Abstract
Purpose
Preoperative planning of scoliosis surgery is essential in the effective treatment of spine pathology. Thus, precontoured rods have been recently developed to avoid iatrogenic sagittal misalignment and rod breakage. Some specific issues exist in adolescent idiopathic scoliosis (AIS), such as a less distal lower instrumented level, a great variability in the location of inflection point (transition from lumbar lordosis to thoracic kyphosis), and sagittal correction is limited by both bone–implant interface. Since 2007, stereoradiographic imaging system is used and allows for 3D reconstructions. Therefore, a software was developed to perform preoperative 3D surgical planning and to provide rod’s shape and length. The goal of this preliminary study was to assess the feasibility, reliability, and the clinical relevance of this new software.
Methods
Retrospective study on 47 AIS patients operated with the same surgical technique: posteromedial translation through posterior approach with lumbar screws and thoracic sublaminar bands. Pre- and postoperatively, 3D reconstructions were performed on stereoradiographic images (EOS system, Paris, France) and compared. Then, the software was used to plan the surgical correction and determine rod’s shape and length. Simulated spine and rods were compared to postoperative real 3D reconstructions. 3D reconstructions and planning were performed by an independent observer.
Results
3D simulations were performed on the 47 patients. No difference was found between the simulated model and the postoperative 3D reconstructions in terms of sagittal parameters. Postoperatively, 21% of LL were not within reference values. Postoperative SVA was 20 mm anterior in 2/3 of the cases. Postoperative rods were significantly longer than precontoured rods planned with the software (mean 10 mm). Inflection points were different on the rods used and the planned rods (2.3 levels on average).
Conclusion
In this preliminary study, the software based on 3D stereoradiography low-dose system used to plan AIS surgery seems reliable for preoperative planning and precontoured rods. It is an interesting tool to improve surgeons’ practice, since 3D planning is expected to reduce complications such as iatrogenic malalignment and to help for a better understanding of the complications, choosing the location of the transitional vertebra. However, further work is needed to improve thoracic kyphosis planning.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Similar content being viewed by others
References
Somerville EW (1952) Rotational lordosis; the development of single curve. J Bone Jt Surg Br 34-B(3):421–427
Newton PO, Yaszay B, Upasani VV, Pawelek JB, Bastrom TP, Lenke LG et al (2010) Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine 35(14):1365–1370
Pankowski R, Roclawski M, Ceynowa M, Mikulicz M, Mazurek T, Kloc W (2016) Direct vertebral rotation versus single concave rod rotation: low-dose intraoperative computed tomography evaluation of spine derotation in adolescent idiopathic scoliosis surgery. Spine 41(10):864–871
Suk S-I, Kim J-H, Kim S-S, Lim D-J (2012) Pedicle screw instrumentation in adolescent idiopathic scoliosis (AIS). Eur Spine J 21(1):13–22
Lowenstein JE, Matsumoto H, Vitale MG, Weidenbaum M, Gomez JA, Lee FY-I et al (2007) Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine 32(4):448–452
Hwang SW, Samdani AF, Tantorski M, Cahill P, Nydick J, Fine A et al (2011) Cervical sagittal plane decompensation after surgery for adolescent idiopathic scoliosis: an effect imparted by postoperative thoracic hypokyphosis. J Neurosurg Spine 15(5):491–496
Newton PO, Fujimori T, Doan J, Reighard FG, Bastrom TP, Misaghi A (2015) Defining the “three-dimensional sagittal plane” in thoracic adolescent idiopathic scoliosis. J Bone Jt Surg Am 97(20):1694–1701
Brink RC, Schlösser TPC, Colo D, Vavruch L, van Stralen M, Vincken KL et al (2017) Anterior spinal overgrowth is the result of the scoliotic mechanism and is located in the disc. Spine 42(11):818–822
Bagchi K, Mohaideen A, Thomson JD, Foley LC (2002) Hardware complications in scoliosis surgery. Pediatr Radiol 32(7):465–475
Albers HW, Hresko MT, Carlson J, Hall JE (2000) Comparison of single- and dual-rod techniques for posterior spinal instrumentation in the treatment of adolescent idiopathic scoliosis. Spine 25(15):1944–1949
Wattenbarger JM, Richards BS, Herring JA (2000) A comparison of single-rod instrumentation with double-rod instrumentation in adolescent idiopathic scoliosis. Spine 25(13):1680–1688
Bago J, Ramirez M, Pellise F, Villanueva C (2003) Survivorship analysis of Cotrel–Dubousset instrumentation in idiopathic scoliosis. Eur Spine J 12(4):435–439
Smith JS, Shaffrey CI, Ames CP, Demakakos J, Fu K-MG, Keshavarzi S et al (2012) Assessment of symptomatic rod fracture after posterior instrumented fusion for adult spinal deformity. Neurosurgery 71(4):862–867
Smith JS, Shaffrey E, Klineberg E, Shaffrey CI, Lafage V, Schwab FJ et al (2014) Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity. J Neurosurg Spine 21(6):994–1003
Dick JC, Bourgeault CA (2001) Notch sensitivity of titanium alloy, commercially pure titanium, and stainless steel spinal implants. Spine 26(15):1668–1672
