Variation in Sagittal Alignment Parameters in Adult Patients before Spine Surgery: A Serial Imaging Study Using Antero-Posterior and Latero-Lateral Projections.

Hunjong Lim,Yusuhn Kang,Dong Kun Lee ,Bo Ram Kim ,Eugene Lee ,Joong-Mo Ahn

doi:10.3390/diagnostics11112141

Hunjong Lim, Yusuhn Kang + Show 4 more

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https://doi.org/10.3390/diagnostics11112141

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Abstract

Sagittal parameters of the spine are closely related to the evaluation and treatment of spine disease. However, there has been little research on variations in preoperative sagittal spinal alignment. This study was conducted to assess the variation in sagittal spinal alignment on serial antero-posterior and latero-lateral projections (EOS imaging) in adult patients before spine surgery. The sagittal parameters of 66 patients were collected from two serial images. Comparison between the first and second sagittal parameters was evaluated using the Wilcoxon signed-rank test. Subgroup analysis was performed based on the time interval between radiographs, patient’s age, and type of surgery. The sagittal vertical axis (SVA) exhibited statistically significant changes (p = 0.023), with the mean SVA increasing statistically (61.7 mm vs. 73.6 mm) and standard deviation increasing (51.5 mm vs. 61.6 mm) in the second image. Subgroup analysis showed significant differences in SVA (p = 0.034) in patients with an interval of >3 months; statistical differences in borderline levels in the SVA (p = 0.049) were observed in patients aged >65 years. Other parameters did not show statistically significant differences, except for SVA. Furthermore, SVA differences were statistically significant with increases in the EOS interval (>3 months) and patient age (>65 years).

Highlights

Regarding spine surgery, evaluating spinal alignment before surgery is routinely performed because there are reports of a significant relationship between sagittal alignment and postoperative patient-reported outcome scores [1,2,3]
Long-level deformity correction surgery was performed in 18 patients with spinal curvature/alignment disorder, whereas others underwent decompression with or without fusion depending on the lesion, at one level or multiple levels
For sagittal curvature evaluation, wholespine standing lateral radiography is widely performed based on its easy usability and simplicity, showing good intra-observer reliability and a good-to-excellent inter-rater reproducibility [20]

Summary

Introduction

Regarding spine surgery, evaluating spinal alignment before surgery is routinely performed because there are reports of a significant relationship between sagittal alignment and postoperative patient-reported outcome scores [1,2,3]. The EOS® slot scanner (EOS imaging, Paris, France) is a proprietary imaging technique based on ultrasensitive X-ray detection technology, which was launched in 2007 This imaging modality depicts the patient’s natural, weightbearing posture by taking frontal and lateral images of the patient’s body with a very low radiation dose (50–80% less than conventional X-rays) and high image quality [5]. EOS images do not cause distortions between the center and edges of the radiograph, because linear X-ray sources and detector arrays move together [6] This full-body EOS enables evaluation of the global alignment of the spine, pelvis, and lower limbs, which is important in diagnosing spinal deformity and surgical outcomes [7,8,9,10,11]. EOS images are increasingly becoming routine before spine surgery [12]

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