standard.

Cited by 16 publications

References 17 publications

The Effect of Proximal Anchor Choice During Distraction-based Surgeries for Patients With Nonidiopathic Early-onset Scoliosis: A Retrospective Multicenter Study

The Effect of Proximal Anchor Choice During Distraction-based Surgeries for Patients With Nonidiopathic Early-onset Scoliosis: A Retrospective Multicenter Study

Frontal and sagittal imbalance in patients with adolescent idiopathic deformity

Spine Deformity With Fused Ribs Treated With Proximal Rib- Versus Spine-Based Growing Constructs

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