Abstract
Purpose
To evaluate the efficacy of pre-operative low-dose radiation computed tomography (CT) in optimizing screw placement in patients with adolescent idiopathic scoliosis (AIS).
Methods
49 patients with AIS who required correction and posterior fusion between January 2018 and December 2019 were included in this retrospective study. All patients underwent surgery performed by the same team of experienced surgeons. Patients were divided in two groups. The study group received a pre-operative low-dose CT scan (CT group, n = 25), differently from the control group (CG, n = 24). Patients of both groups received a post-operative low-dose CT scan. The primary outcome measure was the accuracy of screw placement on the Gertzbein–Robbins scale (grades A and B were considered acceptable). Secondary outcome measures included a comparison of perioperative complications.
Results
A total of 1045 screws were placed. In CT group (n = 25, screws = 528) and CG (n = 24, screws = 517), trajectories were grade A or B in 94.5% and 93.6% of screws, respectively. Two screws (one for each group) were removed because of intra-operative-evoked potentials alteration and one screw required revision after post-operative imaging. No correlation was found between the malpositioning rate and the proximity to the apex of the curve, conversely a significative peak of misplacements was observed at T3 (p < 0.01). No neurological and vascular complications related to screw placement were recorded. There was not intergroup difference neither in screw accuracy (Chi-Square, 2-tailed Fisher’s exact, p = 0.63), nor in complications rate.
Conclusion
Pre-operative low-dose CT scan as surgical plan does not contribute in reducing pedicle screw misplacement rate.
Study design
Retrospective comparative cohort study.
Level of evidence
III.
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Availability of data and material
Data are available on PACS (Picture archiving and communication system) of our Institute.
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No funding was received for this study by National Institutes of Health (NIH), Wellcome Trust, Howard Hughes Medical Institute (HHMI) or others.
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AR: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work, yes; drafted the work or revised it critically for important intellectual content, yes; approved the version to be published, yes; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, yes; type of principal contribution, conception, data interpretation and revision. MF: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work, yes; drafted the work or revised it critically for important intellectual content, yes;approved the version to be published, yes; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, yes; type of principal contribution, conception and writing. MK: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work, yes; drafted the work or revised it critically for important intellectual content, yes;approved the version to be published, yes; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, yes; type of principal contribution, conception and revision. FB: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work, yes; drafted the work or revised it critically for important intellectual content, yes;approved the version to be published, yes; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, yes;Type of principal contribution, Data collection and writing. SP: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work, yes; drafted the work or revised it critically for important intellectual content, yes;approved the version to be published, yes; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, yes;type of principal contribution, data collection and writing. MB: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work, yes; drafted the work or revised it critically for important intellectual content, yes;approved the version to be published, yes; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, yes;Type of principal contribution, Data collection and writing. TG: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work, yes; drafted the work or revised it critically for important intellectual content, yes;approved the version to be published, yes; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, yes; type of principal contribution, supervision and data interpretation. CF: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work, yes; drafted the work or revised it critically for important intellectual content, yes;approved the version to be published, yes; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, yes; type of principal contribution, supervision and data interpretation.
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The study was approved by the institutional review board of our hospital.
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Ruffilli, A., Fiore, M., Martikos, K. et al. Does use of pre-operative low-dose CT-scan in adolescent idiopathic scoliosis improve accuracy in screw placement? Results of a retrospective study. Spine Deform 9, 1403–1410 (2021). https://doi.org/10.1007/s43390-021-00343-1
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DOI: https://doi.org/10.1007/s43390-021-00343-1