Skip to main content

Advertisement

SpringerLink
Log in

Predicting 3D Thoracic Kyphosis Using Traditional 2D Radiographic Measurements in Adolescent Idiopathic Scoliosis

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study Design

Retrospective.

Objective

To develop and validate a prediction formula to estimate three-dimensional (3D) T5–T12 kyphosis in adolescent idiopathic scoliosis (AIS) from standard two-dimensional (2D) radiographic measurements.

Summary of Background Data

2D measurements of thoracic kyphosis in AIS patients overestimate 3D kyphosis; however, there is a lack of widespread availability of 3D imaging technology.

Methods

Retrospective review was performed for AIS patients with right thoracic curves evaluated with EOS Imaging from January 2010 to June 2014. Standard 2D posteroanterior and lateral radiographic measurements, pelvic incidence, Nash-Moe grade, Perdriolle rotation, and “3D T5–T12” sagittal measures (reconstructed with sterEOS, analyzed with custom MatLab code) were input into a multivariate logistic analysis to create a prediction model for 3D T5–T12 sagittal alignment. An initial cohort of 66 patients (curves 14°–85°) was used to create a predictive model, and a separate cohort of 129 patients (curves 16°–84°) was used to validate the formula.

Results

2D thoracic coronal Cobb and 2D T5–T12 kyphosis were the only significant predictors in the model. The prediction formula for estimating 3D T5–T12 sagittal measurement from standard 2D measurements, in degrees, was 18.1 + (0.81*2D T5–T12 sagittal Cobb) − (0.54*2D coronal Cobb), r2 = 0.84. The average model error between predicted and measured 3D T5–T12 kyphosis was ±7°. The predicted 3D T5–T12 kyphosis (8.6° ± 12.1°) and measured 3D T5–T12 kyphosis (8.5° ± 13.0°) were not significantly different (p = .8). 3D kyphosis was less than standard measures of 2D kyphosis (8.5° ± 13.0° vs. 20.2° ± 12.6°, p < .001).

Conclusion

This simple validated formula to predict 3D T5–T12 sagittal alignment using routine 2D thoracic Cobb and T5–T12 kyphosis for thoracic AIS patients has great potential value in assessing historical data collected prior to the development of 3D imaging methods as well as understanding/planning surgical hypokyphosis correction in patients without access to 3D imaging.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gille O, Champain N, Benchikh-El-Fegoun A, et al. Reliability of 3D reconstruction of the spine of mild scoliotic patients. Spine (Phila Pa 1976) 2007;32:568–73.

    Article  Google Scholar 

  2. Ilharreborde B, Steffen JS, Nectoux E, et al. Angle measurement reproducibility using EOS three-dimensional reconstructions in adolescent idiopathic scoliosis treated by posterior instrumentation. Spine (Phila Pa 1976) 2011;36:E1306–13.

    Article  Google Scholar 

  3. Hayashi K, Upasani VV, Pawelek JB, et al. Three-dimensional analysis of thoracic apical sagittal alignment in adolescent idiopathic scoliosis. Spine 2009;34:792–7.

    Article  Google Scholar 

  4. Papin P, Labelle H, Delorme S, et al. Long-term three-dimensional changes of the spine after posterior spinal instrumentation and fusion in adolescent idiopathic scoliosis. Eur Spine J 1999;8:16–21.

    Article  CAS  Google Scholar 

  5. Guo X, Chau WW, Chan YL, et al. Relative anterior spinal overgrowth in adolescent idiopathic scoliosis. Results of disproportionate endochondral-membranous bone growth. J Bone Joint Surg Br 2003;85:1026–31.

    Article  CAS  Google Scholar 

  6. Lowenstein JE, Matsumoto H, Vitale MG, et al. Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine (Phila Pa 1976) 2007;32:448–52.

