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Do Intraoperative Radiographs in Scoliosis Surgery Reflect Radiographic Result?

  • Symposium: Pediatric Spine
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

It is often difficult to predict postoperative radiographic curve magnitude and balance parameters while performing intraoperative correction during scoliosis surgery. We asked whether there was a radiographic correlation between intraoperative long-cassette scoliosis film and postoperative standing radiographs of adolescent idiopathic scoliosis with pedicle screw instrumentation. We retrospectively reviewed 44 patients with adolescent idiopathic scoliosis who underwent posterior instrumentation with pedicle screws. We made preoperative, intraoperative (after instrumentation and correction), and standing postoperative radiographic measurements (eg, curve magnitudes, coronal and sagittal balance, disc angles) and compared those for the intra- and postoperative radiographs. The intraoperative long-cassette scoliosis film correlated with the immediate postoperative standing film for all curve correction and balance parameters. The routine use of a long-cassette intraoperative scoliosis film provides the surgeon with a valuable tool to guide intraoperative decision-making and foreshadows the correction and balance obtained on the immediate postoperative film.

Level of Evidence: Level IV, retrospective study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Acikbas SC, Tuncer MR. New method for intraoperative determination of proper screw insertion or screw malposition. J Neurosurg. 2000;93:40–44.

    CAS  PubMed  Google Scholar 

  2. Belmont PJ Jr, Klemme WR, Dhawan A, Polly DW Jr. In vivo accuracy of thoracic pedicle screws. Spine. 2001;26:2340–2346.

    Article  PubMed  Google Scholar 

  3. D’Andrea LP, Betz RR, Lenke LG, Clements DH, Lowe TG, Merola A, Haher T, Harms J, Huss GK, Blanke K, McGlothlen S. Do radiographic parameters correlate with clinical outcomes in adolescent idiopathic scoliosis? Spine. 2000;25:1795–1802.

    Article  PubMed  Google Scholar 

  4. Jamieson D, Perdios A, Varghese R, Reilly CW. The use of CT in the development and implementation of a preoperative protocol to aid in pedicle screw placement during scoliosis surgery. Pediatr Radiol. 2008;38:452–456.

    Article  PubMed  Google Scholar 

  5. Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD. Free hand pedicle screw placement in the thoracic spine: is it safe? Spine. 2004;29:333–342.

    Article  PubMed  Google Scholar 

  6. Kim YJ, Lenke LG, Cheh G, Riew KD. Evaluation of pedicle screw placement in the deformed spine using intraoperative plain radiographs: a comparison with computerized tomography. Spine. 2005;30:2084–2088.

    Article  PubMed  Google Scholar 

  7. Kim YJ, Lenke LG, Cho SK, Bridwell KH, Sides B, Blanke K. Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine. 2004;29:2040–2048.

    Article  PubMed  Google Scholar 

  8. Kim YJ, Lenke LG, Kim J, Bridwell KH, Cho SK, Cheh G, Sides B. Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine. 2006;31:291–298.

    Article  PubMed  Google Scholar 

  9. Kuklo TR, Lenke LG, O’Brien MF, Lehman RA Jr, Polly DW Jr, Schroeder TM. Accuracy and efficacy of thoracic pedicle screws in curves more than 90º. Spine. 2005;30:222–226.

    Article  PubMed  Google Scholar 

  10. Kuklo TR, Potter BK, Lenke LG. Vertebral rotation and thoracic torsion in adolescent idiopathic scoliosis: what is the best radiographic correlate? J Spinal Disord Tech. 2005;18:139–147.

    Article  PubMed  Google Scholar 

  11. Kuklo TR, Potter BK, Schroeder TM, O’Brien MF. Comparison of manual and digital measurements in adolescent idiopathic scoliosis. Spine. 2006; 31:1240–1246.

    Article  PubMed  Google Scholar 

  12. Learch TJ, Massie JB, Pathria MN, Ahlgren BA, Garfin SR. Assessment of pedicle screw placement utilizing conventional radiography and computed tomography: a proposed systematic approach to improve accuracy of interpretation. Spine. 2004;29:767–773.

    Article  PubMed  Google Scholar 

  13. Lehman RA Jr, Lenke LG, Keeler KA, Kim YJ, Buchowski JM, Cheh G, Kuhns CA, Bridwell KH. Operative treatment of adolescent idiopathic scoliosis with posterior pedicle screw-only constructs; minimum three-year follow-up of one hundred fourteen cases. Spine. 2008;33:1598–1604.

