Abstract
Purpose: To report radiologic outcomes in the horizontal plane after scoliosis correction with high-density pedicle screw constructs through a sterEOS®-3D analysis. Methods: We conducted a retrospective monocentric study on scoliotic patients who underwent a surgical correction with high-density constructs. SterEOS®-3D reconstructions were modelled from pre and postoperative EOS® acquisitions. Amplitude of surgical correction and residual deformity were analysed for rotational parameters (vertebrae vectors coordinates, apical vertebral rotation (AVR), intervertebral rotations, Torsion Index) and transversal offset parameters (Spread of Coronal Offsets (SCO), mean of coronal offsets (CO), T9 and L3 to Gravity Line (GL) CO, T9/L3 Transverse Gravitational Deviation Index (TGDI), T9/L3 TGDI θ categories). Results: 80 sterEOS®3D reconstructions were analysed. Paired t-test comparisons between pre and postoperative values showed a significant reduction for Cobb angles (p<0.0001) and AVR (p = 0.0024) but not for TI (p = 0.69). 51% of the curves with a preoperative AVR > 10° were corrected at a segmental level with an average de-rotation amplitude of 19.3° +/- 8° and 56% at a global level with an average de-torsion index of 54% +/- 30%. Correction of SCO was effective for 95% of patients with a mean amplitude of 30mm +/- 10mm and was associated with a significant reduction in T9 and L3 to GL CO (34mm ± 24mm and 7.6mm +/-10mm respectively). Conclusion: Horizontal corrections achieved with high-density constructs in scoliosis surgery are more significant on translation than rotation at a segmental and global level.
Highlights
The EOS® imaging system is commonly used in clinical practice to evaluate the characteristics of scoliosis, and to follow up patients after surgery while limiting the exposure to radiation [1]
Our study investigated the amplitude of correction achieved in the horizontal plane with high-density pedicle screw constructs in spine deformity surgery, using the sterEOS®3D software to measure rotation and translation indexes in standing position before and after surgery
We found that the transverse correction was systematic and efficient for offsets but varied sharply between cases for rotations
Summary
The EOS® imaging system is commonly used in clinical practice to evaluate the characteristics of scoliosis, and to follow up patients after surgery while limiting the exposure to radiation [1]. The sterEOS® Spine software (EOS imaging, Paris, France) allows the 3D modelling of the entire spinopelvic complex in a standing position, giving access to an exhaustive list of angular measurements that have been shown to be accurate and reliable [2,3,4,5]. The increasing diversity of techniques in spine deformity surgery, supported by various options in terms of correction manoeuvres and hardware selection, brings further uncertainty as to what morphologic outcome is really achieved in the horizontal plane This typically applies to high-density pedicle screw constructs which are believed to allow for good control of detorsion in addition to sagittal balance restoration through multiple vertebral anchorage points, despite the lack of strong published evidence regarding their specific effect. To the best of our knowledge, this study is the first to describe and quantify the amplitudes of segmental and global horizontal correction obtained with high-density pedicle screw constructs in scoliotic patients
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