Adolescent idiopathic scoliosis treated with posteromedial translation: radiologic evaluation with a 3D low-dose system
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ORIGINAL ARTICLE
Adolescent idiopathic scoliosis treated with posteromedial translation: radiologic evaluation with a 3D low-dose system Brice Ilharreborde • Guy Sebag Wafa Skalli • Keyvan Mazda
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Received: 17 August 2012 / Revised: 4 January 2013 / Accepted: 1 April 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose Computed tomography can be used for threedimensional (3D) evaluation of adolescent idiopathic scoliosis (AIS) patients, but at the expense of high radiation exposure, and with the limitation of being performed in the supine position. These drawbacks can now be avoided with low-dose stereoradiography, even in routine clinical use. The purpose of this study was to determine the 3D postoperative correction of AIS patients treated by posteromedial translation. Methods Forty-nine consecutive patients operated for AIS (Lenke 1–4) using posteromedial translation were included. Corrections were evaluated preoperatively, postoperatively and after at least 2 years using the EOS imaging system. 3D angles were measured in the plane of maximum deformity. Results Mean number of levels fused and operative time were 13.5 ± 1 and 215 ± 25 min, respectively. Main thoracic, proximal thoracic, and lumbar curves corrections averaged 64.4 ± 18, 31 ± 10 and 69 ± 20 %, respectively. Mean T4–T12 kyphosis increased 18.8° ± 9° in the subgroup of hypokyphotic patients. Mean apical vertebral rotation reduction was 48.3 ± 20 %. Trunk height gain B. Ilharreborde (&) K. Mazda Pediatric Orthopaedic Department, Robert Debre´ Hospital, AP-HP, Paris Diderot University, 48 Bd Se´rurier, 75019 Paris, France e-mail: [email protected] B. Ilharreborde W. Skalli Laboratory of Biomechanics, Arts et Me´tiers ParisTech, Paris, France G. Sebag Pediatric Radiology Department, Robert Debre´ Hospital, AP-HP, Paris Diderot University, Paris, France
averaged 27.8 ± 14 mm. There was no pseudarthrosis or significant loss of correction in any plane during follow-up. Two patients (4 %) developed asymptomatic proximal junctional kyphosis, despite having normal thoracic kyphosis. Their sagittal balance was shifted posteriorly by 36 and 47 mm, respectively, by the operation, but revision surgery was not performed. Conclusions Low-dose stereoradiography provided 3D reconstructions of the fused and unfused spine in routine clinical use. Postoperative 3D analysis showed that posteromedial translation enhanced sagittal balance correction, without sacrificing frontal or axial correction of the deformity. Keywords Adolescent idiopathic scoliosis Hybrid constructs Three-dimensional Universal clamp Posteromedial translation
Introduction Correcting the spine in the frontal plane while achieving or maintaining physiological sagittal curves is now one of the most challenging goals in adolescent idiopathic scoliosis (AIS) surgery [1–4]. As emphasized by Imrie et al. [5], the development and application of powerful pedicle screw instrumentation constructs has sometimes led to great coronal correction, but at the expense of sagittal alignmen
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