Quantifying Typical Progression of Adolescent Idiopathic Scoliosis: Longitudinal Three-Dimensional MRI Measures of Disc and Vertebral Deformities.

Abstract

Prospective cohort study. Detail typical three-dimensional segmental deformities and their rates of change that occur within developing adolescent idiopathic scoliosis (AIS) spines over multiple timepoints. AIS is a potentially progressive deforming condition that occurs in three-dimensions of the scoliotic spine during periods of growth. However, there remains a gap for multiple time-point segmental deformity analysis in AIS cohorts during development. Thirty-six female patients with Lenke 1 AIS curves underwent two to six sequential MRIs. Scans were reformatted to produce images in orthogonal dimensions. Wedging angles and rotatory values were measured for segmental elements within the major curve. Two-tailed, paired t-tests compared morphological differences between sequential scans. Rates of change were calculated for variables given the actual time between successive scans. Pearson correlation coefficients were determined for multi-dimensional deformity measurements. Vertebral bodies (VBs) were typically coronally convexly wedged, locally lordotic, convexly axially rotated and demonstrated evidence of local mechanical torsion. Between first and final scans, apical measures of coronal wedging and axial rotation were all greater in both vertebral and intervertebral disc (IVD) morphology than non-apical regions (all reaching differences where P<0.05). No measures of sagittal deformity demonstrated a statistically significant change between scans. Cross-planar correlations were predominantly apparent between coronal and axial planes, with sagittal plane parameters rarely correlating across dimensions. Rates of segmental deformity changes between earlier scans were characterised by coronal plane convex wedging and convexly directed axial rotation. The major locally lordotic deformity changes which did occur in the sagittal plane were static between scans. This novel investigation documented a three-dimensional characterisation of segmental elements of the growing AIS spine and reported these changes across multiple timepoints. Segmental elements are typically deformed from initial presentation and subsequent changes occur in separate orthogonal planes at unique times.