Diagnostic accuracy of perioperative electromyography in the positioning of pedicle screws in adolescent idiopathic scoliosis treatment: a cross-sectional diagnostic study

Abstract Background: To investigate electromyography (EMG) thresholds for predicting pedicle screw positioning during adolescent idiopathic scoliosis (AIS) surgery.Methods: 16 patients were included. Each screw was classified as “at risk for nerve injury” (ARNI) or “no risk for nerve injury” (NRNI) using CT and the diagnostic accuracy of EMG thresholds for predicting screw positions ARNI was investigated.Results: 226 pedicles were analyzed. In the axial plane, 204 (90.3%) screws were considered as NRNI, and 22 (9.7%), as ARNI. In the sagittal plane, 183 (81%) pedicle screws were considered as NRNI, and 43 (19%), as ARNI. We observed a significant association between EMG responses and screw positioning ARNI. A 1-mA decrease in EMG threshold corresponded to a 12% increase in the odds of screw position ARNI (OR=1.12; p<.001). The positive predictive value of EMG for diagnosing ARNI was very low, with the highest 18% corresponding to a cutoff of 25 mA, but the negative predictive value was moderate to high (78%-93%) for every cutoff.Conclusions: EMG had a poor accuracy for predicting screws ARNI but was effective for minimizing false-negative screws ARNI.

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Diagnostic accuracy of perioperative electromyography in the positioning of pedicle screws in adolescent idiopathic scoliosis treatment: a cross-sectional diagnostic study

10.21203/rs.2.22355/v1 ◽

2020 ◽

Author(s):

Carlos Eduardo Barsotti ◽

Bruno Moreira Gavassi ◽

Francisco Eugenio Prado ◽

Bernardo Nogueira Batista ◽

Raphael de Resende Pratali ◽

...

Keyword(s):

Idiopathic Scoliosis ◽

Diagnostic Accuracy ◽

Nerve Injury ◽

Sagittal Plane ◽

False Negative ◽

Pedicle Screws ◽

Axial Plane ◽

Diagnostic Study ◽

Cross Sectional ◽

Curve Magnitude

Abstract Background: To investigate in the conventional techniques of the pedicle screws using triggered screw electromyography (t-EMG), considering different threshold cutoffs: 10, 15, 20 25 mA, for predicting pedicle screw positioning during surgery of the adolescent with idiopathic scoliosis (AIS). Methods: Sixteen patients (4 males, 12 females, average age 16.6 years) were included, with an average curve magnitude of 50 degrees and placement of 226 pedicle screws. Each screw was classified as “at risk for nerve injury” (ARNI) or “no risk for nerve injury” (NRNI) using CT and the diagnostic accuracy of EMG considering different threshold cutoffs (10,15, 20 and 25 mA) in the axial and Sagittal planes for predicting screw positions ARNI was investigated. Results: The EMG exam accuracy, in the axial plane, 90.3% screws were considered NRNI. In the sagittal plane, 81% pedicle screws were considered NRNI. A 1-mA decrease in the EMG threshold was associated with a 12% increase in the odds of the screw position ARNI. In the axial and sagittal planes, the ORs were 1.09 and 1.12, respectively. At every threshold cutoff evaluated, the PPV of EMG for predicting screws ARNI was very low in the different threshold cutoff (10 and 15); the highest PPV was 18% with a threshold cutoff of 25 mA. The PPV was always slightly higher for predicting screws ARNI in the sagittal plane than in the axial plane. In contrast, there was a moderate to high NPV (78%-93%) for every cutoff analyzed. Conclusions: EMG had a moderate to high accuracy for positive predicting value screws ARNI with increase threshold cutoffs of 20 and 25 mA. In addition, showed to be effective for minimizing false-negative screws ARNI in the different threshold cutoffs of the EMG in adolescent with idiopathic scoliosis (AIS).

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THE ETIOLOGIC RELEVANCE OF 3-D PATHOANATOMY OF ADOLESCENT IDIOPATHIC SCOLIOSIS

Coluna/Columna ◽

10.1590/s1808-185120171604183510 ◽

2017 ◽

Vol 16 (4) ◽

pp. 302-307

Author(s):

Tom Schlösser ◽

Rob Brink ◽

René Castelein

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Three Dimensional ◽

Imaging Studies ◽

Cross Sectional ◽

Ongoing Research ◽

Biomechanical Loading ◽

Cross Sectional Imaging ◽

Sectional Imaging ◽

The One

ABSTRACT Despite many years of dedicated research into the etiopathogenesis of adolescent idiopathic scoliosis, there is still no single distinct cause for this puzzling condition. In this overview, we attempt to link knowledge on the complex three-dimensional pathoanatomy of AIS, based on our ongoing research in this field, with etiopathogenic questions. Evidence from multiple recent cross-sectional imaging studies is provided that supports the hypothesis that AIS has an intrinsic biomechanical basis: an imbalance between the biomechanical loading of the upright human spine due to its unique sagittal configuration on the one hand, and the body’s compensating mechanisms on the other. The question that remains in the etiology of AIS, and the focus of our ongoing research, is to determine what causes or induces this imbalance.