Nguyen T-Q, Buckley JM, Ames C, Deviren V (2011) The fatigue life of contoured cobalt chrome posterior spinal fusion rods. Proc Inst Mech Eng [H] 225(2):194–198
Johnston CE, Ashman RB, Sherman MC, Eberle CF, Herndon WA, Sullivan JA et al (1987) Mechanical consequences of rod contouring and residual scoliosis in sublaminar segmental instrumentation. J Orthop Res 5(2):206–216
Lindsey C, Deviren V, Xu Z, Yeh R-F, Puttlitz CM (2006) The effects of rod contouring on spinal construct fatigue strength. Spine 31(15):1680–1687
Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine 30(6):682–688
Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30(18):2024–2029
Schwab F, Farcy J-P, Bridwell K, Berven S, Glassman S, Harrast J et al (2006) A clinical impact classification of scoliosis in the adult. Spine 31(18):2109–2114
Schwab F, Patel A, Ungar B, Farcy J-P, Lafage V (2010) Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine 35(25):2224–2231
Moal B, Schwab F, Ames CP, Smith JS, Ryan D, Mummaneni PV et al (2014) Radiographic outcomes of adult spinal deformity correction: a critical analysis of variability and failures across deformity patterns. Spine Deform 2(3):219–225
Clements DH, Marks M, Newton PO, Betz RR, Lenke L, Shufflebarger H et al (2011) Did the Lenke classification change scoliosis treatment? Spine 36(14):1142–1145
Le Huec JC, Charosky S, Barrey C, Rigal J, Aunoble S (2011) Sagittal imbalance cascade for simple degenerative spine and consequences: algorithm of decision for appropriate treatment. Eur Spine J 20(Suppl 5):699–703
Watanabe K, Nakamura T, Iwanami A, Hosogane N, Tsuji T, Ishii K et al (2012) Vertebral derotation in adolescent idiopathic scoliosis causes hypokyphosis of the thoracic spine. BMC Musculoskelet Disord 13:99
Helenius I, Remes V, Yrjönen T, Ylikoski M, Schlenzka D, Helenius M et al (2003) Harrington and Cotrel–Dubousset instrumentation in adolescent idiopathic scoliosis. Long-term functional and radiographic outcomes. J Bone Jt Surg Am 85-A(12):2303–2309
Lonner BS, Ren Y, Newton PO, Shah SA, Samdani AF, Shufflebarger HL et al (2017) Risk factors of proximal junctional kyphosis in adolescent idiopathic scoliosis—the pelvis and other considerations. Spine Deform 5(3):181–188
Wade R, Yang H, McKenna C, Faria R, Gummerson N, Woolacott N (2013) A systematic review of the clinical effectiveness of EOS 2D/3D X-ray imaging system. Eur Spine J 22(2):296–304
Hirsch C, Ilharreborde B, Mazda K (2015) EOS suspension test for the assessment of spinal flexibility in adolescent idiopathic scoliosis. Eur Spine J 24(7):1408–1414
Ilharreborde B, Sebag G, Skalli W, Mazda K (2013) Adolescent idiopathic scoliosis treated with posteromedial translation: radiologic evaluation with a 3D low-dose system. Eur Spine J 22(11):2382–2391
Mac-Thiong J-M, Roussouly P, Berthonnaud E, Guigui P (2010) Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine 35(22):E1193–E1198
Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Jt Surg Am 87(2):260–267
Schwab F, Lafage V, Patel A, Farcy J-P (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine 34(17):1828–1833
Schwab FJ, Smith VA, Biserni M, Gamez L, Farcy J-PC, Pagala M (2002) Adult scoliosis: a quantitative radiographic and clinical analysis. Spine 27(4):387–392
Lafage V, Schwab F, Patel A, Hawkinson N, Farcy J-P (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine 34(17):E599–E606
Ilharreborde B, Hirsch C, Presedo A, Penneçot G-F, Mazda K (2012) Circumferential fusion with anterior strut grafting and short-segment multipoint posterior fixation for burst fractures in skeletally immature patients: a preliminary report. J Pediatr Orthop 32(5):440–444
Salmingo RA, Tadano S, Abe Y, Ito M (2014) Influence of implant rod curvature on sagittal correction of scoliosis deformity. Spine J 14(8):1432–1439
Hey HWD, Wong GC, Chan CX, Lau L-L, Kumar N, Thambiah JS et al (2017) Reproducibility of sagittal radiographic parameters in adolescent idiopathic scoliosis—a guide to reference values using serial imaging. Spine J 17(6):830–836
Aubin CE, Labelle H, Chevrefils C, Desroches G, Clin J, Eng ABM (2008) Preoperative planning simulator for spinal deformity surgeries. Spine 33(20):2143–2152
Lavelle WF, Beltran AA, Carl AL, Uhl RL, Hesham K, Albanese SA (2016) Fifteen to twenty-five year functional outcomes of twenty-two patients treated with posterior Cotrel–Dubousset type instrumentation: a limited but detailed review of outcomes. Scoliosis Spinal Disord 11:18
Merriman M, Hu C, Noyes K, Sanders J (2015) Selection of the lowest level for fusion in adolescent idiopathic scoliosis—a systematic review and meta-analysis. Spine Deform 3(2):128–135
Larson AN, Fletcher ND, Daniel C, Richards BS (2012) Lumbar curve is stable after selective thoracic fusion for adolescent idiopathic scoliosis: a 20-year follow-up. Spine 37(10):833–839
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest, exept B Ilharreborde who is consultant but no funding was received for that study.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Ferrero, E., Mazda, K., Simon, AL. et al. Preliminary experience with SpineEOS, a new software for 3D planning in AIS surgery. Eur Spine J 27, 2165–2174 (2018). https://doi.org/10.1007/s00586-018-5591-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-018-5591-3