Gerinckorrekciós műtétek háromdimenziós hatékonysági vizsgálata serdülőkori idiopathiás gerincferdülésben

Összefoglaló. Bevezetés: Nincs egységesen elfogadott álláspont, hogy a serdülőkori idiopathiás gerincferdülés sebészi korrekcióját melyik életkorban optimális elvégezni. Világszerte 11 éves kortól akár (kezeletlen esetben) 50–60 éves korig végeznek fúziós műtétet a betegségben, 63–83%-os átlagos koronális síkú korrekciós hatékonysággal. Célkitűzés: Célul tűztük ki, hogy felmérjük a gerinckorrekciós műtétek hatékonyságát három dimenzióban, illetve a páciens életkorának függvényében. Módszerek: A vizsgálatba 23, serdülőkori idiopathiás gerincferdüléssel diagnosztizált beteget (12 fő 17 évnél fiatalabb, 11 fő 17 évnél idősebb) vontunk be. Minden betegnél csavaros derotációt és spondylodesist végeztünk, és a beavatkozás előtt és után EOS 2D/3D felvételeket, majd sterEOS 3D rekonstrukciókat készítettünk. A következő paramétereket számítottuk: Cobb-fok, háti kyphosis, ágyéki lordosis, apicalis csigolyarotáció, maximális csigolyarotáció. A különböző életkorú csoportok közötti különbséget kétmintás t-próbával, illetve Wilcoxon-féle próbával vizsgáltuk. Eredmények: A gerinckorrekciós műtétek során a koronális síkú eltérést 78,2%-ban (átlagosan 55,1 Cobb-fokról 12,0 Cobb-fokra), az apicalis csigolyarotációt 56,7%-ban (átlagosan 21,0 fokról 9,1 fokra) tudtuk korrigálni. A 17 éves életkor után operált páciensek esetén átlagosan 79,2%-os Cobb-fok-csökkenést értünk el, míg a fiatalabb betegcsoportban 77,0%-ban korrigáltuk a koronális főgörbületet (p = 0,614). Az idősebb betegcsoportban szignifikánsan kevésbé sikerült az apicalis csigolyarotáció korrekciója (átlagosan 38,1%; 21,8 fokról 12,4 fokra), mint a fiatalabb pácienseknél (átlagosan 68,5%; 20,2 fokról 6,2 fokra; p = 0,016). Következtetés: Összességében a nemzetközi publikációknak megfelelő korrekciót értünk el. A koronális síkban közel azonos korrekciós hatékonyság figyelhető meg a különböző életkorú betegcsoportok között, a csigolyarotáció azonban 17 éves életkor előtt hatékonyabban korrigálható. Orv Hetil. 2021; 162(39): 1573–1578. Summary. Introduction: There is no clear recommendation for the optimal age to perform corrective surgery in adolescent idiopathic scoliosis. Fusion surgery is performed from the age of 11 to 50–60 years, with an average coronal plane correction efficiency of 63–83%. Objective: We aimed to evaluate the effectiveness of correction surgeries in three dimensions in adolescent idiopathic scoliosis. In addition, our objective was to examine the influence of the patient’s age on the correction. Methods: The study included 23 patients with adolescent idiopathic scoliosis (12 patients younger than 17 years, 11 patients older than 17 years). All patients underwent screw-derotation and spondylodesis and underwent EOS 2D/3D imaging before and after the operation, followed by sterEOS 3D reconstructions. The following parameters were calculated: Cobb degree, thoracic kyphosis, lumbar lordosis, apical vertebral rotation, maximal vertebral rotation. Differences between different age groups were examined by paired-sample t-test and Wilcoxon rank sum test. Results: The mean efficiency of correction surgeries was 78.2% in the coronal plane (from an average of 55.1 Cobb degrees to 12.0 Cobb degrees) and 56.7% in the axial plane (from an average of 21.0 degrees to 9.1 degrees). We achieved an average 79.2% reduction of Cobb angle in patients operated after the age of 17 years, which was 77.0% in the younger group (p = 0.614). Apical vertebral rotation correction was significantly less successful in the elderly group (mean 38.1%; from 21.8 degrees to 12.4 degrees) than in patients operated before the age of 17 years (mean 68.5%; from 20.2 degrees to 6.2 degrees; p = 0.016). Conclusion: We achieved scoliosis correction in line with the international publications. Nearly the same correction efficiency was observed between different age groups of patients in the coronal plane. However, vertebral rotation can be derotated more effectively before the age of 17 years. Orv Hetil. 2021; 162(39): 1573–1578.