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Uniplanar cannulated pedicle screws in the correction of Lenke type 1 adolescent idiopathic scoliosis (AIS)

10.21203/rs.3.rs-34233/v1 ◽

2020 ◽

Author(s):

Yiwei Zhao ◽

Wubo Liu ◽

Suomao Yuan ◽

Yonghao Tian ◽

Xinyu Liu

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Pedicle Screws ◽

Vertebral Rotation ◽

Concave Side ◽

Convex Side ◽

X Rays ◽

Group A ◽

Group B

Abstract Background In the present study, we reported the clinical use of uniplanar cannulated pedicle screws for the correction of Lenke type 1 adolescent Idiopathic scoliosis (AIS), and its safety and clinical outcomes were also evaluated. Methods 68 patients with Lenke type 1 AIS were included, among which 38 patients were treated with uniplanar cannulated screws at the concave side of periapical levels and multiaxial screws at the other levels (group A). Moreover, the remaining 30 patients were treated with all multiaxial screws (group B). The preoperative and postoperative radiographic parameters of the Lenke type 1 AIS, axial vertebral rotation, and the safety of the pedicle screws were evaluated by X-rays and computed tomography (CT). Results Preoperative data was comparable between two groups. The postoperative proximal thoracic (PT) curve, main thoracic (MT) curve, thoracolumbar/lumbar (TL/L) curve, and apical vertebral rotation were significantly improved compared with the preoperative data. The coronal correction rates in group A and B were 83% and 81.9%, respectively (P > 0.05). The derotation rates in group A and B were 60.8% and 43.2%, respectively (P < 0.05). The rotation classification in the group A was also better compared with the group B. The misplacement rate in group A and B was 7.9% and 11.8%, respectively (P < 0.05), and the total misplacement rate on the concave side (11.4%) was higher than that of convex side (8.4%). The lateral perforation was found at the concave side, while the medial perforation was found at the convex side. On the concave side, the misplacement rate in group A and B was 9.7% and 12.3%, respectively (P < 0.05). The grades 2 and 3 perforations were three (3.5%) in the group A and eight (8.2%) in the group B (P < 0.05). On the convex side, the misplacement rate in group A and B was 5.9% and 11.1%, respectively (P < 0.05). The grades 2 and 3 perforations were one (0.9%) in the group A and four (4.4%) in the group B (P < 0.05). Conclusion Collectively, uniplanar cannulated pedicle screws could effectively increase the accuracy of pedicle screws and facilitate the derotation of the apical vertebra compared with the multiaxial pedicle screws. Trial registration retrospectively registered

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Monaxial Versus Multiaxial Thoracic Pedicle Screws in the Correction of Adolescent Idiopathic Scoliosis

Spine ◽

10.1097/01.brs.0000179260.73267.f4 ◽

2005 ◽

Vol 30 (18) ◽

pp. 2113-2120 ◽

Cited By ~ 81

Author(s):

Timothy R. Kuklo ◽

Benjamin K. Potter ◽

David W. Polly ◽

Lawrence G. Lenke

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Pedicle Screws ◽

Thoracic Pedicle Screws

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PHOTOGRAMMETRY: A PROPOSAL OF OBJECTIVE ASSESSMENT OF CHEST WALL IN ADOLESCENT IDIOPATHIC SCOLIOSIS

Revista Paulista de Pediatria ◽

10.1590/1984-0462/;2019;37;2;00001 ◽

2019 ◽

Vol 37 (2) ◽

pp. 225-233

Author(s):

Anderson Sales Alexandre ◽

Evandro Fornias Sperandio ◽

Liu Chiao Yi ◽

Josy Davidson ◽

Patrícia Rios Poletto ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Lung Function ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Chest Wall ◽

Healthy Subjects ◽

Objective Assessment ◽

Spine Deformity ◽

Xiphoid Process ◽

Cross Sectional

ABSTRACT Objective: To evaluate the chest wall shape in patients with adolescent idiopathic scoliosis (AIS) in comparison to healthy subjects and the association between the chest wall shape with the spine deformity and lung function in patients with AIS. Methods: This cross-sectional study enrolled 30 AIS patients and 20 healthy subjects aged 11-18 years old. The Cobb angle evaluation was performed in AIS patients. The chest wall shape was assessed by the photogrammetry method, using the Postural Assessment Software (PAS). We created thoracic markers shaped as angles (A) and distances (D), as follows: A2 (right acromion/xiphoid/left acromion), A4L (angle formed between the outer point of the smallest waist circumference and its upper and lower edges on the left side), A7 (angle formed by the intersection of the tangent segments of the upper and lower scapulae angles), D1R/D1L [distance between the xiphoid process and the last false rib on the right (R) and left (L) sides], and D3 (distance between xiphoid process and anterior superior iliac spine). Results: The thoracic markers A2 and A7 were significantly higher, while the A4L and D1R/D1L were significantly reduced in the AIS group compared to the control. Moderate correlations were found between: A2 and the main and proximal thoracic Cobb angles (r=0.50, r=0.47, respectively); D1R/D1L and the main thoracic Cobb angle (r=- 0.40); and the forced expiratory volume in the first second (FEV1) and D3R (r=0.47). Conclusions: The photogrammetry method was able to detect chest wall changes in AIS patients, besides presenting correlation between Cobb angles and lung function.

