Estimating pulmonary function after surgery for adolescent idiopathic scoliosis using biplanar radiographs of the chest with 3D reconstruction

2022 ◽  
Vol 104-B (1) ◽  
pp. 112-119
Author(s):  
Raphaël Pietton ◽  
Houssam Bouloussa ◽  
Tristan Langlais ◽  
Jessica Taytard ◽  
Nicole Beydon ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pulmonary Function ◽  
3D Reconstruction ◽  
Cobb Angle ◽  
Vital Capacity ◽  
Surgical Correction ◽  
Rib Cage ◽  
Biplanar Radiographs ◽  
Before And After

Aims This study addressed two questions: first, does surgical correction of an idiopathic scoliosis increase the volume of the rib cage, and second, is it possible to evaluate the change in lung function after corrective surgery for adolescent idiopathic scoliosis (AIS) using biplanar radiographs of the ribcage with 3D reconstruction? Methods A total of 45 patients with a thoracic AIS which needed surgical correction and fusion were included in a prospective study. All patients underwent pulmonary function testing (PFT) and low-dose biplanar radiographs both preoperatively and one year after surgery. The following measurements were recorded: forced vital capacity (FVC), slow vital capacity (SVC), and total lung capacity (TLC). Rib cage volume (RCV), maximum rib hump, main thoracic curve Cobb angle (MCCA), medial-lateral and anteroposterior diameter, and T4-T12 kyphosis were calculated from 3D reconstructions of the biplanar radiographs. Results All spinal and thoracic measurements improved significantly after surgery (p < 0.001). RCV increased from 4.9 l (SD 1) preoperatively to 5.3 l (SD 0.9) (p < 0.001) while TLC increased from 4.1 l (SD 0.9) preoperatively to 4.3 l (SD 0.8) (p < 0.001). RCV was correlated with all functional indexes before and after correction of the deformity. Improvement in RCV was weakly correlated with correction of the mean thoracic Cobb angle (p = 0.006). The difference in TLC was significantly correlated with changes in RCV (p = 0.041). It was possible to predict postoperative TLC from the postoperative RCV. Conclusion 3D rib cage assessment from biplanar radiographs could be a minimally invasive method of estimating pulmonary function before and after spinal fusion in patients with an AIS. The 3D RCV reflects virtual chest capacity and hence pulmonary function in this group of patients. Cite this article: Bone Joint J 2022;104-B(1):112–119.

The Effect of Surgical Correction for Increased Cobb Angle and Sagittal Contour on Thoracic Volume in Adolescent Idiopathic Scoliosis

2014 ◽  
Vol 14 (11) ◽  
pp. S159
Author(s):  
Charles Gerald T. Ledonio ◽  
Jennifer Wozniczka ◽  
David W. Polly ◽  
Ben Rosenstein ◽  
David J. Nuckley
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Surgical Correction

scholarly journals EFFECTS OF SCHROTH EXERCISE ON COBB’S ANGLE, VITAL CAPACITY AND THE IMPROVEMENT OF DAILY ACTIVITIES ON PATIENTS WITH ADOLESCENT IDIOPATHIC SCOLIOSIS

2021 ◽  
Vol 8 (2) ◽  
pp. 1-4
Author(s):  
Ajsel Oseku ◽  
◽  
Surven Metolli ◽  
Keyword(s):  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Vital Capacity ◽  
Exercise Program ◽  
Daily Activities ◽  
Risser Sign ◽  
Trunk Inclination ◽  
Idiopathic Adolescent Scoliosis ◽  
Before And After ◽  
Cobb’S Angle

The aim of this study was to investigate the effects of Schroth exercise on Cobb's angle, vital capacity as well as the improvement of daily activities on patients with idiopathic adolescent scoliosis. Forty patients with idiopathic scoliosis with a Cobb thoracic vertebral angle of 15-30 degrees or higher and the Risser sign stage 3 or higher. The Schroth exercise was applied 3 times a week for 12 weeks. We measured the chest trunk inclination, Cobb angle and vital capacity before and after exercise program. A comprehensive search for all published review articles for spinal deformity was undertaken on PubMed, PEDRO, Google Scholar, Physiopedia up to December 2018. All full-text articles reporting evaluation, validation, surgical, orthotic, and/or physiotherapeutic scoliosis specific exercises (PSSE) treatment outcomes of these spinal deformities were retrieved and analyzed by us and methodology for functional assessment of patients with AIS was developed. Forty patients with idiopathic scoliosis with a Cobb thoracic vertebral angle of 15-30 degrees or higher and the Risser sign stage 3 or higher. The Schroth exercise was applied 3 times a week for 12 weeks. We measured the chest trunk inclination, Cobb angle and vital capacity before and after exercise program. For a period of 12 weeks we accessed adolescents with AIS. All adolescents make Schroth PSSE. The analysis of the results confirms the positive effect of the PSSE to improve muscle endurance, balance and correction of the scoliosis. Within a month from the beginning, patients reported no back pain and within 2 months – a respiratory improvement, an enlargement of the chest, a reduced Cobb angle, an increased vital capacity. PSSE seem to have positive effects by reducing the symptoms and improving functions and body asymmetries. Schroth method is effective of preventing the scoliosis’ progression. The conservative method of treating scoliosis was found to be effective even at a Cobb angle of 35 degrees or higher. In the future, universal methods of approaching exercises and preventive training for the treatment of scoliosis needs to be further developed.