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RADIOGRAPHIC PARAMETERS OF SPINE CORONAL PLANE BEFORE AND AFTER THE SURGICAL ADOLESCENT IDIOPATHIC SCOLIOSIS CORRECTION

Medicinos teorija ir praktika ◽

10.15591/mtp.2016.022 ◽

2016 ◽

Vol 22 (2) ◽

pp. 152-157

Author(s):

Kęstutis Saniukas ◽

Giedrius Bernotavičius ◽

Irena Karmonaitė ◽

Rimantas Zagorskis

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Coronal Plane ◽

Microsoft Excel ◽

Radiographic Parameters ◽

Scoliosis Correction ◽

Before And After

Reikšminiai žodžiai: koronarinis balansas, jaunatvinė idiopatinė skoliozė, žemiausio fiksuoto slankstelio nuokrypis, viršūninio slankstelio pasivertimas, Kobo kampas. Skoliozė – tai trijų dimensijų stuburo deformacija, apibūdinama kaip šoninis stuburo iškrypimas koronarinėje plokštumoje daugiau kaip 10°. Operacinis gydymas rekomeduojamas jaunuoliams, kai Kobo kampas viršija 45°–50°. Chirurginio gydymo esmė – saugi derotacija, lemianti stuburo balanso atkūrimą, o ne maksimali stuburo korekcija koronarinėje plokštumoje. Tikslas. Įvertinti radiologinius stuburo koronarinės plokštumos parametrus prieš ir po chirurginio jaunatvinės idiopatinės skoliozės (Lenke 1 tipo) gydymo. Tyrimo medžiaga ir metodai. Tiriamieji – 46 pacientai, chirurgiškai gydyti dėl jaunatvinės idiopatinės skoliozės (Lenke 1 tipo) bei stebėti 2 metus. Visi operuoti vienoje ligoninėje. Dviejų krypčių rentgenogramos stovint buvo atliktos prieš operaciją ir iškart po jos bei praėjus 1,3 mėnesio ir 2 metams po operacijos. Naudojantis jomis ir norint įvertinti stuburo išsilyginimą koronarinėje plokštumoje, buvo apskaičiuotas Kobo kampas, koronarinis balansas ir šoninio lenkimo testo, kuris atliktas tik prieš operaciją, rezultatai. Norint įvertinti nefiksuotų slankstelių pokyčius po operacijos, vertintas žemiausio fiksuoto slankstelio kampas ir viršutinis viršūninio slankstelio pasivertimas. Duomenys apdoroti SAS ir „Microsoft Excel 2013“ programomis. Rezultatai. 40 moterų ir 6 vyrai, sergantys jaunatvine idiopatine skolioze, buvo įtraukti į šią studiją. Vidutinis pacientų amžius – 14,1 metų. Vidutinė korekcija po operacijos krūtininėje stuburo dalyje buvo 32,76° (santykinė korekcija 65,04 proc.), juosmeninėje – 27,41° (69,66 proc.). Per dvejus metus po operacijos buvo prarasta 0,27° ± 4,52° (tai 1,53 proc. pasiektos korekcijos, p < 0,05) pasiektos krūtininėje stuburo dalyje bei 1,61° ± 5,55° (13,48 proc., p < 0,05) juosmeninėje. Korekcija krūtininėje stuburo dalyje buvo 38,85 proc. didesnė (p < 0,05) nei prognozuota pagal šoninio lenkimo testo rezultatus. Koronarinis balansas buvo pagerintas 3,62 mm pacientų su subalansuotu stuburu prieš operaciją grupėje, bet suprastėjo 7,67 mm pacientų, prieš operaciją buvusių su subalansuotu stuburu, grupėje. Buvo rasta silpna koreliacija (rs = 0.34668 ir p-valu = 0.0183) tarp žemiausio fiksuoto slankstelio kampo bei nefiksuotų slankstelių skaičiaus. Išvados. Pooperacinės Lenke 1 tipo skoliozės gydymo išeitys negali būti nustatytos pagal linkio kryptį. Laikotarpiu po operacijos dalis per operaciją pasiektos korekcijos prarandama, žymiau tai pastebima juosmeninėje stuburo dalyje. Matuoti koronarinį balansą iš karto po operacijos nėra būtinybės, nes tai kliniškai nėra svarbu. Fiksuotas segmentas virš nefiksuoto segmento gali pakeisti nefiksuoto segmento biomechaniką. Šoninio lenkimo testas galėtų turėti vertės prognozuojant būsimos operacijos rezultatus juosmeninėje dalyje, tačiau krūtininėje dalyje šis testas prognostiškai nepatikimas, nes pasiekiama didesnė, nei tikėtasi, korekcija.

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Is There a Correlation between the Apical Vertebral Rotation and the Pelvic Incidence in Adolescent Idiopathic Scoliosis?