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Does quality of exercises affect results in adolescent idiopathic scoliosis treatment to avoid braces? SEAS.02 results at two years

Scoliosis ◽

10.1186/1748-7161-2-s1-s8 ◽

2007 ◽

Vol 2 (Suppl 1) ◽

pp. S8 ◽

Cited By ~ 2

Author(s):

Michele Romano ◽

Stefano Negrini ◽

Fabio Zaina ◽

Alessandra Negrini ◽

Silvana Parzini

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Scoliosis Treatment

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Adolescent idiopathic scoliosis detection and referral trends: impact treatment options

Spine Deformity ◽

10.1007/s43390-020-00182-6 ◽

2020 ◽

Vol 9 (1) ◽

pp. 75-84

Author(s):

Alison Anthony ◽

Reinhard Zeller ◽

Cathy Evans ◽

Jennifer A. Dermott

Keyword(s):

Family History ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Geographic Location ◽

Initial Assessment ◽

Brace Treatment ◽

Level Of Evidence ◽

Cross Sectional ◽

Curve Magnitude

Abstract Study design Retrospective cross-sectional study. Objective To analyze the patient demographic referred for scoliosis to the Hospital for Sick Children to determine the proportion of patients suitable for brace treatment, as per the Scoliosis Research Society guidelines. Summary of background data There is level 1 evidence that bracing in adolescent idiopathic scoliosis (AIS) decreases the risk of curve progression and need for surgery, but optimal brace treatment requires early curve detection. Methods We performed a retrospective review of 618 consecutive patients who underwent initial assessment in our Spine Clinic between Jan. 1 and Dec. 31, 2014. We included children 10–18 years, with scoliosis greater than 10°, excluding those diagnosed with non-idiopathic curves. Primary outcomes were Cobb angle, menarchal status, and Risser score. We analyzed the effect of specific referral variables (family history, the person who first noticed the curve, and geographic location of residence) on presenting curve magnitude. Results During the study period, 335 children met the inclusion criteria, with an average age of 14.1 ± 1.8 years and a mean Cobb angle of 36.8 ± 14.5°. Brace treatment was indicated in 17% of patients; 18% had curves beyond optimal curve range for bracing (> 40°), and 55% were skeletally mature, therefore not brace candidates. The majority of curves (54%) were first detected by the patient or family member and averaged 7° more than curves first detected by a physician. A family history of scoliosis made no difference to curve magnitude, nor did geographic location of residence. Conclusion The majority of AIS patients present too late for effective management with bracing. Level of evidence III.

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Prognostic Factors of Thoracic Hypokyphosis after Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis using by All Pedicle Screws Instrumentation

Global Spine Journal ◽

10.1055/s-0036-1582680 ◽

2016 ◽

Vol 6 (1_suppl) ◽

pp. s-0036-1582680-s-0036-1582680

Author(s):

Perez Vergara Silvia ◽

Rubio Belmar Pedro ◽

Bas Hermida Teresa ◽

Bas Hermida Paloma

Keyword(s):

Prognostic Factors ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Pedicle Screws ◽

Posterior Spinal Fusion

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Comparative analysis of pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.185510 ◽

2016 ◽

Vol 7 (04) ◽

pp. 550-553 ◽

Cited By ~ 4

Author(s):

Sohail Rafi ◽

Naseem Munshi ◽

Asad Abbas ◽

Rabia Hassan Shaikh ◽

Imtiaz Hashmi

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Pedicle Screw ◽

Pedicle Screws ◽

Scoliosis Surgery ◽

Hybrid Instrumentation ◽

System Versus ◽

Cobb’S Angle

ABSTRACT Introduction: Adolescent idiopathic scoliosis is the most common type of scoliosis. A Cobb angle of 50° will progress beyond the age of spinal maturity. Surgery over bracing is advised at a Cobb angle above or equal to 50°. The aim of surgery is to bring the Cobb angle down below 50° to prevent reprogression as well as improve the quality of life. The objective of the study is to analyze the efficacy and significance in lifestyle improvement of pedicle screw-only fixation system versus the more common hybrid instrumentation system used for the surgical treatment of adolescent idiopathic scoliosis. Materials and Methods: A prospective cohort study was conducted involving two groups of patients were included in the study. One group was operated with pedicle screw-only method while the other with hybrid instrumentation system. The pre- and post-operative Cobb’s angles were taken across a follow-up of 4 years. An SRS-30 questionnaire was given in a yearly follow-up to assess the lifestyle improvement of the patient. Results: Pedicle screw-only method was significantly more effective in reducing Cobb’s angle (P = 0.0487). It was showed less loss of correction (P = 0.009) pedicle screw-only surgery was also better at reducing thoracic curves (P = 0.001). There seemed a better recovery time with pedicle screw surgery (P = 0.003). Conclusion: Pedicle screws are more effective and durable than hybrid systems at when treating adolescent idiopathic scoliosis.

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