Abstract
Purpose
To investigate the aorta movement following correction surgery for patients with thoracolumbar/lumbar scoliosis and to determine the subsequent risk of the aorta impingement for pedicle screw (PS) misplacement.
Methods
Thirty-six AIS patients with a main thoracolumbar or lumbar curve were included in this study. According to the direction of the main curve, the patients were divided into Group R and Group L, with Group R comprising 16 patients with a right-sided curve and Group L comprising 20 patients with a left-sided curve. All patients underwent CT scans of the lower thoracic and lumbar spine before and after surgery. To identify the relative positions of the aorta to vertebral body, several parameters were measured from the CT images of the middle transverse planes of vertebrae from T11 to L4, including aorta–vertebra angle (α), vertebral rotation angle (β), left safety distance (LSD) and right safety distance (RSD). The risk of the aorta impingement from T11 to L4 was calculated. An intragroup comparison regarding the position of the aorta relative to the vertebral body before and after correction surgery was performed accordingly.
Results
After surgery, the aorta moved toward the vertebral body among all levels in both groups. Compared with that in Group L, the aorta in Group R was significantly closer to the entry point at all levels, especially at T11. Before surgery, the aorta in Group R was at a high risk of impingement from left PS placement regardless of the diameters of the simulated screws. While in Group L, the risk of aorta impingement was mainly caused by the right placement of 45 mm PS. After surgery, both groups had an increased risk of aorta impingement from PS insertion, especially at T11. The risk of aorta impingement from PS placement was significantly higher in Group R than in Group L.
Conclusion
The risk of aorta impingement increased as the aorta shifted leftward after correction surgery, especially in right-sided Lenke 5C curve. Thus, preoperative risk evaluation could be insufficient for clinical practice due to aorta movement following correction surgery. Surgeons should be aware of the potential risk of aorta impingement, especially when placing PS in patients with right-sided curves.
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References
Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA (2008) Adolescent idiopathic scoliosis. Lancet 371:1527–1537
Akçalı Ö, Alıcı E, Koşay C (2003) Apical instrumentation alters the rotational correction in adolescent idiopathic scoliosis. Eur Spine J 12:124–129
Hwang SW, Samdani AF, Gressot LV, Hubler K, Marks MC, Bastrom TP, Betz RR, Cahill PJ (2012) Effect of direct vertebral body derotation on the sagittal profile in adolescent idiopathic scoliosis. Eur Spine J 21:31–39
Hee HT, Yu ZR, Wong HK (2007) Comparison of segmental pedicle screw instrumentation versus anterior instrumentation in adolescent idiopathic thoracolumbar and lumbar scoliosis. Spine 32:1533–1542
Li M, Ni J, Fang X, Liu H, Zhu X, He S, Gu S, Wang X (2009) Comparison of selective anterior versus posterior screw instrumentation in Lenke 5C adolescent idiopathic scoliosis. Spine 34:1162–1166
Lenke LG, Bridwell KH, Blanke K, Baldus C (1995) Analysis of pulmonary function and chest cage dimension changes after thoracoplasty in idiopathic scoliosis. Spine 20:1343–1350
Şarlak AY, Buluç L, Sarısoy HT, Memişoğlu K, Tosun B (2008) Placement of pedicle screws in thoracic idiopathic scoliosis: a magnetic resonance imaging analysis of screw placement relative to structures at risk. Eur Spine J 17:657–662
Liu J, Shen J, Zhang J, Li S, Zhao H, Qiu G, Wang Y (2012) The position of the aorta relative to the spine for pedicle screw placement in the correction of idiopathic scoliosis. J Spinal Disord Tech 25:E103–E107
Minor ME, Morrissey NJ, Peress R, Carroccio A, Ellozy S, Agarwal G, Teodorescu V, Hollier LH, Marin ML (2004) Endovascular treatment of an iatrogenic thoracic aortic injury after spinal instrumentation: case report. J Vasc Surg 39:893–896