Global Spine Journal ◽

10.1055/s-0036-1583044 ◽

2016 ◽

Vol 6 (1_suppl) ◽

pp. s-0036-1583044-s-0036-1583044

Author(s):

Khalil Kharrat ◽

Amer Sebaaly ◽

Ayman Assi ◽

Ismat Ghanem ◽

Rami Rachkidi

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Pelvic Incidence ◽

Vertebral Rotation ◽

Apical Vertebral Rotation

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Adolescent Idiopathic Scoliosis. Correction of Vertebral Rotation with Use of Wisconsin Segmental Spinal Instrumentation*

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-199611000-00011 ◽

1996 ◽

Vol 78 (11) ◽

pp. 1707-12 ◽

Cited By ~ 12

Author(s):

J. G. JARVIS ◽

R. N. GREENE

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Instrumentation ◽

Vertebral Rotation ◽

Scoliosis Correction

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Concave or convex rod translation first in adolescent idiopathic scoliosis instrumentation with differential rod contouring?

Studies in Health Technology and Informatics - Research into Spinal Deformities 9 ◽

10.3233/shti210455 ◽

2021 ◽

Author(s):

X Wang ◽

CE Aubin ◽

RM Schwend

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Thoracic Kyphosis ◽

Deformity Correction ◽

Vertebral Rotation ◽

Convex Side ◽

Bone Screw ◽

Apical Vertebral Rotation ◽

Clinically Significant

The objective was to assess deformity correction and bone-screw force associated respectively with concave manipulation first, convex manipulation first, and different differential rod contouring configurations. Instrumentation scenarios were computationally simulated for 10 AIS cases with mean thoracic Cobb angle (MT) of 54±8°, apical vertebral rotation (AVR) of 19±2° and thoracic kyphosis of 21±9°. Instrumentations with major correction maneuvers using the concave side rod were first simulated; instrumentations with major correction maneuvers using the convex side rod were then simulated. Simulated correction maneuvers were concave/convex rod translation followed by apical vertebral derotation and then convex/concave rod translation. There were no significant differences in deformity corrections and bone-screw forces between concave rod translation first and convex rod translation first with differential rod contouring. Increasing differential rod contouring angle and concave rod diameter improved AVR correction and increased the TK and bone-screw forces; the effect on the MT Cobb angle was not clinically significant.

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Fixed lumbar apical vertebral rotation predicts spinal decompensation in lenke type 3c adolescent idiopathic scoliosis after selective posterior thoracic correction and fusion

European Spine Journal ◽

10.1007/s00586-007-0397-8 ◽

2007 ◽

Vol 16 (10) ◽

pp. 1570-1578 ◽

Cited By ~ 25

Author(s):

Hannes Behensky ◽

Ashley A. Cole ◽

Brian J. C. Freeman ◽

Michael P. Grevitt ◽

Hossein S. Mehdian ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Vertebral Rotation ◽

Apical Vertebral Rotation

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Intraoperative Computed Tomography versus Perdriolle and Scoliometer Evaluation of Spine Rotation in Adolescent Idiopathic Scoliosis

BioMed Research International ◽

10.1155/2015/460340 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Rafal Pankowski ◽

Szymon Wałejko ◽

Marek Rocławski ◽

Marcin Ceynowa ◽

Tomasz Mazurek

Keyword(s):

Computed Tomography ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Scoliosis Surgery ◽

Significant Discrepancy ◽

Indirect Methods ◽

Rib Hump ◽

Intraoperative Computed Tomography ◽

Scoliosis Correction ◽

Before And After

Numerous indirect methods for apical vertebral rotation (AVR) measurement have been reported and none of them seems to be as accurate as computed tomography evaluation. The aim of this study was to compare spinal rotation changes during innovative technique of intraoperative computed tomography (ICT) evaluation with indirect methods such as Perdriolle and clinical evaluation with scoliometer. We examined 42 adolescent idiopathic scoliosis (AIS) patients treated with posterior scoliosis surgery (PSS). The mean age at the time of surgery was 16 years. ICT evaluation was performed before and after scoliosis correction in prone position. Clinical rib hump measure with scoliometer and radiographic Perdriolle were performed before and after surgery. There was 71,5% of average rib hump correction with scoliometer but only 31% of correction with ICT (P=0,026) and there was no significant correlation between them (R=0,297,p=0,26). Mean postcorrectional Perdriolle AVR had a decrease of 16,5°. The average ICT AVR had a decrease of only 1,2° (P=0,003). There was no significant statistic correlation between ICT and Perdriolle AVR evaluation (R=0,297,p=0,2). There is a significant discrepancy in AVR and rib hump assessment between scoliometer and Perdriolle methods and ICT evaluation, which seems to be the most accurate tool for spinal derotation measurement.

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Is the apical vertebra the most rotated vertebra in the scoliotic curve?