scholarly journals The influence of early thoracic fusion on the pulmonary function of patients with idiopathic scoliosis in the early period of the second growth peak with different Risser signs

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xiaolin Xu ◽  
Shengru Wang ◽  
Yang Yang ◽  
You Du ◽  
Guanfeng Lin ◽  
...  
Keyword(s):  
Idiopathic Scoliosis ◽  
Pulmonary Function ◽  
Thoracic Kyphosis ◽  
Vital Capacity ◽  
Early Period ◽  
Forced Expiratory Volume ◽  
Risser Sign ◽  
Second Growth ◽  
Before And After

Abstract Background Previous reports confirmed early spinal fusion may compromise pulmonary function and thoracic development in skeletal immature patients with scoliosis. However, the different effects in patients with various Risser signs remain unknown. This study aimed to compare the influence of early thoracic fusion on pulmonary function and thoracic growth in patients with idiopathic scoliosis (IS) with closed triangular cartilage (TRC) and different Risser signs. Methods Thirty-six patients with IS and a closed TRC were retrospectively selected and divided into the low Risser (LR, Risser sign ≤2, 22 patients) and high Risser (HR, 2<Risser sign≤4, 14 patients) groups. Patient age, Risser sign, main Cobb angle, thoracic kyphosis, and fusion levels were recorded. Perioperative and minimum of 2-year follow-up pulmonary function and thoracic diameters were compared between both groups. Results There were no differences in patients’ general characteristics between two groups. The preoperative forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were 2.06±0.43 L and 2.50±0.49 L, respectively, in the LR group, and 2.31±0.49 L (p = 0.067) and 2.74±0.56 L (p = 0.122), respectively, in the HR group. While these values significantly increased postoperatively, to 2.62±0.46 L (p < 0.001) and 3.09±0.69 L (p < 0.001), in the LR group, they remained unchanged in the HR group [2.53±0.56 L (p = 0.093) and 2.70±0.98 L (p = 0.386), respectively]. The FEV1/FVC in both groups was >80% before and after surgery. The T1-T12 and anteroposterior thoracic diameter significantly increased after surgery in both groups, while the maximum inner chest diameter only increased in the LR group at the final follow-up. However, there were no significant differences in respiratory function and thoracic data between both groups. Conclusion For patients with IS, early fusion did not deteriorate pulmonary function or thoracic development in TRC-closed patients whose Risser sign was ≤2 compared with those with a Risser sign >2.

scholarly journals Effectiveness and Safety of Surgical Interventions for Treating Adolescent Idiopathic Scoliosis: a Bayesian Meta-analysis

2020 ◽  
Author(s):  
Long Chen ◽  
Zeyu Sun ◽  
Jingming He ◽  
Yunwen Xu ◽  
Zhuhai Li ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pulmonary Function ◽  
Cobb Angle ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Practical Recommendation ◽  
Surgical Interventions ◽  
Post Operation

Abstract Background Adolescent idiopathic scoliosis (AIS) is the most common form of spinal deformity in children and adolescents which presents as complex three-dimensional (3D) deformity of the spine and rib cage. This study aimed to estimate the effectiveness and safety of surgical interventions for AIS using Bayesian meta-analysis.Methods The PubMed, EMBASE, and Cochrane Controlled Register of Trials were searched through Oct 1, 2019, without language restrictions. Relevant studies evaluating combined effectiveness and safety of surgical interventions for AIS were included according to eligibility criteria. The primary outcome measures included pulmonary function (change of absolute forced vital capacity and forced expiratory volume in one second from pre-operation to post-operation) and incidence of complications. The secondary outcome measure was change of Cobb angle from pre-operation to post-operation. Data was pooled using a random effects model in pairwise meta-analysis. Bayesian meta-analysis combined direct and indirect evidence using a Bayesian framework.Results 28 case-controlled studies with totally 1970 participants were included. This Bayesian meta-analysis combining direct and indirect evidences indicated that posterior fusion with instrumentation without thoracoplasty (PSF) had the highest probability to achieve better pulmonary function and lower complication rate; video assisted anterior fusion with instrumentation without thoracoplasty (VAT) had the highest probability to obtain better Cobb angle correction based on analysis of rank probability.Conclusion This Bayesian meta-analysis gives a practical recommendation of PSF as a primary surgical treatment for AIS. The results also support statistics that current surgeries adopted more PSF but less open anterior approach surgery and thoracoplasty. More research work is required to address the effectiveness and safety of VAT for treating AIS more convincingly.