Kakkos SK, Shepard AD (2008) Delayed presentation of aortic injury by pedicle screws: report of two cases and review of the literature. J Vasc Surg 47:1074–1082
Qiao J, Zhu F, Xu L, Zhu Z, Qian B, Liu Z, Qiu Y (2012) Comparison of the aorta impingement risks between thoracolumbar/lumbar curves with different convexities in adolescent idiopathic scoliosis: a computed tomography study. Eur Spin J 21:2043–2049
Wang W, Zhu Z, Zhu F, Wang B, Chu WC, Cheng JC, Qiu Y (2008) The changes of relative position of the thoracic aorta after anterior or posterior instrumentation of type I Lenke curve in adolescent idiopathic thoracic scoliosis. Eur Spin J 17:1019–1026
Takeshita K, Maruyama T, Ono T, Ogihara S, Chikuda H, Shoda N, Nakao Y, Matsudaira K, Seichi A, Nakamura K (2010) New parameters to represent the position of the aorta relative to the spine for pedicle screw placement. Eur Spin J 19:815–820
Sucato DJ, Duchene C (2003) The position of the aorta relative to the spine: a comparison of patients with and without idiopathic scoliosis. J Bone Joint Surg 85:1461–1469
Milbrandt TA, Sucato DJ (2007) The position of the aorta relative to the spine in patients with left thoracic scoliosis: a comparison with normal patients. Spine 32:E348
Cinotti G, Gumina S, Ripani M, Postacchini F (1999) Pedicle instrumentation in the thoracic spine: a morphometric and cadaveric study for placement of screws. Spine 24:114–119
Qiu X, Jiang H, Qian B, Wang W, Zhu F, Zhu Z, Qiu Y (2013) Influence of prone positioning on potential risk of aorta injury from pedicle screw misplacement in adolescent idiopathic scoliosis patients. J Spinal Disord Tech 27(5):E162–E167
Takeshita K, Maruyama T, Nakao Y, Ono T, Taniguchi Y, Chikuda H, Shoda N, Oshima Y, Higashikawa A, Nakamura K (2010) Aorta movement in patients with scoliosis after posterior surgery. Spine 35:E1571–E1576
Kakkos SK, Shepard AD (2008) Delayed presentation of aortic injury by pedicle screws: report of two cases and review of the literature. J Vasc Surg 47:1074–1082
Wegener B, Birkenmaier C, Fottner A, Jansson V, Dürr HR (2008) Delayed perforation of the aorta by a thoracic pedicle screw. Eur Spine J 17:351–354
Faro FD, Farnsworth CL, Shapiro GS, Mohamad F, White KK, Breisch E, Mahar Andrew T, Tomlinson T, Bawa M, Gomez M, Newton PO (2005) Thoracic vertebral screw impingement on the aorta in an in vivo bovine model. Spine 30:2406–2413
Shufflebarger HL, Geck MJ, Clark CE (2004) The posterior approach for lumbar and thoracolumbar adolescent idiopathic scoliosis: posterior shortening and pedicle screws. Spine 29:269–276
Huang Z, Wang Q, Yang J, Li F (2014) Vertebral derotation by vertebral column manipulator improves postoperative radiographs outcomes of Lenke 5C patients for follow up minimum 2 year. J Spinal Disord Tech
Jiang H, Qiu X, Wang W, Zhu Z, Qian B, Guo J, Qiu Y (2012) The position of the aorta changes with altered body position in single right thoracic adolescent idiopathic scoliosis: a magnetic resonance imaging study. Spine 37:E1054–E1061
Oertel MF, Hobart J, Stein M, Schreiber V, Scharbrodt W (2011) Clinical and methodological precision of spinal navigation assisted by 3D intraoperative O-arm radiographic imaging: technical note. Journal of Neurosurgery: Spine 14:532–536
Acknowledgments
This work was supported by the National Public Health Benefit Research Foundation, China (Grant No. 201002018).
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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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Chen, L., Xu, L., Qiu, Y. et al. The risks of aorta impingement from pedicle screw may increase due to aorta movement during posterior instrumentation in Lenke 5C curve: a computed tomography study. Eur Spine J 24, 1481–1489 (2015). https://doi.org/10.1007/s00586-015-3823-3
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DOI: https://doi.org/10.1007/s00586-015-3823-3