Journal of Neurosurgery Spine ◽

10.3171/2019.6.spine19203 ◽

2019 ◽

Vol 31 (6) ◽

pp. 873-879

Author(s):

Chris Labaki ◽

Joeffroy Otayek ◽

Abir Massaad ◽

Ziad Bakouny ◽

Mohammad Karam ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Significant Proportion ◽

Vertebral Rotation ◽

Scoliotic Curve ◽

3D Reconstructions ◽

Apical Vertebra ◽

Multinomial Models ◽

Apical Vertebral Rotation ◽

The Difference

OBJECTIVEThe aim of this study was to determine if the apical vertebra (AV) in patients with adolescent idiopathic scoliosis (AIS) is the most rotated vertebra in the scoliotic segment.METHODSA total of 158 patients with AIS (Cobb angle range 20°–101°) underwent biplanar radiography with 3D reconstructions of the spine and calculation of vertebral axial rotations. The type of major curvature was recorded (thoracic, thoracolumbar, or lumbar), and both major and minor curvatures were included. The difference of levels (DL) between the level of maximal vertebral rotation (LMVR) and the AV was calculated as follows: DL = 0 if LMVR and AV were the same, DL = 1 if LMVR was directly above or below the AV, and DL = 2 if LMVR was separated by 1 vertebra or more from the AV. To investigate which factors explained the divergence of the LMVR from the AV, multinomial models were computed.RESULTSThe distribution of the DL was as follows: for major curvatures, 143 were DL = 0, 11 were DL = 1, and 4 were DL = 2; and for minor curvatures, 53 were DL = 0, 9 were DL = 1, and 31 were DL = 2. The determinants of a DL = 2 (compared with DL = 0) were lumbar curvature (compared with thoracic; adjusted OR 0.094, p = 0.001), major curvature (compared with minor; adjusted OR 0.116, p = 0.001), and curvatures with increasing apical vertebral rotation (adjusted OR 0.788, p < 0.001).CONCLUSIONSThis study showed that the AV is the most rotated vertebra in the majority of major curvatures, while in minor curvatures, the most rotated vertebra appears to be the junctional vertebra between major and minor curvatures in a significant proportion of cases.

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The Relationship Between Apical Vertebral Rotation and Truncal Rotation in Adolescent Idiopathic Scoliosis Using 3D Reconstructions

Spine Deformity ◽

10.1016/j.jspd.2017.10.003 ◽

2018 ◽

Vol 6 (3) ◽

pp. 213-219 ◽

Cited By ~ 1

Author(s):

Pawel P. Jankowski ◽

Burt Yaszay ◽

Krishna R. Cidambi ◽

Carrie E. Bartley ◽

Tracey P. Bastrom ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Vertebral Rotation ◽

3D Reconstructions ◽

Apical Vertebral Rotation ◽

The Relationship

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The effectiveness of core stabilization exercise in adolescent idiopathic scoliosis: A randomized controlled trial

Prosthetics and Orthotics International ◽

10.1177/0309364616664151 ◽

2016 ◽

Vol 41 (3) ◽

pp. 303-310 ◽

Cited By ~ 13

Author(s):

Gözde Gür ◽

Cigdem Ayhan ◽

Yavuz Yakut

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Controlled Trial ◽

Research Society ◽

Vertebral Rotation ◽

Control Group ◽

Scoliosis Research Society ◽

Core Stabilization ◽

Randomized Controlled ◽

Apical Vertebral Rotation

Background: Core stabilization training is used to improve postural balance in musculoskeletal problems. Objectives: The purpose of this study was to investigate the effectiveness of stabilization training in adolescent idiopathic scoliosis. Study design: A randomized controlled trial, pretest–posttest design. Methods: In total, 25 subjects with adolescent idiopathic scoliosis were randomly divided into two groups: stabilization group ( n = 12) and control group ( n = 13). The stabilization group received core stabilization in addition to traditional rehabilitation, and the control group received traditional rehabilitation for 10 weeks. Assessment included Cobb’s angle on radiograph, apical vertebral rotation in Adam’s test, trunk asymmetry (Posterior Trunk Symmetry Index), cosmetic trunk deformity (Trunk Appearance Perception Scale), and quality of life (Scoliosis Research Society-22 questionnaire). Results: Inter-group comparisons showed significantly greater improvements in the mean change in lumbar apical vertebral rotation degree and the pain domain of Scoliosis Research Society-22 in the stabilization group than those in the control group ( p < 0.05). No significant differences were observed for other measurements between the groups; however, trends toward greater improvement were observed in the stabilization group. Conclusion: Core stabilization training in addition to traditional exercises was more effective than traditional exercises alone in the correction of vertebral rotation and reduction of pain in adolescent idiopathic scoliosis. Clinical relevance Stabilization exercises are more effective in reducing rotation deformity and pain than traditional exercises in the conservative rehabilitation of adolescent idiopathic scoliosis. These improvements suggest that stabilization training should be added to rehabilitation programs in adolescent idiopathic scoliosis.

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