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The deformity angular ratio: can three-dimensional computed tomography improve prediction of intraoperative neuromonitoring events?

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Abstract

Purpose

Assess whether a novel deformity angular ratio (DAR) calculated using preoperative three-dimensional computed tomography (3D CT) is more accurate than total DAR (T-DAR) radiographic measurements at predicting intraoperative neuromonitoring (IONM) events during vertebral column resection (VCR).

Methods

Consecutive, unique patients undergoing thoracic VCR by a single surgeon from 2015 to 2021 were identified. The T-DAR was calculated by dividing the total radiographic Cobb angle by the number of vertebral segments the angle subtends. 3D CT DAR was calculated for each patient from a preoperative CT scan by finding the maximum angle subtended by three contiguous vertebral segments. All patients were assessed for IONM events. A binary threshold of 25 was used for T-DAR and 3D CT DAR measurements for predictive analysis. p < 0.05 indicated significance.

Results

In total, 68 patients were identified. Mean age was 28 years. Mean levels fused was 15. Twenty-one patients (31%) had IONM events. In patients, with and without an IONM event, mean T-DAR was 26.6 ± 9.8 and 21.5 ± 8.8 (p = 0.04), respectively. 3D CT DAR mean values were 26.4 ± 10.8 and 18.4 ± 5.6, respectively (p < 0.001). 3D CT DAR accurately classified 81% of patients with a positive predictive value (PPV) of 75%. In comparison, T-DAR accurately classified 60% of patients with a PPV of 39%.

Conclusion

3D CT substantially improves preoperative IONM event prediction when compared to traditional radiographic measurements. A 3D CT DAR of 25 or greater was correlated with an increased rate of IONM events. 3D CT reconstructions are a useful adjunct for planning prior to a VCR.

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Funding

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Authors and Affiliations

  1. The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, 5141 Broadway, New York, NY, 10034, USA

    Varun Puvanesarajah, Gerard F. Marciano, Fthimnir M. Hassan, Nathan J. Lee, Earl D. Thuet, Joseph M. Lombardi, Zeeshan M. Sardar, Ronald A. Lehman & Lawrence G. Lenke

Authors
  1. Varun Puvanesarajah
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  2. Gerard F. Marciano
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  3. Fthimnir M. Hassan
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  4. Nathan J. Lee
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  5. Earl D. Thuet
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  6. Joseph M. Lombardi
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  7. Zeeshan M. Sardar
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  8. Ronald A. Lehman
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  9. Lawrence G. Lenke
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Corresponding author

Correspondence to Varun Puvanesarajah.

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Conflict of interest

Lawrence G. Lenke has received grant support from AO Spine, International Spine Summit Group, Scoliosis Research Society, EOS Technology and Setting Scoliosis Straight Foundation as a study investigator. Ronald A. Lehman has received grant support from the Department of Defense as a study investigator. Joseph M. Lombardi, Zeeshan M. Sardar, Ronald A. Lehman, and Lawrence G. Lenke have received consulting fees from Medtronic. Joseph M. Lombardi has received consulting fees from Stryker. Lawrence G. Lenke has received consulting fees from Acuity Surgical and Abryx. Lawrence G. Lenke has received reimbursements from Broadwater, AO Spine, and Scoliosis Research Society for attending meetings/travel. Ronald A. Lehman and Lawrence G. Lenke have received royalties and are patent holders from Medtronic. Ronald A. Lehman has received royalties and is a patent holder from Stryker. Varun Puvanesarajah, Gerard F. Marciano, Fthimnir M. Hassan, Nathan J. Lee, and Earl Thuet declare that they have no conflict of interest.

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Puvanesarajah, V., Marciano, G.F., Hassan, F.M. et al. The deformity angular ratio: can three-dimensional computed tomography improve prediction of intraoperative neuromonitoring events?. Spine Deform 10, 1047–1053 (2022). https://doi.org/10.1007/s43390-022-00518-4

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  • DOI: https://doi.org/10.1007/s43390-022-00518-4

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