    Article  Google Scholar 

  7. Kim YJ, Lenke LG, Kim J, et al. Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2006;31:291–8.

    Article  Google Scholar 

  8. Perdriolle R, Le Borgne P, Dansereau J, et al. Idiopathic scoliosis in three dimensions: a succession of two-dimensional deformities? Spine (Phila Pa 1976) 2001;26:2719–26.

    Article  CAS  Google Scholar 

  9. Péloux JFR, Foucon B, Stagnara P. Le plan d’election pour l’examen radiologique des cyphoscolioses. Rev Chir Orthop Reparatrice Appar Mot 1965;51:517–27.

    PubMed  Google Scholar 

  10. O’Brien MF, Kuklo TR, Blanke KM, Lenke LG. Spinal deformity study group radiographic measurement manual. Memphis, TN: Medtronic Sofamor Danek USA, Inc.; 2005.

    Google Scholar 

  11. Nash Jr CL, Moe JH. A study of vertebral rotation. J Bone Joint Surg Am 1969;51:223–9.

    Article  Google Scholar 

  12. Perdriolle R, Vidal J. Thoracic idiopathic scoliosis curve evolution and prognosis. Spine (Phila Pa 1976) 1985;10:785–91.

    Article  CAS  Google Scholar 

  13. Newton PO, Fujimori T, Doan J, et al. Defining the “three-dimensional sagittal plane” in thoracic adolescent idiopathic scoliosis. J Bone Joint Surg Am 2015;97:1694–701.

    Article  Google Scholar 

  14. Carreau JH, Bastrom T, Petcharaporn M, et al. Computer-generated, three-dimensional spine model from biplanar radiographs: a validity study in idiopathic scoliosis curves greater than 50 degrees. Spine Deform 2014;2(2):81–8.

    Article  Google Scholar 

  15. Labelle H, Aubin CE, Jackson R, et al. Seeing the spine in 3D: how will it change what we do? J Pediatr Orthop 2011;31:S37–45.

    Article  Google Scholar 

  16. Nault ML, Mac-Thiong JM, Roy-Beaudry M, et al. Three-dimensional spinal morphology can differentiate between progressive and non-progressive patients with adolescent idiopathic scoliosis at the initial presentation. Spine (Phila Pa 1976) 2014;139(10):E601–6.

    Article  Google Scholar 

  17. Somerville EW. Rotational lordosis; the development of single curve. J Bone Joint Surg Br 1952;34:421–7.

    Article  Google Scholar 

  18. Cruickshank JL, Koike M, Dickson RA. Curve patterns in idiopathic scoliosis. A clinical and radiographic study. J Bone Joint Surg Br 1989;71:259–63.

    Article  CAS  Google Scholar 

  19. Millner PA, Dickson RA. Idiopathic scoliosis: biomechanics and biology. Eur Spine J 1996;5:362–73.

    Article  CAS  Google Scholar 

  20. Roaf R. The basic anatomy of scoliosis. J Bone Joint Surg Br 1966;48:786–92.

    Article  CAS  Google Scholar 

  21. Porter RW. Idiopathic scoliosis: the relation between the vertebral canal and the vertebral bodies. Spine (Phila Pa 1976) 2000;25:1360–6.

    Article  CAS  Google Scholar 

  22. Somoskeoy S, Tunyogi-Csapo M, Bogyo C, et al. Accuracy and reliability of coronal and sagittal spinal curvature data based on patient-specific three-dimensional models created by the EOS 2D/3D imaging system. Spine J 2012;12:1052–9.

    Article  Google Scholar 

  23. Kuklo TR, Potter BK, O’Brien MF, et al. Reliability analysis for digital adolescent idiopathic scoliosis measurements. J Spinal Disord Tech 2005;18:152–9.