    Article  PubMed  Google Scholar 

  14. Lehman RA Jr, Sasso RC, Helgeson MD, Dmitriev AE, Gill NW, Rosner MR, Riew DK. Accuracy of intraoperative plain radiographs to detect violations of intralaminar screws placed into the C2 vertebrae: a reliability study. Spine. 2007;32:3036–3040.

    Article  PubMed  Google Scholar 

  15. Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am. 2001;83:1169–1181.

    PubMed  Google Scholar 

  16. Lowenstein JE, Matsumoto H, Vitale MG, Weidenbaum M, Gomez JA, Lee FY, Hyman JE, Roye DP Jr. Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine. 2007;32:448–452.

    Article  PubMed  Google Scholar 

  17. Mok JM, Berven SH, Diab M, Hackbarth M, Hu SS, Deviren V. Comparison of observer variation in conventional and three digital radiographic methods used in the evaluation of patients with adolescent idiopathic scoliosis. Spine. 2008;33:681–686.

    Article  PubMed  Google Scholar 

  18. O’Brien MF, Kuklo TR, Blanke KM, Lenke LG, eds. Spinal Deformity Study Group Radiographic Measurement Manual. Minneapolis, MN: Medtronic Sofamor Danek, Inc; 2005.

    Google Scholar 

  19. Potter BK, Kuklo TR, Lenke LG. Radiographic outcomes of anterior spinal fusion versus posterior spinal fusion with thoracic pedicle screws for treatment of Lenke type I adolescent idiopathic scoliosis curves. Spine. 2005;30:1859–1866.

    Article  PubMed  Google Scholar 

  20. Sabharwal S, Zhao C. Assessment of lower limb alignment: supine fluoroscopy compared with a standing full-length radiograph. J Bone Joint Surg Am. 2008;90:43–51.

    Article  PubMed  Google Scholar 

  21. Sapkas GS, Papadakis SA, Stathakopoulos DP, Papagelopoulos PJ, Badekas AC, Kaiser JH. Evaluation of pedicle screw position in thoracic and lumbar spine fixation using plain radiographs and computed tomography. A prospective study of 35 patients. Spine. 1999;24:1926–1929.

    Article  CAS  PubMed  Google Scholar 

  22. Smorgick Y, Millgram MA, Anekstein Y, Floman Y, Mirovsky Y. Accuracy and safety of thoracic pedicle screw placement in spinal deformities. J Spinal Disord Tech. 2005;18:522–526.

    Article  PubMed  Google Scholar 

  23. Suk SI, Kim WJ, Lee SM, Kim JH, Chung ER. Thoracic pedicle screw fixation in spinal deformities: are they really safe? Spine. 2001;26:2049–2057.

    Article  CAS  PubMed  Google Scholar 

  24. Suk SI, Lee CK, Kim WJ, Chung YJ, Park YBl. Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine. 1995;20:1399–1405.

    CAS  PubMed  Google Scholar 

  25. Yazici M, Acaroglu ER, Alanay A, Deviren V, Cila A, Surat A. Measurement of vertebral rotation in standing versus supine position in adolescent idiopathic scoliosis. J Pediatr Orthop. 2001;21:252–256.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Pediatric and Adult Spine, Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, Washington, DC, USA

    Ronald A. Lehman Jr. MD

  2. Orthopaedic Surgery Service, Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, Washington, DC, USA

    Melvin D. Helgeson MD & Tobin T. Eckel MD

  3. Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA

    Lawrence G. Lenke MD & Kathryn A. Keeler MD

  4. Pediatric and Adult Spine, Walter Reed Army Medical Center, 1528 Blue Meadow Road, Potomac, MD, 20854, USA

    Ronald A. Lehman Jr. MD

Authors
  1. Ronald A. Lehman Jr. MD
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  2. Lawrence G. Lenke MD
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  3. Melvin D. Helgeson MD
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  4. Tobin T. Eckel MD
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  5. Kathryn A. Keeler MD
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Corresponding author

Correspondence to Ronald A. Lehman Jr. MD.

Additional information

One or more of the authors (LGL) has received funding from Medtronic, DePuy, Axial Biotech, and Quality Medical Publishing.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Walter Reed Army Medical Center, Washington, DC, and Washington University School of Medicine, St Louis, MO.

The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or the US Government. Three authors are employees of the US Government. This work was prepared as part of their official duties and as such there is no copyright to be transferred.

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Lehman, R.A., Lenke, L.G., Helgeson, M.D. et al. Do Intraoperative Radiographs in Scoliosis Surgery Reflect Radiographic Result?. Clin Orthop Relat Res 468, 679–686 (2010). https://doi.org/10.1007/s11999-009-0873-z

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  • DOI: https://doi.org/10.1007/s11999-009-0873-z

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