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Three- instead of two-dimensional evaluation of key parameters alters the choice of the lowest instrumented vertebra in Lenke 1 and 2 AIS patients

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Abstract

Purpose

Treatment of AIS, a three-dimensional spinal (3D) deformity, is guided by a two-dimensional (2D) evaluation. Novel 3D approaches that address the 2D limitations have not been adopted in AIS care due to their lengthy and complex 3D reconstruction procedures. This study aims to introduce a simple 3D method that translates the 2D key parameters (Stable vertebra (SV), Lenke lumbar modifier, Neutral vertebra (NV)) into 3D and to quantitively compare these 3D corrected parameters to the 2D assessment.

Methods

The key parameters of 79 surgically treated Lenke 1 and 2 patients were measured in 2D by two experienced spine surgeons. Next, these key parameters were measured in 3D by indicating relevant landmarks on biplanar radiographs and using the 'true' 3D CSVL which was perpendicular to the pelvic plane. Differences between the 2D and 3D analysis were examined.

Results

A 2D-3D mismatch was identified in 33/79 patients (41.8%) for at least one of the key parameters. More specifically, a 2D-3D mismatch was identified in 35.4% of patients for the Sag SV, 22.5% of patients for the SV and 17.7% of patients for the lumbar modifier. No differences in L4 tilt and NV rotation were found.

Conclusion

The findings highlight that a 3D evaluation alters the choice of the LIV in Lenke 1 and 2 AIS patients. Although, the true impact of this more precise 3D measurement on preventing poor radiographic outcome needs further investigation, the results are a first step toward establishing a basis for 3D assessments in daily practice.

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Acknowledgements

The authors thank Simon Moustie for his assistance in the data analysis.

Funding

This study was funded by a grant internal UZ Leuven Academic research funding (KOOR).

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Author notes

  1. Joint last author: Lennart Scheys and Thijs Ackermans contributed equally to this work.

Authors and Affiliations

  1. Division of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium

    Sebastiaan Schelfaut, Pierre Moens, Anja Van Campenhout, Lieven Moke & Lennart Scheys

  2. Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Louvain, Belgium

    Thomas Overbergh, Steven Cornelis, Lieven Moke, Lennart Scheys & Thijs Ackermans

Authors
  1. Sebastiaan Schelfaut
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  2. Pierre Moens
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  4. Steven Cornelis
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  6. Lieven Moke
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  8. Thijs Ackermans
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Contributions

Study design: SS, PM, AVC, LM, LS, TA; Data acquisition: SS, PM, TO, SC, LS, TA; Data analysis: all authors; Drafted the work: SS; Revised the work: PM, TO, SC, AVC, LM, LS, TA; Approved this version: all authors; agree to be accountable: all authors.

Corresponding author

Correspondence to Thijs Ackermans.

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The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethics approval

The study was approved by the institution’s research ethics committee (S63053), and was carried out according to the guidelines for Good Clinical Practice (ICH/GCP) and the declaration of Helsinki for the protection of people who participate in clinical studies.

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Schelfaut, S., Moens, P., Overbergh, T. et al. Three- instead of two-dimensional evaluation of key parameters alters the choice of the lowest instrumented vertebra in Lenke 1 and 2 AIS patients. Spine Deform 11, 1137–1143 (2023). https://doi.org/10.1007/s43390-023-00711-z

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