Upper instrumented vertebra to the right of the lowest instrumented vertebra as a predictor of an increase in the main thoracic curve after selective posterior fusion for the thoracolumbar/lumbar curve in Lenke type 5C adolescent idiopathic scoliosis: multicenter study on the relationship between fusion area and surgical outcome

2019 ◽  
Vol 31 (6) ◽  
pp. 857-864 ◽  
Author(s):  
Hiroki Oba ◽  
Jun Takahashi ◽  
Sho Kobayashi ◽  
Tetsuro Ohba ◽  
Shota Ikegami ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Posterior Fusion ◽  
Main Thoracic ◽  
Lowest Instrumented Vertebra ◽  
Line Tilt ◽  
The Right ◽  
Upper Instrumented Vertebra

OBJECTIVEUnfused main thoracic (MT) curvatures occasionally increase after selective thoracolumbar/lumbar (TL/L) fusion. This study sought to identify the predictors of an unacceptable increase in MT curve (UIMT) after selective posterior fusion (SPF) of the TL/L curve in patients with Lenke type 5C adolescent idiopathic scoliosis (AIS).METHODSForty-eight consecutive patients (44 females and 4 males, mean age 15.7 ± 2.5 years, range 13–24 years) with Lenke type 5C AIS who underwent SPF of the TL/L curve were analyzed. The novel “Shinshu line” (S-line) was defined as a line connecting the centers of the concave-side pedicles of the upper instrumented vertebra (UIV) and lowest instrumented vertebra (LIV) on preoperative radiographs. The authors established an S-line tilt to the right as S-line positive (S-line+, i.e., the UIV being to the right of the LIV) and compared S-line+ and S-line− groups for thoracic apical vertebral translation (T-AVT) and MT Cobb angle preoperatively, early postoperatively, and at final follow-up. The predictors for T-AVT > 20 mm at final follow-up were evaluated as well. T-AVT > 20 mm was defined as a UIMT.RESULTSAmong the 48 consecutively treated patients, 26 were S-line+ and 22 were S-line−. At preoperative, early postoperative, and final follow-up a minimum of 2 years later, the mean T-AVT was 12.8 mm (range −9.3 to 32.8 mm), 19.6 mm (range −13.0 to 41.0 mm), and 22.8 mm (range −1.9 to 68.7 mm) in the S-line+ group, and 10.8 mm (range −5.1 to 27.3 mm), 16.2 mm (range −11.7 to 42.1 mm), and 11.0 mm (range −6.3 to 26.9 mm) in the S-line− group, respectively. T-AVT in S-line+ patients was significantly larger than that in S-line− patients at the final follow-up. Multivariate analysis revealed S-line+ (odds ratio [OR] 23.8, p = 0.003) and preoperative MT Cobb angle (OR 7.9, p = 0.001) to be predictors of a UIMT.CONCLUSIONSS-line+ was defined as the UIV being to the right of the LIV. T-AVT in the S-line+ group was significantly larger than in the S-line− group at the final follow-up. S-line+ status and larger preoperative MT Cobb angle were independent predictors of a UIMT after SPF for the TL/L curve in patients with Lenke type 5C AIS. Surgeons should consider changing the UIV and/or LIV in patients exhibiting S-line+ during preoperative planning to avoid a possible increase in MT curve and revision surgery.

scholarly journals Sagittal profile modifications in hybrid versus all screw technique in adolescent idiopathic scoliosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Laura Scaramuzzo ◽  
Antonino Zagra ◽  
Giuseppe Barone ◽  
Stefano Muzzi ◽  
Leone Minoia ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Thoracic Kyphosis ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Sagittal Profile ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Lenke Classification

AbstractAim of the study was to evaluate sagittal parameters modifications, with particular interest in thoracic kyphosis, in patients affected by adolescent idiopathic scoliosis (AIS) comparing hybrid and all-screws technique. From June 2010 to September 2018, 145 patients were enrolled. Evaluation included: Lenke classification, Risser scale, coronal Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS). Patients were divided in two groups (1 all-screws and 2 hybrid); a further division, in both groups, was done considering preoperative TK values. Descriptive and inferential statistical analysis was conducted. 99 patients were in group 1, 46 in group 2 (mean follow-up 3.7 years). Patients with a normo-kyphotic profile developed a little variation in TK (Δ pre–post = 2.4° versus − 2.0° respectively). Hyper-kyphotic subgroups had a tendency of restoring a good sagittal alignment. Hypo-kyphotic subgroups, patients treated with all-screw implants developed a higher increase in TK mean Cobb angle (Δ pre–post = 10°) than the hybrid subgroup (Δ pre–post = 5.4°) (p = 0.01). All-screws group showed better results in restoring sagittal alignment in all subgroups compared to hybrid groups, especially in hypo-TK subgroup, with the important advantage to give better correction on coronal plane.

Sign in / Sign up

Export Citation Format

Share Document