    Article  Google Scholar 

  24. Castelein RM, Veraart B. Idiopathic scoliosis: prognostic value of the profile. Eur Spine J 1992;1:167–9.

    Article  CAS  Google Scholar 

  25. Brenner D, Elliston C, Hall E, et al. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001;176:289–96.

    Article  CAS  Google Scholar 

  26. Newton PO, Yaszay B, Upasani VV, et al. Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2010;35:1365–70.

    Article  Google Scholar 

  27. Illes T, Somoskeoy S. Comparison of scoliosis measurements based on three-dimensional vertebra vectors and conventional two-dimensional measurements: advantages in evaluation of prognosis and surgical results. Eur Spine J 2013;22:1255–63.

    Article  Google Scholar 

  28. Sudo H, Abe Y, Abumi K, et al. Surgical treatment of double thoracic adolescent idiopathic scoliosis with a rigid proximal thoracic curve. Eur Spine J 2016;25:569–77.

    Article  Google Scholar 

  29. Clement JL, Chau E, Geoffray A, et al. Restoration of thoracic kyphosis by simultaneous translation on two rods for adolescent idiopathic scoliosis. Eur Spine J 2014;23(Suppl 4):S438–45.

    Article  Google Scholar 

  30. Liu H, Li Z, Li S, et al. Main thoracic curve adolescent idiopathic scoliosis: association of higher rod stiffness and concave-side pedicle screw density with improvement in sagittal thoracic kyphosis restoration. J Neurosurg Spine 2015;22:259–66.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA

    Kevin C. Parvaresh MD, Emily J. Osborn MD & Peter O. Newton MD

  2. Orthopedic Research Department, Children’s Specialist of San Diego, 3030 Childrens Way, Suite 410, San Diego, CA, 92123-4228, USA

    Fredrick G. Reighard MPH, Joshua Doan MEng, Tracey P. Bastrom MA & Peter O. Newton MD

  3. Division of Orthopedic Surgery, Rady Children’s Hospital, 3030 Children’s Way, Suite 410, San Diego, CA, 92123, USA

    Peter O. Newton MD

Authors
  1. Kevin C. Parvaresh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emily J. Osborn MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fredrick G. Reighard MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joshua Doan MEng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tracey P. Bastrom MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter O. Newton MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter O. Newton MD.

Additional information

Author disclosures

KCP (none); EJO (none); FGR (reports grants from Setting Scoliosis Straight Foundation, during the conduct of the study); JD (reports grants from Setting Scoliosis Straight Foundation, during the conduct of the study); TPB (reports grants from Setting Scoliosis Straight Foundation, during the conduct of the study); PON (reports grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and other from Setting Scoliosis Straight Foundation, other from Rady Children’s Specialists, grants and personal fees from DePuy Synthes Spine, personal fees from Law firm of Carroll, Kelly, Trotter, Franzen & McKenna, personal fees from Law firm of Smith, Haughey, Rice & Roegge, grants from NIH, grants from OREF, grants and other from SRS, grants from EOS imaging, personal fees from Thieme Publishing, other from NuVasive, personal fees from Ethicon Endosurgery, other from Electrocore, personal fees from Cubist, other from International Orthopedic Think Tank, other from Orthopediatrics Institutional Support, personal fees from K2M, outside the submitted work; In addition, Dr. Newton has a patent Anchoring systems and methods for correcting spinal deformities (8540754) with royalties paid to DePuy Synthes Spine, a patent Low profile spinal tethering systems (8123749) issued to DePuy Spine, Inc., a patent Screw placement guide (7981117) issued to DePuy Spine, Inc., and a patent Compressor for use in minimally invasive surgery (7189244) issued to DePuy Spine, Inc.).

Study conducted Rady Children’s Hospital, San Diego.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Parvaresh, K.C., Osborn, E.J., Reighard, F.G. et al. Predicting 3D Thoracic Kyphosis Using Traditional 2D Radiographic Measurements in Adolescent Idiopathic Scoliosis. Spine Deform 5, 159–165 (2017). https://doi.org/10.1016/j.jspd.2016.12.002

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.jspd.2016.12.002

Keywords

Level of Evidence

Search

Navigation