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Morphometric Analysis of the Thoracic Intervertebral Foramen Osseous Anatomy in Adolescent Idiopathic Scoliosis Using Low-Dose Computed Tomography

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Abstract

Purpose

The dimensions of the thoracic intervertebral foramen in adolescent idiopathic scoliosis (AIS) have not previously been quantified. Better understanding of the dimensions of the foramen may be useful in surgical planning. This study describes a reproducible method for measurement of the thoracic foramen in AIS using computed tomography (CT).

Methods

In 23 preoperative female patients with Lenke 1 type AIS with right-side convexity major curves confined to the thoracic spine the foraminal height (FH), foraminal width (FW), pedicle to superior articular process distance (P-SAP), and cross-sectional foraminal area (FA) were measured using multiplanar reconstructed CT. Measurements were made at entrance, midpoint, and exit of the thoracic foramina from T1–T2 to T11–T12. Results were also correlated with dependent variables of major curve Cobb angle measured on X-ray and CT, age, weight, Lenke classification subtype, Risser grade, and number of spinal levels in the major curve.

Results

The FH, FW, P-SAP, and FA dimensions and ratios are all significantly larger on the convexity of the major curve and maximal at or close to the apex. Mean thoracic foraminal dimensions change in a predictable manner relative to position on the major thoracic curve. There was no statistically significant correlation with the measured foraminal dimensions or ratios and the individual dependent variables. The average ratio of convexity to concavity dimensions at the apex foramina for entrance, midpoint, and exit, respectively, are FH (1.50, 1.38, 1.25), FW (1.28, 1.30, 0.98), FA (2.06, 1.84, 1.32), and P-SAP (1.61, 1.47, 1.30).

Conclusion

Foraminal dimensions of the thoracic spine are significantly affected by AIS. Foraminal dimensions have a predictable convexity-to-concavity ratio relative to the proximity to the major curve apex. Surgeons should be aware of these anatomical differences during scoliosis correction surgery.

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Authors and Affiliations

  1. Paediatric Spine Research Group Centre for Children’s Health Research Level 5, Queensland University of Technology and Mater Health Services Brisbane Ltd, 62 Graham Street, South Brisbane, Queensland, 4104, Australia

    Thorbjorn J. Loch-Wilkinson MBBS, BSc, Maree T. Izatt BPhty, Robert D. Labrom MBBS, MSc, FRACS, Geoffrey N. Askin MBBS, FRACS, Mark J. Pearcy BSc, PhD, DEng & Clayton J. Adam BEng, PhD

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  1. Thorbjorn J. Loch-Wilkinson MBBS, BSc
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  2. Maree T. Izatt BPhty
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  3. Robert D. Labrom MBBS, MSc, FRACS
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  4. Geoffrey N. Askin MBBS, FRACS
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  5. Mark J. Pearcy BSc, PhD, DEng
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  6. Clayton J. Adam BEng, PhD
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Correspondence to Clayton J. Adam BEng, PhD.

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Author disclosures

TJLW (none); MTI (travel allowances to institution from NuVasive; research support salary from Medtronic); RDL (received payment for speaking and/or teaching arrangements from Medtronic; research support salaries to institution from Synthes and Medtronic; grants to institution from DePuy Synthes in negotiation; fellowship support to institution from DePuy Synthes); GNA (received payment for speaking and/or teaching arrangements from Medtronic; research support salaries to institution from Synthes and Medtronic; grants to institution from DePuy Synthes in negotiation, all outside of submitted work); MJP (owns stock in Tissue Therapies; travel allowances to institution from NuVasive; holds scientific advisory board or other office from Therapeutics Goods Administration, Australia); CJA (travel allowances to institution from NuVasive; research support salaries and materials to institution from Synthes and Medtronic; grants to institution from DePuy Synthes in negotiation; fellowship support from European Union Fellowship FP7-PEOPLE-2010-IIF-274964 salary 2012–13, all outside of submitted work).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Loch-Wilkinson, T.J., Izatt, M.T., Labrom, R.D. et al. Morphometric Analysis of the Thoracic Intervertebral Foramen Osseous Anatomy in Adolescent Idiopathic Scoliosis Using Low-Dose Computed Tomography. Spine Deform 4, 182–192 (2016). https://doi.org/10.1016/j.jspd.2015.10.004

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