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Assessment of the axial plane deformity in subjects with adolescent idiopathic scoliosis and its relationship to the frontal and sagittal planes



Investigate the axial plane deformity in the scoliotic segment and its relationship to the deformity in the frontal and sagittal planes.


Two hundred subjects with AIS (Cobb ≥ 20°) underwent low dose biplanar X-rays with 3D reconstruction of the spine and pelvis. All structural curves were considered and were distributed as follows: 142 thoracic (T), 70 thoracolumbar (TL), and 47 lumbar curves (L). Common 3D spino-pelvic and scoliosis parameters were collected such as: frontal Cobb; torsion index (TI); hypokyphosis/lordosis index (HI). Parameters were compared between each type of curvature and correlations were investigated between the 3 planes.


Frontal Cobb was higher in all T (45 ± 19°) and TL (41 ± 15°) curves compared to L curves (35 ± 14°, p = 0.004). TI was higher in T curves when compared to TL and L curves (TI: 15 ± 8°, 9 ± 6°, 7 ± 5°, p < 0.001). HI was similar between curve types. T curves showed significant correlations between the 3 planes: Cobb vs. TI (r = 0.76), Cobb vs. HI (r = − 0.54) and HI vs. TI (r = − 0.42). The axial plane deformity was related to the frontal deformity and the type of curvature (adjusted-R2 = 0.6).


Beside showing the most severe deformity frontally and axially compared to TL and L curves, the T curves showed strong correlations between the 3 planes of the deformity. Moreover, this study showed that the axial plane deformity cannot be fully determined by the frontal and sagittal deformities, which highlights the importance of 3D assessment in the setting of AIS.

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This research was funded by the research council of the University of Saint-Joseph in Beirut (Project FM300).

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MK, CV, WS, AJB, JM, GK, KK, IG, AA: 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. MK, CV, WS, AJB, JM, GK, KK, IG, AA: drafted the work or revised it critically for important intellectual content. MK, CV, WS, AJB, JM, GK, KK, IG, AA: approved the version to be published. MK, CV, WS, AJB, JM, GK, KK, IG, AA: 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.

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Correspondence to Ayman Assi.

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This is an IRB approved study (University of Saint-Joseph-CEHDF742).

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Karam, M., Vergari, C., Skalli, W. et al. Assessment of the axial plane deformity in subjects with adolescent idiopathic scoliosis and its relationship to the frontal and sagittal planes. Spine Deform (2021).

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  • Scoliosis
  • 3D reconstruction
  • Axial plane
  • Frontal plane
  • Sagittal plane
  • Scoliosis surgery